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David Egilman, Rest in Peace, Part 3

April 30th, 2024

Egilman was sufficiently clever to discern that if his “method” led to a conclusion that silicone gel breast implants cause autoimmune disease, but the Institute of Medicine, along with court-appointed experts, found no basis for a causal conclusion, then by modus tollens Egilman’s “method” was suspect and must be rejected.[1] This awareness likely explains the extent to which he went to cover up his involvement in the plaintiffs’ causation case in the silicone litigation.

Egilman’s selective leaking of Eli Lilly documents was also a sore point. Egilman’s participation in an unlawful conspiracy was carefully detailed in an opinion by the presiding judge, Hon. Jack Weinstein.[2] His shenanigans were also widely covered in the media,[3] and in the scholarly law journals.[4] When Egilman was caught with his hand in the cookie jar, and conspiring to distribute confidential Zyprexa documents to the press, he pleaded the fifth amendment. The proceedings did not go well, and Egilman ultimately stipulated to his responsibility for violating a court order, and agreed to pay a monetary penalty of $100,000. Egilman’s settlement was prudent. The Court of Appeals affirmed sanctions against Egilman’s co-conspirator, for what the court described as “brazen” conduct.[5]

 

Despite being a confessed contemnor, Egilman managed to attract a fair amount of hagiographic commentary.[6] An article in Science, described Egilman as “the scourge of companies he accuses of harming public health and corrupting science,”[7] and quoted fawning praise from his lawsuit industry employers: “[h]e’s a bloodhound who can sniff out corporate misconduct better than security dogs at an airport,”[8] In 2009, a screen writer, Patrick Coppola, announced that he was developing a script for a “Doctor David Egilman Project”. A webpage (still available on the Way-Back machine)[9] described the proposed movie as Erin Brockovich meets The Verdict. Perhaps it would have been more like King Kong meets Lenin in October.

After I started my blog, Tortini, in 2010, I occasionally commented upon David Egilman. As a result, I received occasional emails from various correpondents about him. Most were lawyers aggrieved by his behavior at deposition or in trial, or physicians libeled by him. I generally discounted those partisan and emotive accounts, although I tried to help by sharing transcripts from Egilman’s many testimonial adventures.

One email correspondent was Dennis Nichols, a well-respected journalist from Cincinnati, Ohio. Nichols had known Egilman in the early 1980s, when he was at NIOSH, in Cincinnait. Nichols had some interests in common with Egilman, and had socialized with him 40 years ago. Dennis wondered what had become of Egilman, and one day, googled Egilman, and found my post “David Egilman’s Methodology for Divining Causation.”  Nichols found my description of Egilman’s m.o. consistent with what he remembered from the early 1980s. In the course of our correspondence, Dennis Nichols shared his recollections of his interactions with the very young David Egilman. Dennis Nichols died in February 2022,[10] and I am taking the liberty of sharing his first-hand account with a broader audience.

“I met David Egilman only two or three times, and that was more than 30 years ago, when he was an epidemiologist at NIOSH. When I remarked on the content of conversation with him in about 1990, he and a lawyer representing him threatened to sue me for libel, to which I picked up the gauntlet. I had a ‘blood from the turnip’ defense to accompany my primary defense of truth, and besides, Egilman was widely known as a Communist.

I had lunch with Egilman in a Cincinnati restaurant in 1982 after someone suggested that he might be interested in supporting an arts and entertainment publishing venture that I was involved with, called The Outlook; notwithstanding that I was a conservative, The Outlook leaned left, and its key staff were Catholic pacifists and socialists. Over lunch, Egilman explained to me that he considered himself a Marxist-Leninist, his term, and that the day would come when people like him would have to kill people like me, again his language.

He subsequently invited me and the editor of The Outlook to a reception he had at his house on Mt. Adams, a Cincinnati upscale and Bohemian neighborhood, or at least as close as Cincinnati gets to Bohemian, where he served caviar that he had brought back from his most recent trip to Moscow and displayed poster-size photographs of Lenin, Marx, Stalin, Luxemburg, Gorky and other heroes of the Soviet Union and Scientific Socialism. I do not recall that Egilman admired Mao; the USSR had considerable tension in those years with China, and Egilman was clearly in the USSR camp in those days of Brezhnev, and he said so. Egilman said he traveled often to the Soviet Union, I think in the course of his work, which probably was not common in 1982.

The Outlook editor had met Egilman in the course of his advocacy journalism in reporting on the Fernald Feed Materials Production Center, now closed, which processed fuel cores for nuclear weapons.

Probably none of this matters a generation later, but is just nostalgia about an old communist and his predations before he got into exploiting medical mal. May he rot.”[11]

The account from Mr. Nichols certainly rings true. From years of combing over Egilman’s website (before he added password protection), anyone could see that he viewed litigation as class warfare that would advance his political goals. Litigation has the advantage of being lucrative, and bloodless, too – perfect for fair-weather Marxists.

Did Egilman remain a Marxist into the 1990s and the 21st century? Does it matter?

If Egilman was as committed to Marxist doctrine as Mr. Nichols suggests, he would have recognized that, as an expert witness, he needed to tone down his public rhetoric. Around the time I corresponded with Mr. Nichols, I saw that Egilman was presenting to the Socialist Caucus of the American Public Health Association (2012-13). Egilman always struck me as a bit too pudgy and comfortable really to yearn for a Spartan workers’ paradise. In any event, Egilman was probably not committed to the violent overthrow of the United States government because he had found a better way to destabilize our society by allying himself with the lawsuit industry. The larger point, however, is that political commitments and ideological biases are just as likely to lead to motivated reasoning, if not more so.

Although Egilman’s voice needed no amplification, he managed to turn up the wattage of his propaganda by taking over the reins, as editor in chief, of a biomedical journal. The International Journal of Occupational and Environmental Health (IJOEH) was founded and paid for by Joseph LaDou, in 1995. By 2007, Egilman had taken over as chief editor. He ran the journal out of his office, and the journal’s domain was registered in his name. Egilman published frequently in the journal, which became a vanity press for his anti-manufacturer, pro-lawsuit industry views. His editorial board included such testifying luminaries as Arthur Frank, Barry S. Levy, and David Madigan.

Douglas Starr, in an article in Science, described IJOEH as having had a reputation for opposing “mercenary science,” which is interesting given that Egilman, many on his editorial board, and many of the authors who published in IJOEH were retained, paid expert witnesses in litigation. The journal itself could not have been a better exemplar[12] of mercenary science, in support of the lawsuit industry.

In 2015, IJOEH was acquired by the Taylor & Francis publishing group, which, in short order, declined to renew Egilman’s contract to serve as editor. The new publisher also withdrew one of Egilman’s peer-reviewed papers that had been slated for publication. Taylor & Francis reported to the blog Retraction Watch that Egilman’s article had been “published inadvertently, before the review process was completed,” and was later deemed “unsuitable for publication.”[13] Egilman and his minions revolted, but Taylor & Francis held the line and retired the journal.[14]

Egilman recovered from the indignity foisted upon him by Taylor & Francis, by finding yet another journal, the Journal of Scientific Practice and Integrity (JOSPI).[15] Egilman probably said all that was needed to describe the goals of this new journal by announcing that the

Journal’s “partner” was the Collegium Ramazzini. Egilman of course was the editor in chief, with an editorial board made up of many well-known, high-volume testifiers for the lawsuit industry: Adriane Fugh-Berman, Barry Castleman, Michael R. Harbut, Peter Infante, William E. Longo, David Madigan, Gerald Markowitz, and David Rosner.

Some say that David Egilman was a force of nature, but so are hurricanes, earthquakes, volcanoes, and pestilences. You might think I have nothing good to say about David Egilman, but that is not true. The Lawsuit Industry has often organized and funded mass radiographic and other medical screenings to cull plaintiffs from the population of workers.[16] Some of these screenings led to the massive filing of fraudulent claims.[17] Although he was blind to many of the excesses of the lawsuit industry, Egilman spoke out against attorney-sponsored and funded medico-legal screenings. He published his criticisms in medical journals,[18] and he commented freely in lay media. He told one reporter that “all too often these medical screenings are little more than rackets perpetrated by money-hungry lawyers. Most workers usually don’t know what they’re getting involved in.”[19] Among the Collegium Ramazzini crowd, Egilman was pretty much a lone voice of criticism.

[1] See “David Egilman’s Methodology for Divining Causation,” Tortini (Sept. 6, 2012).

[2] In re Zyprexa Injunction, 474 F.Supp. 2d 385 (E.D.N.Y. 2007). The Zyprexa case was not the first instance of Egilman’s involvement in a controversy over a protective order. Ballinger v. BrushWellman, Inc., 2001 WL 36034524 (Colo. Dist. June 22, 2001), aff’d in part and rev’d in part, 2002 WL 2027530 (Colo. App. Sept. 5, 2002) (unpublished).

[3] “Doctor Who Leaked Documents Will Pay $100,000 to Lilly,” N. Y. Times (Sept. 8, 2007).

[4] William G. Childs, “When the Bell Can’t Be Unrung: Document Leaks and Protective Orders in Mass Tort Litigation,” 27 Rev. Litig. 565 (2008).

[5] Eli Lilly & Co. v. Gottstein, 617 F.3d 186, 188 (2d Cir. 2010).

[6] Michelle Dally, “The Hero Who Wound Up On the Wrong Side of the Law,” Rhode Island Monthly 37 (Nov. 2001).

[7] Douglas Starr, “Bearing Witness,” 363 Science 334 (2019).

[8] Id. at 335 (quoting Mark Lanier, who fired Egilman for his malfeasance in the Zyprexa litigation).

[9] Doctor David Egilman Project, at <https://web.archive.org/web/20130902035225/http://coppolaentertainment.com/ddep.htm>.

[10] Bill Steigerwald, “The death of a great Ohio newspaperman,” (Feb. 08, 2022) (“Dennis Nichols of Cincinnati’s eastern suburbs was a dogged, brilliant and principled journalist who ran his family’s two community papers and gave the local authorities all the trouble they deserved.); John Thebout, Village of Batavia Mayor, “Batavia Mayor remembers Dennis Nichols,” Clermont Sun (Feb. 9, 2022).

[11] Dennis Nichols email to Nathan Schachtman, re David Egilman (Mar. 9, 2013)

[12] Douglas Starr, “Bearing Witness,” 363 Science 334, 337 (2019).

[13] See “Public health journal’s editorial board tells publisher they have ‘grave concerns’ over new editor,” Retraction Watch (April 27, 2017).

[14] “David Egilman and Friends Circle the Wagon at the IJOEH,” Tortini (May 4, 2017).

[15] See “A New Egilman Bully Pulpit,” Tortini (Feb. 19, 2020).

[16] Schachtman, “State Regulators Impose Sanction Unlawful Screenings 05-25-07,” Washington Legal Foundation Legal Opinion Letter, vol. 17, no. 13 (May 2007); Schachtman, “Silica Litigation – Screening, Scheming, and Suing,” Washington Legal Foundation Critical Legal Issues Working Paper (December 2005); Schachtman & Rhodes, “Medico-Legal Issues in Occupational Lung Disease Litigation,” 27 Seminars in Roentgenology 140 (1992).

[17] In re Silica Prods. Liab. Litig., 398 F. Supp. 2d 563 (S.D. Tex. 2005) (Jack, J.).

[18] See David Egilman and Susanna Rankin Bohme, “Attorney-directed screenings can be hazardous,” 45 Am. J. Indus. Med. 305 (2004); David Egilman, “Asbestos screenings,” 42 Am. J. Indus. Med. 163 (2002).

[19] Andrew Schneider, “Asbestos Lawsuits Anger Critics,” St. Louis Post-Dispatch (Feb. 11, 2003).

Posted in Cognitive Biases, Conflicts of Interest, Expert Witnesses, Public Nuisances, Scientific Publishing | 41 Comments »

Access to a Study Protocol & Underlying Data Reveals a Nuclear Non-Proliferation Test

April 8th, 2024

The limits of peer review ultimately make it a poor proxy for the validity tests posed by Rules 702 and 703. Published peer review articles simply do not permit a very searching evaluation of the facts and data of a study. In the wake of the Daubert decision, expert witnesses quickly saw that they can obscure the search for validity by the reliance upon published studies, and frustrate the goals of judicial gatekeeping. As a practical matter, the burden shifts to the party that wishes to challenge the relied upon facts and data to learn more about the cited studies to show that the facts and data are not sufficient under Rule 702(b), and that the testimony is not the product of reliable methods under Rule 702(c). Obtaining study protocols, and in some instances, underlying data, are necessary for due process in the gatekeeping process. A couple of case studies may illustrate the power of looking under the hood of published studies, even ones that were peer reviewed.

When the Supreme Court decided the Daubert case in June 1993, two recent verdicts in silicone-gel breast implant cases were fresh in memory.[1] The verdicts were large by the standards of the time, and the evidence presented for the claims that silicone caused autoimmune disease was extremely weak. The verdicts set off a feeding frenzy, not only in the lawsuit industry, but also in the shady entrepreneurial world of supposed medical tests for “silicone sensitivity.”

The plaintiffs’ litigation theory lacked any meaningful epidemiologic support, and so there were fulsome presentations of putative, hypothetical mechanisms. One such mechanism involved the supposed in vivo degradation of silicone to silica (silicon dioxide), with silica then inducing an immunogenic reaction, which then, somehow, induced autoimmunity and the induction of autoimmune connective tissue disease. The degradation claim would ultimately prove baseless,[2] and the nuclear magnetic resonance evidence put forward to support degradation would turn out to be instrumental artifact and deception. The immunogenic mechanism had a few lines of potential support, with the most prominent at the time coming from the laboratories of Douglas Radford Shanklin, and his colleague, David L. Smalley, both of whom were testifying expert witnesses for claimants.

The Daubert decision held out some opportunity to challenge the admissibility of testimony that silicone implants led to either the production of a silicone-specific antibody, or the induction of t-cell mediated immunogenicity from silicone (or resulting silica) exposure. The initial tests of the newly articulated standard for admissibility of opinion testimony in silicone litigation did not go well.[3]  Peer review, which was absent in the re-analyses relied upon in the Bendectin litigation, was superficially present in the studies relied upon in the silicone litigation. The absence of supportive epidemiology was excused with hand waving that there was a “credible” mechanism, and that epidemiology took too long and was too expensive. Initially, post-Daubert, federal courts were quick to excuse the absence of epidemiology for a novel claim.

The initial Rule 702 challenges to plaintiffs’ expert witnesses thus focused on  immunogenicity as the putative mechanism, which if true, might lend some plausibility to their causal claim. Ultimately, plaintiffs’ expert witnesses would have to show that the mechanism was real by showing that silicone exposure causes autoimmune disease through epidemiologic studies,

One of the more persistent purveyors of a “test” for detecting alleged silicone sensitivity came from Smalley and Shanklin, then at the University of Tennessee. These authors exploited the fears of implant recipients and the greed of lawyers by marketing a “silicone sensitivity test (SILS).” For a price, Smalley and Shanklin would test mailed-in blood specimens sent directly by lawyers or by physicians, and provide ready-for-litigation reports that claimants had suffered an immune system response to silicone exposure. Starting in 1995, Smalley and Shanklin also cranked out a series of articles at supposedly peer reviewed journals, which purported to identify a specific immune response to crystalline silica in women who had silicone gel breast implants.[4] These studies had two obvious goals. First, the studies promoted their product to the “silicone sisters,” various support groups of claimants, as well as their lawyers, and a network of supporting rheumatologists and plastic surgeons. Second, by identifying a putative causal mechanism, Shanklin could add a meretricious patina of scientific validity to the claim that silicone breast implants cause autoimmune disease, which Shanklin, as a testifying expert witness, needed to survive Rule 702 challenges.

The plaintiffs’ strategy had been to paper over the huge analytical gaps in their causal theory with complicated, speculative research, which had been peer reviewed and published. Although the quality of the journals was often suspect, and the nature of the peer review obscure, the strategy had been initially successful in deflecting any meaningful scrutiny.

