TORTINI

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

Conflicts of Interest, Footnote 17, and Scientific McCarthyism

June 12th, 2011

In Exxon Shipping Co. v. Baker, 554 U.S. 471, 501 (2008) – the Exxon Valdez case – the Supreme Court struck down a $2.5 billion punitive damage award.  Justice Souter wrote the opinion for a fragmented court, in a 5-3 decision, with several concurrences.  There are many interesting aspects to the case, including a curious statement with a more curious footnote.  Justice Souter wrote:

“We are aware of no scholarly work pointing to consistency across punitive awards in cases involving similar claims and circumstances.17

In the corresponding footnote, Justice Souter explained:

“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.”

Professor Sunstein, then at University of Chicago, of course now serves in President Obama’s administration.  Professor Kahneman is a Nobel Laureate.  Professor Viscusi has been one of the most prolific writers about and investigators of punitive damages.  Justice Souter’s footnote could easily be interpreted to impugn the integrity of their research by virtue of their corporate sponsorship.

The footnote was curious in large part because Exxon won the case, which leaves open why Justice Souter went out of his way to call into question research that supported his concern about the vagaries of punitive damage awards.  Having in large measure adopted an approach urged by the Exxon-sponsored studies, Justice Souter’s disclaimer seems rather disingenuous.  Perhaps Justice Souter was simply acknowledging that the Court was aware of the work, and for sake of appearances, wanted to note that the Court had reached its decision independently of the litigant-sponsored studies.

There was nothing underhanded done by Exxon; the studies disclosed their funding source.

Since the Exxon Valdez case, expert witnesses, litigants, and courts have pointed to footnote17 inappropriately to suggest that party-sponsored studies should be disregarded without consideration of their merits.

For almost a century, litigants have invoked social science research designed to influence court’s decisions about “legislative facts” or policy.  Such research is very different from research studies upon which expert witnesses rely when appearing before trial courts and juries, responsible for finding facts.

Footnote 17 was thus torn from its context of using social science research to shape policy, and extended to apply to scientific studies that are relied upon by expert witnesses at the trial court level.  Overlooking this distinction, Judge Jack Weinstein jumped on the issue when he commented on sponsorship of pharmaceutical companies’ clinical trials, and generalized (without any reliable scientific basis) that the “commercial bias found in today’s research laboratories means studies are often lacking in essential objectivity, with the potential for misinformation, skewed results or cover-ups….”  In re Zyprexa Prod. Liab. Litig., 253 F.R.D. 69, 106-08 (E.D.N.Y. 2008) (citing Exxon).

A new front of “Scientific McCarthyism” has opened.  This intolerance toward corporate sponsorship has been going on for some time.  Journal editors and industry critics have been using the “conflicts of interest” mantra to impugn industry-sponsored studies, and to impose greater burdens on the publication of such studies than required for federally funded studies.  Curiously, the same journal editors have stuck their heads in the sand when it comes to studies sponsored by plaintiffs’ counsel, or conducted by scientists who are consultants to, or witnesses for, plaintiffs’ counsel in tort cases.

Back in 1993, Ken Rothman referred to this anti-industry as the “new McCarthyism in science.” Kenneth J. Rothman, “Conflict of interest: the new McCarthyism in science,” 269 J. Am. Med. Ass’n 2782 (1993).  The McCarthyites were undeterred.  The anti-industry journals pushed forward by increasing the burdens on industry sponsored studies, especially on pharmaceutical clinical trials.  See, e.g., Catherine D. DeAngelis, P. B. Fontanarosa, and A. Flanagin, “Reporting financial conflicts of interest and relationships between investigators and research sponsors 286 J. Am. Med. Ass’n 89 (2001)

Courageously, some scientists fought for science to be judged on its merits.  See Thomas P. Stossel, “Has the hunt for conflicts of interest gone too far?” 336 Brit. Med. J. 476 (2008); Nature Publishing Group, “Nothing to see here: based on one company’s past poor publishing practices, a top-tier medical journal misguidedly stigmatizes any paper from industry,” 26 Nature Biotechnol. 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), and 332 Brit. Med. J. 151 (2006) (erratum).

Professor Stossel and others created an organization, ACRE – The Association of Clinical Researchers and Educators, to defend legitimate interactions between Physicians and Industry. ACRE has spoken out against the lopsided demonization of the pharmaceutical industry, and the lionizing of the industry’s critics.

