First page

Articles & documents from before (and later)

  Articles

Industrial ties in three acts

Act 1 - Unfolding a hidden agenda

In December 2001 the most spread Swedish daily Aftonbladet had a full page revealing Hans-Olov Adami's hidden industrial ties. The article was met with silence [1]. Any PR consultant would have given the Karolinska Institute and Adami the advice to give an open account of his industrial ties. If such advice was given it was not taken.

In September 2002 the Swedish medical journal, Medikament, published my article Greenwashing - An introduction (title translated, the article is in Swedish). The aim of this article was to illustrate the greenwashing concept related to researchers working with industry on issues concerning environment and health, but without revealing their industrial connections. You could say that these researchers, often prominent in their fields, appear as independent researchers, but tend to come up with results that are pleasing to the industry which has secretley hired them. To illustrate the problem Hans-Olov Adami was chosen as an example. His hidden industrial ties were still not accounted for.

Most discussions in public are very general in character and are commonly presented as abstract ethical issues - "in principle". This way anyone can use nice language to demonstrate a "high ethical standard". By taking an example from the real world and expose a prominent person's real actions I wanted to bring the ethical issue of conflicts of interests down to earth. To make a change possible real world affairs must be taken into consideration. Real world examples from your own backyard are needed to escape the safety of the ivory tower.

Medikament shared information with another Swedish science journal, Dagens Forskning (literally translated: Today's Science), so there was more on the subject, but little new substance [2].

A main theme in the greenwashing article is that industry has a general strategy to implement its goals of expanding markets and deregulation. In some instances deregulation is in conflict with the precautionary principle safeguarding public health and environment. The industrial response to such conflicts often takes the form of reversal of the precautionary principle to a precaution of business opportunities and safeguarding of profits on the "free market" (which is not so free for consumers). Tobacco industry, chemical industry, biotechnology industry, and others share this general idea. There is nothing odd about this. Corporate leaders are paid to ensure dividends on the investors' investments. That's the heart of business. So, industry has a legitimate greenwashing interest. One would expect elected politicians in democracies to be the safeguards of public interest, balancing the vested interests of industry. Instead, political interests have increasingly become nested with industrial interests. From a democratic viewpoint this may be seen as irresponsible politics. We have to ask: Who is defending the public interest? The balancing of conflicting interests is out of balance, and, possibly, out of control.

In spite of more articles on the greenwashing theme there was no public discussion of this problem of obvious concern for public policy. However, there were a lot of discussions in the corridors of the establishment. In December 2002 the association of Swedish medical writers had a meeting to which Hans-Olov Adami was invited. In translation the subject given was: What happened, Hans-Olov? This meeting resulted in an article entitled (translated) "Adami's inconceivable naivety" by Monika Starendal, features' editor of Dagens Forskning. [3]

In the introductory paragraph the scene is set:

"At a meeting with the Society of Swedish Medical Journalists shortly before Christmas Adami preferred to talk about 'scandal journalism' rather than his unaccounted jobs on the side on behalf of industry. For him it was a new experience 'after sixteen years of faithful co-operation with Swedish medical writers to meet disturbing questions about his own role as a scientist; it was shocking to meet journalists using the methods of Hell's Angels like threats, lies, and impoliteness - and threatening e-mails'." (Translations of Swedish citations are mine) [3]

This meeting was held almost exactly a year after the first article was published, and Adami still refused to account for his industrial ties. Adami's remarks on the methods merit a note. Although I exposed Adami's industrial ties, we have never had any direct contact. We have not met, talked on the phone, or exchanged e-mail. Adami's record was reconstructed through means available to anyone caring to do the research. Since he is a prominent person with a lot of influence in both the medical and the scientific communities his record is certainly of public interest, even more so since the record raises suspicions of a hidden agenda.

During the meeting critical questions were few, and little was learnt on the issue of conflicts of interest.

"Maybe because 16 years of faithful co-operation have sunk deeply into some medical journalists" [3].

The issue of public trust was avoided, and Adami repeatedly stated that only fundamentalists and environmental activists question co-operation between academia and industry.

Later this year, 2003, a new head of IARC, a body under WHO producing a monograph series on cancer risks with great impact on national regulation policies globally, is to be appointed.

In the U.S. there has been a strong movement the last couple of years to keep scientific views that don't harmonize with political priorities out from the political process. An editorial in Science expresses serious concerns about this development where industrial interests of deregulation weighs more than public health interests [4]. The scientific quest to learn what is worth knowing is thwarted by political ambitions to hide inconvenient knowledge.

