Document R26XMY8vRr4kq5VJj9Q5KNmv

1 1 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY 2 3 GRACE M. GRASSO, EXECUTRIX OF THE 4 ESTATE OF JOHN C. GRASSO, DECEASED, 5 PLA INTIFF, -V6 8.F. GOODRICH COMPANY. 7 DEFENDANT I DOCKET NUMBER 78--1 5^2 TR I AL VOLUME 3 8 9 10 BEFORE: 11 ~ THE HONORABLE STANLEY S . BROTMAN, UNITED STATES DISTRICT JUDGE 12 DATE: THURSDAY, JANUARY 22, 1981 13 14 APPEARANCES: 15 16 MESSRS. BROWN, CONNERY, KULP, WILLE, PURNELL AND GREENE, 17 BY: MICHAEL J. VASSALOTT ESQUIRE, ATTORNEYS FOR THF PLAINTIFF. 18 19 MESSRS. SCHUENEMANN AND GERCKE 20 BY: STEPHEN DUMSER, ESQUIRE, AND 21 MESSRS. HARVEY, PENNINGTON, HERTING AND RENNEIS EN 22 BY: G. WAYNE RENNE I SEN, ESQUIRE, ATTORNEYS FOR THE DEFENDANT. 23 24 25 r 21109001 U. S. DISTRICT COURT - CAMDEN, NEW JERSEY BFG09743 1 1 CERTIFICATE 2 I, P. LYNNE BELL, A NOTARY PUBLIC 3 AND CERTIFIED SHORTHAND REPORTER OF THE STATE 4 OF NEW JERSEY DO HEREBY CERTIFY THAT THE 5 FOREGOING IS A TRUE AND ACCURATE TRANSCRIPT 6 OF THE TESTIMONY AS TAKEN STENOGRAPHICALLY BY 7 AND BEFORE ME AT THE TIME, PLACE AND ON THE 8 DATE HEREINBEFORE SET. FORTH. 9 I DO FURTHER CERTIFY THAT I AM 10 NEITHER A RELATIVE NOR EMPLOYEE NOR ATTORNEY'' 11 NOR COUNSEL OF ANY OF THE PARTIES TO THIS 12 ACTION, AND THAT I AM NEITHER A RELATIVE NOR 13 EMPLOYEE OF SUCH ATTORNEY OR COUNSEL AND THAT 14 I AM NOT F INANC IALLY ' INTERESTED IN THIS 15 ACTION. 16 17 18 P. LYNNE BELL, C . S . R . 19 NOTARY PUBLIC, STATE OF NEW JERSEY 20 MY COMMISSION EXPIRES 5/18/31 21 DATE: JANUARY 22, 1981 22 23 24 25 BFG09744 Z0060TT2 2 1 2 3 4 CERTIFICATION 5j j I, STEPHEN J. DANER, OFFICIAL 6 COURT REPORTER FOR THE UNITED STATES DISTRICT 7 COURT, FOR THE DISTRICT OF NEW JERSEY, DO 4i 8 HERESY CERTIFY THAT THE FOREGOING MATTER IS A j 9 .TRUE AND ACCURATE TRANSCRIPT OF MY 10 STENOGRAPHIC NOTES TAKEN AT THE TIME AND 11 PLACE HEREINBEFORE SET FORTH. 12 1 13 14 15 16 17 18 -t 1 19 DANER, CP, RPR S. REPORTER /' 20 DATE 21 22 23 24 25 ; i BFG09745 U. S. DISTRICT COURT CAMOFM, NEW JERSEY 2JL1C9003 3 1 CTHE FOLLOWING TAKES PLACE IN OPEN COURT.) 2 THE COURT: ALL RIGHT, BRING 3 THE JURY IN. 4 (THE FOLLOWING TAKES PLACE IN OPEN COURT WITH 5 THE JURY PRESENT.) 6 THE COURT: GOOD MORNING, 7 LADIES AND GENTLEMEN. YOU MAY NOW PROCEED. 8 9 YOUR HONOR. MR. VASSALOTTI: THANK YOU, 10 YOUR HONOR, BEFORE CALLING 11 OUR NEXT WITNESS, PLAINTIFF MOVES TO MOVE 12 INTO EVIDENCE PLAINTIFF'S EXHIBITS SEVEN, 13 EIGHT AND NINE, WHICH WERE THE CHARTS SHOWING 14 THE RESULTS OF THE TESTIMONY OF PROFESSOR -- 15 DAVID SON AND PESKIN. 16 THE COURT: ANY OBJECTION?. 17 MR. RENNEISEN: YOUR HONOR, I 18 DIDN'T OBJECT TO THEM 8EING MARKED. I DON'T 19 OBJECT TO THEM BEING ADMITTED INTO EVIDENCE. 20 AT THIS POINT, I DON'T THINK IT WOULD BE 21 APPROPRIATE TO DECIDE WHAT EVIDENCE THE JURY 22 WOULD TAKE INTO THE JURY ROOM. AND I WOULD 23 LIKE TO RESERVE MY RIGHT TO REVIEW ALL THE 24 EVIDENCE AND MAKE OBJECTIONS TO WHAT THE JURY 25 SEES AT THE END OF TRIAL. 'O O o O T T St bFG09746 4 1 THE COURT: WELL, ARE YOU 2 OBJECTING TO IT BEING MARKED INTO EVIDENCE AT 3 THIS TIME OR NOT? I MEAN, NOW IS THE TIME. I F 4 YOU HAVE OBJECTIONS/ WE'LL HEAR YOUR 5 OBJECTIONS?. 6 MR. RENNEISEN: I WOULD LIKE 7 TO MAKE THE OBJECTIONS OUT OF THE HEARING OF . 8 THE JURY. 9 THE COURT: YES, OF COURSE. 10 WE'LL DO THAT. BUT, YOU DO HAVE OBJECTIONS? 11 MR. RENNEISEN: YES. 12 THE COURT: LET'S HOLD UP ON 13 THAT, THEN. 14 MR. RENNEISEN: I HAVE NO IS OBJECTION TO THE WITNESS SEEING IT, YOUR 16 HONOR. 17 MR. VASSALOTTI: IT FORMS THE 18 BASIS OF THE NEXT TWO WITNESSES OPINIONS AND 19 I THINK IT'S IMPORTANT THAT WE GET A RULING. 20 THE COURT: LAD I ES AND 21 GENTLEMEN, I'LL EXCUSE YOU WHILE WE HEAR 22 COUNSEL ON THIS, PLEASE. 23 Cat which time the jury leaves the courtroom.) *3 24 THE COURT: I'LL HEAR YOUR 25 OBJECTIONS. 1.109005 jypG09,74'7 5 1 MR. renneisen: YOUR HONOR, 2 THE CHART, I HAVE NO OBJECTION TO THE 3 AUTHENTICITY OF THE CHART. IT IS WHAT IT 4 PURPORTS TO BE. IT IS A SUMMARY OF THE 5 TESTIMONY OF PROFESSOR PESKIN. 6 MY OBJECTION IS IS THAT IT'S 7 A SELECTION OF HIS TESTIMONY. I HAVE NO 8 OBJECTION TO IT BEING USED AS AN EXHIBIT, TO 9 ASSIST WITNESSES AND SO FORTH. BUT THE AT THE 10 CONCLUSION OF THE TRIAL, I DON'T THINK IT'S 11 APPROPRIATE TO TAKE PART OF TESTIMONY AND 12 GIVE IT TO THE JURY AS AN EXHIBIT WHEN IT 13 REALLY ISN'T A DOCUMENT THAT WAS CREATED 14 PRIOR TO TRIAL. IT'S AS THOUGH l WERE TO 15 TAKE STATEMENTS OF DOCTOR PESKIN'S TESTIMONY, 16 MARK THEM AS EXHIBITS AND ASK THAT THEY GO TO 17 THE JURY, WHICH I DON'T THINK IS APPROPRIATE. 18 MR. VASSALOTTI: YOUR HONOR, 19 IN RESPONSE TO THAT, I WOULD SAY UNDER NORMAL 20 CIRCUMSTANCES, MR. RENNEISEN'S OBJECTION 21 MIGHT BE WELL NOTED. BUT, THIS IS NOT A 22 NORMAL, IN THAT THE TESTIMONY THAT WAS GIVEN 23 BY PROFESSOR DAVIDSON AND PROFESSOR PESKIN, 24 THEY MADE SPECIFIC CALCULATIONS THAT OCCURRED 25 AT CERTAIN TIMES AND UNDER CERTAIN CONDITIONS. BFG09748 sooeoY T Z 6 1 I THINK IT WOULD BE -- AND THEY ALSO 2 TESTIFIED THAT THE ENTRIES THAT THEY MADE ON 3 THESE TABLES WERE THE ELEMENTS OF THEIR 4 CALCULATION AND CONCLUSIONS. I THINK IT'S A 5 UNFAIR BURDEN ON THE JURY IN THIS CASE TOO 6 ASK THEM TO REMEMBER HOW MUCH WAS EMITTED IN 7 1970, HOW MUCH WAS EMITTED IN 1971, HOW MANY 8 DAYS DID THE WINDS BELOW IN THE RIGHT 9 DIRECTION IN 1971. I THINK IT WOULD BE A BIG 10 ASSISTANCE TO THE JURY. LET'S TAKE EACH 11 EXHIBIT. LET'S GET THE EXHIBITS. 12 MR. RENNEISEN: I HAVE NINE 13 OF THEM ALREADY 14 THE COURT: NOW, LET'S TAKE 15 EACH ONE. 16 MR . VASSALOTTI: JUDGE, THIS 17 IS EXHI 8 IT P-7. 18 THE COURT: YES. 19 MR. VAS5ALOTTI: THIS IS A 20 TABLE WHICH HAS -- IT'S A TABLE WHICH HAS A 21 COMBINATION OF ENTRIES THAT WERE MADE BY 22 PROFESSOR DAVIDSON WHO CALCULATED THE TOTAL 23 EMISSION OF VINYL CHLORIDE ON AN ANNUAL BASIS 24 FOR EACH OTHER AND THE HOURLY FLOW OR THE 25 HOURLY RATE OF EMISSION OR VINYL CHLORIDE FOR BFG09749 21109007 7 1 EACH YEAR AND TESTIFIED TO THAT. IT ALSO HAS 2 TWO OTHER COLUMNS IN WHICH PROFESSOR PESKIN 3 ENTERED HIS FINDINGS ON THE RATE OF EXPOSURE 4 IN THE AREA OF THE GRASSO HOME DURING EACH 5 YEAR IN QUESTION AND THE NUMBER OF HOURS 6 DURING EACH OF THOSE YEARS WHEN THAT RANGE OF 7 EXPOSURE WOULD HAVE BEEN EXPECTED AT THE 8 GRASSO HOME. 9 THE COURT: IS THIS A SUMMARY, 10 REALLY. DOESN'T THAT COME IN UNDER THE 11 SUMMARY EXCEPTION RULE 1006, RULES OF 12 EVIDENCE, TO A CERTAIN EXTENT? I MEAN THERE'S 13 NO QUESTION IT'S HELPFUL TO THE JURY. THE 14 JURY IS IN NO WAY IS GOING TO REMEMBER THAT. 15 AND EVEN IF THEY DID, THERE'S A QUESTION IN 16 MY MIND WHETHER IT'S GOING TO MAKE SENSE. 