TORTINI

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

Acetaminophen – Lobbying the Court – Part 4

August 8th, 2026

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

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

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

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

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

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

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

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

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

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

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

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

Oral Argument in the Second Circuit

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

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

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

The answer was simple: No!

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

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

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

(to be continued)


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

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

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

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

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

[6] Id.

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

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

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

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

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

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

Acetaminophen – Distortion of Scientific Publication – Part 3

August 5th, 2026

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

The Supposed NIH Funding

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

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

The NIEHS awarded grant R35ES031688 to Andrea Baccarelli, while he was at Columbia University, for his project “Extracellular Vesicles in Environmental Epidemiology Studies of Aging.” The research focuses on extracellular vesicles (EVs) and their role in environmental health, particularly as it relates to aging. Under the NIEHS grant contract, Baccarelli promised to study the effects of air pollution on accelerated brain aging, and disease states such as dementia. Baccarelli noted that his focus would be on intra-cellular communication enabled by extracellular vesicles, in reaction to air pollution. The described research would understandably be viewed as potentially relevant to the NIEHS mission statement, but it has nothing to do with autism among children of women who ingested acetaminophen during pregnancy.  The phrases “extracellular vesicles” and “air pollution” do not appear in the Prada review. NIEHS grant R35ES031688 is irrelevant to research on acetaminophen.

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

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

Dr. Baccarelli did not have NIH or NIEHS support for conducting a review of acetaminophen and autism. The support, a best, was for DEI purposes, or perhaps general “walking-around” money for research on environmental pollution and brain aging, which has nothing to do with the medical issue driving the Prada review. There is no evidence that Baccarelli or the other authors of the Prada review ever prepared a study proposal or protocol related to acetaminophen for evaluation by a funding committee at NIH. The NIH provided no peer review or guidance for the authors’ acetaminophen review. In short, there is nothing that marks the Prada review as an NIH work product other than the over-claiming of the authors with respect to funding sources.

By claiming that his research was “NIH funded,” Baccarelli was attempting to boost the prestige of the research even though his acetaminophen review was done for litigation, not for the federal government. Apparently the NIEHS acquiesces in this charade because it suggests to the uninitiated that its research grants result in more published papers, even though the topics of those papers are unrelated to the funded research proposal, and the unrelated topics never receiving committee peer review.

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

The Journal Chosen for the Prada Review

Peer Review

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

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

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

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

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

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

Baccarelli’s Choice of Journal

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

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

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

Anemic Conflicts of Interest Disclosures

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

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

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

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

Dr. Baccarelli’s disclosure self-servingly, and with epistemic arrogance, claims that he “made every effort to ensure that this current work—like his past work as an expert witness on this matter—was conducted with the highest standards of scientific integrity and objectivity.” Baccarelli neglected to omit any mention that his work failed critical scrutiny in the multi-district litigation. In an extensive, closely reasoned opinion, federal district court judge Denise Cote ruled that Dr. Baccarelli’s proffered opinions failed to meet the relevance and reliability standards of federal law.[18]

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

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

The Navigation Guide Methodology

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

History of the Navigation Guide

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

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

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

Second, the Organizing Committee urged the need for precautionary assessments, which might make their method potentially appropriate when evidence syntheses for precautionary pronouncements are called for. In the United States, regulatory assessments vary depending up the governing statutes that create the regulatory mandate. Some regulatory assessments call for precautionary assessment; determining causation in litigation does not.  Indeed, in personal injury litigation, the precautionary principle is nothing less than an end run around the burden of proof on the party claiming harm and suing in tort. The designated subject matter of environmental exposures for the proposed systematic review technique offers an insight into why these authors believed that they had to propose a new-fangled systematic review methodology. Previously described methods interfered with authors’ ability to elevate “iffy” associations into conclusions of causality in the name of the precautionary principle.

The third remarkable aspect of the 2009 Committee’s proposed approach is its omission of any need or desirability for a pre-specified protocol. Later articles on the proposed navigation guide methodology similarly failed to describe the need for such a protocol.[29] By 2014, however, two of the original committee members published an article describing the proposed methodology in which they added the requirement of a pre-specified protocol to the requirements for a navigation guide systematic reviews.[30] This 2014 publication did not, however, prescribe, as most systematic review approaches do, the public pre-registration of the protocol.

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

“The purposes of the protocol are to discourage ad-hoc changes to methodology during the review process which may introduce bias, to allow any justifiable methodological changes to be tracked, and also to allow peer-review of the work that it is proposed, to help ensure the utility and validity of its objectives and methods.”[32]

A more recent definition and assessment of systematic reviews similarly points to their essence in terms of a protocol:

“Systematic review (SR) is a rigorous, protocol-driven approach designed to minimise error and bias when summarising the body of research evidence relevant to a specific scientific question.”[33]

The Prada Review’s Application of the Navigation Guide

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

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

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

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

(to be continued)


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

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

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

[4] Id.

[5] Id. at 593-94.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[21] See, e.g., In re Roundup Prods. Liab. Litig., 390 F. Supp. 3d 1102 (2018);  Barrera v. Monsanto Co., Del. Super. Ct. (May 31, 2019), at https://scholar.google.com/scholar_case?case=1288295772524535914&q=BARRERA+v.+MONSANTO&hl=en&as_sdt=2006Pilliod v. Monsanto Co., 67 Cal. App. 5th 591, 282 Cal. Rptr. 3d 679 (2021). See also Dan Charles, Taking the stand: For scientists, going to court as an expert witness brings risks and rewards, 383 SCIENCE 942 (Feb. 29, 2024) (quoting Ritz as coyly suggesting that she was reluctant to get involved as an expert witnesses).

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

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

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

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

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

[26] Patrice Sutton, Heather Sarantis, Julia Quint, Mark Miller, Michele Ondeck, Rivka Gordon & Tracey Woodruff, Navigating the Scientific Evidence to Improve Prevention: A Proposal to Develop A Transparent and Systematic Methodology to Sort the Scientific Evidence Linking Environmental Exposures to Reproductive Health Outcomes (July 29, 2009), available at https://www.healthandenvironment.org/uploads-old/7-29-09%20Complete%20Final%20Discussion%20Document%20Navigating%20the%20Science%20Workshop.pdf.

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

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

[29] Tracey J. Woodruff, Patrice Sutton, and The Navigation Guide Work Group, An Evidence-Based Medicine Methodology To Bridge The Gap Between Clinical And Environmental Health Sciences, 30 HEALTH AFFAIRS 931 (2011); Julia R. Barrett, The Navigation Guide Systematic Review for the Environmental Health Sciences, 122 ENVT’L HEALTH PERSP. A283 (2014).

[30] Tracey J. Woodruff & Patrice Sutton, The Navigation Guide Systematic Review Methodology: A Rigorous and Transparent Method for Translating Environmental Health Science into Better Health Outcomes, 122 ENVT’L HEALTH PERSP. 1007 (2014).

[31] Paul Whaley, Crispin Halsall, Marlene Ågerstrand, Elisa Aiassa, Diane Benford, Gary Bilotta, David Coggon, Chris Collins, Ciara Dempsey, Raquel Duarte-Davidson, Rex Fitzgerald, Malyka Galay-Burgos, David Gee, Sebastian Hoffmann, Juleen Lam, Toby Lasserson, Len Levy, Steven Lipworth, Sarah Mackenzie Ross, Olwenn Martin, Catherine Meads, Monika Meyer-Baron, James Miller, Camilla Pease, Andrew Rooney, Alison Sapiets, Gavin Stewart, and David Taylor, Implementing systematic review techniques in chemical risk assessment: Challenges, opportunities and recommendations, 92-93 ENV’T  INTERNAT’L 556, 560 (2016).

[32] Id.

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

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

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

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

[37] Id. at 485.

