Schachtman Law

TORTINI

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

IARC’s Industry Sniffing Bots Are Coming for You

October 8th, 2025

“Hey, hey, you, you, get off of my cloud.” …. Jagger & Richards

For the last 50 years, critics, cranks, and anti-industry zealots have argued that industry-sponsored science is vitiated by conflicts of interest. What started as the whining of scientists who were regulatory “political scientists” and adjuncts to plaintiffs’ law firms, has become a major movement. The rise of post-modernism in philosophy has supported the rejection of robust debate of scientific assessments of causation on grounds that all such judgments are politically and socially determined. Evidence is just casuistry, at least when done by those with whom we disagree.

The anti-industry bias has had demonstrably bad consequences in distorting scientific judgment. Over 30 years ago, a science journalist published a story in the Journal of the National Cancer Institute, about how dire predictions of asbestos mortality never came to pass.[1] In investigating the failure of these predictions, the journalist concluded that they had been the product of exaggerations by government scientists who suffered from a form of “white-hat” bias”:

“the government’s exaggeration of the asbestos danger reflects a 1970s’ Zeitgeist that developed partly in response to revelations of industry misdeeds. ‘It was sort of the “in” thing to exaggerate … [because] that would be good for the environmental movement’…. ‘At the time it looked like you were wearing a white hat if you made these wild estimates. But I wasn’t sure whoever did that was doing all that much good.”[2]

The existence of “white-hat” bias is perhaps the most benign explanation for the propagation of badly done science. The deployment of political correctness applied to issues that really depend upon scientific method, data, and inference for their resolution should not, however, be seen as particularly benign.

In 2010, over a decade after the description of white-hat bias in the JNCI, two public health researchers, Mark B. Cope and David B. Allisosn, described white-hat bias as a prevalent cognitive error in how research is reported and interpreted.[3] They described white-hat bias as a “bias leading to the distortion of information in the service of what may be perceived to be righteous ends.” Perhaps the temptation to overstate the evidence against a toxic substance is unavoidable, but it diminishes the authority and credibility of regulators entrusted with promulgating and enforcing protective measures. And error is still error, regardless of its origins and motivations.

Allison and Cope gave examples of white-hat bias in how papers are cited, with “exonerative” studies cited less often than those than claim harmful outcomes. And when positive papers were cited, they were often interpreted misleadingly to overstate the harms previously reported.

The principle of charity suggests white-hat bias should be considered for much of the anti-industry prejudices exhibited by public health scientists. The persistence, virulence, and irrationality of many instances of prejudiced judgments, however, make the charitable explanation implausible.

Kenneth Rothman, the founder of Epidemiology, the official journal of the International Society for Environmental Epidemiology (ISEE), provided a more insightful explanation to the anti-industry bias as the “new McCarthyism in science.”[4] Rothman identified an anti-manufacturing industry bias as manifesting as intolerance toward industry-sponsored studies, and strict scrutiny of “conflict-of-interest” (COI) disclosures. The McCarthyites amplify the gamesmanship over COI disclosures by excusing or justifying non-disclosure of COIs from scientists aligned with advocacy groups or the lawsuit industry, or from positional COIs.

The quaint notion that “an opinion should be evaluated on the basis of its contents, not on the interests or credentials of the individuals who hold it,” has been generally banished.[5] The offense to honest scientific inquiry receives little attention,[6] but the sanctimonious deployment of COI claims allows scientists to over-indulge in poor quality research by claiming that they have extirpated industry influence.

In 1995, anti-tobacco historian and expert witness, Robert Proctor, coined the term agnotology from the Greek ágnosis (“not knowing”) and -logia (study of).[7] Agnotology is now a specialty of scientist-advocates and expert witnesses for the lawsuit industry; it has been the subject of numerous and repetitive books,[8] too many articles to cite, and even doctoral dissertations.[9]

The anti-manufacturing industry jihad is little more than defamation against every scientist or citizen who has called for evidence-based regulation and law in dealing with scientific issues. The movement would deprive legislators, regulators, and juries of important, relevant scientific evidence based upon a smear.

What is truly fascinating, however, is the hypocrisy built into the anti-industry COI movement. There is another industry that is protected from criticism – the lawsuit industry. The lawsuit industry that has grown up parasitically around a system of tort law, which now includes not only law firms that service claimants, but also their retinue of expert witnesses, their litigation funders, and even investment firms that collude with hit-piece journalists who work on “distort and short” schemes of trading in the securities of their targets.

The critics of research done or funded by manufacturing industry argue that industry studies disproportionately report outcomes favorable to their sponsors. The implied potential conflicts posed by industry-sponsored research studies are fairly obvious. Industries that make or sell products, raw materials, or chemicals have an interest in having toxicological and epidemiologic studies support claims of safety. Research that suggests an industry’s product causes harm may hurt the industry’s financial interests directly by inhibiting sales, or indirectly by undermining the industry’s position in litigation, or by leading to greater regulatory scrutiny and control. Indirect harms may result from heightened warnings or instructions, which may limit sales or encourage sales of competing, less hazardous products. If the harm evidenced by the research is sufficiently severe, the research may lead to product recall or bans, again with serious economic consequences for the industry.

The lawsuit industry has conflicts of interest that mirror those of manufacturing industry.[10] Manufacturing evidence and conclusions of harm is good for the lawsuit industry, and provides rich sources of revenue for its go-to expert witnesses. There are also ideological interests that motivate many players in the lawsuit industry. Lawsuit industry COIs are frequently ignored or down-played, even though the research funded, sponsored, or written by its members has a strange propensity to support claims made in court and in agencies.

The International Agency for Research on Cancer (IARC) has become ground zero for hypocritical exorcisms of COIs. In 2018, several authors wrote a commentary in which they declared that IARC and its cancer hazard evaluations were under attack from those with “economic interests” (manufacturing firms or their consultants).[11] Several of the commentary authors, Peter F. Infante, Ronald Melnick, and James Huff, were full-fledged members of the lawsuit industry, with consulting firms that work to help claimants in tort litigation. The authors’ own COIs, however, did not inhibit them from declaring that only “scientific experts who do not have conflicts of interest should be allowed to criticize IARC pronouncements. Three of the four authors (Infante, Melnick, Huff) of this hit piece identified themselves as having consulting firms, but only James Huff gave a disclosure that he had “been retained as expert consultant on long-term animal bioassays of glyphosate in litigation for plaintiffs.” Infante and Melnick gave no disclosure, although they have been far more than consultants; they have appeared in testimonial roles for tort claimants. To top off the hypocrisy, the journal editor, Steven B. Markowitz, felt compelled to declare that he had “no conflict of interest in the review and publication decision regarding this article.” Markowitz is a not infrequent testifying expert witness for the lawsuit industry.[12] It is a safe bet that the great majority of the studies authored by Infante, Melnick, Huff, and Markowitz claim or suggest harms from chemical exposures.

It seems rudimentary that scientific research should be evaluated on the merits of studies, methods, data, and inference, and not the source of the funding. We are, however, deep into the post-modern world that regards science as a way of exercising political power and social control, and not a search for the truth. Given our Zeitgeist, no one should be surprised that an IARC official has just come out with a paper that attempted to deploy a large-language model (LLM) to identify possible industry influence, down to parts per trillion or whatever the level of detection may be.

Last month, Mary K. Schubauer-Berigan, the head of the Evidence Synthesis and Classification Branch of IARC, along with several other scientists, published a paper that proposed the use of an LLM to identify industry influence.[13] Schubauer-Berigan is an occupational epidemiologist, but she is also an amateur agnotologist. The first sentence of her article really tells all you need to know: “Industry-funded research poses a threat to the validity of scientific inference on carcinogenic hazards.” The authors claim that their LLM can help assess bias from industry studies in evidence synthesis and identify “industry influence” on scientific inference. These authors reflect the IARC dogma that only manufacturing industry has COIs of concern. Lawsuit industry influence is never mentioned.

The authors applied their LLM to identify industry relationships among authors of review articles on issues related to three specific IARC hazard classifications (benzene, cobalt, and aspartame). The search apparently included direct funding for studies of the agent under consideration, as well as whether studies or reviews had an industrial sponsor or a trade association, whether they used data provided by an industry source, or whether authors were paid consulting fees or provided expert testimony. The authors’ algorithm did not include whether spouses, children, parents, good friends, professional colleagues, or mentors ever had some dalliance with manufacturing industry.

IARC’s LLM was never let loose in search of lawsuit industry connections. Are you surprised?

[1] Tom Reynolds, “Asbestos-Linked Cancer Rates Up Less Than Predicted,” 84 J. Nat’l Cancer Instit. 560 (1992).

[2] Id. at 562.

[3] Mark B. Cope and David B. Allison, “White hat bias: examples of its presence in obesity research and a call for renewed commitment to faithfulness in research reporting,” 34 Internat’l J. Obesity 84 (2010).

[4] Kenneth J. Rothman, “Conflict of interest: the new McCarthyism in science,” 269 J. Am. Med. Ass’n 2782 (1993). See Schachtman, “The Rhetoric and Challenge of Conflicts of Interest,” Tortini (July 30, 2013).

[5] Brian MacMahon, “Epidemiology: another perspective,” 37 Internat’l J. Epidem. 1192, 1192 (2008).

[6] See Thomas P. Stossel, “Has the hunt for conflicts of interest gone too far?” 336 Brit. Med. J. 476 (2008); Kenneth J. Rothman & S. Evans, “Extra scrutiny for industry funded trials: JAMA’s demand for an additional hurdle is unfair – and absurd, 331 Brit. Med. J. 1350 (2005) & 332 Brit. Med. J. 151 (2006) (erratum).

[7] Robert Proctor, The Cancer Wars: How Politics Shapes What We Know and Don’t Know About Cancer 8 & not (1995).

[8] See, e.g., David Michaels, The Triumph of Doubt: Dark Money and the Science of Deception (2020); David Michaels, Doubt Is Their Product: How Industrys Assault on Science Threatens Your Health (2008); Naomi Oreskes & Erik M. Conway, Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming (2010); Robert N. Proctor & Londa Schiebinger, eds., Agnotology: The Making and Unmaking of Ignorance (2008); Janet Kourany & Martin Carrier, eds, Science and the Production of Ignorance: When the Quest for Knowledge Is Thwarted (2020); Blake D. Scott, “Agnotology and Argumentation: A Rhetorical Taxonomy of Not-Knowing,” OSSA Conference Archive 133 (2016).

[9] Craig Alex Biegel, Manufactured Science, the Attorneys’ Handmaiden: The Influence of Lawyers in Toxc [sic] Substance Disease Research, Dissertation for Florida State University (2016).

[10] See 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 (2009).

[11] Peter F. Infante, Ronald Melnick, James Huff & Harri Vainio, “Commentary: IARC Monographs Program and public health under siege by corporate interests,” 61 Am J. Indus. Med. 277 (2018).

[12] See In re Joint Eastern & Southern District Asbestos Litig., 758 F.Supp. 199 (S.D.N.Y. 1991); Juni v. A.O. Smith Water Prods. Co., 32 N.Y.3d 1116, 116 N.E.3d 75 (2018); Konstantin v. 630 Third Avenue Assocs., N.Y.S.Ct. (N.Y. Cty.) No. 190134/2010 (jury verdict returned Aug. 17, 2011); Koeberle v. John Crane, Inc., Phila. Cty. Ct. C.P. No. 000887 (jury verdict returned Feb. 2010).

[13] Nathan L. DeBono, Vanessa Amar, Hardy Hardy, Mary K. Schubauer-Berigan, Derek Ruths & Nicholas B. King, “A large language model-based tool for identifying relationships to industry in research on the carcinogenicity of benzene, cobalt, and aspartame,” 24 Envt’l Health 64 (2025).

Posted in Cognitive Biases, Conflicts of Interest, Scientific Misconduct | No Comments »

Prada – Fashionable, But Unreliable Review on Acetaminophen and Autism

September 30th, 2025

Back in the first week of this month, I posted about a paper (Prada 2025),[1] which featured a so-called navigation-guide systematic review of the scientific evidence on the issue whether pregnant women’s ingestion of acetaminophen causes their children to develop autism.[2] The focus of my post was on some dodgy aspects of the Prada review, such as its anemic disclosures of interest, and its squirrely claim to have been “NIH funded.”

Since posting, the Prada review has been very much in the news. Last week, President Trump held a news conference, where we learned that he cannot pronounce acetaminophen and that he has a strongly held opinion that acetaminophen causes autism.[3] Trump was surrounded by officials in his administration, including plaintiffs’ lawyer Robert Kennedy, Jr., and three physicians, Drs. Oz, Makary, and Bhattacharya, who looked on in apparent approval. Once upon a time, a risk communication such as this one about acetaminophen, would have come out from a non-political FDA employee, such as Janet Woodcock, who was head of Drug Safety, and for many years the Director of Center for Drug Evaluation and Research. Over her tenure, Dr. Woodcock weighed in on many pharmaceutical safety issues. Those of us who have been involved in litigation of those safety issues remember that Dr. Woodcock chose her language very carefully. She did not just give opinions; she marshalled facts.

