Hospitals are awash with Pharma freebies. CCU is littered with the logo of the latest statin, the psychiatrist’s pen bears the name of the latest modified-release SNRI, and the chest clinic post-it notes are adorned with inhaler brands.
The paediatric ward is slightly different though. Just as the rest of the hospital is branded by Big Pharma, the paeds ward is branded by ‘Big Formula’. The logos on the pens and lanyards of the paediatricians, and the adverts filling their journals, are all for formula milk brands.
And the formula companies are now hungrily eyeing up primary care. At a recent CCG educational event, our local paediatric immunologist gave a talk on cows’ milk allergy (CMA) in children. We were handed glossy, branded copies of the MAP (Milk Allergy in Primary Care) Guideline. We were offered “free” courses to study for a diploma, courtesy of the ever-beneficent formula companies.
According to the guideline, a diagnosis of CMA should be considered if a child has “one, or often more than one” of the following symptoms:
- Vomiting, ‘reflux’, GORD.
- Food refusal or aversion.
- Loose or frequent stools.
- Perianal redness.
- Abdominal discomfort.
- Blood/mucus in stools of an otherwise well infant.
- Pruritis/erythema. Significant atopic eczema.
- ‘Catarrhal’ upper airways symptoms.
Remember: “One, or often more than one” of these.
I had my third child 10 months ago. She has had many of these symptoms fairly frequently. As did both of my other children. In fact, I would find it extremely hard to find any child who doesn’t have “one, or more than one” among the many children I see each day in surgery. They are all extremely common symptoms in infancy.
Most of these children with mild symptoms don’t ever come onto our radar as clinicians, as parents correctly realise that they are part of normal childhood. However, since the companies are now marketing their products directly to patients through websites (www.isitcowsmilkallergy.co.uk), TV adverts (here) and newspaper articles (more GP-bashing from the Daily Mail), I suspect we will be seeing much more of it. We are at great risk of medicalising normal infancy.
Financial links to a variety of milk manufacturers, including Mead Johnson Nutrition and Danone, have been disclosed by authors, as outlined in a 2013 BMJ article. Mead Johnson Nutrition are the very people behind my glossy handout, and the website and TV ads outlined above. This has echoes of the recent scandal around dementia screening, when campaigns to increase diagnosis turned out to have been funded by a drug company with a new product to sell (discussed here by Margaret McCartney).
I do not doubt for a moment that CMA exists, and I do not doubt that it makes some infants very ill. I do not doubt that specialised formula milk is an excellent treatment for these children. I have seen and treated cases myself (both during my paediatric jobs and as a GP): of babies becoming very unwell due to CMA, and making a remarkable improvement with the correct milk.
I do however, have significant concerns about GPs being asked to diagnose and treat CMA on the basis of this low-threshold diagnostic guideline, which is promoted by milk manufacturers, and whose authors are paid by those very same companies.
Worst of all, these companies are marketing directly to patients to drum up business.
This is industry-sponsored disease creep, and we should be questioning it much further before accepting it.
This article is crossposted from Jonny’s own blog: https://jonnycoates.wordpress.com/2016/02/17/this-milk-tastes-sour/
Update 30th March. In response to feedback this blog was edited to remove a reference to the MAP guideline being funded by milk manufacturers. This was an error: the guideline itself was not funded by industry.