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

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

Acetaminophen – Partisan Politics Corrupts Scientific Assessments – Part 2

July 30th, 2026

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

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

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

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

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

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

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

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

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

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

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

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

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

Scientific Community’s Reaction to Trump’s News Conference

Trump’s press conference on acetaminophen and vaccines was widely met with condemnation and disbelief.[15] Most medical organizations were appalled at the administration’s sloppy messaging. The day after the press conference, the American College of Medical Toxicology (ACMT) issued a statement in response, to affirm the safety of acetaminophen in pregnancy.  The ACMT noted that its position agreed with those of the American College of Obstetrics and Gynecologists, the Society for Maternal-Fetal Medicine, the American Academy of Pediatrics, and the Society for Developmental and Behavioral Pediatrics.[16]

In Europe, where pharmaceutical regulation is typically even more precautionary than in the United States, the European Medicines Agency (EMA) announced, a day after the Trump news conference, that using acetaminophen during pregnancy was safe, with no showing that it causes autism in offspring. The EMA announcement quoted Steffen Thirstrup, the EMA’s Chief Medical Officer, as stating that “[p]aracetamol remains an important option to treat pain or fever in pregnant women. Our advice is based on a rigorous assessment of the available scientific data and we have found no evidence that taking paracetamol during pregnancy causes autism in children.”[17] In the United Kingdom, the governmental Medicines & Healthcare Products Regulatory Agency issued a notice, on September 23, 2025, that acetaminophen was safe to take in pregnancy and that the medication has not been shown to cause autism in children.[18]

The day of the news conference, the Autism Science Foundation issued a statement of deep concern about Trump’s announcement. The Foundation observed that “[b]ased on the existing data, there is not sufficient evidence to support a link between acetaminophen and autism.”[19] Medical ethicist Dr. Professor Arthur Caplan, who is not given to hyperbole, called the conference “the saddest display of a lack of evidence, rumors, recycling old myths, lousy advice, outright lies, and dangerous advice I have ever witnessed by anyone in authority.”[20]

The official governmental messaging in the wake of Trump’s press conference was more circumspect. In her press release on the day of the news conference, Press Secretary Karoline Leavitt used the meaningless locution, “suggested link,” and cited the Prada review, which eschewed causal conclusions.[21] Leavitt gratuitously added that “[t]he Trump Administration does not believe popping more pills is always the answer for better health.” Unless of course, it is Propecia for Donald Trump, testosterone for Peter Hegseth, or ketamine for Elon Musk.

When the administration physicians communicated with the public, they said something very different from Trump’s presentation. Dr. Mehmet Oz, former surgeon and television talking head, who stood mute by Trump’s side, found his voice later in the week, when he acknowledged that pregnant women of course should take acetaminophen when physicians direct them to do so.[22]

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

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

           * * *

To be clear, while an association between acetaminophen and autism has been described in many studies, a causal relationship has not been established and there are contrary studies in the scientific literature.”[23]

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

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

(to be continued)


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

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

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

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

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

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

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

[7] Transcript at 24:35.

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

[9] Prada Review at 38.

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

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

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

[13] Id.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Recrudescence of Ferebee – Part Two

July 1st, 2026

In 2010, almost 30 years after Ferebee was decided, the Solicitor General cited the case in an amicus brief before the Supreme Court case, in Matrixx Iniatives, Inc. v. Siracusano. The case was a securities fraud class action, which was dismissed initially by the trial court on consideration of the defendant’s motion that the complaint failed to allege causation supported by statistically significant studies. The Supreme Court would go on unanimously to reject causation as a criterion for establishing a prima facie case of securities fraud, which made statistical significance irrelevant. Because the FDA could (and later did) require the company to recall its product upon a showing that material evidence suggested that there might be a possible causally induced harm, the Court held that the plaintiff class did not have to allege causation.[1] The harm to the shareholders came in the form of management’s bullish financial projections for a product that was later recalled for safety concerns, even if the recalled product never was shown to cause any harm. The Solicitor General’s amicus brief advanced the Ferebee case as an example of a causal relationship that could be established “through consideration of multiple factors independent of statistical significance.”[2] Although the government’s amicus brief correctly discerned that the causal connection between paraquat exposure and pulmonary fibrosis was established without analytical epidemiologic studies, and the necessary tools of statistical analysis for such studies, the brief mistakenly placed the allegations that Zycam caused anosmia in the same conceptual framework as paraquat. Unlike paraquat toxicity, millions of people used Zycam for relief from cold and flu symptoms, and the alleged harm, anosmia, commonly occurs in the aftermath of colds and flu. The Zycam personal injury claims fared poorly in litigation because of the dearth of supportive evidence that was appropriate to support causation, as opposed to materiality in securities law.[3]

The Ferebee case correctly observed that epidemiology was not necessary to establish the causal claim involving paraquat dermal exposure and lung toxicity and fibrosis. At the time that Mr. Ferebee sustained extensive paraquat exposure as a result of his governmental employer’s extreme negligence, the scientific community fully accepted that paraquat exposure, by ingestion, inhalation, or dermal exposure caused systemic toxicity and deleterious lung effects. This “general causation” had been established by case reports and case series, along with studies of paraquat’s metabolic fate and distribution in humans and non-human animals (including non-human primates), and assessment of mechanistic effects in cells and tissues of the target organs affected by paraquat when it became systemically distributed in the human body.

About the time of the Ferebee litigation, a textbook on agricultural chemicals described the toxic effects of dipyridyl compounds in humans, including paraquat:

“Human Toxicology Experience: A considerable amount of clinical experience has been reported in the literature with over 100 cases of illness and/or death. The chemical is unique in the sense that there is not only an acute toxicity syndrome but, in addition, it has the ability to produce a delayed fibroblastic response in the lungs. The latter is usually the principal mechanism of death.

For industrial workers, paraquat is not considered very dangerous. Inhalation hazard is extremely low due to the low vapor pressure of the chemical. Nevertheless, protective respiratory equipment should be used particularly when other atmospheric contamination might occur. * * * On no occasion should an applicator be allowed to walk through drifting spray.” [4]

This textbook cited studies that suggested that dermal and respiratory exposure to paraquat did not appear to be a hazard to field applicators, despite the demonstration of absorption, as long as precautions against overexposure are taken.[5] The premise of the textbook discussion, that appropriate, well-known safety measures and protective gear are employed, was an important part of its analysis.

This early textbook discussion also flagged delayed lung fibrosis as the main problem caused by all modes of paraquat exposure, including dermal absorption:

“Although the acute symptoms of paraquat intoxication are of concern and are dangerous, the principal problem relates to the unique delayed manifestations of this chemical’s ability to produce a fibroblastic change in the lung which begins a number of days after absorption. * * * Experiments then found that it was possible to induce respiratory failure as a result of both dermal and aerosol routes of absorption (Newhouse, 1978).”[6]

An early review by the World Health Organization also emphasized that paraquat exposure was not expected to pose a health risk as long as safe work practices are followed:

“Occupational exposure to paraquat does not pose a health risk if the recommendations for use are followed and there is adherence to safe working practices.

                   *     *     *

In the small number of reported cases of paraquat poisoning allegedly resulting from occupational exposure, the cause can be identified as one or a combination of a number of factors, viz contamination of the skin with concentrated products, use of inadequately diluted solutions, use of faulty equipment, misuse of equipment (e.g., blowing blocked spray jets) or failure to take action in the event of contamination of skin or clothing.”[7]

Cases of dermal exposure to undiluted paraquat (20%), especially when exposure involved dermal exposure to the scrotum, can produce serious systematic toxicity.[8]

Ferebee was not given an appropriate respirator even when exposed to intense atmospheric contamination. He was drenched in paraquat spray, and remained drenched for hours. The gross negligence of his employer ensured that there would not be many similar cases, and that the tools of analytical epidemiology would not be available.[9] Indeed, epidemiology was never involved in determining general causation of paraquat exposure and lung fibrosis. Given that the outcome of interest would likely occur only in the context of negligent or intentional over-exposure, epidemiology will never be available.

Revisiting the Ferebee decision and the unique facts of the case place the decision in a better perspective for judging how courts continue to cite the case. The facts of the case readily distinguish the case, the claimed harm, and the manner of showing causation, from the facts in cancer, birth defects, and other cases where epidemiology is essential. The principle of charity would require the frequently quoted language on expert witness admissibility to be taken as a statement of the appellate standard of review for the jury’s determination of medical causation. Most of the glib characterizations of the Ferebee turn out to be wrong on close inspection of the case.

a. Ferebee was not a precedent under the Federal Rules of Evidence

Chevron’s evidentiary arguments were posed under Maryland law. Neither Rule 702[10] nor Rule 703[11] was ever mentioned in the district court or the Court of Appeals decisions.

b. Ferebee does not support a false distinction between scientific and legal causation.

In a later Bendectin birth defects case, Richardson v. Richardson-Merrell, Inc., the Court of Appeals struggled to distinguish Ferebee and its holdings based upon the ample epidemiologic evidence involving Bendectin. The Court mischaracterized Ferebee as not pertinent because it was on the “frontier of current medical and epidemiological inquiry.”[12] The Richardson court was impressed by the 20 years of research on Bendectin, including multiple epidemiologic studies. Unfortunately, the court was apparently ignorant of the irrelevance of epidemiology to the Ferebee case, and the extensive research base for determining the lung toxicity of paraquat. This ignorance seems to have resulted from Judge Mikva’s generalizations and overstatements of the paucity of evidence in Ferebee.

c. Ferebee does not support the false distinction between scientific and legal certainty.