The anti-industry prejudice seemed to jump the shark when a gaggle of plaintiffs’ expert witnesses published a “case study” of publication abuses allegedly perpetrated by Merck.  Some of the authors were paid expert witnesses in litigation against Merck, but this unseemly conflict of interest did not seem to disturb the journal’s editors.  J. S. Ross, K. P. Hill, David S. Egilman, and Harlan M. Krumholz, “Guest authorship and ghostwriting in publications related to rofecoxib: a case study of industry documents from rofecoxib litigation. 299 J. Am. Med. Ass’n 1800 (2008); Catherine D. DeAngelis & P.B. Fontanarosa, “Impugning the integrity of medical science: the adverse effects of industry influence,” 299 J. Am. Med. Ass’n 1833 (2008).

Along with Ken Rothman, another bold voice has cried out against the unfairness and partiality of journals’ conflict-of-interest rules and policies.  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).  Dr. Hirsch published a strongly worded commentary that journals’ concerns are often poorly disguised prejudices against industry.  Many of the journals in question rarely or never fuss over the obvious conflicts of interest created by the “profit motive” of researchers who want to climb the academic ladder, increase their salaries, enlarge their budgets, extend their influence, travel to organizational conferences, bolster their prestige, win more grants, enhance their reputations, or advance their political goals or ideologies.

Dr Hirsch uses the publication by Ross, Hill, Egilman, and Krumholz as an example of the double standard.  Their publication in the Journal of the American Medical Association was accompanied by an anemic disclosure that they had been consultants to the plaintiffs in Vioxx litigation, but they neglected to mention that they had actually testified for plaintiffs, and had earned thousands of dollars for their efforts.

Dr Hirsch published a correction last year in which he noted that “Dr Egilman has not testified in court in breast implant and connective tissue disease, or in antidepressant or antipsychotic drug cases.”  Laurence J. Hirsch, “Corrections,” 85 Mayo Clin. Proc. 99 (2010).  This correction was curious because Dr Egilman had testified in a breast implant case:  Vasallo v. Baxter Healthcare, tried in Massachusetts, in the late 1990s.  The Vassallo case involved allegations that silicone had caused systemic disease, an allegation that was ultimately shown to be meritless.

Judge Jack B. Weinstein, “Preliminary Reflections on Administration of Complex Litigation.” Cardozo Law Review DeNovo 1, 14 (2009) (“[t]he breast implant litigation was largely based on a litigation fraud. …  Claims—supported by medical charlatans—that enormous damages to women’s systems resulted could not be supported.”)

The medical profession, the courts, and the public are seriously misled by the obsession with conflicts of interest, on either side.  The obsession allows a disclosed or undisclosed conflict of interest to substitute for the much harder work of considering the merits of a study.

Manufactured Certainty

May 27th, 2011

With the help of Selikoff’s Lobby, the anti-asbestos zealots have created a false, manufactured certainty about various asbestos issues.  The manufacturing of faux certainty has taken place with respect to the history of knowledge about asbestos, as well as to the current state of knowledge about asbestos hazards.

The Selikoff lobby exercised a great deal of influence on regulators and scientists.  The Lobby was able to bully many scientists and policy makers into adopting a position that held all asbestos mineral fiber types as relatively equal in their potency to cause disease.  The Lobby accomplished this by suppressing evidence of past use of amphibole asbestos, and by overstating the hazards of chrysotile asbestos.

In the past, I have marshaled evidence of Selikoff’s activities as a crocidolite denier.  But was there really a controversy among honest scientists outside the Lobby?

Of course, there was and there is, but the Lobby has done a good job of branding the contrarians as tools of industry.  It is important, therefore, to come to terms with evidence that scientists without connections to industry took similar positions.

For many years, starting in the late 1970s, Dr. Gerrit Schepers was a mainstay of the plaintiffs’ state-of-the-art case against asbestos mining and manufacturing companies in asbestos personal litigation.  Dr. Schepers testified as a hired expert witness for plaintiffs near and far.  I encountered and crossexamined Dr. Schepers on several occasions, for different clients.  He was a fascinating witness, filled with contradictions and mixed motives.  In one particularly horrible mesothelioma case (Hill v. Carey Canada), I confronted Dr. Schepers with his own publication, from 1973, in which he largely exonerated chrysotile as a carcinogen.  Dr. Schepers twisted and turned, but he really had no where to go to avoid the full force of his own statements.  This publication is worth revisiting as an historical document, to show that there was a good deal of dissent from the Lobby’s positions, at least until the asbestos personal injury and property damage litigations mushroomed out of control in the early 1980s.

