TORTINI

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

Reference Manual’s Chapter on Expert Witness Testimony Admissibility – Part 4

March 5th, 2026

In the district court, Judge George O’Toole conducted a pre-trial hearing over four days, and heard testimony from Smith and Cranor, as well as from defense expert witnesses. Judge O’Toole’s published opinion carefully and accurately stated the facts, the applicable law, and presented a well-reasoned judgment as to why Smith’s opinion was not admissible under Rule 702. Without admissible opinions on general causation to support Milward’s case, Judge O’Toole granted summary judgment to the defendants.

Milward appealed the judgment. A panel of judges in the First Circuit heard argument, and reversed in an opinion that is riddled with serious errors.[1] In reviewing the district court’s application of Rule 702, the panel, in an opinion written by Chief Judge Lynch, credulously accepted most of Smith’s and Cranor’s arguments that an ill-defined WOE approach is acceptable method of guiding scientific judgment. Cranor equated WOE, as used by Smith, to the approach that Sir Austin Bradford Hill described, in 1965, for identifying causal associations from epidemiologic data.[2] Chief Judge Lynch’s opinion tracked accurately Cranor’s and Milward’s lawyers’ misrepresentations about Sir Austin’s paper:

“Dr. Smith’s opinion was based on a ‘‘weight of the evidence’’ methodology in which he followed the guidelines articulated by world-renowned epidemiologist Sir Arthur [sic] Bradford Hill in his seminal methodological article on inferences of causality. See Arthur [sic] Bradford Hill, The Environment and Disease: Association or Causation?, 58 Proc. Royal Soc’y Med. 295 (1965).

Hill’s article explains that one should not conclude that an observed association between a disease and a feature of the environment (e.g., a chemical) is causal without first considering a variety of ‘viewpoints’ on the issue.”[3]

The quoted language from the First Circuit opinion, which twice refers to “Arthur Bradford Hill,” rather than Austin Bradford Hill, may suggest that neither Chief Judge Lynch nor his judicial colleagues and their law clerks read the classic paper. An even stronger indicator that the appellate court did not actually read this paper is evidenced in the court’s equating WOE to Bradford Hill viewpoints, without consideration of the necessary predicate for those nine viewpoints. In his short paper, Sir Austin clearly spelled out that there was a foundation needed before parsing the nine viewpoints:

“Disregarding then any such problem in semantics we have this situation. Our observations reveal an association between two variables, perfectly clear-cut and beyond what we would care to attribute to the play of chance. What aspects of that association should we especially consider before deciding that the most likely interpretation of it is causation?”[4]

Whatever Sir Arthur had to say about the matter, Sir Austin defined the starting point of causal analysis as an association free of invalidating bias and random error. The Milward decision ignored this all important predicate for assessing the various considerations that might allow for a valid association to be considered a causal association.[5] The resulting abridgement was a failure of scientific due process that distorted the Bradford Hill paper.

The First Circuit amplified its error when it asserted that from the nine considerations “no one type of evidence must be present before causality may be inferred.”[6] Although Sir Austin said something similar, one of the considerations he noted was “temporality,” in which the putative cause must come before the effect.  Most scientists would consider this consideration to be essential, unless they were observing events that were moving faster than the speed of light. The other eight considerations are more dependent upon context of the exposures and outcomes of interest, but surely strength and consistency of the clear-cut association across multiple studies is an extremely important consideration.

The First Circuit proceeds from misreading Sir Austin’s paper to misunderstanding another paper invoked by Cranor and by Milward’s lawyers. Carelessly tracking Cranor, the appellate court suggested that there was no “hierarchy of evidence”:

“For example, when a group from the National Cancer Institute was asked to rank the different types of evidence, it concluded that ‘‘[t]here should be no such hierarchy.’’ Michele Carbon [sic] et al., Modern Criteria to Establish Human Cancer Etiology, 64 Cancer Res. 5518, 5522 (2004); see also Sheldon Krimsky, The Weight of Scientific Evidence in Policy and Law, 95 Am. J. Pub. Health S129, S130 (2005).”[7]

This quoted language from the Milward opinion shows how slavishly and credulously the court adopted and regurgitated plaintiff’s argument. Sheldon Krimky was actively involved with SKAPP, and his article was presented at the SKAPP-funded Coronado Conference, discussed earlier in this series. Krimsky actually acknowledged that although “the term [WOE] is applied quite liberally in the regulatory literature, the methodology behind it is rarely explicated.”

As for the article by Carbon [sic], this publication never rejected a hierarchy of evidence. The court’s language, quoted above, follows immediately after the court’s discussion of Sir Austin’s nine types of corroborating evidence that would support the causal interpretation of an association. As such, the court seems to imply, incorrectly, that there was no hierarchy of these considerations.[8]

The court’s language also suggests that the quoted language came from the National Cancer Institute (NCI), but its provenance is quite different. The cited article’s lead author, Michele Carbone (not Carbon), was reporting on a workshop hosted by the NCI at an NCI building; it was not an official NCI event or publication. The NCI did sponsor or conduct the meeting, and Carbone’s paper was not an official statement of the NCI. Carbone’s paper was styled “Meeting Report,” and published as a paid advertisement in Cancer Research, not in the Journal of the National Cancer Institute as a scholarly article.

The discipline of epidemiology was not strongly represented at the meeting; most of the chairpersons and scientists in attendance were pathologists, cell biologists, virologists, and toxicologists. The authors of the meeting report reflect the interests and focus of the scientists in attendance. The lead author, Michele Carbone, a pathologist at the University of Hawaii, was an enthusiastic proponent of Simian Virus 40 as a cause of mesothelioma, a hypothesis that has not fared terribly well in the crucible of epidemiologic science.

The cited article did report some suggestions for modifying Bradford Hill’s criteria in the light of modern molecular biology, as well as a sense of the group that there was no “hierarchy” in which epidemiology was at the top of disciplines.  The group definitely did not address the established concept that some types of epidemiologic studies are analytically more powerful to support inferences of causality than others — the hierarchy of epidemiologic evidence. The group also did not address or reject a ranking of importance of Bradford Hill’s nine viewpoints. There was nothing remarkable about the tumor biologists’ statement that in some cases causality can be determined by careful identification of genetic inheritance or molecular biological pathways. There was no evidence of this sort in the Milward case, and the citation by Cranor and Milward’s lawyers was nothing more than hand waving.

Carbone’s meeting report summarizes informal discussion sessions at the 2003 meeting.  Those in attendance broke out into two groups, one chaired by Brook Mossman, a pathologist, and the other group chaired by Dr. Harald zur Hausen, a virologist. The meeting report included a narrative of how the two groups responded to twelve questions. Drawing from plaintiff’s (and Cranor’s) argument, the court’s citation to this meeting report is based upon one sentence in Carbone’s report, about one of twelve questions:

6. What is the hierarchy of state-of-the-art approaches needed for confirmation criteria, and which bioassays are critical for decisions: epidemiology, animal testing, cell culture, genomics, and so forth?

There should be no such hierarchy. Epidemiology, animal, tissue culture and molecular pathology should be seen as integrating evidences in the determination of human carcinogenicity.”[9]

Considering the fuller context of the meeting, there is nothing particularly surprising about this statement.  The full question and answer in the meeting report does not even remotely support the weight given to it by the court. There was quite a bit of disagreement among meeting participants over criteria for different kinds of carcinogens, as seen the report on another question:

“2. Should the criteria be the same for different agents (viruses, chemicals, physical agents, promoting agents versus initiating DNA-damaging agents)?

There were different opinions. Group 1 debated this issue and concluded that the current listing of criteria should remain the same because we lack sufficient evidence to develop a separate classification. Group 2 strongly supported the view that it is useful to separate the biological or infectious agents from chemical and physical carcinogens due to their frequently entirely different mode of action.”[10]

Carbone and the other authors of the meeting report noted the importance to epidemiology for general causation, while acknowledging its limitations for determining specific causation:

“Concerning the respective roles of epidemiology and molecular pathology, it was noted that epidemiology allows the determination of the overall effect of a given carcinogen in the human population (e.g., hepatitis B virus and hepatocellular carcinoma) but cannot prove causality in the individual tumor patient.”[11]

Clearly, the report was not disavowing the necessity for epidemiology to confirm carcinogenicity in humans. Specific causation of Mr. Milward’s APML was irrelevant to his first appeal to the First Circuit. Carbone’s report emphasized the need to integrate epidemiologic findings with molecular biology; it did not suggest that epidemiology was not necessary or urge that epidemiology be ignored or disregarded:

“A general consensus was often reached on several topics such as the need to integrate molecular pathology and epidemiology for a more accurate and rapid identification of human carcinogens.”[12]

                 * * * * *

“Ideally, before labeling an agent as a human carcinogen, it is important to have epidemiological, experimental animals, and mechanistic evidence (molecular pathology).”[13]

The court’s implication that there was “no hierarchy of evidence” is unsupported by the meeting report. The suggestion that WOE allows some loosey-goosey, ad hoc, unstructured assessment of diverse lines of evidence is rejected in the meeting report with a careful admonition about the lack of validity of some animal models and mechanistic research:

“Moreover, carcinogens and anticarcinogens can have different effects in different situations. As shown by the example of addition of β-carotene in the diet, β- carotene has chemopreventive effects in many experimental systems, yet it appears to have increased the incidence of lung cancer in heavy smokers. Animal experiments can be very useful in predicting the carcinogenicity of a given chemical. However, there are significant differences in susceptibility among species and within organs in the same species, and differences in the metabolic pathway of a given chemical among human and animals could lead to error.”[14]

Inference to the Best Explanation

The First Circuit asserted that “no serious argument can be made that the weight of the evidence approach is inherently unreliable.”[15] As discussed above, this assertion is demonstrably false. In his testimony at the Rule 702 pre-trial hearing, Cranor classified WOE as based upon “inference to the best explanation,” and the First Circuit obsequiously accepted this claim. In articulating and accepting Cranor’s reduction of scientific method to IBE, the appellate court seemed unaware that IBE as an epistemic theory has been roundly criticized. In a very general sense, IBE draws on Charles Pierce’s description of abduction as a mode of reasoning, although many writers have been eager to distinguish abduction from IBE. Bas van Fraassen criticized IBE as lacking merit as a mode of argument in a way germane to Cranor’s presentation of the notion, and the First Circuit’s uncritical acceptance:

“As long as the pattern of Inference to the Best Explanation—henceforth, IBE—is left vague, it seems to fit much rational activity. But when we scrutinize its credentials, we find it seriously wanting.”[16]

The IBE approach raises thorny problems of knowing how to discern the best explanation, or how to tell whether an explanation is simply the best of a bad lot. Other philosophers of science have questioned why explanatoriness should matter as opposed to predictive ability and resistance to falsification upon severe or robust testing.