Courts and commentators have attempted to explain the result in Ferebee by invoking what is largely a false distinction between scientific and legal certainty (or sufficiency). The Ferebee decision itself provided the ammunition by asserting a distinction between the requirements of scientific and legal decision making:

“In a courtroom, the test for allowing a plaintiff to recover in a tort suit of this type is not scientific certainly but legal sufficiency.”[13]

This was a common approach in distinguishing Ferebee, in the Bendectin litigation,[14] but it was picked up and promulgated by scientists and legal commentators.[15] Invoking this alleged distinction has become a common rhetorical move to excuse inadequate or insufficient evidence to support an expert witness’s causation opinion in litigation. The generalization from the facts of Ferebee to all scientific and legal questions of causation was wrong from the inception, and citations to a single case, Ferebee, cannot make those generalizations true.[16]

d. Ferebee did not establish the irrelevance or the dispensability of epidemiologic evidence in cancer or birth defects cases.

The Ferebee case observed that “a cause-effect relationship need not be clearly established by animal or epidemiological studies before a doctor can testify that in his opinion such a relationship exists.”[17] The bit about animal studies certainly cannot be part of the holding because the plaintiffs’ expert witnesses relied extensively on animal studies, along with human case reports, and human clinical studies of the metabolic fate and distribution of paraquat in both animals and humans.

The Ferebee case does properly stand for the proposition that there is a subset of all health effect cases for which epidemiologic evidence is unavailable and unnecessary for an expert witness to have for a valid conclusion of general and specific causation. The case illustrates how the ill effects of paraquat were observed shortly after exposure, and were sufficiently unique to not have a meaningful base- or background- rate. Adding the studies of absorption, metabolic fate and distribution, and mechanism of action, the plaintiff’s expert witnesses had an ample scientific, and legal, basis to assess causality. 

The Ferebee case is sometimes mistakenly thought of as a cancer case, which would have required epidemiologic evidence.[18] This mistake may well result from later courts citing Ferebee in cancer cases, for the proposition that epidemiologic evidence is unnecessary to support plaintiff’s causal claim between some exposure and some cancer. Perhaps the Illinois Supreme Court has provided the most egregious example of this sort of mistake. In Donaldson, a case involving plaintiff’s exposure to coal tar and his later development of neuroblastoma, the Court confusedly found Ferebee to be “of particular significance.”[19] The Donaldson court affirmed the trial court’s admission of plaintiffs’ expert witness testimony about “a causal link causal link despite the lack of a statistical number of others with neuroblastoma and a history of coal tar exposure.”[20] The court rambled on about how the plaintiffs were not required to prove general or specific causation “with 100% certainty that neuroblastoma.” This assertion was a common strawman argument that channels a misreading of Ferebee. The defense in Donaldson did not argue that 100% certainty was required, and such a level of posterior probability has never been required in law or in science.

The Ferebee case also did not establish that statistical significance was not required in epidemiologic studies for expert witnesses to be able reasonably to rely upon such studies. Because epidemiologic evidence was not at issue, there was no holding about epidemiologic studies or statistical significance as a criterion of the validity of such studies.

e. Ferebee did not establish that a clinician can opine about causation without sufficient facts and data.

One of plaintiff’s expert witnesses in Ferebee was Dr. Crystal, who was both a physician and a research scientist. His opinion as an expert witness was hardly without supporting facts and data, and the facts and data were of the exact kind that led to the scientific acceptance of the causal connection between some paraquat exposures and lung fibrosis. Crystal’s opinion was certainly not proffered without any evidentiary basis, as some have suggested.[21] Nor was Ferebee a case in which expert witnesses opined without facts and data to support unprecedented opinions on general and specific causation.[22]

This overwrought, over-extended interpretation of Ferebee as permitting causation opinions based upon only clinical observations of the patient appeared in the first edition of the Reference Manual on Scientific Evidence, but disappeared in all subsequent editions. In the chapter by evidence law professor Margaret Berger, the Manual reported that Ferebee was frequently cited for a “holding that causation can be established by the testimony of treating physicians.”[23] Berger’s observation about frequent citation is correct, but the observation does nothing to validate the opinion cited. Berger offered no comments or analysis in critique of the frequent miscitation of Ferebee, leaving the reader to believe that citing Ferebee for the sufficiency of treating physician opinion without data was somehow appropriate. The citations to which Berger referred were erroneous in 1994, and they remain erroneous today.


[1] Matrixx Iniatives, Inc. v. Siracusano, 563 U.S. 27, 131 S.Ct. 1309, 1320 (2011).

[2] Brief for the United States as Amicus Curiae, in Matrixx Iniatives, Inc. v. Siracusano, No. 09-1156, 2010 WL 4624148, at *15 (Nov. 2010).

[3] See, e.g., Benkwith v. Matrixx Initiatives, Inc., 467 F. Supp. 2d 1316, 1326, 1330, 1332 (M.D. Ala. 2006) (granting defendant’s motion to exclude testimony of an expert in the field of epidemiology regarding Zicam nasal spray’s causing plaintiff’s anosmia, because the opinions had not been tested and a rate of error could not be provided).

[4] Sheldon L. Wagner, CLINICAL TOXICOLOGY OF AGRICULTURAL CHEMICALS 198, 199-200 (1983).

[5] Id. at 200 (citing “[s]tudies by Staiff and co-workers (1975)” on occupationally exposed persons).

[6] Id. at 201. See also A. J. Gardiner, Pulmonary oedema in paraquat poisoning, 27 THORAX 132 (1972).

[7] WORLD HEALTH ORGANIZATION, ENVIRONMENTAL HEALTH CRITERIA 39: PARAQUAT AND DIQUAT at § 1.1.5. Effects on man (1984).

[8] See K. Tungsanga, S. Chusilp, S. Iarasena & V. Sitprija, Paraquat poisoning: evidence of systemic toxicity after dermal exposure, 59 POSTGRAD. MED. J. 338, 338 (1983).

[9] Cf. Zuchowicz v. United States, 140 F.3d 381 (2nd Cir. 1998) (analyzing causation in the context of defendants clear negligence that resulted in undisputed overexposure to prescription medication Danocrine). Unlike Zuchowicz, however, the Ferebee case did provide a strong evidentiary base for causation.

[10] See Kenneth J. Chesebro, Taking Daubert’s “Focus” Seriously: The Methodology/Conclusion Distinction, 15 CARDOZO L. REV. 1745, 1747, 1753 (1994) (misciting Ferebee as a Rule 702 case).

[11] See Alani Golanski, Judicial Scrutiny of Expert Testimony in Environmental Tort Litigation, 9 PACE ENVT’L L. REV. 399, 406-07 (1992) (misrepresenting Ferebee as a case under Rule 703; “this evidentiary issue was resolved through examination of the facts or data underlying the proffered expert opinion only to the extent necessary to make a Rule 703 determination on whether they are of the type reasonably relied upon by experts in the field.”). See also Michael C. McCarthy, “Helpful” or “Reasonably Reliable”? Analyzing the Expert Witness’s Methodology Under Federal Rules of Evidence 702 and 703, 77 CORNELL L. REV. 350, 373 (1992) (discussing Ferebee as a Rule 702 and 703 decision).

[12] Richardson v. Richardson-Merrell, Inc., 857 F.2d 823, 831-832 (D.C. Cir. 1988).

[13] Ferebee, 736 F.2d at 1536.

[14] Id.

[15] Louis Lasagna & Sheila R. Shulman, Bendectin and the Language of Causation, chap. 5, at 111, in Kenneth R. Foster, David E. Bernstein & Peter W. Huber, eds., PHANTOM RISK: SCIENTIFIC INFERENCE AND THE LAW (1993)

[16] See Michael C. McCarthy, “Helpful” or “Reasonably Reliable”? Analyzing the Expert Witness’s Methodology Under Federal Rules of Evidence 702 and 703, 77 CORNELL L. REV. 350, 373 (1992) (“Essentially, the Ferebee decision distinguished between the level of certainty required by a scientific discipline-and the level of certainty required by a court in drawing conclusions regarding causation”: and “Ferebee stands for the proposition that courts, in determining whether a given substance more likely than not caused a plaintiff’s injury, cannot always wait for the sciences.”).

[17] Ferebee, 736 F.2d 1529, 1535 (D.C. Cir. 1984).

