TORTINI

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

Acetaminophen – Lobbying the Court – Part 4

August 8th, 2026

Appellate advocates are limited to trial court records. The judgment winner may raise arguments, based upon those factual records, which would support the judgment, whether they raised or made the arguments below, and regardless whether the court below actually considered the arguments.[1] The judgment loser, on the other hand, is strictly confined to the arguments presented to the court below.

Responsible appellate advocates closely observe the limits of what they may argue in their briefs or in oral argument. In the Acetaminophen MDL, the plaintiffs’ counsel decidedly stepped out beyond what lawyers for an appellant are permitted to argue.

The parties filed their appellate briefs in the Acetaminophen MDL, in 2024. On August 15, 2025, plaintiffs’ counsel, Ashley Keller, filed a letter brief to advise the appellate court that Baccarelli’s for-litigation navigation guide review had been published in the pro-lawsuit industry journal, Environmental Health (and to provide the court with a copy).[2] The propriety of this submission was questionable, in pointing to evidence de hors the record. Keller never as much as asked for leave to file. Perhaps trying to justifying the questionable letter brief, Keller acknowledged that the published article “draws extensively on analysis from the reports the District Court excluded.” While perhaps excusing some of what plaintiffs were submitting, outside the record, the acknowledgment was a damning admission of a fact Baccarelli had failed to disclose in the published Prada review itself.

In this letter brief, Keller wandered even further outside the record and misrepresented the nature of peer review by suggesting that the peer reviewers of the Prada review agreed substantively with Baccarelli’s views on biological plausibility. Keller also distorted the ability of the Prada review to account for genetic and other confounding, when the review methodology was set up to downgrade null studies and count studies with stronger associations more heavily. The letter brief misleadingly claims that the article’s analyses “provide strong evidence that the observed relationship was not confounded but in fact was likely [a] relationship….” Importantly, the quoted language failed to qualify what kind of relationship, causal or non-causal, was being claimed or asserted.[3]

Keller harped on the Prada review’s statement that it had shown that causation was “plausible,” but not definitive. The Prada review, however, never advanced a claim that the available evidence supported a causal association. The Prada review authors not only disclaimed a definitive showing of causation, it also never suggested or intimated that causation had been provisionally or probably shown. Baccarelli, in his tweet and his official statement the following month, on September 22, 2025, confirmed that his published review did not establish causation, even in his own mind.

On September 24, 2025, Keller filed yet another letter brief, in an attempt to inject additional materials, outside the trial court record, from the Trump news conference of two days earlier.[4] In this brief, Keller argued that the FDA had commenced a safety labeling change in the form of a “Dear Doctor” letter, which stated that “the use of acetaminophen by pregnant women may be associated with an increased risk of … autism and ADHD in children.”[5] Keller’s argument ignored the failure of Doctor Makary’s letter’s to support the plaintiffs’ causal claim.  That the FDA commissioner believed only that there “may be an association” was actually a potent point in favor of the defense’s position.

The Keller letter brief also adverted to Makary’s quoting and citing Baccarelli’s for-litigation report, in which Baccarelli had used causal language. Keller did not, however, try to explain how and why Makary was quoting from a litigation document, when the published Prada review eschewed causal conclusions. Nor did Keller try to reconcile Baccarelli’s very public statements that similarly eschewed causal conclusions and couched his clinical recommendations as “precautionary.”

Keller’s letter brief, which violated the law and norms of appellate advocacy, then jumped the shark in advancing a pseudo-preemption argument. Keller claimed that “[e]xpert opinion that is sound enough to persuade every Senate-confirmed federal scientist easily clears Rule 702(d)’s bar.” Of course, Makary, in his official communications with physicians, spoke only of an association and explicitly disclaimed causation. Similarly, NIH director Jay Bhattacharya and Dr. Oz never asserted that there was a causal association.

Keller’s argument turned from improper to bizarre, as he claimed that sustaining the Rule 702 exclusion of Baccarelli’s opinion “would pose grave separation of powers concerns.” Keller’s attempted to explain:

“The executive branch safeguards public health from dangerous pharmaceutical interventions. A decision holding that a jury may not hear the same expert evidence that the executive branch credited will badly damage the public trust required for the executive to take care that the public-health laws are faithfully executed.”[6]

Keller did not cite any judicial or other authority to support his argument. None exists. The separation of powers does not mean that the executive branch can unilaterally determine scientific facts. Plaintiffs’ counsel had made sure that Dr. Makary had Baccarelli’s litigation report for the Trump news conference, and they then used Makary’s off-hand quotation from the litigation report to support their litigation efforts.

Keller’s lobbying appeared to have had the effect of delaying the oral argument.[7] Just as the lawsuit industry had injected itself into the political assessment of acetaminophen, that same industry then capitalized on its own lobbying efforts to mislead the judicial process.

Oral Argument in the Second Circuit

The parties appeared before a panel of the United States Court of Appeals for the Second Circuit for oral argument, on November 17, 2025.[8] Judges Guido Calabresi, Gerard E. Lynch, and Eunice C. Lee made up the panel. The argument did not seem to go well for the defense. Keller made up facts, such as when he asserted falsely that no one had said that the Prada review was unreliable.[9]

When the defense counsel was at the podium, Judge Calibresi, 93 years old, wandered into a revealing but irrelevant story about his father who had been a cardiologist:

“Let me just tell you one thing. Years ago, my father, who was a doctor, a cardiologist, and smoked two packs of cigarettes a day, I showed him that first study that linked cigarettes and cancer, and he went through the whole thing saying there’s this wrong with it, there’s that wrong with it. It doesn’t demonstrate the answer. And that evening at supper, he said, I’m giving up smoking. And I asked him why, and he said, I don’t need to wait for the perfect study. I don’t need to wait for it. It’s enough for me to want to make that decision. Isn’t that the level at which we are supposed to be deciding?”[10]

The answer was simple: No!

Judge Calebresi had described a personal, subjective, precautionary assessment based upon a single study. It was not a conclusion that the father, Dr. Calebresi, ever defended in a scientific journal. The defense counsel wandered into a technical answer with citations to case law, but this response missed the important point. Judge Calebresi had illegimately invoked the precautionary principle, which is quite different from well understood concepts of causation in science and in law.

From Judge Calebresi’s personal anecdote, the audience was left guessing when that “first study” was reviewed by the judge and his father. Studies generally do not “demonstrate” a conclusion, with a quod erat demonstrandum at the end. The first controlled epidemiologic study was probably one published by Franz Hermann Müller, in German, in 1939.[11] Judge Calebresi was seven at the time; his family and he left Italy that same year to escape from fascist anti-Jewish legislation. A more likely candidate was the famous paper, published in English, in 1950, by Sir Austin Bradford Hill and Sir Richard Doll.[12] The English language studies of the 1950s generally reported risks of lung cancer increased by 1,000 percent and more, a very different scenario from the small, inconsistent associations relied upon by Baccarelli.

Regardless of the vague, ambiguous personal anecdote, Judge Calebresi presented defense counsel with a compellingly easy hypothetical question: is the law interested in only satisfying itself that there is one single study that supports an association when it must evaluate a claim of causation? The answer is no, that hypothetical is not a showing of causation, but of an association. It may be later supported so that a body of similar studies leads to a conclusion of causation, but Judge Calebresi’s hypothetical does not satisfy the requirements of law or science, not even remotely.

(to be continued)


[1] Williams v. Norris, 25 U.S. (12 Wheat.) 117, 120 (1827) (“If the judgment should be correct, although the reasoning, by which the mind of the Judge was conducted to it, should be deemed unsound, that judgment would certainly be affirmed in the superior Court.”); U.S. v. American Railway Express Co., 265 U.S. 425, 435 (1924) (“the appellee may, without taking a cross-appeal, urge in support of a decree any matter appearing in the record, although his argument may involve an attack upon the reasoning of the lower court or an insistence upon matter overlooked or ignored by it.”). See also Lee v. Porter, 63 Ga. 345 (1879) (the “tipsy coachman” doctrine).

[2] Ashley Keller, Letter Brief on behalf of Plaintiffs-Appellants, In re Acetaminophen – ASD-ADHD Prods. Liab. Litig., Appeal Nos. 24-916(L), 24-1121 (con), 24-2360 (con), docket entry 217.1 (Aug. 15, 2025).

[3] Id., citing and quoting Prada Review at 29 (the interpolated “a” was correcting the text and should have been [sic]).

[4] Ashley Keller, Letter Brief on behalf of Plaintiffs-Appellants, In re Acetaminophen – ASD-ADHD Prods. Liab. Litig., Appeal Nos. 24-916(L), 24-1121 (con), 24-2360 (con), docket entry 226.1 (Sept. 24, 2025).

[5] Id., citing and quoting from Martin Makary, FDA Commissioner, Notice to Physicians on the Use of Acetaminophen During Pregnancy (Sept. 22, 2025).

[6] Id.

[7] Amanda Bronstad, 2nd Circuit Delays Arguments in Acetaminophen Appeal After Trump Targets Tylenol, LAW.COM (Sept. 25, 2025) at https://www.law.com/2025/09/25/2nd-circuit-delays-argumen ts-in-acetaminophen-appeal-after-trump-targets-tylenol/.

[8] Audio recording and transcript of oral argument, In re Acetaminophen – ASD-ADHD Prods. Liab. Litig., Appeal Nos. 24-916(L), 24-1121 (con), 24-2360 (con) (Nov. 17, 2025), at https://www.courtlistener.com/audio/101306/in-re-acetaminophen-asd-adhd-products-liability-litigation/.

[9] Id. at 15:02 – 15:22 (minutes, seconds of recording).

[10] Id. at 28:49 – 29:33 (Calibresi, J.).

[11] Franz Hermann Müller, Tabakmissbrauch und Lungencarcinoma, 49 ZEITSCHRIFT FÜR KREBSFORSCH 57 (1939).

[12] Richard Doll & Austin Bradford Hill, Smoking and carcinoma of the lung, 2 BRIT MED. J. 740 (1950). See Colin White, Research on smoking and lung cancer: a landmark in the history of chronic disease epidemiology, 63 YALE J. BIOL. & MED. 29 (1990).

Acetaminophen – Distortion of Scientific Publication – Part 3

August 5th, 2026

Both in acetaminophen litigation and in performative political assertion, the Prada Review has loomed large. As noted in an earlier post, one of the authors of the Prada Review was Andrea Baccarelli, who was also a key witness for plaintiffs in the acetaminophen MDL. FDA Commissioner Makary quoted a causal conclusion from Baccarelli’s litigation report at Trump’s September 2025 news conference as though it were a trusted source. Baccarelli tweeted, the same day as the news conference, that his paper, the Prada Review, had reached only a conclusion with respect to an association, not causation, and that his recommendations were based upon the Precautionary Principle.

The Supposed NIH Funding

Baccarelli’s tweet, on the day of the Trump news conference, described his paper, the Prada Review, as funded by the NIH. The paper itself makes a funding disclosure, with the authors stating that their “study was supported by NIH (R35ES031688; U54CA267776).” This disclosure and Baccarelli’s claim to NIH funding, however, are misleading.

The research grant referenced, R35ES031688, is a National Institute of Environmental Health Sciences (NIEHS) research grant. The NIEHS is, of course, one of the National Institutes, but not the Institute that is involved in funding research on a pharmacoepidemiologic issues. Indeed, this grant has nothing to do with children’s neurological status in relation to their mother’s ingestion of acetaminophen.

The NIEHS awarded grant R35ES031688 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. Under the NIEHS grant contract, Baccarelli promised 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. NIEHS grant R35ES031688 is irrelevant to research on acetaminophen.

The second grant claimed as supporting 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, given the Trump administrations embrace of the Prada review, this U54 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 would 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. The only author affiliated with the Icahn School is Diddier Prada.

Dr. Baccarelli did not have NIH or NIEHS support for conducting a review of acetaminophen and autism. The support, a best, was for DEI purposes, or perhaps general “walking-around” money for research on environmental pollution and brain aging, which has nothing to do with the medical issue driving the Prada review. There is no evidence that Baccarelli or the other authors of the Prada review ever prepared a study proposal or protocol related to acetaminophen for evaluation by a funding committee at NIH. 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.

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.

The journal that published the Prada Review is a member of the Committee on Publication Ethics (COPE), and claims to be committed to the “highest level of integrity in the content published.”[1] COPE’s guidance on declaring funding sources prescribes that authors identify “the activities supported by the grant should be included in funding statements.”[2] Baccarelli’s declaration of NIH funding sources failed to specify the activities actually supported by the grants. Completely absent from Baccarelli’s funding disclosure was any mention that he developed the navigation guide review while working for the lawsuit industry to advance litigation claims in court.

The Journal Chosen for the Prada Review

Peer Review

Ever since the Supreme Court identified peer review as a hallmark of “reliable” science, lawyers and judges have mechanically and hopefully pointed to the presence or absence of peer review to avoid the hard work of assessing the validity and studies and causal inference from a body of evidence. The Daubert case did indeed, in dicta, suggest that courts could rely upon peer review to help determine the admissibility of expert witness opinion testimony.[3] Nothing in Daubert, in later decisions, or in Rule 702 itself, however, supports admitting expert witness testimony just because the witness relied upon peer-reviewed studies, especially when the studies relied upon are invalid or are based upon questionable research practices. The Daubert Court was careful to point out that peer-reviewed publication was “not a sine qua non of admissibility; it does not necessarily correlate with reliability, … ”[4]

Well-ground opinions, or the facts and data on which they are based, may not have been published. The fact of peer-reviewed publication may be relevant but certainly not dispositive in assisting in the key inquiry, which concerns “the scientific validity of a particular technique or methodology on which an opinion is premised.”[5] At best, peer review is a crude proxy for study validity. If the Supreme Court were writing today, it might well have written that peer review is often a feature of bad science, advanced by scientists who know that peer-reviewed publication is the price of admission to the advocacy arena. The wild proliferation of journals, including predatory, “pay-to-play,” and ideologically driven journals, accelerates the decline in the value o peer review.

The chapter, “How Science Works,” in the third edition of the Reference Manual on Scientific Evidence, by the late Professor David Goodstein, provides a helpful discussion of peer review. Goodstein’s chapter emphasizes that peer review “works very poorly in catching cheating or fraud.”[6] Goodstein invokes his own experience as a peer reviewer to note that “peer review referees and editors limit their assessment of submitted articles to such matters as style, plausibility, and defensibility; they do not duplicate experiments from scratch or plow through reams of computer-generated data in order to guarantee accuracy or veracity or certainty.”[7] Indeed, Goodstein’s chapter characterizes the ability of peer review to warrant study validity as a “myth”:

Myth: The institution of peer review assures that all published papers are sound and dependable.

Fact: Peer review generally will catch something that is completely out of step with majority thinking at the time, but it is practically useless for catching outright fraud, and it is not very good at dealing with truly novel ideas. …

It certainly does not ensure that the work has been fully vetted in terms of the data analysis and the proper application of research methods.”[8]

Baccarelli’s Choice of Journal

Medical and scientific journals have proliferated, with the field populated by many predatory and pay-to-play journals. Another dubious category of journals are those that exist in an ideological silo. Baccarelli, the corresponding author of the Prada, placed the review in a journal that was started and carried forward by members of a pro-lawsuit industry advocacy group.

