Document J3qxdLy3GJzd2wYEM0N3bXJO6

1 IN THE SUPERIOR COURT OF THE STATE OF DELAWARE IN AND FOR NEW CASTLE COUNTY IN RE: ASBESTOS LITIGATION ) C.A. No. 77C-ASB-2 BEFORE: HONORABLE JOSEPH R. SLIGHTS, III, J. APPEARANCES: JOHN J. SPILLANE, ESQ. BARON & BUDD, P.C. for the Plaintiff CAMERON R. WADDELL, ESQ. LeBLANC & WADDELL, LLP for the Plaintiff JOSEPH BIDEN, III, ESQ. BIFFERATO, GENTILOTTI, BIDEN & BALICK for the Plaintiff THOMAS C. CRUMPLAR, ESQ. JACOBS & CRUMPLAR for the Plaintiff DAUBERT HEARING TRANSCRIPT TUESDAY, OCTOBER 18, 2005 - A.M. SESSION 500 LYNNE BELL COALE, RDR, CRR SUPERIOR COURT OFFICIAL REPORTERS N. King Street, Suite 2609, 2nd Floor Wilmington, Delaware 19801-3725 (302) 255-0562 00001 2 APPEARANCES CONTINUED: SAMUEL L. TARRY, JR., ESQ. McGUIREWOODS LLP for the Defendant DaimlerChrysler JAMES M. KRON, ESQ. SOMERS S. PRICE, JR., ESQ. POTTER, ANDERSON & CORROON LLP for the Defendant DaimlerChrysler STEVEN T. JOHNSON, ESQ. PEPPLE, JOHNSON, CANTU & SCHMIDT, for the Defendant OI, Inc. PLLC ALSO PRESENT: David deBruim Erin Farris William A. Kohlburg Kathleen D. Hadley Michael Angelides Melissa Crowe Perry J. Browder Amy Garrett Christopher Lyon Bernard Kuery Francis J. Gribbin Margaret England Joseph A. Gabay Christian J. Singewald C. Scott Reese Miranda D. Clifton Gary Kaplan Mark Reardon Kai Seelaus J. Michael Johnson Neal Glenn Christine Boyd Eric Henry 00002 3 1 2 3 PRESENT: TUESDAY, OCTOBER 18, Courtroom No. 8B 9:03 a.m. 2005 4 As noted. 5 6 7 THE COURT: Good morning. 8 ALL COUNSEL: Good morning, your Honor 9 MR. WADDELL: Plaintiffs will call Dr. 10 Hammar to the stand. 11 SAMUEL HAMMAR, M.D. 12 having first duly affirmed, was examined and testified 13 as follows: 14 DIRECT EXAMINATION 15 BY MR. WADDELL: 16 Q. Dr. Hammar, are you a trained physician in the 17 diagnosis and cause of asbestos disease in humans? 18 A. Yes. 19 Q. And I want us to go through with his Honor your 20 background and expl ain to him about that, how you became 21 a trained phys ician in the diagnosis and cause of 22 asbestos disease in humans. Okay? 23 A. All right. 00003 4 1 Q. What type of doctor are you? 2 A. Pathologist. 3 Q. All right. And what areas of pathology are you 4 board certified in? 5 A. I'm board certified in anatomic and clinical 6 pathology. 7 Q. What's the difference? 8 A. The difference is, anatomic pathology deals 9 with the diagnosis and diseases by looking at cells, 10 tissues and organs. Primarily, we receive biopsy 11 specimens from clinical doctors, and we are asked to 12 evaluate them, to determine if that biopsy specimen 13 shows some type of a disease process, such as a cancer, 14 an inflammatory process, a degenerative process, 15 etcetera. We write reports indicating what we see. 16 That information is then sent back to the clinical 17 doctor, who asks us to review the specimen and they act 18 upon what information we give them. 19 Clinical pathology deals with running a 20 laboratory. At this point in time, our main job is to 21 make sure that all of the machines that perform tests on 22 things like blood are accurately calibrated and that we 23 have very good quality control in the lab, to make sure 00004 5 1 the results that are generated in the clinical 2 laboratory are correct. 3 We will sometimes help the clinical doctors 4 interpret some of the laboratory findings and try to 5 help make a specific diagnosis in a patient. 6 Q. Okay. Dr. Hammar, your board certifications 7 were in 1975; correct? 8 A. That is correct. 9 Q. Now, when did you first become involved in 10 seeing or participating in the diagnosis of asbestos 11 disease in humans? 12 A. Very early on in my training. As a resident in 13 pathology, I saw cases of asbestos-related lung disease. 14 That would probably be the first time. That would be in 15 the early 1970s. 16 Q. Okay. And where do you practice, Dr. Hammar? 17 A. I practice in a small town, a small city called 18 Bremerton, Washington, which is about 15 miles across 19 Puget Sound from Seattle. 20 Q. Is there something unique about where you 21 practice that got you heavily involved in asbestos? 22 A. Yes. 23 Q. Could you explain that to the Court. 00005 6 1 A. The Puget Sound Naval Shipyard is located in 2 Bremerton, Washington, and has been in existence since 3 about 1909. As a result of that, about a fifth 4 generation of individuals living in the Bremerton area, 5 which is in Kitsap, K-I-T-S-A-P, County, live in that 6 area. As a result of the shipyard and those individuals 7 working in the shipyard, a significant number of those 8 people have been exposed to asbestos. And as a result 9 of that, we see a very high incidence of asbestos 10 related disease in Bremerton. We see ten to 20 new 11 cases of mesothelioma per year, about a similar number 12 of cases of lung cancer related to asbestos per year, 13 and probably 40 cases or so of asbestos-induced plural 14 disease in Bremerton every year. 15 Right now, the highest incidence of 16 mesothelioma in the United States is in Bremerton. We 17 have a population in Kitsap County of about 3,000 - 18 excuse me, 300,000 people, and we see, again, ten to 20 19 new cases of mesothelioma per year, which is an 20 incredible incidence, if you compare it to the 21 background, which is basically zero. 22 Q. Is even seeing one single case of mesothelioma 23 significant, in your opinion? 00006 7 1 A. Yes. 2 Q. And why is that? 3 A. It's because that is such a rare tumor in 4 general, that seeing even one case is significant. 5 Q. When did you begin seeing mesothelioma cases 6 specifically in your regular practice as a pathologist 7 in Bremerton? 8 A. I started actually seeing them when I worked in 9 Seattle. Before I went to Bremerton, I worked at an 10 institution in Seattle called the Virginia Mason Medical 11 Center, and we saw a significant number of cases there. 12 And in fact, in early 1980s, we put on an exhibit for 13 the International Academy of Pathology on mesothelioma, 14 in which we described a number of cases and showed their 15 various pathologic features. 16 Q. Right now, currently, could you describe for 17 the Court the types of cases you see in your practice, 18 or outside of your medical practice, so to speak? 19 A. Sure. I see cases from physicians who take 20 care of patients with asbestos-related disease in 21 Bremerton. These are primarily the pulmonologists and 22 surgeons who take care of these individuals. Like I 23 said, we see about ten to 20 new cases of meso per year 00007 8 1 I also receive a significant number of cases 2 that are sent to me in consultation from other 3 pathologists, sometimes in the northwest. But I also 4 see cases from all over the United States. And I also 5 see a few cases that are sent to me from pathologists 6 and physicians outside of the United States. 7 I also see a significant number of cases of 8 mesothelioma and other asbestos-related lung diseases 9 that are sent to me by attorneys like yourself. 10 Q. Okay. And you've testified in courts before in 11 litigation involving asbestos; correct? 12 A. Yes. 13 Q. And, initially, you testified for defendants in 14 litigation; right? 15 A. That is correct . 16 Q. And now, it's currently primarily at the 17 request of plaintiffs' lawyers like myself? 18 A. Yes. 19 Q. Are you a researcher or have been a researcher 20 regarding asbestos disease in humans? 21 A. Yes. 22 Q. Could you explain that to his Honor. 23 A. Well, I've been very interested in 00008 9 1 mesothelioma. And we have, myself and some other 2 individuals, have published quite a few papers that deal 3 with various aspects of mesothelioma. 4 In 1986, myself and two other pathologists, one 5 by the name of John Bolen, B-O-L-E-N, another by the 6 name of Michael McNutt, published a paper on what we 7 termed the multipotential subserosal cell, which was a 8 paper that dealt with injury to the pleural surface and 9 how the pleural surface responded to injury and how one 10 could relate that response to injury to the morphology, 11 which is the features of mesothelioma that a pathologist 12 saw through the microscope. 13 We started doing a significant amount of 14 evaluation of cases of mesothelioma through the electron 15 microscope, and it turns out that a subtype of 16 mesothelioma, called epithelial mesotheliomas, have very 17 unique ultrastructural characteristics which allow for 18 their diagnosis. I would say, for epithelial 19 mesothelioma, that probably is the single best 20 diagnostic modality there is. 21 And then in the mid 1990s, Dr. Dodson and I 22 started working together on a variety of different 23 projects. In 1997, we wrote an article on fiber 00009 10 1 analysis in lung tissue with 55 people with 2 mesothelioma. In the year 2000, we wrote an article 3 published in a journal called Chest that dealt with 4 translocation of asbestos from the lung to 5 extrapulmonary sites -- specifically, the omentum and 6 mesentery tissue, which is the fat tissue in the 7 abdominal cavity. In that article, we demonstrated that 8 asbestos does translocate to other parts of the body, 9 and specifically other parts of the body where 10 mesotheliomas develop. 11 Right now, Dr. Dodson and I are doing a 12 research project, in which we're looking at the 13 concentration of asbestos in various tissues; 14 specifically, the normal visceral pleura, the normal 15 parietal pleura, hyaline pleural plaques, mesothelial 16 tumor tissue, and all of the lymph nodes that are 17 present around where the vessels and air tubes enter the 18 lung, and also the lymph nodes that are present in the 19 central part of the chest, which is called the 20 mediastinum. So, that's the research projects we have 21 going right now. 22 Q. And your research has made it into the 23 scientific and medical literature? 00010 11 1 A. It has, yes. 2 Q. And, in fact, under publications on your 3 curriculum vitae, there are 114? 4 A. Yes. The latest -- actually, there's one more. 5 I'm part of the US-Canadian Mesothelioma Panel, 6 and we just wrote an article on a rare type of 7 mesothelioma called a localized malignant mesothelioma. 8 Q. So, there will be 115 then? 9 A. That's correct. 10 Q. Peer reviewed? 11 A. Yes. 12 Q. And Dr. Hammar, I need to ask this question: 13 When you're doing research and you're doing 14 your writings, are you applying generally accepted 15 scientific and medical principles and methodology when 16 doing so? 17 A. Yes. 18 Q. How about -- we talked about publications and 19 things. Textbooks, have you done that? 20 A. Yes, I have . 21 Q. Okay. Could you explain to his Honor textbooks 22 that you've written, chapters that you've written that 23 have made it in other textbooks regarding asbestos. 00011 12 1 A. Yes. That book there is a second edition of a 2 book called Pulmonary Pathology. The first edition was 3 published in 1987. Myself and David H. Dail are the 4 editors in that book there. And in the first edition, I 5 wrote five of the chapters. And in that book there, 6 Dr. Dodson and I wrote the chapter titled "Asbestos," 7 which is Chapter 28. I wrote Chapter 34 which is titled 8 "Pleural Diseases," of which about 90 percent deals with 9 the disease mesothelioma. 10 Myself, Dr. Dail, and Dr. Thomas Colby, who's a 11 pathologist at Mayo Clinic, wrote another textbook 12 called Pulmonary Pathology Tumors that deals with the 13 neoplasms that occur in the lung and chest cavity. 14 Dr. Dodson and myself just wrote a book that 15 was just published called Asbestos: Risk Assessment, 16 Epidemiology and Health Effects, in which we discussed 17 some of the technical aspects about asbestos and 18 asbestos measurements, and also epidemiology, molecular 19 biology, and the pathologic changes that one sees in 20 asbestos-related lung disease. 21 And I've written about 40 chapter in textbooks 22 for other individuals, several of which have dealt with 23 mesothelioma. 00012 13 1 Q. Because of your experience, your training, and 2 your work, has your expertise risen to the level in 3 skill where your peers have placed you in positions of 4 leadership? 5 A. Yes. 6 Q. Could you explain that to his Honor. 7 A. Well, I guess, in leadership, is that I guess 8 my peers think that I know enough about mesothelioma to 9 be selected to the US and Canadian Mesothelioma Panel, 10 which is a panel of 12 pathologists, ten in the 11 United States, one in Canada, and one in Wales, Great 12 Britain. And what we do is review cases for other 13 pathologists or other physicians who are sent to us 14 where there's a question of whether a disease is or is 15 not mesothelioma. And we do this free of charge, and we 16 indicate on a form whether we think the case is or is 17 not mesothelioma. And the information is tabulated and 18 then sent back to the person who sent us the case. 19 I'm also a member of the International 20 Mesothelioma Pathology Group which is again a relatively 21 small group of about 25 pathologists throughout the 22 world. And we just finished writing a book for the 23 French government because of their epidemic of 00013 14 1 mesothelioma in that country, and the title of that book 2 is Pathology of Mesothelioma. 3 I have been asked to lecture on mesothelioma 4 fairly extensively. The last talk I gave was in San 5 Antonio, Texas, in February of 2005. And that had to do 6 with the macroscopic, histologic, histochemical 7 immunohistochemical, and ultrastructural features of 8 mesothelioma. 9 Dr. Dodson and a few other people are also 10 involved in doing, again, some additional research 11 projects that we are involved with that are, hopefully, 12 going to be published. 13 And I've also been a member of the World Health 14 Organization . We published a book in 1999, which was 15 the Current Classification of Lung Cancers and 16 Mesothelioma, and another book in 2004 which was the 17 Pathology and Genetics of Lung Cancer, including 18 mesothelioma as well as tumors of the thymus and tumors 19 of the heart. 20 Q. And even in groups outside of your specialty, I 21 guess, area in asbestos, have you also risen to the top 22 in societies that you are a member of in pathology? 23 A. I have. I've been very fortunate. I was the 00014 15 1 second president of the International Pulmonary 2 Pathology Group. I've been the past president of the 3 Society of Ultrastructural Pathology. I've been on - 4 the program chairman of both of those societies for many 5 years. I still am very active in both of those 6 societies and have been involved in organizing programs 7 for the Pulmonary Pathology Society. And this coming, 8 see -- it will be next August, I'm going to chair a 9 session on diseases of the pleural -- pleura for the 10 International Academy of Pathology, which is going to be 11 held in Montreal Canada. 12 Q. Having discussed briefly your training and 13 experience and skill as a pathologist and in asbestos 14 disease in humans, have you had the opportunity to 15 become, I guess for lack of a better word, very familiar 16 with other areas of medicine, about asbestos disease 17 other than pathology? 18 A. I would say so, yes. 19 Q. Okay. 20 A. And one thing that I get to see when I see the 21 legal cases that are sent to me by attorneys and also 22 because of where I work, I get to see the entire 23 histories of these individuals and how they presented, 00015 16 1 how they were treated, what happened to them, and know a 2 lot about the radiology of asbestos-induced lung 3 disease. I've seen over 4000 cases of mesothelioma. 4 I've done over -- about 475 autopsies on patients with 5 mesothelioma. And I've seen over a thousand cases of 6 autopsy tissue from patients with mesothelioma and lung 7 cancer that have been sent to me, primarily by 8 attorneys, sometimes by the pathologists. So, I've been 9 able to see a lot of that . 10 I sometimes am asked by the thoracic surgeons 11 who do surgery, to come into the operating room and help 12 them determine where the best place is to biopsy. I've 13 presented a chest conference in Bremerton, where I work, 14 every month, where we discuss cases of lung disease, 15 including asbestos-related lung disease, where all of 16 the various aspects of the disease are presented, such 17 as a clinical history, the radiographic findings, the 18 pathologic findings and the treatment of those 19 individuals. 20 So, I have been in a very somewhat unique 21 position of being able to see not only the pathologic 22 features of asbestos-related disease, but also the 23 clinical features of that disease. 00016 17 1 Q. And not just in the conte xt of cases that 2 appear in courtrooms like this; co rrect? 3 A. That's right. I happen t o be the chairman of 4 our Cancer Committee at the hospit al in Bremerton, which 5 is Harrison Hospital . And we disc uss cases like this 6 and try to determine what the best treatment is for 7 these individuals. 8 Q. Do you also have an occas ion -- because most 9 people think pathologists are stuc k in some room in a 10 hospital, that they never get to s ee their patients. Do 11 you get a chance to see and visit with your patients as 12 well ? 13 A. I do. Pathologists usual ly don't see patients, 14 but there are times when I have be en fortunate enough to 15 have contact with the individual p atients, pri marily 16 individual patients who have mesot helioma, and have 17 gotten to know these people extrem ely well. 18 Q. You told me about one thi s morning, I think, 19 that came from Italy; right? 20 A. Yes. I told you about a Mr. Neltson (PH.), 21 Douglas Neltson, young man, relati vely young, 58 years 22 old, was diagnosed in Bremerton wi th mesothelioma; had a 23 very unique course, in that he was treated primarily 00017 18 1 with chemotherapy, initially with some Carboplatin and 2 Taxol. And, then, he received some Gemcitabine and 3 subsequently received Pemetrexed and Cisplatin, and had 4 a very good response and actually survived about eight 5 years with the tumor. And then, unfortunately, he died 6 from Gemcitabine interstitial fibrosis as a consequence 7 or as a bad side effect of the chemotherapy that 8 actually was keeping his tumor at bay. 9 Q. We're going to need a few minutes after . . . 10 You mentioned histories of individuals that 11 have, unfortunately, been diagnosed with mesothelioma. 12 Do you also have the opportunity of seeing those in the 13 context of just your normal practice outside the 14 courtroom setting? 15 A. Sure. Again, I see that on a -- basically, a 16 weekly basis or monthly basis in Bremerton, where I 17 work . 18 Q. Are the principals of medicine and science that 19 you use in the courtroom any different than those that 20 you use outside the courtroom? 21 A. Not really. As far as my involvement in the 22 asbestos-related legal arenas, I do the same thing there 23 as I would do as a practicing pathologist. The only 00018 19 1 difference would be that, often, with the legal cases, I 2 see more of the actual clinical history on the patient 3 than I do on the cases that I am treating pathologist. 4 Q. In a minute, we're going to go through a few 5 more things in detail. 6 But when it comes to causation, is there just 7 one thing you're going to look at as a pathologist and 8 say, "Ah hah, that is it, and I don't need to look in 9 anything else in the fields of medicine and science"? 10 A. No, I think you always have to keep your mind 11 open to a variety of causes of any disease. 12 Pathologists do what clinical doctors do in some 13 respect, in that we have what are called pathologic 14 differential diagnoses, in that you could have a tumor, 15 for example, that had a certain morphology and you would 16 have to determine whether that was a mesothelioma or was 17 it a lung cancer that looked like a mesothelioma. 18 Q. And in diagnosing, you apply a lot of the same 19 principles as you would to causation; right? 20 A. Well, the diagnosis is certainly, in some 21 respects, the same but also is different. In diagnosis, 22 you're basically trying to say what a tumor is from a 23 pathology point of view. 00019 20 1 As far as the causation, obviously, that can be 2 extremely important. It can be important, obviously, in 3 asbestos-related disease because, if one person has an 4 asbestos-related disease, there's a chance that that 5 individual is going to get another asbestos-related 6 disease that the individual should know about that, to 7 potentially be screened or somehow have some type of a 8 followup, so if he does develop another asbestos-related 9 disease, that, hopefully, that disease can be detected 10 at a stage or time where he might, or she might, have 11 some type of therapeutic options. 12 Q. And I think I asked a bad question in that 13 regard. I guess one of the things I wanted to convey to 14 his Honor, do you look at the whole picture? 15 A. Of course. 16 Q. Do you even -- do you even look at things, even 17 in the diagnosis and look to exclude certain things? 18 A. Well, you have to always make sure that you're 19 not going to exclude things and that you make the 20 correct diagnosis because what treatment is based on is 21 the diagnosis, and the diagnosis has to be correct. 22 Q. I apologize. And in regards to looking at 23 causation, is there fields of science that you just want 00020 21 1 to totally disregard - 2 A. No. 3 Q. To the exclusions of others? 4 A. You never disregard, you -- to try to exclude 5 something else. You look at the whole picture. 6 Q. When someone comes in and you get involved in a 7 case, either in a legal setting or in a hospital 8 setting, and you're asked to look at the potential cause 9 or causes of the injury to the victim, do you start off 10 with the checklist and go, "Let me just make sure that 11 that passes epidemiological muster before I consider 12 anything"? 13 A. I don't think you do it that way, no. 14 Q. Do you try to fit all the pieces of the puzzle 15 together to get the best picture of what happened? 16 A. Sure. 17 Q. Now, I want to go through just a few things 18 real quick because, as a doctor, it is a little bit 19 different than a cell biologist or someone. But 20 focusing on the anatomy of the human lung, okay, and 21 inside the lung and outside the lung and what happens 22 when humans breathe asbestos. 23 A. All right. 00021 22 1 Q. My first question to you - 2 MR. WADDELL: And this is my drawing, so I 3 apologize, your Honor. 4 THE COURT: It's pretty good. 5 BY MR. WADDELL: 6 Q. Is a brake mechanic's lung any different than 7 your lung or my lung? 8 A. No. 9 Q. Okay. When a brake mechanic breathes asbestos, 10 does anything magical happen with the fibers outside his 11 body? 12 A. No. 13 Q. Does anything magic that's different than me or 14 you, does anything magical happen once those fibers are 15 inhaled inside the lung? 16 A. No. 17 Q. Does the reaction that the body has in 18 ultimately producing disease, is it any different in a 19 brake mechanic as it is with anyone else? 20 A. No. 21 Q. There are commercially used in the 22 United States what types of fibers? 23 A. Primarily, it's been chrysotile, amosite, and 00022 23 1 crocidolite and, to a lesser extent, tremolite and 2 fosterite. 3 Q. And a few of the things that I want to briefly 4 cover with his Honor today is the diseases that asbestos 5 fibers, when inhaled into a human cause inside the lung 6 and outside the lung? 7 A. Yes. 8 Q. And I've written scarring enhancer. If you 9 could walk his Honor? 10 MR. WADDELL: Your Honor, may he come down? 11 THE COURT: Absolutely. 12 BY MR. WADDELL: 13 Q. If I could ask you, Dr. Hammar, if you could 14 explain how fibers are inhaled and how they cause injury 15 in humans, including brake mechanics. 16 A. Well, the way that asbestos fibers happen to be 17 inhaled are usually in the situation where an individual 18 is in an area where some type of asbestos-containing 19 product is being altered that results in that product 20 releasing asbestos fibers into the air and that 21 individual would then breathe the air that contained the 22 asbestos fibers. 23 There are other situations that potentially 00023 24 1 could result in exposure to asbestos. Let's just say, 2 for example, if you were in a certain part of the world 3 where asbestos naturally occurred, that you could 4 potentially inhale fibers in that situation -- like, for 5 example, in Quebec, Canada, South Africa, Bolivia, even 6 in certain parts of the United States, where you could 7 potentially inhale asbestos fibers as a result of 8 environmental release of fibers into the air. But that 9 is very uncommon compared to a person inhaling asbestos 10 fibers as a result of inhalation of fibers that came 11 from a product. 12 So, when you breathe the air, the air comes 13 into your nose or mouth, goes down the windpipe, which 14 is called the trachea, and goes through the main stem 15 bronchi, which are these large tubes that carry the air 16 to the right and the left lung. And the asbestos 17 fibers, many of them are actually trapped up in our nose 18 and mouth. Some of them are cleared by what's called 19 the mucociliary apparatus, which is a type of 20 specialized epithelium that lines the surface of these 21 air tubes. But a certain percentage of these fibers do 22 get into the outer part of the lung, and they are first 23 deposited in the region of what's called the respiratory 00024 25 1 bronchial and the alveolar ducts. And these are really 2 tiny air tubes, and they are lodged in that area. And 3 once they are lodged in that area, then they can cause 4 injury. 5 Q. And when a -- in the process we're describing 6 as fibers, are you limiting it to any specific kinds? 7 A. No, it's all the same. They are all deposited 8 in that location. Whether they get inhaled or get into 9 the lungs probably depends a little bit on their 10 diameter. For example, the larger their diameter, the 11 less chance they will have of reaching the lung. And, 12 also, it's dependent on how good a person's clearance is 13 or how good their defense system is of trying to inhibit 14 the fibers from getting into the lung. 15 Q. Okay. Do short fibers of asbestos cause 16 disease? 17 A. Sure. 18 Q. Do long fibers in -- Dr. Dodson spoke about 19 this yesterday -- cause disease in humans? 20 A. Yes. 21 Q. Okay. And it's whether they can become 22 respirable and get down to a specific target, so to 23 speak, where they can cause injury; right? 00025 26 1 A. That is correct . 2 Q. All right. The inside of the lung, the 3 scarring that's caused there, is called what? 4 A. It's called asbestosis. And that is a type of 5 disease in which it usually occurred first in the lower 6 parts of the lung, although, interestingly, it probably 7 occurs just as much in the upper lobes, and that 8 asbestos concentration has been shown by Dr. Dodson and 9 Dr. Churg that you have basically as much asbestos in 10 the lower part of the lung as do you in the upper parts. 11 But, usually, what you see clinically is that the 12 scarring first occurs in the region of the respiratory 13 bronchial and alveolar duct. And that is sometimes 14 referred to as small airways disease or, according to 15 the CAP-NIOSH criteria published in 1982, would be focal 16 grade 1 asbestosis. And that's the earliest stage of 17 the scarring process that occurs. 18 Q. And you mentioned clinically occurring. Is 19 there a -- there is a difference between clinical and 20 pathological asbestosis, for instance? 21 A. There is . 22 Q. Okay. And the difference would be what? 23 A. The difference would usually be the degre 00026 27 1 severity because a person, in fact, in the study that 2 Dr. Dodson and I wrote in 1997, where I went back and 3 looked pathologically at the 55 cases of mesothelioma, 4 29 of those had actual pathologic asbestosis; but of 5 that 29, there are only three that actually had clinical 6 asbestosis. So, if a person sees features of clinical 7 asbestosis, which would be evidence of scarring in the 8 lungs identified radiographically, or abnormal pulmonary 9 function tests, or abnormal physical examination 10 findings, that would generally indicate, in most 11 instances, at least grade 3 CAP-NIOSH asbestosis. 12 Q. When does injury begin to occur on a cellular 13 level in a human that inhales asbestos fibers? 14 A. Almost immediately after they are inhaled, 15 that's when the actual injury starts. 16 Q. Okay. And my question is geared towards that. 17 If the injury actually starts shortly after inhalation, 18 whether it be the scarring or ultimately the cancer, is 19 one just suddenly going to see it? 20 A. No, that's not the way it happens. 21 Q. Okay. Well, then, walk us through that, that 22 process of how a clinical asbestosis finally appears. 23 A. Okay. Well, first of all, not everybody that 00027 28 1 inhales asbestos into their lung are going to develop 2 clinical or pathologic asbestosis. And that is what I 3 like to refer to as individual susceptibility or genetic 4 variability in response to an agent. 5 But in the people that get it, here's how it 6 works. Basically, the body sees asbestos as a foreign 7 material because it's not normally there. So, it 8 initially incites an inflammatory process that, if you 9 look at the experimental studies, is an acute process 10 where you involve cells called neutrophils and 11 eosinophils, which are the acute inflammatory cells in 12 inflammation. And that, over a period of time, gives 13 rise or changes to a chronic inflammatory process, in 14 which you have cells called lymphocytes, plasma cells, 15 and macrophages that are involved in that inflammatory 16 process. And the lymphocytes and macrophages then can 17 start releasing things that are called cytokines and 18 chemokines. And these are mediators of inflammation and 19 mediators of other events. 20 For example, the lymphocytes can produce a 21 fibroblast growth factor, and that is a factor that 22 causes the interstitial cells of the lung, called 23 fibroblasts, to start producing more of the things that 00028 29 1 they normally produce, which would be collagen and 2 elastin. So, the way it would happen in a person who 3 did develop, say, grade 3 or grade 4 asbestosis would be 4 that they initially had this inflammatory response in 5 the region of the alveolar duct and respiratory 6 bronchial. Over a period of time, that response would 7 expand and would involve adjacent areas of the lung with 8 fibrosis around the bronchi -- I mean around the small 9 bronchials. You then start developing fibrosis between 10 the respiratory bronchial units, and that is referred to 11 as interstitial fibrosis. And then as the progress or 12 the process progressed, it would start causing more and 13 more fibrosis until a certain amount of your lung was 14 destroyed and replaced with scar tissue. 15 And that's how it would happen. And that might 16 take as long as maybe even 40 years for that whole 17 process to happen, and not everybody who actually 18 inhales the asbestos are going to develop that. 19 Q. Is clinical as 20 changes that you've jus 21 A. Yes. 22 Q. Okay. And in 23 occur on a cellular lev 00029 30 1 the accumulation of those changes and say which fibers 2 ed it and which once didn't ? 3 A. No, you can 't do that. 4 Q. Okay . And the term cumulative exposures, is 5 that applying that principle that all of the exposures 6 contribute to the end result? 7 A. That's the idea, yes. 8 Q. Okay. Is chrysotile unique in that it doesn't 9 cause those changes you just described? 10 A. No. 11 Q. All right. Is chrysotile and friction products 12 that a human inhales unique and does it cause those 13 changes? 14 A. No. 15 Q. The -- we talked about the accumulation of 16 those pathological changes to produce clinical 17 asbestosis or scarring inside the lung. Does scarring 18 happen outside the lung as well? 19 A. It does. There's a variety of ways that 20 scarring occurs or locations that scarring occurs in the 21 lung. Probably, the most common area of scarring would 22 involve the visceral pleura, which is the pleura that 23 covers the lung, and also, not shown here, would be the 00030 31 1 parietal pleura, which is the pleura that covers the 2 chest cavity. And what happens is that asbestos is 3 translocated from where it is initially deposited in the 4 region of the respiratory bronchial and alveolar duct to 5 the pleura, where it can cause an inflammatory and 6 fibrotic response and end up with scarring. I have 7 several pictures in that book, for example, of visceral 8 pleural scarring. 9 And, then, in the parietal pleura, the scarring 10 is somewhat unique, in that it tends to be localized 11 more on the diaphragmatic surface of the parietal pleura 12 and in the lower part of the chest cavity involving the 13 parietal pleura, usually in the distribution of the 14 ribs. And that scarring is called hyaline pleural 15 plaque. 16 There's a subtype of visceral pleural scarring 17 in which the pleura gets so scarred, that it starts to 18 wrinkle or invaginate in, and that process is referred 19 to as round atelectasis. 20 Q. The scarring or fibrosis on the pleura, whether 21 it be the visceral or the parietal pleura, are 22 chrysotile fibers unique in that they cause those 23 changes? 00031 32 1 A. No, all types of asbestos can cause that. It 2 turns out that, if you were to analyze the parietal 3 pleura, hyaline pleural plaques by energy dispersive 4 x-ray analysis and x-ray diffraction after digesting 5 that tissue, you would find the dominant fiber to be 6 chrysotile. 7 Q. Is chrysotile fibers that are liberated during 8 the use of friction products unique in that they can't 9 cause those changes? 10 A. No. 11 Q. We talked about the scarring inside and outside 12 the lung. And if we could discuss cancer that occurs 13 inside and outside the lung, what -- no one knows, 14 correct, Dr. Hammar, exactly how cancer happens; right? 15 A. Well, we don't know exactly how it happens, but 16 we do know some things. 17 For example, in every solid tumor that has ever 18 been looked at has shown at least two mutations in what 19 are called protooncogenes and tumor suppressor jeans. 