Admittedly, Trump’s autism press conference was not as deranged as his 2020 press conference at which he suggested that injecting sodium hypochlorite (bleach) into patients would cure Covid-19 infections. Still, most of the world was left with the impression that Trump was replacing (DOGE-ing) scientific research and replacing it with irrational speculation. Trump’s press conference on acetaminophen and vaccines was widely met with skepticism and disbelief. Medical ethicist Dr. Arthur Caplan, who is not given to hyperbole, called the conference “the saddest display of a lack of evidence, rumors, recycling old myths, lousy advice, outright lies, and dangerous advice I have ever witnessed by anyone in authority.”[4]

When the administration physicians communicated with the public, they said something very different from Trump’s presentation. In her press release, Press Secretary Karoline Leavitt used the meaningless locution, “suggested link,” and cited the Prada review, which eschewed causal conclusions:[5]

“Andrea Baccarelli, M.D., Ph.D., Dean of the Faculty, Harvard T.H. Chan School of Public Health: “Colleagues and I recently conducted a rigorous review, funded by a grant from the National Institutes of Health (NIH), of the potential risks of acetaminophen use during pregnancy… We found evidence of an association between exposure to acetaminophen during pregnancy and increased incidence of neurodevelopmental disorders in children.

Harvard University: Using acetaminophen during pregnancy may increase children’s autism and ADHD risk.”

Of course, saying that something “may increase risk” is not even close to saying that something causes the outcome in question. And Baccarelli’s description of his paper, Prada review, as funded by the National Institutes of Health is misleading at best.[6]

Leavitt went on to declare that “[t]he Trump Administration does not believe popping more pills is always the answer for better health.” Unless of course, it is Propecia for Mr. Trump, testosterone for Mr. Kennedy, or ketamine for Mr. Musk.

FDA Commissioner Martin A. Makary issued a Notice, the same day, in which he declared:

“In recent years, evidence has accumulated suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children.

* * *

To be clear, while an association between acetaminophen and autism has been described in many studies, a causal relationship has not been established and there are contrary studies in the scientific literature.”[7]

So the FDA is clearly not declaring that acetaminophen causes autism.

Dr. Mehmet Oz, former surgeon and television talking head, who stood mute by Trump’s side at the infamous press conference, found his voice later in the week, when he acknowledged that pregnant women of course should take acetaminophen when physicians direct them to do so.

In Europe, where pharmaceutical regulation is typically more precautionary than in the United States, both the European Medicines Agency and the U.K.’s Medicines and Healthcare Products Regulatory Agency announced that using acetaminophen during pregnancy was safe with no showing that it causes autism in offspring.[8] Steffen Thirstrup, the EMA’s Chief Medical Officer, announced a day after the Trump bungle, that:

“Paracetamol [acetaminophen] remains an important option to treat pain or fever in pregnant women. Our advice is based on a rigorous assessment of the available scientific data and we have found no evidence that taking paracetamol during pregnancy causes autism in children.”

Most medical organizations were appalled at the administration’s sloppy messaging. The day after the press conference, the American College of Medical Toxicology (ACMT) issued a statement in response, to affirm the safety of acetaminophen in pregnancy.[9] The ACMT noted that its position was in agreement with the American College of Obstetrics and Gynecologists, the Society for Maternal-Fetal Medicine, the American Academy of Pediatrics, and the Society for Developmental and Behavioral Pediatrics.

The acetaminophen kerfuffle seems always to come back to the Prada “navigation guide” systematic review and its authors, including the Harvard Dean, Andrea Baccarelli, who was the well-paid member of the plaintiffs’ expert witness team in acetaminophen litigation.[10] Why did Dr. Andrea Baccarelli in the Prada review use this curious, arcane, and infrequently used method of review? Why did Baccarelli and his co-authors publish this review in Environmental Health, which is dedicated to publishing “manuscripts on important aspects of environmental and occupational medicine,” which places maternal ingestion of a licensed pharmaceutical outside its stated competence? Why did Baccarelli offer a litigation opinion that acetaminophen causes autism, but retreat to “association” when writing for the scientific community? And why did Baccarelli and his co-authors not disclose that Baccarelli had submitted essentially the same navigation guide systematic review as his proffered expert witness testimony, and that a federal court had rejected his opinion as not “the product of reliable principles and methods,” and not “a reliable application of the principles and methods to the facts of the case”[11]? Perhaps the answers are obvious to most observers, but candid disclosures certainly would have provided important context, and saved some people the embarrassment of relying upon the Prada review.

In digging deeper into the history of the navigation guide method itself, the earliest citation I could find to such systematic reviews was in 2009, in a conference paper that discussed this approach as a proposal.[12] The authors that made up the Navigating the Scientific Evidence to Improve Prevention Workshop Organizing Committee were not particularly well known or distinguished in the field of research synthesis. Still, there must be other reasons that “navigation guide” reviews are not more prevalent if the Organizing Committee had been truly on to something important.

The Committee never identified a rationale for a new systematic review approach. When the Organizing Committee outlined its approach in 2009, there were well over three decades of experience with systematic reviews,[13] with well-regarded full-length textbook treatment by experts in the field.[14]

In addition to the lack of experience among its authors and the preemption of the subject by comprehensive treatments elsewhere, there were three additional curious take aways from a cursory reading of the Organizing Committee’s 2009 manuscript. First, Committee emphasized the alleged need for a review methodology for environmental exposures. This emphasis was never accompanied by a showing that well-described methodologies long in use were somehow inadequate or inappropriate for environmental exposures.

Second, the authors urged the need for precautionary assessments, which might make their method fine where syntheses for precautionary pronouncements were called for. In the United States, regulatory assessments vary depending up the governing statutes that create the regulatory mandate. In personal injury litigation, the precautionary principle is nothing less than an end run around the burden of proof on the party claiming harm and suing in tort. The designated subject matter of environmental exposures for the proposed systematic review technique offers an insight into why these authors believed that they had to propose a new fangled systematic review methodology. Previously described methods interfered with authors’ ability to elevate “iffy” associations into conclusions of causality in the name of the precautionary principle.

The third curiosity in the 2009 manuscript is that the authors never described the need for a pre-specified protocol. Later articles on this proposed methodology similarly failed to describe the need for such a protocol,[15] although by 2014, authors from the original Organizing Committee reversed course to add a pre-specified protocol to the requirements for a navigation guide systematic review.[16]

A recent article defines a systematic review essentially in terms of a protocol:

“Systematic review (SR) is a rigorous, protocol-driven approach designed to minimise error and bias when summarising the body of research evidence relevant to a specific scientific question.”[17]

The purpose of a protocol may be obvious to anyone who has been paying attention to the replication crisis in biomedical literature, but the same article offers a helpful description of its rationale:

“The purposes of the protocol are to discourage ad-hoc changes to methodology during the review process which may introduce bias, to allow any justifiable methodological changes to be tracked, and also to allow peer-review of the work that it is proposed, to help ensure the utility and validity of its objectives and methods.”[18]

Systematic reviews vary widely in quality, methodological rigor, and validity, but one of the key determinants of their validity is whether they were preceded by pre-specified protocol. Although systematic reviews are often described the “gold standard” for evidence synthesis, their methodological rigor vary widely. Reviews that lack a pre-specified protocol are decidedly less rigorous than those reviews that employ a protocol.[19] The absence of a protocol is thus an important tell that a systematic review may be untrustworthy.

The Prada paper put together by Baccarelli’s team has no protocol. It may satisfy the Trump administration’s Fool’s Gold Standard for Science, but that is far short of the requirements of Federal Rule of Evidence 702. Given Baccarelli’s abridgement of scientific method, we should not be overly surprised by Judge Cote’s judgment of the failures of Baccarelli’s and the other plaintiffs’ expert witnesses’ proffered opinions in the acetaminophen litigation:

“their analyses have not served to enlighten but to obfuscate the weakness of the evidence on which they purport to rely and the contradictions in the research. As performed by the plaintiffs’ experts, their transdiagnostic analysis has obscured instead of informing the inquiry on causation.”[20]

Judge Cote carefully reviewed Baccarelli’s proffered testimony and found it replete with cursory analyses, cherry-picked data, and result-driven assessments of studies.[21] Her Honor’s findings would seem to apply with equal measure to the Prada review.

[1] Diddier Prada, Beate Ritz, Ann Z. Bauer and Andrea A. Baccarelli, “Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology,” 24 Envt’l Health 56 (2025).

[2] See Schachtman, “Acetaminophen & Autism – Prada Review Misleadingly Claims to Be NIH Funded,” Tortini (Sept. 9, 2025).

[3] Jeff Mason, Ahmed Aboulenein, and Julie Steenhuysen, “Trump Links Autism to Tylenol and Vaccines, Claims Not Backed by Science,” Reuters (Sept. 22, 2025); Brianna Abbott & Andrea Petersen, “The Trump administration said acetaminophen could cause autism. Doctors maintain it is safe during pregnancy,” Wall St. J. (Sept. 22, 2025) (“Studies looking at a link [sic] between acetaminophen and autism are inconclusive.”); Will Weissert, “Dr. Trump? The president reprises his COVID era, this time sharing unproven medical advice on autism,” Wash. Post (Sept. 23, 2025).

[4] Ali Swenson & Lauran Neergaard, “Trump makes unfounded claims about Tylenol and repeats discredited link between vaccines and autism,” Assoc. Press (Sept. 23, 2025).

[5] Leavitt, “FACT: Evidence Suggests Link Between Acetaminophen, Autism,” The White House (Sept. 22, 2025).

[6] See Schachtman, “Acetaminophen & Autism – Prada Review Misleadingly Claims to Be NIH Funded,” Tortini (Sept. 9, 2025). The referenced grants had nothing to do with acetaminophen and autism, or even autism generally. The NIEHS granted Dr. Baccarelli money to study air pollution and brain aging. The exposure of interest was not acetaminophen, and the outcome of interest was not autism. By claiming that his research was “NIH funded,” Baccarelli was attempting to boost the prestige of the research even though his acetaminophen review was done for litigation, not for the federal government. Apparently the NIEHS acquiesces in this charade because it suggests to the uninitiated that its research grants result in more published papers, even though the topics of those papers are unrelated to the funded research proposal, and the unrelated topics never receiving committee peer review.

[7] Martin A. Makary, “Notice to Physicians on the Use of Acetaminophen During Pregnancy,” (Sept. 22, 2025).

[8] E.M.A., “Use of paracetamol during pregnancy unchanged in the EU,” (Sept. 23, 2025).

[9] ACMT Supports the Safe Use of Acetaminophen in Pregnancy (Sept. 23, 2025).

[10] Rebecca Robbins & Azeen Ghorayshi, “Harvard Dean Was Paid $150,000 as an Expert Witness in Tylenol Lawsuits,” N.Y. Times (Sept. 23, 2025).

[11] Fed. R. Evid. 702.

[12] Patrice Sutton, Heather Sarantis, Julia Quint, Mark Miller, Michele Ondeck, Rivka Gordon, and Tracey Woodruff, “Navigating the Scientific Evidence to Improve Prevention: A Proposal to Develop A Transparent and Systematic Methodology to Sort the Scientific Evidence Linking Environmental Exposures to Reproductive Health Outcomes,” (July 29, 2009).

[13] See Quan Nha Hong & Pierre Pluye, “Systematic reviews: A brief historical overview,” 34 Education for Information 261, 261 (2018) (describing the evolution of systematic reviews as made up of a “foundation period 1970-1989,” an “institutionalization period 1990-2000, and a “diversification period” from 2001 forward.)

[14] Matthias Egger, Julian P. T. Higgins, and George Davey Smith, Systematic Reviews in Health Research: Meta-Analysis in Context (3^rd ed. 2022). The first edition of this text was published in 1995.

[15] Tracey J. Woodruff, Patrice Sutton, and The Navigation Guide Work Group, “An Evidence-Based Medicine Methodology To Bridge The Gap Between Clinical And Environmental Health Sciences,” 30 Health Affairs 931 (2011); Julia R. Barrett, “The Navigation Guide Systematic Review for the Environmental Health Sciences,” 122 Envt’l Health Persp. A283 (2014).

[16] Tracey J. Woodruff & Patrice Sutton, “The Navigation Guide Systematic Review Methodology: A Rigorous and Transparent Method for Translating Environmental Health Science into Better Health Outcomes,” 122 Environ Health Perspect. 1007 (2014).

[17] Paul Whaley, Crispin Halsall, Marlene Ågerstrand, Elisa Aiassa, Diane Benford, Gary Bilotta, David Coggon, Chris Collins, Ciara Dempsey, Raquel Duarte-Davidson, Rex Fitzgerald, Malyka Galay-Burgos, David Gee, Sebastian Hoffmann, Juleen Lam, Toby Lasserson, Len Levy, Steven Lipworth, Sarah Mackenzie Ross, Olwenn Martin, Catherine Meads, Monika Meyer-Baron, James Miller, Camilla Pease, Andrew Rooney, Alison Sapiets, Gavin Stewart, and David Taylor, “Implementing systematic review techniques in chemical risk assessment: Challenges, opportunities and recommendations,” 92-93 Env’t Internat’l 556 (2016).

[18] Id. at 560.

[19] Julia Menon, Fréderique Struijs & Paul Whaley, “The methodological rigour of systematic reviews in environmental health,” 52 Critical Rev Toxicol. 167 (2022).

[20] In re Acetaminophen ASD-ADHD Prods. Liab. Litig., 707 F. Supp. 3d 309, 334, 2023 WL 8711617 (S.D.N.Y. 2023) (Cote, J.).

