TORTINI

For your delectation and delight, desultory dicta on the law of delicts.

Siracusano Dicta Infects Daubert Decisions

September 22nd, 2012

Gatekeeping is sometimes  intellectually challenging, but the challenge does not excuse sloppy thinking.  Understandably, judges will sometimes misunderstand the relevant science.  The process, however, allows the public and the scientific community to see what is happening in court cases, rather than allowing the critical scientific reasoning to be hidden in the black box of jury determinations.  This transparency can and should invite criticism, commentary, corrections, and consensus, when possible.

Bad legal reasoning is much harder to excuse.  The Supreme Court, in Matrixx Initiatives, Inc. v. Siracusano, 131 S. Ct. 1309 (2011), unanimously affirmed the reversal of a trial court’s Rule 12(b)(6) dismissal of a securities fraud class action.  The corporate defendant objected that the plaintiffs failed to plead statistical significance in alleging causation between Zicam and the loss of the sense of smell.  The Supreme Court, however, made clear that causation was not required to make out a claim of securities fraud.  It was, and would be, sufficient for the company’s product to have raised sufficient regulatory concerns, which in turn would bring regulatory scrutiny and action that would affect the product’s marketability.

The Supreme Court could have disposed of the essential issue in a two page per curiam opinion.  Instead the Court issued an opinion signed by Justice Sotomayor, who waxed carelessly about causation and statistical significance, which discussion was not necessary to the holding.  Not only was Justice Sotomayor’s discussion obiter dicta, but the dicta were demonstrably incorrect. Matrixx Unloaded (Mar. 29, 2011).

The errant dicta in Siracusano has already led one MDL court astray:

“While the defendant repeatedly harps on the importance of statistically significant data, the United States Supreme Court recently stated that ‘[a] lack of statistically significant data does not mean that medical experts have no reliable basis for inferring a causal link between a drug and adverse events …. medical experts rely on other evidence to establish an inference of causation.’ Matrixx Initiatives, Inc. v. Siracsano, 131 S.Ct. 1309, 1319 (2011).”

Memorandum Opinion and Order at 22, In re Chantix (Varenicline) Products Liability Litigation, MDL No. 2092, Case 2:09-cv-02039-IPJ Document 642 (N.D. Ala. Aug. 21, 2012)[hereafter cited as Chantix].  See Open Admissions for Expert Witnesses in Chantix Litigation.

It was only a matter of time before the Supreme Court’s dictum would be put to this predictably erroneous interpretation.  SeeThe Matrixx Oversold” (April 4, 2011).  Within two weeks, the error in Chantix propagated itself in another MDL case, with another trial court succumbing to the misleading dicta in Justice Sotomayor’s opinion.  See Memorandum in Support of Separate Pretrial Order No. 8933, Cheek v. Wyeth Pharm. Inc. (E.D.Pa. Aug. 30, 2012)(Bartle, J.).

In Cheek, Judge Harvey Bartle rejected a Rule 702 challenge to plaintiffs’ expert witness’s opinion.  I confess that I do not know enough about the expert witness’s opinion or the challenge to assess Judge Bartle’s conclusion.  Judge Bartle, however, invoked the Matrixx decision for the dubious proposition that:

Daubert does not require that an expert opinion regarding causation be based on statistical evidence in order to be reliable. Matrixx Initiatives, Inc. v. Siracusano, 131 S. Ct. 1309, 1319 (2011). In fact, many courts have recognized that medical professionals often base their opinions on data other than statistical evidence from controlled clinical trials or epidemiological studies. Id. at 1320.”

Cheek at 16.  The Cheek decision is a welter of non-sequiturs.  The fact that in some instances statistical evidence is not necessary is hardly a warrant to excuse the lack of statistical evidence in every case. The truly disturbing gaps in reasoning, however, are not scientific, but legal. Siracusano was not a “Daubert” opinion; and Siracusano does not, and cannot, support the refusal to inquire whether statistical evidence was necessary in a causation opinion, in main part because causation was not at issue in Siracusano.

 

 

 

 

 

 

 

It’s Alimentary, My Dear Watson

September 20th, 2012

Mr. Watson, who claimed to have consumed thousands of bags of popcorn with diacetyl, sued for bronciolitis obliterans allegedly caused by the diacetyl.

Actually, with the help of frequent testifier David Egilman, Wayne Watson claimed his lung injury was inhalational.

The trial judges in Watson denied essentially the same challenges that were sustained in Newkirk v. ConAgra Foods, Inc., 727 F. Supp. 2d 1006 (E.D.Wash. 2010), aff’d, 438 Fed.Appx. 607 (9th Cir. 2011).

Yesterday, the jury returned a verdict for compensatory damages of $1.2 million, and punitive damages of $6 million, against the defendants, some of which had settled before trial.

For a predictably misleading, mainstream media account that fails to mention the interesting Daubert exclusions and defense verdicts in this litigation, see  Colorado man Wayne Watson wins $7 million in “popcorn lung” lawsuit; and ‘Popcorn Lung’ Lawsuit Nets $7.2M Award (Sept. 20, 2012).

The supermarket defendant at trial should certainly appeal.  It remains to be seen who gets the last pop in this case.

Bipartisan Junk Science – Pork-Barrel Causation

September 19th, 2012

Despite the hand waving and finger pointing, junk science is embraced by both political parties in the United States, when it suits their purposes.  Both parties want to have God and science on their sides.

Congress created September 11th Victim Compensation Fund, 49 USC § 40101, also known as the James Zadroga 9/11 Health and Compensation Act (P.L. 111-347) (signed into law in January 2011). The Act was a touching acknowledgement of the dedication and sacrifices of first responders to the World Trade Center and Pentagon victims of an Islamic jihad. Being a victim, however, implies that the harm to be compensated was caused by the attack and its consequences.  The New York politicians soon learned that causality can be turned into a very malleable concept.

The law allocated over $4 billion for medical screening and treatment of fire fighters, policemen, emergency responders, and survivors.  Most of the covered conditions were acute onset respiratory and mental disorders caused by gases, fumes, dusts, and stresses, to which the workers were exposed.  The law also made the director of CDC’s National Institute for Occupational Safety and Health (NIOSH), the head of a World Trade Center Health Program, which could add new conditions to the list of compensable diseases, based upon a review of scientific evidence.

In September 2011, several New York congressmen and Senators petitioned the director, citing flimsy or non-existent scientific evidence, to add cancer to the list.  Senators Kirsten Gillibrand (D-NY) and Charles Schumer (D-NY), and Representatives Carolyn Maloney (D-NY), Jerrold Nadler (D-NY), Peter King (R-NY), Charles Rangel (D-NY), Nita Velazquez (D-NY), Michael Grimm (R-NY),  and Yvette Clark (D-NY), made their request, citing R. Zeig-Owens, M. Webber, C.B. Hall, et al., “Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study,” 378 Lancet 898 (2011).

This is pork barrel politics masquerading as sympathy for putative victims.  The Zeig-Owens study reported a non-statistically significant standardized incidence ratio for all cancer, of either 1.10 (95% CI 0.98–1.25), with a comparison group of the generalized U.S. male population, or 1.19 (95% CI 0.96–1.47), with unexposed firefighters as a comparison group, and corrected for possible surveillance bias.  Of course, given that there is no disease of cancer, the composite end point is not particularly meaningful.

Here are the authors’ (including Dr. Prezant’s) published interpretation of the data:

“We reported a modest excess of cancer cases in the WTC-exposed cohort. We remain cautious in our interpretation of this finding because the time since 9/11 is short for cancer outcomes, and the reported excess of cancers is not limited to specific organ types. As in any observational study, we cannot rule out the possibility that effects in the exposed group might be due to unidentified confounders.”

Zeig-Owens, at 898.  The Zeig-Owens study did not support any conclusions of causality between the workers’ exposures in 2001, and any type of cancer. See NIOSH Report Sets Up Run on September 11th Victim Compensation Fund by Non-Victims.

