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DL declares receipt of grants from Abbvie, Amgen, AstraZeneca, Bristol-Myers Squibb, Pfizer and Sanofi, and past participation in advisory boards and/or receipt of honoraria from Abbvie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Edwards Lifesciences, Novartis, Pfizer, Sanofi and Shire, outside the submitted work

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In summary, the reasons a GP surgery may refuse an early B12 injection are often rooted in a strict interpretation of established, but imperfect, guidelines, a misunderstanding of the actual science of B12 storage and metabolism, and a desire to maintain administrative consistency