An ad, a question

Should public-funded institutions endorse commercial products?

By Vibha Varshney
Published: Thursday 15 September 2005

A recent advertising campaign for "Horlicks", a beverage, has drawn sharp protest from Health Action by People (hap), a Kerala based non-governmental organisation. The beverage's maker, GlaxoSmithKline Consumer Health Care, is using a study by Hyderabad-based National Institute of Nutrition (nin) to say it is now clinically proven that their product enhances growth in children. The tv ad shows a boarding school campus. Here, kids get the same kind of food, are taught by the same set of teachers and engage in similar physical activities. But they don't glug the same health beverage. After 14 months, the ad shows, those drinking Horlicks get taller, stronger and sharper.

hap points out it is unethical that the promotion of a high-priced commercial product is piggy-backing on a public-funded organisation. In 1995, The Indian Council of Medical Research, Delhi (icmr) allowed its laboratories to carry out contract research for industry. Under the "Guidelines for contract research, consultancy and technical services", a company can approach icmr, which puts it through to a suitable lab. The lab makes a protocol, approved then by its scientific advisory committee as well as icmr. An mou is signed, also about ownership of data.

This is the context in which nin tested Horlicks, which is micronutrient-fortified, on 869 children aged 6-16 years. The children were from middle income families, with above-average weight and height. A biochemical analysis carried out showed these children were deficient in essential micronutrients (a condition called sub-clinical malnutrition). Half the kids were served the beverage; the rest were served a placebo (with no micronutrients). Results showed the fortified drink could tackle sub-clinical malnutrition and lead to better growth.

In 2002, these results were presented in a symposium on micronutrient supplementation in health and disease in Delhi. nin does not mention its study is specifically about Horlicks. It uses a generic description: "micronutrient-fortified nutritional beverage". But GlaxoSmith Kline's brochures and ads are explicit. Says one: "Horlicks is now clinically proven by nin, icmr, to increase height and weight of school going children!" The study is the process of being considered for a peer-reviewed journal, a process that validates the research. But GlaxoSmithKline has gone ahead and splashed the results. As the information is already in public domain, doubts are also being raised whether the research would be accepted by any reputed journal.

nin has taken a tortuous route just to prove a point for the company's benefit, alleges hap chairperson C R Soman. Instead of just trying to prove micronutrient supplementation enhances growth, the researchers try to show that supplementation in the form of a particular beverage taken twice a day does the real trick. The 'twice a day' recommendation is integral to the campaign, which specifically mentions Horlicks. "This is deceitful," Soman says. "The least nin can do is to mention in their study that they have validated a commercial product." Soman demands nin should come out publicly on whether they support such use of the study. Says nin director B Sivakumar to Down To Earth: "We neither endorse nor support promotion of any commercial product based on this study. " But neither nin nor icmr have publicly objected to the ad campaign. Meanwhile GlaxoSmithKline spokesperson Ira Gupta reveals "agreement with nin provides conclusions of the study may be quoted by us for commercial purposes."

An nin objectives is to find suitable ways of tackling malnutrition in the country; is carrying out studies on Horlicks the way to go about it? The product is too expensive for poor people. Moreover, even Sivakumar accepts the nutrients that enrich the beverage can be obtained from micronutrient-rich vegetables, fruits or milk. "It is essential such public-private partnerships should be in areas of national priority," says Umesh Kapil, department of human nutrition, All India Institute of Medical Sciences, New Delhi. To avoid such misunderstanding in the future, he adds, the mou should be more carefully negotiated.

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