[21] Id. at 354-56.

Posted in Causation, Expert Witness Hall of Shame, Rule 702, Scientific Evidence | No Comments »

Specific Causation – The Process of Elimination

September 24th, 2025

Specific causation causes some courts to become costive, and sometimes, courts overuse so-called differential etiology as a laxative. The phrase “differential etiology” is an analogy to differential diagnosis, the reasoning process by which clinicians assess the identity of a disease or disorder. Differential etiology, like laxatives, can be overused and misused.

Last month, the Ninth Circuit affirmed a district court’s summary judgment in a glyphosate case. Engilis v. Monsanto Co., No. 23-4201, D.C. No. 3:19-cv-07859-VC (9th Cir. August 12, 2025). The trial court found that plaintiff’s expert witness’s differential etiology was unreliable because the putative expert witness acknowledged that obesity could be a cause of plaintiff’s disease, but then failed reliably to rule out obesity as a differential etiology. Instead, the excluded expert witness glibly inferred that glyphosate was a cause of plaintiff’s cancer. The trial and appellate courts were faced with a great example of invalid, motivated reasoning, or the lack of reasoning.

The Ninth Circuit’s affirmance was significant because it clearly acknowledged that there was no presumption of admissibility, and that the district court was well within its discretion to find that the proffered expert witness opinion had failed to meet the requirements of Rule 702.[1]

The decision in Engilis was simple and straightforward; it was based upon specific or individual causation or its absence. In cases involving diseases with multiple potential causes, none of which is necessary for the outcome, an exposure or lifestyle factor may be capable of causing a particular disease, but that factor may not have played a causal role in everyone who experienced the exposure or lifestyle factor and who developed the disease. (Not everyone who smoked cigarettes develops lung cancer, and not all lung cancer patients smoked.) Courts and litigants are thus left with the puzzle of individual causation.

In a case such as Engilis, courts can basically assume, arguendo, that glyphosate can cause the claimed outcome (Non-Hodgkin’s Lymphoma or NHL), but then insist that there is competent and sufficient evidence to show that the claimant’s specific case of NHL was caused by the claimed exposure.

Some courts and commentators have suggested that a process of “differential etiology, by analogy to differential diagnosis, can get a claimant to the finish line. This attempted solution assumes arguendo that glyphosate can cause NHL, but then it still must resolve whether this specific case of NHL (or whatever claimed) was caused by the claimed exposure.

As suggested above, differential etiology is something like constipation, which is resolved by the process of elimination. Formally, the reasoning process is an “iterative disjunctive syllogism.” We start with an exhaustive listing of the possible established general causes of the claimed disease:

A or B or C (exhausting the possible general causes of the claimed disease).

Because the diseases may multifactorial, the set of disjuncts may be more complex:

A or B or C or A*B or B*C or A*C or A*B*C.

But if the claimant had never been exposed to A, we can deduce:

B or C or B*C.

And if the claimant had never been exposed to B, we can infer that:

And if C is the tortogen under investigation, for which general causation was established, the claimant would have an unequivocal submissible case to the jury.

Of course many diseases have unknown causes, so-called idiopathic or sporadic cases. In such instances, any proper differential etiology must include a disjunct D, for idiopathic cause. We can see that the iterative disjunctive syllogism in such cases leaves us with uneliminated D in some of the remaining disjuncts, and the claimant cannot reach an unequivocal conclusion in support of his claim.

There may perhaps be a solution to this problem that turns on the effect size, and the probability of attribution associated with each uneliminated disjunct, but that is a story for another day.

[1] See Paul Driessen, “Nation’s most liberal court rejects plaintiff expert’s claims that glyphosate caused couple’s cancer,” Eurasia Review (Sept. 23, 2025).

Posted in Causation, Expert Witnesses, Rule 702 | No Comments »

Acetaminophen & Autism – Prada Review Misleadingly Claims to Be NIH Funded

September 9th, 2025

A few weeks ago, four scientists published what they called a “navigation guide” systematic review on acetaminophen use and autism.[1] The last named author, Andrea A. Baccarelli, is an environmental epidemiologist, who has been an expert witness for plaintiffs’ counsel in lawsuits against the manufacturers and sellers of acetaminophen. Another author, Beate Ritz, frequently testifies for the lawsuit industry in cases against various manufacturing industries. A third author, Ann Z. Bauer, was the lead author of a [faux] “consensus statement” that invoked the precautionary principle to call for limits on the use of acetaminophen (N-acetyl-p-aminophenol or APAP) by pregnant women, on grounds that such use may increase the risks of neurodevelopmental (including autism), reproductive and urogenital disorders.[2] The lead author was Diddier Prada, who works in Manhattan, at the Icahn School of Medicine at Mount Sinai, in the environmental and climate science department, within the Institute for Health Equity Research. The Mount Sinai website describes Dr. Diddier Prada as an environmental and molecular epidemiologist who focuses on the role of environmental toxicants in age-related conditions

Curious readers might wonder how someone whose interest is in environmental issues and “health equity” became involved in a review of pharmaco-epidemiology and teratology. The flavor of systematic review deployed in the paper, “navigation guide,” originated and has had limited use in the field of environmental issues. To my knowledge, so-called navigation guides have never been used previously in pharmaco-epidemiologic or teratologic controversies.[3]

The Prada paper and its deployment of a “navigation guide” systematic review deserve greater critical scrutiny. In this post, however, I want to address some peripheral issues, such as “competing interests” and misleading claims about the paper’s having been NIH funded.

Only Dr. Baccarelli disclosed a potential conflict of interest, in a statement that many would judge to be anemic:

“Dr. Baccarelli served as an expert witness for the plaintiff’s legal team on matters of general causation involving acetaminophen use during pregnancy and its potential links to neurodevelopmental disorders. This involvement may be perceived as a conflict of interest regarding the information presented in this paper on acetaminophen and neurodevelopmental outcomes. Dr. Baccarelli has made every effort to ensure that this current work—like his past work as an expert witness on this matter—was conducted with the highest standards of scientific integrity and objectivity.”

The disclosure fails to mention whether Dr. Baccarelli was compensated for his playing on the “plaintiff’s legal team,” and if so, then how much. Using the passive voice, he suggests that this work might be perceived as a conflict of interest, when surely he knows that it is a serious issue. If industry scientists working on the relevant issue had published, they surely would be accused of having had a conflict.

Dr. Baccarelli self-servingly, falsely, and with epistemic arrogance, asserts that he made every effort in this paper, and in his past work as an expert witness, to conform to the “highest standards of scientific integrity and objectivity.” Despite his best efforts to be “scientific,” Baccarelli’s work failed critical scrutiny in the multi-district litigation that consolidated acetaminophen cases for pre-trial handling. In that litigation, the defense challenged Dr. Baccarelli’s opinions under Rule 702, for their lack of validity. In an extensive, closely reasoned opinion, federal district court judge Denise Cote ruled that Dr. Baccarelli’s proffered opinions failed to meet the relevance and reliability standards of federal law.[4]

The MDL court easily found that Dr. Baccarelli was qualified to provide an opinion on epidemiology, although the focus of his career has been on environmental issues. Baccarelli’s substantive problem was that he deviated from accepted and valid methods of causal inference by cherry picking different results and outcomes across multiple studies. Baccarelli’s sophistical trick was to advance a “transdiagnostic” analysis that lumps an already heterogenous autism spectrum disorder (ASD), with attention-deficit hyperactivity disorder (ADHD), and a grab bag of “other neurodevelopmental disorders.” If a study found a putative association with only one of the three end points, Baccarelli would claim success on all three. Baccarelli avoided conducting separate ASD and ADHD analyses, and he cherry picked the end points that supported his pre-determined conclusions.

Judge Cote found that the transdiagnostic analyses advanced by plaintiffs’ expert witnesses, including Baccarelli, obscured and obfuscated more than they informed the causal inquiry.[5] The court’s analysis casts considerable shade upon Baccarelli’s self-serving claim to have used “the highest standards of scientific integrity and objectivity.” Judge Cote barred Baccarelli and the other members of the plaintiffs’ “expert team” from testifying.

Conspicuously absent from the conflict disclosure section of the Prada article was any mention of the litigation work of co-author Beate Ritz. In 2007, Ritz became a fellow of the Collegium Ramazzini, which functions in support of the lawsuit industry much as the scientists of the Tobacco Institute supported tobacco legal defense efforts in times past. Ritz’s fellowship in the Collegium makes her a full-fledged member of the Lobby and a supporter of the lawsuit industry.[6] Ritz has testified, for claimants, in cases involving claims of heavy metals in baby food, in cases involving claims that paraquat exposure caused Parkinson’s disease, and most notoriously for plaintiffs in glyphosate litigation, where her witnessing is often done for the Wisner Baum lawfirm that employs the son of Robert F. Kennedy, Jr.[7]

The conflict of interest disclosure statement is hardly the only misleading aspect of the Prada paper. At the end of the paper, the authors state, with respect to funding that their “study was supported by NIH (R35ES031688; U54CA267776).” Some people may incorrectly believe that the Prada review was directly sponsored and funded by the National Institutes of Health. Nothing could be further from the truth.

The research grant referenced, R35ES031688, is a National Institute of Environmental Health Sciences (NIEHS) research grant. The curious reader might inquire what whether and why the NIEHS would be concerned about a pharmacological issue. The short answer is that the NIEHS is not, and that this grant has nothing to do with children’s neurological status in relation to their mother’s ingestion of acetaminophen.

The NIEHS award this research grant to Andrea Baccarelli, while he was at Columbia University, for his project “Extracellular Vesicles in Environmental Epidemiology Studies of Aging.” The research focuses on extracellular vesicles (EVs) and their role in environmental health, particularly as it relates to aging. What Baccarelli promised to do with this NIEHS grant was to study the effects of air pollution on accelerated brain aging, and disease states such as dementia. Baccarelli noted that his focus would be on intra-cellular communication enabled by extracellular vesicles, in reaction to air pollution. The described research would understandably be viewed as potentially relevant to the NIEHS mission statement, but it has nothing to do with autism among children of women who ingested acetaminophen during pregnancy. The phrases “extracellular vesicles” and “air pollution” do not appear in the Prada review.

The second grant listed under funding for the Prada review was U54CA267776. The U54 designation marks this as a career award, not specific to a specific topic or this published work. Ironically, the grant is a diversity, equity, and inclusion grant to the Mount Sinai Icahn School of Medicine, in Manhattan. The Icahn School has long had one of the most ethically, racially, culturally diverse faculties of any medical school, and hardly needs financial incentives to hire minority physicians and scientists.

The NIH awarded grant U54CA267776 for “Cohort Cluster Hiring Initiative at Icahn School of Medicine at Mount Sinai.” The NIH describes the grant as aiming to reduce “[t]he barriers to research and career success for underrepresented groups in academic medicine.” The text of the U54 grant is written largely in bureaucratic jargon, which may require a degree in DEI to understand fully. What is abundantly clear is that nothing in this U54 grant, or in its stated criteria for evaluation, has anything to do with studying the teratologic potential of acetaminophen.

What so far has escaped the media’s attention is that Prada and colleagues did not have NIH (or NIEHS) support for their acetaminophen review. They had career-level support for DEI purposes, or perhaps general “walking-around” money for research on environmental pollution and brain aging, which has nothing to do with the subject of their navigation guide review. The authors of the Prada review never prepared a study proposal related to acetaminophen for evaluation by a funding committee at NIH. The authors never submitted a protocol to the NIH, and the NIH provided no peer review or guidance for the authors’ acetaminophen review. In short, there is nothing that marks the Prada review as an NIH work product other than the over-claiming of the authors with respect to funding sources.

The Prada review has attracted a lot of attention in the media and from the worm-brained Secretary of Health and Human Services. An article in the Washington Post described the Prada review as NIH funded, which tracks the paper’s misleading disclosure.[8] The media no doubt jumped on the publication of the Prada review last month because Secretary Kennedy promised to reveal the cause of autism by September. We can imagine that Kennedy will be tempted to embrace the Prada review because he can falsely mischaracterize it as an NIH-funded review.

Not only is the funding claim dodgy, but so is the suggestion that the review supports a conclusion of causation between maternal ingestion of acetaminophen and autism in children. The lead author, Dr. Diddier Prada, noted the frequent confusion between correlation and causation and explicitly stated the authors of the review “cannot answer the question about causation.”[9]

[2] Ann Z. Bauer et al., “Paracetamol Use During Pregnancy — A Call for Precautionary Action,” 17 Nature Rev. Endocrinology 757 (2021).

[3] See Tracey J. Woodruff, Patrice Sutton, and The Navigation Guide Work Group, “An Evidence-Based Medicine Methodology To Bridge The Gap Between Clinical And Environmental Health Sciences,” 30 Health Affairs 931 (May 2011).

[4] In re Acetaminophen ASD-ADHD Prods. Liab. Litig., 707 F. Supp. 3d 309, 2023 WL 8711617 (S.D.N.Y. 2023) (Cote, J.).

[5] Id. at 334.

[6] See F.D.K. Liddell, “Magic, Menace, Myth and Malice,” 41 Ann. Occup. Hyg. 3, 3 (1997).