20 There's also a lot of changes in the way the cells cycle 21 works. There's changes in the receptors on the cell 22 membrane of cancer cells. And there are a lot of 23 changes that go on. 00032 33 1 And these have been described a lot in various 2 publications. In our book, we have a good chapter on 3 the molecular biology of asbestos-related disease. A 4 report by Kemp and Whitesman in 1999, in July, in the 5 Journal Of Thorax is an excellent overview of the 6 molecular biology. And there have been several others. 7 I guess the bottom line is that it seems to be 8 a very complex process involving a lot of different 9 systems, and we don't know exactly how it happens. We 10 don't know exactly the time course that it happens, but 11 we kind of know the general stages that it goes through 12 pathologically. And we know that all the solid cancers 13 originate from just a single cancer cell that is formed 14 from the effect of a carcinogen like asbestos that then 15 undergoes this clonal proliferation to form a tumor 16 mass, be it a tumor mass that's in the lung parenchyma 17 or a tumor that arises from the pleura, which would be 18 primarily mesothelioma. 19 Q. Has there ever been any discussions that you're 20 aware of that brake mechanics somehow get cancer 21 differently or don't get cancer differently than other 22 human beings? 23 A. No. 00033 34 1 Q. And one of the problems I guess in knowing the 2 exact mechanism of how cancer develops -- for instance, 3 in asbestos-exposed individuals -- would be that there's 4 not the technology to have fiber cams when fibers get 5 inhaled; correct? 6 A. You can't see what's going on in there all the 7 time. And we really don't know. We know that there are 8 cases, for example, of mesothelioma and lung cancer that 9 have a very short latency, maybe as short as five to ten 10 years; and we also know there are cases of lung cancer 11 and mesothelioma that have latent periods over 60 or 12 70 years, even. So, we don't know what's going on, and 13 we don't know exactly why there is a difference in those 14 latency periods, for example. 15 Q. And you mentioned -- I'll let you go back up 16 there -- latency. And we've talked about disease 17 process -- I've kind of got it to the side -- the 18 scarring versus the cancer that we're talking about. 19 You mentioned that all the fiber types cause the 20 scarring and the cancer both in and outside the lung; 21 right? 22 A. Yes. 23 Q. Okay. Latency for the disease process of 00034 35 1 scarring inside the lung and outside the lung versus 2 cancer, is there a difference that has been observed by 3 doctors over time? 4 A. There may be a little bit of difference, but 5 there would be a wide overlap. 6 Q. Okay. And what would the -- I guess there's 7 averages, obviously - 8 A. Sure. 9 Q. -- as to what to expect. And those averages in 10 an individual would depend maybe on a lot of factors; 11 right? 12 A. They could be, yes. 13 Q. Okay. Is one of those factors the dose that an 14 individual is getting of asbestos, the amount of fibers 15 he's breathing? 16 A. That usually is, yes. 17 Q. Okay. And why is that important in looking at 18 that, in an individual case, for latency? 19 A. Well, at least in mesothelioma -- and I'm not 20 sure this is true in every asbestos-related disease, but 21 it may be -- is that usually the higher the dose, the 22 shorter the latency. But that's not a hundred percent. 23 Q. Okay. 00035 36 1 A. There are exceptions to that rule. 2 Q. And that factors in something again I'm writing 3 down, is individual susceptibility. 4 A. Right. 5 Q. All right. And for whatever reason we don't 6 know, some individuals can get cancer, for instance, 7 from smoking cigarettes, and some don't. 8 A. That is correct. 9 Q. But the general rule would be regarding dose 10 and response is what? 11 A. Is that there's a definite dose response 12 relationship to every asbestos-related disease, which 13 means that the more you're exposed to, the higher your 14 risk would be of developing any of these diseases. 15 Q. Okay. We talked about accumulation of the 16 injuries and separating out which exposures can be a 17 contributing cause and not be. Are you able to separate 18 out if an individual has been exposed to mixed fiber 19 types, amphiboles and serpentine fibers, the chrysotile 20 versus the amosite and crocidolite, which ones 21 contributed and which ones didn't? 22 A. No. 23 Q. Okay. Do you have to also factor, I guess in 00036 37 1 that kind of discussion, this, latency? 2 A. Sure. 3 Q. Okay. And why is that? I mean, if somebody's 4 exposed to a product that contained asbestos last week, 5 is that going to factor into a physician that 's t rained 6 in causation assessment? 7 A. Usually not, no, because if you look at 8 cancers, there's probably a very good chance that most 9 of the lung cancer and mesothelioma probably have been 10 in existence on a microscopic scale probably at least 11 ten years before a person is diagnosed clinic ally to 12 have the disease. 13 Q. In the causation question, because I want to 14 get -- move along to this question specifical ly, 15 Chrysler has filed a motion with his Honor, a sking him 16 to exclude any and all evidence asbestos-cont aining 17 friction products cannot be a cause or increa se one's 18 risk, an individual's risk, of developing an asbestos 19 disease. Okay? 20 A. Okay. 21 Q. Do you agree with that? 22 A. No. 23 Q. Why do you, as a trained physician i n the 00037 38 1 diagnosis and cause of asbestos disease in humans, 2 disagree with that? 3 A. Well, I disagree for several reasons. 4 Q. Okay. 5 A. First is that I think there's overwhelming 6 evidence that chrysotile asbestos can cause injury and 7 cause disease, specifically scarring disease, and 8 neoplastic disease. I think that chrysotile has the 9 ability to do that. 10 With respect to the -- the brake chrysotile 11 issue, I think that there have been a number of case 12 reports which have shown the development of mesothelioma 13 and other diseases in individuals who have been exposed, 14 at least according to the best information we have, only 15 to chrysotile asbestos from friction products. 16 Third would be the studies -- for example, 17 there have been a couple of -- one of the earliest 18 studies in the case reports was a case reported by Dr. 19 Elliott McCaughey, who was the previous chairman of the 20 US-Canadian Mesothelioma Panel, and Dr. Arthur Langer, 21 who is a well-known scientist involved in 22 asbestos-related disease where, in 1983, they -- they 23 reported a 55-year-old man who developed mesothelioma, 00038 39 1 whose only occupation had been as a brake mechanic, 2 brake repair. And they found only chrysotile asbestos 3 in his lung tissue, and it turned out that ten percent 4 of that chrysotile asbestos had a fiber length of 5 greater than ten micrometers long. 6 Another report about the same time was by 7 Dr. Huncharek, H-U-N-C-H-A-R-E-K, of the mesothelioma 8 that developed in another person who it appeared that 9 only the exposure -- the only exposure they had to 10 asbestos was from chrysotile. And, then, Dr. Lemen, in 11 the American Journal of Industrial Medicine in 2004 12 wrote a review article in which he stated that there was 13 evidence of 165 cases of mesothelioma in individuals who 14 had friction product exposure to chrysotile asbestos. 15 So, that's -- that's that information. 16 Then, the other information, actually, that I 17 think is important actually has to do with something 18 that came out of Australia. 19 Q. Well, let me stop you before we get into that 20 because I want give his Honor just a brief overview, and 21 then we'll go into a little bit more specifics. 22 A. Okay. 23 Q. I wrote down "Others have seen it," that 00039 40 1 exposure to asbestos-containing friction products are 2 causing disease in an individual. Have you seen it? 3 A. I've seen it about ten times, yes. 4 Q. Okay. And those ten times that you've seen it, 5 was that in the context of litigation or outside of 6 litigation? 7 A. Well, I think probably most of those cases did 8 end up in litigation. But there were at least three 9 cases that I saw initially as a treating pathologist. 10 Q. Okay. And I guess one thing to clarify is that 11 you can see a case outside of litigation when it's 12 asbestos caused and it can end up in litigation? 13 A. That usually is what happens, yes. 14 Q. Okay. 15 A. At least with mesothelioma. 16 Q. And you've said ten cases. Now, all of those 17 ten cases, I take it you wrote a report and had it 18 published in the medical literature? 19 A. I didn't report any of those. I did write a 20 report about those cases, but they were not published. 21 Q. So, you're seeing cases in the real world that 22 aren't being published in the literature? 23 A. That is correct, yes. 00040 41 1 Q. Okay. Are you aware of other trained 2 physicians like yourself that are seeing cases that are 3 similar to that that aren't getting published in the 4 medical literature? 5 A. I think that's probably true of almost any rare 6 diseases: That you see a certain number of cases that 7 you see and you know about these cases and you know some 8 of the interesting information about these cases, but 9 you basically just don't have the time to publish them, 10 or you're just not inclined to publish them. 11 Q. Okay. And maybe one of the reasons is there's 12 just enough cases that have been out there that people 13 know this? 14 A. Well, that's right. For example, I'm very 15 interested in a rare type of mesothelioma called 16 deciduoid mesothelioma. And there now have been about 17 30 cases reported of that. I have about 120 cases. And 18 it comes to a point of whether or not does it add 19 anything to what has already been published. And 20 sometimes it's hard to say. 21 Q. Okay. And sorry to have interrupted you, but 22 the third reason is that you mentioned Australian 23 literature. 00041 42 1 A. Yeah. There's -- Australia has the highest 2 incidence of mesothelioma in the world, and that's been 3 the case for some time. And, actually, even though they 4 had a number of asbestos mines in Australia, the most 5 notable of which is the Wittenoom, W-I-T-T-E-N-O-O-M, 6 Mine, even though they had these mines, they actually 7 imported more asbestos than they actually produced. So, 8 they actually, at this point in time, have the highest 9 incidence of mesothelioma than any other country in the 10 world. 11 And what they did for a significant period of 12 time was have a mesothelioma registry, in which, 13 initially, they actually had cases or individuals that 14 were interviewed by usually nurses about their 15 occupational history, and all of the cases were reviewed 16 by the Australian Mesothelioma Panel. Later, that 17 changed to the point where they just sent out 18 questionnaires, and the cases were looked over to see if 19 it made sense that they were the correct diagnosis . And 20 what they did was have a list of various occupations 21 that these mesotheliomas occurred in. And that was 22 published in an article written by Dr. James Leigh, 23 L-E-I-G-H, in 2004, where he talked about mesothelioma 00042 43 1 in Australia and actually had a list -- I think it's on 2 the second to the last page -- of all of the various 3 occupations in which one saw mesotheliomas in. And one 4 of the occupations listed there were either people that 5 repaired brakes or people that manufactured brakes. 6 And, then, in some -- in a report by Dr. 7 Henderson, Douglas W. Henderson, who is the chief of 8 Pathology in the University of Adelaide in South 9 Australia, he wrote part of the WTO document that was a 10 response that was requested by the French government to 11 try to determine whether or not they should allow the 12 importation of chrysotile into the country. And in that 13 document that was written by Dr. Henderson, he talked 14 about the Australia Mesothelioma Registry, he talked 15 about the release of asbestos from friction products, he 16 talked about the concentrations that were generated by 17 various activities. He also mentioned the 18 epidemiological studies that have been published to 19 date. And, then, he did an analysis of what his 20 conclusion was of how many cases of mesothelioma they 21 had in Australia that were directly related to brake 22 repair, which was the dominant thing, or brake 23 manufacturing, which was a lesser number of patients, 00043 44 1 and came up with a significantly elevated number 2 compared to what they considered to be a background 3 rate, which was one to two cases of mesothelioma per 4 million person years. 5 Q. And we'll get back to those specifically. 6 The Australian experience -- and just, is there 7 a mesothelioma registry here in the United States? 8 A. There is no mesothelioma registry in the 9 United States. There is a thing called the SEER, 10 S-E-E-R, data, and that stand for Surveillance, 11 Epidemiology, and End Points Review. And where I work 12 in Bremerton, for example, we're part of the 13 percent 13 of the hospitals in the United States that provide data 14 to the SEER organization, which keeps track of the 15 incidents of various types of canc ers in the 16 United State s. And that would be about the only thing. 17 And you have to realize - - for example, like in 18 Bremerton -- we have basically the highest incidence of 19 mesothelioma in the United States, and there would be 20 other places in the United States, probably -- I don't 21 know, maybe the mid west -- where there would be a 22 significant les ser number of cases , so that it's always 23 possible that the SEER data, which only represents, 00044 45 1 again, about 13 percent of all hospitals in the 2 United States, may be somewhat skewed. 3 Q. I have three major categories. Anything else 4 that you would like to add? 5 A. I don't think so. I think that's basically 6 about it. 7 Q. Okay. And I want to go back in just a little 8 bit of detail because you've referenced some reports. 9 The first one was the McCaughey. Who was Dr. 10 Elliott McCaughey? 11 A. Elliott McCaughey was the -- he worked in a 12 hospital in Ottawa. He was the head of Pathology there. 13 He was the first chairman of the US and Canadian 14 Mesothelioma Panel. On the latest issue of the -- of 15 the AFIP fascicles, he was a co-author with Dr. Hector 16 Battifora on tumors of the serosal membranes, which is 17 basically mesotheliomas and some things that look like 18 mesotheliomas. He was an extremely well-versed 19 individual in the disease mesothelioma and had seen a 20 significant number of cases that occurred in Canada. 21 Q. And going back in time, he reported 22 mesotheliomas fairly early; right? 23 A. Yeah, he was actually second. It was Paul 00045 46 1 Cartier in 1952 that reported two cases of mesothelioma 2 in the Quebec miners. And, then, Dr. McCaughey, in 3 1958, I think he reported either eight or 12 cases of 4 mesothelioma in the Quebec miners/millers. 5 Q. Now, if a trained physician, in diagnosing 6 asbestos disease and the causes of asbestos diseases, 7 had waited until epidemiology said you can make that 8 connection, would doctors that were seeing, like 9 Dr. Wagner in 1960, would they have been able then, if 10 this is the criteria, to connect asbestos to 11 mesothelioma back in 1960? 12 A. Obviously not. Dr. Wagner's report was a from 13 part of South Africa where they had a crocidolite mining 14 region that he reported in the British Journal of 15 Industrial Medicine, with Dr. Steggs and Dr. Marchand, 16 33 cases of mesothelioma, and he related 32 of those 17 cases to crocidolite asbestos exposure, even though 18 there was never a control group for that study. It was 19 not an epidemiologic study. It was a multiple case 20 report study, but it was that study that probably more 21 alerted the world's medical attention to the disease 22 mesothelioma than anything else, even though as early as 23 about 1955, the South Africans were seeing cases of 00046 47 1 mesothelioma in their country. 2 And the unique thing about the Wagner thing was 3 also the fact that where they were located, which was in 4 Kimberly, South Africa, that was actually a TB hospital, 5 and a lot of the patients that were initially 6 hospitalized there, they thought that they had TB. And 7 instead of usually getting better like most of the TB 8 patients did, these people died. It was actually those 9 people that had the mesotheliomas. 10 Q. Okay. And did Wagner, Dr. Wagner, or Wagner, 11 also discuss chrysotile in his 1960 paper? 12 A. He did. And he referred to the cases by 13 Cartier and by McCaughey in the discussion part of that 14 paper. And I think the reason he did that was because, 15 obviously, those were cases in which people were exposed 16 to asbestos, but they had not drawn the link between 17 asbestos and mesothelioma, which Dr. Wagner did. 18 Q. And from your training and reviewing the 19 medical literature after Dr. Wagner's case reports came 20 out, was there a discussion within the medical community 21 of disclaimers, that, "We don't have that epi studies 22 now, so, therefore, let's don't be going around saying, 23 'Asbestos causes meso'"? 00047 48 1 A. No, there were not those studies. But that 2 information probably had started to initiate those 3 studies. 4 Q. And what happened in the American experience 5 with Selikoff? 6 A. Well, the American consequence is that 7 Dr. Selikoff and his group in Mount Sinai in New York 8 City, they started evaluating a case, a unique - 9 somewhat unique group of individuals, the members of the 10 Heat and Frost Insulation Unions, in the United States 11 and Canada. And it turned out that there was 17,800 of 12 those, and some of those individuals went back as early 13 as the 1920s and 1930s when they did the insulating 14 work. What Dr. Selikoff and these individuals did was 15 look at the incidents of mesothelioma and other 16 asbestos-related diseases in that group of people. And 17 the -- they didn't obviously have everybody die at the 18 same time, so they looked at these at various time 19 periods. For example, the first major reports that came 20 out were in about 1964, 1965, where they showed that 21 about ten percent of the insulators developed 22 mesothelioma, about 21 percent lung cancer, and about 23 16 percent asbestosis. And, then, they kept following 00048 49 1 this cohort over a period of time, updating the 2 incidents of the diseases that occurred in them over the 3 period of time. 4 Q. And I'm asking you a little bit about this 5 experience that we had in America on this. Did 6 Dr. Selikoff, when he was reporting, insulators are 7 getting sick from asbestos, also report mixed exposures 8 that they're having? 9 A. Sure. He recognized that early on. He 10 initially thought there were individuals who developed 11 mesothelioma from chrysotile exposure only because of 12 the information they had on what types of asbestos were 13 imported into the United States. In 1964, in the New 14 England Journal of Medicine, he made an observation 15 that, of the types of asbestos that were imported into 16 the United States, crocidolite seemed to be the least 17 imported. And that turned out to be probably very 18 important because, as late as 1991, Dr. Wagner was 19 stating that the only cause of mesothelioma in the 20 United States and other parts of the world was 21 crocidolite asbestos, which was proven to be incorrect. 22 Q. And scientists and doctors can argue about 23 things? 00049 50 1 A. I suppose so. 2 Q. Okay. Well, and I guess when Selikoff was 3 reporting the American experience with insulators, did 4 he tell the medical and scientific community the 5 insulators had something really funky with their lungs 6 and the reason why they were getting asbestos disease as 7 opposed to other trades? 8 A. No. In fact, he said the exact opposite. He 9 said that the only thing that was important was being 10 exposed to asbestos. 11 Q. And did he say, I think it was, asbestos fibers 12 do not respect job classifications? 13 A. That's right. And for example, in the 14 shipyards that he studied, he showed a number of 15 different occupations in the shipyard and showed that 16 there was a dose response relationship between the 17 asbestos-related disease and how much the individual 18 group of workers were exposed to asbestos. 19 Q. Okay. Dr. McCaughey, real quick, and 20 Dr. Langer, can you read with me, Dr. Hammar, because 21 we've gone through this, just to try to shorten this as 22 much as we could. But you pointed out with McCaughey 23 and Langer that it was important, in your opinion, what 00050 51 1 they were discussing in this article. 2 A. Right . 3 Q. And could you just review with his Honor 4 what you feel is of significance. 5 A. Well, they started out that by talking about 6 what Merewether's speculation was about asbestosis that 7 would include manufacturers of asbestos, brake linings, 8 where it was then unknown whether or not that happened, 9 that that did happen; and, also, asbestos-related 10 pleural disease happened in brake workers. And, then, 11 they reported a case of mesothelioma in a 55-year-old 12 man whose only exposure to asbestos was from friction 13 products as primarily a brake mechanic; and when they 14 did the autopsy on that individual, they did a fiber 15 analysis on that individual's lung and found only 16 chrysotile asbestos. They did not find any amosite or 17 crocidolite. And they also subsequently published that 18 ten percent of the fibers were ten micrometers or 19 greater in length. And was that kind of an example or 20 probably the first well-documented example of a 21 mesothelioma occurring in a person exposed to friction 22 products. 23 Q. And this is what you're talking about, that no 00051 52 1 amphibole fibers were found; correct? 2 A. That's correct, yes. 3 Q. And I'm trying to find the ten percent. 4 A. I don't think that's in there. That was 5 actually in a later -6 Q. Okay. 7 A. -- publication. In fact, that's referenced in 8 Dr. Lemen's chapter in our book. 9 Q. Okay. And you mentioned something interesting, 10 is that Dr. Merewether -- and this hasn't come up yet. 11 I know Dr. Lemen is going to discuss this, or maybe 12 discuss this. 13 Who was Dr. Merewether, just real quick? And I 14 wrote the date down, 1930. 15 A. Well, he was the chief inspector of British 16 factories. And in the 1930s and 1940s, he was looking 17 at the incidence of various diseases, including the 18 diseases that occurred in individuals who worked in 19 these factories that had to do with asbestos. And what 20 he found -- and this was actually published in JAMA, the 21 Journal of the American Medical Association, in 1948, 22 that there was an increased incidence of lung cancer and 23 tumors that he referred to, either tumors of the lining 00052 53 1 of the lung or pleural tumors that certainly one would 2 think probably were mesotheliomas. I guess one might 3 speculate maybe they were pseudo mesos, possibly. 4 But he also compared the incidence that he 5 found in the -- in the factories to the people who did 6 not work in the factories and found an increased 7 incidence of lung cancers and tumors in the lining of 8 the lung in those individuals. 9 Q. Okay. And that was a little bit later than 10 what I put down, 1930? 11 A. That's when he started, though. 12 Q. Okay. And in 1949, he reported increased 13 incidence of those workers getting lung cancers and 14 pleural tumors? 15 A. That is correct, yes. 16 Q. And I wrote down "end product users" because it 17 was discussed in McCaughey and Langer's article, 18 Mesothelioma and Brake Repair Worker, and it says 19 Merewether's speculation in 1933 that asbestosis would 20 manifest itself in industries other than what he was 21 looking at. And I wrote "end product users" down. 22 A. Right . 23 Q. In that Merewether study, did he also, I guess, 00053 54 1 caution that others can be affected than just the 2 population he was studying? 3 A. He did, yes. 4 Q. Including brake linings? 5 A. Yes. 6 Q. And that's because -- or is it because, 7 asbestos fibers do not respect job classifications? 8 A. That is correct . 9 Q. The fibers get in, they can cause disease? 10 A. Yes. 11 Q. Now, the next report which you mentioned and 12 the significance -- you may have covered this -- I think 13 you did real quickly -- but was the pleural mesothelioma 14 in a brake mechanic. 15 A. Right. That's just another case. This is by 16 Dr. Huncharek, who's written about the subject. 17 Q. Okay. And I had highlighted "47-year-old." If 18 we can just briefly in this, what's the significance 19 again of this? 20 A. Again, he thought the only exposure he had was 21 from friction products. 22 Q. Okay and that was just one of the reports in 23 the literature. And one of the discussions -- and we've 00054 55 1 briefly talked about this -- is epidemiological 2 research. And just within those studies itself, has it 3 also been reported that individuals are getting sick 4 from asbestos friction products? 5 A. It is, yes. They have reported that, that 6 there have been cases where they have looked at people 7 for epidemiologic evaluation, where they have identified 8 mesotheliomas in those individuals. 9 Q. And in looking as a trained physician in 10 asbestos disease and the causes in a specific 11 individual, epidemiological studies are an important 12 thing; right? 13 A. Sure, they are. 14 Q. Okay. And they're an important piece of the 15 puzzle, along with all of the other things that you 16 consider; right? 17 A. I think they are, yes. 18 Q. Okay. The Australian experience -- and we're 19 talking about studies of groups of population, 20 population groups now. Are Aussies' lungs different 21 than American lungs? 22 A. No. 23 Q. Okay. And this is malignant mesothelioma in 00055 56 1 Australia. This is Dr. Leigh? 2 A. L-E-I-G-H. Leigh, I think, is the correct 3 pronunciation. 4 Q. And in this report or article published in the 5 International Journal of Occupational Environmental 6 Health -- I'm going to skip all the way to the 7 next-to-the-last page first, there's a chart. 8 A. Right . 9 Q. And it's "Asbestos Exposures as Documented in 10 the Australian Mesothelioma Register from January 1986 11 to the end of December 2001." 12 A. Yes. 13 Q. And segregated are job classifications. 14 A. Right . 15 Q. And one of those that's segregated is brake 16 linings made slash repaired. 17 A. Correct . 18 Q. And we've highlighted this. And what's 19 significant? 20 A. Because this is one of the major categories of 21 individuals who developed mesothelioma in Australia. 22 Q. Okay. And, for instance, right above it, 23 there's a boilermaker -- 00056 57 1 A. Right. 2 Q. -- a category for them. 3 Contained in that report -- and it's a few 4 pages long -- is a sentence that says, "The risk in 5 brake mechanics is also elevated consistent with 6 chrysotile-only causation." And in that one sentence, 7 is there additional information that you'd like to 8 discuss about those findings? 9 A. Well, I think there's information that is the 10 basis for that statement, yes. 11 Q. Okay. Not only contained in the back, right, 12 that we just showed? 13 A. Right . 14 Q. And I have the letter that you referenced on 15 the information quality guideline staff directed to them 16 as well as the World Trade Organization document. Which 17 would be best to put it in context? 18 A. I'd say the WTO document first. 19 Q. Okay. 20 A. That was written in 2001 by Douglas W. 21 Henderson, again, chief of Pathology at the University 22 of Adelaide, South Australia -23 Q. Okay. 00057 58 1 A. -- where he was one of the individuals hired by 2 the WTO to evaluate that. 3 Q. And you mentioned quite a few names. For 4 instance, you mentioned Dr. McCaughey. You knew him, 5 didn't you? 6 A. Sure. 7 Q. In fact, you all worked together? 8 A. He was a good friend of mine. 9 Q. Okay. And Dr. Henderson, you know him? 10 A. He and I do a lot of stuff together right now. 11 Q. And I take it, from what I can appreciate, the 12 pathologists that have this experience and have risen to 13 the levels that you are and Dr. McCaughey and others 14 are, you all kind of, I guess, hang out together at 15 seminars and do things like that worldwide; right? 16 A. I guess you might say that, yes. 17 Q. Okay. And has anybody ever stopped you, 18 Dr. Hammar, and said, "You know, you're nuts. You're 19 espousing some opinions here that are just so 20 unscientific and unvalid"? 21 A. No. 22 Q. Okay. Are the opinions that you're sharing 23 with his Honor and for those who may see in the record 00058 59 1 of this case generally accepted within the medical 2 community? 3 A. Yes. 4 Q. Are they based upon reasonable and reliable 5 principles of science and medicine? 6 A. Yes. 7 Q. Are they based upon reasonable and scientific 8 principles and methodology of medicine? 9 A. Yes. 10 Q. In applying that, those fields -- and those 11 fields are quite big -- in an individual case like you 12 do ? 13 A. That is correct . 14 Q. The Australian experience -- and you mentioned 15 Dr. Henderson in this article. If we could briefly 16 cover the importance of what Dr. Henderson is telling 17 us. And I had "Automotive" starting with "Friction 18 Products," Page 300. And we can either -- if you can 19 summarize or you can go through what we - 20 A. I don't think we have to go through all of it. 21 Q. Okay. 22 A. I think maybe we can start at that 5.244. 23 Q. Okay. Right here. 00059 60 1 A. It says, "Literature contains anecdotal reports 2 of malignant mesothelioma among automotive and brake 3 mechanics. However, the question that arises is whether 4 these anecdotal reports are explicable as a chance 5 occurrence of spontaneous or background mesotheliomas 6 among a large population of mechanics, or whether this 7 group of workers has sustained other significant 8 exposures to asbestos, including one or more amphiboles. 9 In other words, the question is whether there is a 10 general increase in the incidence of mesothelioma among 11 automotive and brake mechanics with no other exposures 12 to asbestos ." 13 Q. That question sounds familiar. 14 A. Well, I think that's the crux of the whole 15 question, I guess. 16 Q. Okay. 17 A. And, then, I think you could probably -- he 18 then goes through really and talks about the various 19 concentrations that -- of asbestos that are released by 20 various types of activity on brakes. He, then, also 21 goes in and cites several epidemiological studies that 22 have not shown any increased incidence of mesothelioma 23 in the brake mechanics. And, then, he finally does an 00060 61 1 analysis of the data that he had from Australia on what 2 the Australian evidence was, of whether or not there was 3 or was not an increased incidence of mesothelioma in 4 people exposed to chrysotile asbestos from friction 5 products. 6 And I should have also said that, from the 7 beginning, he states that, as far as he knows, the only 8 type of asbestos that was used in friction products in 9 Australia was chrysotile. And I've asked him this many 10 times, because chrysotile (sic) was a country that did 11 mine asbestos, and primarily crocidolite asbestos, as 12 well as other types, and did use it but not to the same 13 extent that they actually imported it. So, it's my 14 understanding from Dr. Leigh and Dr. Henderson that they 15 only used chrysotile asbestos in the friction products. 16 Q. Okay. 17 A. And, then, in the last part of this, he goes 18 through this analysis of what the mesothelioma registry 19 showed and what the number of mechanics was in 20 Australia. And it's probably worth reading that, 5.253. 21 Q. And let's do that, 5.253. Dr. Henderson's what 22 kind of doctor? 23 A. He's a pathologist, like myself. 00061 62 1 Q. Pathologist? 2 A. Yes. 3 Q. Trained physician in the diagnosis and cause of 4 asbestos disease; correct? 5 A. He's maybe one of those pathologists that 6 probably is at the real top of the ladder, so to speak, 7 in that, in his 2004 article on lung cancer that was 8 published in a journal in -- in Australia called 9 Pathology, which probably is more epidemiology in that 10 article than there is anything else. So, he's a pretty 11 knowledgeable gentleman. 12 Q. Okay. And he discusses what's out there, and 13 you've summarized what he's discussing in his paper, the 14 epidemiology studies and the case reports; right? 15 A. Right. 16 Q. And after reviewing all of that material, this 17 physician, who's at the top, discusses what as far as 18 the opinion, the Australian experience? 19 A. He says -- he states, "Nonetheless, the 1990 20 report for the Australian Mesothelioma Register (AMR 99) 21 records 58 mesotheliomas among brake mechanics with no 22 other exposure to asbestos, during the almost 13-year 23 period between 01 January 1986 and 31 October 1999 00062 63 1 (total cases with a stated history of asbestos exposure 2 = 2585) . Mechanics who frequently or consistently work 3 on brake linings and brake locks represent only a 4 subfraction of the total workforce of mechanics in 5 Australia. If one takes the 1996 census figure of 6 82,827 for male mechanic, this amounts to 58 7 mesotheliomas in 1,062,946 person years (equals 54.6 8 mesothelioma per million person years). If one rounds 9 off the workforce to 100,000 male mechanics, the figure 10 becomes 45 mesotheliomas per million person years. If 11 one then doubles the workforce population to take into 12 account retirees and other workers who moved on to other 13 occupations (although a figure of 200,000 is almost 14 certainly an overestimate because it would include all 15 mechanics, where brake mechanics constitute a smaller 16 sub-class), the mesothelioma rate becomes 22.6 per 17 million person years, well under the rate of 337 18 mesotheliomas per million person years for the Quebec 19 chrysotile miners and millers, but still substantially 20 above the upper limit of the estimated background rate 21 of 1- 2 mesothelioma per million person years ( about 22 10-fold). One might suspect that mesotheliomas in brake 23 mechanics were clustered in those involved in the 00063 64 1 grinding, bevelling, and other operations on new brake 2 blocks and brake linings (i.e., brake materials 3 unaltered by heat)." 