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Dagens Forskning [Today's Science] no 12, 10-11 June 2002

Philip Morris assigned secret grants to Swedish professor

Dagens Forskning no 12, 2002.

[In Swedish]

A respected Swedish scientist has been under quite heavy fire the last year — in Switzerland. Ragnar Rylander, professor of environmental medicine in Gothenburg, is also engaged at the university of Geneva, where he has been doing research on the connections between environmental tobacco smoke and lung disease, research that has been secretely funded by the tobacco company Philip Morris. Professor Rylander has been accused of manipulating his studies to suit his covert financier, and of thus partaking in a "scientific fraud without precedent".

Almost nothing has been written about this case in the Swedish press, but in Switzerland this "l'affaire Rylander" has been a serial story during the last 14 months. The latest news is that Rylander's sharpest critics, two gentlemen from the anti-tobacco organizations CIPRET-Genève and OxyGenève, Jean-Charles Rielle and Pascal Diethelm respectively, were sued for defamation by professor Rylander. This was brought on because of what they say at their web site "Prévention" (www.prevention.ch) about fraud and big money. Although they presented a lot of documentation, for instance correspondence between Dr Rylander and Philip Morris' main office in Richmond, Virginia, which confirmed much of their allegations, they were at the end of May found guilty of defamation, which came as a surprise to most observers.

A researcher being accused of secretly receiving money from a party that has a direct interest in the research's showing a certain result — this is not just a minor detail. And many regard the tobacco industry, of all branches, as the worst financier one can have. In 1996, when Cambridge university was about to accept a 1.5 million pound grant from the British American Tobacco Company, the British Medical Journal compared the tobacco industry with the Colombian drug cartel.

During the last decade, more and more facts have been unveiled, that show the systematic work of the tobacco companies, how they have created a network of scientists working for them, how conferences have been directed, and how hundreds of articles have been planted in scientific journals, where alternative causes for lung cancer among smokers or people exposed to the smoke of others — apart from tobacco smoke — have been introduced. One popular idea was, for instance, the keeping of pet birds, "a far more serious factor than anyone has ever alleged ETS [environmental tobacco smoke] to be", as they put it in a previously strictly confidential document from the law firm Covington & Burling, which handled the strategies of the British American Tobacco Company. According to the same document, the tobacco industry even had an editor at the Lancet on its pay-roll for some time. [Document]

Swedes have also appeared in this context. Last winter the Swedish evening paper Aftonbladet wrote about a couple of renowned Swedish scientists at the Karolinska Institute, who had received money from Philip Morris. One of them was supposed to report about the doings of one of his colleagues, in the same corridor, a colleague doing research on health effects of passive smoking.

According to a study from 2001 by Chung-Yol Lee and Stanton Glantz at the University of California, Ragnar Rylander has, however, been the key figure among the so-called consultants of the tobacco industry. A document from 1991 shows that the budget which was then allocated to him was 60,000 dollars a year as an unrestricted research grant and 90,000 dollars a year consultancy. The same document also has this comment: "This is a commitment: he gets paid this amount regardless of what we ask him to do." [Document]

All this has been revealed in the aftermath of the big tobacco trials in the US at the end of the 90's, when Philip Morris and other tobacco companies were sentenced to pay very large damages, and they were also obliged to publicize inconceivably large amounts of internal documents, in total around 40 million document pages, which are now accessible on the Internet (for instance at www.pmdocs.com). Then, the concern was class action, mostly on behalf of people afflicted with lung cancer, but these documents contain an abundance of other information which nobody has yet perused. Here, all people with an Internet account may do their own research. The old expression "that great detective — the public" might again be restored. (It is, by the way, an interesting phenomenon in our new electronic public sphere, that the Internet is being used for so-called distributed work in more and more areas.)

