Monday, 16 December 2013

Day 195: Dr. James Hogg and Medical Mendicants

It was a mind-numbing minus 20 degrees outside the courtroom at the Montreal's Palais de Justice where Justice Riordan sat in front of a small crowd of lawyers and a camera.

Thirty-seven hundred kilometers away, 3 hours earlier and in a city 30 degrees warmer, Dr. James Hogg also sat in front of a camera as he became the 64th witness at the Montreal tobacco trials.

Dr. James Hogg
Like many of the witnesses who preceded him, Dr. Hogg, at 78 years of age, is well past the usual retirement age. But this man shows no sign of having stepped beyond a lifetime's work looking for - if not finding - the missing link between the damage that is caused to the lining of the airways to the lung and the lung disease that is caused by smoking.

Unless the video conference feed is particularly flattering, Dr. Hogg is an extremely vibrant and youthful septuagarian. So it was not physical frailty that prevented this witness from testifying in person, instead of by video-conference.

It was a different kind of vulnerability that made him refuse to come to Montreal - or even to testify anywhere until he was forced to do so by an order of the British Columbia court system. (Apparently there is not the same type of a reciprocal arrangement between British Columbia and Quebec for subpoenas, as there is between Quebec and some other provinces).

The reason given for Dr. Hogg's insistence on the mountain coming to him was, as explained by Imperial Tobacco counsel Craig Lockwood that "he receives funding from a body that says that if anybody assists or testifies on behalf of a tobacco company, they can lose their funding. And so he is not in a position to put either his endorsement or,  more importantly, his PhD students at risk, so he is not willing to."  (These provisions of the American Thoracic Society are Exhibit 20255).

(No such reason would have prevented him from testifying against tobacco companies, which he nonetheless refused to do even after being asked by the State of Vermont in 2007.)

The piper and his tune

His qualms about the way that his current funder would perceive his actions - and the hoops he was prepared to go in order to protect financing  - was thus our first introduction to this man.

This was more than a tad ironic introduction, given that the apparent aim of the defendants' counsel in asking him to testify was to demonstrate that when he received money from the tobacco industry, there were no conditions or pressure being put on the recipients.

It was Imperial Tobacco's lawyer, Ms. Nancy Roberts, who was in Vancouver and who was given the task of highlighting the illustrious career of Dr. Hogg, the high opinion he had of other CTMC grantees, the value of his research to medicine, and the complete independence his tobacco industry patrons gave him in reporting his findings.

(It was while watching Ms. Roberts long distance that I received a note from a reader of last Thursday's blog who was quite confident that the signature and address of the woman who had written the Minister of Health in 1985 to implore him to introduce bans on tobacco advertising was indeed the same Ms. Nancy Roberts who is now representing Imperial Tobacco.  I found myself liking Ms. Roberts a little more, knowing that at least at one point in her life she seems to have understood that "If the tobacco companies show they have no conscience then the government must set an example.")

Fifty years of accomplishments

Graduating in Medicine in 1962, Dr. Hogg has had a medical career that is older than many of the lawyers working on this file!

The story of his early career that he told the court yesterday is glowingly captured in a film produced to accompany his induction to the Canadian Medical Hall of Fame. But induction to this pantheon is only one of many accolades this man has received.

Even the UBC lab he set up had been named after him. And yet! True to the theme of today's testimony about the relationship between funder and fundee, Dr. Hogg reported that the UBC James Hogg Research Centre had recently been renamed, and  "switched to the Centre for Heart and Lung Innovation recently in the hope that they are going to get a donor."

Fifteen years of medical research grants

It was the receipt by Dr. James Hogg of research grants from the CTMC that was the focus of most of Ms. Roberts questions. A summary of the grants made by the CTMC from 1968 to 1986 (when it stopped providing these grants) was conveniently provided in Exhibit 21045. The table at the end of this post presents the grantees, together with an inflation-adjusted statement of their awards.

Dr. Hogg was one of the major recipients. Of the $4.8 million in CTMC grants awarded between 1971 and 1986, Dr. Hogg's share was $1.2 million, or around 25%. The largest amount of money went to the McGill University research laboratory where Dr. Hogg was based until he moved to the University of British Columbia in 1977. In addition to the money it received when Dr. Hogg was based in Montreal, the Meakins-Christie Laboratory and its other associated researchers received $2 million in grants between 1968 and 1986. 