4 Q. The key, if I'm -- correct me if I'm wrong - 5 is that? 6 A. 22.6 per million person years compared to a 7 background rate of one to two cases per million person 8 years. 9 Q. Okay. And he goes on to say that that rate is 10 less than expected of miners and millers; right? 11 A. Yes. 12 Q. Is that surprising when discussing dose 13 response? 14 A. No. 15 Q. Okay. And, yet, still significantly above the 16 background rate of one to two expected cases? 17 A. Yes. 18 Q. Is that significant, in your opinion? 19 A. Yes. 20 Q. Are the opinions you've given today based upon 21 reasonable medical probability? 22 A. Yes. 23 Q. Can, more probable than not, medically 00064 65 1 asbestos-containing friction products cause disease in 2 individual cases? 3 A. Yes. 4 MR. WADDELL: Pass the witness, your Honor. 5 THE COURT: Why don't we take our morning 6 recess at this time. We'll break for ten minutes and 7 return back at 20 until 11:00. Our plan would to go 8 roughly until noon, maybe a little after, and then take 9 our luncheon recess. 10 All right. Thank you. 11 (Short recess.) 12 BY MR. TARRY: 13 Q. Good morning, Dr. Hammar. 14 A. Good morning. 15 Q. My name is Sam Tarry. I don't believe we've 16 met before. I appreciate you coming out and answering 17 questions for us today. 18 A. You're welcome. 19 Q. And I also appreciate your candor earlier with 20 respect to what is known and unknown about cancer and 21 especially mesothelioma. So I'm actually going to 22 shorten up some of the questions that I intended to ask 23 you on that front. 00065 66 1 Without getting into too much detail about what 2 was known at the molecular level, will you agree with me 3 that we don't understand how a fiber starts the process 4 that results in mesothelioma; there are theories about 5 it; we're doing work on that, but we don't understand 6 the whole process? 7 A. I agree . 8 Q. And, in fact, the Kamp paper that you 9 referenced -- this is it. When they talk about what 10 scientists are uncovering, they frame it as just that, 11 as a hypothesis; correct? A radical hypothesis is the 12 heading of that chapter; correct? 13 A. Yes. 14 Q. And there -- this is a thorough paper. There 15 are I think about 193 references. We're not going to 16 talk about all those. 17 But do you know how many, if any, of these 18 reference experiments relied upon by Kamp involved 19 experiments using Grade 7 chrysotile asbestos? 20 A. No, I don't know the answer to that. 21 Q. So then we also don't know how many, if any, of 22 those experiments were involving chrysotile with the 23 same surface chemistry, chrysotile that would had been 00066 67 1 heated, bound, and resins and actually gone through the 2 process that chrysotile fibers or friction products go 3 through; correct? 4 A. I agree. 5 THE COURT: Mr. Tarry, it just dawned on me 6 that I did not, at least for the record -- I think we 7 decided that the order of presentation, or at least 8 questioning, was going to allowed by Mr. Johnson to step 9 in if he wished. 10 MR. JOHNSON: I can solve the problem. I have 11 no questions at this point based on plaintiffs' 12 examination. 13 THE COURT: I apologize. I just didn't clarify 14 that on the record. 15 MR. TARRY: I apologize, too. That was 16 presumptive. I thought he went after me yesterday. 17 MR. JOHNSON: I think I did. I'm generally not 18 going to have a lot to say given the kind of alignment 19 that - 20 THE COURT: That's fine. I think it made some 21 sense in our initial discussions that you would go 22 second in the line with plaintiffs' witnesses so that 23 the cross-examination could address all those issues. 00067 68 1 MR. JOHNSON: Okay. That's fine, Your Honor 2 THE COURT: Appreciate it. 3 BY MR. TARRY: 4 Q. Dr. Hammar, when science doesn't fully 5 comprehend the mechanism of disease, what we talk about 6 is a concept called risk; correct? 7 A. I think that's correct, yes. 8 Q. And to oversimplify it, we identify certain 9 factors that might be risk factors in contributing to 10 the development of a disease; right ? 11 A. Fair enough. 12 Q. What epidemiologists -- I know you're not an 13 epidemiologist, but just a couple quick questions on 14 this. What epidemiologists do is to try to test 15 hypotheses about risk factors; correct? 16 A. I agree . 17 Q. Now, there was a discussion about different 18 disciplines. I'm sorry. Could I get this? 19 THE COURT: Sure. 20 BY MR. TARRY: 21 Q. I wanted to find the listing where you talked 22 about the whole picture and the evidence that you 23 looked. 00068 69 1 MR. TARRY: Chip, can you find that? It had 2 one, two and three. 3 (Pause.) 4 BY MR. TARRY: 5 Q. I'm sorry if this is a stupid question. We 6 have never met. I've never taken your deposition. But 7 do you prescribe medicine in your practice? 8 A. Hardly ever, no. I would never prescribe it to 9 a patient. I might prescribe something for my wife or 10 my son or daughter, but I mean hardly ever. 11 Q. Do you belong to the American Medical 12 Association? 13 A. I don't belong to that association, no. 14 Q. Do you know of something called the 15 evidence-based medicine movement generally within the 16 medical field? 17 A. Yeah, I do know something about that. 18 Q. Okay. Tell us what that is. 19 A. Well, what it is is kind of a catchie phrase 20 for what's been done for basically ions of time. I 21 mean, when I went to medical school, we didn't call it 22 evidence-based medicine. But basically all medicine is 23 evidence based. 00069 70 1 For example, if you have a patient whose got a 2 pleural effusion and you're trying to figure out what 3 the pleural effusion is caused by, you do certain things 4 to gain evidence of what that pleural effusion was 5 codified. To me that's evidence-based medicine just 6 like it is in a person who comes in with a chest pain 7 and you want to determine if that person has a 8 myocardial infarct. You'll do certain tests, such as a 9 component, EKG, a CPK, things like that to get evidence 10 to determine what disease a person has. 11 So to me this new thing, evidence-based 12 medicine is something that has been going on forever. 13 Q. Right. In fact, it's not really new. Good 14 doctors have been practicing evidence-based medicine for 15 a long, long time? 16 A. Yeah. I don't know. I was just told by a 17 friend of mine who is a pulmonologist that this 18 apparently is something big now no medical schools. And 19 somebody that he interviewed asked him if he practiced 20 evidence-based medicine. He started laughing at him. 21 Q. The reason it seems new is because the AMA 22 actually put together multi-disciplinary panel and they 23 generated a consensus report on evidence-based medicine 00070 71 1 and a need to just try to and make sure that there was 2 consistency across the country in how we deal with 3 issues of both causation and treatment; right? 4 A. I didn't know that. I guess I know that now. 5 Q. Are you aware of the final publication in the 6 Journal of the American Medical Association? 7 A. I don't look at that -- I don't receive that 8 are journal. And I don't belong to the American Medical 9 Association. 10 Q. Would you be surprised if they had reported 11 that, while you ought to consider everything, you don't 12 disregard any type of evidence; that there are -- there 13 is a hierarchy of certain types of evidence depending on 14 what you're looking at that may be more probative or 15 more relevant for your inquiry? 16 A. I think that's totally true. For example, the 17 American Rheumatologic Society for years has published 18 major and minor criteria for diagnosing collagen 19 vascular diseases. I don't think that's really 20 something new. It doesn't surprise me that they did 21 that. In some respects maybe that's a good thing. I 22 don't know. 23 Q. And it's really not altogether different if 00071 72 1 we're talking about treatment or identification of 2 etiology of a disease, is it? 3 A. I guess it depends on how you -- what you're 4 trying to do, whether you're trying to determine the 5 etiology of the disease or whether you're trying to 6 determine what the disease is or how to treat it. 7 For example, there's a lot of diseases that we 8 don't know what the etiology is that we do have good 9 treatments for. 10 Q. Let's go back to the concept of risk factor. 11 Okay? A drug really is a risk factor for a cure. 12 There's a good chance hopefully that a good drug is 13 going to have a biological effect which actually cures 14 you or makes you better; is that correct? 15 A. That's true. 16 Q. We call that positive effect or a protective 17 effect? 18 A. Okay. 19 Q. For instance, if I came to you as a doct or and 20 said, what's going to happen to me if I increase the 21 fruit intake in my die t, you would probably tell me 22 that's a good thing; I 'd encourage you to do that ; 23 because there do appea r to be some protective eff ects of 00072 73 1 eating fruit; correct? 2 A. That is correct, yes. 3 Q. So that's protective. And then on one side 4 there are also risk factors that can be harmful, that 5 can contribute in a meaningful manner to the development 6 of disease. Those are the bad things that we can 7 identify throughout evidence-based medicine; correct? 8 A. I would agree, sure. 9 Q. And that hierarchy that we're talking about 10 starts with randomized clinical trials. You wouldn't 11 dispute that that's probably, all things being equal, 12 where a doctor ought to start; right? In other words - 13 A. I think, yeah. Randomized clinical trials is 14 probably the thing that has been done today, at least in 15 testing new drugs, for example, or testing new 16 therapeutic devices, etc., etc. 17 I think in the earlier years in medicine it was 18 probably kind of a -- kind of chance and observe or do 19 something and observe to see what happens. But I think 20 randomized trials now are obviously the best way to 21 determine if something is or is not effective. 22 Q. And so that we're not confusing anything on the 23 record, just so the Judge understands exactly what we're 00073 74 1 talking about with randomized clinical trials, that's 2 actually monitoring in a prospective manner some dose of 3 something in human beings and following them for a 4 certain period of time and watching the result; correct? 5 A. Sure. Like chemotherapy, that would be 6 probably the big thing right now. 7 Q. Now, that is absolutely unavailable in this 8 inquiry we're involved in today because there's no way 9 we're ever going to give people a dose of asbestos to 10 see how they respond; correct? 11 A. Well, you're not going to do that knowingly. 12 What people have tried to do retrospectively is tried to 13 see what dose is necessary to cause a certain disease. 14 For example, in the case of asbestos, I think it's 15 fairly well accepted that it takes less asbestos to 16 cause mesothelioma than it does to cause, say, lung 17 cancer or asbestosis or Grade 4 asbestosis. 18 Q. And that's why observational studies, which 19 tend to call epidemiology, observational studies where 20 you're not controlling the dose, you're just watching 21 people either prospectively or retrospectively, 22 observational studies fall below the trials on the 23 hierarchy of evidence-based medicine; correct? 00074 75 1 A. I would think that would probably be correct, 2 yes . 3 Q. And specifically what we know is that the best 4 way to look at that is through a systematic review of 5 observational studies. In other words, you don't just 6 want to cherry pick. We don't want doctors answering 7 the question about fruit, for instance , by just picking 8 up one article and ignoring three others; you need to do 9 a systematic review; correct? 10 A. I agree. 11 Q. And below observational studies, we get down to 12 the observation of an individual clinician; right, the 13 descriptive observational techniques such as case 14 reports; right? 15 A. Fair enough, yes. 16 Q. So it's not a matter of asking anybody to 17 exclude anything. We want you to review all of the 18 evidence. But it's not fair to say that in the whole 19 picture everything is of equal weight, is it? 20 A. No. 21 (Pause.) 22 BY MR. TARRY: 23 Q. Are you affiliated with the University of 00075 76 1 Washington still? 2 A. Yes . 3 Q. And you know Dr . Checkoway, Harvey Checkoway, 4 A. No . 5 Q. You don''t know him? 6 A. No. 7 Q. I'll represent to you that Dr. Checkoway is a 8 full-time faculty member there at the School of Public 9 Health and a professional epidemiologist. I think if 10 you reviewed the epidemiology on brake mechanics or on 11 broad exposures, you may be familiar with him as one of 12 the Teschke paper? 13 A. Okay. I know the Teschke paper at least by the 14 first name, but I don't know all the other authors on 15 that. 16 Q. Are you aware of the textbook that he published 17 or he and Dr. Pearce and Dr. Kriebel published entitled 18 Occupational Epidemiology Research Methods? 19 A. I'm not familiar with that. That's something 20 that I don't study a lot. 21 Q. He makes a statement that I'd like to get your 22 reaction to. 23 A. Okay. 00076 77 1 Q. I think this is maybe germane to the question 2 of different types of evidence. 3 And it's not going to let me show this, is it? 4 Let's see. 5 I apologize for the glare. Can you read that 6 at all? 7 A. Yeah. Right there is fine. 8 Q. "It is sometimes helpful to distinguish dose 9 from the concept of biologically active dose, which 10 arises when only some fraction of the dose can produce 11 an effect. Although it is possible to measure tissue 12 levels of some toxic substances at the sites of 13 biological activity, it is generally impossible to 14 determine the amount that is or has been biologically 15 active." 16 Let me stop there. So far, do you agree with 17 the science behind that statement? 18 A. I do. 19 Q. " For example, asbestos fibers can be quantified 20 in lung tissue and related to the severity of pulmonary 21 fibrosis." 22 Do you agree with that? 23 A. I do. 00077 78 1 Q. "These measurements are actually measures of 2 organ burdens." -- is that legible up there? 3 A. It is . 4 Q. " Rather than biologically active doses because 5 of uncertainties about the time course of burden and the 6 fiber characteristics that initiate or promote disease 7 process." 8 I think that's consistent with your earlier 9 testimony. I just want to make sure. 10 A. It is, yes. 11 Q. All right. And I mentioned that Dr. Checkoway 12 was one of the authors of the Teschke study entitled 13 " Mesothelioma Surveillance to Locate Sources of Asbestos 14 Exposure." Do you recognize that paper? 15 A. I do. I have it right here. 16 Q. I think we'll stipulate on the record, you 17 don't understand that anybody is making a claim that 18 there's anything magical about the lungs of any 19 occupational brake work, do you? 20 A. No. 21 Q. What Dr. Checkoway and others were 22 investigating in this were the different health outcomes 23 of different circumstances of exposure to different 00078 79 1 types of asbestos in different at mospheres at different 2 doses; correct? 3 A. Yes. 4 Q. And they concluded that that three -- can you 5 read that or do I need to zoom in ? I'm on page 164. 6 A. No. I can see that. 7 Q. They found three occupat ional groups with odd 8 ratios of 5. 0 or greater in the i nitial analysis, sheet 9 metal workers, plumbers, pipefitt ers, and ship building 10 workers. And ship building we ta lked about a little 11 bit. That comes as no surprise t o you because you know 12 that they have a very high increa se of risk of 13 mesothelioma; is that correct? 14 A. They do, yes. 15 Q. They also investigated, because there was 16 suspicion about the release of as bestos fibers from the 17 resin in brake linings, they inve stigated vehicle 18 mechanics? 19 A. Right . 20 Q. I don't know whether you can see the heading. 21 This is small. But they're actually included in a 22 priori suspect occupational groups; correct? 23 A. I see that. 00079 80 1 Q. Not only was it not over five, it was .8, which 2 is technically -- that would be protective, but nobody 3 is ever going to make the argument that you ought to 4 have dust inhalation to prevent mesothelioma; correct? 5 A. I think that's correct. 6 Q. So effectively what that is a finding of no 7 increased risk by working on vehicles for this disease? 8 A. That's what they said. 9 Q. And, in fact, it's a little bit lower than the 10 number they were reported for people who are sales 11 clerks, who were in the other occupational groups not 12 necessarily expected to be exposed to asbestos; right? 13 A. Well, that would be true. But I think even 14 though if you look at the confidence intervals in both 15 of those there is an upper end to that. Again, I'm not 16 an epidemiologist. I'll let Dr. Lemen go on there. It 17 seems to me there's a variation there. And it's always 18 going to depend on exactly on what the person did. 19 Q. But although you don't know Dr. Checkoway, you 20 know the University of Washington, and you wouldn't 21 question his scientific credibility here today, would 22 you? 23 A. No. I wouldn't have any reason to. 00080 81 1 Q. In fact, I think you can see -- and we'll get 2 to Australia in just a moment, but up until the time of 3 Australia, the evidence you were aware of indicated no 4 increased risk of mesothelioma by working on cars or 5 working in in a garage? 6 A. No. And I said that before. That based on 7 those studies that have been done, I don't see any. 8 There have been some criticisms of those studies that I 9 am not in the position to discuss one way or the other 10 Q. Dr. Roggli is someone you know? 11 A. I do . 12 Q. Is he also on the U. S./Canadian mesothelioma 13 panel? 14 A. He is , yes . 15 Q. And he 's someone who you respect? 16 A. Sure . 17 Q. And he comes to a different conclusion on the 18 question of before the Court today about the risk of 19 malignant mesothelioma and garage workers and brake 20 mechanics, do you agree? 21 A. He does. 22 Q. That was a bad question. Do you agree that he 23 comes to a different conclusion? 00081 82 1 A. He has, yes. 2 Q. Let's talk about Australia. 3 A. Okay. 4 Q. It's true, isn't it, that the impact on your 5 thinking of these claims made by Dr. Henderson and 6 Dr. Leigh from Australia is really even more important 7 than you testified to today? In other words, the 8 Australian data is extremely important to you, isn't it? 9 A. I think it is. At least to me that would be a 10 epidemiologic evidence that there was an increased 11 incidence of mesothelioma in the people that were 12 dealing with brake products, primary in brake mechanic 13 repair and less likely as actual manufacturer of the 14 brake shoes. 15 Q. And, in fact, in the process of weighing all of 16 the evidence, which you've always done -- you didn't 17 just start doing that today, did you? 18 A. No. 19 Q. In the process of weighing all of the evidence 20 on this question of whether doing this work with this 21 type of product under those circumstances one would 22 expect increase rate of mesothelioma, until Australia 23 you're opinion was that there is no evidence of an 00082 83 1 increased risk? 2 A. Well, that was correct based on what had been 3 published by those people and based on their opinions, 4 yes . 5 Q. Just so I don't misstate it, let me show you 6 testimony you have gave in Texas. There was a 7 hypothetical by Mr. Lopez. 8 MR. WADDELL: Your Honor, I know this is kind 9 of a freelance hearing, so to speak . I object to the 10 use as improper on cross-examination, impeaching his 11 testimony. He's done nothing but agree with what he 12 said. 13 THE COURT: Overruled. 14 BY MR. TARRY: 15 Q. Just to be clear, I don't want to be unfair. I 16 understand the answer. I just want to make sure the 17 record is clear about the prior testimony about the 18 importance of the Australian data. All right? 19 A. Okay. 20 Q. Mr. Lopez asked you: "For example, if you've 21 been hired, say, in 2001 in this case by a defendant 22 representing a brake or clutch manufacturer, your 23 opinion would have been that Mr. McDowell's exposure to 00083 84 1 friction or clutch products was not a causative factor 2 in the development of his mesothelioma; correct?" 3 And you said: "No, I think it would be exactly 4 the opposite." 5 He says: " I'm talking about over two years 6 ago." 7 "ANSWER: Oh, two years ago. 8 "QUESTION: Yes. I said let's just say roughly 9 2000." 10 Your clarifying question was: "You mean before 11 the Henderson document came out?" 12 "Yes, the year 2000." 13 And you responded: "Okay. Before the 14 Henderson document came out, I would say that I could 15 not prove that that was a cause of mesothelioma." 16 Is that still your opinion? 17 A. That's correct, yes. 18 Q. So it's difficult to overstate how important 19 then in the weighing of all the evidence this Australian 20 information is to you when you testify to this Court 21 today? 22 A. It is. And I think there it kind of suggests 23 that something is wrong, either that the Australian 00084 85 1 information is wrong or maybe that the information 2 that's been published by these various individuals -- I 3 think there's been six individual reports and three META 4 analyses that something is wrong with their data. I 5 guess that's something that the epidemiologists have to 6 decide. 7 I still think, though, that if you look at it 8 from just a pure point of view of the development of 9 mesothelioma and exposure to asbestos that it would be 10 very hard to not conclude that, say, the case of 11 McCaughey and Langer reported, that that wasn't an 12 example of an asbestos-induced mesothelioma, just like 13 the one Huncharek reported. 14 So despite the epidemiology, it would be very 15 hard for me to conclude from those case reports that 16 asbestos were not the cause. I believe in the 17 epidemiology. I think it's very important. And I think 18 that somehow that there seems to be a big significant 19 discrepancy here with respect to what both Henderson and 20 Leigh have published versus what has been published in 21 this country primarily and Canada also. 22 Q. Thank you for clarifying that, because that is 23 something that this Court needs to understand. There is 00085 86 1 a huge discrepancy between the risks reported by 2 Dr. Henderson and Leigh out of Australian and all of the 3 other global research that was available to you prior to 4 the time that came out. They're not even close? 5 A. They're not even close, that's correct. 6 Q. Either everybody in the world who looked at 7 this issue was wrong and there is a risk, and not only 8 is it a risk, it's a really, really high risk of 9 mesothelioma, or there's something wrong with Henderson 10 and Leigh's cl aims? 11 A. It's a really, really high risk of 12 mesothelioma. Again, you look at the tot al number of 13 cases, though. It's not a real big risk that way. 14 Because still, of he number of cases of mesothelioma 15 reported in these brake individuals is relatively few 16 compared to, say, Puget Sound Naval Shipyard. But it's 17 still a significant number because it's a horrible 18 disease. 19 Q. I'm not trying to beat a dead horse. So the 20 Judge is clear, those case reports that you find 21 important, Huncharek or anybody else's, they were not 22 important enough to you, using evidenced-based medicine 23 or whatever rubric you employ prior to the information 00086 87 1 from Australian coming out, would have led you back then 2 to giving the opinions that you're prepared to give 3 today that it increases the risk, working with brakes 4 increases the risks? 5 A. That is correct. 6 On the other hand, though, the reason that I 7 would say that I couldn't prove it is because I would 8 not have any epidemiologic evidence. But if you ask me, 9 though, how do -- what would be my opinion with respect 10 to the case that McCaughey and Langer reported and the 11 case that Huncharek reported with respect to what would 12 cause that individual's mesothelioma was, I would say 13 chrysotile asbestos. I wouldn't have any doubt about 14 that. I'm just saying that sometimes you can't always 15 prove things from an epidemiologic studies. I can give 16 you another example that's even better. 17 Right now the only known cause of mesothelioma 18 in the United States is asbestos. That's the only known 19 cause. Myself and a number of other individuals 20 happened to belive very strongly that there is another 21 cause of mesothelioma in the United States. And what 22 that is therapeutic radiation that is given to other 23 cancers. And there have been epidemiologic studies to 00087 88 1 see if there's any evidence of an increase incidence of 2 mesothelioma in people receiving therapeutic radiation. 3 And one of the biggest groups that they've 4 actually studied are women who have breast cancer who 5 then received therapeutic radiation for breast cancer. 6 There is no epidemiologic evidence that therapeutic 7 radiation causes mesothelioma. But I have seen at least 8 five cases of lymphomas who have been radiated where 9 there's no history of exposure to asbestos who developed 10 mesothelioma. 11 I saw one very sad case of a young child who 12 developed a tumor in the pineal gland who then had 13 neuraxis radiation who developed mesothelioma. I report 14 in that book, for example, a case of a child who had 15 Wilms tumor who received therapeutic radiation who 16 developed mesothelioma. 17 But here's another example where epidemiologic 18 does not show that there's an increased risk of this 19 disease where it's clearly evident to myself and a lot 20 of other people that therapeutic radiation is a cause. 21 I would say there's nothing different between this and 22 potentially, say, chrysotile asbestos in friction 23 product exposure. Maybe the risk is small enough that 00088 89 1 the epidemiologic studies cannot evaluate this. And 2 that's something that I'm not an expert on. 3 Q. Thank you for clarifying that. And we'll deal 4 with the technical epidemiologic questions with a 5 professional epidemiologist. 6 But for your testimony to the Court today, I 7 want to be clear. The reliability, the scientific 8 reliability and integrity of both the data and the 9 methodologies employed by Dr. Leigh and Dr. Henderson in 10 reporting from what they reported from Australian 11 directly impacts the reliability and the scientific 12 credibility of your testimony to this court today on the 13 question? 14 A. That's true. 15 Q. You testified about latency. It's important, 16 is it not, when considering mesotheliomas and whether 17 particular exposure may have played a role in developing 18 mesothelioma to look at the latency factor? 19 A. It is, yes. 20 Q. If I showed up at your office today with 21 mesothelioma and I told you that I changed my brakes 22 yesterday but I had some other exposures ten or 20 years 23 ago, the ten or 20 years ago exposure would be the one 00089 90 1 that you would focus on; you would not be concerned 2 about what I did yesterday? 3 A. That is correct. 4 Q. And the reason is because there was not 5 sufficient latency between the exposure and the 6 development of the disease, the progression of the tumor 7 time? 8 A. That is correct. 9 Q. And you use -- what is the general latency - 10 A. Well, the Helsinki consensus criteria, which I 11 have a copy if anybody wants it -- they give the 12 shortest latency as ten years. The shorts latency that 13 I know for asbestos that has been published in the 14 medical literature is five and a half years. The 15 shortest latency for therapeutic radiation, 16 interestingly, is only a year. The longest latency that 17 I have seen myself is 72 years. And in the article that 18 Dr. Dodson and I reported in 1997, it ranges between 25 19 on the short end, 72 on the long end. 90 percent, 95 20 percent were between the 30 and 60 years. And the 21 average was 47 years. 22 Q. All right. In any event, if Dr. Leigh and 23 Dr. Henderson are makings claims about cases of 00090 91 1 mesothelioma where the suspected cause or the only 2 identified exposure is from professional brake work or 3 from the manufacturing of brake linings, they ought to 4 take latency into effect, shouldn't they? Shouldn't 5 they record the time when the people were exposed? 6 A. Well, I suspect that they probably should have. 7 They might even have that information, although it might 8 not be published. I don't know. 9 (Pause.) 10 BY MR. TARRY: 11 Q. You're aware, Dr. Hammar, that -- can we switch 12 this back to my computer? 13 THE COURT: I can give it a shot. 14 (Pause.) 15 THE COURT: Is it working now? 16 MR. TARRY: Our screen is still blank. 17 (Pause.) 18 MR. PRICE: Mr. Gribben is an IT person from 19 our office. If I could ask him to join in the 20 assistance? 21 THE COURT: Sure. 22 BY MR. TARRY: 23 Q. Are you aware that Dr. Leigh gave sworn 00091 92 1 testimony in American litigation about the process used 2 in making these claims of increased incidence from 3 Australian? 4 A. I heard that hearsay. I heard that hearsay 5 that two U. S. attorneys deposed him at a time that I'm 6 not sure exactly it was. And the only thing I heard was 7 that some of the cases -- and I don't know how many - 8 that he had initially stated were exposed only to 9 friction product asbestos chrysotile was not correct, 10 that they had some other exposures. As far as how many 11 cases, I never heard that number. And exactly when this 12 happened, I don't know that either. 13 Q. It would be important to you, as you just 14 stated, though, to know whether or not they considered 15 latency in reporting these numbers? 16 A. Well, I think with respect to the other 17 exposures, yeah, that would be important, yes. 18 Q. Well, wait a minute. 19 A. It would be important to know if what the 20 latency was for any exposure they had to asbestos . 21 Q. Let me let you listen to what Dr. Leigh said 22 about latency in these numbers. 23 A. Okay. 00092 93 1 (Whereupon the following video clip was 2 played.) 3 "QUESTION: What I want to ask you about this 4 particular case is you'd agree that the work exposure, 5 possible exposure to brakes in work in the garage over 6 the last ten years would be -- have sufficient latency 7 to be included as a - 8 "ANSWER: Well, it's a very short latency, very 9 short latency, but it's possible. It can occur in less 10 than ten years. The shortest latency we had was four 11 years. 12 "QUESTION: So you haven't -- you included any 13 exposure regardless of latency in your 43 - 14 "ANSWER: Yes. 15 "QUESTION: You've got to let me finish - 16 vehicle mechanics without other exposure? 17 "ANSWER: Yes. 18 "QUESTION: And you would agree with that, that 19 exposure actually occurred, since it's ten years and he 20 was diagnosed in 1992, sometime between 1982 and '92; 21 right? 22 "ANSWER: Yes. 23 "QUESTION: Okay." 00093 94 1 BY MR. TARRY: 2 Q. They just pulled together all the reports they 3 could regardless of the time of exposure. That's what 4 he said; right? 5 A. I don't know. Could you ask that again. I'm 6 not sure. 7 Q. They reported this number 58, then later 43 - 8 A. Okay. 9 Q. Dr. Leigh. 10 A. Right . 11 Q. They reported that without regard to when the 12 exposure occurred. Is that what he just said? 13 A. Did he say that for all the cases or just the 14 one case? 15 Q. That was one example of somebody with a latency 16 under ten years that was included. But we can watch it 17 again. The question was: Did you consider latency? 18 Would it be helpful to watch that again? I know I was 19 flipping back and forth. 20 A. Yeah. 21 Q. Let's watch that again. 22 (Whereupon the following video clip was 23 played.) 00094 95 1 "QUESTION: What I want to ask you about this 2 particular case is you'd agree that the work exposure, 3 possible exposure to brakes in work in the garage over 4 the last ten years would be -- have sufficient latency 5 to be included as a - 6 "ANSWER: Well, it's a very short latency, very 7 short latency, but it's possible. It can occur in less 8 than ten years. The shortest latency we had was four 9 years. 10 MR. TARRY: The next question. 11 (Whereupon the video clip continued.) 12 "QUESTION: So you haven't -- you included any 13 exposure regardless of latency in your 43 - 14 "ANSWER: Yes. 15 "QUESTION: You've got to let me finish - 16 vehicle mechanics without other exposure? 17 "ANSWER: Yes. 18 "QUESTION: And you would agree with that, that 19 exposure actually occurred, since it's ten years and he 20 was diagnosed in 1992, sometime between 1982 and '92; 21 right? 22 "ANSWER: Yes." 23 BY MR. TARRY: 00095 96 1 Q. They didn't consider latency? 2 A. Seems to me that he's saying two things there. 3 He's talking about an individual case where he said that 4 the latency between not that individual case, that the 5 '82 to '92 was a ten-year latency. And he said the 6 shortest they had it and latencies -- and I don't know 7 whether this was in general or for friction products - 8 was four years. And then they -- asked about the 9 43 cases. But he didn't say what the latency was. He 10 didn't say which ones had a short latency and which ones 11 had a long latency. He didn't say whether he really had 12 the data for that. 13 Q. That's exactly the point, isn't it? He didn't 14 offer any information on latency because that's not what 15 they did when they were reporting these numbers? 16 A. Well, it wasn't like you said, though. It's 17 not that he didn't report it, though. What he was 18 talking about was a single case. Now, what the 19 latencies were on the other 43 cases, I have no idea. 20 Unless you know those numbers, I don't know what those 21 numbers are. 22 Q. We may talk about that depending on how much 23 time we have or we can talk about it with Dr. Lemen. 