The impression one gets from browsing these formerly secret documents from the tobacco industry is how completely unscrupulous this business has been when it comes to pretending not to know. The industry has been well aware of studies showing various harmful effects but has chosen to keep this knowledge confidential. Officially one has claimed that there is no proof of risks. Helmut Wakeham, head of research and development at Philip Morris, wrote the following to his CEO, Joseph Cullman, in 1979: "It has been stated that CTR [Council for Tobacco Research] is a program to find out 'the truth about smoking and health'... Let's face it. We are interested in evidence which we believe denies the allegation that cigaret [sic] smoking causes disease." [Document] Fred Panzer, at the Tobacco Institute, wrote in a confidential memo in 1972 that the industry's strategy "has always been a holding strategy, consisting of — creating doubt about the health charge without actually denying it." [Document]

A search on Rylander's name in the Philip Morris document database retrieves almost 20,000 documents. Certainly, I have not read them all, but maybe a couple of hundred, and from this one surely gets an impression of a scientist who for thirty years has co-operated very intimately, willingly — and for the most part secretly — with the big tobacco company.

Passive smoking was foremost the issue on which they wanted Dr. Rylander to focus. This had become a crucial matter for the business during the 80's and 90's, since the role of active smoking in the etiology of lung cancer and other diseases had already been established and was difficult to call in question. The task now was to save what could be saved, so that smoking would not be prohibited at all places where there might be non-smokers present.

Professor Rylander's work for Philip Morris was initiated in 1972, when he visited Dr. Thomas Osdene, one of the directors of research and development. During the years he also associated with Osdene privately. Now Ragnar Rylander also became nothing less than the Philip Morris representative to Europe at INBIFO (Institut für biologische Forschung), a research institute in Cologne that the tobacco company very discreetly had purchased in 1971 [Document]. Dr Rylander was supposed to visist the institute every month, discussing "scientific methods and product evaluation" [Document]. At this time Dr. Rylander was also engaged at the National Swedish Environmental Protection Board as well as at the university in Gothenburg.

I have not found many documents hinting at the size of the remunerations during the 70's. One might guess, however, that it was hardly free of charge if Dr. Rylander put his name under articles which other people had written for him, as he was supposed to do in 1974, when a report from a meeting was to be published in the journal Science. The article in question had "been prepared by Nick Fina at the Philip Morris Research Center as a ghost writer and is intended to be published over the name of Ragnar Rylander approval." This was the words of the head of research, Helmut Wakeham, in a confidential letter. [Document]

Dr. Rylander was often the person pulling the strings during the planning of international conferences and workshops. Before a conference, in 1973, Dr. Rylander received a letter from one Dr. W.B. Dublin, who unsuspectingly wrote to Rylander (who he thinks shares his own beliefs) that "ambient smoking is one of the most (if not the most) urgent of the problems which we face relative to the atmospheric environment." Yet, Dr Dublin says, whole symposia and congresses devoted to air pollution make no provision for contamination with tobacco smoke. And Dr Dublin approaches the area which will later become the primary field of research for professor Rylander: "The greatest abuse is in the case of children in the homes of smoking parents ... I am certain that I only echo your own conclusions in this matter." [Document]

Dr Rylander immediately wrote to one of Philip Morris' attorneys, Donald Hoel, enclosing the letter from Dr Dublin: "Would he be a suitable person to invite to the conference? Even if he appears to be somewhat biased it is probably important to balance the participation list so that we will not be accused of having chosen only one category of people." [Document]

In 1982 the organizers of a workshop on ETS very deliberately abstained from inviting two scientists, Takeshi Hirayama and Lawrence Garfinkel, who had earlier presented some very interesting research findings, implying a connection between lung cancer and passive smoking. On January 27, 1982, Don Hoel wrote to Tom Osdene: "Although Dr Rylander does not have a specific list of invites in mind at this time, he was very receptive to suggestions. He would not invite Garfinkel, Hirayama, etc." [Document]

In 1990 the American Environmental Protection Agency (EPA) compiled a report on passive smoking, featuring commentary by 47 — supposedly — independent experts [Document]. One of them was Ragnar Rylander, who now worked hard to propagate his ideas that passive smoking in connection with lung cancer was merely a so-called confounder, that is, an irrelevant factor distorting the picture of the true causal connection. In this case diet, according to professor Rylander, was a more important element. Dr. Rylander's second main argument concerned the multitude of symptoms that children with smoking parents are afflicted with: since the symptoms are so numerous and diversified, there cannot be one single factor that causes them [Document]. This is a frequently seen argument, used also by the chemical industry, for instance, when discussing symptoms appearing in connection with exposure to dioxins or vinyl chloride.