[18] David E. Bernstein, The Misbegotten Judicial Resistance to the Daubert Revolution, 89 NOTRE DAME L. REV. 27, 36 (2013); David E. Bernstein, Expert Witnesses, Adversarial Bias, and the (Partial) Failure of the Daubert Revolution, 93 IOWA L. REV. 451, 465 (2008) (“Ferebee involved a claim that exposure to an herbicide caused an individuals’ cancer.”).

[19] Donaldson v. Central Illinois Public Service Co., 313 Ill. App.3d 1061, 730 N.E.2d 68, 79 (2000).

[20] Id.

[21] Lee Loevinger, Evidentiary Framework Margaret A. Berger Reference Manual on Scientific Evidence, 36 JURIMETRICS J. 149, 153 & n.21 (1996) (discussing the before (Daubert) times when “mere qualification and the facial relevance of an opinion might suffice to let an expert testify in some jurisdictions.”).

[22] See Kenneth J. Chesebro, Taking Daubert’s “Focus: Seriously: The Methodology/Conclusion Distinction, 15 CARDOZO L. REV. 1745, 1747 & n.20 (1994) (incorrectly arguing that Ferebee involved an expert witness offered an “unprecedented expert factual conclusion which no published literature supported.”

[23] See Margaret A. Berger, Evidentiary Framework, 39, 81 & n.164, in FEDERAL JUDICIAL CENTER, REFERENCE MANUAL ON SCIENTIFIC EVIDENCE (1st ed. 1994).

The Recrudescence of Ferebee – Part One

June 29th, 2026

The infamous Ferebee decision is certainly a contender to be a Dred Scott decision involving scientific evidence,[1] by declaring that science has no validity issues that the law is bound to respect.[2] The decision is often cited for its dictum, written with impressive rhetorical flourish, about how courts should not interfere with expert witness opinion testimony. The dictum, when written in 1984, was contrary to the law of Federal Rule of Evidence 702, and was relegated in 1993 to the trash bin of jurisprudential history by the Supreme Court’s 1993 decision in Daubert.[3]

Since 1993, scofflaw judges continued to cite Ferebee’s discredited dictum, without looking at the specific facts of the case. Indeed, even after Rule 702 was amended to clarify its meaning, courts have cited Ferebee as precedential for a let-it-all-in approach to expert witness testimony. As recently as February 2026, the Chief Judge of the Federal Circuit, of the United States Court of Appeals, cited Ferebee in derogation of Federal Rule of Evidence 702.[4] This recrudenscence of Ferebee warrants revisiting the case, what was actually decided, and whether it has any continuing jurisprudential relevance.

The Ferebee case was a personal injury case against the manufacturer of paraquat, a herbicide, for damages for severe pulmonary fibrosis. Interestingly, the case is sometimes erroneously cited as a cancer causation case, which may explain why some commentators criticize its dismissal of epidemiology and statistical significance.

Critics of Ferebee, as well as its acolytes, rarely describe the factual context of the case. The facts of a case are always germane to its holding, and Ferebee cannot be cited appropriately without a sane appreciation of its facts.

  1. Ferebee is a government negligence case.

The plaintiff worked for the federal government when he was exposed to paraquat. Richard Ferebee began working for the Department of Agriculture’s Beltsville Agricultural Research Center (BARC), in Beltsville, Maryland. He started spraying paraquat in the summer of 1977, and used the herbicide regularly through the time he was diagnosed with pulmonary fibrosis, in November 1979.[5] Mr. Ferebee sued Chevron Chemical Company, the supplier of the paraquat, for failing to warn. The important failure to warn, however, was committed by the federal governmental, which had actual knowledge of the hazard, and which owned the BARC facility, employed Ferebee, controlled and supervised his use of paraquat, and failed to comply with Chevron’s instructions. The federal government itself further regulated the sale and use of paraquat extensively, first by the Department of Agriculture, and later by the Environmental Protection Agency. [6]

  1. The exposure.

Ferebee filed his lawsuit in 1981; he died in 1982. His case was tried twice. In the first trial, the jury deadlocked. In the second trial, the jury returned a verdict in favor of his estate, and for his family, for $60,000. In his deposition testimony, Ferebee described how he sprayed paraquat, in the summer of 1977. The chemical was diluted for use, per Chevron’s instructions. There was no evidence that Ferebee ever had direct contact with undiluted paraquat, or that the paraquat he was exposed to was not diluted according to the proportions recommended on Chevron’s label.[7]

Crediting Ferebee’s testimony, the federal government was at best grossly negligent; at worst, the government was an intentional tortfeasor. In flagrant disregard of Chevron’s written instructions (as required by federal regulation), Ferebee frequently had the chemical on his ungloved hands.[8] Ferebee further described an occasion when he was drenched with paraquat as he walked behind a tractor that was spraying the chemical, and another incident when he used a defective sprayer that leaked paraquat “all over his pants.”[9]

On the occasions of Ferebee’s being exposed to paraquat without appropriate protective gear, the federal government deviated from its employer common law, statutory, and regulatory duties. Ferebee did not wash when he was dermally exposed to paraquat, and he went home contaminated, where he fell asleep, tired and dizzy, without showering.[10]  The exposure that Ferebee described would not have occurred had his federal employer followed the instructions on the label that the government itself mandated. In 1978, the federal Occupational Health & Safety Administration published Guidelines on the need for protective clothing, respirators, immediate washing of contaminated skin. Ferebee’s federal governmental employer recklessly disregarded the guidelines it mandated that Chevron provide.

  1. The warnings.

Paraquat could be sold in the United States only when labeled in accordance with EPA regulations, promulgated pursuant to the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).[11] The statute bars EPA from allowing sale of regulated herbicides, such as paraquat, unless the chemicals, as labeled, will not cause “unreasonable adverse effects on the environment.”[12] Such effects are in turn defined as any unreasonable risk to man or the environment, taking into account the economic, social, and environmental costs and benefits of the use of [the] pesticide.[13] FIFRA further requires the EPA to require labeling that is “adequate to protect health and the environment” and that is “likely to be read and understood.”[14]

In the Ferebee case, both the district and the circuit courts failed to provide the complete warning label and the material data safety sheets that Chevron supplied to the federal government employer, as required by the federal government. There are “snippets” of the warning communications in the published opinions, which make clear that the government was largely if not entirely to blame for failing to comply with the directions required under FIFRA. For instance, the district court, in a footnote, acknowledged:

“For example, the label advised the user spraying paraquat to wear waterproof clothing and goggles, to avoid working in spray mist, and to wash splashes on the skin or eyes immediately with water.”[15]

The Court of Appeals Ferebee opinion described the label,[16] as stating a warning in large bold letters:

DANGER

CAN KILL IF SWALLOWED

HARMFUL TO THE EYES AND SKIN

The label also informed users to wash any exposed areas immediately, and to remove contaminated clothing.[17]

  1. The Stipulation.

Essential to understanding the holding in Ferebee are the facts of the case, including the parties’ stipulation:

“that Mr. Ferebee’s only significant exposure to paraquat was on his intact skin; i.e., there was no evidence that Mr. Ferebee swallowed or inhaled paraquat, or that he spilled or sprayed it on an area of his skin upon which he had any apparent cuts or scrapes. The jury was not, of course, precluded from concluding that a person engaged in Mr. Ferebee’s line of work could have had some, or even many, minor cuts or abrasions not readily discernible to the naked eye or likely to be remembered some time later.”[18]

Why did the plaintiffs try to present their case solely as a dermal exposure cases? As we will see, this stratagem made their medical causation case a little more difficult, but it avoided defenses of serious misuse and lack of proximate cause. Ferebee had been instructed by his co-workers and supervisors that paraquat was extremely dangerous if swallowed or inhaled. The warning label was unequivocal in detailing the dangers and the need to avoid ingestion. (Without the full label, it is difficult to evaluate how well the label warned against inhalation, but the 1978 OSHA guidelines address the use of a proper respirator for situations in which paraquat may be inhaled.) On the other hand, the label had a weakness, which could be exploited, as long as the preemption defense could be held at bay: the label urged protective clothing, goggles, and immediate washing of contaminated skin, but it failed to describe the consequence of dermal exposure other than irritation. Ferebee could thus try to avoid his own culpable conduct, as well as a sophisticated intermediary defense, by claiming that his exposure was only dermal.