00096 97 1 But is it your testimony that he considered 2 latency or he didn't consider latency when selecting 3 cases to claim were mechanics whose only exposure, only 4 cause of exposure could have been from brakes? 5 MR. WADDELL: I apologize for interrupting, 6 Mr. Tarry. It's getting argumentative as to what 7 actually was said and played. Is he interpreting -- I 8 apologize, Your Honor. It is what it is. 9 THE COURT: The witness' interpretation is I 10 think the subject of the question. And I'll allow that 11 in that context. How you interpret, if you're able to, 12 what Dr. Leigh was saying. 13 THE WITNESS: I can't interpret it. 14 Here's the deal about latency, though. It's 15 not as clearcut as people think it is. For example, 16 some people say that there's an inverse relationship 17 between latency and dose. But that's not always the 18 case. 19 For example, in the Dodson paper that he and I 20 wrote, I can show you examples of people that had short 21 latencies who had short or minimal exposures . And what 22 Dr. Leigh was saying in his, if I understood it, that he 23 has short latencies as earlier as four years. And there 00097 98 1 had been, by Dr. Roggli's reports some people who had 2 had sarcomatoid mesotheliomas who have had very short 3 latencies also. And if you look at the only data 4 published on doubling times of sarcomatoid 5 mesotheliomas, there can be some incredibly short 6 latencies. So it seems to me that there's more to this 7 issue than just purely the number of years. 8 And the other issue that also comes up that's 9 been published in that Kamp and Weitzman article and 10 that has to do with the fact that asbestos is not only 11 an initiator of cancer, it's also a promoter. So even 12 if the person had a latency, say, of ten years, that it 13 is still possible that continued exposure to asbestos 14 would contribute be to the development of that tumor. 15 And that's in the Kamp and Weitzman article. 16 THE COURT: Just for clarification, though, as 17 you listen to the testimony that was just played, were 18 you able to determine from that whether or not the Leigh 19 or Henderson study considered latency or not? 20 THE WITNESS: I can't tell what that said. 21 Seems to me there was one case that they reported where 22 there was a suggestion of ten-year latency and that the 23 shortest they had was four. But I can't tell what they 00098 99 1 meant by that other than -- maybe I'm not getting it, 2 but I don't know what they meant. 3 MR. TARRY: We're going to stipulate to put the 4 transcript in and let the Court decide instead of 5 beating this to death. 6 THE COURT: All right. I suspect we might 7 revisit this with some other folks. 8 MR. TARRY: Good likelihood. 9 BY MR. TARRY: 10 Q. Dr. Henderson first made these claims - 11 actually, I don't need to put it on the overhead. Don't 12 worry about it, Your Honor. 13 THE COURT: It's available to me. 14 MR. TARRY: Okay. 15 BY MR. TARRY: 16 Q. He first made these claims in March 2001 before 17 the Word Trade Organization in what was a trade dispute 18 involving the importation of chrysotile asbestos; is 19 that correct? 20 A. That is correct . 21 Q. And Dr. Henderson believes, like you do, I 22 believe, that chrysotile, even short fiber chrysotile 23 may be carcinogenic and we shouldn't assume that it's 00099 100 1 safe in the abstract; correct? 2 A. That is right. 3 Q. He was advocating that position in a political 4 forum; right? And these were numbers generated for the 5 first time ever in public to support his hypothesis; 6 right? 7 A. As far as I know, that is correct, as far as 8 published numbers. I had not seen that before. I had 9 talked to Doug Henderson before about chrysotile 10 asbestos and mesothelioma causation. And he said his 11 opinion, like I have for many years, that chrysotile 12 caused this mesothelioma in general. 13 Q. And the number 58 -- we need to make this clear 14 on the record. The number 58, Henderson was not saying 15 these are profession brake mechanics. He was saying 16 these are professional brake mechanics with no exposure 17 that I know of based on information plus some people who 18 worked in mills where they fabricated from raw asbestos 19 the actual product; right? 20 A. That is correct. 21 Q. And, in fact, the category -- the Leigh paper 22 illustrates that the category they were referring to was 23 called "brake linings, made, repaired; right? 00100 101 1 A. That's correct . 2 Q. Is that a category that you have ever heard of 3 under any of the standardized oc cupational codes? Do 4 you know what - 5 A. Yeah, I understand what you're saying. I don't 6 think I've ever seen that before 7 Q. It's not, is it? 8 A. No. 9 Q. There's no, either in Europe or the United 10 States, there is no standardized occupational code for 11 brake linings, made and repaired? 12 A. That's true. But it turns out that Dr. Leigh 13 did actually in a letter to the EPA indicate that group, 14 exactly how many were involved in the manufacturing 15 versus the repairs. So he did know that information. 16 Q. Dr. Leigh and Dr. Henderson were the ones 17 responsible for the creation of that category in the 18 mid-1990s in the Australian registry, weren't they? 19 A. I have no idea if they were. 20 Q. If we went and looked at the data prior and, in 21 fact, subsequent to the time of these reports, there is 22 no such category reported; they've gone back to the 23 occupational codes that they used prior to this; right? 00101 102 1 A. First of all, I don't know if Dr. Leigh and 2 Dr. Henderson did that or not. I have no way of knowing 3 that . 4 But with respect to doing that I don't think 5 it's all that -- it's not that surprising that they 6 would combine categories for individuals who were 7 exposed primarily to chrysotile asbestos in this type of 8 work. I mean, they were either brake mechanics that 9 they were exposed or they actually were producing the 10 product themselves. I mean, in a way I think you could 11 have exposure to chrysotile asbestos in either one of 12 those situations and that perhaps would not be 13 surprising. 14 Q. All right. Would it be concern you if the 15 timing of this creation of the special category happened 16 to coincide with the time that Dr. Henderson and 17 Dr. Leigh started doing litigation consulting in 18 Australia? 19 A. You know, that's not fair. Dr. Henderson is 20 probably one of the smartest and honest guys in the 21 world I know. And Dr. Leigh is the same way. I don't 22 know him as well as I do Dr. Henderson. 23 But, you know, that is -- if that was the case, 00102 103 1 I would be very, very disappointed. And I just don't 2 think -- I've never known Doug Henderson to do anything 3 that's dishonest. And I know him as well as anybody as 4 a pathology. 5 Q. No accusation of dishonesty - 6 A. That's what it sounded like, though. 7 Q. Perhaps opportunism in the advancement of a 8 political agenda, so just to be clear. 9 A. But that's not fair in science. If you're a 10 good scientist and you're going to start lying and start 11 doing things that really distort the truth, then you 12 better get out fast. Because that's exactly what that 13 is all about. I mean, if they're doing that -- and I 14 can't see how it would be any gain to them from a 15 financial point of view unless you say, well, they get 16 more cases that they're involved in legally. I just 17 can't believe those two guys would do that, especially 18 Dr. Henderson. 19 Q. Well - 20 A. I hate -- you know, it really bothers me when 21 somebody accuses or makes an accusation like that 22 because I don't know -- Dr. Henderson is just not that 23 type of person in my. 00103 104 1 Q. And I don't intend to make an accusation. And 2 I will withdraw the implication. 3 Let me ask you the question. Are you aware of 4 that category? 5 A. I was not aware of that category. I had always 6 seen it as that category in the articles that I had 7 read. 8 Q. Here's the question. The Court can draw 9 whatever inference it decides to. Subsequent to the 10 deposition Dr. Leigh gave -- and we're going to look at 11 some more of these clips -- where he was forced to 12 withdraw a number of these, are you aware of a change 13 being made in this category if they report in the 14 register? 15 A. No. What I heard about that was is that when 16 Dr. Leigh looked over some of the additional 17 occupational information that he was given, that he 18 would take those people out of one of those categories 19 because they had been exposed to asbestos in another 20 setting. That's the only thing that I had ever heard. 21 Q. The integrity of the day is important. And you 22 would not advocate the publication of inaccurate or 23 unreliable data, would you? 00104 105 1 A. No. In fact, Dr. Leigh in his article -- I 2 mean his letter to the EPA actually talked about some 3 possibilities based on some of the variations that could 4 exist. 5 Q. This is the book we talked about earlier that 6 your name is on the front of. You edited it. 7 A. It is . 8 Q. What did you undertake to insure the accuracy 9 and reliability of the statements and data presented in 10 this book? 11 A. Basically the references that were given. 12 Q. Page 241. And the chapter "Epidemiology of 13 Asbestos Tolerated Diseases," can you read this? 14 A. I can. 15 Q. " Henderson reports that 58 mesotheliomas were 16 reported among Australian brake mechanics, mechanics, 17 having no other exposures to asbestos? 18 Is that accurate in light of what we just 19 talked about, that number 58 had already been disowned 20 by Leigh and it was actually 43? 21 Let me ask it a different way. Did 22 Dr. Henderson ever represent that the 58 were brake 23 mechanics? 00105 106 1 A. Well, the way he said it, he said it exactly - 2 he says ... 3 Let me go back. 4 (Pause.) 5 THE WITNESS: He said this: He said, 6 Nonetheless, the 1999 report, the Australian 7 mesothelioma register, he references that, records 58 8 mesotheliomas among brake mechanics with no other 9 exposures to asbestos during the almost 13-year period 10 between '01 January 1986 and 31 October 1999. That's 11 what he said. 12 BY MR. TARRY: 13 Q. What we know now is that it's not 58 brake 14 mechanics, at most it was 43, and the rest were people 15 who worked in the fabrication plants; right? 16 A. Let me see if I can -- I don't know if that's 17 where the rest of them worked there or not. Let me see 18 if Dr. Leigh's letter to the EPA states that. 19 (Pause.) 20 THE WITNESS: Dr. Leigh says in his letter 21 addressed to the EPA, 1 October 2003, states in the 22 fifth paragraph states that: In the cases 1986-2001, 23 78 cases, and then in parentheses, out of three -- 3,956 00106 107 1 responding to the occupational history questionnaire or 2 providing a history gave a history of asbestos exposure 3 in brake lining repair or manufacture, 73 were brake 4 lining repair, five manufacture. In 43 of these brake 5 lining repair was the only source of asbestos exposure. 6 BY MR. TARRY: 7 Q. So by 2003 when Dr. Leigh is writing a letter 8 -- by the way, this is also a letter advocating a 9 political position; correct? He was writing to the EPA 10 encouraging them not to withdraw a document called the 11 Gold Book. That's the reason he wrote this letter; 12 right? 13 A. Yeah. But I think, again, though, I would have 14 an opinion that he had a different reason for writing 15 the letter. My reason would be that he disagrees with 16 the six reports and three META analyses that were 17 published in the United States. 18 Q. We don't need to disagree. I'm not reading 19 anything nefarious into this. He could be advocating 20 public health to the best of his ability. 21 The point is is that it was -- he wasn't 22 submitting this for peer review. He was submitting it 23 for political reasons? 00107 108 1 A. What reason would it be? Maybe he was sending 2 to it to try to tell the EPA that there actually had 3 been a mistake and that in Australia they actually did 4 have an excess number mesotheliomas due to these people 5 who worked with brake linings or brake repairs. Isn't 6 that just a logical of a reason that he did it? 7 Q. May be fair enough. Back to our original 8 question. We're down to 43 now. 9 A. Okay. 10 Q. All right. So the 58, which you report in your 11 textbook - 12 A. Well, that's what was taken out of the WTO. 13 Maybe Dr. Lemen, who wrote this chapter, had not seen 14 that letter. I hadn't seen that until just recently. 15 And that was published in the actual Australian register 16 itself. So there would be no reason to believe that 17 that be was not correct. 18 Q. The data was published without the discussion? 19 A. Yes. 20 Q. Now, Dr. Leigh in his article "Malignant 21 Mesothelioma in Australia" was published in the 22 International Journal of Occupational and Environmental 23 Health -- 00108 109 1 A. Okay. 2 Q. -- made some comments that you discussed -- or 3 he provided the data again. I think we saw that chart. 4 A. Yes. 5 Q. Is this a real peer review journal? Are you 6 familiar with that journal? 7 A. I'm not familiar with that journal. Let me 8 see. I don't know. I would assume that it's peer 9 review. 10 Q. It's an online publication, isn't it? 11 A. I don't know that. 12 Q. You don't know who the owner, who the two 13 owners of the journal are? 14 A. I don't, no. 15 Q. If this article wasn't subject to rigorous peer 16 review, it would impact your ability to rely on it or 17 your willingness to rely on it, wouldn't it? 18 A. I guess what really would effect my ability to 19 rely on it, I guess, is basically what the correct 20 information is. And I guess if this is not correct, 21 yeah, it could potentially have an effect. But I think 22 Dr. Leigh in that letter to the EPA made some statements 23 that... 00109 110 1 It states the following: "It should be noted 2 that this is a different analysis to the case reference 3 studies included in the META analysis of Wong." And 4 they have a reference in 2000. "The comparison in these 5 studies estimates odds ratio (relative risk 6 approximation) forever employed as auto mechanic 7 compared to never employed as auto mechanic and 8 effectively compares risk as auto mechanic to risk 9 average over all other occupations, which is not the 10 same as risk compared to background environmental 11 exposures." 12 Then he says: For comparison for such studies, 13 the cohort equivalent would be approximately 73. And 14 then it has the number 49,000 ten times 16 times 70, 15 average lifetime risk for Australia. Then he puts in 16 parentheses all occupations but equal to 0.6 percent, 17 slash, 0.22 percent equals 2. 96, which is still clearly 18 greater than unity. 19 And then he states: If restricted to auto 20 mechanic work where this was the only asbestos exposure 21 the corresponding figure would be -- I'll just give you 22 the number -- 1.7, which is greater than unity. 23 BY MR. TARRY: 00110 111 1 Q. And you would hope that those statements were 2 subjected to credible peer review? 3 A. Yes. Well, again, maybe I believe in basic 4 honesty more. I can't believe that people are going to 5 really write something that's not true. That's like, 6 you know, basically hanging your neck out -- or whatever 7 that cliche -- is to dry. If you're not going to be 8 honesty in what you publish, the consequences are 9 potentially disastrous. 10 Q. Can I get an agreement from you right now that 11 during this whole lining of questioning I'd be more 12 comfortable using the word "accurate" instead of 13 "honest"? I'm not impugning anyone's honesty. I'm 14 talking about the accuracy of data. Is that fair? 15 A. That's fair. 16 Q. Can we use that term instead of "honesty"? I'm 17 not accusing anybody of lying, and I don't want to be. 18 A. Yes. But you're saying that they did that for 19 political reasons. If that hasn't to do with honesty - 20 I mean, we know enough about politicians nowadays to 21 know why they do things one way or the other. So it's 22 not about facts sometimes, it's about what's going to 23 get them the most, I guess, whatever. 00111 112 1 THE COURT: Let me just say that I don't know 2 that an attorney or a witness should really be 3 commenting on the motives of any other person unless 4 those are clearly identified in some meaningful way. So 5 trying to go figure out why he said what he said when he 6 was testifying or why he wrote what he wrote when he was 7 submitting papers to the EPA, we'll leave that to the 8 folks who wrote it. 9 MR. TARRY: Thank you, Your Honor. 10 THE COURT: And also, I don't think anyone is 11 attempting to attack the honesty of folks. 12 MR. TARRY: Thank you. 13 BY MR. TARRY: 14 Q. The point is, Dr. Hammar, is that there's a 15 reason why we have something called peer review process; 16 correct? 17 A. Sure, there is. Absolutely. 18 Q. And it's important because even the best 19 researchers are human beings and they can make mistakes. 20 They can have data that's inaccurate or conclusions that 21 haven't been well thought out that the peer reviewers 22 can catch and there can be a correction; right? 23 A. Yeah. But just take, for example, okay, say 00112 113 1 that this wasn't a peer review, and they were going to 2 peer review it. Say they were just going to send it to 3 Jane Tata, and send it to your friend at the University 4 of Washington. 5 Now, you're going to tell me that they don't 6 have a bias? You're going to tell me that they have a 7 way that they can tell what Dr. Henderson and Dr. Leigh 8 is saying is honest -- drop that word -- is accurate or 9 not accurate? Basically, the only way they can do it is 10 -- from a peer review is to determine whether the 11 statistics are correct or not. If they think that the 12 statistics are correct or I guess they would request, 13 say, that they don't believe what Dr. Henderson or 14 Dr. Leigh said was accurate, and they want a list of all 15 of the cases, and they want a list of when the person 16 was first exposed, when he or she was last exposed, the 17 time that they first developed symptoms of mesothelioma 18 or the time they were diagnosed, I think that would be 19 probably a reasonable request. 20 And maybe then in contrast -- or not in 21 contrast. That's not the best word. Somebody should 22 have also asked for the same data for those six articles 23 that were written by Tata, etc. And they want the exact 00113 114 1 same list. They get the same list. They want to know 2 exactly the dates of the information; how many people 3 have mesothelioma, were there any excluded because of a 4 different time period or they didn't look at the 5 records. Everybody gets to look at the same thing. And 6 then I would say that, once you had that, then maybe 7 they could figure it out. Because it can go both ways. 8 Q. Is it important to you in testimony you give 9 today that this article was subjected to credible, 10 meaningful peer review by somebody who was qualified? 11 A. I would say that that is always important. 12 Peer review is very important. 13 MR. TARRY: Your Honor, can we toggle back to 14 the computer? 15 I'd like you to see what Dr. Leigh says about 16 this journal and this issue. 17 THE WITNESS: Okay. 18 (Whereupon the following video clip was 19 played.) 20 "QUESTION: All right. And I'm going to ask 21 you now about the estimates of lifetime risk that you 22 made for vehicle mechanics in your article with 23 Driscoll, Exhibit No. 14, "Malignant Mesothelioma in 00114 115 1 Australia". 2 Now, this appeared in the International Journal 3 of Occupational Environmental Health; is that correct? 4 "ANSWER: Yeah. 5 "QUESTION: Okay. Is that a peer review 6 publication? 7 "ANSWER: Yes. 8 " QUESTION: Who reviewed your paper, do you 9 know? 10 "ANSWER: No. 11 "QUESTION: Do you know who the referees were? 12 "ANSWER: No. 13 "QUESTION: Does the -- does the journal have 14 any particular reputation: 15 "ANSWER: No. I think -- I think -- I think 16 it's a -- it's an international journal. And there is a 17 certain, you know, it does tend to sort of publish 18 provocative papers at times. 19 "QUESTION: Okay. 20 "ANSWER: It's not afraid to publish 21 provocative papers. 22 "QUESTION: It appeared in Volume 9, No. 3, the 23 July/September 2003 edition. 00115 116 1 "ANSWER: Yes. 2 " QUESTION: And it's a special issue of this 3 journal; right? 4 "ANSWER: Yes. 5 "QUESTION: And the issue is titled "The 6 Asbestos War." 7 "ANSWER: Yes. 8 "QUESTION: The guest editor is Laurie 9 Kazan-Allen. 10 "ANSWER: Yes. 11 "QUESTION: Do you know a Laurie Kazan-Allen? 12 "ANSWER: Yes. 13 "QUESTION: Who is she? 14 "ANSWER: She's a -- a journalist and runs the 15 British asbestos newsletter. And she's a bit of an 16 international activist. 17 "QUESTION: But she's not a scientist; right? 18 "ANSWER: I don't -- I don't think she's got a 19 science degree. 20 "QUESTION: What is our exhibit? What are we 21 at? No. 18? Can we mark that, please. 22 (Pause.) 23 "QUESTION: I've got a copy of the journal in 00116 117 1 which your article appeared. It's now marked Exhibit 2 No. 18, International Journal of Occupational 3 Environmental Health, Volume 9, No. 3, 4 July/September 2003. 5 As I open the journal up to the table of 6 contents, the listing of the articles in the table of 7 contents are -- "The Asbestos War" is the first one by 8 Laurie Kazan-Allen. The next one is "Scientific 9 Controversy and Asbestos." The next one is by you, 10 "Malignant Mesothelioma in Australia," by you 11 Dr. Driscoll. The next one is "Cape Place South African 12 Mine Works, Quest For Justice." The next one is 13 "Asbestos Mining in Southern Africa." The next one is 14 "Asbestos, Sorrowful Legacy: A Photo Essay." The next 15 one is a cross-country comparative overview of the 16 asbestos situation in ten Asian countries. And it goes 17 on . 18 Doctor, do you agree that the purpose of this 19 special interest publication, in which your article 20 appears, is to give the public forum for asbestos 21 victims and -- and victim support groups? 22 "ANSWER: It's partly that. I think it's 23 obviously a -- an issue that's drawing -- drawing 00117 118 1 attention to the global asbestos problem. 2 "QUESTION: Indeed, that's what the editor of 3 the article says that its purpose is; right? 4 "ANSWER: Yeah, not just -- not just in the aid 5 of victim groups. It's also, you know, directed at 6 governments, industry, etc. 7 "QUESTION: And you'd agree with me that 8 there's not a single case control study or cohort study 9 in this publication; right? 10 "ANSWER: In this issue? 11 "QUESTION: In that issue. 12 "ANSWER: Yes. It's not primarily an issue 13 published on epidemiologic papers. It's more, you know, 14 national overview sort of papers, asbestos problems in 15 various countries. 16 "QUESTION: Okay. With respect to the 17 calculation of risk that -- the lifetime risk that you 18 calculated in this article that appears at Table 5, for 19 vehicle mechanic, you've stated previously that you 20 used -- you actually used 78 cases for that? 21 "ANSWER: Yes. 22 "QUESTION: Is that right? 23 "ANSWER: I did -- I did the vehicle mechanic 00118 119 1 plus, plus or minus for exposures for that particular 2 one. 3 "QUESTION: Okay. So that really shouldn't be 4 stated as a risk, a lifetime risk for vehicle mechanics. 5 Would you agree? 6 "ANSWER: Not really. It's -- it's vehicle 7 mechanics -- not solely vehicle mechanics, ever being a 8 vehicle mechanic. It's a lifetime risk for vehicles - 9 it's different to the ones in the EPA. That's why I 10 didn't report that in the EPA letter. So that's 11 different. All the lifetime risks there are based on 12 the -- they're sort of giving the high end, if you 13 like." 14 BY MR. TARRY: 15 Q. In this journal there was not a single case 16 control cohort study including Dr. Leigh's. That's what 17 he's admitted to; correct? 18 A. Yes. 19 Q. In other words, there's no analytical 20 epidemiology, the sort of the information that would 21 have been at the stage above case reports? 22 A. Well, in that journal. But what about the one 23 before it? What about the one after it? Just because 00119 120 1 there's isn't any analytic epidemiologic studies in 2 there, doesn't mean that's it's not accurate and not 3 correct and doesn't reflect the people -- reflect the 4 opinion of the people who wrote those articles. 5 It's nothing different that happens all the 6 time in the United States every day. In fact, about, 7 what, five years ago the USA Today had a three-day 8 period where on the front page was the problem about 9 mesothelioma in Eastern European countries where people 10 are dying from mesothelioma in their thirties. 11 And, you know, something is happening in this 12 world where people are concerned about that. And just 13 because we are -- people are concerned about that 14 doesn't mean that when they publish those articles that 15 it's not necessarily accurate. But I do agree with what 16 you said. 17 Q. And everybody ought to be concerned and try to 18 reduce the amount of disease; correct? 19 A. Absolutely. 20 Q. Part of that is accurately identifying the 21 actual risk factors for a disease so we don't waste 22 resources where there are false risk factors; correct? 23 A. I would agree with that. 00120 121 1 Q. All right. And it's important when you are 2 conducting scientific research on a topic like this to 3 be as careful as possible; correct? 4 A. I agree. 5 Q. And to be as thorough as possible so that you 6 can assure accuracy of the data you report and the 7 conclusions to be drawn from those; correct? 8 A. I agree. 9 Q. And for you to assume -- well, for you to give 10 the testimony you have today, you have to assume, don't 11 you, that Dr. Leigh and Dr. Henderson were careful and 12 thorough in both selecting the data and drawing 13 conclusions from the data? 14 A. Well, that is correct. I mean, I have the 15 highest regard for both individuals. Dr. Leigh was the 16 head of EPA in Australia. Dr. Henderson is probably one 17 of the world's best known individuals on 18 asbestos-related lung disease. 19 Q. If I wasn't clear before, let me state it 20 again. I am not suggesting anything about their 21 reputations or about other work they've done. The 22 inquiry before the Court today is how careful and 23 thorough they were on this data. 00121 122 1 A. Right. 2 Q. Is that all right? 3 A. That's fine . 4 Q. Okay. Let' s look a little bit of Dr. Leigh's 5 testimony about how careful they might have been in 6 reporting these cases. 7 (Whereupon the following video clip was 8 played.) 9 "QUESTION: And I understand that you may not 10 be able to say with confidence whether the case reported 11 in the notebook No. 11 is the same as the person 12 identified as 89090 on your Exhibit 6? 13 "ANSWER: No, I can't say that. 14 "QUESTION: Okay. Is that fair? 15 But just using the information on Exhibit 6, 16 there is certainly no information suggesting that this 17 person was an auto mechanic -- a vehicle mechanic; is 18 that right? 19 "ANSWER: I counted him though. 20 "QUESTION: You did count him? 21 "ANSWER: I did count him. 22 "QUESTION: Do you agree that there's not any 23 information that would allow -- 00122 123 1 "ANSWER: I agree that that could be -- that 2 could be validly, you know, not counted. 3 "QUESTION: Okay. 4 "ANSWER: I mean, he could have been a vehicle 5 mechanic. He could have been a home amateur, you know, 6 as you say. But I made the decision to count that case 7 for the -- " 8 BY MR. TARRY: 9 Q. Do you still believe that Dr. Leigh and Dr. 10 Henderson were careful in reporting data from this 11 register? 12 A. Depends how you evaluate that. I said he could 13 have been. Okay. What if he worked as a shade tree 14 mechanic for 30 years and did, say, a thousand brake 15 jobs? How do you know that that's not correct? 16 What you're implying is that what he said was 17 that the guy never did that. That's not what Dr. Leigh 18 said. 19 (Whereupon the following video clip was 20 played.) 21 "ANSWER: He worked with flaking asbestos roof 22 and worked with brake line. 23 "QUESTION: Would you agree that this person 00123 124 1 should have been classified as having other exposure? 2 "ANSWER: Possibly could have been. 3 "QUESTION: When you say possibly could have 4 been, this guy worked with -- this guy worked with - 5 under flaking asbestos roof, which I think is one of the 6 actual circumstances you actually described earlier 7 talking about when insulation is breaking apart; right? 8 "ANSWER: Yes. 9 "QUESTION: That would definitely be 10 categorized under one of these other circumstances of 11 exposure; right? 12 "ANSWER: Okay. 13 "QUESTION: You agree? 14 "ANSWER: Yep. 15 "QUESTION: Okay." 16 BY MR. TARRY: 17 Q. Based on that example, do you believe that 18 Dr. Leigh and Dr. Henderson were careful and accurate in 19 reporting their claims of increased incidence from 20 mesothelioma among brake workers with no other exposure 21 in Australia? 22 A. We've seen three cases now where you've given 23 some information that they may have had other exposure. 00124 125 1 I would say that they didn't seem to be particularly 2 careful in those. But maybe they thought that the brake 3 was still the dominant exposure. But I would agree with 4 you that they should have put in any information that 5 they had of any other exposure. 6 Q. In the interest of time, I've got a lot of 7 these. I think based on that last statement, we can 8 agree that the number that is reported in your textbook 9 is inaccurate. Is that fair? 10 A. I would say it's inaccurate with respect to 11 what you've given the information today, yes. 12 Q. Who is the target audience of your technical 13 book? 14 A. Pardon me? 15 Q. Who is the target audience of your technical 16 book? 17 A. I don't even think text books have target 18 audiences. I would say this is for anybody who wants to 19 know information about asbestos-related lung disease. 20 Q. It includes the chapter on clinicians in the 21 courtroom; correct? 22 A. It does, yes. 23 Q. And what's the purpose of that chapter? 00125 126 1 A. I guess to make somebody related be aware of 2 what usually happens in the courtroom. 3 MR. TARRY: Dr. Hammar, thank you for your 4 time . 5 THE WITNESS: You're welcome. Thank you. 6 MR. JOHNSON: I think I'm after you. I think 7 we've got that correct. 8 Am I right about that, Your Honor? 9 THE COURT: No. The clear going forward, I 10 think the order for plaintiffs' witness should be 11 plaintiffs' counsel, Mr. Johnson, and then 12 cross-examination. So right now we've got 13 cross-examination. I think you would be next, 14 Mr. Johnson, if you have questions. 15 MR. JOHNSON: I may have. Let me make sure I 16 have it straight. I'm sorry to belabor this, Your 17 Honor. 18 THE COURT: We're out of order for this 19 witness , so we're going to jump back in. I think we 20 were in order yesterday but perhaps we - 21 MR. JOHNSON: Let me see if I understand You 22 wanted the direct followed by the cross? 23 THE COURT: No. Because you're -- 00126 127 1 MR. JOHNSON: Then I would be part of the 2 direct, in essence, but I would follow plaintiffs on 3 direct. 4 THE COURT: I think that's how we discussed it 5 during our conference. 6 Mr. Crumplar, is that accurate? 7 MR. CRUMPLAR: Yes. I think last time he 8 waived his direct. 9 MR. JOHNSON: That's my understanding, that 10 they did direct. I had no further direct. We then went 11 to cross. And then my understanding would be that we're 12 back to redirect followed by me followed by cross. 13 THE COURT: All right. Fine. 14 MR. CRUMPLAR: That was the confusion. I don't 15 think he had any direct at this time, and he didn't last 16 time also. 17 THE COURT: I follow. 18 MR. JOHNSON: That's what I'm trying to alert 19 the Court to. I may have some additional direct, but 20 it's probably going to be nominal. 21 THE COURT: Redirect. Fine. 22 MR. WADDELL: I want to I apologize to the 23 Court, Your Honor, for not standing up. 00127 128 1 THE COURT: That's all right. 2 BY MR. WADDELL: 3 Q. What's the No. 1 risk factor for a person to 4 develop an asbestos disease? 5 A. Asbestos. 6 Q. Breathing it? 7 A. Yeah. Exposure. 8 Q. All right. And as a trained physician in 9 diagnosing asbestos disease and the cause or causes of 10 asbestos disease, you consider individual circumstances; 11 right? 12 A. Sure. 13 Q. Because would it be fair if you saw a case 14 where this is the information , Dr. Hammar, an individual 15 develops mesothelioma, he is an insulator, is that 16 mesothelioma caused by asbest os? 17 A. Well, you certainly would think that's a good 18 possibility, yes. 19 Q. Because the job clas sification tells you some 20 information, doesn't it? 21 A. It does. 22 Q. But it also doesn't tell you the individualized 23 circumstances of that person; right? 00128 129 1 A. That's correct. 2 Q. Because if I further told you that individual 3 was an insulator who only worked with cold insulation, 4 that gives you some more information; right? 5 A. It does. 6 Q. And if the -- if he only worked with cork 7 insulation and nonasbestos-containing information now 8 that you had that, that classification doesn't apply to 9 that individual, does it? 10 A. It does not. It would distort it. 11 Q. And, in fact, cases get reported in peer review 12 literature where there is no epidemiology associated - 13 to support something; right? 14 A. Right. 15 Q. Because I want to talk about a case that's 16 surprising came from Delaware that you reported. And 17 it's on 106 of your CV. I'll just read it into the 18 record to speed it along. 19 Rom, R-O-M, was the author and you. And the 20 name of this peer review publication was "Malignant 21 Mesothelioma From Neighborhood Exposure to Anthophyllite 22 Asbestos." 23 Now, do you recall that? 00129 130 1 A. Sure. 2 Q. Okay. And just a little bit of a background on 3 that case. Could you tell His Honor about the 4 circumstances of how you got involved -- how it made it 5 into this peer review publication and additionally into 6 the medical and scientific literature? 