BMJ ceases breastmilk substitute ads as firms' ties come under increased scrutiny

The decision is the latest in a growing backlash against infant formula firms and their relationships with publications, national health services, paediatricians and membership organisations.

Just last month, The Royal College of Paediatrics and Child Health (RCPCH) agreed to suspend future funding agreements​​ with formula milk companies pending a College review.

Fiona Godlee, BMJ’s editor-in-chief referenced bodies such as the RCPCH in the journal’s decision adding, “The BMJ has been reminded of the substantial harms caused by promotion of breastmilk substitutes and the biases introduced into research and clinical practice by industry influence”.​

“We have also gained a greater understanding of the WHO code that seeks to reduce these harms and have reviewed our policy, consulting advertisers and canvassing readers.”​

“As a result, we have decided to stop carrying these advertisements in The BMJ and other BMJ journals, including Gut, Frontline Gastroenterology, and Archives of Diseases in Childhood, as soon as possible. ​

“We have chosen a complete ban because previous attempts to implement a due diligence approach have failed.” ​

BSNA response ​

In an editorial, Godlee said the ban on product advertising was not a boycott of the companies adding that the journal would honour existing contracts for formula milk advertising. The final advert would appear later this year.

“Our objective is not to drive an anti-formula campaign, as we recognise that formula milks are essential products for children with complex medical or nutritional needs and for those women for whom breastfeeding is not possible. ​

“But decisions on when and how to use infant formula are best informed by sources of unbiased evidence rather than commercial advertisements.”​

The BMJ’s decision was featured as part of a documentary​​ on UK’s Channel 4, in which the programme claimed the €47bn (£40bn) infant formula industry was putting profit before babies.

The ‘Dispatches’ programme also revealed that since 2014 almost a third of 195 clinical commissioning groups in England had recorded a breach of the World Health Organisation guidance – such as a gift or sponsorship from a formula company.

However, The British Specialist Nutrition Association (BSNA), who represent the formula milk industry, accused the channel of “televising a very misleading episode, with many inaccuracies and assertions likely to unduly concern parents who, whether due to medical need or personal choice, feed their children infant formula”.​

In a statement, the BSNA called for balanced reporting in important baby feeding debate adding, “As an industry, we also provide life-saving formulas without which some babies would not thrive, and in some cases not survive.​

“We are a highly regulated industry and rightly so. The strict legal framework within which we operate sets standards for the composition and communication about baby milks.  It gives parents a high level of protection and is closely scrutinised.  ​

“Additionally, companies are only able to use European Food Safety (EFSA) approved claims on product labels. We would therefore urge any parent who has concerns about their specialised formula to speak to their healthcare professional before making any changes.”​

The WHO code ​

The BSNA highlighted that whilst all formulas satisfied mandatory requirements, formulas differed due to additional ingredients led by scientific innovation.

“Our long history of research and innovation has led to significant improvements to infant formulas without which babies and parents would not benefit from the advanced formulas that are available today.​

“We respect the role and integrity of clinicians and are committed to the principles and aims of the WHO Code, as set out in UK law. “ ​

Current guidelines by the World Health Organisation (WHO) allow for companies and healthcare professionals to work together to conduct research and share scientific and factual information.  

The BDNA added the principles of its members’ engagement with healthcare professionals were fully transparent and were set out in the Infant Nutrition Industry (INI) Code.

“We believe that clinicians are well able to make good judgements about their relationship with industry of any type, within the framework of their own professional code of ethics.​

“We share a common goal with healthcare professionals to ensure that all babies have access to the best nutrition.”​