TORTINI

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

April Fool – Zambelli-Weiner Must Disclose

April 2nd, 2020

Back in the summer of 2019, Judge Saylor, the MDL judge presiding over the Zofran birth defect cases, ordered epidemiologist, Dr. Zambelli-Weiner to produce documents relating to an epidemiologic study of Zofran,[1] as well as her claimed confidential consulting relationship with plaintiffs’ counsel.[2]

This previous round of motion practice and discovery established that Zambelli-Weiner was a paid consultant in advance of litigation, that her Zofran study was funded by plaintiffs’ counsel, and that she presented at a Las Vegas conference, for plaintiffs’ counsel only, on [sic] how to make mass torts perfect. Furthermore, she had made false statements to the court about her activities.[3]

Zambelli-Weiner ultimately responded to the discovery requests but she and plaintiffs’ counsel withheld several documents as confidential, pursuant to the MDL’s procedure for protective orders. Yesterday, April 1, 2020, Judge Saylor entered granted GlaxoSmithKline’s motion to de-designate four documents that plaintiffs claimed to be confidential.[4]

Zambelli-Weiner sought to resist GSK’s motion to compel disclosure of the documents on a claim that GSK was seeking the documents to advance its own litigation strategy. Judge Saylor acknowledged that Zambelli-Weiner’s psycho-analysis might be correct, but that GSK’s motive was not the critical issue. According to Judge Saylor, the proper inquiry was whether the claim of confidentiality was proper in the first place, and whether removing the cloak of secrecy was appropriate under the facts and circumstances of the case. Indeed, the court found “persuasive public-interest reasons” to support disclosure, including providing the FDA and the EMA a complete, unvarnished view of Zambelli-Weiner’s research.[5] Of course, the plaintiffs’ counsel, in close concert with Zambelli-Weiner, had created GSK’s need for the documents.

This discovery battle has no doubt been fought because plaintiffs and their testifying expert witnesses rely heavily upon the Zambelli-Weiner study to support their claim that Zofran causes birth defects. The present issue is whether four of the documents produced by Dr. Zambelli-Weiner pursuant to subpoena should continue to enjoy confidential status under the court’s protective order. GSK argued that the documents were never properly designated as confidential, and alternatively, the court should de-designate the documents because, among other things, the documents would disclose information important to medical researchers and regulators.

Judge Saylor’s Order considered GSK’s objections to plaintiffs’ and Zambelli-Weiner’s withholding four documents:

(1) Zambelli-Weiner’s Zofran study protocol;

(2) Undisclosed, hidden analyses that compared birth defects rates for children born to mothers who used Zofran with the rates seen with the use of other anti-emetic medications;

(3) An earlier draft Zambelli-Weiner’s Zofran study, which she had prepared to submit to the New England Journal of Medicine; and

(4) Zambelli-Weiner’s advocacy document, a “Causation Briefing Document,” which she prepared for plaintiffs’ lawyers.

Judge Saylor noted that none of the withheld documents would typically be viewed as confidential. None contained “sensitive personal, financial, or medical information.”[6]  The court dismissed Zambelli-Weiner’s contention that the documents all contained “business and proprietary information,” as conclusory and meritless. Neither she nor plaintiffs’ counsel explained how the requested documents implicated proprietary information when Zambelli-Weiner’s only business at issue is to assist in making lawsuits. The court observed that she is not “engaged in the business of conducting research to develop a pharmaceutical drug or other proprietary medical product or device,” and is related solely to her paid consultancy to plaintiffs’ lawyers. Neither she nor the plaintiffs’ lawyers showed how public disclosure would hurt her proprietary or business interests. Of course, if Zambelli-Weiner had been dishonest in carrying out the Zofran study, as reflected in study deviations from its protocol, her professional credibility and her business of conducting such studies might well suffer. Zambelli-Weiner, however, was not prepared to affirm the antecedent of that hypothetical. In any event, the court found that whatever right Zambelli-Weiner might have enjoyed to avoid discovery evaporated with her previous dishonest representations to the MDL court.[7]