They were a worthy lot!  From Dr. Hogg's testimony, it would appear that the CTMC allocated its money only to "outstanding researchers."  Dr. Thurlbeck was "a great scientist"  Dr. Munro was "an outstanding clinician." Dr. Modovy - "an outstanding teacher." Malcolm King - "an excellent researcher." (The same Dr. King, it would appear, as is the scientific director of the CIHR Institute on Aboriginal People's Health - Exhibit 21048.)

The trial has already heard of some of the more controversial recipients of CTMC funds  -- Hans Selye, Verner Knott and Theodore Sterling -- but Dr. Hogg seemed to have no views on the qualities of these men.

Asking Paul to pay Peter

Lawyer Pierre Boivin represented the plaintiffs during Dr. Hogg's testimony, and he drew attention to one reason that McGill may have been favoured by the CTMC and its largest donor company, Imperial Tobacco. The head of the facility, Dr. Macklem, was a "lifelong friend" of the brother of the man who ran Imperial Tobacco.

In a memoir of the Meakins Christie Laboratories, Peter Macklem recalls that " Almost as soon as I was appointed, Peter Paré, my lifelong friend and professional colleague, told me that his brother, Paul Paré, then a vice president of Imperial Tobacco, was going to be made president. He suggested that we
approach Paul to support respiratory research at the RVH. [Royal Victoria Hospital] Our pitch was that the tobacco industry was causing lung/disease and that since it was incapable of undertaking research into the diseases it was causing, it should support the research of scientists who could investigate how smoking led to disease. Paul, a man of great integrity, agreed. This led to negotiations with the Canadian Tobacco Manufacturer’s Council, the consortium of Canadian tobacco companies. They agreed to donate $300,000 to McGill to build new laboratories for respiratory research and to provide overhead costs for the first 10 years of operation." (Exhibit 1663)

Family ties

Dr. Peter Paré, pere, was a colleague of Dr. Hogg's at the Meakens-Christie institute, and Dr. Peter Paré, fils, followed today's witness to Vancouver to continue research in the same area.

But the Paré clan were not the only reference today to close relationships between prominent families in tobacco and medicine.

Early in his research career, Dr. Hogg had accepted the invitation to tour BAT's research facilities in the United Kingdom. There he met the head of BAT's research department, the chemist Geoffrey Felton. "We became friends," Dr. Hogg said. "His daughter was a medical student who did an elective in Canada. She spent a Christmas with us. I still exchange Christmas cards with her."

What gets published.... and what does not

Ms. Roberts drew attention to Dr. Hogg's success as a published researcher, and the fact that much of his work had been accepted by prestigious journals with "high impact factors." (Exhibits 20191; 20192; 20193; 20195; 20196; 20197; 20198; 20199; 20200; 20203).

PubMed shows more than 350 peer-reviewed articles on lung issues authored or co-authored by Dr. Hogg. If the CTMC is acknowledged as a funder on any of these papers, it is not picked up by the PubMed search engine.

It seemed important to Ms. Roberts to have Dr. Hogg say on the record that the CTMC had never attempted to have him alter his findings, or ever prevented him from publishing his findings. "No," said Dr. Hogg to such questions. And a firm "no" again when she asked whether any grants he received came "with strings attached."

She asked him to dispel any impression that might have been left after testimony last spring from Dr. Bilimoria, that there were associations with industry which were not disclosed, or authorship that was not made public. Dr. Hogg comfortably said that such omissions were not uncommon or out of place.

Dr. Hogg explained that it was the "coinciding" of Mr. Bilimoria's focus on enzymes and Dr. Hogg's focus on morphology that had brought these two men to work more closely together. And ti was the availability of equipment for animal experimentation at McGill that was the trigger for Dr. Bilimoria's relocation to the University setting.

The relationship between employee scientist Bilimoria and grantee scientist Hogg was a "normal, scientific exchange" and "a good atmosphere for research" said Dr. Hogg. There was no attempt of either man to influence the work of the other.

Susceptibility and causality 

Dr. Hogg stated clearly and emphatically that smoking causes lung cancer and lung disease, but he was more nuanced in his description of the degree or nature of harm that it causes than I have heard other physicians describe it.