Many of the silicone cases were pending in a multi-district litigation, MDL 926, before Judge Sam Pointer, in the Northern District of Alabama. Judge Pointer, however, did not believe that ruling on expert witness admissibility was a function of an MDL court, and by 1995, he started to remand cases to the transferor courts, for those courts to do what they thought appropriate under Rules 702 and 703. Some of the first remanded cases went to the District of Oregon, where they landed in front of Judge Robert E. Jones. In early 1996, Judge Jones invited briefing on expert witness challenges, and in face of the complex immunology and toxicology issues, and the emerging epidemiologic studies, he decided to appoint four technical advisors to assist him in deciding the challenges.

The addition of scientific advisors to the gatekeeper’s bench made a huge difference in the sophistication and detail of the challenges that could be lodged to the relied-upon studies. In June 1996, Judge Jones entertained extensive hearings with viva voce testimony from both challenged witnesses and subject-matter experts on topics, such as immunology and nuclear magnetic resonance spectroscopy. Judge Jones invited final argument in the form of videotaped presentations from counsel so that the videotapes could be distributed to his technical advisors later in the summer. The contrived complexity of plaintiffs’ case dissipated, and the huge analytical gaps became visible. In December 1996, Judge Jones issued his decision that excluded the plaintiffs’ expert witnesses’ proposed testimony on grounds that it failed to satisfy the requirements of Rule 702.[5]

In October 1996, while Judge Jones was studying the record, and writing his opinion in the Hall case, Judge Weinstein, with a judge from the Southern District of New York, and another from New York state trial court, conducted a two-week Rule 702 hearing, in Brooklyn. Judge Weinstein announced at the outset that he had studied the record from the Hall case, and that he would incorporate it into his record for the cases remanded to the Southern and Eastern Districts of New York.

Curious gaps in the articles claiming silicone immunogenicity, and the lack of success in earlier Rule 702 challenges, motivated the defense to obtain the study protocols and underlying data from studies such as those published by Shanklin and Smalley. Shanklin and Smalley were frequently listed as expert witnesses in individual cases, but when requests or subpoenas for their protocols and raw data were filed, plaintiffs’ counsel stonewalled or withdrew them as witnesses. Eventually, the defense was able to enforce a subpoena and obtain the protocol and some data. The respondents claimed that the control data no longer existed, and inexplicably a good part of the experimental data had been destroyed. Enough was revealed, however, to see that the published articles were not what they claimed to be.[6]

In addition to litigation discovery, in March 1996, a surgeon published the results of his test of the Shanklin-Smalley silicone sensitivity test (“SILS”).[7] Dr. Leroy Young sent the Shanklin laboratory several blood samples from women with and without silicone implants. For six women who never had implants, Dr. Young submitted a fabricated medical history that included silicone implants and symptoms of “silicone-associated disease.” All six samples were reported back as “positive”; indeed, these results were more positive than the blood samples from the women who actually had silicone implants. Dr. Young suggested that perhaps the SILS test was akin to cold fusion.

By the time counsel assembled in Judge Weinstein’s courtroom, in October 1996, some epidemiologic studies had become available and much more information was available on the supposedly supportive mechanistic studies upon which plaintiffs’ expert witnesses had previously relied. Not too surprisingly, plaintiffs’ counsel chose not to call the entrepreneurial Dr. Shanklin, but instead called Donard S. Dwyer, a young, earnest immunologist who had done some contract work on an unrelated matter for Bristol-Myers Squibb, a defendant in the litigation.  Dr. Dwyer had filed an affidavit previously in the Oregon federal litigation, in which he gave blanket approval to the methods and conclusions of the Smalley-Shanklin research:

“Based on a thorough review of these extensive materials which are more than adequate to evaluate Dr. Smalley’s test methodology, I formed the following conclusions. First, the experimental protocols that were used are standard and acceptable methods for measuring T Cell proliferation. The results have been reproducible and consistent in this laboratory. Second, the conclusion that there are differences between patients with breast implants and normal controls with respect to the proliferative response to silicon dioxide appears to be justified from the data.”[8]

Dwyer maintained this position even after the defense obtaining the study protocol and underlying data, and various immunologists on the defense side filed scathing evaluatons of the Smalley-Shanklin work.  On direct examination at the hearings in Brooklyn, Dwyer vouched for the challenged t-cell studies, and opined that the work was peer reviewed and sufficiently reliable.[9]

The charade fell apart on cross-examination. Dwyer refused to endorse the studies that claimed to have found an anti-silicone antibody. Researchers at leading universities had attempted to reproduce the findings of such antibodies, without success.[10] The real controversy was over the claimed finding of silicone antigenicity as shown in t-cell or the cell-mediated specific immune response. On direct examination, plaintiffs’ counsel elicited Dwyer’s support for the soundness of the scientific studies that purported to establish such antigenicity, with little attention to the critiques that had been filed before the hearing.[11] Dwyer stuck to his unqualified support he had expressed previously in his affidavit for the Oregon cases.[12]

The problematic aspect of Dwyer’s direct examination testimony was that he had seen the protocol and the partial data produced by Smalley and Shanklin.[13] Dwyer, therefore, could not resist some basic facts about their work. First, the Shanklin data failed to support a dose-response relationship.[14] Second, the blood samples from women with silicone implants had been mailed to Smalley’s laboratory, whereas the control samples were collected locally. The disparity ensured that the silicone blood samples would be older than the controls, which was a departure from treating exposed and control samples in the same way.[15] Third, the experiment was done unblinded; the laboratory technical personnel and the investigators knew which blood samples were silicone exposed and which were controls (except for samples sent by Dr. Leroy Young).[16] Fourth, Shanklin’s laboratory procedures deviated from the standardized procedure set out in the National Institute of Health’s Current Protocols in Immunology.[17]

The SILS study protocol and the data produced by Shanklin and Smalley made clear that each sample was to be tested in triplicate for t-cell proliferation in response to silica, to a positive control mitogen (Con A), and to a negative control blank. The published papers all claimed that the each sample was tested in triplicate for each of these three response situations (silica, mitogen, and nothing).[18] Shanklin and Smalley described their t-cell proliferation studies, in their published papers, as having been done in triplicate. These statements were, however, untrue and never corrected.[19]

The study protocol called for the tests to be run in triplicate, but they instructed the laboratory that two counts may be used if one count does not match the other counts, which is to be decided by a technical specialist on a “case-by-case” basis. Of data that was supposed to be reported in triplicate, fully one third had only two data points, and 10 percent had but one data point.[20] No criteria were provided to the technical specialist for deciding which data to discard.[21] Not only had Shanklin excluded data, but he discarded and destroyed the data such that no one could go back and assess whether the data should have been excluded.[22]

Dwyer agreed that this exclusion and discarding of data was not at all a good method.[23] Dwyer proclaimed that he had not come to Brooklyn to defend this aspect of the Shanklin work, and that it was not defensible at all. Dwyer conceded that “the interpretation of the data and collection of the data are flawed.”[24] Dwyer tried to stake out a position that was incoherent by asserting that there was “nothing inherently wrong with the method,” while conceding that discarding data was problematic.[25] The judges presiding over the hearing could readily see that the Shanklin research was bent.

At this point, the lead plaintiffs’ counsel, Michael Williams, sought an off-ramp. He jumped to his feet and exclaimed “I’m informed that no witness in this case will rely on Dr. Smalley’s [and Shanklin’s] work in any respect.” [26] Judge Weinstein’s eyes lit up with the prospect that the Smalley-Shanklin work, by agreement, would never be mentioned again in New York state or federal cases. Given how central the claim of silicone antigenicity was to plaintiffs’ cases, the defense resisted the stipulation about research that they would continue to face in other state and federal courts. The defense was saved, however, by the obstinence of a lawyer from the Weitz & Luxenberg firm, who rose to report that her firm intended to call Drs. Shanklin and Smalley as witnesses, and that they would not stipulate to the exclusion of their work. Judge Weinstein rolled his eyes, and waved me to continue.[27] The proliferation of the t-cell test was over. The hearing before Judges Weinstein and Baer, and Justice Lobis, continued for several more days, with several other dramatic moments.[28]

In short order, on October 23, 1996, Judge Weinstein issued a short, published opinion, in which he granted partial summary judgment on the claims of systemic disease for all cases pending in federal court in New York.[29] What was curious was that the defendants had not moved for summary judgment. There were, of course, pending motions to exclude plaintiffs’ expert witnesses, but Judge Weinstein effectively ducked those motions, and let it be known that he was never a fan of Rule 702. It would be many years later, before Judge Weinstein allowed his judicial assessment see the light of day. Two decades and some years later, in a law review article, Judge Weinstein gave his judgment that

“[t]he breast implant litigation was largely based on a litigation fraud. …  Claims—supported by medical charlatans—that enormous damages to women’s systems resulted could not be supported.”[30]

Judge Weinstein’s opinion was truly a judgment from which there can be no appeal. Shanklin and Smalley continued to publish papers for another decade. None of the published articles by Shanklin and others have been retracted.

[1] Reuters, “Record $25 Million Awarded In Silicone-Gel Implants Case,” N.Y. Times at A13 (Dec. 24, 1992) (describing the verdict returned in Harris County, Texas, in Johnson v. Medical Engineering Corp.); Associated Press, “Woman Wins Implant Suit,” N.Y. Times at A16 (Dec. 17, 1991) (reporting a verdict in Hopkins v. Dow Corning, for $840,000 in compensatory and $6.5 million in punitive damages); see Hopkins v. Dow Corning Corp., 33 F.3d 1116 (9th Cir. 1994) (affirming judgment with minimal attention to Rule 702 issues).

[2] William E. Hull, “A Critical Review of MR Studies Concerning Silicone Breast Implants,” 42 Magnetic Resonance in Medicine 984, 984 (1999) (“From my viewpoint as an analytical spectroscopist, the result of this exercise was disturbing and disappointing. In my judgement as a referee, none of the Garrido group’s papers (1–6) should have been published in their current form.”). See also N.A. Schachtman, “Silicone Data – Slippery & Hard to Find, Part 2,” Tortini (July 5, 2015). Many of the material science claims in the breast implant litigation were as fraudulent as the health effects claims. See, e.g., John Donley, “Examining the Expert,” 49 Litigation 26 (Spring 2023) (discussing his encounters with frequent testifier Pierre Blais, in silicone litigation).

[3] See, e.g., Hopkins v. Dow Corning Corp., 33 F.3d 1116 (9th Cir. 1994) (affirming judgment for plaintiff over Rule 702 challenges), cert. denied, 115 S.Ct. 734 (1995). See Donald A. Lawson, “Note, Hopkins v. Dow Corning Corporation: Silicone and Science,” 37 Jurimetrics J. 53 (1996) (concluding that Hopkins was wrongly decided).

[4] See David L. Smalley, Douglas R. Shanklin, Mary F. Hall, and Michael V. Stevens, “Detection of Lymphocyte Stimulation by Silicon Dioxide,” 4 Internat’l J. Occup. Med. & Toxicol. 63 (1995); David L. Smalley, Douglas R. Shanklin, Mary F. Hall, Michael V. Stevens, and Aram Hanissian, “Immunologic stimulation of T lymphocytes by silica after use of silicone mammary implants,” 9 FASEB J. 424 (1995); David L. Smalley, J. J. Levine, Douglas R. Shanklin, Mary F. Hall, Michael V. Stevens, “Lymphocyte response to silica among offspring of silicone breast implant recipients,” 196 Immunobiology 567 (1996); David L. Smalley, Douglas R. Shanklin, “T-cell-specific response to silicone gel,” 98 Plastic Reconstr. Surg. 915 (1996); and Douglas R. Shanklin, David L. Smalley, Mary F. Hall, Michael V. Stevens, “T cell-mediated immune response to silica in silicone breast implant patients,” 210 Curr. Topics Microbiol. Immunol. 227 (1996). Shanklin was also no stranger to making his case in the popular media. See, e.g., Douglas Shanklin, “More Research Needed on Breast Implants,” Kitsap Sun at 2 (Aug. 29, 1995) (“Widespread silicone sickness is very real in women with past and continuing exposure to silicone breast implants.”) (writing for Scripps Howard News Service). Even after the Shanklin studies were discredited in court, Shanklin and his colleagues continued to publish their claims that silicone implants led to silica antigenicity. David L. Smalley, Douglas R. Shanklin, and Mary F. Hall, “Monocyte-dependent stimulation of human T cells by silicon dioxide,” 66 Pathobiology 302 (1998); Douglas R. Shanklin and David L. Smalley, “The immunopathology of siliconosis. History, clinical presentation, and relation to silicosis and the chemistry of silicon and silicone,” 18 Immunol. Res. 125 (1998); Douglas Radford Shanklin, David L. Smalley, “Pathogenetic and diagnostic aspects of siliconosis,” 17 Rev. Environ Health 85 (2002), and “Erratum,” 17 Rev Environ Health. 248 (2002); Douglas Radford Shanklin & David L Smalley, “Kinetics of T lymphocyte responses to persistent antigens,” 80 Exp. Mol. Pathol. 26 (2006). Douglas Shanklin died in 2013. Susan J. Ainsworth, “Douglas R. Shanklin,” 92 Chem. & Eng’g News (April 7, 2014). Dr. Smalley appears to be still alive. In 2022, he sued the federal government to challenge his disqualification from serving as a laboratory director of any clinical directory in the United States, under 42 U.S.C. § 263a(k). He lost. Smalley v. Becerra, Case No. 4:22CV399 HEA (E.D. Mo. July 6, 2022).

[5] Hall v. Baxter Healthcare Corp., 947 F. Supp. 1387 (D. Ore. 1996); see Joseph Sanders & David H. Kaye, “Expert Advice on Silicone Implants: Hall v. Baxter Healthcare Corp., 37 Jurimetrics J. 113 (1997); Laurens Walker & John Monahan, “Scientific Authority: The Breast Implant Litigation and Beyond,” 86 Virginia L. Rev. 801 (2000); Jane F. Thorpe, Alvina M. Oelhafen, and Michael B. Arnold, “Court-Appointed Experts and Technical Advisors,” 26 Litigation 31 (Summer 2000); Laural L. Hooper, Joe S. Cecil & Thomas E. Willging, “Assessing Causation in Breast Implant Litigation: The Role of Science Panels,” 64 Law & Contemp. Problems 139 (2001); Debra L. Worthington, Merrie Jo Stallard, Joseph M. Price & Peter J. Goss, “Hindsight Bias, Daubert, and the Silicone Breast Implant Litigation: Making the Case for Court-Appointed Experts in Complex Medical and Scientific Litigation,” 8 Psychology, Public Policy &  Law 154 (2002).

[6] Judge Jones’ technical advisor on immunology reported that the studies offered in support of the alleged connection between silicone implantation and silicone-specific T cell responses, including the published papers by Shanklin and Smalley, “have a number of methodological shortcomings and thus should not form the basis of such an opinion.” Mary Stenzel-Poore, “Silicone Breast Implant Cases–Analysis of Scientific Reasoning and Methodology Regarding Immunological Studies” (Sept. 9, 1996). This judgment was seconded, over three years later, in the proceedings before MDL 926 and its Rule 706 court-appointed immunology expert witness. See Report of Dr. Betty A. Diamond, in MDL 926, at 14-15 (Nov. 30, 1998). Other expert witnesses who published studies on the supposed immunogenicity of silicone came up with some creative excuses to avoid producing their underlying data. Eric Gershwin consistently testified that his data were with a co-author in Israel, and that he could not produce them. N.A. Schachtman, “Silicone Data – Slippery and Hard to Find, Part I,” Tortini (July 4, 2015). Nonetheless, the court-appointed technical advisors were highly critical of Dr. Gershwin’s results. Dr. Stenzel-Poore, the immunologist on Judge Jones’ panel of advisors, found Gershwin’s claims “not well substantiated.” Hall v. Baxter Healthcare Corp., 947 F.Supp. 1387 (D. Ore. 1996). Similarly, Judge Pointer’s appointed expert immunologist Dr. Betty A. Diamond, was unshakeable in her criticisms of Gershwin’s work and his conclusions. Testimony of Dr. Betty A. Diamond, in MDL 926 (April 23, 1999). And the Institute of Medicine committee, charged with reviewing the silicone claims, found Gershwin’s work inadequate and insufficient to justify the extravagent claims that plaintiffs were making for immunogenicity and for causation of autoimmune disease. Stuart Bondurant, Virginia Ernster, and Roger Herdman, eds., Safety of Silicone Breast Implants 256 (1999). Another testifying expert witness who relied upon his own data, Nir Kossovsky, resorted to a seismic excuse; he claimed that the Northridge Quake destroyed his data. N.A. Schachtman, “Earthquake Induced Data Loss – We’re All Shook Up,” Tortini (June 26, 2015); Kossovsky, along with his wife, Beth Brandegee, and his father, Ram Kossowsky, sought to commercialize an ELISA-based silicone “antibody” biomarker diagnostic test, Detecsil. Although the early Rule 702 decisions declined to take a hard at Kossovsky’s study, the U.S. Food and Drug Administration eventually shut down the Kossovsky Detecsil test. Lillian J. Gill, FDA Acting Director, Office of Compliance, Letter to Beth S. Brandegee, President, Structured Biologicals (SBI) Laboratories: Detecsil Silicone Sensitivity Test (July 15, 1994); see Gary Taubes, “Silicone in the System: Has Nir Kossovsky really shown anything about the dangers of breast implants?” Discover Magazine (Dec. 1995).