[7] See, e.g., In re Roundup Prods. Liab. Litig., 390 F. Supp. 3d 1102 (2018); Barrera v. Monsanto Co., Del. Super. Ct. (May 31, 2019); Pilliod v. Monsanto Co., 67 Cal. App. 5th 591, 282 Cal. Rptr. 3d 679 (2021). See also Dan Charles, “Taking the stand: For scientists, going to court as an expert witness brings risks and rewards,” 383 Science 942 (Feb. 29, 2024) (quoting Ritz as suggesting that she was reluctant to get involved as an expert witnesses).

[8] Ariana Eunjung Cha, Caitlin Gilbert and Lauren Weber, “MAHA activists have been pushing for more investigation into use of the common pain killer during pregnancy,” Wash. Post (Sept. 5, 2025). See also Liz Essley Whyte & Nidhi Subbaraman, “RFK Jr., HHS to Link Autism to Tylenol Use in Pregnancy and Folate Deficiencies,” Wall St. J. (Sept. 5, 2025).

[9] Jess Steier, “Saturday Morning Thoughts on the Tylenol-Autism News: The public health whiplash continues as we play another round of ‘autism cause’ roulette,” Unbiased Science (substack) (Sept. 06, 2025).

Posted in Causation, Conflicts of Interest, Expert Witnesses, Rule 702, Scientific Evidence | 5 Comments »

AAAS Conference on Scientific Evidence and the Courts

September 8th, 2025

Back in September 2023, the American Association for the Advancement of Science (AAAS), with its Center for Scientific Responsibility and Justice, sponsored a two day meeting on Scientific Evidence and the Courts. If there were notices for this conference, I missed them. The meeting presentations are now available online. Judging from camera views of the audience, the conference did not appear to be well attended. Most of the material was forgettable, but some of the presentations are worth watching.

Jennifer L. Mnookin opened the conference with a keynote presentation on “Where Law and Science Meet.” Chancellor Mnookin presented a broad overview and some interesting insights on the development of the evidence law of expert witness testimony.

Following Mnookin, Professors Ronald Allen and Andrew Jurs presented on the “Unintended Impacts [sic] of the Daubert Standard.” The conference took place only a few months before amendment to Rule 702 became effective, and the reference to a “Daubert” standard was untoward. Allen’s comments followed the path of his previous articles. Jurs presented some empirical legal research, which seemed flawed for its assumption that the Frye standard was universally applied in federal court before the advent of Daubert. Assessing whether these standards lead to different outcomes when both standards have been applied heterogeneously, and one standard, Frye, is often not applied at all, and Daubert is often flyblown by judges hostile to the gatekeeping enterprise, Jurs’ empirical research seemed both invalid and very much beside the point. Both presenters missed the key point of Daubert, in which case plaintiff’s counsel advocated for no standard at all, beyond basic subject-matter qualification, for giving expert opinions in court.

A Session on “An International Perspective,” Scott Carlson discussed the efforts of the American Bar Association (ABA), and its Center of Global Programs, on supporting judges in foreign countries. Prateek Sibal discussed the history and work of the UNESCO Global Judges Initiative. My sincere wish is that the ABA would support judges more in the United States.

Panelists Valerie P. Hans, Emily Murphy, and Dr. Michael J. Saks presented on various jury issues, in a session “In the Minds of the Jury.” The presentations on how foreign countries process expert witness testimony were lacking any mention of how juries rarely if ever sit in civil cases that involve complex technical and scientific issues.

Two editors of scientific journals, Adriana Bankston and Valda Vinson, along with law professor Michael Sakes, spoke about peer review and publication, in a session “As a Matter of Fact: ‘General Acceptance’ in Emerging vs. Established Science.” Their discussion on the publication process shed very little light on how courts and juries should assess the validity of specific papers, particularly in view of the lax practices at many journals. Towards the end of this session, a question from the audience proved to be very revealing of the prejudices of the law professor on the panel. The questioner rose to complain that after beginning research on a topic that has litigation relevance her research is now frequently questioned. She asked the panel how she might deal with the annoyance of being questioned. Some on the panel basically urged her to buck up, but the law professor invoked the spirit of agnothologist, and lawsuit industry expert witness, David Michael, to suggest that “manufacturing doubt” was just a corporate tactic in the face of scientific evidence. The prejudice against corporate speech is remarkable when the lawsuit industry has a long history of playing the ad hominem game in advancing its pecuniary interests.

The session that followed addressed how trustworthy science might best be put before courts. The organizers described this session, Utilizing Scientific and Technical Expertise, as going to the heart of the issues targeted by the conference. Joe S. Cecil, Deanne M. Ottaviano, and Shari Seidman Diamond discussed how scientific expertise enters into the evidentiary record in American courtrooms. Their presentations were interesting, but curiously no one mentioned that the primary avenue for expert witness opinion is through oral testimony!

Joe Cecil discussed methods judges have to obtain scientific and technical evidence to advance justice. (By this I hope he meant the truth, and not just the outcome preferred by social justice warriors.) As noted, Joe Cecil did not focus on the ordinary methods of direct and cross-examination of party expert witnesses, but rather, he identified other methods of introducing expertise into the courtroom for the benefit of the judge or the jury. Only one suggestion really affects jury comprehension, namely the appointment of non-party expert witnesses by the court. The other methods really only provide expertise to the trial judge, who perhaps is challenged to make a ruling under Federal Rule of Evidence 702. The federal courts have the inherent supervisory power to appoint technical advisors to act as special law clerks on issues. Similarly, appointed special masters can address technical implementation issues, subject to the district judges’ control. The judges are always free to read outside the briefs and testimony, but there are ethical and notice issues for such conduct. The Reference Manual on Scientific Evidence (RMSE) sits on the shelves on every federal judge’s bookshelf, even if in pristine, unused condition. Judges can at least read the RMSE on specific issues without having to disclose their extra-curricular research to the parties. Of course, parties are well advised to consider any materials in the RMSE, which support or oppose their contentions.

In discussing the RMSE, Cecil noted that the fourth edition was in the works. He also mentioned that all the old chapter topics would be carried forward to the fourth edition, and that new topics would include eyewitness identification, computer science, artificial intelligence, and climate science. Sadly, there will be no chapter on genetic determination of disease, but perhaps the clinical medicine chapter will take on the subject in greater detail than previous editions. This conference took place two years ago, and yet the RMSE, fourth edition, is still not published. The National Academies website previously listed the project as completed, but the site now describes the work as “in progress.”

Joe Cecil’s analysis of the various extraordinary expert techniques was pretty much spot on, especially his assessment that “experiments” with court-appointed experts were often failures or at best modest successes. The discussion of Judge Pointer’s Rule 706 independent expert witnesses in the silicon [sic] breast implant litigation, MDL926, seemed to lack context. Cecil acknowledged that the court’s expert witnesses contributed some value to admissibility decisions, but Judge Pointer notoriously did not believe that he, as the MDL judge, had any responsibility for Rule 702 determinations, and he made none except in cases that he tried in the Northern District of Alabama. (And these decisions were before the Science Panel was appointed.) So the Rule 706 witnesses really could not have aided in admissibility decisions.

The real value – in my view – of the Science Panel was that it demonstrated that Judge Pointer was quite wrong in believing that both sides’ expert witnesses were simply “too extreme,” or too partisan, and that the truth was somehow in the middle. Indeed, Judge Pointer said so on many occasions, and he was judicially gobsmacked when all four of his experts roundly rejected the plaintiffs’ distortions of the science of immunology, epidemiology, toxicology, and rheumatology. The courts’ expert witnesses sat for discovery depositions, and then gave testimony de bene esse. To my knowledge, their testimony was never admitted in any of the subsequent trials.

Judge Jed Rakoff gave an interesting presentation, “Strengthening Cooperation Between the Scientific Enterprise and the Justice System,” on the intersection between scientific and legal expertise and the need for their better integration. Judge Rakoff focused on the astonishing lack of compliance of trial judges with the gatekeeping requirements of Rule 702 in addressing the admissibility of forensic evidence. Several subsequent panels also addressed forensic topics, including “A Texas Case Study in Accountability for Forensic Sciences,” “Innovations in Investigative Technologies Improvements and Drawbacks,” and “Artificial Intelligence and the Courts,” “Wrongful Convictions and Changed Science: Statutes,” and “Standing Up for Justice: When the Law and Science Work Hand-in-Hand.”

One of the more curious sessions was on “Statistical Modeling and Causation Science,” presented by the American Statistical Association along with the AAAS. Maria Cuellar, from the University of Pennsylvania, discussed the role of statistical thinking in causal assessment, with slides that referred to a nonparametric estimator for the probability of causation. Cuellar, however, never defined what an estimator was; nor did she differentiate nonparametric from parametric estimators. She displayed other equations, again without explaining their origin and meaning, or identifying symbols or meanings. Similarly, Rochelle E. Tractenberg, discussed the use of statistics as evidence and as part of inferring causal inference in litigation, in a model of unclarity. At one point, Tractenberg appeared to suggest that general causation could be taken from regulatory pronouncements. Her discussion of glyphosate implied that general causation was established, which may have led me to disregard her presentation.

Finally, the conference sported a discussion, “Toxic Tort 2.0: Emerging Trends in Climate Change Related Litigation,” The two presenters were Dr. L. Delta Merner, the “Lead Scientist” for the Science Hub for Climate Litigation, Union of Concerned Scientists, and Dr. Paul A. Hanle, Visiting Scholar and Founder of the Climate Judiciary Project, Environmental Law Institute. The Science Hub actively promotes climate change litigation, which made me wonder whether its scientists are involved in that new chapter in the upcoming fourth edition of the Reference Manual.

Posted in Causation, Reference Manual on Scientific Evidence, Rule 702, Scientific Evidence, Scientific Publishing | 6 Comments »

Lack of Trust in Science – The Situation Our Situation Is In

August 29th, 2025

The United States is in political crisis as its citizens are frogmarched into an authoritarian, illiberal, and unlawful dystopia. The seriousness of the political situation makes it difficult to focus on scientific issues, but as with past fascist regimes in history, the crisis is not limited to any one sphere of life in the United States.

Scholars of fascism have pointed out that not all fascist regimes are the same, but there are some key features that give them all a family resemblance. In the political realm, fascist leaders point to an idyllic history, however mythical or false, in which the country was once great. The greatness has been eroded and squandered by the country’s enemies, internal and external. Confronting enemies within and without is an emergency, which cannot be addressed within the rule of law. Only an authoritarian leader can fix it by suspending the rule of law.

Fascism does not operate solely in the political sphere, but insists upon ideological purity in art, culture, education, business, finance, military, law, and science.[1]

Yes, even science. Nazi Germany had its bogus science of racial purity. The Soviet Union had its Lysenkoism. Theocratic fascist regimes, such as Iran or the United States, have their “god talk” and blasphemy squads, which suppress scientific curiosity, experimentation, and development, except for the creation of weapons (where replicability, validity, and predictive accuracy really matter).

There are various reasons for Felonious Trump’s election, but the epistemic sin of credulousness of the American people is certainly one of them. We are living in Orwell’s 1984 world where many people have been tethered to TV screens to receive their daily influx of state-approved propaganda. Character for truth has ceased to be a virtue. “And even truth can become a lie in the mouth of a born liar.”[2]

The credulity of the American people has manifested as distrust in scientific expertise and willingness to believe charlatans such as Robert Kennedy, Jr. The phenomenon of transferring trust from legitimate scientists to charlatans is probably one of the clearest and strongest symptom of our current malaise.

Professor Arthur L. Caplan[3] is a scientist and medical ethicist who has never been shy about asking discomforting questions. Not surprisingly, Caplan has spoken out against some of the bone-headed anti-science actions of the present regime in Washington.[4]

In an essay entitled “How Stupid has Science Been?” Caplan asks:

“So how can U.S. President Trump, Secretary of Health Robert F. Kennedy, Jr., or Director of the Centers for Medicare and Medicaid Mehmet Oz and their enthusiastic followers be succeeding in defunding research and installing ideological oversight and censorship that is crushing science, technology and engineering and will for many years to come?”[5]

Caplan blames the scientific community itself, in part, for the current crisis by disparaging and discouraging scientists from engaging with the public. Obviously, Caplan is not thinking of the cadre of scientists who seek phony validation by becoming highly paid expert witnesses for the lawsuit industry. Nor is he thinking of the dodgy TV doctors such as Dr. Oz. Caplan’s focus is on the harm done to the careers of accomplished scientists, such as the late Carl Sagan, who was denied tenure at Harvard University and membership in the National Academies of Science because his popularizing efforts eclipsed his substantial scientific accomplishments. Caplan thus blames the American scientific establishment itself for having “disparaged its public communication as unnecessary and looked down on those few who tried to educate broader audiences about the wonders, benefits, methods and advancements of science.”

Professor Caplan argues that in popularizing scientific ideas, theories, and methods, scientists – such as the late Carl Sagan – undermined their own careers. The result is that high-achieving scientists ignored the public square and retreated into their own scientific community’s ivory tower. Caplan’s critique of the detachment of the scientific community could well be extended to its frequent failures to speak out against charlatans in its own midsts, and politicians who distort and misrepresent scientific research in the public arena.