The Zofran Study Protocol

GSK sought production of the Zofran study protocol, which in theory contained the research plan for the Zofran study and the analyses the researchers intended to conduct. Zambelli-Weiner attempted to resist production on the specious theory that she had not published the protocol, but the court found this “non-publication” irrelevant to the claim of confidentiality. Most professional organizations, such as the International Society of Pharmacoepidemiology (“ISPE”), which ultimately published Zambelli-Weiner’s study, encourage the publication and sharing of study protocols.[8] Disclosure of protocols helps ensure the integrity of studies by allowing readers to assess whether the researchers have adhered to their study plan, or have engaged in ad hoc data dredging in search for a desired result.[9]

The Secret, Undisclosed Analyses

Perhaps even more egregious than withholding the study protocol was the refusal to disclose unpublished analyses comparing the rate of birth defects among children born to mothers who used Zofran with the birth defect rates of children with in utero exposure to other anti-emetic medications.  In ruling that Zambelli-Weiner must produce the unpublished analyses, the court expressed its skepticism over whether these analyses could ever have been confidential. Under ISPE guidelines, researchers must report findings that significantly affect public health, and the relative safety of Zofran is essential to its evaluation by regulators and prescribing physicians.

Not only was Zambelli-Weiner’s failure to include these analyses in her published article ethically problematic, but she apparently hid these analyses from the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency, which specifically inquired of Zambelli-Weiner whether she had performed such analyses. As a result, the PRAC recommended a label change based upon Zambelli-Weiner’s failure to disclosure material information. Furthermore, the plaintiffs’ counsel represented they intended to oppose GSK’s citizen petition to the FDA, based upon the Zambelli-Weiner study. The apparently fraudulent non-disclosure of relevant analyses could not have been more fraught for public health significance. The MDL court found that the public health need trumped any (doubtful) claim to confidentiality.[10] Against the obvious public interest, Zambelli-Weiner offered no “compelling countervailing interest” in keeping her secret analyses confidential.

There were other aspects to the data-dredging rationale not discussed in the court’s order. Without seeing the secret analyses of other anti-emetics, readers were deprive of an important opportunity to assess actual and potential confounding in her study. Perhaps even more important, the statistical tools that Zambelli-Weiner used, including any measurements of p-values and confidence intervals, and any declarations of “statistical significance,” were rendered meaningless by her secret, undisclosed, multiple testing. As noted by the American Statistical Association (ASA) in its 2016 position statement, “4. Proper inference requires full reporting and transparency.”

The ASA explains that the proper inference from a p-value can be completely undermined by “multiple analyses” of study data, with selective reporting of sample statistics that have attractively low p-values, or cherry picking of suggestive study findings. The ASA points out that common practices of selective reporting compromises valid interpretation. Hence the correlative recommendation:

“Researchers should disclose the number of hypotheses explored during the study, all data collection decisions, all statistical analyses conducted and all p-values computed. Valid scientific conclusions based on p-values and related statistics cannot be drawn without at least knowing how many and which analyses were conducted, and how those analyses (including p-values) were selected for reporting.”[11]

The Draft Manuscript for the New England Journal of Medicine

The MDL court wasted little time and ink in dispatching Zambelli-Weiner’s claim of confidentiality for her draft New England Journal of Medicine manuscript. The court found that she failed to explain how any differences in content between this manuscript and the published version constituted “proprietary business information,” or how disclosure would cause her any actual prejudice.

Zambelli-Weiner’s Litigation Road Map

In a world where social justice warriors complain about organizations such as Exponent, for its litigation support of defense efforts, the revelation that Zambelli-Weiner was helping to quarterback the plaintiffs’ offense deserves greater recognition. Zambelli-Weiner’s litigation road map was clearly created to help Grant & Eisenhofer, P.A., the plaintiffs’ lawyers,, create a causation strategy (to which she would add her Zofran study). Such a document from a consulting expert witness is typically the sort of document that enjoys confidentiality and protection from litigation discovery. The MDL court, however, looked beyond Zambelli-Weiner’s role as a “consulting witness” to her involvement in designing and conducting research. The broader extent of her involvement in producing studies and communicating with regulators made her litigation “strategery” “almost certainly relevant to scientists and regulatory authorities” charged with evaluating her study.”[12]

Despite Zambelli-Weiner’s protestations that she had made a disclosure of conflict of interest, the MDL court found her disclosure anemic and the public interest in knowing the full extent of her involvement in advising plaintiffs’ counsel, long before the study was conducted, great.[13]

The legal media has been uncommonly quiet about the rulings on April Zambelli-Weiner, in the Zofran litigation. From the Union of Concerned Scientists, and other industry scolds such as David Egilman, David Michaels, and Carl Cranor – crickets. Meanwhile, while the appeal over the admissibility of her testimony is pending before the Pennsylvania Supreme Court,[14] Zambelli-Weiner continues to create an unenviable record in Zofran, Accutane,[15] Mirena,[16] and other litigations.