Dr. Rylander also said he was afraid that authoritites would take steps that might be popular but scientifically unfounded. "If, based upon an insufficient evaluation of scientific data in the literature, the advice to a mother with a child with repeated upper respiratory infections, is to stop smoking instead of the appropriate recommendation that the child should be fed a better diet, the public health effort will fail", he wrote [Document]. Dr. Rylander was going to send these comments to the EPA, but first he sent them to Philip Morris for approval, specifically pointing out that he wished all corrections to be sent to his private fax machine, not to the one at Gothenburg university [Document].

On August the 15th 1990, Dr. Rylander wrote something quite remarkable to Tom Osdene. He wondered if his colleague Linda Koo ought to write something to the EPA too: "From a political point of view I don't know whether this is good — does the case strengthen if she submits something as well?" [Document] He received an immediate response via fax from Robert Page, at the same department as Osdene: "Yes, our 'case' would most certainly be helped ..." [Document]

In June 1994 Philip Morris asked Dr. Rylander to carry out a confounder study in Sweden [Document]. He did, and the result was accounted for 1999 in an article in the European Journal of Public Health, titled "Dietary habits for non-smoking females living with smokers or non-smokers." The idea here is that women with smoking husbands have less healthy dietary habits and thus get sick from inadequate nutrition, not primarily from environmental smoke [Document]. Dr. Rylander did not disclose that this study was financed by the tobacco industry (through the organization Centre for Indoor Air Research) [Document], which was a violation of the journal's ethical rules, which say that all "relationships that might lead to a conflict of interest" must be stated in writing prior to publishing. There were quite a few who knew about Dr. Rylander's collaboration with the tobacco industry, so there were protests, which eventually made the editor distance himself from the publication of Rylander's article.

A similar article had been published in 1997 in Social Science and Medicine, and then Dr. Rylander's ties to the tobacco industry were taken notice of in the Lancet. Swedish daily Dagens Nyheter referred to the critique in the Lancet and asked for a comment from Peter Allebeck, who at that time was prefect of the Department of Environmental Medicine at Gothenburg university:

— I got a bit scared in 1997 when I saw that Ragnar Rylander received grants from the tobacco industry. That is not very nice, but all our scientists have the right to try out their hypotheses and it is difficult to censor what they do, he says (Dagens Nyheter, 4/8/2000). It might be a problem when research is being openly financed by some industry. But when such financing is done secretly, and the prefect does not find out until somebody has read formerly confidential documents, then more than one person's credibility is at stake. There is one document, from November 17th 1974, in which Dr. Rylander asks Tom Osdene at Philip Morris to transfer the funds to the universities in Geneva and Gothenburg through quarterly payments of 10.000 dollars to his personal bank account in New York [Document].

Professor Gösta Axelsson, who is today head of Environmental Medicine in Gothenburg, refers to the decision from April 2002, made by the department board, in which they state that no new research grants will be applied for or received from the tobacco industry. However, "means from the two research grants from PM (from 1999) shall be spent during the year 2002." Apparently, the university received tobacco money in 1999, although the prefect "got a bit scared" already in 1997.

Professor Axelsson also mentions "the concern among employees at the department that maybe the consultant assignments of the emeritus [professor Rylander] might harm the department's reputation." Therefore, the department board has recommended that "the consultancy may not be carried out within the Department of Environmental Medicine." Does this imply that it is perfectly alright to carry out services for the tobacco industry outside of the work at the department? Is not the cardinal question here too whether there are any ties to any party, which might have an interest in a particular outcome of the research in question?

The question of the harmful effects of tobacco is, of course, far from fully explored. Certainly, there are many factors involved — both aggravating and protecting ones. The difficulty of studying additive effects is a generic problem regarding the assessment of environmental hazards in today's complex world, where we are exposed to a multitude of substances. There are debaters who maintain that if one wants to focus on such relations, it is especially important to be financially independent, to avoid the suspicion that results might be requested by a certain party.

