Journal of the Australasian College of Nutritional & Environmental Medicine - April 2006 - 1
®
Conflict of Interest & Bias in Health
Advisory Committees: A case study of the WHO’s
Electromagnetic Field (EMF) Task Group
Don Maisch
EMFacts Information Service
Introduction
The potential problem of conflicts-of-interest biasing outcomes in papers submittedto bio-medical journals, including paperspublished in journals by expert advisory bodies,was an issue addressed by the InternationalCommittee of Medical Journal Editors inNovember 2003. To quote from their “ÜniformRequirements”:
“Conflict of interest exists when an author(or the author’s institution), reviewer, or editorhas financial or personal relationships thatinappropriately influence (bias) his or heractions. . . The potential for conflict of interestcan exist whether or not an individual believesthat the relationship affects his or her scientificjudgement. Financial relationships . . . are themost easily identifiable conflicts of interest andthe most likely to undermine the credibility ofthe journal, the authors, and of science itself.”1This paper briefly examines this problem,using recent actions taken by the World HealthOrganisation’s (WHO) International EMFProject and the International Commission onNon-Ionizing Radiation Protection (ICNIRP). In both organisations the case is presentedthat maintaining independence from industryvested interests is essential for maintainingscientific objectivity and credibility in givingexpert advice on public health matters.At the May 2001 Australian Senate Inquiryinto Electromagnetic Radiation,MichaelRepacholi, head of the WHO’s InternationalEMF Project, informed the Senate Committeethat the WHO had a firm policy against industryinvolvement in its processes. To quote:“The World Health Organization does notallow industry to participate in either standardsetting or in health risk assessment. The WHOtakes the view that there cannot be industryrepresentation on standard setting workinggroups. There cannot be someone on theworking group who is having an influence onhealth effects for an industry when they derivebenefit from that industry.”2ICNIRP clearly states on its website that allcommission members are independent expertsin their respective scientific disciplines and donot represent either their countries or institutesand specifically they cannot be employed byindustry. In order to maintain this independencefrom industry or other vested interests it isstated:“Members are reminded frequently of theneed to declare any interests detrimental toICNIRP’s status as an independent advisorybody. . . ICNIRP also does not accept fundingfrom industry.”3These requirements were established so thatICNIRP’s credibility of its advice andguidelines cannot be said to be influenced orbiased by industry vested interests. Dr KenJoyner, from Motorola, stressed theindependence of ICNIRP from industry at theAustralian Senate Inquiry into ElectromagneticRadiation in May 2001. Joyner stated:“If you want to look at one standards bodythat has specifically excluded any industryrepresentatives, there is the ICNIRP body. Youcannot be a member of the ICNIRP if you arepart of industry. They exclude you from thatprocess.”4The ICNIRP website also explains that thescientific reviews carried out by ICNIRPmembers are combined with risk assessmentsdone by WHO International EMF Projectworking groups with the resultant being thepublication of ICNIRP’s EMF exposureguidelines. Therefore the claim that ICNIRP’sscientific advice is value-free from industryinfluence must also include the samerequirement for any WHO risk assessmenttask group. That was what Repacholi stated tothe Australian Senate Committee in May 2001(as previously quoted).“There cannot be someone on the workinggroup who is having an influence on healtheffects for an industry when they derive benefitfrom that industry.”The close working relationship betweenICNIRP and the WHO’s EMF Task Groupevaluating power frequency research is seen inthe makeup of the membership of the TaskGroup. Out of the 20 members from 17countries 5, we have Paolo Vecchia, the currentICNIRP Chairman, Anders Ahlbon, LarryAnderson, Rudiger Matthes as members ofICNIRP’s main commission, with Ahlbon alsoon ICNIRP’s Standing Committee onEpidemiology. Other ICNIRP StandingCommittee members include ChristofferJohansen, Jukka Juutilainen, AlasdairMcKinlay and Zhengping Xu. Eric van Rongenis a consulting expert for ICNIRP. In addition,Michael Repacholi, head of the WHO’sJ. Aust. Coll. Nutr. & Env. Med. Vol. 25 No. 1 (April 2006) pages 15-17
... a number ofindependent researcherswere involved in thepreparation and reviewof the draft, but it was“highly unusual, if notunprecedented, for aWHO health documentto be reviewed by somany with such strong
ties to the affectedindustry”13
2 - Journal of the Australasian College of Nutritional & Environmental Medicine - April 2006
International EMF Project, is also ChairmanEmeritis of ICNIRP.6Including Repacholi, half of the officialmembers of the WHO task group are alsomembers of ICNIRP, so it is obvious that thereare no secrets between ICNIRP and the TaskGroup.
