If a baby is allergic to milk, it’s common sense to avoid milk. But what if parents mistakenly thought their baby was allergic? And worse, what if someone had convinced them that it was? This may sound farfetched, but may have been happening for years. Based on a new report, many parents could be unnecessarily avoiding milk products and breastfeeding due to the baby formula industry’s inappropriate influence on how milk allergies are diagnosed.
In a paper published in The British Medical Journal on Wednesday, Chris van Tulleken, Ph.D., an honorary senior lecturer at University College London, wrote that children in the UK were diagnosed with cows’ milk protein allergy at a nearly 500-percent higher rate in 2016 compared to 2006, and van Tulleken suggests that the baby formula industry is to blame for this skyrocketing rate of diagnoses, which often results in children being transitioned quickly to non-dairy formulas.
And while this increase translated to 700 percent higher spending on these products by the National Health Service, van Tulleken writes, there’s no evidence that more children are actually developing this allergy. Research from 2007 and 2016 suggest that there was not been a significant rise in the prevalence of cows’ milk protein allergy over that time period.
As van Tulleken reports, this overstatement doesn’t appear to be an accident. Out of six different milk allergy guidelines published between 2007 and 2017, the vast majority of contributing authors were researchers or doctors who received funding from the infant formula industry. In two cases, the guidelines were actually funded by the manufacturers themselves.
According to the World Health Organization’s International Code of Marketing of Breast-milk Substitutes, published in 1981, companies that make milk substitutes are not supposed to directly educate mothers, create conflicts of interest, or advertise through health systems. But based on the information van Tulleken presents, it seems that infant formula manufacturers are finding ways to exert a strong influence on how doctors diagnose and treat patients.
“I obviously work within a high-tech medical system, but I see firsthand that we need to be really aware of the harm we can do and the immense influence industry has over our profession,” van Tulleken tells Inverse. “No one is more vulnerable than a breastfeeding infant and their parent to industry exploitation.”
And the consequences of this trend aren’t just the profits for baby formula companies. In a report published earlier in 2018 by Save the Children, researchers found that formula companies have been offering gifts to healthcare workers like doctors and midwives, a direct violation of the WHO Code. In the Philippines, van Tulleken writes, data suggest that 16,000 deaths each year can be linked to formula feeding.
To a significant degree, the industry’s influence is enabled by the specific nature of cows’ milk protein allergy. Whereas some cows’ milk protein allergies are Immunoglobin E (IgE) mediated — like what we think of with peanut or bee sting allergies — others are less obvious and appear more as a food sensitivity. And since the only way to confirm a non-IgE cows’ milk protein allergy is for a baby to completely switch to a substitute before re-testing their tolerance, the baby formula industry benefits from creating and sponsoring guidelines that are more generous in the use of milk substitutes. In the service of these guidelines, the industry overstates the importance of stopping breastfeeding during this process.
“The basic research that provides the evidence that an infant can get a serious allergy through allergens in breastmilk is really really weak,” says van Tulleken. “We have a profusion of guidelines and educational programs for patients and doctors with so little investment in understanding the science of what is going on.”
And while the industry’s involvement in shaping healthcare policies may sound obviously detrimental to the health of children, the bias involved in conflicts of interest is often subtle. In the video above, for instance, Dr. Rosie Hague presented on how to diagnose and treat cows’ milk allergy, and at the very beginning of her lecture, she discloses that she receives funding from the industry.
“I hope that that doesn’t influence anything that I say, but you should know that,” she said. And while it’s possible that funding sources don’t influence how doctors treat patients, the truth is that they often do — whether it’s subtly, as in tobacco industry-sponsored research finding fruity vape flavors are a problem, or explicitly, as in the case of pharmaceutical company INSYS Therapeutics paying doctors to overprescribe fentanyl.
Moving forward, van Tulleken hopes to get the WHO Code “enshrined in law” to prevent the kind of industry influence that has pervaded, as well as making conflict of interest declarations mandatory for doctors.