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The World Health Organization: no game of thrones

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g4265 (Published 26 June 2014) Cite this as: BMJ 2014;348:g4265

Rapid Response:

Re: The World Health Organization: no game of thrones

The Journal provides us with three unbalanced pieces about the World Health Organization (WHO):
a) “Perhaps WHO is a victim”(1)
b) “The essential role of WHO is most often appreciated when outbreaks of infectious disease cross borders"(2)
c) “This latest assembly was record breaking: it had 3500 registered participants…”(3)

“WHO is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.”(2)

However, WHO does the splits with evidence-based policy as with professionalism.

First, WHO clinical practices guidelines are characterized by strong recommendations on low or very low confidence estimates for evidence.(4,5) When recommendations are well evidence-based, this is the case for the 2004 Convention for Tobacco Control, WHO is enduringly failing to shame countries into compliance despite repeated violation of basic principles such as the article 5.3 of the Convention, which requires protecting public health policies from the influence of the tobacco industry.(6,7) From 1980 to 2004 the decrease in the prevalence of daily smoking was reaching 2% per year; since 2004, the year of the Convention, it has turned back and, the 2012 annualized rate of change in prevalence of daily smoking is now almost null.(8, see Fig 1b) Even worse, WHO’s status report on the progress of alcohol control in Europe congratulated France, claiming that the 2009 law on “Hospital, Patients, Health and Territories” improved control with bans on the sale of refrigerated alcoholic beverages in petrol stations and to young people aged under 18 years.(9, see p64) This is futile as no sting operations are performed in France. Even worse, WHO hide this law specifically authorized the marketing of alcohol on the internet, until then Evin’s law was not allowing it.(10)

Second, for professionalism, WHO enduringly failed to have a policy regarding conflicts of interest. The result: disease mongering that serves vested interests. WHO participated in 1994 in a small study group to define normal bone density: brutally, half of all women over 50 suffer from osteoporosis and osteopenia.(11) Two years later it claimed depression is a worldwide epidemic that within twenty years will be second only to cardiovascular disease as the world’s most debilitating disease.(12) In 2009 WHO called for an unprecedented campaign of mass vaccination and stockpiling of drugs against flu. Coincidentally, Juhani Eskola (Finland) a member of the WHO group ‘Strategic Advisory Group of Experts’ (SAGE) has received 6 million Euros for his research center from the vaccine manufacturer GlaxoSmithKline during 2009 and, Albert Osterhaus (Netherlands) has received a salary from several vaccine manufacturing companies.(13) (14) (15)

Albert Einstein’s quote: "Insanity: doing the same thing over and over again and expecting different results", allows us little hope from the new assembly and its 3500 participants.(2,3) The Oslo Commission on Global Governance for Health may offer a brighter future.(16)

1 Abbasi K. The World Health Organization: no game of thrones century. BMJ 2014;348:g4265.

2 Sridhar D, Frenk J, Gostin L, Moon S.Global rules for global health: why we need an independent, impartial WHO. BMJ 2014;348:g3841.

3 Kickbusch I, Bonk M, Making the World Health Assembly fit for the 21st century. BMJ 2014;348:g4079.

2 http://www.who.int/about/en/ Accessed 2014, June 27

4 Alexander PE, Bero L, Montori VM et al. World Health Organization recommendations are often strong based on low confidence in effectestimates. J Clin Epidemiol 2014; 67:629-34.

5 Kiguli S, Akech SO, Mtove G et al. WHO guidelines on fluid resuscitation in children: missing the FEAST data. BMJ 2014;348:f7003.

6 Braillon A, Dubois G. Framework convention on tobacco control... in search of outcomes. The responsibility to protect. Health Policy 2011;103:98-9.

7 Braillon A, Dubois G. Tobacco control: up in smoke in Europe? Addiction. 2012;107:1016-7.

8 Ng M, Freeman MK, Fleming TD et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014;311:183-92.

9 WHO regional office for Europe. Status report on alcohol and health in 35 European countries. 2013. Available at
http://www.euro.who.int/__data/assets/pdf_file/0017/190430/Status-Report... Accessed 2014, June 27.

10 Braillon A, Dubois G. Alcohol control policy: evidence-based medicine versus evidence-based marketing. Addiction. 2011;106:852-853.

11 Alonso-Coello P, García-Franco AL, Guyatt G, Moynihan R. Drugs for pre-osteoporosis: prevention or disease mongering? BMJ 2008;336:126-129.

12 Summerfield D. J R Soc Med 2006;99: 161–162.

13 Butler D. Flu experts rebut conflict claims. Nature 2010;465:672-673. http://www.nature.com/news/2010/100609/full/465672a.html

14 Cohen D, Carter P. WHO and the pandemic flu “conspiracies”. BMJ 2010;340:c2912.

15 Carlowe J. WHO vaccine expert had conflict of interest, Danish newspaper claims. BMJ 2010;340:c201.

16 Ottersen OP, Dasgupta J, Blouin C et al. The political origins of health inequity: prospects for change. Lancet 2014;383:630-67.

Competing interests: No competing interests

27 June 2014
Alain Braillon
public health
Northern hospital
80000 Amiens. France