Similar concerns, about undue industrial influence related to the IARC process of appointing its new head, were raised by 31 scientists in a letter to the WHO, among them former head of IARC Lorenzo Tomatis [5]. This critique of industrial influence was referred to by Adami at the meeting with medical journalists. Starendal tells from the meeting:

"He [Adami] contemptously dismissed the critique from Lorenzo Tomatis...as an 'old communist'..." [3]

Dagens Forskning had told the Swedish public about the letter to WHO on the increasing influence of industry within IARC. This article also told about rumours of Adami beeing an applicant for the post as head of IARC. He denied beeing an applicant [6].

Act 2 - Revealing the hidden ties

What had been unveiled about the industrial ties of Adami at the end of 2001 was his participation in the lengthy (more than two decade-long) industrial detoxification campaign concerning dioxin, now in part orchestrated by the consultancy firm Exponent, Inc. Adami's participation was confirmed from the e-mail correspondence between him and Jack Mandel at Exponent, Inc. Some other projects were also discussed in this correspondence. However these have not been fully reported. Since Adami remained silent, and has no legal obligation to answer questions about his jobs outside of his academic position, another route had to be tried. One who has to keep himself informed on these matters is the President of the Karolinska Institute (KI), and Adami is bound to tell the President about his outside commissions. The reason, of course, is that the President has a responsibility to control that employees at KI are not involved in activitities which may put KI's credibility in jeopardy. This is similar to industrial consultants' contracts with industry with the exception that industry is not interested in credibility, but in whatever they define as their interest.

For this reason I asked Hans Wigzell, KI President, about Adami's outside commissions. The information delivered this way belongs to the public domain, so Wigzell could not refuse. It took some time, but I received a list. The list was shorter than expected, but also more descriptive than I expected. However one fact was consistently left out, viz. who paid for the job. Since a commission hardly is decently reported without telling who the commissioner is, there was a new round of questioning, also taking some time. Answers of the second round of questioning were announced to have been sent by ordinary mail, but nothing arrived. After two weeks, I had an e-mail from Hans Wigzell asking if I had received the post and I responded with a "no". The day after I had it as attachments by e-mail.

These commissions, ongoing as of December 9, 2002, were reported to Hans Wigzell and the information is given here without comments:

• Is Beryllium a risk factor for lung cancer? The work is described as preparatory for a study design. A committee has been formed at Harvard with four professors from Harvard, and one from IARC, to work with the issue. The work is paid for by Brush Wellman.
• Cancer risks in dry cleaning from exposure to trichloroethylene. A study is in preparation by Dr. Elsebeth Lynge, and there is an international committee of four persons to help in the preparations. One is from IARC, one is Dr. Jack Mandel at Emory University who also has a direct tie to the research company Exponent. One is the head of the Department of Epidemiology at the National Cancer Institute. This work is also on the study design. Paid for by the Halogenated Solvents Industry Association (HSIA).
• Trying to find out whether there is a link between exposure to the herbicide atrazine and prostate cancer at a production facility in Louisiana, or if the increased cancer frequency is due to PSA screening. A document discussing the issue was written in July 2002 at Harvard. Authors were Adami, two professors at Harvard, and Jack Mandel. Later Adami was asked to help with a study design for investigation of the possible connection between atrazine exposure and prostate cancer. In this new group Adami works together with Dimitrios Trichopoulos and Harris Pastides. Work is paid for by Syngenta Crop Protection, Inc.
• Adami is on the External Scientific Advisory Committee of CEFIC, the European branch organization for the chemical industry. Adami's activities in this committee has resulted in funding of a project lead by Anders Ekbom (at the same department as Adami) on environmental toxins and cryptorchism and hypospadias. [7]

In addition to this information Adami offered a copy of the review on atrazine. Accordingly I asked for this copy.

There are two projects I asked specifically about. One concerned asbestos and was mentioned in the correspondence between Adami and Jack Mandel at Exponent. Adami says he has no knowledge of this project later than the autumn 2001. The other project concerned dioxin and endocrine disruption. Adami didn't understand what I referred to, and this is because my memory slipped. The reason for asking about it is the following quote from a mail by Jack Mandel during the finalization of the review Dioxin and Cancer in the summer 2000:

"The Chlorine Chemistry Council has asked me to submit a proposal to review the non-cancer endpoints (there are a large number that have been addressed). I would like to propose our current group because of your familiarity with the field and your expertise in epidemiology. I would add one or two people with expertise in specific areas such as children's health, neurobehavioral testing, immunology, etc. Would you be willing to work on this new project? I have very much enjoyed working with all of you and would look forward to continuing our collaboration on the new project. Please let me know at your earliest convenience." [8]

This review was done, concluding there are no adverse health effects on humans from dioxin regarding immunologic or neurologic endpoints, nor does dioxin cause diabetes, but Adami was not participating in the review work more than to receive an introductory acknowledgement [9]. At this time (the year 2000) it is obvious from the correspondence that Adami was involved in more projects, but also that the engagements have been thinning out.