In the hands of Smith and Cranor, these philosophical quandries become largely beside the point. For Smith and Cranor IBE becomes telling just so stories, which transform “but for” causation into “could be” causation. Drawing directly from Cranor, the Circuit Court explained that an inference to the best explanation involves six general steps for scientists:

“(1) identify an association between an exposure and a disease,

(2) consider a range of plausible explanations for the association,

(3) rank the rival explanations according to their plausibility,

(4) seek additional evidence to separate the more plausible from the less plausible explanations,

(5) consider all of the relevant available evidence, and

(6) integrate the evidence  using professional judgment to come to a conclusion about the best explanation.”[17]

Of course assessing causation requires judgment, but Cranor and Smith radically abridge the process of judging by eliminating:

  • the robust testing of, and attempts to falsify, hypotheses,
  • the weighting of study designs,
  • the pre-specification of kinds of studies to be included or excluded, the assignment of weights to different kinds and qualities of studies, and
  • the pre-specification of criteria of study validity, experimental design, consistency, and exposure-response.

The vague, contentless IBE and WOE, in the hands of Smith, operates just as van Fraassen anticipated. With Cranor’s “philosophizing,” IBE creates a permission structure to reach any desired conclusion. Indeed, Cranor’s approach makes no allowance for when careful scientists withhold judgment because the evidence is inadequate to the task. Furthermore, Cranor’s approach and the Milward decision would cheerily approve cherry picking of studies and data within studies, post hoc weighing of evidence, and even fabricating and rejiggering of evidence, all of which was on display in Smith’s for-litigation opinion.

The First Circuit uttered its mantra of approval of Smith’s scientific delicts in language that became the target of the revision of Rule 702 in 2023:

“the alleged flaws identified by the [district] court go to the weight of Dr. Smith’s opinion, not its admissibility. There is an important difference between what is unreliable support and what a trier of fact may conclude is insufficient support for an expert’s conclusion.”[18]

Earlier in its opinion, the appellate court quoted from the version of Rule 702 in effect when it heard the appeal:

“if (1) the testimony is based upon sufficient facts or data, (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case.”[19]

Sufficiency, reliability, and validity were all preliminary questions to be decided by the court as part of its gatekeeping responsibility.  The appellate court simply ignored the law in its decision to green light Smith’s testimony.

                    (to be continued)


[1] Milward v. Acuity Specialty Products Group, Inc., 639 F.3d 11 (1st Cir. 2011), cert. denied sub nom., U.S. Steel Corp. v. Milward, 565 U.S. 1111 (2012).

[2] Austin Bradford Hill, The Environment and Disease: Association or Causation?, 58 PROC. ROYAL SOC’Y MED. 295 (1965).

[3] Milward, 639 F.3d at 17.

[4] Id. at 295.

[5] See Frank C. Woodside, III & Allison G. Davis, The Bradford Hill Criteria: The Forgotten Predicate, 35 THOMAS JEFFERSON L. REV. 103 (2013).

[6] Milward, 639 F.3d at 17.

[7] Id. (internal citations omitted).

[8] The Reference Manual chapter on medical testimony carefully discusses the hierarchy of evidence as it factors into the assessment of medical causation. John B. Wong, Lawrence O. Gostin & Oscar A. Cabrera, Reference Guide on Medical Testimony, in National Academies of Sciences, Engineering and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 687, 723 -24 (2011); John B. Wong, Lawrence O. Gostin, & Oscar A. Cabrera, Reference Guide on Medical Testimony, in National Academies of Sciences, Engineering and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 1105, 1150-52 (4th ed. 2025). Interestingly, the chapter on epidemiology in the third edition of the Reference Manual cited to the Carbone workshop with apparent approval, but the same chapter in the fourth edition has dropped the reference. Compare Michael D. Green, D. Michal Freedman & Leon Gordis, Reference Guide on Epidemiology, in National Academies of Sciences, Engineering and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 549, 564 n.48 (3rd ed. 2011) with Steve C. Gold, Michael D. Green, Jonathan Chevrier, & Brenda Eskenazi, Reference Guide on Epidemiology, in National Academies of Sciences, Engineering and Medicine & Federal Judicial Center, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 897 (4th ed. 2025).

[9] Carbone at 5522.

[10] Carbone at 5521.

[11] Carbone at 5518 (emphasis added).

[12] Carbone at 5518.

[13] Carbone at 5519.

[14] Carbone at 5521.

[15] Milward, 639 F.3d at 18-19.

[16] Bas van Fraassen, LAWS AND SYMMETRY 131 (1989).

[17] Milward, 639 F.3d at 18.

[18] Milward, 639 F.3d at 22.

[19] Milward, 639 F.3d at 14.

Reference Manual’s Chapter on Expert Witness Testimony Admissibility – Part 3

March 2nd, 2026

Richter and Capra treat WOE in Justice Steven’s lone dissenting opinion in Joiner as if it were the law. Of course, it was not; nor was it a particularly insightful analysis into scientific method, Rule 702, or the law of expert witnesses. The Manual authors elevate WOE by their complete failure to offer any criticisms or by citing to the scientific and legal scholars who have criticized WOE.

Richter and Capra do cite to a couple of cases that are skeptical of expert witnesses who had offered WOE opinions, but they fail to cite to any cases that disparage WOE itself.[1] In aggravation of their misplaced focus on the Joiner dissent, Richter and Capra proceed to spend two full pages on the Milward case, which had posthumously appeared in Professor Berger’s version of the law chapter in the 2011, third edition of the Reference Manual. The attention given to Milward in the fourth edition is greater than to any other non-Supreme Court case, including Frye. Richter and Capra offer no commentary or analysis critical of the case, although many legal commentators have criticized the Milward opinion on WOE.[2]

Richter and Capra’s chapter fails to note that a dark cloud hangs over the Milward case due to the unethical non-disclosure of CERT’s amicus brief filed in support of reversing the exclusion of CERT’s founders, Carl Cranor and Martyn Smith,[3] or CERT’s funding Smith’s research, or CERT’s involvement in shaking down corporations in California for Prop 65 bounties.

In their extensive coverage of the 2011 Milward decision, Richter and Capra failed to report that after the First Circuit reversed and remanded, the trial court again excluded plaintiffs’ expert witnesses for failing to give a valid opinion on specific causation. On the second appeal, the First Circuit affirmed the exclusion of specific causation expert witness testimony and the entry of final judgment for defendants.[4] Given that the first appellate decision was no longer necessary to the final disposition of the case, it is questionable whether there is any holding with respect to general causation in the case.

The most salient aspect of Richter and Capra’s uncritical coverage of the Milward case is their complete failure to identify the legal errors made by the First Circuit in its decision on Rule 702 and general causation. As the Reporter to the Rules Advisory Committee, Professor Capra was intimately involved in many meetings and memoranda that addressed the failings of courts to engage properly in gatekeeping. These failings were the gravamen of the basis for the 2023 amendments to Rule 702. The Milward decision in 2011 managed to check almost every box for bad decision making: the appellate panel ignored the text of Rule 702, disregarded Supreme Court precedent in the Joiner case, relied upon over-ruled, obsolete, pre-Daubert decisions, ignored the policy considerations urged by the Supreme Court, bungled basic scientific concepts, and egregiously and credulously endorsed WOE as advocated as a scientific methodology. Professor David E. Bernstein has pointed to the 2011 Milward decision, as “the most notorious,” and “[t]he most prominent example of such judicial truculence” in resisting following the requirements of Rule 702, as it existed in 2011.[5]

Milward is an important case, much as the Berenstain Bears stories are important and helpful in teaching children what not to do. Unfortunately, Richter and Capra discuss Milward in a way that might lead readers to believe that the case represents a reasonable or proper treatment of the science involved in the case. To correct this biased coverage of Milward, readers will have to roll up their sleeves and actually look at what the court did and did not do, and what scientific methodology issues were involved.

Perhaps the best place to begin is the beginning. Brian Milward filed a lawsuit in which he claimed that he was exposed to benzene as a refrigerator technician.[6] He developed acute promyelocytic leukeumia (APML), and claimed that he had been exposed to benzene from having used products made or sold by roughly two dozen companies. APML is a rare disease, type M3 of acute myeloid leukemia (AML), defined by specific chromosomal abnormalities that are necessary but not sufficient to result in APML. APML has an incidence of fewer than five cases per million per year. APML occurs with equal frequency in both sexes; there are no known environmental or occupational causes of APML.[7] APML occurs in the general population without benzene exposure, and its occurrence in all populations is sparse. There are no biomarkers that suggest that some putative benzene-related mechanism is involved in some APML cases, which biomarker would identify the rarity of benzene involvement in causation.

Milward’s General Causation Expert Witness, Martyn T. Smith

Milward did not serve a report from an epidemiologist, or anyone with significant expertise in epidemiology. His only general causation expert witness was Martyn Smith, a toxicologist, who testified that the “weight of the evidence” supported his opinion that benzene exposure causes APML.[8] As noted above, Smith is a member of the advocacy group, the Collegium Ramazzini; and for over 30 years, he has been a frequent testifier for plaintiffs in chemical exposure cases.[9]

Despite the low but widespread prevalence of APML in the general population, with no sex specificity, and the absence of any identifying biomarker of supposed benzene-related etiology in individual cases, Smith maintained that epidemiology was not necessary to reach a causal opinion about benzene and APML. The principal thrust of Smith’s proffered testimony is that APML is a plausible outcome of benzene exposure, because benzene can cause other varieties of AML, by structurally altering chromosomes (clastogenic) by breaking them and causing re-arrangements.[10]

The trial court found that Smith’s extrapolations were problematic and lacking in supporting evidence. The clear differences among AML subtypes made the extrapolation to APML, a unique clinical entity, inappropriate. The characteristic translocation in APML is absent from other varieties of AML, and APML, unlike other AML varieties, is treatable with all-trans retinoic acid.[11]

Smith advanced speculation that benzene targeted cells in the pathway of  leukemic transformation to APML, but the state of science was clearly devoid of sufficient evidence to show that benzene was involved in the APML translocations. Although the parties agreed that mechanistic evidence showed that benzene can effectuate chromosome damage that are characteristic of some AML subtypes other than APML, the trial court found that:

“[n]o evidence has been published making a similar connection between benzene exposure and the t(15;17) translocation, characteristic of APL [APML].”[12]

The trial court assessed Smith’s extrapolation from benzene’s clastogenic effect in breaking and rearranging chromosomes to induce some types of AML to its causing the specific APML t(15;17) translocation, as a

“bull in the china shop generalization: since the bull smashes the teacups, it must also smash the crystal. Whether that is so, of course, would depend on the bull having equal access to both teacups and crystal. If the teacups were easily knocked over, but the crystal securely stored away, a reason would exist to question, if not to reject, the proposition that the crystal was in as much danger as the teacups.”[13]

The trial judge clearly saw that Smith’s plausibility proved too much, and would support attributing virtually any disease to benzene through a putative mechanism of breaking chromosomes.