Caplan is, however, very clear that the scientific community’s insularity, and its “resulting failure to communicate about science to the public is a major factor in explaining why so few have rallied to science’s defense today against government policies promoting ignorance, illiteracy and quackery.” Indeed, although at this point, it is also clear that frank communications about the government’s promotion of scientific quackery will be punished by the Regime’s cancellation of grants, firing from advisory councils, and retaliations against scientists’ universities.

I take Caplan’s critique to be an invitation to engage in counter-factual thinking about what our current situation might look like if scientists had robustly “occupied the field” of communication and education of the public. Citing a recent article in a Nature journal,[6] Caplan observes that populists and right-wing thinkers have been losing faith in science for years. This diagnosis, however, is not quite accurate. Populists, left and right, have succumbed to motivated reasoning in learning to ignore scientific conclusions, regardless of validity concerns, on emotive or political grounds. This mode of (non)-thinking allows populists, left and right, to subscribe to putative scientific claims without any appreciation of the nuances of scientific inference and threats to validity.

Caplan is right to call out the right-wing attack on science, but some of the attack on science is coming from left-wing populists, such as the worm-brained Robert F. Kennedy, Jr. And historically, there have been many instances in which environmental and occupational health advocates have outrun their headlights to press claims based upon hypothetical models and unvalidated assumptions.

All people, whether they hang politically left or right, are vulnerable to the emperor of all cognitive biases – apophenia, the psychological tendency to discern causal patterns in random noise. Although apophenia was originally thought of an abnormal psychological process,[7] the phenomenon is common to “normal” as well as mentally ill persons.[8]

Many people, left and right, are willing to endorse, or subscribe to, pseudo-scientific claims based upon their motivations to accept claims, without regard to the methods used to support those claims. Professor Caplan is correct that serious scientists have been too shy to step into the public square, and the scientific community should encourage, not punish, engagement with the public. (Caplan passes over the problem of how university publicists often misrepresent and exaggerate the findings and research of university scientists.)

The problem of lack of trust in science, however, is a much bigger problem. On average, American education and acumen in math and science lags that of many countries in the world,[9] even as post-secondary education in the United States excels and attracts many of the best and the brightest domestically and internationally. Immigrants have helped American universities keep their leadership role in the world, despite shortfalls in domestic funding of primary and secondary science education. Of course, this international leadership in science and math university education, gained with the help of immigrants, is now under attack from the MAGAT regime.[10]

No one is eager to blame those who evidence their lack of trust in science, and to be sure, there is plenty of blame to go around. There are multiple systemic causes of poor quality science and improvident claims to scientific knowledge.[11] In assessing the causes of the prevalent distrust in science, we should not lose sight of the responsibility of those who claim that scientists cannot be trusted. There is at bottom a widespread moral failure in the land. “It is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence.”[12]

доверяй, но проверяй!

[1] Zachary Basu, “Trump knee-caps America’s institutions,” Axios (Aug. 27, 2025); Elisabeth Zerofsky, “Robert Paxton, A Leading Historian Of Fascism, Long Resisted Applying The Label To Trumpism. Then He Changed His Mind..,” N.Y. Times Mag. 45 (Oct. 27, 2024).

[2] Thomas Mann, “The Problem of Freedom: An Address to the Undergraduates and Faculty of Rutgers University at Convocation,” (April 28, 1939).

[3] Arthur L. Caplan, PhD., is the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics, Department of Population Health, and the founder of the Division of Medical Ethics at NYU Grossman School of Medicine’s Department of Population Health in New York City. I had the pleasure to meet Professor Caplan, and present to one of his classes, back when he taught at the University of Pennsylvania.

[4] See, e.g., Arthur L. Caplan, “Fed Action Toward Medical Journals Is ‘Dangerous’, Ethicist Says,” Medscape (Aug. 26, 2025).

[5] Arthur L. Caplan, entitled “How Stupid has Science Been?” EMBO reports (Aug. 2025).

[6] Vukašin Gligorić, Gerben A. van Kleef, and Bastiaan T. Rutjens, “Political ideology and trust in scientists in the USA,” 9 Nature Human Behaviour 1501 (2025) (“Since the 1980s, trust of science among conservatives in America has been plummeting”).

[7] See Aaron L Mishara, “Klaus Conrad (1905–1961): Delusional Mood, Psychosis, and Beginning Schizophrenia,” 36 Schizophr Bull. 9 (2009); Scott D. Blain, Julia M. Longenecker, Rachael G. Grazioplene, Bonnie Klimes-Dougan, and Colin G. DeYoung, “Apophenia as the disposition to false positives: A unifying framework for openness and psychoticism,” 129 J. Abnormal Psych. 279 (2020).

[8] Donna L Roberts, “Apophenia: The Human Tendency to Find Patterns in Randomness,” Medium (Jan. 9, 2024); Ahmed S. Sultan & Maryam Jessri, “Pathology is Always Around Us: Apophenia in Pathology, a Remarkable Unreported Phenomenon,” 7 Diseases 54 (2019).

[9] Drew DeSilver, “U.S. students’ academic achievement still lags that of their peers in many other countries,” Pew Research Center (Feb. 15, 2017).

[10] Is it not high time that we call the movement by its essential motivation: make American great again for the Trumps?

[11] See, e.g., Lex Bouter, Mai Har Sham & Sabine Kleinert, “The Lancet–World Conferences on Research Integrity Foundation Commission on Research Integrity,” 406 The Lancet 896 (2025).

[12] William K. Clifford, “The Ethics of Belief,” 29 Contemporary Rev. 289, 295 (1877).

Posted in Causation, Cognitive Biases, Scientific Evidence, Scientific Misconduct | No Comments »

Junk Journalism

August 19th, 2025

There is plenty of room for a healthy science-based environmentalism, but finding the room in the American political house has always been difficult. The current administration brings together the horseshoe wacko excesses of the worm-brained Robert Kennedy, Jr., and the crony capitalism of Felonious Trump. In this toxic, post-truth milieu, environmental groups such as Sierra Club and Greenpeace are both complaining about their setbacks,[1] as well as stepping up their own propaganda.

In the face of advocacy group propaganda, journalists should provide a strong science filter before allowing misinformation and emotive appeals to be passed off as scientific truth. Sadly, well-motivated manufacturing industry can rarely count on either the main stream media for sympathy or accuracy in reporting environmental issues. Readers of major newspapers, however, deserve careful reporting and the separation from hyperbole and fact.

A recent article in the Washington Post makes the point. Activist journalist Amudalat Ajasa reported her story this week that “Her dogs kept dying, and she got cancer. Then they tested her water.”[2] Oh my goodness; that must be a scandal; right? Queue the outrage.

Now widespread journalistic practice means that Ms. Ajasa may not have written the headline, and it was likely an editor who concocted the click-bait headline that suggested that something in the water killed some woman’s dogs and caused her cancer. Upon reading the story, however, readers would be justified in concluding that the author was clearly in on the ploy to misinform. So shame on both the would-be journalist and her editor.

Ms. Ajasa tells us that the residents of Elkton, Maryland, worry about “forever chemicals” in their water, a worry instigated in large measure by mass and social media, advocacy NGOs, state and federal agencies, and the lawsuit industry. Focusing on her anecdotal datum, Ajasa reports that Ms. Debbie Blankenship, a resident of the Elkton area, had “chalked up her health problems, including losing her right leg to an infection, to bad luck.” Bad luck? Ajasa must have gotten a HIPAA release and waiver to discuss Ms. Blankenship’s medical condition in a very public forum because the WaPo story discusses health details and features photographs of Ms. Blankenship, who is clearly obese, has had one leg amputated, and is confined to a wheel chair. Apparently, neither Ms. Blankenship nor Ms. Ajasa ever considered that lifestyle factors combined to cause Ms. Blankenship to develop diabetes mellitus and cancer (of some unspecified type).

The obvious, however, is ignored or pushed aside by Ajasa’s reporting that in 2023, W.L. Gore & Associates, a manufacturer of Gore-Tex, telephoned with a request to test the Blankenship water well for perfluorooctanoic acid (PFOA), which had been used in its manufacture of Teflon (polytetrafluoroethylene or PFTE). PFOA is one of the family of PFAS chemicals that has been the subject of a regulatory furor in recent years, including the issuance of action levels below the limits of detection for many laboratories.

The request to test the Blankenship water well was triggered by a lawsuit, filed in 2022, by a former W.L. Gore employee, Stephen Sutton. The lawsuit industry jumped on Sutton’s lawsuit with a class action environmental complaint in 2024. In any event, according to Ms. Ajasa, the company’s request to test the Blankenship well led to the eureka moment of scientific insight. Ms. Blankenship and her dogs drank well water, but her husband and children always drank bottled water. She was poisoned by the well water. Quod erat demonstrandum!

Ajasa’s reporting forces the reader to wade through a lot of activist propaganda and scientific hooey, such as claims that there is no safe level of PFOA, passed off as scientific fact. Agency assumptions and precautionary principle statements are not facts. Ignorance about no observable effect level is not knowledge that there is no safe level.

The WaPo readers are similarly regaled with a claim, masquerading as a statement of fact, that PFAS chemicals have “been linked to serious health problems including high cholesterol, cardiovascular disease, infertility, low birth weight and certain cancers.” Use of the verb “link” is a meaningless term in science, and thus a favorite of sloppy journalists. Whether a link is an association, a cause, a suggestion from an anecdote, a lawyer’s allegation, or a claim by an environmental group is anyone’s guess, and is left to the reader’s imagination. Whether Ms. Blankenship’s cancer is one of the “certain cancers” is not reported. Sloppy journalism of this sort, whether intentional, reckless, or negligent, undermines evidence-based legislation, regulation, and adjudication. “The credulous man is father to the liar and the cheat.”[3]

Ms. Ajasa eventually gets around to telling her readers that the water samples from Ms. Blankenship’s well contained PFOA concentrations of 3.4 parts per trillion (ppt), below the Environmental Protection Agency’s precautionary and unsupported maximum action level of 4 ppt. Rather than looking for other potential causes of Ms. Blankenship’s health problems, Ms. Ajasa glibly channels the EPA’s unsupported assertions that “that small amounts of the chemical can cause serious health impacts [sic], including cancer.” The reader is left to believe that this is a fact and that the undefined “small amounts” must include the 3.4 ppt detected in Blankenship’s well. Ajasa uses innuendo to substitute for the absence of evidence.

Journalists have an important role in informing and educating the public about scientific issues and controversies. Innuendo, unquestioned assumptions, and sloppy thinking – this is how the junk journalism sausage is made. Junk journalism is much like junk science. If we understand that junk journalism is a form of information pollution, then a well-considered, evidence-based environmentalism calls for remediation.

[1] David Gelles, Claire Brown and Karen Zraick, “Environmental Groups Face ‘Generational’ Setbacks Under Trump,” N.Y. Times (Aug. 16, 2025). The list of aggrieved seems endless: Sierra Club, Greenpeace, Climate and Communities Institute, Natural Resources Defense Council, Earthjustice, the Southern Environmental Law Center, etc.

[2] Amudalat Ajasa, “Her dogs kept dying, and she got cancer. Then they tested her water,” Wash. Post (Aug. 14, 2025).

[3] William Kingdon Clifford, “The Ethics of Belief” (1877), in Leslie Stephen & Sir Frederick Pollock, eds., The Ethics of Belief and Other Essays 70, 77 (1947).

Posted in Causation, Regulation, Scientific Evidence, Scientific Publishing | No Comments »

Victor Schwartz – An Intellectual Leader of the American Defense Bar

August 8th, 2025

Victor Elliot Schwartz died late last month. His passing was marked with several obituaries, from his colleagues, friends, and family, which marked his many achievements.[1] At the defense bar, Victor was truly a thought leader and tort scholar, as well as an advocate for sensible reform. Victor’s work had tremendous influence, although sadly, because of a rapacious, rent-seeking lawsuit industry, not as much influence as it should have had.

His work and insights inspired my own efforts on several fronts. Just as I was coming out of my clerkship, Victor published a law review article, in the University of Cincinnati Law Review, on the often otiose warnings required for products and raw materials sold for use in the workplace of large manufacturing concerns.[2] The learning of Victor’s scholarship became essential in fashioning a defense to dozens of silicosis cases filed in western Pennsylvania, in the early 1980s. The pursuer was a law firm that hoped to exploit the usual David-Goliath narrative from its asbestos cases, coming out of the large U.S. Steel and Bethlehem Steel factories and foundries. Victor’s work emphasized the importance of the epistemic context of occupational exposures cases that arose from employment in factories owned by sophisticated users and purchasers of potentially hazardous materials. Along with my co-defense counsel, we implemented Victor’s insights in the Cambria County, Pennsylvania, silicosis litigation. When the dust settled, the pursuer and his clients went away empty handed.[3]

Victor’s insights into the law and communication theory were equally valuable in asbestos litigation. Because most cases in Philadelphia were tried through the cockamamie reverse-bifurcation procedure, the defense rarely got a chance to put on a state-of-the-art or sophisticated intermediary defense. There was one blessed judge, the Hon. Levan Gordon, who distained reverse bifurcation, and gave me the opening to present both defenses in response to plaintiffs’ counsel’s insistence upon trying negligence and punitive damage claims in an all-issue case. Although I had the weaker side of the medical dispute, my adversary turned the case into a passion play on failure to warn. The jury returned a no cause verdict for the defense, without reaching the medical claim.[4]

Some years later, I was invited by the National Industrial Sand Association to talk about the recrudescence of silicosis litigation. The sand mining companies were very concerned about the bogus radiographic screenings and liability claims. Victor was also invited, but as things turned out, I spoke first. As a young brash lawyer, I thought I should include some concrete recommendations on what the companies could do to avoid liability. I suggested that they ask for indemnifications for any third-party suits by the buyers’ employees. I acknowledged that this was a tough ask so I had a fall-back suggestion that the firms put in recitations in the sales documents that the buyer warrants and represents that it is conversant with all pertinent regulations and industrial hygiene procedures to handle silica sand safely in its business. The audience, made up of owners and executives, was clearly uncomfortable over the suggestion that they request such concessions from their buyers in a highly competitive market. The comments were hostile, but Victor jumped in, and said that he had planned to offer the same suggestions and that the sand companies should take these suggestions very seriously. Victor had the gray hair and the gravitas that I lacked, and the company executives piped down and I got on with my talk.