The journal Environmental Health was established in 2002 as a peer-reviewed journal, to be an outlet for research in the field of “environmental health.”[9] The current webpage for the journal describes its aims and scope a bit more broadly as publishing “on important aspects of environmental and occupational health.”[10] The Prada review involved an issue of pharmacoepidemiology and medicinal safety, not environmental or occupational health.

The founding editor of Environmental Health was David Ozonoff; its current editors in chief are Ruth A. Etzel and Philippe Grandjean.[11] All three lead editors are fellows of an advocacy organization known as the Collegium Ramazzini,[12] which is committed to the precautionary principle.[13] The principle, as its name suggests, seeks to shift the burden of proof, out of caution, to those who would resist a claim of harm.[14] From its inception, the Collegium has been closely aligned with the lawsuit industry in the United States. The organization was founded in 1982, by an American physician, Dr. Irving Selikoff, who distinguished himself for his ability to influence legislation and regulations on occupational health issues, on behalf of labor unions. Selikoff’s zealous advocacy sometimes crossed the line, as when he and his Collegium Ramazzini sponsored and funded a conference, for scientific presentations on asbestos hazards. The Collegium paid for judges’ expenses to attend what was nothing more than a one-sided ex parte meeting for judges and plaintiffs’ litigation and consulting expert witnesses. The Collegium’s shenanigans led to the disqualification of one attending judge, who had a large asbestos class action pending before him.[15] The Collegium, however, escaped any consequences for its efforts to pervert the course of justice.

Anemic Conflicts of Interest Disclosures

The authors of the Prada review chose to publish in a journal founded and controlled by members of the Collegium Ramazzini. Two of the authors, Andrea Baccarelli and Beate Ritz, are both members of the Collegium, with its ideological commitment to the precautionary principle. Both the editors and the authors of this review had ideological conflicts of interest, not disclosed in the text of the published article.

The disclosure of conflicts of interest has become a ritual in scientific publication. Disclosures by scientists with ties to manufacturing industry face demanding scrutiny and criticism. Disclosures by scientists with ties to the lawsuit industry often pass without comment. In the case of the Prada review, the senior and final author, Andrea A. Baccarelli, had been an expert witness for plaintiffs’ counsel in lawsuits against the manufacturers and sellers of acetaminophen. Baccarelli was the only author to include a conflict disclosure in the published Prada review:

“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 convoluted statement is revealing. Using the passive voice, Baccarelli states that this work might be perceived as a conflict of interest, which suggests that the problem lies with those persons who might think so. In his sworn testimony, Baccarelli acknowledged that he reported his involvement in the acetaminophen litigation to his university employer as a potential conflict of interest, so he knew very well there were persons would did, in fact, see his activities as a potential conflict of interest.[16] If industry scientists working on the relevant issue had published, members of the Collegium Ramazzini would have been the forefront of those accusing the authors of having had conflicts. Baccarelli’s published disclosure was seriously incomplete in failing to mention whether Dr. Baccarelli was compensated for his playing on the “plaintiff’s legal team,” and if so, then how much. Plaintiffs’ counsel paid him $700 an hour, for an amount at least $150,000,[17] for his work that included producing a “guide” review of the evidence that maternal use of acetaminophen had a relationship with children’s autism. The very article for which Baccarelli was giving a disclosure substantially included work done for and paid by plaintiffs’ counsel in the acetaminophen litigation. Baccarelli failed to disclose that he had been paid for much of the actual content of the published paper.

Dr. Baccarelli’s disclosure self-servingly, and with epistemic arrogance, claims that he “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.” Baccarelli neglected to omit any mention that his work failed critical scrutiny in the multi-district litigation. 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.[18]

Only Dr. Baccarelli attempted to disclose conflicts of interest, but there are serious questions concerning two of the three remaining authors. Anne Z. Bauer was the lead author of the 2021 article that falsely claimed a consensus for precautionary action to restrict pregnant women’s use of acetaminophen.[19] Bauer’s prior advocacy positions were a potential conflict of interest, which should have been declared. Furthermore, Bauer may well have been a consulting expert witness for the “plaintiffs’ team.” Parties usually do not have to disclose their consulting expert witnesses, but when those witnesses publish, they are under the ethical constraints of their profession to declare their conflicts. In a regulatory filing by Kenvue Brands LLC, the manufacturer of Tylenol (acetaminophen) identified Bauer as an expert or a consultant to the plaintiffs’ litigation team.[20]

Although author Beate Ritz does not appear to have served as an expert witness in acetaminophen litigation to date, she is a frequent expert witness for other lawsuit industry endeavors. Ritz has played a large role in the lawsuit industry’s campaign against glyphosate.[21] Ritz has testified, for claimants, in cases involving claims of heavy metals in baby food.[22] And she has been involved on behalf of the lawsuit industry in claims that paraquat exposure causes Parkinson’s disease.[23] Ritz’s litigation work in glyphosate and baby food cases has been on behalf of the Wisner Baum firm, which employs a son of Secretary Robert Kennedy, Jr.,[24]  and which is a source of the Secretary’s personal income.[25] In the Prada review, Ritz did not disclose any of her activities that constitute actual or potential conflicts of interest.

The Navigation Guide Methodology

The Navigation Guide “methodology” is a relatively arcane approach to reviewing studies. It was created with precautionary principle assessments in mind by staff scientists at the Environmental Protection Agency. Relatively few published papers have actually used this so-called navigation guide. Before the Prada review, no scientists appear to have used this approach to assess a body of pharmacoepidemiologic evidence. The Prada paper and its deployment of a “navigation guide” systematic review thus cry out for critical scrutiny. 

History of the Navigation Guide

The history and purposes of the so-called navigation guide method are obscure. The earliest citation to navigation guide review methodology appeared in a 2009 conference paper, which discussed the methodology as a proposal.[26] The authors of the conference paper described themselves as the Navigating the Scientific Evidence to Improve Prevention Workshop Organizing Committee. None was particularly well known in the field of research synthesis.

The Organizing Committee never identified a clear rationale for a new, different approach to systematic review. By the time of the 2009 conference paper, there were well over three decades of experience with systematic reviews,[27] with well-regarded full-length textbook treatment by experts in the field.[28] The Organizing Committee 2009 paper does not explain the rationale for their new approach, other than their own felt need to emphasize the precautionary principle in derogation of causal analysis.

Aside from the authors’ inexperience in field of evidence synthesis and the preemption of their topic by treatises and dozens of articles on systematic reviews, there are at least three other questions raised by the 2009 conference paper relevant to Baccarelli’s invocation of navigation guide methodology. First, the Organizing Committee emphasized the alleged need for a review methodology for environmental exposures. The Committee did not attempt to justify its focus on environmental exposures with a showing that well-described methodologies already in use were in any way inadequate or inappropriate for environmental exposures. Baccarelli’s Prada review did not address an environmental exposure, which makes this consideration irrelevant as a rationale.

Second, the Organizing Committee urged the need for precautionary assessments, which might make their method potentially appropriate when evidence syntheses for precautionary pronouncements are called for. In the United States, regulatory assessments vary depending up the governing statutes that create the regulatory mandate. Some regulatory assessments call for precautionary assessment; determining causation in litigation does not.  Indeed, 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 remarkable aspect of the 2009 Committee’s proposed approach is its omission of any need or desirability for a pre-specified protocol. Later articles on the proposed navigation guide methodology similarly failed to describe the need for such a protocol.[29] By 2014, however, two of the original committee members published an article describing the proposed methodology in which they added the requirement of a pre-specified protocol to the requirements for a navigation guide systematic reviews.[30] This 2014 publication did not, however, prescribe, as most systematic review approaches do, the public pre-registration of the protocol.

Although systematic reviews are often described the “gold standard” for evidence synthesis, their methodological rigor vary widely. Given standard practice for over two decades, omitting reference to a protocol in describing any type of systematic review is methodologically egregious. 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 protocols. Reviews that lack a pre-specified protocol are decidedly less rigorous than those reviews that employ a protocol.[31] The absence of a protocol is thus an important tell that a systematic review may be untrustworthy:

“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.”[32]

A more recent definition and assessment of systematic reviews similarly points to their essence 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.”[33]

The Prada Review’s Application of the Navigation Guide

The Prada review, put together by Baccarelli’s team, purports to use the Navigation Guide methodology, but the published paper does not cite to any source for this methodology. The Prada review as published has no protocol, which marks a serious deviation from the scientific standard of care. The absence of methodological rigor in systematic reviews and meta-analyses can readily change the outcome.[34] Several other reviews of the acetaminophen issue were published about the time of the Prada review, but with pre-specified and pre-registered protocols. One such review was an “umbrella” review of systematic reviews, published in 2025, concluded that there was no clear “link” between maternal acetaminophen use during pregnancy and children’s autism or ADHD.[35] In 2026, two additional high-quality systematic reviews, with preregistered protocols, were published. One group, led by Anick Bérard, published a systematic review and meta-analyses, which was conducted with the benefit of a protocol, and which found no increased in risks for neurodevelopmental disorders, including autism, and small associations for ADHD that were not confirmed as causal. The authors noted that the findings suggested cautious interpretation for clinical guidance.[36] In their review of the extant studies and prior reviews Bérard and colleagues noted the methodological inadequacy of the Prada review for causal analysis.[37]

Another systematic review and meta-analysis published in 2026, in a Lancet journal, concluded that the current state of the evidence did not show clinically important increases in ASD or ADHD in children born to women who used acetaminophen.[38]

The Prada review has other features that point to the unreliability of its methodology.[39] The Prada review’s risk of bias assessment was controversial, to say the least. The published article rates study quality, including bias, on a scale of -2 to +2. The paper fails to explain fully how the authors selected the bias scores. Part of the Prada review study score was association size, but this conflates study result with methodological quality, and thus assumes that that exposure is strongly associated or not associated with the outcome. This scoring scheme downplays the contribution of a well-designed null study with a relative risk equal to 1.0. The Prada review authors ignored potential for recall bias and for confounding by genetic and familial factors.

The Navigation Guide approach, as applied by the Prada review, weighs the individual studies being considered, but does not give greater weight to studies that have more robust design and are better suited to support causal inference. The Prada review provides no quantification of the risk of bias. The Prada review also exhibited self-interested personal bias. The review assessed a body of studies including studies written by Beate Ritz, a co-author of the Prada review. Not surprisingly, the studies for which Ritz was a co-author were evaluated as studies with low risk of bias. The sum total of the Prada review’s scoring system and study evaluation created substantial cherry picking or outcome bias.

(to be continued)


[1] Environmental Health – Ethics & disclosures, https://link.springer.com/journal/12940/ethics-and-disclosures

[2] Committee on Publication Ethics, Guidance on Declaring funding sources for research – Last reviewed: 29 April 2026, https://publicationethics.org/guidance/discussion-document/declaring-funding-sources-research.

[3] Daubert v. Merrell Dow Pharms., Inc., 509 U.S. 579, 593 (1993).

[4] Id.

[5] Id. at 593-94.

[6] David Goodstein, How Science Works, in National Academies of Sciences, Engineering and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 37, 44-45  (3rd 2011). Goodstein’s chapter is vastly superior to the parallel chapter in the fourth edition, published in December 2025.

[7] Id. at 44-45 n. 11.

[8] Id. at 48 (emphasis added).

[9] Philippe Grandjean & David Ozonoff, Environmental Health: the first five years, 6 ENVT’L HEALTH 27, 27 (2007). See Environmental Health, available at https://link.springer.com/journal/12940.

[10] Environmental Health: Aims and scope, available at https://link.springer.com/journal/12940/aims-and-scope.

[11] Environmental Health: editorial board, available at https://link.springer.com/journal/12940/editorial-board,

[12] Collegium Ramazzini Membership, available at https://perma.cc/9B25-WXB9.

[13] See Council of Fellows, Seventh Collegium Ramazzini Statement – The Precautionary Principle: Implications for Research and Policy Making, (Oct. 25, 2003), 45 AM. J. INDUS. MED. 380 (2004); Collegium Ramazzini, The

Precautionary Principle: Implications for Research and Policy Making, 11 HUM. & ECOL. RISK ASSESS. 3 (2005).

[14] See Wingspread Conference on the Precautionary Principle (Jan. 26, 1998), https://perma.cc/R6N7-9PLR (among those in attendance was David Ozonoff, founding editor of Environmental Health and member of the Collegium Ramazzini).

[15] In re School Asbestos Litig., 977 F.2d 764 (3d Cir. 1992). See Cathleen M. Devlin, Disqualification of Federal Judges – Third Circuit Orders District Judge James McGirr Kelly to Disqualify Himself So as to Preserve ‘The Appearance of Justice’ Under 28 U.S.C. § 455 – In re School Asbestos Litigation (1992), 38 VILL. L. REV. 1219 (1993); Bruce A. Green, May Judges Attend Privately Funded Educational Programs? Should Judicial Education Be Privatized?:

Questions of Judicial Ethics and Policy, 29 FORDHAM URB. L. J. 941, 996-98 (2002).

[16] Notes of Testimony from Deposition of Andrea Baccarelli, In re Acetaminophen ASD-ADHD Prods. Liab. Litig., Case No. 1:22-md-03043-DLC, at 55-56 (Aug. 14, 2023).

[17] Rebecca Robbins & Azeen Ghorayshi, Harvard Dean Was Paid $150,000 as an Expert Witness in Tylenol LawsuitsN.Y. TIMES (Sept. 23, 2025), available at https://www.nytimes.com/2025/09/23/health/harvard-dean-autism-tylenol-lawsuits-payment.html.

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

[19] Ann Z. Bauer, Shanna H. Swan, David Kriebel, Zeyan Liew, Hugh S. Taylor, Carl- Gustaf Bornehag, Anderson M. Andrade, Jørn Olsen, Rigmor H. Jensen, Rod T. Mitchell, Niels E. Skakkebaek, Bernard Jégou & David M. Kristensen, Paracetamol use during pregnancy — a call for precautionary action, 17 NATURE REV. ENDOCRINOL. 757 (2021). [Call for Precautionary Action]

[20] Kenvue Brands LLC, Comment to Docket No. FDA-2025-P-4153, Response to the citizen petition filed by the Informed Consent Action Network (“Petitioner”)

on September 22, 2025 (Oct. 17, 2025) (identifying Baccarelli and Bauer as experts / consultants in the acetaminophen litigation), available at https://www.kenvue.com/kenvue-brands-citizen-petition-response.

[21] 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), at https://scholar.google.com/scholar_case?case=1288295772524535914&q=BARRERA+v.+MONSANTO&hl=en&as_sdt=2006Pilliod 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 coyly suggesting that she was reluctant to get involved as an expert witnesses).

[22] In re Baby Food Prods. Liab. Litig., case No. 24-md-03101-JSC (N.D. Calif. Feb. 27, 2026), available at https://scholar.google.com/scholar_case?case=3987170845628579218&q=%22Beate+Ritz%22&hl=en&as_sdt=2006; R. Brent Wisner, Expert Hearing for Heavy Metals in Baby Food Litigation Begins Jan. 31, 2022, WISNER BAUM (Jan. 25, 2022), at https://www.wisnerbaum.com/blog/2022/january/expert-hearing-for-heavy-metals-in-baby-food-lit/.

[23] Mary-Rose Abraham, How are pesticides and Parkinson’s disease linked? One doctor’s research spans 25 years, UCLA HEALTH NEWS (June 12, 2025)

https://www.uclahealth.org/news/article/how-are-pesticides-and-parkinsons-disease-linked-beate-ritz.