The WTC Health Program director requested recommendations from the program’s Scientific – Technical Advisory Committee (STAC), whether to add cancer generally, or any particular kind of cancer, to the Zadroga Act’s list of compensable conditions.  In April 2012, the STAC made its recommendations, essentially relying upon likely exposures, without any consideration of individual dose, duration, latency, and without any serious consideration of the available epidemiologic evidence.

The STAC claimed that the Lancet study reported statistically significant excesses of cancer; it did not. The Committee also failed to come to grips with the biological implausibility of excess rates of solid malignant tumors presenting within less than a decade since exposure:

“Given that cancer latencies for solid tumors average 20 years or more, it is noteworthy that the published FDNY study of fire fighters showed a statistically significant excess in all-site cancer with only 7 years of follow-up.”

In June 2012, NIOSH director, Dr. Howard, reported that he was inclined to accept the STAC’s recommendation, but held open a public comment period.  See Anemona Hartocollis, “Sept. 11 Health Fund Given Clearance to Cover Cancer,” N.Y. Times (June 8, 2012).  Not surprising, given the political pressure, the WTC Health Program director promulgated his final rule to include 50 types of cancer, including many that occurred less often than expected in the Zeig-Owens study.

This decision ignores appropriate scientific methodology for reaching causal conclusions.  Worse than its intellectual shabbiness, the decision insults the true victims of the jihad terrorism.

The rule is effective October 12, 2012.

 

Watson Popcorn Case Pops Along

September 8th, 2012

Earlier today, I discussed the pending motion that would have limited, or eliminated, Dr. Egilman’s testimony in the Watson diacetyl case. See Good’s Expert Witness Opinion Not Good Enough in Tenth Circuit.  Apparently, Chief Judge Daniel denied the defendant’s renewed Rule 702 motion, and so “this trial must be tried.”  Whether the gatekeeping was sufficiently exact, time will tell.

Details to follow.

 

 

 

Good’s Expert Witness Opinion Not Good Enough in Tenth Circuit

September 8th, 2012

Last month, the Tenth Circuit reversed a significant judgment against Ford Motor Company in a rollover accident.  Hoffman v. Ford Motor Co., No. 10-1137, 2012 WL 3518997,  2012 U.S. App. LEXIS 17215 (10th Cir. Aug. 16, 2012) (unpublished), rev’g 690 F. Supp. 2d 1179 (D. Colo. 2010).  The plaintiff, Erica Hoffman, sustained severe injuries, with resulting quadriplegia, when she was thrown out of the passenger seat, and out of her parents’ 1999 Mercury Cougar, during the rollover.

Hoffman sued Ford Motor Company on the claim that the seatbelt, which she claims to have been wearing, released during the accident.  Hoffman’s expert witness, Dr. Craig Good opined that Hoffman’s seatbelt “most probably” unlatched during the accident due to a design defect that permitted unlatching under various inertial forces.  Dr. Good supported his opinion by testing that sought to show the threshold of inertial forces under which unlatching occurred.  Good, however, lacked rollover crash data, and he thus used data from crash tests conducted only in the horizontal plane, rather than the more complex forces at work in a rollover situation.  From the “planar” data, Good concluded that Hoffman’s accident presented sufficient force to cause the inertial unlatching of her seatbelt during the accident.  The jury found Ford liable; the verdict, molded for comparative negligence, amounted to 4.5 million dollars.

Ford had objected, under Rule 702, to Good’s testimony, and to his extrapolation of his test data from a horizontal test scenario to the three-dimensional array of forces involved in the actual rollover accident.  The gravamen of Ford’s complaint was that Good had failed to show the levels of acceleration needed to induce inertial unlatching in the laboratory in the real-world setting of Hoffman’s accident.

The panel of the Tenth Circuit, divided 2 to 1, agreed with Ford that the trial judge had not been:

“a sufficiently exacting gatekeeper; Daubert requires more precision. Good failed to present a scientific connection between the accelerations he found necessary to inertially unlatch buckles tested in the laboratory and accelerations that occurred could have occurred on Erica’s buckle during the rollover. As a result, his opinion (that Erica’s buckle was defective because it inertially unlatched during the accident) should not have been admitted at trial.”

Hoffman, 2012 U.S. App. LEXIS 17215, *4-5.  Because Good’s opinion was necessary to support plaintiff’s recovery, and because there was no other evidence to support the claim of design defect, the Circuit reversed and remanded with instructions that judgment be entered in favor of Ford.

The Hoffman decision does not really broach new ground in the law of expert witnesses.  The law requires that testing data bear on the situation in which the product supposedly malfunctioned.  The opinion, however, has already had the salutary effect of causing the newly assigned trial judge to Watson v. Dillon Companies, to reconsider the previous Rule 702 rulings in this diacetyl consumer case.

Chief Judge Wiley Daniel took over the case for trial, when Senior Judge Miller assumed inactive senior status.  Plaintiff Watson claims lung injuries from diacetyl inhaled in the course of consuming upwards of 7,000 bags of popcorn, over seven years.  Judge Miller heard, and largely denied, defendants’ 702 motions. Watson v. Dillon Companies, Inc., 797 F. Supp. 2d 1138 (D.Colo. 2012).  Chief Judge Daniel found the Hoffman precedent sufficiently on point to the challenged diacetyl exposure assessment, that he invited renewed argument on the challenges to plaintiffs’ expert witnesses.  Order of Aug. 29, 2012.

In Chief Judge Daniel’s words:

“After reviewing the Tenth Circuit’s recent pronouncement on Daubert challenges and the admissibility of expert testimony at trial, I reexamined pertinent documents in this matter. Specifically, I reread Judge Miller’s June 22, 2011 order denying the motions to exclude expert testimony of Plaintiffs’ expert witnesses along with the opinion issued by the United States District Court for the Eastern District of Washington in Newkirk v. ConAgra Foods, Inc., 727 F. Supp. 2d 1006 (E.D.Wash. 2010). I also revisited the material submitted by Defendants surrounding the issue of the reliability of Dr. Martyny’s testing of diacetyl levels at Plaintiffs’ home, as Plaintiffs’ expert witnesses based some of their opinions on these test results.

I find that the Hoffman opinion may impact previous expert witness rulings including, but not limited to, Dr. David Egilman’s opinions. Accordingly, on Tuesday, September 4, 2012, prior to the commencement of jury selection in this matter, the parties shall be prepared to discuss these issues and how they may impact the trial.”

Along with the encouragement provided by the Hoffman case, the Chief Judge may have been moved to revisit the 702 issues by a defense filing that challenged the plaintiffs’ exposure level evidence.  The defendant filed a motion in limine to preclude plaintiffs’ expert witnesses’ reliance upon data generated by an Innova Model 1312 Photoacoustic Multi-Gas Monitor.  The court denied this motion, with leave to raise it at trial, but also precluded mention of the testing in front of the jury until the evidentiary matter is resolved. Order of June 22, 2012.

It appears that the plaintiffs may have withdrawn the challenged evidence, which if true, will have significance beyond this case, given the media and regulatory fora sought out by Dr. Egilman and his colleagues.

Let us hope that the Hoffman opinion inspires the court to be the sufficiently exacting gatekeeper required by law.

The Supreme Court’s Unsteady Gatekeeping Pre-Daubert

September 8th, 2012

Some writers assert that the United States Supreme Court did not wade into the troubled waters of medical causation and expert witness testimony until it decided Daubert v. Merrell Dow Pharmaceuticals, 509 U.S. 579 (1993).  Actually, the Court swam in these stormy waters in admiralty and FELA cases, at least up through the 1950’s.

