Document NGnZ1Q7ZjEZ3eroK3JVmZoLwp

file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3897 1 (THE FOLLOWING PROCEEDINGS 2 WERE HAD IN OPEN COURT IN THE 3 PRESENCE OF THE JURORS:) 4 5 THE COURT: JURORS AND ALTERNATES ARE AGAIN PRESENT. 6 YOU MAY PROCEED, MR. RIFF 7 8 JOHN WHYSNER, 9 HAVING BEEN PREVIOUSLY SWORN, RESUMED THE STAND AND TESTIFIED 10 FURTHER: 11 12 DIRECT EXAMINATION (RESUMED) 13 BY MR. RIFF: 14 Q SO, DR. WHYSNER, WHEN YOU'RE LOOKING AT THIS MAP 15 OF EPI-STUDIES AND THE BOTTOM LINE RESULT OF THE STUDY, 16 WHETHER IT'S EXPRESSED IN AN S.M.R. OR THE OTHER KIND OF STUDY 17 THAT YOU'LL TELL US ABOUT BEING EXPRESSED AS A RELATIVE RISK, 18 YOU'RE LOOKING TO SEE HOW THAT NUMBER COMPARES WITH THE NUMBER file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (1 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 ONE. IS THAT TRUE? 20 A YES. 21 Q SO, FOR EXAMPLE, IN THE BENZENE STUDIES ABOUT 22 NON-HODGKIN'S LYMPHOMA OR THE SOLVENT STUDIES ABOUT 23 NON-HODGKIN'S LYMPHOMA, YOU'RE LOOKING TO GO SEE THE STRENGTH 24 OF THE ASSOCIATION BETWEEN, SAY, BENZENE AND NON-HODGKIN'S 25 LYMPHOMA IS IT NEAR ONE OR IS IT NOT NEAR ONE? 26 A CORRECT. 27 Q THAT'S ONE WAY TO LOOK AT IT? 28 A YES. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (2 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3898 1 Q AMONG THESE BRADFORD-HILL ELEMENTS, TOTAL, HOW 2 MANY ARE THERE? 3 A I THINK ORIGINALLY HE PUT FORTH NINE, BUT WHEN 4 THE E.P.A. AND THE -- SORT OF RECODIFIED IT, THEY'RE USING 5 ABOUT SEVEN OF THEM AS BEING THE MOST IMPORTANT ONES. 6 Q I WANT TO TRY, IF WE CAN, TO EVEN TRUNCATE THAT 7 LIST FURTHER TO THE ONES THAT YOU THOUGHT WERE THE MOST 8 CRITICAL, IMPORTANT, INFLUENTIAL, SENSITIVE, WHATEVER THE 9 RIGHT WORD IS, FOR THIS EXERCISE. 10 SO WHAT WOULD BE THE NEXT ONE, PLEASE? 11 A WELL, AND THIS IS ACTUALLY IMPORTANT BUT NOT 12 VERY IMPORTANT, BUT IT'S ESSENTIAL. THAT IS, THE CRITERIA 13 CALLED "TEMPORALITY." IN OTHER WORDS, THE DISEASE HAS TO 14 OCCUR AFTER THE EXPOSURE. IN OTHER WORDS, IF THE DISEASE 15 OCCURS BEFORE THE EXPOSURE, THEN IT'S NOT THOUGHT TO BE 16 ATTRIBUTED TO THE CHEMICAL. 17 SO THE STUDY HAS TO LOOK AT THINGS THAT OCCUR 18 AFTER THE EXPOSURE HAS HAPPENED. THAT'S SORT OF -- BUT THAT'S file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (3 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 AN IMPORTANT CRITERIA, BUT IT'S NOT ONE THAT YOU USUALLY HAVE 20 TO USE IN TERMS OF LOOKING AT STUDIES BECAUSE THEY USUALLY ARE 21 LOOKING AFTER EXPOSURES. 22 PROBABLY THE MOST IMPORTANT ONE IS CONSISTENCY. 23 IN OTHER WORDS, WE HAVE EXPOSURES TO CHEMICALS IN VARIOUS 24 GROUPS OF PEOPLE. AND LOTS OF THINGS CAN HAPPEN IN THOSE 25 GROUPS OF PEOPLE THAT WE'RE STUDYING. SO YOU CAN GET 26 RANDOMLY -- YOU CAN GET POSITIVE ASSOCIATIONS OR YOU CAN GET 27 AN ASSOCIATION JUST BECAUSE THERE'S SOMETHING THAT THAT GROUP 28 MAY HAVE BEEN EXPOSED TO THAT REALLY HAS NOTHING TO DO WITH file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (4 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3899 1 THE CHEMICAL. 2 SO WHAT YOU'RE REALLY LOOKING FOR ARE PEOPLE WHO 3 HAVE BEEN EXPOSED TO A PARTICULAR CHEMICAL, BUT UNDER 4 DIFFERENT CIRCUMSTANCES OR DIFFERENT OCCUPATIONAL GROUPS, AND 5 IS THAT A CONSISTENT PICTURE? IN OTHER WORDS, DO YOU SEE A 6 CONSISTENTLY INCREASED S.M.R. AMONG STUDIES OF THAT CHEMICAL, 7 AND ARE THESE IN SORT OF DIFFERENT TYPES OF GROUPS OF PEOPLE? 8 Q FAIR ENOUGH. I THINK THAT COVERS THAT NICELY. 9 WHAT ELSE BY WAY OF IMPORTANT BRADFORD-HILL 10 ELEMENTS THAT YOU CONSIDERED IN DOING THE JOB WE GAVE YOU 11 HERE? 12 A SOMETIMES YOU'LL FIND AN INCREASE, BUT IF 13 THEY'VE BEEN ABLE TO MEASURE EXPOSURE LEVELS AND DIVIDED THE 14 PEOPLE WHO HAVE BEEN EXPOSED INTO DIFFERENT EXPOSURE LEVEL 15 GROUPS, IF YOU DON'T SEE THE DISEASE GOING UP WITH THE LEVEL 16 OF EXPOSURE, THEN YOU THINK TO YOURSELF: WELL, IT'S NOT 17 REALLY -- DOESN'T SEEM TO BE ASSOCIATED IN THAT SENSE. 18 SO THERE'S ANOTHER CRITERIA CALLED file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (5 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 "DOSE-RESPONSE RELATIONSHIP." OFTEN YOU DON'T HAVE THAT 20 INFORMATION IN STUDIES, BUT IF YOU DO, THEN THAT PROVIDES YOU 21 WITH EVEN A STRONGER BELIEF THAT THAT STUDY IS SHOWING YOU 22 SOMETHING BECAUSE IT'S GONE UP A LITTLE BIT WITH LOWER 23 EXPOSURES, MORE WITH HIGHER EXPOSURES, AND EVEN MORE WITH THE 24 HIGHEST EXPOSURES. 25 Q IS THAT THE SAME CONCEPT AS YOU WERE SHOWING US 26 EARLIER WITH RESPECT TO INCREASING THE DOSE OF ASPIRIN AND 27 ALCOHOL IN TERMS OF EFFECT? 28 A YES. EXCEPT WE WERE LOOKING AT DIFFERENT file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (6 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3900 1 EFFECTS AT HIGHER DOSES. HERE YOU BELIEVE THAT MORE PEOPLE 2 SHOULD BE AFFECTED AT HIGHER EXPOSURE LEVELS. 3 Q IN TERMS OF YOUR METHODOLOGY IN APPLYING THE 4 BRADFORD-HILL ELEMENTS, WHAT OTHER ONES DO YOU THINK IS USEFUL 5 TO TALK ABOUT WITH THE JURY BEFORE GETTING INTO SOME OF THE 6 DATA? 7 A THERE'S SOMETHING CALLED "STATISTICAL 8 SIGNIFICANCE." THIS MEANS THAT WHEN YOU DO A COMPARISON 9 BETWEEN TWO DIFFERENT GROUPS, THERE ARE CERTAIN STATISTICAL 10 RULES THAT ONE HAS TO APPLY THAT MEAN THAT YOU WON'T GET THOSE 11 KINDS OF ASSOCIATIONS JUST FROM CHANCE. IN OTHER WORDS, WHAT 12 WE TRY TO DO IS WE TRY TO -13 THERE'S SORT OF A RULE OF THUMB. THAT WOULD BE 14 THAT IT WOULDN'T OCCUR BY CHANCE ALONE MORE THAN 120 TIMES. 15 SO, IN OTHER WORDS, IF YOU HAVE 20 STUDIES, YOU 16 WOULD EXPECT ONE OF THEM COULDN'T BE POSITIVE JUST FROM 17 CHANCE. THIS HAS TO DO WITH THE WAY IN WHICH -- THE 18 MATHEMATICS IN WHICH THE STUDIES ARE ANALYZED. SO THE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (7 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 STATISTICAL SIGNIFICANCE IS AN IMPORTANT ALSO PART OF THIS 20 ANALYSIS. 