[7] Leroy Young, “Testing the Test: An Analysis of the Reliability of the Silicone Sensitivity Test (SILS) in Detecting Immune-Mediated Responses to Silicone Breast Implants,” 97 Plastic & Reconstr. Surg. 681 (1996).

[8] Affid. of Donard S. Dwyer, at para. 6 (Dec. 1, 1995), filed in In re Breast Implant Litig. Pending in U.S. D. Ct, D. Oregon (Groups 1,2, and 3).

[9] Notes of Testimony of Dr. Donnard Dwyer, Nyitray v. Baxter Healthcare Corp., CV 93-159 (E. & S.D.N.Y and N.Y. Sup. Ct., N.Y. Cty. Oct. 8, 9, 1996) (Weinstein, J., Baer, J., Lobis, J., Pollak, M.J.).

[10] Id. at N.T. 238-239 (Oct. 8, 1996).

[11] Id. at N.T. 240.

[12] Id. at N.T. 241-42.

[13] Id. at N.T. 243-44; 255:22-256:3.

[14] Id. at 244-45.

[15] Id. at N.T. 259.

[16] Id. at N.T. 258:20-22.

[17] Id. at N.T. 254.

[18] Id. at N.T. 252:16-254.

[19] Id. at N.T. 254:19-255:2.

[20] Id. at N.T. 269:18-269:14.

[21] Id. at N.T. 261:23-262:1.

[22] Id. at N.T. 269:18-270.

[23] Id. atN.T. 256:3-16.

[24] Id. at N.T. 262:15-17

[25] Id. at N.T. 247:3-5.

[26] Id. at N.T. at 260:2-3

[27] Id. at N.T. at 261:5-8.

[28] One of the more interesting and colorful moments came when the late James Conlon cross-examined plaintiffs’ pathology expert witness, Saul Puszkin, about questionable aspects of his curriculum vitae. The examination was revealed such questionable conduct that Judge Weinstein stopped the examination and directed Dr. Puszkin not to continue without legal counsel of his own.

[29] In re Breast Implant Cases, 942 F. Supp. 958 (E.& S.D.N.Y. 1996). The opinion did not specifically address the Rule 702 and 703 issues that were the subject of pending motions before the court.

[30] Hon. Jack B. Weinstein, “Preliminary Reflections on Administration of Complex Litigation” 2009 Cardozo L. Rev. de novo 1, 14 (2009) (emphasis added).

Posted in Data Sharing, Expert Witness Hall of Shame, Rule 702, Rule 703, Scientific Misconduct, Scientific Publishing | 43 Comments »

QRPs in Science and in Court

April 2nd, 2024

Lay juries usually function well in assessing the relevance of an expert witness’s credentials, experience, command of the facts, likeability, physical demeanor, confidence, and ability to communicate. Lay juries can understand and respond to arguments about personal bias, which no doubt is why trial lawyers spend so much time and effort to emphasize the size of fees and consulting income, and the propensity to testify only for one side. For procedural and practical reasons, however, lay juries do not function very well in assessing the actual merits of scientific controversies. And with respect to methodological issues that underlie the merits, juries barely function at all. The legal system imposes no educational or experiential qualifications for jurors, and trials are hardly the occasion to teach jurors the methodology, skills, and information needed to resolve methodological issues that underlie a scientific dispute.

Scientific studies, reviews, and meta-analyses are virtually never directly admissible in evidence in courtrooms in the United States. As a result, juries do not have the opportunity to read and ponder the merits of these sources, and assess their strengths and weaknesses. The working assumption of our courts is that juries are not qualified to engage directly with the primary sources of scientific evidence, and so expert witnesses are called upon to deliver opinions based upon a scientific record not directly in evidence. In the litigation of scientific disputes, our courts thus rely upon the testimony of so-called expert witnesses in the form of opinions. Not only must juries, the usual trier of fact in our courts, assess the credibility of expert witnesses, but they must assess whether expert witnesses are accurately describing studies that they cannot read in their entirety.

The convoluted path by which science enters the courtroom supports the liberal and robust gatekeeping process outlined under Rules 702 and 703 of the Federal Rules of Evidence. The court, not the jury, must make a preliminary determination, under Rule 104, that the facts and data of a study are reasonably relied upon by an expert witness (Rule 703). And the court, not the jury, again under Rule 104, must determine that expert witnesses possess appropriate qualifications for relevant expertise, and that these witnesses have proffered opinions sufficiently supported by facts or data, based upon reliable principles and methods, and reliably applied to the facts of the case. (Rule 702). There is no constitutional right to bamboozle juries with inconclusive, biased, and confounded or crummy studies, or selective and incomplete assessments of the available facts and data. Back in the days of “easy admissibility,” opinions could be tested on cross-examination, but limited time and acumen of counsel, court, and juries cry out for meaningful scientific due process along the lines set out in Rules 702 and 703.

The evolutionary development of Rules 702 and 703 has promoted a salutary convergence between science and law. According to one historical overview of systematic reviews in science, the foundational period for such reviews (1970-1989) overlaps with the enactment of Rules 702 and 703, and the institutionalization of such reviews (1990-2000) coincides with the development of these Rules in a way that introduced some methodological rigor into scientific opinions that are admitted into evidence.[1]

The convergence between legal admissibility and scientific validity considerations has had the further result that scientific concerns over the quality and sufficiency of underlying data, over the validity of study design, analysis, reporting, and interpretation, and over the adequacy and validity of data synthesis, interpretation, and conclusions have become integral to the gatekeeping process. This convergence has the welcome potential to keep legal judgments more in line with best scientific evidence and practice.

The science-law convergence also means that courts must be apprised of, and take seriously, the problems of study reproducibility, and more broadly, the problems raised by questionable research practices (QRPs), or what might be called the patho-epistemology of science. The development, in the 1970s, and the subsequent evolution, of the systematic review represented the scientific community’s rejection of the old-school narrative reviews that selected a few of all studies to support a pre-existing conclusion. Similarly, the scientific community’s embarrassment, in the 1980s and 1990s, over the irreproducibility of study results, has in this century grown into an existential crisis over study reproducibility in the biomedical sciences.

In 2005, John Ioannidis published an article that brought the concern over “reproducibility” of scientific findings in bio-medicine to an ebullient boil.[2] Ioannidis pointed to several factors, which alone or in combination rendered most published medical findings likely false. Among the publication practices responsible for this unacceptably high error rate, Ioannidis identified the use of small sample sizes, data-dredging and p-hacking techniques, poor or inadequate statistical analysis, in the context of undue flexibility in research design, conflicts of interest, motivated reasoning, fads, and prejudices, and pressure to publish “positive” results.  The results, often with small putative effect sizes, across an inadequate number of studies, are then hyped by lay and technical media, as well as the public relations offices of universities and advocacy groups, only to be further misused by advocates, and further distorted to serve the goals of policy wonks. Social media then reduces all the nuances of a scientific study to an insipid meme.

Ioannidis’ critique resonated with lawyers. We who practice in health effects litigation are no strangers to dubious research methods, lack of accountability, herd-like behavior, and a culture of generating positive results, often out of political or economic sympathies. Although we must prepare for confronting dodgy methods in front of jury, asking for scientific due process that intervenes and decides the methodological issues with well-reasoned, written opinions in advance of trial does not seem like too much.

The sense that we are awash in false-positive studies was heightened by subsequent papers. In 2011, Uri Simonsohn and others showed that by using simulations of various combinations of QRPs in psychological science, researchers could attain a 61% false-positive rate for research outcomes.[3] The following year saw scientists at Amgen attempt replication of 53 important studies in hematology and oncology. They succeeded in replicated only six.[4] Also in 2012, Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research at the Food and Drug Administration, “estimated that as much as 75 per cent of published biomarker associations are not replicable.”[5] In 2016, the journal Nature reported that over 70% of scientists who responded to a survey had unsuccessfully attempted to replicate another scientist’s experiments, and more than half failed to replicate their own work.[6] Of the respondents, 90% agreed that there was a replication problem. A majority of the 90% believed that the problem was significant.

The scientific community reacted to the perceived replication crisis in a variety of ways, from conceptual clarification of the very notion of reproducibility,[7] to identification of improper uses and interpretations of key statistical concepts,[8] to guidelines for improved conduct and reporting of studies.[9]

Entire books dedicated to identifying the sources of, and the correctives for, undue researcher flexibility in the design, conduct, and analysis of studies, have been published.[10] In some ways, the Rule 702 and 703 case law is like the collected works of the Berenstain Bears, on how not to do studies.

The consequences of the replication crisis are real and serious. Badly conducted and interpreted science leads to research wastage,[11] loss of confidence in scientific expertise,[12] contemptible legal judgments, and distortion of public policy.

The proposed correctives to QRPs deserve the careful study of lawyers and judges who have a role in health effects litigation.[13] Whether as the proponent of an expert witness, or the challenger, several of the recurrent proposals, such as the call for greater data sharing and pre-registration of protocols and statistical analysis plans,[14] have real-world litigation salience. In many instances, they can and should direct lawyers’ efforts at discovery and challenging of the relied upon scientific studies in litigation.

[1] Quan Nha Hong & Pierre Pluye, “Systematic Reviews: A Brief Historical Overview,” 34 Education for Information 261 (2018); Mike Clarke & Iain Chalmers, “Reflections on the history of systematic reviews,” 23 BMJ Evidence-Based Medicine 122 (2018); Cynthia Farquhar & Jane Marjoribanks, “A short history of systematic reviews,” 126 Brit. J. Obstetrics & Gynaecology 961 (2019); Edward Purssell & Niall McCrae, “A Brief History of the Systematic Review,” chap. 2, in Edward Purssell & Niall McCrae, How to Perform a Systematic Literature Review: A Guide for Healthcare Researchers, Practitioners and Students 5 (2020).

[2] John P. A. Ioannidis “Why Most Published Research Findings Are False,” 1 PLoS Med 8 (2005).

[3] Joseph P. Simmons, Leif D. Nelson, and Uri Simonsohn, “False-Positive Psychology: UndisclosedFlexibility in Data Collection and Analysis Allows Presenting Anything as Significant,” 22 Psychological Sci. 1359 (2011).

[4] C. Glenn Begley and Lee M. Ellis, “Drug development: Raise standards for preclinical cancer research,” 483 Nature 531 (2012).

[5] Edward R. Dougherty, “Biomarker Development: Prudence, risk, and reproducibility,” 34 Bioessays 277, 279 (2012); Turna Ray, “FDA’s Woodcock says personalized drug development entering ‘long slog’ phase,” Pharmacogenomics Reporter (Oct. 26, 2011).

[6] Monya Baker, “Is there a reproducibility crisis,” 533 Nature 452 (2016).

[7] Steven N. Goodman, Daniele Fanelli, and John P. A. Ioannidis, “What does research reproducibility mean?,” 8 Science Translational Medicine 341 (2016); Felipe Romero, “Philosophy of science and the replicability crisis,” 14 Philosophy Compass e12633 (2019); Fiona Fidler & John Wilcox, “Reproducibility of Scientific Results,” Stanford Encyclopedia of Philosophy (2018), available at https://plato.stanford.edu/entries/scientific-reproducibility/.

[8] Andrew Gelman and Eric Loken, “The Statistical Crisis in Science,” 102 Am. Scientist 460 (2014); Ronald L. Wasserstein & Nicole A. Lazar, “The ASA’s Statement on p-Values: Context, Process, and Purpose,” 70 The Am. Statistician 129 (2016); Yoav Benjamini, Richard D. DeVeaux, Bradly Efron, Scott Evans, Mark Glickman, Barry Braubard, Xuming He, Xiao Li Meng, Nancy Reid, Stephen M. Stigler, Stephen B. Vardeman, Christopher K. Wikle, Tommy Wright, Linda J. Young, and Karen Kafadar, “The ASA President’s Task Force Statement on Statistical Significance and Replicability,” 15 Annals of Applied Statistics 1084 (2021).

[9] The International Society for Pharmacoepidemiology issued its first Guidelines for Good Pharmacoepidemiology Practices in 1996. The most recent revision, the third, was issued in June 2015. See “The ISPE Guidelines for Good Pharmacoepidemiology Practices (GPP),” available at https://www.pharmacoepi.org/resources/policies/guidelines-08027/. See also Erik von Elm, Douglas G. Altman, Matthias Egger, Stuart J. Pocock, Peter C. Gøtzsche, and Jan P. Vandenbroucke, for the STROBE Initiative, “The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement Guidelines for Reporting Observational Studies,” 18 Epidem. 800 (2007); Jan P. Vandenbroucke, Erik von Elm, Douglas G. Altman, Peter C. Gøtzsche, Cynthia D. Mulrow, Stuart J. Pocock, Charles Poole, James J. Schlesselman, and Matthias Egger, for the STROBE initiative, “Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration,” 147 Ann. Intern. Med. W-163 (2007); Shah Ebrahim & Mike Clarke, “STROBE: new standards for reporting observational epidemiology, a chance to improve,” 36 Internat’l J. Epidem. 946 (2007); Matthias Egger, Douglas G. Altman, and Jan P Vandenbroucke of the STROBE group, “Commentary: Strengthening the reporting of observational epidemiology—the STROBE statement,” 36 Internat’l J. Epidem. 948 (2007).

[10] See, e.g., Lee J. Jussim, Jon A. Krosnick, and Sean T. Stevens, eds., Research Integrity: Best Practices for the Social and Behavioral Sciences (2022); Joel Faintuch & Salomão Faintuch, eds., Integrity of Scientific Research: Fraud, Misconduct and Fake News in the Academic, Medical and Social Environment (2022); William O’Donohue, Akihiko Masuda & Scott Lilienfeld, eds., Avoiding Questionable Research Practices in Applied Psychology (2022); Klaas Sijtsma, Never Waste a Good Crisis: Lessons Learned from Data Fraud and Questionable Research Practices (2023).

[11] See, e.g., Iain Chalmers, Michael B Bracken, Ben Djulbegovic, Silvio Garattini, Jonathan Grant, A Metin Gülmezoglu, David W Howells, John P A Ioannidis, and Sandy Oliver, “How to increase value and reduce waste when research priorities are set,” 383 Lancet 156 (2014); John P A Ioannidis, Sander Greenland, Mark A Hlatky, Muin J Khoury, Malcolm R Macleod, David Moher, Kenneth F Schulz, and Robert Tibshirani, “Increasing value and reducing waste in research design, conduct, and analysis,” 383 Lancet 166 (2014).

[12] See, e.g., Friederike Hendriks, Dorothe Kienhues, and Rainer Bromme, “Replication crisis = trust crisis? The effect of successful vs failed replications on laypeople’s trust in researchers and research,” 29 Public Understanding Sci. 270 (2020).

[13] R. Barker Bausell, The Problem with Science: The Reproducibility Crisis and What to Do About It (2021).

[14] See, e.g., Brian A. Noseka, Charles R. Ebersole, Alexander C. DeHavena, and David T. Mellora, “The preregistration revolution,” 115 Proc. Nat’l Acad. Soc. 2600 (2018); Michael B. Bracken, “Preregistration of Epidemiology Protocols: A Commentary in Support,” 22 Epidemiology 135 (2011); Timothy L. Lash & Jan P. Vandenbroucke, “Should Preregistration of Epidemiologic Study Protocols Become Compulsory? Reflections and a Counterproposal,” 23 Epidemiology 184 (2012).