17 WE'VE HAD A LOT OF PHYSICIAN, A LOT OF REAL 18 EXPERT TESTIMONY, AND WHETHER OR NOT THE JURY 19 IS ABSORBING THAT, I DON'T KNOW. WE HAVE A 20 LOT OF NUMBERS THROWN AT THEM. 21 MR. VASSALOTTI: THAT'S WHY I 22 THINK IT'S IMPORTANT THAT THEY NOT BE 23 HIGHLIGHTED. 24 THE COURT: I SEE NO HARM 25 LETTING THE JURY SEE THIS, WHATEVER PURPOSE BFG09750 21109008 3 1 THEY MA Y MAKE OF I T . IN MANY INSTANCES, WE 2 HAVE QUESTION MARK SOMETHING ON A CHART AND 3 IT GOES TV3 THE JURY . IT'S ONLY PART OF THEIR 4 TESTIMONY.\OF COURSE, THE JURY IS INSTRUCTED, 5 THEY'RE TO TAKE THE ENTIRE TESTIMONY OF A 6 WITNESS. THEyVaN'T, IN MY OPINION, THEY 7 CAN'T BE EXPECTS!) TO REMEMBER THESE SERIES OF 8 COMPUTATIONS. \ 9 MR. RENNEISEN! YOUR HONOR, 10 IT IS A SUMMARY OF THE TESTIMONY. BUT MY 11 PROBLEM IS THAT SOME -- YOU TAKE THIS 12 COLUMN, THE EMISSION DATA, SPECIFICALLY 13 I'M NOT SURE WHAT TEN TO THE SIXTH IS EITHER, 14 BUT 8ASICALLY, I THINK THE TESTIMONY WILL 15 AGREE ON THIS PR08LEM. BUT THERE'S 16 SIGNIFICANCE -- THERE WILL BE SIGNIFICANT 17 DIFFERENCES IN THE TESTIMONY -- 18 THE COURT: THAT ALWAYS 19 HAPPENS. THAT ALWAYS HAPPENS. IF YOURS 20 DIFFERS FROM THIS, YOU PREPARE A LIKE CHART 21 AND PUT IN YOURSELF. 22 MR. RENNEISEN: WELL, MAY BE 23 24 THE COURT: I WANT YOU TO DO 25 THAT . BFG09751 21109009 9 1 MR. RENNEISEN: THANK YOU, 2 YOUR HONOR. 1 MADE MY OBJECTION. 3 THE COURT: YOU ARE OVERRULED. 4 LET'S PUT THEM IN. AS I SAY, WHETHER THE JURY 5 IS ABSORBING THIS, THERE'S A QUESTION IN MY 6 MIND. WE'LL ALLOW IT IN EVIDENCE. THAT'S 7 EXHI8IT 7, 8 AND 9; IS THAT CORRECT.3 MR. VASSALOTTI: THAT'S RIGHT, 9 YOUR HONOR 10 THE COURT: MARKED IN 11 EVIDENCE. 12 ( AT WHICH TIME THE AFOREMENTIONED E X HI 8 ITS 13 WERE MARKED IN EVIDENCE. 14 (JURY ENTERS THE COURTROOM). 15 THE COURT: EXHIBITS, SEVEN, 16 EIGHT AND NINE ARE ADMITTED INTO EVIDENCE. 17 YOU MAT CALL YOUR NEXT WITNESS. > 18 MR. VASSALOTTI: CLfrfefrQfl.,. 1 19 20 FREDERICK LAUCIUS SWORN 21 DIRECT EXAMINATION BY MR. VASSALOTTI. 22 Q. DOCTOR LAUCIUS, WHAT IS YOUR 23 PROFESSION? 24 A. I'M A PHYSICIAN. I'M A SPECIALIST IN 25 MEDICINE AND A SU8SPEC I AL I ST IN MEDICAL CTOSQTTZ BFG09752 i 55 1 THE COURT: I'M ONLY ABOUT 2 EIGHT MINUTES OVER MY ALLOTTED TIME TO 3 PRESENT YOU WITH AN 0IN I ON ON YOUR MOTIONS. 4 I GUESS I'M ENTITLED TO EIGHT MINUTES MORE 5 UNDER THESE CIRCUMSTANCES. 6 THIS IS THE COURT ' S 7 DETERMINATION WITH RESPECT TO THE DEFENDANT'S 8 MOTIONS THAT WERE MADE PRIOR ON THE LUNCHEON 9 RECESS . 10 THIS IS A WRONGFUL DEATH 11 SURVIVAL ACTION BASED ON THE DEATH OF 12 PLAINTIFF'S DECEDENT, WHICH DEATH -- WHICH 13 DEATH ALLEGEDLY RESULTED FROM THE EMISSION OF 14 NOXIOUS VINYL CHLORIDE FUMES FROM A PLANT 15 OWNED AND OPERATED BY DEFENDANT AND LOCATED 16 APPROX IMATELY ONE POINT SEVEN MILES FROM the 17 DECEDENT'S HOME. 18 PLAINTIFF SEEKS COMPENSATORY 19 AND PUNITIVE DAMAGES BASED ON THREE THEORIES 20 OF RELIEF: STRICT LIABILITY, NUISANCE AND 21 NEGLIGENCE. CURRENTLY BEING CONSIDERED BY THE 22 COURT IS DEFENDANT'S MOTION FOR A DIRECTED 23 VERDICT RAISED UPON THE CONCLUSION OF 24 PLAINTIFF'S CASE. THAT'S RULE OF CIVIL 25 PROCEDURE 5 0 C A) . BFG09753 21109011 1 THE STANDARD FOR GRANTING A 2 MOTION FOR DIRECTED VERDICT IS A STRIDE NT ONE. 3 BECAUSE GRANTING SUCH A MOTION DEPRIVES A 4 PARTY OF T jH E OPPORTUNITY TO HAVE FACTUAL 5 QUESTIONS DECIDED 3Y THE JURY, THESE MOTIONS 6 MUST BE CLOSELY SCRUTINIZED AND SPARINGLY 7 GRANTED. SEE WILKIN V. SUNBEAM CORPORATION, 8 AT PAGE 347, TENTH CIRCUIT, 195 7, CERT. 9 DENIED, 3^9 U.S. 973, DECIDED IN 19 5 3. 10 A MOTION FOR A DIRECTED 11 VERDICT SHOULD BE DENIED WHENEVER THERE IS 12 SUFFICIENT EVIDENCE UPON WHICH A REASONABLE 13 JURY COULD POSSIBLY DELIVER A VERDICT FOR THE 14 NON-MOVING PARTY. SEE GENERALLY WRIGHT AND 15 MILLER, 9 FED. PRAC. S PROC., SECTION 2524. 16 THE COURT OF APPEALS FOR THE THIRD CIRCUIT 17 HAS RECENTLY EXPRESSED THE STANDARD FOR A 18 DIRECTED VERDICT AS FOLLOWS: 19 "WHEN YOU MUST EXAMINE THE 20 RECORD IN A LIGHT MOST FAVORABLE TO THE 21 PLAINTIFF AND REVIEW THE SPECIFIC EVIDENCE IN 22 THE RECORD AND ALL INFERENCES REASONABLY 23 CAPABLE OF BEING DRAWN THEREFROM, w E MUST 24 DETERMINE WHETHER, AS A MATTER OF LAW, THE 25 RECORD IS CRITICALLY DEFICIENT OF THAT BFG09754 21109012 57 1 MINIMUM QUANTUM OF EVIDENCE FROM WHICH A JURY 2 MIGHT REASONABLY AFFORD RELIEF. IF THE 3 EVIDENCE IS OF SUCH CHARACTER THAT REASON A 3 LE 4 MEM IN THE IMPARTIAL EXERCISE OF THEIR 5 JUDGMENT MAY REACH DIFFERENT CONCLUSIONS, THE 6 CASE SHOULD BE SUBMITTED TO THE JURY." 7 SINCE A DIRECTED VERDICT 8 MOTION DEPRIVES A PARTY OF JURY FACT 9 DETERMINATION, IT SHOULD BE GRANTED SPARINGLY 10 AND CIRCUMSPECTLY. "NEVERTHELESS, THE FEDERAL 11 COURTS DO NOT FOLLOW THE RULE THAT A 12 SCINTILLA OF EVIDENCE IS ENOUGH. THE QUESTION 13 IS NOT WHETHER THERE I S L I TERALLY NO EVIDENCE 14 SUPPORTING THE PARTY AT W H 0 M THE MOTION'S 15 DIRECTED BUT WHETHER THERE IS EVIDENCE UPON 16 WHICH THE JURY COULD PROBABLY FIND A VERDICT 17 FOR THAT PARTY." PATZIG V. O'NEILL, 557 F.2D 18 8 41 AT PAGE 8 5 4, THIRD .CIRCUIT, 1078, 19 CITATIONS DELETED. THIS IS AN OPINION OF 20 JUDGE GARTH, JOINED 3Y CHIEF JUDGE SEITZ AND 21 JUDGE 8ROTMAN. IT'S WHEN I SAT ON THE 22 C I RCU i T. 23 WITH THIS STANDARD IN MIND, 24 WE TURN TO THE SUBSTANCE OF DEFENDANT'S 25 MOTION. DEFENDANT ARGUES THAT THE PLAINTIFFS BFG09755 CT060TT2 59 1 CASE IS CRITICALLY DEFICIENT WITH RESPECT TO 2 .EVIDENCE NECESSARY TO SUPPORT THE SEVERAL 3 CAUSES OF ACTION. PLAINTIFF HAS RAISED CLAIMS 4 FOR RELIEF BASED ON VARIOUS LEGAL THEORIES: 5 STRICT LIA8ILIY, NEGLIGENCE AND NUISANCE. WE 6 WILL EXAMINE THESE CLAIMS IN THE EVIDENCE IN 7 SUPPORT OF THEM. 8 PLAINTIFF'S CLAIM FOR RELIEF 9 BASED ON STRICT LIA3ILITY HAS TWO ASPECTS: 10 FIRST, PLAINTIFF ASSERTS THAT DEFENDANT IS 11 STRICTLY LIABLE FOR THE PROXIMATE RESULTS OF 12 THE HAZARDOUS ACTIVITY IT IS CONDUCTING; 13 SECONDLY, PLAINTIFF ARGUES THAT SHE HAS A 14 RIGHT TO RECOVER BASED ON SECTION 402(A) OP 15 THE RESTATEMENT OF TORTS. ALTHOUGH SECTION 16 4 U 2 (A) HAS BEEN ADOPTED IN NEW JERSEY, 17 PLAINTIFF'S CLAIM BASED DIRECTLY ON THAT 18 SECTION IS WITHOUT MERIT. SECTION 402(A) 19 IMPOSES LIA8ILITY UPON, AND I QUOTE, "ONE WHO 20 SELLS AN Y PRODUCT IN A DEFECTIVE CONOITI0 N, 21 UNREASONABLY DANGEROUS TO THE USER OR 22 CONSUMER." THAT LANGUAGE SIMPLY DOES NOT 23 APPLY HERE, WHERE PLAINTIFF'S ACTION IS BASED 24 ON HARMFUL E F F t.C T S ALLEGEDLY RESULTING FROM 25 DEFENDANT'S RELEASE OF BYPRODUCTS INTO THE BFG09756 frT O S O T T Z 59 1 \ atmosphere, we are simply not dealing with a \ 2 DEFECTIVE PRODUCT IN THIS CASE. THAT IS NOT \ 3 TO SAY,\HOWEVER, THAT PLAINTIFF DOES NOT HAVE 4 \ A CLAIM ^ 0R RELIEF 3 A S E 0 ON STRICT LIABILITY \ 5 IN TORT. ^N THE CONTRARY, PLAINTIFF DOES HAVE 6 SUCH A CLA\M. ONE OF THE OLDEST BRANCHES OF \ 7 STRICT LIABILITY THEORY IN EXISTENCE LONG \ 8 3EFORE PRODUCTS LIABILITY WAS EVEN A GLIMMER \ 9 \ IN THE EYE OF THE PLAINTIFF'S BAR, WAS THE \ ______ __ _ _______ 10 DOCTRINE THAT P F^SQrN-SrrFrA-y:i:;8-&J ftE L P*-' S T ft fCTLr~ 11 L I Fi l I TTET^CONDUC TEcT"~ONi~~: 12 T H ft l.FT THE PROXIMATE CAUSE 13 HER PERSON 'S INJUR I ES , ~S E E RYL-ANOS V. 14 FLETCHER, NOT RECITING THE CITATIONS. 