Lacking the courage of his convictions, Smith, non-epidemiologist, proceeded to offer opinions about the epidemiology of benzene and APML, some of them quite fanciful. No published or unpublished study showed a statistically significant increase in APML among benzene-exposed workers. The most Smith could draw from the published epidemiologic studies on benzene was one Chinese study that found a small risk ratio, without even nominal statistical significance: a crude odds ratio of 1.42 for benzene exposure and APML. Despite Smith’s hand waving about lack of power,[14] this Chinese study suggested that chloramphenicol was a risk factor for APML (M3), and it was able to identify a nominally statistically significant association between benzene and another sub-type of AML (M2a), with an odds ratio of 1.54.[15]

Smith offered no meta-analysis to show that the available studies collectively established a summary estimate of increased risk for APML among benzene workers. Undaunted, Smith set about to re-jigger the numbers in published studies to make something out of nothing. Neither physician nor epidemiologist, Smith altered diagnoses and exposure status as reported in published papers so that his reclassified cases and controls would yield, where none existed. These re-analyses were done speculatively, inconsistently, and incompetently, and were driven by the motivation to make something out of nothing. His approach was unsupported, unprincipled, and lacking in any reasonable methodology. The proffered re-analyses were never published, never presented at a professional society meeting, and never could comply with the standards used by epidemiologists used in their non-litigation activities. As a toxicologist, Smith did not have any non-litigation epidemiologic activities of note.

Smith’s representation of the relevant epidemiologic methods and studies was misleading and contained numerous errors that cumulatively led to erroneous conclusions; his own re-jiggering was carried out to reach a preferred conclusion to support plaintiff’s litigation case.[16]

One of the epidemiologic studies relied upon by Smith was Golumb (1982).[17] This study did not explore associations with benzene; it was a study of insecticides, chemicals and solvents, and petroleum. Crude oil contains very little benzene, typically about 0.1 percent.[18] Smith, without any evidentiary support, assumed that petroleum exposure equated to benzene exposure.

There were eight cases of cases of leukemia with petroleum exposure; one of those cases was APML. The authors of Golumb (1982) reported that this particular case with APML was actually a crane operator.[19]

In analyzing published epidemiologic studies, Smith insisted that he could re-classify APML cases to non-APML in control subjects, in studies, when the karyotype was normal. Karyotype analysis identifies the defining translocations of specific chromosomes in APML, and is found in virtually all such cases. The obvious result of Smith’s ad hoc reclassifications were to increase risk ratios for APML among benzene-exposed subjects. His arbitrary reclassifications of data allowed him to create the result he desired. In reviewing other published studies, Smith insisted that normal karyotype did not require reclassifying cases out of the APML category, when this approach would yield a risk ratio above one. 

Taking data from the Golumb 1982 paper, Smith attempted to inflate his calculation of an odds ratio, which would support his causation opinion. He arbitrarily discarded two APML from the non-exposed cases, and he discarded eight non-APML cases from the exposed subjects. He did not report p-values or confidence intervals for his reanalyses. At the hearing, the defense epidemiologist showed that Smith’s rejiggered odds ratio (1.51) had a p-value of 0.72, and a 95 percent confidence interval of 0.15 – 14.91. Not only was the result not statistically significant, the confidence interval shows that there was a range of alternative hypotheses over an order of magnitude in range, with none of them being rejected based upon the sample data at an alpha of 0.05. Without the rejiggering of exposed and unexposed cases, the odds ratio would have been 0.71, p = 0.76. All results, both as reported in the published article and as rejiggered by Smith were highly compatible with no association whatsoever.

In discussing other studies, Smith repeated his re-labeling of leukemia cases as APML, in the absence of karyotyping, to support his claims that there were more APML cases observed than expect on general population rates.[20] Smith also cited studies improvidently in supposed support of his opinion (Rinsky 1981; updated in 1994), where there was no association at all. Even workers heavily exposed to benzene in these studies did not develop APML.[21]  Similarly, in support of his opinion, Smith cited another Chinese study, which actually declared that:

“Acute promyelocytic leukemia has been reported infrequently in benzene-exposed groups as well as in t-ANLL. Although ANLL-M3 occurred in at least 4 patients in this series, its general representation among the subtypes of ANLL was similar in its distribution in de novo ANLL in China.”[22]

Smith’s methodological improprieties were the subject of a four day pre-trial hearing before Judge O’Toole. In the course of the hearings, Smith attempted to defends his methods, but like Donny Kerabatsos, in the Big Lebowski, Smith was out of his depth. The trial court found that Dr. Smith’s arbitrary creating and choosing data to support his beliefs was unreliable and not in accordance with generally accepted scientific methodology in the fields of medicine or epidemiology. Smith was simply fabricating data to fit his made-for-litigation beliefs.

Carl Cranor’s Attempt to Bolster Smith

Milward also submitted a report from Carl Forest Cranor, Smith’s business partner in founding the Prop 65 bounty-hunting CERT, and a fellow member of the advocacy group Collegium Ramazzini. Cranor has no expertise in toxicology or epidemiology, and he has never published on the cause of APML. As a professor of philosophy, Cranor has written about scientific methodology, including WOE and “inference to the best explanation (IBE).” Cranor’s publications are riddled with basic misunderstandings of statistical concepts.[23] Essentially, Cranor testified at the Rule 702 hearing, as a cheerleader for Smith, and to advocate for open admissions of dodgy scientific conclusions as acceptable with a methodology he described as WOE or IBE. Cranor stretched to resurrect Justice Stevens’ use of WOE, and attempted to pass it off as a generally accepted scientific mode of reasoning.

The trial court carefully reviewed the proffered opinion testimony in a four day pre-trial hearing. The trial court found that Smith had shown that his hypothesis was plausible and possible, but not that it was “scientific knowledge,” as required by Rule 702. Lacking sufficient scientific methodological validity and support, Smith’s opinions failed to satisfy the requirements of Rule 702, and were thus inadmissible. As a result of excluding plaintiff’s sole general causation expert witness, the trial court granted summary judgment to the defendants.[24]

(to be continued)


[1] See, e.g., Allen v. Pennsylvania Eng’g Corp., 102 F.3d 194, 197-98 (5th Cir. 1996) (“We are also unpersuaded that the ‘weight of the evidence’ methodology these experts use is scientifically acceptable for demonstrating a medical link between Allen’s EtO [ethylene oxide] exposure and brain cancer.”); Magistrini v. One Hour Martinizing Dry Cleaning, 180 F. Supp. 2d 584, 601-02 (D.N.J. 2002) (excluding David Ozonoff, whose WOE analysis of whether perchloroethylene causes acute myelomonocytic leukemia was criticized by court-appointed technical advisor), aff’d, 68 F. App’x 356 (3d Cir. 2003).

[2] See Eric Lasker, Manning the Daubert Gate: A Defense Primer in Response to Milward v. Acuity Specialty Products, 79 DEF. COUNS. J. 128, 128 (2012); David E. Bernstein, The Misbegotten Judicial Resistance to the Daubert Revolution, 89 NOTRE DAME L. REV. 27, 29, 53-58 (2013); David E. Bernstein & Eric G. Lasker, Defending Daubert: It’s Time to Amend Federal Rule of Evidence 702, 57 WM. & MARY L. REV. 1, 33 (2015); Richard Collin Mangrum, Comment on the Proposed Revision of Federal Rule 702: “Clarifying” the Court’s Gatekeeping Responsibility over Expert Testimony, 56 CREIGHTON LAW REVIEW 97, 106 & n.45 (2022); Thomas D. Schroeder, Toward a More Apparent Approach to Considering the Admission of Expert Testimony, 95 NOTRE DAME L. REV. 2039, 2045 (2020); Lawrence A. Kogan, Weight of the Evidence: A Lower Expert Evidence Standard Metastasizes in Federal Court, Washington Legal Foundation Critical Legal Issues WORKING PAPER Series no. 215 (Mar. 2020); Note, Judicial Conference Amends Rule 702. — Federal Rule of Evidence 702, 138 HARV. L. REV. 899, 903 (2025); Nathan A. Schachtman, Desultory Thoughts on Milward v. Acuity Specialty Products, DOI: 10.13140/RG.2.1.5011.5285 (Oct. 2015), available at https://www.researchgate.net/publication/282816421_Desultory_Thoughts_on_Milward_v_Acuity_Specialty_Products .

[3] See David DeMatteo & Kellie Wiltsie, When Amicus Curiae Briefs are Inimicus Curiae Briefs: Amicus Curiae Briefs and the Bypassing of Admissibility Standards, 72 AM. UNIV. L. REV. 1871 (2022) (noting that amicus briefs often include “unvetted and potentially inaccurate, misleading, or mischaracterized expert information,” without the procedural safeguards in place for vetting expert witnesses at trial).

[4] Milward v. Acuity Specialty Prods. Group, Inc., 969 F. Supp. 2d 101, 109 (D. Mass. 2013), aff’d sub. nom., Milward v. Rust-Oleum Corp., 820 F.3d 469, 471, 477 (1st Cir. 2016).

[5] David E. Bernstein, The Misbegotten Judicial Resistance to the Daubert Revolution, 89 NOTRE DAME L. REV. 27, 53, 29 (2013).

[6] Milward v. Acuity Specialty Products Group, Inc., 664 F. Supp. 2d 137 (D. Mass. 2009) (O’Toole, J.), rev’d, 639 F.3d 11 (1st Cir. 2011), cert. denied, U.S. Steel Corp. v. Milward, 565 U.S. 1111 (2012).

[7] Andrew Y. Li, et al., Clustered incidence of adult acute promyelocytic leukemia in the vicinity of Baltimore, 61 LEUKEMIA & LYMPHOMA 2743 (2021); Hassan Ali, et al., Epidemiology and Survival Outcomes of Acute Promyelocytic Leukemia in Adults: A SEER Database Analysis, 144 BLOOD 5942 S1 (2024).

[8] Milward, 664 F. Supp. 2d at 142.

