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Lancet 11 September 2004 - Volume 364, Number 9438 - World Report - Tobacco ties

EU health commissioner David Byrne has won praise for his vehement campaigns against smoking. But the appointment to an EU health advisory committee of a long-time consultant for tobacco giant Phillip Morris has drawn criticism from public health experts. Pelle Neroth reports.

EU health commissioner David Byrne must be embarrassed. He is known around Brussels for his antismoking views yet last week it was revealed that one of the science committees that gives him advice on health issues employs a man who was a consultant for tobacco giant Phillip Morris for 30 years.

Ragnar Rylander, a 68-year-old emeritus professor in environmental health from Gothenburg University, lost a libel case on appeal earlier this year in Geneva, which was brought about after two antitobacco activists alleged that he had engaged in "scientific cheating without precedent" in the area of tobacco research, while working as a professor at Geneva university.

The background to the libel action was that the two activists, Pascal Diethelm and Jean-Charles Rielle, had found out that, while working at Geneva University, Rylander had secretly received funds for research from the tobacco industry, which amounted to as much as US$85 000 dollars. They claimed this money was used to produce findings which were subsequently distorted to underplay the dangers of passive smoking.

In one of Rylander reports, published in 1997, the conclusion stated that "diet and lifestyles ought to be taken into consideration when considering the health effects of passive smoking". The study showed that non-smoking women who are married to smoking men ate less healthy food--a contributor to ill health--than other non-smoking women. Critics claim this work down plays the effects of passive smoking because it implies that the ill health of people exposed to second hand smoke at home may be a consequence of low socioeconomic status and associated behaviours, rather than smoke exposure itself.

Rylander also down played the risk of cancer caused by smoking in an interview for Swedish newspaper, Dagens Nyheter, published 6 months ago. Rylander pointed out that a "recent survey shows that the risk of not eating vegetables increases the risk of receiving cancer forty-fold" in order to put the well known 20-fold risk of lung cancer from active smoking into perspective.

In a letter published in 2001, in the European Journal of Public Health, before the court case, Rylander repeated his findings that cast doubt on the dangers of passive smoking.

Martin McKee, a London academic and former editor-in-chief of the journal, is not happy about Rylander's EU appointment, he told The Lancet. He has since denounced Rylander's contribution in his journal. "When he submitted the paper he denied any conflict of interest. When we became suspicious we asked him explicitly if he had been a consultant for the tobacco industry and he denied it. His paper examined the effects of passive smoking with reference to Swiss and Swedish subjects. His findings were inconsistent but he argued that they challenged the now overwhelming evidence that passive smoking is dangerous. It is now clear that the paper had the characteristics of the 'confounder' studies established by the tobacco industry to undermine this evidence. I am sure that the European Commission will be asking some tough questions: unless they are well acquainted with people's backgrounds, it is difficult for them. But we need to know if he was asked about conflicts of interest when he applied to join the committee and what he said".

The commission's anti-smoking efforts have--publicly, anyway--been highly vigorous in recent times, due to Byrne's strongly stated antipathy to the smoking industry.

Although much lambasted for its decades of subsidising tobacco farmers in mediterranean countries, the EU plans to phase out these sums by 2010. The commission recently funded a European antismoking campaign worth €75 million (US$90·5 million), with television adverts, a no-smoking bus tour across the continent, and international no-smoking days. A few years ago, the commission pushed through a directive requiring the large labels to be added to cigarette packet drawing attention to health warnings.

When the commission was informed of Rylander's appointment following lobbying from Brussels health NGOs, its health spokesman told The Lancet that "we will be re-examining his appointment and will let you know in due course. He will not be attending the committee's first meeting."

Last year, in interviews with Swedish newspapers after losing the appeal of the libel case, Rylander defended himself by saying that most of his consultancy fees were spent on trips between Sweden and Geneva, on an assistant, and on a laboratory. His hourly fee was no more than 1500 Swedish kronor, he said--a little under $200. He added that he had no regrets working for Phillip Morris, that he still worked--6 months ago--as a consultant for them and that he still considers his data to be good.

The whole affair that culminated in the Swiss libel case began in March 2001, at a press conference in Geneva. Diethelm and Rielle, from the two public health organisations CIPRET-Geneve and Oxy-Geneve, revealed Rylander's close collaboration with Phillip Morris over a 30-year period. The duo accused him of falsifying his scientific findings and of deceiving the University of Geneva by keeping secret the names of the companies financing him. They said he was guilty of scientific deception and that he had been the "highest-paid consultant in the company [Phillip Morris]".

Rylander told the Swedish press recently that, after these allegations, he had had enough. "I sued them for libel", he said. "I felt personally persecuted," he added, blaming his situation on the public's changed opinion of the tobacco industry. "I was being punished for playing with the 'wrong' guys. A lot of medical research is funded by the drugs companies. No one says anything about that. But it is another matter if the research is funded by, say, Nestle or Shell . . . My scientific research was good and we, not the company, came up with research suggestions."

Rylander sued the activists, and won the initial libel case. In 2002, however, his Phillip Morris link became public and Geneva University, though not Gothenburg, severed its connections with him. Then, in April this year, an appeal court in Geneva exonerated the activists' allegations, saying that the expression "deceit without equal", which they had used to describe Rylander's activities, was not exaggerated and that he had indeed said a very small part of the truth.

The judgement concluded that several symposia given by Rylander have aspired to question and down play the dangers of passive smoking. It stated: "Geneva has been the platform for scientific cheating without equal. Ragnar Rylander, as deputy professor at the university, exploited its influence and reputation and not hesitated to abuse science in the interests of capitalistic profit." The judgement also mentions how, at a meeting of the American Thoracic Society in 1992, Rylander insisted that there was no link between passive smoking and respiratory diseases. The judgment said: "Ragnar Rylander has said very little of the truth. And among others things he has been quiet about the fact that his articles were being sent to Phillip Morris before they were published."

The revelations about Rylander's past, whatever the EU decides about his continued membership of the committee, is sure to prove an embarrassment to David Byrne, who welcomed Rylander's appointment to his health advisory committee with the comment: "I am very pleased with the high level of scientific excellence and independence of the newly appointed members . . . We need world class scientists and world class advice if we are going to get it right."

But Goran Boethius, the chairman of the Swedish doctors against tobacco group, said: "The tobacco industry works in a very clever way to get scientists and doctors to tell people things that support their interests and it has mostly been on the question of downgrading passive smoking."

In April this year, Phillip Morris was fined an unprecedented €1 billion for collusion in smuggling across Europe's open borders. To the suspicious, to permit the company to have one of its consultants on the EU's health committee at a time when the extension of Ireland's smoking ban across Europe is up for discussion, might be a fair reward for the largest ever addition to the EU's coffers.

Pelle Neroth