Writing in the British Medical Journal, Dr Chris van Tulleken, honorary senior lecturer at University College London describes the creation of a network of conflicted individuals and institutions that affects research, policy, and guidelines.
Additionally, the prospect of over diagnosing the condition may also have negative effects on breast-feeding.
“Epidemiological data give no indication of such a large increase in true prevalence [of the condition],” Dr van Tulleken wrote.
“The extensive links between the formula industry and the research, guidelines, medical education, and public awareness efforts around CMPA have raised the question of industry driven overdiagnosis.
According to one document, between 2006 and 2016, prescriptions of specialist formula milks for infants with CMPA increased by nearly 500% from 105 029 to over 600 000 a year.
Similar research has identified the UK’s National Health Service (NHS) spending on these products jump by nearly 700% from €8.9m (£8.1m) to over €66.5m (£60m) annually.
However, Declan O’Brien, director general of the British Specialist Nutrition Association (BSNA), addressed questions over the influence of infant formula manufacturers on these prescription and spending increases.
Citing a number of guidelines that include guidance from the World Health Organization (WHO) and the BSNA’s recently devised Infant Formula [Nutrition] Industry (INI) code, O’Brien said, “We do not believe that the WHO code precludes all interaction between healthcare professionals and industry.
“Instead, the code seeks to limit and define this interaction so as to manage potential conflicts of interest...
“The BSNA strongly believes that industry has a role to play both in scientific research and the education of healthcare professionals. We also recognise the need to put in place policies to ensure that potential conflicts of interest can be managed and avoided. The measures in the Infant Formula [Nutrition] Industry (INI) code are in line with the WHO code, UK regulations, the ABPI code and GMC guidance.”
Despite these industry measures, there have been frequent allegations of code violations, including the Breaking The Rules Report from the International Baby Food Action Network.
In November 2017, campaign organisation Changing Markets Foundation claimed that four leading manufacturers of milk formulas were boosting profits by exploiting parents’ desire to give the best possible nutrition to their offspring.
Consumer preferences over science?
In a report that looked at over 400 infant formulas made for babies under 12 months old, Nestlé, Danone, Mead Johnson Nutrition and Abbott stood accused of selling these products in 14 markets based on consumer preferences rather than science-based fact.
Further findings claimed manufacturers were needlessly adding nutrients to ‘premium’ products in an attempt to better mimic breastmilk or represent ‘the latest developments in nutritional science’.
At the time, the International Special Dietary Foods Industries (ISDI), an international expert association representing the special dietary food sector that counts the BSNA as a member, said the sector “provides—based on the latest available science—high quality, safe and age appropriate nutrition for infants, and young children”.
“Putting a product on the market is affected by many factors, including R&D, which is at the core of infant and toddler nutritional products, ingredient quality, and production processes and packaging.
“Likewise, other environmental, regulatory or business considerations in each country will have an impact. When marketing follow-up formula and growing-up milk, our industry agrees that it needs to be ethical, unambiguous and done transparently.”
Dr van Tulleken’s article also highlighted the patient and medical education resources for CMPA provided by bodies receiving funding from the formula industry.
The Allergy Academy, a collaborative initiative run from the department of paediatric allergy at King’s College London, which provides education on allergy to healthcare professionals and patients and their families, is sponsored by formula manufacturers Abbott, Mead Johnson, and Nutricia.
According to The Royal College of Paediatrics and Child Health’s (RCPCH) website, the professional body for paediatricians, “will not accept advertising or conference stands promoting standard breast milk substitutes.
“However, we will accept advertising and conference stands providing information about specialist formulas,” its due diligence policy added.
“Specialist formulas are not exempt from the WHO code, but contact with “non-state actors’ (in this case the formula milk industry) is permissible under the 2016 amendment to the Code,” the RCPCH said in a response to the article.
“Over the last year, we’ve been working with the major FMCs, and so far Danone and Nestle have met the due diligence criteria. The procedures and policies of both companies will continued to be reviewed by the RCPCH, as will our work with them to further improve the marketing of their infant formula milk products. Discussions will continue with the other companies who are yet to meet our due diligence criteria.”
Published online: doi.org/10.1136/bmj.k5056
“Overdiagnosis and industry influence: how cow’s milk protein allergy is extending the reach of infant formula manufacturers.”
Authors: Chris van Tulleken