[9] See, e.g., PPG Industries, Inc. v. Wells, No. 21-0232 (Feb. 10, 2023 W.Va.S.Ct.); Hall v. ConocoPhillips, 248 F. Supp. 3d 1177 (W.D. Okla. 2017); In re Levaquin Prods. Liab. Litig., 739 F.3d 401 (8th Cir. 2014); Jacoby v. Rite Aid Corp., No. 1508 EDA 2012 (Dec. 9, 2013 Pa. Super.); Harris v. CSX Transp., Inc., 232 W.Va. 617, 753 S.E.2d 275 (2013); In re Baycol Prods. Litig., 495 F. Supp. 2d 977 (D. Minn. 2007); In re Rezulin Prods. Liab. Litig., MDL 1348, 441 F.Supp.2d 567 (S.D.N.Y. 2006) (advocating mythological “silent injury”); Perry v. Novartis, 564 F.Supp.2d 452 (E.D. Pa. 2008); Dodge v. Cotter Corp., 328 F.3d 1212 (10th Cir. 2003); Sutera v. The Perrier Group of America Inc., 986 F. Supp. 655 (D. Mass. 1997); Redland Soccer Club, Inc. v. Dep’t of Army, 835 F.Supp. 803 (M.D. Pa. 1993).

[10] Milward, 664 F.Supp. 2d at 143-44.

[11] Milward, 664 F.Supp. 2d at 144.

[12] Id. at 146

[13] Id.

[14] The claim that a study lacks power is meaningless without a specification of the alternative hypothesis, the risk ratio the researcher thinks is the population parameter, at a specified level of alpha (typically p < 0.05), and a specified probability model. While virtually all studies would have reasonable statistical power (say 80 percent probability) to reject an alternative hypothesis that the risk ratio exceeded 10,000, no study would have power to detect a risk ratio of 1.0001, at a high level of probability.

[15] Yi Zhongguo, et al. (National Investigative Group for the Survey of Leukemia & Aplastic Anemia), Countrywide Analysis of Risk Factors for Leukemia and Aplastic Anemia, 14 ACTA ACADEMIAE MEDICINAE SINICAE 185 (1992).

[16] Milward, 664 F. Supp. 2d at 148-49.

[17] Harvey M. Golomb, et al., Correlation of Occupation and Karyotype in Adults With Acute Nonlymphocytic Leukemia, 60 BLOOD 404 (1982).

[18] Bo Holmberg, Per Lundberg, Benzene: standards, occurrence, and exposure, 7 AM. J. INDUS. MED. 375 (1985).

[19] Golumb, supra at note 17, at 407.

[20] See, e.g., Song-Nian Yin, et al., A cohort study of cancer among benzene-exposed workers in China: overall results, 29 AM. J. INDUS. MED. 227 (1996).

[21] Robert A. Rinsky, et al., Leukemia in Benzene Workers, 2 AM. J. INDUS. MED. 217 (1981); Mary B. Paxton, et al., Leukemia Risk Associated with Benzene Exposure in the Pliofilm Cohort: I. Mortality Update and Exposure Distribution, 14 RISK ANALYSIS 147 (1994); Mary B. Paxton, et al., Leukemia Risk Associated with Benzene Exposure in the Pliofilm Cohort II. Risk Estimates, 14 RISK ANALYSIS 155 (1994).

[22] Lois B. Travis, et al., Hematopoietic Malignancies and Related Disorders Among Benzene-Exposed Workers in China, 14 LEUKEMIA & LYMPHOMA 91, 99 (1994).

[23] See, e.g., Carl F. Cranor, REGULATING TOXIC SUBSTANCES: A PHILOSOPHY OF SCIENCE AND THE LAW at 33-34(1993) (conflating random error with posterior probabilities: “One can think of α, β (the chances of type I and type II errors, respectively) and 1- β as measures of the “risk of error” or “standards of proof.”); id. at 44, 47, 55, 72-76.

[24] 664 F. Supp. 2d at 140, 149.

The Fourth Edition’s Chapter on Admissibility of Expert Witness Testimony – Part 2

February 24th, 2026

The Manual’s new law chapter on the admissibility (vel non) of expert witness testimony was written by two law professors who teach evidence, and who often write articles with each another.[1] Liesa Richter teaches at the University of Oklahoma College of Law. Daniel Capra teaches at Fordham School of Law, in Manhattan. For the last three decades, Capra has been the Reporter for the Judicial Conference Advisory Committee on the Federal Rules of Evidence. There probably is no evidence law scholar more involved with the Federal Rules, including with the key expert witness rules, Rule 702 and Rule 703, than Capra.

The new chapter’s strengths follow from Professor Capra’s involvement in the evolution of Rule 702. The chapter plainly acknowledges that the Supreme Court decisions in the 1990s follow from an epistemic standard, and the use of the terms “scientific” and “knowledge” in Rule 702. Counting heads, as suggested by the Frye case, was at times a weak and ambiguous proxy for knowledge.[2] The new chapter has the important advantage of not having authors entwined in the advocacy of dodgy groups such as SKAPP, and the Collegium Ramazzini. Gone from the new chapter are Berger’s gratuitous and unwarranted endorsements and mischaracterizations of carcinogenicity evaluations by the International Agency for Research on Cancer (IARC).

Like Berger’s previous versions of this chapter, the new chapter carefully explains the Supreme Court decisions on expert witness admissibility and the changes in Rule 702, over time, including the 2023 amendment to 702. One glaring omission from the new chapter is absence of any mention of the fourth Supreme Court case in the 1993-2000 quartert: Weisgram v. Marley.[3] This important opinion by Justice Ginsburg was a clear expression of the seriousness with which the Court took the gatekeeping enterprise:

“Since Daubert, moreover, parties relying on expert testimony have had notice of the exacting standards of reliability such evidence must meet… . It is implausible to suggest, post-Daubert, that parties will initially present less than their best expert evidence in the expectation of a second chance should their first trial fail.”[4]

Professor Berger discussed this case in her last chapter, but the new authors fail to mention it all.[5] 

On the plus side, Richter and Capra discuss, although way too briefly, the role that Federal Rule of Evidence 703 plays in governing expert witness testimony.[6]  Rule 703 does not address the admissibility of expert witnesses’ opinions, but it does give trial courts control over what hearsay facts and data (such as published studies), otherwise inadmissible, upon which expert witnesses can rely.[7] Richter and Capra do not, however come to grips what how Rule 703 will often require trial courts to engage with the specifics of the validity and flaws of specific studies in order to evaluate the reasonableness of expert witness reliance upon them. Berger, in the third edition of the Manual, completely failed to address Rule 703, and its important role in gatekeeping.

Richter and Capra helpfully advise judges to be cautious in relying upon pre-2023 amendment cases because that most recent amendment was designed to correct clearly erroneous applications of Rule 702 in both federal trial and appellate courts.[8] The new Manual authors also deserve credit for being willing to call out judges for ignoring the Rule 702 sufficiency prong and for invoking the evasive dodge of many courts in characterizing expert witness challenges as going to “weight not admissibility.”[9]

Richter and Capra improve upon past chapters by simply reporting that the 2023 amendment to Rule 702 addressed important concerns that courts were failing to keep expert witnesses “within the bounds of what can be concluded from a reliable application of the expert’s basis and methodology,” and that Rule Rule 702(d) was amended to emphasize their legal obligation to do so.[10] Berger could have discussed this phenomenon even back in 2010-11, but failed to do so.

The new authors report that the Rules Advisory Committee had been concerned that expert witnesses engage regularly in overstating or overclaiming the appropriate level of certainty for their opinions, especially in the context of forensic science.[11] Although the recognition of problematic overclaiming in forensic science is a welcomed development, Richter and Capra fail to recognize that overclaiming is at the heart of the Milward case involving benzene exposure and acute promyelocytic leukemia (APL). And they seem unaware that overclaiming is baked into the precautionary principle that drives IARC pronouncements, advocacy positions of groups such as the Collegium Ramazzini, and much of regulatory rule-making.

In several respects, Richter and Capra have improved upon the past three editions in presenting the law of expert witness testimony. The new chapter gives a brief exposition of the Joiner case,[12] where the Court concluded that that there was an “analytical gap” between the plaintiffs’ experts witnesses’ conclusion on causation and the animal and human studies upon which they relied. The authors’ summary of the case explains that the Supreme Court majority concluded that the trial court below was well within its discretion to find that the plaintiffs’ expert witnesses had a cavernous analytical gap between their relied upon evidence and their conclusion that polychlorobiphenyls (PCBs) caused Mr. Joiner’s lung cancer.

Richter and Capra’s goes sideways in addressing the dissent by Justice Stevens and by giving it uncritical, disproportionate attention. As a dissent, which has never gained any serious acceptance on the high court by any other member, Justice Stevens’ opinion in Joiner hardly deserved any mention at all. Richter and Capra note, however, early in the chapter that Justice Stevens’ criticized the majority in Joiner for having “examined each study relied upon by the plaintiff’s experts in a piecemeal fashion and concluded that the experts’ opinions on causation were unreliable because no one study supported causation.”[13] Stevens’ criticism was wide of the mark in that the Court specifically addressed the “mosaic” theory that was a reprise of the plaintiffs’ unsuccessful strategy in the Bendectin litigation.[14]

Justice Stevens’ dissent wantonly embraced Joiner’s expert witnesses’ use of a “weight of the evidence” (WOE) methodology. Stevens asserted that WOE is accepted in regulatory circles, which is true but irrelevant, and that it is accepted in scientific circles, which is a gross exaggeration and misrepresentation. Richter and Capra somehow manage to discuss Stevens’ WOE argument twice,[15] thereby giving undue, uncritical emphasis and appearing to endorse it over the majority opinion, which after all contained the holding of the Joiner case. The authors give credence to the WOE argument in Joiner by suggesting that the majority had not adequately addressed it, and by failing to provide or cite any critical commentary on WOE.

Careful readers will be left wondering why their time is being wasted with the emphasis on a dissent that was never the law, that mischaracterized the majority opinion, that endorsed a method, WOE, that has been widely criticized, and that never persuaded any other justice to join.

The scientific community has never been seriously impressed by the so-called WOE approach to determining causality.  The phrase is vague and ambiguous; its use, inconsistent.[16] Although the phrase, WOE, is thrown around a lot, especially in regulatory contexts, it has no clear, consistent meaning or mode of application.[17]

Many lawyers, like Justice Stevens, Richter, and Capra, may feel comfortable with WOE because the phrase is used often in the law, where the subjectivity, vagueness, lack of structure and hierarchy to the metaphor “weighing” evidence is seen as a virtue that avoids having to worry too much about the evidential soundness of verdicts.[18] The process of science, however, is not like that of a jury’s determination of a fact such as who had the right of way in a car collision case. Not all evidence is the same in science, and a scientific judgment is not acceptable when it hangs on weak evidence and invalid inferences.