21 Q HOW IMPORTANT? 22 A IN MY EXPERIENCE AT I.A.R.C., FOR EXAMPLE, 23 PEOPLE DID NOT REALLY CONSIDER STUDIES TO BE POSITIVE UNLESS 24 IT WAS A STATISTICALLY SIGNIFICANT FINDING. IT WAS SORT OF A 25 RULE THAT YOU NOT ONLY HAD TO HAVE STATISTICAL SIGNIFICANT 26 FINDINGS, BUT YOU HAD TO HAVE CONSISTENTLY CONSISTENT 27 STATISTICALLY SIGNIFICANT FINDINGS AMONG DIFFERENT STUDIES. 28 Q BY THE WAY, THIS SLIDE THAT WE MAY OR MAY NOT file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (8 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3901 1 SHOW, WHO PREPARED THIS SLIDE? 2 A I DID. 3 Q IS THERE ANY OTHER OF THE BRADFORD-HILL ELEMENTS 4 THAT YOU WANT TO TALK ABOUT AT THIS POINT TO HELP DESCRIBE 5 YOUR METHOD TO THE JURY? 6 A I DON'T THINK WE REALLY NEED TO AT THIS POINT. 7 Q OKAY. THEN I WANT TO CHANGE TOPICS A LITTLE BIT 8 AND APPLY A LITTLE BIT OF WHAT YOU WERE TELLING US TO SOME OF 9 THE SPECIFIC FACTS OF THIS CASE. 10 DOES THE WORD "PLIOFILM" MEAN ANYTHING TO YOU? 11 A YES. 12 Q THE JURY HAS HEARD A LITTLE BIT ABOUT THE 13 PLIOFILM COHORT AND THE PLIOFILM STUDY. SO WITH THAT 14 UNDERSTANDING, JUST REFRESH OUR MEMORY ABOUT WHAT THE PLIOFILM 15 STUDY AND COHORT ARE. 16 A PLIOFILM WAS A PROCESS IN WHICH PURE, NATURAL 17 RUBBER WAS USED IN ORDER TO PRODUCE TIRES. A LOT OF TIRES ARE 18 PRODUCED BY OTHER KINDS OF PROCESSES RATHER THAN NATURAL file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (9 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 RUBBER. IN THIS CASE PEOPLE WERE PRODUCING TIRES WITH NATURAL 20 RUBBER, AND IT WAS BEING DISSOLVED IN PURE BENZENE. 21 THE RUBBER WAS MIXED UP WITH THE BENZENE IN 22 ORDER TO MAKE IT INTO A LIQUID, AND THEN IT WAS ROLLED OUT AND 23 PROCESSED IN VARIOUS WAYS IN ORDER TO DEVELOP THE PLIES FOR 24 THE TIRE MANUFACTURING. 25 SO IN THE PLIOFILM COHORT PEOPLE WERE REALLY 26 EXPOSED TO LARGE AMOUNTS OF PURE BENZENE IN AN AREA WHERE THE 27 BENZENE WAS EVAPORATING OUT OF THE RUBBER IN ORDER TO MAKE THE 28 TIRES. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (10 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3902 1 Q WHEN WE SAY "THE PLIOFILM COHORT," C-O-H-O-R-T, 2 IS THAT REFERRING TO A GROUP OF PEOPLE? 3 A YES. THIS WAS THE GROUP OF WORKERS WHO WERE 4 USING THIS METHOD. 5 Q NOW, ARE YOU AWARE THAT PETER INFANTE FIRST 6 PUBLISHED SOMETHING ABOUT THE PLIOFILM COHORT IN ABOUT 1977? 7 A YES. 8 Q SINCE THEN, HAVE OTHER EPIDEMIOLOGISTS EVALUATED 9 THAT PLIOFILM COHORT TO TRY TO GET A HANDLE ON THE BENZENE 10 EXPOSURE THAT THOSE FOLKS RECEIVED? 11 A YES. 12 Q WHO DID THAT? 13 A THERE WAS A STUDY PUBLISHED BY RINSKY, ET AL. IN 14 1987. AND THESE ARE, AGAIN, PEOPLE THAT, I BELIEVE, WHO WERE 15 STILL AT THE NATIONAL INSTITUTE OF ENVIRONMENTAL -- I MEAN, 16 OCCUPATIONAL SAFETY AND HEALTH. 17 Q N.I.O.S.H? 18 A N.I.O.S.H. WHICH IS WHERE DR. INFANTE WAS DOING file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (11 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 HIS WORK FROM AT THE TIME, AND THEY CONTINUED TO FOLLOW THESE 20 PEOPLE. SO THEY LOOKED AT EXPOSURE EVALUATIONS. I THINK THEY 21 PUBLISHED A COUPLE OF PAPERS EARLIER THAN THAT THAT ACTUALLY 22 PUT OUT THEIR METHODOLOGY AND HOW THEY WERE DOING THIS. 23 AND IN THE STUDY IN 1987 WAS THE ONE WHERE THEY 24 DEVELOPED, AGAIN, THE S.M.R. RELATED TO THE EXPOSURE LEVEL 25 THAT THE PEOPLE HAD RECEIVED. 26 Q S.M.R. MEANS WHAT? 27 A STANDARDIZED MORTALITY RATE. 28 Q THAT IS ONE OF THOSE NUMBERS -- file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (12 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3903 1 THAT IS THE BOTTOM LINE OUTPUT NUMBER OF THE 2 EPIDEMIOLOGY STUDY THAT'S COMPARED TO THE NUMBER ONE? 3 A FOR A COHORT STUDY. A COHORT STUDY IS WHERE 4 YOU'RE COMPARING PEOPLE WHO HAVE AN EXPOSURE TO PEOPLE WHO 5 DON'T HAVE AN EXPOSURE. 6 Q NOW, LET ME ASK YOU SOMETHING. HAVE THE 7 SCIENTISTS PUBLISHED IN THE PEER-REVIEWED LITERATURE THE 8 RESULTS OF THE EXPOSURE ASSESSMENT FOR THE PLIOFILM COHORT AS 9 IT RELATES TO THE DISEASE A.M.L? 10 A YES. 11 Q DID THE PLIOFILM COHORT SHOW EXPOSURE TO 12 ASSESSMENT PUBLICATIONS IN YOUR OPINION, TO A REASONABLE 13 DEGREE OF SCIENTIFIC PROBABILITY, THAT BENZENE IS IN FACT 14 CAPABLE OF CAUSING A.M.L. IN HUMAN BEINGS? 15 A YES. 16 Q MAKING A NOTE. PLIOFILM. BENZENE. A.M.L., 17 YES. 18 DR. WHYSNER, HAVE SCIENTISTS LOOKED AT THE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (13 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 PLIOFILM COHORT TO SEE IF IN THIS GROUP OF BENZENE-EXPOSED 20 WORKERS WHETHER THERE WAS AN INCREASE IN NON-HODGKIN'S 21 LYMPHOMA IN THAT POPULATION? 22 A YES. 23 Q WHAT'S THE ANSWER? 24 A THERE WAS NOT. THEY FOUND EXACTLY A NUMBER OF 25 CASES AS THEY WOULD HAVE EXPECTED IN THAT GROUP OF PEOPLE IN 26 THE GENERAL POPULATION. AND THAT WAS PUBLISHED IN -- AN 27 UPDATE WAS DONE IN 2002. 28 Q LET ME ASK YOU THIS: ARE YOU FAMILIAR WITH THE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (14 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3904 1 CUMULATIVE DOSE MEASURE OR UNIT CALLED A "P.P.M. YEAR"? 2 A YES. 3 Q IN YOUR OPINION, TO A REASONABLE DEGREE OF 4 SCIENTIFIC PROBABILITY, WHAT IS THE CUMULATIVE DOSE EXPRESSED 5 IN P.P.M. YEAR NECESSARY TO INCREASE THE RISK OF A HUMAN BEING 6 CONTRACTING A.M.L. FROM BENZENE? 7 A IT WOULD BE AT LEAST 40 P.P.M. YEARS. 8 NOW, THERE HAVE BEEN OTHER PEOPLE WHO HAVE 9 ANALYZED THAT SAME PLIOFILM COHORT AND SAID IT MAY BE HIGHER 10 THAN THAT, AS HIGH AT 200 P.P.M. YEARS, BUT AT LEAST TAKING 11 THE RINSKY STUDY THAT WAS DONE IN 1987, THEY DIDN'T FIND ANY 12 INCREASE UP TO 40 P.P.M. YEARS. 13 Q WOULD A FAIR SUMMARY OF WHAT YOU JUST SAID BE 14 THAT IN YOUR OPINION, TO A REASONABLE DEGREE OF SCIENTIFIC 15 MEDICAL PROBABILITY, HUMANS HAVE TO BE EXPOSED SOMEWHERE IN 16 THE RANGE OF BETWEEN 40 AND 200 P.P.M. YEARS BEFORE THE 17 EPIDEMIOLOGY SHOWS AN INCREASED RISK FOR INCIDENTS OF A.M.L. 18 FROM BENZENE? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (15 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 A YES. 20 Q NOW, I WANT TO JUST STOP FOR A MOMENT. 21 (PAUSE.) 22 Q DR. WHYSNER, I WANT YOU TO ASSUME THAT AN EXPERT 23 IN EXPOSURE ASSESSMENT HAS COME AND TALKED TO THIS JURY NAMED 24 REISS, AND HIS ANALYSIS IS SHOWN ON EXHIBIT 110, WHICH IS IN 25 EVIDENCE, IS THAT MR. MOLINA'S BENZENE EXPOSURE BASED ON HIS 26 DEPOSITION TESTIMONY, THE BOTTOM LINE WAS BETWEEN 4.5 AND 7.8 27 -- 4.5 TO 7.8 P.P.M. YEARS. 28 DO YOU UNDERSTAND WHAT I'VE JUST SAID? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (16 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3905 1 A YES. 2 Q THAT'S LESS THAN 40 TO 200 P.P.M. YEARS? 3 A YES. 4 Q WELL, AND LET'S ASSUME FURTHER THAT DR. REISS 5 TOOK DR. NICAS' HIGHEST NUMBER FOR BENZENE EXPOSURE FOR MR. 6 MOLINA. THIS IS EXHIBIT 111 IN EVIDENCE. THIS IS SUMMARY OF 7 BENZENE EXPOSURE ESTIMATES FOR MR. MOLINA BASED UPON HIS, 8 DR. NICAS', INTERVIEW WITH DR. NICAS. AND HE COMES UP WITH A 9 BOTTOM LINE OF 9 TO 12.3 P.P.M. YEARS. 10 ARE YOU WITH ME? 11 A YES. 12 Q DR. NICAS AND DR. REISS COULD HAVE BEEN 100 13 PERCENT WRONG. THE NUMBERS COULD HAVE BEEN DOUBLE, 18 TO 24, 14 AND IT'S STILL LESS THAN THE 40 TO 200 P.P.M. YEARS THAT 15 YOU'VE TOLD US ABOUT, TRUE? 16 A YES. 17 Q AND THAT'S IF THE DISEASE IN QUESTION IN THIS 18 CASE WERE LEUKEMIA RATHER THAN NON-HODGKIN'S LYMPHOMA? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (17 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 A YES. 20 Q NOW, WHAT I WANT TO DO IS HAVE YOU WALK US 21 THROUGH -- I'LL SAY BRIEFLY, WE'LL SEE HOW BRIEFLY THIS IS -22 YOUR ANALYSIS OF THE EPI-STUDIES THAT YOU CONSIDERED IN 23 FORMING THE OPINIONS THAT YOU FORMED WITH RESPECT TO BENZENE 24 ON THE ONE HAND AND SOLVENTS ON THE OTHER HAND AND 25 NON-HODGKIN'S LYMPHOMA IN HUMANS. 26 ARE YOU WITH ME? 27 A YES. 28 Q LET'S GET YOUR ULTIMATE OPINION OUT ON THE TABLE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (18 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3906 1 FIRST. I THINK WE ALREADY HAVE YOUR OPINION, BECAUSE I'VE 2 ALREADY ASKED YOU WHETHER IN YOUR OPINION BENZENE AT ANY DOSE 3 AND ANY DURATION OF EXPOSURE IS CAPABLE OF CAUSING 4 NON-HODGKIN'S LYMPHOMA IN HUMANS, AND YOU HAVE GIVEN US YOUR 5 OPINION ALREADY ON THAT POINT, HAVEN'T YOU? 6 A YES. 7 Q LET ME CHANGE THE QUESTION. 8 DO YOU HAVE AN OPINION TO A REASONABLE DEGREE OF 9 MEDICAL OR SCIENTIFIC PROBABILITY WHETHER HYDROCARBON 10 SOLVENTS, REFINED PETROLEUM SOLVENTS -- WHATEVER YOU WANT TO 11 CALL THEM -- ARE CAPABLE IN ANY DOSE AND FOR ANY DURATION OF 12 EXPOSURE IN CAUSING NON-HODGKIN'S LYMPHOMA IN HUMANS? 13 A YES. WITH THE CAVEAT THAT WE'RE RESTRICTING 14 THIS NOW TO THE LEVELS THAT HAVE BEEN ACTUALLY STUDIED IN 15 PEOPLE. 16 Q WHAT'S YOUR OPINION? 17 A AT LEAST AT THE LEVELS THAT HAVE BEEN STUDIED IN 18 THE LITERATURE, THERE IS NO CAUSAL RELATIONSHIP BETWEEN file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (19 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 SOLVENT EXPOSURE AND NON-HODGKIN'S LYMPHOMA. 20 Q AND WHAT IS THIS CAVEAT YOU'RE LEAVING OUT? 21 WHAT ARE YOU TELLING US ABOUT EXPOSURES BEING STUDIED IN THE 22 LITERATURE? 23 A WELL, IT'S SORT OF A FINE POINT BUT -- BECAUSE 24 YOU CAN'T -25 IF SOMEBODY SAYS TO YOU AT ANY DOSE, AT ANY TIME 26 COULD SOMETHING HAPPEN? WELL, WE CAN ONLY COMMENT ON WHAT'S 27 ACTUALLY BEEN STUDIED. WHAT WE ACTUALLY KNOW ABOUT. IN OTHER 28 WORDS, WHAT THE BOUNDS ARE OF THE EPIDEMIOLOGY STUDIES. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (20 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3907 1 SOME OF THESE EPIDEMIOLOGY STUDIES HAVE HAD VERY 2 LARGE EXPOSURES. FOR EXAMPLE, THE PLIOFILM COHORT PEOPLE WERE 3 EXPOSED TO INCREDIBLY HIGH AMOUNTS OF BENZENE. 4 SO WITHIN THOSE BOUNDS WE CAN MAKE A STATEMENT. 5 BUT I JUST DON'T WANT TO GET PUT INTO A SITUATION WHERE -- YOU 6 KNOW, YOU HAVE TO STAY WITHIN THE DATA THAT WE HAVE AVAILABLE 7 TO US, THE SCIENTIFIC DATA. 8 Q FINE. THEN LET ME ASK YOU THE QUESTION AND MAKE 9 IT CLEANER. 10 DO YOU HAVE AN OPINION, TO A REASONABLE DEGREE 11 OF MEDICAL AND SCIENTIFIC PROBABILITY, BASED UPON THE WORLD 12 PEER-REVIEWED LITERATURE THAT YOU HAVE STUDIED FOR SOLVENT 13 EXPOSURE -- ALL OF THAT LITERATURE -- BASED ON ALL OF THAT, IN 14 YOUR OPINION, ARE SUCH SOLVENTS CAPABLE OF CAUSING 15 NON-HODGKIN'S LYMPHOMA IN HUMANS? 16 A I DO HAVE AN OPINION ON THAT. 17 Q WHAT IS YOUR OPINION? 18 A THAT THEY DO NOT CAUSE NON-HODGKIN'S LYMPHOMA. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (21 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 Q NOW, I WANT -20 DID YOU, AS PART OF YOUR ANALYSIS, MAKE A 21 DISTINCTION BETWEEN EPIDEMIOLOGIC STUDIES THAT ARE COHORT 22 STUDIES ON THE ONE HAND AND CASE-CONTROL STUDIES ON THE OTHER 23 HAND? 24 A YES. 25 Q WHY? 26 A THEY JUST HAVE TO BE LOOKED AT IN DIFFERENT 27 WAYS. WHEN I DID MY ANALYSIS TO LOOK FOR CONSISTENCY, I 28 LOOKED FOR CONSISTENCY AMONG THE COHORT STUDIES, AND I LOOKED file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (22 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3908 1 FOR CONSISTENCY AMONG THE CASE-CONTROL STUDIES. 2 Q I WANT YOU TO REMIND US, BECAUSE WE MAY HAVE 3 HEARD THIS FROM ANOTHER WITNESS, ABOUT THESE TWO STUDY DESIGNS 4 IN EPIDEMIOLOGY CALLED "COHORT" AND "CASE-CONTROL." NOW, TRY 5 TO CONFINE YOURSELF TO A SENTENCE OR A COUPLE -- COUPLE OF 6 SENTENCES OR A SHORT PARAGRAPH. 7 DEFINE OR DESCRIBE, RATHER, WHAT A COHORT STUDY 8 IS AND THEN WHAT A CASE-CONTROL STUDY IS IN TERMS OF THEIR 9 DESIGN, PLEASE. 