In 1953, Mr. Sentilles, a marine engineer, was thrown to the deck of his ship, and washed off deck, by a wave.  He became ill with tuberculosis, and he brought a person injury action (for “maintenance and cure”) against vessel owner.  Inter-Caribbean Shipping Corp. v. Sentilles, 256 F.2d 156 (5th Cir. 1958).  The vessel owner defended on the theory that the plaintiff’s diabetes pre-disposed him to TB, and that the plaintiffs’ expert witnesses were equivocal in their conclusions of causality or aggravation.  The jury nonetheless found for the plaintiff.

The judgment entered on a jury verdict for the seaman was reversed by the Fifth Circuit, which found the plaintiffs’ expert witnesses’ testimony inadequate to support submission of the case to the jury:

“The rule as to the medical testimony respecting causation which is required to take a case to a jury has been thus stated:

It appears to be well settled that medical testimony as to the possibility of a causal relation between a given accident or injury and the subsequent death or impaired physical or mental condition of the person injured is not sufficient, standing alone, to establish such relation. By testimony as to possibility is meant testimony in which the witness asserts that the accident or injury `might have’, `may have’, or `could have’ caused, or `possibly did’ cause the subsequent physical condition or death or that a given physical condition (or death) `might have,’ `may have,’ or `could have’ resulted or `possibly did’ result from a previous accident or injury — testimony, that is, which is confined to words indicating the possibility or chance of the existence of the causal relation in question and does not include words indicating the probability or likelihood of its existence.”

Id. (internal citations omitted).

The Supreme Court granted a writ of certiorari, heard argument, and reversed the Court of Appeals.  Sentilles v. Inter-Caribbean Shipping Corp., 361 U.S. 107 (1959).  In announcing the Court’s opinion, Justice Brennan voiced the remarkable doctrine that the jury could find reasonable probability when the expert witnesses could not:

“The jury’s power to draw the inference that the aggravation of petitioner’s tubercular condition, evident so shortly after the accident, was in fact caused by that accident, was not impaired by the failure of any medical witness to testify that it was in fact the cause.  Neither can it be impaired by the lack of medical unanimity as to the respective likelihood of the potential causes of the aggravation, or by the fact that other potential causes of the aggravation existed and were not conclusively negated by the proofs.  The matter does not turn on the use a of particular form of words by the physicians in giving their testimony.  The members of the jury, not the medical witnesses, were sworn to make a legal determination of the question of causation.  They were entitled to take all the circumstances, including the medical testimony into consideration.  Though this case involves a medical issue, it is no exception to the admonition that, ‘It is not the function of a court to search the record for conflicting circumstantial evidence in order to take the case away from the jury on a theory that the proof gives equal support to inconsistent and uncertain inferences.  The focal point of judicial review is the reasonableness of the particular inference or conclusion drawn by the jury. * * * The very essence of its function is to select from conflicting inferences and conclusions that which it considers most reasonable.  * * * Courts are not free to reweigh the evidence and set aside the jury verdict merely because the jury could have drawn different inferences or conclusions or because judges feel that other results are more reasonable.’”

Id. at 109-10.  Justice Brennan thus ignored equally venerable precedent that juries are not free to speculate, and he failed to consider how the jury in this case could reach a determination in the face of conflicting evidence, and without ruling out alternative causes.

Sentilles was decided before the enactment of the Federal Rules of Evidence, and there was no challenge to the plaintiff’s expert witnesses’ testimony under the Frye doctrine.  Another crucial difference, of course, is that Sentilles was an isolated case, not likely to recur frequently in the federal courts.  With the rise of product liability law, and the emergence of epidemiology as a basis for inferring causality, the federal courts would soon see mass exposure situations resulting in mass torts.  Dubious expert witness testimony resulting in dubious judgments of causation would attain much greater notoriety, for the expert witnesses, for the trial bar, and for the courts that tolerated the results.

 

 

David Egilman’s Methodology for Divining Causation

September 6th, 2012

If the Method Yields An Erroneous Conclusion, then the Method is Wrong

David Stephen Egilman wanted very much to testify in a diacetyl case.  One judge, however, did not think that this was such a good idea, and excluded Dr. Egilman’s testimony. Newkirk v. Conagra Foods, Inc.  727  F.Supp. 2d 1006 (E.D. Wash. 2010).

Egilman was so distraught by being excluded that he sought to file a personal appeal to the United States Court of Appeal. See “Declaration of David Egilman, M.D., M.P.H., in Support of Opposition to Motion for Order to Show Cause Why Appeal Should Not Be Dismissed for Lack of Standing.”  (Attached: Egilman Motion Appeal Diacetyl Exclusion 2011 and Egilman Declaration Newkirk Diacetyl Appeal 2011.)

Egilman improvidently, if not scurrulously, attacked the district judge for having excluded Egilman’s proffered testimony.  If Egilman’s attack on the trial judge were not sufficiently odd, Egilman also claimed a right to intervene in the appeal by advancing the claim that the Rule 702 exclusion hurt his livelihood.  Here is how Egilman put the matter:

“The Daubert ruling eliminates my ability to testify in this case and in others. I will lose the opportunity to bill for services in this case and in others (although I generally donate most fees related to courtroom testimony to charitable organizations, the lack of opportunity to do so is an injury to me). Based on my experience, it is virtually certain that some lawyers will choose not to attempt to retain me as a result of this ruling. Some lawyers will be dissuaded from retaining my services because the ruling is replete with unsubstantiated pejorative attacks on my qualifications as a scientist and expert. The judge’s rejection of my opinion is primarily an ad hominem attack and not based on an actual analysis of what I said – in an effort to deflect the ad hominem nature of the attack the judge creates ‘straw man’ arguments and then knocks the straw men down, without ever addressing the substance of my positions.”

Egilman Declaration at ¶ 11.

The Ninth Circuit, unmoved by the prospect of an impoverished Dr. Egilman, denied his personal appeal, and affirmed the district court’s exclusion. Newkirk v. Conagra Foods, Inc., 438 Fed. Appx. 607 (9th Cir. 2011).

In his appellate papers, Egilman did not stop at simply citing his pecuniary interest.  With no sense of false shame or modesty, Egilman recited what a wonderful expert witness he has been.  Egilman suggested that courts have been duly impressed by his views on the scientific assessment of causation:

“My views on the scientific standards for the determination of cause-effect relationships (medical epistemology) have been cited by the Massachusetts Supreme Court (Vassallo v. Baxter Healthcare Corporation, 428 Mass. 1 (1998)):

‘Although there was conflicting testimony at the Oregon hearing as to the necessity of epidemiological data to establish causation of a disease, the judge appears to have accepted the testimony of an expert epidemiologist that, in the absence of epidemiology, it is “sound science…. to rely on case reports, clinical studies, in vivo tests and animal tests.” The judge may also have relied on the affidavit of the plaintiff’s epidemiological expert, Dr. David S. Egilman, who identified several examples in which disease causation has been established based on animal and clinical case studies alone to demonstrate that “doctors utilize epidemiological data as one tool among many”.’”

Egilman Declaration at p.5-6.

We may excuse Dr. Egilman, a non-lawyer, for incorrectly referring to a non-existent court.  Massachusetts does not have a “Supreme Court,” but the quoted language did indeed come from the Supreme Judicial Court of Massachusetts, in Vassallo v. Baxter Healthcare Corporation, 428 Mass. 1, 12, 696 N.E.2d 909, 917 (1998).