15 AS THE EXCHEQUER CHAMBER HELD 16 IN THAT CASE -- AND THAT WAS AN 13S5 CASE 17 "WE THINK THAT THE TRUE RULE OF LAW IS 18 THAT THE PERSON WHO FOR HIS OWN PURPOSES 19 20 HTB-f'. y QA M f g tT 21 22 --frOT polsfo j^E V^oES^^litofv :iLL.yc;ig: he 23 D 0 S^^gTny~C^^S'S7="T'S ftSl HA' 9FfflS'lE** ANSWERABLE- FOR ^a^jaewgjaqMntqy--gvyrirwwv# nwy^Tni'wi'iu --- ------' ^.vw**.* 24 THEI.U PACKAGE WNICH: lSI THE NATURAL -* 25 (1109015 .***. BFG09757 <0 1 THIS ANCIENT DOCTRINE RETAINS 2 VALIDITY TODAY AND PLAINTIFF HAS PRESENTED 3 SUFFICIENT EVIDENCE TO PRESENT A CLAIM FOR 4 RELIEF FOUNDED ON THIS G R 0 U N D TO THE JURY. 5 THIS CLAIM IS ONE 3ASED ON ARE YOU STRICT 6 LIABILITY AND DOES NOT REQUIRE A 7 DEMONSTRATION OF ANY CULPABILITY ON THE PART 8 OF DEFENDANT. IN ADDITION, ALTHOU GH WE HAVE 9 HELD THAT PLAINTIFF DOES NOT HAVE A CAUSE OF 10 DIRECTION DIRECTLY BASED ON SECTION '4 02(A), 11 WE AGREE WITH PLAINTIFF THAT THE PRINCIPLES 12 APPLICABLE TO 402(A) CLAIMS ARE APPLICABLE IN 13 THIS CONTEXT. AT LEAST TWO NEW JERSEY COURTS 14 HAVE COME TO A SIMILAR CONCLUSION. SEE 15 DEPAR THE NT_QF TRANSPORTATION V. P 5 C; IT'S A 16 LAW DIVISION CASE, 1980, I DON'T HAVE THE 17 EXACT CITATION. I DON'T THINK IT'S BEEN 18 REPORTED YET. CITY OF BRIDGETON V. 8.P. OIL 19 COMPANY, 146 N.J. SUPER 1159 LAW DIVISION, 20 1 9 7 6 . 21 WE FEEL CONFIDENT THAT WHEN 22 THE TIME COMES FOR THE SUPREME COURT OF NEW 23 JERSEY TO CONSIDER THE MATTER, IT WILL ARRIVE 24 AT A SIMILAR RESULT. THUS, ALTHOUGH 25 PLAINTIFF'S 402(A) CLAIM SHALL BE STRICKEN, BFG09758 21109016 1 THE STRICT LIA3ILITY CAUSE OF ACTION IS VALID. 2 PLAINTIFF HAS CLEARLY PRESENTED SUFFICIENT 3 EVIDENCE TO RAISE A JURY QUESTION WITH 4 RESPECT TO THE FACTUAL MATTERS RELEVANT TO 5 THIS CLAIM. 6 NEXT, WE CONSIDER PLAINTIFF'S 7 CLAIM 3ASED ON NUISANCE. HERE, TOO, WE FIND 8 THAT PLAINTIFF HAS PRESENTED FACTS SUFFICIENT 9 TO SURVIVE A MOTION FOR A DIRECTED VERDICT. 10 THE STANDARDS APPLICABLE UNDER NEW JERSEY LAW 11 ARE ESSENTIALLY THOSE OF THE RESTATEMENT (2D) 12 OF TORTS. THE PARTIES DO NOT DISPUTE THIS. 13 HOwEVER, DEFENDANT'S VIGOROUSLY ARGUES THAT 14 ITS ACTIONS WERE NEITHER INTENTIONAL NOR 15 UNREASONABLE. AND THAT THERE IS NECESSITY 16 EVIDENCE IN THE RECORD SUFFICIENT TO SUPPORT 17 A FINDING ON THE CONTRARY. THIS ARGUMENT IS 18 WITHOUT MERIT. WHAT CONSTITUTES AN 19 INTENTIONAL INVASION IS DEFINED BY THE 20 RESTATEMENT SECTION R 2 5 AS FOLLOWS, AND WE 21 QUOTE:|^"AN INVASION OF ANOTHER INTERESTS IN 22 THE USE AND ENJOYMENT OF LAND OR AN 23 INTERFERENCE WITH THE PUBLIC RIGHT LS 24 INTENTIONAL IF THE ACTOR, A, ACTS FOR THE 25 PURPOSE OF CAUSING IT; OR, B, KNOWS THAT THE $pG097 59 X10901 S2 1 resulting or is substantially CERTAIN to 2 RESULT FROM 4[S CONOUCT."|THIS SECTION IM NO 3 WAY DEPARTS FROM THE GENERAL RULE GOVERNING 4 INTENTIONAL TORTS WHICH HOLDS THAT THE 5 CRITICAL QUESTION IS WHETHER THE ACTION WAS 6 INTENTIONALLY TAKEN. IT IS IRRELEVANT THAT 7 THERE IS NO EVIDENCE IN THE RECORD THAT 8 DEFENDANT INTENDED TO CAUSE HARM. THE SOLE 9 RELEVANT FACT IS THAT THERE IS CONSIDERABL^E7 10 EYfb^NCE aEl^REC0RD THAT- OFFENQAMT 11 D mHBR A T ETLY'' A N q'^REi'uZAai; iJf .EM. ITT ED 12 13 I tOieT i_..... ........................... .... mu___ ii i ---- '*"r 14 THAT -TVfW-t Hfr# frrrTff*'*' 15 HAT EVIDENCE IS SUFFICIENT 16 TO SATISFY THE I N T~5~N T STANDARD OF RFRTATFmfnt 17 SECTIONS 822 AND 325 18 SECTION 822 ALSO REQUIRES, 19 HOWEVER, THAT THE ACTIONS BE UNREASONABLE. 20 THIS TERM IS DEFINED 3Y SECTION 325 AS 21 FOLLOWS: "UNREASONABLENESS OF INTENTIONAL 22 INVASION. Air~FtrFEWfS^ 23 .. :"l ln 24 t NT It R E 5 T~ ~if Nt" g'^JOTWEPt r--w r rr-ar 25 m psqnTz BFG09760 S3 1 CONBUC-T-Q R , 3 , in '*--1 -r i i mu.......... 'ft.t-.xHp frAn;e.o 2 * . a>/j.T* ^1* Y*`'v'.s 3 i-EM4"" 0F"'"CtJTi'p E N S A T I NG F0R"TH~t S' AND" SIMILAR 4 %f.ii>i. i npywa^i^ 5 THE RELEVANT STANDARD IS THAT OF SUBSECTION 8; IT IS CLEAR THAT THE HARM IN THIS MATTER WAS EXTREMELY SERIOUS. IN ADDITION, THERE IS CONSIDERABLE EVIDENCE IN THE RECORD, MUCH OP IT BROUGHT OUT BY DEF EMCTAHT .- T H A T. T H E j gccurren-ce^of' tmiFTTsease_' `Ts'^ra're;^ ^ . / PARTICULARLY WITH RESPECT TO PERSONS IN THE POSITION OF THIS DECEDENT WHO DID NOT WORK IN THE PLAINTIFF'S PLANT AND WAS NOT DIRECTLY EXPOSED TO THE ~8WjWflEgniF;?t ____________ .NUMBER GF ,? ~ hi,j^,^iiuwiw wwm\nmwimu p pw ii'wn "n 'i<|nri! PL A f MT r FFST WHO .MAYfyjjl N C U R.1.1 Nvt U RY 0R~0 EATHT'j`A-.Sr ltt;. ^ REST/LT^OF THeiOPWBATICNrbF; POtTVrNYLCHLpRTTrr C ON DUCT; MQ;X S t B L E . f 'TFTEB^F OR E, THIS 21 ACTIVITY COULD BE FOUND UNREASONABLE BY A 22 REASONABLE JURY. AS IT ALSO COULD BE FOUND TO 23 BE AN INTENTIONAL A C T I V I T-Y- 24 25 A JURY QUESTION IS ALSO 2J.1090.19 .Cvi'*lWk*\Aw. . .... ..-w, BFG09761 n '4 1 RAISED WITH RESPECT TO THE CAUSE OF ACTION 2 8ASED ON *1C E . TJ "J 3 p i iv-nrr r rrrui n jit * n* thii r r-nn-m--ro that 4 thitffQ?`*v7"5e'ngE 0?'~'YBE'-'P'C'S'SfSirE 5 6 TTT" "gW!r&g. Kgyirr^r~rer 7 usfTrr^t'HE^Du-ty,,jro .do 8 R E`SE>a-H^4S?:Q:hAlHg aA-ttG-EROOS- AggCT^--OF TH t-S. 9 CHE^'M ICALC.T ALTHOUGH DEFENDANT MAY NOT HAVE 10 SEEN NEGLIGENT, GIVEN THE STATE OF THE 11 KNOWLEDGE IN THE PERIOD IN QUESTION, 12 PLAINTIFF HAS'PRESENTED SUFFICIENT EVIDENCE 13 TO RAISE A JURY QUESTION ON THIS ISSUE. 14 ACCORDINGLY, DEFENDANT'S MOTION FOR DIRECTED 15 VERDICT WILL SE DENIED WITH RESPECT TO THE 16 CLAIMS SOUNDING IN NEGLIGENCE, NUISANCE AND 17 STRICT LIABILITY IN TORT. WITH RESPECT TO THE 18 CLAIM BASED DIRECTLY ON SECTION 402(A) OF THE 19 RESTATEMENT OF TORTS SECOND, DEFENDANT'S 20 MOTION WILL BE GRANTED. 21 A SOMEWHAT DIFFERENT ANALYSIS 22 MUST BE APPLIED TO THE MOTION TO DIRECT A 23 VERDICT WITH RESPECT TO THE CLAIM FOR 24 PUNITIVE DAMAGES. TO PREVAIL ON HER CLAIM FOR 25 PUNITIVE DAMAGES, PLAINTIFF MUST MEET A OZ060YT2: *4 14. '.Si,L v V W. .. 11 BFG09762 1 RIGOROUS STANDARD. SEE, FOR EXAMPLE, R 0 G 1 NS < Y 2 VR ICHARDSON-MERRELL, INC., 333 37 F.2D, 332 3 S c C 0 N 0 CIRCUIT, 1 9 rW ; T H 0 M A S _ V_;__ A M E R J_C A N 4 CTSTOSCOPE MAKERS, INC. , 414 F. SUPP. 255 5 EASTERN DISTRICT OF PENNSYLVANIA, 19 7 8- UNDER. 