10 A FOR A COHORT STUDY, ONE, AS I SAID BEFORE, 11 COMPARES PEOPLE WHO HAVE BEEN EXPOSED TO A CHEMICAL OR GROUP 12 OF CHEMICALS OR PEOPLE WHO HAVE NOT BEEN EXPOSED. AND THEN 13 WHAT YOU USUALLY DO, YOU LOOK AT A WHOLE RANGE OF DISEASES: 14 DIFFERENT KINDS OF CANCERS. MAYBE LOOK AT DIABETES, HEART 15 DISEASE -- JUST TO SEE WHETHER OR NOT PEOPLE WHO HAVE EXPOSED 16 TO THIS CHEMICAL HAVE INCREASED EITHER -- COULD BE INCREASED 17 RATES OF MORTALITY OR IT COULD BE INCREASED INCIDENTS. IF 18 YOU'RE JUST LOOKING AT PEOPLE THAT ACTUALLY HAVE THE DISEASE. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (23 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 THAT'S WHAT YOU DO IN A COHORT STUDY. SO YOU 20 HAVE A COHORT OF PEOPLE THAT YOU ARE STUDYING. 21 Q IS THE PLIOFILM STUDY A COHORT STUDY? 22 A YES. THERE ARE SEVERAL OTHER STUDIES THAT HAVE 23 BEEN KNOWN FOR BENZENE -24 Q PARDON ME. I KNOW I'M INTERRUPTING YOU, BUT 25 WHEN THE RESULT OF A COHORT STUDY ARE REPORTED BY 26 EPIDEMIOLOGISTS, ARE THEY REPORTED AS S.M.R.'S? 27 A YES. 28 Q AND, AGAIN, THAT IS COMPARING THAT NUMBER TO THE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (24 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3909 1 NUMBER ONE? 2 A USUALLY. 3 NOW, SOME PEOPLE MULTIPLY THE ONE BY A HUNDRED 4 SO YOU'RE -5 YOU WILL SEE STUDIES WHERE YOU'RE COMPARING IT 6 TO THE HUNDRED. SO IF YOU HAD A DOUBLING, INSTEAD OF IT BEING 7 REPORTED AS AN S.M.R. OF TWO, IT WOULD BE REPORTED AS AN 8 S.M.R. OF 200. THAT DOESN'T MEAN IT'S 200-FOLD TIMES GREATER. 9 IT'S A DOUBLING. SO THERE ARE TWO DIFFERENT CONVENTIONS IN 10 THE WAY THAT S.M.R.'S ARE REPORTED. 11 Q CASE-CONTROL STUDIES ARE LITTLE MORE 12 COMPLICATED. PLEASE DESCRIBE THAT DESIGN FOR US. 13 A IN A CASE-CONTROL STUDY, AS OPPOSED TO A GROUP 14 OF PEOPLE WHO HAVE A PARTICULAR EXPOSURE, YOU LOOK AT A GROUP 15 OF PEOPLE THAT HAVE A PARTICULAR DISEASE. IN THE CASE WE'RE 16 INTERESTED HERE IS NON-HODGKIN'S LYMPHOMA. 17 SO WHAT YOU'LL DO IS TAKE A GROUP OF PEOPLE WHO 18 HAVE NON-HODGKIN'S LYMPHOMA AND THOSE ARE THE CASES, CASES OF file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (25 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 NON-HODGKIN'S LYMPHOMA, AND YOU COMPARE THEM TO CONTROLS. 20 AND THOSE CONTROLS COULD BE, FOR EXAMPLE, IF 21 SOMEBODY CAME INTO A HOSPITAL HAD NON-HODGKIN'S LYMPHOMA. THE 22 NEXT PERSON WHO IS ADMITTED TO THE HOSPITAL, FOR WHATEVER THEY 23 HAD, COULD BE THE CONTROL PERSON. 24 YOU TAKE THE CASES AND YOU MATCH THE CONTROLS 25 AND THEN YOU LOOK FOR DIFFERENCES IN TYPES OF EXPOSURES. 26 SO THERE YOU'RE ASKING THE QUESTION, DO PEOPLE 27 WHO HAVE NON-HODGKIN'S LYMPHOMA HAVE A HIGHER RATE OF BEING 28 EXPOSED TO CERTAIN KINDS OF CHEMICALS, OR ARE THEY IN CERTAIN file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (26 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3910 1 KINDS OF PROFESSIONS? THERE ARE VARIOUS KINDS OF QUESTIONS 2 YOU CAN ASK ABOUT THOSE PEOPLE. 3 AND THERE WHAT WE DO IS WE TALK IN TERMS OF 4 EITHER AN ODDS RATIO -5 WE TALK IN TERMS OF AN ODDS RATIO, "O.R." 6 Q SOMETIMES IT'S ALSO CALLED A "RELATIVE RISK"? 7 A RELATIVE RISK IS A TERM THAT CAN CUT BOTH WAYS. 8 RELATIVE RISK CAN BE USED IN A CASE CONTROL. IT MAY ALSO BE 9 USED IN A COHORT STUDY IF YOU'RE COMPARING TWO GROUPS OF 10 PEOPLE. SO LET'S JUST STICK WITH ODDS RATIO. 11 Q SO LET ME MAKE AN EXAMPLE. WOULD THIS BE AN 12 EXAMPLE OF A CASE-CONTROL STUDY: YOU LOOK AT CASES OF PEOPLE 13 WITH NON-HODGKIN'S LYMPHOMA, AND YOU ARE LOOKING AT 14 CONTROLS -- PEOPLE WITHOUT NON-HODGKIN'S LYMPHOMA TO SEE, FOR 15 EXAMPLE, WHETHER THEY'VE USED HAIR DYE? 16 A RIGHT. 17 Q OR BODY MASS INDEX? 18 A YES. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (27 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 Q OR SMOKING? 20 A YES. 21 Q OR EXPOSURE TO SOLVENTS -- THAT KIND OF THING? 22 IS THAT WHAT WE'RE TALKING ABOUT? 23 A YES, UH-HUH. 24 Q NOW, DID YOU PREPARE A SLIDE THAT COLLECTS IN 25 THREE COLUMNS COHORT STUDIES OF BENZENE-EXPOSED WORKERS, WHICH 26 DESCRIBES THE NAME OF THE STUDY, THE PUBLICATION DATE, THE 27 TYPES OF WORKERS INVOLVED AND THE S.M.R. AND WHETHER THE 28 RESULT IS STATISTICALLY SIGNIFICANT OR NOT? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (28 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3911 1 A YES. 2 MR. RIFF: LET ME MARK FOR IDENTIFICATION AS 132- -3 THE COURT: 6. 4 MR. RIFF: THANK YOU, YOUR HONOR. 132-6, THAT SLIDE. 5 AND I PROPOSE TO DISPLAY IT. 6 THE COURT: ANY OBJECTION? 7 MR. WAGNON: NO. 8 THE COURT: YOU MAY DISPLAY IT. THANK YOU. 9 (MARKED FOR IDENTIFICATION 10 EXHIBIT 132-6, SLIDE.) 11 MR. RIFF: YOUR HONOR, I'M GOING TO JUST QUICKLY FLIP 12 THROUGH A COUPLE OF THESE. THERE WE ARE. 13 Q NOW, STANDING UP AS NECESSARY WITH YOUR LASER 14 POINTER, PLEASE TELL US WHAT YOU'RE SHOWING US IN 132-6 AND 15 WHAT IT MEANS TO YOU TO A REASONABLE DEGREE OF MEDICAL OR 16 SCIENTIFIC PROBABILITY. 17 A WELL, IT MEANS THAT THE STUDIES AREN'T 18 CONSISTENTLY SHOWING ANY POSITIVE ASSOCIATION -- file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (29 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 Q WAIT, DOCTOR. YOU'RE ASSUMING TOO HIGH A LEVEL 20 OF FAMILIARITY WITH THIS. LET'S START AT THE BEGINNING. 21 YOU'VE LISTED A STUDY BY SORAHAN IN 2005, RIGHT? 22 A YES. 23 Q THAT INVOLVES BENZENE WORKERS IN BRITAIN, YES? 24 A YES. 25 Q IT'S A COHORT STUDY, RIGHT? 26 A YES. 27 Q WHICH MEANS THAT THE RIGHT WAY TO REPORT OUT 28 THIS RESULT IS AS A STANDARD MORTALITY RATE AND IT'S 0.94, file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (30 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3912 1 WHICH RESULT WAS NOT SIGNIFICANT, RIGHT? 2 A YES. 3 Q LET'S JUST FOCUS ON THAT ONE FOR SAKE OF 4 ARGUMENT. 