Why did Chevron agree to the stipulation? Ferebee surely had some inhalational exposure when he walking behind applicators and when he was drenched in paraquat. The Chevron warning label, per government-employer regulations, did not specify respirator usage for ordinary work exposures of applicators (as opposed to workers who handled undiluted paraquat, or who worked in confined spaces). The defendant probably felt sanguine about its preemption defense, and thus also about the adequacy of its warnings overall. The stipulation limited the plaintiff’s medical causation case to a route of exposure that put it into an arguable “first instance” case report. Chevron stood to gain a claim of “lack of notice,” and thus lack of actual or constructive knowledge of the risk of lung disease from dilute dermal exposure. The clinical presentation itself differed from many of the cases of known paraquat poisoning, and Chevron probably believed that it could deal with the medical causation claim better if exposure was limited to transdermal absorption on unbroken skin.

  1. Medical causation

Chevron stridently argued that there had been no previous documented cases of pulmonary fibrosis in workers exposed to diluted paraquat on unbroken skin. The manufacturer’s argument was clever by halves.  The following facts were uncontroverted as known at the time of Chevron’s sale of the product:

  • Paraquat causes pulmonary fibrosis in humans.
  • The evidence that established paraquat as a cause of pulmonary fibrosis was largely case series of acute onset of pulmonary fibrosis after ingestion.
  • Paraquat induces pulmonary fibrosis relatively rapidly.
  • Paraquat can be absorbed through the skin.
  • The parties agreed that any type of exposure – ingestion, inhalation, or dermal absorption – could cause lung damage.[19]
  • Once paraquat is ingested, inhaled, or absorbed, it can travel to the lungs.
  • Lung fibrosis caused by dermal absorption of paraquat had been described previously only with skin lesions before or after the injury.[20]
  • The lungs are the target organ for paraquat, regardless of route of administration.
  • There are numerous causes of pulmonary fibrosis (such as asbestosis, scleroderma, rheumatoid arthritis, etc.).
  • The variants of pulmonary fibrosis do not all look alike clinically or pathologically, present alike, or progress alike.
  • Ferebee had no known other disease or exposure that could account for his pulmonary fibrosis.
  • There are cases of pulmonary fibrosis with no identifiable cause, known as idiopathic pulmonary fibrosis (IPF).
  • IPF is relatively rare; it too has a rapid onset and progression, although arguably not as fast as the cases described after exposure to undiluted paraquat.
  • Ferebee’s medical history was largely unhelpful in explaining his clinical course.
  • Ferebee had some shortness of breath before starting to use paraquat.[21]
  • Ferebee used or was exposed to paraquat occasionally over three years before he was diagnosed with pulmonary fibrosis.

These stipulated facts are rarely acknowledged in the discussion of the Ferebee case. The legal implications of these facts are far reaching. General causation in a sense was not contested. Paraquat causes pulmonary fibrosis. The issue was whether diluted paraquat through dermal exposure over three years causes pulmonary fibrosis, and whether this exposure caused Ferebee’s pulmonary fibrosis. Chevron stridently asserted that the “scientific method” required controlled experimental or observational (epidemiologic) studies. The problem with Chevron’s position was that general causation had already been established, and not by analytical epidemiologic studies. General causation between paraquat exposure of any kind and pulmonary fibrosis had been established by case reports, based upon close temporal proximity between exposure and pulmonary toxicity and fibrosis. Animal toxicology and mechanistic studies confirmed the toxicity observed in clinical studies.[22]

Because idiopathic pulmonary fibrosis is rare, the appearance of this disease in a series of exposed workers soon after they were exposed to a specific toxic chemical really did not require the rigors of analytical epidemiology. The causal analysis between paraquat and lung fibrosis was more akin to the analysis that is used to attribute liver failure to herbal exposure than the epidemiologic approach to the relationship between smoking and lung cancer. At the time of Ferebee’s exposure and his litigation, there was no serious dispute that paraquat caused pulmonary fibrosis when inhaled or swallowed, or that paraquat was absorbed dermally, or that the lung was a target organ of paraquat exposure of any sort.

  1. The expert witnesses.

Ferebee was initially treated by Dr. Muhammed Yusuf, a pulmonary specialist, who diagnosed pulmonary fibrosis. Dr. Yusef referred Ferebee to the National Institutes of Health (NIH), where he came under the care of Dr. Ronald G. Crystal of the Heart, Lung, and Blood Institute. (Dr. Crystal is now Chairman of Genetic Medicine at Weill-Cornell Medical College, where he continues to practice pulmonary medicine.)

In the litigation, Chevron called Dr. Carrington, who diagnosed Ferebee with idiopathic pulmonary fibrosis. Dr. Carrington challenged the plaintiffs’ expert witnesses’ opinions for lacking reliance upon controlled observational or experimental studies.[23] Dr. Carrington, however, acknowledged that dermal cases are too rare for observational epidemiologic analysis, but emphasized that no animal studies of sufficient size had been done to support plaintiffs’ hypothesis. Chevron also called a Dr. Fisher, who presented a toxicokinetic (TK) analysis of Ferebee’s dermal absorption. Based upon his TK analysis, Dr. Fisher concluded that the maximal amount of paraquat absorbed by Ferebee was too small, based upon known cases and animal studies, to have caused paraquat toxicity with lung fibrosis.[24]

  1. Chevron’s challenge to plaintiffs’ expert witnesses’ causation opinion.

None of the defendant’s expert witnesses examined Ferebee. The courts thought this was relevant, but the judicial opinions never articulated what would have been observed on physical examination that was important to resolving the differential diagnosis of paraquat toxicity versus IPF. There was no dispute that Ferebee had rapidly progressing pulmonary fibrosis. The expert witnesses on both sides evaluated Ferebee’s clinical data, presentation, clinical course, and arrived at different diagnoses, either paraquat-induced lung fibrosis or IPF. The plaintiffs’ expert witnesses’ diagnosis involved a causal attribution to paraquat exposure; the defendant’s expert witness’s diagnosis of IPF ruled out any causal toxic exposure.

The Ferebee case was litigated under Maryland law because federal statutory law requires state law to control in a wrongful death action arising out of the neglect or wrongful act of another on a federal enclave.[25] The choice of law had implications both for procedural and substantive law. Chevron appears to have relied upon Maryland’s articulation of the Frye general acceptance doctrine, and the courts analyzed Chevron’s arguments as a Frye challenge.[26] Under the Erie doctrine, a federal court should have applied its own procedural law to the case at hand, including Rule 702 of the Federal Rules of Evidence.[27] The use of Maryland law to determine an evidentiary issue in federal court was error.

Chevron pressed its challenge in terms of Maryland’s version of Frye, and not under Federal Rule of Evidence 702. The oft-repeated infamous language used by both the district and the circuit courts was, therefore, not an interpretation of federal law. Rule 702 was never cited or discussed in either the trial or the appellate court’s opinion. This oddity has profound implications for how we evaluate the Ferebee decision, and how it can be cited. Before the Supreme Court decided the Daubert case, the epistemic implications of Rule 702 were largely ignored. Defendants sometimes attempted to press the Frye twilight-zone general acceptance test into a rule of decision that would reject an expert witness’s opinion testimony.[28] The Frye case was decided by a federal appellate court, but superseded by the enactment of Rule 702, in 1975. Ferebee was, of course, decided before the Supreme Court breathed life into Rule 702, but Rule 702 was nonetheless the law when the Ferebee case was litigated.

  1. The judicial resolution of  Chevron’s Frye challenge

The district court insightfully recognized that Chevron was demanding a level of evidence, which had never been required to establish paraquat’s generally accepted ability to cause pulmonary fibrosis. This recognition led to the district court’s rhetorical language:

“It is true that medical expert testimony must be grounded in proper scientific methodology, but the extremely stringent standard that defendant suggests is beyond reason. Product liability law, especially as it relates to relatively new products or those with a relatively rare yet significant danger, would be rendered next to meaningless if a plaintiff could prove he was injured by a product only after a ‘statistically significant’ number of other people were also injured. A civilized legal system does not require that much human sacrifice before it can intervene. The fact that this is the first case of this exact type – or at least the first of its exact type in which the involvement of paraquat was discovered by alert doctors – cannot be enough by itself to shield defendant from liability. Defendant’s experts were not able to fault Dr. Crystal for his basic diagnostic methodology; in fact, they used the same kinds of test results, consultations, and other tools that he did. What they disagreed with chiefly were his conclusions.”[29]

The important observation is that general causation had been established case series and reports of human exposure. There never was statistical evidence that had been evaluated for “significance,” to establish general causation for undiluted paraquat, and the trial court refused, under Maryland law, to require such evidence for general causation for diluted paraquat. In this context, we can see that the trial court’s suggestion that statistical significance was not required has little bearing upon cases in which general causation could only be established using epidemiologic evidence, with its attendant statistical inferences.