Industry influence endemic inthe decision making process
As reported by the New York basedpublication, Microwave News, onOctober 1, 2005, the 20 member WHOTask Group writing a new EnvironmentalHealth Criteria (EHC) document onpower frequency EMFs included, at therequest of Repacholi, repre-sentativesfrom the electrical utilities, ororganisations with close ties with theindustry.Their task was to both assistin writing the initial draft and review thecompleted draft.7 This is in clear conflictwith what Repacholi stated in histestimony in the May 2001 AustralianSenate Inquiry hearings. To quote again:“There cannot be someone on theworking group who is having an influenceon health effects for an industry whenthey derive benefit from that industry.”One of the central authors of the draft, andmember of the EHC Task Group, LeekaKheifets, was a former WHO assistant toMichael Repacholi. She disclosed in Sept. 2005in a letter (declaring any potential conflicts ofinterest) to the British Medical Journal thatshe “works with the Electric Power ResearchInstitute… and consults with utilities.”8 Otherpower industry representatives who assistedKheifets in preparing the draft were GaborMezei, from the EPRI, Jack Sahl from SouthernCalifornia Edison (USA), and Jack Swansonfrom the National Grid (UK). When Repacholisent a draft of the EHC out for review in earlyJuly 2005, the reviewers included re-presentatives from the power industry bodies:The Federation of Electric Power Companiesof Japan, Pacificorp (USA), Hydro-Quebec(Canada), the Utility Health Sciences Group(USA) and Exponent Inc (USA).9 The questionof liability must have also been on the agenda,as Exponent has described its business activitiesas follows:“Exponent serves clients in automotive,aviation, chemical, construction, energy,government, health, insurance, manufacturing,technology and other sectors of the economy.Many of our engagements are initiated bylawyers or insurance companies, whose clientsanticipate, or are engaged in, litigation over analleged failure of their products, equipment orservices.”10
In addition to WHO staff, the only otherobservers that Repacholi invited to the WHOTask Group meeting in Geneva on 3 Octoberto recommend exposure limits, were eightrepresentatives from the power industry. Members of the press were barred fromattending.11 In addition the meeting was notpublicised on either the WHO web site meetingslist or the Bioelectromagnetics SocietyNewsletter’s conference calendar and very fewmembers of the EMF scientific community,including important EMF epidemiologists,were even aware of the meeting.12Only industryrepresentatives received invitations. Why werethe epidemiologists who were directly involvedin the research that the WHO’s risk assessmenttask group would evaluate, not also invited asobservers and reviewers?The Microwave News article points out thata number of independent researchers wereinvolved in the preparation and review of thedraft, but it was “highly unusual, if notunprecedented, for a WHO health document tobe reviewed by so many with such strong tiesto the affected industry,”13One example of an industry reviewer’sviewpoint, seeking to downplay potential healthhazards, is seen in the comments from MichelPlante, representing Hydro-Quebec:“The whole section on cancer seems morelike a desperate attempt to maintain somepositive statistical association fromepidemiological studies alive than a factualand honest presentation of arguments both forand against carcinogenicity.”14Plante’s role as a protector of his employer’sinterests in denying a cancer link with EMFswas amply demonstrated in his involvement,as a Hydro-Quebec representative, insuppressing potentially damaging cancer datain a 1994 Hydro-Quebec funded epi-demiological study by Dr Gilles Theriault et al.from McGill University. The initial analysisof the data collected from three electric utilitiesfound that workers who had the greatestexposures to magnetic fields had twelve timesthe expected rate of astrocytomas, a type ofbrain tumour, based on a small number of cases.15In a later re-analysis of the data, this timelooking at high frequency transients (HFT),the McGill University team found up to a 10-fold increased risk of developing lung canceramongst highly exposed utility workers, witha “very clear” exposure-response relationship.17When Gilles Theriault’s McGill team wantedto further analyse the HFT data for otherassociations, Hydro-Quebec, which funded the$3 million study, and therefore owned thecollected data, refused further access to thedata. Plante said at the time that “we have acontract problem that has to be resolved andthere will be no new mandate until it is solved”.Plante argued that by Theriault publishing thefindings on HFT he had violated the contractwith the utilities. Many senior EMF researchersand epidemiologists saw the HFT data ashaving important implications andneeding further analysis by otherresearchers.18 As of October 2005 theHydro-Quebec HFT data hascontinued to be suppressed from anyfurther analysis by the scientificcommunity – and Plante, as Hydro-Quebec’s man at the centre of thatsuppression, has now been asked byRepacholi to review