TORTINI

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

Wrong Words Beget Causal Confusion

February 12th, 2018

In clinical medical and epidemiologic journals, most articles that report about associations will conclude with a discussion section in which the authors hold forth about

(1) how they have found that exposure to X “increases the risk” of Y, and

(2) how their finding makes sense because of some plausible (even if unproven) mechanism.

In an opinion piece in Significance,1 Dalmeet Singh Chawla cites to a study that suggests the “because” language frequently confuses readers into believing that a causal claim is being made. The study abstract explains:

Most researchers do not deliberately claim causal results in an observational study. But do we lead our readers to draw a causal conclusion unintentionally by explaining why significant correlations and relationships may exist? Here we perform a randomized study in a data analysis massive online open course to test the hypothesis that explaining an analysis will lead readers to interpret an inferential analysis as causal. We show that adding an explanation to the description of an inferential analysis leads to a 15.2% increase in readers interpreting the analysis as causal (95% CI 12.8% – 17.5%). We then replicate this finding in a second large scale massive online open course. Nearly every scientific study, regardless of the study design, includes explanation for observed effects. Our results suggest that these explanations may be misleading to the audience of these data analyses.”

Leslie Myint, Jeffrey T. Leek, and Leah R. Jager, “Explanation implies causation?” (Nov. 2017) (on line manuscript).

Invoking the principle of charity, these authors suggest that most researchers are not deliberately claiming causal results. Indeed, the language of biomedical science itself is biased in favor of causal interpretation. The term “statistical significance” suggests causality to naive readers, as does stats talk about “effect size,” and “fixed effect models,” for data sets that come no where near establishing causality.

Common epidemiologic publication practice tolerates if not encourages authors to state that their study shows (finds, demonstrates, etc.) that exposure to X “increases the risk” of Y in the studies’ samples. This language is deliberately causal, even if the study cannot support a causal conclusion alone or even with other studies. After all, a risk is the antecedent of a cause, and in the stochastic model of causation involved in much of biomedical research, causation will manifest in a change of a base rate to a higher or lower post-exposure rate. Given that mechanism is often unknown and not required, then showing an increased risk is the whole point. Eliminating chance, bias, confounding, and study design often is lost in the irrational exuberance of declaring the “increased risk.”

Tighter editorial control might have researchers qualify their findings by explaining that they found a higher rate in association with exposure, under the circumstances of the study, followed by an explanation that much more is needed to establish causation. But where is the fun and profit in that?

Journalists, lawyers, and advocacy scientists often use the word “link,” to avoid having to endorse associations that they know, or should know, have not been shown to be causal.2 Using “link” as a noun or a verb clearly implies a causal chain metaphor, which probably is often deliberately implied. Perhaps publishers would defend the use of “link” by noting that it is so much shorter than “association,” and thus saves typesetting costs.

More attention is needed to word choice, even and especially when statisticians and scientists are using their technical terms and jargon.3 If, for the sake of argument, we accept the sincerity of scientists who work as expert witnesses in litigation in which causal claims are overstated, we can see that poor word choices confuse scientists as well as lay people. Or you can just read the materials and methods and the results of published study papers; skip the introduction and discussion sections, as well as the newspaper headlines.


1 Dalmeet Singh Chawla, “Mind your language,” Significance 6 (Feb. 2018).

2 See, e.g., Perri Klass, M.D., “https://www.nytimes.com/2017/12/04/well/family/does-an-adhd-link-mean-tylenol-is-unsafe-in-pregnancy.html,” N.Y. Times (Dec. 4, 2017); Nicholas Bakalar, “Body Chemistry: Lower Testosterone Linked to Higher Death Risk,” N.Y. Times (Aug. 15, 2006).

3 Fang Xuelan & Graeme Kennedy, “Expressing Causation in Written English,” 23 RELC J. 62 (1992); Bengt Altenberg, “Causal Linking in Spoken and Written English,” 38 Studia Linguistica 20 (1984).

