E-drug: Update on WHO and sponsorship
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Dear E-Drug Subscribers,
During the 52nd World Health Assembly in May, Health Action
International (HAI) sent a letter to Dr. Gro Harlem Brundtland, WHO's
Director General, raising concerns about the organisation's
increasingly close ties with the pharmaceutical industry. During the
Assembly, a number of international NGOs endorsed the principles of
the letter. The letter was also posted on E-drug and a number of you
asked to be added to the list of those supporting it. Since then, 27
organisations and individuals have asked to sign the statement in
support of the letter.
In view of some discussions on sponsorship raised at the WHA, we
expect the WHO to respond shortly. However, as of today, no response has yet
been received. As soon as one is given, we will of course post it on this
list. Below you will find a copy of the letter to Dr. Brundtland as well as
the statement in support of it. If you would like to add your organisation's
name to the statement, please contact HAI at the address given below.
Best wishes,
Lisa Hayes
Publications & Information Officer
HAI Europe
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Originally Released
20 May 1999
Endorsers:
Health Action International
Act Up-Paris
Consumers International
Consumer Project on Technology
Fondation du Present
International Baby Food Action Network
INFACT
International Federation of Health Records Organizations
International Network of Drug Information Centres
International Society of Drug Bulletins
Medical Lobby for Appropriate Marketing
National Groups and Individuals supporting the Statement:
Canada
Warren Bell, MD, General Practitioner, Salmon Arm, British Columbia
Breast Cancer Action - Montreal
Canadian Health Coalition
DES Action - Canada
Penny Van Esterik, Department of Anthropology, York University,
Toronto
Carol Kushner, Health Care Consultant, Toronto
Abby Lippman
Carla Marcelis, Naturopath, Montreal
Harriet Rosenberg, Department of Sociology, York University, Toronto
Therapeutics Initiative, University of British Columbia
Carl Whiteside MD, General Practitioner, Vancouver
Working Group on Women and Health Protection
India
National Campaign Committee for Drug Policy
The Netherlands
Wemos
United States
Pat Cody, Program Director, DES Action - USA
Yemen
The Yemen Drug Action Programme
Public Interest NGOs raise concerns about industry sponsorship of WHO
Will WHO be able to bite the hand that feeds it?
Geneva 19 May 1999: Today a network of public interest NGOs endorsed
a letter to the World Health Organization's Director General
protesting WHO's increasingly close contact with industry and
objecting to the conflict of interest it may cause. The organisations
express doubt that WHO will be able to focus on its public health
mandate when industry is directly involved in an increasing number of
its programmes.
In the letter sent by Health Action International (HAI) to Dr. Gro
Harlem Brundtland during the opening days of the 52nd World Health
Assembly, two recent examples of WHO partnership with specific
companies are given to illustrate the pharmaceutical industry's
possible influence on WHO's priorities. The most recent case involves
the discovery that the pharmaceutical company Merck, Sharp and Dohme
(MSD) has seconded an employee to the staff of WHO's Tobacco Free
Initiative. An internal MSD announcement portrays the employee as an
"effective ambassador."
The letter also criticises the process by which controversial
guidelines on hypertension were developed by WHO and an international
working group. The recommendations conflict with the current
evidence-based guidelines on treating hypertension and
inappropriately expand the potential market for anti-hypertension
drugs.
Public interest NGOs maintain that such partnerships presume
an equal power relationship between the two partners. They also
ignore the fundamental fact that there is inherently more value in
WHO's mission in society than in that of corporations. The NGOs call
upon the Director General to explain how the organisation is working
to avoid perceived or actual conflicts of interest when accepting
funding or working in close partnership with the private sector.
The NGOs endorsing this letter believe there must be much greater
transparency and accountability by WHO in all of its decision-making
involving industry partnerships. They urge WHO to formulate and
publish guidelines for co-operation with the commercial sector. The
NGOs also propose that secondment be excluded as an option for
partnership arrangements between WHO and the industry.
For more information contact representatives of HAI.
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This is the text of a letter that was sent to Dr Brundtland on 18 May
1999
Amsterdam, 18 May 1999
Re: WHO's partnership with the pharmaceutical industry
Dear Dr Brundtland,
Health Action International (HAI) has been monitoring the
developments taking place in the "new" WHO under your leadership
closely and we have been encouraged by your initiatives to build
closer partnerships for public interest NGOs also working to promote
public health. However, members of the HAI international network have
asked us to write to you now to express our serious concern about how
WHO's partnership with industry appears to be evolving. We are
concerned that recent developments involving drug industry
sponsorship directly affect the role that the WHO will play in the
world of public health.
Through several postings on the Internet mailing list E-Drug we have
discovered that the pharmaceutical company, MSD, has succeeded in
seconding a senior staff member to the staff of the WHO Tobacco Free
Initiative (TFI). According to an internal MSD announcement, this is
a "pioneering arrangement", "a marvellous opportunity to continue to
build bridges", and the corporation expects the person to be an
"effective ambassador". HAI greets this news with alarm. We believe
there is a fundamental difference between the core purpose of WHO
--which is to serve the public interest -- and the aim of
pharmaceutical companies, which is to maximise profits for their
shareholders. HAI is concerned that this type of industry secondment
may become common place within the organization as it strives to
carry out its mandate on limited funds.