the WHO’sEnvironmental Health Criteria riskassessment.It is not known if Plante was askedat the meetings about the “positivestatistical association” seen in theHydro-Quebec HFT data, but he couldhave replied that it is not importantbecause it has not yet been replicated!The Utility Health Sciences Group, anotherpower industry group that Repacholi asked toreview the EHC draft document, plainlyindicated that they considered increased coststo industry should take precedence over healthconsiderations when they proposed a changein the chapter on protective measures thatstated:“It should also be pointed out that redirectingfacilities or redesigning electrical systems maybe so expensive as to be inconsistent with thelow-cost and no-cost steps typically viewed asprudent avoidance.”19The UHSG also proposed a statement beincluded in the summary:“It would be useful for the summary toinclude a clear statement that the scientificresearch does not establish ELF EMF as acause or contributing factor in any disease oradverse health effect, including cancer.”20
The Myth of not acceptingfunding from industry
It is stated on the ICNIRP web site that inorder to protect its status as an independentadvisory body, “ ICNIRP also does not acceptfunding from industry”.21 When it comes to theWHO’s International EMF Project, however,no such restrictions apply. As Repacholi hasstated, the: “[EMF]Project can receive funding fromany source through Royal Adelaide Hospital;an agency established through WHO LegalDepartment agreement to collect funds for theproject.”22© 2004 Daan SpijerJournal of the Australasian College of Nutritional & Environmental Medicine - April 2006 - 3Questions of a conflict-of-interest and evenmoney laundering could be raised at this pointwhen it was revealed by Microwave News thatRepacholi, as head of the EMF Project, receives$150,000 annually from the cellphoneindustry.23 However, Repacholi couldrightfully still claim that he does not receiveany direct funding from industry sources sinceit is funneled through the Royal AdelaideHospital. This arrangement may be in violationof a current WHO rule against employees andconsultants accepting any “gift orremumeration” from external sources“incompatible” with their duties to WHO. 24A Claytons oversight committee?According to a fact sheet,NewElectromagnetic Fields Exposure Guidelines,published by the European Commission inDecember 2005, an “International AdvisoryCommittee” (IAC) has been set up to provideoversight to the WHO’s International EMFProject. This committee consists ofrepresentatives of international organisations,independent scientific institutions and nationalgovernments who are supporting the Project.25In this case IAC oversight should essentiallyoperate much the same as a judicial oversightcommittee where a judicial branch of thegovernment watches or monitors what is goingon or happening in a case or matter. In thejudicial arena it is a form of checks and balancesthat operates to keep law officers from abusingtheir powers.26 In the case of the WHO’s EMFProject IAC oversight should operate toprevent WHO officials from abusing theirpowers - and this should include preventingthe possibility of bias through conflict-of-interest. It would also be important for theIAC to maintain an arms-length distance fromthe project activities that it is supposed tomonitor.The question then needs to be asked of theIAC: Why have they failed to intervene in thecase of blatant industry influence on the WHO’sEMF Task Group?
Forgotten Lessons: Big Tobacco andProtecting the Integrity of WHODecision Making
In July 2000 the WHO Committee of Expertson Tobacco Industry Documents released a260-page report documenting the tactics usedby the tobacco industry’s strategies toundermine the work of the WHO.27 At thesame time the WHO issued a 15-page responsedocument listing a detailed response to ensurethat the WHO was never undermined again.Just a few of the 58 are worth quoting:6.WHO should urge other UN organisationsto investigate possible tobacco companyinfluences on their decisions and programs,and to report their findings publically. 7.WHO should advocate implementation andconsistent enforcement of effective conflictof interest and ethics policies throughoutUN agencies.8.WHO should urge Member States toconduct their own investigations of possibletobacco company influence on nationaldecisions and policies, and to publish reportson their findings.11.Appoint an ombudsman or otherindependent offices, outside the standardlines of reporting authority, with autonomyand clear authority for enforcing ethicalrules.12. Disseminate conflict of interest rules morebroadly.14. Introduce a formal process for vettingprospective employees, consultants,advisers, and committee members, toidentify conflicts of interest..19. Prohibit employees, consultants, advisers,and committee members from holding anysubstantial financial affiliation with thetobacco industry, including any employeeorconsulting relationship. . .20. Disqualify any professional services fromperforming work on behalf of WHO if thefirm also provides a tobacco company withservices likely to be adverse to the interestof public health. . .