Posted in Expert Witnesses, Rule 702, Rule 703, Scientific Evidence, Scientific Publishing | 18 Comments »

The Role of Peer Review in Rule 702 and 703 Gatekeeping

November 19th, 2023

“There is no expedient to which man will not resort to avoid the real labor of thinking.”
              Sir Joshua Reynolds (1723-92)

Some courts appear to duck the real labor of thinking, and the duty to gatekeep expert witness opinions,  by deferring to expert witnesses who advert to their reliance upon peer-reviewed published studies. Does the law really support such deference, especially when problems with the relied-upon studies are revealed in discovery? A careful reading of the Supreme Court’s decision in Daubert, and of the Reference Manual on Scientific Evidence provides no support for admitting expert witness opinion testimony that relies upon peer-reviewed published studies, when the studies are invalid or are based upon questionable research practices.[1]

In Daubert v. Merrell Dow Pharmaceuticals, Inc.,[2] The Supreme Court suggested that peer review of studies relied upon by a challenged expert witness should be a factor in determining the admissibility of that expert witness’s opinion. In thinking about the role of peer-review publication in expert witness gatekeeping, it is helpful to remember the context of how and why the Supreme was talking about peer review in the first place. In the trial court, the Daubert plaintiff had proffered an expert witness opinion that featured reliance upon an unpublished reanalysis of published studies. On the defense motion, the trial court excluded the claimant’s witness,[3] and the Ninth Circuit affirmed.[4] The intermediate appellate court expressed its view that unpublished, non-peer-reviewed reanalyses were deviations from generally accepted scientific discourse, and that other appellate courts, considering the alleged risks of Bendectin, refused to admit opinions based upon unpublished, non-peer-reviewed reanalyses of epidemiologic studies.[5] The Circuit expressed its view that reanalyses are generally accepted by scientists when they have been verified and scrutinized by others in the field. Unpublished reanalyses done for solely for litigation would be an insufficient foundation for expert witness opinion.[6]

The Supreme Court, in Daubert, evaded the difficult issues involved in evaluating a statistical analysis that has not been published by deciding the case on the ground that the lower courts had applied the wrong standard.  The so-called Frye test, or what I call the “twilight zone” test comes from the heralded 1923 case excluding opinion testimony based upon a lie detector:

“Just when a scientific principle or discovery crosses the line between the experimental and demonstrable stages is difficult to define. Somewhere in this twilight zone the evidential force of the principle must be recognized, and while the courts will go a long way in admitting expert testimony deduced from a well recognized scientific principle or discovery, the thing from which the deduction is made must be sufficiently established to have gained general acceptance in the particular field in which it belongs.”[7]

The Supreme Court, in Daubert, held that with the promulgation of the Federal Rules of Evidence in 1975, the twilight zone test was no longer legally valid. The guidance for admitting expert witness opinion testimony lay in Federal Rule of Evidence 702, which outlined an epistemic test for “knowledge,” which would be helpful to the trier of fact. The Court then proceeded to articulate several  non-definitive factors for “good science,” which might guide trial courts in applying Rule 702, such as testability or falsifiability, a showing of known or potential error rate. Another consideration, general acceptance carried over from Frye as a consideration.[8] Courts have continued to build on this foundation to identify other relevant considerations in gatekeeping.[9]

One of the Daubert Court’s pertinent considerations was “whether the theory or technique has been subjected to peer review and publication.”[10] The Court, speaking through Justice Blackmun, provided a reasonably cogent, but probably now out-dated discussion of peer review:

 “Publication (which is but one element of peer review) is not a sine qua non of admissibility; it does not necessarily correlate with reliability, see S. Jasanoff, The Fifth Branch: Science Advisors as Policymakers 61-76 (1990), and in some instances well-grounded but innovative theories will not have been published, see Horrobin, “The Philosophical Basis of Peer Review and the Suppression of Innovation,” 263 JAMA 1438 (1990). Some propositions, moreover, are too particular, too new, or of too limited interest to be published. But submission to the scrutiny of the scientific community is a component of “good science,” in part because it increases the likelihood that substantive flaws in methodology will be detected. See J. Ziman, Reliable Knowledge: An Exploration of the Grounds for Belief in Science 130-133 (1978); Relman & Angell, “How Good Is Peer Review?,” 321 New Eng. J. Med. 827 (1989). The fact of publication (or lack thereof) in a peer reviewed journal thus will be a relevant, though not dispositive, consideration in assessing the scientific validity of a particular technique or methodology on which an opinion is premised.”[11]

To the extent that peer review was touted by Justice Blackmun, it was because the peer-review process advanced the ultimate consideration of the scientific validity of the opinion or claim under consideration. Validity was the thing; peer review was just a crude proxy.

If the 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. And of course, the wild proliferation of journals, including the “pay-to-play” journals, facilitates the festschrift.

Reference Manual on Scientific Evidence

Certainly, judicial thinking evolved since 1993, and the decision in Daubert. Other considerations for gatekeeping have been added. Importantly, Daubert involved the interpretation of a statute, and in 2000, the statute was amended.

Since the Daubert decision, the Federal Judicial Center and the National Academies of Science have weighed in with what is intended to be guidance for judges and lawyers litigating scientific and technical issue. The Reference Manual on Scientific Evidence is currently in a third edition, but a fourth edition is expected in 2024.

How does the third edition[12] treat peer review?

An introduction by now retired Associate Justice Stephen Breyer blandly reports the Daubert considerations, without elaboration.[13]

The most revealing and important chapter in the Reference Manual is the one on scientific method and procedure, and sociology of science, “How Science Works,” by Professor David Goodstein.[14] This chapter’s treatment is not always consistent. In places, the discussion of peer review is trenchant. At other places, it can be misleading. Goodstein’s treatment, at first, appears to be a glib endorsement of peer review as a substitute for critical thinking about a relied-upon published study:

“In the competition among ideas, the institution of peer review plays a central role. Scientifc articles submitted for publication and proposals for funding often are sent to anonymous experts in the field, in other words, to peers of the author, for review. Peer review works superbly to separate valid science from nonsense, or, in Kuhnian terms, to ensure that the current paradigm has been respected.11 It works less well as a means of choosing between competing valid ideas, in part because the peer doing the reviewing is often a competitor for the same resources (space in prestigious journals, funds from government agencies or private foundations) being sought by the authors. It works very poorly in catching cheating or fraud, because all scientists are socialized to believe that even their toughest competitor is rigorously honest in the reporting of scientific results, which makes it easy for a purposefully dishonest scientist to fool a referee. Despite all of this, peer review is one of the venerated pillars of the scientific edifice.”[15]

A more nuanced and critical view emerges in footnote 11, from the above-quoted passage, when Goodstein discusses how peer review was framed by some amici curiae in the Daubert case:

“The Supreme Court received differing views regarding the proper role of peer review. Compare Brief for Amici Curiae Daryl E. Chubin et al. at 10, Daubert v. Merrell Dow Pharms., Inc., 509 U.S. 579 (1993) (No. 92-102) (“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”), with Brief for Amici Curiae New England Journal of Medicine, Journal of the American Medical Association, and Annals of Internal Medicine in Support of Respondent, Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993) (No. 92-102) (proposing that publication in a peer-reviewed journal be the primary criterion for admitting scientifc evidence in the courtroom). See generally Daryl E. Chubin & Edward J. Hackett, Peerless Science: Peer Review and U.S. Science Policy (1990); Arnold S. Relman & Marcia Angell, How Good Is Peer Review? 321 New Eng. J. Med. 827–29 (1989). As a practicing scientist and frequent peer reviewer, I can testify that Chubin’s view is correct.”[16]

So, if, as Professor Goodstein attests, Chubin is correct that peer review does not “guarantee accuracy or veracity or certainty,” the basis for veneration is difficult to fathom.

Later in Goodstein’s chapter, in a section entitled “V. Some Myths and Facts about Science,” the gloves come off:[17]

“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. Peer review mostly assures that all papers follow the current paradigm (see comments on Kuhn, above). 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.”[18]

Goodstein is not a post-modern nihilist. He acknowledges that “real” science can be distinguished from “not real science.” He can hardly be seen to have given a full-throated endorsement to peer review as satisfying the gatekeeper’s obligation to evaluate whether a study can be reasonably relied upon, or whether reliance upon such a particular peer-reviewed study can constitute sufficient evidence to render an expert witness’s opinion helpful, or the application of a reliable methodology.

Goodstein cites, with apparent approval, the amicus brief filed by the New England Journal of Medicine, and other journals, which advised the Supreme Court that “good science,” requires a “a rigorous trilogy of publication, replication and verification before it is relied upon.” [19]

“Peer review’s ‘role is to promote the publication of well-conceived articles so that the most important review, the consideration of the reported results by the scientific community, may occur after publication.’”[20]

Outside of Professor Goodstein’s chapter, the Reference Manual devotes very little ink or analysis to the role of peer review in assessing Rule 702 or 703 challenges to witness opinions or specific studies.  The engineering chapter acknowledges that “[t]he topic of peer review is often raised concerning scientific and technical literature,” and helpfully supports Goodstein’s observations by noting that peer review “does not ensure accuracy or validity.”[21]

The chapter on neuroscience is one of the few chapters in the Reference Manual, other than Professor Goodstein’s, to address the limitations of peer review. Peer review, if absent, is highly suspicious, but its presence is only the beginning of an evaluation process that continues after publication:

“Daubert’s stress on the presence of peer review and publication corresponds nicely to scientists’ perceptions. If something is not published in a peer-reviewed journal, it scarcely counts. Scientists only begin to have confidence in findings after peers, both those involved in the editorial process and, more important, those who read the publication, have had a chance to dissect them and to search intensively for errors either in theory or in practice. It is crucial, however, to recognize that publication and peer review are not in themselves enough. The publications need to be compared carefully to the evidence that is proffered.”[22]

The neuroscience chapter goes on to discuss peer review also in the narrow context of functional magnetic resonance imaging (fMRI). The authors note that fMRI, as a medical procedure, has been the subject of thousands of peer-reviewed, but those peer reviews do little to validate the use of fMRI as a high-tech lie detector.[23] The mental health chapter notes in a brief footnote that the science of memory is now well accepted and has been subjected to peer review, and that “[c]areful evaluators” use only tests that have had their “reliability and validity confirmed in peer-reviewed publications.”[24]

Echoing other chapters, the engineering chapter also mentions peer review briefly in connection with qualifying as an expert witness, and in validating the value of accrediting societies.[25]  Finally, the chapter points out that engineering issues in litigation are often sufficiently novel that they have not been explored in peer-reviewed literature.[26]

Most of the other chapters of the Reference Manual, third edition, discuss peer review only in the context of qualifications and membership in professional societies.[27] The chapter on exposure science discusses peer review only in the narrow context of a claim that EPA guidance documents on exposure assessment are peer reviewed and are considered “authoritative.”[28]

Other chapters discuss peer review briefly and again only in very narrow contexts. For instance, the epidemiology chapter discusses peer review in connection with two very narrow issues peripheral to Rule 702 gatekeeping. First, the chapter raises the question (without providing a clear answer) whether non-peer-reviewed studies should be included in meta-analyses.[29] Second, the chapter asserts that “[c]ourts regularly affirm the legitimacy of employing differential diagnostic methodology,” to determine specific causation, on the basis of several factors, including the questionable claim that the methodology “has been subjected to peer review.”[30] There appears to be no discussion in this key chapter about whether, and to what extent, peer review of published studies can or should be considered in the gatekeeping of epidemiologic testimony. There is certainly nothing in the epidemiology chapter, or for that matter elsewhere in the Reference Manual, to suggest that reliance upon a peer-reviewed published study pretermits analysis of that study to determine whether it is indeed internally valid or reasonably relied upon by expert witnesses in the field.

[1] See Jop de Vrieze, “Large survey finds questionable research practices are common: Dutch study finds 8% of scientists have committed fraud,” 373 Science 265 (2021); Yu Xie, Kai Wang, and Yan Kong, “Prevalence of Research Misconduct and Questionable Research Practices: A Systematic Review and Meta-Analysis,” 27 Science & Engineering Ethics 41 (2021).

[2] 509 U.S. 579 (1993).

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

[4] 951 F. 2d 1128 (9th Cir. 1991).

[5]  951 F. 2d, at 1130-31.

[6] Id. at 1131.

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

[8]  Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 590 (1993).

[9] See, e.g., In re TMI Litig. II, 911 F. Supp. 775, 787 (M.D. Pa. 1995) (considering the relationship of the technique to methods that have been established to be reliable, the uses of the method in the actual scientific world, the logical or internal consistency and coherence of the claim, the consistency of the claim or hypothesis with accepted theories, and the precision of the claimed hypothesis or theory).

[10] Id. at  593.

[11] Id. at 593-94.

[12] National Research Council, Reference Manual on Scientific Evidence (3rd ed. 2011) [RMSE]

[13] Id., “Introduction” at 1, 13

[14] David Goodstein, “How Science Works,” RMSE 37.

[15] Id. at 44-45.

[16] Id. at 44-45 n. 11 (emphasis added).

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

[18] Id. at 49 n.16 (emphasis added)

[19] David Goodstein, “How Science Works,” RMSE 64 n.45 (citing Brief for the New England Journal of Medicine, et al., as Amici Curiae supporting Respondent, 1993 WL 13006387 at *2, in Daubert v. Merrell Dow Pharms., Inc., 509 U.S. 579 (1993).

[20] Id. (citing Brief for the New England Journal of Medicine, et al., 1993 WL 13006387 *3)

[21] Channing R. Robertson, John E. Moalli, David L. Black, “Reference Guide on Engineering,” RMSE 897, 938 (emphasis added).

[22] Henry T. Greely & Anthony D. Wagner, “Reference Guide on Neuroscience,” RMSE 747, 786.

[23] Id. at 776, 777.

[24] Paul S. Appelbaum, “Reference Guide on Mental Health Evidence,” RMSE 813, 866, 886.

[25] Channing R. Robertson, John E. Moalli, David L. Black, “Reference Guide on Engineering,” RMSE 897, 901, 931.

[26] Id. at 935.

[27] Daniel Rubinfeld, “Reference Guide on Multiple Regression,” 303, 328 RMSE  (“[w]ho should be qualified as an expert?”); Shari Seidman Diamond, “Reference Guide on Survey Research,” RMSE 359, 375; Bernard D. Goldstein & Mary Sue Henifin, “Reference Guide on Toxicology,” RMSE 633, 677, 678 (noting that membership in some toxicology societies turns in part on having published in peer-reviewed journals).

[28] Joseph V. Rodricks, “Reference Guide on Exposure Science,” RMSE 503, 508 (noting that EPA guidance documents on exposure assessment often are issued after peer review).

[29] Michael D. Green, D. Michal Freedman, and Leon Gordis, “Reference Guide on Epidemiology,” RMSE 549, 608.

[30] Id. at 617-18 n.212.

Posted in Evidence, Peer Review, Rule 702, Rule 703, Scientific Publishing | 4 Comments »

The Dodgy Origins of the Collegium Ramazzini

November 15th, 2023

Or How Irving Selikoff and His Lobby (the Collegium Ramazzini) Fooled the Monsanto Corporation

Anyone who litigates occupational or environmental disease cases has heard of the Collegium Ramazzini. The group is named after a 17th century Italian physician, Bernardino Ramazzini, who is sometimes referred to as the father of occupational medicine.[1] His children have been an unruly lot. In Ramazzini’s honor, the Collegium was founded just over 40 years old, to acclaim and promises of neutrality and consensus.

Back in May 1983, a United Press International reporter chronicled the high aspirations and the bipartisan origins of the Collegium.[2] The UPI reporter noted that the group was founded by the late Irving Selikoff, who is also well known in litigation circles. Selikoff held himself out as an authority on occupational and environmental medicine, but his actual training in medicine was dodgy. His training in epidemiology and statistics was non-existent.

Selikoff was, however, masterful at marketing and prosyletizing. Selikoff would become known for misrepresenting his training, and creating a mythology that he did not participate in litigation, that crocidolite was not used in products in the United State, and that asbestos would become a major cause of cancer in the United States, among other things.[3] It is thus no surprise that Selikoff successfully masked the intentions of the Ramazzini group, and was thus able to capture the support of two key legislators, Senators Charles Mathias (Rep., Maryland) and Frank Lautenberg (Dem., New Jersey), along with officials from both organized labor and industry.

