Conflict of InterestConflict of Interest

Dr. Arun Gupta MD FIAPDr. Arun Gupta MD FIAP

One Asia Breastfeeding One Asia Breastfeeding Partners Forum 6 18-21 Partners Forum 6 18-21

Colombo, November 2009Colombo, November 2009

The Market of The Market of MalnutritionMalnutrition

The world's most exciting, fastest-growing new The world's most exciting, fastest-growing new market?market? It's where you least expect it: at the It's where you least expect it: at the bottom of the pyramid. Collectively, the bottom of the pyramid. Collectively, the world's billions of poor people have immense world's billions of poor people have immense entrepreneurial capabilities and buying power. entrepreneurial capabilities and buying power. You can learn how to serve them and help You can learn how to serve them and help millions of the world's poorest people escape millions of the world's poorest people escape poverty…. It is being done—profitably. Whether poverty…. It is being done—profitably. Whether you're a business leader or an anti-poverty you're a business leader or an anti-poverty activist, business guru Prahalad shows why you activist, business guru Prahalad shows why you can't afford to ignore "Bottom of the Pyramid can't afford to ignore "Bottom of the Pyramid (BOP) markets. (BOP) markets.  - - Wharton School of Management promoting C.K. Prahalad’s book, Wharton School of Management promoting C.K. Prahalad’s book, Fortune at the Fortune at the

Bottom of the PyramindBottom of the Pyramind        

When food and health become When food and health become commodities of trade, commodities of trade, science, international and science, international and national decision making national decision making processes become prey to processes become prey to

conflict of interestconflict of interest

Conflict of interest Conflict of interest occurs when occurs when

a party influences a party influences or tries to influence or tries to influence

decision making decision making in an independent in an independent

body, body, with a view to gain with a view to gain

financially or promote financially or promote something specific something specific

from such a decision from such a decision

Conflict of interest Conflict of interest can exist in can exist in • research research

• International International decision making decision making

• National decision National decision making making

Conflict of interest

• International Decision-making • The Global Compact has given corporations legitimate The Global Compact has given corporations legitimate

place in the United Nations System in the decision place in the United Nations System in the decision making processmaking process

• Corporations are now investing mega funds in health Corporations are now investing mega funds in health to promote their products and services, eg. BMGF, to promote their products and services, eg. BMGF, ILSI, etc.ILSI, etc.

• The UN, along with the funding agencies like BMGF, have The UN, along with the funding agencies like BMGF, have created international organisations like Global Alliance created international organisations like Global Alliance for Improved Nutrition (GAIN) and Global Alliance for for Improved Nutrition (GAIN) and Global Alliance for Vaccines and Immunisation (GAVI) to promote corporate Vaccines and Immunisation (GAVI) to promote corporate interests.interests.

• Recently, the WHO guidelines on preventing diarrhoea Recently, the WHO guidelines on preventing diarrhoea ignored breastfeeding, and instead promoted Rotavirus ignored breastfeeding, and instead promoted Rotavirus Vaccine, which is being pushed also by GAVI.Vaccine, which is being pushed also by GAVI.

• GAIN has observer status at Codex Alimentarius and is GAIN has observer status at Codex Alimentarius and is lobbying with governments to change standards of lobbying with governments to change standards of complementary feeding in countries with high malnutrition, complementary feeding in countries with high malnutrition, so as to create new markets for baby food manufacturers.so as to create new markets for baby food manufacturers.

Arrived last evening..Arrived last evening..

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PLUMPY NUT PLUMPY NUT – an example of conflict of – an example of conflict of

interest interest at all levelsat all levels

In 1999, Andre Briend, a French In 1999, Andre Briend, a French Scientist with the the Institut de Scientist with the the Institut de Recherche pour le Développement (IRD) - Recherche pour le Développement (IRD) - a French public research institution a French public research institution developed a paste made of peanut developed a paste made of peanut butter, milk powder, vegetable oil, and butter, milk powder, vegetable oil, and vitamins and minerals, for treating the vitamins and minerals, for treating the severely malnourished in emergency severely malnourished in emergency situations. situations.

Some of the initial research was funded Some of the initial research was funded by Nutriset and Nestle. by Nutriset and Nestle.

Andre Briend applied for a patent Andre Briend applied for a patent for the product, now called for the product, now called Plumpy Nut, along with Michael Plumpy Nut, along with Michael Lescanne, the CEO of Nutriset. Lescanne, the CEO of Nutriset. He also joined Nutriset as a He also joined Nutriset as a Consultant. Consultant.

Subsequently, Andre Briend joined Subsequently, Andre Briend joined the Department of Child and the Department of Child and Adolescent Health, WHO, Adolescent Health, WHO, specialising in malnutrition and specialising in malnutrition and its treatment.its treatment.

In 2007, the WHO came out with new In 2007, the WHO came out with new guidelines for treatment of guidelines for treatment of Malnutrition, in which it recommended a Malnutrition, in which it recommended a specific formula.specific formula.

In its earlier Manual for Physicians, In its earlier Manual for Physicians, 1999, WHO had specified the role of 1999, WHO had specified the role of nutrition education of the mothers on nutrition education of the mothers on how to use family foods, the need for how to use family foods, the need for stimulation, and so on. These were stimulation, and so on. These were missing from the new guidelines. missing from the new guidelines. Instead, the new guidelines stressed Instead, the new guidelines stressed that governments must devise ways to that governments must devise ways to introduce this new treatment at the introduce this new treatment at the community level.community level.