The Massachusetts court’s suggestion that there was conflicting testimony at the “Oregon hearing,” about the need for epidemiologic evidence is itself rather bizarre.  The Oregon hearing was the Rule 702 hearing before Judge Jones, of the District of Oregon.  Judge Jones appointed four technical advisors to assist him in ruling on the defendants’ motions to exclude plaintiffs’ causation opinions.  One of the appointed advisors was an epidemiologist.  More important, the plaintiffs’ counsel presented the testimony of an epidemiologist, Dr. David Goldsmith.  The Massachusetts court did not, and indeed, could not cite the Oregon District Court’s opinion, or the underlying record, for any suggestion that epidemiologic testimony was not needed to show a causal relationship between silicone breast implants and the development of autoimmune disease.  See Hall v. Baxter Healthcare Corp., 947 F. Supp. 1387 (D. Or. 1996). Judge Jones made his views very clear:  epidemiology was needed, but lacking, in the plaintiffs’ case.  The argument that epidemiology was unnecessary came from Dr. Egilman’s report, and the plaintiffs’ counsel’s briefs.

There is more, however, to the disingenuousness of Dr. Egilman’s citation to the Vassallo case.  The Newkirk court, in receiving his curious affidavit, would not likely know that Vassallo was a silicone gel breast implant case, and one may suspect that Dr. Egilman wanted to keep the Ninth Circuit uninformed of his role in the silicone litigation.  If Dr. Egilman submitted an affidavit in connection with the so-called Oregon hearings, which took place during the summer of 1996, it was not a particularly important piece of evidence.  Egilman is not mentioned by name in the Hall decision, even though the district court clearly rejected the plaintiffs’ witnesses and affiants, in their efforts to make a case for silicone as a cause of autoimmune disease.

A few months after the Oregon hearings, Judge Weinstein, in the fall of 1996, along with other federal and state judges, held a “Daubert” hearing on the admissibility of expert witness opinion testimony in breast implant cases, pending in New York state and federal courts.  Plaintiffs’ counsel suggested that Egilman might testify, but ultimately he was a no show.  After the New York hearings, Judge Weinstein granted, sua sponte, partial summary judgment against all plaintiffs’ claims of systemic immune-system injury.  In re Breast Implant Cases, 942 F. Supp. 958 (E.&S.D.N.Y. 1996).

At the New York hearings, plaintiffs’ counsel again attempted to make an epidemiologic case, and once again called Dr. David Goldsmith.  Marshaling the evidentiary display that Egilman would have presented had he shown up in New York, Dr. Goldsmith’s testimony did not go well. At one point, Judge Weinstein interrupted and offered his interim assessment of Dr. Goldsmith and the plaintiffs causation case:

THE COURT: Why are you presenting this witness, for epidemiological purposes?

MR. GORDON: That’s correct.

THE COURT: And I can tell you for epidemiological purposes, based on the only testimony I have seen, he doesn’t meet my standard of anybody who can be helpful to a jury, not because he isn’t a great epidemiologist, I’m sure he is, but because the data he is relying on admittedly is almost useless. I’m not going to go forward with a trial on this kind of haphazard abstract without any basic definition or explication.

Transcript at p.159:7-18, from Nyitray v. Baxter Healthcare Corp., CV 93-159 (E.D.N.Y. Oct. 9, 1996)(pre-trial hearing before Judge Jack Weinstein, Justice Lobis, and Magistrate Cheryl Pollak).  In his semi-autobiographical writings, Judge Jack B. Weinstein elaborated upon his published breast-implant decision, with a bit more detail about how he viewed the plaintiffs’ expert witnesses.  Judge Jack B. Weinstein, “Preliminary Reflections on Administration of Complex Litigation” 2009 Cardozo L. Rev. de novo 1, 14 (2009) (describing plaintiffs’ expert witnesses in silicone litigation as “charlatans”; “[t]he breast implant litigation was largely based on a litigation fraud. … Claims—supported by medical charlatans—that enormous damages to women’s systems resulted could not be supported.”)

When Judge Weinstein began to create a process for the selection of Rule 706 court-appointed expert witnesses, plaintiffs’ counsel rushed to have Judge Pointer take control over the process.  Because Judge Pointer believed that there must be some germ of validity in the plaintiffs’ case, the plaintiffs were hoping that his courtroom, the center of MDL 926, would be a more favorable forum than Judge Weinstein’s withering skepticism.  Ultimately, Judge Pointer, through a select nominating committee, appointed appointed expert witnesses, in the fields of toxicology, immunology, rheumology, and epidemiology.  MDL 926 Order No. 31 (Appointment of Rule 706 Expert Witnesses).

Each of the four witnesses prepared, presented, and defended his or her own report, but all the reports soundly rejected plaintiffs’ causation theories.  Laural L. Hooper, Joe S. Cecil, and Thomas E. Willging, Neutral Science Panels: Two Examples of Panels of Court-Appointed Experts in the Breast Implants Product Liability Litigation (Fed. Jud. Ctr. 2001).

In the United Kingdom, the British Minister of Health ordered an independent review of the breast implant controversy, which led to the formation of the Independent Review Group (IRG) to evaluate the causal claims that were being made by claimants and advocates. The IRG concluded that there was no demonstrable risk of connective tissue disease from silicone breast implants. Independent Review Group, Silicone Breast Implants: The Report of the Independent Review Group 8, 22-23 (July 1998).

In 1999, The Institute of Medicine delivered its assessment of the safety of silicone breast implants.  Again, the plaintiffs’ theories were rejected.  Stuart Bondurant, Virginia Ernster, and Roger Herdman, eds., Safety of Silicone Breast Implants (1999).

Still, Egilman persisted.  As late as 2000, Egilman was posting his breast-implant litigation report at his Brown University website.  His conclusion, however awkwardly worded, was clear enough:

“Although a prospective, large epidemiological study investigating atypical symptoms and disease would clearly contribute to underestimating of the strength of association between silicone breast implants and disease, the available epidemiologic evidence is suggestive of a causal association for silicone breast implants and atypical connective tissue diseases and scleroderma.”

David S. Egilman, “Breast Implants and Disease” (2000) (“For purposes of this report SBI induced disease is considered an iatrogenic environmental disease.”) (<http://209.67.232.40/brown/implants/sbi.html> lasted visited on Mar. 28, 2000).

Sometime after 2000, Egilman developed a sensitivity to being associated with the plaintiffs’ side of the silicone litigation.  In 2009, Dr. Laurence Hirsch, published an article critical of Egilman’s disclosures of conflicts of interest, in some of his published articles.  Hirsch struck a sensitive nerve in mentioning Egilman’s involvement in the breast implant litigation:

“Egilman reports having testified for plaintiffs in legal cases involving asbestosis, occupational lung disease, beryllium poisoning, silicone breast implants and connective tissue disease (characterized as the epitome of junk science91), selective serotonin reuptake inhibitor and suicide risk, atypical antipsychotics and metabolic changes, and selective COX-2 inhibitors and cardiovascular disease, an amazing breadth of medical expertise.”

Laurence J. Hirsch, “Conflicts of Interest, Authorship, and Disclosures in Industry-Related Scientific Publications: The Tort Bar and Editorial Oversight of Medical Journals,” 84 Mayo Clin. Proc. 811, 815 (2009).

Egilman apparently besieged Dr. Hirsch and the Mayo Clinic Proceedings with his protests, and it seems that he was able to induce the author or the journal into a “correction”:

“Dr Egilman has not testified in court in breast implant and connective tissue disease, or in antidepressant or antipsychotic drug cases.”

Laurence J. Hirsch, “Corrections,” 85 Mayo Clin. Proc. 99 (2010).  But this correction is itself incorrect because Dr. Egilman testified over the course of three days, in court, in the same Vassallo v. Baxter Healthcare case he holds up as having embraced his causal “principles.”  The Vassallo case involved allegations that silicone had caused systemic autoimmune disease, an allegation that was ultimately shown to be meritless by the MDL court’s neutral expert witnesses, as well as the Institute of Medicine.

Perhaps this history helps explain Dr. Egilman’s coyness in what he told the Newkirk appellate court about his involvement in the Vassallo case.  More likely is that Dr. Egilman understands, all too well, the logical implications of his being wrong in the breast implant litigation.  If his vaunted method leads to an erroneous conclusion, then the method must be wrong.  It is a simple matter of modus tollens.