6 NEW JERSEY LAW, WHICH GOVERNS THIS DIVERSITY 7 - *rt.\ ACTION, AN -A.i4AAa-r.aF PUNITIVE DAMAGES IS^ONLY 8 A P PTTOP R I rtTSTWH f'W 1 TH L^",t?f^NJGSo&RS r_XQNJD U C T, IS 9 ESPECIALLY EGREGIOUSF I RST NATIONAL STATE 10 BANK V. COMMERCE FEDERAL SAVINGS, 4 S5 F. 11 SUPP., 454, PAGE 470-471 DISTRICT OF NEW 12 JERSEY, 1973, QUOTING L E j_ M G R. U B. E R._ V C L A R ]_ D G E 13 AS.SOCJ_ATES, 73 N.J. 450 AT PAGE 4 54, DECIDED 14 I N L 9 7 7 15 THE NEW JERSEY SUPREME COURT 16 ENUNCIATED THE APPLICABLE PRINCIPLES IN 17 OI_GiOVANNi_V^__PE SSEL, 55 N.J. 133, DECIDED 18 1970 AND I QUOTE: "SOMETHING MORE THAN MERE 19 COMMISSION OF A TORT IS ALWAYS REQUIRED FOR 20 PUNITIVE DAMAGES. T ME R' I 21 TTF?r,AG6RAVAT lON ORT. OOTRf'1L 22 EVIL MOT; 1 VE . ON - T H E 7J 'PENDANT ORUSUCHL A CONSC I OUS. -AND 8--r 24 BELXaEJULTE .0 I SR EGA* O - OP ~T ITT PTES T S 0 F 25 S CONDUCT MAJ-l^e.^CALLEO WILLFUL 21109021 BFG09763 i> ____ f 1 LACK- L3C ~ Tttll.,1Bi-ffMg N f. MERE 2 NE'gtjf GENC~E 6R(X5-51.^ _IS ,; G; E M E RALLY HHL 0 3 >fo^?<TjMErE'loUGH. the DJ__G J_0 V_A NNJ_ CASE AT 4 PAGE a0 QUOTING PROSSER ON TORTS, SECTION TWO, 5 SECOND EDITION, 1975. SEE ALSO VO L Z, 6 AT PAGE 3 A 7, THIRD CIRCUIT, 1 a 7 4. 7 THUS, THE PI G I 0 V A N N I COURT 8 ADOPTED THE FOLLOWING STANDARD: AN ACT TO 9 GIVE RISE TO A RIGHT TO PUNITIVE DAMAGE MUST 10 3 E ACTUATED 8 Y ([ 0NACTUAL MALICE, WHICH IS 11 NOTHING MORE- OR LESS THAN INTENTION AGO 12 WRONGDOING, AN EVIL MINDED ACT ,(j3R Two) AN 13 ACT ACCOMPANIED BY A WONTON AND WILLFUL 14 DISREGARD OF THE RIGHTS OF ANOTHER. 55 N.J. 15 19 1 QUOTING L A_B R.U N 0_V^_L A W R E N C E , 64 N.J. 16 SUPER. 570, 575 APPELLATE DIVISION, I960,> 17 CERTIFICATION DENIED, 34 N.J. 323, 1961. 18 THUS, IN ANALYZING THE MOTION 19 FOR A DIRECTED VERDICT INSOFAR AS IT PERTAINS 20 SOLELY TO THE CLAIMS FOR PUNITIVE DAMAGES, WE 21 MUST CONSIDER WHETHER THERE IS EVIDENCE IN 22 THE RECORD ON WHICH! ANY REASONABLE JURY COULD 23 FIND EITHER ACTUAL MALICE OR WONTON AND 24 WILLFUL DISREGARD OF THE RIGHTS OF ANOTHER ON 25 THE PART OF GOODRICH. THE RECORD BEFORE US IN ZZOSOTTS . iW'J.n.iW.. BFG09764 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTI6 6 1 A. I AM . 2 Q. COULD YOU GIVE US A SUMMARY OF YOUR 3 EDUCATIONAL BACKGROUND IN THE MEDICAL FIELD? 4 A. [ GRADUATED IN MEDICINE IN LONDON IN 5 1950, HAVING QUALIFIED BEFORE THAT AS A 6 PHYSIOLOGIST. I SPENT SEVERAL YEARS IN THE 7 ARMY AS A PATHOLOGIST. I THEN WORKED IN 8 LONDON UNIVERSITY TEACHING MEDICINE, 9 PATHOLOGY AND TOXICOLOGY AND ALSO DOING 10 RESEARCH IN AREAS OF CANCER. I CAME TO THIS 11 COUNTRY IN I960 TO HAVARD AND WORKED AT THE 12 CHILDREN'S CANCER RESEARCH FOUNDATION IN 13 BOSTON ON PROBLEMS OF ENVIROMENTAL TOXICOLOGY: 14 THAT IS AGAIN THE TOXIC EFFECT OF CHEMICALS 15 IN AIR, FOOD AND WATER AND WAS ALSO A 16 PATHOLOGIST AT HARVARD MEDICAL SCHOOL. 17 I WENT TO CASE WESTERN 18 RESERVE MEDICAL SCHOOL IN CLEVELAND WHERE I 19 HAD A CHAIR IN HUMAN ECOLOGY AND MOVED TO 20 CHICAGO IN 1976. 21 Q. AND THAT IS WHERE YOU WORK NOW, IN 22 CHICAGO? 23 A. THAT IS CORRECT. 24 Q. DOCTOR, HAVE YOU RECEIVED ANY AWARDS 25 FOR YOUR MEDICAL OR RESEARCH WORK? 2110S023 BFG09765 EXAMINATION SAMUEL EPSTEIN MR. VASSALOTT I S 7 1A YES. I RECEIVED A VARIETY AWARDS IN 2 the army medical corp 3Q 4A THAT'S IS IN THE BRITISH ARMY? BRITISH ARMY. I'VE ALSO RECEIVED 5 SOCIETY OF TOXICOLOGY. IT'S AN AWARD IN THIS 6 COUNTRY IN 1969, SOCIETY -- SOCIETY OF 7 TOXICOLOGY ACHIEVEMENT AWARD AND A VARIETY 8 OTHER PROFESSIONAL SCHOLARSHIP AND 9 DI ST INCTI ON. 10 Q. WHAT I S' TOXICOLOGY? 11 A. TOXICOLOGY IS THE SCIENCE OF ADVERSE 12 EFFECTS, THE STUDY OF ADVERSE EFFECTS 13 GENERALLY IN RELATION TO THE EFFECTS OF 14 CHEMICALS. 15 Q. AND YOU MENTIONED THAT YOUR PRIMARY 16 INTERESTS AS A PHYSICIAN WAS STUDYING THE 17 TOXIC AND CANCER CAUS I NG EFFECTS OF CHEMICALS 18 IN THE ENVIRONMENT? 19 A. THAT IS CORRECT. 20 Q. AND IN THE WORK PLACE AS WELL? 21 A . 22 Q. YES . DOCTOR, HAVE YOU SERVED ON ANY 23 GOVERNMENT COMMITTEES OR WORKED WITH ANY 24 GOVERNMENT AGENCIES AS A CONSULTANT OR ACTED 25 AS A CONSULTANT TO ANY OTHER ORGANIZATIONS 21109024 BFG09766 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 58 1 RELATED TO YOUR WORK IN THE FIELD OF 2 TOXICOLOGY AND ENVIROMENTAL AND OCCUPATIONAL 3 MEDICINE? 4 A. YES. I SERVE AS A CONSULTANT TO THE 5 UNITED STATES CONGRESS, THE SENATE COMMITTEE 6 OF PU3LIC WORKS FOR SEVERAL YEARS. 7 Q. WHEN WAS THAT? 8 A. A30UT 1959 TO A80UT 1974, SOMETHING 9 LIKE THAT. 10 AND VARIOUS OTHER 11 CONGRESSIONAL COMMITTEES ON SUBSEQUENT 12 OCCASIONS SINCE THEN. I'VE CONSULTED 13 EXTENSIVELY AND ACTED AS AN EXPERT WITNESS 14 FOR THE ENVIROMENTAL PROTECTION AGENCY IN 15 PROCEEDINGS RELATING TO CANCER CAUSING 16 PESTICIDES AND ACTIONS TAKEN TO REMOVE THESE 17 FROM THE MARKET. I'VE ALSO CONSULTED AND 18 ACTED AS AN EXPERT WITNESS FOR THE 19 OCCUPATIONAL SAFETY AND HEALTH COMMISSION 20 THAT GOES THE PART OF THE DEPARTMENT OF 21 LABOR THAT HAS AUTHORITY AND JURISDICTION ON 22 PROBLEMS OF WORKERS HEALTH AND PUBLISHED 23 SAFETY AND HAVE INTERESTS IN THIS CONNECTION, 24 I WAS ON A COMMITTEE ESTABLISHED IN 1973 BY 25 THE DEPARTMENT OF LA80R TO EXAMINE THE 21108025 BFG09767 EC EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT[^9 1 QUESTION OF STANDARD SETTING FOR CANCER 2 CAUSING CHEMICALS IN THE WORK PLACE. AND I'VE 3 ALSO SERVED AS CONSULTANT AND EXPERT IN OTHER 4 AGENCIES, INCLUDING THE NATIONAL INSTITUTE OF 5 HEALTH. OCCASIONS, I'VE SERVED ON AN ADHOC 6 BASIS AS CONSULTANT TO LABOR, TO THE AFL-CIO, 7 I'VE ALSO SERVED AS CONSULTANT TO INDUSTRIES 3 THAT HAVE ASKED FOR MY SERVICES IN CONNECTION 9 WITH PROBLEMS IN THE WORK' PLACE. 10 Q. DOCTOR, HAVE YOU WRITTEN ANY 11 ARTICLES THAT HAVE BEEN PUBLISHED IN ANY 12 SCIENTIFIC OR MEDICAL JOURNALS? 13 A. APPROXIMATELY 250 ARTICLES I'VE 14 WRITTEN IN -- WHICH HAVE APPEARED IN 15 SCIENTIFIC JOURNALS. I'M AN AUTHOR OF 34 OR 16 35 BOOKS. 17 Q. . WELL, HAVE ANY OF THOSE ARTICLES 13 LET'S STICK WITH THOSE FOR AWHILE 19 OR THE BOOKS DEALT WITH ISSUES ARE CANCER OR 20 CANCER CAUSING CHEMICALS? 21 A. ' I WOULD SAY THE MAJORITY, THE GREAT 22 MAJORITY. OF MY WRITINGS HAVE BEEN IN THE 23 AREAS OF CANCER, CANCER IN HUMANS, CANCER 24 CAUSATION, EXPERIMENTAL STUDIES IN ANIMALS 25 AND THE REGULATORY IMPLICATIONS OF THESE 21103026 BFG09768 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTI70 1 SC I ENT IFIC FINDINGS. 2 Q. HAVE YOU, IN FACT, ENGAGED IN 3 CLINICAL RESEARCH CANCER CAUSING CHEMICALS? 4 A. I'VE DONE VERY EXTENSIVE STUDIES IN 5 ANIMALS ON CERTAIN CARC I NOGEN I CS, EFFECTS OF 6 CHEMICAL, THAT IS THE ABILITY OF CHEMICALS TO 7 INDUCE IN ANIMALS AND ALSO SUSCEPTIBILITY. 