7 A. It made it in was a case Mr. Crumplar sent to 8 me and where the individual had mesothelioma. And we 9 did some investigation. And I can't remember all the 10 details about it. But it turned out that this patient 11 lived fairly close to a plant that made these very large 12 plastic containers. 13 And as part of the plastic containers and 14 making these, they added anthophyllite asbestos into 15 these the containers. And then to additional 16 information it was found that this plant, in producing 17 these large plastic containers actually released 18 asbestos fibers of an anthophyllite into the area. And 19 this individual had what is referred to as neighborhood 20 exposure, which was described by a new house many, many 21 years ago as a type of way individuals can be exposed to 22 asbestos. 23 So we obtained lung tissue on this be 00130 131 1 individual I think after he died. And that was sent to 2 Dr. Dodson, who did asbestos fiber analysis, who found 3 elevated numbers of anthophyllite asbestos fibers in 4 that individual's lung tissue. 5 Q. Now, when you submitted this for peer review 6 and eventually publication, did they, when you submitted 7 the article, they said, wait a minute; we don't have 8 "epi" studies on women in Delaware living near a 9 plastics plant; you can't put this in the literature? 10 A. Well, they must not have thought that. Because 11 when a lot of other articles published by -- about 12 asbestos that were published has not been peer reviewed 13 literature. And I think the reason that they published 14 it was not because it wasn't peer review literature was 15 because that there was other examples of neighborhood 16 exposure that resulted in the development of 17 asbestos-related disease like mesothelioma. And that 18 was an acceptable way that an individual could be 19 exposed. 20 Q. Generally accepted in at least the publications 21 that made it out? 22 A. Right. It wasn't in re any different than what 23 Cartier and McCaughey did with chrysotile asbestos in 00131 132 1 Quebec. They reported those cases. It wasn't any 2 different than what Wagner, Sluggs, and Marshan did in 3 South Africa 1960 in the British Journal of Industrial 4 Medicine. That wasn't a epidemiologic-type study. 5 There have been all kinds of case report 6 studies in the United States and throughout the world 7 that have drawn attention to disease and exposure. 8 Certainly, angiosarcoma in the liver and vinyl chloride 9 was based on five cases of exposure. 10 Like I said, therapeutic radiation, which I 11 think the majority of people who study mesothelioma 12 believe can cause mesothelioma. There's no 13 epidemiologic literature that suggests that that is the 14 cause of mesothelioma. There are some things that you 15 observe and you -- based on basic scientific premises 16 that asbestos is a carcinogen, that asbestos is known to 17 cause mesothelioma. And you find a case of it in an 18 unusual setting or something that's unique is often 19 important to be published because then people can look 20 for more of those cases. And they can potentially try 21 to do something about that exposure. 22 Q. Well -- and the reason why I ask those 23 questions, as a trained physician in diagnosing asbestos 00132 133 1 disease in humans and the cause of that, is it a 2 scientifically sound and reasonable approach -- to have 3 a blanket approach to go, uh-uh, it doesn't occur in 4 individuals because we looked at groups that don't have 5 risk, for instance, anthophyllite exposure in Delaware 6 women? Would that be a fair and reasonable approach 7 scientifically? 8 A. No, it wouldn't be reasonable. 9 Q. 'Cause when you're looking at individuals, you 10 have to look at the individual circumstances; right? 11 A. That is correct. 12 Q. And in what may or may not have been a cause; 13 correct? 14 A. That is correct. 15 Q. A blanket approach by product elimination or by 16 job classification would be unreasonable and 17 unscientific; right? 18 A. Well, if you did it in a blanket approach, yes. 19 Q. When you're looking at individuals? 20 A. Right. 21 Q. And that's why they're wrong? 22 A. Well, that's why I think they are wrong with 23 respect to stating that chrysotile doesn't cause 00133 134 1 mesothelioma in a setting where people are exposed from 2 brake products. Because we know that chrysotile in 3 generally does cause mesothelioma. It causes it in most 4 settings. It could can cause it in different types of 5 situations. There wouldn't had been any reason to 6 exclude the possibility that chrysotile could not cause 7 mesothelioma in an individual who was exposed in 8 basically any way, whether brakes, whether it was a 9 clock, whether it's whatever. 10 Q. Would it be fair to say that an individual who 11 has developed an asbestos-related disease has 12 100 percent risk of getting asbestos disease? 13 A. No . 14 Q. He's got it already; right? 15 A. He's got it already, yes . 16 Q. You have to go back and look 17 circumstances of how; right? 18 A. That's correct. 19 Q. And there's been some figures thrown out. Is 20 58 individuals in looking at a job classification or a 21 product use significant in your opinion, Dr. Hammar? 22 A. Well, it's extremely significant when you look 23 at what the background issue is. That's something we 00134 135 1 didn't talk a whole lot about. 2 But the background incidence of mesothelioma, 3 according to this data that was first published by 4 Selikoff in his group in the Annals of the New York 5 Academy of Science in 1964 -- I think that was the 6 year -- '65 -- excuse me -- the background incidence 7 that they gave for mesothelioma was zero. And they 8 basically couldn't calculate a relative risk, because 9 with a zero denominator, you can't do it. It's 10 basically infinity. 11 And if you look at the most recent publication 12 that I know on about low level exposure and exposure 13 from nonoccupational exposure, that's by Gunner 14 Hillerdaul published in 1999 in a peer review journal - 15 I have that article with me -- published in Occupational 16 Environmental Medicine in 1999, Volume 56, pages 505 and 17 513, basically states in there that he thinks the 18 background level for mesothelioma is way below the one 19 case per million people per year. And that's why 20 basically any case of mesothelioma is highly 21 significant. 22 Q. And whether that number is 48 -- how about 43? 23 A. Again, if that was the accurate data, that 00135 136 1 would be very significant. 2 Q. How about 40? 3 A. Also, very significant. 4 Q. And using those figures going back into what 5 was the articles we discussed is still statistically 6 significant? 7 A. Yes. 8 Q. Okay. Talking about, I guess, background or 9 unknown idiopathic spontaneous cases of mesothelioma, 10 that lady from Delaware who unfortunately got 11 mesothelioma, did you at first think or did you know 12 what the exposures were and all of that - 13 A. I didn't know initially what the exposures 14 were. I think start looking -- any time a person has 15 mesothelioma such as a signal tumor, you start looking 16 for potential ways that individuals develop mesothelioma 17 and where they were exposed to asbestos. That's the 18 first thing you would look for. 19 The second thing I would look for usually would 20 be if there was any history of therapeutic radiation. 21 Q. Okay. And possible exposure, latency, dose, 22 those other things? 23 A. Sure. You always look for that. That's 00136 137 1 important. Latency. And tha t's talked about in the 2 Helsinki consensus report. 3 Q. I guess to put it si mply, this unfortunate lady 4 could have been a spontaneous meso but upon further 5 review she had asbestos expos ure; right? 6 A. Yes, elevated concen trations of anthophyllite 7 in the lungs. 8 Q. Let's simplify this. As a doctor, okay, simple 9 doctor's opinion, if a person came into a clinician's 10 office, got a broken arm, hit by a white Ford Taurus, 11 should a doctor under those c ircumstances in accessing 12 causation in an individual ba sis go, uh-uh? What kind 13 of car did you get hit by? A white Ford Taurus. We 14 don't have the data on a whit e Ford Taurus causing 15 injuries that way, should cau sation be excluded? 16 A. Of course not. 17 Q. Hypothesis. Wasn't it once a hypothesis that 18 asbestos could cause disease in humans? 19 A. Sure. 20 Q. Has that hypothesis been played out over and 21 over and proven correct? 22 A. Yes. 23 Q. Has it been played o ut and proven correctly in 00137 138 1 individuals that others have seen and that you have seen 2 (indicating), that the world has seen when it comes to 3 asbestos-containing friction products? 4 A. I believe it has, yes. 5 MR. WADDELL: Thank you, Your Honor. 6 MR. JOHNSON: I have a few minutes worth of 7 questions, Your Honor. Thank you. 8 THE COURT: All right. 9 BY MR. JOHNSON: 10 Q. Good afternoon, Dr. Hammar. 11 A. Good afternoon. 12 Q. So the Court knows, we're both from Seattle. 13 We've known each other for a long, long time. 14 A. We have, yes. 15 Q. We generally see each other -- like 16 99.999 percent of the time, you're testifying for the 17 other side? 18 A. That is correct. 19 Q. We're good friends? 20 A. We're good friends. 21 Q. Okay. I'd like to follow up a little bit very 22 briefly on the background incidence. Can you tell the 23 Court what the largest cohort ever studied of asbestos 00138 139 1 exposed people is? 2 A. The asbestos insulators, members of the heat 3 and frost insulators union. 4 Q. And how many people have been in that cohort? 5 A. 17,800. 6 Q. What's the expected incidence of mesothelioma 7 going against the general public in a cohort of 17,800 8 people? 9 A. Basically, the experience there is that they 10 have 10 percent of the people have died from 11 mesothelioma. The expected rate of death in 12 mesothelioma in generally is basically zero. 13 Q. So if it was -- the expected rate would be zero 14 in a cohort of 17,800 people? 15 A. That is correct. 16 Q. What would the expected rate be in 178,000 17 people? 18 A. Zero. 19 Q. Okay. What would the expected rate be in 20 500,000 people? 21 A. Zero. 22 Q. Does this, in your opinion, in terms of your 23 review of epidemiology, this fact that we're dealing 00139 140 1 with a disease that is so rare that the background rate 2 approaches zero, does that have an impact on the use of 3 epidemiology in the evaluation of that disease? 4 A. Sure, it does. 5 Q. Okay. And not to belabor the obvious, but 6 could you explain briefly why that is. 7 A. Because if you think that mesothelioma has a 8 certain rate of existence as a spontaneous tumor in the 9 background population, that's going to really change 10 your data with respect to if there was an increased 11 number of cases versus a lack of increased number of 12 cases in a population of people that are being studied, 13 especially in case -- control type studies where there 14 are a small number of people. 15 I'm not an epidemiologist, but that's going to 16 markedly skew that data. Because if you say you have a 17 number of three cases per million people as a 18 background, and that's how many cases you find in a 19 certain number of people that you calculate that, then 20 there's going to be no increase in incidence. To me 21 that doesn't mean, based on what I think is correct, 22 that those people with mesothelioma was not caused by 23 asbestos. 00140 141 1 Q. In terms of scientific information available to 2 you in formulating the opinions that you express here 3 and that you express when you testify, is the data 4 regarding the effect of asbestos and its impact when 5 exposed to tissue in the laboratory in experimental 6 animals and in human tissue relevant to you? 7 A. Well, it's relevant to me in that I think that 8 there has to be certain types of mechanisms that 9 asbestos uses to cause disease or cause injury. And in 10 that respect it's relevant. It's relevant I think also 11 in animals in that, if you can produce the disease in 12 mammals, which are what humans are, then there's 13 evidence again that that would be important as a 14 potential cause of a disease in humans. 15 But it's not totally the same. And you've got 16 to understand that there's certain limitations between 17 what you can extrapolate from animal studies and in 18 vitro scientific studies. And you've got to be very 19 careful about that. Like the lifespan of a rat, for 20 example, I think is about, what, one and a half to two 21 years. And lifespan of a human is, say, 75 to 80 years. 22 You can't necessarily totally relate one to the other, 23 but you can relate some of the mechanisms of that. 00141 142 1 The same way in vitro studies. Just because, 2 for example, you can produce mesothelioma cancer cell 3 lines that have doubling times as short as about 4 15 days, that doesn't mean that doubling time of an 5 epithelial mesothelioma in a human being is going to be 6 15 days. Because if was, it would kill the person 7 probably in about three or four months. 8 Q. Without going through chapter and verse of 9 everything, outside of epidemiology in formulating your 10 opinions that you've expressed here today, are you 11 looking at things like the scientific data and 12 information on asbestos effects on tissue, on 13 translocation of asbestos fibers to get them out to the 14 site where cancers are caused, on the propensity of 15 chrysotile asbestos to cause genetic changes on the 16 ability of friction products to release fibers that are 17 respirable? Are you looking at all that kind of 18 scientific data? 19 A. Absolutely. In fact, in Dr. Roggli's paper 20 where he talked -- and I reviewed that paper. And 21 Dr. Roggli's one of my best friends. I'd never say 22 anything bad about him. But one thing when I reviewed 23 that paper that was published in Ultrastructured 00142 143 1 Pathology, I think it was 2003, I said that it would be 2 very interesting to know what the concentrations of 3 asbestos were at the target sites, say, the pleura 4 versus the lung tissue if you're going to make a 5 conclusion that asbestos did not contribute to a 6 mesothelioma in a person who had multiple exposures. 7 And that's just basically simple knowledge. Or 8 I think it's simple knowledge, in that if you believe 9 you have to have the carcinogen at the site of exposure, 10 wouldn't in a way you would want to look at where the 11 exposure was and what the concentration was there versus 12 what the concentration was in the lung and say that 13 based on the concentration in the lung, I'm going to say 14 that this mesothelioma is cause by amphiboles; and it 15 doesn't matter that he was exposed to chrysotile because 16 I can't find any chrysotile in the lung. And even 17 though the Helsinki consensus report states that it's a 18 lousy way to determine chrysotile exposure by looking at 19 concentrations of chrysotile in the lung because it's 20 clear. 21 So, you know, there's some things that happen 22 or people make conclusions that I think other people can 23 make conclusions that are not necessarily the same and 00143 144 1 potentially maybe both can be right. 2 Maybe what Dr. Roggli should have said, and 3 that's what I think he maybe should have said, and maybe 4 in some respects he is saying that. And that is that if 5 you find amphiboles in the lung at a higher 6 concentration than you'd expect, then it's likely that 7 they contributed to a person's mesothelioma. But that 8 doesn't necessarily take away that the chrysotile didn't 9 also contribute to the person's mesothelioma just 10 because you can't find it in the lung. 11 Q. I'm not sure whether you're aware of this, but 12 I don't think it's being contested in this particular 13 hearing that chrysotile is an agent that causes 14 mesothelioma and asbestos disease in human beings. 15 Let me clarify one other thing. And that is, 16 prior to the publication of the Henderson and Leigh data 17 from Australia, if you had been given a case such as a 18 case report that you described and without the benefit 19 of epidemiological proof, you had in that case a history 20 of chrysotile exposure due solely to brake or friction 21 product work and you had tissue findings showing a high 22 concentration of chrysotile fibers in the body, in a 23 case of a mesothelioma under those circumstances, what 00144 145 1 would your conclusion have been as to the cause of that 2 mesothelioma? 3 A. My conclusion would have been that that 4 person's mesothelioma was caused by chrysotile asbestos. 5 Q. Notwithstanding the absence of epidemiological 6 proof as to the generic question? 7 A. That is correct. 8 Q. Finally, and I think this was touched on, but 9 just to make sure it's clear, the Wagner study in 1960, 10 was that an epidemiological study? 11 A. No. 12 Q. To the best of your knowle dge, how many cases 13 of mesothelioma did he report? 14 A. There were 33 cases on the northwestern cape 15 province of South Africa of which h e thought 32 were 16 directly related to crocidolite asb estos exposure. 17 Q. To the best of your knowle dge, was there any 18 doubt in the mind of any medical au thority anywhere that 19 that study established that asbesto s had caused those 20 33 cases of mesothelioma? 21 A. No. 22 Q. Are there any epidemiological studies to your 23 knowledge that show whether calcium silicate pipe 00145 146 1 covering taken alone, i.e., a person exposed only to 2 calcium silicate pipe covering in the field causes 3 mesothelioma? Has that ever been studied 4 epidemiologically to your knowledge? 5 A. No. 6 Q. Okay. Does the absence of an epidemiological 7 study on calcium silicate pipe covering cause you to 8 doubt whether that product is capable of causing 9 mesothelioma? 10 A. No. 11 MR. JOHNSON: I have no further questions. 12 Thank you. 13 MR. TARRY: Your Honor, I think I just have a 14 couple questions, if in the interest of time the witness 15 will concede the more technical questions on 16 epidemiology to the two witnesses who are going to 17 testify later about that? 18 THE WITNESS: I will. 19 BY MR. TARRY: 20 Q. Okay. Then I just have a couple of questions I 21 think. 22 In the case of a broken leg caused by a car, do 23 we understand the mechanism by which pressure applies 00146 147 1 and creates in a break? 2 A. I suppose we do . 3 Q. We don't, don't we? 4 A. Yes . 5 Q. We understand how pressure can create breaks 6 bones? 7 A. I suppose, yes . 8 MR. TARRY: That's it. Thank you. 9 THE COURT: Doctor, I just have a couple 10 question s. There was some testimony that you offered 11 earlier about the fact that it's really impossible to 12 identify an asbestos disease being caused by a single 13 fiber or even group of fibers as you do some fiber 14 studies later and identify asbestos fibers in the lung 15 or in other areas. So it's really a cumulative exposure 16 that causes you to reach the diagnosis for the causation 17 opinion. 18 THE WITNESS: Right. I mean, it's all the 19 exposures that a person would have had to asbestos that 20 would have caused that. 21 The issue, though, that does come up sometimes 22 would be -- and that's what's talked about in that 1982 23 versus that 1992 thing -- the issue we don't know really 00147 148 1 too much about is exactly when the first cancer cell 2 develops, and that anything after that -- say, a person 3 was diagnosed with mesothelioma in 2000, and say they 4 were exposed to asbestos, say, up to 1995, say, if it 5 was an epithelial mesothelioma, I think the evidence 6 would suggest, based on what we do know, which is not 7 very much, that probably the exposures only before say 8 1990 would have been causative of the mesothelioma, 9 unless you accept the idea that asbestos is a tumor 10 promoter. I don't know if that answers your question or 11 not . 12 THE COURT: Actually, I was just making sure I 13 was clear on your testimony before I asked my question. 14 And my question is, and just to be clear, so it 15 is this sort of cumulative exposure that allows you to 16 make a diagnosis; it's not so much that you can say 17 exposure at this moment in time or even this period in 18 time in the big picture or in the continuum of exposure 19 is what actually has caused the disease process. 20 THE WITNESS: No. I would say this. If you 21 look at the mechanism of carcinogenesis, which is very 22 complicated, is that what is thought to happen is 23 basically you get mutations in protooncogenes, which 00148 149 1 control cell growth; mutations in tumor suppressor genes 2 that control cell death; changes in the cell cycle 3 system which basically organizes the cell -- what time 4 to make the DNA, what time to divide, changes in the 5 receptor mechanism of the cell which determine how fast 6 a cell can grow, all of these changes that occur over a 7 period of time by the cumulative exposures that cause 8 the cancer. 9 And you can't really separate these out at this 10 point in time. We know quite a bit about what those are 11 from a biochemical point of view. But we don't know 12 much about the timing effect of it exactly; how fast it 13 happens, say, for a mutation in a tumor suppresser gene 14 to occur or how long it takes for, say, a change in the 15 cell cycle to happen. But we do think that it's entire 16 exposure that contributed to this. 17 THE COURT: Can you identify other areas in 18 science or medicine where that is a dilemma that 19 clinicians like yourself or that scientists face, 20 meaning you can't pinpoint a single individual causative 21 agent because of the nature of the disease process or 22 the nature of the carcinogen involved or whatever the 23 dynamic might be that precludes one from doing that; but 00149 150 1 nevertheless that is what is done in order to make a 2 diagnosis or to link an agent to a disease? 3 THE WITNESS: I think the answer to that 4 question is yes. 5 I think the best example would be cigarette 6 smoking and lung cancer. Say, for example, like in 7 Bremerton where I work, we have an epidemic of lung 8 cancer there because kids start smoking at ten, 12 years 9 old. And they say they got lung cancer at age 50, which 10 is not uncommon. And they you went back and tried to 11 say, well, what cigarettes was it that they smoked that 12 caused the lung cancer. What you would have to say - 13 and there we have more information on doubling times - 14 that probably all of the exposure they had from the 15 carcinogens in cigarette smoke from the time that they 16 first started up until about ten years prior to the 17 diagnosis except for one type of lung cancer called 18 small cell lung cancer that grows faster was responsible 19 for causing that cancer. You couldn't separate out - 20 THE COURT: Can I stop you for just a second, 21 though, just to make sure that I've expressed all of the 22 variables involved here. 23 Is cigarette smoking not different from 00150 151 1 asbestos exposure in the sense that cigarette smoking is 2 a tobacco product with probably not a whole lot of 3 variation in terms of one product to the next that one 4 might be inhaling; whereas with asbestos, as I gather, 5 you've got multiple types of asbestos to which one might 6 be exposed in a lifetime; and, therefore, does that not 7 make a cumulative exposure to asbestos in a diagnosis or 8 a causation opinion related to that different than, say, 9 a cigarette smoking situation? 10 THE WITNESS: It may be. But even there 11 there's some potential problems like in cigarette smoke, 12 for example, the low tar cigarettes contribute as much 13 as the high tar cigarettes, for example. The answer is 14 probably no because people smoke cigarettes different. 15 With respect to the asbestos, it does get into 16 some issues that potentially there might be some 17 differences. For example, there's a suggestion or 18 there's some evidence -- and this is, again, an area of 19 area high controversy -- that there's relative potency 20 of the various types of asbestos in causing 21 mesothelioma. 22 For example, it's basically stated that the 23 amphiboles are more tumorigenic in causing mesothelioma 00151 152 1 than chrysotile. And I think that's true. I think that 2 chrysotile isn't as tumorigenic on a fiber per fiber 3 basis. Yet when Wagner and other people were trying to 4 prove that in experimental animals, they couldn't prove 5 it at all. In fact, the latest study that was done in 6 1992 by direct injection where they directly injected a 7 certain milligram dose of asbestos into the peritoneal 8 cavity of rats, it turned out that the one that produced 9 the most mesotheliomas was UICC chrysotile B, which is 10 in not amosite and not crocidolite. 11 And then the other issue that comes up is this, 12 is that if you were to assume that what Hodson and 13 Darden published in, I think it was 2000, on the 14 relevant potencies of asbestos fiber types with respect 15 to causing mesothelioma where they said that crocidolite 16 was 500 times more potent then chrysotile and that 17 amosite was a hundred times more potent than chrysotile, 18 what would happen if it turned out that you had, say, 19 10,000 times more chrysotile than you had amosite or 20 crocidolite? How would you that work? 21 Because that's often the situation, especially 22 not necessarily in brakes, of course, but, say, in 23 insulation where the dominant fiber actually is 00152 153 1 chrysotile. And it's things like that that cause 2 really -- it's really hard, I think, to separate out. 3 And the other reason - 4 THE COURT: Let me just ask, to move along 5 because we do have some time pressures, would that 6 variable injected into the causation equation or even 7 the diagnosis equation, are there areas in science that 8 you would identify as being similar to that that 9 confront clinicians like yourself where you're dealing 10 with these multiple barriers -- variables and yet you 11 are called upon ultimately to make the diagnosis in 12 terms of causation? 13 THE WITNESS: Yeah. I think the diagnosis by 14 itself stands by itself. So that's not an issue of 15 causation. I can diagnose a mesothelioma without ever 16 knowing what happened to the person based on pathology. 17 THE COURT: Sure. 18 THE WITNESS: Then with respect to the 19 causation, another example for that might be the case - 20 I think there are other carcinogens where you might be 21 exposed to, say, three or four carcinogens that 22 potentially could cause, we'll just say lung cancer, 23 we'll take, for example, beryllium, chromium, arsenic, 00153 154 1 and lead. Each of those have the ability to cause lung 2 cancer. And they might be different abilities based on 3 their concentration. 4 And I think there that if you have a situation 5 like that, I think doctors would say that, well, this 6 person was exposed to a number of inorganic agents that 7 caused lung cancer, and therefore, we're going to say 8 that this lung cancer was caused by that. I think it 9 would be very difficult to separate that out and say 10 that 20 percent of his lung cancer was caused by 11 arsenic, 30 percent by lead, etc. 12 THE COURT: So you're looking at the individual 13 patient, the individual exposures; if you identify 14 multiple carcinogens, then you're not going to attempt 15 to separate those out in terms of ultimately saying this 16 is what caused the problem. 17 THE WITNESS: That's my take on it. 18 And the biggest example of that in asbestos is 19 lung cancer and cigarette smoke and asbestos. And that 20 is that most of the studies have shown that there's a 21 multiplicative synergistic increase in lung cancer that 22 people who are exposed to asbestos and cigarette smoke. 23 And that ranges as high as, say, 90 times relative risk. 00154 155 1 And in most smokers exposed to asbestos it would be 2 about 50. But the rate that is generally given for lung 3 cancer causation to asbestos would be about five times 4 that of a nonasbestos exposure. And to a smoker would 5 be about 11. But when you put them together is 55. 6 And as far as I know, nobody has ever worked it 7 out to say that we're going to apportion this amount to 8 cigarette smoke and this amount to asbestos. Because 9 from a molecular biology point of view, you really don't 10 have any idea what exactly is going on especially if you 11 contrast asbestos and cigarette smoke carcinogens can 12 cause some of the same mutations in the protooncogenes 13 and the tumor suppressor genes. 14 THE COURT: I want to move on to case reports. 15 I just want to get some practical understanding of what 16 you do when a new peer review case report comes across 17 your desk that is of interest to you. 18 How do you incorporate that, if at all, into 19 your practice; to what degree do you rely upon it; how 20 is it utilized by you as a clinician in the big picture? 21 THE WITNESS: I think as a pathologist it's 22 very important. Because a lot of things that are 23 published in pathology are case reports. And it might 00155 156 1 be, for example, a different variant of a mesothelioma. 2 For example, in 1985 there was a case of a 3 tumor described in the peritoneal cavity of a 13-year 4 old girl that was initially described as a gynecologic 5 neoplasm but later was diagnosed as a type of 6 mesothelioma called deciduoid mesothelioma, where they 7 stated that this was not a type of mesothelioma caused 8 by asbestos. 9 And then, like a lot of things, I ripped that 10 out of the journal -- I'm a ripper. I rip this stuff 11 out that I think is important and save them, file them. 12 So I knew about that article. And then the first case I 13 saw was actually probably about 15 years later, maybe 14 ten years later in a old woman. Actually, she was 15 89 years old, who had been exposed to asbestos. I said 16 I've seen this type of tumor before. I said this is a 17 deciduoid mesothelioma. But this was a pleural 18 mesothelioma rather than a peritoneal mesothelioma. And 19 we actually did asbestos analysis on her lung tissue. 20 And she had elevated concentrations of asbestos. 21 So these case reports are very important to me 22 just because I think you can recognize things. And if 23 you see it again, you can diagnosis it. 00156 157 1 Sometimes it's not so important with respect to 2 causation from how what happens to the person and how 3 they're treated, though. That's the way it is. 4 THE COURT: 5 (Pause.) 6 THE COURT: You gave some examples of instances 7 where epidemiology has not kept pace necessarily with 8 the ebb and flow of the medical practice, for example, 9 and what you're seeing in presentation of your patients 10 and decisions that you're having to make. And I assume 11 that you were making those comments in the context of a 12 clinician who is being asked to give advice or give 13 treatment to a particular patient who is there in your 14 office or whose case has been submitted to you for 15 review. 16 What about in the scientific world when you're 17 being called upon to offer guidance to the scientific 18 community in terms of cause and effect? How does the 19 lack of a epidemiological study or guidance from that 20 field affect your ability to offer that guidance to your 21 colleagues in the form of either published papers or 22 presentation that you're making knowing that folks are 23 going to be probably taking what you had to say and 00157 158 1 maybe making very important decisions based on that? 2 THE WITNESS: Well, that's a very good 3 question. 4 And I think in a disease where a cause has not 5 been demonstrated, then you have to be very, very 6 careful. And I think if you have a situation like that, 7 say, you saw some type of a rare lung cancer or, say, 8 you saw a gastrointestinal stomal tumor and there was 9 somebody that thought that this was related to something 10 that had been reported, I think that the prudent thing 11 for a clinician or pathologist to do would be to say 12 that here is the information we know. We know this is a 13 rare tumor. We know that X, Y,and Z have reported that 14 this was associated with this. But at this point in 15 time there are too few cases to make any absolute 16 conclusions about it. 17 And I think that to make a statement that just 18 because a case report or two or three case reports had 19 stated, well, it's likely this was caused by that, and 20 you still have to be really careful about that, very 21 careful about that. Because if you don't, you can do 22 just as much harm by making false statements that way as 23 you can the opposite way. 00158 159 1 THE COURT: All right. Did that prompt any 2 additional questions from counsel? 3 MR. JOHNSON: Just one, possibly two. Try to 4 make it one. 5 BY MR. JOHNSON: 6 Q. Dr. Hammar, in the case of chrysotile asbestos, 7 whether it comes from brake linings, whether it comes 8 from some other source, is that a situation in your 9 opinion where you're dealing with a disease where the 10 cause of the disease has not been identified? 11 A. No. I think that there is overwhelming 12 epidemiologic proof that chrysotile causes mesothelioma. 13 I don't think it's even a question there. 14 I guess in the brake mechanic issue is that 15 based on the epidemiologic studies there seems to be a 16 question as to whether chrysotile exposure causes an 17 increased incidence of mesothelioma based on what has 18 been published. And that if you -- and here -- and I'm 19 not an epidemiologist. And here is where my problem 20 comes with that is just what I've said, is that so here 21 I see a case of a person who we have good evidence that 22 was the only exposure they had. They have elevated 23 concentrations of asbestos in their lung. They have 00159 160 1 elevated concentrations of asbestos in their pleura. 2 You don't find anything else. How can you not say that 3 that was caused by asbestos? 4 Q. In terms of the situation you were just 5 describing for the Court in response to the Court's 6 question, was that a situation in which you have a rare 7 form of disease and as of today there's only theories; 8 medical science doesn't really have any idea what is 9 causing it? 10 A. Yeah. And maybe the best example was is that 11 deciduoid mesothelioma. Because part of the publication 12 on that was that here's an example of mesothelioma 13 that's not caused by asbestos. Ten cases later there 14 were several case reports of deciduoid mesothelioma 15 being caused by asbestos or finding elevated 16 concentrations of asbestos in the lungs of those 17 individuals. 