Wednesday, August 5, 2009

India Blocks Use of Plumpy'Nut

The Indian government has told Unicef to stop using Plumpy'Nut for the treatment of severe acute malnutrition in that country over concerns about importing and becoming dependent on "foreign food." This is a separate issue from the patent controversy that I have blogged about in the past.

The Indian government questions whether RUTFs (ready-to-use therapeutic food) are better than hot-cooked food, as reported by the Times of India.

On that score, the government's concerns about efficacy seem overblown. Plumpy'Nut is a fortified peanut paste that has a good track record as a ready-to-use therapeutic food in several African countries. And hot cooked meals aren't going to provide the concentrated calorie and nutrient power needed in an emergency situation.

But the larger issue--of having to depend on commercial food imports should not be dismissed lightly. Yes, there's a strong whiff of protectionism but that's understandable in light of the growing crisis in the world's supply of staples. (See Lester Brown's article in Scientific American, or for an even more provocative view, this piece by Deborah Fahy Bryceson in the Monthly Review.)

The solution to the Indian impasse, as reported in the Times Online, may be to use locally produced RUTF. Two Indian companies are starting to get into the business of doing just that.

11 comments:

Anonymous said...

Christine,

The fight is between locally made RUTFs and imported RUTFs which obviously cost much more. Hot cooked foods are not considered a solution for severe acute malnutrition by anyone (government or health experts). Hot cooked foods are used for the Indian government's child nutrition programme as a supplement.

Here's the link to a story I did for the science and environment magazine, Down To Earth.

http://www.downtoearth.org.in/full6.asp?foldername=20090815&filename=news&sec_id=50&sid=23

Sumana

Christine Gorman said...

Hi Sumana,
Tried following your link but wasn't able to do so. Care to post again?

Christine

Christine Gorman said...

Sumana,

Found it! I put it through a url shortener to make sure it takes
http://cli.gs/gQV6vs

Curious about Cipla. There's no local market for RUTF in India? I find that hard to believe.

Thanks,
C

Rimmy William said...

This is good move of Indian Government.I think, Plumpy'nut policy should be finished.The child malnutrition rates are worse here than in many sub-Saharan African countries, and they stand out as a paradox in a proud democracy.

Anonymous said...

I wonder what the local production of RUTF would mean for India.Its strange that CIPLA has a market in Africa but not in India.

http://www.projectpeanutbutter.org/science.htm
This websites actually states american produced peanuts were contaminated by Salmonella and still sold in the market.The project peanut butter use local Malawi grown produce; a good incentive for the local farmers and the market.I would really like to know why CIPLA can't do the same. f.sial@hotmail.com

Anonymous said...

Cipla doesn't have a market in India because there are no takers. Since there is no govt policy on treating SAM the govt doesn't buy the product. And international agencies prefer Plumpy'Nut. The sticking point is the lack of policy. Other than Cipla, small non-profits have come up with local solutions based on regional food preferences but these need to scaled up for effective use. The govt again is least bothered it seems and the international agencies insist that these solutions don't work since hygiene cannot be ensured.

My question is how do we know that patented factory produced products are hygienic? Should we believe them because they are 'foreign' or because private large-scale manufacturers are inherently more reliable at maintaining standards?

Sumana

Jamie said...

I work for an NGO in Haiti called Meds & Food for Kids (www.mfkhaiti.org) that produces RUTF for national distribution. For me, and the rest of the global health community (WHO, WFP, MSF, etc.), RUTF is the gold standard for treating SAM. I have a strong doubt that these other local foods have the hygienic production standards or condensed nutritional content required to safely lift these children from the trap of SAM. However, why does this mean that proper RUTF (and it is a defined term for a narrowly defined product) can't be produced in India for sale in the Indian market or in Bangladesh, Pakistan, Nepal, etc? I'm sure if it met the stringent food safety standards and was produced at a reasonable scale, even Unicef would purchase it for local distribution. It is fine with me to disrupt Nutriset's global monopoly (and likewise Unicef's awkward promotion of a for-profit company), but the Indian gov't needs to adapt realistic protocols that would encourage local production and attract international finances to pay for the distribution. Safe, hygienic local production is not easy, but unlike Haiti (or many of the countries in Africa where RUTF has been used with great success), there is plenty of food processing capacity in India. And, India is already the #2 global producer of peanuts! It sounds to me like politics and dubious policy research are keeping MILLIONS of children from getting the treatment they require to meet their full potential. Who is really losing by not at least doing the efficacy and cultural acceptability trials?

Yeast Infection said...

The project peanut butter use local Malawi grown produce; a good incentive for the local farmers and the market.I would really like to know why CIPLA can't do the same.

Dr R P [Ravi] said...

The debate on use of RUTF in India is missing the children who are loosing out on their lives. It is grossly unfare . RUTF has fortified peanut as its composition and has shown very good results in difficult challenged areas of the world.
The debate of either or between Rutf and hot cooked foods is unfortunate. Why can we not think of hot cooked foods with RUTF-- preferably made in India .
The SAM children who are estimated to be around 8 million by NFHS3 deserve nutrition .
ravi
[dr R P Sinha]

Anonymous said...

i think the issues of importation (and use) of Plumpy Nut and treatment of SAM children need to be teased out. Home cooked meals are nice but the will not cure SAM. Withdrawal of RUTF will place the lives of SAM children at risk. there is little doubt that some will die as a result of being denied access to Plumpy Nut. i also object to the NutriSet/UNICEF nexus and monopoly but the GoI should ensure that other (locally produced) RUTF with proven eficacy are available BEFORE stopping importation of Plumpy Nut. In the absence of an alternative the GoI is denying a life saving intervention. Would GoI stop the use of malaria treatments because they were not produced in India?

Anonymous said...

This brings us back to the discussion what is RUTF- a drug or a food? There have been developments considering RUTF a solution for everything with even proposing RUTF for moderate malnutrition or first trials for prevention of malnutrition. Lets go back to the original concept of using it as a drug for severe acute malnutrition and strengthen concepts using local foods for the prevention. Without having treatment of SAM incorporated in prevention programmes RUTF is just reducing mortality but not at all contributing to reduction of malnutrition.