[1]  April Zambelli‐Weiner, Christina Via, Matt Yuen, Daniel Weiner, and Russell S. Kirby, “First Trimester Pregnancy Exposure to Ondansetron and Risk of Structural Birth Defects,” 83 Reproductive Toxicology 14 (2019).

[2]  See In re Zofran (Ondansetron) Prod. Liab. Litig., 392 F. Supp. 3d 179, 182-84 (D. Mass. 2019) (MDL 2657) [cited as In re Zofran].

[3]  “Litigation Science – In re Zambelli-Weiner” (April 8, 2019); “Mass Torts Made Less Bad – The Zambelli-Weiner Affair in the Zofran MDL” (July 30, 2019). See also Nate Raymond, “GSK accuses Zofran plaintiffs’ law firms of funding academic study,” Reuters (Mar. 5, 2019).

[4]  In re Zofran Prods. Liab. Litig., MDL No. 1:15-md-2657-FDS, Order on Defendant’s Motion to De-Designate Certain Documents as Confidential Under the Protective Order (D.Mass. Apr. 1, 2020) [Order].

[5]  Order at n.3

[6]  Order at 3.

[7]  See In re Zofran, 392 F. Supp. 3d at 186.

[8]  Order at 4. See also Xavier Kurz, Susana Perez-Gutthann, the ENCePP Steering Group, “Strengthening standards, transparency, and collaboration to support medicine evaluation: Ten years of the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP),” 27 Pharmacoepidemiology & Drug Safety 245 (2018).

[9]  Order at note 2 (citing Charles J. Walsh & Marc S. Klein, “From Dog Food to Prescription Drug Advertising: Litigating False Scientific Establishment Claims Under the Lanham Act,” 22 Seton Hall L. Rev. 389, 431 (1992) (noting that adherence to study protocol “is essential to avoid ‘data dredging’—looking through results without a predetermined plan until one finds data to support a claim”).

[10]  Order at 5, citing Anderson v. Cryovac, Inc., 805 F.2d 1, 8 (1st Cir. 1986) (describing public-health concerns as “compelling justification” for requiring disclosing of confidential information).

[11]  Ronald L. Wasserstein & Nicole A. Lazar, “The ASA’s Statement on p-Values: Context, Process, and Purpose,” 70 The American Statistician 129 (2016)

See alsoThe American Statistical Association’s Statement on and of Significance” (March 17, 2016).“Courts Can and Must Acknowledge Multiple Comparisons in Statistical Analyses (Oct. 14, 2014).

[12]  Order at 6.

[13]  Cf. Elizabeth J. Cabraser, Fabrice Vincent & Alexandra Foote, “Ethics and Admissibility: Failure to Disclose Conflicts of Interest in and/or Funding of Scientific Studies and/or Data May Warrant Evidentiary Exclusions,” Mealey’s Emerging Drugs Reporter (Dec. 2002) (arguing that failure to disclose conflicts of interest and study funding should result in evidentiary exclusions).

[14]  Walsh v. BASF Corp., GD #10-018588 (Oct. 5, 2016, Pa. Ct. C.P. Allegheny Cty., Pa.) (finding that Zambelli-Weiner’s and Nachman Brautbar’s opinions that pesticides generally cause acute myelogenous leukemia, that even the smallest exposure to benzene increases the risk of leukemia offended generally accepted scientific methodology), rev’d, 2018 Pa. Super. 174, 191 A.3d 838, 842-43 (Pa. Super. 2018), appeal granted, 203 A.3d 976 (Pa. 2019).

[15]  In re Accutane Litig., No. A-4952-16T1, (Jan. 17, 2020 N.J. App. Div.) (affirming exclusion of Zambelli-Weiner as an expert witness).

[16]  In re Mirena IUD Prods. Liab. Litig., 169 F. Supp. 3d 396 (S.D.N.Y. 2016) (excluding Zambelli-Weiner in part).