The lawsuit industry and its expert witnesses have adopted WOE, much as they have the equally vague term, “link,” for WOE’s permissiveness of causal inferences. WOE frees them from the requirement of any meaningful methodology, which means that any conclusion is possible, including their preferred conclusion. Under WOE, any conclusion can survive gatekeeping as an opinion. WOE frees the putative expert witness from the need to consider the quality of research. WOE-ful enthusiasts such as Carl Cranor invoke WOE or seek to inflict WOE without mentioning the crucial “nuts and bolts” of scientific inference, such as concepts of

  • Internal and external validity
  • A hierarchy of evidence
  • Assessment of random error
  • Assessment of known and residual confounding
  • Known and potential threats to validity
  • Pre-specification of end points and statistical analyses
  • Pre-specification of weights to be assigned, and inclusionary and exclusionary criteria for studies
  • Appropriate synthesis across studies, such as systematic review and meta-analysis

These important concepts are lost in the miasma of WOE.

If Richter and Capra wished to take a deeper dive into the Joiner case, rather than elevate the rank speculation of the lone dissenter, Justice Stevens, they may have asked whether Joiner’s expert witnesses relied upon all, or the most carefully conducted, epidemiologic studies.

As the record was fashioned, the Supreme Court’s discussion of the plaintiffs’ expert witnesses’ methodological excesses and failures did not include a discussion of why the excluded witnesses had failed to rely upon all the available epidemiology. The challenged witnesses relied upon an unpublished Monsanto study, but apparently ignored an unpublished investigation by NIOSH government researchers, who found that there were “no excess deaths from cancers of the … the lung,” among PCB-exposed workers at a Westinghouse Electric manufacturing facility. Actually, the NIOSH report indicated a statistically non-significant decrease in lung cancer rate among PCB exposed workers, with fairly a narrow confidence interval; SMR = 0.7 (95% CI, 0.4 – 1.2).[19] By the time the Joiner case was litigated, this unpublished NIOSH report was published and unjustifiably ignored by Joiner’s expert witnesses.[20] Twenty years after Joiner was decided in the Supreme Court, NIOSH scientists published updated data from this cohort, which showed that the long-term lung cancer mortality for PCB-exposed workers remained reduced, with a standardized mortality ratio of 0.88 (95% C.I., 0.7–1.1) for the cohort, and even lower for the workers with the highest levels of exposure, 0.82 (95% C.I., 0.5–1.3).[21]

At the time the Joiner case was on its way up to the Supreme Court, two Swedish studies were available, but they were perhaps too small to add much to the mix of evidence.[22] Another North American study published in 1987, and not cited by Joiner’s expert witnesses, was also conducted in a cohort of North American PCB-exposed capacitor workers, and showed less than expected mortality from lung cancer.[23] Joiner thus represents not only an analytical gap case, but also a cherry picking case. The Supreme Court was eminently correct to affirm the shoddy evidence proffered in the Joiner case.

Thirty years after the Supreme Court decided Joiner, the claim that PCBs cause lung cancer in humans remains unsubstantiated. Subsequent studies bore out the point that Joiner’s expert witnesses were using an improper, unsafe methodology and invalid inferences to advance a specious claim.[24] In 2015, researchers published a large, updated cohort study, funded by General Electric, on the mortality experience of workers in a plant that manufactured capacitors with PCBs. The study design was much stronger than anything relied upon by Joiner’s expert witnesses, and its results are consistent with the NIOSH study available to, but ignored by, them. The results are not uniformly good for General Electric, but on the end point of lung cancer for men, the standardized mortality ratio was 81 (95% C.I., 68 – 96), nominally statistically significantly below the expected SMR of 100.[25]

There is also the legal aftermath of Joiner, in which the Supreme Court reversed and remanded the case to the 11th Circuit, which in turn remanded the case back to the district court to address claims that Mr. Joiner had also been exposed to furans and dioxins, and that these other chemicals had caused, or contributed to, his lung cancer, as well.[26] 

Thus the dioxins were left in the case even after the Supreme Court ruled on admissibility of expert witnesses’ opinions on PCBs and lung cancer. Anthony Roisman, a lawyer with the plaintiff-side National Legal Scholars Law Firm, P.C., argued that the Court had addressed an artificial question when asked about PCBs alone because the case was really about an alleged mixture of exposures, and he held out hope that the Joiners would do better on remand.[27]

Alas, the Joiner case evaporated in the district court. In February 1998, Judge Orinda Evans, who had been the original trial judge, and who had sustained defendants’ Rule 702 challenges and granted their motions for summary judgments, received and reopened the case upon remand from the 11th Circuit. Judge Evans set a deadline for a pre-trial order, and then extended the deadline at plaintiff’s request. After Joiner’s lawyers withdrew, and then their replacements withdrew, the parties ultimately stipulated to the dismissal of the case with prejudice, in February 1999. The case had run its course, and so had the claim that dioxins were responsible for plaintiff’s lung cancer.

In 2006, the National Research Council published a monograph on dioxin, which took the controversial approach of focusing on all cancer mortality rather than specific cancers that had been suggested as likely outcomes of interest.[28] The validity of this approach, and the committee’s conclusions, were challenged vigorously in subsequent publications.[29] In 2013, the Industrial Injuries Advisory Council (IIAC), an independent scientific advisory body in the United Kingdom, published a review of lung cancer and dioxin. The Council found the epidemiologic studies mixed, and declined to endorse the compensability of lung cancer for dioxin-exposed industrial workers.[30]

In 1996, when Justice Stevens dissented in Joiner, and over the course of three decades, Stevens’ assessment of science, scientific methodology, and law have been wrong. His viewpoints never gained acceptance from any other justice on the Supreme Court. Richter and Capra, in writing the first chapter of the new Reference Manual, lead judges and lawyers astray in improvidently elevating the dissent, as though it were law, and in failing to provide sufficient context, analysis, and criticism.

(To be continued.)


[1] 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 (4th ed. 2025).

[2] Id. at 6.

[3] 528 U.S. 440 (2000).

[4] 528 U.S. at 445 (internal citations omitted).

[5] 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, 18-19 (3rd 2011).

[6] Richter & Capra at 17.

[7] See Nathan A. Schachtman, Rule of Evidence 703—Problem Child of Article VII, PROOF 3 (Spring 2009).

[8] Id. at 13.

[9] Id. at 16.

[10] Id. at 22-23.

[11] Id. at 23, 39.

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

[13] Richter & Capra at 10 (citing General Electric Co. v. Joiner, 522 U.S. 136, 150-155 (1997) (Stevens, J.).

[14] Joiner, 522 U.S. at 147-48.

[15] Richter & Capra at 10, 31.

[16] See, e.g., V. H. Dale, G.R. Biddinger, M.C. Newman, J.T. Oris, G.W. Suter II, T. Thompson, et al., Enhancing the ecological risk assessment process, 4 INTEGRATED ENVT’L ASSESS. MANAGEMENT 306 (2008) (“An approach to interpreting lines of evidence and weight of evidence is critically needed for complex assessments, and it would be useful to develop case studies and/or standards of practice for interpreting lines of evidence.”); Igor Linkov, Drew Loney, Susan M. Cormier, F.Kyle Satterstrom & Todd Bridges, Weight-of-evidence evaluation in environmental assessment: review of qualitative and quantitative approaches, 407 SCI. TOTAL ENV’T 5199–205 (2009); Douglas L. Weed, Weight of Evidence: A Review of Concept and Methods, 25 RISK ANALYSIS 1545 (2005) (noting the vague, ambiguous, indefinite nature of the concept of WOE review); R.G. Stahl Jr., Issues addressed and unaddressed in EPA’s ecological risk guidelines, 17 RISK POLICY REPORT 35 (1998); (noting that U.S. EPA’s guidelines for ecological WOE approaches to risk assessment fail to provide meaningful guidance); Glenn W. Suter & Susan M. Cormier, Why and how to combine evidence in environmental assessments: Weighing evidence and building cases, 409 SCI. TOTAL ENV’T 1406, 1406 (2011) (noting arbitrariness and subjectivity of WOE “methodology”).

[17] See Charles Menzie, et al., “A weight-of-evidence approach for evaluating ecological risks; report of the Massachusetts Weight-of-Evidence Work Group,” 2 HUMAN ECOL. RISK ASSESS. 277, 279 (1996)  (“although the term ‘weight of evidence’ is used frequently in ecological risk assessment, there is no consensus on its definition or how it should be applied”); Sheldon Krimsky, “The weight of scientific evidence in policy and law,” 95 AM. J. PUB. HEALTH S129 (2005) (“However, the term [WOE] is applied quite liberally in the regulatory literature, the methodology behind it is rarely explicated.”).

[18] See, e.g., People v. Collier, 146 A.D.3d 1146, 1147-48, 2017 NY Slip Op 00342 (N.Y. App. Div. 3d Dep’t, Jan. 19, 2017) (rejecting appeal based upon defendant’s claim that conviction was against “weight of the evidence”); Venson v. Altamirano, 749 F.3d 641, 656 (7th Cir. 2014) (noting “new trial is appropriate if the jury’s verdict is against the manifest weight of the evidence”).

[19] Thomas Sinks, et al., Health Hazard Evaluation Report, HETA 89-116-209 (Jan. 1991).

[20] Thomas Sinks, et al., Mortality among workers exposed to polychlorinated biphenyls,” 136 AM. J. EPIDEMIOL. 389 (1992).

[21] Avima M. Ruder, et al., Mortality among Workers Exposed to Polychlorinated Biphenyls (PCBs) in an Electrical Capacitor Manufacturing Plant in Indiana: An Update, 114 ENVT’L HEALTH PERSP. 18, 21 (2006).

[22] P. Gustavsson, et al., Short-term mortality and cancer incidence in capacitor manufacturing workers exposed to polychlorinated biphenyls (PCBs), 10 AM. J. INDUS. MED. 341 (1986); P. Gustavsson & C. Hogstedt, “A cohort study of Swedish capacitor manufacturing workers exposed to polychlorinated biphenyls (PCBs),” 32 AM. J. INDUS. MED. 234 (1997) (cancer incidence for entire cohort, SIR = 86, 95%; CI 51-137).

[23] David P. Brown, “Mortality of workers exposed to polychlorinated biphenyls–an update,” 42 ARCH. ENVT’L HEALTH 333, 336 (1987

[24] See Mary M. Prince, et al., Mortality and exposure response among 14,458 electrical capacitor manufacturing workers exposed to polychlorinated biphenyls (PCBs), 114 ENVT’L HEALTH PERSP. 1508, 1511 (2006) (reporting a nominally statistically significant decreased mortality ratio of 0.78, 95% C.I. 0.65–0.93, for men exposed to PCBs); Avima M. Ruder, Mortality among 24,865 workers exposed to polychlorinated biphenyls (PCBs) in three electrical capacitor manufacturing plants: a ten-year update, 217 INT’L J. HYG. & ENVT’L HEALTH 176, 181 (2014) (reporting no increase in the lung cancer standardized mortality ratio for long-term workers, 0.99, 95% C.I., 0.91–1.07).

