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• W3202042945 abstract "‘Bad men need nothing more to compass their ends, than that good men should look on and do nothing.’John Stuart Mill, 1867. It is over 150 years since the invention of formula milk to feed babies and young children when breastfeeding is not possible. The development, proliferation and marketing of formula coincided with a catastrophic decline in breastfeeding in many countries, including the UK.1 Most infants in Europe, North America and China now use formula in place of mother's milk for a significant period during early development. Indeed, global formula sales per child have doubled in the past 15 years.2 The World Health Organization estimates that over 800,000 infants die each year due to insufficient breastfeeding, and marketing of formula is cited as a leading barrier to breastfeeding.3 We might ask what relevance this has to allergists and immunologists—but historians of infant feeding highlight the influential role that healthcare professionals have unwittingly played in undermining breastfeeding and promoting formula over the past 150 years.4 From the early years, the formula industry aligned itself with trusted sources of infant feeding information—these include healthcare staff such as doctors, nurses, midwives, health visitors and dietitians; and nutrition scientists, professional bodies, guideline groups and regulators.5 We do not need to look far to see how formula industry interactions with allergists have led to inappropriate guidance for infant feeding, which falsely ascribes special health-promoting properties to formula or encourages cessation of breastfeeding. Hydrolysed formula has been inappropriately recommended for allergy prevention for over 30 years,6 and there is 10-fold excess consumption of specialized formula in some regions due to milk allergy overdiagnosis.7 In 2016, through World Health Assembly resolution 69.9, the World Health Organization (WHO) called on healthcare professional societies and others to end inappropriate promotion of foods for infants and young children. The new guidance included a specific recommendation that sponsorship of healthcare professional and scientific meetings by companies selling foods for infants and young children should not be allowed. The purpose of this recommendation was to reduce the impact of formula marketing on healthcare education, science and practice. This recommendation by the United Nations public health agency, endorsed by individual nation representatives, has been resisted in many fields. In 2017, WHO authors reviewed over 150 national and regional professional paediatrics associations and found that most of those with available information received financial support from formula companies.8 The most common form of support was conference sponsorship, and no association had a public conflict of interest policy which excluded formula company sponsorship. The landscape shifted in 2018, when BMJ journals and the UK Royal College of Paediatrics and Child Health decided to formally boycott formula sponsorship, triggering a series of UK-based professional bodies to follow suit, including the British Society of Allergy and Clinical Immunology (BSACI). This change in attitude marks an important moment of public recognition that formula sponsorship of healthcare professional societies and conferences is inappropriate. However, the movement has not yet gained traction beyond the UK. For example, a large group of European paediatric societies made a public, formal decision to continue to accept sponsorship from formula companies last year, in defiance of WHO guidance.9 Formal analysis of allergy societies’ relationships with formula companies has not yet been undertaken, but it is likely that most societies and many conferences and educational activities are sponsored by formula companies. In the UK, the BSACI’s updated 2020 industry interaction policy now states that BSACI agrees with recommendations of WHA Resolution 69.9, which include the stipulation that formula milk companies should not sponsor meetings of health professionals.10 The BSACI may be the first national allergy society to formally and publicly reject formula company sponsorship. Unfortunately, the BSACI had already agreed in 2018 to host a high-profile joint BSACI/ World Allergy Organization allergy conference in 2022 that will include formula companies among its sponsors. BSACI do not plan to receive any funding from the formula sponsors but other parties will. While this temporary departure from BSACI’s new policy is disappointing, the continuing acceptance of formula company sponsorship by the World Allergy Organization (WAO) and its member societies is a larger issue for the global allergy community. Most of the world's allergy specialists contribute to WAO through membership of one of the WAO societies, yet WAO and many member societies accept formula company sponsorship of conferences and other activities. It is too easy to regard inappropriate formula marketing as someone else's job to sort out, but very few actors in society have the combined understanding and power to trigger a change in this field (Figure 1). Formula companies themselves are relatively powerless—they have a fiduciary duty to respond to their shareholders’ needs and play their part in a competitive marketplace. However, healthcare professionals and their societies have both an understanding of the individual and societal harms of inappropriate formula marketing and the power to limit this by rejecting inappropriate industry relationships. Indeed, the primary duty of healthcare professionals is towards the patients that they serve rather than their societies. By aligning themselves with formula industry marketing activities, WAO and its member societies lose credibility as trusted allergy societies and trusted sources of allergy information. In this context, individual membership of one of these societies is something that may serve one's personal interests, but contributes to marketing activities which undermine public health. We therefore call on WAO and its member societies to follow WHO guidance, protect the patients that their members serve and stop accepting funding from formula companies. If you would like to comment on this article or the issues raised in it, please tweet us @ClinExpAllergy." @default.
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• W3202042945 date "2021-09-29" @default.
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• W3202042945 title "Allergy societies and the formula industry" @default.
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• W3202042945 doi "https://doi.org/10.1111/cea.14017" @default.
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