The recent article in Canadian Family Physician about the choice of formula for infants with cow’s milk allergy1 neglects to discuss the spate of industry-sponsored guidelines in the United Kingdom in which authors have financial conflicts of interest with companies making the products. The first and second international guidelines in 2007 and 2010, respectively, were both funded by infant formula manufacturers, with many guideline authors declaring conflicts of interest:
Five of the 11 authors of the 2011 food allergy guidelines from the NICE [National Institute for Health and Care Excellence], ten of the 12 authors of the 2012 European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines, all five authors of the 2013 Milk Allergy in Primary Care (MAP) guideline, and all 12 authors of the 2017 iMAP [International Milk Allergy in Primary Care] guideline declared interests with infant formula manufacturers either at the time of writing or subsequently.2
During roughly the same period as when the guidelines were produced, prescriptions for specialist formula milks in the United Kingdom for infants with cow’s milk protein allergy increased by nearly 500% despite the lack of any data showing a substantial change in the prevalence of the condition.2
The 2011 report from the Institute of Medicine (now the National Academy of Medicine) recommends that most of the membership of clinical practice guideline committees should not have conflicts of interest.3 None of the above guidelines published after the report was released conform to that recommendation.
The Canadian Family Physician article mentions 2 guidelines. The guideline from the World Allergy Organization4 does not provide financial conflict of interest statements for the authors but does say that the organization’s Special Committee on Food Allergy is supported through unrestricted educational grants from various charities and companies that are representative of the food industry: Danone, Heinz, Ordesa, Nestlé Nutrition Institute, Dicofarm, and Invest for Children. The other set of guidelines is the one from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition5 mentioned above.
Footnotes
Competing interests
In 2017 to 2020, Dr Lexchin received payments for being on a panel at the American Diabetes Association; for talks at the Toronto Reference Library; for writing a brief on an action for side effects of a drug for Michael F. Smith, Lawyer, and a second brief on the role of promotion in generating prescriptions for Goodmans LLP; and from the Canadian Institutes of Health Research for presenting at a workshop on conflicts of interest in clinical practice guidelines. He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is a member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer and Co, Ltd, for books he has written.
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