Selikoff was able to snooker the Senators and officials with empty talk of a new organization that would work to obtain scientific consensus on occupational and environmental issues. It did not take long after its founding in 1983 for the Collegium to become a conclave of advocates and zealots.

The formation of the Collegium may have been one of Selikoff’s greatest deceptions. According to the UPI news report, Selikoff represented that the Collegium would not lobby or seek to initiate legislation, but rather would interpret scientific findings in accessible language, show the policy implications of these findings, and make recommendations. This representation was falsified fairly quickly, but certainly by 1999, when the Collegium called for legislation banning the use of asbestos.  Selikoff had promised that the Collegium

“will advise on the adequacy of a standard, but will not lobby to have a standard set. Our function is not to condemn, but rather to be a conscience among scientists in occupational and environmental health.”

The Adventures of Pinocchio (1883); artwork by Enrico Mazzanti

Senator Mathias proclaimed the group to be “dedicated to the improvement of the human condition.” Perhaps no one was more snookered than the Monsanto Corporation, which helped fund the Collegium back in 1983. Monte Throdahl, a Monsanto senior vice president, reportedly expressed his hopes that the group would emphasize the considered judgments of disinterested scientists and not the advocacy and rent seeking of “reporters or public interests groups” on occupational medical issues. Forty years in, those hopes are long since gone. Recent Collegium meetings have been sponsored and funded by the National Institute for Environmental Sciences, Centers for Disease Control, National Cancer Institute, and Environmental Protection Agency. The time has come to cut off funding.

[1] Giuliano Franco & Francesca Franco, “Bernardino Ramazzini: The Father of Occupational Medicine,” 91 Am. J. Public Health 1382 (2001).

[2] Drew Von Bergen, “A group of international scientists, backed by two senators,” United Press International (May 10, 1983).

[3] “Selikoff Timeline & Asbestos Litigation History” (Feb. 26, 2023); “The Lobby – Cut on the Bias” (July 6, 2020); “The Legacy of Irving Selikoff & Wicked Wikipedia” (Mar. 1, 2015). See also “Hagiography of Selikoff” (Sept. 26, 2015);  “Scientific Prestige, Reputation, Authority & The Creation of Scientific Dogmas” (Oct. 4, 2014); “Irving Selikoff – Media Plodder to Media Zealot” (Sept. 9, 2014).; “Historians Should Verify Not Vilify or Abilify – The Difficult Case of Irving Selikoff” (Jan. 4, 2014); “Selikoff and the Mystery of the Disappearing Amphiboles” (Dec. 10, 2010); “Selikoff and the Mystery of the Disappearing Testimony” (Dec. 3, 2010).

Posted in Asbestos, Conflicts of Interest, Public Nuisances, Scientific Misconduct, Scientific Publishing | 3 Comments »

Just Dissertations

October 27th, 2023

One of my childhood joys was roaming the stacks of libraries and browsing for arcane learning stored in aging books. Often, I had no particular goal in my roaming, and I flitted from topic to topic. Occasionally, however, I came across useful learning. It was in one college library, for instance, that I discovered the process for making nitrogen tri-iodide, which provided me with some simple-minded amusement for years. (I only narrowly avoided detection by Dean Brownlee for a prank involving NI3 in chemistry lab.)

Nowadays, most old book are off limits to the casual library visitor, but digital archives can satisfy my occasional compulsion to browse what is new and compelling in the world of research on topics of interest. And there can be no better source for new and topical research than browsing dissertations and theses, which are usually required to open new ground in scholarly research and debate. There are several online search tools for dissertations, such as ProQuest, EBSCO Open Dissertation, Theses and Dissertations, WorldCat Dissertations and Theses, Open Access Theses and Dissertations, and Yale Library Resources to Find Dissertation.

Some universities generously share the scholarship of their graduate students online, and there are some great gems freely available.[1] Other universities provide a catalogue of their students’ dissertations, the titles of which can be browsed and the texts of which can be downloaded. For lawyers interested in medico-legal issues, the London School of Hygiene & Tropical Medicine has a website, “LSHTM Research Online,” which is delightful place to browse on a rainy afternoon, and which features a free, open access repository of research. Most of the publications are dissertations, some 1,287 at present, on various medical and epidemiologic topics, from 1938 to the present.

The prominence of the London School of Hygiene & Tropical Medicine makes its historical research germane to medico-legal issues such as “state of the art,” notice, priority, knowledge, and intellectual provenance. A 1959 dissertation by J. D. Walters, the Surgeon Lieutenant of the Royal Nayal, is included in the repository.[2] Walters’ dissertation is a treasure trove of the state-of-the-art case – who knew what when – about asbestos health hazards, written before litigation distorted perspectives on the matter. Walters’ dissertation shows in contemporaneous scholarship, not hindsight second guessing, that Sir Richard Doll’s 1955 study, flawed as it was by contemporaneous standards, was seen as establishing an association between asbestosis (not asbestos exposure) and lung cancer. Walters’ careful assessment of how asbestos was actually used in British dockyards documents the differences between British and American product use. The British dockyards had full-time laggers since 1946, and they used spray asbestos, asbestos (amosite and crocidolite) mattresses, as well as lower asbestos content insulation.

Walters reported cases of asbestosis among the laggers. Written four years before Irving Selikoff published on an asbestosis hazard among laggers, the predominant end-users of asbestos-containing insulation, Walters’ dissertation preempts Selikoff’s claim of priority in identifying the asbestos hazard, and it shows that large employers, such as the Royal Navy, and the United States Navy, were well aware of asbestos hazards, before companies began placing warning labels. Like Selikoff, Walters typically had no information about worker compliance with safety regulations, such as respiratory use. Walters emphasized the need for industrial medical officers to be aware of the asbestosis hazard, and the means to prevent it. Noticeably absent was any suggestion that a warning label on bags of asbestos or boxes of pre-fabricated insulation were relevant to the medical officer’s work in controlling the hazard.

Among the litigation relevant finds in the repository is the doctoral thesis of Francis Douglas Kelly Liddell,[3] on the mortality of the Quebec chrysotile workers, with most of the underlying data.[4] A dissertation by Keith Richard Sullivan reported on the mortality patterns of civilian workers at Royal Navy dockyards in England.[5] Sullivan found no increased risk of lung cancer, although excesses of asbestosis and mesothelioma occurred at all dockyards. A critical look at meta-analyses of formaldehyde and cancer outcomes in one dissertation shows prevalent biases in available studies, and insufficient evidence of causation.[6]

Some of the other interesting dissertations with historical medico-legal relevance are:

Francis, The evaluation of small airway disease in the human lung with special reference to tests which are suitable for epidemiological screening; PhD thesis, London School of Hygiene & Tropical Medicine (1978) DOI: https://doi.org/10.17037/PUBS.04655290

Gillian Mary Regan, A Study of pulmonary function in asbestosis, PhD thesis, London School of Hygiene & Tropical Medicine (1977) DOI: https://doi.org/10.17037/PUBS.04655127

Christopher J. Sirrs, Health and Safety in the British Regulatory State, 1961-2001: the HSC, HSE and the Management of Occupational Risk, PhD thesis, London School of Hygiene & Tropical Medicine (2016) DOI: https://doi.org/10.17037/PUBS.02548737

Michael Etrata Rañopa, Methodological issues in electronic healthcare database studies of drug cancer associations: identification of cancer, and drivers of discrepant results, PhD thesis, London School of Hygiene & Tropical Medicine (2016). DOI: https://doi.org/10.17037/PUBS.02572609

Melanie Smuk, Missing Data Methodology: Sensitivity analysis after multiple imputation, PhD thesis, London School of Hygiene & Tropical Medicine (2015) DOI: https://doi.org/10.17037/PUBS.02212896

John Ross Tazare, High-dimensional propensity scores for data-driven confounder adjustment in UK electronic health records, PhD thesis, London School of Hygiene & Tropical Medicine (2022). DOI: https://doi.org/10.17037/PUBS.046647276/

Rebecca Jane Hardy, (1995) Meta-analysis techniques in medical research: a statistical perspective. PhD thesis, London School of Hygiene & Tropical Medicine. DOI: https://doi.org/10.17037/PUBS.00682268

Jemma Walker, Bayesian modelling in genetic association studies, PhD thesis, London School of Hygiene & Tropical Medicine (2012) DOI: https://doi.org/10.17037/PUBS.01635516

  1. Marieke Schoonen, (2007) Pharmacoepidemiology of autoimmune diseases.PhD thesis, London School of Hygiene & Tropical Medicine. DOI: https://doi.org/10.17037/PUBS.04646551

Claudio John Verzilli, Method for the analysis of incomplete longitudinal data, PhD thesis, London School of Hygiene & Tropical Medicine (2003)  DOI: https://doi.org/10.17037/PUBS.04646517

Martine Vrijheid, Risk of congenital anomaly in relation to residence near hazardous waste landfill sites, PhD thesis, London School of Hygiene & Tropical Medicine (2000) DOI: https://doi.org/10.17037/PUBS.00682274

[1] See, e.g., Benjamin Nathan Schachtman, Traumedy: Dark Comedic Negotiations of Trauma in Contemporary American Literature (2016).

[2] J.D. Walters, Asbestos – a potential hazard to health in the ship building and ship repairing industries, DrPH thesis, London School of Hygiene & Tropical Medicine (1959); https://doi.org/10.17037/PUBS.01273049.

[3] “The Lobby – Cut on the Bias” (July 6, 2020).

[4] Francis Douglas Kelly Liddell, Mortality of Quebec chrysotile workers in relation to radiological findings while still employed, PhD thesis, London School of Hygiene & Tropical Medicine (1978); DOI: https://doi.org/10.17037/PUBS.04656049

[5] Keith Richard Sullivan, Mortality patterns among civilian workers in Royal Navy Dockyards, PhD thesis, London School of Hygiene & Tropical Medicine (1994) DOI: https://doi.org/10.17037/PUBS.04656717

[6] Damien Martin McElvenny, Meta-analysis of Rare Diseases in Occupational Epidemiology, PhD thesis, London School of Hygiene & Tropical Medicine (2017) DOI: https://doi.org/10.17037/PUBS.03894558

Posted in Scientific Evidence, Scientific Publishing, State of the Art | 1 Comment »

PLPs & Five-Legged Dogs

September 1st, 2023

All lawyers have heard the puzzle of “how many legs does a dog have if you call his tail a leg?” The puzzle is often misattributed to Abraham Lincoln, who used the puzzle at various times, including in jury speeches. The answer of course is: “Four. Saying that a tail is a leg does not make it a leg.” Quote investigators have traced the puzzle as far back as 1825, when newspapers quoted legislator John W. Hulbert as saying that something “reminded him of the story.”[1]

What do we call a person who becomes pregnant and delivers a baby?

A woman.

The current, trending fashion is to call such a person a PLP, a person who becomes pregnant and lactates. This façon de parler is particularly misleading if it is meant as an accommodation to the transgender population. Transgender women will not show up as pregnant or lactating, and transgender men will show up only if there transition is incomplete and has left them with functional female reproductive organs.

In 2010, Guinness World Records named Thomas Beatie the “World’s First Married Man to Give Birth.” Thomas Beatie is now legally a man, which is just another way of saying that he chose to identify as a man, and gained legal recognition for his choice. Beatie was born as a female, matured into a woman, and had ovaries and a uterus. Beatie was, in other words, biologically a female when she went through puberty and became biologically a woman.

Beatie underwent partial gender reassignment surgery, consisting at least of double mastectomy, and taking testosterone replacement therapy (off label), but retained ovaries and a uterus.

Guinness makes a fine stout, and we may look upon it kindly for having nurtured the statistical thinking of William Sealy Gosset. Guinness, however, cannot make a dog have five legs simply by agreeing to call its tail a leg. Beatie was not the first pregnant man; rather he was the first person, born with functional female reproductive organs, to have his male gender identity recognized by a state, who then conceived and delivered a newborn. If Guinness wants to call this the first “legal man” to give birth, by semantic legerdemain, that is fine. Certainly we can and should publicly be respectful of transgendered persons, and work to prevent them from being harassed or embarrassed. There may well be many situations in which we would change our linguistic usage to acknowledge a transsexual male as the mother of a child.[2] We do not, however, have to change biology to suit their choices, or to make useless gestures to have them feel included when their inclusion is not relevant to important scientific and medical issues.

Sadly, the NASEM would impose this politico-semanticism upon us while addressing the serious issue whether women of child-bearing age should be included in clinical trials.  At a recent workshop on “Developing a Framework to Address Legal, Ethical, Regulatory, and Policy Issues for Research Specific to Pregnant and Lactating Persons,”[3] the Academies introduced a particularly ugly neologism, “pregnant and lactating persons,” or PLP for short. The workshop reports:

“Approximately 4 million pregnant people in the United States give birth annually, and 70 percent of these individuals take at least one prescription medication during their pregnancy. Yet, pregnant and lactating persons are often excluded from clinical trials, and often have to make treatment decisions without an adequate understanding of the benefits and risks to themselves and their developing fetus or newborn baby. An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will develop a framework for addressing medicolegal and liability issues when planning or conducting research specific to pregnant and lactating persons.”[4]

The full report from NASEM, with fulsome use of the PLP phrase, is now available.[5]

J.K. Rowling is not the only one who is concerned about the erasure of the female from our discourse. Certainly we can acknowledge that transgenderism is real, without allowing the exception to erase biological facts about reproduction. After all, Guinness’s first pregnant “legal man” could not lactate, as a result of bilateral mastectomies, and thus the “legal man” was not a pregnant person who could lactate. And the pregnant “legal man” had functioning ovaries and uterus, which is not a matter of gender identity, but physiological functioning of biological female sex organs. Furthermore, including transgendered women, or “legal women,” without functional ovaries and uterus, in clinical trials will not answer difficult question about whether experimental therapies may harm women’s reproductive function or their offspring in utero or after birth.

The inclusion of women in clinical trials is a serious issue precisely because experimental therapies may hold risks for participating women’s offspring in utero. The law may not permit a proper informed consent by women for their conceptus. And because of the new latitude legislatures enjoy to impose religion-based bans on abortion, a women who conceives while taking an experimental drug may not be able to terminate her pregnancy that has been irreparably harmed by the drug.

The creation of the PLP category really confuses rather than elucidates how we answer the ethical and medical questions involved in testing new drugs or treatments for women. NASEM’s linguistic gerrymandering may allow some persons who have suffered from gender dysphoria to feel “included,” and perhaps to have their choices “validated,” but the inclusion of transgender women, or partially transgendered men, will not help answer the important questions facing clinical researchers. Taxpayers who fund NASEM and NIH deserve better clarity and judgment in the use of governmental funds in supporting clinical trials.

When and whence comes this PLP neologism?  An N-Gram search shows that “pregnant person” was found in the database before 1975, and that the phrase has waxed and waned since.

N-Gram for pregnant person, conducted September 1, 2023

A search of the National Library of Medicine PubMed database found several dozen hits, virtually all within the last two years. The earliest use was in 1970,[6] with a recrudenscence 11 years later.[7]

                                             

From PubMed search for “pregnant person,” conducted Sept. 1, 2023 

In 2021, the New England Journal of Medicine published a paper on the safety of Covid-19 vaccines in “pregnant persons.”[8] As of last year, the Association of American Medical Colleges sponsored a report about physicians advocating for inclusion of “pregnant people” in clinical trials, in a story that noted that “[p]regnant patients are often excluded from clinical trials for fear of causing harm to them or their babies, but leaders in maternal-fetal medicine say the lack of data can be even more harmful.”[9] And currently, the New York State Department of Health advises that “[d]ue to changes that occur during pregnancy, pregnant people may be more susceptible to viral respiratory infections.”[10]

The neologism of PLP was not always so. Back in the dark ages, 2008, the National Cancer Institute issued guidelines on the inclusion of pregnant and breast-feeding women in clinical trials.[11] As recently as June 2021, The World Health Organization was still old school in discussing “pregnant and lactating women.”[12] The same year, over a dozen female scientists, published a call to action about the inclusion of “pregnant women” in COVID-19 trials.[13]

Two years ago, I gingerly criticized the American Medical Association’s issuance of a linguistic manifesto on how physicians and scientists should use language to advance the Association’s notions of social justice.[14] I criticized the Association’s efforts at the time, but its guide to “correct” usage was devoid of the phrase “pregnant persons” or “lactating persons.”[15] Pregnancy is a function of sex, not of gender.

