After years of sharing health information with parents, Hyderabad-based paediatrician Dr Sivaranjani Santosh has gone off instagram. “I am tired of fighting alone. I was hurt by the way the Indian Academy of Paediatrics (IAP) treated me, and more importantly, the way they treated the concerns raised by me,” Dr Santosh told the Indian Express.

She had resigned from the premier body of paediatricians as she felt it did not address her concerns regarding a beverage brand setting up kiosks at their annual conference. The beverage brand in question formerly used the term ORS in its name.

Dr Santosh came into limelight after her eight-year long fight against such fruit-based, non-carbonated beverages marketing themselves as Oral Rehydration Solution — a life-saving drug for those with diarrhoea. Any change in the formulation of an ORS can lead to worsening of diarrhoea and dehydration. The composition of the ORS is based on the daily sodium and potassium requirements and what is lost in the stool, which facilitates the absorption of salt and water. Any change to the composition can change the osmotic pressure, resulting in water getting drawn out of the body to the digestive tract. This can worsen diarrhoea and dehydration.

The Indian Academy of Paediatricians accepted her resignation. Afterwards, she said: “Finally, my resignation from the IAP has been accepted, thankfully! So far, I had to show some restraint before calling the leadership out for their pathetic slavery to pharma! Now, I am under no obligation to show that restraint!”

Not only has she taken on a big consumer health company — Kenvue that was formerly the consumer health division of Johnson and Johnson — she has also been fighting with the IAP leadership, urging them to take a stand against products that use ORS in their brand name without following the proper formulation, particularly Kenvue’s newly branded EZRL.

The country’s apex food regulator, the Food Safety and Standards Authority of India, banned the use of the term ORS for electrolyte drinks that do not follow the WHO recommended ORS formulation. However, months later, Kenvue rebranded its “hydration solution” as EZRL while maintaining the brand-name ORSL for its formulation for diarrhoea.

Dr Santosh raised concerns that the new branding of the product visually represented the old one, thereby continuing to confuse people. She said the brand uses a four-letter name visually similar to the previous brand name, uses similar font style, the same colour and layout, as well as the same photograph of a fruit resulting in people still confusing the two. She filed a trademark opposition in late February based on these findings.

In a reply to her opposition, the company said: “(The opposition)… has been filed with mala fide intent to stall the application of the Applicant and is bad in law. The present opposition proceedings are baseless as the Applicant’s trade mark ERZL … is compliant with all the provisions and in line with the orders passed by the Food Safety and Standards Authority of India (FSSAI) which restricted use of ORS for food products. The Applicant herein has since re-branded their hydration portfolio…”

“Since the subject mark does not contain the term ORS and the subject mark is not similar to ORS, the adoption and use of subject mark is not illegal or misleading or contrary to any Orders of the FSSAI or Hon’ble Courts,” it added.

The company in one of its public statements said that it had “presented at various national conferences” including IAP’s Pedicon. Dr Santosh said while the company never made a scientific presentation, why was it even allowed to set up stalls in the conference for a product that was meant to confuse people.

After she urged the body to support in her fight against the Kenvue product, IAP did issue a position statement on the differences between ORS and electrolyte drinks, urging clinicians to ensure that only products with proper formulation be given to those with diarrhoea. Without naming the brand, it added that these drinks lead to “Look Alike Sound Alike” concerns — where they are often stocked together with similar branding or name confuses people. It went on to say that the recent measures by FSSAI to restrict use of the term ORS to appropriate formulations is likely to help in this regard.

Dr Santosh, however, pointed out that the same statement said non-nutritive sweeteners such as sucralose are regulated and considered safe within established acceptable daily intake limits. She had been raising concerns with parents using the “hydration solution” that uses sucralose regularly. Concerns were raised by a WHO team of experts a couple of years back, with the committee suggesting that in the absence of concrete evidence one way or the other, non-nutritive sweeteners such as sucralose should not be consumed for purposes such as weight-loss and cutting on calories.