A dispute over how electrolyte drinks are marketed for children — and whether they are being confused with medically prescribed oral rehydration salts (ORS) — has led to the resignation of Hyderabad-based paediatrician Dr Sivaranjani Santosh from the Indian Academy of Pediatrics (IAP).
After receiving legal notices from pharmaceutical companies over her public comments on these products, Dr Sivaranjani said she had stepped down from the academy, citing a lack of institutional backing.
Announcing her decision on social media, she said the environment within the IAP had become “too suffocating,” and alleged that its leadership appeared more concerned about corporate funding than child safety. She criticised the academy for not condemning the legal notice issued to her, and for failing to respond to statements by Kenvue regarding the presentation of its hydration products at PEDICON, the IAP’s annual conference. She also took issue with a subsequent position statement issued by the academy on oral rehydration solutions and electrolyte drinks, arguing that it introduced ambiguity rather than clarity.
Dr Sivaranjani, who has been raising concerns for nearly eight years about misleading branding of oral rehydration products, said her resignation followed repeated attempts to flag the issue internally. She told media outlets that she had stepped down a few days ago after concluding that the academy had not supported her despite being alerted in advance.
The controversy centres on a legal notice sent in March 2026 by companies including Johnson & Johnson and Kenvue. The firms accused the paediatrician of making false, misleading, and defamatory statements about their products, and asked her to remove social media posts and refrain from commenting on the offerings, warning of legal consequences.
Dr Sivaranjani has maintained that her remarks were made in the interest of public health, particularly to caution against the routine use of electrolyte drinks as daily hydration products for children. She has argued that such drinks are often confused with medically prescribed oral rehydration salts, which are formulated according to World Health Organisation standards for treating dehydration.
According to her, this confusion is longstanding at the ground level, where parents may mistake commercially marketed drinks for therapeutic solutions. She said she had written to the IAP president weeks before receiving the legal notice, warning that product branding and positioning could mislead “ignorant and innocent parents” and urging the body to intervene. While she was initially told the matter would be examined, she instead received the notice accusing her of disparagement.
She further alleged that the IAP neither condemned the legal action nor publicly supported her, even as some resident doctors’ associations spoke out. Although a committee was later formed within the academy, its eventual position statement did not address the specific product in question. Dr Sivaranjani described the document as unnecessary and ambiguous, particularly on whether electrolyte drinks can be used for routine hydration.
A key point of contention has been the mention of sucralose, an artificial sweetener, in the IAP’s statement. Dr Sivaranjani argued that the focus appeared selective, noting that the product she criticised was the only one in its segment containing the sweetener. She said the statement described sucralose as safe without adequately warning parents about potential long-term risks, including possible effects on gut health and metabolic outcomes.
She pointed to guidance from international paediatric bodies, including the American Academy of Pediatrics and the Canadian Paediatric Society, which advise caution on prolonged use of artificial sweeteners in children due to limited evidence on long-term safety.
The pharmaceutical companies, however, have rejected her claims. In the legal notice, they said sucralose is an approved ingredient under Indian and international regulatory frameworks, and cited global reviews affirming its safety. They accused her of spreading “unscientific myths” and running a campaign that could damage their reputation.
The firms also disputed allegations that their products were being marketed as substitutes for oral rehydration solutions. They said earlier branding had been revised in line with regulatory directions, and that newer products, such as ERZL, are clearly positioned as electrolyte beverages rather than therapeutic formulations. According to them, any suggestion that consumers were being misled was incorrect.
Dr Sivaranjani, however, argued that rebranding and marketing could still create confusion. She alleged that older stock was relabelled and that promotional material continued to draw associations with earlier products, potentially blurring distinctions for consumers. While acknowledging that companies are free to market such drinks, she maintained that they should not be positioned in a manner that suggests routine or health-based use, particularly for children.
The dispute comes against the backdrop of regulatory intervention by the Food Safety and Standards Authority of India (FSSAI), which in October 2025 directed that no product should use the term “ORS” unless it met formulation standards prescribed for oral rehydration salts. The move was intended to prevent consumer confusion and clearly distinguish medically indicated products from commercial beverages.
Dr Sivaranjani said her advocacy had contributed to drawing regulatory attention to the issue, but added that the episode highlights the challenges faced by doctors raising concerns about widely marketed products.