[1] “Suppose You Call a Sheep’s Tail a Leg, How Many Legs Will the Sheep Have?” QuoteResearch (Nov. 15, 2015).

[2] Sam Dylan More, “The pregnant man – an oxymoron?” 7 J. Gender Studies 319 (1998).

[3] National Academies of Sciences, Engineering, and Medicine, “Research with Pregnant and Lactating Persons: Mitigating Risk and Liability: Proceedings of a Workshop in Brief,” (2023).

[4] NASEM, “Research with Pregnant and Lactating Persons: Mitigating Risk and Liability: Proceedings of a Workshop–in Brief” (2023).

[5] National Academies of Sciences, Engineering, and Medicine, Inclusion of pregnant and lactating persons in clinical trials: Proceedings of a workshop (2023).

[6] W.K. Keller, “The pregnant person,” 68 J. Ky. Med. Ass’n 454 (1970).

[7] Vibiana M. Andrade, “The toxic workplace: Title VII protection for the potentially pregnant person,” 4 Harvard Women’s Law J. 71 (1981).

[8] Tom T. Shimabukuro, Shin Y. Kim, Tanya R. Myers, Pedro L. Moro, Titilope Oduyebo, Lakshmi Panagiotakopoulos, Paige L. Marquez, Christine K. Olson, Ruiling Liu, Karen T. Chang, Sascha R. Ellington, Veronica K. Burkel, et al., for the CDC v-safe COVID-19 Pregnancy Registry Team, “Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons,” 384 New Engl. J. Med. 2273 (2021).

[9] Bridget Balch, “Prescribing without data: Doctors advocate for the inclusion of pregnant people in clinical research,” AAMC (Mar. 22, 2022).

[10] New York State Department of Health, “Pregnancy & COVID-19,” last visited August 31, 2023.

[11] NCI, “Guidelines Regarding the Inclusion of Pregnant and Breast-Feeding Women on Cancer Clinical Treatment Trials,” (May 29, 2008).

[12] WHO, “Update on WHO Interim recommendations on COVID-19 vaccination of pregnant and lactating women,” (June 10, 2021).

[13] Melanie M. Taylor, Loulou Kobeissi, Caron Kim, Avni Amin, Anna E Thorson, Nita B. Bellare, Vanessa Brizuela, Mercedes Bonet, Edna Kara, Soe Soe Thwin, Hamsadvani Kuganantham, Moazzam Ali, Olufemi T. Oladapo, Nathalie Broutet, “Inclusion of pregnant women in COVID-19 treatment trials: a review and global call to action,”9 Health Policy E366 (2021).

[14] American Medical Association, “Advancing Health Equity: A Guide to Language, Narrative and Concepts,” (2021); see Harriet Hall, “The AMA’s Guide to Politically Correct Language: Advancing Health Equity,” Science Based Medicine (Nov. 2, 2021).

[15] “When the American Medical Association Woke Up” (Nov.17, 2021).

Posted in Scientific Evidence, Scientific Publishing | 1 Comment »

Links, Ties, and Other Hook Ups in Risk Factor Epidemiology

July 5th, 2023

Many journalists struggle with reporting the results from risk factor epidemiology. Recently, JAMA Network Open published an epidemiologic study (“Williams study”) that explored whether exposure to Agent Orange amoby ng United States military veterans was associated with bladder cancer.[1] The reported study found little to no association, but lay and scientific journalists described the study as finding a “link,”[2] or a “tie,”[3] thus suggesting causality. One web-based media report stated, without qualification, that Agent Orange “increases bladder cancer risk.”[4]

 

Even the authors of the Williams study described the results inconsistently and hyperbolically. Within the four corners of the published article, the authors described their having found a “modestly increased risk of bladder cancer,” and then, on the same page, they reported that “the association was very slight (hazard ratio, 1.04; 95% C.I.,1.02-1.06).”

In one place, the Williams study states it looked at a cohort of 868,912 veterans with exposure to Agent Orange, and evaluated bladder cancer outcomes against outcomes in 2,427,677 matched controls. Elsewhere, they report different numbers, which are hard to reconcile. In any event, the authors had a very large sample size, which had the power to detect theoretically small differences as “statistically significant” (p < 0.05). Indeed, the study was so large that even a very slight disparity in rates between the exposed and unexposed cohort members could be “statistically significantly” different, notwithstanding that systematic error certainly played a much larger role in the results than random error. In terms of absolute numbers, the researchers found 50,781 bladder cancer diagnoses, on follow-up of 28,672,655 person-years. There were overall 2.1% bladder cancers among the exposed servicemen, and 2.0% among the unexposed. Calling this putative disparity a “modest association” is a gross overstatement, and it is difficult to square the authors’ pronouncement of a “modest association” with a “very slight increased risk.”

The authors also reported that there was no association between Agent Orange exposure and aggressiveness of bladder cancer, with bladder wall muscle invasion taken to be the marker of aggressiveness. Given that the authors were willing to proclaim a hazard ratio of 1.04 as an association, this report of no association with aggressiveness is manifestly false. The Williams study found a decreased odds of a diagnosis of muscle-invasive bladder cancer among the exposed cases, with an odds ratio of 0.91, 95% CI 0.85-0.98 (p = 0.009). The study thus did not find an absence of an association, but rather an inverse association.

Causality

Under the heading of “Meaning,” the authors wrote that “[t]hese findings suggest an association between exposure to Agent Orange and bladder cancer, although the clinical relevance of this was unclear.” Despite disclaiming a causal interpretation of their results, Williams and colleagues wrote that their results “support prior investigations and further support bladder cancer to be designated as an Agent Orange-associated disease.”

Williams and colleagues note that the Institute of Medicine had suggested that the association between Agent Orange exposure and bladder cancer outcomes required further research.[5] Requiring additional research was apparently sufficient for the Department of Veterans Affairs, in 2021, to assume facts not in evidence, and to designate “bladder cancer as a cancer caused by Agent Orange exposure.”[6]

Williams and colleagues themselves appear to disavow a causal interpretation of their results: “we cannot determine causality given the retrospective nature of our study design.” They also acknowledged their inability to “exclude potential selection bias and misclassification bias.” Although the authors did not explore the issue, exposed servicemen may well have been under greater scrutiny, creating surveillance and diagnostic biases.

The authors failed to grapple with other, perhaps more serious biases and inadequacy of methodology in their study. Although the authors claimed to have controlled for the most important confounders, they failed to include diabetes as a co-variate in their analysis, even though diabetic patients have a more than doubled increased risk for bladder cancer, even after adjustment for smoking.[7] Diabetic patients would also have been likely to have had more visits to VA centers for healthcare and more opportunity to have been diagnosed with bladder cancer.

Futhermore, with respect to the known confounding variable of smoking, the authors trichotomized smoking history as “never,” “former,” or “current” smoker. The authors were missing smoking information in about 13% of the cohort. In a univariate analysis based upon smoking status (Table 4), the authors reported the following hazard ratios for bladder cancer, by smoking status:

Smoking status at bladder cancer diagnosis

Never smoked      1   [Reference]

Current smoker   1.10 (1.00-1.21)

Former smoker    1.08 (1.00-1.18)

Unknown              1.17 (1.05-1.31)

This analysis for smoking risk points to the fragility of the Agent Orange analyses. First, the “unknown” smoking status is associated with roughly twice the risk for current or former smokers. Second, the risk ratios for muscle-invasive bladder cancer were understandably higher for current smokers (OR 1.10, 95% CI 1.00-1.21) and former smokers (OR 1.08, 95% CI 1.00-1.18) than for non-smoking veterans.

Third, the Williams’ study’s univariate analysis of smoking and bladder cancer generates risk ratios that are quite out of line with independent studies of smoking and bladder cancer risk. For instance, meta-analyses of studies of smoking and bladder cancer risk report risk ratios of 2.58 (95% C.I., 2.37–2.80) for any smoking, 3.47 (3.07–3.91) for current smoking, and 2.04 (1.85–2.25) for past smoking.[8] These smoking-related bladder cancer risks are thus order(s) of magnitude greater than the univariate analysis of smoking risk in the Williams study, as well as the multivariate analysis of Agent Orange risk reported.

Fourth, the authors engage in the common, but questionable practice of categorizing a known confounder, smoking, which should ideally be reported as a continuous variable with respect to quantity consumed, years smoked, and years since quitting.[9] The question here, given that the study is very large, is not the loss of power,[10] but bias away from the null. Peter Austin has shown, by Monte Carlo simulation, that categorizing a continuous variable in a logistic regression results in inflating the rate of finding false positive associations.[11] The type I (false-positive) error rates increases with sample size, with increasing correlation between the confounding variable and outcome of interest, and the number of categories used for the continuous variables. The large dataset used by Williams and colleagues, which they see as a plus, works against them by increasing the bias from the use of categorical variables for confounding variables.[12]

The Williams study raises serious questions not only about the quality of medical journalism, but also about how an executive agency such as the Veterans Administration evaluates scientific evidence. If the Williams study were to play a role in compensation determinations, it would seem that veterans with muscle-invasive bladder cancer would be turned away, while those veterans with less serious cancers would be compensated. But with 2.1% incidence versus 2.0%, how can compensation be rationally permitted in every case?

[1] Stephen B. Williams, Jessica L. Janes, Lauren E. Howard, Ruixin Yang, Amanda M. De Hoedt, Jacques G. Baillargeon, Yong-Fang Kuo, Douglas S. Tyler, Martha K. Terris, Stephen J. Freedland, “Exposure to Agent Orange and Risk of Bladder Cancer Among US Veterans,” 6 JAMA Network Open e2320593 (2023).

[2] Elana Gotkine, “Exposure to Agent Orange Linked to Risk of Bladder Cancer,” Buffalo News (June 28, 2023); Drew Amorosi, “Agent Orange exposure linked to increased risk for bladder cancer among Vietnam veterans,” HemOnc Today (June 27, 2023).

[3] Andrea S. Blevins Primeau, “Agent Orange Exposure Tied to Increased Risk of Bladder Cancer,” Cancer Therapy Advisor (June 30, 2023); Mike Bassett, “Agent Orange Exposure Tied to Bladder Cancer Risk in Veterans — Increased risk described as ‘modest’, and no association seen with aggressiveness of cancer,” Medpage Today (June 27, 2023).

[4] Darlene Dobkowski, “Agent Orange Exposure Modestly Increases Bladder Cancer Risk in Vietnam Veterans,” Cure Today (June 27, 2023).

[5] Institute of Medicine – Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Tenth Biennial Update), Veterans and Agent Orange: Update 2014 at 10 (2016) (upgrading previous finding of “inadequate” to “suggestive”).

[6] Williams study, citing U.S. Department of Veterans Affairs, “Agent Orange exposure and VA disability compensation.”

[7] Yeung Ng, I. Husain, N. Waterfall, “Diabetes Mellitus and Bladder Cancer – An Epidemiological Relationship?” 9 Path. Oncol. Research 30 (2003) (diabetic patients had an increased, significant odds ratio for bladder cancer compared with non diabetics even after adjustment for smoking and age [OR: 2.69 p=0.049 (95% CI 1.006-7.194)]).

[8] Marcus G. Cumberbatch, Matteo Rota, James W.F. Catto, and Carlo La Vecchia, “The Role of Tobacco Smoke in Bladder and Kidney Carcinogenesis: A Comparison of Exposures and Meta-analysis of Incidence and Mortality Risks?” 70 European Urology 458 (2016).

[9] See generally, “Confounded by Confounding in Unexpected Places” (Dec. 12, 2021).

[10] Jacob Cohen, “The cost of dichotomization,” 7 Applied Psychol. Measurement 249 (1983).

[11] Peter C. Austin & Lawrence J. Brunner, “Inflation of the type I error rate when a continuous confounding variable is categorized in logistic regression analyses,” 23 Statist. Med. 1159 (2004).

[12] See, e.g., Douglas G. Altman & Patrick Royston, “The cost of dichotomising continuous variables,” 332 Brit. Med. J. 1080 (2006); Patrick Royston, Douglas G. Altman, and Willi Sauerbrei, “Dichotomizing continuous predictors in multiple regression: a bad idea,” 25 Stat. Med. 127 (2006); Valerii Fedorov, Frank Mannino, and Rongmei Zhang, “Consequences of dichotomization,” 8 Pharmaceut. Statist. 50 (2009). See also Robert C. MacCallum, Shaobo Zhang, Kristopher J. Preacher, and Derek D. Rucker, “On the Practice of Dichotomization of Quantitative Variables,” 7 Psychological Methods 19 (2002); David L. Streiner, “Breaking Up is Hard to Do: The Heartbreak of Dichotomizing Continuous Data,” 47 Can. J. Psychiatry 262 (2002); Henian Chen, Patricia Cohen, and Sophie Chen, “Biased odds ratios from dichotomization of age,” 26 Statist. Med. 3487 (2007); Carl van Walraven & Robert G. Hart, “Leave ‘em Alone – Why Continuous Variables Should Be Analyzed as Such,” 30 Neuroepidemiology 138 (2008); O. Naggara, J. Raymond, F. Guilbert, D. Roy, A. Weill, and Douglas G. Altman, “Analysis by Categorizing or Dichotomizing Continuous Variables Is Inadvisable,” 32 Am. J. Neuroradiol. 437 (Mar 2011); Neal V. Dawson & Robert Weiss, “Dichotomizing Continuous Variables in Statistical Analysis: A Practice to Avoid,” Med. Decision Making 225 (2012); Phillippa M. Cumberland, Gabriela Czanner, Catey Bunce, Caroline J. Doré, Nick Freemantle, and Marta García-Fiñana, “Ophthalmic statistics note: the perils of dichotomising continuous variables,” 98 Brit. J. Ophthalmol. 841 (2014); Julie R. Irwin & Gary H. McClelland, “Negative Consequences of Dichotomizing Continuous Predictor Variables,” 40 J. Marketing Research 366 (2003); Stanley E. Lazic, “Four simple ways to increase power without increasing the sample size,” PeerJ Preprints (23 Oct 2017).

Posted in Confounding, Peer Review, Scientific Evidence, Scientific Publishing | No Comments »

Judicial Flotsam & Jetsam – Retractions

June 12th, 2023

In scientific publishing, when scientists make a mistake, they publish an erratum or a corrigendum. If the mistake vitiates the study, then the erring scientists retract their article. To be sure, sometimes the retraction comes after an obscene delay, with the authors kicking and screaming.[1] Sometimes the retraction comes at the request of the authors, better late than never.[2]

Retractions in the biomedical journals, whether voluntary or not, are on the rise.[3] The process and procedures for retraction of articles often lack transparency. Many articles are retracted without explanation or disclosure of specific problems about the data or the analysis.[4] Sadly, however, misconduct in the form of plagiarism and data falsification is a frequent reason for retractions.[5] The lack of transparency for retractions, and sloppy scholarship, combine to create Zombie papers, which are retracted but continue to be cited in subsequent publications.[6]

LEGAL RETRACTIONS

The law treats errors very differently. Being a judge usually means that you never have to say you are sorry. Judge Andrew Hurwitz has argued that that our legal system would be better served if judges could and did “freely acknowledged and transparently corrected the occasional ‘goof’.”[7] Alas, as Judge Hurwitz notes, very few published decisions acknowledge mistakes.[8]

In the world of scientific jurisprudence, the judicial reticence to acknowledge mistakes is particularly dangerous, and it leads directly to the proliferation of citations to cases that make egregious mistakes. In the niche area of judicial assessment of scientific and statistical evidence, the proliferation of erroneous statements is especially harmful because it interferes with thinking clearly about the issues before courts. Judges believe that they have argued persuasively for a result, not by correctly marshaling statistical and scientific concepts, but by relying upon precedents erroneously arrived at by other judges in earlier cases. Regardless of how many cases are cited (and there are many possible “precedents”), the true parameter does not have a 95% probability of lying within the interval given by a given 95% confidence interval.[9] Similarly, as much as judges would like p-values and confidence intervals to eliminate the need to worry about systematic error, their saying so cannot make it so.[10] Even a mighty federal judge cannot make the p-value probability, or its complement, substitute for the posterior probability of a causal claim.[11]

Some cases in the books are so egregiously decided that it is truly remarkable that they would be cited for any proposition. I call these scientific Dred Scott cases, which illustrate that sometimes science has no criteria of validity that the law is bound to respect. One such Dred Scott case was the result of a bench trial in a federal district court in Atlanta, in Wells v. Ortho Pharmaceutical Corporation.[12]

Wells was notorious for its poor assessment of all the determinants of scientific causation.[13] The decision was met with a storm of opprobrium from the legal and medical community.[14] No scientists or legal scholars offered a serious defense of Wells on the scientific merits. Even the notorious plaintiffs’ expert witness, Carl Cranor, could muster only a distanced agnosticism:

“In Wells v. Ortho Pharmaceutical Corp., which involved a claim that birth defects were caused by a spermicidal jelly, the U.S. Court of Appeals for the 11th Circuit followed the principles of Ferebee and affirmed a plaintiff’s verdict for about five million dollars. However, some members of the medical community chastised the legal system essentially for ignoring a well-established scientific consensus that spermicides are not teratogenic. We are not in a position to judge this particular issue, but the possibility of such results exists.”[15]

Cranor apparently could not bring himself to note that it was not just scientific consensus that was ignored; the Wells case ignored the basic scientific process of examining relevant studies for both internal and external validity.