5 IF THE WORKERS IN THIS STUDY, DR. SORAHAN'S 6 STUDY, IF THE EXPOSED TO BENZENE POPULATION AND THE 7 NON-EXPOSED POPULATION HAD EXACTLY THE SAME OUTCOME FOR 8 NON-HODGKIN'S LYMPHOMA, WHAT WOULD THAT NUMBER BE? 9 A ONE. 10 Q THAT NUMBER IS LESS THAN ONE, ISN'T IT? 11 A YES. 12 Q WELL, DOES THAT MEAN TO YOU, AS AN 13 EPIDEMIOLOGIST AND A PHYSICIAN, THAT BEING EXPOSED TO BENZENE 14 ACTUALLY HAS SOME HEALTH PROTECTIVE EFFECTS RELATIVE TO 15 NON-HODGKIN'S LYMPHOMA? 16 A NO. 17 Q WHY NOT? 18 A BECAUSE THE RESULT'S NOT STATISTICALLY file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (31 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 SIGNIFICANT. IT'S NOT RELIABLE ENOUGH. 20 Q SO JUST GOING ON, HERE'S A STUDY BY BLOEMEN, 21 2004, CHEMICAL WORKERS. 22 NOW, HERE, THIS RESULT OF NON-HODGKIN'S LYMPHOMA 23 EXPOSED COHORT WORKERS WAS 1.01. THAT'S MORE THAN ONE, RIGHT? 24 A YES. 25 Q THE RESULT WAS NOT SIGNIFICANT? 26 A YES. 27 Q AND WHEN YOU -28 WHEN WE'RE TALKING ABOUT SIGNIFICANCE HERE, file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (32 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3913 1 YOU'RE TALKING ABOUT STATISTICAL SIGNIFICANCE? 2 A YES. 3 Q SO NOW WE'RE MAYBE MAKING SOME SENSE OF THIS. 4 HERE'S THAT -- HERE'S RINSKY, YOU WERE TALKING 5 ABOUT. THIS IS THE PLIOFILM COHORT, ISN'T IT? 6 A YES. 7 Q HERE FOR THAT FAMOUS STUDY FOR NON-HODGKIN'S 8 LYMPHOMA EXACTLY THE SAME INCIDENCE OF NON-HODGKIN'S LYMPHOMA 9 FOR THE BENZENE-EXPOSED WORKERS AND THE NON-BENZENE-EXPOSED 10 WORKERS? 11 A YES. 12 Q IN ANY EVENT, THE RESULT WAS NOT SIGNIFICANT ONE 13 WAY OR THE OTHER STATISTICALLY? 14 A YES. 15 Q THESE ARE THE STUDIES OF THE COHORT STUDIES OF 16 BENZENE-EXPOSED WORKERS. 17 WELL, HERE'S ONE. THIS NUMBER IS THREE. DOES 18 THAT MEAN IN THIS STUDY, THE HAYES STUDY IN '97 -- LET ME BACK file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (33 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 UP. 20 HAYES STUDY IN '97 AND YIN '96, IS THIS THE SAME 21 GROUP OF WORKERS IN CHINA? 22 A YES. 23 Q AND FOR THESE -24 NOW, HERE'S A RESULT THAT'S THREE TIMES THE 25 NUMBER ONE, RIGHT? 26 A YES. 27 Q AND YOU'VE WRITTEN "SIGNIFICANT" QUESTION MARK. 28 WHAT DOES THAT MEAN? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (34 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3914 1 A WELL, IT WAS REPORTED IN TWO DIFFERENT -- COUPLE 2 OF DIFFERENT PUBLICATIONS. IN ONE IT SHOWED IT WAS MARGINALLY 3 STATISTICALLY SIGNIFICANT, AND THE OTHER ONE IT WAS MARGINALLY 4 NOT. WE'RE RIGHT ON THE BORDERLINE. 5 IN ONE OF THE GROUPS THEY HAD REMOVED ONE OF THE 6 WORKERS FROM THE COHORT. I WASN'T QUITE CLEAR WHY THEY DID. 7 SO WE'RE RIGHT ON THE CUSP OF STATISTICAL SIGNIFICANCE IN THAT 8 PARTICULAR STUDY. IT'S NOT CLEARLY STATISTICALLY SIGNIFICANT. 9 Q NOW, IF THIS COLLECTION OF STUDIES WERE 10 PRESENTED TO AN I.A.R.C. PANEL -- WITHDRAWN. 11 HERE'S WHAT I WANT TO KNOW: LET'S TALK ABOUT 12 YOUR METHOD OF EVALUATING THIS COLLECTION OF STUDIES, COHORT 13 STUDIES OF BENZENE-EXPOSED WORKERS. LET'S JUST TALK ABOUT 14 STRENGTH OF ASSOCIATION, WHICH IS ONE OF THESE BRADFORD-HILL 15 THINGS. 16 IN YOUR OPINION, TO A REASONABLE DEGREE OF 17 SCIENTIFIC PROBABILITY, HOW WOULD YOU CHARACTERIZE THE 18 STRENGTH OF ASSOCIATION FOR THE PROPOSITION THAT THE BENZENE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (35 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 CAUSES NON-HODGKIN'S LYMPHOMA IN HUMANS? 20 A WELL, USUALLY THE GUIDELINE FOR STRENGTH OF THE 21 ASSOCIATION STUDY HAS TO -- BECAUSE OF THE SIZE OF THE WORKERS 22 GROUPS WE'RE LOOKING AT, USUALLY THE STUDY HAS TO HAVE AN 23 S.M.R. OF TWO OR THREE BEFORE WE CONSIDER THE STRENGTH OF 24 ASSOCIATION TO BE ONE THAT WE WOULD REALLY CONSIDER THAT STUDY 25 TO BE AN IMPORTANT STUDY. IN THIS CASE, THERE'S ONLY ONE 26 STUDY. 27 NOW, WE HAVE TO TAKE INTO ACCOUNT THE FACT WITH 28 THE STATISTICAL SIGNIFICANCE ALWAYS, BUT PUTTING THAT ASIDE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (36 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3915 1 FOR A SECOND, THERE'S REALLY ONLY ONE OF THE EIGHT STUDIES 2 HERE THAT ONE WOULD CONSIDER TO HAVE A SUFFICIENT STRENGTH OF 3 ASSOCIATION THAT ONE WOULD CONSIDER THAT TO BE A, QUOTE, 4 "POSITIVE" STUDY. 5 Q LET'S TALK ABOUT THIS CONCEPT OF THE CONSISTENCY 6 OF RESULTS. 7 BASED ON THIS COLLECTION OF STUDIES, IN YOUR 8 OPINION, HOW DOES THE CONSISTENCY FACTOR -- WITHDRAWN. 9 IN YOUR OPINION, TO A REASONABLE DEGREE OF 10 MEDICAL OR SCIENTIFIC PROBABILITY, HOW DOES ONE CORRECTLY 11 EVALUATE THIS CONSISTENCY FACTOR FOR THIS COLLECTION OF 12 STUDIES? 13 A WE'LL, THEY'RE JUST NOT AT ALL CONSISTENT. 14 THERE'S ONLY ONE STUDY THAT I WOULD CONSIDER TO BE POSSIBLY A 15 POSITIVE STUDY IN THIS CASE. IN ALL THE OTHERS THE NUMBERS 16 ARE VERY SMALL AND THEY'RE NOT STATISTICALLY SIGNIFICANT. SO 17 I WOULD CONSIDER THIS GROUP OF STUDIES NOT TO BE AT ALL 18 CONSISTENT. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (37 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 Q IF BENZENE CAUSED NON-HODGKIN'S LYMPHOMA IN 20 HUMANS OVER THIS COLLECTION OF STUDIES, WHAT WOULD YOU EXPECT 21 THESE NUMBERS ON THE FAR-RIGHT COLUMN TO LOOK LIKE? 22 A INCREASED TO A SUBSTANTIAL AMOUNT. THERE ARE 23 PLENTY OF EXAMPLES OF HUMAN CARCINOGENS, KNOWN HUMAN 24 CARCINOGENS, THAT I'VE LOOKED AT. AND IN THOSE CASES YOU SEE 25 CONSISTENT LARGE INCREASES IN THE NUMBERS OF CANCERS THAT ARE 26 IN EXCESS IN THE GROUP OF EXPOSED PEOPLE. 27 Q NOW, IF LATER ON IN THE DAY ON CROSS-EXAMINATION 28 COUNSEL WERE TO FOCUS SOLELY ON THIS ONE STUDY AND ASK YOU file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (38 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3916 1 HALF AN HOUR, 45 MINUTES' WORTH OF QUESTIONS JUST ON THIS ONE 2 CASE STUDY -- THAT COULD HAPPEN -- I GUESS MY QUESTION IS: 3 WOULD IT BE YOUR VIEW OR NOT BE YOUR VIEW THAT THAT STUDY 4 NEEDS TO BE CONSIDERED IN THIS ENTIRE MASS OF STUDIES? 5 A YES. 6 Q DOES IT OR DOES IT NOT? 7 A YES. IT NEEDS TO BE CONSIDERED IN THE CONTEXT 8 OF ALL THE OTHER STUDIES. 