Beryllium

I have no further information.

Dry cleaning and TCE

The dry cleaning study is interesting. The participant from National Cancer Institute is the Chief of the Occupational Epidemiology Branch, Dr. Aaron Blair. The participant from IARC is possibly Dr. Paolo Boffetta, who also is adjunct professor at Adami's department. From the information given it seems that HSIA paid for the participation of outside experts, and was not involved in the process. Actually HSIA played an active role through Louis Bloemen, an employee of Dow Chemicals, who at least in early stages acted as the coordinator for the project, a role you would expect Dr. Lynge to play. Adami was uneasy about being involved without a clearly defined position in the work, and expressed his concerns to Mandel, who responded:

"Hans-Olov, Here is a copy of the email I sent to Louis yesterday. He called me 15 minutes after I sent the email and we spoke for almost an hour. I told him I was concerned about the way the Advisory Committee was been used, that I felt the review process had to be more formal, that I had some concerns about the protocol and the investigative team, that I felt there should be a chair (I suggested you) of the Advisory Committee who would receive and compile information from the members and send a unified report from the Committee, and that there should be one or two additional people on the Committee (I suggested Dimitrios, Phil Cole and Paola Boffetta). My reason for this latter suggestion was to balance Aaron Blair and provide even greater strength given the importance of this study. I told him that I believe it is better to work with the investigators to ensure the study is done well, properly analyzed and interpreted so that the industry is not put in a position of having to criticize a study they funded.

He was very attentive and interested in my opinion. He will talk to others and get back to me. I did not tell him that you and I communicated about these issues." [10]

Dimitrios Trichopoulos and Philip Cole both participated in the dioxin detoxification campaign orchestrated by Exponent.

Atrazine

Trichopoulos also participates in the work on atrazine, as well as Jack Mandel. It's noteworthy, that Mandel is presented as an academic with "direct ties" to Exponent, as if he is a professor taking commissions for that firm. Actually Jack Mandel is Group Vice President and a senior consultant at Exponent. The third named participant on the atrazine issue is Harris Pastides. He also participated in the dioxin detoxification campaign, beeing co-author of both reviews from Exponent.

Adami gives the following additional comments on the atrazine project in the second response to Wigzell (my translation):

"The review of atrazine is interesting both by being representative for the kind of consultancies I have accepted and because it offers an interesting challenge which with good reason can be said to demand an epidemiological competence which rarely is found within the industry itself. Shortly, the background was that newly discovered prostate cancer was found in excess to what was expected at the plant in question producing atrazine. The basic question was therefore if this was best explained by a carcinogenic effect on the prostate from atrazine or by the fact that all employees were offered free health controls with PSA testing. In a first document these two alternative explanations were penetrated. In the second phase the aim is to go one step further by performing a formal epidemiological study aiming at quantification the effect of atrazine and PSA testing respectively on the incidence of prostate cancer. This is proving to be a delicate methodological issue, and my latest "review" on the subject is about these aspects. I attach it as requested from Bo Walhjalt." [11]

The trickiness of the suggested case-control study is in part due to the small number of cases, 17. In the Exponent review Dioxin and Cancer Adami et al. discusses case-control studies showing increased risk for cancer from exposure to dioxins. In a response to Dagens Forskning Adami refers to this review because he is co-author of one of these studies. He writes:

"The uncertainty about dioxin arises from the indisputable cancerogenic effect in animal trials, while the epidemiological support for a similar effect in humans has been classified as "limited" by the IARC. Also it has been remarkably hard to confirm among other things the positive findings of Swedish researchers in international epidemiological studies. Therefore I have accepted a commission to review the methodology of the Swedish studies - a commission with elements of self criticism since I'm co-author of an early study limited to soft tissue sarcomas. My conclusion is that these studies because of methodological shortcomings do not allow conclusions about a causal relationship between dioxin and cancer." [12]