[24] Conor Kennedy, at WISNER BAUM (Aug. 1, 2026), at https://www.wisnerbaum.com/attorneys/conor-kennedy/.

[25] John Wilkerson, RFK Jr. is giving his son any fees he earns from Gardasil vaccine litigation, STAT (Jan. 31, 2025) (Robert F. Kennedy, Jr., was a consultant and case referral source for the Wisner Baum law firm), at https://www.statnews.com/2025/01/31/rfk-jr-hhs-gardasil-litigation-fees-divest-son-wisner-baum/.

[26] Patrice Sutton, Heather Sarantis, Julia Quint, Mark Miller, Michele Ondeck, Rivka Gordon & 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), available at https://www.healthandenvironment.org/uploads-old/7-29-09%20Complete%20Final%20Discussion%20Document%20Navigating%20the%20Science%20Workshop.pdf.

[27] 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.)

[28] Matthias Egger, Julian P. T. Higgins & George Davey Smith, SYSTEMATIC REVIEWS IN HEALTH RESEARCH: META-ANALYSIS IN CONTEXT (3rd ed. 2022). The first edition of this text was published in 1995.

[29] 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).

[30] 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 ENVT’L HEALTH PERSP. 1007 (2014).

[31] 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, 560 (2016).

[32] Id.

[33] Julia Menon, Fréderique Struijs & Paul Whaley, The methodological rigour of systematic reviews in environmental health, 52 CRITICAL REV. TOXICOL. 167 (2022).

[34] David Coghill, Rigorous Methods Matter: Reassessing Acetaminophen Safety in Pregnancy, 65 J. AM. ACAD. CHILD & ADOLESCENT PSYCHIATRY 477 (2026).

[35] Jameela Sheikh, John Allotey, Soha Sobhy, Maria Nieves Plana, Hilario Martinez-Barros, Harshitha Naidu, Fatima Junaid, Reecha Sofat, Ben W Mol, Louise C Kenny, Melissa Gladstone, Helena Teede, Javier Zamora & Shakila Thangarati, Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews, 391 BRIT. MED. J. e088141 (2025).

[36] Anick Bérard, Judith Cottin, Lisiane F. Leal, Cyndie Picot, Justine Pleau, Jan M. Friedman, MD, Per Damkier, Michel Cucherat, Sura Alwan, Lucie Jurek, Louise M. Winn, Bruce C. Carleton, Andréa D. Bertoldi, Sonia M. Grandi, Reem Masarwa, Philippe Dodin, Michael Ceulemans, Robert W. Platt, Mikail Nourredine, Erika Björkström Gram, Areti Angeliki Veroniki, Jérôme Massardier & Andrea C. Tricco, Systematic Review and Meta-Analysis: Acetaminophen Use During Pregnancy and the Risk of Neurodevelopmental Disorders in Childhood, 65 J. AM. ACAD. CHILD & ADOLESCENT PSYCHIATRY 484 (2026).

[37] Id. at 485.

[38] Francesco D’Antonio, Maria Elena Flacco, Lorenza Della Valle, Smriti Prasad, Lamberto Manzoli, Athina Samara & Asma Khalil, Prenatal paracetamol exposure and child neurodevelopment: a systematic review and meta-analysis, 2 LANCET OBSTET. GYNECOL. WOMEN’S HEALTH e190 (2026).

[39] See Eric Fombonne, The acetaminophen scare: association vs causation, 66 J. AM. ACAD. CHILD & ADOLESCENT PSYCHIATRY 1621, 1623 (2026); Frank Louwen, Eileen Deuster, Fionnuala M. McAuliffe, Bo Jacobsson, Michael Geary, Steven Fleischman & Anne-Beatrice Kihara, Paracetamol (acetaminophen) use during pregnancy and autism risk: Evidence does not support causal association, 171 INTERNAT’L J. GYNECOL. & OBSTET. 915, 916 (2025) (“The Prada et al. 2025 review cited by political figures, while employing the Navigation Guide methodology, suffers from fundamental methodological limitations that significantly compromise its reliability and clinical applicability.”).

Acetaminophen – Partisan Politics Corrupts Scientific Assessments – Part 2

July 30th, 2026

Most medico-legal controversies over causation resolve in the pages of medical journals and within the walls of state and federal courthouses. The claim that pregnant women’s ingestion of acetaminophen causes their children to have an increased risk of autism, however, has become a flash point in American political drama.[1]

After the district court entered judgment against plaintiffs in the acetaminophen MDL, a sea change in the politicization of science occurred in the executive branch of the United States. In November 2024, the United States returned Donald Trump, its first fully post-modern president to office. For most of his life, Trump, in an homage to Michel Foucault, has seen no difference between assertions and truth. In the run up to the general election of 2024, Trump forged an alliance with independent candidate Robert F. Kennedy, Jr., whose disdain for evidence and truth has long made him a notorious source of misinformation on vaccines, autism, antidepressants, pesticides, glyphosate, among other things.

In August 2024, Kennedy quit his campaign and endorsed Trump, in return for a role in a future Trump Administration. After promising Kennedy a cabinet level position, Trump told his supporters that: “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.”[2] Trump kept his promise of an appointment to Kennedy. On February 13, 2025, Robert F. Kennedy Jr. was confirmed by a narrow vote of the Senate, and sworn in as Secretary of Health and Human Services. President Trump immediately issued Executive Order 14211 to establish a “Make America Healthy Again [MAHA] Commission,” to be chaired by Secretary Kennedy.[3] One of the key objectives of the MAHA commission included investigating the causes of chronic childhood diseases and “assess[ing] the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitorsantipsychoticsmood stabilizers, stimulants, and weight-loss drugs.”

Two months later, at a press conference in April 2025, Kennedy asserted that environmental toxic substances were responsible for the increasing prevalence of autism. Only a day earlier, the Centers for Disease Control issued a report in which over 50 government scientists explained that evolving diagnostic criteria and improved awareness of parents and teachers (not to mention entitlements to social and educational support) were largely responsible for the changing patterns of diagnosis and assessment.[4]

Channeling his lawsuit industry practice in which Kennedy labeled any adverse evidence as a manufacturing industry conspiracy, the Secretary dismissed the CDC’s explanations as a (manufacturing) industry “canard” to deflect attention from possible environmental causes. Kennedy promised a massive research initiative to identify the environmental “culprit,” with results to be available by September 2025.[5]

The scientific community might well have been skeptical about how Kennedy was going to deliver answers to etiological questions surrounding autism in five months, when causal conclusions had eluded the scientific world for decades. In the fullness of the next five months, not much new research was done, but with the clock ticking, a conclusion was launched in the absence of evidence.

On September 22, 2025, President Trump, along with Secretary Kennedy, FDA Commissioner Marty Makary, Director of the National Institutes of Health Jay Bhattacharya, and Administrator of the Centers for Medicare & Medicaid Services Mehmet Oz, called a news conference to announce the “conclusion.”[6] Stumbling over the pronunciation of acetaminophen, Trump told women not to take the medication; it caused autism. Kennedy struck a more moderate note about acetaminophen, in describing a “potential” association between acetaminophen and ASD and ADHD. He acknowledged reviewing “contrary” studies showing no association, and announced that the FDA would issue a notice to physicians and begin a change in the medication label.

When Commissioner Makary spoke, he cited studies showing “consistent” associations between acetaminophen and autism. In a flourish, Makary stated that:

“four weeks ago, a Mount Sinai Harvard study [“Pada 2025”] reviewed all the existing literature and found the overwhelming body of evidence points to an association. Sure, you’ll be able to find a study to the contrary, that’s how science works, but to quote the dean of the Harvard School of Public Health, there is a causal relationship between prenatal acetaminophen use and neurodevelopmental disorders of ADHD and autism spectrum disorder.”[7]

The dean referenced by Makary was none other than Andrea Baccarelli, the key expert witness for plaintiffs’ in the acetaminophen MDL, who was excluded by Judge Denise Cote’s Rule 702 decision. Baccarelli has only recently moved from Columbia University to assume a new position at Harvard. The Mount Sinai study published four weeks earlier was a review by four authors, including Baccarelli.[8] Baccarelli and his co-authors, however, decidedly did not embrace a causal conclusion in their publication. In their statement of conclusions in the paper’s abstract, Baccarelli and his co-authors stated that their “analyses using the Navigation Guide thus support evidence consistent with an association between acetaminophen exposure during pregnancy and increased incidence of NDDs.” (emphasis added). In the discussion section of their paper, the authors explained that their “analysis demonstrated evidence consistent with an association between exposure to acetaminophen during pregnancy and offspring with NDDs, including ASD and ADHD, though observational limitations preclude definitive causation.”[9] In his press conference remarks, Makary was quoting not from a peer-reviewed article, but from Baccarelli’s expert witness report, written for litigation, and excluded from evidence by Judge Cote’s decision in 2023.

Makary’s reference to language from Baccarelli’s 2023 expert witness litigation report thus raises two interesting questions. First, given that expert witness reports do not generally find their way to the desks of the FDA Commissioner, how did Makary come by this plaintiffs’ litigation report? Second, and more troubling, why did Baccarelli defend his causal conclusion under oath, at an examination before trial in 2023,[10] when he was unwilling to embrace a causal conclusion two years later, in 2025? The first question raises at least the appearance of collusion between the lawsuit industry and political actors such as Secretary Kennedy and Commissioner Makary. The second question raises the issue of fraud on the court by a witness who is willing to assert a causal conclusion in legal proceedings, but is not willing to publish and defend the causal conclusion to his peers in a scientific journal.

In the wake of the news conference, the New York Times talked with  Baccarelli, and reported that he opined in the interview that “[f]urther research is needed to confirm the association and determine causality, but based on existing evidence, I believe that caution about acetaminophen use during pregnancy — especially heavy or prolonged use — is warranted.”[11] In essence, Baccarelli was offering a precautionary principle interpretation of the available evidence, not a causal conclusion. Baccarelli issued a statement on social media, the day of the news conference, to state that he and his colleagues “had conducted a rigorous review funded by a grant from the National Institutes of Health (NIH), of the potential risks of acetaminophen use during pregnancy.” Baccarelli disclaimed having reached a causal conclusion, describing his review as showing merely “evidence of an association between exposure to acetaminophen during pregnancy and increased incidence of neurodevelopmental disorders in children,” and that “[f]urther research is needed to confirm the association and determine causality….”[12] As we will see, Baccarelli’s claim that the Prada review was funded by an NIH grant was a bit of a tall tale, but his disclaiming a causal conclusion and explaining that his position was based upon the precautionary principle, not a showing of medical causation, was both candid and at odds with his litigation expert report.

The lead author of the Prada Review, Diddier Prada, an epidemiologist at Mount Sinai Hospital in New York, similarly told the Times that “[w]e cannot answer the question about causation — that is very important to clarify.”[13] A third author of the Prada Review was Ann Bauer, the lead author of the 2021 putative consensus paper that was instrumental in starting the acetaminophen mass tort. Bauer commented in advance of the September press conference. In anticipating the Administration’s embrace of a causal claim, Bauer noted that she was “a little concerned about how this message is going to come because I think they may be jumping the gun”; “I think those of us in the research community would like to see stronger evidence.”[14]

Scientific Community’s Reaction to Trump’s News Conference

Trump’s press conference on acetaminophen and vaccines was widely met with condemnation and disbelief.[15] 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.  The ACMT noted that its position agreed with those of 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.[16]

In Europe, where pharmaceutical regulation is typically even more precautionary than in the United States, the European Medicines Agency (EMA) announced, a day after the Trump news conference, that using acetaminophen during pregnancy was safe, with no showing that it causes autism in offspring. The EMA announcement quoted Steffen Thirstrup, the EMA’s Chief Medical Officer, as stating that “[p]aracetamol 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.”[17] In the United Kingdom, the governmental Medicines & Healthcare Products Regulatory Agency issued a notice, on September 23, 2025, that acetaminophen was safe to take in pregnancy and that the medication has not been shown to cause autism in children.[18]

The day of the news conference, the Autism Science Foundation issued a statement of deep concern about Trump’s announcement. The Foundation observed that “[b]ased on the existing data, there is not sufficient evidence to support a link between acetaminophen and autism.”[19] Medical ethicist Dr. Professor 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.”[20]

The official governmental messaging in the wake of Trump’s press conference was more circumspect. In her press release on the day of the news conference, Press Secretary Karoline Leavitt used the meaningless locution, “suggested link,” and cited the Prada review, which eschewed causal conclusions.[21] Leavitt gratuitously added 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 Donald Trump, testosterone for Peter Hegseth, or ketamine for Elon Musk.

When the administration physicians communicated with the public, they said something very different from Trump’s presentation. Dr. Mehmet Oz, former surgeon and television talking head, who stood mute by Trump’s side, 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.[22]

When FDA Commissioner Makary issued a notice to physicians, the same day as the Trump news conference, he carefully avoided causal language:

“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.”[23]

An FDA news release, also on September 22, 2025, announced that the agency was beginning a change in safety labeling, but the agency press release spoke only in terms of association and correlation, and like the FDA notice to physicians, explicitly disavowed a causal conclusion.[24] The FDA also noted that it was undertaking a safety label change, but the official communication did not reveal the dodgy origins of this initiative. The impetus for the label change appears to have come not from FDA scientists, but from Aaron Siri, a plaintiff’s lawyer who worked in concert with Robert Kennedy for years in anti-vaccination litigation. In a remarkable coincidence, Siri filed a citizen’s petition with the FDA, the same day of Trump’s news conference to raise “exigent concerns” over a need for a label change.[25] The New York Times noted some of the troubling ethical concerns raised by Siri’s parallel activities. In 2023, Siri’s law firm recruited plaintiffs for acetaminophen mass tort litigation. In 2024, Siri represented Kennedy in his election campaign.[26] The week before the Trump news conference, Jill Schoff, an employee of Siri’s law firm, uploaded Baccarelli’s expert witness report from the acetaminophen MDL to the Internet Archive, which explains how Dr. Makary was able to quote from its conclusions at the September 22nd news conference.[27] Siri cited to Baccarelli’s for-litigation report, at the Internet Archive, in his citizen’s petition that plumped for a label change.

The politicization of the acetaminophen issue appeared to be complete, when a month after Trump’s press conference, Trump sycophant and Texas Attorney General Ken Paxton sued manufacturers of acetaminophen for “deceptively marketing Tylenol to pregnant mothers despite knowing that early exposure to acetaminophen, Tylenol’s only active ingredient, leads to a significantly increased risk of autism and other disorders.”[28] Only a month earlier, the FDA acknowledged in its press release and its notice to physicians, that causation was not known. Paxton filed the complaint in Panola County, Texas, where Trump received 81.4% of the counted votes in 2024.[29] In addition to lawyers at the Office of the Texas Attorney General, Ashley Keller and others from the Keller Postman LLC firm were listed as representing Texas in its epistemic and scientific overclaiming. Ashley Keller was the principal lawyer for plaintiffs in the MDL, which had been dismissed by Judge Cote in 2024.

(to be continued)


[1] I am indebted to, and thank, Barbara McIntyre for sharing some of the research for this series.

[2] Brett Samuels, Trump says he’ll let RFK Jr. ‘go wild’ on health and food in potential second term, THE HILL (Oct. 27, 2024), available at https://thehill.com/homenews/campaign/4956319-trump-says-hell-let-rfk-jr-go-wild-on-health-and-food-in-potential-second-term/.