9 Q SO THIS IS NOW -10 132-6 IS COHORT STUDIES OF BENZENE-EXPOSED 11 WORKERS. 12 A I MIGHT JUST EXPLAIN ONE OTHER -13 Q HOLD ON, PLEASE. 14 IS THERE SOMETHING ELSE ABOUT THIS THAT YOU NEED 15 TO ADD TO MAKE YOUR TESTIMONY COMPLETE? 16 A I JUST WANT TO EXPLAIN THERE ARE TWO NUMBERS 17 HERE. AND THAT'S BECAUSE THERE WERE ACTUALLY TWO COHORTS IN 18 THIS STUDY. THESE WERE SHOE WORKERS WORKING IN TWO DIFFERENT file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (39 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 COUNTRIES. 20 Q YOU'RE TALKING ABOUT THE FU STUDY FROM '96? 21 A YES. 22 Q THANK YOU. 23 SO IN YOUR OPINION, TO A REASONABLE DEGREE OF 24 SCIENTIFIC PROBABILITY, WHAT IS THE SUMMARY, THE TAKE-AWAY 25 POINT, THAT WE SHOULD TAKE AWAY FROM THIS PARTICULAR GROUP OF 26 COHORT STUDIES OF BENZENE-EXPOSED WORKERS? 27 A THAT THERE IS NO CAUSAL RELATIONSHIP BETWEEN 28 N.H.L. AND BENZENE EXPOSURE THAT HAS BEEN DEMONSTRATED IN file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (40 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3917 1 THESE STUDIES. 2 Q NOW, I WANT TO TAKE SPECIAL NOTE OF ONE 3 PARTICULAR STUDY AND ASK YOU ABOUT IT. IT'S A STUDY BY 4 DRS. WONG AND RAABE. 5 DO YOU KNOW THAT STUDY FROM, I THINK, 2000? 6 A YES. 7 Q TELL THE JURY GENERALLY WHAT DRS. WONG AND RAABE 8 DID IN THAT STUDY, PLEASE. 9 A THERE HAD BEEN MANY COHORT STUDIES OF VARIOUS 10 PETROLEUM WORKERS, WHETHER THEY WORKED FOR VARIOUS PETROLEUM 11 COMPANIES AND THEY WORKED IN DIFFERENT COUNTRIES. AND THEY 12 TOOK ALL -- THEY TOOK 19 OF THESE COHORTS AND ANALYZED THEM 13 ALL TOGETHER TO SEE WHETHER OR NOT THERE WAS ANY INCREASE, AND 14 THEY LOOKED AT VARIOUS KINDS OF DISEASES AND SO FORTH. ONE OF 15 THE DISEASES THEY LOOKED AT WAS NON-HODGKIN'S LYMPHOMA. AND 16 THERE WERE OVER 300,000 PETROLEUM WORKERS THAT THEY USED -17 THAT WERE IN THESE 19 COHORTS. 18 Q LET ME JUST STOP. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (41 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 IS THIS TYPE OF STUDY THAT WONG AND RAABE DID IN 20 2000 CALLED A "META ANALYSIS," M-E-T-A ANALYSIS? 21 A YES. 22 Q IS THAT A RECOGNIZED, APPROPRIATE EPIDEMIOLOGIC 23 TOOL? 24 A YES, IT'S BEEN -25 IT IS BECAUSE IT INCREASES THE NUMBER OF PEOPLE 26 IN A STUDY AND YOU CAN COMBINE GROUPS. I MEAN, IT HAS TO BE 27 DONE PROPERLY, BUT IT IS A RECOGNIZED METHOD NOW IN DOING 28 EPIDEMIOLOGY. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (42 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3918 1 Q AND WONG AND RAABE'S STUDY WAS PUBLISHED IN A 2 PEER-REVIEWED JOURNAL? 3 A YES. 4 Q IT LOOKED AT PETROLEUM WORKERS, RIGHT? 5 A YES. 6 Q AND DO YOU THINK THAT LOOKING AT PETROLEUM 7 WORKERS IS A RELEVANT STUDY FOR A CASE LIKE THIS WHERE WE'RE 8 LOOKING AT A GENTLEMAN WHO WAS EXPOSED TO REFINED HYDROCARBON 9 SOLVENTS? 10 A YES. 11 Q WHY? WHY IS THAT RELEVANT? 12 A WELL, IT'S A VERY LARGE GROUP OF PEOPLE WHO ARE 13 EXPOSED TO THESE REFINED HYDROCARBON SOLVENTS BECAUSE THAT'S 14 WHAT IS BEING PRODUCED IN REFINERIES. 15 Q OKAY. NOW -16 A AND WITH THIS LARGE NUMBERS OF PEOPLE, EVEN IF 17 YOU HAD JUST SMALL INCREASES OR DECREASES, YOU COULD FIND 18 STATISTICAL SIGNIFICANCE BECAUSE THE NUMBERS ARE SO LARGE. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (43 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 Q I THINK YOU TOLD US THIS STUDY INVOLVED 300,000 20 SUCH WORKERS? 21 A YES. 22 Q COMBINED 19 SUCH STUDIES? 23 A YES. 24 Q DID THE STUDY LOOK TO SEE IF NON-HODGKIN'S 25 LYMPHOMA WAS -- THE INCIDENCE OF NON-HODGKIN'S LYMPHOMA WAS 26 INCREASED IN THIS POPULATION? 27 A YES. 28 Q AND WAS IT? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (44 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3919 1 A NO. 2 Q EXPLAIN YOUR ANSWER, PLEASE. 3 A WELL, THEY FOUND A VERY SMALL DECREASED AMOUNT 4 OF -- I BELIEVE, IT WAS .99. THEY FOUND JUST A LITTLE BIT 5 LESS THAN WHAT ONE WOULD HAVE EXPECTED IN A NORMAL POPULATION 6 OF PEOPLE. 7 Q COMPARING NON-EXPOSED WORKERS AND EXPOSED 8 WORKERS, YOU'D EXPECT THE NUMBER ONE -- WITHDRAWN. 9 DO YOU REMEMBER IN THIS STUDY HOW MANY 10 NON-HODGKIN'S LYMPHOMA DEATHS DID THEY RECORD IN THIS 11 POPULATION? 12 A I DON'T REALLY RECALL SITTING HERE NOW. 13 Q WOULD LOOKING AT SLIDE 132-8 REFRESH YOUR 14 RECOLLECTION? 15 A YES. 16 Q DID YOU PREPARE SLIDE 132-8? 17 A YES. 18 Q DID I PREPARE SLIDE 132-8? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (45 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 A NO. 20 Q WOULD YOU TAKE A LOOK AT SLIDE 132-8 AND REFRESH 21 YOUR MEMORY ON THAT POINT. 22 (PAUSE.) 23 A THERE WERE 408 PEOPLE WHO DIED FROM 24 NON-HODGKIN'S LYMPHOMA, AND THE NUMBER EXPECTED WOULD HAVE 25 BEEN 412. SO IN THIS CASE THE S.M.R. WAS .99. 26 Q WHAT'S THE TAKE-AWAY FROM THE WONG AND RAABE 27 STUDY ON THE QUESTION IN YOUR OPINION, TO A REASONABLE DEGREE 28 OF MEDICAL OR SCIENTIFIC PROBABILITY? WHAT IS THE BOTTOM LINE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (46 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3920 1 WITH RESPECT TO WHETHER BEING EXPOSED AS A REFINERY WORKER IS 2 OR IS NOT ASSOCIATED WITH AN INCREASE IN NON-HODGKIN'S 3 LYMPHOMA? 4 A THERE'S NO INDICATION THAT THERE IS ANY INCREASE 5 AMONG THIS GROUP OF WORKERS. 6 Q NOW, DID YOU ALSO, AS PART OF YOUR WORK, THEN 7 COLLECT UP OTHER PETROLEUM WORKER COHORT STUDIES? INDEPENDENT 8 OF THESE BENZENE-EXPOSED WORKERS, WHICH YOU'VE ALREADY LOOKED 9 AT, DID YOU COLLECT UP A LIST OF OTHER COHORT MORTALITY 10 STUDIES OF NON-HODGKIN'S LYMPHOMA IN PETROLEUM WORKERS? 11 A WELL, WHAT I DID WAS -12 FIRST OF ALL, I LOOKED AT THE INDIVIDUAL STUDIES 13 AS WELL, NOT JUST AT THEIR META ANALYSIS TO SEE WHETHER OR NOT 14 THERE WAS ANYTHING THAT WOULD STAND OUT AND THERE REALLY 15 WASN'T. THE META ANALYSIS WAS CONSISTENT WITH WHAT ONE WOULD 16 JUST LOOK -- EXPECT FROM LOOKING AT ALL THE INDIVIDUAL 17 STUDIES. 