Of course, the matter only became worse when Chevron persisted in its argument and presented it to a panel of the D.C. Circuit. The litigants pulled a panel of what can be described as activist judges not known for their scientific acumen. Judge Mikva wrote the opinion for a panel that included Judge Wald, and Senior Judge Bazelon. The panel’s decision ratcheted up the district court’s rhetoric:

“Thus, a cause-effect relationship need not be clearly established by animal or epidemiological studies before a doctor can testify that, in his opinion, such a relationship exists. As long as the basic methodology employed to reach such a conclusion is sound, such as use of tissue samples, standard tests, and patient examination, product liability does not preclude recovery until a ‘statistically significant’ number of people have been injured or until science has had the time and resources to complete sophisticated laboratory studies of the chemical. In a courtroom, the test for allowing a plaintiff to recover is not scientific certainty, but legal sufficiency; if reasonable jurors could conclude from the expert testimony that paraquat more likely than not caused Ferebee’s injury, the fact that another jury might reach the opposite conclusion or that science would require more evidence before conclusively considering the causation question resolved is irrelevant. That Ferebee’s case may have been the first of its exact type, or that his doctors may have been the first alert enough to recognize such a case, does not mean that the testimony of those doctors, who are concededly well qualified in their fields, should not have been admitted.”[30]

Judge Mikva’s dichotomy between levels of certainty needed in science and in the law was false. On behalf of the plaintiff, Dr. Crystal had done much more than give a clinical diagnosis. His assessment of causality was informed by case series of exposure and lung fibrosis, along with physiological evidence of oral, inhalational, and dermal absorption and distribution to the lungs, with toxic effect soon after exposure.

The appellate court’s dismissive attitude towards statistically significant evidence is severely limited to the factual context of a causal analysis that had been made by scientists, to everyone’s satisfaction, for undiluted paraquat, without the need for epidemiologic, statistical evidence. Statistical significance was never really at issue. In this way, Ferebee resembles the untoward dictum on statistical significance from Matrixx Initiatives Inc. v. Siracusano,[31] where the Court held that causation was not at issue.

In Ferebee, causation was very much at issue, but it had been well established – and the subject of warnings – based upon clinical case reports of paraquat exposure and rapid development of lung fibrosis. Dermal absorption and systemic distribution with toxic effects in the lungs were well established, and not the stuff of epidemiologic proofs.

In both Ferebee and Matrixx Initiatives, statistical significance was never really at issue. In Ferebee, there was no statistical evidence needed or used to reach causal conclusions about paraquat’s ability to induce pulmonary fibrosis. In Matrixx Initiatives, allegations of statistical significance and causation were not necessary because the plaintiffs needed only to allege materiality of the facts suppressed by the company in order to plead a securities fraud case. The FDA could impose warnings or require a product recall on evidence that fell well short of establishing causality. Materiality thus could be established without causation, and neither causation nor statistical significance needed to be alleged.

As for Chevron’s Frye challenge, the district court rejected the implied call for a vote on the general acceptance of Dr. Crystal’s reasoning. Frye may require “vote counting” of some sort, but the process becomes irrelevant when virtually no one has registered to vote. Otherwise, both the defense and plaintiffs’ expert witnesses were indeed using the same technique of arguing by analogy to accepted cases of paraquat poisoning or IPF. Dr. Crystal opined that Ferebee’s case was “similar” to three other cases he had identified. Dr. Carrington argued that Ferebee’s case was more like IPF cases, although IPF cases themselves have some clinical heterogeneity as well. Most reported paraquat cases described onset of toxicity to death as a very rapid process. Ferebee did not present with significant symptoms for three years after his first exposure, and then he survived for another two plus years. Ferebee did not report skin lesions, which had been reported in previous cases of dermal exposure leading up to pulmonary fibrosis. On the other hand, there was no precise exposure assessment for Ferebee’s absorption of paraquat. The case presented, on the diagnostic level, with the implied causality, a difficult call, but it is easy to understand the courts’ impatience with the defendant’s insistence upon more stringent criteria and evidence than was used to establish the causal connection with undiluted paraquat. The ability of paraquat to cause pulmonary fibrosis had been well established based upon case reports, including case reports of dermal exposure to open sores, with documented systemic distribution with specific toxicity to the lung, regardless of the route of administration.

  1. Expert witness qualifications.

Chevron never challenged Dr. Yusuf’s or Dr. Crystal’s qualifications, both of whom were highly accomplished and respected clinicians and scientists. Neither was a “hired gun.” The oft-quoted comments about expert witness qualifications were made in the context of describing the appellate court’s standard of review, and the court’s role in not assessing credibility or weighing the evidence:

“These admonitions apply with special force in the context of the present action, in which an admittedly dangerous chemical is alleged through long-term exposure to have caused disease. Judges, both trial and appellate, have no special competence to resolve the complex and refractory causal issues raised by the attempt to link low-level exposure to toxic chemicals with human disease. On questions such as these, which stand at the frontier of current medical and epidemiological inquiry, if experts are willing to testify that such a link exists, it is for the jury to decide whether to credit such testimony.”[32]

Remarkably, this language has been mistakenly invoked as a standard for trial courts to use in determining the admissibility of expert witness opinion testimony. It is no such thing. Some other observations are in order. Although Ferebee worked with diluted paraquat, his exposures were hardly low level. He described himself as drenched in the herbicide, without protective gear, and without his governmental supervisors ever directing him to shower and change clothing.

  1. Preemption and Warnings Causation.

Ultimately, Chevron’s preemption defense was rejected by both the district and the circuit court. The defense’s claim of FIFRA preemption might have gone very differently today, after the Supreme Court’s decisive application of preemption to FIFRA labeling of glyphosate.[33]

Even more important in evaluating liability is the emphasis that both the district and the appellate courts gave to the important role of the employer in the case. The evidence showed that there was indeed a warning label that Ferebee had never read. The plaintiff’s case was thus in jeopardy of failing to show proximate causation between an allegedly inadequate warning and harm. The courts, however, emphasized the role that the employer, through its supervisors and responsible co-workers, play in the complex organizational situation of a modern workplace:

“Mr. Ferebee’s situation was quite different, however. He did not purchase paraquat for his personal use; rather, it was provided to him by his employer for use on the job. The evidence showed that his principal source of information about paraquat was the oral instructions of his supervisors and co-workers, not the written label. He learned from them how to mix the product and how to spray it. It was also from this source that he learned of the danger of getting the product in his mouth: one of his co-workers warned him that if he accidently swallowed paraquat, it would ‘get in his blood’ and poison him. This is a common pattern of instruction and use of occupational materials in the workplace. Learning by doing and learning by oral instruction are tried and true methods of educating manual workers in their jobs. Therefore, although it is crucial to plaintiff’s case that someone would have read the label, it was not necessary for Mr. Ferebee to have done so. And it is obvious that one or more employees at BARC did read the label, since information did reach Mr. Ferebee about the proportions for diluting the product and about the dangers about which the label did warn. It was appropriate for the jury to infer that a warning about the danger of fatal lung disease from dermal exposure would also have been communicated to Mr. Ferebee. See Restatement (Second) of Torts § 388 comment n (seller normally entitled to assume that adequate warning will be passed on by purchaser to ultimate user); cf. Chambers v. G.D. Searle & Co., 441 F.Supp. at 381 (in product liability case involving prescription drug, relevant warning is the one given to doctor, not patient).”[34]

There is significant irony in that the Ferebee case has been the subject of serious criticism from defense counsel, and yet it embraced Section 388, comment n, as well as applied the learned or sophisticated intermediary principles to a case not involving prescription drugs. The appellate court waxed enthusiastic about the principles of Section 388, and went so far as to cite the late Victor Schwartz in support:

“We live in an organizational society in which traditional common-law limitations on an actor’s duty must give way to the realities of society. *** In this case, Mr. Ferebee did not purchase the paraquat for his personal use, and there was substantial evidence that workplace communication about the dangers associated with various chemicals usually took the form of oral instructions from supervisors to workers, the latter of whom then retransmitted the information to co-workers. This, rather than individual reading of product warnings, is a typical method by which information is disseminated in the modern workplace. See Schwartz & Driver, “Warnings in the Workplace: The Need for a Synthesis of Law and Communication Theory,” 52 U. Cinn. L. Rev. 38, 66-83 (1983). The requirement that an improper warning proximately ‘cause’ the injury should be elaborated against this background. We believe Maryland would construe its tort law in this case to require only that someone in the workplace have read the label, not that Mr. Ferebee personally have read it. Because there is no dispute that one or more employees at BARC did read the label, we hold that the jury could properly have inferred that, had a warning about the danger of disease from dermal exposure been included on the label, that warning would have been communicated to Mr. Ferebee and that he would as a result have acted differently. Alternatively, the jury could have inferred that an adequate warning would have led Ferebee’s employers to undertake steps that would have protected him from paraquat poisoning-for example, provision of showers for use after spraying.”[35]