Practical Solutions for the Irreproducibility Crisis

March 3rd, 2020

I have previously praised the efforts of the National Association of Scholars (NAS) for its efforts to sponsor a conference on “Fixing Science: Practical Solutions for the Irreproducibility Crisis.” The conference was a remarkable event, with a good deal of diverse view points, civil discussion and debate, and collegiality.

The NAS has now posted a follow up to its conference, with a link to slide presentations, and to a You Tube page with videos of the presentations. The NAS, along with The Independent Institute, should be commended for their organizational efforts, and their transparency in making the conference contents available now to a wider audience.

The conference took place on February 7th and 8th, and I had the privilege of starting the event with my presentation, “Not Just an Academic Dispute: Irreproducible Scientific Evidence Renders Legal Judgments Unsafe”.

Some, but not all, of the interesting presentations that followed:

Tim Edgell, “Stylistic Bias, Selective Reporting, and Climate Science” (Feb. 7, 2020)

Patrick J. Michaels, “Biased Climate Science” (Feb. 7, 2020)

Daniele Fanelli, “Reproducibility Reforms if there is no Irreproducibility Crisis” (Feb. 8, 2020)

On Saturday, I had the additional privilege of moderating a panel on “Group Think” in science, and its potential for skewing research focus and publication:

Lee Jussim, “Intellectual Diversity Limits Groupthink in Scientific Psychology” (Feb. 8, 2020)

Mark Regnerus, “Groupthink in Sociology” (Feb. 8, 2020)

Michael Shermer, “Giving the Devil His Due” (Feb. 8, 2020)

Later on Saturday, the presenters turned to methodological issues, many of which are key to understanding ongoing scientific and legal controversies:

Stanley Young, “Prevention and Management of Acute and Late Toxicities in Radiation Oncology

James E. Enstrom, “Reproducibility is Essential to Combating Environmental Lysenkoism

Deborah Mayo, “P-Value ‘Reforms’: Fixing Science or Threats to Replication and Falsification?” (Feb. 8, 2020)

Ronald L. Wasserstein, “What Professional Organizations Can Do To Fix The Irreproducibility Crisis” (Feb. 8, 2020)

Louis Anthony Cox, Jr., “Causality, Reproducibility, and Scientific Generalization in Public Health” (Feb. 8, 2020)

David Trafimow, “What Journals Can Do To Fix The Irreproducibility Crisis” (Feb. 8, 2020)

David Randall, “Regulatory Science and the Irreproducibility Crisis” (Feb. 8, 2020)

Good Night Styrene

April 18th, 2019

Perri Klass is a pediatrician who writes fiction and non-fiction. Her editorial article on “disruptive chemicals,” in this week’s Science Section of the New York Times contained large segments of fiction.[1]  The Times gives Dr. Klass, along with Nicholas Kristof and others, a generous platform to advance their chemophobic propaganda, on pesticides, phthalates, bisphenols, and flame retardants, without the bother of having to cite evidence. It has been just two weeks since the Times published another Klass fear piece on hormone disrupters.[2]

In her Science Times piece, Klass plugged Leonardo Trasande’s book, Sicker, Fatter, Poorer: The Urgent Threat of Hormone-Disrupting Chemicals to Our Health and Future . . . and What We Can Do About It (2019), to help wind up parents about chemical threats everywhere. Trasande, is “an internationally renowned leader in environmental health” expert; his website tells us so. Klass relies so extensively upon Trasande that it is difficult to discern whether she is presenting anything other than his opinions, which in some places she notes he has qualified as disputed and dependent upon correlational associations that have not established causal associations.

When it comes to recyclable plastic, number 6, Klass throws all journalistic caution and scientific scruple aside and tells us that “[a] number 6 denotes styrene, which is a known carcinogen.”[3] Known to whom? To Trasande? To Klass? To eco-zealots?

The first gaffe is that number 6 plastic, of course, is not styrene; rather it is polystyrene. Leaching of monomer certainly can occur,[4] and is worth noting, but equating polystyrene with styrene is simply wrong. The second gaffe, more serious yet, is that styrene is not a “known” carcinogen.

The International Agency for Research on Cancer, which has been known to engage in epistemic inflation about carcinogenicity, addressed styrene in its monograph 82.[5] Styrene was labeled a “2B” carcinogen, that is possible, not probable, and certainly not “known.” Last year, an IARC working group revisited the assessment of styrene, and in keeping with its current practice of grade inflation bumped styrene up to Group 2A, “probably carcinogenic to humans” based upon limited evidence in human being and sufficient evidence in rats and close relatives.[6] In any event, the IARC Monograph number 121, which will address styrene, is under preparation.

