Line extension
CMAJ 1997;156:1115
Dr. Younger-Lewis ("Over the counter and into trouble," CMAJ 1997;156:17 [full text]) recommends taking a walk down a drug store aisle in a patient's shoes looking for examples of line extension. I took her advice and, being a pediatrician, chose the aisle for infant products. I recalled a Mead Johnson advertisement "introducing the NEW face of Enfalac's family of formulas: a face a mother could love."
The company's new labelling is indeed cleaner and more appealing but instead of the previous 2 types of Enfalac baby formula (plain or iron-fortified) there are now 4 more varieties. There are Enfalac Lactose Free and Enfalac Soy (a soy-protein-based formula with corn syrup solids instead of lactose). There are also 2 types of Enfalac with hybrid names: Enfalac Nutramigen (casein-hydrolysate-based formula) and Enfalac Next Step (skim-milk-protein-based formula for infants 6 months and older).
I am not aware of any harm resulting from this proliferation of Enfalac products, but I suspect that it causes confusion for some parents. I also suspect that parents assume that there are only minor variations between these formulations, since they share a common name. I have recently noted that several parents, whose infant's diet was temporarily switched to Enfalac Lactose Free because of an acute diarrheal illness, decided to continue feeding their baby this formula for an extended period, at a 45% increase in cost, according to my drug-store-aisle observation.
Allen R. Ciastko, MD
Kamloops, BC
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