For eight years, city-based paediatrician Dr Sivaranjani Santosh waged a solitary battle against sugar-based drinks masquerading as life-saving Oral Rehydration Solutions (ORS). Her persistence has finally paid off. On October 15, the Food Safety and Standards Authority of India (FSSAI) issued a landmark order, banning the use of the term ‘ORS’ on any beverage that does not adhere to the WHO’s strict medical formula, a move that will prevent the misuse of a critical healthcare label. In a conversation with TNIE’s Aarti Kashyap, Dr Sivaranjani speaks about the long fight against industry pressure, regulatory inertia and the way ahead. Edited excerpts:
What prompted you to initiate a campaign against sugar-based drinks?
It began when I noticed children consuming ORS drinks were getting worse, not better. On checking the labels of fruit-flavoured ORS drinks parents were giving them, I realised these contained 9–10 times more sugar than the WHO-recommended formula. Instead of rehydrating, the excess sugar caused diarrhoea. It was shocking to see such misleading marketing in the name of ORS. These drinks were being sold widely — in pharmacies, hospitals, schools and supermarkets — making people believe they were safe rehydration options.
How have these drinks affected children’s health?
In India, of every 100 deaths among under-five children, 13 are due to diarrhoea. Parents, misled by marketing, end up buying drinks that worsen dehydration and could even cause death. Diabetic patients, too, are at serious risk.
What steps did you take against these drinks?
Initially, I started by raising awareness. In 2021, I wrote to the Central Drugs Standard Control Organisation (CDSCO), which said the permissions were under FSSAI’s purview. I then wrote to FSSAI and the Ministry of Health. In April 2022, FSSAI prohibited the use of the ORS label, but it reversed the order in July, allowing companies to use the label with a disclaimer.
Since most people don’t read disclaimers, this was deceptive. I filed a PIL in 2024 and continued raising the issue on social media, gaining support from the Endocrine Society of India and the Women Paediatricians Forum. Unfortunately, the Indian Academy of Paediatrics never supported the campaign and continued taking sponsorships from these companies.
What kept you going despite so many challenges?
It was a lonely battle, and there were moments of dejection. But every obstacle strengthened my resolve. I was angry that such a serious public health issue was being ignored. This year, I wrote to the PMO and the Health Ministry again, supported by evidence from parents and paediatricians. After the recent cough syrup controversy, I questioned the government again, and on October 15, they finally issued an order.
What happens next after the order?
My concern is that companies may pressure the government or approach the court to sell existing stocks. I hope public health and child safety take precedence. These drinks must be relabelled and sold as regular or energy drinks — not as ORS — and must not be available in pharmacies, hospitals or schools.
How did these products enter the market in the first place?
That’s for the government to answer. But clearly, corrupt practices enable such products to slip through the system.
How important is public awareness in such cases?
Extremely important. People must read product labels, ingredients, and expiry dates before purchase, especially when buying for children. Doctors should also educate parents about such risks. Awareness in regional and local languages can make a real difference.
What steps should the government take to curb such products?
The government must enforce strict drug regulation, restrict over-the-counter sales, and strengthen primary healthcare. Increasing the health budget, ensuring quality control and promoting single-drug formulations are also crucial.
What’s your next plan of action?
If companies go to court, I’ll fight it out. I also plan to take up other critical issues like patient privacy and misleading marketing of so-called ‘sugar-free’ products.
