Sometimes when federal courts permit dubious causation opinion testimony over Rule 702 objections, the culprit is bad lawyering by the opponent of the proffered testimony. Allen v. Martin Surfacing, 263 F.R.D. 47 (D. Mass. 2009), may be an important example.
THE CLAIMS
Daniel Allen was the former football coach of the College of The Holy Cross, in Worcester, Massachusetts. In spring of 2001, defendant Martin Surfacing refinished the gymnasium floor at the college. Coach Allen was exposed to solvent fumes, including toluene fumes, during defendant’s work, as well as for a couple of months afterwards. While exposed, Allen experienced “dizziness, headaches, and disorientation.” 263 F.R.D. at 51. After the gym floor resurfacing was completed, Allen experienced other symptoms, such as fatigue, muscle weakness, and fasciculations in his lower limbs. In January 2002, at the age of 45, Allen was diagnosed with amyotrophic lateral sclerosis (ALS). Id. Allen’s condition progressed, and he died three years later, in May 2004. Id. at 52.
Allen’s family sued for wrongful death. The parties’ apparently agreed on the following:
- ALS occurs as a sporadic ALS, as well as “familial ALS,”
- the cause of sporadic ALS is unknown,
- Allen developed and died of sporadic ALS,
- no air sampling established overexposure to any chemical,
- there were no reliable exposure models to quantify Allen’s exposures,
- there are no known causes of sporadic ALS, and
- toluene did not cause Allen’s ALS
Remarkably, defendant lost the Rule 702 challenge to plaintiffs’ expert witnesses’ opinion testimony. It is easy to suspect that the district judge was sleep at the gate, and that his gatekeeping was deficient. A close read of the opinion supports the view that this was not Rule 702’s finest moment, but much more was going on to get to admissibility.
First, the plaintiffs’ counsel cleverly avoided running into a wall by avoiding a claim that toluene caused Allen’s ALS. Instead, plaintiffs’ claimed that toluene accelerated the onset of the disease. This claim was equally dubious, but it allowed the expert witnesses to avoid a mountain of medical opinion, authoritative and well-supportive, that there is no known cause of sporadic ALS.
Second, the plaintiffs’ counsel took the initiative by filing an affirmative motion to admit the testimony of their expert witnesses. Rather than ceding the initiative to the defendant, the plaintiffs seized the initiative and had the first and last word on admissibility. As a result, plaintiffs were able to present and frame their witnesses’ opinions sympathetically rather than defensively.
Third, the plaintiffs had the good fortune of the defendant’s counsel’s apparent failure to find the key fallacies, invalidities, and flaws in plaintiffs’ questionable expert witness opinions.
The Allen case teaches that sometimes good lawyering can win a losing case.
The plaintiffs’ counsel retained and presented an array of expert witnesses who might be the usual suspects in a district court’s exclusion of expert witness testimony:
None of these four expert witnesses was a specialist in ALS or ALS causation; none was a neurologist; none had ever addressed ALS causation in a peer-reviewed article. All four witnesses were frequent testifiers in tort litigation, and some have are repeat offenders when it comes to offering questionable or excludable opinion testimony. Somehow, the defense dashed this opportunity by retaining only one expert, Dean M. Hashimoto, M.D., J.D., M.P.H., who was also not a specialist in ALS, who was not a neurologist, and who had never published anything on ALS. And to make matters worse, the defense proceeded to challenge the plaintiffs’ expert witnesses for lack of qualifications!
The defense’s challenges to qualifications takes up a good deal of Judge Saylor’s published opinion, which illustrates the maxim that judges have short attention spans, and you should not waste the opportunity of a motion on an issue that is so easily decided against you. The scientific issues are difficult and the temptation to avoid them is great. By leading with an issue that will almost certainly lose, the defense wasted a valuable advocacy opportunity to show the court the fallacious reasoning in the plaintiffs’ case. By submitting reports from only one expert witness, who had all the deficiencies claimed in the plaintiffs’ set of witnesses, the defense exhibited a duplicity that must have seriously undermined its credibility for the entire set of Rule 702 motion issues.