Victor was a natural, and as a young lawyer, he was one of my leading role models. Years later, he encouraged me to seek membership in the American Law Institute, and offered helpful guidance about the application process. More recently, when the directors of the Center for Truth in Science wanted to create a legal advisory council, Victor Schwartz was our number one recruit. He will be missed.

[1] “Shook Mourns the Passing of Beloved Public Policy Chair Victor Schwartz,” SHB (Jul. 29, 2025); PR Newswire (Jul. 29, 2025); Legacy.com (Jul. 29, 2025)

[2] Victor E. Schwartz & Russell W. Driver, “Warnings in the Workplace: The Need for a Synthesis of Law and Communication Theory,” 52 U. Cin. L. Rev. 38 (1983). See also Victor E. Schwartz, Mark A. Behrens & Andrew W. Crouse, “Getting the Sand Out of the Eyes of the Law: The Need for a Clear Rule for Sand Suppliers in Texas After Humble Sand & Gravel, Inc. v. Gomez,” 37 St. Mary’s Law J. 283 (2006).

[3] Phillips v. A.P. Green Co., 428 Pa. Super. 167, 630 A.2d 874 (1993) (citing Schwartz & Driver), aff’d on other grounds sub nom. Phillips v. A-Best Products Co., 542 Pa. 124, 665 A.2d 1167 (1995) (citing lack of proximate cause between failure to warn and harm); Smith v. Walter C. Best, Inc., 927 F.2d 736 (3rd Cir. 1990) (Ohio law); Goodbar v. Whitehead Bros., 591 F. Supp. 552 (W.D.Va. 1984) (citing Schwartz & Driver), aff’d sub nom. Beale v. Hardy, 769 F.2d 213 (4th Cir. 1985). See Schachtman, “History of Silicosis Litigation,” Tortini (Jan. 31, 2019).

[4] O’Donnell v. The Celotex Corp., Phila. Cty. Ct.C.P., July 1982 Term, Case. No. 1619 (trial before Hon. Levan Gordon, and a jury; May 1989) (defense verdict in case in which plaintiffs presented negligence claims and defendants presented extensive evidence of federal government’s superior knowledge of hazard and control of workplace). See Schachtman, “Asbestos and Asbestos Litigation Are Forever,” Tortini (Sep. 16, 2014); “Divine Intervention in Litigation,” Torinti (Jan. 27, 2018).

Posted in Learned and sophisticated intermediary, Silica | No Comments »

Systematic Reviews versus Expert Witness Reports

July 2nd, 2025

Back in November 2024, I posted that the fourth edition of the Reference Manual on Scientific Evidence was completed, and that its publication was imminent. I based my prediction upon the National Academies’ website that reported that the project had been completed. Alas, when no Manual was forth coming, I checked back, and the project was, and is as of today, marked as “in progress.” The NASEM website provides no explanation for the retrograde movement. Could the Manual have been DOGE’d? Did Robert F. Kennedy Jr. insist that a chapter on miasma theory be added?

Ever since the third edition of the Manual arrived, I have tried to identify its strengths and weaknesses, and to highlight topics and coverage that should be improved in the next edition. In 2023, knowing that people were working on submissions for the fourth edition, I posted a series of desiderata for the new edition.[1] I might well have extended the desiderata, but I thought that work was close to completion.

One gaping omission in the third edition of the Manual, which I did not address, is the dearth of coverage of the synthesis of data and evidence across studies. To be sure, the chapter on medical testimony does discuss the “hierarchy of medical evidence, and places the systematic review at the apex.[2] The chapter on epidemiology, however, fails to discuss systematic reviews in a meaningful way, and treats meta-analysis, which ideally pre-supposes a systematic review, with some hostility and neglect.[3]

Notwithstanding the glaring omission in the 2011 version of the Reference Manual, the legal academy had been otherwise well aware of the importance of properly conducted systematic reviews. Back in 2006, Professor Margaret Berger organized a symposia on law and science, at which John Ioannidis presented on the importance of systematic reviews.[4] Lisa Bero also presented on systematic reviews and meta-analyses, and identified a significant source of bias in such reviews that results when authors limit their citations to studies that support their pre-selected, preferred conclusion.[5] Bero’s contribution, however, missed the point that a well-conducted systematic review makes cherry picking much more difficult, as well as obvious to the reader.

The high prevalence of biased citation and consideration of, and reliance upon, studies is a major source of methodological error in courtroom proceedings. Even when the studies relied upon are reasonably well done, expert witnesses can manipulate the evidentiary display through biased selection and exclusion of what to present in support of their opinions. Sometimes astute judges recognize and bar expert witnesses who would pass off their opinions, as well considered, when they are propped up only by biased citation. Unfortunately, courts have not always been vigilant and willing to exclude expert witnesses who proffer biased, invalid opinions based upon cherry-picked evidence.[6] Given that cherry picking or “biased citation” is recognized in the professional community as rather serious methodological sins, judges may be astonished to learn that both phrases, “cherry picking” and “biased citation” do not appear in the third edition of the Reference Manual on Scientific Evidence. With the delay in publishing the fourth edition, there is still time to add citations to careful debunking of biased citation, such as the reverse-engineered systematic review and meta-analysis in last year’s decision in the paraquat parkinsonism litigation.[7]

When I began my courtroom career, systematic reviews of the evidence for a causal claim were virtually non-existent. Most reviews and textbook chapters were hipshots that identified a few studies that supported the author’s preferred opinion, with perhaps a few disparaging words about a study that contradicted the author’s preferred outcome. On a controversial issue, lawyers could generally find a textbook or review article on either side of an issue. Cross-examination on a so-called “learned treatise,” however, was limited. In state courts, the learned treatise was not admissible for its truth, but only to show that expert witnesses should not be believed when they disagreed with the statement. It was all too easy for an expert witness to declare, “yes, I disagree with that one sentence, on one page, out of 1,500 pages, in that one book.”

In federal courts, the applicable rule of evidence makes the learned treatise statement admissible for its truth:

“Rule 803. Exceptions to the Rule Against Hearsay

The following are not excluded by the rule against hearsay, regardless of whether the declarant is available as a witness:

(18) Statements in Learned Treatises, Periodicals, or Pamphlets . A statement contained in a treatise, periodical, or pamphlet if:

(A) the statement is called to the attention of an expert witness on cross-examination or relied on by the expert on direct examination; and

(B) the publication is established as a reliable authority by the expert’s admission or testimony, by another expert’s testimony, or by judicial notice.

If admitted, the statement may be read into evidence but not received as an exhibit.”

While this rule historically had some importance in showing the finder of fact that the opinion given in court was not shared with the relevant expert community, the rule was and is problematic. Exactly what counts as “learned” is undefined. Expert witnesses on either side can simply endorse a treatise, a periodical, or a pamphlet as learned to enable a lawyer to use it on direct or cross-examination, and make its contents admissible. The rule was drafted and enacted in 1975, when another rule, Rule 702, was generally interpreted to place no epistemic restraints upon expert witnesses. Allowing Rule 803(18) to be invoked without the epistemic constraints of Rules 702 and 703 raised few concerns in 1975, but in the aftermath of Daubert (1993), the tension within the Federal Rules of Evidence requires that the admissibility of a statement in a learned treatise cannot save an expert witness opinion that is not otherwise sufficiently grounded and valid.[8]

Systematic reviews are a different kettle of fish from the sort of textbook opinions of the 1970s and 1980s, which often lacked comprehensive assessments and consistent application of criteria for validity. The intersection of the evolution of Rule 702 and systematic reviews is remarkable. When Rule 702 was drafted, systematic reviews were non-existent. When the Supreme Court decided the Daubert case in 1993, systematic reviews were just emerging as a different and superior form of evidence synthesis.[9] The lesson for judges, regulators, and lawyers is that the standards for valid synthesis of studies and lines of evidence have changed and become more demanding.

In 2009, several professional groups produced an important guidance for reporting systematic reviews, “the Preferred Reporting Items for Systematic reviews and Meta-Analyses,” or PRISMA.[10] Although the PRISMA guidance ostensibly addresses reporting, if authors have not done something that should be reported, their failure to do it and report about it can be identified as a significant omission from their publication. One of the PRISMA specifications called for the writing of a protocol for any systematic review, and for making this protocol available to the scientific community and the public. The protocol will identify the exact clinical issue under review, the kinds of evidence that bear on the issue, and criteria for including or excluding studies that should be included in the review. The requirement of pre-registration has the ability to damp down data dredging in observational studies and experiments, and to help readers see when authors reverse engineered systematic reviews by declaring their criteria for inclusion and exclusion after reading candidate studies and their conclusions.

In 2011, the Centre for Reviews and Dissemination, at the University of York in England, developed an internet archive, PROSPERO, for prospectively registering systematic reviews. In addition to reducing duplication of systematic reviews, PROSPERO aimed to increase transparency, validity, and integrity of the systematic reviews. Around the same time, the Center for Open Science, also set up a web-based archive for systematic review protocols.[11]

Reviews purporting to be systematic are now commonplace. By 2018, ROSPERO had registered over 30,000 records, but of course, some scientists may have registered systematic reviews which they never completed.[12] Despite the publication of professional guidances, carefully performed systematic reviews can still be hard to find.[13]

In federal court, expert witnesses must proffer their opinions in a specified form. Back in the 1980s, federal court practice on expert witnesses was “loose” not only on admissibility issues, but also on the requirements for pre-trial disclosure of opinions. In some federal districts, such as those within Pennsylvania, federal judges took their cues not from the language of the Federal Rules of Civil Procedure, but from state court practice, which required only cursory disclosure of top-level opinions without identifying all facts and data relied upon by the proposed expert witness. In many state courts, and in some federal judicial districts, lawyers had a difficulty obtaining judicial authorization to conduct examinations before trial to discover all the bases and reasoning (if any) behind an expert witness’s opinion. Under the current version of the Federal Rules of Civil Procedure, trial by ambush has generally given way to full discovery. The current version of Rule 26 provides:

Rule 26. Duty to Disclose; General Provisions Governing Discovery

(a) Required Disclosures.

* * *

(2) Disclosure of Expert Testimony.

(A) In General. In addition to the disclosures required by Rule 26(a)(1) , a party must disclose to the other parties the identity of any witness it may use at trial to present evidence under Federal Rule of Evidence 702 , 703 , or 705 .

(B) Witnesses Who Must Provide a Written Report. Unless otherwise stipulated or ordered by the court, this disclosure must be accompanied by a written report—prepared and signed by the witness—if the witness is one retained or specially employed to provide expert testimony in the case or one whose duties as the party’s employee regularly involve giving expert testimony. The report must contain:

(i) a complete statement of all opinions the witness will express and the basis and reasons for them;

(ii) the facts or data considered by the witness in forming them;

(iii) any exhibits that will be used to summarize or support them;

(iv) the witness’s qualifications, including a list of all publications authored in the previous 10 years;

(v) a list of all other cases in which, during the previous 4 years, the witness testified as an expert at trial or by deposition; and

(vi) a statement of the compensation to be paid for the study and testimony in the case.

An expert’s report or disclosure under Rule 26 remains a far cry from a systematic review, but the Rule goes a long way towards eliminating trial by ambush and surprise in requiring a complete statement of all opinions, all the bases and reasons for the opinions, and all the facts or data considered in reaching the opinions. The requirements of Rule 26, combined with a mandatory oral deposition, go a long way to help reveal cherry picking and motivated reasoning in an expert witness’s opinions.

[1] Schachtman, “Reference Manual – Desiderata for 4th Edition – Part I – Signature Diseases,” Tortini (Jan. 30, 2023); “Reference Manual – Desiderata for 4th Edition – Part II – Epidemiology & Specific Causation,” Tortini (Jan. 31, 2023); “Reference Manual – Desiderata for 4th Edition – Part III – Differential Etiology,” Tortini (Feb. 1, 2023); “Reference Manual – Desiderata for 4th Edition – Part IV – Confidence Intervals,” Tortini (Feb. 10, 2023); “Reference Manual – Desiderata for 4th Edition – Part V – Specific Tortogens,” Tortini (Feb. 14, 2023); “Reference Manual – Desiderata for 4th Edition – Part VI – Rule 703,” Tortini (Feb. 17, 2023).

[2] See John B. Wong, Lawrence O. Gostin, and Oscar A. Cabrera, “Reference Guide on Medical Testimony,” in Reference Manual on Scientific Evidence 687, 723-24 (3d ed. 2011) (discussing hierarchy of medical evidence, with systematic reviews at the apex).

