conflict of interest impacting infant and young child health and nutrition dr. jp dadhich md...
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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
‘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 ……..’
Minister – Nigeria, Member – Nestle Nutrition Duchess Cluba grassroots network of women educating women on the importance of nutrition
Influencing Adolescent girls
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 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
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
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
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?
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