PubMed Refutes Courtroom Historians

February 11th, 2018

Professors Rosner and Markowitz, labor historians, or historians laboring in courtrooms, have made a second career out of testifying about other people’s motivations. Consider their pronouncement:

In the postwar era, professionals, industry, government, and a conservative labor movement tried to bury silicosis as an issue.”

David Rosner & Gerald Markowitz, Deadly Dust: Silicosis and the Politics of Occupational Disease in the Twentieth Century America 213 (Princeton 1991); Gerald Markowitz & David Rosner, “Why Is Silicosis So Important?” Chap. 1, at 27, in Paul-André Rosental, ed., Silicosis: A World History (2017). Their accusation is remarkable for any number of reasons,1 but the most remarkable is that their claim is unverified, but readily falsified.2

Previously, I have pointed to searches in Google’s Ngram Book viewer as well as in the National Library of Medicine’s database (PubMed) on silicosis. The PubMed website has now started to provide a csv file, with articles counts by year, which can be opened in programs such as LibreOffice Calc, Excel, etc, and then used to generate charts of the publication counts over time. 

Here is a chart generated form a simple search on <silicosis> in PubMed, with years aggregated over roughly 11 year intervals:

The chart shows that the “professionals,” presumably physicians and scientists were most busy publishing on, not burying, the silicosis issue exactly when Rosner and Markowitz claimed them to be actively suppressing. Many of the included publications grew out of industry, labor, and government interests and concerns. In their book and in their courtroom performances,, Rosner and Markowitz provide mostly innuendo without evidence, but their claim is falsifiable and false.

To be sure, the low count in the 1940s may well result from the relatively fewer journals included in the PubMed database, as well as the growth in the number of biomedical journals after the 1940s. The Post-War era certainly presented distractions in the form of other issues, including the development of antibiotics, chemotherapies for tuberculosis, the spread of poliomyelitis and the development of vaccines for this and other viral diseases, radiation exposure and illnesses, tobacco-related cancers, and other chronic diseases. Given the exponential expansion in scope of public health, the continued interest in silicosis after World War II, documented in the PubMed statistics, is remarkable for its intensity, pace Rosner and Markowitz.


1Conspiracy Theories: Historians, In and Out of Court(April 17, 2013). Not the least of the reasons the group calumny is pertinent is the extent to which it keeps the authors gainfully employed as expert witnesses in litigation.

2 See also CDC, “Ten Great Public Health Achievements – United States, 1900 – 1999,” 48(12) CDC Morbidity and Mortality Weekly Report 241 (April 02, 1999)(“Work-related health problems, such as coal workers’ pneumoconiosis (black lung), and silicosis — common at the beginning of the century — have come under better control.”).

ToxicHistorians Sponsor ToxicDocs

February 1st, 2018

A special issue of the Journal of Public Health Policy waxes euphoric over a website, ToxicDocs, created by two labor historians, David Rosner and Gerald Markowitz (also known as the “Pink Panthers”). The Panthers have gotten their universities, Columbia University and the City University of New York, to host the ToxicDocs website with whole-text searchable documents of what they advertise as “secret internal memoranda, emails, slides, board minutes, unpublished scientific studies, and expert witness reports — among other kinds of documents — that emerged in recent toxic tort litigation.” According to Rosner and Markowitz, they are “constantly adding material from lawsuits involving lead, asbestos, silica, and PCBs, among other dangerous substances.” Rosner and Markowitz are well-positioned to obtain and add such materials because of their long-term consulting and testifying work for the Lawsuit Industry, which has obtained many of these documents in routine litigation discovery proceedings.

