IAP, in bed with the industry, should not be trusted with our children

Paediatrics body framing rules with GlaxoSmithKline’s help

The Indian Academy of Paediatrics (IAP) is developing guidelines on child nutrition with the "support" of GlaxoSmithKline, which manufactures some of the biggest brands in health drinks targeted at children. Several paediatricians have raised the issue of obvious conflict of interest in partnering with GSK to draw up guidelines and a training module on child nutrition.

Incidentally, GSK has for four years running been held guilty by the Advertising Standards Council of India (ASCI) of running misleading ads making nutritional claims about its health drinks that are "not adequately and scientifically substantiated".

IAP taking pharma funding is illegal: MCI

NEW DELHI: The Indian Academy of Pediatrics (IAP) has been flouting Medical Council of India regulations on two fronts--one it has been accepting funding from the pharma industry in direct contravention of the rule that no medical association or doctor may accept any freebie or funds from the pharma and healthcare industries. Two it has violated the code of ethics prohibiting endorsement or promotion of any brand.

The annual report of the IAP 2012 giving accounts up to March 31, 2012 showed that it had received over Rs 2.7 crore from the pharmaceutical industry. According to the IAP treasurer, Dr Pravin Mehta's statement in the report, the academy's annual expenditure is about Rs 2.77 crore and its income from subscription or membership fees and interest on investment is about Rs 1.77 crore. Thus, industry contributions constitute a significant share of funds for the academy. 

 The IAP being a member of the National Technical Advisory Group on Immunisation (NTAGI) is involved in deciding immunisation schedule and selection of vaccines to be included in the NIP. Any vaccine included in the NIP would mean millions of doses of that vaccine being purchased using public funds, a bonanza for the manufacturers.

"The industry funding is not for promoting vaccines to individual paediatricians but to get them approved for the NIP. This is a long term investment for the vaccine industry. For instance, in the case of the pentavalent vaccine, there was opposition to its approval in the NTAGI meeting and then approval was given for its use in Kerala and Tamil Nadu in the state-funded vaccination programmes. IAP was one of the main proponents. If IAP had opposed the move, there would have been a problem. Such considerations do not go into the approval of drugs other than vaccines," pointed out Dr C M Gulhati, editor of the Monthly Index of Medical Specialties. In fact, Dr Rohit Aggarwal, IAP president 2012, took credit for "convincing the government for inclusion of pentavalent vaccine in NIP" in his message in the annual report. Dr Aggarwal was not only president of IAP but was also the chairperson of the IAP Committee on Immunisation.

In yet another instance of IAP support for a vaccine manufacturer, it flouted MCI regulation against endorsing brands by issuing a public statement (available on its website) endorsing vaccines of Panacea Biotech. In 2011, WHO removed the pentavalent vaccine manufactured by Panacea Biotech from its list of prequalified vaccines due to "serious inadequacies in quality assurance processes". IAP came to the rescue by stating: "The currently marketed products of M/s Chiron Panacea Vaccines Pvt. Ltd. including the brands, Easyfive, Ecovac4, and EnivacHB are absolutely safe and effective." It added that even the WHO had stated that there was no evidence of quality or safety defects with batches already distributed.

Similarly, last month, when a doctor's complaint against GSK's rotavirus vaccine advertisement was upheld by the Advertising Standards Council of India (ASCI) for claiming that existing practices like hand washing did not help and that vaccination alone could reduce the incidence of rotavirus infection, IAP swung into action. IAP president, Dr Rohit Aggarwal, stated in several media reports that hand washing could not help prevent rotavirus infection "as the transmission is mainly through airborne droplets". However, the Center for Disease Control and Prevention, Atlanta clearly states on its website page on rotavirus that transmission is mainly by fecal-oral spread as the virus is shed in high concentration in the stool of the infected person. The National Health Service of the UK also states that rotavirus is spread in faeces and is most often spread when someone who is infected does not wash their hand properly after going to toilet. In this context, IAP's statement against hand washing seems to be misleading and meant to help the vaccine manufacturers.

However, Dr Gupta of IAP insisted that the IAP was careful to ensure that there was no conflict of interest. "All our committee members have to sign conflict of interest statements. We make sure that there is no illegal promotion of products of the companies that give us funds."

It remains to be seen whether the MCI will step in to set things straight and stop violation of its own regulations.

Pharma industry funds for IAP
Company Funds given in lakh Rs
Johnson and Johnson 118.4
Merck 98.6
Wyeth 13.3
Sanofi Pasteur 11.4
Zuventus 11
Glaxo SmithKline 5
X-ray Biocom 4.5
Serum Institute 3
Pfizer 2
Total 267.2

Source: IAP Annual Report 2012