 

 

 

 

Confusing Regulatory and Litigation Standards for Showing Causation – More on Chantix

September 3rd, 2012

 

Before denying Pfizer’s Rule 702 challenges to the plaintiffs’ expert witnesses’ opinion testimony, the Chantix MDL court handed Pfizer a significant victory by holding that the company’s 2009 warnings were adequate as a matter of law.  In re Chantix Products Liab. Litig., 2012 U.S. Dist. LEXIS 101780, *21 (Jul. 23, 2012). The MDL court assessed warnings in the full context of the learned intermediary setting, in which the prescribing physicians are the intended audience for the warnings. The court held that when the warning addresses the particular injury sustained by the plaintiff, the warning is adequate.  Id. at *29-30 n.10. See Michelle Yeary, “Chantix Warnings Adequate As a Matter of Law” (July 31, 2012).

Perhaps the MDL Court felt that it needed to level the playing field by denying the defendant’s Rule 702 motions.  In any event, I seem to be not alone in expressing dismay over the glib pronouncements of the Chantix MDL court’s Rule 702 opinionSee David Oliver, “Of Mice and Monkeys and Men” (Aug. 30, 2012) (noting the court’s indulgence in the extreme assumption that causation in one mammalian species justifies an inference that it will cause in others, including humans).

In “Open Admissions for Expert Witnesses in Chantix Litigation (Sept. 1, 2012),” I detailed much that went wrong in the gatekeeping in the Chantix litigation.  Unfortunately, I only scratched at the surface.

CONFUSING REGULATORY ACTION WITH CAUSAL ASSESSMENTS

One of the more stunning aspects of the Chantix opinion is its holding that the plaintiffs’ expert witnesses need present opinions no more rigorous and warranted than would be required to justify FDA action.  Memorandum Opinion and Order at 22-23, In re Chantix (Varenicline) Prod. Liab. Litig., MDL No. 2092, Case 2:09-cv-02039-IPJ Document 642 (N.D. Ala. Aug. 21, 2012)[hereafter cited as Chantix].  As I noted in the earlier post, this holding against the overwhelming weight of precedent on the issue.  Judge Johnson relied heavily upon the Supreme Court’s decision in Matrixx Initiatives, but that decision carefully distinguished causal judgments in civil actions from regulatory action, at least for a while, before the Court conflated them in dictum.

To be sure, Judge Johnson, in the Chantix litigation, is not the first federal judge to conflate regulatory decision making with the sufficiency and reliability needed to establish medical causation in civil litigation.  Judge Rakoff, confusing statistical significance probability with posterior probability attached to the causation issue, reached a similar conclusion in the Ephedra MDL.  See In re Ephedra Prods. Liab. Litig., 393 F. Supp. 2d 181, 189 (S.D.N.Y. 2005) (relying upon FDA ban despite “the absence of definitive scientific studies establishing causation”).

The FDA could not be clearer that its labeling requirements do not bear on the civil tort standards of liability and causation.  Back in 1979, the FDA stated that its “[l]abeling requirements will not affect adversely the civil tort liability of manufacturers, physicians, pharmacists, and other dispensers of prescription drug products.”  44 Fed. Reg. 40016, 40023 (FDA July 6, 1979) (addressing patient package inserts)
In terms of modifying drug warnings, the FDA requires that manufacturers address potential adverse events “as soon as there is reasonable evidence of a causal association with a drug; a causal relationship need not have been definitely established.” 21 C.F.R. § 201.57(c)(6)(i) (stating requirement for medications approved after June 30, 2001).  For medications approved before July 1, 2001, the FDA requires that warnings be modified “as soon as there is reasonable evidence of an association of a serious hazard with a drug; a causal relationship need not have been proved.” Id. at § 201.80(e).  See also “Labeling of Diphenhydramine Containing Drug Products for Over-the-Counter Human Use,” 67 Fed. Reg. 72,555, at 72,556 (Dec. 6, 2002) (“FDA’s decision to act in an instance such as this one need not meet the standard of proof required to prevail in a private tort action. . .. To mandate a warning or take similar regulatory action, FDA need not show, nor do we allege, actual causation.”)(citing Agent Orange, Glastetter, and Hollander).

SUPREME COURT OF THE UNITED STATES

Matrixx Initiatives, Inc. v. Siracuso, ___U.S. ___, 131 S. Ct. 1309, 1320 (2011) (regulatory and administrative agencies “may make regulatory decisions … based on post-marketing evidence that gives rise to only a suspicion of causation.)(internal citation omitted)

IUD v. API, 448 U.S. 607, 656 (1980)(“agency is free to use conservative assumptions in interpreting the data on the side of overprotection rather than underprotection.”)

First Circuit

In re Neurontin Mktg., Sales Practices, and Prod. Liab. Litig., 612 F. Supp. 2d 116, 136 (D. Mass. 2009) (‘‘It is widely recognized that, when evaluating pharmaceutical drugs, the FDA often uses a different standard than a court does to evaluate evidence of causation in a products liability action. Entrusted with the responsibility of protecting the public from dangerous drugs, the FDA regularly relies on a risk-utility analysis, balancing the possible harm against the beneficial uses of a drug. Understandably, the agency may choose to ‘err on the side of caution,’ … and take regulatory action such as revising a product label or removing a drug from the marketplace ‘upon a lesser showing of harm to the public than the preponderance-of-the-evidence or more-like-than-not standard used to assess tort liability.’’’)(internal citations omitted)

Sutera v. Perrier Group of Am., Inc., 986 F. Supp. 655, 667 (D. Mass. 1997)

Second Circuit

Mancuso v. Consolidated Edison Co., 967 F. Supp. 1437, 1448 (S.D.N.Y. 1997) (“recommended or prescribed precautionary standards cannot provide legal causation”; “[f]ailure to meet regulatory standards is simply not sufficient” to establish liability)

In re Agent Orange Product Liab. Litig., 597 F. Supp. 740, 781 (E.D.N.Y.1984)(“The distinction between avoidance of risk through regulation and compensation for injuries after the fact is a fundamental one.”), aff’d in relevant part, 818 F.2d 145 (2d Cir.1987), cert. denied sub nom. Pinkney v. Dow Chemical Co., 484 U.S. 1004  (1988)

Third Circuit

Gates v. Rohm & Haas Co., 655 F.3d 255 (3d Cir. 2011) (‘‘plaintiffs could not carry their burden of proof for a class of specific persons simply by citing regulatory standards for the population as a whole’’)

In re Schering-Plough Corp. Intron/Temodar Consumer Class Action, 2009 WL 2043604, at *13 (D.N.J. July 10, 2009)(“[T]here is a clear and decisive difference between allegations that actually contest the safety or effectiveness of the Subject Drugs and claims that merely recite violations of the FDCA, for which there is no private right of action.”)

Soldo v. Sandoz Pharm. Corp., 244 F. Supp. 2d 434, 543 (W.D. Pa. 2003) (“FDA is a regulatory agency whose mandate is to control which drugs are marketed in the United States and how they are marketed. FDA ordinarily does not attempt to prove that the drug in fact causes a particular adverse effect.”)

O’Neal v. Dep’t of the Army, 852 F. Supp. 327, 333 (M.D. Pa. 1994) (administrative risk figures are “appropriate for regulatory purposes in which the goal is to be particularly cautious [but] overstate the actual risk and, so, are inappropriate for use in determining” civil liability)

Wade-Greaux v. Whitehall Laboratories, Inc., 874 F. Supp. 1441, 1464 (D.V.I.) (“assumption[s that] may be useful in a regulatory risk-benefit context … ha[ve] no applicability to issues of causation-in-fact”), aff’d, 46 F.3d 1120 (3d  Cir. 1994)

Fourth Circuit

Meade v. Parsley, No. 2:09-cv-00388, 2010 U.S. Dist. LEXIS 125217, * 25 (S.D.W. Va. Nov. 24, 2010) (‘‘Inasmuch as the cost-benefit balancing employed by the FDA differs from the threshold standard for establishing causation in tort actions, this court likewise concludes that the FDA-mandated [black box] warnings cannot establish general causation in this case.’’)

