When Mrs Gro Brundtland was first elected Prime Minister of Norway, a reporter teasingly asked her husband about his approach to housekeeping. Mr Brundtland apparently said he thought the house should be kept clean enough for hygiene but dirty enough to live in. It seems a good approach to health.

Last week, Mrs Brundtland took over the reins at WHO, not a moment too soon [See: Art & the Calling]. She began with a substantial reorganisation and a clean sweep of the senior management. She also introduced a new code of conduct relating to possible of conflicts of interests among senior staff. Until now, there has been no requirement for senior WHO staff to disclose financial interests in the private sector. In future, declarations will not be disclosed, but will be made in confidence to the WHO Legal Counsel.

The significance of these changes is underlined by the increasing trend in WHO to funding from private sector and non-governmental sources. This trend began in earnest 13 years ago, with the freezing of the main WHO budget, which comes from subscriptions from the governments of member countries. The effect has been a slow privatisation of WHO.

The new administration has emphasised that it will be looking in future to create new partnerships with industry. This would partly explain the appointment of Dr Michael Scholtz as the new Executive Director of the Health Technology and Drugs Program. Dr Scholtz trained as an organic chemist and joins WHO from SmithKline Beecham Pharmaceuticals, where he was Vice-President and Director of Marketing Organisation. His new Mission Statement for the Division identifies as a key objective "the development of new forms of partnership with industry in developed and developing countries."

All of this underlines the need for greater transparency in WHO - essential when it is so dependent on the commercial sector for many of its programmes. There needs to be complete clarity about the amounts WHO receives from companies, directly and indirectly, and clear guidelines to help avoid the conflicts of interest that may arise. This needs to be known, because the output of some programmes may have a substantial influence on drug sales. Some, for example, involve drug evaluation and selection, others involve the scheduling of drugs under the UN Narcotics Convention. WHO activities also increasingly include drawing up diagnostic criteria and treatment guidelines; they are as good as blueprints for drug indications and market position.

The following correspondence between Social Audit and the WHO Division of Mental Health relates directly to such concerns.

Charles Medawar
27 July 1998

Further information: the WHO website contains the full text of Mrs Brundtland's reorganisation speech, details of the new code of conduct, plus biography of Dr Scholtz.


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