When public health and private interests cross paths 

A little over a week ago, the day Parliament passed the Bill on transgender rights, another private member Bill was to come up. The Prevention and Management of Conflict of Interest Bill (2015), introduced in the Rajya Sabha by Dr EM Sudarsana Natchiappan.

However, it was not taken up for procedural reasons. Public health experts say there could not be a more opportune time for a “conflict” law – given the many smoking guns in health, food or medicine.

The Bill defines conflicts of interest between public duty and private interest – where a public official’s decision, for instance, is influenced by private interests. And this leads to possible benefits for a person or organisation. The ‘conflict’ controversy took centre-stage recently when the size of pictorial warnings on cigarette packets was to be increased. “It is not just Big Tobacco anymore,” cautioned World Health Organisation Chief Margaret Chan in her Helsinki address (2013). “Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics,” says Chan.

“Research has documented these tactics well,” she says, referring to front groups, lobbies and industry-funded research that confuse evidence and the public. Lobbies do not always play an obvious hand, and the shadow of conflicting interests looms large – from baby food to vaccines and medicines to intellectual property rights (or IPR, impacting medicine affordability). Even the WHO has faced flak on its handling of swine flu and possible links to drug companies that make the flu medicines.

In fact, in the ongoing global discussions on engaging non-state actors, India has recommended to the WHO that it knows the parties it deals with to manage conflict of interest, says KM Gopakumar with Third World Network.

“Conflict” concerns were articulated recently on IPR by the Swadeshi Jagran Manch (SJM), the economic wing of the Rashtriya Swayamsevak Sangh (RSS). The SJM called for the IPR think tank to be reconstituted since it had the participation of people with links to industry.

“You cannot have anyone on an expert group, with a conflict of interest,” says CM Gulati, Editor with drug journal MIMS . If anyone on a Government committee is even partially involved with a private interest that could affect policy, he must recuse himself as he loses the moral right to decide on public health, he adds. Health, like other ministries, does not ask for disclosures and committee members also do not voluntarily disclose their links with business, he observes.

Public health researcher Neethi V Rao nails the conflict in policy. Government has anti-tobacco laws, in compliance with India’s global agreements, but this co-exists with the Tobacco Board Act that supports and promotes the crop.

Health being a State subject, there is no comprehensive planning around it. Independent researcher, Radha Holla says the proposed law will help expose obvious conflict situations.

An oft-heard argument is that the private sector does more research than the Government and this paves the way for “seamless” transfers between public and private spheres, says Holla.

Government officials need to have a cooling period before they join a private organisation, she adds, listing out instances where former health bureaucrats get involved with drug companies.

Giving an outside perspective, Mathuram Santosham, Senior Advisor at International Vaccine Access Centre and Professor at Johns Hopkins Bloomberg School of Public Health, says the industry is allowed to manufacture products and make presentations; “But they do not have a say…on introducing a vaccine into a public health programme. That decision is taken by a committee of public health experts with no links to the industry.”

As the Conflict Bill is expected to come up again, Rao stresses its importance: “We are choosing to be blind, so I am glad it (conflict of interest) is being flagged as an issue.”