After decades of research, he continues to explore why it is that "some people who decline rapidly have smoked no more than other people who have smoked whose function remains nearly normal."

He said that there is a picture that is often shown that depicts "someone celebrating their 100 anniversary smoking a cigarette." (I have not seen this picture - have you?). He noted that "some people can smoke heavily and their lungs don't deteriorate very much."  He described as a "minority" those who are susceptible to lung disease.

"Everybody should stop smoking, but those people [who are susceptible] in particular have to stop. Also they are the people that you need to treat early if you are going to have any chance to prevent the decline."  He did not mention how such a distinction would serve those who were not susceptible to COPD, but were vulnerable to pancreatic cancer, heart disease or other consequences of smoking.

Ms. Roberts asked whether the focus on genetic factors is a deflect - a way to create controversy over whether or not smoking caused disease. Dr. Hogg disagrees with that view because "it just closes down a whole area of research that is actually being quite productive at the moment."

Commissioned research for RJ-Reynolds

Although the CTMC ceased funding Dr. Hogg after 1986, he said today that he continued to receiving funding from the RJ-Reynolds company until the mid 1990s.

Mr. Kevin Laroche represents the company that has succeeded RJR in Canada. He was the second and last industry lawyer to ask questions of this witness, and he invited Dr. Hogg to agree with him that these subsequent funds were designed to allow his research to continue. Again, Dr. Hogg agreed. The suggestion was left that this research undertaking for the one American company was no different than the research supported by CTMC grants, which Dr. Hogg had described as a "competitive" and "investigator-initiated" grant process.  (Exhibit 40415, 40416, 40417).

The paper that was written as a result of this research was never published, however. None of the journals it had been submitted to agreed to consider it for publication "because it had been supported by industry." 

It was only under cross-examination by Mr. Boivin that it was shown that this work was related to the development of the Eclipse cigarette. (The research itself has apparently disappeared -- certainly Mr. LaRoche did not offer it, even after Mr. Boivin's suggestion).

Mr. Boivin also pointed out the condition on the funding from RJ-Reynolds that they be provided with advance notice of any publications. This countered his earlier testimony that there had been no conditions on such funds, and Mr. LaRoche later made the point that this condition applied only to the desire of the company to protect its patent rights.

No regrets

Dr. Hogg had not volunteered this information, nor had he spoken much about about the expressions of concern over the course of his career related to his relationships to tobacco companies, other than to acknowledge that there were  "anti smoking activists" and had been demonstrators "pickets and so on" outside the university where he was based.

The rules of research funding have changed markedly since Dr. Hogg first received money from the Canadian tobacco industry. The change started in Australia in the mid 1990s, he told the court, and in some universities researchers now "run the risk of losing the job at the university if you accept funding."

For that reason, he had asked Ms. Roberts to put on the record that he had returned the cheque that she had been required under Quebec procedural law to provide him with to cover his expenses to testify.

But he expressed no agreement with the changing rules. When asked about views that his engagement with tobacco companies might be seen as unethical, he said simply that "We live in a free society and everyone is entitled to their opinion. I disagree."

There is a telling image on the video prepared by the Canadian Medical Hall of Fame. It shows a young James Hogg in a Huckleberry Finn moment, standing between two other young boys. Clasped in his mouth is a cigarette. Other physicians might have chosen another photo to be remembered by.

The young James Hogg, centre
Dr. Hogg's testimony ended a day earlier than expected. "You've won the lottery!" said Justice Riordan as he thanked this witness warmly.

The trial resumes on Thursday for its last day of hearings in 2013. The witness will be Mr. Robert Robitaille.





