By Dick Clapp 

Opponents in the debate over conflict of interest in cancer research are duking it out, and the current forum for their fight is the American Journal of Industrial Medicine. The article that touched off this particular scuffle was “Secret Ties to Industry and Conflicting Interests in Cancer Research,” by Hardell L, et al. (Am J Ind Med 2007;50:227-233), which details a number of examples of researchers working for industries and not disclosing their ties.  The most widely publicized revelations (see this Guardian story) were about Sir Richard Doll, one of the icons of 20th century epidemiology, and his consulting arrangement with Monsanto, Turner and Newall (a British asbestos manufacturer), the Chemical Manufacturers Association, ICI (a British producer of vinyl chloride), Dow Chemicals and others.  Other sections of the Hardell, et al. paper discuss testimony and articles by Dimitrios Trichopoulos, Hans-Olov Adami, Dennis Paustenbach and Jack Mandel regarding dioxin, Joseph McLaughlin and John Boice regarding cell phones and other examples of apparently undisclosed conflicts of interest.

The original article is well worth a read, but the letters in response – published in AJIM’s March 2007 issue—are just as revealing in their own way.

The letters in response to the Hardell paper are by McLaughlin, Boice and their colleagues at the International Epidemiology Institute; by Trichopoulos, Adami and Stampfer at Harvard School of Public Health; and by Wakeford at the Dalton Nuclear Institute in the UK.  In addition, the journal published an apology to Dr. Hardell and the readers for having omitted publishing Dr. Hardell’s own conflict of interest statement, which he had submitted to the journal twice, in which he states that he was an expert in Newman v. Motorola in 2002 (a cell phone lawsuit). He also has been given the opportunity to rebut the letters, but the letter authors will rebut his rebuttal and get the final word in an upcoming issue of the journal. 

McLaughlin and his IEI colleagues criticize Hardell and his scientific work on cell phones and claim that Hardell “did not disclose a potential conflict of interest,” referring to the Motorola litigation. Apparently, the letter writers were unaware that Hardell had submitted a conflict of interest statement which explicitly mentioned serving as an expert in the Motorola case. They go on to say that in light of this, “claims by Hardell, et al. that IEI researchers should declare nonexistent conflicts of interest appear particularly disingenuous.” (AJIM March 2007, p. 235)   They conclude by saying they are proud to be included in the company of the late Sir Richard Doll and the others who were “criticized by Hardell and associates.”

Trichopoulos and Adami say they have contributed to three peer-reviewed publications in which “support by the industry is acknowledged explicitly.” They complain that Hardell, et al. quote from a report commissioned by Exponent for submission to the EPA and summary presentations to a conference based on this report.  What they don’t say is that the Chlorine Chemistry Council actually paid Exponent to do the review and the conference in Korea in 2001 coincided with a lawsuit brought by Korean veterans exposed to Agent Orange against the manufacturers of the dioxin-contaminated herbicides.  (See a previous post on this topic here.) The presentation was intended to sway scientific opinion and, presumably, influence the trial.  Trichopoulos and Adami re-assert that dioxin is not carcinogenic and that labeling them as such “does not serve society.”  They claim that when a compound is labeled as a carcinogen without adequate evidence in humans, “scientific attention is shifted away from the true culprit(s) and preventive actions are misdirected.”  They also say compounds like dioxin are “regulated anyway on account of their toxicities.”  Say what?  If they are already regulated, and should be regulated because of their toxicities, why spend so much time on saying they are not carcinogenic when IARC, the U.S. EPA, the National Toxicology Program, and others all say they are?  There’s something missing in the Trichopoulos and Adami logic here, and there are clearly some interests willing to pay lots of money to Exponent to get them to go all the way to Korea to speak about it.

Stampfer calls the Hardell, et al. piece a “smear campaign,” and Wakeford (a co-author with Doll on radiation topics) tries to turn the table and say that “scientists linked to pressure groups” are not free from influences upon their work.  This strikes me as the kettle calling the pot black, given the affiliation of the author with a nuclear institute.

We will re-visit this when the next letters appear, but my own view is that Dr. Hardell has done the scientific community a service by exposing some important conflicts of interest even among some icons of the past fifty years.  As a famous judge once put it, sunlight is the best disinfectant.

Dick Clapp is Professor in the Department of Environmental Health at Boston University School of Public Health, and co-Chair of Greater Boston Physicians for Social Responsibility. He has a long-standing interest in the health effects of dioxin and has done research on Vietnam veterans, testified about dioxin before two Committees of Congress, and served as a plaintiffs’ expert witness in three jury trials involving dioxin.