'Article on spirulina supplement makes fraudulent claims': Biocon

The article "Karnataka's decision to feed malnourished children spirulina supplements is highly questionable" by Veena Shatrugna – published on Scroll.in on July 29 – which has a direct reference to Biocon Foundation, contains multiple factual errors and grossly undermines the selfless intervention of the foundation to address child malnutrition in the state of Karnataka.

The article casts aspersions on corporates, citing examples of some companies exploiting this issue to make money. The truth, however, is that organisations like Biocon Foundation and the other corporates named in this story are investing their own funds to address the malnutrition issue. They are strengthening the government initiative at their own cost – there is no commercial gain here.

More importantly, spirulina is a food supplement approved and recommended by the World Health Organisations to governments across the world to combat malnutrition.

As a conscientious and compassionate non-profit organisation, Biocon Foundation has taken up the challenge of bringing down malnutrition in Karnataka, and in the Bagalkot district in particular, on the request of the district administration and in collaboration with state government.

The successful intervention and improvement in the malnutrition status among children aged under five in the last four years by Biocon Foundation has resulted in a tremendous decline in the number of severe acute malnutrition children in the region. As a result, the secretary of women and child development recommended and suggested that Biocon Foundation introduce spirulina along with a number of our ongoing interventions, such as health check ups, provision of medicines, provision of nutritional supplements, referrals, home visits and counselling of caregivers.

It would have been most appropriate if the writer would have verified the facts by reaching out to the organisations mentioned in the story, including us, before publishing such a misleading article.

Several media articles in the past have appreciated the difference such interventions are making in certain districts. In the quest to be different, this story seems to have tread a very misleading path, which is going to discourage corporates from coming forward to support such initiatives. This, in turn, will negatively impact the communities who need our support.

We urge Scroll.in to take note of the facts listed below in response to the erroneous claims made in the article and take corrective action immediately by commissioning a more detailed fact based story on the prevailing conditions of malnutrition and breakthrough solutions which need to be replicated to combat malnutrition in India.

1. The Balaspandana program is run in collaboration with the government, within the framework of the Integrated Child Development Services. Biocon Foundation has not taken over the programme.
2. Biocon Foundation is helping the government address the grave child malnutrition channel.
3. Biocon Foundation has been investing its own funds to strengthen the government initiative and has reduced the number of severe acute malnourished children in the district. When we started this programme, the number of severe acute malnourished children was 3,346. At last count, there were 653 severely acute malnourished children in the district.

More importantly, please take note of these facts about spirulina:

1. Spirulina is a dietary supplement, it is not a substitute for hot home-cooked food.
2. It is grown locally – our supply comes from Natures BEST Health Supplement in Tumkur, Karnataka.
3. Spirulina is administered in the form of granules, not capsules.
4. It is not a drug and hence does not require certification under the Drugs and Cosmetics Act, 1940.
5. It is not a drug and hence does not require clinical trials.
6. It is a food supplement and hence has been certified by the Food Safety and Standards Authority of India (Government of Karnataka) in November 2015.
7. Spirulina strengthens the fight against malnutrition because it is low cost and easy to administer as it is in the form of granules and a very small quantity has to be given to the child.
8. It is also easy to transport and distribute since it has a good shelf life.
9. After much consideration, the product has been approved and recommended by WHO and Central Food and Technological Research Institute, Mysore.
10. WHO and other UN bodies recommend this to governments across the world to combat malnutrition.

Balaspandana programme

The Biocon Foundation’s programme, named Balaspandana, is a comprehensive initiative of Biocon Foundation, aimed at addressing the malnutrition issue, as part of its Corporate Social Responsibility.

The core objectives of Balaspandana program are to:

• Improve health and nutritional status, and address nutritional deficiencies among children
• Reduce absenteeism at health camps which are organised to monitor children with severe acute malnutrition.
• Ensure that the condition of severely malnourished children improves at the earliest.
• Increase awareness and sensitise caregivers.