18 BUT THEN WHAT I DID WAS -- THIS WAS PUBLISHED IN file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (47 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 2000. SINCE THAT TIME, SOME OF THESE SAME 19 COHORTS, THERE'S 20 BEEN MORE RECENT PUBLICATIONS, IN OTHER WORDS, UPDATES OF THE 21 MORTALITY STATISTICS ON THE PEOPLE. SO I LOOKED AT, I THINK, 22 AN ADDITIONAL SIX OR EIGHT OF THESE IN WHICH THEY HAD BEEN 23 UPDATED SINCE THAT TIME. 24 PLUS THERE WAS A WHOLE GROUP OF PETROLEUM 25 WORKERS FROM AUSTRALIA THAT WERE -- THAT WEREN'T INCLUDED IN 26 THIS ORIGINAL META ANALYSIS THAT THEN WERE PUBLISHED ABOUT, 27 AND SO I ALSO LOOKED AT THAT. 28 MR. RIFF: AND I'D ASK TO BE MARKED FOR IDENTIFICATION file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (48 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3921 1 AS 132-9, A TABLE CALLED "COHORT MORTALITY STUDIES OF 2 NON-HODGKIN'S LYMPHOMA IN PETROLEUM WORKERS." 3 MAY THAT BE SO MARKED, YOUR HONOR? 4 THE COURT: IT MAY BE SO MARKED. 5 (MARKED FOR IDENTIFICATION 6 EXHIBIT 132-9, TABLE.) 7 BY MR. RIFF: 8 Q DO YOU HAVE THAT IN FRONT OF YOU THAT TABLE OR 9 CHART, I SHOULD SAY? 10 A YES. 11 Q DID YOU PREPARE IT? 12 A YES. 13 MR. RIFF: I PROPOSE TO DISPLAY IT, YOUR HONOR, 14 MR. WAGNON: NO OBJECTION. 15 THE COURT: YOU MAY. 16 BY MR. RIFF: 17 Q SO WHAT WE'RE LOOKING AT HERE IS YOUR TABLE OF 18 COHORT MORTALITY STUDIES OF NON-HODGKIN'S LYMPHOMA IN file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (49 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 PETROLEUM WORKERS. HERE'S THAT WONG AND RAABE THAT WE TALKED 20 ABOUT, RIGHT? 21 A YES. 22 Q AND YOU'RE TELLING US THAT THERE ARE STUDIES 23 SINCE THAT PUBLICATION THAT ALSO LOOK AT PETROLEUM WORKER 24 POPULATIONS TO SEE ABOUT THE INCIDENTS OF NON-HODGKIN'S 25 LYMPHOMA. 26 IS THAT WHAT YOU'RE TELLING US? 27 A YES. 28 Q GOING DOWN THIS LIST IN THE FAR RIGHT-HAND SIDE, file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (50 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3922 1 WITH RESPECT TO THE STRENGTH OF ASSOCIATION AND WITH RESPECT 2 TO WHETHER THE RESULTS WERE SIGNIFICANT OR NOT SIGNIFICANT 3 STATISTICALLY, IN YOUR OPINION, WHAT IS THE MAJOR TAKE-AWAY 4 FROM THIS CHART? 5 A WELL, FIRST, THERE ARE NO STATISTICALLY 6 SIGNIFICANT INCREASES OR DECREASES. SO THERE IS NO REALLY 7 RELIABLE INFORMATION THAT ANY OF THESE WOULD BE DIFFERENT FROM 8 ONE. 9 AND, SECONDLY, THE NUMBERS ARE -- SOME OF THEM 10 ARE A LITTLE BIT HIGHER AND SOME ARE A LITTLE BIT LOWER. SO, 11 AGAIN, THE CONSISTENCY -- ON THE BASIS OF CRITERIA OF 12 CONSISTENCY, ONE WOULDN'T THINK THERE WAS ANY ASSOCIATION 13 SHOWN. 14 Q LET'S MOVE ON IN YOUR ANALYSIS. 15 TO THE EXTENT YOU HAVEN'T TOLD US, WHAT IS YOUR 16 BOTTOM-LINE OPINION TO A REASONABLE DEGREE OF MEDICAL OR 17 SCIENTIFIC PROBABILITY AS TO THE COHORT MORTALITY STUDIES OF 18 PETROLEUM WORKERS AND N.H.L? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (51 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 A THAT THERE IS NO CAUSAL RELATIONSHIP THAT'S BEEN 20 SHOWN. 21 Q NOW, LET'S CHANGE TO YOUR ANALYSIS OF 22 CASE-CONTROL STUDIES FROM COHORT STUDIES. 23 AND I'D ASK THAT WE MARK AS 132-11 FOR 24 IDENTIFICATION, YOUR HONOR, A TABLE CALLED "CASE CONTROL 25 STUDIES OF OVER 4,000 NON-HODGKIN'S LYMPHOMA CASES AND 26 PETROLEUM-DERIVED BENZENE EXPOSURES." 27 THE COURT: YES, THAT MAY BE SO MARKED. 28 /// file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (52 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3923 1 (MARKED FOR IDENTIFICATION 2 EXHIBIT 132-11, TABLE.) 3 BY MR. RIFF: 4 Q DO YOU HAVE THAT IN FRONT OF YOU? 5 A YES, I DO. 6 Q DID YOU PREPARE 132-11? 7 A YES. 8 MR. RIFF: I'D PROPOSE TO DISPLAY IT, YOUR HONOR. 9 MR. WAGNON: NO OBJECTION. 10 THE COURT: YOU MAY. 11 BY MR. RIFF: 12 Q SO IT SAYS, "CASE CONTROL STUDIES OF OVER 4,000 13 NON-HODGKIN'S LYMPHOMA CASES AND PETROLEUM-DERIVED BENZENE 14 EXPOSURES." 15 WHAT WERE YOU ATTEMPTING TO DO IN THE CREATION 16 OF EXHIBIT 132-11? 17 A COULD THE PROJECTOR BE RAISED UP A LITTLE BIT 18 BECAUSE WE'RE MISSING THE BOTTOM. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (53 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 Q YES. 20 (PAUSE.) 21 A AGAIN, WE'RE TRYING TO LOOK AT PETROLEUM-DERIVED 22 BENZENE -23 Q LOUDER, PLEASE. 24 A I'M SORRY. WE'RE TRYING TO LOOK AT 25 PETROLEUM-DERIVED BENZENE EXPOSURES. 26 WHAT THIS IS, AGAIN, YOU LOOK AT PEOPLE WHO HAVE 27 NON-HODGKIN'S LYMPHOMA, AND THEY ARE EITHER ASKED OR SOME 28 DETERMINATION IS MADE AS TO WHETHER OR NOT THEY HAVE BEEN file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (54 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3924 1 EXPOSED TO BENZENE. AND YOU COMPARE THAT TO A GROUP OF PEOPLE 2 WHO HAVE NOT BEEN EXPOSED TO BENZENE TO SEE IF THERE IS ANY 3 INCREASE. 4 IN THIS CASE, AS I MENTIONED, WHAT'S CALLED THE 5 "ODDS RATIOS" AND WHETHER OR NOT THEY'RE STATISTICALLY 6 SIGNIFICANT. SO I WAS ABLE TO LOCATE 11 STUDIES THAT WERE 7 CASE-CONTROL STUDIES OF PEOPLE WHO HAD REPORTED BENZENE 8 EXPOSURE OR NOT BENZENE EXPOSURE. AND SOMETIMES THERE WAS 9 A -- THERE WERE ACTUALLY DIFFERENT AMOUNTS OF EXPOSURE 10 MENTIONED. SO SOMETIMES YOU CAN DO A TREND STATISTICAL 11 ANALYSIS -12 Q LOUDER. 13 A SORRY. SO SOMETIMES YOU CAN DO A TREND 14 STATISTICAL ANALYSIS OR SOMETIMES YOU ARE JUST LOOKING AT THE 15 EXPOSED PEOPLE VERSUS THE NON-EXPOSED PEOPLE IN THAT GROUP. 16 THIS IS WHAT THIS SLIDE REPRESENTS. 17 Q LET ME ASK YOU THIS: IF I'M READING THIS 18 CORRECTLY, THERE IS ON THIS EXHIBIT ONE STUDY THAT HAS AN file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (55 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 INCREASED ODDS RATIO, THE RESULT OF WHICH IS STATISTICALLY 20 SIGNIFICANT. 21 AM I READING THAT RIGHT? 