[3] Schachtman, “The Treatment of Meta-Analysis in the Third Edition of the Reference Manual on Scientific Evidence,” Tortini (Nov. 14, 2011).

[4] John P.A. Ioannidis & Joseph Lau, Systematic Review of Medical Evidence, 12 J.L. & Pol’y 509 (2004).

[5] Lisa Bero, “Evaluating Systematic Reviews and Meta-Analyses,” 14 J. L. & Policy 569, 576 (2006).

[6] See Schachtman, “Cherry Picking; Systematic Reviews; Weight of the Evidence,” Tortini (April 5, 2015); “The Fallacy of Cherry Picking As Seen in American Courtrooms,” Tortini (May 3, 2014); “The Cherry-Picking Fallacy in Synthesizing Evidence,” Tortini (June 15, 2012).

[7] In re Paraquat Prods. Liab. Litig., 730 F. Supp. 3d 793 (S.D. Ill. 2024); see also Schachtman, “Paraquat Shape-Shifting Expert Witness Quashed,” Tortini (Apr. 24, 2024).

[8] See Schachtman, “Unlearning the Learned Treatise Exception,” Tortini (Aug. 21, 2010).

[9] Iain Chalmers, Larry V. Hedges, Harris Cooper, “A Brief History of Research Synthesis,” 25 Evaluation & the Health Professions 12 (2002); Mark Starr, Iain Chalmers, Mike Clarke, Andrew D. Oxman, “The origins, evolution, and future of The Cochrane Database of Systematic Reviews,” 25 Int J. Technol. Assess. Health Care s182 (2009); Mike Clarke, “History of evidence synthesis to assess treatment effects: personal reflections on something that is very much alive,” 109 J. Roy. Soc. Med. 154 (2016). See also Wen-Lin Lee, R. Barker Bausell & Brian M. Berman, “The growth of health-related meta-analyses published from 1980 to 2000,” 24 Eval. Health Prof. 327 (2001).

[10] Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff, Cynthia Mulrow, Peter C. Gøtzsche, John P.A. Ioannidis, Mike Clarke, Devereaux, Jos Kleijnen, and David Moher, “The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration,” 151 Ann Intern Med. W-65 (2009); “The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration,” 6 PLoS Med. e1000100 (2009).

[11] Alison Booth, Mike Clarke, Gordon Dooley, Davina Ghersi, David Moher, Mark Petticrew & Lesley Stewart, “The nuts and bolts of PROSPERO: an international prospective register of systematic reviews,” 1 Systematic Reviews 1 (2012); Alison Booth, Mike Clarke, Davina Ghersi, David Moher, Mark Petticrew, Lesley Stewart, “An international registry of systematic review protocols,” 377 Lancet 108 (2011).

[12] Matthew J. Page, Larissa Shamseer, and Andrea C. Tricco, “Registration of systematic reviews in PROSPERO: 30,000 records and counting,” 7 Systematic Reviews 32 (2018).

[13][13] John P. Ioannidis, “The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses,” 94 Milbank Q. 485 (2016).

Posted in Expert Witness Discovery, Expert Witnesses, Reference Manual on Scientific Evidence, Rule 702, Scientific Publishing | No Comments »

The FDA Expert Panel on Talc – More Malarky

June 18th, 2025

On May 20, 2025, as announced, FDA Commissioner Martin Makary held his panel discussion on talc in food and medications.[1] The discussion lasted just under two hours, and is available on YouTube for your viewing and perhaps your amusement. Makary opened and closed the event with what could have been the plaintiffs’ opening and closing statements from one of the many talc trials that have clouded courtrooms across the land. He asked rhetorically: “Why don’t we talk about at our oncology meetings the 1993 National Toxicology Program results that found clear evidence of carcinogenic activity of talc in animal studies?’” Perhaps because the talc findings were questionable at best, and the asbestos findings with respect to gastrointestinal cancers were exculpatory for talc.

Makary’s introductory remarks were followed by the panelists’ introducing themselves by their training and involvement with talc issues. Other than Makary, the participants were FDA Deputy Commissioner Sara Brenner, George Tidmarsh, John Joseph Godleski, Sandra McDonald, Daniel Cramer, Joellen Schildkraut, Malcolm Sim, Steven Pfeiffer, Nicolas Wentzensen, and Nicole C. Kleinstreuer. Godleski and Cramer have served as plaintiffs’ expert witnesses in ovarian cancer litigation, which was not particularly germane to the panel discussion. In their initial discussions of qualifications and background, neither Godleski nor Cramer disclosed his potential conflicts of interest, or the amount of fees earned. Sandra McDonald described her experience in assisting Godleski, but she did not declare whether she earned any money for consulting services to the lawsuit industry. Later in the panel discussion, when George Tidmarsh stated that no one should be vilified for past practices in using talc, Daniel Cramer jumped in to vilify Johnson & Johnson with the suggestion that somehow that company had surreptitiously arranged for the National Cancer Institute to remove a statement about how talc “may be associated with talc use” from its website just before he was about to testify in his first talc trial for plaintiffs.

None of the panelists had served as a defense expert witness. Steven Pfeiffer works for a pharmaceutical company, but not one that had any experience with the safety or efficacy of talc as an ingredient in medications.

None of the panelists had participated in any toxicologic or epidemiologic study of talc on cancers or diseases of the digestive organs. None of the panelists made it his or her business to become familiar with the extensive studies of the asbestos and talc on gastrointestinal cancers. The lack of experience, or specific citations to any study, did not stop Daniel Cramer from suggesting that talc was responsible for inflammatory bowel disease, autoimmune diseases, and gastrointestinal cancers. Like Cramer, epidemiologist Joellen Schildkraut, focused on ovarian cancer, and made the false assertion that the relationship between talc and gastrointestinal cancers is understudied. Schildkraut held back from asserting that talc causes ovarian cancer, but she heartily endorsed banning talc on the precautionary principle. All the panelists concurred with the suggestion that talc be eliminated from food and drugs, without waiting for “the epidemiologists to catch up.”

Two issues were grossly misrepresented by the panelists. None of them, however, was well informed enough for the misrepresentations to have been overt lies. The first whopper was that National Toxicology Program (NTP) testing had shown carcinogenicity of talc in its inhalational studies for the lung and other organs. The second whopper was that rice on talc was used prevalently in the United States, and that it was responsible for digestive organ cancers. Nicole C. Kleinstreuer, who has worked at the NTP, and accurately described its activities gave a description of its animal talc studies, perhaps a bit slanted, but not too inaccurate. When George Tidmarsh later misrepresented NTP talc findings, however, Kleinsteuer was silent.

NTP Ingestion Studies

Makary did not identify the NTP studies to which he referred, but Kleinsteuer described a talc inhalation study that has only one referent. The NTP conducted long-term rodent inhalation and ingestion assays for both talc and different kinds of asbestos, in the 1980s and 1990s. For talc, the NTP published, in 1993, only one long-term inhalational study in rats and mice.[2] In mice, exposed to talc by inhalation for up to two years, there was no evidence of any “neoplastic” effects. The results in rats were more difficult to interpret. In male rats, exposed for over two years, there was weak evidence of neoplastic effects based upon an increased incidence of benign or malignant adrenal gland pheochromocytomas. In female rats, the NTP reported “clear evidence” of excess alveolar/bronchiolar (lung) adenomas and carcinomas and benign or malignant adrenal gland pheochromocytomas of the adrenal gland. The meaning of these rodent studies obviously varies depending upon whether you are a rat or a mouse of a certain breed; the meaning for humans is even murkier, even for humans that are rodent-like. The multiple comparisons across exposure levels for dozens if not hundreds of outcomes, and the lumping of benign and malignant effects together, certainly makes the NTP statistical analyses suspect. This report was marked by significant controversy, and some scientists refused to endorse its finding because adrenal gland pheochromocytomas were not treatment-related; the maximum-tolerated dose was exceeded for female rats at the higher exposure level, thus violating the study’s protocol; and talc is thus not expected to cause tumors in rats (and mice) exposed at levels that do not cause “marked chronic lung toxicity.”[3]

One of the lawsuit industry’s, and Makary’s, theories about the harmfulness of ingested talc is based upon the supposition that talc has asbestos contaminants. This theory is as vague as is the term asbestos, which has no mineralogical meaning; instead, the term asbestos was historically used to refer to six different minerals: actinolite, anthophyllite, amosite (cummingtonite-grunerite), chrysotile, crocidolite, and tremolite. All of these minerals, except for chrysotile, are amphibole minerals. Some of the amphibole minerals occur in both fibrous and non-fibrous form, and the ill health effects of the amphibole fibers are generally attributed to their resistance to biological degradation and their high aspect ratio. Things get a bit crazy because the federal government, for purposes of standardizing aerosol measurements, set the aspect ratio for counting “fibers,” at 3:1. The pathogenicity of “federal fibers,” which are not really fibers, is highly disputed.

The NTP never conducted long-term talc ingestion studies; it did something much better. The NTP tested dietary high-dose, long-term ingestion of various asbestos types in multiple species. The NTP did not leave the exposure issue vague with “asbestos” as the dietary source. Instead, the NTP was more precise when testing whether ingesting “asbestos” was harmful to rodents. The NTP ran separate ingestion experiments on chrysotile, amosite, and crocidolite, with the different form of asbestos making up one percent of the animals’ lifetime diet. Overall, these experiments were “null”; that is, they provided no support for the carcinogenicity of ingested asbestos of the types tested.

The NTP conducted lifetime ingestion studies in male and female rats with a diet of one percent crocidolite asbestos, the most toxic and carcinogenic form of asbestos in human beings. The NTP experiments showed that under these conditions, long-term ingestion of crocidolite asbestos was neither overtly toxic nor carcinogenic in male or in female rats.[4] After crocidolite, amosite asbestos, fibrous cummingtonite-grunerite, named for “asbestos mines of South Africa, is the most toxic and carcinogenic of the asbestos fibers. The NTP showed that feeding male and female rats amosite asbestos for one percent of their diet, for their lifetimes, was not overtly toxic, did not affect their survival, and was not carcinogenic.[5] The NTP repeated its life-time one percent amosite diet in Syrian Golden hamsters, again without toxic or carcinogenic response in either the male or female hamsters.[6]

Looking at the least toxic and carcinogenic asbestos mineral, chrysotile, the NTP’s conducted long-term one percent feed studies of both “short range” and “long range” (chrysotile fiber length) in Syrian Golden hamsters. Again the results were “null”; that is, there was no treatment-related toxicity or carcinogenicity.[7] There were no increases in adrenal cortical adenomas (benign growths) when compared with concurrent controls, but there was an increase of these benign tumors when compared with pooled control groups from other experiments. Ultimately, the NTP concluded that the biological importance of these benign adrenal growths in the absence of cancers or tumors of the gastrointestinal tract (which was the target organ) was questionable, at best.

Because of prior research suggesting that carcinogencity was a function of fiber rigidity and length, the NTP tested ingested chrysotile in rats, at two different fiber lengths. For its experiments, the NTP defined “short-range chrysotile (SR)” as short fibers with a median length of 0.66 microns, and a range of 0.088 to 51.1 microns. “Intermediate-range (IR) chrysotile fibers had a median length of 0.82 microns, with a range from 0.104 to 783.4 microns. The NTP did not use long-range chrysotile fibers, which are generally greater than 5 microns in length. Male and female F344/N rats ingested an NTP one percent diet of chrysotile, in the two lengths of chrysotile, SR and IR, for a lifetime. There were no neoplastic or non-neoplastic diseases, overt toxicity, or decrease in survival associated with SR chrysotile ingestion, in either the male or the female rats.[8] In the female rats, there was no effect on fertility or litter, overt toxicity, or carcinogenicity from IR chrysotile ingestion. The male rats also did not show any adverse clinical signs, but they experienced a statistically insignificant increase in benign colonic polyps, which the NTP stretched to characterize as “some” (but not clear) evidence of carcinogenicity.

Rice is Nice, With or Without Talc

The FDA panelists’ inaccurate claims about talc on rice also cry out for rebuttal, which no panelist seemed able or willing to give. Given that the panel was convened with only four days notice, and without public comment, it operated in a fact-free zone, and operated mostly as a propaganda exercise. The history of the ingested asbestos and talc controversy goes back over half a century. Some background is needed to understand exactly how outlandish the rice-on-talc claim is.

The causal association between asbestosis and lung cancer was well established by the early 1960s,[9] as was the causal association between crocidolite asbestos exposure and mesothelioma.[10] Some sources carelessly credit Irving Selikoff with these discoveries, but he was not so much of a discoverer, as he was a zealous spokesman for the safety of asbestos-exposed workers. Selikoff worked hand-in-hand with various labor unions to publicize and politicize asbestos risks that had been shown by other workers. Credit for the lung cancer connection properly goes to earlier work done by Sir Richard Doll and others, and the crocidolite-mesothelioma connection was shown by J. Christopher Wagner, in 1960. Where Selikoff deserves credit is in tireless efforts to expand the scope of asbestos-related diseases beyond lung cancer and mesothelioma, with or without sufficient evidence, and thus to expand the compensability of other diseases of ordinary life in asbestos workers.