Judge Mikva’s prediction, of course, was accurate; Maryland tort law did, soon thereafter, embrace the sophisticated intermediary defense to exculpate the defendant in such remote supplier situations.[36] The principle invoked to excuse plaintiff from reading the warning label also works to exculpate the defendant when that warning label is otherwise adequate, or when the intermediary knows of the hazard in any event. Given that the employer was the federal government, including the scientists at EPA, OSHA, the National Institutes of Health, and the Public Health Service, as well as the plaintiff’s principal expert witness (Dr. Crystal), the employer had complete and superior knowledge to the seller about the known or knowable effects of diluted paraquat.[37]


[1]  Nathan Schachtman, Wells v. Ortho Pharmaceutical Corporation -A Dred Scott Case in Science Jurisprudence, ResearchGate (June 2026); DOI: 10.13140/RG.2.2.30242.18880

[2] Ferebee v. Chevron Chem. Co., 552 F. Supp. 1297 (D.D.C. 1982), aff’d, 736 F.2d 529 (D.C. Cir.), cert. denied, 469 U.S. 1062 (1984).

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

[4] Willis Electric Co., Ltd. v. Polygroup Ltd., 166 F. 4th 1363, 1379, 1380-81 (Fed. Cir. 2026) (citing Ferebee, and declaring that the validity of assumptions underlying an expert witness’s methodology were fact questions for the jury, and not a a proper basis for excluding the challenged expert witness testimony). See also Barry v. DePuy Synthes Cos., 164 F.4th 896, 912 (Fed. Cir. 2026) (characterizing expert witness challenges to “purported flaws” in methodology as objections that “go to the weight the jury might accord to that evidence and not to its admissibility.”)

[5] Ferebee, 736 F.2d at 1531-32.

[6] Id. at 1532.

[7] 552 F. Supp. at 1295 & n. 3.

[8] Ferebee, 552 F. Supp. at 1294-95

[9] Ferebee, 736 F.2d at 1532.

[10] Id.

[11] 7 U.S.C. § 136, et seq.

[12] 7 U.S.C. § 136a(c)(5)(C).

[13] 7 U.S.C. § 136(bb).

[14] 7 U.S.C. § 136(q)(1)(E). See Ferebee 736 F.2d at 1539-40.

[15] 552. F. Supp. at 1304 n.40.

[16] Ferebee, 736 F.2d at 1536.

[17] Id.

[18] 552. F. Supp. at 1295 & n. 3.

[19] Ferebee, 552. F. Supp. at 1300 & n.28.

[20] Ferebee, 736 F.2d at 1538.

[21] Ferebee, 552. F. Supp. at 1295.

[22] See generally Leah Utyasheva, Prabath Amarasinghe & Michael Eddleston, Paraquat at 63 – the story of a controversial herbicide and its regulations: It is time  to put people and public health first when regulating paraquat, 25 BMC PUB. HEALTH 3089 (2025).

[23]  Ferebee, 552. F. Supp. at 1301.

[24] Id.

[25] 16 U.S.C. § 457; Ferebee, 736 F.2d at 1533.

[26] Ferebee, 552 F. Supp. at 1301; 736 F.2d at 1535.

[27] Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 589 & n.6 (1993). See also Cavallo v. Star Enterprise, 100 F.3d 1150, 1157-58 (4th Cir. 1996); Amorgianos v. National Railroad Passenger Corp., 303 F.3d 256 (2d Cir. 2002); Legg v. Chopra, 286 F.3d 286, 289-92 (6th Cir. 2002). See Erie R.R. Co. v. Tompkins, 304 U.S. 64 (1938); Hanna v. Plumer, 380 U.S. 460, 470 (1965) (Erie does not displace the application of federal procedural rules in federal courts).

[28] Frye v. United States, 293 F. 1013, 1014 (D.C.Cir.1923).

[29] Ferebee, 552 F. Supp. at 1301.

[30] Ferebee, 736 F.2d at 1535-36 (emphasis in original).

[31] 563 U.S. 27 (2011). See Nathan Schachtman & David Venderbush, Matrixx Unbounded:  High Court’s Ruling Needlessly Complicates Scientific Evidence Principles, 26(4) WASH. LEG. FDTN. LEG. BACKGROUNDER (2011).

[32] Ferebee, 736 F.2d at 1534.

[33] Monsanto v. Durnell, ___ U.S. ___, Slip op. (June 25, 2026), available at https://www.supremecourt.gov/opinions/25pdf/24-1068_n7ip.pdf

[34] Ferebee, 552 F. Supp. at 1303-04 (internal citations omitted).

[35] Ferebee, 736 F.2d at 1539 (emphasis in original; internal citation omitted).

[36] See, e.g., Kennedy v. Mobay Corp., 84 Md. App. 397 (1990) (applying sophisticated user defense to bar claims against manufacturers of toluene diisocyanate), aff’d, 325 Md. 385 (1992); Higgins v. E.I. DuPont de Nemours, Inc., 671 F. Supp. 1055 (D. Md. 1987) (Maryland law; holding that manufacturer of paint was in better position than bulk supplier to communicate warnings to customers’ employees), aff’d, 863 F.2d 1162 (4th Cir. 1988).

[37] See Miller v. Diamond Shamrock Co., 275 F.3d 414, 422-23 (5th Cir. 2001) (“There can be no reasonable dispute that knowledge possessed by the United States Public Health Service, … [and] the Navy’s Bureau of Medicine and Surgery is the knowledge of the military.”).

The American Public Health Association – Lawsuit Industry Affiliate

June 14th, 2026

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What follows from these contentions? 

“Therefore, APHA:”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                                     * * * * * * *

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

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

                                     * * * * * * *

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


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

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

[3] Id.

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

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

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

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

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

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

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

How Science Works in the New Reference Manual on Scientific Evidence

March 12th, 2026

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Funding Bias – The New McCarthyism

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

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

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

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

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

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

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

STATISTICS DONE POORLY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

META-SHMETA-ANALYSIS

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

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

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

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

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

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

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

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

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

VIRTUE SIGNALING

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

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


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

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

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

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

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

[6] W&T at 72-75.

[7] W&T at 81.

[8] W&T at 81.

[9] W&T at 81 & n.85 (emphasis added), citing Naomi Oreskes & Erik M. Conway, MERCHANTS OF DOUBT: HOW A HANDFUL OF SCIENTISTS OBSCURED THE TRUTH ON ISSUES FROM TOBACCO SMOKE TO GLOBAL WARMING (2010).

[10] W&T at 94-96.

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

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

[13] W&T at 95.

[14] W&T at 55.

[15] W&T at 63, 68.

[16] W&T at 68.

[17] W&T at 65.

[18] W&T at 70.

[19] W&T at 71.

[20] W&T at 66.

[21] W&T at 75.

[22] W&T at 49.

[23] W&T at 83.

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

[25] W&T at 99-100.

[26] W&T at 99.

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

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

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

[30] W&T at 76.

[31] Kenneth J. Rothman, “Conflict of interest: the new McCarthyism in science,” 269 J. AM. MED. ASS’N 2782 (1993). See Schachtman, The Rhetoric and Challenge of Conflicts of Interest, TORTINI (July 30, 2013).

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

[33] W&T at 77.

[34] W&T at 59-60.

[35] W&T at 59-60.

[36] W&T at 76.

[37] W&T at 111.

[38] W&T at 87.

[39] W&T at 90.

[40] W&T at 88.

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

[42] W&T at 88.

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

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

[45] W&T at 99.

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

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

[48] Id. at 373.

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

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

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

[52] Report, Table 22.

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

[54] W&T at 84.

[55] W&T at 50.

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

[57] W&T at 102.

