From the British Medical Journal: Financial Links Among the World Health Organization, Patient Organizations, and Pharmaceutical Companies

We have posted frequently about questionable financial links between commercial firms that produce health care goods and services (for example, pharmaceutical, biotechnology, and medical device companies) and not-for-profit organizations and government agencies that provide or regulate health care (for example, hospitals, academic medical centers, and government agencies). The latest example of such links, and one with global implications, comes from one of my now favorite outlets for investigative journalism, the British Medical Journal. [Day M. Who's funding WHO? Brit Med J 2007; 334: 338-340).

Serious questions have been raised about whether the World Health Organization is using patient groups as a conduit for receiving proscribed donations from the pharmaceutical industry. Email correspondence passed to the BMJ seems to show that in June 2006 Benedetto Saraceno, the director of WHO's department of mental health and substance abuse, suggested that a patient organisation accept $10 000 (£5000; {euro}7000) from GlaxoSmithKline (GSK) on WHO's behalf. The sum was then to be passed on to WHO—ostensibly with the intention of obscuring the origins of the donation. GSK withdrew its offer of funding when it learnt that acceptance was conditional on obscuring its origin. However, the email exchange indicates that other sums of money originating from drug companies may have already been channelled to WHO through patient groups.

When asked about this correspondence, Dr Saraceno told the BMJ that his email to the patient organisation was 'clumsily worded' and that he had 'never intended to solicit donations from the pharmaceutical industry through' the patient organisation. In the email dated 16 June 2006, Dr Saraceno thanks Mary Baker of the European Parkinson's Disease Association (EPDA), for raising the $10 000 'requested by the WHO.' The money was to have funded a report on neurological diseases, including Parkinson's disease, for which GSK produces treatments.

Dr Saraceno then seems to advise Mary Baker on how to get round the WHO's rules forbidding drug industry funding. 'Unfortunately,' he says, 'WHO cannot receive funds from pharmaceutical industry. Our legal Office will reject the donation. WHO can only receive funds from Government agencies, NGOs, foundations and scientific institutions or professional organisations. Therefore, I suggest that this money should be given to EPDA and eventually EPDA can send the funds to WHO which will give an invoice (and acknowledge contribution) to EPDA, but not to GSK.'

According to paragraph 13 of the WHO's guidelines on interactions with commercial enterprises, which deals with cash donations, WHO should avoid indirect collaboration (particularly if arranged by a third party acting as an intermediary between WHO and a commercial enterprise).' Paragraphs 15 and 16 of the guidelines state that funds may not be sought or accepted from commercial enterprises that have a direct commercial interest in the outcome of the project and that caution should be exercised even when the business has an indirect interest. And paragraph 27 says that for reasons of transparency, contributions from commercial enterprises must be acknowledged.

Richard Nicholson, editor of the Bulletin of Medical Ethics, said: 'It would be very bad indeed if the WHO were trying to obtain money surreptitiously from drugs companies. Unfortunately it's also under-funded, and sadly there's always going to be the temptation of senior officials who ought to know better than to accept such money. But they should remember that there's always a price attached to such funding.'

He adds: 'This is in line with what we have done so far with other contributions to the report which all are coming from other professional organisations,' — suggesting that less than transparent transactions were the norm for this fundraising operation.

It turns out this has not been the first time that WHO was accused of being caught up in commercial entanglements.

Ralph Edwards, the director of the WHO's drug monitoring centre in Uppsala, Sweden, warns .... 'These days it's so hard to find anyone completely free of the pharmaceutical industry. A couple of years ago we wanted to publish a safety report on Lapdap [chlorproguanil-dapsone], the combination malaria treatment. The WHO's tropical disease research group had developed the treatment jointly with Glaxo, but Glaxo weren't happy with what we wanted to publish.'

'This was a bad situation and it was very, very difficult. We raised the issue with WHO because we thought that there had not been enough safety studies done. We managed to get the report published eventually, after a lot of lobbying and pressure—but it was delayed for more than a year,' said Dr Edwards.

'It's an example of how tortuous it is working with pharmaceutical industry money.'

This story is yet another reminder of how globally pervasive are financial ties amongst various health care organizations that naively physicians and the public may think are supposed to work at arms' length. However, if we want health care that puts the needs of patients first, we have to align the incentives with the mission, and eliminate opportunities for well-heeled vested interests to pay for increased influence.