The study, which was accused of being fraudulent by the Swiss anti-tobaccco organizations, was published in the Archives of Environmental Health in 2000 and dealt with respiratory diseases in children, related to passive smoking and dietary habits. The study was started already in early spring 1991. In April, Dr. Rylander writes to Tom Osdene, hoping to be able to accomplish a preliminary analysis that summer, and "if the data looks good" he will try to raise money for a larger study [Document]. On August 31st, professor Rylander reports that the "project looks very promising as the first data suggest that diet factors may be of equal or even larger importance for children's respiratory disease than ETS." [Document]

On October 22nd, Don Hoel sends a few scientific articles to Dr. Rylander, who finds them interesting to the extent that "we are now reanalyzing data from Geneva and there are some extraordinary things coming out" — as he writes in a letter to Don Hoel on November 2nd [Document]. That day, he also writes to Tom Osdene: "The data from the child study now start to look extremely interesting. After corrections in the data base, there is now no correlation between ETS exposure and the frequency of upper respiratory infections." There is, however, Dr Rylander adds, "a very close relationship between consumption of eggs and cheese and milk products and respiratory disease." [Document] The crucial question here is this: Did Dr. Rylander change the basic data, or did he change only the way of analyzing them? The latter hardly constitutes fraud, but it may still be a way of biasing the result.

The message that there are no significant connections between lung disease and passive smoking was now frequently delivered at conferences and in reports. A long time passed, however, before the study was published — three possible journals are mentioned in the documents [Document][Document][Document], but it was obviously not published in any of those — maybe it was rejected. The study was finally published, but not until 2000.

The conclusions in the article are astonishing, according to Pascal Diethelm, one of the two who recently were found guilty of defamation. They go against the established scientific consensus on the subject, for instance what the WHO says about the effects of passive smoking in children, regarding bronchitis, coughing, asthma, etc. Pascal Diethelm also finds it remarkable that professor Rylander did not mention the most natural reference, the Swiss SCARPOL study, which covered 4,470 children, while the Rylander study was based on 304 children. The SCARPOL study concludes that there is a direct dose/risk relationship between environmental tobacco smoke exposure and respiratory illness in children.

Dr. Hubert Varonier, one of the scientists behind the SCARPOL study, was called as an expert witness to the defamation trial in Geneva in February 2002:

— One cannot modify the data base of a study while it is going on, without ruining the scientific credibility of the whole research, he said to the newspaper Le Courrier (2/20/2002), that is manipulation.

Pascal Diethelm believes that there are dubieties also regarding professor Rylander's relationship with Gothenburg university. A great deal of the correspondence with the American EPA was carried out on the stationary of the university, although the text written on it, had been edited and revised by Philip Morris. Dr. Rylander had made efforts to keep his contacts a secret, which is evident from, for instance, a document from June 1997, where he is hesitant to co-operate openly with the Philip Morris office in Neuchâtel: "I have never been involved with any Philip Morris executive in meetings or contacts with outside persons, to retain as far as possible the image as an independent scientist." [Document]

All these allegations finally led the rectorate at the university of Geneva to carry out an investigation about Dr. Rylander's activities, and they published a report in November 2001, in which they criticized him — in rather mild terms. The rectorate found that his work had not been based on an "irreproachable scientific rigour in all points" and the context in which he had chosen to research did not "seem innocent in all resepects." They did not, however, find that Dr. Rylander was guilty of scientific fraud [Document/PDF].

The Swiss press has produced heaps of articles about the Rylander affair. But the most material about it is to be found at the Web site Prévention, and the men behind it were, as said earlier, sued by Dr. Rylander. The striking thing about the verdict, however, is that it agrees with much of what the defendants have said, although it rejects one of the main issues, that of scientific fraud. It is quite unusual, but the winning plaintiff did not demand that the verdict be published, which is understandable, since it almost vilifies more than it vindicates.