8 Q. NOW, DOCTOR, YOU'VE MENTIONED YOU'VE 9 WRITTEN -- I THINK YOU SAID FOUR BOOKS THAT 10 DEALT WITH THE SUBJECT -- WELL, DO THEY DEAL 11 WI THE SUBJECT OF CANCER AND CANCER - CAUS I NG 12 CHEMI CALS ? 13 A. WELL, LET'S TRY TO REMEMBER. THE 14 FIRST 800K WAS ON THE GENETIC HAZARD FROM IS PESTICIDES, WHICH REALLY ISN'T DIRECTLY 16 RELATED TO CANCER, BUT THIS IS ANOTHER SET OF 17 HAZARDS. THESE ARE HAZARDS FROM EXPOSURE TO 18 PESTICIDES. 19 ANOTHER 3 00 K WAS ON THE NON 20 PSYCHIATRIC EFFECTS, HAZARDOUS EFFECTS OF 21 DRUGS OF ABUSE, THE ABILITY OF DRUG ABUSE TO 22 PRODUCE BIRTH DEFECTS, CANCER, GENETIC 23 ABMORMALITIE S. I'VE ALSO WRITTEN TWO VOLUMES 24 ON CONSUMER PRODUCT SAFETY, THE WHOLE 25 QUESTION OF HAZARD OF CONSUMER PRODUCTS, 4Z0S0TT BFG09769 E C EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 71 1 AMONG OTHERS, REFERENCE TO THE AN ABILITY OF 2 PRODUCTS TO PRODUCE CANCER. THE- RECENT BOOK 3 OF ONE IS ON THE -- IT WAS TITLED THE 4 POLITICS OF CANCER, WHICH DISCUSSES THE 5 SCIENCE OF CANCER. I HAD RANGE OF RELATED 6 PROBLEMS OF CANCER CAUSING CHEMICALS IN THE 7 ENVIRONMENT IN AIR, WATER FOOD AND THE WORK 8 PLACE AND DRUGS. \ I THINK THOSE ARE THE MAJOR 9 BOOKS WHICH I C A N^ RECALL . 10 Q. NOW, DOCTOR, IN YOUR WORK AS A 11 MEDICAL DOCTOR PHYSICIAN, SPECIALIZING 12 IN THE TOXIC AND CANCER CAUSING EFFECTS OF 13 CHEMICALS, HAVE YOU BECOME FAMILIAR WITH A 14 DISEASE AS ANGIOSARCOMA OF THE LIVER? IS A. YES. 16 Q. WHAT IS ANGIOSARCOMA OF THE LIVER? 17 A. IT IS A MALIGNANT DISEASE OR CANCER . 18 IN A GENERAL SENSE OF THE WORD. IT ISN'T A 19 TRUE CANCER, BECAUSE IT AFFECTS PARTICULAR 20 NON-EPITHELIAL CELLS IN THE BODY. IN THE 21 LAYMEN'S SENSE OF THE WORD, YOU CAN CALL IT A 22 CANCER OF BLOOD FORMING CELLS WHICH CAN OCCUR 23 IN DIFFERENT PARTS OF THE BODY, BUT IN 24 PARTICULAR IN THE LIVER, WHICH IS THE 25 PERHAPS THE COMMONEST SIGHT OF WHICH IT HAS 21109028 BFG09770 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 72 l 1 SEEN NOTED. 2 Q. \ WELL, IS THAT A COMMON FORM OF v 3 CANCER. I'M A LAYMAN. I'M GOING TO CALL IT 4 CANCER? A 5 A. 6 Q. NO, Tt'S A VERY RARE FORM OF CANCER. \ TO YOUR KNOWLEDGE, DOCTOR, ARE THERE 7 ANY KNOWN CAUSES\oF ANGIOSARCOMA OF THE LIVER 8 THAT HAVE 8 E E N GENERALLY ACKNOWLEDGED OR 9 ACCEPTED IN THE MEDICAL COMMUNITY? 10 A. YES, I THINK IT'S FAIR TO SAY THERE 11 ARE FOUR RECOGNIZED CAUSES. THE FIRST IS. 12 VINYL CHLORIDE, THE SECOND ARE ARSENIC 13 COMPOUNDS, THE THIRD IS THORIUM DIOXIDE OR 14 THORAS AND THE FOUR ARE ANTIBIOTIC STEROIDS. 15 Q. NOW, YOU MENTIONED, DOCTOR,THAT 16 VINYL CHLORIDE IS ACCEPTED AS A PROBABLE 17 CAUSE OF ANGIOSARCOMA OF THE LIVER. IS THAT. 18 THE GAS USED IN THE MANUFACTURER OF PVC? ARE 19 YOU FAM ILIAR' WITH THE PVC INDUSTRY? 20 A. YES, YES. 21 Q. AND VINYL CHLORIDE IS USED IN THE 22 MANUFACTURE OF PVC? 23 A-. CORRECT. 24 Q. DOCTOR, ARE YOU FAMILIAR WITH THE 25 STRIKE THAT. 21109029 BFG09771 EXAM I NAT I ON SAMUEL EPSTEIN MR. VASS A LOTT I 73 1 WHEN DID IT BECAME 2 STRIKE THAT, ALSO. 3 IN THIS CASE, DOCTOR, 3.F. 4 GOODRICH COMPANY, I BELIEVE, IS TAKING THE 5 POSITION THAT IT WASN'T UNTIL THE VERY END OF 6 1973 OR THE BEGINNING OF 1974 THAT THEY 7 REALIZED THAT THERE WAS ANY CONNECTION 3 BETWEEN VINYL CHLORIDE AND ANGIOSARCOMA OF 9 THE LIVER. ARE YOU FAMILIAR WITH THE 10 SCIENTIFIC AND MEDICAL EVIDENCE IN RESEARCH 11 THAT LED TO THE CONCLUSION THAT VINYL 12 CHLORIDE WAS THE CAUSE OF CANCER AND 13 ANGIOSARCOMA OF THE LIVER BEFORE THAT TIME? 14 A. COULD I ASK YOU TO REPHRASE THAT, 15 BECAUSE 16 MR. RENNEISEN: I'D LIKE TO 17 OBJECT TO THE QUESTION. . 18 THE COURT: I'M GOING TO 19 SUSTAIN THE OBJECTION. LET'S ASK THE QUESTION. 20 LET'S NOT 21 MR. VASSALOTTI: I'M SORRY, 22 YOUR HONOR. 23 THE COURT: GET TO THE 24 QUESTION AND LET'S NOT HAVE ANY STATEMENT. 25 8Y MR. VASSALOTTI: 21108030 BFG09772 EXAMINATION SAMUEL EPSTEIN MR . VASSALOTT I 74 1 Q. ARE YOU FAMILIAR WITH THE 2 DEVELOPMENT OF SCIENTIFIC AND MEDICAL 3 EVIDENCE IN RESEARCH THAT LED TO THE 4 CONCLUSION THAT VINYL CHLORIDE IS A CAUSE OF 5 ANGIOSARCOMA OF THE LIVER? 6 A. YES . 7 Q. ARE YOU ABLE TO TRACE THE 8 DEVELOPMENT OF THAT LITERATURE FOR US HERE? 9 A. YES. I WOULD ALSO LIKE TO INCLUDE IN 10 THIS TRACING A VERY 8RIEF STATEMENT OF 11 EFFECTS OTHER THAN CANCER INDUCED BY VINYL 12 CHLORIDE, WHICH I THINK IT WOULD BE HELPFUL 13 TO THE COURT'S UNDERSTANDING OF THIS ISSUE, 14 IF I MAY. 15 Q. OKAY . 16 A. I'LL -- 17 MR.RENNEISEN: YOUR HONOR, I / 18 WOULD OBJECT. I THINK COUNSEL SHOULD ASK 19 QUESTIONS AND THE WITNESS SHOULD ANSWER THE 20 QUESTIONS. THAT'S THE WAY 21 THE COURT: I'M GOING TO 22 ALLOW HIM TO INCLUDE THAT. OVERRULED. LET'S 23 PROCEED. 24 A. LETME LIST BRIEFLYTHE CHRONOLOGY 25 OF INFORMATION THAT DEVELOPED BEFORE 1974 21109031 BFG09773 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTI75 1 WHEN IT FIRST PUBLISHED RECOGNITION OF THE 2 CANCER HAZARD OF VINYL CHLORIDE IN THE WORK 3 PLACE WERE KNOWN, AND I'LL DIVIDE MY ANSWER 4 INTO TWO CLASSES. FIRST OF ALL, INFORMATION 5 KNOWN WITH RESPECT TO ANIMAL STUDIES AND 6 SECONDLY, INFORMATION KNOWN WITH RESPECT TO 7 HUMAN DATA. 8 THERE'S VERY EXTENSIVE 9 LITERATURE GOING BACK TO 1930 ON THE EFFECTS 10 OF VINYL CHLORIDE IN ANIMAL STUDIES AND AS 11 EARLY AS 1930, THERE WERE REPORTS IN THE 12 LITERATURE THAT VINYL CHLORIDE HAD VERY HIGH 13 CONCENTRATIONS, FIVE PERCENT CONCENTRATIONS, 14 COULD PRODUCE ACUTE TOXICITY IN ANIMALS. 15 SUBSEQUENT TO THAT, FROM ABOUT 1930 ON WARD, 16 FROM 1930 TO 1950, THERE WERE SEVERAL 17 PUBLICATIONS, AGAIN CONFIRMING THE ACUTE 18 TOXICITY -- THAT'S THE ABILITY OF HIGH 19 CONCENTRATION OF VINYL CHLORIDE TO KILL 20 AND IT WAS SHOWN THAT A CONCENTRATION OVER 21 FIVE PERCENT, IT WOULD PRODUCE NARCOSIS, IT 22 WOULD PRODUCE CARDIAC ARREST, AND PULONARY 23 EDEMA, THE LUNGS WOULD BECOME FULL OF FLUID. 24 FROM ABOUT 19 -- FROM ABOUT 1949 ONWARD, 25 THERE WERE A SERIES OF PUBLICATIONS, BFG09774 21109032 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTI7S 1 PREDOMINANTLY IN THE EUROPEAN LITERATURE, AND 2 IT WAS KNOWN THAT VINYL CHLORIDE COULD 3 PRODUCE A WIDE RANGE OF EFFECTS IN ANIMALS, 4 DEGENERATIVE EFFECTS IN THE LIVER, 5 DEGENERATIVE KIDNEY CHANGES, TOO. AND BY THE 6 EARLY SIXTIES, IT WAS ALSO SHOWN THAT VINYL 7 CHLORIDE PRODUCED A TOXIC EFFECT ON BLOOD 8 VESSELS AND ALSO ON BONE, TOO. 9 Q. 10 A. WHAT WAS THAT? A TOXIC EFFECT ON BLOOD VESSELS, 11 CALLED ANG I OF I BROS IS AND ALSO AN EFFECT ON 12 BONE, ThE LINING OF BONE, CALLED THE 13 PERIOSTEUM. 14 IN 1970, AN ITALIAN 15 PATHOLOGIST CAME OVER TO THIS COUNTRY AND 16 PRESENTED A PAPER AT THE INTERNATIONAL CANCER 17 CONGRESS IN HOUSTON, SHOWING THAT VINYL . 