[25] Renate D. Kimbrough, et al., Mortality among capacitor workers exposed to polychlorinated biphenyls (PCBs), a long-term update, 88 INT’L ARCH. OCCUP. & ENVT’L HEALTH 85 (2015).

[26] Joiner v. General Electric Co., 134 F.3d 1457 (11th Cir. 1998) (per curiam).

[27] Anthony Z. Roisman, The Implications of G.E. v. Joiner for Admissibility of Expert Testimony, 65 VT. J. ENVT’L L. 1 (1998).

[28] See David L. Eaton (Chairperson), HEALTH RISKS FROM DIOXIN AND RELATED COMPOUNDS – EVALUATION OF THE EPA REASSESSMENT (2006).

[29] Paolo Boffetta, et al., TCDD and cancer: A critical review of epidemiologic studies,” 41 CRIT. REV. TOXICOL. 622 (2011) (“In conclusion, recent epidemiological evidence falls far short of conclusively demonstrating a causal link between TCDD exposure and cancer risk in humans.”).

[30] Industrial Injuries Advisory Council – Information Note on Lung cancer and Dioxin (December 2013). See also Mann v. CSX Transp., Inc., 2009 WL 3766056, 2009 U.S. Dist. LEXIS 106433 (N.D. Ohio 2009) (Polster, J.) (dioxin exposure case) (“Plaintiffs’ medical expert, Dr. James Kornberg, has opined that numerous organizations have classified dioxins as a known human carcinogen. However, it is not appropriate for one set of experts to bring the conclusions of another set of experts into the courtroom and then testify merely that they ‘agree’ with that conclusion.”), citing Thorndike v. DaimlerChrysler Corp., 266 F. Supp. 2d 172 (D. Me. 2003) (court excluded expert who was “parroting” other experts’ conclusions).

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 First Daubert Motion

February 20th, 2026

As every school child knows, or at least every law student in the United States knows, Daubert was a Bendectin case. The plaintiff claimed that his mother’s use of Bendectin, a prescription anti-nausea medication, during pregnancy caused him to be born with a major limb reduction defect.

Filed in 1984, the Daubert case was pending, in summer 1989, before Judge Earl Ben Gilliam, in the Southern District of California. A trial date was approaching, and a deadline for motions for summary judgment. The first Daubert motion was filed in August 1989, in Daubert v. Merrell Dow Pharmaceuticals, Inc.[1] It was a motion for summary judgment, not a motion specifically to exclude plaintiffs’ expert witness’s proffered testimony.

By the time of the first Daubert motion, the plaintiff was relying upon the anticipated testimony of John Davis Palmer, M.D. For the time, John Davis Palmer was not an unlikely expert witness. Although Palmer practiced internal medicine, he had a doctorate in pharmacology. Palmer, however, had no experience studying Bendectin, and no real expertise in epidemiology. He had never designed or published an epidemiologic study, and he had never done any kind of research on Bendectin. The standard for qualifying an expert witness, even in federal court, has always been very low, and thus not an effective way to police the quality of scientific evidence.

Palmer was a rather late substitute for expert witnesses previously listed by the plaintiff. Alan Kimball Done, a pediatrician, had been the main warhorse of the Bendectin plaintiffs, but he was withdrawn by plaintiff’s counsel after he was found to have committed perjury about his academic credentials in another Bendectin case.[2]

Plaintiff also needed to drop another expert witness, William Griffith McBride, who had been a star in plaintiff’s counsel’s stable. McBride helped show the teratogenicity of thalidomide in the early 1960s,[3] and his work in the Bendectin litigation gave these dodgy cases some patina of respectability. In 1988, however, McBride was accused of fraud, for which he would eventually lose his medical license.[4] McBride also chose, rather improvidently, to sue journalists, journals, and Merrell Dow executives, for reporting his rather extensive fees, only to lose that litigation.[5] When plaintiff’s counsel withdrew McBride, plaintiff was left with only Dr. Palmer to serve as plaintiff’s sole expert witness on both general and specific causation.

At the time that the first Daubert motion was filed, manufacturer Merrell Dow had voluntarily withdrawn Bendectin from the market, without any suggestion from the FDA that this action was necessary or in the public interest. The manufacturer had also enjoyed considerable success in court. The company had tried a case that consolidated the general causation claims of over 800 plaintiffs, to a defense jury verdict, in 1985, before Chief Judge Carl Rubin, of the Southern District of Ohio.[6] Despite some isolated trial losses, the company was vindicated in three federal circuits at the time its lawyers filed the “Daubert” motion.[7] The First, Fifth, and District of Columbia Circuits of the United States Court of Appeals, had all held that the plaintiffs’ case was legally insufficient to sustain a verdict against the defendant, or that the expert testimony involved was inadmissible.

In the Daubert case, Merrell Dow Pharmaceuticals was represented by the law firm Dickson, Carlson & Campillo. The important task of drafting the motion for summary judgment landed on the desk of a first year associate, Pamela Yates, who is now a partner at Arnold & Porter. Given that Merrell Dow had succeeded in other appellate courts, the task may have seemed straight forward, but the legal theories were actually all over the map.

The first Daubert motion was not styled as a motion to exclude expert witness opinion testimony, but rather as a motion for summary judgment, pursuant to Federal Rule of Civil Procedure 56, on the issue of causation. Merrell Dow’s supporting brief did not clearly invoke the distinction between general and specific causation, which distinction was not widely drawn until later in the 1990s. The supporting brief implicitly addressed both general and specific causation.

At the time that the first Daubert motion was made, there was no clear consensus of precedent that identified the source of support for a trial court’s ruling peremptorily on a weak evidentiary display on the causation issue. The evidence supporting the defense expert witnesses’ opinion that Bendectin had not been shown to cause birth defects generally and limb reduction defects specifically was strong. For all major congenital defects, there had been no change in overall incidence for the years in which Bendectin was marketed. Such an ecological argument usually has no validity, but in the case of Bendectin, for several years, roughly half of all pregnant women used the medication. When the medication was abruptly withdrawn,[8] not because of the science but because of the cost of the litigation, the rate of birth defects remained unaffected. The great majority of birth defects have no known cause, and there was no scientific consensus that Bendectin caused birth defects; indeed by 1989, the nearly universal consensus was that Bendectin did not cause birth defects.[9]

There were also many analytical epidemiologic studies, which both individually or in combination failed to support a conclusion of causation.

In the face of the defense’s affirmative evidence, the plaintiff relied upon a potpourri of evidence:

1) chemical structure activity analysis;

2) in vitro (test tube) studies;

3 ) in vivo studies (animal teratology) studies; and

4) reanalysis of epidemiology studies.

Plaintiff’s lead counsel Barry Nace[10] had concocted this potpourri approach, which he called “mosaic theory,” and which might more aptly be called the tsemish or the shmegegge theory.[11] Whatever Nace called it, he fed it to his expert witness to argue that:

“Like the pieces of a mosaic, the individual studies showed little or nothing when viewed separately from one another, but they combined to produce a whole that was greater than the sum of its parts: a foundation for Dr. Done’s opinion that Bendectin caused appellant’s birth defects.”[12]

Although philosopher Harry Frankfurt had not yet written his seminal treatise on the subject, most courts saw that this was bullshit, which tends to result “whenever a person’s obligations or opportunities to speak about some topic exceed his knowledge of the facts that are relevant to that topic.”[13]

In addition to favorable opinions from the First, Fifth, and District of Columbia Circuits, Merrell Dow had a favorable Zeitgeist working in its favor. The plaintiff-friendly influential judge, Judge Jack Weinstein, had rolled up his sleeves and taken a hard look at the plaintiffs’ scientific evidence in the Agent Orange litigation. Judge Weinstein found that evidence wanting in an important opinion in 1985.[14] Although the alleged causal agent in Agent Orange was not Bendectin, Judge Weinstein recognized that epidemiological studies were, in a similar medico-legal context, “the only useful studies having any bearing on causation.[15] Judge Weinstein relied heavily upon Federal Rule of Evidence Rule 703, which governed what inadmissible studies expert witnesses could rely upon, to whittle down the reliance list of plaintiffs’ expert witnesses before declaring their opinions too fragile to support a reasonable jury’s verdict in favor of plaintiffs.

More generally, discerning members of the legal system were reaching the end of their tolerance for the common law laissez-faire approach to expert witness evidence. In 1986, the Department of Justice issued a report that explicitly called for meaningful judicial gatekeeping of expert witnesses.[16] And in that same year, 1986, Judge Patrick Higginbotham wrote an influential opinion, in which he warned that expert witness opinion testimony was out of control, with expert witnesses becoming mouth pieces for the lawyers and advocates of policy beyond their proper role. Judge Higginbotham observed that trial judges (with support from appellate court judges) had a duty to address the problem by policing the soundness of opinions proffered in litigation, and to reject the system’s reliance upon expert witnesses simply because they “say[] it is so:”[17]

“we recognize the temptation to answer objections to receipt of expert testimony with the short hand remark that the jury will give it ‘the weight it deserves’. This nigh reflective explanation may be sound in some cases, but in others it can mask a failure by the trial judge to come to grips with an important trial decision. Trial judges must be sensitive to the qualifications of persons claiming to be experts … . Our message to our able trial colleagues: It is time to take hold of expert testimony in federal trials.”[18]

Although Merrell Dow had a substantial tailwind behind its motion for summary judgment, there was no one clear theory upon which it could rely. Some of the Bendectin appellate court opinions were based upon the insufficiency of the plaintiffs’ expert witness evidence, on the basis of the entire record after trial. The evidence in Daubert was virtually the same if not more restricted than what was of record in some of those appellate court cases. The ecological evidence was clear.

Some of the judgments relied upon by Merrell Dow were based upon the Frye test, and some were based upon Rule 703, which addresses what kinds of otherwise inadmissible evidence expert witnesses may rely upon in formulating their opinions. Finally, some courts, such as Fifth Circuit in In Re Air Crash Disaster at New Orleans, were beginning to see Rule 702 as the source of their authority to control wayward expert witness opinion testimony.