In Dioxin and Cancer there is only a short dismissal of the positive Swedish studies. It reads:

"Case-control studies of pesticide applicators have focused on soft-tissue sarcoma and malignant lymphoma. Studies on soft-tissue sarcoma may be divided into those done by Hardell and those done by others. Studies by Hardell reported very high relative risks, with the exception of the study co-authored by Adami [20]. Even this study needs careful interpretation due to small numbers (low statistical power), multiple comparisons and possible differential misclassification of exposure. In contrast..."

and:

"The single case-control exception is again a study by Hardell [21] that reported statistically significantly elevated 5-fold risks." [13]

In the study co-authored by Adami there was also an instance of 5-fold elevation of risk. The exception on risk elevations when Adami is involved thus seems overstated. [14]

The careful interpretation needed is stated to be due to the small number of cases. This is interesting because we can compare the difference in numbers of cases needed in a case-control study to reach a reliable result depending on the agenda.

In the case of exposure to dioxin the agenda is to refute cancer risks in hindsight of research already done. Then 237 cases compared to 237 controls are too few to give enough statistical power according to the Exponent review (this is the number of cases in the study where Adami is co-author!). Adami goes so far that he says his conclusion is that it gives no guidance on the issue of causality.

In the case of exposure to atrazine the agenda is to perform a study refuting the risk. The lower the statistical power, the more likely any real risk will be missed. Perhaps 17 cases are few enough for a guarantee that no risk will be demonstrated no matter how high the real risk may be? I'm not a professional, so this is a question that should be answered by professionals. The answer will shine light on the degree of academic integrity Adami brings into his industrial commissions.

In the Swedish Medical Journal, 4/2003 (Swedish edition), Adami is interviewed. His summary comment on his industrial ties:

"What I have done is absolutely uncontroversial. I'm following the path of Science and Truth. If something else is demanded from me, I decline." [15]

The question burns: Are 237 cases too few, while 17 cases may be enough for a case-control study.

CEFIC's External Scientific Advisory Board

Hans Wigzell is very pleased with the fact that Adami's presence on this board has payed off in research money to KI. If the grant had been given from another grant giving body, this would probably had been viewed as a challenge of conflicting interests. Adami would not have been allowed to take part in the decision. Here Wigzell emphasizes that his presence was profitable for KI - a sales argument for having presence on the right boards.

Act 3 - The IARC game

The "discussion" on IARC and the search for a new head at the meeting of the Swedish medical journalists was mentioned above, and also that Adami had denied being an applicant for that post. This was of course true. It is also true that he was the nominee of the Swedish government for that very same post. His answer was true, but yet misleading. He had a keen interest in that post.

Already in the summer 2002 the Ministry of Health and Welfare asked the Swedish Science Council to try finding a Swedish candidate with broad support in the Swedish academic society. There was one such person, but he did not wish to be nominated. The question went one round further, but no name could be found to have general support, so the Ministry didn't have anyone to nominate.

Dagens Forskning tells about this in its latest issue (5/2003). It is said that Adami's name only had support from the Dean of KI, but a secretary at the Ministry, Cecilia Halle, says in the article that she had received an informal confirmation that the Science Council supports Adami as a candidate.

The Dean of Uppsala University, Kjell Öberg, gives the reasons for not supporting the nomination of Adami

"Hans-Olov Adami is an internationally well reputed scientist. But he is deeply controversial. He is not a listening person. He slashes down on people and can be unreasonable as a negotiator. This makes him unsuitable as head of such an organization.

Furthermore his consultancies for American chemical industry stands in his way. He has not succeded to respond to the questions raised, but slipped away. These were the reasons we could not support his candidature." [16]

Apparently the Ministry of Health and Welfare after this article finds itself caught with a legitimacy problem. To find out the political reaction I called Cecilia Halle. She didn't have time talk because she was in a meeting, but she promised to call the same afternoon. I was called back by Deputy Director Lars Blomgren, who wished to give an account of the nomination procedure.

Up to the point where the Ministry ended up with nobody to nominate, the descriptions are the same. What happened next, according to Blomgren is that the Ministry received a letter from the KI President, Hans Wigzell, suggesting Adami as a candidate to be head of the IARC. Next Wigzell's wife, Kerstin Wigzell, head of The National Board of Health and Welfare, and also Swedish representative on the board of WHO, reported to the Ministry that she had informally asked representatives of the other Nordic countries if they had any objections against a Swedish nomination of Adami as head of IARC, and that no such objections were raised. The letter to the Ministry seems to be a personal letter of recommendation, and the questions in the WHO corridors seems to be derived from Wigzell's breakfast table.

