PHA-Exch> An interesting article on Gates Foundation

[Claudio Schuftan]

From: Ted  Schrecker tschrecker at sympatico.ca

 Gates Foundation's Influence Criticized

By DONALD G. McNEIL
Jr.<http://topics.nytimes.com/top/reference/timestopics/people/m/donald_g_jr_mcneil/index.html?inline=nyt-per>

>From *The New York Times*, February 16, 2008

The chief of malaria for the World Health
Organization<http://topics.nytimes.com/top/reference/timestopics/organizations/w/world_health_organization/index.html?inline=nyt-org>has
complained that the growing dominance of malaria research by the Bill
and Melinda Gates
Foundation<http://topics.nytimes.com/top/reference/timestopics/organizations/g/gates_bill_and_melinda_foundation/index.html?inline=nyt-org>risks
stifling a diversity of views among scientists and wiping out the
world health agency's policy-making function.

In a memorandum, the malaria chief, Dr. Arata Kochi, complained to his boss,
Dr. Margaret Chan, the director general of the W.H.O., that the foundation's
money, while crucial, could have "far-reaching, largely unintended
consequences."

Many of the world's leading malaria scientists are now "locked up in a
'cartel' with their own research funding being linked to those of others
within the group," Dr. Kochi wrote. Because "each has a vested interest to
safeguard the work of the others," he wrote, getting independent reviews of
research proposals "is becoming increasingly difficult."

Also, he argued, the foundation's determination to have its favored research
used to guide the health organization's recommendations "could have
implicitly dangerous consequences on the policy-making process in world
health."

Dr. Tadataka Yamada, executive director of global health at the Gates
Foundation, disagreed with Dr. Kochi's conclusions, saying the foundation
did not second-guess or "hold captive" scientists or research partnerships
that it backed. "We encourage a lot of external review," he said.

The memo, which was obtained by The New York Times, was written late last
year but circulated this week to the heads of several health agency
departments, with a note asking whether they were having similar struggles
with the Gates Foundation.

A spokeswoman for the director general said Dr. Chan saw the memo last year
but did not respond to it. It is "the view of one department, not the W.H.O.'s
view," said the spokeswoman, Christine McNab. The agency has cordial
relations with the foundation, and the agency's policies are set by
committees, which include others besides Gates-financed scientists, she
said.

The Gates Foundation has poured about $1.2 billion into malaria research
since 2000. In the late 1990s, as little as $84 million a year was spent —
largely by the United States military and health institutes, along with
European governments and foundations. Drug makers had largely abandoned the
field. (China was developing a drug, artemisinin, that is now the
cornerstone of treatment.)

The World Health Organization is a United
Nations<http://topics.nytimes.com/top/reference/timestopics/organizations/u/united_nations/index.html?inline=nyt-org>agency
with a $4 billion budget. It gives advice on policies, evaluates
treatments — especially for poor countries — maintains a network of
laboratories and sends teams to fight outbreaks of diseases, like avian flu
or Ebola. It finances little research; for diseases of the poor, the Gates
Foundation is the world's biggest donor.

Dr. Kochi, an openly undiplomatic official who won admiration for
reorganizing the world fight against tuberculosis but was ousted from that
job partly because he offended donors like the Rockefeller Foundation,
called the Gates Foundation's decision-making "a closed internal process,
and as far as can be seen, accountable to none other than itself."

Moreover, he added, the foundation "even takes its vested interest to seeing
the data it helped generate taken to policy."

As an example, he cited an intervention called intermittent preventive
treatment for infants, known as IPTi.

Other experts said IPTi involved giving babies doses of an older
anti-malaria drug, Fansidar, when they got their shots at 2 months, 3 months
and 9 months. In early studies, it was shown to decrease malaria cases about
25 percent. But each dose gave protection for only a month. Since it is not
safe or practical to give Fansidar constantly to babies because it is a
sulfa drug that can cause rare but deadly reactions and because
Fansidar-resistant malaria is growing, World Health Organization scientists
had doubts about it.

Nonetheless, Dr. Kochi wrote, although it was "less and less
straightforward" that the health agency should recommend it, the agency's
objections were met with "intense and aggressive opposition" from
Gates-backed scientists and the foundation. The W.H.O., he wrote, needs to
"stand up to such pressures and ensure that the review of evidence is
rigorously independent of vested interests."

Amir Attaran, a health policy expert at the University of Ottawa who has
criticized many players in the war on malaria, said he thought Dr. Kochi's
memo was "dead right." His own experience with Gates-financed policy groups,
he said, was that they are cowed into "stomach-churning group think." But
Dr. Attaran said he believed that scientists were not afraid of the
foundation, but of its chief of malaria, Dr. Regina Rabinovich, whom he
described as "autocratic."

Dr. Rabinovich, when told of Dr. Attaran's characterization, said she did
not want to respond. Dr. Yamada of the Gates Foundation called it
"unfortunate and inaccurate."

"I'm not a grantee of hers," he said, "but she's an extremely knowledgeable
leader. And if she has an opinion, she's entitled to it." He said he did not
know the details of the IPTi issue, but added that researchers often
differed about policy implications.

There have been hints in recent months that the World Health Organization
feels threatened by the growing power of the Gates Foundation. Some
scientists have said privately that it is "creating its own W.H.O."

One oft-cited example is its $105 million grant to create the Institute for
Health Metrics and Evaluation at the University of
Washington<http://topics.nytimes.com/top/reference/timestopics/organizations/u/university_of_washington/index.html?inline=nyt-org>.
Its mission is to judge, for example, which treatments work or to rank
countries' health systems.

These are core W.H.O. tasks, but the institute's new director, Dr.
Christopher J. L. Murray, formerly a health organization official, said a
new path was needed because the United Nations agency came under pressure
from member countries. His said his institute would be independent of that.
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