[3] Executive Order 14211, Establishing the President’s Make America Healthy Again Commission”The White House (Feb. 13, 2025), available at https://www.whitehouse.gov/presidential-actions/2025/02/establishing-the-presidents-make-america-healthy-again-commission/.

[4] Kelly A. Shaw, et al., Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years — Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022, 74 MORBIDITY & MORTALITY WEEKLY REP. 1 (Apr. 17, 2025).

[5] Meredith Wadman, Claiming autism ‘epidemic,’ RFK Jr. describes NIH initiative to find environmental causes, SCIENCE (Apr. 16, 2025), available at https://www.science.org/content/article/claiming-autism-epidemic-rfk-jr-describes-nih-initiative-find-environmental-causes

[6] Transcript, News Conference – Remarks: Donald Trump Makes an Autism Announcement at the White House, ROLLCALL (Sept. 22, 2025), available at

https://rollcall.com/factbase/trump/transcript/donald-trump-remarks-health-autism-white-house-september-22-2025/ (Transcript).

[7] Transcript at 24:35.

[8] 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) [Prada]

[9] Prada Review at 38.

[10] Notes of Testimony from Deposition of Andrea Baccarelli, In re Acetaminophen ASD-ADHD Prods. Liab. Litig., Case No. 1:22-md-03043-DLC (Aug. 14, 2023).

[11] Azeen Ghorayshi, Trump Issues Warning Based on Unproven Link Between Tylenol and Autism, N.Y. TIMES (Sept. 22, 2025), available at https://www.nytimes.com/2025/09/22/health/kennedy-autism-tylenol-trump.html?searchResultPosition=2

[12] Statement from Andrea Baccarelli on X (Sept. 22, 2025), available at https://x.com/RapidResponse47/status/197023187271541578.

[13] Id.

[14] Jon Hamilton, Yuki Noguchi & Nell Greenfieldboyce, Trump blames Tylenol for autism. Science doesn’t back him up, NAT. PUBLIC RADIO (Sept. 22, 2025) (quoting Dr. Bauer), available at https://www.npr.org/sections/shots-health-news/2025/09/22/nx-s1-5550153/trump-rfk-autism- tylenol-leucovorin- pregnancy#:~:text=Many%20physicians%20and%20autism%20advocacy,studies%20in%20the %20scientific%20literature.%22

[15] Jeff Mason, Ahmed Aboulenein, and Julie Steenhuysen, Trump Links Autism to Tylenol and Vaccines, Claims Not Backed by Science, REUTERS (Sept. 22, 2025) (quoting Britain’s health regulator as saying that using paracetamol was safe and that there is no evidence paracetamol caused autism in children; quoting Coalition of Autism Scientists as stating that “[t]he data cited do not support the claim that Tylenol causes autism … .”) available at https://www.reuters.com/business/healthcare-pharmaceuticals/trump-expected-link-autism-with-tylenol-experts-say-more-research-needed-2025-09-22/; 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) (“Doctors and medical societies say acetaminophen, the active ingredient in Tylenol, remains the best option for treating fever and pain during pregnancy”), available at https://www.wsj.com/politics/policy/tylenol-pregnancy-autism-trump-report-what-to-know-2873d8e1; Will Weissert, Dr. Trump? The president reprises his COVID era, this time sharing unproven medical advice on autism, ASSOC. PRESS NEWS (Sept. 23, 2025), available at https://apnews.com/article/trump-doctor-vaccines-autism-tylenol-covid-disinfectants-22f5bcfe2fd3c18fdd412419941541f8; Editorial Board, ‘I’m not a doctor’: This shoddy autism science helps no one; President Donald Trump’s rant on vaccines and Tylenol has no basis in fact, WASH. POST (Sept. 22, 2025), available at https://www.washingtonpost.com/opinions/2025/09/22/trump-autism-vaccines-tylenol-acetaminophen/; Vivian Ho & Karla Adam, WHO joins global health leaders rejecting U.S. acetaminophen warnings; The World Health Organization is the latest to criticize claims from President Donald Trump and Robert F. Kennedy Jr. linking autism to Tylenol use during pregnancy, WASH. POST (Sept. 24, 2025), available at https://www.washingtonpost.com/health/2025/09/24/paracetamol-acetaminophen-tylenol-autism-who-trump/; Ariana Eunjung Cha, Matt Viser & Dan Diamond, As Trump ties Tylenol to autism, doctors raise alarms; U.S. officials will issue a warning label for pregnant individuals — a move that contradicts the guidance from the major medical societies, WASH. POST (Sept. 23, 2025), available at https://www.washingtonpost.com/health/2025/09/22/tylenol-autism-trump-announcement/

[16] American College of Medical Toxicology, ACMT Position Statement: ACMT Supports the Safe Use of Acetaminophen in Pregnancy (Sept. 23, 2025), available at https://www.acmt.net/news/acmt-position-statement-acmt-supports-the-safe-use-of-acetaminophen-in-pregnancy/

[17] European Medicines Agency, Use of paracetamol during pregnancy unchanged in the EU (Sept. 23, 2025), available at https://www.ema.europa.eu/en/news/use-paracetamol-during-pregnancy-unchanged-eu

[18] Medicines & Healthcare Products Regulatory Agency, MHRA confirms taking paracetamol during pregnancy remains safe and there is no evidence it causes autism in children (Sept. 23, 2025), available at https://www.gov.uk/government/news/mhra-confirms-taking-paracetamol-during-pregnancy-remains-safe-and-there-is-no-evidence-it-causes-autism-in-children.

[19] Autism Science Foundation, Statement on White House Announcement on Autism (Sept. 22, 2025), available at

https://autismsciencefoundation.org/press_releases/asf-statement-wh-briefing/.

[20] Ali Swenson & Lauran Neergaard, “Trump makes unfounded claims about Tylenol and repeats discredited link between vaccines and autism,” ASSOC. PRESS (Sept. 23, 2025) (quoting Prof. Caplan), available at https://apnews.com/article/tylenol-cause-autism-trump-kennedy-0847ee76eedecbd5e9baa6888b567d66

[21] Karoline Leavitt, “FACT: Evidence Suggests Link Between Acetaminophen, Autism,” WHITE HOUSE (Sept. 22, 2025), available at https://www.whitehouse.gov/releases/2025/09/fact-evidence-suggests-link-between-acetaminophen-autism/

[22] Sara Moniuszko & Céline Gounder, Dr. Oz says “of course” pregnant women should take Tylenol if a doctor says so (Sept. 26, 2025), available at https://www.cbsnews.com/news/dr-oz-says-of-course-pregnant-women-should-take-tylenol-if-a-doctor-says-so/

[23] Martin A. Makary, Notice to Physicians on the Use of Acetaminophen During Pregnancy, (Sept. 22, 2025) (emphasis added), available at https://www.fda.gov/media/188843/download?attachment=&utm_medium=email&utm_source=govdelivery

[24] FDA News Release, FDA Responds to Evidence of Possible Association Between Autism and Acetaminophen Use During Pregnancy (Sept. 22, 2025), available at https://www.fda.gov/news-events/press-announcements/fda-responds-evidence-possible-association-between-autism-and-acetaminophen-use-during-pregnancy.

[25] Informed Consent Action Network, Citizen Petition regarding safety-related labeling changes for the use of over-the-counter acetaminophen drug products during pregnancy, (Sept. 22, 2025), available at https://static01.nyt.com/newsgraphics/documenttools/88fe67f3f222ab88/66655cc8-full.pdf

[26] Christina Jewett, Kennedy’s Ties to Ally Leading Vaccine Lawsuits Raise Ethical Concerns, N.Y. TIMES (Oct. 3, 2025), available at https://www.nytimes.com/2025/10/03/health/kennedy-aaron-siri-vaccines-lawsuits.html

[27] Andrea Baccarelli, Rule 26 Witness Report, In re Acetaminophen ASD-ADHD Prods. Liab. Litig., Case No. 1:22-md-03043-DLC (Oct. 10, 2023), uploaded to Internet Archive on Sept. 16, 2025, available at https://archive.org/details/baccarelli-expert-report-acetaminophen-asd-adhd.

[28] Office of Texas Attorney General, Press Release: Attorney General Paxton Sues Big Pharma Manufacturers for Deceptively Marketing Tylenol to Pregnant Mothers Despite Known Dangers to Unborn Children (Oct. 28, 2025) (emphasis added), available at https://www.texasattorneygeneral.gov/news/releases/attorney-general-paxton-sues-big-pharma-manufacturers-deceptively-marketing-tylenol-pregnant-mothers.

[29] Panola County, TX Voting, available at https://www.bestplaces.net/voting/county/texas/panola.

The American Public Health Association – Lawsuit Industry Affiliate

June 14th, 2026

Over a decade ago, I wrote a post about the American Public Health Association (APHA) and its position papers opposing the Daubert regime of gatekeeping the validity of expert witness opinion testimony. I am updating the post, with some modifications, because the links to the APHA documents are broken. It appears that the APHA now keeps its meeting minutes and policy position statements as secrets for the cognoscenti, and so I have uploaded documents that once were publicly available to document the APHA’s tepid relationship with science.

The APHA was once a significant organization committed to the improvement of public health. The Association has many thousands of members, and it engages in the pretense that it represents the entire public health community. Among its many activities, the APHA publishes a journal, the American Journal of Public Health

Here is how the APHA described itself and its activities, in 2014, to advance public health:

“The American Public Health Association champions the health of all people and all communities. We strengthen the profession of public health, share the latest research and information, promote best practices and advocate for public health issues and policies grounded in research. We are the only organization that combines a 140-plus year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health.”

How could anyone be against the APHA? Let’s see.

The mission statement currently on the APHA’s website has added the ultimate social justice adjective, “equitable,” and emphasized the association’s advocacy roles:

“We champion optimal, equitable health and well-being for all. We speak out for public health issues and policies backed by science. We are the only organization that combines a 150-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health.”

Somewhere along the way, the association was commandeered by revolutionaries who remade it in the “Spirit of 1848.[1]” The APHA evolved into a tool of the lawsuit industry and its putative scientist allies. In 2004, after several years of lobbying, agents of the lawsuit industry managed to push a policy statement past the Association’s leadership, to condemn the requirement of evidence-based reasoning in federal courts in the United States. The APHA has since proven itself an enemy of good science on many fronts.

The success of the lawsuit industry’s influence was dutifully memorialized in the “Final Minutes of Meetings of the APHA Governing Council,” held in November 2004. The lawsuit industry’s attack on evidence-based science and data transparency, known as “Policy Number: 2004-11 Threats to Public Health Science,” was adopted as an official APHA policy statement.

APHA 2004-11” was published in an American Journal of Public Health newsletter, but is now available only to members on the APHA website, as Policy Number: 2004-11:  Threats to Public Health Science. I have excerpted contentions and recommendations from the APHA policy, in the left column of the chart, below. The policy statement is typical of what comes out of precautionary principle NGOs and groups such as the Collegium Ramazzini, and passed off for scientific commentary. The APHA policy is parsed in the left-hand column; my comments to quoted language are in the right-hand column.

APHA Policy Comment
“Acknowledging that within science, absolute proof and perfect information are rare;” Note the false dichotomy between absolute proof and perfect information and the entire remaining spectrum of scientific information.  This dichotomization has been part of the litigation strategy of passing off hypotheses, preliminary conclusions, unreplicated findings, etc., as though they were acceptable bases for causal conclusions.
“Recognizing that special interests have exploited the nature of science, specifically scientific uncertainty, to delay protective legal and/or regulatory action;”  

Note the asymmetry of the accusations; the APHA apparently has no concern for the “special interests” that exploit science by passing off hypotheses as conclusions, and seeking to accelerate protective legal and regulatory action by manufacturing faux scientific consensuses and conclusions.

“Acknowledging that some public health decisions must be made in the absence of perfect scientific information;”  

Le mieux est l’ennemi du bien.” But isn’t the good also the enemy of the shabby, dodgy, and fraudulent? Note again the false dichotomy between “perfect” information and everything else, as though our failing to achieve the perfect opens the door to the worst. True, of course, that sometimes action is needed on incomplete records, but such action is rarely needed for compensation claims.

“Recognizing that special interests, under the guise of a call for “sound science” have sponsored and promoted changes in public policy that have weakened and continue to threaten public health protections;”  

If the call for sound science cannot be sustained, then this rhetorical gambit will blow back hard on those “special interests.”  Why are these putative scientists, at APHA, so afraid of sound science?

“Recognizing that special interests have challenged highly regarded public health research and researchers, and inappropriately characterized established scientific methods as ‘junk science’;”  

Mon Dieu! Highly regarded by whom? How cheeky of those special interests.  See the discussion of Dr. Barry S. Levy, below. Of course, special interests from the folks at Green Peace, and EWG, etc., are welcome. The claim that the challenges are inappropriate is a mere conclusion without evidence.

“Recognizing that the Daubert decision has propagated misinterpretations and misapplications of scientific principles relied upon throughout the public health sciences, such as insisting that any epidemiologic study that is relied on to support causation demonstrate a twofold increase in risk as well as a reliance on significance testing to determine which scientific findings are to be allowed as evidence;”  

This contention seriously misrepresents the basic nature of evidence law. Studies, whether they have statistically significant results, or not, are rarely admissible in evidence.  What is admissible, or not, are the opinions of duly qualified expert witnesses, who explain and show the epistemic warrant for their opinions.  With respect to general causation opinions, expert witnesses will often have to show, among other things, that they have relied upon studies that have ruled out chance, bias, and confounding to arrive at a causal conclusions.  Significance testing can be abused, in both directions, but the APHA ignores the need for having some quantitative assessment of  random variability and error. As for relative risks greater than two, the APHA is correct that general causation may often be found with small relative risks, but the attribution of causation in an individual claimant often can be made only on probabilistic inferences that will require relative risks greater than two, or even larger.

“Recognizing that special interests are engaged in a campaign to extend Daubert’s reach to those states that have not embraced prescriptive definitions of scientific reliability.”  

The APHA makes common cause with the rent-seeking and special pleading of “special interests” that would abolish all limits on the admissibility of expert witness opinions, and all normative assessments of scientific research. This position ignores the prescriptive aspect of methodology, and the nature of epistemic warrant in a methodology.

What follows from these contentions? 

“Therefore, APHA:”

“Opposes legislation or administrative policies that attempt to define the characteristics of valid public health science, or dictate prescriptive scientific methodologies; and”  

Admittedly, defining good science is very difficult, but the law often works like science as defining health as the absence of disease.  There are obviously some well-known pathologies of scientific method, and it hardly seems extravagant to urge courts to avoid flaws, fallacies, and fraud.  

“Supports the efforts of other scientific organizations to promote the government’s ability to utilize the best available science to protect the public’s health; and”  

Of course, sometimes the “best” available science is rather shabby. The science will only protect public health if it is valid and supports valid causal inferences.

“Urges friend of the court briefs that address the problem inherent in the adoption of Daubert and Daubert-like court rulings, the application of Daubert in regulatory proceedings, and when judges misinterpret scientific evidence in their implementation of the Daubert ruling.”  

There are no instances of the APHA’s deploring jury verdicts that offend scientific sensibilities; and so the APHA’s urging here is one-sided and partisan.  The fact, however, that judges’ misinterpretations of scientific evidence can be criticized publicly is one of the key differences that separates judicial gatekeeping from the black box of jury determinations.