18 So, again, it's a thing one has to be -- a 19 situation I think -- and this is both ways -- you have 20 to be very, very careful about stating that it was not 21 caused by something or caused by something. Because you 22 can be wrong both ways, especially when there's 23 barely -- you know, there's not very much information 00160 161 1 about it. 2 Q. Finally, just to make sure it's clear in 3 response to something else the Court was asking -- and 4 I'm going to try and shorthand a subject you and I have 5 discussed a million times over a period of years. 6 Neither you nor -- in a case where somebody is 7 exposed to multiple products, neither you nor anybody 8 else can say which fibers from which products were the 9 ones that actually caused the changes to the cell that 10 led to the cancer; correct? 11 A. That's absolutely correct. 12 MR. JOHNSON: Okay. Thank you. 13 BY MR. TARRY: 14 Q. Dr. Hammar, short fiber chrysotile, the 15 shortest available commercial grade or even shorter than 16 that -- I think Dr. Dodson testified yesterday about 17 short amphiboles, also. Those short fibers are the 18 types of fibers that all of us just in the general 19 population, to the extent we're exposed, are exposed to, 20 the shorter fibers; correct? 21 A. Well, I think that would be the most likely you 22 would get from nonoccupational exposure, yes. 23 Q. You said mesothelioma is a rare disease. The 00161 162 1 vast majority of us who are carrying around these short 2 chrysotile fibers in our lungs right now -- when I say 3 short chrysotile fibers, I mean counting everything else 4 as equal; not talking about things like changes in 5 surface, charged or surface chemistry; it's been milled 6 or anything like that, just short fiber chrysotile - 7 the vast majority of us walking around with that stuff 8 in our lungs, in our pleura never develop mesothelioma; 9 correct? 10 A. I think that would be correct. But it's my 11 understanding -- maybe Dr. Dodson said something 12 differently -- but if you look at his article published 13 in 2000, I think, in the American Journal of Industrial 14 Medicine on asbestos concentrations on people who are 15 non-occupationally exposed, it's my understanding that 16 he didn't find any asbestos in the people that were 17 under 25 years old, short fibers, long fibers, 18 amphiboles, chrysotile, etc. And that's really terrific 19 news in a way. 20 You're a young guy. I'm an old guy. I don't 21 think that everybody, all the young guys in here have 22 chrysotile asbestos in their lungs. I don't think they 23 have anything in their lungs nowadays. I think those 00162 163 1 people are free. I know where I was exposed to 2 asbestos. I did a lot of work when I was young kid on a 3 lot different things. But I don't think the young 4 people really are at risk. 5 Q. Let me make the three categories. Whether the 6 people who never get exposed to a single fiber or some 7 who get exposed just environmentally because they live 8 in the urban area perhaps, and that's been demonstrated, 9 or they have occupational exposure, the vast majority of 10 all of those never develop mesothelioma? 11 A. That is true. You could say that about 12 asbestos, cigarette smoke. The vast amount of people 13 who smoke cigarettes are not going to get lung cancer. 14 But the primary cause of lung cancer is cigarettes smoke 15 carcinogens. And the primary cause of mesothelioma is 16 asbestos. 17 Q. And we're able through the use of control 18 groups, right, to identify types of exposures and 19 certain circumstances of exposure where those risks 20 might weigh out? 21 A. That is true. 22 MR. WADDELL: Your Honor, just real quick on 23 that vein, too. 00163 164 1 BY MR. WADDELL: 2 Q. If someone was to throw out really in regards 3 to smoking and lung cancer that there's no 4 epidemiological studies on Marlboro cigarettes, is that 5 accepted in the medical and scientific literature, well, 6 you know, that's right; Marlboros don't cause lung 7 cancer; is that reasonable? 8 A. No. Of course that's not reasonable. 9 Q. How about if they were Marlboros or Marlboro 10 Lights? 11 A. That would be a little more complicated, but 12 probably not any different. 13 Q. Filtered versus unfiltered? 14 A. No difference because of the way people smoke. 15 Q. Modified versus unmodified? 16 A. No different. 17 Q. How about because it all goes to an individual 18 circumstance, the dose; right? 19 A. Right. 20 Q. Okay. Any safe level dose of asbestos where 21 one's not at risk of developing mesothelioma? 22 A. Not with respect to an occupational or 23 bystandards exposure. 00164 165 1 Q. And, Dr. Hammar, in applying, as a medical 2 doctor, causation principles, you have to look at the 3 individual circumstances; correct? 4 A. Yes. 5 Q. Blanket approaches on doses by classification 6 or products can be maybe helpful as a clinician, as a 7 physician, but not always the rule of thumb; right? 8 A. Sure. I think that's true, sure. 9 Q. It depends on the circumstances again, 10 individually? 11 A. It does. 12 MR. WADDELL: Thank you, Dr. Hammar. 13 THE COURT: All right. Doctor, I think that's 14 it. You may step down. 15 THE WITNESS: Thank you, Judge. 16 THE COURT: Folks, we're going to take our 17 luncheon recess. We'll recess for an hour, at least 18 that's when I'm going to ask you to get back. I'm going 19 to tell you, if I'm at the DMV at ten till two and they 20 have not yet taken care of me, then I'll leave and do 21 that on another day if I need to. But I'm going to try 22 to get it done today because it needs to get done. So 23 if I'm a little late, I guess what I'm saying is, please 00165 166 1 excuse me. We'll stand in recess. 2 (Whereupon a lunch recess was taken at 12:49 3 p.m.) 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 00166 167 CERTIFICATE OF COURT REPORTER We, Lynne B. Coale, Registered Diplomate Reporter and Certified Realtime Reporter, and Domenic Verechia, Registered Professional Reporter, Official Court Reporters of the Superior Court, State of Delaware, do hereby certify that the foregoing is an accurate transcript of the proceedings had, as reported by us, in the Superior Court of the State of Delaware, in and for New Castle County, in the case herein stated, as the same remains of record in the Office of the Prothonotary at Wilmington, Delaware. 2005. WITNESS our hands this 18th day of October, Lynne Bell Coale, RDR, CRR, Cert. # 165-PS Official Court Reporter Domenic Verechia, RPR, Cert. # 162-PS Official Court Reporter 00167 1 1 '01 - 106-10 65 - 135:6 82 - 96:5 92 - 93:20, 95:20, 96:5 'asbestos - 47:23 0 0.22 -110:17 0.6 - 110:16 01 - 62:23 1 1 - 26:16, 106:21, 128:3 1,062,946 - 63:7 1-2 - 63:21 1.7 - 110:22 10 - 139:10 10,000 - 152:19 10-fold - 63:22 100 - 134:12 100,000 - 63-9 106 - 129:17 11 - 122:11, 155:5 114 - H:3 115 - 11:8 11:00 - 65:7 12 - 13:10, 46:3, 150:8 120 - 41:17 12:49 - 166:2 13 - 44:12, 45:1 13-year - 62:22, 106:9, 156:3 14 - 114:23 15 - 5:18, 142:4, 142:6, 156:13 16 - 48:23, 110:14 162-ps - 167:19 164 - 79:5 165 - 39:13 165-ps - 167:16 17,800 - 48:11, 139:5, 139:7, 139:14 178,000 - 139:16 18 - 1:18, 3:1, 116:21, 117:2 18th - 167:12 1909 - 6:3 1920s - 48:13 193 - 66:15 1930 - 52:14, 53:10 1930s - 48:13, 52:16 1933 - 53:19 1940s - 52:16 1948 - 52:21 1949 - 53:12 1952 - 46:1 1955 - 46:23 1958 - 46:3 1960 - 46:9, 46:11, 47:11, 132:3, 145:9 1964 - 48:20, 49:13, 135:5 1965 - 48:20 1970s - 5:15 1975 - 5:7 19801-3725 - 1:22 1980s - 7:12 1982 - 26:15, 93:20, 95:20, 147:22 1983 - 38:22 1985 - 156:2 1986 - 9:4, 56:10, 62:23, 106:10 1986-2001 - 106:22 1987 - 12:3 1990 - 62:19, 148:8 1990s - 9:21 1991 - 49:18 1992 - 93:20, 95:20, 147:23, 152:6 1995 - 148:4 1996 - 63:5 1997 - 9:23, 27:2, 90:18 1999 - 14:14, 33:4, 62:23, 106:6, 106:10, 135:14, 135:16 2 2.96 -110:17 20 - 6:10, 6:18, 7:23, 65:7, 89:22, 89:23, 154:10 200,000 - 63:13 2000 - 10:2, 84:9, 84:12, 110:4, 148:3, 152:13, 162 13 2001 - 56:11, 57:20, 83:21,99:16 2003 - 106:21, 107:7, 115:23, 117:4, 143:1 2004 - 14:16, 39:11, 42:23, 62:7 2005 - 1:18, 3:1, 14:5, 167:13 21 - 48:22 22.6 - 63:16, 64:6 241 -105:12 25 - 13:21, 90:18, 162:17 255-0562 - 1:22 2585 - 63:2 2609 - 1:21 28 -12:7 29 - 27:4, 27:5 2nd - 1:21 3 3 - 27 11, 29:3, 115:22, 117:3 3,000 - 6:17 3,956 - 106:23 30 - 41:17, 90:20, 123:14, 154:11 300 - 59:18 300,000 - 6:18 302 - 1:22 31 - 62:23, 106:10 32 - 46:16, 145:15 33 - 46:16, 145:14, 145:20 337 - 63:17 34 - 12:7 4 4 - 29:3, 74:17 40 - 6:13, 12:21, 29:16, 136:2 4000 - 16:3 43 - 93:13, 94:7, 95:13, 96:9, 96:19, 105:20, 106:14, 107:4, 108:8, 135:22 45 - 63:10 47 - 90:21 47-year-old - 54:17 475 - 16:4 48 - 135:22 49,000 - 110:14 5 5 - 118:18 5.0 - 79:8 5.244 - 59:22 5.253 - 61:20, 61:21 50 - 150:9, 155:2 500 - 1:21, 152:16 500,000 - 139:20 505 - 135:16 513 - 135:17 54.6 - 63:7 55 - 10:1, 27:3, 155:5 55-year-old - 38:23, 51:11 56 - 135:16 58 - 17:21, 62:21, 63:6, 94:7, 100:13, 100:14, 105:15, 105:19, 105:22, 106:7, 106:13, 108:10, 134:20 6 6 - 122:12, 122:15 60 - 34:11,90:20 7 7 - 66:19 70 - 34:12, 110:14 72 - 90:17, 90:19 73 - 107:3, 110:13 75 - 141:21 77c-asb-2 - 1:3 78 - 106:23, 118:20 8 8 - 80:1 80 - 141:21 82,827 - 63:6 89 - 156:15 89090 - 122:12 8b - 3:1 9 9 - 115:22, 117:3 90 - 12:8, 90:19, 154:23 95 - 90:19 99 - 62:20 99.999 - 138:16 9:03 - 3:2 A abdominal - 10:7 abilities - 154:2 ability - 38:9, 107:20, 109:16, 109:18, 142:16, 154:1, 157:20 able - 16:9, 16:21, 29:23, 36:17, 46:9, 97:11,98:18, 122:10, 163:17 abnormal - 27:8, 27:9 absence - 145:5, 146:6 absolute - 158:15 absolutely - 74:7, 161:11 Absolutely - 23:11, 112:17, 120:19, 142:19 abstract - 100:1 Academy - 7:13, 15:10, 135:5 accept - 148:9 acceptable - 131:18 accepted - 11:14, 59:1, 74:15, 131:20, 164:5 accessing - 137:11 according - 26:14, 38:14, 135:3 account - 63:12 accumulation 29:19, 29:22, 30:1, 30:15, 36:15 accuracy - 105:8, 111:14, 121:6 accurate - 105:18, 111:12, 113:8, 113:9, 113:14, 120:2, 120:15, 124:18, 127:6, 135:23, 167:6 accurately - 4:22, 120:20 accusation - 103:5, 103:21, 104:1 accuses - 103:21 accusing - 111:17 act - 4:17 active - 15:5, 77:9, 77:15, 78:4 activist - 116:16 activities - 43:17 activity - 60:20, 77:13 actual - 19:2, 27:4, 27:15, 82:13, 100:19, 108:15, 120:21, 124:6 acute - 28:9, 28:11 add - 41:18, 45:4 added - 130:14 additional - 14:10, 57:7, 104:16, 127:19, 130:15, 159:2 additionally - 130:5 address - 67:23 addressed - 106:21 Adelaide - 43:8, 57:22 admitted - 119:17 advancement 103:7 advice - 157:12 advocate - 104:22 advocating - 100:3, 107:8, 107:19 affect - 157:20 affected - 54:1 affiliated - 75:23 affirmed - 3:12 Afip - 45:15 afraid - 115:20 Africa - 24:5, 46:13, 47:4, 117:13, 132:3, 145:15 African - 117:11 Africans - 46:23 afternoon - 138:10, 138:11 age - 150:9 agenda - 103:8 agent - 28:4, 144:13, 149:21, 150:2 agents - 154:6 ago - 84:6, 84:7, 89:23, 120:7, 130:21 agree - 37:21,66:2, 66:7, 67:4, 68:16, 738, 75:10, 77:16, 77:22, 81:20, 81:22, 83:11,93:4, 93:18, 95:2, 95:18, 117:18, 118:7, 119:5, 120:15, 120:23, 121:4, 121:8, 122:22, 123:1, 123:23, 124:13, 125:3, 125:8 agreement - 111:10 aid - 118:4 air - 10:17, 23:20, 23:21, 24:8, 24:12, 24:15, 24:21, 25:2 airways - 26:14 alert -127:18 alerted - 46:21 alignment - 67:18 allen - 116:9, 116:11, 117:8 allow - 9:17, 43:11, 97:10, 122:23 allowed - 67:8 allows - 148:15 62:22, 63:13, 106:9 Almost - 27:14 alone - 146:1 altered - 23:19 altogether - 71:23 alveolar - 25:1, 26:13, 29:5, 31:4 Ama - 70:21 amateur -123:5 America - 49:5 American - 39:11, 48:4, 48:6, 50:3, 52:21, 55:21, 69:11, 71:6, 71:8, 71:17, 92:1, 162:13 amosite - 22:23, 36:20, 51:16, 152:10, 152:17, 152:19 amount - 9:13, 29:13, 35:14, 77:14, 120:18, 155:7, 155:8, 163:12 amounts - 63:6 amphibole - 52:1 amphiboles 36:19, 60:8, 143:14, 144:5, 151:23, 161:17, 162:18 Amr - 62:20 Amy - 2:13 analyses - 85:4, 107:16 analysis - 10:1, 32:4, 43:19, 51:15, 61:1, 61:18, 79:8, 110:2, 110:3, 131:2, 156:19 analytic - 120:1 analytical - 119:19 analyze - 32:2 anatomic - 4:5, 4:8 anatomy - 21:20 Anderson - 2:5 anecdotal - 60:1, 60:4 Angelides - 2:11 angiosarcoma 132:8 animal - 141:17 animals - 141:6, 141:11, 152:4 Annals - 135:4 Answer - 84:7, 93:8, 93:14, 93:17, 93:22, 00168 2 95:6, 95:14, 95:17, 95:22, 115:4, 115:7, 115:10, 115:12, 115:15, 115:20, 116:1, 116:4, 116:7, 116:10, 116:12, 116:14, 116:18, 117:22, 118:4, 118:10, 118:12, 118:21, 118:23, 119:6, 122:13, 122:19, 122:21, 123:1, 123:4, 123:21, 124:2, 124:8, 124:12, 124:14 answer - 66:20, 83:16, 150:3, 151:13 answering - 65:16, 75:6 answers - 148:10 Anthophyllite 129:21 anthophyllite 130:14, 130:18, 131:3, 133:5, 137:6 Antonio - 14:5 apart - 124:7 apologize - 20:22, 22:3, 67:13, 67:15, 77:5, 97:5, 97:8, 127:22 apparatus - 24:19 appear - 17:2, 72:23 Appearances - 1:7, 2:1 appeared - 39:8, 115:2, 115:22, 117:1 applies - 146:23 apply - 19:18, 129:8 applying - 11:14, 30:5, 59:10, 165:1 apportion - 155:7 appreciate - 58:11, 65:16, 65:19 Appreciate - 68:2 approach - 133:2, 133:3, 133:6, 133:15, 133:18 approaches 140:2, 165:5 approximation 110:6 area - 6:4, 6:6, 14:21, 23:18, 25:2, 25:3, 30:21, 130:18, 151:18, 151:19, 163:8 areas - 4:3, 15:16, 29:7, 147:15, 149:17, 153:7 arenas - 18:22 argue - 49:22 argument - 80:3 argumentative 97:6 arises - 33:17, 60:3, 77:10 arm -137:10 arsenic - 153:23, 154:11 Arthur - 38:20 article - 9:23, 10:2, 10:7, 11:6, 39:12, 42:22, 51:1, 53:17, 56:4, 59:15, 62:7, 62:10, 75:8, 90:17, 98:9, 98:15, 105:1, 108:20, 109:15, 114:9, 114:22, 117:1, 117:19, 118:3, 118:18, 131:7, 135:15, 156:12, 162:12 articles - 104:6, 113:22, 117:6, 120:4, 120:14, 131:11, 136:5 asbestos - 3:17, 3:22, 5:10, 5:13, 5:21, 6:8, 6:9, 6:12, 6:13, 7:20, 8:8, 8:11, 8:20, 10:4, 10:8, 10:13, 11:23, 12:17, 12:18, 12:20, 14:21, 15:13, 15:16, 16:2, 16:15, 16:22, 18:22, 20:3, 20:4, 20:5, 20:8, 21:22, 22:9, 23:4, 23:16, 23:18, 23:20, 23:22, 24:1, 24:3, 24:7, 24:9, 24:16, 25:15, 26:8, 26:9, 27:13, 28:1, 28:6, 29:18, 31:2, 32:1, 33:3, 33:14, 34:3, 35:14, 35:20, 36:12, 37:4, 37:16, 37:18, 38:1, 38:6, 38:15, 38:22, 39:2, 39:4, 39:10, 39:14, 40:1, 40:12, 42:4, 42:7, 43:15, 46:6, 46:10, 46:17, 47:16, 47:17, 48:16, 49:7, 49:12, 49:15, 49:21, 50:6, 50:10, 50:11, 50:17, 50:18, 51:7, 51:9, 51:12, 51:16, 52:19, 54:7, 55:4, 55:10, 60:8, 60:12, 60:19, 61:4, 61:8, 61:11, 61:15, 62:4, 62:22, 63:1, 65:1, 66:19, 74:9, 74:14, 74:15, 77:19, 79:1, 79:16, 80:12, 85:9, 85:12, 85:16, 87:13, 87:18, 88:9, 88:22, 90:13, 92:9, 92:20, 98:10, 98:13, 99:18, 100:10, 100:18, 102:7, 102:11, 104:19, 105:17, 106:9, 107:2, 107:5, 110:20, 116:15, 117:16, 117:20, 118:1, 118:14, 121:18, 123:21, 124:5, 125:19, 128:4, 128:9, 128:10, 128:16, 130:14, 130:18, 130:22, 131:2, 131:3, 131:12, 131:17, 131:23, 132:16, 132:23, 134:11, 134:12, 136:17, 137:5, 137:18, 138:3, 138:23, 139:2, 140:23, 141:4, 141:9, 142:12, 142:13, 142:15, 143:3, 143:5, 144:14, 145:4, 145:16, 145:19, 147:12, 147:14, 147:19, 148:4, 148:9, 151:1, 151:4, 151:5, 151:7, 151:15, 151:20, 152:7, 152:14, 154:18, 154:19, 154:22, 155:1, 155:3, 155:8, 155:11, 156:8, 156:15, 156:19, 156:20, 159:6, 159:23, 160:1, 160:3, 160:13, 160:15, 160:16, 162:14, 162:16, 162:22, 163:2, 163:12, 163:16, 164:20 Asbestos - 1:3, 12:6, 12:15, 56:9, 78:13, 105:13, 116:6, 117:7, 117:9, 117:13, 117:14, 128:5, 129:22 asbestoscontaining - 23:18, 37:16, 40:1, 65:1, 138:3 asbestos-exposed - 34:3 asbestos-induced 6:13, 16:2, 85:12 asbestos-related 5:13, 7:20, 8:8, 12:20, 16:15, 16:22, 18:22, 20:3, 20:4, 20:5, 20:8, 33:3, 35:20, 36:12, 38:22, 48:16, 50:17, 51:9, 121:18, 125:19, 131:17, 134:11 asbestosis - 26:4, 26:16, 26:20, 27:4, 27:6, 27:7, 27:11, 27:22, 28:2, 29:3, 29:19, 30:17, 48:23, 51:6, 53:19, 74:17 Asian -117:16 aspects - 9:3, 12:17, 16:16 assessment - 37:6 Assessment - 12:15 assistance - 91:20 associated 129:12, 158:14 association - 69:13 Association - 52:21, 69:12, 71:6, 71:9 assume - 99:23, 109:8, 121:9, 121:10, 152:12, 157:10 assure - 121:6 atelectasis - 31:19 atmospheres - 79:1 attack - 112:11 attempt - 154:14 attempting - 112:11 attention - 46:21, 118:1, 132:7 attorney - 112:2 attorneys - 8:9, 15:21, 16:8, 92:5 audience - 125:12, 125:15 audiences - 125:18 August - 15:8 Aussies' - 55:20 Australia - 39:18, 42:1, 42:4, 43:1, 43:9, 43:14, 43:21, 56:1, 56:21, 57:22, 61:1, 61:9, 61:20, 62:8, 63:5, 81:2, 81:3, 82:2, 82:6, 82:22, 102:18, 108:3, 108:21, 110:15, 115:1, 117:10, 121:16, 124:21, 144:17 Australian - 41:22, 42:16, 44:6, 55:18, 56:10, 59:14, 61:2, 62:18, 62:20, 82:8, 83:18, 84:19, 84:23, 86:2, 87:1, 89:10, 92:3, 101:18, 105:16, 106:6, 108:15 author - 45:15, 129:19 authority - 145:18 authors - 76:14, 78:12 auto - 110:6, 110:7, 110:8, 110:19, 122:17 automotive - 60:2, 60:11 Automotive - 59:17 autopsies - 16:4 autopsy - 16:6, 51:14 available - 86:3, 99:13, 141:1, 161:15 average - 90:21, 110:9, 110:15 averages - 35:7, 35:9 aware - 33:20, 41:1, 71:5, 76:16, 81:3, 91:11,91:23, 104:3, 104:5, 104:12, 126:1, 144:11 B background - 3:20, 6:21, 44:2, 60:5, 63:20, 64:7, 64:16, 110:10, 130:2, 134:23, 135:2, 135:6, 135:18, 136:8, 138:22, 140:1, 140:9, 140:18 bad - 18:7, 20:12, 73:6, 81:22, 142:22 Balick - 1:13 barely - 160:23 Baron - 1:9 barriers - 153:10 Based - 124:17 based - 20:20, 59:4, 59:7, 64:20, 67:11, 69:15, 69:22, 69:23, 70:5, 70:11, 70:14, 70:20, 70:23, 73:7, 74:23, 81:6, 83:2, 83:3, 86:22, 100:17, 105:3, 119:11, 125:7, 132:9, 132:15, 140:21, 143:13, 148:6, 153:16, 154:2, 158:1, 159:15, 159:17 basic - 111:3, 132:15 basis - 18:16, 57:10, 137:12, 152:3 Battifora - 45:16 bay - 18:8 beat - 86:19 beating - 99:5 became - 3:20 become - 5:9, 15:15, 25:21 becomes - 63:10, 63:16 begin - 7:5, 27:12 beginning - 61:7 behind - 77:17 beings - 33:22, 74:3, 112:19, 144:14 belabor - 126:16, 140:5 believes - 99:21 belive - 87:20 Bell - 1:20, 167:15 belong - 69:11, 69:13, 71:8 below - 74:22, 75:11, 135:18 benefit - 144:18 Bernard - 2:14 beryllium - 153:23 best - 9:19, 16:12, 17:6, 21:15, 38:14, 57:17, 73:20, 75:3, 107:20, 112:18, 113:21, 121:17, 142:21, 145:12, 145:17, 150:5, 160:10 better - 15:15, 47:7, 72:14, 87:16, 103:12 between - 26:19, 29:9, 47:16, 50:16, 62:23, 86:1, 88:21, 90:5, 90:18, 90:20, 93:20, 95:20, 96:4, 97:17, 106:10, 141:16 bevelling - 64:1 bias - 113:6 Biden - 1:12, 1:13 Bifferato - 1:13 big - 59:11, 70:18, 74:6, 85:18, 86:13, 148:18, 155:20 biggest - 88:3, 154:18 biochemical 149:11 biological - 72:13, 77:13 biologically - 77:9, 77:14, 78:4 biologist - 21:19 biology - 12:19, 33:3, 33:6, 155:9 biopsy - 4:10, 4:12, 16:12 bit - 21:18, 25:9, 35:4, 39:21, 45:8, 49:4, 53:9, 79:11, 80:9, 116:15, 122:4, 130:2, 138:21, 149:10 blank - 91:16 Blanket - 165:5 blanket - 133:3, 133:15, 133:18 blocks - 64:2 blood - 4:22 board - 4:4, 4:5, 5:6 body - 10:8, 10:9, 22:11, 22:17, 28:6, 144:22 boilermaker - 56:23 Bolen - 9:5 Bolivia - 24:5 bones - 147:6 Book - 107:11 book - 12:1, 12:2, 12:4, 12:5, 12:14, 13:22, 14:1, 14:14, 14:16, 31:7, 33:2, 52:8, 88:14, 105:5, 105:10, 125:13, 125:16 books - 125:17 bothers - 103:20 bottom - 33:7 bound - 67:1 Boyd - 2:14 brake - 22:6, 22:9, 22:19, 23:15, 33:20, 38:10, 39:1, 39:2, 43:21, 43:22, 51:7, 51:10, 51:13, 54:4, 00169 3 54:14, 56:15, 57:5, 60:2, 60:11, 60:23, 62:21, 63:3, 63:15, 63:22, 64:1, 64:2, 76:10, 78:19, 79:17, 81:19, 82:12, 82:14, 83:22, 86:15, 91:2, 91:3, 100:15, 100:16, 100:23, 101:11, 102:8, 105:16, 105:22, 106:8, 106:13, 107:3, 107:4, 108:5, 123:14, 123:22, 124:20, 125:2, 134:2, 144:20, 159:7, 159:14 Brake - 53:18 brakes - 43:5, 60:20, 87:3, 89:21, 93:5, 95:3, 97:4, 134:8, 152:22 break - 65:6, 147:1 breaking - 124:7 breaks - 147:5 breast - 88:4, 88:5 breathe - 21:22, 23:21, 24:12 breathes - 22:9 Breathing - 128:6 breathing - 35:15 Bremerton - 5:18, 6:2, 6:4, 6:10, 6:14, 6:16, 7:7, 7:9, 7:21, 16:13, 17:4, 17:22, 18:16, 44:12, 44:18, 150:7 brief - 39:20 briefly - 15:12, 23:3, 54:18, 55:1, 59:15, 138:22, 140:6 Britain - 13:12 British - 46:14, 52:15, 116:15, 132:3 broad - 76:11 broken - 137:10, 146:22 bronchi - 24:15, 29:8 bronchial - 25:1, 26:13, 29:6, 29:10, 31:4 bronchials - 29:9 Browder - 2:12 Budd - 1:9 building - 79:9, 79:10 burden - 78:5 burdens - 78:2 bystandards 164:23 C Ca - 1:3 calcium - 145:23, 146:2, 146:7 calculate - 135:8, 140:19 calculated - 118:18 calculation - 118:17 calibrated - 4:22 Cameron - 1:10 cams - 34:4 Canada -13:11, 15:11, 24:5, 45:20, 48:11, 85:21 canadian -11:5, 38:20 Canadian - 13:9, 45:13 Cancer - 14:17, 17:4 cancer - 4:13, 6:12, 16:7, 19:17, 27:18, 32:12, 32:14, 32:22, 33:13, 33:20, 33:21, 34:2, 34:8, 34:10, 34:18, 34:20, 35:2, 36:6, 37:9, 48:22, 52:22, 62:7, 65:20, 74:17, 88:4, 88:5, 98:11, 142:2, 148:1, 149:8, 150:6, 150:8, 150:9, 150:12, 150:17, 150:18, 150:19, 153:22, 154:2, 154:7, 154:8, 154:10, 154:19, 154:21, 155:3, 158:7, 161:10, 163:13, 163:14, 164:3, 164:7 cancers - 33:12, 37:8, 44:15, 53:7, 53:13, 87:23, 142:14 Cancers - 14:15 candor - 65:19 cannot - 37:17, 89:1 Cantu - 2:7 Cap - 26:15, 27:11 Cap-niosh - 26:15, 27:11 capable - 146:8 cape - 145:14 Cape - 117:11 car - 137:13, 146:22 Carboplatin - 18:1 carcinogen - 33:14, 132:16, 143:9, 149:22 carcinogenesis 148:21 carcinogenic 99:23 carcinogens 150:15, 153:20, 153:21, 154:14, 155:11, 163:15 care - 7:20, 7:22, 165:20 careful - 121:3, 121:11, 121:22, 122:5, 123:10, 124:18, 125:2, 141:19, 158:6, 158:20, 158:21, 160:20 carry - 24:15 carrying - 162:1 cars - 81:4 Cartier - 46:1, 47:13, 131:23 case - 6:22, 7:4, 13:16, 13:18, 21:7, 35:18, 38:11, 38:18, 40:11,42:3, 46:19, 47:19, 48:8, 51:11, 54:15, 59:1, 59:11, 62:14, 74:14, 75:13, 83:21, 85:10, 85:15, 86:20, 87:10, 87:11, 88:11, 88:14, 93:4, 94:14, 95:2, 96:3, 96:4, 96:18, 97:18, 98:21, 102:23, 110:2, 118:8, 119:15, 119:21, 122:10, 123:6, 128:13, 129:15, 130:3, 130:7, 132:5, 132:17, 135:19, 135:20, 140:13, 144:17, 144:18, 144:19, 144:23, 146:22, 153:19, 155:14, 155:16, 155:23, 156:2, 156:12, 156:21, 157:14, 158:18, 159:6, 159:21, 160:14, 161:6, 167:9 cases - 5:13, 6:11, 6:12, 6:13, 6:19, 7:5, 7:11, 7:14, 7:17, 7:19, 7:23, 8:1, 8:4, 8:5, 8:7, 9:14, 13:12, 15:21, 16:3, 16:5, 16:14, 17:1, 17:5, 19:1, 19:3, 27:3, 34:8, 34:10, 39:13, 40:7, 40:9, 40:16, 40:17, 40:20, 40:21, 41:2, 41:6, 41:7, 41:8, 41:12, 41:17, 42:13, 42:15, 42:18, 43:20, 44:3, 44:22, 45:20, 46:1, 46:3, 46:16, 46:17, 46:23, 47:12, 47:15, 55:6, 63:1, 64:7, 64:16, 65:2, 86:13, 86:14, 88:8, 90:23, 92:7, 92:11, 94:13, 96:9, 96:19, 97:3, 103:16, 106:22, 106:23, 113:15, 118:20, 122:6, 124:22, 129:11, 132:1, 132:9, 132:20, 136:9, 140:11, 140:12, 140:17, 140:18, 145:12, 145:14, 145:20, 158:15, 160:13 Castle - 1:2, 167:9 catch - 112:22 catchie - 69:19 categories - 45:3, 56:20, 102:6, 104:18, 163:5 categorized 124:10 category - 57:2, 100:21, 100:22, 101:2, 101:17, 101:22, 102:15, 104:4, 104:5, 104:6, 104:13 causation - 19:6, 19:19, 20:1, 20:23, 37:6, 37:13, 57:6, 71:3, 100:10, 137:12, 137:15, 147:16, 151:8, 153:6, 153:12, 153:15, 153:19, 155:3, 157:2, 165:2 causative - 84:1, 148:8, 149:20 caused - 26:3, 30:2, 40:12, 70:3, 100:12, 128:16, 140:22, 142:14, 145:4, 145:19, 146:22, 147:12, 147:20, 148:19, 150:12, 154:7, 154:8, 154:10, 154:16, 156:7, 158:19, 160:3, 160:13, 160:15, 160:21, 161:9 causes - 19:11, 21:9, 28:22, 46:6, 47:23, 55:10, 88:7, 128:9, 134:3, 144:13, 146:2, 147:16, 159:12, 159:16 causing - 29:12, 40:2, 137:14, 146:8, 150:19, 151:20, 151:23, 152:15, 160:9 caution - 54:1 cavity - 10:7, 12:13, 31:2, 31:12, 152:8, 156:3 cell - 9:7, 21:19, 32:21, 33:13, 142:2, 148:1, 149:1, 149:2, 149:3, 149:5, 149:6, 149:15, 150:18, 161:9 cells - 4:9, 28:10, 28:11, 28:14, 28:22, 32:20, 32:22 cellular - 27:12, 29:23 census - 63:5 Center - 7:11 central - 10:19 Cert - 167:16, 167:19 certain - 19:15, 20:17, 24:2, 24:6, 24:21, 29:13, 41:6, 68:8, 70:3, 70:8, 71:13, 74:4, 74:13, 115:17, 140:8, 140:19, 141:8, 141:16, 152:7, 163:19 Certainly - 132:8 certainly - 19:20, 53:1, 63:14, 122:16, 128:17 Certificate - 167:1 certifications - 5:6 certified - 4:4, 4:5 Certified - 167:3 certify - 167:6 chair - 15:8 chairman -15:4, 17:3, 38:19, 45:13 chance - 17:11, 20:4, 25:11, 37:8, 60:4, 72:12, 73:18 change - 104:12, 140:9, 149:14 changed - 42:17, 89:21 changes - 12:19, 28:13, 29:20, 29:22, 30:1, 30:9, 30:13, 30:16, 31:23, 32:9, 32:20, 32:21, 32:23, 142:15, 149:2, 149:4, 149:6, 161:9, 162:4 chapter - 12:6, 12:21, 33:2, 52:8, 66:12, 105:12, 108:13, 125:20, 125:23, 142:8 Chapter - 12:7 chapters - 11:22, 12:5 characteristics 9:17, 78:6 charge - 13:15 charged - 162:5 chart - 56:7, 109:3 checklist - 21:10 Checkoway - 76:3, 76:7, 78:11, 78:21, 80:19 chemistry - 66:23, 162:5 chemokines - 28:18 chemotherapy - 18:1, 18:7, 74:5 cherry - 75:6 Chest - 10:3 chest - 10:19, 12:13, 16:13, 31:2, 31:12, 70:6 chief - 43:7, 52:15, 57:21 child - 88:11, 88:14 Chip - 69:1 chloride - 132:8 Christian - 2:10 Christine - 2:14 Christopher - 2:13 chromium - 153:23 chronic - 28:13 Chrysler - 37:15 chrysotile - 22:23, 30:8, 30:11, 31:22, 32:6, 32:7, 36:19, 38:6, 38:8, 38:10, 38:15, 39:2, 39:4, 39:10, 39:14, 43:12, 47:11,49:11, 51:16, 57:6, 61:4, 61:9, 61:10, 61:15, 63:19, 66:19, 66:22, 66:23, 67:2, 87:13, 88:22, 92:9, 99:18, 99:22, 100:9, 100:11, 102:7, 102:11, 131:23, 133:23, 134:2, 134:6, 142:15, 143:15, 143:16, 143:18, 143:19, 144:8, 144:13, 144:20, 144:22, 145:4, 152:1, 152:2, 152:9, 152:16, 152:17, 152:19, 153:1, 159:6, 159:12, 159:16, 161:14, 162:2, 162:3, 162:6, 162:18, 162:22 chrysotile-only 57:6 Churg - 26:9 cigarette - 150:5, 150:15, 150:23, 151:1, 151:9, 151:11, 154:19, 154:22, 155:8, 155:11, 163:12 cigarettes - 36:7, 150:11, 151:12, 151:13, 151:14, 163:13, 163:14, 164:4 circumstance 164:18 circumstances 78:23, 82:21, 124:6, 124:10, 128:10, 128:23, 130:4, 133:10, 134:17, 137:11, 144:23, 163:19, 165:3, 165:9 Cisplatin - 18:3 cites - 60:21 City - 48:8 city - 5:17 claim - 78:17, 97:3 claims - 82:5, 86:10, 90:23, 92:2, 99:10, 99:16, 124:19 clarification - 98:16 clarify - 40:10, 67:13, 144:15 clarifying - 84:10, 85:22, 89:3 class - 63:16 Classification 14:15 00170 4 classification 128:19, 129:8, 133:16, 134:20, 165:5 classifications 50:12, 54:7, 56:13 classified - 124:1 clear - 83:15, 83:17, 86:20, 89:7, 100:13, 103:8, 121:19, 126:9, 143:20, 145:9, 148:13, 148:14, 161:2 clearance - 25:12 clearcut - 97:15 cleared - 24:18 clearly - 88:19, 110:17, 112:4 clerks - 80:11 clich - 111:7 Clifton - 2:11 Clinic - 12:11 Clinical - 4:19 clinical - 4:5, 4:11, 4:16, 5:1, 5:3, 16:17, 16:23, 19:2, 19:12, 26:19, 27:5, 27:6, 27:22, 28:2, 29:19, 30:16, 73:10, 73:13, 74:1 clinically - 26:11, 26:18, 37:11 clinician - 75:12, 155:20, 157:12, 158:11, 165:6 clinician's - 137:9 clinicians - 125:20, 149:19, 153:9 clip - 93:1,94:22, 95:11, 114:18, 122:7, 123:19 clips - 104:11 clock - 134:9 clonal - 33:15 close - 86:4, 86:5, 130:11 clustered - 63:23 clutch - 83:22, 84:1 co - 45:15 co-author - 45:15 Coale - 1:20, 167:2, 167:15 code - 101:10 codes - 101:3, 101:23 codified - 70:5 cohort - 49:1, 110:13, 118:8, 119:16, 138:23, 139:4, 139:7, 139:14 coincide - 102:16 Colby - 12:10 cold - 129:3 collagen - 29:1, 71:18 colleagues - 157:21 combine - 102:6 comfortable 111:12 coming - 15:7, 65:16, 87:1 commenting 112:3 comments - 109:2, 157:11 commercial 161:15 commercially 22:21 Committee - 17:4 common - 30:21 community - 47:20, 50:4, 59:2, 157:18 comparative - 117:15 compare - 6:20 compared - 24:9, 44:2, 53:4, 64:6, 86:16, 110:7, 110:10 compares - 110:8 comparison 110:4, 110:12 complex - 33:8 complicated 148:22, 164:11 component - 70:9 comprehend - 68:5 computer - 91:12, 114:14 concede - 146:15 concentration 10:13, 26:8, 143:11, 143:12, 143:13, 144:6, 144:22, 154:3 concentrations 43:16, 60:19, 137:6, 143:2, 143:19, 156:20, 159:23, 160:1, 160:16, 162:14 concept - 68:6, 72:10, 77:9 concern - 102:14 concerned - 90:1, 120:12, 120:13, 120:17 conclude - 85:10, 85:15 concluded - 79:4 conclusion - 43:20, 81:17, 81:23, 143:5, 145:1, 145:3 conclusions 112:20, 121:7, 121:13, 143:22, 143:23, 158:16 conducting - 121:2 conference - 16:13, 127:5 confidence - 80:14, 122:10 confront - 153:9 confusing - 73:22 confusion - 127:14 connect - 46:10 connection - 46:8 consensus - 70:23, 90:10, 137:2, 143:17 consequence 18:6, 48:6 consequences 111:8 consider - 21:11, 55:16, 71:11, 94:17, 96:1, 97:2, 128:10 considered - 44:2, 92:14, 97:1, 98:19 considering - 89:16 consistency - 71:2 consistent - 57:5, 78:8 consistently - 63:2 constitute - 63:15 consultation - 8:2 consulting - 102:17 contact - 17:15 Contained - 57:3 contained - 23:21, 37:4, 57:11 containers 130:12, 130:13, 130:15, 130:17 containing - 23:18, 37:16, 40:1, 65:1, 129:7, 138:3 contains - 60:1 contents - 117:6, 117:7 contested - 144:12 context - 17:1, 18:13, 40:5, 57:17, 97:11, 157:11 Continued - 2:1 continued - 95:11, 98:13 continuum - 148:18 contrast - 113:20, 113:21, 155:11 contribute - 30:6, 73:5, 98:14, 143:5, 144:9, 151:12 contributed - 36:21, 144:7, 149:16 contributing 36:17, 68:9 control - 4:23, 46:18, 118:8, 119:16, 140:13, 149:1, 149:2, 163:17 controlling - 74:20 Controversy - 117:9 controversy 151:19 convey - 20:13 copy - 90:11, 116:23 cork - 129:6 correct - 5:2, 5:7, 5:8, 8:11, 8:15, 11:9, 17:2, 20:20, 20:21, 26:1, 32:14, 34:5, 36:8, 40:23, 42:19, 52:1, 52:2, 53:15, 54:8, 56:2, 59:13, 62:4, 64:4, 66:11, 66:12, 67:3, 68:6, 68:7, 68:15, 72:14, 73:1, 73:2, 73:7, 74:4, 74:10, 74:23, 75:1, 75:9, 79:2, 79:13, 79:22, 80:4, 80:5, 83:2, 84:2, 84:17, 86:5, 87:5, 90:3, 90:8, 92:9, 99:19, 99:20, 100:1, 100:7, 100:20, 101:1, 107:9, 108:17, 109:19, 109:20, 112:16, 113:11, 113:12, 115:3, 119:17, 120:3, 120:18, 120:22, 121:3, 121:7, 121:14, 123:15, 125:21, 126:7, 129:1, 133:11, 133:13, 133:14, 134:18, 137:21, 138:18, 139:15, 140:21, 145:7, 161:10, 161:11, 161:20, 162:9, 162:10, 165:3 Correct - 56:17 correction - 112:22 correctly - 137:23 corresponding 110:21 Corroon - 2:5 Counsel - 3:8 counsel - 126:11, 159:2 count - 122:20, 122:21, 123:6 counted - 122:19, 123:2 counting - 162:3 countries - 117:16, 118:15, 120:9 country - 14:1, 42:9, 43:12, 47:1, 61:10, 71:2, 85:21, 117:15 County - 1:2, 6:5, 6:17, 167:9 couple - 38:17, 68:13, 146:14, 146:20, 147:9 course - 17:23, 20:15, 33:10, 78:5, 137:16, 152:22, 164:8 court - 89:12 Court - 1:1, 1:21, 3:7, 5:23, 7:17, 22:4, 23:11, 65:5, 67:5, 67:13, 67:20, 68:2, 68:19, 81:18, 83:13, 84:20, 85:23, 89:6, 91:13, 91:15, 91:21, 97:9, 98:16, 99:4, 99:6, 99:13, 104:8, 112:1, 112:10, 121:22, 126:9, 126:18, 126:23, 127:4, 127:13, 127:17, 127:19, 127:21, 127:23, 128:1, 138:8, 138:12, 138:23, 147:9, 148:12, 149:17, 150:20, 153:4, 153:17, 154:12, 155:14, 157:4, 157:6, 159:1, 160:5, 161:3, 165:13, 165:16, 167:1, 167:4, 167:5, 167:8, 167:17, 167:20 Court's - 160:5 Courtroom - 3:1 courtroom - 18:14, 18:19, 18:20, 125:21, 126:2 courtrooms - 17:2 courts - 8:10 cover - 23:4, 59:16 covered - 54:12 covering - 146:1, 146:2, 146:7 covers - 30:23, 31:1 Cpk - 70:9 create - 147:5 creates - 147:1 creation - 101:17, 102:15 credibility - 80:21, 89:12 credible - 111:2, 114:9 criteria - 26:15, 46:10, 71:18, 90:10 criticisms - 81:8 crocidolite - 23:1, 36:20, 46:13, 46:17, 49:16, 49:21, 51:17, 61:11, 145:16, 152:10, 152:15, 152:20 cross - 67:23, 83:10, 117:15, 126:12, 126:13, 126:22, 127:11, 127:12 cross-country 117:15 cross-examination - 67:23, 83:10, 126:12, 126:13 Crowe - 2:12 Crr - 1:20, 167:15 Crumplar - 1:14, 1:15, 127:6, 127:7, 127:14, 130:7 crux - 60:14 cumulative - 30:4, 147:15, 148:15, 149:7, 151:7 cure - 72:11 cures - 72:13 Current - 14:15 curriculum - 11:3 Cv - 129:17 cycle - 32:20, 149:2, 149:15 cytokines - 28:17 D Dail - 12:3, 12:10 Daimlerchrysler 2:3, 2:5 Darden - 152:13 data - 44:10, 44:13, 44:23, 61:1, 82:8, 83:18, 85:4, 89:8, 96:12, 98:3, 101:20, 104:23, 105:9, 108:18, 109:3, 111:14, 112:20, 113:22, 121:6, 121:12, 121:13, 121:23, 123:10, 135:3, 135:23, 137:14, 140:10, 140:16, 141:3, 142:11, 142:18, 144:16 date - 43:19, 52:14 dates - 114:2 Daubert - 1:18 daughter - 69:10 David - 2:9, 12:3 dawned - 67:5 days - 142:4, 142:6 dead - 86:19 deal - 9:2, 71:2, 89:3, 97:14 dealing - 82:12, 139:23, 153:9, 159:9 deals - 4:8, 4:19, 12:8, 12:12 dealt - 9:8, 10:3, 12:22 death - 99:5, 139:11, 149:2 debruim - 2:9 December - 56:11 decide - 85:6, 99:4 decided - 67:7 decides - 104:9 deciduoid - 41:16, 156:6, 156:17, 160:11, 160:14 decision - 123:6 decisions - 157:10, 158:1 defendant - 83:21 Defendant - 2:3, 2:5, 2:7 defendants - 8:13 defense - 25:13 definite - 36:11 definitely - 124:9 degenerative - 4:14 degree - 26:23, 116:19, 155:19 00171 5 Delaware - 1:1, 1:22, 129:16, 131:8, 133:5, 136:10, 167:5, 167:8, 167:11 demonstrated 10:7, 158:5, 163:8 denominator 135:9 dependent - 25:12 deposed - 92:5 deposited - 24:23, 25:7, 31:3 deposition - 69:6, 104:10 describe - 7:16 described - 7:14, 29:20, 30:9, 33:1, 124:6, 130:20, 144:18, 156:3, 156:4 describing - 25:5, 160:5 descriptive - 75:13 desk - 155:17 despite - 85:14 destroyed - 29:14 detail - 19:5, 45:8, 66:1 details - 130:10 detected - 20:9 determine - 4:12, 16:12, 17:6, 19:16, 43:11, 70:7, 70:10, 72:4, 72:6, 73:21, 77:14, 98:18, 113:10, 143:18, 149:5 develop - 10:10, 20:8, 28:1, 29:3, 29:18, 128:4, 136:16, 162:8, 163:10 developed - 38:23, 39:8, 48:21,49:10, 56:21, 88:9, 88:12, 88:13, 88:16, 113:17, 134:11 developing - 29:9, 36:14, 37:18, 89:17, 164:21 development 38:12, 68:10, 73:5, 84:2, 85:8, 90:6, 98:14, 131:16 develops - 34:2, 128:15, 148:2 devices - 73:16 diagnose - 153:15 diagnosed - 17:22, 18:11, 37:11, 93:20, 95:20, 113:18, 148:3, 156:5 diagnoses - 19:14 diagnosing - 19:18, 46:5, 71:18, 128:9, 132:23 diagnosis - 3:17, 3:21, 4:9, 5:5, 5:10, 9:18, 19:20, 19:21, 20:17, 20:20, 20:21, 38:1, 42:19, 62:3, 147:16, 148:16, 150:2, 150:17, 151:7, 153:7, 153:11, 153:13, 156:23 diagnostic - 9:20 diameter - 25:10 diaphragmatic 31:11 die - 48:17 died - 18:5, 47:8, 131:1, 139:10 diet - 72:21 difference - 4:7, 4:8, 19:1, 26:19, 26:22, 26:23, 34:13, 35:2, 35:4, 164:14 differences 151:17 different - 9:22, 18:19, 19:21, 21:19, 22:6, 22:13, 22:18, 33:8, 50:15, 55:20, 68:17, 71:23, 77:2, 78:22, 78:23, 79:1, 81:17, 81:23, 88:21, 105:21, 107:14, 110:2, 114:4, 119:9, 119:11, 120:5, 131:22, 132:2, 134:4, 150:23, 151:8, 151:14, 154:2, 156:1, 163:3, 164:12, 164:16 differential - 19:14 differently - 33:21, 162:12 difficult - 84:18, 154:9 diffraction - 32:4 digesting - 32:4 dilemma - 149:18 Diplomate - 167:2 Direct - 3:14 direct - 126:22, 127:2, 127:3, 127:8, 127:10, 127:15, 127:19, 152:6 directed - 57:15, 118:5 directly - 43:21, 89:11, 145:16, 152:6 disagree - 38:2, 38:3, 107:18 disagrees - 107:15 disappointed 103:1 disastrous - 111:9 disciplinary - 70:22 disciplines - 68:18 disclaimers - 47:21 discrepancy 85:19, 86:1 discuss - 16:14, 17:5, 32:12, 47:11, 52:11, 52:12, 57:8, 81:9 discussed - 12:16, 15:12, 53:17, 109:2, 127:4, 136:5, 161:5 discusses - 62:12, 62:17 discussing - 51:1, 62:13, 64:12 discussion - 37:1, 47:13, 47:20, 68:17, 108:18 discussions 33:19, 54:23, 67:21 disease - 3:17, 3:22, 4:13, 5:11, 5:13, 6:10, 6:14, 7:20, 8:20, 12:9, 12:20, 13:14, 15:14, 15:16, 16:3, 16:14, 16:15, 16:16, 16:22, 16:23, 19:11, 20:3, 20:4, 20:6, 20:9, 22:18, 25:16, 25:19, 26:5, 26:14, 33:3, 34:16, 34:23, 35:20, 36:12, 37:12, 37:19, 38:1, 38:7, 38:8, 38:22, 40:2, 45:19, 46:6, 46:21, 50:6, 50:17, 51:10, 54:9, 55:10, 62:4, 65:1, 68:5, 68:10, 70:10, 72:2, 72:5, 72:6, 73:6, 74:13, 78:6, 80:7, 86:18, 88:19, 90:6, 120:18, 120:21, 121:18, 125:19, 128:4, 128:9, 128:10, 131:17, 132:7, 133:1, 134:11, 134:12, 137:18, 140:1, 140:3, 141:9, 141:11, 141:14, 144:14, 147:12, 148:19, 149:21, 150:2, 158:4, 159:9, 159:10, 160:7, 161:23 Diseases - 12:8, 105:13 diseases - 4:9, 8:8, 15:9, 23:4, 36:14, 38:13, 41:6, 46:6, 48:16, 49:2, 52:17, 52:18, 71:19, 72:7 dishonest - 103:3 dishonesty - 103:5 disowned - 105:19 dispersive - 32:3 dispute - 73:11, 99:17 disregard - 21:1, 21:4, 71:12 distinguish - 77:8 distort - 103:11, 129:10 distribution - 31:13 divide - 149:4 Dmv - 165:19 Dna - 149:4 Doctor - 117:18, 147:9, 165:13 doctor - 4:1, 4:17, 21:18, 61:22, 72:19, 73:12, 137:8, 137:11, 165:2 doctor's - 137:9 doctors - 4:11, 5:3, 19:12, 35:3, 46:8, 49:22, 70:14, 75:6, 154:5 document - 43:9, 43:13, 57:16, 57:18, 84:11, 84:14, 107:10 Documented - 56:9 documented 51:20 Dodson - 9:21, 10:11, 12:6, 12:14, 14:9, 25:18, 26:8, 27:2, 90:18, 97:19, 131:2, 161:16, 162:11 Domenic - 167:3, 167:19 dominant - 32:5, 43:22, 125:3, 152:23 done - 11:19, 16:4, 69:20, 73:14, 81:7, 82:16, 83:11, 121:21, 150:1, 152:5, 165:22 dose - 35:13, 35:21, 36:9, 36:11, 50:16, 64:12, 74:2, 74:9, 74:13, 74:20, 77:8, 77:9, 77:10, 97:17, 136:21, 152:7, 164:18, 164:20 doses - 78:4, 79:2, 165:5 doubles - 63:11 doubling - 98:4, 142:3, 142:4, 150:13 doubt - 87:13, 145:18, 146:8 Doug - 100:9, 103:2 Douglas - 17:21, 43:7, 57:20 down - 23:10, 24:13, 25:22, 36:3, 39:23, 52:14, 53:10, 53:16, 53:21, 75:11, 108:8, 165:14 Dr - 3:9, 3:16, 5:6, 5:16, 9:21, 10:11, 11:12, 12:6, 12:10, 12:14, 14:9, 23:13, 25:18, 26:8, 26:9, 27:2, 32:14, 38:18, 38:20, 39:7, 39:10, 42:22, 43:6, 43:13, 45:9, 45:15, 46:2, 46:9, 46:12, 46:15, 47:10, 47:17, 47:19, 48:7, 48:14, 49:6, 49:18, 50:19, 50:20, 52:8, 52:10, 52:11, 52:13, 54:16, 56:1, 58:4, 58:9, 58:13, 58:18, 59:15, 59:16, 61:14, 61:21, 65:13, 68:4, 76:3, 76:7, 76:17, 78:11, 78:21, 80:16, 80:19, 81:10, 82:5, 82:6, 86:2, 89:9, 90:18, 90:22, 90:23, 91:11,91:23, 92:21, 94:9, 96:23, 97:12, 97:22, 98:1, 99:10, 99:21, 101:12, 101:16, 102:1, 102:2, 102:16, 102:17, 102:19, 102:21, 102:22, 103:18, 103:22, 104:10, 104:16, 105:1, 105:22, 106:18, 106:20, 107:7, 108:13, 108:20, 109:22, 112:14, 113:7, 113:13, 113:14, 114:15, 117:11, 119:16, 121:11, 121:15, 121:16, 122:4, 123:9, 123:17, 124:18, 126:3, 128:14, 131:2, 134:21, 138:10, 142:19, 142:21, 144:2, 159:6, 161:14, 161:16, 162:11, 165:1, 165:12 draw - 104:8 drawing - 22:2, 117:23, 121:12 drawn - 47:16, 121:7, 132:7 Driscoll - 114:23, 117:11 drop - 113:8 drug - 72:11, 72:12 drugs - 73:15 dry - 111:7 duct - 26:13, 29:5, 31:4 ducts - 25:1 due - 108:4, 144:20 duly - 3:12 during - 32:7, 62:22, 106:9, 111:11, 127:5 dust - 80:4 dying - 120:10 dynamic - 149:23 E earliest - 26:16, 38:17 early - 5:12, 5:15, 7:12, 45:22, 46:22, 48:12, 49:9 Eastern - 120:9 eating - 73:1 ebb - 157:8 edited - 105:6 edition - 12:1, 12:2, 12:4, 115:23 editor - 116:8, 118:2 editors - 12:4 effect - 18:7, 33:14, 72:13, 72:16, 72:17, 77:11,91:4, 109:18, 109:21, 141:4, 149:12, 157:18 effective - 73:21 effectively - 80:6, 110:8 Effects - 12:16 effects - 72:23, 142:12 effusion - 70:2, 70:3, 70:4 eight - 18:4, 46:3 either - 21:7, 43:4, 46:3, 52:23, 59:18, 74:21, 84:23, 92:12, 101:9, 102:8, 102:11, 157:21 Either - 86:6 Ekg - 70:9 elastin - 29:2 electron - 9:14 elevated - 44:1, 57:5, 131:3, 137:6, 156:20, 159:22, 160:1, 160:15 elimination 133:15 Elliott - 38:19, 45:10, 45:11 employ - 86:23 employed - 89:9, 110:6, 110:7 encourage - 72:22 encouraging 107:10 End - 44:11 end - 30:6, 31:6, 40:8, 40:12, 53:16, 53:21, 56:11, 80:15, 90:19, 119:12 energy - 32:3 England - 2:15, 49:14 enhancer - 23:8 enter - 10:17 entire - 15:22, 149:15 entitled - 76:17, 78:12 environmental 24:8, 110:10 Environmental 56:5, 108:22, 115:3, 117:3, 135:16 environmentally 163:7 eosinophils - 28:11 Epa - 101:13, 105:2, 106:18, 106:21, 00172 6 107:9, 108:2, 109:22, 112:7, 119:9, 119:10, 121:16 epi - 47:21, 131:8 epidemic - 13:23, 150:7 epidemiologic 46:19, 55:7, 82:10, 87:8, 87:15, 87:23, 88:6, 88:17, 89:1, 89:4, 118:13, 120:1, 132:4, 132:13, 159:12, 159:15 epidemiologic-type - 132:4 epidemiological 21:11, 43:18, 55:1, 55:11, 60:21, 144:19, 145:5, 145:10, 145:22, 146:6, 157:19, 164:4 epidemiologically 146:4 epidemiologist 68:13, 76:9, 80:16, 89:5, 140:15, 159:19 epidemiologists 68:12, 68:14, 85:5 Epidemiology 12:16, 44:11, 76:18, 105:12 epidemiology 12:18, 46:7, 62:9, 62:14, 74:19, 76:10, 85:14, 85:17, 119:20, 129:12, 139:23, 140:3, 142:9, 146:16, 157:7 epithelial - 9:16, 9:18, 142:5, 148:5 epithelium - 24:20 equal - 73:11, 75:19, 110:16, 162:4 equals - 63:7, 110:17 equation - 153:6, 153:7 equivalent - 110:13 Eric - 2:14 Erin - 2:10 especially - 65:21, 103:17, 140:13, 152:21, 155:10, 160:22 espousing - 58:19 Esq - 1:8, 1:10, 1:12, 1:14, 2:2, 2:4, 2:6 Essay -117:14 essence - 127:2 established 145:19 estimated - 63:20 estimates - 110:5, 114:21 etc - 73:16, 113:23, 118:6, 154:11, 162:18 etcetera - 4:15 etiology - 72:2, 72:5, 72:8 Europe - 101:9 European - 120:9 evaluate - 4:12, 58:2, 89:1, 123:12 evaluating - 48:8 evaluation - 9:14, 55:7, 140:3 event - 90:22 events - 28:19 eventually - 131:6 evidence - 27:7, 37:16, 38:6, 39:13, 61:2, 68:22, 69:15, 69:22, 69:23, 70:4, 70:5, 70:9, 70:11, 70:14, 70:20, 70:23, 71:12, 71:13, 73:7, 74:23, 75:18, 77:2, 81:3, 82:10, 82:16, 82:19, 82:23, 2419, 87:8, 88:1, 88:6, 141:13, 148:5, 151:18, 159:21 evidence-based 69:15, 69:22, 70:5, 70:11, 70:14, 70:20, 70:23, 73:7, 74:23 evidenced - 86:22 evidenced-based 86:22 evident - 88:19 exact - 34:2, 50:8, 113:23 exactly - 32:14, 32:15, 33:9, 33:10, 34:13, 73:23, 80:18, 84:3, 92:6, 92:11, 96:13, 101:14, 103:12, 106:1, 114:2, 148:1, 149:12, 155:10 Examination - 3:14 examination - 27:9, 67:12, 67:23, 83:10, 126:12, 126:13 examined - 3:12 example - 19:15, 24:2, 24:5, 25:10, 28:20, 31:7, 32:17, 34:8, 34:14, 38:16, 41:14, 44:12, 44:17, 48:19, 50:13, 51:19, 51:20, 70:1, 71:16, 72:7, 73:15, 74:14, 77:19, 83:20, 85:12, 87:16, 88:14, 88:17, 94:15, 97:15, 97:19, 112:23, 124:17, 141:20, 142:2, 150:5, 150:6, 151:12, 151:13, 151:17, 151:22, 153:19, 153:23, 154:18, 156:1, 156:2, 157:8, 160:10, 160:12 examples - 97:20, 131:15, 157:6 excellent - 33:5 except - 150:17 exceptions - 36:1 excess - 108:4 exclude - 20:17, 20:19, 21:4, 37:16, 75:17, 134:6 excluded - 114:3, 137:15 exclusions - 21:3 excuse - 6:18, 135:6, 166:1 Exhibit - 114:23, 117:1, 122:12, 122:15 exhibit - 7:12, 116:20 exist - 105:4 existence - 6:2, 37:10, 140:8 expand - 29:7 expect - 35:9, 82:22, 144:6 expected - 64:10, 64:16, 80:12, 139:6, 139:11, 139:13, 139:16, 139:19 experience - 13:1, 15:13, 44:6, 48:4, 49:5, 50:3, 55:18, 58:12, 59:14, 62:18, 139:9 experimental 28:9, 141:5, 152:4 experiments 66:18, 66:19, 66:22 expert - 89:2 expertise - 13:2 explain - 3:20, 5:23, 8:22, 11:21, 13:6, 23:14, 140:6 explicable - 60:4 exposed - 6:8, 34:3, 36:13, 36:18, 37:4, 38:13, 47:15, 50:10, 50:18, 51:21, 61:4, 80:12, 91:5, 92:8, 102:7, 102:9, 104:19, 113:16, 130:21, 131:19, 134:1, 134:7, 136:17, 139:1, 141:5, 143:15, 146:1, 148:4, 151:6, 153:21, 154:6, 154:22, 155:1, 156:15, 161:7, 161:19, 162:15, 163:1, 163:6, 163:7 Exposure - 78:14, 128:7, 129:21 exposure - 24:1, 39:9, 39:14, 40:1, 46:17, 49:11, 51:12, 54:20, 62:22, 63:1, 78:23, 83:23, 85:9, 88:9, 88:23, 89:17, 89:23, 90:5, 91:2, 92:20, 93:4, 93:5, 93:13, 93:16, 93:19, 94:3, 94:12, 95:2, 95:3, 95:13, 95:16, 95:19, 97:3, 97:4, 98:13, 100:16, 102:11, 107:2, 107:5, 110:20, 124:1, 124:11, 124:20, 124:23, 125:3, 125:5, 130:20, 131:16, 132:7, 132:9, 132:21, 133:5, 135:12, 135:13, 136:21, 137:5, 143:9, 143:11, 143:18, 144:20, 145:16, 147:15, 148:15, 148:17, 148:18, 149:16, 150:14, 151:1, 151:7, 155:4, 159:16, 159:22, 161:22, 163:9, 163:19, 164:23 Exposures - 56:9 exposures - 30:4, 30:5, 36:16, 49:7, 60:8, 60:11, 76:11, 89:22, 92:10, 92:17, 97:21, 105:17, 106:9, 110:11, 119:1, 136:12, 136:13, 143:6, 147:19, 148:7, 149:7, 154:13, 163:18 express - 141:2, 141:3 expressed - 142:10, 150:21 extensively - 14:4 extent - 23:1,61:13, 161:19 extrapolate - 141:17 extrapulmonary - 10:5 extremely - 17:17, 20:2, 45:18, 82:8, 134:22 F fabricated - 100:18 fabrication - 106:15 face - 149:19 fact - 7:12, 11:2, 27:1, 47:3, 50:8, 52:7, 58:7, 66:8, 70:13, 80:9, 81:1, 82:15, 98:10, 100:21, 101:21, 105:1, 120:6, 129:11, 139:23, 142:19, 147:11, 152:5 factor - 28:21, 36:23, 37:5, 72:10, 72:11, 84:1, 89:18, 128:3 factories - 52:16, 52:19, 53:5, 53:6 factors - 35:10, 35:13, 36:2, 68:9, 68:15, 73:4, 120:21, 120:22 facts - 111:22 faculty - 76:8 Fair- 68:11, 75:15 fair - 75:18, 102:19, 103:9, 108:7, 111:14, 111:15, 122:14, 125:9, 128:13, 133:6, 134:10 fairly - 14:4, 45:22, 74:15, 130:11 fall - 74:22 false - 120:22, 158:22 familiar -15:15, 60:13, 76:11, 76:19, 109:6, 109:7 far - 18:21, 20:1, 61:7, 62:17, 77:16, 92:10, 100:7, 155:6 Farris- 2:10 fascicles - 45:15 fast - 103:12, 149:5, 149:12 faster - 150:18 fat - 10:6 features - 7:15, 9:11, 14:7, 16:22, 16:23, 27:6 February- 14:5 few - 8:5, 9:2, 14:9, 18:9, 19:4, 21:17, 23:3, 57:3, 58:3, 86:15, 138:6, 158:15 fiber - 9:23, 32:5, 34:4, 34:19, 36:18, 39:4, 51:14, 66:3, 78:6, 99:22, 131:2, 147:13, 152:2, 152:14, 152:23, 161:14, 162:6, 163:6 fibers - 22:10, 22:14, 22:22, 23:5, 23:14, 23:16, 23:20, 23:22, 24:4, 24:7, 24:8, 24:10, 24:17, 24:21, 25:6, 25:14, 25:15, 25:18, 27:13, 30:1, 31:22, 32:7, 34:4, 35:14, 36:19, 50:11, 51:18, 52:1, 54:7, 54:9, 67:2, 77:19, 79:16, 130:18, 131:3, 142:13, 142:16, 144:22, 147:13, 147:14, 161:8, 161:17, 161:18, 161:20, 162:2, 162:3, 162:17 fibroblast - 28:21 fibroblasts - 28:23 fibrosis - 18:6, 29:8, 29:9, 29:11, 29:13, 31:20, 77:21 fibrotic - 31:6 field - 69:16, 146:2, 157:20 fields - 19:9, 20:23, 59:10, 59:11 fifth - 6:3, 106:22 figure - 63:5, 63:9, 63:13, 70:2, 110:21, 112:5, 114:7 figures - 134:19, 136:4 file - 156:11 filed - 37:15 Filtered- 164:13 final - 71:5 Finally- 145:8, 161:2 finally - 27:22, 60:23 financial - 103:15 findings - 5:4, 16:17, 16:18, 27:10, 57:8, 144:21 fine - 67:20, 68:1, 77:7, 122:3 Fine- 127:13, 127:21 finish - 93:15, 95:15 finished - 13:22 first - 3:12, 5:9, 5:14, 12:2, 12:4, 22:1, 24:22, 26:5, 26:12, 27:23, 45:9, 45:13, 48:19, 51:20, 56:7, 57:18, 76:14, 99:10, 99:16, 100:5, 113:16, 113:17, 117:7, 135:3, 136:11, 136:18, 148:1, 150:16, 156:12 First- 38:5, 102:1 fit - 21:14 five - 12:5, 34:9, 80:1, 88:8, 90:14, 107:4, 120:7, 132:9, 155:3 flaking - 123:21, 124:5 flipping - 94:19 Floor- 1:21 flow - 157:8 focal - 26:15 focus - 90:1 focusing - 21:20 Folks- 165:16 folks - 99:7, 112:8, 112:11, 157:22 follow - 127:2, 127:17, 138:21 followed - 126:22, 127:12 following - 48:23, 74:3, 93:1,94:22, 110:1, 114:18, 122:7, 123:19 follows - 3:13 00173 7 followup - 20:8 forced - 104:11 Ford- 137:10, 137:13, 137:14 foregoing - 167:6 foreign - 28:6 forever - 70:12, 110:6 form - 13:16, 33:15, 157:21, 160:7 formed - 33:13 formulating - 141:2, 142:9 forth - 94:19 fortunate - 14:23, 17:14 forum - 100:4, 117:20 forward - 126:9 fosterite - 23:2 four - 93:10, 95:8, 96:8, 97:23, 98:23, 142:7, 153:21 fraction - 77:10 frame - 66:10 Francis- 2:14 free - 13:15, 163:1 freelance - 83:9 French- 13:23, 43:10 frequently - 63:2 friction - 30:11, 32:8, 37:17, 38:15, 39:14, 40:1,43:15, 51:12, 51:21, 54:21, 55:4, 61:4, 61:8, 61:15, 65:1, 67:2, 84:1, 88:22, 92:9, 96:7, 138:3, 142:16, 144:20 Friction- 59:17 friend - 58:8, 70:17, 113:3 friends - 138:19, 138:20, 142:21 front - 65:23, 105:6, 120:8 frost - 139:3 Frost- 48:10 fruit - 72:21, 73:1, 75:7 full - 76:8 full-time - 76:8 fully - 68:4 function - 27:9 funky - 50:5 G Gabay - 2:9 gain - 70:4, 103:14 garage - 81:5, 81:19, 93:5, 95:3 Garrett - 2:13 Gary - 2:11 gastrointestinal 158:8 gather - 151:4 geared - 27:16 Gemcitabine - 18:2, 18:6 gene - 149:13 general - 7:4, 33:11, 36:9, 60:10, 90:9, 96:7, 100:12, 139:7, 161:18 generally - 11:14, 27:10, 59:1, 67:17, 69:15, 77:13, 134:3, 138:15, 139:12, 155:2 Generally - 131:20 generated - 5:1, 43:16, 70:23, 100:4 generation - 6:4 generic - 145:6 genes - 149:1, 155:13 genetic - 28:3, 142:15 Genetics - 14:17 Gentilotti - 1:13 gentleman - 62:11 germane - 77:1 girl - 156:4 given - 64:20, 67:18, 87:22, 104:17, 105:11, 124:22, 125:11, 144:17, 155:2 gland - 88:12 glare - 77:5 Glenn - 2:13 global - 86:3, 118:1 Gold- 107:11 government 13:23, 43:10 governments 118:6 grade - 26:16, 27:11, 29:3, 161:15 Grade - 66:19, 74:17 Great - 13:11 greater - 39:5, 51:19, 79:8, 110:18, 110:22 Gribben - 91:18 Gribbin - 2:14 grinding - 64:1 Group - 13:20, 15:2 group - 13:21, 46:18, 48:7, 48:9, 48:16, 50:18, 60:7, 101:13, 135:4, 147:13 groups - 14:20, 55:19, 55:20, 79:7, 79:22, 80:11, 88:3, 117:21, 118:5, 133:4, 163:18 grow - 149:6 grows - 150:18 growth - 28:21, 149:1 guess - 13:7, 14:21, 15:15, 20:13, 33:7, 34:1, 35:6, 36:23, 40:10, 50:2, 53:2, 53:23, 58:14, 58:16, 60:15, 71:4, 72:3, 85:5, 109:18, 109:19, 109:20, 111:23, 113:12, 126:1, 136:8, 137:3, 159:14, 165:23 guest - 116:8 guidance - 157:17, 157:19, 157:20 guideline - 57:15 Gunner - 135:13 guy - 123:17, 124:4, 162:20 guys - 102:20, 103:17, 162:21 gynecologic 156:4 H Hadley - 2:11 hah - 19:8 half - 90:14, 141:20 Hammar - 3:10, 3:11, 3:16, 5:6, 5:16, 11:12, 23:13, 32:14, 50:20, 58:18, 65:13, 68:4, 91:11, 112:14, 126:3, 128:14, 134:21, 138:10, 159:6, 161:14, 165:1, 165:12 hand - 87:6 hands - 167:12 hang - 58:14 hanging - 111:6 hard - 41:20, 85:10, 85:15, 153:2 Hardly - 69:8 hardly - 69:10 harm -158:22 harmful - 73:4 Harrison - 17:5 Harvey - 76:3 hate - 103:20 head - 45:12, 121:16 heading - 66:12, 79:20 health - 78:22, 107:20 Health - 12:16, 14:13, 56:6, 76:9, 108:23, 115:3, 117:3 heard - 92:4, 92:6, 92:11, 101:2, 104:15, 104:20 Hearing - 1:18 hearing - 83:9, 144:13 hearsay - 92:4 heart - 14:19 Heat - 48:10 heat - 64:3, 139:2 heated - 67:1 heavily - 5:21 Hector - 45:15 held - 15:11 help - 5:3, 5:5, 16:11 helpful - 77:8, 94:18, 165:6 Helsinki - 90:10, 137:2, 143:17 Henderson - 43:7, 43:13, 57:21, 58:9, 59:15, 59:16, 61:14, 82:5, 84:11, 84:14, 85:19, 86:2, 86:9, 89:9, 90:23, 98:19, 99:10, 99:21, 100:9, 100:14, 101:16, 102:2, 102:16, 102:19, 102:22, 103:2, 103:18, 103:22, 105:15, 105:22, 113:7, 113:13, 121:11, 121:16, 123:10, 124:18, 144:16 Henderson's 61:21 Henry - 2:14 hereby - 167:6 herein - 167:9 hierarchy - 71:13, 73:9, 74:23 high - 6:9, 79:12, 86:8, 86:11, 119:12, 144:21, 151:13, 151:19, 154:23 higher - 35:21, 36:13, 144:5 highest - 6:15, 42:1, 42:8, 44:18, 121:15 highlighted - 54:17, 56:18 highly - 135:20 Hillerdaul - 135:14 hired - 58:1, 83:21 histochemical 14:6 histologic - 14:6 histories - 15:23, 18:10 history - 16:17, 19:2, 42:15, 63:1, 88:9, 107:1, 107:2, 136:20, 144:19 hit - 137:10, 137:13 Hodson - 152:12 home - 123:5 honest - 102:20, 111:13, 113:8 honesty - 111:4, 111:8, 111:13, 111:16, 111:19, 112:11 Honor - 3:8, 3:19, 8:22, 11:21, 13:6, 20:14, 22:3, 23:4, 23:9, 23:10, 37:15, 39:20, 51:3, 58:23, 65:4, 68:1, 83:8, 97:8, 99:12, 112:9, 114:13, 126:8, 126:17, 127:23, 130:3, 138:5, 138:7, 146:13, 163:22 Honorable - 1:6 hope - 111:1 hopefully - 14:11, 20:9, 72:12 horrible - 86:17 horse - 86:19 hospital - 17:4, 17:10, 21:7, 45:12, 47:4 Hospital - 17:5 hospitalized - 47:6 hospitals - 44:13, 45:1 hour - 165:17 house - 130:20 huge - 86:1 human - 21:20, 23:5, 27:13, 30:12, 33:22, 74:3, 112:19, 141:6, 141:21, 142:5, 144:14 humans - 3:17, 3:22, 5:11, 8:20, 15:14, 21:22, 23:15, 25:19, 38:1, 133:1, 137:18, 141:12, 141:14 Huncharek - 39:7, 54:16, 85:13, 86:21, 87:11 hundred - 35:22, 152:17 hyaline - 10:15, 31:14, 32:3 hypotheses - 68:15 hypothesis - 66:11, 100:5, 137:17, 137:20 Hypothesis - 137:17 hypothetical - 83:7 \ idea - 30:7, 96:19, 101:19, 148:9, 155:10, 160:8 identification - 72:1 identified - 27:8, 55:7, 91:2, 112:4, 122:12, 159:10 identify - 68:8, 73:7, 147:12, 147:14, 149:17, 153:8, 154:13, 163:18 identifying - 120:20 idiopathic - 136:9 ignoring - 75:8 \ii - 1:6, 1:12 illustrates - 100:22 immediately - 27:14 immunohistochemi cal - 14:7 impact - 82:4, 109:16, 140:2, 141:4 impacts - 89:11 impeaching - 83:10 implication - 104:2 implying - 123:16 importance - 59:16, 83:18 important - 20:2, 35:17, 39:17, 49:18, 50:9, 50:23, 55:11, 55:14, 82:6, 82:8, 84:18, 85:17, 86:21, 86:22, 89:15, 92:13, 92:17, 92:19, 104:21, 112:18, 114:8, 114:11, 114:12, 121:1, 132:19, 137:1, 141:13, 155:22, 156:11, 156:21, 157:1, 158:1 importation - 43:12, 99:18 imported - 42:7, 49:13, 49:15, 49:17, 61:13 impossible - 77:13, 147:11 improper - 83:10 impugning - 111:13 inaccurate - 104:22, 112:20, 125:9, 125:10 \nc - 2:7 incidence - 6:9, 6:15, 6:20, 42:2, 42:9, 44:18, 52:17, 52:22, 53:4, 53:7, 53:13, 60:10, 60:22, 61:3, 82:11, 88:1, 92:2, 124:19, 135:2, 135:6, 138:22, 139:6, 140:20, 159:17 incidents - 44:15, 48:15, 49:2 incites - 28:8 inclined - 41:10 include - 51:7, 63:14 included - 79:21, 93:7, 93:12, 94:16, 95:5, 95:12, 110:3 includes - 125:20 including - 14:17, 16:15, 23:15, 52:17, 60:8, 119:16 \ncluding - 54:4 incorporate 155:18 incorrect - 49:21 increase - 37:17, 60:10, 72:20, 79:12, 82:22, 88:1, 140:20, 154:21 increased - 52:22, 53:6, 53:12, 60:22, 61:3, 80:7, 81:4, 00174 8 82:10, 83:1, 88:18, 92:2, 124:19, 140:10, 140:11, 159:17 increases - 87:3, 87:4 incredible - 6:20 incredibly - 98:5 indicate - 13:16, 27:10, 101:13 indicated - 81:3 indicating - 4:15, 138:2 individual - 17:15, 17:16, 20:5, 20:6, 23:17, 23:21, 28:3, 29:20, 35:10, 35:14, 35:18, 36:3, 36:18, 40:2, 45:19, 50:17, 51:14, 55:11, 59:11, 65:2, 75:12, 85:3, 96:3, 96:4, 128:10, 128:14, 129:2, 129:9, 130:8, 130:19, 131:1, 131:18, 133:10, 134:7, 134:10, 137:12, 149:20, 154:12, 154:13, 164:17, 165:3 individual's - 37:18, 51:15, 87:12, 131:4 individualized 128:22 individually 165:10 individuals - 6:4, 6:6, 7:22, 9:2, 12:22, 15:23, 16:19, 17:7, 18:10, 34:3, 36:6, 38:13, 39:13, 42:13, 48:9, 48:12, 48:14, 49:10, 52:18, 53:8, 55:3, 55:8, 56:21, 58:1, 85:2, 86:15, 87:19, 102:6, 121:15, 121:17, 130:21, 133:4, 133:9, 133:19, 134:20, 136:16, 138:1, 160:17 induced - 6:13, 16:2, 85:12 Industrial - 39:11, 46:15, 132:3, 162:13 industries - 53:20 industry - 118:6 inference - 104:9 infinity - 135:10 inflammation 28:12, 28:18 inflammatory 4:14, 28:8, 28:11, 28:13, 28:15, 29:4, 31:5 information - 4:16, 4:18, 13:17, 38:14, 39:15, 39:16, 41:8, 48:2, 49:12, 57:7, 57:9, 57:15, 84:20, 85:1, 86:23, 91:7, 96:14, 100:17, 101:15, 104:17, 109:20, 114:2, 119:20, 122:15, 122:16, 122:23, 124:23, 125:4, 125:11, 125:19, 128:14, 128:20, 129:4, 129:7, 130:16, 141:1, 142:12, 150:13, 158:12, 160:23 inhalation - 24:10, 27:17, 80:4 inhale - 24:4, 24:7 inhaled - 22:15, 23:5, 23:14, 23:17, 25:8, 27:14, 34:5 inhales - 27:13, 28:1, 29:18, 30:12 inhaling - 24:9, 151:4 inhibit - 25:13 initial - 67:21, 79:8 initiate - 48:2, 78:6 initiator - 98:11 injected - 152:6, 153:6 injection - 152:6 injuries - 36:16, 137:15 injury - 9:8, 9:9, 9:10, 21:9, 23:14, 25:4, 25:23, 27:12, 27:15, 27:17, 38:6, 141:9 inorganic - 154:6 inquiry - 71:15, 74:8, 121:22 inside - 21:21, 22:15, 23:5, 26:2, 30:17, 32:11, 32:13, 35:1 inspector - 52:15 instance - 26:20, 34:2, 36:6, 56:22, 58:4, 72:19, 75:7, 133:5 instances - 27:11, 157:6 instead - 47:7, 99:4, 111:12, 111:16 institution - 7:10 insulating - 48:13 insulation - 124:7, 129:3, 129:7, 152:23 Insulation - 48:10 insulator - 128:15, 129:3 insulators - 48:21, 49:6, 50:3, 50:5, 139:2, 139:3 insure - 105:8 intake - 72:21 integrity - 89:8, 104:21 intend - 104:1 intended - 65:22 interest - 117:19, 125:6, 146:14, 155:17 interested - 8:23, 41:15 interesting - 41:8, 52:9, 143:2 interestingly - 26:6, 90:16 international 115:16, 116:16 International - 7:13, 13:19, 15:1, 15:10, 56:5, 108:22, 115:2, 117:2 interpret - 5:4, 97:11,97:13 interpretation 97:9 interpreting - 97:7 interrupted - 41:21 interrupting - 97:5 interstitial - 18:6, 28:22, 29:11 intervals - 80:14 interviewed - 42:14, 70:19 invaginate - 31:18 inverse - 97:16 investigated - 79:15, 79:17 investigating - 78:22 investigation 130:9 involve - 28:10, 29:7, 30:22 involved - 5:9, 5:21, 14:10, 14:11, 15:6, 21:6, 28:15, 38:21, 63:23, 66:18, 74:8, 101:14, 103:16, 130:4, 149:22, 150:22 involvement - 18:21 involving - 8:11, 31:12, 33:8, 66:22, 99:18 ions - 69:20 issue - 38:11, 45:14, 86:7, 98:7, 98:8, 114:16, 116:2, 116:5, 117:23, 118:10, 118:11, 118:12, 134:23, 147:21, 147:23, 152:11, 153:14, 159:14 issues - 67:23, 71:3, 151:16 Italy - 17:19 itself - 53:20, 55:2, 108:16, 153:14 J Jacobs- 1:15 Jama- 52:20 James- 2:4, 42:22 Jane- 113:3 January- 56:10, 62:23, 106:10 jeans - 32:19 job - 4:20, 50:12, 54:7, 56:13, 128:19, 133:16, 134:20 jobs - 123:15 John- 1:8, 9:5 Johnson- 2:6, 2:7, 2:13, 67:8, 67:10, 67:17, 68:1, 126:6, 126:11, 126:14, 126:15, 126:21, 127:1, 127:9, 127:18, 138:6, 138:9, 146:11, 159:3, 159:5, 161:12 join - 91:19 Joseph- 1:6, 1:12, 2:9 Journal - 33:5, 39:11,46:14, 49:14, 52:21, 56:5, 71:6, 108:22, 115:2, 117:2, 132:3, 162:13 journal - 10:3, 62:8, 71:8, 109:5, 109:6, 109:7, 109:13, 114:16, 115:13, 115:16, 116:3, 116:23, 117:5, 119:15, 119:22, 135:14, 156:10 journalist - 116:14 Jr- 2:2, 2:4 Judge- 73:23, 86:20, 165:15 July- 33:4 July/september115:23, 117:4 jump - 126:19 Justice- 117:12 K Kai - 2:12 Kamp - 66:8, 66:18, 98:9, 98:15 Kaplan - 2:11 Kathleen - 2:11 Kazan - 116:9, 116:11, 117:8 Kazan-allen - 116:9, 116:11, 117:8 keep - 19:10 keeping - 18:8 keeps - 44:14 Kemp - 33:4 kept - 48:23, 157:7 key - 64:4 kid - 163:2 kids - 150:8 kill - 142:6 Kimberly - 47:4 kind - 33:11, 34:17, 37:1, 51:19, 58:14, 61:22, 67:18, 69:19, 73:18, 83:8, 84:22, 137:12, 142:17 kinds - 25:6, 132:5 King - 1:21 Kitsap - 6:5, 6:17 knowing - 34:1, 102:2, 153:16, 157:22 knowingly - 74:11 knowledge - 143:7, 143:8, 145:12, 145:17, 145:23, 146:4 knowledgeable 62:11 known - 38:21, 65:20, 66:2, 87:17, 87:18, 103:2, 121:17, 132:16, 138:13 knows - 32:13, 61:7, 138:12 Kohlburg - 2:10 Kriebel - 76:17 Kron - 2:4 Kuery - 2:14 L lab - 4:23 laboratory - 4:20, 5:2, 5:4, 141:5 lack - 15:15, 140:11, 157:19 ladder - 62:6 lady - 136:10, 137:3 Langer- 38:20, 50:20, 50:23, 85:11, 87:10 Langer's- 53:17 large - 24:15, 60:6, 130:11, 130:17 larger - 25:10 largest - 138:23 last - 14:4, 37:4, 43:2, 56:7, 61:17, 93:6, 95:4, 113:16, 125:7, 127:7, 127:15 late - 49:18, 165:23 latencies - 96:6, 96:19, 97:21, 97:23, 98:3, 98:6 latency - 34:9, 34:14, 34:16, 35:18, 35:22, 37:1, 89:15, 89:18, 90:5, 90:9, 90:12, 90:15, 90:16, 91:4, 92:15, 92:20, 92:22, 93:6, 93:8, 93:9, 93:10, 93:13, 94:15, 94:17, 95:4, 95:6, 95:7, 95:8, 95:13, 96:1, 96:4, 96:5, 96:9, 96:10, 96:11, 96:14, 97:2, 97:14, 97:17, 98:12, 98:19, 98:22, 136:21 Latency- 34:23, 137:1 latent - 34:11 latest - 11:4, 45:14, 152:5 laughing - 70:20 Laurie- 116:8, 116:11, 117:8 lawyers - 8:17 lead - 154:1, 154:11 leadership - 13:4, 13:7 least - 27:11, 32:18, 35:19, 37:10, 38:14, 40:8, 40:15, 49:16, 67:6, 67:7, 73:14, 76:13, 82:9, 88:7, 131:20, 165:17 leave - 112:7, 165:20 Leblanc- 1:11 lecture - 14:3 led - 87:1, 161:10 left - 24:16 leg - 146:22 Legacy- 117:14 legal - 15:21, 18:22, 19:1, 21:7 legally - 103:16 legible - 78:2 Leigh- 42:22, 42:23, 56:1, 56:2, 61:14, 82:6, 85:20, 86:2, 89:9, 90:22, 91:23, 92:21,94:9, 97:12, 97:22, 98:18, 100:21, 101:12, 101:16, 102:1, 102:17, 102:21, 104:10, 104:16, 105:1, 105:20, 106:20, 107:7, 108:20, 109:22, 113:7, 113:14, 114:15, 121:11, 121:15, 123:9, 123:17, 124:18, 144:16 Leigh's- 86:10, 106:18, 119:16, 122:4 Lemen- 39:10, 52:11, 80:16, 96:23, 108:13 Lemen's- 52:8 length - 39:4, 51:19 less - 25:11, 64:10, 74:15, 82:13, 93:9, 95:7 lesser - 23:1, 43:23, 44:22 letter - 57:14, 101:13, 105:2, 106:18, 106:20, 107:7, 107:8, 107:11, 107:15, 108:14, 00175 9 109:22, 119:10 level - 13:2, 27:13, 29:23, 66:2, 135:12, 135:18, 164:20 levels - 58:13, 77:12 liberated - 32:7 lifespan - 141:19, 141:21 lifetime - 110:15, 114:21, 118:17, 119:4, 119:8, 119:11, 151:6 light - 105:18 Lights- 164:10 likelihood - 99:8 likely - 82:13, 144:6, 158:19, 161:21 limit - 63:20 limitations - 141:16 limiting - 25:6 line - 33:7, 67:22, 123:22 lines - 24:20, 142:3 lining - 52:23, 53:7, 107:3, 107:4, 107:5, 111:11 linings - 51:7, 54:4, 56:16, 63:3, 64:2, 79:17, 91:3, 100:23, 101:11, 108:5, 159:7 link - 47:16, 150:2 list - 42:20, 43:1, 113:14, 113:15, 114:1 listed - 43:4 listen - 92:21, 98:17 listing - 68:21, 117:6 literature - 10:23, 40:18, 40:22, 41:4, 41:23, 47:19, 54:23, 90:14, 129:12, 130:6, 131:9, 131:13, 131:14, 132:13, 164:5 Literature- 60:1 litigation - 8:11, 8:14, 40:5, 40:6, 40:8, 40:11, 40:12, 92:1, 102:17 Litigation- 1:3 live - 6:5, 163:7 lived - 130:11 liver - 132:8 living - 6:4, 131:8 Llp- 1:11, 2:2, 2:5 lobes - 26:7 localized - 11:7, 31:10 Locate- 78:13 located - 6:1,47:3 location - 25:8 locations - 30:20 locks - 63:3 lodged - 25:2, 25:3 logical - 108:6 longest - 90:16 look - 19:7, 19:8, 20:14, 20:16, 20:17, 21:5, 21:8, 28:9, 37:7, 45:17, 48:15, 71:7, 75:4, 80:14, 85:7, 86:12, 89:18, 98:3, 104:10, 114:4, 114:5, 122:4, 132:19, 133:10, 134:16, 134:22, 135:11, 136:18, 136:19, 136:23, 143:10, 148:21, 162:12, 165:2 looked - 19:17, 27:3, 32:18, 42:18, 48:18, 55:6, 68:23, 86:6, 101:20, 104:16, 133:4 looking - 4:9, 10:12, 20:22, 35:17, 52:16, 53:21, 55:9, 71:14, 133:9, 133:19, 134:20, 136:14, 136:15, 142:11, 142:17, 143:18, 154:12 Lopez- 83:7, 83:20 lousy - 143:18 low - 135:12, 151:12 lower - 26:5, 26:10, 31:12, 80:9 lunch - 166:2 luncheon - 65:9, 165:17 Lung- 14:15, 14:17 lung - 5:13, 6:12, 8:8, 10:1, 10:4, 10:18, 12:13, 12:20, 16:2, 16:6, 16:14, 16:15, 19:17, 21:20, 21:21, 22:6, 22:7, 22:15, 23:5, 23:6, 24:16, 24:22, 25:11, 25:14, 26:2, 26:6, 26:10, 28:1, 28:22, 29:7, 29:13, 30:17, 30:18, 30:21, 30:23, 32:12, 32:13, 33:16, 34:8, 34:10, 34:20, 35:1, 37:9, 39:3, 48:22, 51:15, 52:22, 53:1, 53:7, 53:8, 53:13, 62:7, 74:16, 77:20, 121:18, 125:19, 130:23, 131:4, 143:4, 143:12, 143:13, 143:16, 143:19, 144:5, 144:10, 147:14, 150:6, 150:7, 150:9, 150:12, 150:17, 150:18, 153:22, 154:1, 154:7, 154:8, 154:10, 154:19, 154:21, 155:2, 156:19, 158:7, 159:23, 163:13, 163:14, 164:3, 164:6 lungs - 25:9, 27:8, 50:5, 55:20, 55:21, 78:18, 137:7, 160:16, 162:2, 162:8, 162:22, 162:23 lying - 103:10, 111:17 lymph - 10:16, 10:18 lymphocytes 28:14, 28:16, 28:20 lymphomas - 88:8 Lynne- 1:20, 167:2, 167:15 Lyon- 2:13 M machines - 4:21 macrophages 28:15, 28:16 macroscopic - 14:6 magic - 22:13 magical - 22:10, 22:14, 78:18 main - 4:20, 24:14 major - 45:3, 48:19, 56:20, 71:18 majority - 132:11, 162:1, 162:7, 163:9 makings - 90:23 male - 63:6, 63:9 Malignant - 108:20, 114:23, 117:10, 129:20 malignant - 11:7, 55:23, 60:2, 81:19 mammals - 141:12 man - 17:21, 38:23, 51:12 manifest - 53:20 manner - 73:5, 74:2 manufacture 107:3, 107:4 manufactured 43:5 manufacturer 82:13, 83:22 manufacturers 51:7 manufacturing 43:23, 91:3, 101:14 March - 99:16 Marchand - 46:15 Margaret - 2:15 mark - 116:21 Mark - 2:12 marked - 117:1 markedly - 140:16 Marlboro - 164:4, 164:9 Marlboros - 164:6, 164:9 Marshan - 132:2 Mason - 7:10 mass - 33:16 material - 28:7, 62:16 materials - 64:2 matter - 75:16, 143:15 Mayo - 12:11 Mccaughey - 38:19, 45:9, 45:10, 45:11, 46:2, 47:13, 50:19, 50:22, 53:17, 58:4, 58:13, 85:11, 87:10, 131:23 Mcdowell's - 83:23 Mcguirewoods 2:2 Mcnutt - 9:6 Md - 3:11 mean - 29:8, 37:3, 69:10, 69:21, 84:10, 102:8, 102:10, 103:13, 105:2, 111:20, 120:2, 120:14, 121:14, 123:4, 140:21, 142:4, 147:18, 162:3 meaning - 149:20 meaningful - 73:5, 112:4, 114:10 means - 36:13 meant - 99:1, 99:2 measure - 77:11 measurements - 12:18, 78:1 measures - 78:1 mechanic - 22:9, 22:19, 39:1, 51:13, 54:14, 63:6, 82:12, 110:6, 110:7, 110:8, 110:20, 118:19, 118:23, 119:8, 122:17, 123:5, 123:14, 159:14 mechanic's - 22:6 Mechanics - 63:2 mechanics - 23:15, 33:20, 57:5, 60:3, 60:6, 60:11, 60:23, 61:19, 62:21, 63:4, 63:9, 63:15, 63:23, 76:10, 79:18, 81:20, 93:16, 95:16, 97:3, 100:15, 100:16, 102:8, 105:16, 105:23, 106:8, 106:14, 114:22, 119:4, 119:7 mechanism - 34:2, 68:5, 146:23, 148:21, 149:5 mechanisms 141:8, 141:23 mediastinum 10:20 mediators - 28:18, 28:19 Medical - 7:10, 52:21, 69:11, 71:6, 71:8 medical - 7:18, 10:23, 11:15, 40:18, 41:4, 46:21, 47:19, 47:20, 50:4, 59:1, 64:21, 69:16, 69:21, 70:18, 90:14, 130:6, 145:18, 157:8, 160:8, 164:5, 165:1 medically - 64:23 Medicine - 39:11, 46:15, 49:14, 132:4, 135:16, 162:14 medicine - 15:16, 18:18, 19:9, 59:5, 59:8, 69:7, 69:15, 69:22, 70:5, 70:12, 70:14, 70:20, 70:23, 73:7, 73:17, 74:23, 86:22, 149:18 Melissa - 2:12 member - 13:19, 14:13, 14:22, 76:8 members - 48:9, 139:2 membrane - 32:22 membranes - 45:16 mentioned - 18:10, 26:18, 34:15, 34:19, 41:22, 43:17, 52:9, 54:11, 58:3, 58:4, 59:14, 78:11 Merewether 52:10, 52:13, 53:23 Merewether's 51:6, 53:19 mesentery - 10:6 meso - 7:23, 137:4 meso' - 47:23 mesos - 53:3 mesothelial - 10:15 mesothelioma 6:11, 6:16, 6:19, 6:22, 7:5, 7:13, 8:8, 9:1, 9:3, 9:11, 9:14, 9:16, 9:19, 10:2, 11:7, 12:9, 12:23, 13:8, 13:15, 13:17, 14:1, 14:3, 14:8, 14:18, 16:3, 16:5, 16:6, 17:16, 17:22, 18:11, 19:16, 19:17, 27:3, 33:18, 34:8, 34:11, 35:19, 37:9, 38:12, 38:23, 39:7, 39:13, 40:15, 41:15, 41:16, 42:2, 42:9, 42:12, 42:23, 43:20, 44:3, 44:7, 44:8, 44:19, 45:19, 46:1, 46:4, 46:11, 46:16, 46:22, 47:1, 47:17, 48:15, 48:22, 49:11,49:19, 51:11, 51:21, 54:13, 55:23, 56:21, 60:2, 60:10, 60:22, 61:3, 61:18, 63:8, 63:16, 63:21, 65:21, 66:4, 74:16, 79:13, 80:4, 81:4, 81:12, 81:19, 82:11, 82:22, 84:2, 84:15, 85:9, 85:12, 86:9, 86:12, 86:14, 87:12, 87:17, 87:21, 88:2, 88:7, 88:10, 88:13, 88:16, 89:18, 89:21, 91:1, 100:10, 100:12, 106:7, 113:17, 114:3, 120:9, 120:10, 124:20, 128:15, 128:16, 130:8, 131:17, 132:11, 132:12, 132:14, 132:17, 134:1, 134:3, 134:7, 135:2, 135:7, 135:18, 135:20, 136:9, 136:11, 136:15, 136:16, 139:6, 139:11, 139:12, 140:7, 140:22, 142:2, 142:5, 143:6, 143:14, 144:7, 144:9, 144:14, 144:23, 145:2, 145:4, 145:13, 145:20, 146:3, 146:9, 148:3, 148:5, 148:8, 151:21, 151:23, 152:15, 153:15, 156:1, 156:6, 156:7, 156:17, 156:18, 159:12, 159:17, 160:11, 160:12, 160:14, 161:23, 162:8, 163:10, 163:15, 164:21 Mesothelioma 11:5, 13:9, 13:20, 14:2, 14:16, 38:20, 42:16, 43:14, 45:14, 53:18, 56:10, 62:20, 78:13, 108:21, 114:23, 117:10, 129:21 mesotheliomas 9:16, 10:10, 42:21, 43:3, 45:17, 45:18, 45:22, 47:9, 53:2, 55:8, 60:5, 62:21, 63:7, 63:10, 63:18, 63:22, 89:16, 98:2, 98:5, 105:15, 106:8, 108:4, 152:9 met - 65:16, 69:6 Meta - 85:3, 107:16, 110:3 metal - 79:9 methodologies 89:9 methodology 11:15, 59:8 Methods - 76:18 Michael - 2:11, 2:13, 9:6 micrometers - 39:5, 00176 10 51:18 microscope - 9:12, 9:15 microscopic - 37:10 mid - 9:21,44:21 mid-1990s - 101:18 might - 20:10, 29:15, 53:2, 58:16, 63:22, 68:9, 69:9, 91:7, 99:6, 122:5, 149:23, 151:4, 151:5, 151:16, 153:19, 153:20, 154:2, 155:23, 163:20 miles - 5:18 milled - 162:5 millers - 63:19, 64:10 milligram - 152:7 million - 44:4, 63:8, 63:10, 63:17, 63:18, 63:21, 64:6, 64:7, 135:19, 140:17, 161:5 mills - 100:18 mind - 19:10, 145:18 Mine - 42:6, 117:12 mine - 58:8, 61:11, 70:17 miners - 46:2, 63:19, 64:10 miners/millers 46:4 mines - 42:4, 42:6 minimal - 97:21 Mining - 117:13 mining - 46:13 minor - 71:18 minus - 119:1 minute - 19:4, 92:18, 131:7 minutes - 18:9, 65:6, 138:6 Miranda - 2:11 misstate - 83:5 mistake - 108:3 mistakes - 112:19 mixed - 36:18, 49:7 modality - 9:20 Modified - 164:15 molecular - 12:18, 33:3, 33:6, 66:2, 155:9 moment - 81:2, 148:17 monitoring - 74:2 month - 16:14 monthly - 18:16 months - 142:7 Montreal - 15:11 morning - 3:7, 3:8, 17:18, 65:5, 65:13, 65:14 morphology - 9:10, 19:15 most - 17:8, 27:10, 30:21, 37:8, 40:7, 42:4, 47:7, 106:14, 111:23, 134:3, 135:11, 152:9, 154:20, 155:1, 161:21 motion - 37:15 motives - 112:3 Mount - 48:7 mouth - 24:13, 24:18 move - 37:14, 153:4, 155:14 moved - 63:12 movement - 69:15 mucociliary - 24:19 multi - 70:22 multi-disciplinary 70:22 multiple - 46:19, 143:6, 151:5, 153:10, 154:14, 161:7 multiplicative 154:21 multipotential - 9:7 must - 131:10 muster - 21:11 mutation - 149:13 mutations - 32:18, 148:23, 149:1, 155:12 myocardial - 70:8 N name - 9:5, 9:6, 65:15, 76:14, 105:6, 129:20 names - 58:3 national - 118:14 naturally - 24:3 nature - 149:21, 149:22 Naval - 6:1, 86:16 Neal - 2:13 near - 131:8 necessarily - 80:12, 120:15, 141:22, 143:23, 144:8, 152:22, 157:7 necessary - 74:13 neck - 111:6 need - 11:12, 18:9, 19:8, 71:1, 75:8, 79:5, 99:11, 100:13, 107:18, 165:21 needs - 85:23, 165:22 nefarious - 107:19 Neighborhood 129:21 neighborhood 130:19, 131:15 Neltson - 17:20, 17:21 neoplasm - 156:5 neoplasms - 12:13 neoplastic - 38:8 neuraxis - 88:13 neutrophils - 28:10 never - 17:10, 21:4, 46:18, 69:6, 69:8, 92:11, 103:2, 110:7, 123:17, 142:21, 162:8, 163:6, 163:10 nevertheless 150:1 new - 6:10, 6:19, 7:23, 64:1, 70:11, 70:13, 70:27, 71:20, 73:15, 130:20, 155:16 New - 1:2, 48:7, 49:13, 135:4, 167:9 news - 162:19 newsletter - 116:15 next - 15:8, 54:11, 56:7, 95:10, 117:8, 117:9, 117:11, 117:12, 117:13, 117:14, 126:13, 151:3 next-to-the-last 56:7 niosh - 26:15, 27:11 nobody - 80:2, 155:6 nodes - 10:16, 10:18 nominal - 127:20 non - 162:15 non-occupationally - 162:15 nonasbestos 129:7, 155:4 nonasbestoscontaining - 129:7 Nonetheless 62:19, 106:6 nonoccupational 135:13, 161:22 noon - 65:8 normal - 10:14, 18:13 normally - 28:7, 29:1 northwest - 8:3 northwestern 145:14 nose - 24:13, 24:17 notable - 42:5 notebook - 122:11 noted - 3:4, 110:1 nothing - 83:11, 88:21, 120:5 Notwithstanding 145:5 nowadays -111:20, 162:23 number - 6:7, 6:11, 7:11, 7:14, 8:1, 8:7, 38:11,41:6, 42:4, 43:23, 44:1, 44:22, 45:20, 50:14, 61:19, 80:10, 86:12, 86:14, 86:17, 87:19, 92:11, 94:7, 98:7, 100:13, 100:14, 104:12, 105:19, 108:4, 110:14, 110:22, 