Investigation into cows’ milk protein allergy and infant formula

By Hollie Ewers on 07 December 2018 Formula Milk World Health Organisation BMJ Study - British Medical Journal Cows' milk protein allergy - CMPA

An investigation suggests that cows’ milk protein allergy (CMPA) may be helping the formula industry to form relationships with healthcare professionals in the UK and around the world.

Published by the BMJ, the report finds examples of ‘unnecessary and improper use of formula’ to treat CMPA, and industry funding of healthcare professionals, medical education and clinical guidelines.

Between 2006 and 2016, prescriptions of specialist formula milks used to treat CMPA increased by nearly 500% from 105,029 to over 600,000, while NHS spending on these products increased by nearly 700% from £8.1m to over £60m annually. But the report says the data give no indication of such a large increase in the number of infants with the condition.

The author of the investigation, honorary senior lecturer at University College London Dr Chris van Tulleken, says CMPA may be acting as a Trojan horse for the $50bn (£40bn; €44bn) global formula industry. And he names prominent individuals involved in developing CMPA guidelines who receive funding from the formula industry for activities such as research, consultancy, and lectures – as well as industry-funded bodies that run allergy training for healthcare professionals – creating a potential for bias.

Chris says the findings raise the question of industry-driven overdiagnosis of CMPA with potential for harm to mothers and children – and prompt calls for more independence.

He says that many milk allergy guidelines have direct or indirect support from industry, and are often written by experts with interests in formula manufacturers. 

Despite a World Health Organization (WHO) code of practice that aims to restrict companies from sponsoring educational events, links to industry-sponsored courses on CMPA can be found.

The BMJ’s editor in chief Dr Fiona Godlee said: ‘The growth in prevalence of CMPA has all the hallmarks of overdiagnosis fuelled by commercial interests. While recognising that some infants will develop CMPA, we need tighter diagnostic criteria and guidelines drawn up by experts who are free from financial conflicts of interest. 

‘In light of this investigation and our own growing concerns, BMJ is reviewing our policies on accepting advertising for these products. We will report back early in the new year.’

Access the full report by the BMJ here.