THE WITNESSES
Dr. Christine Oliver has been testifying in asbestos and other occupational lung disease cases for decades. She is a pulmonary physician on staff at Massachusetts General Hospital, in Boston, and an associate professor of clinical medicine at the Harvard Medical School. She is board certified in internal medicine and in occupational medicine (American Board of Preventive Medicine), and her clinical interests are asthma occupational lung disease, and health hazards of construction work. If the defense had presented real expert witnesses in ALS causation, Dr. Oliver’s expertise would have seemed quite irrelevant. Dr. Oliver has, as well as I can determine, never researched or published on ALS causation. She has, however, published on “multiple chemical sensitivity,” which should give a disinterested court some pause. See L. Christine Oliver and Alison Johnson, “Multiple Chemical Sensitivity: Reflections” (Nov. 4, 2011).
Richard Clapp, professor emeritus at the Boston University School of Public Health, is a known purveyor of dubious courtroom testimony. See, e.g., Sutera v. The Perrier Group of America Inc., 986 F.Supp. 655 (D. Mass. 1997). He is a frequent testifier and a charter member of the surreptitiously funded SKAPP organization. Clapp is a non-physician epidemiologist, who has never published on ALS.
Marcia Ratner Ph.D. may be best known for her possession of mace and an unlicensed gun, but she does occasionally show up in civil litigation as an expert witness. See “Quincy District Court News,” Patriot Ledger June 09, 2010 (reporting that Ratner pleaded guilty to criminal possession of mace and a firearm).
Ratner is a postdoctoral researcher at Boston University, where she works as a neurotoxicologist. She does not appear to have ever published a peer-reviewed paper on ALS or ALS causation. Plaintiffs’ counsel claimed that she was researching a new drug with therapeutic potential for ALS treatment, although they were quite sketchy about details. Ratner does not appear to hold any NIH grants for ALS drug research.
[Please see update on the discussion of Dr. Ratner at http://schachtmanlaw.com/gatekeeping-in-allen-v-martin-surfacing-postscript/]
William Ewing, an industrial hygienist, frequently testifies in asbestos litigation. He offered no opinion on causation.
Against this field of witnesses, the defense punted on presenting its own witness with relevant expertise. Dr. Dean M. Hashimoto, the defense’s sole witness on causation, is a physician, lawyer, and has a master’s degree in occupational health. Hashimoto has no specialized training in ALS or clinical neurology, although he serves on the Massachusetts Workers’ Compensation Board. A pubmed search shows that Hashimoto has never published on the neurology or causation of ALS.
CAUSATION
The plaintiffs had a huge problem to avoid: ALS has no known cause. Counsel table could be filled up with textbooks and review articles, but perhaps the following, lengthy quote from the National Institute for Neurological Disorders and Stroke website suffices to make the point:
“What causes ALS?
The cause of ALS is not known, and scientists do not yet know why ALS strikes some people and not others. An important step toward answering that question came in 1993 when scientists supported by the National Institute of Neurological Disorders and Stroke (NINDS) discovered that mutations in the gene that produces the SOD1 enzyme were associated with some cases of familial ALS. This enzyme is a powerful antioxidant that protects the body from damage caused by free radicals. Free radicals are highly reactive molecules produced by cells during normal metabolism. If not neutralized, free radicals can accumulate and cause random damage to the DNA and proteins within cells. Although it is not yet clear how the SOD1 gene mutation leads to motor neuron degeneration, researchers have theorized that an accumulation of free radicals may result from the faulty functioning of this gene. In support of this, animal studies have shown that motor neuron degeneration and deficits in motor function accompany the presence of the SOD1 mutation.
Studies also have focused on the role of glutamate in motor neuron degeneration. Glutamate is one of the chemical messengers or neurotransmitters in the brain. Scientists have found that, compared to healthy people, ALS patients have higher levels of glutamate in the serum and spinal fluid. Laboratory studies have demonstrated that neurons begin to die off when they are exposed over long periods to excessive amounts of glutamate. Now, scientists are trying to understand what mechanisms lead to a buildup of unneeded glutamate in the spinal fluid and how this imbalance could contribute to the development of ALS.