18 CHLORIDE INDUCED CANCER IN RATS. THIS IN 1970 19 WAS THE FIRST PUBLISHED AND OPEN INFORMATION' 20 ON THE CANCER CAUSING ABILITY OF Vj N Y L 21 CHLORIDE. 22 Q. WHO WAS IT, THE RESEARCHER WHO MADE 23 THOSE FINDINGS? 24 A. HIS NAME WAS VIOLA. HE WAS AN 25 EMPLOYEE OF ITALIAN INDUSTRY CALLED SULVATE CE0G0TT2 BFG09775 EXAM I NAT I ON SAMUEL EPSTEIN MR. V A SSALOTT I 77 1 INDUSTRIES LIMITED IN ITALY. 2 SUBSEQUENT TO VIOLA'S 3 FINDINGS, THESE -- THIS INFORMATION WAS 4 CONFIRMED AND EXTENDED BY ANOTHER ITALIAN 5 PATHOLOGIST CALLED MATALONI, WHO BY 1972, BY 6 AUGUST -- OR BY THE FALL OF 1972, HAD 7 CONFIRMED AND EXTENDED THESE FINDINGS, 8 ALTHOUGH INFORMATION ON THIS WAS NOT MADE 9 AVAILABLE UNTIL 1974, THE SAME DAY THAT THERE 10 WAS THE PUBLISHED ANNOUNCEMENT OF THE 11 OCCURRENCE OF THE CANCER IN THE 8.F. GOODRICH 12 WORKERS. THAT VERY BRIEFLY IS THE STATEMENT 13 OF IT IN ALL LITERATURE. 14 AS FAR AS THE HUMAN STUDIES 15 ARE CONCERNED, THE EARLY LITERATURE ON THIS, 16 VERY INTERESTINGLY, I S EUROPEAN. THERE WERE 17 VERY LITTLE IN THE WAY OF AMERICAN STUDIES 18 PUBLISHED ON THE HUMAN EFFECTS OF VINYL 19 CHLORIDE. 20 ONE OF THE VERY EARLY 21 IMPORTANT PAPERS WAS A RUSSIAN PAPER IN 1949, 22 WHICH SHOWED THAT EXPOSURE TO VINYL CHLORIDE 23 COULD PRODUCE CHRONIC HEPATITIS -- THAT'S 24 TOXIC EFFECT IN THE LIVER, GASTRITIS, SKIN 25 IRRITATION, AND THIS WAS SHOWN IN A GROUP OF 21109034 BFG09776 EXAMINATION - SAMUEL EPSTEIN - MR. V4SSAL0TT I 73 1 73 RUSSIAN WORKERS. AND THIS WAS SUBSEQUENT 2 TO that: 3 IN 1957, IT WAS SHOWN THAT AT 4 LEVELS LOWER THAN RUSSIAN STANDARDS -- THE 5 RUSSIAN STANDARD THEN WAS ABOUT 590 PARTS PER 6 MILLION -- THAT IT WAS SHOWN AT LEVELS 7 BELOW THAT THAT VINYL CHLORIDE WOULD PRODUCE 8 TOXIC EFFECTS KNOWN AS TOXIC ANGI 0NEUR0PATHY. 9 Q. WHAT IS THAT? 10 A. IT MEANS AN IRRITANT EFFECT OF BLOOD 11 VESSELS AND NERVES TO THE BLOOD VESSELS. 12 IN THE SAME YEAR, IT WAS 13 SHOWN THAT VINYL CHLORIDE WOULD PRODUCE 14 RAYNAUD'S DISEASE. RAYNAUD'S DISEASE IS A 15 DISEASE WHICH IS RECOGNIZED IN LAY TERMS BY 16 HANDS GOING VERY COLD AND BECOMING NUMB AND 17 GOING VERY COLD AND THE SKIN BECOMING WHITE. 18 AND THIS WAS ASSOCIATED WITH SOME BONEY 19 CHANGES KNOWN AS ACROOSTEOLYS I S. BY 1 95 3, A 20 CHARACTERISTIC PICTURE HAD EMERGED OF THE 21 TOXIC EFFECTS OF -- OF VINYL CHLORIDE AND 22 THIS WAS WELL SUMMARIZED, AGAIN, IN A FOREIGN 23 PUBLICATION BY SUCIO, S-U-C-I-O, IN 1953, 24 WHERE IT WAS SHOWN THAT VINYL CHLORIDE 25 PRODUCED HEPATITIS, SPLENOMEGALY, A BIG 21109035 BFG09777 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 79 1 SPLEEN, DERMATITIS, IRRITATION OF THE SKIN, 2 RAYNAUD'S DISEASE, WHICH WE'VE TALKED ABOUT 3 ALREADY, GUT UP DISTURBANCE, CENTRAL NERVOUS 4 SYSTEM DISTURBANCES AND THIS WAS VERY WELL 5 DESCRIBED, AS l SAY, IN 1963. THREE YEARS 6 LATER IN A BELGUIM PUBLICATION, THERE WAS A 7 FURTHER CONFIRMATION OF VINYL CHLORIDE 8 PRODUCED ACROOSTEOLYS I S THAN RAYNAUD'S 9 DISEASE, AND BY 1970, 1972, IT WAS SHOWN THAT 10 A DOSE RESPONSE EFFECT COULD BE PRODUCED; IN 11 OTHER WORDS, OVER THE HIGH CONCENTRATIONS OF 12 VINYL CHLORIDE, THE WORST THESE DISEASES 13 THE WORST THE DISEASE, THE WORST WERE THE 14 INCIDENCES OF THE DISEASE AND THE WORST WERE 15 THE SYMPTOMS. AND IT WAS SHOWN THEY WERE 16 PRODUCED OVER A RANGE OF 35 TO 800 PARTS PER 17 MILLION AND THE DIFFICULTY WAS EVEN NOTED AT 18 LEVELS OF 40 PARTS PER MILLION. 19 20 Q. NOW, COMING CLOSER TO DOCTOR, LET ME INTERRUPT YOU FOR A 21 SECOND. 22 ALL THESE PUBLICATIONS AND 23 ARTICLES THAT YOU REFER TO, WERE THESE 24 ARTICLES GENERALLY AVAILABLE IN MEDICAL 25 LITERATURE TO PERSONS WHO MAY HAVE BEEN 21109036 BFG09778 \ EC EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTl30 1 INTERESTED IN FINDING OUT ABOUT THE TOXICITY 2 OR EFFECTS OF VINYL CHLORIDE? 3 A. CERTAINLY. THESE ARTICLES WERE 4 PUBLISHED UN THE OPEN SCIENTIFIC LITERATURE 5 AND ANYBOD^ WHO HAD ANY INTEREST AT ALL IN 6 THIS ISSUE tOULD HAVE HAD ACCESS TO THIS 7 MATERIAL \ 8 \ NOW, THERE ARE SOME OTHER 9 INTERESTING POINTS. PRIOR TO -- WELL, LET 10 ME JUST GO BACK ON THAT FOR ONE MOMENT. 11 \PR I OR TO 1971, EIGHT CASES OF 12 CANCER OF THE LIVER HAD BEEN NOTED IN VINYL A13 CHLORIDE WORKERS EI GUT CASES OF CANCER OF 14 THE LIVER HAD BEE N\ NOTED IN VINYL CHLORIDE, 15 POLYVINYLCHLORIDE WORKERS PRIOR TO 1971. ONE 16 OF THESE HAD OCCURRED IN SWEDEN, SEVEN 17 OCCURRED IN THE UNITED STATES, THREE OF WHICH 18 WERE IN B.F. GOODRICH. ALL THESE EIGHT CASES 19 WERE SUBSEQUENTLY REDIAGNOSED AS ANGIOSARCOMA. 20 IT IS OF INTEREST THAT ONE OF THESE THREE 21 CASES OCCURRED IN A B.F. GOODRICH WORKER WHO 22 IN 1965 HAD RECEIVED WORKMEN'S COMPENSATION 23 FOR TOXIC HEPATITIS BUT HAD BEEN RETURNED TO 24 WORK SUBSEQUENTLY. 25 NOW, OVER AND ABOVE THESE 21109037 BFG09779 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTI 31 1 EIGHT CAUSES OF LIVER CANCER IN VINYL 2 CHLORIDE WORKERS WHICH HAD OCCURRED PRIOR TO 3 1975, THERE'S SOME OTHER INTERESTING 4 INFORMATION ON THE CANCER-CAUSING EFFECTS OF 5 VINYL CHLORIDE IN HUMANS. DOCTOR MATALONI IN 6 1959 HAD DEMONSTRATED MALIGNANT TYPE CELLS IN 7 THE SPUTUM OF VINYL CHLORIDE WORKERS. IN 8 OTHER WORDS, ONE WAY OF DIAGNOSING LUNG 9 CANCER, EFFECTIVELY IF YOU'RE TRYING TOO PICK 10 IT UP AT AN EARLY STAGE, TO GET SOMEBODY TO 11 SPIT INTO A LITTLE POT. YOU GET THE SPUTUM, 12 YOU LOOK IN THE CELLS AND BY LOOKING AT THE 13 CELLS YOU CAN TELL WHETHER THEY'RE CANCER 14 TYPE CELLS OR NOT. ANIMALS IN 1969, HAD 15 ALREADY SHOWN THAT THERE WAS A HIGH INCIDENCE 16 OF CANCER LIKE CELLS IN THE SPUTUM OF VINYL 17 CHLORIDE WORKERS. INTERESTINGLY ENOUGH, THIS 18 INFORMATION WAS NOT MADE AVAILABLE IN THE 19 OPEN SCIENTIFIC LITERATURE UNTIL 1975. SO, IT 20 IS -- TO SUMMARIZE, I WOULD SAY THAT THERE 21 WAS EXTENSIVE EVIDENCE OF TOXIC EFFECTS OF 22 VINYL CHLORIDE, BOTH IN ANIMALS AND IN HUMANS, 23 PRIOR TO 1974, THE BULK OF THIS LITERATURE ON 24 THE CHRONIC TOXIC EFFECTS COMING FROM THE 25 EUROPEAN LITERATURE. BUT THERE WERE ALSO VERY BFG09780 8E060TTZ E C EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 82 1 CLEAR INDICATIONS OF ITS CARCINOGENICITY AS 2 EVIDENCED 3Y THE VIOLA PAPER IN 1970, THE 3 EIGHT CASES .OF LIVER CANCER WHICH HAD \ 4 OCCURRED IN THIS COUNTRY AND IN SWEDEN, WHICH \ 5 WERE SUBSEQUENTLY DIAGNOSIED AS ANGIOSARCOMA, 6 AND PERHAPS LESS ACCESSIBLE WERE THE FINDINGS 7 OF MATALONI, THE TWO KINDS OF FINDINGS OF 8 MATALONI, ONE, THE EXPERIMENTAL CONFIRMATION 9 OF THE CANCER-CAUSING EFFECTS IN ANIMALS AND 10 THE MALIGNANT CELLS IN SPUTUM. 11 HOWEVER, I SHOULD MENTION \ 12 THAT MATALONI*S INFORMATION ON THE CANCER13 CAUSING EFFECT OF VINYL CHLORIDE IN ANIMALS, 14 WHICH AS I INDICATED BEFORE, HAD BEEN 15 OBTAINED BY THE FALL OF 1972, WAS 16 COMMUNICATED TO THE AMERICAN INDUSTRY, TO THE 17 MANUFACTURING CHEMI STS ASSOCIATION. 