Conflict of Interest impacting infant and young child health and nutrition

Dr. JP Dadhich MD (Pediatrics)National Coordinator,

Breastfeeding Promotion Network of India (BPNI)

What is Conflict of interests

A conflict of interest can occur when a partner’s ability to exercise judgment in one role is impaired by his or her obligations in another role or by the existence of competing interests (WHO)

Why We Should Talk About It?

• Industry is entering into international and national

– policy making and planning

– program implementations

– research

– Regulatory bodies

Deregulations, market driven solutions, increasing profits

Industry is omnipresent in policy and planning, and program implementations

National Regulatory Mechanisms

Programmes at National Level

Programmes at International Level

InternationalRegulations,Guidelines,Resolutions

Industry

CodexWTO

WHA etc.

FDA

National Codex Process

The Code/ legislationsManaging severe MN

Global Nutrition and Health Paradigm -- H & N v/s Trade

Front Organisation

Examples of COI in Health and Nutrition

• Front Organisations– International Life Sciences Institute (ILSI)– Nestle Nutrition Institute (NNI)

• BINGOs– Global Alliance for Improved Nutrition (GAIN)– Bill and Melinda Gates Foundation (BMGF)

• Research• Industry in regulatory/standards making

bodies

Food industry

Vaccine makers

‘Our CommitmentFor more than 60 years, Nestlé has contributed to the continuing nutrition education of health professionals.The formation of the Nestlé Nutrition Institute formalizes this long-standing commitment at a global level ……..’

64th Nestlé Nutrition Institute WorkshopPediatric Program

Sydney, November 2–6, 2008

Programme Implementation

Nestlé Healthy Kids

Global Programme

Minister – Nigeria, Member – Nestle Nutrition Duchess Cluba grassroots network of women educating women on the importance of nutrition

Influencing Adolescent girls

GAIN

GAIN Business Alliance

“The GAIN Business Alliance (BA) is a rapidly expanding global business network dedicated to promoting market-based solutions which address malnutrition through engagement in low income consumer markets.”

GAIN website

GAIN Business Alliance

16 members

Gain Board of Directors 2007

• Bill & Melinda Gates Foundation, USA.• International Life Science Institute• U.S. Agency for International Development• PATH, USA• World Health Organization• UNICEF• CIDA• Groupe Danone• Unilever• World Bank• Bankers• Business houses

Large-scale FortificationPrograms

The Bill and Melinda Gates Foundation

• BMGF corporate stock endowment is heavily invested in food and drug firms – – McDonald– Coca Cola – Johnson and Johnson– Eli Lilly– Wyeth – Merck

• Just 3 percent of its grants for non-communicable diseases • Majority grants for vaccines

Summary of Bill & Melinda Gates Foundation stock portfolios, 2010

One who has gold makes the rules

Anatomy of research funding

• Industry is spending more than public agencies– Private corporations funded approximately

1 out of every 3 original manuscripts published

– 1 out of every 3-4 author had a COI– Authors with COI were 10 to 20 times less

likely to present negative findingsLee and Richter. J Gen Intern Med. 2004 January; 19(1): 51–56.

Anatomy of research funding

• The choice of topics and the direction of research -- More emphasis on commercially useful research than basic research.

• The 5 companies most frequently reported as study sponsors were GlaxoSmithKline, Aventis, Merck, Pfizer, and Hoffman-LaRoche.

Lee S Friedman, Elihu D Richter. J Gen Intern Med. 2004 January; 19(1): 51–56.

Conclusions

• Biomedical research may be used by the market to boost profits

• Public funding• Regulatory system for financial support and

publications of research

Interfering in regulatory mechanisms

Supreme Court of India Slams the Door on these Companies !

FSSAI

Codex Alimentarius

• The International Association of Infant Food Manufacturers represents industry in the Int. Codex process

• Industry is member of official delegations to Codex committee meetings

• Industry sponsors national delegation to CC meetings

National Codex process

• Food Safety and Standards Authority of India – National Codex Contact Point

• Central Advisory Council – Industry is a member• CAC decides about composition of various shadow

committees for Codex• Industry is present in many of these Shadow

committees• Industry influences national positions in Codex

process

Influencing policies

• Code of hygienic practice for powdered formulae for infants and young children 2008 – Microbial criteria for PIF for first six mo. but not for follow up formula – Manufacturing/transport/storage guidance– Appropriate information to health professionals, care givers, parents– Labelling – Product is not sterile

“The label should include information to make clear the potential risks of inappropriate preparation, handling and use because powdered formula is not sterile and because failure to follow manufacturers’ instructions may cause serious illness”

• Nestle India is a member of the FSSAI panel for labelling and Claims/ Advert. • Efforts to include ES contamination warning on the label?

Raise Your Voice !!!

•Submitted to UN •138 Organisations•Differentiate between BINGOs and PINGOs

Mobilise action at country level

• Get information on conflicts of interests • Come together and formulate a position • Be a part of the regulatory process at national level• Monitor what international/ national organisations;

BINGO are doing • Question them for COI and demand transparency in

public interests• Provide feedback for global solidarity• Report to media and other civil society organisations,

national and international

Make your resistance known, your voice heard

GO BACK , GAIN ! India takes action !!!

“Frontline” Article and ResponseInvolve Media as a partner in the fight

Questioning COI

• Participants

• Objection

• COI Statement

• Boycott in protest

Thanks !!!