Blomgren says this gave the Ministry a candidate to nominate. At the Ministry they had no knowledge about Adami's industrial ties before the article on the nomination was published. When asked about how the Ministry reacts, Blomgren answers, that there is nothing for the Ministry to do. They have put forward the nomination, and they can't change it. The choice was to nominate or not nominate. Blomgren also mentioned Adami was very pleased being nominated.

A note on "industrial ties"

To understand Adami's view it's important to note what he said about his industrial ties already in December 2001, when asked if he didn't bother about how people wonder when researchers are paid by those whose products they are reviewing

"No, almost all leading scientists are involved in such co-operations. Industry fund research. All realize that we're only in the beginning, and that these borders will be wiped out." [1, the second article]

If there is no difference between working for industry and working for academia, then the issue of industrial ties changes character, and maybe Adami is not demonstrating the problem of trust following hidden industrial ties, but how academic research departments are turned into business departments in a corporate takeover.

Adami was pursuaded to move his department from Uppsala University to KI by Wigzell's vision of building Europe's largest science park, a multi-billion-dollar project. The money to put the plans into action comes from building industrial ties. Karolinska, Inc. - and Adami's move from Uppsala to Stockholm - was featured in Science, September 28, 2001. This embodies the future Adami describes when saying that the borders between industry and academy will be wiped out, and he is in the middle of it. A kind of academic sell out.

Today, March 10, Adami is on interview at the IARC, an international public body which many corporations would like to see follow a path more sensitive to industrial needs than the path of precautionary action.

Bo Walhjalt

---

References:

1. Lars Söderberg: Nobelprofessor hyrs av kemijätte. Aftonbladet, 17/12, 2001.
Lars Söderberg: “Att få betalt för arbete ser jag inte som något kontroversiellt”. Aftonbladet, 17/12, 2001.

2. Thomas Heldmark: KI-forskare kritiserar cancerlarm på uppdrag av kemisk industri. Dagens Forskning 18/2002.
Thomas Heldmark: Cancerfonden kollar inte forskares vandel. Dagens Forskning 19/2002.

3. Monika Starendal: Adamis obegripliga naivitet. Dagens Forskning 1/2003.

4. David Michaels, Eula Bingham, Les Boden, Richard Clapp, Lynn R. Goldman, Polly Hoppin, Sheldon Krimsky, Celeste Monforton, David Ozonoff, Anthony Robbins: Advice Without Dissent. Science 298:703, 25 October 2002.

5. Integrity in Science keeps an updated page with links to documents related to the WHO/IARC including the letters referred to.

6. Thomas Heldmark: Forskarprotester mot industriintressen i WHO. Dagens Forskning 23/2002

7. E-mail from Hans Wigzell Mon, 9 Dec 2002, and Wed, 12 Feb 2003. The last mail was the copy of Adami's response to the second round of questions as an attachment and also attached the requested atrazine review.

8. E-mail from Jack Mandel to Adami Sat, 29 Jul 2000

9. James Albers, Philip Cole, Jack Mandel, Harris Pastides, Thomas Starr, and Dimitrios Trichopoulos: Dioxin and Immunologic and Neurologic Effects and Diabetes. - This review was presented to the EPA Science Advisory Board.

10. E-mail from Jack Mandel to Adami Wed, 26 Sep 2001.

11. The response from February 12 (see note 7).

12. Hans-Olov Adami: Bespara människor okritiska larm. Dagens Forskning 20/2002.

13. Hans-Olov Adami, Philip Cole, Jack Mandel, Harris Pastides, Thomas B. Starr, Dimitrios Trichopoulos: Dioxin and Cancer. The first Exponent review to be presented to the EPA Science Advisory Board. There are more versions circulating, because it has also been used in legal processes.

14. Eriksson M, Hardell L, Adami HO: Exposure to dioxins as a risk factor for soft tissue sarcoma: a population-based case-control study. J Natl Cancer Inst 82(6):486-90, 1990. ISSN 0027-8874

15. Hans-Olov Adami interviewed by Björn Ramel. »Jag går forskningens och sanningens ärende«. Läkartidningen 100(4):206-7, 2003.

16. Thomas Heldmark: Regeringens WHO-kandidat saknar stöd i Forskarsverige. Dagens Forskning 5/2003.

 

Links:

The WHO-list of candidates for the future leadership of the IARC. (Word-file)