Notwithstanding this scholarly consensus and condemnation, we have witnessed the repeated recrudescence of the Wells decision. In Matrixx Initiatives, Inc. v. Siracusano,[16] in 2011, the Supreme Court, speaking through Justice Sotomayor, wandered into a discussion, irrelevant to its holding, whether statistical significance was necessary for a determination of the causality of an association:

“We note that courts frequently permit expert testimony on causation based on evidence other than statistical significance. See, e.g., Best v. Lowe’s Home Centers, Inc., 563 F. 3d 171, 178 (6th Cir 2009); Westberry v. Gislaved Gummi AB, 178 F. 3d 257, 263–264 (4th Cir. 1999) (citing cases); Wells v. Ortho Pharmaceutical Corp., 788 F. 2d 741, 744–745 (11th Cir. 1986). We need not consider whether the expert testimony was properly admitted in those cases, and we do not attempt to define here what constitutes reliable evidence of causation.”[17]

The quoted language is remarkable for two reasons. First, the Best and Westberry cases did not involve statistics at all. They addressed specific causation inferences from what is generally known as differential etiology. Second, the citation to Wells was noteworthy because the case has nothing to do with adverse event reports or the lack of statistical significance.

Wells involved a claim of birth defects caused by the use of spermicidal jelly contraceptive, which had been the subject of several studies, one of which at least yielded a nominally statistically significant increase in detected birth defects over what was expected.

Wells could thus hardly be an example of a case in which there was a judgment of causation based upon a scientific study that lacked statistical significance in its findings. Of course, finding statistical significance is just the beginning of assessing the causality of an association. The most remarkable and disturbing aspect of the citation to Wells, however, was that the Court was unaware of, or ignored, the case’s notoriety, and the scholarly and scientific consensus that criticized the decision for its failure to evaluate the entire evidentiary display, as well as for its failure to rule out bias and confounding in the studies relied upon by the plaintiff.

Justice Sotomayor’s decision for a unanimous Court is not alone in its failure of scholarship and analysis in embracing the dubious precedent of Wells. Many other courts have done much the same, both in state[18] and in federal courts,[19] and both before and after the Supreme Court decided Daubert, and even after Rule 702 was amended in 2000.[20] Perhaps even more disturbing is that the current edition of the Reference Manual on Scientific Evidence glibly cites to the Wells case, for the dubious proposition that

“Generally, researchers are conservative when it comes to assessing causal relationships, often calling for stronger evidence and more research before a conclusion of causation is drawn.”[21]

We are coming up on the 40th anniversary of the Wells judgment. It is long past time to stop citing the case. Perhaps we have reached the stage of dealing with scientific evidence at which errant and aberrant cases should be retracted, and clearly marked as retracted in the official reporters, and in the electronic legal databases. Certainly the technology exists to link the scholarly criticism with a case citation, just as we link subsequent judicial treatment by overruling, limiting, and criticizing.

[1] Laura Eggertson, “Lancet retracts 12-year-old article linking autism to MMR vaccines,” 182 Canadian Med. Ass’n J. E199 (2010).

[2] Notice of retraction for Teng Zeng & William Mitch, “Oral intake of ranitidine increases urinary excretion of N-nitrosodimethylamine,” 37 Carcinogenesis 625 (2016), published online (May 4, 2021) (retraction requested by authors with an acknowledgement that they had used incorrect analytical methods for their study).

[3] Tianwei He, “Retraction of global scientific publications from 2001 to 2010,” 96 Scientometrics 555 (2013); Bhumika Bhatt, “A multi-perspective analysis of retractions in life sciences,” 126 Scientometrics 4039 (2021); Raoul R.Wadhwa, Chandruganesh Rasendran, Zoran B. Popovic, Steven E. Nissen, and Milind Y. Desai, “Temporal Trends, Characteristics, and Citations of Retracted Articles in Cardiovascular Medicine,” 4 JAMA Network Open e2118263 (2021); Mario Gaudino, N. Bryce Robinson, Katia Audisio, Mohamed Rahouma, Umberto Benedetto, Paul Kurlansky, Stephen E. Fremes, “Trends and Characteristics of Retracted Articles in the Biomedical Literature, 1971 to 2020,” 181 J. Am. Med. Ass’n Internal Med. 1118 (2021); Nicole Shu Ling Yeo-Teh & Bor Luen Tang, “Sustained Rise in Retractions in the Life Sciences Literature during the Pandemic Years 2020 and 2021,” 10 Publications 29 (2022).

[4] Elizabeth Wager & Peter Williams, “Why and how do journals retract articles? An analysis of Medline retractions 1988-2008,” 37 J. Med. Ethics 567 (2011).

[5] Ferric C. Fanga, R. Grant Steen, and Arturo Casadevall, “Misconduct accounts for the majority of retracted scientific publications,” 109 Proc. Nat’l Acad. Sci. 17028 (2012); L.M. Chambers, C.M. Michener, and T. Falcone, “Plagiarism and data falsification are the most common reasons for retracted publications in obstetrics and gynaecology,” 126 Br. J. Obstetrics & Gyn. 1134 (2019); M.S. Marsh, “Separating the good guys and gals from the bad,” 126 Br. J. Obstetrics & Gyn. 1140 (2019).

[6] Tzu-Kun Hsiao and Jodi Schneider, “Continued use of retracted papers: Temporal trends in citations and (lack of) awareness of retractions shown in citation contexts in biomedicine,” 2 Quantitative Science Studies 1144 (2021).

[7] Andrew D. Hurwitz, “When Judges Err: Is Confession Good for the Soul?” 56 Ariz. L. Rev. 343, 343 (2014).

[8] See id. at 343-44 (quoting Justice Story who dealt with the need to contradict a previously published opinion, and who wrote “[m]y own error, however, can furnish no ground for its being adopted by this Court.” U.S. v. Gooding, 25 U.S. 460, 478 (1827)).

[9] See, e.g., DeLuca v. Merrell Dow Pharms., Inc., 791 F. Supp. 1042, 1046 (D.N.J. 1992) (”A 95% confidence interval means that there is a 95% probability that the ‘true’ relative risk falls within the interval”) , aff’d, 6 F.3d 778 (3d Cir. 1993); In re Silicone Gel Breast Implants Prods. Liab. Litig, 318 F.Supp.2d 879, 897 (C.D. Cal. 2004); Eli Lilly & Co. v. Teva Pharms, USA, 2008 WL 2410420, *24 (S.D.Ind. 2008) (stating incorrectly that “95% percent of the time, the true mean value will be contained within the lower and upper limits of the confidence interval range”). See also “Confidence in Intervals and Diffidence in the Courts” (Mar. 4, 2012).

[10] See, e.g., Brock v. Merrill Dow Pharmaceuticals, Inc., 874 F.2d 307, 311-12 (5th Cir. 1989) (“Fortunately, we do not have to resolve any of the above questions [as to bias and confounding], since the studies presented to us incorporate the possibility of these factors by the use of a confidence interval.”). This howler has been widely acknowledged in the scholarly literature. See David Kaye, David Bernstein, and Jennifer Mnookin, The New Wigmore – A Treatise on Evidence: Expert Evidence § 12.6.4, at 546 (2d ed. 2011); Michael O. Finkelstein, Basic Concepts of Probability and Statistics in the Law 86-87 (2009) (criticizing the blatantly incorrect interpretation of confidence intervals by the Brock court).

[11] In re Ephedra Prods. Liab. Litig., 393 F.Supp. 2d 181, 191 (S.D.N.Y. 2005) (Rakoff, J.) (“Generally accepted scientific convention treats a result as statistically significant if the P-value is not greater than .05. The expression ‘P=.05’ means that there is one chance in twenty that a result showing increased risk was caused by a sampling error — i.e., that the randomly selected sample accidentally turned out to be so unrepresentative that it falsely indicates an elevated risk.”); see also In re Phenylpropanolamine (PPA) Prods. Liab. Litig., 289 F.Supp. 2d 1230, 1236 n.1 (W.D. Wash. 2003) (“P-values measure the probability that the reported association was due to chance… .”). Although the erroneous Ephedra opinion continues to be cited, it has been debunked in the scholarly literature. See Michael O. Finkelstein, Basic Concepts of Probability and Statistics in the Law 65 (2009); Nathan A. Schachtman, “Statistical Evidence in Products Liability Litigation,” at 28-13, chap. 28, in Stephanie A. Scharf, George D. Sax, & Sarah R. Marmor, eds., Product Liability Litigation: Current Law, Strategies and Best Practices (2d ed. 2021).

[12] Wells v. Ortho Pharm. Corp., 615 F. Supp. 262 (N.D. Ga.1985), aff’d & modified in part, remanded, 788 F.2d 741 (11th Cir.), cert. denied, 479 U.S. 950 (1986).

[13] I have discussed the Wells case in a series of posts, “Wells v. Ortho Pharm. Corp., Reconsidered,” (2012), part one, two, three, four, five, and six.

[14] See, e.g., James L. Mills and Duane Alexander, “Teratogens and ‘Litogens’,” 15 New Engl. J. Med. 1234 (1986); Samuel R. Gross, “Expert Evidence,” 1991 Wis. L. Rev. 1113, 1121-24 (1991) (“Unfortunately, Judge Shoob’s decision is absolutely wrong. There is no scientifically credible evidence that Ortho-Gynol Contraceptive Jelly ever causes birth defects.”). See also Editorial, “Federal Judges v. Science,” N.Y. Times, December 27, 1986, at A22 (unsigned editorial) (“That Judge Shoob and the appellate judges ignored the best scientific evidence is an intellectual embarrassment.”);  David E. Bernstein, “Junk Science in the Courtroom,” Wall St. J. at A 15 (Mar. 24,1993) (pointing to Wells as a prominent example of how the federal judiciary had embarrassed American judicial system with its careless, non-evidence based approach to scientific evidence); Bert Black, Francisco J. Ayala & Carol Saffran-Brinks, “Science and the Law in the Wake of Daubert: A New Search for Scientific Knowledge,” 72 Texas L. Rev. 715, 733-34 (1994) (lawyers and leading scientist noting that the district judge “found that the scientific studies relied upon by the plaintiffs’ expert were inconclusive, but nonetheless held his testimony sufficient to support a plaintiffs’ verdict. *** [T]he court explicitly based its decision on the demeanor, tone, motives, biases, and interests that might have influenced each expert’s opinion. Scientific validity apparently did not matter at all.”) (internal citations omitted); Bert Black, “A Unified Theory of Scientific Evidence,” 56 Fordham L. Rev. 595, 672-74 (1988); Paul F. Strain & Bert Black, “Dare We Trust the Jury – No,” 18 Brief  7 (1988); Bert Black, “Evolving Legal Standards for the Admissibility of Scientific Evidence,” 239 Science 1508, 1511 (1988); Diana K. Sheiness, “Out of the Twilight Zone: The Implications of Daubert v. Merrill Dow Pharmaceuticals, Inc.,” 69 Wash. L. Rev. 481, 493 (1994); David E. Bernstein, “The Admissibility of Scientific Evidence after Daubert v. Merrell Dow Pharmacueticals, Inc.,” 15 Cardozo L. Rev. 2139, 2140 (1993) (embarrassing decision); Troyen A. Brennan, “Untangling Causation Issues in Law and Medicine: Hazardous Substance Litigation,” 107 Ann. Intern. Med. 741, 744-45 (1987) (describing the result in Wells as arising from the difficulties created by the Ferebee case; “[t]he Wells case can be characterized as the court embracing the hypothesis when the epidemiologic study fails to show any effect”); Troyen A. Brennan, “Causal Chains and Statistical Links: Some Thoughts on the Role of Scientific Uncertainty in Hazardous Substance Litigation,” 73 Cornell L. Rev. 469, 496-500 (1988); David B. Brushwood, “Drug induced birth defects: difficult decisions and shared responsibilities,” 91 W. Va. L. Rev. 51, 74 (1988); Kenneth R. Foster, David E. Bernstein, and Peter W. Huber, eds., Phantom Risk: Scientific Inference and the Law 28-29, 138-39 (1993) (criticizing Wells decision); Peter Huber, “Medical Experts and the Ghost of Galileo,” 54 Law & Contemp. Problems 119, 158 (1991); Edward W. Kirsch, “Daubert v. Merrell Dow Pharmaceuticals: Active Judicial Scrutiny of Scientific Evidence,” 50 Food & Drug L.J. 213 (1995) (“a case in which a court completely ignored the overwhelming consensus of the scientific community”); Hans Zeisel & David Kaye, Prove It With Figures: Empirical Methods in Law and Litigation § 6.5, at 93(1997) (noting the multiple comparisons in studies of birth defects among women who used spermicides, based upon the many reported categories of birth malformations, and the large potential for even more unreported categories); id. at § 6.5 n.3, at 271 (characterizing Wells as “notorious,” and noting that the case became a “lightning rod for the legal system’s ability to handle expert evidence.”); Edward K. Cheng , “Independent Judicial Research in the ‘Daubert’ Age,” 56 Duke L. J. 1263 (2007) (“notoriously concluded”); Edward K. Cheng, “Same Old, Same Old: Scientific Evidence Past and Present,” 104 Michigan L. Rev. 1387, 1391 (2006) (“judge was fooled”); Harold P. Green, “The Law-Science Interface in Public Policy Decisionmaking,” 51 Ohio St. L.J. 375, 390 (1990); Stephen L. Isaacs & Renee Holt, “Drug regulation, product liability, and the contraceptive crunch: Choices are dwindling,” 8 J. Legal Med. 533 (1987); Neil Vidmar & Shari S. Diamond, “Juries and Expert Evidence,” 66 Brook. L. Rev. 1121, 1169-1170 (2001); Adil E. Shamoo, “Scientific evidence and the judicial system,” 4 Accountability in Research 21, 27 (1995); Michael S. Davidson, “The limitations of scientific testimony in chronic disease litigation,” 10 J. Am. Coll. Toxicol. 431, 435 (1991); Charles R. Nesson & Yochai Benkler, “Constitutional Hearsay: Requiring Foundational Testing and Corroboration under the Confrontation Clause,” 81 Virginia L. Rev. 149, 155 (1995); Stephen D. Sugarman, “The Need to Reform Personal Injury Law Leaving Scientific Disputes to Scientists,” 248 Science 823, 824 (1990); Jay P. Kesan, “A Critical Examination of the Post-Daubert Scientific Evidence Landscape,” 52 Food & Drug L. J. 225, 225 (1997); Ora Fred Harris, Jr., “Communicating the Hazards of Toxic Substance Exposure,” 39 J. Legal Ed. 97, 99 (1989) (“some seemingly horrendous decisions”); Ora Fred Harris, Jr., “Complex Product Design Litigation: A Need for More Capable Fact-Finders,” 79 Kentucky L. J. 510 & n.194 (1991) (“uninformed judicial decision”); Barry L. Shapiro & Marc S. Klein, “Epidemiology in the Courtroom: Anatomy of an Intellectual Embarrassment,” in Stanley A. Edlavitch, ed., Pharmacoepidemiology 87 (1989); Marc S. Klein, “Expert Testimony in Pharmaceutical Product Liability Actions,” 45 Food, Drug, Cosmetic L. J. 393, 410 (1990); Michael S. Lehv, “Medical Product Liability,” Ch. 39, in Sandy M. Sanbar & Marvin H. Firestone, eds., Legal Medicine 397, 397 (7th ed. 2007); R. Ryan Stoll, “A Question of Competence – Judicial Role in Regulation of Pharmaceuticals,” 45 Food, Drug, Cosmetic L. J. 279, 287 (1990); Note, “A Question of Competence: The Judicial Role in the Regulation of Pharmaceuticals,” Harvard L. Rev. 773, 781 (1990); Peter H. Schuck, “Multi-Culturalism Redux: Science, Law, and Politics,” 11 Yale L. & Policy Rev. 1, 13 (1993); Howard A. Denemark, “Improving Litigation Against Drug Manufacturers for Failure to Warn Against Possible Side  Effects: Keeping Dubious Lawsuits from Driving Good Drugs off the Market,” 40 Case Western Reserve L.  Rev. 413, 438-50 (1989-90); Howard A. Denemark, “The Search for Scientific Knowledge in Federal Courts in the Post-Frye Era: Refuting the Assertion that Law Seeks Justice While Science Seeks Truth,” 8 High Technology L. J. 235 (1993)

[15] Carl Cranor & Kurt Nutting, “Scientific and Legal Standards of Statistical Evidence in Toxic Tort and Discrimination Suits,” 9 Law & Philosophy 115, 123 (1990) (internal citations omitted).