Merrell Dow advanced multiple lines of analyses to show that plaintiffs cannot establish causation based upon the then current scientific record. The first Daubert motion had no clear line of authority, and so, understandably, it cast a wide net on all available potential legal rules and doctrines to oppose the plantiff’s potpourri Bendectin causation theory. The motion harnessed precedents based upon sufficiency of the plaintiffs’ proffered expert witness, Federal Rules 702 and 703, as well as the 1923 Frye case.[19]

The cases that invoked Frye doctrine presented several interpretative problems. Frye was a criminal case that prohibited expert witnesses from testifying about their interpretations of the output of a mechanical device. The Frye case’s insistence upon general acceptance, when imported into a causation dispute in a tort case, was ambiguous as to what exactly had to be generally accepted: the specific causal claim, or the method used to reach the causal claim, or the method used as applied to the facts of the case. Furthermore, Frye’s requirement of general acceptance was not explicitly incorporated into either Rule 702 or 703, when promulgated in 1975.[20]

Merrell Dow had ample evidence that there was no general acceptance of the plaintiff’s causal claim, but its counsel also showed that by applying generally accepted methodology, scientists could not reach the plaintiff’s causal conclusion, and no scientist outside of the litigation had done so. In particular, there was general acceptance of the propositions that non-human in vivo and in vitro teratology experiments have little if any predictive ability for human outcomes. Because randomized controlled trials were never an option for testing human teratogenicity, observational epidemiology was required, and the available studies were largely exonerative. Only by post-publication data dredging and manipulation was plaintiffs’ expert witness Palmer (following what Shann Swan had done in previous cases) able to raise questions about possible associations. Plaintiff’s expert witness Palmer could not show that these manipulations were a generally accepted method for interpreting or re-analyzing published studies.

In its last point, the first Daubert motion also maintained that the standard for medical causation required that the relevant relative risk exceed two.[21] As noted, the brief did not distinguish general from specific causation, a distinction that had not entered the legal lexicon fully in 1989. The brief’s citation to swine-flu cases, however, clarifies the nature of Merrell Dow’s argument. In the swine-flu litigation, the United States government assumed liability for adverse effects of a vaccine for swine flu. The government recognized that within a certain time window after vaccination, patients had more than a doubled risk of Guillain-Barré syndrome (GBS), an autoimmune neurological condition. The government refused compensation for claimants outside that window. Merrell Dow relied heavily upon one swine flu case, Cook v. United States, which articulated and applied the principle:

“Wherever the relative risk to vaccinated persons is greater than two times the risk to unvaccinated persons, there is a greater than 50% chance that a given GBS case among vaccinees of that latency period is attributable to vaccination, thus sustaining plaintiff’s burden of proof on causation.”[22]

In other words, the government had conceded that the swine-flu vaccine could cause GBS in some temporal situations, but not others. The magnitude of the causal association had been quantified in relative risk terms by epidemiologic studies. Only for those claimants vaccinated in time windows with relative risks greater than two could courts conclude that GBS was, more likely than not, caused by vaccination.

Unlike the federal government in the swine-flu GBS litigation, Merrell Dow was not, however, conceding general causation for any exposure scenarios. The first Daubert motion can only be read to deny general causation, but to explain further that even if the court were to assume, arguendo, that Bendectin causes limb reduction deficits based upon Palmer’s schmegegge and Swan’s re-jiggered risk ratios, that there would still be no proper inference that Bendectin more likely than not caused Jason Daubert’s birth defects.

In response to these arguments, the plaintiff’s counsel argued their mosaic, potpourri, schmegegge theories. Although plaintiffs were down to Dr. Palmer, they filed transcripts and affidavits from a host of other expert witnesses, from previous Bendectin cases.

As for the legal rules of decision, Barry Nace, on behalf of plaintiffs, argued that Rule 703 had “absorbed” the Frye rule. Having been shown to be qualified under the minimal standard of Rule 702, these expert witnesses then satisfied Rule 703 by relying upon “scientific evidence” of the sort that experts in their field rely upon, even if other scientists would not rely upon such evidence in support of a conclusion. Otherwise those expert witnesses were unrestrained by the law, and they were free to assess their relied upon facts and data as sufficient to show that Bendectin probably causes birth defects and that Bendectin caused Jason Daubert’s birth defects. Nace argued that as long as expert witnesses, properly qualified, offered relevant opinions, based upon “things of science,” they could opine that the earth was flat, and it was for the jury to sort out whether to believe them.

Judge Earl Gilliam found Nace’s position untenable, and granted summary judgment later in 1989.[23] Interestingly Judge Gilliam’s opinion in the district court never cited Federal Rule of Evidence 702. Instead, the opinion pointed to Rule 703, as restricting evidence, even if “science,” unless the proponent showed that the underlying principle had gained general acceptance in the relevant field.[24] Opinions not based upon facts or data “of a type reasonably relied upon by experts in the particular field” would be confusing, misleading, and unhelpful, and thus inadmissible. The reference to helpfulness might perhaps be taken as an implicit invocation of Rule 702.

Judge Gilliam had the benefit of the Circuit decisions in Brock, Richardson, and Lynch, with their various holdings of insufficiency or inadmissibility of plaintiffs’ expert witness evidence. In particular, Judge Gilliam cited Brock for the proposition that trial courts must “critically evaluate the reasoning process by which the experts connect data to their conclusions in order for courts to consistently and rationally resolve the disputes before them.”[25] Following Judge Weinstein on Agent Orange, and the previous federal decisions on Bendectin, Judge Gilliam observed that causation in the Bendectin cases could be established, under the circumstances of plaintiffs’ evidentiary display, only through reliance upon epidemiologic evidence. Dr. Done’s schmeggege, concocted as it was by Barry Nace, would not get plaintiffs to a jury.

Judge Gilliam went further to point out that some of plaintiffs’ proffer did not even purport to claim causation. Shanna Swan’s prior testimony asserted that Bendectin was “associated” with limb reduction. Jay Glasser, a specialist in biostatistics, epidemiology and biometry had opined that “Bendectin is within a reasonable degree of epidemiological certainty associated with congenital disorders, including limb defects.” Dr. Johannes Thiersch, a specialist in pathology and pharmacology, proclaimed that “structure analysis” was “of great interest.”[26] In other words, there was a good deal of true, true, but immaterial opinion in what Mr. Nace had thrown over the transom, in opposition to the motion for summary judgment.

Nace appealed, and the Daubert case was argued to the Ninth Circuit in 1991. In a short opinion by Judge Kozinski, the appellate court affirmed the judgment below.[27] The affirmance did not mention Rule 702; rather it relied upon the decisions of other Circuits, in which the plaintiffs’ evidentiary display had been found insufficient to sustain a reasonable jury verdict.

Judge Kozinski’s opinion tilted towards Rule 703 and the Frye standard in citing to cases that stated, based upon Frye, that expert witnesses must use generally accepted techniques from the scientific community. As a legal determination, the determination of general acceptance vel non was a legal determination reviewable de novo. For its de novo decision on general acceptance, the Ninth Circuit relied upon the cases coming from the First, Fifth, and District of Columbia Circuits,[28] and of course, the record below.

By 1991, another Circuit, the Third, had weighed in on the same evidentiary display, when it reversed summary judgment for Merrell Dow, and remanded for reconsideration under the Third Circuit’s approach to Rule 702. Judge Kozinski declared that the Third Circuit’s approach was not followed in the Ninth Circuit, and proceeded to ignore the DeLuca case.[29]

Judge Kozinski treated the insufficiency and the invalidity of the Nace/Done schmeggege theory as legal precedent, and thus the court’s opinion gave very little attention by way of expository description or explanation of the problems with the four factors (in vitro, in vivo, structure analysis, and re-analysis of epidemiologic studies). As Judge Kozinski put the matter:

 “For the convincing reasons articulated by our sister circuits, we agree with the district court that the available animal and chemical studies, together with plaintiffs’ expert reanalysis of epidemiological studies, provide insufficient foundation to allow admission of expert testimony to the effect that Bendectin caused plaintiffs’ injuries.”[30]

And thus, summary judgment was proper in Daubert. Judge Kozinksi, like Judge Gilliam in the district court, never reached the specific causation argument that involved risk ratios less than two.

Some of the Circuit court cases relied upon by Judge Kozinski delved into the invalidity of these methods for determining the causes of human birth defects. The Lynch decision explored in some detail the Shanna Swan made-for-litigation rejiggering of a study based upon data from the Metropolitan Atlanta Congenital Defects Program, which included a challenge to whether it could be reasonably relied upon (Rule 703), as well as its pretense to support a scientific conclusion (Rule 702).[31] Later commentators would skirt the validity issue by asserting that re-analysis, in the abstract, is not impermissible or invalid, without addressing the specific issues discussed in the reported decisions. Other commentators have misrepresented Swan’s re-analysis as a meta-analysis, which it was not.

Some commentators have complained that the defense in Daubert made too much of the lack of statistical significance. Their complaint, in the abstract, might have some salience. In some contexts, an isolated and elevated risk ratio greater or less than one may well have important information, even if the p-value is a bit above 0.05. The lack of statistical significance at the conventional five percent, however, conveys important information about the finding’s imprecision, especially when there was a large dataset to evaluate. In 1994, a meta-analysis was published that found a summary estimate of all birth defects in the available epidemiologic studies to be an odds ratio of 0.95 (95% C.I., 0.88-1.04), and the summary estimate for limb reduction defects to be an odds ratio 1.12 (95% C.I., 0.83-1.48).[32]


[1] Defendant’s Memorandum of Points and Authorities in Support of Its Motion for Summary Judgment on the Issue of Causation, Daubert v. Merrell Dow Pharms., Inc., Case No. 84-2013-G(I) (S.D. Cal. Aug. 2, 1989). The motion was made in a companion case before Judge Gilliam as well, Schuller v. Merrell Dow Pharms., Inc., Case No. 84-2929-G(I). The first Daubert motion may not have been the first one drafted. The linked brief is the first one as filed.

[2] See Oxendine v. Merrell Dow Pharms., Inc., 563 A.2d 330 (D.C. Ct. App. 1989).

[3] William Griffith McBride, Thalidomide and Congenital Abnormalities, 278 LANCET 1358 (1961).

[4] William Griffith McBride, McBride criticizes inquiry, 336 NATURE 614 (1988); Norman Swan, Disciplinary tribunal for McBride, 299 BRIT. MED. J. 1360 (1989); G. F. Humphrey, Scientific fraud: the McBride case, 32 MED. SCI. LAW 199 (1992); Mark Lawson, McBride found guilty of fraud, 361 NATURE 673 (1993); Leigh Dayton, Thalidomide hero found guilty of scientific fraud, NEW SCI. (Feb.27, 1993); William McBride: alerted the world to the dangers of thalidomide in fetal development, 362 BRIT. MED. J. k3415 (2018).

[5] McBride v. Merrell Dow & Pharms., Inc., 800 F.2d 1208 (D.C. Ct. App. 1986). McBride ultimately failed against all his litigation targets.