In 2005, the APHA published, in its journal, APJH, a special supplement, “Scientific Evidence and Public Policy,” with

“academic analysis of the conflicts arising in the use of science in regulatory, civil and criminal proceedings. This special issue examines how recent developments in the legal and regulatory arenas have emboldened corporations involved in civil litigation and regulatory proceedings to accuse adversaries of practicing ‘junk science’.”

Apparently, the APHA was not, and is not, concerned with the emboldening the lawsuit industry and its efforts to subvert the truth-finding function of civil litigation. 

David Michaels served as the guest editor for the APJH special supplement.  Michaels repeated many of the contentions of the 2004 Policy Statement, above, and in an introductory essay,[2] he added some new dubious assertions:

  • Judges are no better than juries in assessing scientific evidence.
  • Scientists evaluate all the evidence by applying a “weight-of-the-evidence” approach.
  • Uncertainty in science is normal and does not mean the underlying science flawed.

These are all serious half truths.  Many judges are quite astute when evaluating scientific evidence, but even the lowest aptitude judges must give articulated reasons for their decisions, which opens up a public process of comment, correction, and criticism.  Juries vote in secret, without having to explain or justify their verdicts. Judges can review the actual studies relied upon; juries never read the entire studies that are cited by expert witnesses. The collective judgment of juries can, on occasion, be more insightful than that of a single judge. Juries can also be more emotive and less analytical than judges, and they can be seduced by the hyperbolic rhetoric, and evidence-free claims. It seems obvious what aspects of the jury system are being endorsed by the APHA.

Scientists, metaphorically speaking, weigh evidence, as do non-scientists, but this opaque metaphor hardly explicates the process of how scientists arrive at conclusions about causal relationships.  And uncertainty is a condition of many scientific fields, but the error lies in trying to pass off tentative, uncertain, preliminary observations and findings as knowledge.

Michaels sees the development of judicial gatekeeping as favoring “the powerful,” and hurting “the weak and vulnerable.”[3]  Michaels showed no compunction with having his editorial recommendations favoring the lawsuit industry and undermining the truth.  Michaels was the head of the Occupational Health & Safety Administration, where he squandered his tenure with a shambolic rulemaking on silica, which did little actually to protect workers.

As for self-righteousness, Michaels’ special issue of the American Journal of Public Health was itself funded by corrupt interests. Michaels and the APHA described the funding for the special AJPH supplement:

“Support for the supplement was provided through unrestricted funding to the Project on Scientific Knowledge and Public Policy (SKAPP) from the Common Benefit Litigation Trust, a fund established by court order in the Silicone Gel Breast Implant Products Liability Litigation. SKAPP is an initiative of scholars that examines the application of scientific evidence in the legal and regulatory arenas. SKAPP is based at the George Washington University School of Public Health and Health Services; more information is available at  www.DefendingScience.org.”[4]

This pseudo-disclosure provides a window of discovery into the fraudulent aspect of the entire APHA enterprise.  The Common Benefit Trust was a fund that was held back from settlement monies paid by defendants in the silicone gel breast implant litigation.  The Trust was nothing more than the Plaintiffs’ Steering Committee’s war chest, and “walking-around-money,” from which it could advance litigation goals within MDL 926 (silicone breast implant cases).  Ironically, the appointment of neutral, court-appointed expert witnesses led to the success of “sound science,” and the collapse of the plaintiffs’ counsel house of cards.  Rather than returning their litigation expense fund to the claimants, the plaintiffs’ counsel diverted the funds to an illegitimate recipient, SKAPP, to advance their litigation goals, not for MDL 926, but for the next MDL, and the next, and the next….[5]  

                                     * * * * * * *

The same year that the APHA published the SKAPP-inspired and funded challenges to Federal Rules of Evidence 702, the APHA awarded its most prestigious award, the Sedgwick Medal, to Barry S. Levy, a physician whose opinions had routinely been found to be unreliable and irrelevant in various litigation industry efforts.[6]

Perhaps the APHA had Levy in mind when it complained that “special interests have challenged highly regarded public health … researchers….”  Dr. Levy seems to have less favorable accolades from trial and appellate judges.[7]  For instance, one federal judge found Levy engaged in a dubious enterprise to manufacture silicosis claims in Mississippi.[8] Interestingly, Judge Jack’s opinion was not mentioned in the APHA press release for Dr. Levy’s award ceremony.

                                     * * * * * * *

The APHA is still at it. The July 2026 issue of the American Journal of Public Health features articles on ultra-processed foods and public health. The association, in its website, describes the issue as “[a] curated collection of peer-reviewed research on the health impacts of ultraprocessed food consumption, food marketing, regulatory policy, and community-level interventions.”[9] The casual observer will no doubt detect that this issue is a one-sided presentation of advocacy positions, including a sop to the lawsuit industry about how litigation is necessary to challenge the food industry’s “toxic practices.”[10] The APHA has become an unserious politicized organization, which contributes to the erosion of trust in science and scientists.


[1] See APHA, Spirit of 1848 Caucus, available at https://www.apha.org/apha-communities/caucuses/spirit-of-1848-caucus.

[2] David Michaels, Editorial: Scientific Evidence and Public Policy, 95 (Supp. 1) AM. J. PUB. HEALTH S5 (2005).

[3] Id.

[4] This press release had been available at the APHA website <http://www.apha.org/about/news/pressreleases/2005/05arenas.htm>, last visited on February 10, 2014, but alas is no longer available. The press release, Is Public Health Science Being Derailed in the Legal and Regulatory Arenas (July 20, 2005), is available here.

[5] See Schachtman, SKAPP A LOT, TORTINI (April 30, 2010), available at https://schachtmanlaw.com/2010/04/30/skapp-a-lot/; and Conflicted Public Interest Groups, TORTINI (Nov. 3, 2013), available at https://schachtmanlaw.com/2013/11/03/conflicted-public-interest-groups/.

[6]Barry Levy Wins APHA’s Oldest and Most Prestigious Award, the Sedgwick Medal.” APHA News (Dec 11, 2005). This newsletter is no longer online, but the Wikipedia entry for the Sedgwick medal shows Levy as the 2005 recipient. Sedgwick Medal, in WIKIPEDIA, available at https://en.wikipedia.org/wiki/Sedgwick_Memorial_Medal.

[7] See Schachtman, Silica Litigation: Screening, Scheming & Suing; Washington Legal Foundation Critical Legal Issues Working Paper Series No. 135 (Dec. 2005) (exploring the ethical and legal implications of the entrepreneurial litigation in which Levy and others were involved). See also Lofgren v. Motorola, Inc., 1998 WL 299925, No. CV 93-05521 (Ariz. Super. Ct., Maricopa Cty. June 1, 1998); Harman v. Lipari, N.J. L. Div. GLO-L-1375-95, Order of Nov. 3, 2000 (Tomasello, J.) (barring the opinions of B.S. Levy in a class action for medical monitoring damages); Castellow v. Chevron USA, 97 F. Supp. 2d 780, 793-95 (S.D. Tex. 2000); Knight v. Kirby Inland Marine Inc., 482 F.3d 347 (5th Cir. 2007); Watts v. Radiator Specialty Co., 990 So. 2d 143 (Miss. 2008); Aurand v. Norfolk So. Ry., 802 F. Supp.2d 950 (2011); Mallozzi v. Ecosmart Technologies, Inc., 2013 WL 2415677, No. 11-CV-2884 (SJF) (ARL) (E.D.N.Y. May 31, 2013).

[8] .  In re Silica Products Liability Litigation, 398 F. Supp. 2d 563, 611-16, 622 & n.100 (S.D. Texas 2005) (expressing particular disappointment with Dr. Barry Levy, who although not the worst offender of a bad lot of physicians, betrayed his “sterling credentials” in a questionable enterprise to manufacture diagnoses of silicosis for litigation).

[9] See Ultraprocessed Food Section, AM. J. PUB. HEALTH online, available at https://ajph.aphapublications.org/ultraprocessedfoodssection.

[10] See Jennifer L. Pomeranz & Kelly D. Brownell, Litigation as a Necessary Tool to Challenge Food Industry’s Toxic Practices, AM. J. PUB. HEALTH, published online on June 3, 2026, at https://ajph.aphapublications.org/doi/10.2105/AJPH.2026.308539.

How Science Works in the New Reference Manual on Scientific Evidence

March 12th, 2026

The Second and Third Editions of the Reference Manual on Scientific Evidence contained a chapter, “How Science Works,” by Professor David Goodstein. This chapter ambitiously set out to cover philosophy and sociology of science to help orient judges as strangers in a strange land. Goodstein’s chapter had been a useful introduction to scientific methodology, and it countered some of the antic ideas seen in some judicial opinions, as well as in some other chapters of the Manual. Goodstein brought a good deal of experience and expertise to the task. He was a distinguished professor of physics and Vice Provost at the California Institute of Technology, and he had written engagingly about scientific discovery and the pathology of science.[1] Sadly, Goodstein died in April 2024. His death may have had some role in the delayed publication of the Fourth Edition of the Manual,[2] and the improvident replacement of his chapter with a new chapter written by authors less articulate about how science works.

The substitute chapter on “How Science Works” was written by two authors considerably less accomplished than the late Professor Goodstein.[3] Michael Weisberg is a professor of philosophy at the University of Pennsylvania, where he is the deputy director of Perry World House, which “analyzes global policy challenges through the realms of climate, democracy, global justice and human rights, and security.” The connection with Perry House may explain the new chapter’s heavy reliance upon the development of the chlorofluorocarbon (CFC) connection to ozone layer depletion as an exemplar of scientific discovery and knowledge. The University of Pennsylvania webpage describes Weisberg as “educat[ing] the next generation of environmental leaders in the classroom, at the negotiating table, and in the field, ensuring that their voices have maximal impact on addressing the climate crisis.”[4] So we have a philosopher of advocacy science, as it were. Some readers might think those credentials are not optimal for preparing a nuts-and-bolts description of how science works. Reading sections of the new chapter will not diminish their concerns.

Joining with Weisberg on this new version of “How Science Works,” is Anastasia Thanukos, who works at the University of California Museum of Paleontology. Thanukos has her masters degree in integrative biology, and her doctorate in science education.[5] 

The new “method” chapter has some virtues. As did Goodstein’s chapter, the new authors put peer review into a realistic perspective that should keep judges from being snoockered into admitting weak or bogus evidence because it had been published in a peer reviewed journal.[6] The authors should have gone much farther in pointing out that the rise of predatory and pay-to-play journals, as well as journals controlled by advocacy groups, have undermined much of the publishing model of modern science.

Weisberg and Thanukos discuss “expertise” in a way that is interesting but irrelevant to legal cases.  They seem blithely unaware that the standard for qualifying an expert witness is extremely low. Who will disbuse them when they argue that “[i]t is worth evaluating the closeness of a scientist’s disciplinary expertise to a scientific topic on which expert testimony is delivered”?[7] In what emerges as a consistent pattern of giving anti-manufacturing industry examples, the authors point to Richard Scorer as an accomplished scientist, who had no specific expertise in CFC ozone depletion. Notwithstanding the lack of specific expertise, an industry-backed group promoted Scorer’s views that criticized the CFC-ozone depletion hypothesis.[8] Citing Naomi Oreskes, the new Manual chapter states that “[t]he problem of scientists with legitimate expertise in one field weighing in on a scientific question outside their area of expertise is a pernicious one that has affected public acceptance of science and policy on issues such as climate change and tobacco exposure.”[9] Later, when Weisberg and Thanukos discuss the Milward case, they miss the pernicious influence that flowed from allowing Martyn Smith, a toxicologist, to give methodologically muddled opinion testimony on epidemiology. Pernicious is where you find it, and the authors of the new chapter find virtually all untoward instances of poor scientific method and conduct to originate from manufacturing industry.

Weisberg and Thanukos introduce a discussion of the “replication crisis,” a phrase and concept absent from the third edition of the Reference Manual.[10] The authors express some skepticism that there is an actual crisis over replication,[11] but their focus on climate science may mean that they are simply blinded by groupthink in that discipline. Their discussion of retractions omits the steep rise in retraction rates in most scientific disciplines,[12] and the authors ignore the proliferation of poor quality journals. Positively, the authors introduce a discussion of study preregistration, a notion absent from the third edition of the Manual, and they explain that such preregistration may serve as a bulwark against data dredging post hoc analyses.[13] Negatively, the authors ignore how frequently preregistered protocols are not used, or are used and then violated.

Weisberg and Thanukos appropriately ignore “weight of the evidence” (WOE) and “inference to the best explanation” (IBE). Readers might (mistakenly) think that the new chapter implicitly rejects WOE, as put forth by Carl Cranor and credulously accepted by the First Circuit in Milward, when the chapter authors insist that 

“the judge’s task requires a deeper examination of the available evidence and methods by which it was arrived at, as well as an assessment of how the community of experts in this area has evaluated or would evaluate the evidence and reasoning in question.”[14]

Contrary to the Milward decision from 2011, the new authors are not shy about stating the obvious; there is good science, and there is bad science.  Not all “judgment” about causality is acceptable and fit for submission to juries.[15] Given the judicial resistance to Rule 702, the obvious here requires stating. Weisberg and Thanukos acknowledge that some scientific judgment is unreliable or invalid because it was based upon work that was not carried out in accordance with current standards for scientific investigation and inference.[16] It should not surprise anyone that most of their examples of bad science are the product of manufacturing industry; the authors are oblivious to bad science sponsored by the lawsuit industry or by non-governmental advocacy organizations (NGOs).

Weisberg and Thanukos frame scientific disagreements and debates as governed by both data and ethical norms. Science is not infinitely contestable. There are identifiable norms, including a norm that scientists should “seek relevant information,” and “scrutinize ideas and evidence.”[17] Contrary to Milward’s standard of judicial abstention and credulity in the face of dodgy causal claims, these authors state what should be obvious, that scientific scrutiny involves, among other things, “an evaluation of methods, considering potential biases and oversights.”[18]

The chapters’ authors, non-lawyers, get closer to the heart of the error in Milward’s abstention doctrine with their recognition of what should have been obvious to the authors of the law chapter (Richter & Capra):

“When research relevant to a trial has not yet been scrutinized by a community with the appropriate technical expertise, a judge may be placed in the position of providing or requesting this scrutiny.”[19]  

Rather than some vague, subjective, and content-free WOE standard, Weisberg and Thanukos urge scientists, and by implication judges as well, to engage in serious efforts to “identify and avoid bias” and abide by ethical guidelines.[20] In other (my) words, the new authors agree that there is a standard of care reflected in the norms of science, and consequently there can be deviations from that standard. For Weisberg and Thanukos, compliance with the normative structure of scientific investigations is at the heart of building up accurate and predictive conclusions from data.[21] As part of their communitarian and normative conception of the scientific process, the authors appear to accept the reality and necessity for judges to act as gatekeepers.[22]

And while this recognition of standards and the need to police against deviations from standards is commendable, Weisberg and Thanukos proceed to give an abridgment of scientific method and process that is distorted and erroneous. They steadfastly ignore the concept of hierarchy of evidence, and thus provide illegitimate cover for levelers of evidence. In discussing randomized controlled trials, for instance, they note that such trials are often taken as “the gold standard,” but then they counter, without citation, support, or argument, that such trials “are just one line of evidence among many.”[23] The authors elide discussion and reconciliation of when that “just one line of evidence” conflicts with observational studies.