Despite the hoopla, the ToxicDocs website is nothing new or novel. Tobacco litigation has spawned several such on-line repositories: Truth Tobacco Industry Documents Library,” Tobacco Archives,” and “Tobacco Litigation Documents.” And the Pink Panthers’ efforts to create a public library of the documents upon which they rely in litigation go back several years to earlier websites. See David Heath & Jim Morris, “Exposed: Decades of denial on poisons. Internal documents reveal industry ‘pattern of behavior’ on toxic chemicals,” Center for Public Integrity (Dec. 4, 2014).

The present effort, however, is marked by shameless self promotion and support from other ancillary members of the Lawsuit Industry. The Special Issue of Journal of Public Health Policy is introduced by Journal editor Anthony Robbins,1 who was a mover and shaker in the SKAPP enterprise and its efforts to subvert judicial assessments of proffered opinions for validity and methodological propriety. In addition, Robbins, along with the Pink Panthers as guest editors, have recruited additional “high fives” and self-congratulatory cheerleading from other members of, and expert witnesses for, the Lawsuit Industry, as well as zealots of the type who can be counted upon to advocate for weak science and harsh treatment for manufacturing industry.2

Rosner and Markowitz, joined by Merlin Chowkwanyun, add to the happening with their own spin on ToxicDocs.3 As historians, it is understandable that they are out of touch with current technologies, even those decades old. They wax on about the wonders of optical character recognition and whole text search, as though it were quantum computing.

The Pink Panthers liken their “trove” of documents to “Big Data,” but there is nothing quantitative about their collection, and their mistaken analogy ignores their own “Big Bias,” which vitiates much of their collection. These historians have been trash picking in the dustbin of history, and quite selectively at that. You will not likely find documents here that reveal the efforts of manufacturing industry to improve the workplace and the safety and health of their workers.

Rosner and Markowitz disparage their critics as hired guns for industry, but it is hard for them to avoid the label of hired guns for the Lawsuit Industry, an industry with which they have worked in close association for several decades, and from which they have reaped thousands of dollars in fees for consulting and testifying. Ironically, neither David Rosner nor Gerald Markowitz disclose their conflicts of interest, or their income from the Lawsuit Industry. David Wegman, in his contribution to the love fest, notes that ToxicDocs may lead to more accurate reporting of conflicts of interest. And yet, Wegman does not report his testimonial adventures for the Lawsuit Industry; nor does Robert Proctor; nor do Rosner and Markowitz.

It is a safe bet that ToxicDocs does not contain any emails, memoranda, letters, and the like about the many frauds and frivolities of the Lawsuit Industry, such as the silica litigation, where fraud has been rampant.4 I looked for but did not find the infamous Baron & Budd asbestos memorandum, or any of the documentary evidence from fraud cases arising from false claiming in the asbestos, silicone, welding, Fen-Phen, and other litigations.5

The hawking of ToxicDocs in the pages of the Journal of Public Health Policy is only the beginning. You will find many people and organizations promoting ToxicDocs on Facebook, Twitter, and LinkedIn. Proving there is no limit to the mercenary nature of the enterprise, you can even buy branded T-shirts and stationery online. Ah America, where even Marxists have the enterpreurial spirit!


1 Anthony Robbins & Phyllis Freeman, “ToxicDocs (www.ToxicDocs.org) goes live: A giant step toward leveling the playing field for efforts to combat toxic exposures,” 39 J. Public Health Pol’y 1 (2018). SeeMore Antic Proposals for Expert Witness Testimony – Including My Own Antic Proposals” (Dec. 30 2014).