Our strategy to address the issue of malnutrition is as follows:

• Facilitate health check-up through government Primary Health Centres and Community Health Centres.
• Regularly monitoring growth of malnourished children using WHO growth chart.
• Distribution of essential nutrition supplements when prescribed by the government doctors in Primary and Community Health Centres.
• Home visits for children with severe acute malnutrition to reiterate the importance of follow-up and care.
• Behaviour change communication through effective information, education and communication resources.
• Hand-holding in case of referral to secondary or tertiary centres for chronic or congenital problems.
• Increase knowledge, attitude and skills of health workers through periodic training.

This letter was submitted to Scroll.in by Seema Ahuja, VP & Global Head of Communications, Biocon.

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A response by Veena Shatrugna and Dr Sylvia Karpagam.

Firstly, Biocon Foundation claims to have started giving spirulina to children from “2012 even before the government embarked on the ‘project’," according to this article in the Times of India. This means that for three years, from 2012 to 2015, Biocon has issued spirulina to children even before the Food Safety and Standards Authority of India's approval in 2015.

These children are from the anganwadi and Biocon cannot directly access children and issue them nutraceuticals under the banner of the Department of Women and Child Development. If the department has approved Biocon issuing spirulina to children with severe acute malnutrition even before it has passed any safety standards, it becomes equally culpable and criminally liable for allowing this product to be issued.

If Biocon Foundation has indeed chosen to address malnutrition, then there are adequate guidelines for their ready reference that should have encouraged them to feed children locally produced foods and eggs. In any event, corporates have been clearly instructed to stay away from provision of food to children by a Supreme Court order in 2014 (PUCL vs Union Government) as commercial interests have always taken precedence over the nutritional requirements of children, particularly those from the the most marginalised sections.

If CSR is indeed the agenda, it is ironic that the Department of Women and Child Development has to then set aside Rs 3.6 crores for spirulina.

Malnutrition is represented in terms of standard-deviation classification, not in absolute numbers, so it is clear that Biocon does not understand elementary principles of nutrition. In their note on the Balaspandana programme, Biocon claims that: "According to a 2013 Lancet series on Maternal and Child Nutrition, increasing intake of protein, vitamin and minerals through nutrition supplements is an evidence based direct intervention which has an unusually high benefit-cost ratio".

The Lancet statement is valid only when children have access to adequate food (calories). It is known that children from these areas of Karnataka had been starving and had a massive calorie deficiency, resulting in severe acute malnutrition (a deficit of approximately 400-600 calories). In this situation it is a mockery of sorts to provide vitamins and minerals on a hungry stomach, because no amount of vitamins and minerals work if there is no food – that is, energy. The tragedy is that spirulina, which could make matters worse, was distributed.

In fact, in many of the anganwadis visited by us, severely malnourished children have not been given eggs for several months and not even the basic foods, under the pretext of not having the requisite supplies and facilities to make the meals. In effect, children are being given spirulina granules as the only supplement, without even a single meal from the anganwadi.

The claim by the corporate that "the successful intervention and improvement in the malnutrition status among children aged under five in the last four years by Biocon Foundation has resulted in a tremendous decline in the number of severe acute malnutrition children in the region" has no basis and amounts to undue misrepresentation to ensure that this product is marketed at a large scale by a corporate entity.

Even in the best-case scenarios, children shift from severe acute malnutrition to moderate malnutrition (that is, from a -2 standard deviation to a -3 standard deviation). We were given to understand that no baseline information was collected. In any case, the data is not in the public domain and has not been peer reviewed. The nature of the claim that using spirulina reduces malnutrition too has not been substantiated.

The statement that spirulina is approved and recommended by WHO to governments across the world to combat malnutrition is a fraudulent claim and not backed by any WHO statement. In fact, this so-called endorsement has been prominently displayed on all the boxes of spirulina issued to children and has the Karnataka government's logo on it to give it official sanction. This amounts to fraud and may be taken up by the authorities concerned.

Lastly, the health camps that in place after the Justice NK Patil issued recommendations in response to a public interest litigation in Karnataka have stopped functioning and in many children have in fact not had regular health check ups.

Veena Shatrugna is the former deputy director of National Insitute of Nutrition. Dr Sylvia Karpagam is public health consultant based in Bengaluru.