Notwithstanding their helpful comments about the need to evaluate studies for bias and other errors, these authors enter into the Milward controversy with an observation that assessing many lines of evidence is required and can be difficult for courts, and has led to “controversy.” Citing to papers including one  by the late Margaret Berger at her notorious lawsuit industry SKAPP-funded Coronado Conference, Weisberg and Thanukos float the observation that:

“In science, the available evidence (some of which may come from other research programs not designed to test the hypothesis under consideration) is evaluated as a body, along with the strengths, weaknesses, and caveats relating to each type of data, an approach which, some scholars have argued, the judiciary has not always followed.98[24]

This claim that the available evidence is evaluated as “a body” is presented as a fact about how science works, without any citation or argument. Several comments are in order. First, the claim is at odds with the authors’ own statements that scientific norms require evaluating each study for biases and other disqualifying flaws. Second, the claim is at odds with the authors’ own reference to systematic reviews and meta-analyses,[25] which are governed by protocols with inclusionary and exclusionary criteria for individual studies, and which require consideration of individual study validity before it enters the “body” of evidence that is quantitatively or qualitatively evaluated. In the authors’ words, “authors delineate both the criteria that studies must meet for inclusion in the review and the methods that will be used to assess the studies.”[26] The Milward case involved an expert witness who had proffered the very opposite of a systematic review in the form of post hoc rejiggering of studies and their data to fit a pre-conceived litigation goal. In the context of addressing the replication crisis, Weisberg and Thanukos correctly observe “peer review alone cannot ensure that the conclusions of published studies are actually correct, highlighting the responsibility judges bear in evaluating the validity of the methodologies that contributed to a particular piece of research.”[27] Of course, the Milward case involved a hired expert witness whose unprincipled re-analysis of studies was never peer reviewed or published.

Third, the authors could easily have found additional support for the contrary proposition that individual studies must be evaluated before being considered as part of the entire evidentiary display. The IARC Preamble, which roughly describes how that agency arrives at its so-called hazard classifications of human carcinogenicity, specifies that individual studies within each of three streams of evidence are evaluated for validity and soundness before contributing to a sub-conclusion with respect to (1) epidemiology, (2) toxicology, and (3) mechanistic lines of evidence.[28] Each of those three lines of evidence is adjudged “sufficient,” “limited,” or “inadequate,” by specialists in the three respective areas, before an overall evaluation is reached. There is much that is objectionable in the IARC working group procedures, but this division of labor and the need to consider disparate lines of evidence and studies within each line separately before attempting a synthesis, is present in all systematic review methodology. The suggestion from Weisberg and Thanukos that “the available evidence” in science is “evaluated as a body” is not only unsupported, but it is demonstrably false and misleading.

This claim about holistic evaluation is a fairly transparent but failed attempt to support a claim made in the chapter on the admissibility of expert witness evidence by Liesa Richter and Daniel Capra, who present an exposition of the notorious Milward case, without criticism, in a way to suggest that the case represents appropriate judicial gatekeeping under Rule 702, and that the case is consistent with scientific norms.[29] The chapter on how science works, after  having stated a false claim about scientific methodology for synthesis and integrating disparate lines of evidence, attempts to provide a gloss on the similar and equally benighted claim of Richter and Capra, in footnote 98:

“98. Some scholars have raised concerns that the courts have on occasion unfairly dismissed numerous individual lines of evidence as being flawed or insufficiently conclusive and concluded that evidence is lacking, when in fact the body of evidence, taken as a whole, points to a clear conclusion. For more, see discussion of Milward v. Acuity Specialty Products Group, Inc.; see also Liesa L. Richter & Daniel J. Capra, The Admissibility of Expert Testimony, in this manual; Berger 2005, supra note 97; and Steve C. Gold, A Fitting Vision of Science for the Courtroom, 3 Wake Forest J.L. & Pol’y 1 (2013).”

Some “scholars” have indeed said such things in their more unscholarly moments; some scholars have criticized Milward, but they are not cited in this new methods chapter. The footnote is accurate, but highly misleading by omission. The First Circuit in Milward also said as much, also without support or justification, and Richter and Capra, in their chapter of the Manual, fourth edition, parrot the Milward case. Weisberg and Thanukos cite to two articles, by Margaret Berger and by Steven Gold, both law professors, not scientists, and both ideologically hostile to Rule 702 gatekeeping. The Berger article was from a lawsuit-industry SKAPP funded symposium known as the Coronado Conference, and the Gold paper comes out of a symposium sponsored by the lawsuit industry itself and the Center for Progressive Reform, an advocacy NGO to which one of Mr. Milward’s expert witnesses, Carl Cranor, belongs. So the authors of the new science methodology chapter failed to cite any scientific source, but cited to papers by lawyers in the capture of the lawsuit industry, and a single (infamous) decision that ignored Rules 702 and 703, as well as the extensive literature on systematic reviews.  Weisberg and Thanukos could have cited many sources that contradicted their claim, and the claim of the lawsuit industry sponsored lawyers, but they did not. This is what biased and subversive scholarship looks like.

Funding Bias – The New McCarthyism

The selective citation to articles sponsored by the lawsuit industry is ironic in the context of what Weisberg and Thanukos have to say elsewhere about the “funding effect.” Some of what the authors say about personal bias is almost reasonable. For instance, they suggest that funding source is a “valid consideration” in evaluating methodologies and conclusions of expert testimony, and presumably of published studies as well, but not a sufficient reason to exclude such testimony or reliance.[30] Interestingly, these authors ignored the funding and the ideological interests of the symposia they cited in support of the repudiated Milward abstention doctrine.

Over three decades ago, Kenneth Rothman, the founder of Epidemiology, the official journal of the International Society for Environmental Epidemiology (ISEE), wrote his protest against the obsession with funding in article that should have been cited in the new chapter, for balance. Rothman described the fixation on funding as the “new McCarthyism in science,” which manifested as intolerance toward industry-sponsored studies, and strict scrutiny of “conflict-of-interest” (COI) disclosures.[31] The new McCarthyites amplify the gamesmanship over COI disclosures by excusing or justifying non-disclosure of COIs from scientists who have positional conflicts, or who are aligned with advocacy groups or with the lawsuit industry.

This asymmetrical standard for adjudging conflicts is on full display in the Weisberg and Thanukos chapter, when they claim that “in pharmaceuticals, there is a strong tendency for industry-sponsored trials to favor the industry’s product.”[32] The chapter authors, and their cited source, ignore the context in which the pharmaceutical industry scientists publish clinical trial results.  A successful clinical trial that showed efficacy with minimal adverse events is the result of years of prior research, including phase I and II trials, and preclinical testing. If the research fails to show efficacy, or shows unreasonable harm, in any of this prior research, the phase III trial is never done and so never published. If the medication is never licensed, the phase III trial will generally not be published. The selection effects are obvious and overwhelming in determining that the published results of phase III trials will be work that favors the sponsor. The “failed” phase III trial may result in a securities class action against the pharmaceutical company. In the realm of observational studies, some work commissioned by manufacturing industry has its origins in the poorly conducted, flawed work of environmental zealots and NGOs. Manufacturing industry has an obvious interest in correcting the scientific record, and again, any carefully done study would rebut that of the zealots and favor the industry sponsor.

Elsewhere, the authors offer a more balanced assessment when they observe that “[a]ll research is potentially influenced by bias, and every funder of research has the potential to introduce a source of bias.”[33] Similarly, the fourth edition chapter notes that “[a]ll scientists have some sort of motivation for their work, and this does not preclude scientific knowledge building, so long as biased methodologies and interpretations are avoided.”[34] Their recognition that motivated reasoning is everywhere suggests that all research should receive scrutiny regardless of apparent or disclosed funding source.[35]

When it comes to providing examples of funding-effect distortions of science, Weisberg and Thanukos seem to blank on instances created by the lawsuit industry or by environmental NGOs. The reader should contrast how readily and stridently the authors point to bias in industry-sponsored research with how the authors tie themselves up with double negatives when making the same point about NGOs:

“That is not to suggest that government-or nongovernmental organization (NGO)-sponsored research is necessarily free from bias.”[36]

The cognitive dissonance is palpable. The only conclusion that could be drawn from such a locution is that Weisberg and Thanukos have not worked very hard to identify and disclose their own biases.

STATISTICS DONE POORLY

When it comes to explaining and discussing the role of statistical methods in the scientific process, Weisberg and Thanukos go off the rails. The new chapter is an unmitigated disaster, which should have been corrected in the peer review and oversight process. The first sign of trouble became apparent upon checking the definition of “p-value” in the chapter’s glossary:

p-value. A statistic that gives the calculated probability that the null hypothesis could be true even given the observed differences between conditions.”[37]

This definition is the transposition fallacy on steroids. Obviously, a p-value cannot be the probability that the null hypothesis “could be true” when the procedure for calculating a p-value must assume that the null hypothesis is true, along with a specified probability model. Equally important, the p-value does not describe a probability in connection with the null hypothesis because it describes the probability of observing data as different from the null, or more so, as seen in this particular sample.  The statistics chapter in the Manual by Hall and Kaye states the meaning correctly.  The coverage of statistical concepts by Weisberg and Thanukos should be studiously ignored.

The outrageously incorrect definition of p-value in the glossary is not an isolated error.  The authors are clearly statistically challenged. In the text of their chapter, they incorrectly describe the p-value, consistently with their aberrant glossary entry:

“the commonly used p-value approach, scientists compare a test hypothesis (e.g., that drug X is effective) to a null (e.g., that there is no difference in cure rates between those who took drug X and those who took a placebo). Scientists then calculate the probability that the null hypothesis could be true even with the observed difference between conditions (e.g., the cure rate of patients taking drug X compared to that of those taking a placebo).”[38]

Weisberg and Thanukos thus conflate frequentist and Bayesian statistics. They also obliterate the meaning of the confidence interval, an important concept for judges and lawyers to understand. Here is how the authors describe the confidence interval in their chapter:

Evaluating estimates: In science (and in contrast to their lay meanings), the terms uncertainty and error refer to the variability of a set of data that is intended to estimate a single number. Uncertainty and error are generally expressed as a range, within which we are confident that, if the study were repeated, the new result would fall. Scientists often use a 95% confidence interval for this purpose.”[39]

Describing the confidence interval in the same sentence as “uncertainty and error” is bound to induce uncertainty and error. The confidence interval provides a range of estimates based upon random error, and uncertainty only in the form of imprecision in the point estimate. There are of course myriad other kinds of uncertainty and error not captured by the confidence interval. The most important of the authors’ errors is that they assert incorrectly that the confidence interval provides a range within which new results from the study repeated would fall.  This is, again, a variant on the transposition fallacy that the authors commit in their definition of the p-value. The confidence interval provides a range of results that would not be rejected as alternative null hypotheses by the data in the obtained sample. Because of random error, future samples would give different results, with different confidence intervals, which would not be co-extensive with the first obtained confidence interval. To be sure, the statistics chapter states the matter correctly, and the epidemiology chapter finally gets it correct in its text (after having mangled the concept in the second and third editions), but the epidemiology chapter perpetuates its previous errors in defining confidence intervals in its glossary. This sort of issue, and it is a serious one, could have been eliminated had there been meaningful peer review and editorial oversight for consistency and accuracy of the Manual as a whole.

Weisberg and Thanukos address statistical power in a way that may also mislead readers. They tell us that “[p]ower refers to a test’s ability to reject a hypothesis that is indeed false.” W&T at 88. If only were it so. The authors omit that power is a probability that at a specified level of significance (say p < 0.05), and a specified alternative hypothesis, sample size, and probability model, the sample result will reject the null hypothesis in favor of the alternative hypothesis. Then the authors suggest confusingly that “[w]ell-designed studies have sufficient power to detect the differences of interest, but it may not be apparent when a test lacks power.”[40]

If the study at issue presents a confidence interval around a point estimate of interest, then it will be clear what alternative null hypotheses are statistically compatible with the sample result at the pre-specified level of alpha (significance). Any point outside the interval would be rejected by such a test of significance, and so the casual reader will have a rather good idea of what could and could not be rejected by the sample data. And of course, virtually every study will have low power to detect extremely small increased risks, say relative risk of 1.00001. And most studies will have high power to detect risk ratios of over 1,000.

This new chapter on “How Science Works” also propagates some well-known fallacies about statistical significance testing. Implicit in the authors’ committing the transposition fallacy, is a conceptual and mathematical confusion between the coefficient of confidence (1-α) and the posterior probability of an hypothesis.

The authors’ mistake comes in their insistence upon labeling precision in a test result as “certainty.” In the quote below, the authors’ confusion is clear and obvious:

“Note that the 95% and 5% cutoffs are somewhat arbitrary, and a higher degree of confidence might be required if more certainty were desired—for example if an impactful policy decision depended on the conclusion.”[41]

An impactful [sic] policy decision might well call for more certainty, or a higher posterior probability, but a higher coefficient of confidence will not necessarily map to hypothesis probability at all. The authors’ confusion and conflation of the probability of alpha and the Bayesian posterior probability arises elsewhere within the chapter:

“(1) A p-value lower than 0.05 does not prove that a null hypothesis is false. It is strong evidence, but there is a small chance that the difference observed could be the result of chance alone.

(2) Using a low p-value (e.g., 0.05) as a criterion for significance sets a high bar for rejecting the null hypothesis, minimizing the chance of getting a false positive… .”[42]

Again, a p-value less than five percent is hardly strong evidence in the context of large database studies, especially when there are multiple comparisons and the outcome is not the pre-specified outcome of the analysis. The authors’ confusion is on full display when they discuss the Zoloft birth defects litigation, where the Third Circuit affirmed the exclusion of plaintiffs’ expert witnesses’ causation opinions and the grant of summary judgment to the defendants. According to the authors’ narrative:

“plaintiffs’ expert’s testimony would have argued that multiple, nonsignificant associations between Zoloft use and birth defects indicated a causal relationship. The testimony was excluded because these results were consistent with a weak causal relationship (a small effect size), one that is ‘so weak that one cannot conclude that the risk is greater than that seen in the general population’.”[43]

Of course, in the Zoloft litigation, the excluded plaintiffs’ expert witnesses were caught red-handed – at cherry picking – and attempting to circumvent the lack of significance with a methodologically incorrect meta-analyses.[44]

If the risk of birth defects among children born to mothers who used Zoloft in pregnancy was no greater than seen in the general population, then there would be no risk, not risk “so weak” it cannot be seen. Locutions such as the “results were consistent with a weak causal relationship,” when the results were equally consistent with no causal relationship suggest that the writers cannot bring themselves to say that the causal hypothesis was simply not supported at all. Of course, no study may exclude an increased risk of 0.01 percent, or a relative risk of 1.01, but at some point, when multiple attempts fail to reveal an increased risk, we may conclude that the proponents of the causal claim have failed to make their case.

META-SHMETA-ANALYSIS

Weisberg and Thanukos address meta-analysis incompletely in the context of systematic reviews. The authors do not provide any insights into how meta-analyses are done, and more glaringly, they fail to mention that not all systematic reviews can or should result in quantitative syntheses of estimates of association. On the positive side, they state that meta-analyses are important in litigation, and that the application of rigorous methodologies should be required.[45] With clearly unintended irony, Weisberg and Thanukos offer, as support for their statement, the Paoli Railroad Yard case, “in which the exclusion of a contested meta-analysis was overturned.”[46]

Weisberg and Thanukos have stepped into the wet corner of a pigsty. The issue in the Paoli case arose from a meta-analysis of mortality rates associated with polychlorobiphenyl (PCB) exposures. The district court excluded the proponent of the meta-analysis, not because it was unreliable, but because it was novel. Holding it up in conjunction with a statement about application of rigorous or reliable methodologies was way off the relevant legal point.