Autoimmune responses—which occur when the body’s immune system attacks normal cells—have been suggested as one possible cause for motor neuron degeneration in ALS. Some scientists theorize that antibodies may directly or indirectly impair the function of motor neurons, interfering with the transmission of signals between the brain and muscles.
In searching for the cause of ALS, researchers have also studied environmental factors such as exposure to toxic or infectious agents. Other research has examined the possible role of dietary deficiency or trauma. However, as of yet, there is insufficient evidence to implicate these factors as causes of ALS.
Future research may show that many factors, including a genetic predisposition, are involved in the development of ALS.”
NINDS – “Amyotrophic Lateral Sclerosis (ALS) Fact Sheet.”
As a result, the plaintiffs adopted a strategy of confession and avoidance; they renounced any claim that they were asserting a causal claim. Instead, they insisted that they were “merely” claiming that toluene exposure had accelerated the onset of sporadic ALS in Coach Allen. This mere claim, however, was actually a causal claim in disguise, and the district judge was taken in by the ruse. If plaintiffs were claiming that toluene can accelerate the onset of ALS by a meaningful period of time (years), then they were making a causal claim, legally and scientifically. A shift in the age of onset of a sporadic disease is a causal claim, and it requires supporting evidence, not hand waving.
PLAUSIBLE MECHANISM
One scientist could postulate a reasonable mechanism even for a sporadic disease. Professional journals and textbooks are filled with such speculation. These postulations are part of science in that they inform research hypotheses and funding, but they are not conclusions of causality. The quote above from the NINDS discusses the lack of an anti-oxidizing enzyme and glutamate toxicity as potential mechanisms in familial ALS, but even there, the authors are appropriately modest in avoiding a claim to know the pathogenesis of familial ALS.
The plaintiffs’ approach was to take the suggestion of a mechanism, misrepresent it as a known mechanism, and then claim that toluene activated glutamate toxicity and exercised an oxidizing effect on neurons. The plaintiffs’ team had no basis for claiming that short-term exposure to solvents, or toluene specifically, translated into a toxicity to the relevant human motor neurons that are involved in ALS. It is a long stretch from suggesting a mechanism to documenting the mechanism to be actually at work in producing, or accelerating, a disease in humans.
A typical statement, from the Yale School of Medicine, Division of Neurology, in 2012:
“Why the motor neurons begin to die is still unknown. Recent evidence, however, have implicated glutamate excitotoxicity, free radical toxicity, and mitochondrial dysfunction as possible mechanisms, and this is an area of active research.”
“Amyotrophic Lateral Sclerosis (ALS)” (emphasis added). See also Adams and Victor’s Principles of Neurology 1157-58 (7th ed. 2001) (noting that the pathogenesis of ALS and similar motor neuron diseases is not known).
The district judge seemed mesmerized by Ratner’s having providing a biologically plausible theory for tying ALS progression to toluene exposure. 263 F.R.D. at 60. Judge Saylor stated that the defense did not address any flaw in Ratner’s methodology other than to point out that her theory was not supported by epidemiology. The court seemed to equate providing a plausible theory with establishing a scientific conclusion. More to the point, the court was truly asleep at its gatekeeping task because Ratner’s theory actually presupposed that she knew that Coach Allen was going to develop ALS in any event, only not as early as 2001. The court faulted the defense for not showing that Ratner’s (and the other plaintiffs’ witnesses’) theory was unreliable, but the burden was on the plaintiffs to show reliability. Id. The court not only faulted the defense for carrying a burden it did not have, but it overlooked the very telling criticisms of Ratner’s theories of acceleration and mechanism.
EXCUSES – EPIDEMIOLOGY
Plaintiffs’ expert witnesses had a welter of excuses as to why there was no epidemiologic data to support their theories. The absence of statistical significance, according to plaintiffs’ expert witnesses does not mean that a study should be disregarded. Id. at 58. Their claim is superficially true, but a study not disregarded does not necessarily support a causal inference, either alone or conjunction with other such studies. Similarly, plaintiffs’ claim that flawed studies should not be disregarded is also a half truth. A flawed study may lead to a much better one, which can support valid inferences. Flawed studies are thus part of the scientific process because they may lead to a self-correcting triangulation of the truth, but there is little to recommend relying upon flawed studies to support scientific conclusions of causality. Nevertheless, the district court appeared to swallow these half truths, whole.