A responsible journalist, or scientist, regulator, or lawyer, is obligated however to note tha “probably” does not mean “more likely than not” in IARC-jargon.[7] Given that all empirical propositions have a probability of being true, somewhere between 0 and 100%, but never actually equal to 0 or 100%, the IARC classifications of “probably” causing cancer are probably not particularly meaningful.  Everything “probably” causes cancer, in this mathematical sense.[8]

In the meanwhile, what does the scientific community have to say about the carcinogenicity of styrene?

Recent reviews and systematic reviews of the styrene carcinogenicity issue have mostly concluded that there is no causal relationship between styrene exposure and any form of cancer in humans.[9] Of course, the “Lobby,” scientists in service to the litigation industry, disagree.[10]


[1]  Perri Klass, “Beware of Disruptive Chemicals,” N.Y. Times (April 16, 2019).

[2] Perri Klass, “How to Minimize Exposures to Hormone Disrupters,” N.Y. Times (April 1, 2019).

[3]  Klass (April 16, 2019), at D6, col. 3.

[4]  See, e.g., Despoina Paraskevopoulou, Dimitris Achiliasa, and Adamantini Paraskevopoulou, “Migration of styrene from plastic packaging based on polystyrene into food simulants,” 61 Polymers Internatl’l 141 (2012); J. R. Withey, “Quantitative Analysis of Styrene Monomerin Polystyrene and Foods Including Some Preliminary Studies of the Uptake and Pharmacodynamics of the Monomer in Rats,” 17 Envt’l Health Persp. 125 (1976).

[5]  IARC Monograph No. 82, at 437-78 (2002).

[6]  IARC Working Group, “Carcinogenicity of quinoline, styrene, and styrene-7,8-oxide,” 19 Lancet Oncology 728 (2018).

[7]  The IARC Preamble definition of probable reveals that “probable” does not mean greater than 50%. See also “The IARC Process is Broken” (May 4, 2016).

[8] See Ed Yong, “Beefing With the World Health Organization’s Cancer Warnings,” The Atlantic (Oct 26, 2015).

[9]  Boffetta, P., Adami, H. O., Cole, P., Trichopoulos, D. and Mandel, J. S., “Epidemiologic studies of styrene and cancer: a review of the literature,” 51 J. Occup. & Envt’l Med. 1275 (2009) (“The available epidemiologic evidence does not support a causal relationship between styrene exposure and any type of human cancer.”); James J. Collins & Elizabeth Delzell, “A systematic review of epidemiologic studies of styrene and cancer,” 48 Critical Revs. Toxicol. 443 (2018)  (“Consideration of all pertinent data, including substantial recent research, indicates that the epidemiologic evidence on the potential carcinogenicity of styrene is inconclusive and does not establish that styrene causes any form of cancer in humans.”).

[10] James Huff & Peter F. Infante, “Styrene exposure and risk of cancer,” 26 Mutagenesis 583 (2011).

Passing Hypotheses Off as Causal Conclusions – Allen v. Martin Surfacing

November 11th, 2018

The November 2018 issue of the American Bar Association Journal (ABAJ) featured an exposé-style article on the hazards of our chemical environment, worthy of Mother Jones, or the International Journal of Health Nostrums, by a lawyer, Alan Bell.1 Alan Bell, according to his website, is a self-described “environmental health warrior.” Channeling Chuck McGill, Bell also describes himself as a:

[v]ictim, survivor, advocate and avenger. This former organized crime prosecutor almost died from an environmentally linked illness. He now devotes his life to giving a voice for those too weak or sick to fight for themselves.”

Bell apparently is not so ill that he cannot also serve as “a fierce advocate” for victims of chemicals. Here is how Mr. Bell described his own “environmentally linked illness” (emphasis added):

Over the following months, Alan developed high fevers, sore throats, swollen glands and impaired breathing. Eventually, he experienced seizures and could barely walk. His health continued to worsen until he became so ill he was forced to stop working. Despite being examined and tested by numerous world-renowned doctors, none of them could help. Finally, a doctor diagnosed him with Multiple Chemical Sensitivity, a devastating illness caused by exposure to environmental toxins. The medical profession had no treatment to offer Alan: no cure, and no hope. Doctors could only advise him to avoid all synthetic chemicals and live in complete isolation within a totally organic environment.”