Here is what Dr. Schepers wrote, in 1973, while an employee of the United States government (Chief of the Medical Service, Veterans Administration, Lebanon, Pa.):

“There are marked differences between the capacities of the individual classes of silicate minerals to provoke responses in human and animal tissues. There also are major misconceptions as to what these substances can do when inhaled by man or other mammals. Two of the most extreme of these are (1) that all siliceous minerals are equally pathogenic and (2) that there is even the least semblance between the effects of the asbestiform and the non-asbestiform silicates.”

Gerrit W. H. Schepers, M.D. D.Sc., “The Biological Action of Talc and Other Silicate Minerals,” at 54, in Aurel Goodwin, Proceedings of the symposium on talc: U.S. Bureau of Mines; Information Circular 8639 (1974) [available at http://www.scribd.com/doc/56461314].  The symposium was sponsored by the United States Department of the Interior, in May 1973. Recall that the dispute of non-asbestiform amphibole health effects was very much at issue in the Reserve Mining case, and the trial proceedings were about to start when Dr. Schepers delivered his paper, in 1973. Members of the Lobby, from Selikoff on down, were very much involved in the Reserve Mining case.  See U.S. Environmental Protection Agency v. Reserve Mining Co., 514 F.2d 492 (8th Cir. 1975) (en banc).

“Is chrysotile a carcinogen? This is a very perplexing question. A crescendo of popular opinion has sought to incriminate chrysotile. This author remains unconvinced.  The main premise for carcinogenicity stems from epidemiological observation of employees of the insulation and shipbuilding industries. In both these industries there has been in the past considerable exposure of pipe laggers to asbestos dust. Only in recent decades, however, have these insulation bats been composed predoninantly of chrysotile. In former years crocidolite and amosite were important components.

***

Finally, it should be pointed out that the role of cigarette smoking has not been satisfactorily discounted in the referenced epidemiological studies of lung cancer among insulation workers. In some groups reported an excess prevalence of lung cancer was not demonstrable when cigarette smoking was taken into consideration. Epidemiological surveys of chrysotile workers in Quebec showed no excess of lung cancer. A review of pleural mesothiliomatosis in Canada also failed to focus attention on Quebec or any other center where chrysotile industries are concentrated.”

Id. at 70.

That was in 1973, but within a few years, Dr. Schepers was coopted by the asbestos plaintiff industry, which manufactured lawsuits and epistemic certainty about the hazards of all asbestos minerals.  The rest is “history.”

Interestingly, another would-be historian in the asbestos litigation, Dr. David S. Egilman, has written a paper, highly critical of W.R. Grace, based in part on another presentation given at the 1973 symposium, referenced above.  David Egilman, Wes Wallace, and Candace Hom, Corporate corruption of medical literature: Asbestos studies concealed by W. R. Grace & Co., 6 Accountability in Research 127 (1998)(citing a paper in the same volume by Dr. William E. Smith, “Experimental studies on biological effects of tremolite talc on hamsters.”).  Egilman’s paper was available at is website, http://www.egilman.com/Documents/publications/Wr_Grace.pdf The paper by Dr. Schepers no doubt missed Egilman’s attention, even though it follows immediately after Dr. Smith’s contribution.

More Hypocrisy Over Conflicts of Interest

December 4th, 2010

The Center for Science in the Public Interest, through its “Integrity in Science Project,” has declared war on corporate influence on science and science-related public policy.  Lest you think that I am overstated its animosity, check out the CSPI website, where the CSPI states that the project “combats” corporate influence by maintaining surveillance of federal advisory committees, media, and scientific publications for failures to disclose conflicts of interest.  http://www.cspinet.org/integrity/.  The project also maintains a database of public records that document scientists’ connections to industry.

Remarkably, the Center does not track connections to labor, consumer advocacy groups, plaintiffs’ litigation firms and consortia, NGOs, or ideologies that seek to influence science public policy.  This is just another example of hypocrisy in the continuing wars over supposed conflicts of interest, and a distraction from evidence-based policy.  See “Hypocrisy In Conflict Disclosure Rules,” <http://schachtmanlaw.com/hypocrisy-in-conflict-disclosure-rules/> (Nov. 30, 2010).  In an earlier discussion of conflicts, I pointed out that Sheldon Samuels, an advocate for the international labor movement, presented a paper at an American Public Health Association (APHA), for which he declared that he had “NO financial interests or other relationship with the manufactures [sic] of commercial products, suppliers of commercial services or commercial supporters.”  Id. (emphasis in the original). See  http://apha.confex.com/apha/133am/techprogram/paper_120225.htm  I do not know what the APHA’s disclosure rules were at the time Samuels submitted his abstract, and so I cannot say that he violated the APHA’s rules.  I can say that it seems peculiar to have a rule that requires disclosure of relationships with manufacturers, but not with unions or with advocacy groups.