Dunn v. Sandoz Pharm. Corp., 275 F. Supp. 2d 672, 684 (M.D.N.C. 2003) (FDA “risk benefit analysis” “does not demonstrate” causation in any particular plaintiff).

Fifth Circuit

Johnson v. Arkema Inc., 2012 WL ______ (5th Cir. June 20, 2012) (per curiam) (affirming exclusion of expert witness who relied upon regulatory pronouncements; noting the precautionary nature of such statements, and the absence of specificity for the result claimed at the exposures experienced by plaintiff)

Allen v. Pennsylvania Eng’g Corp., 102 F.3d 194, 198-99 (5th Cir. 1996)(“Scientific knowledge of the harmful level of exposure to a chemical, plus knowledge that the plaintiff was exposed to such quantities, are minimal facts necessary to sustain the plaintiffs’ burden in a toxic tort case”; regulatory agencies,  charged with protecting public health, employ a lower standard of proof in promulgating regulations than that used in tort cases)

Cano v. Everest Minerals Corp., 362 F. Supp. 2d 814, 825 (W.D. Tex. 2005) (noting that a product that “has been classified as a carcinogen by agencies responsible for public health regulations is not probative of” common-law specific causation);

Burleson v. Glass, 268 F.Supp. 2d 699, 717 (W.D. Tex. 2003) (“the mere fact that [the product] has been classified by certain regulatory organizations as a carcinogen is not probative on the issue of whether [plaintiff’s] exposure . . . caused his . . . cancers”), aff’d, 393 F.3d 577 (5th Cir. 2004)

Newton v. Roche Labs., Inc., 243 F. Supp. 2d 672, 677, 683 (W.D. Tex. 2002) (“Although evidence of an association may. . .be important in the scientific and regulatory contexts. . ., tort law requires a higher standard of causation.”)(FDA’s precautionary decisions on labeling are not a determination of causation of specified adverse events)

Molden v. Georgia Gulf Corp., 465 F. Supp. 2d 606, 611 (M.D. La. 2006) (“regulatory and advisory bodies make prophylactic rules governing human exposure based on proof that is reasonably lower than that appropriate in tort law”)

Sixth Circuit

Nelson v. Tennessee Gas Pipeline Co., 243 F.3d 244, 252-53 (6th Cir. 2001)(exposure above regulatory levels is insufficient to establish causation)

Stites v Sundstrand Heat Transfer, Inc., 660 F. Supp. 1516, 1525 (W.D. Mich. 1987) (rejecting use of regulatory standards to support claim of increased risk, noting the differences in goals and policies between regulation and litigation)

Baker v. Chevron USA Inc., 680 F. Supp. 2d 865, 880 (S.D. Ohio 2010) (“[t]he mere fact that Plaintiffs were exposed to [the product] in excess of mandated limits is insufficient to establish causation”; rejecting Dr. Dahlgren’s opinion and its reliance upon a “one-hit” or “no threshold” theory of causation in which exposure to one molecule of a cancer-causing agent has some finite possibility of causing a genetic mutation leading to cancer, a theory that may be accepted for purposes of setting regulatory standards, but as reliable scientific knowledge; ‘‘regulatory agencies are charged with protecting public health and thus reasonably employ a lower threshold of proof in promulgating their regulations’’)

Eighth Circuit

Glastetter v. Novartis Pharms. Corp., 107 F. Supp. 2d 1015, 1036 (E.D. Mo. 2000) (“[T]he [FDA’s] statement fails to affirmatively state that a connection exists between [the drug] and the type of injury in this case.  Instead, it states that the evidence received by the FDA calls into question [drug’s] safety, that [the drug] may be an additional risk factor. . .and that the FDA had new evidence suggesting that therapeutic use of [the drug] may lead to serious adverse experiences.  Such language does not establish that the FDA had concluded that [the drug] can cause [the injury]; instead, it indicates that in light of the limited social utility of [the drug for the use at issue] and the reports of possible adverse effects, the drug should no longer be used for that purpose.”) (emphasis in original), aff’d, 252 F.3d 986, 991 (8th Cir. 2001) (FDA’s precautionary decisions on labeling are not a determination of causation of specified adverse events; “methodology employed by a government agency results from the preventive perspective that the agencies adopt”)(“The FDA will remove drugs from the marketplace upon a lesser showing of harm to the public than the preponderance-of-the-evidence or the more-like-than-not standard used to assess tort liability . . . . [Its] decision that [the drug] can cause [the injury] is unreliable proof of medical causation.”)

Wright v.Williamette Indus., Inc., 91 F.3d 1105, 1107 (8th Cir. 1996)

Nelson v. Am. Home Prods. Corp., 92 F. Supp. 2d 954, 958 (W.D. Mo. 2000) (FDA’s precautionary decisions on labeling are not a determination of causation of specified adverse events)

National Bank of Commerce v. Associated Milk Producers, Inc., 22 F. Supp. 2d 942, 961 (E.D.Ark. 1998), aff’d, 191 F.3d 858 (8th Cir. 1999)

Junk v. Terminix International Co., 594 F. Supp. 2d 1062, 1071 (S.D. Iowa 2008) (“government agency regulatory standards are irrelevant to [plaintiff’s] burden of proof in a toxic tort cause of action because of the agency’s preventative perspective”)

Ninth Circuit

Lopez v. Wyeth-Ayerst Labs., Inc., 1998 WL 81296, at *2 (9th Cir. Feb. 25, 1998) (FDA’s precautionary decisions on labeling are not a determination of causation of specified adverse events)

Tenth Circuit

Hollander v. Shandoz Pharm. Corp., 95 F. Supp. 2d 1230, 1239 (W.D. Okla. 2000) (distinguishing FDA’s threshold of proof as lower than appropriate in tort law), aff’d in relevant part, 289 F.3d 1193, 1215 (10th Cir. 2002)

Mitchell v. Gencorp Inc., 165 F.3d 778, 783 n.3 (10th Cir. 1999) (state administrative finding that product was a carcinogen was based upon lower administrative standard than tort standard)

In re Breast Implant Litig., 11 F. Supp. 2d 1217, 1229 (D.Colo. 1998)

Eleventh Circuit

Rider v. Sandoz Pharm. Corp., 295 F.3d 1194, 1201 (11th Cir. 2002)(FDA may take regulatory action, such as revising warning labels or withdrawing drug from the market ‘‘upon a lesser showing of harm to the public than the preponderance-of-the-evidence or more-likely-than-not standard used to assess tort liability’’)(“A regulatory agency such as the FDA may choose to err on the side of caution. Courts, however, are required by the Daubert trilogy to engage in objective review of the evidence to determine whether it has sufficient scientific basis to be considered reliable.”)

McClain v. Metabolife Internat’l, Inc., 401 F.3d 1233, 1248-1250 (11th Cir. 2005)(ephedra)( “[U]se of FDA data and recommendations raises a more subtle methodological issue in a toxic tort case. The issue involves identifying and contrasting the type of risk assessment that a government agency follows for establishing public health guidelines versus an expert analysis of toxicity and causation in a toxic tort case.’’)

Siharath v. Sandoz Pharm. Corp., 131 F. Supp. 2d 1347, 1370 (N.D. Ga. 2001)(“The standard by which the FDA deems a drug harmful is much lower than is required in a court of law.  The FDA’s lesser standard is necessitated by its prophylactic role in reducing the public’s exposure to potentially harmful substances.”)