In his efforts to extend the scope of compensation, Selikoff did not limit himself to risks that had been scientifically established; he sought to expand the list of asbestos-related diseases. He advanced the unsubstantiated notions that all six kinds of asbestos minerals carried the same risks, that asbestos caused virtually every kind of cancer in humans, that any asbestos in the environment required extreme remedial action, and that asbestos was responsible for a very high percentage of all human cancers.

No doubt Selikoff wanted credit for scientific discoveries, but he also wanted science that would support compensation. Selikoff understood that if the asbestos workers stopped smoking, their risks of lung cancer would fall, and their cancer morbidity and mortality would be more influenced by gastrointestinal cancers, given that colorectal cancer was the leading cause of cancer-related death in non-smoking men, in the 1960s.

By 1950, Selikoff had already become an advocate, who testified and wrote reports as a claimants’ expert witness in many asbestos cases. In the early 1950s, New Jersey lawyer Carl Gelman retained Selikoff to examine 17 workers from the Paterson plant of Union Asbestos and Rubber Company (UNARCO). Gelman filed workers’ compensation claims on behalf of these UNARCO workers, and Selikoff supported Gelman’s claims with reports and testimony. In the early 1950s, Anton Szczesniak, one of the UNARCO claimants, with Selikoff’s support as an expert witness, sought compensation for “intestinal cancer.” In 1965, Selikoff testified to support an asbestos insulator’s claim that asbestos exposure caused his colorectal cancer.[11] In 1974, Selikoff wrote a review article on asbestos exposure and gastrointestinal cancers, without any disclosure of his pro-plaintiff testimonial adventures.[12] Serious epidemiologists such as Sir Richard Doll and Sir Richard Peto pushed back on Selikoff’s exaggerated projections of asbestos-related mortality,[13] and his assertion that asbestos caused digestive system cancers.[14] Forty years after Selikoff testified for the claimant in an asbestos colorectal cancer case, the Institute of Medicine published a systematic review of the evidence available to Selikoff and later evidence, which showed that the evidence was insufficient “to infer a causal relationship between asbestos exposure and pharyngeal, stomach, and colorectal cancers.”[15]

Selikoff’s rent-seeking and fear-mongering spawned many asbestos scares. Some scientists accepted Selikoff’s dogma that a single asbestos fiber, of any variety, could cause any human cancer. The Mt. Sinai jihad against “asbestos” extended to any exposures involving asbestos, or even other minerals that contained “elongated mineral particles,” that nominally met the crude definition of asbestos. This jihad led to a prolonged litigation against the Reserve Mining Company, which had permits to dump taconite tailings in Lake Superior, since the late 1940s. Using Selikoff’s claim that “asbestiform” mineral particles had entered the water supply, the U.S. Environmental Protection Agency was able to obtain an injunction against the mining company.[16]

Regulatory overreach, Selikoff’s exaggerated testimony, and the trial judge’s partiality and bias marred the litigation.[17] After decades of research on asbestos in drinking water, there remains no substantial evidence that supports a conclusion that ingested asbestos in drinking water causes gastrointestinal or any other cancer.[18]

Selikoff was the head of an anti-asbestos lobby that promoted the fiction that asbestos was responsible for all manners of human ailments, regardless of dose or route of administration.[19] One of the panics he helped initiate involved the claim that talc-dusted rice was responsible for the high rate of stomach cancer among Japanese in Japan.

Reuben Merliss published an article in Science, in 1971, in which he attempted to attribute the high rate of stomach cancer in Japan to the Japanese custom of dusting rice with talc. Merliss relied upon overall population rates and trends to draw an ecologic inference that the Japanese rice (with talc and any asbestos contaminants) was responsible for the Japanese higher incidence of stomach cancer.[20]

The Merliss hypothesis, inspired by Selikoff, was sunk by a much more careful analysis (which got less media coverage). Two epidemiologists analyzed data about use of talc-coated rice in Japan and Hawaii, and found no support for the claim that talc-coated rice increased the risk of developing stomach cancer.[21]

Their more careful dietary assessment found high rates of stomach cancer among Japanese in Japan who did not consume talc-coated rice, while Japanese in Hawaii, who consumed considerable quantities of talc-coated rice had intermediate rates of stomach cancer (lower than in Japan). Filipinos in Hawai had very low rates of gastric cancer, even though they consumed the greatest amounts of talc-coated rice of any of the observed groups. The secular incidence trend of stomach cancer decreased more substantially among the talc-exposed Japanese living in Hawaii than among the non-exposed Japanese living in Japan.

Although the asbestos perpetual motion litigation machine continues to churn, the lawsuit industry has been hampered by the bankruptcy of virtually every company that made an asbestos-containing product, and the reduction of asbestos use and exposures over the last 50 years. The lawsuit industry’s shift to demonize and monetize talc as the next mineral target was predictable. What was not predictable was that we would have a Secretary of Health & Human Services whose sole experience in medicine has been in suing pharmaceutical and other manufacturing industries, perpetuating medieval beliefs in the miasma theory of disease causation,[22] and spreading conspiracies, misinformation, and disinformation. FDA Commissioner Makary has shown himself to be a willing accomplice in advancing the Secretary’s agenda. In his closing remarks, Makary made unsupported assertions, then retreated to the dodge that he was just asking questions. Makary strongly suggested that the recent increase in colorectal cancer among young people has been caused by the use of talc in food and medications. He failed to reference any evidence for his suggestion, which is, in any event, hard to square with the history of use of talc in medications for centuries, and the steady overall decline in the incidence of colorectal cancer in men and women.[23]

The Center for Truth in Science has sponsored rigorous systematic reviews of the evidence on cosmetic talc use and female reproductive cancers,[24] and respiratory cancers.[25] The systematic review of talc on reproductive organ cancers integrated evidence across toxicologic and epidemiologic studies, and found suggestive evidence of no association between the use of perineal talc and ovarian and endometrial cancers. The systematic review of talc use and respiratory cancers similarly integrated the available toxicologic and epistemiologic evidence, and rejected a causal association. The review reached a conclusion of suggestive evidence in the opposite direction – of no association between inhaled talc and mesothelioma or lung cancer.

The FDA talc panel was fool’s gold, and not the promised “gold standard” science. Rather than engaging with the systematic reviews sponsored by the Center, or for that matter with any systematic reviews, Commissioner Makary and his panel wallowed in anecdotes, stories, and isolated study results, without trying to identify and synthesize all the available evidence.

[1] FDA Expert Panel on Talc, “Independent Expert Panel to Evaluate Safety and Necessity of Talc in Food, Drug, and Cosmetic Products,” FDA (May 20, 2025).

[2] NTP Technical Report on the Toxicology and Carcinogenesis Studies of Talc (CAS No. 14807-96-6) in F344/N Rats and B6C3F Mice (Sept. 1993).

[3] Jay I. Goodman, “An Analysis of the National Toxicology Program’s (NTP) Technical Report (NTP TR 421) on the Toxicology and Carcinogenesis Studies of Talc,” 21 Regulatory Toxicol. & Pharmacology 244 (1995). See also Robyn L. Prueitt, Nicholas L. Drury, Ross A. Shore, Denali N. Boon & Julie E. Goodman, “Talc and human cancer: a systematic review of the experimental animal and mechanistic evidence,” 54 Critical Reviews in Toxicology 359 (2024).

[4] NTP TR-280 Toxicology and Carcinogenesis Studies of Crocidolite Asbestos (CASRN 12001-28-4) In F344/N Rats (Feed Studies) (1988).

[5] NTP TR-279 Toxicology and Carcinogenesis Studies of Amosite Asbestos (CASRN 12172-73-5) in F344/N Rats (Feed Studies) (1990).

[6] NTP TR-249 Lifetime Carcinogenesis Studies of Amosite Asbestos (CASRN 12172-73-5) in Syrian Golden Hamsters (Feed Studies) (1983).

[7] NTP TR-246 Lifetime Carcinogenesis Studies of Chrysotile Asbestos (CASRN 12001-29-5) in Syrian Golden Hamsters (Feed Studies) (1990).

[8] NTP – TR-295 Toxicology and Carcinogenesis Studies of Chrysotile Asbestos (CASRN 12001-29-5) in F344/N Rats (Feed Studies) (1985).

[9] See Richard Doll, “Mortality from Lung Cancer in Asbestos Workers,” 12 Br. J. Indus. Med. 81 (1955).

[10] See J. Christopher Wagner, C.A. Sleggs, and Paul Marchand, “Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province,” 17 Br. J. Indus. Med. 260 (1960); J. Christopher Wagner, “The discovery of the association between blue asbestos and mesotheliomas and the aftermath,” 48 Br. J. Indus. Med. 399 (1991).

[11] See “Health Hazard Progress Notes,”16 The Asbestos Worker 13 (May 1966) (“A recent decision has widened the range of compensable diseases for insulation workers even further. A member of Local No. 12. Unfortunately died of a cancer of the colon. Dr. Selikoff reported to the compensation court that his research showed that these cancers of the intestine were at least three times as common among the insulation workers as in men of the same age in the general population. Based upon Dr. Selikoff’s testimony, the Referee gave the family a compensation award, holding that the exposure to many dusts during employment was responsible for the cancer. The insurance company appealed this decision. A special panel of the Workman’s Compensation Board reviewed the matter and agreed with the Referee’s judgment and affirmed the compensation award. This was the first case in which a cancer of the colon was established as compensable and it is likely that this case will become an historical precedent.”).

[12] Irving J. Selikoff, “Epidemiology of Gastrointestinal Cancer,” 9 Envt’l Health Persp. 299 (1974).

[13] Richard Doll & Richard Peto, “The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today,” 66 J. Nat’l Cancer Instit. 1191 (1981).

[14] Richard Doll and Julian Peto, Asbestos: Effects on Health of Exposure to Asbestos 8 (1985).

[15] Jonathan M. Samet, et al., Asbestos: Selected Cancers – Institute of Medicine (2006).

[16] See Wendy Wriston Adamson, Saving Lake Superior: A Story of environmental action (1974); Frank D. Schaumburg, Judgment Reserved: A Landmark Environmental Case (1976); Robert V. Bartlett, The Reserve Mining Controversy: Science, Technology, and Environmental Quality (1980); Thomas F. Bastow, This Vast Pollution: United States of America v. Reserve Mining Company (1986); Michael E. Berndt & William C. Brice, “The origins of public concern with taconite and human health: Reserve Mining and the asbestos case,” 52 Regulatory Toxicol. & Pharmacol. S31 (2008).

[17] Reserve Mining Co. v. Lord, 529 F.2d 181 (8th Cir. 1976) (removing Judge Lord from case).

[18] See World Health Organization, Asbestos in Drinking Water (4th ed. 2021) (“no causal association between asbestos exposure via drinking-water and cancer development has been reported for any asbestos fibre type”); Jennifer Go, Nawal Farhat, Karen Leingartner, Elvin Iscan Insel, Franco Momoli, Richard Carrier & Daniel Krewski, “Review of epidemiological and toxicological studies on health effects from ingestion of asbestos in drinking water,” 54 Critical Reviews in Toxicology 856 (2024) (“Based on high-quality animal studies, an increased risk for cancer or non-cancer endpoints was not supported, aligning with findings from human studies. Overall, the currently available body of evidence is insufficient to establish a clear link between asbestos contamination in drinking water and adverse health effects.”); Kenneth D. MacRae, “Asbestos in drinking water and cancer,” 22 J. Royal Coll. Physicians 7 (1988).

[19] Francis Douglas Kelly Liddell, “Magic, Menace, Myth and Malice,” 41 Ann. Occup. Hyg. 3, 3 (1997) (“[A]n anti-asbestos lobby, based in the Mount Sinai School of Medicine of the City University of New York, promoted the fiction that asbestos was an all-pervading menace, and trumped up a number of asbestos myths for widespread dissemination, through media eager for bad news.”).

[20] Rueben R. Merliss, “Talc-Treated Rice and Japanese Stomach Cancer,” 173 Science 1141 (1971). The claim persists in the underworld of medical speculation. See E. Whitin Kiritani, “Asbestos and Stomach Cancer in Japan – A Connection?” 33 Medical Hypotheses 159 (1990).

[21] Grant N. Stemmermann & Lawrence N. Kolonel, “Talc-coated rice as a risk factor for stomach cancer,” 31 Am. J. Clin. Nutrition 2017 (1978).

[22] Paul Offit, “Understanding RFK Jr.,” Beyond the Noise (Feb. 11, 2025).

[23] American Cancer Society, “Key Statistics for Colorectal Cancer” (last revised April 28, 2025).

[24] Heather N. Lynch, Daniel J. Lauer, Olivia Messina Leleck, Rachel D. Freid, Justin Collins, Kathleen Chen, William J. Thompson, A. Michael Ierardi, Ania Urban, Paolo Boffetta & Kenneth A. Mundt, “Systematic review of the association between talc and female reproductive tract cancers,” 5 Front. Toxicol. 1157761 (2023).

[25] Heather N. Lynch, Daniel J. Lauer, William J. Thompson, Olivia Leleck, Rachel D. Freid, Justin Collins, Kathleen Chen, A. Michael Ierardi, Ania M. Urban, Michael A. Cappello, Paolo Boffetta & Kenneth A. Mundt, “Systematic review of the scientific evidence of the pulmonary carcinogenicity of talc,” 10 Front. Public Health 989111 (2022).

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