2 Robert N. Proctor, “God is watching: history in the age of near-infinite digital archives,” 39 J. Public Health Pol’y 24 (2018); Stéphane Horel, “Browsing a corporation’s mind,” 39 J. Public Health Pol’y 12 (2018); Christer Hogstedt & David H. Wegman, “ToxicDocs and the fight against biased public health science worldwide,” 39 J. Public Health Pol’y 15 (2018); Joch McCulloch, “Archival sources on asbestos and silicosis in Southern Africa and Australia,” 39 J. Public Health Pol’y 18 (2018); Sheldon Whitehouse, “ToxicDocs: using the US legal system to confront industries’ systematic counterattacks against public health,” 39 J. Public Health Pol’y 22 (2018); Elena N. Naumova, “The value of not being lost in our digital world,” 39 J. Public Health Pol’y 27 (2018); Nicholas Freudenberg, “ToxicDocs: a new resource for assessing the impact of corporate practices on health,” 39 J. Public Health Pol’y 30 (2018). These articles are free, open-access, but in this case, you may get what you have paid for.

3 David Rosner, Gerald Markowitz, and Merlin Chowkwanyun, “ToxicDocs (www.ToxicDocs.org): from history buried in stacks of paper to open, searchable archives online,” 39 J. Public Health Pol’y 4 (2018).

4 See, e.g., In re Silica Products Liab. Litig., MDL No. 1553, 398 F.Supp. 2d 563 (S.D.Tex. 2005).

5 See Lester Brickman, “Fraud and Abuse in Mesothelioma Litigation,” 88 Tulane L. Rev. 1071 (2014); Peggy Ableman, “The Garlock Decision Should be Required Reading for All Trial Court Judges in Asbestos Cases,” 37 Am. J. Trial Advocacy 479, 488 (2014).

Fake Friends and Fake Followers

January 28th, 2018

In the Black Mirror production of Nosedive, based upon a short story by Charlie Brooker, a young woman named Lacie lives in a world in which social media approval metrics determine social, economic, and political opportunities. Every interaction is graded on a scale from one to five. Lacie’s approval rating is slipping, thus jeopardizing her participation in her friend’s wedding, and she is determined to improve her rating. She tries her best to be “nice,” and then enlists a ratings coach, but her efforts cannot stop her approval rating from its nosedive. Perhaps if Lacie had greater financial resources, she could have improved her ratings by paying people to like her on social media.

Would people really pay for the appearance of social approval? “Celebrities, athletes, pundits and politicians have millions of fake followers,” and they paid for them. Thus announces the New York Times in an exposé of the practice of paying for followers on social media.1 Perhaps even the President has paid for fake followers who are mere bots. Maybe bots are the only friends he has.

Although I am skeptical of the utility of Facebook and Twitter, I have come reluctantly to admit that these and other social media – even blogs – have some utility if properly used. The business of buying followers, however, is just plain sick.

Finally, Eric Schneiderman has announced an investigation into an issue of some importance. He is investigating Devumi, a company that he claims sells fake followers on social media. The company is alleged to have created over 55,000 bots based upon living people and their identifying features.2

Stealing identities and selling fake followers is deplorable, and Scheiderman’s crusade is a laudable exercise of prosecutorial discretion. But so is buying fake followers to lard up one’s social media metrics. The crime involves two separate criminal acts, and we should not lose sight of the fraudulent nature of the representations about inflated number of followers. It takes two parties to enter the contract to defraud the public. Devumi’s clients may well be in pari delicto.

Let us hope that when Schneiderman opens the books at Devumi, he will have the fortitude to tell us which “celebrities, athletes, pundits, and politicians” have been juking their stats. Schneiderman’s investigation has the promise of making Eliot Spitzer’s commercial transactions look like child’s play. Inquiring minds want to know who would buy a friend or a follower.


1 Nicholas Confessore, Gabriel J.X. Dance, Richard Harris, and Mark Hansen, “The Follower Factory: Everyone wants to be popular online. Some even pay for it. Inside social media’s black market,” N.Y. Times (Jan. 27, 2018).

2 Nicholas Confessore, “New York Attorney General to Investigate Firm That Sells Fake Followers,” N.Y. Times (Jan. 27, 2018).

The opinions, statements, and asseverations expressed on Tortini are my own, or those of invited guests, and these writings do not necessarily represent the views of clients, friends, or family, even when supported by good and sufficient reason.