Just last month, the APHA held its 138th Annual Meeting in Denver, Colorado.  One of the many panels dealt with issues of asbestos health effects, and I was interested to see what sort of disclosures were given by the presenters in this highly politicized area of science and medicine.  I was not disappointed.  See 4374.0, Disease Prevention and Social Justice: the Case of Asbestos.  http://apha.confex.com/apha/138am/webprogram/Session29243.html

The panel included three scientists – Richard Lemen, Arthur Frank, and Barry Castleman, all of whom have testified for plaintiffs in asbestos personal injury litigation, as well as some other litigations, for many years. 

Dr. Frank presented a “Case Study of Asbestos: History and Epidemiology.”  His abstract contains a disclosure, which is typical of all three:

“Presenting author’s disclosure statement:

Qualified on the content I am responsible for because: Longstanding national and international research regarding asbestos disease and exposure.

Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.”

http://apha.confex.com/apha/138am/webprogram/Paper229357.html

Dr. Frank thus made no mention of his expert witness activities in litigation; nor did he apparently feel that such a disclosure was necessary.  Barry Castleman similarly failed to mention that he had served as an expert witness in litigation, and that he participates in several advocacy organizations that have strong political positions concerning asbestos. 

Dr. Lemen did at least mention that he felt qualified on the content because he had served as an expert witness in asbestos litigation.  The casual reader would be left guessing what parties had asked, and paid, Dr. Lemen for his services.  Lemen’s statement of qualification is curious in that it suggests that he is qualified to present at a scientific conference because he was found qualified to testify in court.  Some people might think that this was a reversal of the usual path to expertise, especially given that in many courts, all one must show to be qualified as an expert is that one knows more than the average juror on the matter.  The bar is set very low.

None of the three presenters disclosed expert witness work and compensation as a conflict of interest.  None disclosed memberships in advocacy groups.

I was intrigued by the reference, in each of these gentlemen’s disclosures, to the American Public Health Association Conflict of Interest and Commercial Support Guidelines.  A quick search of the APHA website did not identify these guidelines, but a telephone call to the APHA quickly led to my receiving the Guidelines by email.  The APHA Guidance on conflicts of interest, revised December 2009, provides:

“Policy 2:  Policy on Conflicts of Interest (COI).

Definitions of a COI:  A COI may be actual or potential.  If a reasonable person might perceive a COI, then it is a perceived conflict.  If there is only a potential or perceived COI, then these must be treated the same as if a COI actually exists.  An actual COI exists when one has a financial, professional and/or personal relationship that may influence the educational content.  These types of relationships may overlap or exist simultaneously. 

  • A ‘financial interest’ may include, but is not limited to, a financial benefit that is expected by the individual through employment, … independent contractor, … consulting or speaking fee, … . 
  • A ‘professional interest’ may include, but is not limited to, a situation in which an entity receives a contract or grant and manages the funds, but an individual is the principal, named investigator, or is in any position to influence the results or outcomes.  This includes students. 
  • A ‘personal interest’ may include, but is not limited to, a financial relationship that is held by one’s spouse or partner.  Also any of the relationships above may also be a ‘personal interest’.

 A) A COI must be disclosed while a conflict is present and for 12 months after it is ended.”

 The APHA Guidance is not absolutely clear, but it would seem that it covers expert witness work as a “financial interest.”  Furthermore, consulting for legal counsel, or testifying at counsel’s request, would appear to be a “personal interest.”  Both interests seem to suggest a potential or perceived conflict, which under the Guidance, must be treated as an actual conflict, and thus must be disclosed.  Of course, there is a time limit on the conflict of interest, which expires in 12 months, which seems unduly short but was the APHA’s policy choice.

The disclosures made by Frank, Lemen, and Castleman seem to omit important information about their backgrounds, professional and personal interests, finances, memberships and activities in advocacy groups, and consultations and testimonial adventures in litigation.  Their disclosures do not seem to line up with the words or the spirit of the APHA rules.

Do not expect the Center for Science in the Public Interest to flag this issue in its Integrity of Science Project.