Conflict of interest

• National Decision making • GAIN and Micronutrient Initiative in India are GAIN and Micronutrient Initiative in India are

lobbying with the government to promote food lobbying with the government to promote food fortificationfortification

• Danone/Britannia distributed their Tiger Danone/Britannia distributed their Tiger Biscuits to over a lakh children through the Biscuits to over a lakh children through the government Mid Day Meal Programme in Andhra government Mid Day Meal Programme in Andhra Pradesh as a result of successful lobbying by Pradesh as a result of successful lobbying by GAIN. GAIN.

• GAIN has been lobbying with Indian Parliamentarians to GAIN has been lobbying with Indian Parliamentarians to change laws so that new markets can be created. After change laws so that new markets can be created. After a GAIN briefing, a young Parliamentarian introduced a a GAIN briefing, a young Parliamentarian introduced a Bill to compel the country to fortify milk with Bill to compel the country to fortify milk with vitamin A. vitamin A.

• The Food Safety Standards Authority of India has The Food Safety Standards Authority of India has constituted scientific panels. These panels include constituted scientific panels. These panels include several corporations. several corporations.

““Horlicks”.. heard about Horlicks”.. heard about it ?it ?

In 2008, following liberalisation In 2008, following liberalisation measures and rise in food prices, measures and rise in food prices, as well as massive unemployment, as well as massive unemployment, news reports highlighted the news reports highlighted the extremely high rates of extremely high rates of malnutrition in the state of Madhya malnutrition in the state of Madhya Pradesh.Pradesh.

UNICEF imported Plumpy Nut, without UNICEF imported Plumpy Nut, without getting the requisite permission, getting the requisite permission, and did not just start distributing and did not just start distributing it in Madhya Pradesh, but sent the it in Madhya Pradesh, but sent the product to several other states.product to several other states.

Questions were raised in Parliament about Questions were raised in Parliament about UNICEF’s challenge to India’s sovereignty.UNICEF’s challenge to India’s sovereignty.

Civil society also questioned the use of Plumpy Civil society also questioned the use of Plumpy Nut as a mainstream treatment, because it Nut as a mainstream treatment, because it created a food dependency, ignored local created a food dependency, ignored local treatment protocols, and diverted attention treatment protocols, and diverted attention from questions of why people cannot access from questions of why people cannot access food.food.

UNICEF hit back by trying to shame India UNICEF hit back by trying to shame India globally for asking UNICEF to return the globally for asking UNICEF to return the products that had been imported without products that had been imported without permission.permission.

UNICEF and the promoters of Plumpy Nut continue UNICEF and the promoters of Plumpy Nut continue to pressurise the government and professional to pressurise the government and professional bodies such as Indian Academy of Pediatrics bodies such as Indian Academy of Pediatrics and National Institute of Nutrition to and National Institute of Nutrition to mainstream Plumpy Nut.mainstream Plumpy Nut.

How to tackle conflict of How to tackle conflict of Interest?Interest?

Advocate strongly at national Advocate strongly at national and regional level for UN and and regional level for UN and governments to avoid conflicts governments to avoid conflicts of interests of interests

Use FCTC example of guidelines Use FCTC example of guidelines on conflicts of interests on conflicts of interests

Draft Proposal of guidelines to Draft Proposal of guidelines to do so.do so.

We call upon all governments of the We call upon all governments of the world to:world to:

Adopt the annexed guidelines as National Adopt the annexed guidelines as National Policy to prevent conflict of interest in Policy to prevent conflict of interest in decision-making processes in the sectors of decision-making processes in the sectors of food, health and nutrition at all levels of food, health and nutrition at all levels of governancegovernance

Create a mechanism such as a Board or Create a mechanism such as a Board or Authority for identifying and resolving Authority for identifying and resolving conflict of interest in the sectors of conflict of interest in the sectors of food, health and nutrition. The composition food, health and nutrition. The composition of such Board or Authority should have at of such Board or Authority should have at least 50% representation of civil society least 50% representation of civil society organizations. The decision of the Board or organizations. The decision of the Board or Authority should be binding on all parties Authority should be binding on all parties including the government.including the government.

We further call upon the United Nations and We further call upon the United Nations and especially UNICEF, WHO and CODEX especially UNICEF, WHO and CODEX

ALIMENTARIUS to ensure:ALIMENTARIUS to ensure: That the recommendations of all the bodies of the UN are That the recommendations of all the bodies of the UN are

in harmony with the International Code for Marketing of in harmony with the International Code for Marketing of Breastmilk Substitutes and subsequent World Health Breastmilk Substitutes and subsequent World Health Resolutions related to infant and young child feeding. Resolutions related to infant and young child feeding.

That the recommendations made in the areas of infant and That the recommendations made in the areas of infant and child health and nutrition are based on independent child health and nutrition are based on independent research free from the influence of the corporate research free from the influence of the corporate sector;sector;

That the initiatives lanched by the UN body such as That the initiatives lanched by the UN body such as REACH should remain free from conflict of interestREACH should remain free from conflict of interest

That UN and its various organs stay independent of That UN and its various organs stay independent of bodies that promote corporate interest such as GAIN.bodies that promote corporate interest such as GAIN.