Ratner also advanced a claim that the acceleration theory had not been subjected to epidemiologic analysis because of “funding limitations, as most funding goes toward finding treatment or cures for the disease, not towards finding what accelerates the course of the disease.” Id. at 59 n. 14. The district court repeats this excuse without critical thought. If a commonly used solvent such as toluene accelerated the onset of a terrible disease such as ALS by decades, such a putative effect would be amenable to epidemiologic analysis and would be a source of incredible concern and funding efforts by the NIH, NINDS, NIEHS, and other granting agencies and organizations. Despite excusifying verbiage, Ratner maintained that there were no epidemiologic data that refuted her novel acceleration. Id. at 59. Of course, if her excuses were taken seriously, then this absence of refutation was fairly irrelevant, but in any event, this supposed absence could not support the reliability of Ratner’s inferences or conclusions.
The defense focused on the lack of short-term exposures in epidemiologic studies, and also the lack of statistical significance in some studies. What appears to have been missing from both sides was a comprehensive analysis of the available epidemiologic data. If long-term exposure were associated with earlier age of onset of ALS, or even a greater risk of ALS, then it would have given some support to Ratner’s novel theory. The defense appeared to punt on the epidemiology by claiming its irrelevance. It might have been helpful to point out internal as well as external validity issues to the court.
As for both sides citing different studies, and no side presenting a comprehensive view of the epidemiologic evidence, the court could have given some consideration to the ethical considerations of the incomplete presentation:
“Basis of Expert Medical Testimony
The testimony of an expert medical witness should be founded on a thorough and critical review of the pertinent medical and scientific facts, available data, and relevant literature.”
Ethical Guidelines for Occupational and Environmental Medicine Physicians Serving as Expert Witnesses (Oct. 25, 2007).
DIFFERENTIAL DIAGNOSIS
The plaintiffs’ claim that they were not asserting causation was disingenuous. As noted above, acceleration of onset is a form of causation. Of course, exposure to a neurotoxic material, with some symptoms, might have made Allen more aware of other symptoms, and so the time to diagnosis was abbreviated. The plaintiffs, however, were claiming more than earlier ascertainment; they claimed the toluene exposure caused an underlying disease process to accelerate.
Oliver actually went further and performed an invalid differential etiologic analysis. Oliver reviewed medical records and claimed to have applied “differential diagnosis to the review.” Id. at 63. This claim was quite bogus because there was no dispute that Allen had and died of ALS, but the district court was beguiled. Having ruled out family history, Oliver claimed to then rule out other “putative causes” of ALS: “pesticides and agricultural chemicals containing solvents, 60-hertz magnetic fields, and welding fumes.” Id. at 63. In one fell swoop, Oliver created several known causes to be ruled out, and then ruled them out in Allen’s case. This is remarkable given that NINDS and most of medical sciences does not recognize any known or putative causes of sporadic ALS, and that Oliver failed to rule out the one potential cause that some scientists take seriously: cigarette smoking. See, e.g., Hao Wang, Éilis J. O’Reilly, Marc G. Weisskopf, Giancarlo Logroscino, Marji L. McCullough, Michael Thun, Arthur Schatzkin, Laurence N. Kolonel, Alberto Ascherio, “Smoking and risk of amyotrophic lateral sclerosis: a pooled analysis of 5 prospective cohorts” 68 Arch. Neurol. 207 (2011); A. Alonso, G. Logroscino, M.A. Hernán, “Smoking and the risk of amyotrophic lateral sclerosis: a systematic review and meta-analysis,” 81 J. Neurol. Neurosurg. & Psychiatry 1249 (2010); F. Fang & W. Ye, “Smoking may be considered an established risk factor for sporadic ALS,” 74 Neurology 1927 (2010).
Of course, Oliver, and the entire plaintiffs’ expert witness team failed to rule out the most obvious, most prevalent explanation for Allen’s ALS: unknown.