Recipients of medical research grants from the Canadian Tobacco Manufacturers Council.
Taken from Exhibit 21045

Year
Amount
Institution
Researcher
$2013 equiv.
1972
$18,000
Hotel Dieu
$99,283
1965
$21,300
Manitoba
Modovy
$155,024
1967
$45,000
McGill
Thurlbeck
$302,459
1968
$300,000
McGill
Macklem
$1,942,110
1971
$98,550
McGill
Hogg
$571,777
1971
$2,100
McGill
Reininger
$12,184
1971
$1,650
McGill
Thurlbeck
$9,573
1972
$54,000
McGill
Meakins Christie Laboratories
$297,848
1973
$119,300
McGill
Hogg
$606,354
1975
$107,360
McGill
Hogg
$443,128
1978
$20,460
McGill
Bilimoria/ Ecobichon
$66,931
1978
$42,548
McGill
Macklem
$139,187
1978
$57,476
McGill
Richardson
$188,021
1979
$19,850
McGill
Ecobichon / Bilimoria
$59,550
1979
$73,240
McGill
Macklem / Martin / King
$219,720
1979
$54,417
McGill
Zorychta / Richardson
$163,251
1980
$21,230
McGill
Ecobichon / Bilimoria
$57,518
1980
$102,080
McGill
Macklem / Martin / King
$276,565
1980
$62,524
McGill
Zorychta / Richardson
$169,396
1981
$24,200
McGill
Bilimoria
$58,136
1981
$114,923
McGill
King
$276,080
1981
$69,472
McGill
Zorychta 
$166,893
1982
$32,289
McGill
Bilimoria
$70,542
1982
$88,808
McGill
King
$194,019
1982
$69,368
McGill
Zorychta
$151,548
1983
$35,518
McGill
Bilimoria / Ecobichon
$73,920
1983
$94,446
McGill
Meakins Christie Laboratories
$196,561
1983
$110,242
McGill
Zorychta
$229,436
1984
$100,000
McGill
Ecobichon / Bilimoria
$201,310
1984
$47,223
McGill
Macklem
$95,065
1984
$79,254
McGill
Zorychta
$159,546
1985
$100,000
McGill
Meakins Christie Laboratories
$193,400
1985
$83,780
McGill
Zorychta
$162,031
1986
$100,000
McGill
Meakins Christie Laboratories
$185,240
1976
$127,980
McGill / Université de Montreal
Hogg / Witschi
$496,575
1977
$100,422
McGill / Université de Montreal / University of British Columbia
Hogg/Witschi, Inoue
$358,025
1968
$10,000
Montreal General Hospital
Burgess
$64,737
1968
$13,705
Ontario Veterinary College
$88,722
1970
$9,000
Queens
Wan
$54,265
1968
$25,000
Royal Edward Chest Hospital
$161,843
1971
$14,340
Royal Edward Chest Hospital
Munro
$83,199
1977
$29,194
Royal Ottawa Hospital
Knott
$104,082
1978
$11,000
Royal Ottawa Hospital
Knott
$35,984
1979
$39,750
Royal Ottawa Hospital
Knott
$119,250
1980
$37,655
Royal Ottawa Hospital
Knott
$102,019
1981
$42,925
Royal Ottawa Hospital
Knott
$103,119
1982
$86,789
Royal Ottawa Hospital
Knott
$189,608
1983
$219,011
Royal Ottawa Hospital
Knott
$455,806
1984
$58,996
Royal Ottawa Hospital
Knott
$118,765
1985
$66,794
Royal Ottawa Hospital
Knott
$129,180
1986
$88,603
Royal Ottawa Hospital
Knott
$164,128
1969
$300,000
Université de Montréal
Selye
$1,854,270
1972
$300,000
Université de Montréal
Selye
$1,654,710
1977
$20,000
Université de Montréal
Renaud
$71,304
1978
$35,500
Université de Montréal
Renaud
$116,131
1979
$35,000
Université de Montréal
Renaud
$105,000
1980
$32,000
Université de Montréal
Renaud
$86,698
1981
$30,000
Université de Montréal
Renaud
$72,069
1971
$18,900
University of British Columbia
Harrison
$109,656
1978
$40,000
University of British Columbia
Hogg
$130,852
1979
$60,000
University of British Columbia
Hogg
$180,000
1980
$63,351
University of British Columbia
Hogg
$171,637
1981
$72,490
University of British Columbia
Hogg
$174,143
1982
$73,688
University of British Columbia
Hogg
$160,986
1984
$128,930
University of British Columbia
Hogg
$259,549
1983
$81,056
University of British Columbia
Hogg
$168,694
1985
$92,726
University of British Columbia
Hogg
$179,332
1986
$96,006
University of British Columbia
Hogg
$177,842
1986
$56,000
Sterling
$103,734
Total
$4,887,419


$16,799,516