18 MR. RENNEISEN: OBJECTION, 19 YOUR HONOR, UNLESS THERE'S EVIDENCE IT WAS 20 COMMUNICATED TO B.F. GOODRICH COMPANY. HE 21 SAID IT WASN'T MADE AVAILABLE TO THE PUBLIC. 22 AND IT'S GROSS HEARSAY AS TO 23 THE COURT: WELL, THIS HAS 24 BEEN AN EXPERT IN T-hE FIELO. I'M GOING TO 25 ALLOW IT. I'M GOING TO ALLOW IT. BFG09781 21109039 EC ' EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTI33 1 MR. VASSALOTTI: YOUR HONOR, 2 I MIGHT FURTHER ADD 3 MR. RENNEISEN: THE JUDGE HAS 4 RULED. I DON'T THINK IT'S TIME FOR COUNSEL 5 TO MAKE A SPEECH. I OBJECT. 6 BY MR. VASSALOTTI: 7 Q. DOCTOR, YOU MENTIONED THAT PROFESSOR 8 MATALONI'S FINDINGS WERE COMMUNICATED TO AN 9 ORGANIZATION CALLED THE MANUFACTURING 10 CHEMISTS ASSOCIATION? 11 A. 12 Q. THAT IS CORRECT. AND WHEN WHAT WAS THAT? 13 A. 14 LET ME GIVE YOU THE DETAILS OF THIS. IN AUGUST, 1972, THE 15 MANUFACTURING CHEMISTS' ASSOCIATION -- THAT 16 IS, THE TRADE L08BY, THE ASSOCIATION IN THIS 17 COUNTRY THAT REPRESENTS THE CHEMICAL INDUSTRY 18 ENTERED INTO AN UNDERSTANDING WITH A 19 CONSORTIUM OF AMERICAN-EUR0PEAN INDUSTRIES. 20 MR. RENNEISEN: YOUR HONOR, I 21 OBJECT. THIS IS SIMPLY NOT MEDICAL EXPERT 22 TESTIMONY. 23 THE COURT: I'M GOING TO 24 SUSTAIN THE OBJECTION. IT'S GONE A LITTLE BIT 25 TOO FAR. 21109040 BFG09782 REC EXAMINATION - SAMUEL EPSTEIN - MR. VA SSALOTT I 84 1 BY MR. VASSALOTTI: 2 Q. IF YOU-COULO, DOCTOR EPSTEIN, JUST 3 LIMIT YOURSELF TO THE DEVELOPMENT OF 4 KNOWLEDGE REGARDING 5 A. FINE. 8 Y OCTOBER,'72, MATALONI HAD 6 CONFIRMED -- HAD REPEATED THE KIND OF 7 STUDIES THAT VIOLA HAD DONE AND HAD SHOWN 8 EFFECTS AT LOWER CONCENTRATIONS AND ON A 9 WIDER RANGE OF ORGANS. 10 Q. WHAT CONCENTRATIONS, WHAT LEVELS OF n EXPOSURES DID HE TEST? 12 A. MATALONI WENT DOWN TO THE HUNDRED 13 P.P.M. KIND OF BALLPARK LEVEL AND HAD, IN 14 FACT, LEVELS WERE FOUND, CONCENTRATIONS 15 MATALONI'S SUBSEQUENT STUDIES HAD, IN FACT, 16 DEMONSTRATED CARCINOGENIC EFFECTS DOWN TO ONE 17 PART PER MILLION IN SUBSEQUENT STUDIES OF 18 MATALONI. BUT BY'72, EFFECTS IN THE HUNDRED 19 PARTS PER MILLION HAD BEEN DEMONSTRATED- AND 20 THIS INFORMATION FIRST BECAME AVAILABLE IN 21 JANUARY, 1974, THE SAME DAY AS THERE WAS A 22 THE PUBLIC ANNOUNCEMENT BY 8.F. GOODRICH ON 23 THE OCCURRENCE OF FOUR CANCERS IN ITS WORKERS 24 IN THE LOUISVILLE -- FOR ANGIOSARCOMAS IN 25 THE LIVER IN WORKERS IN ITS 9. F. GOODRICH TtOSOTTZ BFG09783 EXAMINATION - SAMUEL EPSTEIN - MR. VA S SALOTT I 35 1 PLANT, IN ITS PLANT IN LOUISVILLLE, KENTUCKY. 2 Q. DOCTOR, YOU'VE MENTIONED ANIMAL 3 TESTS WERE DONE. DID THAT INCLUDE TESTS ON 4 RATS? IS THAT WHAT MATALONI AND VIOLA DID? 5 A. VIOLA'S STUDIES WERE ON RATS. 6 MATALONI STUDIES WERE MORE EXTENSIVE. THEY 7 INCLUDED MICE, RATS, HAMSTERS AND THEY WERE A 8 VERY, VERY EXTENSIVE SET OF STUDIES. 9 Q. WHAT'S THE SIGNIFICANCE OF THE 10 MEDICAL FIELD AND PARTICULARLY IN THE FIELDS 11 OF CANCER-CAUSING CHEMICALS OF ANIMAL TESTS 1? IN THE STUDIES? 13 A. IT'S GENERALLY ACCEPTED 8Y ALL 14 AUTHORITIES IN THE FIELD THAT TESTS IN 15 ANIMALS AFFORD A PROPER METHOD OF PREDICTING 16 WHETHER A CHEMICAL IS LIKELY TO INDUCE CANCER 17 IN HUMANS. AND TESTS IN ANIMALS FOR THIS 18 REASON ARE STANDARD METHODS OF FINDING 19 WHETHER A CHEMICAL IS LIKE TO BE CARCINOGENIC 20 OR OTHERWISE AND THE METHODOLOGY FOR CANCER 21 TESTING IN ANIMALS ARE FAIRLY WELL DEVELOPED 22 AND HAVE BEEN SO WELL DEVELOPED FOR DECADES. 23 THERE'S A WIDE RANGE OF EXPERT, BODIES 24 NATIONALLY AND INTERNATIONALLY THAT HAVE 25 UNEQUIVOCALLY CONCLUDED THAT INFORMATION 21109042 BFG09784 EXAMINATION SAMUEL EPSTEIN MR. VASSALOTT I 35 1 DERIVEO FROM WELL DEVELOPED ANIMAL TESTS GIVE 2 YOU A REAL PREDICTION AS TO THE LIKLIHOOD OF 3 WHETHER A CHEMICAL WOULD INDUCE CANCER IN 4 HUMANS OR NOT. 5 Q. DOCTOR, DOES THE MEDICAL LITERATURE 6 OR STATE OF THE MEDICAL ART AT THE PRESENT 7 TIME ESTABLISH HOW VINYL CHLORIDE CAUSES 8 CANCER? 9 A. THE ANSWER IS NO, AND IT'S ALSO 10 CLEAR TO SAY THAT WE DON'T KNOW THE MECHANISM 11 OF ACTION OF ANY CHEMICAL CARCINOGEN. YOU CAN 12 DESCR.IBE SOME OF THE EFFECTS OF A CHEMICAL 13 CARCINOGEN, THAT IT PRODUCES A DISTURBANCE OF 14 THIS METABOLIC SYSTEM, THIS BIOCHEMICAL 15 SYSTEM, THIS IMMUNOLOGICAL SYSTEM, BUT WE 16 DON'T KNOW THE MECHANISM OF ACTION OF 17 CARCINOGENS, INCLUDING VINYL CHLORIDE. 18 WE KNOW MANY THINGS ABOUT THE 19 OCCURRENCE OF THE -- HOW THE CARCINOGENIC 20 PROCESS DEVELOPS, 3 UT WE DON'T KNOW THE 21 MECHANISM. 22 Q. DOCTOR, HAVE ANY OF THE MEDICAL OR 23 SCIENTIFIC STUDIES OONE TO DATE SHOWN THAT 24 THERE IS ANY SAVE LEVEL OF VINYL CHLORIDE 25 EXPOSURE TO WHICH A HUMAN COULD BE EXPOSED? 2110S043 BFG09785 R EC examination SAMUEL EPSTEIN MR. VASSALOTT I 37 1 L'gf H T WO ; PLAR Ts`: 7 "2 ........... ,ji.~ . :-^G41iSEN.S.US 3 L1^CQMHUMOTIFS. THAT 4 Wi *-AHXJtJk'L. A Ft ~ 5 i ) i ip m~n---mn--n--nr---*----"----------^-irm n m ............ L6MHTfW0 E NS AHQ, ,:T HERE LS ' 6 >**. 7 8 tnjJLKff> i -9m*f- ~frgfartiry~'a ,*f A'y "TS^TTHyt-9 10 11 0 - G EN jAL. S TATEHEHI --' ' J|)>IM^Uptnp>Trrfn-iT-w^^ri^ r~-ir- i -- i r~---- 1 i im n m i ji-i.i_ i 12 THAT WgOONrT:;X.XO. OF ANY WAY OF SETT f NG SAFE, i a,11 ^wp^www^i--n^mmiu'ainyi. mm iii. 'Tt 13 14 * |IWI|I.HAI till -tfEHAVF 15 16 CHnufFIUrk-:UMi Ejfc'kpuc AUll fWUUb.HlL Jirr"'fiW~'^J"^'' r'1|l|1 ltw~T---------- --------- "" ~ '' -........... itirt 17 18 co^EirFirrry?5^--:' W~f*w*r Og-a.!i--------- 19 MkMh* 20 TWIiK;Klg-^::;iaifrTgAlt,l. , *L't~y 21 Dgcrgg'-tfus- i - " -ViiT|,~:',i,V'ti:">r1-'V--!. --- --T "' : ] '........ ~~ '- . ' 22 HAWWyrg----- 23 inre^FgrTTgTCTTTET5* " f nt t E KMi-~nF 24 wtafec5iiriTI75iiJ.B*gi^^ ATR, 25 w fj,,i? ,R,, i,l '* ttfrfwts-of - 21109044 BFG09786 EC EXAMINATION - SAMUEL EPSTEIN - MR. VASSALQTTI 83 1 2 MQR,g,*THNS- (JP 1 wurgrirfEis*. 3 NOW, AS I SAID BEFORE, WE 4 HAVE EXTENSIVE EVIDENCE ON THE 5 CARCINOGENICITY OF VINYL CHLORIDE AT LOW 6 CONCENTRATIONS AND LET ME, IF I MAY, BRIEFLY 7 SUMMARIZE THIS FOR YOU. 8 Q. COULD YOU, DOCTOR? 9 A. FIRST OF ALL, IN THE OVERWHELMING 10 MAJORITY OF CARCINOGENS OF THE TESTS THAT 11 HAVE BEEN SHOWN ON VINYL CHLORIDE IN ANIMALS, 12 CANCER-CAUSING EFFECTS HAVE BEEN DEMONSTRATED 13 AT THE LOWEST LEVEL TESTED. LET'S SAY 50 14 PARTS PER MILLION WAS THE LOWEST LEVEL TESTED. 15 CANCER CAUSING EFFECTS WERE DEMONSTRATED AT 16 THAT. THAT DOESN'T MEAN TO SAY THAT 50 PARTS 17 PER MILLION IS A SAFE LEVEL --. THERE'S NO 18 SUCH THING AS A SAFE LEVEL. THAT SIMPLY MEANS 19 THAT 50 PARTS WAS THE LOW TEST DOSE TESTED. 