Multiple chemical sensitivity (MCS)? Does anyone still remember “clinical ecology”? Despite the strident advocacy of support groups and self-proclaimed victims, MCS is not recognized as a chemically caused illness by the World Health Organization, the American Medical Association, the American Academy of Allergy and Immunology, and the American College of Physicians.2 Double-blinded, placebo-controlled clinical trials have shown that putative MCS patients respond to placebo as strongly as they react to chemicals.3

Still, Bell’s claims must be true; Bell has written a book, Poisoned, about his ordeal and that of others.4 After recounting his bizarre medical symptoms, he describes his miraculous cure in a sterile bubble in the Arizona desert. From safe within his bubble, Bell has managed to create the “Environmental Health Foundation,” which is difficult if not impossible to find on the internet, although there are some cheesy endorsements to be found on YouTube.

According to Bell’s narrative, Daniel Allen, the football coach of the College of the Holy Cross was experiencing neurological signs and symptoms that could not be explained by physicians in the Boston area, home to some of the greatest teaching hospitals in the world. Allen and his wife, Laura, reached out Bell through his Foundation. Bell describes how he put the Allens in touch with Marcia Ratner, who sits on the Scientific Advisory Board of his Environmental Health Foundation. Bell sent the Allens to see “the world renown” Marcia Ratner, who diagnosed Mr. Allen with amyotrophic lateral sclerosis (ALS). Bell’s story may strike some as odd, considering that Ratner is not a physician. Ratner could not provide a cure for Mr. Allen’s tragic disease, but she could help provide the Allens with a lawsuit.

According to Bell:

Testimony from a sympathetic widow, combined with powerful evidence that the chemicals Dan was exposed to caused him to die long before his time, would smash their case to bits. The defense opted to seek a settlement. The case settled in 2009.5

The ABAJ article on the Allen case is a reprise of chapter 15 of Bell’s book “Chemicals Take Down a Football Coach.” Shame on the A.B.A. for not marking the article as unpaid advertising. More shame on the A.B.A. for not fact checking the glib causal claims made in the article, some of which have been the subject of a recently published “case report” in the red journal, the American Journal of Industrial Medicine, by Dr. Ratner and some, but not all, of the other expert witnesses for Mr. Allen’s litigation team.6 Had the editors of the ABAJ compared Mr. Bell’s statements and claims about the Allen case, they would have seen that Dr. Ratner, et al., ten years after beating back the defendants’ Daubert motion in the Allen case, described their literature review and assessment of Mr. Allen’s case, as merely “hypothesis generating”:

This literature review and clinical case report about a 45-year-old man with no family history of motor neuron disease who developed overt symptoms of a neuromuscular disorder in close temporal association with his unwitting occupational exposure to volatile organic compounds (VOCs) puts forth the hypothesis that exposure to VOCs such as toluene, which disrupt motor function and increase oxidative stress, can unmask latent ALS type neuromuscular disorder in susceptible individuals.”7

         * * * * * * *

In conclusion, this hypothesis generating case report provides additional support for the suggestion that exposure to chemicals that share common mechanisms of action with those implicated in the pathogenesis of ALS type neuromuscular disorders can unmask latent disease in susceptible persons. Further research is needed to elucidate these relationships.”8

So in 2018, the Allen case was merely a “hypothesis generating” case report. Ten years earlier, however, in 2008, when Ratner, Abou-Donia, Oliver, Ewing, and Clapp gave solemn oaths and testified under penalty of perjury to a federal district judge, the facts of the same case warranted a claim to scientific knowledge, under Rule 702. Judges, lawyers, and legal reformers should take note of how expert witnesses will characterize facile opinions as causal conclusions when speaking as paid witnesses, and as mere hypotheses in need of evidentiary support when speaking in professional journals to scientists. You’re shocked; eh?

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. The published case report by Ratner helps demonstrate that Allen v. Martin Surfacing, 263 F.R.D. 47 (D. Mass. 2009), was the result of litigation overreach by plaintiffs’ counsel and their paid expert witnesses, and a failure of organized skepticism by defense counsel and the judiciary.

Marcia H. Ratner, Ph.D.