[6] See In Re Richardson-Merrell. Inc. Bendectin Prods. Liab. Litig., 624 F.Supp. 1212 (S.D. Ohio 1985); aff’d sub nom. In re Bendectin Litig., 857 F.2d 290 (6th Cir. 1988); cert. denied, 488 US 1006 (1989).

[7] Brock v. Merrell Dow Pharmaceuticals Inc., 874 F.2d 307 (5th Cir. 1989); Richardson y. Richardson-Merrell, 857 F.2d 823 (D.C. Cir. 1988); Lynch v. Merrell-National Labs., 830 F.2d 1190 (1st Cir. 1987) (affirming grant of summary judgment).

[8] US Food & Drug Admin., Determination That Bendectin Was Not Withdrawn from Sale for Reasons of Safety or Effectiveness, 64 FED. REG. 43190–1 (1999).

[9] Brief at 3-4.

[10] Barry Nace was one of the lead plaintiffs’ counsel in the Bendectin litigation, and he represented the Daubert family. Nace was also formerly President of the lawsuit industry’s principal lobbying organization, the American Trial Lawyers Association (now the AAJ). See also In re Barry J. Nace, A Member of the Bar of the District of Columbia Court of Appeals (Bar Registration No. 130724), No. 13–BG–1439, Slip op. (Sept. 4, 2014), available at <https://www.dccourts.gov/sites/default/files/pdf-opinions/13-BG-1439.pdf>, last visited on Feb. 8, 2026.

[11] See Michael D. Green, Pessimism about Milward, 3 WAKE FOREST J. L & POL’Y 41, 63 (2013) (paraphrasing Nace as describing the mosaic theory as “[d]amn brilliant, and I was the one who thought of it and fed it to Alan [Done].”).

[12] Id. at 61 (2013) (citing Oxendine v. Merrell Dow Pharm., Inc., 506 A.2d 1100, 1110 (D.C. 1986).

[13] Harry Frankfurt, ON BULLSHIT 63 (2005).

[14] In re “Agent Orange” Prod. Liab. Litig., 611 F. Supp. 1223 (E.D.N.Y. 1985), aff’d, 818 F.2d 187 (2d Cir. 1987), cert. denied, 487 U.S. 1234 (1988).

[15] Id. at p. 1231.

[16] United States Dep’t of Justice, Tort Policy Working Group, Report of the Tort Policy Working Group on the causes, extent and policy implications of the current crisis in insurance availability and affordability at 35 (Report No. 027-000-01251-5) (Wash. DC 1986), available at https://archive.org/details/micro_IA41152903_0369.

[17] In Re Air Crash Disaster at New Orleans, 795 F.2d 1230, 1233-34 (5th Cir. 1986).

[18] Id. at 1233-34.

[19] The Brief, at 2, cited United States v. Kilgus, 571 F.2d 508, 510 (9th Cir. 1987) (citing Frye).

[20] An Act to Establish Rules of Evidence for Certain Courts and Proceedings. Pub. L. 93–595, 88 Stat. 1926 (1975).

[21] Brief at 17.

[22] 545 F.Supp. 306, 308 (N.D. Cal. 1982). See generally Richard E. Neustadt & Harvey V. Fineberg, THE SWINE FLU AFFAIR: DECISION-MAKING ON A SLIPPERY DISEASE (Nat’l Acad. Sci. 1978).

[23] Daubert v. Merrell Dow Pharms., Inc., 727 F.Supp. 570 (S.D. Cal. 1989).

[24] Id. at 571, citing United States v. Kilgus, 571 F.2d 508, 510 (9th Cir.1978).

[25] Id. at 572 (citing Brock, 874 F.2d at 310).

[26] Id. at 574. The use of “association” was at best ambiguous, because it begged the question whether it as an association that was “clear cut” (reasonably free from bias and confounding), and beyond that which we would care to attribute to chance.

[27] Daubert v. Merrell Dow Pharms., Inc., 951 F.2d 1128 (9th Cir. 1991).

[28] Brock v. Merrell Dow Pharms., Inc., 874 F.2d 307, modified, 884 F.2d 166 (5th Cir.1989), cert. denied, 494 U.S. 1046 (1990); Richardson v. Richardson–Merrell, Inc., 857 F.2d 823 (D.C.Cir.1988), cert. denied, 493 U.S. 882 (1989); Lynch v. Merrell–National Labs., 830 F.2d 1190 (1st Cir.1987).

[29] DeLuca v. Merrell Dow Pharmaceuticals, Inc., 131 F.R.D. 71 (D.N.J.) (granting summary judgment), rev’d and remanded, 911 F.2d 941 (3d Cir.1990). On remand, the district court entered summary judgment on the alternative reasoning of Rule 702, as interpreted by the Third Circuit. DeLuca v. Merrell Dow Pharms., Inc., 791 F.Supp. 1042, 1048 (D.N.J. 1992) (re-entering summary judgment after considering Rule 702), aff’d, 6 F.3d 778 (3d Cir.1993) (per curiam), cert. denied, 510 U.S. 1044 (1994).

[30] Daubert v. Merrell Dow Pharms., Inc., 951 F.2d 1128, 1131 (9th Cir. 1991).

[31] Lynch v. Merrell–National Labs., 830 F.2d 1190, 1194-95 (1st Cir.1987).

[32] Paul M. McKeigue, Steven H. Lamm, Shai Linn & Jeffrey S. Kutcher, Bendectin and Birth Defects: I. A Meta-Analysis of the Epidemiologic Studies, 50 TERATOLOGY 27 (1994). This meta-analysis made no correction for multiple comparisons in examining many different types of birth defects.

A New Year, A New Reference Manual

January 5th, 2026

The fourth edition of the Reference Manual on Scientific Evidence was quietly released in the waning hours of 2025, in the twilight of American democracy.[1] The Manual had been slated to be published in 2023, but that date slid to 2024, and then to 2025.  Perhaps the change in directorship of the Federal Judicial Center slowed things up. (Judge Robin Rosenberg of Zantac fame is now the Director)

The new volume is available for download at:

https://www.nationalacademies.org/publications/26919

Although I was a reviewer of one chapter of the Manual, I am just seeing this new edition for the first time today. The basic structure of the volume has not changed, although it has now grown to over 1,600 pages. Many of the key chapters on statistics, epidemiology, toxicology, and medical testimony are carried over from previous editions, with some new authors added and some previous authors no longer participating. In addition, there are some new chapters on exposure science, artificial intelligence, climate science, mental health, neuroscience, and eyewitness identification.

The individual chapters and authors in the new edition of the Manual are:

Liesa L. Richter & Daniel J. Capra, The Admissibility of Expert Testimony, at 1.

Michael Weisberg & Anastasia Thanukos, How Science Works, at 47

Valena E. Beety, Jane Campbell Moriarty, & Andrea L. Roth, Reference Guide on Forensic Feature Comparison Evidence, at 113

David H. Kaye, Reference Guide on Human DNA Identification Evidence, at 207

Thomas D. Albright & Brandon L. Garrett, Reference Guide on Eyewitness Identification, at 361

David H. Kaye & Hal S. Stern, Reference Guide on Statistics and Research Methods, at 463

Daniel L. Rubinfeld & David Card, Reference Guide on Multiple Regression and Advanced Statistical Models, at 577

Shari Seidman Diamond, Matthew Kugler, & James N. Druckman, Reference Guide on Survey Research, at 681

Mark A. Allen, Carlos Brain, & Filipe Lacerda, Reference Guide on Estimation of Economic Damages, at 749

Prologue to the Reference Guide on Exposure Science and Exposure Assessment, the Reference Guide on Epidemiology, and the Reference Guide on Toxicology, at 829i

Elizabeth Marder & Joseph V. Rodricks, Reference Guide on Exposure Science and Exposure Assessment, at 831

Steve C. Gold, Michael D. Green, Jonathan Chevrier, & Brenda Eskenazi, Reference Guide on Epidemiology, at 897

David L. Eaton, Bernard D. Goldstein, & Mary Sue Henifin, Reference Guide on Toxicology, at 1027

John B. Wong, Lawrence O. Gostin, & Oscar A. Cabrera, Reference Guide on Medical Testimony, at 1105

Henry T. Greely & Nita A. Farahany, Reference Guide on Neuroscience, at 1185

Kirk Heilbrun, David DeMatteo, & Paul S. Appelbaum, Reference Guide on Mental Health Evidence, at 1269

Chaouki T. Abdallah, Bert Black, & Edl Schamiloglu, Reference Guide on Engineering, at 1353

Brian N. Levine, Joanne Pasquarelli, & Clay Shields, Reference Guide on Computer Science, at 1409

James E. Baker & Laurie N. Hobart, Reference Guide on Artificial Intelligence, at 1481

Jessica Wentz & Radley Horton, Reference Guide on Climate Science, at 1561

Some quick comments on changes in authorship in some of the chapters. Bernard Goldstein, a member of the dodgy Collegium Ramazzini, remains an author of the toxicology chapter in the new edition. David Eaton, however, has been added. Professor Eaton was the president of the Society of Toxicology for many years, and perhaps he has brought some balance to the new edition’s work on toxicology.

An author of the statistics chapter, David Kaye, is also the sole author of the chapter on DNA evidence. Professor Kaye is a distinguished scholar of DNA evidence with serious statistical expertise. David Freedman had been a co-author of the statistics chapter in the third edition, but sadly Professor Freedman died before the third edition was published. Freedman is replaced by Hal Stern, an accomplished statistician from the University of California.

The chapter on epidemiology lost Leon Gordis, who died in 2015. The chapter in the fourth edition has the return of law professors Steve C. Gold and Michael D. Green, whose pro-plaintiff biases are well known, along with two new authors, epidemiology professors Jonathan Chevrier, & Brenda Eskenazi. Like Goldstein, Eskenazi is a fellow of the Collegium Ramazzini.

The Reference Manual, for better or worse, has had substantial influence on the litigation of scientific and technical issues in federal court, and in some state courts as well. I hope to write more substantively about the new edition in 2026.


[1] National Academies of Sciences, Engineering, and Medicine & Federal Judicial Center, Reference Manual on Scientific Evidence (4th ed. 2025).

Specific Causation – The Process of Elimination

September 24th, 2025

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

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

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

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

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

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

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

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

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

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

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

B or C or B*C.

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

C.

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

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

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


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

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).

Systematic Reviews versus Expert Witness Reports

July 2nd, 2025

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

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

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

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

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

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

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

“Rule 803. Exceptions to the Rule Against Hearsay

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

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

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

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

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

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

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

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

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

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

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

Rule 26. Duty to Disclose; General Provisions Governing Discovery

(a) Required Disclosures.

* * *

(2) Disclosure of Expert Testimony.

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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).