22 A YES. 23 Q DOES THAT MEAN, DR. WHYSNER, THAT THIS IS THE 24 RIGHT ANSWER, AND EVERYTHING ELSE IS THE WRONG ANSWER OR 25 BACKGROUND NOISE OR TO BE REJECTED OR SOMETHING LIKE THAT? 26 A NO, IT DOESN'T MEAN THAT. 27 Q EXPLAIN THAT, PLEASE. 28 A BECAUSE, FIRST OF ALL, THE ONE POSITIVE RESULT file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (56 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3925 1 IS NOT THAT HIGH. AND SECONDLY, WE DON'T -- IT'S NOT 2 CONSISTENT WITH ANY OF THE OTHER FINDINGS. SOME OF THEM ARE 3 LESS THAN ONE. SOME OF THEM ARE A LITTLE BIT GREATER THAN 4 ONE. 5 Q SO, IN YOUR OPINION, TO A REASONABLE DEGREE OF 6 SCIENTIFIC OR MEDICAL PROBABILITY, WHAT'S THE BOTTOM-LINE 7 TAKE-AWAY FROM THE COLLECTION OF CASE-CONTROL STUDIES LOOKING 8 AT PETROLEUM-DERIVED BENZENE EXPOSURES AND NON-HODGKIN'S 9 LYMPHOMA? 10 A THAT IT DOESN'T DEMONSTRATE ANY CAUSAL 11 ASSOCIATION. 12 Q OKAY. WE'RE ALMOST DONE WITH TABLES. I'VE GOT 13 ONE MORE I WANT TO SHOW YOU. 14 YOUR HONOR, MAY WE MARK AS 132-14 A TABLE 15 ENTITLED "CASE-CONTROL STUDIES OF NON-HODGKIN'S LYMPHOMA AND 16 PETROLEUM-DERIVED SOLVENT EXPOSURES"? 17 THE COURT: YES, IT MAY BE SO MARKED. 18 (MARKED FOR IDENTIFICATION file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (57 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 EXHIBIT 132-14, TABLE.) 20 BY MR. RIFF: 21 Q DO YOU HAVE THAT TABLE IN FRONT OF YOU? 22 A YES. 23 Q DID YOU PREPARE IT? 24 A YES. 25 MR. RIFF: NOW, IN THIS -26 WELL, I WOULD LIKE TO DISPLAY 132-14, YOUR 27 HONOR, IF THERE'S NO OBJECTION. 28 MR. WAGNON: NO OBJECTION. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (58 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3926 1 THE COURT: IT MAY BE DISPLAYED. 2 BY MR. RIFF: 3 Q NOW, WHY DO YOU HAVE THE WORD "SOLVENT" IN 4 QUOTATION MARKS? 5 A THIS IS ONE OF THE DIFFICULTIES WITH STUDIES OF 6 SOLVENTS BECAUSE ALL SOLVENT MEANS IS THAT THE CHEMICAL IS 7 USED TO DISSOLVE SOMETHING. SO THERE ARE DIFFERENT CLASSES 8 AND TYPES OF CHEMICALS THAT ARE SOLVENT. 9 ONE EXAMPLE WOULD BE WATER. WATER IS A SOLVENT 10 BECAUSE IT'S USED TO DISSOLVE THINGS. HYDROCARBON SOLVENTS 11 DOESN'T INCLUDE WATER. SO IF YOU HAVE THE HYDROCARBON 12 SOLVENTS, THOSE ARE USED TO DISSOLVE THINGS THAT ARE USUALLY 13 NOT DISSOLVABLE IN WATER. 14 AND THEN THERE ARE GROUPS OF CHLORINATED 15 SOLVENTS. SO A LOT OF TIMES THE PROBLEM WITH THESE STUDIES IS 16 THEY WILL IDENTIFY THAT SOMEBODY HAS BEEN EXPOSED TO SOLVENT, 17 BUT IT REALLY DOESN'T TELL YOU ABOUT WHAT WE'RE INTERESTED IN 18 THIS PARTICULAR CASE, AND THAT IS A PETROLEUM-BASED SOLVENT. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (59 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 SO WE'RE TALKING ABOUT THINGS THAT ARE ANALOGOUS 20 TO -- LIKE TOLUENE, XYLENE -- ALL THESE OTHER COMPONENTS OF 21 MINERAL SPIRITS OR STODDARD SOLVENTS OR WHATEVER. THESE ARE 22 ALL PETROLEUM-BASED SOLVENTS. 23 AND THERE'S A WHOLE OTHER CLASS OF SOLVENTS 24 CALLED "GLYCOL ETHERS" THAT REALLY DON'T HAVE ANYTHING 25 CHEMICALLY TO DO WITH EITHER CHLORINATED SOLVENTS OR 26 PETROLEUM-BASED SOLVENTS. 27 THERE'S LOTS OF STUDIES ABOUT SOLVENTS BUT I 28 REALLY TRIED TO FIND STUDIES WHERE YOU CAN ACTUALLY BELIEVE file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (60 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3927 1 THAT WHAT THEY WERE TALKING ABOUT WAS A PETROLEUM-BASED 2 SOLVENT. 3 Q SO ON THIS EXHIBIT, AGAIN, IT'S THE FAMILIAR 4 FORMAT. YOU HAVE THE NAME OF THE STUDY AND THE YEAR OF THE 5 PUBLICATION. THE EXPOSURE OR EXPOSURES TESTED FOR IN 6 ASSOCIATION WITH NON-HODGKIN'S LYMPHOMA. IN OTHER WORDS, THE 7 KIND OF THE STUFF PEOPLE WERE EXPOSED TO, RIGHT? 8 A YES. 9 Q AND THEN OVER HERE THE ODDS RATIO AND WHETHER OR 10 NOT THERE WAS STATISTICAL SIGNIFICANCE, TRUE? 11 A YES. 12 Q AND HERE OF THESE NINE PUBLICATIONS, THERE'S 13 ONE, HARDELL '94, THAT SHOWS AN INCREASED ODDS RATIO THAT IS 14 STATISTICALLY SIGNIFICANT. 15 AM I READING THAT CORRECTLY? 16 A YES. 17 Q WELL, DOES THAT MEAN THAT HARDELL WAS THE RIGHT 18 ONE AND EVERYTHING ELSE IS WRONG? file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (61 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 A NO. 20 Q FOR THE REASONS YOU ALREADY HAVE EXPLAINED? 21 A CORRECT. 22 Q SO IN YOUR OPINION, TO A REASONABLE DEGREE OF 23 MEDICAL AND SCIENTIFIC PROBABILITY, WHAT IS THE CORRECT 24 TAKE-AWAY FROM THIS EXHIBIT AND YOUR ANALYSIS WITH RESPECT TO 25 CASE-CONTROL STUDIES OF SOLVENT EXPOSURES IN NON-HODGKIN'S 26 LYMPHOMA? 27 A "SOLVENT," MEANING PETROLEUM-BASED SOLVENT 28 EXPOSURES, THAT THERE IS NO CAUSAL ASSOCIATION, CORRECT. file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (62 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3928 1 MR. RIFF: YOUR HONOR, THIS WOULD BE A VERY CONVENIENT 2 TIME TO BREAK. I KNOW IT'S A LITTLE EARLY, BUT WE'RE ABOUT TO 3 MOVE TO AN ENTIRELY NEW TOPIC. 4 THE COURT: THAT'S FINE. 5 ALL RIGHT. LADIES AND GENTLEMEN, WE'LL SEE YOU 6 BACK HERE AT 1:30, THE USUAL TIME. 7 PLEASE REMEMBER DO NOT DISCUSS THE CASE AMONG 8 YOURSELVES OR WITH ANYONE. DON'T FORM ANY OPINIONS ON IT 9 UNTIL THE MATTER IS SUBMITTED TO YOU. 1:30. THANK YOU. 10 11 (WHEREUPON AT 11:54 A.M. A RECESS 12 WAS HAD UNTIL 1:30 P.M. OF THE 13 SAME DAY.) 14 15 16 17 18 file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (63 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 20 21 22 23 24 25 26 27 28 file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (64 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 3929 1 (3929-4000) 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (65 of 66) [10/18/2010 2:21:58 PM] file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt 19 20 21 22 23 24 25 26 27 28 file:///C|/Users/MadeK42/Desktop/whysner-upload/Whysner,%20John%20--%2010-28-08%20--%20Part%20II.txt (66 of 66) [10/18/2010 2:21:58 PM]