I first encountered Dr. Ratner as an expert witness for the litigation industry in cases involving manganese-containing welding rods. Plaintiffs’ counsel, Dickie Scruggs, et al., withdrew her before the defense could conduct an examination before trial. When I came across the Daubert decision in the Allen case, I was intrigued because I had read Ratner’s dissertation9 and her welding litigation report, and saw what appeared to be fallacies10 similar to those that plagued the research of Dr. Brad Racette, who also had worked with Scruggs in conducting screenings, from which he extracted “data” for a study, which for a while became the center piece of Scruggs’ claims.11

The Allen case provoked some research on my part, and then a blog post about that case and Dr. Ratner.12 Dr. Ratner took umbrage to my blog post; and in email correspondence, she threatened to sue me for tortious interference with her prospective business opportunities. She also felt that the blog post had put her in a bad light by commenting upon her criminal conviction for unlawful gun possession.13 As a result of our correspondence, and seeing that Dr. Ratner was no stranger to the courtroom,14 I wrote a post-script to add some context and her perspective on my original post.15

One fact Dr Ratner wished me to include in the blog post-script was that plaintiffs’ counsel in the Allen case had pressured her to opine that toluene and isocyanates caused Mr. Allen’s ALS, and that she had refused. Dr. Ratner of course was making a virtue of necessity since there was, and is, a mountain of medical opinion, authoritative and well-supportive, that there is no known cause of sporadic ALS.16 Dr. Ratner was very proud, however, of having devised a work-around, by proffering an opinion that toluene caused the acceleration of Mr. Allen’s ALS. This causal claim about accelerated onset could have been tested with an observational study, but the litigation claim about earlier onset was as lacking in evidential support as the more straightforward claim of causation.

Bell’s article in the ABAJ – or rather his advertisement17 – cited an unpublished write up of the Allen case, by Ratner, The Allen Case: Our Daubert Strategy, Victory, and Its Legal and Medical Landmark Ramifications, in which she kvelled about how the Allen case was cited in the Reference Manual on Scientific Evidence. The Manual’s citations, however, were about the admissibility of the industrial hygienist’s proffered testimony on exposure, based in turn on Mr. Allen’s account of acute-onset symptoms.18 The Manual does not address the dubious acceleration aspect of Ratner’s causal opinion in the Allen case.

The puff piece in the ABAJ caused me to look again at Dr. Ratner’s activities. According to the Better Business Bureau reports that Dr. Marcia Ratner is a medical consultant in occupational and environmental toxicology. Since early 2016, she has been the sole proprietor of a consulting firm, Neurotoxicants.com, located in Mendon, Vermont. The firm’s website advertises that:

The Principals and Consultants of Neurotoxicants.com provide expert consulting in neurotoxicology and the relationships between neurotoxic chemical exposures and neurodegenerative disease onset and progression.

Only Ratner is identified as working on consulting through the firm. According to the LinkedIn entry for Neurotoxicants.com, Ratner is the also founder and director of Medical-Legal Research at Neurotoxicants.com. Ratner’s website advertises her involvement in occupational exposure litigation as an expert witness for claimants.19 Previously, Ratner was the Vice President and Director of Research at Chemical Safety Net, Inc., another consulting firm that she had founded with the late Robert G. Feldman, MD.

Conflict of Interest

The authors of the published Allen case report gave a curious conflict-of-interest disclosure at the end of their article:

The authors have no current specific competing interests to declare. However, Drs. Ratner, Abou-Donia and Oliver, and Mr. Ewing all served as expert witnesses in this case which settled favorably for the patient over 10 years ago with an outcome that is a fully disclosed matter of public record. Drs. Ratner, Abou-Donia and Oliver and Mr. Ewing are occasionally asked to serve as expert witnesses and/or consultants in occupational and environmental chemical exposure injury cases.”20

The disclosure conveniently omitted that Dr. Ratner owns a business that she set up to provide medico-legal consulting, and that Dr. Oliver testifies with some frequency in asbestos cases. None of the authors was, or is, an expert in the neuroepidemiology of ALS. Dr. Ratner’s conflict-of-interest disclosure in the Allen case report was, however, better than her efforts in previous publications that touched on the subject matter of her commercial consulting practice.21


1 Alan Bell, “Devastated by office chemicals, an attorney helps others fight toxic torts,Am. Bar. Ass’n J. (Nov. 2018).

2 See, e.g., American Academy of Allergy, Asthma and Immunology, “Idiopathic environmental intolerances,” 103 J. Allergy Clin. Immunol. 36 (1999).