[16] 131 S.Ct. 1309 (2011) [Matrixx]

[17] Id. at 1319.

[18] Baroldy v. Ortho Pharmaceutical Corp., 157 Ariz. 574, 583, 760 P.2d 574 (Ct. App. 1988); Earl v. Cryovac, A Div. of WR Grace, 115 Idaho 1087, 772 P. 2d 725, 733 (Ct. App. 1989); Rubanick v. Witco Chemical Corp., 242 N.J. Super. 36, 54, 576 A. 2d 4 (App. Div. 1990), aff’d in part, 125 N.J. 421, 442, 593 A. 2d 733 (1991); Minnesota Min. & Mfg. Co. v. Atterbury, 978 S.W. 2d 183, 193 n.7 (Tex. App. 1998); E.I. Dupont de Nemours v. Castillo ex rel. Castillo, 748 So. 2d 1108, 1120 (Fla. Dist. Ct. App. 2000); Bell v. Lollar, 791 N.E.2d 849, 854 (Ind. App. 2003; King v. Burlington Northern & Santa Fe Ry, 277 Neb. 203, 762 N.W.2d 24, 35 & n.16 (2009).

[19] City of Greenville v. WR Grace & Co., 827 F. 2d 975, 984 (4th Cir. 1987); American Home Products Corp. v. Johnson & Johnson, 672 F. Supp. 135, 142 (S.D.N.Y. 1987); Longmore v. Merrell Dow Pharms., Inc., 737 F. Supp. 1117, 1119 (D. Idaho 1990); Conde v. Velsicol Chemical Corp., 804 F. Supp. 972, 1019 (S.D. Ohio 1992); Joiner v. General Elec. Co., 864 F. Supp. 1310, 1322 (N.D. Ga. 1994) (which case ultimately ended up in the Supreme Court); Bowers v. Northern Telecom, Inc., 905 F. Supp. 1004, 1010 (N.D. Fla. 1995); Pick v. American Medical Systems, 958 F. Supp. 1151, 1158 (E.D. La. 1997); Baker v. Danek Medical, 35 F. Supp. 2d 875, 880 (N.D. Fla. 1998).

[20] Rider v. Sandoz Pharms. Corp., 295 F. 3d 1194, 1199 (11th Cir. 2002); Kilpatrick v. Breg, Inc., 613 F. 3d 1329, 1337 (11th Cir. 2010); Siharath v. Sandoz Pharms. Corp., 131 F. Supp. 2d 1347, 1359 (N.D. Ga. 2001); In re Meridia Prods. Liab. Litig., Case No. 5:02-CV-8000 (N.D. Ohio 2004); Henricksen v. ConocoPhillips Co., 605 F. Supp. 2d 1142, 1177 (E.D. Wash. 2009); Doe v. Northwestern Mutual Life Ins. Co., (D. S.C. 2012); In re Chantix (Varenicline) Prods. Liab. Litig., 889 F. Supp. 2d 1272, 1286, 1288, 1290 (N.D. Ala. 2012); Farmer v. Air & Liquid Systems Corp. at n.11 (M.D. Ga. 2018); In re Abilify Prods. Liab. Litig., 299 F. Supp. 3d 1291, 1306 (N.D. Fla. 2018).

[21] Michael D. Green, D. Michal Freedman & Leon Gordis, “Reference Guide on Epidemiology,” 549, 599 n.143, in Federal Judicial Center, National Research Council, Reference Manual on Scientific Evidence (3d ed. 2011).

Posted in Confounding, Reference Manual on Scientific Evidence, Rule 702, Scientific Evidence, Scientific Misconduct, Scientific Publishing | 1 Comment »

Mass Tortogenesis

January 22nd, 2023

Mass torts are created much as cancer occurs in humans. The multistage model of tortogenesis consists of initiating and promoting events. The model describes, and in some cases, can even predict mass torts. The model also offers insights into prevention.

INITIATION

Initiating events can take a variety of forms. A change in a substance’s categorization in the International Agency for Research on Cancer’s treatment of cancer “hazards” will often initiate a mass tort by stirring interest in the lawsuit industry. A recent example of an IARC pronouncement’s initiating mass tort litigation is its reclassification of glyphosate as a “probable” human carcinogen.  Although the IARC monograph was probably flawed at its inception, and despite IARC’s specifying that its use of “probable” has no quantitative meaning, the IARC glyphosate monograph was a potent initiator of mass tort litigation against the manufacturer of glyphosate.

Regulatory rulemaking will often initiate a mass tort. Asbestos litigation existed as workman’s compensation cases from the 1930s, and as occasional, isolated cases against manufacturers, from the late 1950s.[1] By 1970, federal regulation of asbestos, in both occupational and environmental settings, however, helped create a legal perpetual motion machine that is still running, half a century later.

Publication of studies, especially with overstated results, will frequently initiate a mass tort. In 2007, the New England Journal of Medicine published a poorly done meta-analysis by Dr. Steven Nissen, on the supposed risk of heart attack from the use of rosiglitazone (Avandia).[2] Within days, lawsuits were filed against the manufacturer, GlaxoSmithKline, which ultimately paid over six billion dollars in settlements and costs.[3] Only after the harm of this mass tort was largely complete, the results of a mega-trial, RECORD,[4] became available, and the FDA changed its regulatory stance on rosiglitazone.[5]

More recently, on October 17, 2022, the Journal of the National Cancer Institute, published an observational epidemiologic study, “Use of Straighteners and Other Hair Products and Incident Uterine Cancer.”[6] Within a week or two, lawsuits began to proliferate. The authors were equivocal about their results, refraining from using explicit causal language, but suggesting that specific (phthalate) chemicals were “driving” the association:

“Abstract

Background

Hair products may contain hazardous chemicals with endocrine-disrupting and carcinogenic properties. Previous studies have found hair product use to be associated with a higher risk of hormone-sensitive cancers including breast and ovarian cancer; however, to our knowledge, no previous study has investigated the relationship with uterine cancer.

Methods

We examined associations between hair product use and incident uterine cancer among 33947 Sister Study participants aged 35-74 years who had a uterus at enrollment (2003-2009). In baseline questionnaires, participants in this large, racially and ethnically diverse prospective cohort self-reported their use of hair products in the prior 12 months, including hair dyes; straighteners, relaxers, or pressing products; and permanents or body waves. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) to quantify associations between hair product use and uterine cancer using Cox proportional hazard models. All statistical tests were 2-sided.

Results

Over an average of 10.9 years of follow-up, 378 uterine cancer cases were identified. Ever vs never use of straightening products in the previous 12 months was associated with higher incident uterine cancer rates (HR= 1.80, 95% CI = 1.12 to 2.88). The association was stronger when comparing frequent use (> 4 times in the past 12 months) vs never use (HR=2.55, 95% CI = 1.46 to 4.45; P trend=.002). Use of other hair products, including dyes and permanents or body waves, was not associated with incident uterine cancer.

Conclusion

These findings are the first epidemiologic evidence of association between use of straightening products and uterine cancer. More research is warranted to replicate our findings in other settings and to identify specific chemicals driving this observed association.”

The JNCI article might be considered hypothesis generating, but we can observe the article, in real time, initiating a mass tort. A petition for “multi-district litigation” status was filed not long after publication, and the lawsuit industry is jockeying for the inside post in controlling the litigation. Although the authors acknowledged that their findings were “novel,” and required more research, the lawsuit industry did not.

PROMOTION OF INITIATED MASS TORTS

As noted, within days of publication of the JNCI article on hair straighteners and uterine cancer, lawyers filed cases against manufacturers and sellers of hair straighteners. Mass tort litigation is a big business, truly industrial in scale, with its own eco-system of litigation finance, and claim finding and selling. Laws against champerty and maintenance have gone the way of the dodo. Part of the ethos of this eco-system is the constant deprecation of manufacturing industry’s “conflicts of industry,” while downplaying the conflicts of the lawsuit industry.

Here is an example of an email that a lawsuit industry lawyer might have received last month. The emphases below are mine:

“From:  ZZZ

To:  YYYYYYYYY

Date:  12/XX/2022
Subject:  Hair relaxer linked to cancer

Hi,

Here is the latest information on the Hair Relaxer/Straightener tort.

A recent National Institute of Health sister study showed proof that hair straightener products are linked to uterine cancer.

Several lawsuits have been filed against cosmetic hair relaxer companies since the release of the October 2022 NIH study.

The potential plaintiff pool for this case is large since over 50,000 women are diagnosed yearly.

A motion has been filed with the Judicial Panel on Multi District Litigation to have future cases moved to a class action MDL.

There are four cosmetic hair relaxers that are linked to this case so far.  Dark & Lovely, Olive Oil Relaxer, Motions, and Organic Root Stimulator.

Uterine fibroids and endometriosis have been associated with phthalate metabolites used in hair relaxers.

Are you looking to help victims in this case

ZZZ can help your firm sign up these thousands of these claimants monthly with your hair relaxer questionnaire, criteria, retainer agreement, and Hippa without the burden of doing this in house at an affordable cost per signed retainer for intake fees.

  • ZZZ intake fees are as low as $65 dollars per signed based upon a factors which are criteria, lead conversion %, and length of questionnaire.  Conversion rates are averaging 45%.
  • I can help point you in the right direction for reputable marketing agencies if you need lead sources or looking to purchase retainers.  

Please contact me to learn more about how we can help you get involved in this case.

Thank you,

ZZZ”

As you can see from ZZZ’s email, the JNCI article was the tipping point for the start of a new mass tort. ZZZ, however, was a promoter, not an initiator. Consider the language of ZZZ’s promotional efforts:

“Proof”!

As in quod erat demonstrandum.

Where is the Department of Justice when you have the makings of a potential wire fraud case?[7]

And “link.” Like sloppy journalists, the lawsuit industry likes to link a lot.

chorizo sausage links (courtesy of Wikipedia)[8]

And so it goes.

Absent from the promotional email are of course, mentions of the “novelty” of the JNCI paper’s finding, its use of dichotomized variables, its multiple comparisons, or its missing variables. Nor will you see any concern with how the JNCI authors inconsistently ascertained putative risk factors. Oral contraception was ascertained for over 10 years before base line, but hair straightener use was ascertained only for one year prior to baseline.

SYSTEMIC FAILURES TO PREVENT MASS TORTOGENESIS

Human carcinogenesis involves initiation and promotion, as well as failure of normal defense mechanisms against malignant transformation. Similarly, mass tortogenesis involves failure of defense mechanisms. Since 1993, the federal courts have committed to expert witness gatekeeping, by which they exclude expert witnesses who have outrun their epistemic headlights. Gatekeeping in federal court does not always go well, as for example in the Avandia mass tort, discussed above. In state courts, gatekeeping is a very uneven process.

Most states have rules or law that looks similar to federal law, but state judges, not uncommonly, look for ways to avoid their institutional responsibilities. In a recent decision involving claims that baby foods allegedly containing trace metals cause autism, a California trial judge shouted “not my job”[9]:

 “Under California law, the interpretation of epidemiological data — especially data reported in peer-reviewed, published articles — is generally a matter of professional judgment outside the trial court’s purview, including the interpretation of the strengths and weaknesses of a study’s design. If the validity of studies, their strengths and weaknesses, are subject to ‘considerable scientific interpretation and debate’, a court abuses its discretion by ‘stepping in and resolving the debate over the validity of the studies’. Nor can a court disregard ‘piecemeal … individual studies’ because it finds their methodology, ‘fully explained to the scientific community in peer-reviewed journals, to be misleading’ – ‘it is essential that… the body of studies be considered as a whole’. Flaws in study methodology should instead be ‘explored in detail through cross-examination and with the defense expert witnesses’ and affect ‘the weight[,] not the admissibility’ of an expert’s opinions.”

When courts disclaim responsibility for ensuring validity of evidence used to obtain judgments in civil actions, mass tortogenesis is complete, and the victim, the defendants, often must undergo radical treatment.

[1] The first civil action appears to have been filed by attorney William L. Brach on behalf of Frederick LeGrande, against Johns-Manville, for asbestos-related disease, on July 17, 1957, in LeGrande v. Johns-Manville Prods. Corp., No. 741-57 (D.N.J.).

[2] Steven E. Nissen, M.D., and Kathy Wolski, M.P.H., “Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes,” 356 New Engl. J. Med. 2457, 2457 (2007).

[3] In re Avandia Marketing, Sales Practices and Product Liability Litigation, 2011 WL 13576, *12 (E.D. Pa. 2011) (Rufe, J.).  See “Learning to Embrace Flawed Evidence – The Avandia MDL’s Daubert Opinion” (Jan. 10, 2011). Failed expert witness opinion gatekeeping promoted the mass tort into frank mass tort.

[4] Philip D. Home, Stuart J Pocock, et al., “Rosiglitazone Evaluated for Cardiovascular Outcomes in Oral Agent Combination Therapy for Type 2 Diabetes (RECORD),” 373 Lancet 2125 (2009) (reporting hazard ratios for cardiovascular deaths 0.84 (95% C.I., 0·59–1·18), and for myocardial infarction, 1·14 (95% C.I., 0·80–1·63). See “Revisiting the Avandia Scare: Results from the RECORD Trial” DiaTribe Learn (updated Aug. 14, 2021).

[5] FDA Press Release, “FDA requires removal of certain restrictions on the diabetes drug Avandia” (Nov. 25, 2013). And in December 2015, the FDA abandoned its requirement of a Risk Evaluation and Mitigation Strategy for Avandia. FDA, “Rosiglitazone-containing Diabetes Medicines: Drug Safety Communication – FDA Eliminates the Risk Evaluation and Mitigation Strategy (REMS)” (Dec. 16, 2015).

[6] Che-Jung Chang, Katie M O’Brien, Alexander P Keil, Symielle A Gaston, Chandra L Jackson, Dale P Sandler, and Alexandra J White, “Use of Straighteners and Other Hair Products and Incident Uterine Cancer,”114 J.Nat’l Cancer Instit. 1636 (2022).

[7] See, e.g., United States v. Harkonen, 2010 WL 2985257, at *5 (N.D. Calif. 2010) (denying defendant’s post–trial motions to dismiss the indictment, for acquittal, or for a new trial), aff’d, 510 Fed. Appx. 633, 2013 WL 782354, 2013 U.S. App. LEXIS 4472 (9th Cir. March 4, 2013), cert. denied 134 S.Ct. 824 (2013).

[8] See https://en.wikipedia.org/wiki/List_of_sausages.

[9] NC v Hain Celestial Group, Inc., 21STCV22822, Slip op. sur motion to exclude expert witnesses, Cal. Super. Ct. (Los Angeles May 24, 2022) (internal citations omitted).

Posted in Public Nuisances, Rule 702, Scientific Evidence, Scientific Publishing | 2 Comments »

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