Conflict of Interest Dr. Arun Gupta MD FIAP One Asia Breastfeeding Partners Forum Colombo, November 2009

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

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

Conflict of interest occurs when a party influences or tries to influence decision making in an independent body, with a view to gain financially or promote something specific from such a decision

Conflict of interest can exist in research research International decision making International decision making National decision making National decision making

Conflict of interest International Decision-making The Global Compact has given corporations legitimate place in the United Nations System in the decision making processThe Global Compact has given corporations legitimate place in the United Nations System in the decision making process Corporations are now investing mega funds in health to promote their products and services, eg. BMGF, ILSI, etc.Corporations are now investing mega funds in health to promote their products and services, eg. BMGF, ILSI, etc. The UN, along with the funding agencies like BMGF, have created international organisations like Global Alliance for Improved Nutrition (GAIN) and Global Alliance for Vaccines and Immunisation (GAVI) to promote corporate interests.The UN, along with the funding agencies like BMGF, have created international organisations like Global Alliance for Improved Nutrition (GAIN) and Global Alliance for Vaccines and Immunisation (GAVI) to promote corporate interests. Recently, the WHO guidelines on preventing diarrhoea ignored breastfeeding, and instead promoted Rotavirus Vaccine, which is being pushed also by GAVI.Recently, the WHO guidelines on preventing diarrhoea ignored breastfeeding, and instead promoted Rotavirus Vaccine, which is being pushed also by GAVI. GAIN has observer status at Codex Alimentarius and is lobbying with governments to change standards of complementary feeding in countries with high malnutrition, so as to create new markets for baby food manufacturers.GAIN has observer status at Codex Alimentarius and is lobbying with governments to change standards of complementary feeding in countries with high malnutrition, so as to create new markets for baby food manufacturers.

Arrived last evening..

PLUMPY NUT – an example of conflict of interest at all levels In 1999, Andre Briend, a French Scientist with the the Institut de Recherche pour le Développement (IRD) - a French public research institution developed a paste made of peanut butter, milk powder, vegetable oil, and vitamins and minerals, for treating the severely malnourished in emergency situations. In 1999, Andre Briend, a French Scientist with the the Institut de Recherche pour le Développement (IRD) - a French public research institution developed a paste made of peanut butter, milk powder, vegetable oil, and vitamins and minerals, for treating the severely malnourished in emergency situations. Some of the initial research was funded by Nutriset and Nestle. Some of the initial research was funded by Nutriset and Nestle.

Andre Briend applied for a patent for the product, now called Plumpy Nut, along with Michael Lescanne, the CEO of Nutriset. He also joined Nutriset as a Consultant. Subsequently, Andre Briend joined the Department of Child and Adolescent Health, WHO, specialising in malnutrition and its treatment.

In 2007, the WHO came out with new guidelines for treatment of Malnutrition, in which it recommended a specific formula. In its earlier Manual for Physicians, 1999, WHO had specified the role of nutrition education of the mothers on how to use family foods, the need for stimulation, and so on. These were missing from the new guidelines. Instead, the new guidelines stressed that governments must devise ways to introduce this new treatment at the community level.

Conflict of interest National Decision making GAIN and Micronutrient Initiative in India are lobbying with the government to promote food fortificationGAIN and Micronutrient Initiative in India are lobbying with the government to promote food fortification Danone/Britannia distributed their Tiger Biscuits to over a lakh children through the government Mid Day Meal Programme in Andhra Pradesh as a result of successful lobbying by GAIN.Danone/Britannia distributed their Tiger Biscuits to over a lakh children through the government Mid Day Meal Programme in Andhra Pradesh as a result of successful lobbying by GAIN. GAIN has been lobbying with Indian Parliamentarians to change laws so that new markets can be created. After a GAIN briefing, a young Parliamentarian introduced a Bill to compel the country to fortify milk with vitamin A.GAIN has been lobbying with Indian Parliamentarians to change laws so that new markets can be created. After a GAIN briefing, a young Parliamentarian introduced a Bill to compel the country to fortify milk with vitamin A. The Food Safety Standards Authority of India has constituted scientific panels. These panels include several corporations.The Food Safety Standards Authority of India has constituted scientific panels. These panels include several corporations.

“Horlicks”.. heard about it ?

In 2008, following liberalisation measures and rise in food prices, as well as massive unemployment, news reports highlighted the extremely high rates of malnutrition in the state of Madhya Pradesh. UNICEF imported Plumpy Nut, without getting the requisite permission, and did not just start distributing it in Madhya Pradesh, but sent the product to several other states.

Questions were raised in Parliament about UNICEF’s challenge to India’s sovereignty. Civil society also questioned the use of Plumpy Nut as a mainstream treatment, because it created a food dependency, ignored local treatment protocols, and diverted attention from questions of why people cannot access food. UNICEF hit back by trying to shame India globally for asking UNICEF to return the products that had been imported without permission. UNICEF and the promoters of Plumpy Nut continue to pressurise the government and professional bodies such as Indian Academy of Pediatrics and National Institute of Nutrition to mainstream Plumpy Nut.

How to tackle conflict of Interest? Advocate strongly at national and regional level for UN and governments to avoid conflicts of interests Advocate strongly at national and regional level for UN and governments to avoid conflicts of interests Use FCTC example of guidelines on conflicts of interests Use FCTC example of guidelines on conflicts of interests Draft Proposal of guidelines to do so. Draft Proposal of guidelines to do so.

We call upon all governments of the world to: Adopt the annexed guidelines as National Policy to prevent conflict of interest in decision-making processes in the sectors of food, health and nutrition at all levels of governance Adopt the annexed guidelines as National Policy to prevent conflict of interest in decision-making processes in the sectors of food, health and nutrition at all levels of governance Create a mechanism such as a Board or Authority for identifying and resolving conflict of interest in the sectors of food, health and nutrition. The composition of such Board or Authority should have at least 50% representation of civil society organizations. The decision of the Board or Authority should be binding on all parties including the government. Create a mechanism such as a Board or Authority for identifying and resolving conflict of interest in the sectors of food, health and nutrition. The composition of such Board or Authority should have at least 50% representation of civil society organizations. The decision of the Board or Authority should be binding on all parties including the government.

We further call upon the United Nations and especially UNICEF, WHO and CODEX ALIMENTARIUS to ensure: That the recommendations of all the bodies of the UN are in harmony with the International Code for Marketing of Breastmilk Substitutes and subsequent World Health Resolutions related to infant and young child feeding. That the recommendations of all the bodies of the UN are in harmony with the International Code for Marketing of Breastmilk Substitutes and subsequent World Health Resolutions related to infant and young child feeding. That the recommendations made in the areas of infant and child health and nutrition are based on independent research free from the influence of the corporate sector; That the recommendations made in the areas of infant and child health and nutrition are based on independent research free from the influence of the corporate sector; That the initiatives lanched by the UN body such as REACH should remain free from conflict of interest That the initiatives lanched by the UN body such as REACH should remain free from conflict of interest That UN and its various organs stay independent of bodies that promote corporate interest such as GAIN. That UN and its various organs stay independent of bodies that promote corporate interest such as GAIN.