The expert witness who proffered the meta-analysis in Paoli was William  Nicholson, who was a physicist with no professional training in epidemiology. For his opinion that PCBs were causally associated with human liver cancer, Nicholson relied upon a non-peer-reviewed, unpublished report he wrote for the Ontario Ministry of Labor.[47] Nicholson described his report as a “study of the data of all the PCB worker epidemiological studies that had been published,” from which he concluded that there was “substantial evidence for a causal association between excess risk of death from cancer of the liver, biliary tract, and gall bladder and exposure to PCBs.”[48]

The defense challenged Nicholson’s opinion, not on Rule 702, but on case law that pre-dated the Daubert decision.[49] The challenge included pointing out the unreliability of the Nicholson’s meta-analysis, but also asserted (incorrectly) the novelty of meta-analysis generally. The district court sustained the defense objection on the grounds of “novelty,” without reaching the reliability analysis.[50] The Third Circuit appropriately reversed and remanded for consideration of the reliability of Nicholson’s meta-analysis.[51]

The consideration of Nicholson’s “meta-analysis” never occurred on remand; plaintiffs’ counsel and their expert witnesses withdrew their reliance upon Nicholson’s analysis. Their about face was highly prudent. Nicholson’s report presented SMRs (standardized mortality ratios); for the all cancers statistic, he reported an SMR of 95. What Nicholson did, in this analysis, and in all other instances, was simply divide the observed number of deaths by the expected, and multiply by 100. This crude, simplistic calculation fails to present a standardized mortality ratio, which requires taking into account the age distribution of the exposed and the unexposed groups, and a weighting of the contribution of cases within each age stratum. Nicholson’s presentation of data was nothing short of a fraud.

Nicholson’s Report was replete with many other methodological sins. He used a composite of three organs (liver, gall bladder, bile duct) without any biological rationale. His analysis combined male and female results, and still his analysis of the composite outcome was based upon only seven cases. Of those seven cases, some of the cases were not confirmed as primary liver cancer, and at least one case was confirmed as not being a primary liver cancer.[52]

As noted, Nicholson failed to standardize the analysis for the age distribution of the observed and expected cases, and he failed to present meaningful analysis of random or systematic error. When he did present p-values, he presented one-tailed values, and he made no corrections for his many comparisons from the same set of data.

Finally, and most egregiously, Nicholson’s meta-analysis was meta-analysis in name only. What he had done was simply to add “observed” and “expected” events across studies to arrive at totals, and to recalculate a bogus risk ratio, which he fraudulently called a standardized mortality ratio. Adding events across studies, without weighting by the inverse of study variance, is not a valid meta-analysis; indeed, it is a well-known example of how to generate the error known as Simpson’s Paradox, which can change the direction or magnitude of any association.[53]

In citing to the Paoli case as a reversal of exclusion of a contested meta-analysis, Weisberg and Thanukos give a truncated analysis that misleads readers, judges, and lawyers. There never was a proper consideration of the reliability vel non of Nicholson’s meta-analysis in the Paoli litigation, and in the final analysis, the Paoli plaintiffs abandoned reliance upon Nicholson’s ill-conceived meta-analysis.

VIRTUE SIGNALING

Although there are no land acknowledgments for the property on which Federal Judicial Center building is located, Weisberg and Thanukos miss few opportunities to let us know that they are woke scholars. There is the gratuitous and triggering “pregnant people,”[54] which begs any number of biological questions. Then there is the authors’ statement that they are limiting their focus to the “Western conception of science,” which begs another question, why would we call any other epistemically valid approach, from any corner of the globe, as something other than “science.”[55]

Equally gratuitous are the authors’ endorsements of DEI and “diversity,” with overbroad generalizations that diversity per se advances science,[56] and a claim that “women, people of color, other historically oppressed groups, and non-Western people” are not taken seriously as scientists.[57] In over 40 years of litigating technical and scientific issues, I have never seen a judge or a lawyer disrespect an expert witness based upon sex, race, ethnicity, or national origin. Of course, I have seen expert witnesses treated roughly for propounding bad science, and that seems perfectly appropriate.


[1] See David Goodstein, ON FACT AND FRAUD: CAUTIONARY TALES FROM THE FRONT LINES OF SCIENCE (2010).

[2] Weisberg and Thanukos frequently refer to other chapters in the Manual, which suggests that their chapter was written late in the development of the Fourth Edition, and perhaps contributed to the delayed publication.

[3] Michael Weisberg & Anastasia Thanukos, How Science Works, in National Academies of Sciences, Engineering, and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 47 (4th ed. 2025) [cited as W&T].

[4] See Michael Weisberg, University of Pennsylvania Philosophy, at https://philosophy.sas.upenn.edu/people/michael-weisberg.

[5] Anna Thanukos, Staff, available at https://ucmp.berkeley.edu/people/anna-thanukos/#:~:text=Her%20background%3A%20Anna%20has%20a,Education%2C%20both%20from%20UC%20Berkeley

[6] W&T at 72-75.

[7] W&T at 81.

[8] W&T at 81.

[9] W&T at 81 & n.85 (emphasis added), citing 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).

[10] W&T at 94-96.

[11] W&T at 95 n.120.

[12] Richard Van Noorden, More than 10,000 research papers were retracted in 2023 — a new record, 624 NATURE 479 (2023).

[13] W&T at 95.

[14] W&T at 55.

[15] W&T at 63, 68.

[16] W&T at 68.

[17] W&T at 65.

[18] W&T at 70.

[19] W&T at 71.

[20] W&T at 66.

[21] W&T at 75.

[22] W&T at 49.

[23] W&T at 83.

[24] W&T at 86 (citing Richter and Capra’s discussion of Milward in chapter one of the Manual, and Professor Gold’s article from the lawsuit industry celebratory conference on the Milward case).

[25] W&T at 99-100.

[26] W&T at 99.

[27] W&T 96 (emphasis added).

[28] IARC MONOGRAPHS ON THE IDENTIFICATION OF CARCINOGENIC HAZARDS TO HUMANS – PREAMBLE (2019), available at https://monographs.iarc.who.int/wp-content/uploads/2019/07/Preamble-2019.pdf

[29] Liesa L. Richter & Daniel J. Capra, The Admissibility of Expert Testimony, National Academies of Sciences, Engineering, and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 1, 32-33 (4th ed. 2025).

[30] W&T at 76.

[31] 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).

[32] W&T at 76 & n.67, citing Sergio Sismondo, Pharmaceutical Company Funding and Its Consequences: A Qualitative Systematic Review, 29 CONTEMP. CLINICAL TRIALS 109 (2008).

[33] W&T at 77.

[34] W&T at 59-60.

[35] W&T at 59-60.

[36] W&T at 76.

[37] W&T at 111.

[38] W&T at 87.

[39] W&T at 90.

[40] W&T at 88.

[41] W&T at 90 (emphasis added).

[42] W&T at 88.

[43] W&T at 90 (internal citations omitted).

[44] In re Zoloft (Sertraline Hydrochloride) Prods. Liab. Litig., 26 F. Supp. 3d 449 (E.D. Pa. 2014); No. 12-md-2342, 2015 WL 314149, at *3 (E.D. Pa. Jan. 23, 2015) (rejecting proffered expert witness opinion based upon “cherry-picking of studies and data within studies”), aff’d, 858 F.3d 787 (3rd Cir. 2017).

[45] W&T at 99.

[46] W&T at 99 & n.134, citing In re Paoli R.R. Yard PCB Litig., 916 F.2d 829 (3d Cir. 1990).

[47] William Nicholson, Report to the Workers’ Compensation Board on Occupational Exposure to PCBs and Various Cancers, for the Industrial Disease Standards Panel (ODP); IDSP Report No. 2 (Toronto Dec. 1987) [Report].

[48] Id. at 373.

[49] See United States v. Downing, 753 F.2d 1224 (3d Cir.1985).

[50] In re Paoli RR Yard Litig., 706 F. Supp. 358, 372-73 (E.D. Pa. 1988).

[51] In re Paoli RR Yard PCB Litig., 916 F.2d 829 (3d Cir. 1990), cert. denied sub nom. General Elec. Co. v. Knight, 499 U.S. 961 (1991).

[52] Report, Table 22.

[53] See James A. Hanley, et al., Simpson’s Paradox in Meta-Analysis, 11  EPIDEMIOLOGY 613 (2000); H. James Norton & George Divine, Simpson’s paradox and how to avoid it, SIGNIFICANCE 40 (Aug. 2015); George Udny Yule, Notes on the theory of association of attributes in statistics, 2 BIOMETRIKA 121 (1903).

[54] W&T at 84.

[55] W&T at 50.

[56] W&T at 71 n. 52-54.

[57] W&T at 102.

The Reference Manual’s Chapter on Expert Witness Testimony Admissibility – Part One

February 23rd, 2026

With the retraction of the climate science chapter, The Reference Manual on Scientific Evidence is now one chapter shorter, at least in the Federal Judicial Center’s version. At the time of this writing, for curious souls, the National Academies version is still sporting the climate advocacy chapter. Even without the climate chapter, the Manual is over 1,000 pages, and more than a casual weekend read. Many judges, finding this tome on their desks, will read individual subject matter chapters pro re nata. The first chapter in the Manual, however, is about the law, not science, and might be the starting place for the ordinary work-a-day judge. As in past editions of the Manual, the new edition has a chapter on the The Admissibility of Expert Testimony. In the first, second, and third editions, this chapter was written by Professor Margaret Berger. In the fourth edition, the chapter on the law was written by law professors Liesa Richter and Daniel Capra. To understand and evaluate the most recent iteration, the reader should have some sense of what has gone before.

Previous Chapters on Admissibility of Expert Witness Testimony

Professor Berger’s past chapters had been idiosyncratic productions.[1] Berger was an evidence law scholar, who wrote often about expert witness admissibility issues.[2] She was also known for her antic proposals, such as calling for abandoning the element of causation in products liability cases.[3] As an outspoken ideological opponent of expert witness gatekeeping, Berger was a strange choice to write the law chapter of the Manual.[4] Berger’s chapters in the first through the third editions made her opposition to gatekeeping obvious, and this hostility may have been responsible for some of the judicial resistance to applying the clear language of Rule 702, even after its 2000 revision.

Berger was not only a law professor; she was at the center of ideological and financially conflicted groups that worked to undermine the application of Rule 702 in health effects cases. One of the key players in this concerted action was David Michaels. Currently, Michaels teaches epidemiology at the George Washington University Milken Institute School of Public Health. He is a card-carrying member of the Collegium Ramazzini, an organization that has participated in efforts to corrupt state and federal judges by funding ex parte conferences with lawsuit industry expert witnesses.[5] Michaels is the author of two books, both highly anti-manufacturing industry, and biased in favor of the lawsuit industry.[6] Both books are provocatively titled anti-industry diatribes, which have little scholarly value, but are used regularly by plaintiffs counsel solely to smear corporate defendants and defense expert witnesses. Most clear-eyed trial judges have quashed these efforts on various grounds, including Rule 703, because the books are not the sort of material upon which scientists would reasonably rely.[7]

In 2002, David Michaels created an anti-Daubert advocacy organization, the Project on Scientific Knowledge and Public Policy (SKAPP), from money siphoned from the plaintiffs’ common-benefit fund in MDL 926 (silicone gel breast implant litigation).[8] Michaels lavished some of the misdirected money to prepare and publish an anti-Daubert pamphlet for SKAPP, in 2003.[9] In this anti-Daubert publications, and many others sponsored by SKAPP, Michaels and the SKAPP grantees typically acknowledged the source of SKAPP funding obliquely to hide that it was nothing more than plaintiffs counsels’ walking around money:

“I am also grateful for the support SKAPP has received from the Common Benefit Trust, a fund established pursuant to a court order in the Silicone Gel Breast Implant Liability litigation.”[10]

Many credulous lawyers, judges, and legal scholars were duped into believing that SKAPP, SKAPP publications, and SKAPP-sponsored publications were supported by the Federal Judicial Center.

Michaels directed a good amount of SKAPP’s anti-Daubert funding to support Professor Berger’s efforts in organizing a series of symposia on science and the law. Several of Berger’s SKAPP conferences were held in Coronado, California, and featured a predominance of scientists who work for the lawsuit industry and are affiliated with advocacy organizations, such as the Collegium Ramazzini. The papers from one of the Coronado Conferences were published in a special issue of the American Journal of Public Health, the official journal of the American Public Health Association,[11] which has issued position papers highly critical of Rule 702 gatekeeping.[12]

The spider web of connections between SKAPP, the Collegium Ramazzini, the American Public Health Association, the Tellus Institute, the lawsuit industry,  Professor Berger, and others hostile to Rule 702 is a testament to the concerted action to undermine the Supreme Court’s decisions in the area, and the codification of those decisions in Rule 702. That Professor Berger was within this web of connections, and was writing the chapter on the admissibility of expert witness opinion testimony, in the first three editions of the Reference Manual, explains but does not justify many of the opinions contained within those chapters.

Professor David Bernstein, who has written extensively on expert witness issues, restated the situation thus:

“In 2003, the toxic tort plaintiffs’ bar used money from a fund established as part of the silicone breast implant litigation settlement to sponsor four conference in Coronado, California, that resulted in a slew of policy papers excoriating the Daubert gatekeeping requirement.”[13]

The active measures of these groups and Professor Berger explain the straight line between Berger’s symposia and the First Circuit’s decision in Milward v. Acuity Specialty Products Group, Inc.[14] Carl Cranor was one of the speakers at the Coronado Conferences, and along with Martyn Smith, another member of the Collegium Ramazzini, founded a Proposition 65 bounty-hunting organization, Council for Education on Research on Toxics (CERT). Cranor has long advocated for a loosey-goosey “weight of the evidence” approach that had been rejected by the Supreme Court in Joiner.[15] Cranor, along with Smith, unsurprisingly turned up as expert witnesses for plaintiff in Milward, in which case they reprised their weight-of-the evidence approach opinions. When Milward appealed the exclusion of Cranor and Smith, CERT filed an amicus brief, without disclosing that Cranor and Smith were founders of the organization, and that CERT funded Smith’s research through donations to his university, from CERT’s shake-down operations under Prop 65. The First Circuit’s 2011 decision in Milward resulted from a fraud on the court.

Professor Berger died in November 2010, but when the third edition of the Manual was released in 2011, it contained Berger’s chapter on the law of expert witnesses, with a citation to the Milward case, decided after her death.[16] An editorial note from an unnamed editor to her posthumous chapter suggested that

“[w]hile revising this chapter Professor Berger became ill and, tragically, passed away. We have published her last revision, with a few edits to respond to suggestions by reviewers.”