In re Seroquel Products Liab. Litig., 601 F. Supp. 2d 1313, 1315 (M.D. Fla. 2009)(noting that administrative agencies “impose[] different requirements and employ[] different labeling and evidentiary standards” because a “regulatory system reflects a more prophylactic approach” than the common law)

STATES

New York

Parker v. Mobil Oil Corp., 7 N.Y.3d 434, 450, 857 N.E.2d 1114, 1122, 824 N.Y.S.2d 584 (N.Y. 2006) (“standards promulgated by regulatory agencies as protective measures are inadequate to demonstrate legal causation”)

In re Bextra & Celebrex, 2008 N.Y. Misc. LEXIS 720, *20, 239 N.Y.L.J. 27 (2008) (characterizing FDA Advisory Panel recommendations as regulatory standard and protective measure).

Ohio

Valentine v. PPG Industries, Inc., 821 N.E.2d 580, 597-98 (Ohio App. 2004), aff’d, 850 N.E.2d 683 (Ohio 2006).

Pennsylvania

Betz v. Pneumo Abex LLC, 44 A. 3d 27 (Pa. 2012).

Texas

Exxon Corp. v. Makofski, 116 S.W.3d 176, 184-85 (Tex. App. 2003)

Open Admissions for Expert Witnesses in Chantix Litigation

September 1st, 2012

Chantix is medication that helps people stop smoking.  Smoking kills people, but make a licensed drug and the lawsuits will come.

Earlier this month, Judge Inge Prytz Johnson, the MDL trial judge in the Chantix litigation, filed an opinion that rejected Pfizer’s challenges to plaintiffs’ general causation expert witnesses.  Memorandum Opinion and Order, In re Chantix (Varenicline) Products Liability Litigation, MDL No. 2092, Case 2:09-cv-02039-IPJ Document 642 (N.D. Ala. Aug. 21, 2012)[hereafter cited as Chantix].

Plaintiffs claimed that Chantix causes depression and suicidality, sometimes severe enough to result in suicide, attempted or completed.  Chantix at 3-4.  Others have written about Judge Johnson’s decision.  See Lacayo, “Win Some, Lose Some: Recent Federal Court Rulings on Daubert Challenges to Plaintiffs’ Experts,” (Aug. 30, 2012).

The breadth and depth of error of the trial court’s analysis, or lack thereof, remains, however, to be explored.

 

STATISTICAL SIGNIFICANCE

The Chantix MDL court notes several times that the defendant “harped” on this or that issue; the reader might think the defendant was a music label rather than a pharmaceutical manufacturer.  One of the defendant’s chords that failed to resonate with the trial judge was the point that the plaintiffs’ expert witnesses relied upon statistically non-significant results.  Here is how the trial court reported the issue:

“While the defendant repeatedly harps on the importance of statistically significant data, the United States Supreme Court recently stated that ‘[a] lack of statistically significant data does not mean that medical experts have no reliable basis for inferring a causal link between a drug and adverse events …. medical experts rely on other evidence to establish an inference of causation.’ Matrixx Initiatives, Inc. v. Siracsano, 131 S.Ct. 1309, 1319 (2011).”

Chantix at 22.

Well, it was only a matter of time before the Supreme Court’s dictum would be put to this predictably erroneous interpretation.  SeeThe Matrixx Oversold” (April 4, 2011).

Matrixx involved a motion to dismiss the complaint, which the trial court granted, but the Ninth Circuit reversed.  No evidence was offered; nor was any ruling that evidence was unreliable or insufficient at issue. The Supreme Court affirmed the Circuit on the issue whether pleading statistical significance was necessary.  Matrixx Initiatives took this position in the hopes of avoiding the merits, and so the issue of causation was never before the Supreme Court.  A unanimous Supreme Court held that because FDA regulatory action does not require reliable evidence to support a causal conclusion, pleading materiality for a securities fraud suit does not require an allegation of causation, and thus does not require an allegation of statistically significant evidence. Everything that the Court said about statistical significance and causation was obiter dictum, and rather ill-considered dictum at that.

The Supreme Court thus wandered far beyond its holding to suggest that courts “frequently permit expert testimony on causation based on evidence other than statistical significance.” Matrixx Initiatives, Inc. v. Siracsano, 131 S.Ct. 1309, 1319 (2011) (citing Wells v. Ortho Pharm. Corp., 788 F.2d 741, 744-745 (11th Cir.1986)).  But the Supreme Court’s citation to Wells, in Justice Sotomayor’s opinion, failed to support the point she was trying to make, or the decision that the trial court announced in Chantix.

Wells involved a claim of birth defects caused by the use of spermicidal jelly contraceptive.  At least one study reported a statistically significant increase in detected birth defects over the expected rate.  Wells v. Ortho Pharmaceutical Corp., 615 F. Supp. 262 (N.D.Ga. 1985), aff’d, and rev’d in part on other grounds, 788 F.2d 741 (11th Cir.), cert. denied, 479 U.S.950 (1986).  Wells is not an example of a case in which an expert witness opined about causation in the absence of a scientific study with statistical significance. Of course, finding statistical significance is just the beginning of assessing the causality of an association; the Wells case was and remains notorious for the expert witness’s poor assessment of all the determinants of scientific causation, including the validity of the studies relied upon.

The Wells decision was met with severe criticism in the 1980s.  The decision was widely criticized for its failure to evaluate the entire evidentiary display, as well as for its failure to rule out bias and confounding in the studies relied upon by the plaintiff.  See, e.g., James L. Mills and Duane Alexander, “Teratogens and ‘Litogens’,” 15 New Engl. J. Med. 1234 (1986); Samuel R. Gross, “Expert Evidence,” 1991 Wis. L. Rev. 1113, 1121-24 (1991) (“Unfortunately, Judge Shoob’s decision is absolutely wrong. There is no scientifically credible evidence that Ortho-Gynol Contraceptive Jelly ever causes birth defects.”). See also Editorial, “Federal Judges v. Science,” N.Y. Times, December 27, 1986, at A22 (unsigned editorial);  David E. Bernstein, “Junk Science in the Courtroom,” Wall St. J. at A 15 (Mar. 24,1993) (pointing to Wells as a prominent example of how the federal judiciary had embarrassed the American judicial system with its careless, non-evidence based approach to scientific evidence). A few years later, another case in the same judicial district, against the same defendant, for the same product, resulted in the grant of summary judgment.  Smith v. Ortho Pharmaceutical Corp., 770 F. Supp. 1561 (N.D. Ga. 1991) (supposedly distinguishing Wells on the basis of more recent studies).

Neither the Justices in Matrixx Initiatives nor the trial court in Chantix can be excused for their poor scholarship, or their failure to note that Wells was overruled sub silentio by the Supreme Court’s own subsequent decisions in Daubert, Joiner, Kumho Tire, and Weisgram.  And if the weight of precedent did not kill the concept, then there is the simple matter of a supervening statute:  the 2000 amendment of Rule 702, of Federal Rules of Evidence.

 

CONFUSING REGULATORY ACTION WITH CAUSAL ASSESSMENTS

The Supreme Court in Matrixx Initiatives was careful to distinguish causal judgments from regulatory action, but then went on in dictum to conflate the two.  The trial judge in Chantix showed no similar analytical care.  Judge Johnson held that the asserted absence of statistical significance was not a basis for excluding plaintiffs’ expert witnesses’ opinions on general causation.  Her Honor adverted to the Matrixx Initiatives dictum that the FDA “does not apply any single metric for determining when additional inquiry or action is necessary.” Matrixx, 131 S.Ct. at 1320.  Chantix at 22.  Judge Johnson noted

“that ‘[n]ot only does the FDA rely on a wide range of evidence of causation, it sometimes acts on the basis of evidence that suggests, but does not prove, causation…. the FDA may make regulatory decisions against drugs based on postmarketing evidence that gives rise to only a suspicion of causation’.  Matrixx, id. The court declines to hold the plaintiffs’ experts to a more exacting standard as the defendant requests.”