HAI and many other public interest NGOs promoting public health
currently cooperate with WHO on the basis of a clear understanding of
each other's responsibilities, missions and mutual recognition of the
need for independence. We have deep doubts about whether it will be
possible to know if in the future when communicating with WHO the WHO
staff member is actually accountable to a public organisation or the
international commercial sector.
HAI is also concerned about how WHO is working with more general
partnerships with industry lately. We have followed the recent
controversy about the new Guidelines for the Management of
Hypertension prepared by a WHO/International Society of Hypertension
(ISH) Working Group. Several people have pointed out that the task
force ignored ground rules of clinical assessment and placed a great
deal of weight on the results of two trials funded by pharmaceutical
companies (1). However, the main issue for us is not only the
recommendations themselves, but also the process that was used to
arrive at them. According to our information, the sponsor of one of
the trials funded the press conference given by the working group,
and the company's logo appears on the welcome page of the ISH web
site. Independent review, for example in La Revue Prescrire(2), of
this trial shows that it provides no evidence in the study to
recommend aiming for a blood pressure below 140/90 in non-diabetics.
The corporate sponsor of the trial has been promoting the guidelines,
claiming that the study shows the optimal target diastolic blood
pressure to be as low as 83 to 85 mm Hg. We fear that in this case
WHO has not been able to prevent conflict of interests. We also fear
that because of this WHO has endorsed recommendations that will be
used to encourage an increased use of anti-hypertensive drugs, at
great expense, and for little public health benefit.
Both of these recent examples have raised a number of fundamental
questions about how the WHO is currently working to avoid any actual
or perceived conflict of interest when accepting funds from and
working closely with commercial enterprises. In the spirit of our
earlier open and frank discussions on drug policy issues we would
like to ask you to clarify the following questions:
On the principles for cooperation with the commercial sector
We note that WHO has used draft Guidelines on the Acceptability of
Donations from Commercial Enterprises since 1996. When does WHO
plan to finalise and adopt its principles for cooperation with the
commercial sector and how does it plan to implement these? What
procedure do you follow to finalise the guidelines? Do you intend
to consult other international agencies and bodies and use their
experiences in finalising the guidelines? Will the guidelines be
made publicly available? When?
On secondment
Given the concerns raised above about the conflicts of interest
between the aims of the employee of a pharmaceutical firm and the
aims of WHO, we think it is impossible to avoid conflict of
interest in secondments. The only option we see is to specifically
exclude this option in future guidelines for WHO interaction with
the industry and not to establish a principle that might be
followed by other programmes. In case you do plan to keep this
option open, we think that there is an urgent need to clarify the
procedure used for deciding on secondments. How does WHO plan to
ensure that the secondment of industry representatives does not
cause any real or perceived conflict of interest?
On transparency
In your May 4 response to the open letter on the hypertension
guidelines by the members of WONCA, the international association
of family doctors, you mention the recent establishment of the
Committee on Private Sector Collaboration. Who are the members of
the Committee and which Guidelines will the Committee use in
monitoring private sector collaboration? Will every collaboration
initiative be subject to monitoring by this committee? How does the
WHO intend to promote transparency of its internal monitoring
process?
On principles and methodologies for the elaboration of treatment
guidelines
In your May 4 letter you also indicate that the WHO Noncommunicable
Disease Cluster is developing new principles and methodologies for
the elaboration of future treatment guidelines. This raises the
question of what principles and methodologies are now being used.
Would you please send us a copy? Could you please explain how WHO
plans to avoid conflict of interest in developing guidelines and
standards? Would you also please explain how the new methodologies
and principles will be developed? And with input from whom?
We look forward to receiving your answers on the above questions. We
also think that the WHO-NGO Roundtable process could be an appropriate
forum for further discussion on how public interest NGOs can be
substantially involved in addressing the issues raised in this letter.
HAI sees great potential for the WHO in the years ahead and we are
convinced that clarity on these issues will only serve to benefit all
partnerships and collaborative efforts that are presently being
developed with WHO.
Yours sincerely,
Bas van der Heide
Coordinator HAI Europe
On behalf of:
Dr. K. Balasubramaniam, Coordinator HAI Asia/Pacific (ARDA)
Beryl Leach, Coordinator HAI Africa
Roberto Lopez Linares, Coordinator HAI Latin America (AIS)
c.c.
Dr M. Scholtz, EXD HTP
Dr J. Quick, Director EDM
1. Among others: Bradbury J. In: Lancet 1999; 353: 563 Open letter to
Brundtland "HOT: can we turn WHO around?" and several postings on
E-Drug.
2. See "Les traitements antihypertenseurs". Rev Prescr 1999;
19 (194): 288-296 and "Les recommandations contestables et contestees
de l'OMS dans l'HTA" Rev Prescr 1999; 19 (195): 378-381
Elizabeth Hayes
Health Action International Europe
Jacob van Lennepkade 334 T, 1053 NJ Amsterdam, Netherlands
tel: +31 20 6833684, fax: +31 20 6855002
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