Given that Berger was an ideological opponent of expert witness gatekeeping, there can be little doubt that she would have endorsed the favorable references to Milward made after her passing, but adding them can hardly be considered non-substantive edits. Curious readers might wonder who was the editor who took such liberties of adding the chapter citations to Milward. Curious readers do not have to wonder, however, what would have happened if the incestuous relationships among Berger, SKAPP, the plaintiffs’ bar, and others had been replicated by similar efforts of manufacturing industry to influence the interpretation and application of the law. In 2008, the Supreme Court decided an important case involving constitutional aspects of punitive damages. The Court went out of its way to decline to rely upon empirical research that showed the unpredictability of punitive damage awards because it was funded in part by Exxon:

“The Court is aware of a body of literature running parallel to anecdotal reports, examining the predictability of punitive awards by conducting numerous ‘mock juries’, where different ‘jurors’ are confronted with the same hypothetical case. See, e.g., C. Sunstein, R. Hastie, J. Payne, D. Schkade, & W. Viscusi, Punitive Damages: How Juries Decide (2002); Schkade, Sunstein, & Kahneman, Deliberating About Dollars: The Severity Shift, 100 Colum. L.Rev. 1139 (2000); Hastie, Schkade, & Payne, Juror Judgments in Civil Cases: Effects of Plaintiff’s Requests and Plaintiff’s Identity on Punitive Damage Awards, 23 Law & Hum. Behav. 445 (1999); Sunstein, Kahneman, & Schkade, Assessing Punitive Damages (with Notes on Cognition and Valuation in Law), 107 Yale L.J. 2071 (1998). Because this research was funded in part by Exxon, we decline to rely on it.”[17]

Unlike the situation with SKAPP, David Michaels, the plaintiffs’ bar, and Professor Berger, the studies sponsored in part by Exxon had disclosed their funding clearly. Those studies involved outstanding scientists whose integrity were unquestionable, and for its trouble, Exxon was rewarded with gratuitous shaming from Justice Souter. The anti-Daubert papers sponsored by the plaintiffs’ bar through SKAPP, and Professor Berger’s ideological conflicts of interest have received a free pass. This disparate treatment between conflicts of interest within manufacturing industry and those within the lawsuit industry and its advocacy group allies is a serious social, political, and legal problem. It was a problem on full display in the now-retracted climate science chapter in the Manual. In evaluating the new fourth edition’s chapter on the law of expert witness admissibility (and other chapters), we should be asking whether there are signs of undue political influence.


[1] See Schachtman, The Late Professor Berger’s Introduction to the Reference Manual on Scientific Evidence, TORTINI (Oct. 23, 2011).

[2] See generally Edward K. Cheng, Introduction: Festschrift in Honor of Margaret A. Berger, 75 BROOKLYN L. REV. 1057 (2010). 

[3] Margaret A. Berger, Eliminating General Causation: Notes towards a New Theory of Justice and Toxic Torts, 97 COLUM. L. REV. 2117 (1997).

[4] See, e.g., Margaret A. Berger & Aaron D. Twerski, “Uncertainty and Informed Choice:  Unmasking Daubert,” 104 MICH. L.  REV. 257 (2005). 

[5] In re School Asbestos Litig., 977 F.2d 764 (3d Cir. 1992). See Cathleen M. Devlin, Disqualification of Federal Judges – Third Circuit Orders District Judge James McGirr Kelly to Disqualify Himself So As To Preserve ‘The Appearance of Justice’ Under 28 U.S.C. § 455 – In re School Asbestos Litigation (1992), 38 VILL. L. REV. 1219 (1993); Bruce A. Green, May Judges Attend Privately Funded Educational Programs? Should Judicial Education Be Privatized?: Questions of Judicial Ethics and Policy, 29 FORDHAM URB. L. J. 941, 996-98 (2002).

[6] David Michael, DOUBT IS THEIR PRODUCT: HOW INDUSTRY’S WAR ON SCIENCE THREATENS YOUR HEALTH (2008); David Michaels, THE TRIUMPH OF DOUBT (2020).

[7] See In re DePuy Orthopaedics, Inc. Pinnacle Hip Implant Prods. Liab. Litig., 888 F.3d 753, 787 n.71 (5th Cir. 2018) (advising the district court to weigh carefully whether Doubt is Their Product has any legal relevance); King v. DePuy Orthopaedics, Inc., 2024 WL 6953089, at *2 (D. Ariz. July 9, 2024) (finding Michaels’ books to be legally irrelevant); Sarjeant v. Foster Wheeler LLC, 2024 WL 4658407, at *1 (N.D. Cal.Oct. 24, 2024) (ruling that Doubt Is Their Product is legally irrelevant hearsay, and not the type of material upon which an expert witness would rely to form scientific opinion). See also Evans v. Biomet, Inc., 2022 WL 3648250, at *4 (D. Alaska Feb. 1, 2022) (quashing plaintiff’s subpoena to defendant’s expert for material in connection with Doubt Is Their Product).

[8] See Ralph Klier v. Elf Atochem North America Inc., 2011 U.S. App. LEXIS 19650 (5th Cir. 2011) (holding that district court abused its discretion in distributing residual funds from class action over arsenic exposure to charities; directing that residual funds be distributed to class members with manifest personal injuries). A “common benefit” fund is commonplace in multi-district litigation of mass torts.  In such cases, federal courts may require the defendant to “hold back” a certain percentage of settlement proceeds, to pay into a fund, which is available to those plaintiffs’ counsel who did “common benefit work,” work for the benefit of all claimants.  Plaintiffs’ counsel who worked for the common benefit of all claimants may petition the MDL court for compensation or reimbursement for their work or expenses.  See, e.g., William Rubenstein, On What a ‘Common Benefit Fee’ Is, Is Not, and Should Be, CLASS ACTION ATT’Y FEE DIG. 87, 89 (Mar. 2009).  In the silicone gel breast implant litigation (MDL 926), plaintiffs’ counsel on the MDL Steering Committee undertook common benefit work in the form of developing expert witnesses for trial, and funding scientific studies.  By MDL Orders 13, and 13A, the Court set hold-back amounts of 5 or 6%, and later reduced the amount to 4%.  Id. at 94.

[9] Eula Bingham, Leslie Boden, Richard Clapp, Polly Hoppin, Sheldon Krimsky, David Michaels, David Ozonoff & Anthony Robbins, Daubert: The Most Influential Supreme Court Ruling You’ve Never Heard Of (June 2003). The authors described the publication as a publication of SKAPP, coordinated by the Tellus Institute, and funded by The Bauman Foundation, a private foundation that supports “progressive social change advocacy.” Boden, Hoppin, Michaels, and Ozonoff are fellows of the Collegium Ramazzini.

[10] David Michael, DOUBT IS THEIR PRODUCT: HOW INDUSTRY’S WAR ON SCIENCE THREATENS YOUR HEALTH 267 (2008). See Nathan Schachtman, “SKAPP A LOT,” TORTINI (April 30, 2010); “Manufacturing Certainty” TORTINI (Oct. 25, 2011); “David Michaels’ Public Relations Problem” TORTINI (Dec. 2, 2011); “Conflicted Public Interest Groups” TORTINI (Nov. 3, 2013). 

[11] 95 AM. J. PUB. HEALTH S1 (2005).

[12] See, e.g., Am. Pub. Health Assn, Threats to Public Health Science, Policy Statement 2004-11 (Nov. 9, 2004), available at https://www.apha.org/policy-and-advocacy/public-health-policy-briefs/policy-database/2014/07/02/08/52/threats-to-public-health-science

[13] David E. Bernstein & Eric G. Lasker, Defending Daubert: It’s Time to Amend Federal Rule of Evidence, 702, 57 WM. & MARY L. REV. 1, 39 (2015), available at https://scholarship.law.wm.edu/wmlr/vol57/iss1/2. See David Michaels & Neil Vidmar, Foreword, 72 LAW & CONTEMP. PROBS. i, ii (2009) (“SKAPP has convened four Coronado Conferences.”).

[14] Milward v. Acuity Specialty Products Group, Inc., 639 F.3d 11 (1st Cir. 2011), cert. denied sub nom., U.S. Steel Corp. v. Milward, 132 S. Ct. 1002 (2012).

[15] General Electric Co. v. Joiner, 522 U.S. 136, 136-37 (1997).

[16] Margaret A. Berger, The Admissibility of Expert Testimony, in National Academies of Sciences, Engineering and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 11, 20 n.51, 23-24 n.61 (3rd 2011).

[17] Exxon Shipping Co. v. Baker, 554 U.S. 471, 128 S. Ct. 2605, 2626 n.17 (2008).

The FJC Retracts Climate Science Chapter in New Reference Manual

February 10th, 2026

When the new, fourth, edition of the Reference Manual on Scientific Evidence was released late last year,[1] I remarked that there were some new chapters,[2] including one on climate change. I found the addition of a chapter on climate change curious largely because I was unfamiliar with the science or the need to address the area for federal judges, and because I thought there were other more pressing topics, such as genetic causation, from which judges could benefit, but which were not included.

I confess that I did not read the new chapter on climate change,[3] which is not a subject that comes up in my practice or in my writing. Writers at the National Review, however, did read the chapter on climate, and found it objectionable. Writing on January 17th of this year, Michael Fragoso observed that the chapter on climate science was an advocacy piece that would resolve climate change litigation in favor of plaintiffs.[4]

If Fragoso’s charge is correct, the implications are extremely serious. Judges have an ethical obligation not to go beyond the adversary process to educate themselves about the factual issues before them in pending litigation. In the past, judges who have done so have found themselves on the wrong end of a petition for a writ of mandamus, and have been disqualified and removed from cases.[5] The Federal Judicial Center (FJC), which is the research and educational division of the federal courts, has tried to create a safe space for teaching judges about technical subjects that arise in litigation in a way that is balanced and removed from partisan advocacy. The last edition, the third, and the current edition, the fourth, of the Manual have been the joint product of the both the FJC and the National Academies of Science, Engineering and Medicine (NASEM), in the hope of producing disinterested tutorials on key areas of science that are important to judges in their adjudication of civil and criminal cases, as well as their performance of judicial review of regulation and agency action.

Following up on the National Review article, on January 29, 2026, the Attorneys General of 24 states[6] wrote a letter to Judge Robin Rosenberg, the director of the Federal Judicial Center. The letter identified the advocacy perspective of the climate chapter and its authors, who wrote what the Attorneys General described as an amicus brief that placed a thumb on the scales of justice, with respect to issues currently pending at all levels of the federal courts. The Attorneys General requested the immediate withdrawal of the offending chapter.

Judge Rosenberg is a savvy judge of scientific horse flesh. She presided over the Zantac multi-district litigation (MDL No. 2924), in which she excluded plaintiffs’ expert witnesses in a detailed, analytically careful opinion of over 300 pages.[7] On February 6, a week after the request to withdraw the climate chapter was made, Judge Rosenberg, wrote to West Virginia Attorney General John McCuskey, to report that the chapter had been omitted.[8] Given the prompt response from Judge Rosenberg, the decision was likely not a difficult one.  A decision not to include this chapter, as written, in the first place, would have been an even easier one.

Retractions of publications of the NASEM, which includes what was formerly the Institute of Medicine, are rarer than hens teeth.  This one received coverage and some intense harrumphing.[9] The retraction of the climate science chapter comes on the heels of a high-profile retraction, in December 2025, of an article in the prestigious journal Nature,[10] which argued that the costs of climate change would reach $38 trillion a year by 2049.[11]

The climate science chapter appears to be the outcome of what the late Daniel Kahneman called poor decision hygiene.  The chapter in question had two authors, and both were from the same institution, published together, and shared the same advocacy perspectives on climate change. Hardly a team of rivals. The editors of the Manual certainly could have done better in selecting these authors and in editing the work product.

Jessica Wentz is a Non-Resident Senior Fellow at the Sabin Center for Climate Change Law, at the Columbia Law School. The Sabin Center website describes itself as “develop[ing] legal techniques to combat the climate crisis and advance climate justice, and train the next generation of leaders in the field.” The language of “combat” and “crisis” certainly suggests a hardened, adversarial stance. Wentz’s writings reveal her advocacy and adversarial positions.[12]

Radley Horton is a Professor at Columbia University’s Climate School. He describes his research as focusing on climate extremes, and related topics. Horton’s curriculum vitae, social media, social media, testimony,[13] and professional work certainly mark him as an advocate for “attribution science” in litigation to address climate crises. Horton and Wentz previously published a law review article that seems to be a brief for plaintiffs’ positions in climate litigation.[14] One of the key issues in climate litigation is whether litigation is an appropriate avenue for addressing climate issues, and Horton and Wentz have both clearly committed to endorsing litigation strategies, and the plaintiffs’ positions to boot.

This kerfuffle at FJC and NASEM has a larger meaning. There is a glib assumption afoot that the only conflicts of interest that matter are ones that are attributed to industrial stakeholders and their scientific supporters. This naïve view was attacked and debunked back in 1980, by Sir Richard Peto, writing in the pages of Nature. Sir Richard noted that whereas industry may downplay risks, “environmentalists usually exaggerate the likely hazards and are largely indifferent to the costs of control.” Positional conflicts can be, and often are, more powerful than the ones created by profit.[15]


[1] National Academies of Sciences, Engineering, and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE (4th ed. 2025) (cited as RMSE 4th ed.).

[2] Nathan Schachtman, A New Year, A New Reference Manual, in TORTINI (Jan. 5, 2026).

[3] Jessica Wentz & Radley Horton, Reference Guide on Climate Science, RMSE 4th ed.

[4] Michael A. Fragoso, Bias and the Federal Judicial Center’s ‘Climate Science’, NAT’L REV. (Jan. 17, 2026). Fragoso also took umbrage to the use of the silly phrase “pregnant people” elsewhere in the Manual. RMSE 4th ed. at 84.

[5] In re School Asbestos Litigation, 977 F.2d 764 (3d Cir. 1992). See Cathleen M. Devlin, Disqualification of Federal Judges – Third Circuit Orders District Judge James McGirr Kelly to Disqualify Himself So As To Preserve ‘The Appearance of Justice’ Under 28 U.S.C. § 455 – In re School Asbestos Litigation (1992), 38 VILL. L. REV. 1219 (1993);

[6] Alabama, Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Missouri, Montana, Nebraska, New Hampshire, North Dakato, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakato, Tennessee, Texas, Utah, West Virginia, West Virginia, and Wyoming.

[7] In re Zantac (Ranidine) Prods. Liab. Litig., 644 F. Supp. 3d 1075 (S.D. Fla. 2022).

[8] Hon. Robin Rosenberg, Letter in Response to Attorneys General (Feb. 6, 2026).

[9] Editorial Board, A Failed Climate Coup in the Courts,  WALL ST. J. (Feb. 9, 2026); Charles Creitz, Judicial research center cuts climate section from judges’ manual, FOX NEWS (Feb. 9, 2026); Suzanne Monyak, Judiciary Cuts Climate Part of Science Manual after Backlash, BLOOMBERG LAW (Feb. 9, 2026).

[10] Maximilian Kotz, Anders Levermann & Leonie Wenz, The economic commitment of climate change, 628 NATURE 551 (2024) (retracted on Dec. 3, 2025).

[11] Authors retract Nature paper projecting high costs of climate change, RETRACTION WATCH (Dec. 3, 2025).

[12] Michael Burger, Jessica Wentz & Daniel Metzger, Climate science in rights-based advocacy contexts (June 28, 2020).

[13] Written Testimony of Radley Horton, Lamont Associate Research Professor, Columbia University, before the Committee on Science, Space, and Technology Subcommittee on Environment Sea Change: Impacts of Climate Change on Our Oceans and Coasts (Feb. 27, 2019).

[14] Michael Burger, Radley M. Horton & Jessica Wentz, The Law and Science of Climate Change Attribution, 45 COLUMBIA J. ENVT’L J. L. 57  (2020).

[15] Richard Peto, Distorting the epidemiology of cancer: the need for a more balanced overview, 284 NATURE 297, 297 (1980).

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).

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]


[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] 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).

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).