The verdict says that Dr. Rylander's independence can be "seriously questioned by the documents that were produced." In the explanatory part it says: "Apparently, there are disturbing indications of a potential conflict of interest between the scientific research results accomplished by the plaintiff and the undisclosed financing of the research in question, from the tobacco industry." [Document]

Regarding the question of scientific fraud, the verdicts says: "Another [document] implies that the results of research carried out by him [the plaintiff] were changed, and still another [document] implies that the base established before the initiation of a research was modified so that the results would meet the expectations of the financier." This sounds quite grave, but it was obviously not enough for the court to regard it as fraud. Pascal Diethelm claims that they did prove that the scientific process was fraudulent — but the court demanded proof that the results were false or fraudulent:

— Rylander was too sophisticated to produce results that were blatantly false. Such results would have been of no interest to his sponsor, Diethelm says. He and Jean-Charles Rielle have already appealed, and they have good hope of being cleared. There were, for instance, witnesses who could not be heard at the recently held trial.

”I have never been a consultant for PM”

— Scientists in Sweden have always to a large extent been co-operating with the industry, Ragnar Rylander writes to me in an e-mail. During the last years, all of a sudden it has become a very bad thing to have connections with the tobacco industry, he says.

But the problem here is that the grants from Philip Morris were not openly accounted for. Furthermore, Dr. Rylander has not only accepted grants but he has been a key consultant with a great deal of influence.

— I have never been an actual consultant, have never signed any consultancy contract and have never taken part in product testing or questions of company policy, says Ragnar Rylander.

But in many of the formerly confidential documents in the Philip Morris database, professor Rylander refers to himself as a "consultant" [Document] [Document]. And contracts are mentioned in several documents.

— It is true that somebody in a correspondence with Philip Morris mentions me in connection with a contract, but this individual simply did not know about the state of affairs, professor Rylander says.

One of those who mentions a contract is, however, well-informed: Tom Osdene, Dr. Rylander's closest contact and personal friend at Philip Morris, writes to Dr Rylander in December of 1972: "I am enclosing a copy of the consultant agreement signed by Dr. Wakeham for your files." [Document]

Regarding INBIFO, the PM owned research institute in Cologne, Ragnar Rylander says that he has only been their "scientific advisor" and "helped them establish a research on toxicology." A document dated July 1972 says otherwise: "He would officially be carried on the books as a consultant ... His duties, however, would involve supervising our projects at INBIFO and he would also assist in planning and organizing this work." [Document]

— There has never been any talk about "projects on request" or control of the presentation of data, professor Rylander writes. But in this case, the article in the European Journal of Public Health may serve as an example. The study accounted for in that article was initiated on request from Philip Morris in 1994. [Document].

— There is, in fact, also a policy document from Philip Morris on the web, says professor Rylander, where they declare it to be a principal point in their policy to support scientifically correct studies of the hazards of smoking tobacco. For natural reasons this document is never quoted in the debate lead by the groups who have attacked me.

When Ragnar Rylander finally sends me the reference number, it turns out to be one of the most well-known and quoted documents of them all, Fred Panzer's letter from 1972, also mentioned here in the main article, where Panzer says that the industry's strategy has been "creating doubt" [Document]. It is also said in this document that they will now bring about a study, and "if the results are favorable", then a book will be produced, which will "only have to be seen — not read — to be believed." How can Ragnar Rylander possibly regard this as proof of a "policy to support scientifically correct studies"?

— What I was referring to is the first page, where it clearly says that one wishes to support objective research, Dr. Rylander says.

I read it once more. But there is no trace of such a thought on page 1. Ragnar Rylander says that he is beginning to feel like "an old fixture" at Philip Morris:

— If I hadn't been independent and objective, I would probably have been kicked out a long time ago.

Note: This is the original text of the article. Some passages were omitted in the printed version, due to lack of space. To see which passages that were discarded, click here. In this Web version direct links have been added to the quoted documents. The facsimile images shown here were not published in the paper version.

Correction: It has been pointed out to me that the plaintiff, Professor Rylander, actually did demand that there should be a court order for the verdict to be published in Swiss newspapers. The tribunal did not grant this, however. The tribunal stated that the expected writings in the press after the trial without any doubt would be sufficient to compensate the plaintiff for a possible moral disadvantage caused by the uttered allegations and through the proceedings.

 Professor Rylander has published a response to this article, available at the web site of Dagens Forskning (Swedish only).

 Read also my reply to Ragnar Rylander's objections, "Ragnar Rylander has willingly offered his services".

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