GENETIC SUSCEPTIBILITY
Ratner testified “to a reasonable degree of scientific certainty that Allen was genetically predisposed to develop ALS and would have developed and died from ALS later in his life.” 263 F.R.D. at 61. This assertion was truly an incredible, unsupported, unverifiable, and unfalsifiable statement. If a drug company ever made a similarly unsupported claim in an electronically transmitted document, the Department of Justice would prosecute it for wire fraud. United States v. Harkonen, 2010 WL 2985257 (N.D. Calif. 2010).
The parties had essentially stipulated that Allen did not suffer from familial ALS, and neither Ratner nor anyone else identified any gene that was responsible for his “susceptibility.” The district court, of course, did not report how Ratner could possibly have known that Allen was going to develop ALS, only at some unspecified date later than the date when Allen first became aware of signs and symptoms of motor neuron disease. The district court announced that plaintiffs’ expert witnesses were not propounding “junk science,” but perhaps the heavy perfume helped masquerade the garbage.
POST HOC ERGO PROPTER HOC
The court conclusorily noted, without explanation, that the temporal relationship between exposure and disease manifestation would allow a conclusion of causality:
“Finally, after interpreting the data within a chronological context, the clinician may conclude that the patient’s disease is a neurotoxic illness.”
Id. at 61. The court appears to accept the temporal pattern as sufficient in itself, or with other information, to support the conclusion. This reasoning is fallacious.
AGE OF ONSET
Allen developed ALS when he was 45 years old. Ratner reasoned that the average age of onset was 60, and Allen developed his disease “much earlier than would be expected”; therefore toluene accelerated the onset of Allen’s disease. Id. at 61. The problem is that there is no “therefore” that can reasonably be claimed in the court’s sentence.
Most publications put the mean and median of age of ALS onset around 55 years, but even if the court were to accept Ratner’s reference to 60 as correct, surely the court recognized that half the cases therefore occurred below the age of 60. The question of course is the variability in age of onset, and the court’s opinion is silent about the scatter or distribution of age-of-onset data. Ratner’s reasoning was prima facie invalid unless there was additional information to show a very narrow distribution of age of onset around the mean. It is difficult to discern whether the defense made this point, but Ratner could not have supported this counterfactual claim.
Here is what the ALS association has to say about the issue:
“Most people who develop ALS are between the ages of 40 and 70, with an average age of 55 at the time of diagnosis. However, cases of the disease do occur in persons in their twenties and thirties.”
“Who Gets ALS.”
Ratner essentially conceded that her argument was vacuous and invalid. When confronted at her deposition about whether age of onset greater than the mean would have changed her opinion, she emphatically denied its relevance:
“My opinion would be the same even if that guy died at 60 instead of 75 and had history of this exposure … but you wouldn’t have bothered to depose me in that case… . Somebody else has moved down from where they are to here. But it may not result in a lawsuit, and I wouldn’t be here, because— I wouldn’t be here.”
Ratner Deposition at 172-3.
RULE 702 ANALYSIS
The district court recognized the novelty of Ratner’s analysis, but opined that Ratner, Oliver, and Clapp had provided sufficient cumulative evidence to support their theories. 263 F.R.D. at 61. The trial court apparently conducted a Rule 702 hearing, over three days. Both sides filed what appears to have been extensive briefing and affidavits. There are some huge gaps in the reasoning of the plaintiffs’ expert witnesses, and in the district court’s opinion. Perhaps those gaps could be filled in with volumes of testimony. My unscientific opinion is to doubt it. Although the plaintiffs should have had the burden of showing admissibility, the defendant had the practical burden of illustrating the analytical gaps, ipse dixit, fallacies, and invalid inferences that were before the court. The defense may have indeed pointed out such problems, which were fulsomely present, but the district court’s opinion does not report the obvious defense arguments. Without more background information, it is difficult to evaluate comprehensively the court’s or the defense’s handling of the scientific issues that were clearly before the court on the Rule 702 motions. What is clear from what the district court reports is, however, sufficient to document an unsatisfactory judicial review of the evidence discussed.