Chantix at 23.

In the trial court’s analysis, the difference between regulatory action and civil litigation fact adjudication is obliterated.  This, however, is not the law of the United States, which has consistently acknowledged the difference. See, e.g., IUD v. API, 448 U.S. 607, 656 (1980)(“agency is free to use conservative assumptions in interpreting the data on the side of overprotection rather than underprotection.”)

As the Second Edition of the Reference Manual on Scientific Evidence (which was the out-dated edition cited by the court in Chantix) explains:

“[p]roof of risk and proof of causation entail somewhat different questions because risk assessment frequently calls for a cost-benefit analysis. The agency assessing risk may decide to bar a substance or product if the potential benefits are outweighed by the possibility of risks that are largely unquantifiable because of presently unknown contingencies. Consequently, risk assessors may pay heed to any evidence that points to a need for caution, rather than assess the likelihood that a causal relationship in a specific case is more likely than not.”

Margaret A. Berger, “The Supreme Court’s Trilogy on the Admissibility of Expert Testimony,” in Reference Manual On Scientific Evidence at 33 (Fed. Jud. Ctr. 2d. ed. 2000).

 

CONCLUSIONS VS. METHODOLOGY

Judge Johnson insisted that the “court’s focus was solely on the principles and methodology, not on the conclusions they generate.” Chantix at 9.  This insistence, however, is contrary to the established law of Rule 702.

Although the United States Supreme Court attempted, in Daubert, to draw a distinction between the reliability of an expert witness’s methodology and conclusion, that Court soon realized that the distinction was flawed. If an expert witness’s proffered testimony is discordant from regulatory and scientific conclusions, a reasonable, disinterested scientists would be led to question the reliability of the testimony’s methodology and its inferences from facts and data, to its conclusion.  The Supreme Court recognized this connection in General Electric v. Joiner, and the connection between methodology and conclusions was ultimately incorporated into a statute, the revised Federal Rule of Evidence 702:

“[I]f scientific, technical or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training or education, may testify thereto in the form of an opinion or otherwise, if

  1. the testimony is based upon sufficient fact or data,
  2. the testimony is the product of reliable principles and methods; and
  3. the witness has applied the principles and methods reliably to the facts.”

When the testimony is a conclusion about causation, the Rule 702 directs an inquiry into whether that conclusion is based upon sufficient fact or data, and whether that conclusion is the product of reliable principles and methods.  The court’s focus should indeed be on the conclusion as well the methodology claimed to generate the conclusion.  The Chantix MDL court thus ignored the clear mandate of a statute, Rule 702(1), and applied dictum from Daubert, superseded by Joiner, and an Act of Congress.  The ruling is thus legally invalid to the extent it departs from the statute.

 

EPIDEMIOLOGY

For obscure reasons, Judge Johnson sought to deprecate the need to rely upon epidemiologic studies, whether placebo-controlled clinical trials or observational studies.  See Chantix at 25 (citing Rider v. Sandoz Pharm. Corp., 295 F.3d 1194, 1198-99 (11 Cir.2002)). Of course, the language cited in Rider came from a pre-Daubert, pre-Joiner, case, Wells v. Ortho Pharm. Corp., 788 F.2d 741, 745 (11th Cir.1986) (holding that “a cause-effect relationship need not be clearly established by animal or epidemiological studies”).  This dubious legal lineage cannot support the glib dismissal of the need for epidemiologic evidence.

 

WEIGHT OF THE EVIDENCE (WOE)

According to Judge Johnson, plaintiffs’ expert witness Shira Kramer considered all the evidence relevant to Chantix and neuropsychiatric side effects, in what Kramer described as a “weight of the evidence” analysis.  Chantix at 26.  In her report, Kramer had written that determinations about the weight of evidence are “subjective interpretations” based upon “various lines of scientific evidence. Id. (citing and quoting Kramer’s report). Kramer also claimed that every scientist “brings a unique set of experiences, training and expertise …. Philosophical differences exist between experts…. Therefore, it is not surprising that differences of opinion exist among scientists. Such differences of opinion are not necessarily evidence of flawed scientific reasoning or methodology, but rather differences in judgment between scientists.” Id.

Without any support from scientific literature, or the Reference Manual on Scientific Evidence, Judge Johnson accepted Kramer’s explanation of a totally subjective, unprincipled approach as a scientific methodology.  Not surprisingly, Judge Johnson cited the First Circuit’s embrace of a similar vacuous embrace of a WOE analysis in Milward v. Acuity Specialty Products Group, Inc. 639 F.3d 11, 22 (1st Cir. 2011).  Chantix at 51.

 

CHERRY PICKING

Judge Johnson noted, contrary to her earlier suggestion that Shira Kramer had considered all the studies, that Kramer had excluded data from her analysis.  Kramer’s basis for excluding data may have been based upon pre-specified exclusionary principles, or they may have been completely ad hoc, as were the lack of weighting principles in her WOE analysis.  In its gatekeeping role, however, the trial court expressed complete indifference to Kramer’s selectivity in excluding data.  “Why Dr. Kramer chose to include or exclude data from specific clinical trials is a matter for cross-examination.”  Chantix at 27.  This indifference is an abdication of the court’s gatekeeping responsibility.

 

POWER

The trial court attempted to justify its willingness to mute defendant’s harping on statistical significance by adverting to the concept of statistical power:

“Oftentimes, epidemiological studies lack the statistical power needed for definitive conclusions, either because they are small or the suspected adverse effect is particularly rare. Id. [Michael D. Green et al., “Reference Guide on Epidemiology,” in Reference Manual on Scientific Evidence 333, 335 (Fed. Judicial Ctr. 2d ed. 2000)… .

Chantix at 29 n.16.

To be fair to the trial court, the Reference Manual invited this illegitimate use of statistical power because it, at times, omits the specification that statistical power requires not only a level of statistical significance to be attained, but also a specified alternative hypothesis to assess power.  See Power in the Courts — Part One; Power in the Courts — Part Two.  The trial court offered no alternative hypothesis against which any measure of power was to be assessed.

Judge Johnson did not report any power analyses, and she certainly did not report any quantification of power or lack thereof against some specific alternative hypothesis.  Judge Johnson’s invocation of power was just that – power used arbitrarily, without data, evidence, or reason.

 

CONFIDENCE INTERVALS

As with the invocation of statistical power, the trial also invoked the concept of confidence intervals to suggest that such intervals provide a more refined approach to assessing statistical significance:

“A study found to have ‘results that are unlikely to be the result of random error’ is ‘statistically significant’. Reference Guide on Epidemiology, supra, at 354. Statistical significance, however, does not indicate the strength of an association found in a study. Id. at 359. ‘A study may be statistically significant but may find only a very weak association; conversely, a study with small sample sizes may find a high relative risk but still not be statistically significant.’ Id. To reach a ‘more refined assessment of appropriate inferences about the association found in an epidemiologic study’, researchers rely on another statistical technique known as a confidence interval’. Id. at 360.”

Chantix at 30 n.17.  True, true, but immaterial.  The trial court, again, never carries through with the direction given by the Reference Manual.  Not a single confidence interval is presented.  No confidence intervals are subjected to this more refined assessment.  Why have more refined assessments when even the cruder assessments are not done?

 

OPEN ADMISSIONS IN SCHOOL OF EXPERT WITNESSING

The trial court somehow had the notion that all it had to do was state that every disputed fact and opinion went to the weight not the admissibility, and then pass to a presumably more scientifically literate jury.  To be sure, the court engaged in a good deal of hand waving, going through the motions of deciding a contested issues.  Not only did the Judge Johnson smash poor Pfizer’s harp, Her Honor unhinged the gate that federal judges are supposed to keep.  Chantix declares that it is now open admissions for expert witnesses testifying to causation in federal cases.  This is a judgment in search of an appeal.