Reference Manual’s Chapter on Expert Witness Testimony Admissibility – Part 5

March 7th, 2026

By ignoring Milward’s expert witnesses’ omissions from, and abridgements of, WOE and IBE, the appellate court blinded itself to these witnesses’ distortions of scientific method. The need for judgment, which the Milward court was keen to honor, does not mean that there are not aberrant or deviant judgments, or deviations from the standard of scientific care that are disqualifying. The need for judgment must also allow for equipoise and uncertainty that stands in the way of an inculpatory or exonerative verdict. And then there is the business of questionable research practices that subvert causal judgment. The district court had followed and acknowledged the showing of questionable research practices that pervaded Martyn Smith’s for-litigation opinions. The cheerleaders for Milward seem eager to obscure these practices by their insistence that causation is, after all, only a judgment.

The Milward decision, in its embrace of some truly aberrant methodology and judgment, and some absence of methodology, made some of its own whoopers. Martyn Smith’s incompetent analyses of the epidemiologic evidence had been thoroughly debunked in the district court, but the circuit court glibly adopted Smith’s characterizations. The appellate court failed to understand and come to grips with Smith’s rejiggering of data, and his inconsistently redefining exposures and outcomes in epidemiologic studies to make up new, fanciful results that favored his WOE-ful opinion. The appellate court also failed to understand that scientific judgment is not some vague, amorphous, unstructured decision that turns on whatever looks to be “explanatory.” Even the International Agency for Research on Cancer, which issues hazard classifications that are distorted by non-scientific precautionary principle reasoning, insists that three streams of evidence (epidemiologic, toxicologic, mechanistic) be considered separately, in accordance with criteria, with attention to the validity of each study, and synthesized into a judgment of causality following a carefully structured analysis.[1]

The appellate court in Milward took the demonstration of Smith’s failure to calculate odds ratios correctly to be something that merely went to the weight, not the admissibility, on the theory that a jury, which does not have access to the Reference Manual or to the actual studies as published, could sort it all out. And yet, when the court improvidently set out a definition of what an odds ratio is, it bungled the definition beyond understanding:

“An odds ratio represents the difference in the incidence of a disease between a population that has been exposed to benzene and one that has not.”[2]

The court’s definition is not even wrong. The difference between incidence of a disease in an exposed group and a non-exposed group is the risk difference. It is not an odds ratio. Perhaps the court might have realized what most third graders know, that there is a difference between a ratio (division) and a difference (subtraction). And of course, the odds of exposure is not the same as the incidence of a disease. The relevant odds ratio represents the odds of exposure in cases with APML diagnoses divided by the odds of exposure in study subjects without APML. The odds ratio does involve measurements of incidence although in some cases the odds ratio will approximate a risk ratio, which does involve a ratio of incidences. This is not some hyper-technicality; it is a vivid display that Chief Judge Lynch, writing for a panel of three judges of the First Circuit, had no idea of what she was reviewing or writing.

Richter and Capra devote two pages to a discussion of the Milward case and its embrace of WOE and IBE. There is not, in this discussion, a single adjective of approval or of disapproval. The attention to this one intermediate appellate court opinion far exceeds any other case decided at a level below the Supreme Court, and an engaged reader must ask why the authors of the first chapter of the new Reference Manual wrote about this case at all, especially given the 2023 amendments to Rule 702, which would suggest that Milward was bad law when decided in 2011, and clearly and emphatically bad law in December 2025, when the new Manual was published.

The chapter provides one not-so-subtle clue of the authors’ intent. At the conclusion of their extended, uncritical, and incomplete exposition of Milward,[3] Richter and Capra refer the reader to a law review symposium,[4] “[f]or a detailed analysis of the Milward decision and the weight of the evidence approach to scientific reasoning.” Like Richter and Capra’s coverage of Milward, the cited symposium was hardly an objective analysis; rather, it was more like a drunken celebration at a family reunion.

There have been many law review articles that have discussed the Milward case, but Richter and Capra chose to cite to one particular symposium, which was sponsored by two corporations, the Center for Progressive Reform (CPR) and the Robert A. Habush Foundation. The Center for Progressive Reform (CPR) is a not-for-profit corporation. Its website describes the CPR as a “research and advocacy organization that works in the service of responsive government; climate justice, mitigation, and adaptation; and protecting against environmental harm.”[5] CPR describes one of its key activities as defending science from corporate interference. Presumably its own corporate activities and those of the lawsuit industry are acceptable, but those of corporate manufacturing industry are not. From reviewing CPR’s website, it is not clear that the CPR believes manufacturing corporations should even be allowed to defend against lawsuits. Milward’s retained expert witness Carl Cranor is a “member scholar” at CPR, which makes CPR’s sponsorship of the symposium rather incestuous.[6]

CPR is also apparently comfortable with one highly politicized “corporation,” namely the American Association for Justice (AAJ), which is the trade group for the American lawsuit industry.[7] The AAJ describes itself as a corporation, or a “collective,” that supports plaintiff trial lawyers as their “collective voice … on Capitol Hill and in courthouses across the nation … .” The Robert A. Habush Foundation is endowed by the AAJ, and serves its “educational” mission.  Through the Habush Foundation, the AAJ funds educational programs, “think tanks,” and writing projects designed to influence judges, law professors, lawyers, and the public, on issues of importance to the AAJ:  “the civil justice system and individual rights” for bigger, better, and more profitable litigation outcomes. The AAJ may be a “not-for-profit” corporation, but it represents the interests of one of the most powerful, wealthiest, interest groups in American society — the plaintiffs’ bar.

The Milward symposium agenda and papers from its participants were published at the website for the Wake Forest Journal of Law and Public Policy, but now are marked as “currently private. If you would like to request access, we’ll send your username to the site owner for approval.”

The symposium cited by Richter and Capra for “analysis,” was very much a family affair. The choice of venue, at the Wake Forest Law School, was connected to the web of interests involved. CPR board member, Sid Shapiro, is a law professor at Wake Forest. Shapiro presented at the symposium, along with the Wake Forest professor Michael Green. Cranor, Shapiro’s CPR colleague, and party expert witness for plaintiff, presented.[8] There was only one practicing lawyer who presented at the symposium, Steven Baughman Jensen, who was a past chair of the AAJ’s Section on Toxic, Environmental, and Pharmaceutical Torts. Jensen represented Milward, and hired Cranor as one of the plaintiff’s expert witnesses. Attorney Jensen’s contribution to the symposium has been published along with Cranor’s as well, in the proceedings of the Milward symposium were published volume 3, no. 1 of the Wake Forest Journal of Law and Public Policy,[9] which is now also marked private. Jensen also published an abbreviated paean to Milward in in the AAJ’s trade journal.[10] No defense counsel or defense expert witness participated at the symposium, referenced by Richter and Capra.

Consistent with the financial, advocacy, and political interests of the symposium sponsors, the articles are almost all partisan high-fives for the Milward decision. Writing for the Federal Judicial Center and the National Academies, the authors of a chapter on the law of expert witnesses, a legal issue, for the Reference Manual, should have been aware of the partisan nature of the CPR-AAJ sponsored symposium. They should have flagged the advocacy nature of the symposium, and identified the funding sources and the conflicts created. Furthermore, Richter and Capra should have cited papers that criticized the Milward case, from various perspectives, including its failure to adhere to the law of Rule 702.[11] Their failure to do so is a significant failure of this chapter.


[1] IARC MONOGRAPHS ON THE IDENTIFICATION OF CARCINOGENIC HAZARDS TO HUMANS – PREAMBLE (2019).

[2] Milward, 639 F.3d at 23.

[3] Richter & Capra at 33n.96 (“For a detailed analysis of the Milward decision and the weight of the evidence approach to scientific reasoning…”).

[4] Symposium: Toxic Tort Litigation: After Milward v. Acuity Products, 3 WAKE FOREST JOURNAL OF LAW & POLICY 1 (2013).

[5] The Center for Progressive Reform, at https://progressivereform.org/, last visited on Feb. 24, 2026

[6] Carl Cranor Biography, Center for Progressive Reform, Member Scholars, at https://progressivereform.org/member-scholars/

[7] The AAJ was previously known by the more revealing name, Association of Trial Lawyers of America (ATLA®). 

[8] Carl F. Cranor, Milward v. Acuity Specialty Products: Advances in General Causation Testimony in Toxic Tort Litigation, 3 WAKE FOREST JOURNAL OF LAW & POLICY 105 (2013).

[9] Steve Baughman Jensen, Sometimes Doubt Doesn’t Sell: A Plaintiffs’ Lawyer’s Perspective on Milward v. Acuity Products, 3 WAKE FOREST JOURNAL OF LAW & POLICY 177 (2013).

[10] Steve Baughman Jensen, Reframing the Daubert Issue in Toxic Tort Cases, 49 TRIAL 46 (Feb. 2013).

[11] 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 .

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 not 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.