21. Prohibit employees, consultants, advisersand committee members from accepting anyitem of value from a Tobacco company orits affiliates. . . 35. WHO and IARC should take steps to educatetheir scientific investigators andcollaborators about tobacco company effortsto undermine research and the need forspecial vigilance in protecting the integrityof tobacco-related research.28”Although the above sample of WHOrecommendations were in response to BigTobacco’s attempts to undermine WHOintegrity, its direct relevance to other largeindustrial interests cannot be ignored, be it thepower industry or telecommunications.Unfortunately it seems that in this case atleast, WHO has forgotten the hard lessonslearnt with its previous experiences with BigTobacco. In the case of WHO’s Task Groupwriting the new Environmental Health Criteria(EHC) for power frequency EMFs, a violationof the above recommendations urgently callsfor an independent evaluation to protect bothpublic health and WHO’s integrity.
In Conclusion
It is acknowledged that in an everincreasingly globalized world the reliance oninternational organisations to set standards toprotect public health is an irrefutable fact ofmodern life. It is also a fact that internationalorganizations charged with this task need to be“eternally vigilant” to ensure that theirorganisations are not co-opted by vestedinterests groups – as exampled by Big Tobaccoand WHO.However when it comes to non-ionizingradiation issues (in this case for powerfrequency health risk assessment) the evidenceis clear that Michael Repacholi has used hisstanding in both WHO and ICNIRP to stackthe WHO’s Environmental Health CriteriaTask Group for power frequency exposureswith representatives of the power industry incontravention of WHO policy. This can onlybe to the detriment of the group’s ability toevaluate the scientific literature in an unbiasedway. This action can only be construed asbeing aimed at ensuring that industryinvolvement in determining the WHOEnvironmental Health Criteria will biasICNIRP’s risk assessment for power frequencyexposure limits for years to come. This willconveniently provide economic protection forthe industry against the need to spendenormous sums of money on upgradingdistribution systems as well as risks oflitigation. Such a blatant disregard for thefundamental principles of credible science, aswell as WHO’s mission on protecting worldhealth, speaks of a desperation to buryindependent science at all costs, even if thatcost is the integrity of WHO.The Author is not affiliated with any companysupplying telecommunications services.
Such a blatantdisregard for thefundamentalprinciples of crediblescience as well as WHO’smission on protectingworld health speaks of a
desperation to buryindependent science atall costs, even if that costis the integrity of WHO.
4 - Journal of the Australasian College of Nutritional & Environmental Medicine - April 2006
J. Aust. Coll. Nutr. & Env. Med. Vol. 25 No. 1 (April 2006) page 18
References
1. Uniform Requirements for ManuscriptsSubmitted to Biomedical Journals: Writingand Editing for Biomedical Publication,
International Committee of Medical JournalEditors, page 8, November 2003
2.Inquiry into Electromagnetic Radiation,Report of the Senate Environment,Communications, Information Technology
and the Arts References Committee, Section
4.115, page 151, May 2001
3. AccessedAugust 22, 2005.
4. Inquiry into Electromagnetic Radiation, (asabove), Section 4.68, page 137, May 2001
5.As listed in Microwave News, “WHOWelcomes Electric Utility Industry To KeyEMF Meeting, Bars the Press”, Sept. 22,
2005 hefi el d. ht ml #part nersAccessed October 10, 2005.
6. As listed on the ICNIRP website: Accessed October 12, 2005.
7. Microwave News, “From the Field, WHO andElectric Utilities: A Partnership onEMFs”, October 1, 2005. hefi el d. ht ml #part nersAccessed October 10, 2005.
8. “Letters, Childhood cancer and power lines”,British Medical Journal, Vol. 331,pp. 634-638, September 17, 2005.
9. Microwave News, “WHO and ElectricUtilities” (as above).
10. Bohme SR, et al. “Maximizing Profit andEndangering Health: Corporate Strategies toAviod Litigation and Regulation”, Int J OccupEnviron Health, Vol. 11, No. 4,pp.338-348, Oct/Dec 2005.
11. Microwave News, “WHO Welcomes ElectricUtility Industry To Key EMF Meeting, Barsthe Press”, Sept. 22, 2005
hefi el d. ht ml #part nersAccessed October 10, 2005.
12.ibid.
13. ibid.
14. ibid.
15.Theriault G, et al. “Cancer Risks Associatedwith Occupational Exposure to MagneticFields Among Electric Utility WorkersinOntario and Quebec, Canada, and France:1970-1989”, American Journal ofEpidemiology, Vol. 139, pp. 550-572, 1994.