125:8, 135:22, 140:11, 140:14, 140:17, 140:19, 154:6 numbers - 92:15, 92:22, 96:15, 96:20, 96:21, 100:4, 100:8, 131:3 nurses - 42:14 nuts - 58:18 0 object - 83:9 observation 49:14, 75:12 observational 74:18, 74:19, 74:22, 75:5, 75:11, 75:13 observe - 73:18, 73:19, 132:15 observed - 35:2 obtained - 130:23 obvious - 140:5 Obviously - 46:12 obviously - 20:1, 20:2, 35:7, 47:15, 48:17, 73:20, 117:23 occasion - 17:8 occupation - 39:1 0ccupational 56:5, 76:18, 108:22, 115:3, 117:2, 135:15 occupational 42:15, 78:19, 79:7, 79:22, 80:11, 101:3, 101:10, 101:23, 104:17, 107:1, 163:9, 164:22 occupationally - 162:15 occupations - 42:20, 43:3, 43:4, 50:15, 63:13, 110:9, 110:16 occur - 12:13, 27:12, 29:23, 93:9, 95:7, 133:3, 149:6, 149:14 occurred - 24:3, 26:5, 42:21, 45:20, 49:2, 52:18, 93:19, 94:12, 95:19 occurrence - 60:5 occurring - 26:18, 51:21 occurs - 26:7, 26:12, 26:17, 30:20, 32:12 October - 1:18, 3:1, 62:23, 106:10, 106:21, 167:12 odd - 79:7 odds - 110:5 offer - 96:14, 157:17, 157:20 offered - 147:10 office - 89:20, 91:19, 137:10, 157:14 Office - 167:10 Official - 1:21, 167:4, 167:17, 167:20 often - 19:1, 132:18, 152:21 Oi- 2:7 old - 17:22, 150:9, 156:4, 156:14, 156:15, 162:17, 162:20 omentum - 10:5 once - 22:14, 25:3, 30:2, 114:6, 137:17 one - 6:22, 7:4, 9:4, 9:9, 11:4, 12:19, 13:11, 15:20, 17:18, 19:7, 20:3, 20:13, 27:19, 32:13, 34:1, 35:13, 38:17, 40:10, 41:11,43:3, 44:3, 45:9, 53:1, 53:2, 54:22, 54:23, 56:15, 56:20, 57:6, 58:1, 60:8, 62:5, 63:5, 63:8, 63:11, 64:7, 64:16, 69:2, 73:3, 75:8, 76:11, 78:12, 81:9, 82:21, 85:13, 88:3, 88:11, 89:23, 94:14, 94:15, 98:21i 102:11, 102:20, 104:18, 111:21, 117:7, 117:8, 117:9, 117:11, 117:12, 117:13, 117:15, 119:2, 119:22, 119:23, 121:16, 124:5, 124:10, 135:18, 141:20, 141:22, 142:21, 142:22, 144:15, 149:23, 150:17, 151:3, 151:5, 152:8, 159:3, 159:4, 160:18 One - 63:22 one's - 37:17, 164:21 ones - 36:20, 36:21, 96:10, 101:16, 119:9, 161:9 online - 109:10 open - 19:11, 117:5 operating - 16:11 operations - 64:1 opinion - 6:23, 50:23, 62:18, 64:18, 82:23, 83:23, 84:16, 87:9, 100:11, 107:14, 120:4, 134:21, 137:9, 139:22, 147:17, 151:8, 159:9 opinions - 58:19, 58:22, 64:20, 83:3, 87:2, 141:2, 142:10 opportunism 103:7 opportunity 15:14, 18:12 opposed - 50:7 opposite - 50:8, 84:4, 158:23 options - 20:11 order - 67:7, 126:10, 126:18, 126:20, 150:1 organ - 78:2 Organization 14:14, 57:16, 99:17 organization 44:14 organizes - 149:3 organizing - 15:6 organs - 4:10 original - 108:7 originate - 33:13 Ottawa - 45:12 ought - 71:11, 73:12, 80:3, 91:3, 120:17 outcomes - 78:22 outer - 24:22 outside - 7:18, 8:6, 14:20, 18:13, 18:20, 21:21, 22:10, 23:6, 30:18, 32:11, 32:13, 34:20, 35:1, 40:5, 40:11, 142:9 overestimate 63:14 overhead - 99:11 overlap - 35:5 Overruled - 83:13 oversimplify - 68:8 overstate - 84:18 overview - 33:5, 39:20, 117:15, 118:14 overwhelming 38:5, 159:11 owner - 109:12 owners - 109:13 P pace - 157:7 page - 43:2, 56:7, 79:5, 120:8 Page - 59:18, 105:12 pages - 57:4, 135:16 pain - 70:6 Panel - 11:5i 13:9, 38:20, 42:16, 45:14 panel - 13:10, 70:22, 81:13 paper - 9:6, 9:8, 47:11,47:14, 62:13, 66:8, 66:14, 76:12, 76:13, 78:14, 97:19, 00177 11 100:21, 115:8, 142:19, 142:20, 142:23 papers - 9:2, 112:7, 115:18, 115:21, 118:13, 118:14, 157:21 paragraph - 106:22 Pardon - 125:14 parenchyma 33:16 parentheses 106:23, 110:16 parietal - 10:15, 31:1, 31:9, 31:11, 31:13, 31:21, 32:2 Part - 120:20 part - 10:19, 11:5, 24:2, 24:22, 26:10, 31:12, 43:9, 44:12, 46:13, 47:13, 61:17, 127:1, 130:13, 160:11 participating - 5:10 particular - 89:17, 93:4, 95:2, 115:14, 119:1, 144:12, 157:13 particularly - 125:1 partly - 117:22 parts - 10:8, 10:9, 24:6, 26:6, 26:10, 49:20 Pass - 65:4 passes - 21:11 past - 15:2 pathologic - 7:15, 12:19, 16:18, 16:21, 19:13, 27:4, 28:2 pathological 26:20, 30:16 pathologically 27:3, 33:12 pathologist - 7:6, 9:11, 12:11, 15:13, 18:23, 19:3, 19:7, 40:9, 61:23, 155:21, 158:11 Pathologist - 4:2, 62:1 Pathologists 17:13, 19:12 pathologists - 8:3, 8:5, 9:4, 13:10, 13:13, 13:21, 16:8, 17:9, 58:12, 62:5 Pathology - 7:13, 12:2, 12:12, 13:20, 14:2, 14:17, 15:2, 15:3, 15:7, 15:10, 43:8, 45:12, 57:21, 62:9, 143:1 pathology - 4:3, 4:6, 4:8, 4:19, 5:13, 14:22, 15:17, 19:23, 103:4, 153:16, 155:23 patient - 5:5, 19:2, 69:9, 70:1, 130:10, 154:13, 157:13 patients - 7:20, 16:4, 16:6, 17:10, 17:11, 17:13, 17:15, 17:16, 43:23, 47:5, 47:8, 157:9 Paul - 45:23 Pause - 69:3, 75:21, 91:9, 91:14, 91:17, 106:4, 106:19, 116:22, 157:5 Pc - 1:9 Pearce - 76:17 109:5, 109:8, 109:15, 111:2, 112:15, 112:21, 113:1, 113:2, 113:10, 114:10, 115:5, 129:11, 129:20, 130:5, 131:5, 131:12, 131:14, 135:14, 155:16 Peer - 11:10, 114:12 peers - 13:3, 13:8 Pemetrexed - 18:3 people - 6:8, 6:18, 10:1, 14:9, 17:9, 17:17, 28:5, 41:12, 43:4, 43:5, 47:8, 47:9, 47:15, 48:16, 53:5, 55:6, 61:4, 74:9, 74:12, 74:21, 80:10, 82:11, 83:3, 88:2, 88:20, 91:5, 97:15, 97:16, 97:20, 98:1, 100:17, 104:18, 106:14, 108:4, 111:4, 114:2, 120:3, 120:4, 120:9, 120:12, 120:13, 132:11, 132:19, 134:1, 135:19, 139:1, 139:4, 139:8, 139:10, 139:14, 139:17, 139:20, 140:12, 140:14, 140:17, 140:19, 140:22, 143:22, 151:14, 152:3, 154:22, 162:14, 162:16, 163:1, 163:4, 163:6, 163:12, 164:14 Pepple - 2:7 per - 6:11, 6:12, 6:19, 7:23, 44:3, 63:8, 63:10, 63:16, 63:18, 63:21, 64:6, 64:7, 135:19, 140:17, 152:2 percent - 12:8, 35:22, 39:3, 44:12, 45:1, 48:21, 48:22, 48:23, 51:18, 52:3, 90:19, 90:20, 110:16, 110:17, 134:12, 138:16, 139:10, 154:10, 154:11 percentage - 24:21 perform - 4:21 Perhaps - 103:7 perhaps - 102:12, 126:20, 163:8 period - 28:12, 29:6, 42:11, 49:1, 49:3, 62:23, 74:4, 106:9, 114:4, 120:8, 148:17, 149:7, 161:5 periods - 34:11, 34:14, 48:19 peritoneal - 152:7, 156:3, 156:18 Perry - 2:12 person - 13:18, 20:3, 24:9, 27:1, 27:6, 29:2, 37:11, 39:8, 44:4, 51:21, 63:7, 63:8, 63:10, 63:17, 63:18, 63:21, 64:6, 64:7, 70:6, 70:7, 70:10, 80:18, 91:18, 98:12, 103:23, 112:3, 113:15, 122:11, 122:17, 123:23, 128:3, 128:23, 136:14, 137:9, 142:6, 143:6, 146:1, 147:19, 148:2, 153:16, 154:6, 157:2, 159:21 person's - 25:12, 144:7, 144:9, 145:4 Ph - 17:20 Photo - 117:14 phrase - 69:19 physical - 27:9 physician - 3:16, 3:21, 37:5, 37:23, 46:5, 55:9, 62:3, 62:17, 128:8, 132:23, 165:7 physicians - 7:19, 8:6, 13:13, 41:2 pick - 75:6 picking - 75:7 picture - 20:14, 21:5, 21:15, 68:22, 75:19, 148:18, 155:20 pictures - 31:7 piece - 55:14 pieces - 21:14 pineal - 88:12 pinpoint - 149:20 pipe - 145:23, 146:2, 146:7 pipefitters - 79:9 place - 16:12 Place - 117:11 placed - 13:3 places - 44:20 Plaintiff - 1:9, 1:11, 1:13, 1:15 plaintiffs - 127:2 Plaintiffs - 3:9 plaintiffs' - 8:17, 67:11, 67:22, 126:10, 126:11 plan - 65:7 plant - 130:11, 130:16, 131:9 plants - 106:15 plaque - 31:15 plaques - 10:15, 32:3 plasma - 28:14 plastic - 130:12, 130:13, 130:17 plastics - 131:9 played - 89:17, 93:2, 94:23, 97:7, 98:17, 114:19, 122:8, 123:20, 137:20, 137:23 pleura - 10:14, 10:15, 15:9, 30:22, 31:1, 31:5, 31:9, 31:11, 31:13, 31:17, 31:20, 31:21, 32:3, 33:17, 143:3, 160:1, 162:8 Pleural - 12:8 pleural - 9:8, 9:9, 10:15, 15:9, 31:8, 31:14, 31:16, 32:3, 51:10, 53:1, 53:14, 54:13, 70:2, 70:3, 70:4, 156:17 Pllc - 2:7 plumbers - 79:9 plural - 6:13 plus - 100:17, 119:1 Pm - 166:3 point - 4:20, 19:23, 41:18, 42:8, 42:17, 67:11, 85:8, 96:13, 103:15, 107:21, 112:14, 149:10, 149:11, 155:9, 158:14 pointed - 50:22 Points - 44:11 political - 100:3, 103:8, 107:9, 107:23, 111:19 politicians - 111:20 population - 6:17, 54:2, 55:19, 55:20, 60:6, 63:11, 140:9, 140:12, 161:19 position - 16:21, 81:9, 100:3, 107:9 positions - 13:3 positive - 72:16 possibilities - 105:3 possibility - 128:18, 134:6 possible - 44:23, 77:11,93:5, 93:9, 95:3, 95:7, 98:13, 121:3, 121:5, 136:21 possibly - 53:3, 124:3, 159:3 Possibly - 124:2 potencies - 152:14 potency - 151:19 potent - 152:16, 152:17 potential - 21:8, 136:16, 141:14, 151:11 potentially - 20:7, 23:23, 24:4, 24:7, 88:22, 109:21, 111:9, 132:20, 144:1, 151:16, 153:22 Potter - 2:5 practical - 155:15 practice - 5:16, 5:17, 5:21, 7:6, 7:17, 7:18, 18:13, 69:7, 155:19, 157:8 practiced - 70:19 practicing - 18:23, 70:14 precludes - 149:23 premises - 132:15 prepared - 87:2 prescribe - 69:7, 69:8, 69:9 present - 10:17, 10:18 Present - 2:9, 3:3 presentation - 67:7, 157:9, 157:22 presented - 15:23, 16:13, 16:16, 105:9 president - 15:1, 15:2 pressure - 146:23, 147:5 pressures - 153:5 presumptive 67:16 pretty - 22:4, 62:10 prevent - 80:4 previous - 38:19 previously - 118:19 Price - 2:4, 91:18 primarily - 7:21, 8:16, 16:7, 17:15, 17:23, 33:18, 51:13, 61:11, 85:21, 102:7, 118:12 Primarily - 4:10, 22:23 primary - 82:12, 163:14, 163:15 principle - 30:5 principles - 11:15, 19:19, 59:5, 59:8, 165:2 priori - 79:22 probability - 64:21 probable - 64:23 probative - 71:14 problem - 67:10, 118:1, 120:8, 154:16, 159:19 problems - 34:1, 118:14, 151:11 proceedings 167:7 process - 4:13, 4:14, 25:5, 26:17, 27:22, 28:8, 28:9, 28:13, 28:16, 29:12, 29:17, 31:18, 33:8, 34:17, 34:23, 66:3, 66:6, 67:2, 78:7, 82:15, 82:19, 92:1, 112:15, 148:19, 149:21 produce - 28:20, 29:1, 30:16, 77:10, 141:11, 142:2 produced - 42:7, 152:8 producing - 22:18, 28:23, 102:9, 130:16 product - 23:19, 24:11, 37:4, 39:14, 53:16, 53:21, 82:21, 88:23, 92:9, 100:19, 102:10, 133:15, 134:21, 144:21, 146:8, 151:2, 151:3 products - 30:11, 32:8, 37:17, 38:15, 40:1, 43:15, 51:13, 51:22, 54:21, 55:4, 61:5, 61:8, 61:15, 65:1, 67:2, 82:12, 84:1, 96:7, 134:2, 138:3, 142:16, 161:7, 161:8, 165:6 Products - 59:18 profession - 100:15 professional - 76:9, 89:5, 91:2, 100:16 Professional 167:4 program - 15:4 programs - 15:6 progress - 29:11 progressed - 29:12 progression - 90:6 project - 10:12 projects - 9:23, 10:20, 14:11 proliferation - 33:15 promote - 78:6 promoter - 98:11, 148:10 prompt - 159:1 pronunciation 56:3 proof - 144:19, 145:6, 159:12 propensity - 142:14 prospective - 74:2 prospectively 74:21 protective - 72:16, 72:23, 73:3, 80:2 Prothonotary 167:10 00178 12 32:19, 148:23, 155:12 prove - 84:15, 87:7, 87:15, 152:4 proven - 49:21, 137:21, 137:23 provide - 44:13 provided - 109:3 providing - 107:2 province - 145:15 provocative - 115:18, 115:21 prudent - 158:10 pseudo - 53:3 public - 100:5, 107:20, 117:20, 139:7 Public - 76:8 publication - 52:7, 71:5, 104:22, 109:10, 115:6, 117:19, 118:9, 129:20, 130:5, 131:6, 135:11, 144:16, 160:11 publications - 11:2, 11:18, 33:2, 131:20 publish - 41:9, 41:10, 111:8, 115:17, 115:20, 120:14 published - 9:2, 9:6, 10:3, 12:3, 12:15, 14:12, 14:14, 26:15, 40:18, 40:20, 40:22, 41:3, 41:19, 42:22, 43:18, 51:17, 52:20, 56:4, 62:8, 71:17, 76:16, 76:17, 83:3, 85:2, 85:20, 90:13, 91:8, 98:4, 98:9, 100:8, 107:17, 108:15, 108:18, 108:21, 118:13, 131:11, 131:12, 131:13, 132:19, 135:3, 135:14, 135:15, 142:23, 152:13, 155:23, 157:21, 159:18, 162:12 Puget - 5:19, 6:1, 86:16 pulled - 94:2 pulmonary - 27:8, 77:20 Pulmonary - 12:2, 12:12, 15:1, 15:7 pulmonologist 70:17 pulmonologists 7:21 pure - 85:8 purely - 98:7 purpose - 117:18, 118:3, 125:23 put - 7:12, 53:10, 57:17, 70:22, 99:3, 99:11, 125:4, 131:9, 137:3, 155:5 puts - 110:15 puzzle - 21:14, 55:15 Q qualified - 114:10 quality - 4:23, 57:15 quantified - 77:19 Quebec - 24:5, 46:2, 46:4, 63:18, 132:1 Quest - 117:12 questioning - 67:8, 111:11 questionnaire 107:1 questionnaires 42:18 questions - 65:17, 65:22, 67:11, 68:13, 89:4, 126:14, 132:23, 138:7, 146:11, 146:14, 146:15, 146:20, 147:10, 159:2 quick - 21:18, 50:19, 52:13, 68:13, 163:22 quickly - 54:13 quite - 9:2, 58:3, 59:11, 149:10 R radiated - 88:8 radiation - 87:22, 88:2, 88:5, 88:7, 88:13, 88:15, 88:20, 90:15, 132:10, 136:20 radical - 66:11 radiographic 16:17 radiographically 27:8 radiology - 16:2 randomized 73:10, 73:20, 74:1 Randomized- 73:13 ranges - 90:18, 154:23 rare - 7:3, 11:6, 41:5, 41:15, 140:1, 158:7, 158:13, 160:6, 161:23 rat - 141:19 rate - 44:3, 63:16, 63:17, 63:20, 64:7, 64:9, 64:16, 82:22, 139:11, 139:13, 139:16, 139:19, 140:1, 140:8, 155:2 rather - 156:18 Rather- 78:4 ratio - 110:5 ratios - 79:8 rats - 152:8 raw - 100:18 ray - 32:4 Rdr- 1:20, 167:15 re - 131:22 Re- 1:3 reach - 147:16 reaching - 25:11 reaction - 22:17, 76:22 read - 50:20, 77:5, 79:5, 104:7, 105:13, 129:17 reading - 61:20, 107:18 real - 21:18, 40:21, 50:19, 52:13, 54:13, 62:6, 86:13, 109:5, 163:22 realize - 44:17 really - 18:21, 25:1, 34:7, 50:5, 60:18, 70:13, 71:19, 71:23, 72:11, 82:6, 86:8, 86:11,96:11, 103:11, 103:20, 109:18, 111:5, 112:2, 119:3, 119:6, 140:9, 147:11, 147:15, 147:23, 149:9, 153:2, 155:9, 158:20, 160:8, 162:18, 163:4, 164:2 Realtime- 167:3 Reardon- 2:12 reason - 36:5, 41:22, 47:14, 50:6, 70:21, 80:23, 87:6, 90:4, 107:11, 107:14, 107:15, 108:1, 108:6, 108:16, 112:15, 131:13, 132:22, 134:5, 153:3 reasonable - 59:4, 59:7, 64:21, 113:19, 133:2, 133:6, 133:8, 164:7, 164:8 reasons - 38:3, 41:11, 107:23, 111:19 receive - 4:10, 8:1, 71:7 received - 18:2, 18:3, 88:5, 88:15 receiving - 88:2 recent - 135:11 recently - 108:14 receptor - 149:5 receptors - 32:21 recess - 65:6, 65:9, 65:11, 165:17, 166:1, 166:2 recognize - 78:14, 156:22 recognized - 49:9 record - 58:23, 67:6, 67:14, 73:23, 78:16, 83:17, 91:5, 100:14, 129:18, 167:10 records - 62:21, 106:7, 114:5 redirect - 127:12 Redirect- 127:21 reduce - 120:18 Reese- 2:10 refer - 28:3 referees - 115:11 reference - 66:18, 110:2, 110:4 referenced - 45:8, 52:7, 57:14, 66:9 references - 66:15, 105:11, 106:7 referred - 26:14, 29:10, 31:18, 47:12, 52:23, 130:19 referring - 100:22 reflect - 120:3 regard - 20:13, 94:11, 121:15 regarding - 8:20, 11:23, 36:9, 141:4 regardless - 93:13, 94:3, 95:13 regards - 20:22, 164:2 region - 24:23, 26:12, 29:5, 31:4, 46:14 register - 104:14, 106:7, 108:15, 123:11 Register- 56:10, 62:20 Registered- 167:2, 167:4 registry - 42:12, 44:7, 44:8, 61:18, 101:18 Registry- 43:14 regular - 7:6 relate - 9:10, 141:22, 141:23 related - 5:13, 6:10, 6:12, 7:20, 8:8, 12:20, 16:15, 16:22, 18:22, 20:3, 20:4, 20:5, 20:8, 33:3, 35:20, 36:12, 38:22, 43:21, 46:16, 48:16, 50:17, 51:9, 77:20, 121:18, 125:19, 126:1, 131:17, 134:11, 145:16, 151:8, 158:9 relationship 36:12, 50:16, 97:16 relative - 110:5, 135:8, 151:19, 154:23 relatively - 13:20, 17:21, 86:15 release - 24:8, 43:15, 79:16, 142:16 released - 60:19, 130:17 releasing - 23:20, 28:17 relevant - 71:15, 141:6, 141:7, 141:10, 152:14 reliability - 89:7, 89:8, 89:11, 105:9 reliable - 59:4 relied - 66:18 rely - 109:16, 109:17, 109:19, 155:19 remains - 167:10 remember - 130:9 Repair- 53:18 repair - 39:2, 43:22, 82:13, 107:3, 107:4, 107:5 repaired - 43:5, 56:16, 100:23, 101:11 repairs - 101:15, 108:5 replaced - 29:14 report - 33:4, 39:6, 40:17, 40:19, 40:20, 43:6, 46:12, 46:20, 49:7, 54:11, 56:4, 57:3, 62:20, 70:23, 88:13, 96:17, 104:13, 106:6, 108:10, 119:10, 121:6, 132:5, 137:2, 143:17, 144:18, 145:13, 155:16, 158:18 reported - 38:18, 38:23, 41:17, 45:21, 46:1, 46:3, 46:14, 51:11, 53:12, 55:3, 55:5, 71:10, 80:10, 85:11, 85:13, 86:1, 86:15, 87:10, 87:11, 89:10, 90:18, 94:7, 94:11,98:21, 101:22, 105:16, 122:10, 125:8, 129:11, 129:16, 132:1, 158:10, 158:13, 167:7 Reporter- 167:1, 167:2, 167:3, 167:4, 167:17, 167:20 Reporters- 1:21, 167:5 reporting - 49:6, 50:3, 89:10, 92:15, 96:15, 122:6, 123:10, 124:19 reports - 4:15, 38:12, 38:18, 45:8, 47:19, 48:19, 54:22, 60:1, 60:4, 62:14, 75:14, 85:3, 85:15, 86:20, 94:2, 98:1, 101:21, 105:15, 107:16, 119:21, 155:14, 155:23, 156:21, 158:18, 160:14 represent - 63:3, 76:7, 105:22 representing 83:22 represents - 44:23 reputation - 115:14 reputations 121:21 request - 8:17, 113:12, 113:19 requested - 43:10 Research- 76:18 research - 10:12, 10:20, 10:22, 11:13, 14:10, 55:2, 86:3, 121:2 researcher - 8:19 researchers 112:19 resident - 5:12 resin - 79:17 resins - 67:1 resources - 120:22 respect - 19:13, 38:10, 50:12, 54:7, 65:20, 81:15, 85:19, 87:9, 87:11, 92:16, 102:4, 118:16, 125:10, 133:23, 140:10, 141:10, 151:15, 152:14, 153:18, 157:1, 164:22 respects - 19:21, 71:21, 144:4 respirable - 25:22, 142:17 respiratory - 24:23, 26:12, 29:5, 29:10, 31:4 respond - 74:10 responded - 9:9, 84:13 responding - 107:1 response - 9:10, 18:4, 28:4, 29:4, 29:6, 31:6, 36:10, 36:11, 43:10, 50:16, 64:13, 160:5, 161:3 responsible 101:17, 150:18 rest - 106:14, 106:17 restricted - 110:19 result - 6:3, 6:6, 6:8, 24:1, 24:7, 24:10, 30:6, 74:4 resulted - 131:16 results - 5:1, 23:19, 66:4 retirees - 63:12 retrospectively 74:12, 74:21 return - 65:7 review - 4:17, 13:12, 39:12, 51:3, 75:4, 75:9, 75:17, 107:22, 109:5, 109:9, 109:16, 111:2, 112:15, 113:1, 113:2, 113:10, 114:10, 114:12, 115:5, 00179 13 129:11, 129:20, 130:5, 131:5, 131:14, 135:14, 137:5, 139:23, 155:16, 157:15 Review- 44:11 reviewed -11:10, 42:15, 76:10, 115:8, 131:12, 142:20, 142:22 reviewers -112:21 reviewing - 47:18, 62:16 revisit - 99:7 Rheumatologic71:17 ribs - 31:14 rigorous - 109:15 rip - 156:10 ripped - 156:9 ripper - 156:10 rise - 28:13 risen - 13:2, 14:21, 58:12 risk - 36:14, 37:18, 57:4, 68:6, 68:9, 68:15, 72:10, 72:11, 73:4, 79:12, 80:7, 81:4, 81:18, 83:1, 86:7, 86:8, 86:11, 86:13, 87:3, 88:18, 88:23, 110:5, 110:8, 110:10, 110:15, 114:21, 118:17, 119:4, 119:8, 120:21, 120:22, 128:3, 133:5, 134:12, 135:8, 154:23, 163:4, 164:21 Risk- 12:15 risks - 86:1, 87:4, 119:11, 163:19 Roggli- 81:10, 144:2 Roggli's- 98:1, 142:19, 142:21 role - 89:17 Rom- 129:19 roof - 123:21, 124:5 room - 16:11, 17:9 roughly - 65:8, 84:8 round - 31:19 rounds - 63:8 Rpr- 167:19 rubric - 86:23 rule - 36:1, 36:9, 165:7 running - 4:19 runs - 116:14 S S./canadian - 81:12 sad - 88:11 safe - 100:1, 164:20 sales - 80:10 Sam - 3:9, 65:15 Samuel - 2:2, 3:11 San - 14:4 sarcomatoid - 98:2, 98:4 save - 156:11 saw - 5:13, 7:11, 9:12, 40:9, 43:3, 88:11, 109:3, 128:13, 156:13, 158:7, 158:8 scale - 37:10 scar - 29:14 scarred - 31:17 scarring - 23:8, 26:3, 26:12, 26:17, 27:7, 27:18, 30:17, 30:20, 30:21, 31:6, 31:8, 31:9, 31:14, 31:16, 31:20, 32:11, 34:18, 34:20, 35:1, 38:7 Schmidt - 2:7 School - 76:8 school - 69:21 schools - 70:18 science - 18:18, 19:9, 20:23, 59:5, 68:4, 77:17, 103:9, 116:19, 149:18, 153:7, 160:8 Science - 135:5 Scientific - 117:8 scientific - 10:23, 11:15, 50:4, 59:7, 80:21, 89:7, 89:11, 121:2, 130:6, 132:15, 141:1, 141:18, 142:11, 142:18, 157:16, 157:17, 164:5 scientifically 133:2, 133:7 scientist - 38:21, 103:10, 116:17 scientists - 49:22, 66:10, 149:19 Scott - 2:10 screen - 91:16 screened - 20:7 Seattle - 5:19, 7:9, 7:10, 138:12 second - 12:1, 15:1, 43:2, 45:23, 67:22, 136:19, 150:20 see - 4:15, 6:9, 6:10, 6:18, 7:17, 7:19, 7:23, 8:4, 8:5, 8:7, 15:8, 15:20, 15:22, 16:9, 16:21, 17:10, 17:11, 17:13, 18:15, 19:2, 26:11, 27:19, 34:6, 40:11,41:6, 41:7, 42:18, 58:23, 73:19, 74:10, 74:13, 77:4, 79:6, 79:20, 79:23, 81:1, 81:7, 88:1, 103:14, 106:16, 106:17, 109:8, 114:15, 126:21, 138:15, 156:23, 159:21 seeing - 5:10, 6:22, 7:4, 7:5, 7:8, 18:12, 40:21,41:2, 46:8, 46:23, 157:9 Seelaus - 2:12 seem - 125:1 Seer - 44:9, 44:10, 44:14, 44:23 sees - 12:19, 27:6, 28:6 segregated - 56:13, 56:15 selected - 13:9 selecting - 97:2, 121:12 Selikoff - 48:5, 48:7, 48:14, 49:6, 50:2, 135:4 seminars - 58:15 send - 113:2, 113:3 sending - 108:1 sense - 42:19, 67:21, 151:1 sent - 4:16, 8:2, 8:5, 8:9, 13:13, 13:18, 15:21, 16:7, 42:17, 130:7, 131:1 sentence - 57:4, 57:6 separate - 29:23, 36:17, 149:9, 150:19, 153:2, 154:9, 154:15 separating - 36:16 serosal - 45:16 serpentine - 36:19 Session - 1:18 session - 15:9 setting - 18:14, 21:7, 21:8, 104:20, 132:18, 134:1 settings - 134:4 several - 12:22, 31:7, 33:6, 38:3, 60:21, 160:14 severity - 27:1, 77:20 shade - 123:13 sharing - 58:22 sheet - 79:8 ship - 79:9, 79:10 shipyard - 6:6, 6:7, 50:15 Shipyard - 6:1, 86:16 shipyards - 50:14 shoes - 82:14 Short - 65:11 short - 25:15, 34:9, 90:19, 93:8, 93:9, 95:6, 95:7, 96:10, 97:20, 97:21, 97:23, 98:2, 98:5, 99:22, 142:3, 161:14, 161:17, 162:1, 162:3, 162:6, 162:17 shorten - 50:21, 65:22 shorter - 35:22, 161:15, 161:20 shortest - 90:12, 90:15, 93:10, 95:8, 96:6, 98:23, 161:15 shorthand - 161:4 shortly - 27:17 shorts - 90:12 shot - 91:13 show - 77:3, 83:5, 88:18, 97:20, 145:23 showed - 7:14, 48:20, 50:14, 50:15, 57:12, 61:19, 89:20 showing - 144:21 shown - 26:8, 30:23, 32:18, 38:12, 60:22, 154:20 shows - 4:13 sic - 61:10 sick - 49:7, 55:3 side - 18:7, 34:17, 73:3, 138:17 signal - 136:15 significance - 51:4, 54:12, 54:18 significant - 6:7, 6:23, 7:4, 7:11, 8:1, 8:7, 9:13, 42:11, 44:22, 45:20, 56:19, 60:7, 64:18, 85:18, 86:17, 134:21, 134:22, 135:21, 136:1, 136:3, 136:6 significantly - 44:1, 64:15 silicate - 145:23, 146:2, 146:7 similar - 6:11,41:3, 153:8 simple - 137:8, 143:7, 143:8 simplify - 137:8 simply - 137:3 Sinai - 48:7 Singewald - 2:10 single - 6:22, 9:19, 33:13, 96:18, 118:8, 119:15, 147:12, 149:20, 163:6 site - 142:14, 143:9 sites - 10:5, 77:12, 143:3 situation - 23:17, 24:4, 117:16, 151:9, 152:21, 154:4, 158:6, 159:8, 160:4, 160:6, 160:19 situations - 23:23, 102:12, 134:5 six - 85:3, 107:16, 113:22 skew - 140:16 skewed - 45:2 skill - 13:3, 15:13 skip - 56:6 slash - 56:16, 110:17 Slights - 1:6 Sluggs - 132:2 small - 5:17, 13:21, 26:14, 29:8, 79:21, 88:23, 140:14, 150:18 smaller - 63:15 smartest - 102:20 smoke - 150:15, 151:11, 151:14, 154:19, 154:22, 155:8, 155:11, 163:12, 163:13, 163:14, 164:14 smoked - 150:11 smoker - 155:4 smokers - 155:1 smoking - 36:7, 150:6, 150:8, 150:23, 151:1, 151:9, 164:3 societies - 14:22, 15:4, 15:6 Society - 15:3, 15:7, 71:17 solely - 119:7, 144:20 solid - 32:17, 33:12 solve - 67:10 someone - 21:6, 21:19, 81:10, 81:15, 164:2 Somers - 2:4 sometime - 93:20, 95:20 sometimes - 5:3, 8:3, 16:8, 16:10, 26:13, 41:20, 77:8, 87:14, 111:22, 147:21 Sometimes - 157:1 somewhat - 16:20, 31:10, 45:2, 48:9 son - 69:10 Sorrowful - 117:14 sorry - 41:21, 68:18, 69:5, 126:16 sort - 115:17, 118:14, 119:12, 119:20, 148:15 sound - 133:2 Sound - 5:19, 6:1, 86:16 sounded - 103:6 sounds - 60:13 source - 107:5, 159:8 Sources - 78:13 South - 24:5, 43:8, 46:13, 46:23, 47:4, 57:22, 117:11, 132:3, 145:15 Southern - 117:13 special - 102:15, 116:2, 117:19 specialized - 24:20 specialty - 14:20 specific - 5:5, 25:6, 25:22, 55:10 specifically - 7:6, 10:5, 10:9, 10:14, 37:14, 38:7, 44:5, 75:3 specifics - 39:21 specimen - 4:12, 4:17 specimens - 4:11 speculate - 53:3 speculation - 51:6, 53:19 speed - 129:18 Spillane - 1:8 spontaneous 60:5, 136:9, 137:4, 140:8 staff - 57:15 stage - 20:10, 26:16, 119:21 stages - 33:11 stand - 3:10, 44:10, 166:1 standardized 101:3, 101:10 standing - 127:23 stands - 153:14 start - 21:9, 28:17, 28:23, 29:9, 29:12, 59:22, 73:12, 82:17, 103:10, 136:14, 136:15, 150:8 started - 7:8, 9:13, 9:22, 48:2, 48:8, 51:5, 53:11, 70:20, 102:17, 150:16 starting - 59:17 starts - 27:15, 27:17, 31:17, 66:3, 73:10 state - 121:19 State - 1:1, 167:5, 167:8 statement - 57:10, 76:21, 77:17, 125:7, 158:17 statements - 105:9, 109:22, 111:1, 158:22 States - 6:16, 8:4, 8:6, 13:11, 22:22, 24:6, 44:7, 44:9, 44:13, 44:16, 44:19, 44:20, 45:2, 48:10, 49:13, 49:16, 49:20, 87:18, 87:21, 101:10, 107:17, 120:6, 132:6 states - 61:7, 62:19, 106:18, 106:21, 106:22, 110:1, 110:19, 135:17, 143:17 stating - 49:19, 133:23, 160:20 statistically - 136:5 statistics - 113:11, 00180 14 113:12 Steggs - 46:15 stem - 24:14 step - 67:8, 165:14 Steven - 2:6 still - 15:5, 63:19, 64:15, 76:1, 84:16, 85:7, 86:14, 86:17, 91:16, 98:13, 110:17, 123:9, 125:3, 136:5, 158:20 stipulate - 78:16, 99:3 stomal - 158:8 stop - 39:19, 77:16, 150:20 stopped - 58:17 straight - 126:16 Street - 1:21 strongly - 87:20 stuck - 17:9 studied - 50:14, 88:4, 138:23, 140:12, 146:3 studies - 28:9, 38:16, 38:18, 43:18, 47:21,48:1,48:3, 55:2, 55:11, 55:19, 60:21, 62:14, 74:18, 74:19, 74:22, 75:5, 75:11, 81:7, 81:8, 87:15, 87:23, 89:1, 110:3, 110:5, 110:12, 120:1, 131:8, 132:6, 140:13, 141:17, 141:18, 142:1, 145:22, 147:14, 154:20, 159:15, 164:4 study - 27:1,46:18, 46:19, 46:20, 53:23, 76:20, 78:12, 98:19, 118:8, 119:16, 132:4, 132:11, 145:9, 145:10, 145:19, 146:7, 152:5, 157:19 studying - 54:2 stuff - 58:10, 156:10, 162:7 stupid - 69:5 sub - 63:16 sub-class - 63:16 subfraction - 63:4 subject - 54:16, 97:10, 109:15, 161:4 subjected - 111:2, 114:9 submitted - 131:5, 131:6, 157:14 submitting 107:22, 112:7 Subsequent - 104:9 subsequent 101:21 subsequently 18:3, 51:17 subserosal - 9:7 substances - 77:12 substantially 63:19 subtype - 9:15, 31:16 suddenly - 27:19 sufficient - 90:5, 93:6, 95:4 suggest - 148:6 suggesting 121:20, 122:16 suggestion - 98:22, 151:17 suggests - 84:22, 132:13 Suite - 1:21 summarize - 59:19 summarized - 62:13 Superior - 1:1, 1:21, 167:5, 167:8 support - 100:5, 117:21, 129:13 suppose - 50:1, 147:2, 147:7 suppresser - 149:13 suppressor - 32:19, 149:1, 155:13 surface - 9:8, 9:9, 24:20, 31:11, 66:23, 162:5 surgeons - 7:22, 16:10 surgery - 16:11 surprise - 71:20, 79:11 surprised - 71:10 surprising - 64:12, 102:5, 102:13, 129:16 Surveillance 44:10, 78:13 survived - 18:4 susceptibility 28:3, 36:3 suspect - 63:22, 79:22, 91:6, 99:6 suspected - 91:1 suspicion - 79:16 sustained - 60:7 switch - 91:11 sworn - 91:23 symptoms - 113:17 synergistic - 154:21 system - 25:13, 149:3 systematic - 75:4, 75:9 systems - 33:9 T table - 117:5, 117:6 Table- 118:18 tabulated - 13:17 talks - 60:18 tar - 151:12, 151:13 target - 25:22, 125:12, 125:15, 125:17, 143:3 Tarry- 2:2, 65:12, 65:15, 67:5, 67:15, 68:3, 68:20, 69:1, 69:4, 75:22, 83:14, 91:10, 91:16, 91:22, 94:1, 95:10, 95:23, 97:6, 99:3, 99:8, 99:9, 99:14, 99:15, 106:12, 107:6, 110:23, 112:9, 112:12, 112:13, 114:13, 119:14, 123:8, 124:16, 126:3, 146:13, 146:19, 147:8, 161:13 Tata- 113:3, 113:23 Taurus- 137:10, 137:13, 137:14 Taxol-18:2 Tb- 47:4, 47:6, 47:7 technical - 12:17, 89:4, 125:12, 125:15, 146:15 technically - 80:2 techniques - 75:13 technology - 34:4 ten - 6:10, 6:18, 7:23, 13:10, 34:9, 37:11, 39:3, 39:5, 40:3, 40:4, 40:16, 40:17, 48:21, 51:18, 52:3, 65:6, 89:22, 89:23, 90:12, 93:6, 93:10, 93:19, 94:16, 95:4, 95:8, 95:19, 96:5, 98:12, 98:22, 110:14, 117:16, 150:8, 150:16, 156:14, 165:19 Ten- 160:13 ten-year - 96:5, 98:22 tend - 74:19, 115:17 tends - 31:10 term - 30:4, 111:16 termed - 9:7 terms - 139:22, 141:1, 151:3, 153:12, 154:15, 157:18, 160:4 terrific - 162:18 Teschke- 76:12, 76:13, 78:12 test - 68:14 testified - 3:12, 8:10, 8:13, 82:7, 89:15, 161:16 testify - 84:20, 141:3, 146:17 testifying - 112:6, 138:16 testimony - 78:9, 83:6, 83:11, 83:17, 89:6, 89:12, 92:1, 97:1, 98:17, 114:8, 121:10, 122:5, 147:10, 148:13 testing - 73:15 tests - 4:21, 27:9, 70:8 Texas- 14:5, 83:6 text - 125:17 textbook - 12:11, 76:16, 108:11, 125:8 Textbooks- 11:19 textbooks - 11:21, 11:23, 12:21 themselves 102:10 theories - 66:4, 160:7 therapeutic - 20:11, 73:16, 87:22, 88:2, 88:5, 88:6, 88:15, 88:20, 90:15, 132:10, 136:20 therefore - 47:22, 151:6, 154:7 they've - 88:3, 101:22, 121:21 thinking - 82:5 thinks - 135:17 Third- 38:16 third - 41:22 thirties - 120:10 Thomas- 1:14, 12:10 thoracic - 16:10 Thorax- 33:5 thorough - 66:14, 121:5, 121:12, 121:23 thousand - 16:5, 123:14 three - 27:5, 40:8, 45:3, 69:2, 75:8, 79:4, 79:7, 85:3, 106:23, 107:16, 120:7, 124:22, 140:17, 142:7, 153:21, 158:18, 163:5 three-day - 120:7 throughout - 13:21, 73:7, 132:6 throw - 164:2 thrown - 134:19 thumb - 165:7 thymus - 14:18 timing - 102:15, 149:12 tiny - 25:2 tissue - 10:1, 10:6, 10:16, 16:6, 29:14, 32:5, 39:3, 77:11, 77:20, 130:23, 131:4, 141:5, 141:6, 142:12, 143:4, 144:21, 156:19 tissues - 4:10, 10:13 title - 14:1 titled - 12:6, 12:7, 116:5 tobacco - 151:2 Today- 120:7 today - 23:4, 64:20, 65:17, 73:14, 74:8, 80:21, 81:18, 82:7, 82:17, 84:21, 87:3, 89:6, 89:12, 89:20, 114:9, 121:10, 121:22, 125:11, 142:10, 160:7, 165:22 together - 9:22, 21:15, 58:7, 58:10, 58:14, 70:22, 94:2, 155:5 toggle - 114:13 Tolerated- 105:13 top - 14:21, 62:6, 62:17 topic - 121:2 total - 63:1, 63:4, 86:12 totally - 21:1, 71:16, 141:15, 141:22 touched - 145:8 towards - 27:16 town - 5:17 toxic - 77:12 trachea - 24:14 track - 44:14 trade - 99:17 Trade- 57:16, 99:17 trades - 50:7 Trained- 62:3 trained - 3:16, 3:21, 37:5, 37:23, 41:1, 46:5, 55:9, 128:8, 132:23 training - 5:12, 13:1, 15:12, 47:18 transcript - 99:4, 167:7 Transcript- 1:18 translocate - 10:8 translocated - 31:3 translocation 10:4, 142:13 trapped - 24:17 treat - 72:6 treated - 16:1, 17:23, 157:3 treating - 19:3, 40:9 treatment - 16:18, 17:6, 20:20, 71:3, 72:1, 157:13 treatments - 72:9 tree - 123:13 tremolite - 23:1 trials - 73:10, 73:13, 73:20, 74:1, 74:22 tried - 74:12, 150:10 true - 35:20, 41:5, 71:16, 72:15, 80:13, 82:4, 89:14, 101:12, 111:5, 152:1, 163:11, 163:21, 165:8 truth - 103:11 try - 5:4, 17:6, 21:4, 21:14, 43:11, 50:21, 68:14, 71:1, 108:2, 120:17, 132:20, 161:4, 165:21 Try- 159:3 trying - 19:22, 25:13, 52:3, 70:2, 72:4, 72:5, 86:19, 112:5, 127:18, 152:3 tubes - 10:17, 24:15, 24:21, 25:2 Tuesday- 1:18, 3:1 tumor - 7:3, 10:16, 18:5, 18:8, 19:14, 19:22, 32:17, 32:19, 33:15, 33:16, 33:17, 88:12, 88:15, 90:6, 98:14, 136:15, 140:8, 148:9, 149:1, 149:13, 155:13, 156:3, 156:16, 158:8, 158:13 tumorigenic 151:23, 152:2 Tumors- 12:12 tumors - 14:18, 45:16, 52:23, 53:1, 53:7, 53:14 turned - 39:3, 48:11,49:17, 130:10, 152:8, 152:18 turns - 9:15, 32:2, 101:12 two - 9:4, 32:18, 44:3, 46:1, 64:7, 64:16, 69:2, 84:5, 84:7, 92:5, 96:2, 103:17, 109:12, 141:20, 146:16, 158:18, 159:3, 165:19 type - 4:1, 4:13, 11:6, 20:7, 20:11, 23:18, 24:19, 26:4, 41:15, 61:8, 71:12, 82:21, 102:7, 103:23, 130:21, 132:4, 140:13, 150:17, 156:5, 156:7, 156:16, 158:7 types - 7:17, 22:22, 32:1, 34:19, 36:19, 44:15, 49:12, 49:15, 60:20, 61:12, 71:13, 77:2, 79:1, 134:4, 141:8, 151:5, 151:20, 152:14, 161:18, 163:18 U Uicc - 152:9 ultimately - 22:18, 27:18, 153:11, 154:15 Ultrastructural 15:3 ultrastructural 9:17, 14:7 Ultrastructured 142:23 unaltered - 64:3 00181 unavailable - 14:1 uncertainties - 18:5 uncommon - 24:9, 150:10 uncovering - 66:10 under - 11:2, 63:11, 82:21,94:16, 101:3, 124:5, 124:10, 131:11, 144:23, 162:11 undergoes - 33:15 understood - 91:22 undertake - 105:8 unfair - 83:15 unfiltered - 164:13 unfortunate - 131:3 unfortunately 18:5, 18:11, 136:10 union - 139:3 Unions - 48:10 unique - 5:20, 9:11, 16:20, 11:23, 30:8, 30:12, 31:10, 31:22, 32:8, 41:2, 48:8, 48:9, 132:18 United - 6:16, 8:4, 8:6, 13:11, 22:22, 24:6, 44:1, 44:9, 44:13, 44:16, 44:19, 44:20, 45:2, 48:10, 49:13, 49:16, 49:20, 81:18, 81:21, 101:9, 101:11, 120:6, 132:6 units - 29:10 unity - 110:18, 110:22 University - 43:8, 51:21, 15:23, 80:20, 113:3 unknown - 51:8, 65:20, 136:9 unless - 103:15, 112:3, 148:9 Unless - 96:20 unmodified 164:15 unreasonable 133:16 unreliable - 104:23 unscientific 58:20, 133:11 unusual - 132:18 unvalid - 58:20 up - 24:11, 31:6, 34:15, 40:8, 40:12, 44:1, 52:10, 65:22, 15:8, 18:2, 81:2, 89:20, 98:8, 111:5, 121:23, 138:21, 141:21, 148:4, 150:16, 152:11 updating - 49:1 upper - 26:1, 26:10, 63:20, 80:15 urban - 163:8 Us-canadian - 11:5, 38:20 Usa - 120:1 users - 53:16, 53:21 uses - 141:9 utilized - 155:20 V validly - 123:2 variability - 28:4 variable - 153:6 variables - 150:22, 153:10 variant - 156:1 variation - 80:11, 151:3 variations - 105:3 variety - 9:22, 19:11, 30:19 various - 1:15, 9:3, 10:13, 16:16, 33:1, 42:20, 43:2, 43:11, 44:15, 48:18, 52:11, 60:18, 60:20, 85:2, 118:15, 151:20 vascular - 11:19 vast - 162:1, 162:1, 163:9, 163:12 vehicle - 19:11, 93:16, 95:16, 114:22, 118:19, 118:23, 119:4, 119:6, 119:1, 119:8, 122:11, 123:4 vehicles - 80:1, 119:8 vein - 163:23 Verechia - 161:3, 161:19 verse - 142:8 versed - 45:18 versus - 34:18, 35:1, 36:20, 85:20, 101:15, 140:11, 143:4, 143:11, 141:23, 164:13, 164:15 vessels - 10:11 victim - 21:9, 111:21, 118:5 victims - 111:21 video - 93:1, 94:22, 95:11, 114:18, 122:1, 123:19 view - 19:23, 85:8, 103:15, 149:11, 155:9 vinyl - 132:8 Virginia - 1:10 visceral - 10:14, 30:22, 31:1, 31:16, 31:21 visit - 11:11 vitae - 11:3 vitro - 141:18, 142:1 Volume - 115:22, 111:3, 135:16 W Waddell - 1:10, 1:11, 3:9, 3:15, 22:2, 22:5, 23:10, 23:12, 65:4, 83:8, 91:5, 121:22, 128:2, 138:5, 163:22, 164:1, 165:12 Wagner - 46:9, 41:2, 41:10, 41:11, 49:18, 132:2, 145:9, 152:3 Wagner's - 46:12, 41:19 wait - 92:18, 131:1 waited - 46:1 waived - 121:8 Wales -13:11 walk - 23:9, 21:21 walking - 162:1 wants - 90:11, 125:18 War - 116:6, 111:1 Washington - 5:18, 6:2, 16:1, 80:20, 113:4 waste - 120:21 watch - 94:16, 94:18, 94:21_________________ watching - 14:4, 14:20 ways - 30:19, 114:1, 136:16, 160:19, 160:22 week - 31:4 weekly - 18:16 weigh - 163:20 weighing - 82:15, 82:19, 84:19 weight - 15:19 Weitzman - 98:9, 98:15 welcome - 65:18, 126:5 well-documented 51:20 well-known - 38:21 well-versed - 45:18 west - 44:21 whereas - 151:4 white - 131:10, 131:13, 131:14 Whitesman - 33:4 whole - 20:14, 21:5, 29:16, 60:14, 66:6, 68:22, 15:18, 111:11, 135:1, 151:2 wide - 35:5 wife - 69:9 William - 2:10 willingness 109:11 Wilmington - 1:22, 161:11 Wilms - 88:15 windpipe - 24:13 wished - 61:9 withdraw - 104:2, 104:12, 101:10 Witness - 91:13, 98:20, 106:5, 106:20, 114:11, 126:5, 146:18, 141:18, 148:20, 150:3, 151:10, 153:13, 153:18, 154:11, 155:21, 158:2, 165:15, 161:12 witness - 65:4, 112:2, 126:10, 126:19, 146:14 witness' - 91:9 witnesses - 61:22, 146:16 Wittenoom - 42:5 woman - 156:14 women - 88:4, 131:8, 133:6 Wong - 110:3 word -15:15, 111:12, 113:8, 113:21 Word - 99:11 words - 60:9, 13:12, 15:5, 82:1, 119:19 Worker - 53:18 workers - 50:18, 51:10, 53:13, 60:1, 63:12, 19:9, 19:10, 81:19, 124:20 workforce - 63:4, 63:9, 63:11 works - 28:6, 32:21 Works -111:12 world - 13:22, 24:2, 40:21,42:2, 42:10, 49:20, 86:6, 102:21, 120:12, 132:6, 138:2, 151:16 World - 14:13, 51:16 world's - 46:21, 121:11 worldwide - 58:15 worry - 99:12 worth - 61:20, 138:6 wrinkle - 31:18 write - 4:15, 40:19, 111:5 writing - 13:22, 36:2, 101:1, 101:9, 101:14 writings - 11:14 written - 11:22, 12:21, 23:8, 42:22, 43:13, 54:16, 51:20, 113:23 wrote - 9:23, 10:2, 11:6, 12:5, 12:6, 12:1, 12:11, 12:14, 21:2, 39:12, 39:23, 40:11, 43:9, 52:14, 53:16, 53:21,91:20, 101:11, 108:13, 112:6, 112:8, 120:4 Wto- 43:9, 51:18, 58:2, 108:12 X x-ray - 32:4 Y year - 6:11, 6:12, 6:14, 6:19, 1:23, 10:2, 84:12, 90:16, 96:5, 98:22, 135:6, 135:19 years - 15:5, 11:21, 18:5, 29:16, 34:10, 34:12, 31:11, 44:4, 63:1, 63:8, 63:10, 63:11, 63:18, 63:21, 64:6, 64:8, 11:11, 13:11, 84:5, 84:1, 89:22, 89:23, 90:12, 90:14, 90:11, 90:20, 90:21,93:6, 93:10, 93:11,93:19, 94:16, 95:4, 95:8, 95:9, 95:19, 96:8, 91:23, 98:1, 98:12, 100:11, 120:1, 123:14, 130:21, 141:21, 150:8, 150:16, 156:13, 156:14, 156:15, 161:5, 162:11 yesterday - 25:19, 61:16, 89:22, 90:2, 126:20, 161:16 York - 48:1, 135:4 young - 11:21, 88:11, 162:20, 162:21, 163:2, 163:3 yourself - 8:9, 41:2, 149:19, 153:9 Z zero - 6:21, 135:1, 135:9, 139:12, 139:13, 140:2 Zero - 139:18, 139:21 zoom - 19:5 15 00182