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Journalism of Courage
A diabetic child from Chennai was rushed to the ICU, severely dehydrated. His parents had done everything right — or so they thought. They had given him a tetra-pack “ORS” drink after he began vomitting and passing loose stool. By the time he reached the hospital, his condition had spiralled into an emergency.
In another part of the country, a young girl recovering from burn injuries suddenly became critical because of dehydration. Her caregivers, too, had been faithfully administering a store-bought “ORS” product.
The common thread in both stories? Packaged, flavoured drinks that claim to be “ORS solutions”.
For years, the Hyderabad-based paediatrician, Dr Sivaranjini Santhosh, has been collecting stories like these — heartbreaking accounts from parents, colleagues and anxious relatives who reach out to her through her social media platforms. Her aim has been to ensure that children with diarrhoea do not end up consuming flavoured, sweetened beverages in place of the genuine Oral Rehydration Solution (ORS), a landmark discovery in medicine pioneered by Dr Dilip Mahalanabis.
On Wednesday, the country’s food regulator issued an order banning all beverages from using the term ORS in their trademarked name, withdrawing an earlier order allowing the term with disclaimers. “Over the last decade or so, several tetra-pack products claiming to be ORS have entered the market without actually adhering to the sugar and salt ratios needed for a person to effectively absorb the water they are drinking,” Dr Santhosh told The Indian Express.
A CRUSADE THAT BEGAN EIGHT YEARS AGO
Her journey started with educating people on social media around eight years ago — she saw children coming to her clinics who were severely dehydrated despite being given what the parents assumed was an ORS solution.
But she knew that was not enough. These products were not only giving children excess sugar; they were actively harming their health. “Even if a product carries the warning ‘not ORS’ — which many of the new products do not — people still think that it is an ORS solution because that’s what the brand name suggests. It misleads people into choosing products that can actually worsen the diarrhoea in children and may even lead to deaths if timely medical intervention does not happen,” said Dr Santhosh.
“ORS is a medical product that has saved millions of lives. Around 13 per cent of the deaths in children under the age of five years happen because of diarrhoea and ORS is an effective tool for preventing these deaths. There is a fixed formula for how much glucose, sodium chloride and potassium chloride should be present in the ORS solution. This formula is such that the sugar and salt actually pull water with them into the body and rehydrate a person. Any excess sugar will actually pull the water back into the gut and worsen the diarrhoea,” she explained.
A LONG LEGAL BATTLE
In her eight-year long journey to ensure that people are not misled, she went to the Telangana High Court, wrote to the Union Health Minister and the Prime Minister. “I knew I had to stop this when I saw severely dehydrated children coming into my clinics, when my colleagues reported that children ended up in ICUs because they were given these tetra-pack solutions that did not really help.”
But there were several ups and downs. At first, she did not even know who she should reach out to. “Being a medical product, I assumed that the drug regulator (Central Drugs and Standards Control Organisation) would regulate these products. When they wrote back to me, I was surprised to find out that it was actually the food regulator.”
Dr Santhosh also wrote to medical associations to discontinue sponsorships from these products. “I was isolated, people would talk behind my back. Even my family at times thought whether it was worth it — these were big companies like Johnson and Johnson, Dr Reddy’s that I was taking on.” She also found out that the Indian Paediatric Association continued to have stalls of some of these drinks at their events.
A MATTER OF ETHICS
At one point, she considered giving up. But she knew she would not be able to live with herself. She said her college, JIPMER Puducherry, had taught her to be ethical and she knew she had to keep going.
Then came an April 2022 order where the Food Safety and Standards Authority of India (FSSAI) restricted the use of the term ORS, but the relief did not last long. “Within months, there was another order that said that the companies could continue to use ORS in their names as long as they carried a warning stating that it was not an ORS solution. Even that order was not implemented properly. Newer products entered the market that did not carry the warning either,” said Dr Sathosh.
Her struggle came to fore earlier this month when she posted a video about the deaths of children in Madhya Pradesh after consuming tainted syrup. She asked a simple question — how could doctors alone ensure the safety of children when regulators kept allowing harmful products to enter the market. She asked how many children would have to die for the regulator to take action on the ORS solutions.
WHAT FSSAI SAID
And, finally, the FSSAI on Wednesday banned the use of ‘ORS’ in these beverage names.
“It is hereby clarified that, upon further review, the use of the term ‘ORS’ in the trademarked name or in the naming of any food product otherwise-whether fruit-based, non-carbonated, or ready-to-drink beverages-even when accompanied by a prefix or suffix, constitutes a violation of the provisions of the Food Safety and Standards Act, 2006 and the regulations made thereunder,” the order said. This will come into effect immediately, meaning these products cannot be sold anymore.
“We have won,” said Dr Santhosh.