3 See Susanne Bornschein, Constanze Hausteiner, Horst Römmelt, Dennis Nowak, Hans Förstl, and Thomas Zilker, “Double-blind placebo-controlled provocation study in patients with subjective Multiple Chemical Sensitivity and matched control subjects,” 46 Clin. Toxicol. 443 (2008); Susanne Bornschein, Hans Förstl, and Thomas Zilker, “Idiopathic environmental intolerances (formerly multiple chemical sensitivity) psychiatric perspectives,” 250 J. Intern. Med. 309 (2001).

4 Poisoned: How a Crime-Busting Prosecutor Turned His Medical Mystery into a Crusade for Environmental Victims (Skyhorse Publishing 2017).

5 Steven H. Foskett Jr., “Late Holy Cross coach’s family, insurers settle lawsuit for $681K,” Telegram & Gazette (Oct. 1, 2009). Obviously, the settlement amount represented a deep compromise over any plaintiff’s verdict.

6 Marcia H. Ratner, Joe F. Jabre, William M. Ewing, Mohamed Abou-Donia, and L. Christine Oliver, “Amyotrophic lateral sclerosis—A case report and mechanistic review of the association with toluene and other volatile organic compounds,” 61 Am. J. Ind. Med. 251 (2018).

7 Id. at 251.

8 Id. at 258 (emphasis added).

9 Marcia Hillary Ratner, Age at Onset of Parkinson’s Disease Among Subjects Occupationally Exposed to Metals and Pesticides; Doctoral Dissertation, UMI Number 3125932, Boston University (2004). Neither Ratner’s dissertation supervisor nor her three readers were epidemiologists.

11 See Brad A. Racette, S.D. Tabbal, D. Jennings, L. Good, Joel S. Perlmutter, and Brad Evanoff, “Prevalence of parkinsonism and relationship to exposure in a large sample of Alabama welders,” 64 Neurology 230 (2005).

13 See Quincy District Court News,” Patriot Ledger June 09, 2010 (reporting that Ratner pleaded guilty to criminal possession of mace and a firearm).

14 Ratner v. Village Square at Pico Condominium Owners Ass’n, Inc., No. 91-2-11 Rdcv (Teachout, J., Aug. 28, 2012).

17 Bell is a client of the Worthy Marketing Group.

18 RMSE3d at 505-06 n.5, 512-13 n. 26, 540 n.88; see also Allen v. Martin Surfacing, 2009 WL 3461145, 2008 U.S. Dist. LEXIS 111658, 263 F.R.D. 47 (D. Mass. 2008) (holding that an industrial hygienist was qualified to testify about the concentration and duration of plaintiffs’ exposure to toluene and isocyanates).

20 Id. at 259. One of the plaintiffs’ expert witnesses, Richard W. Clapp, opted out of co-author status on this publication.

21 See Marcia H. Ratner & Edward Fitzgerald, “Understanding of the role of manganese in parkinsonism and Parkinson disease,” 88 Neurology 338 (2017) (claiming no relevant conflicts of interest); Marcia H. Ratner, David H. Farb, Josef Ozer, Robert G. Feldman, and Raymon Durso, “Younger age at onset of sporadic Parkinson’s disease among subjects occupationally exposed to metals and pesticides,” 7 Interdiscip. Toxicol. 123 (2014) (failing to make any disclosure of conflicts of interest). In one short case report written with Dr. Jonathan Rutchik, another expert witness actively participated for the plaintiffs’ litigation industry in welding fume cases, Dr. Ratner let on that she “occasionally” is asked to serve as an expert witness, but she failed to disclose that she has a business enterprise set up to commercialize her expert witness work. Jonathan Rutchik & Marcia H. Ratner, “Is it Possible for Late-Onset Schizophrenia to Masquerade as Manganese Psychosis?” 60 J. Occup. & Envt’l Med. E207 (2018) (“The authors have no current specific competing interests to declare. However, Dr. Rutchik served as expert witnesses [sic] in this case. Drs. Rutchik and Ratner are occasionally asked to serve as expert witnesses and/or consultants in occupational and environmental chemical exposure injury cases.”)