20 HOWEVER, M A.TALQN'-t1-yA S' - D-QWC ; -i 21 E xm\OTi>KSE^ % 22 WJ' ----Vi-I ji.i..iiinniirnTowri'w1 --------- v. -L~'----- - - ---- ^X 23 -Q-N-E P'QTfi.T S. - P 5 ft M l LUt Cftl WITH INTERMITTENT 24 EXPOSURE OVER A YEAR. WITH INTERMITTENT 25 EXPOSURE OF RATS TO LEVELS OF VINYL CHLORIDE 21109045 BFG09787 EC EXAMINATION - SAMUEL EPSTEIN - MR. VA5SALOTT I 3 9 1 AT ONE PART PER MILLION, HE HAS DEMONSTRATED 2 CANCER INDUCED BY VINYL CHLORIDE. OVER AN AND 3 ABOVE THIS, WE A LSQ- T OtT 10 ED 4 yutA I NED . E XPOS.URES *To VINTL 1 5 C HCCTO Ttrg^'a '"'GET' rCANC E R . AS ^ LJ. T T L E_,A,S,,0-HE_. - . f--|| ,lt|ltu i I,,,, umin --" 6 H0uR,,I E NO USH XQ G IVE YOU CANCEL. 7 Q. HAS THERE BE ANY RESEARCH IN THAT 8 REGARD > DOCTOR? 9 A. YES. THERE IS A VERY EXTENSIVE STUDY 10 BY THE CONSUMER PRODUCTS SAFETY COMMISSION n THAT SHOWS THAT ONE HOUR EXPOSURE OF ANIMALS 12 TO VINYL CHLORIDE WILL PRODUCE CANCER-CAUSING 13 EFFECTS. AND THE SAME DOCUMENT FROM THAT 14 CONSUMER PRODUCTS SAFETY COMMISSION WARNS 15 EXPLICITLY OF THE DANGERS OF SPILLS OF VINYL 16 CHLORIDE BECAUSE ONE EXPOSURE AS SHORT AS AN 17 HOUR CAN PRODUCE THESE EFFECTS. SO, ALREADY 18 WE HAVE SEEN WITHOUT REVIEWING THE WIDE RANGE 19 OF ANIMAL TEST ON -- ON THt CARCINOGENIC 20 EFFECTS OF VINYL CHLORIDE, WE'VE SEEN ONE 21 POINT ONE, THE LOWEST LEVEL TESTED SO FAR. 22 ONE PART PER MILLION, CANCER CAUSING EFFECTS 23 WERE INDUCED BY VINYL CHLORIDE. TRUE, CANCER 24 CAUSING EFFECTS WERE CAUSED BY AS SHORT A 25 PERIOD OF AN HOUR. 2X109046 BFG09788 examination SAMUEL EPSTEIN MR. VASSALOTTI90 1 LET'S EXAMINE THAT. 2 Q DOCTOR, IS THERE ANY INDICATION 3 WE'VE BEEN TALKING ABOUT ANIMALS OF THESE 4 LOWER LEVELS. IS THERE ANY MEDICAL LITERATURE 5 WHICH INDICATES THAT HUMANS ARE AT RISK OF 6 DEVELOPING CANCER, AND ANGIOSARCOMA OF THE 7 LIVER IN PARTICULAR, FROM THESE LOW LEVELS OF 8 VINYL.CHLORIDE EXPOSURE? 9 A. YES, 10 MR. RENNEISEN: YOUR HONOR, I 11 OBJECT TO THE QUESTION. I DON'T THINK AT RISK 12 IS WHAT WE'RE TALKING ABOUT HERE. 13 THE COURT: WHY DON'T YOU 14 REPHRASE YOUR QUESTION. 15 BY MR. VASSALOTT I : 16 Q OrT-: IS-fHR. , ANr rfggFCTt 17 EftC U(B.Cbf^.ai||'llWff E iwf HAT m M 18 ST,P..Qj giWI 0. 19' -- 20 P A i T~ i... GO frEVSgQt*^ ............... AMR ......... f O-g * ITC8gtA.- Qg - T-Hg . - L j.VF 21 A. 22 Q. 23 A. 24 T Y 25 YES, THERE IS SUCH EVIDENCE. CAN YOU DESCRIBE TO JD*0 : "Of*; STUGY. THE ' iff?Trfe 21X09047 BFG09789 EXAMINATION SAMUEL EPSTEIN MR . VASSALOTT I 91 1 2 COMM U^^y'^^QPL SLj^gfilL EO?-4>L A-N-T S .. 3 OP all discuss the evidence 4 FOR THE CARCINOGENICITY OF VINYL CHLORIDE IN 5 THE WORKPLACE AT LOW LEVELS OF EXPOSURE. 6 NOW, I SHOULD EXPLAIN THAT 7 THERE'S THREE KINDS OF PROCESSES IN WHICH A 8 WORKER IN THE -- IN THE VINYL CHLORIDE, 9 POLYVINYLCHLORIDE PLASTIC INDUSTRY IS 10 ASSOCIATED, THE FIRST IN THE MANUFACTURE OF 11 VINYL CHLORIDE. VINYL CHLORIDE IS A SMALL 12 BUILDING BLOCK WHICH WHEN STRUNG TOGETHER 13 FORMS LONG CHAINS CALLED POLYVINYLCHLORIDE. 14 SO, IN THE PROCESS, THE WORKER CAN 3E EXPOSED 15 TO VINYL CHLORIDE WHEN HE MAKES THE VINYL 16 CHLORIDE, THAT'S ONE; TWO, WHEN THE VINYL 17 CHLORIDE IS COOKED IN A PRESSURE POT, WHEN 18 THE SMALL MOLECULES ARE STRUNG TOGETHER TO 19 FORM POLYVINYL CHLORIDE, AND WHEN YOU MAKE 20 THE VINYL CHLORIDE AND WHEN YOU MAKE THE 21 POLYVINYLCHLORIDE, LEVELS OF EXPOSURE CAN BE 22 VERY HIGH, CAN BE PARTICULARLY IF WORK 23 PRACTICES ARE BAD. 24 THERE ' S A THIRD KIND OF 25 EXPOSURE 21109048 BFG09790 EC EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT192 1 MR. RENNEISEN: YOUR HONOR, I 2 DON'T LIKE TO KEEP OBJECTING. BUT I WAS UNDER 3 THE IMPRESSION THAT HE WAS TELLING US A 3 0 U T 4 HOW PEOPLE CAN GET CANCER FROM LOW LEVELS AND 5 HE'S JUST TOLD US ABOUT HIGH LEVELS. 6 MR. VASSALOTTI: YOUR HONOR, 7 I THINK HE'S DESCRIBING -- AND I DON'T WANT 8 TO PUT WORDS IN YOUR MOUTH, DOCTOR -- THE 9 DIFFERENCE IN EXPOSURE LEVELS. 10 MR. RENNEISEN: THAT WASN'T 11 THE QUESTION THEN. I ASK THAT THE ANSWER BE 12 STRICKEN AND THAT QUESTION BE ASKED. 13 THE COURT: I'M GO ING TO 14 ALLOW IT. I THINK THE JURY SHOULD HEAR THIS 15 BACKGROUND. WE HAVE AN EXPERT. YOU HAVE NOT 16 OBJECTED TO HIS QUALIFICATIONS. THE COURT 17 FINDS HIM WELL QUALIFIED. THE COURT WILL 18 ALLOW THIS. IT BEARS EXACTLY ON THE ISSUES IN 19 THIS CASE. 20 THE WITNESS: THE THIRD KIND 21 OF EXPOSURE IS THE EXPOSURE WHERE LEVELS ARE 22 LOW. AND WHEN YOU TAKE THE POLYVINYL RESIN 23 AND YOU WORK ON IT, YOU MAKE PHONOGRAPHS, YOU 24 MAKE PLASTIC. THAT IS WHAT WE CALL 25 FABRICATION. SO, I'M MAKING DISTINCTIONS BFG09791 J.109O49 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 9? 1 BETWEEN TWO KINDS OF EXPOSURES TO VINYL 2 CHLOR I DE . 3 the very low levels, when you 4 TAKE THE VINYL -- THE PRODUCT, THE 5 POLYVINYLCHLORIDE PRODUCT AND MAKE THINGS 6 LIKE RECORDS OR WHAT HAVE YOU OR GARDEN HOSE, 7 AND WHEN YOU FABRICATE -- WHEN YOU 8 FABRICATE THE POLYVINYLCHLORIDE, THE LEVELS 9 OF VINYL CHLORIDE ARE VERY LOW, COMPARED TO 10 WHAT THEY ARE WHEN YOU EITHER MANUFACTURE THE 11 VINYL CHLORIDE OR WHEN YOU HANDLE THE 12 POLYVINYLCHLORIDE. OKAY. 13 SO, THE RELEVANCE OF ALL THIS 14 IS AS FOLLOWS: IN THE POLYVINYLCHLORIDE 15 FABRICATION, LEVELS OF VINYL CHLORIDE 16 EXPOSURE ARE LOW AND THERE WAS A STUDY BY THE 17 NATIONAL INSTITUTE OF OCCUPATIONAL SAFETY AND 18 HEALTH IN 1978 WHICH DID A SURVEY OF 19 FABRICATING PLANTS, EVERY VINYL CHLORIDE 20 FABRICATING PLANT, IN WHICH THEY SHOWED THE 21 LEVEL OF VINYL CHLORIDE IN THE FABRICATING 22 PLANT, RANGED FROM THE N0NDETECTA8LE 23 they were so low you couldn't pick them up to 24 A MAXIMUM OF ABOUT TWO PARTS PER MILLION. 25 OKAY. SO, WE'RE DEALING NOW WITH AN INDUSTRY, BFG09792 OS060TT E C EXAMINATION SAMUEL EPSTEIN MR. VASSALOTT I 94 1 THE POLYVINYLCHLORIDE FABRICATION INDUSTRY IN 2 WHICH THE LEVELS OF VINYL CHLORIDE EXPOSURE 3 IS DEMONSTRABLY LOW. LET US NOW EXPERIENCE 4 THE EXPERIENCE IN THIS INDUSTRY TO SEE WHAT 5 IS THE EFFECT AND YOU'LL GET SOME INDICATION 6 THERE. 7 WE FIND, FIRST OF ALL, IN A 3 PLANT IN CONNECTICUT IN PUBLICATION CHRISTINE, \ 9 1974, TWO ANGIOSARCOMAS OF THE LIVER WERE 10 DESCRIBED IN 1974. ONE OF THESE CASES WASN'T 11 EVEN A WORKER, HE WAS AN ACCOUNTANT, NOT 12 LIKELY TO BE TOOLING AND FABRICATING THE 13 STUFF ALL DAY LONG. SO, IN THESE PLANTS WHERE 14 LEVELS OF EXPOSURE ARE LOW, TWO ANGIOSARCOMAS 15 ARE DESCRIBED, INCLUDING ONE ACCOUNTANT. 16 WHAT ELSE DO WE FIND? IN A 17 PUBLISHED TEXT BY BAXTER IN 1.9 4 7 , AN 18 ANGIOSARCOMA OF THE WORKER IN A 19 POLYVINYLCHLORIDE FABRICATOR. WHAT.ELSE DO WE 20 FIND? 21 COULD I TROUBLE YOU FOR A 22 DROP OF WATER, PLEASE? 23 WHAT ELSE DO WE FIND? IN 24 ANOTHER STUDY, IN A BRITISH PLANT, BY BAXTER, 25 WE FIND -- WE FIND AN EXAMPLE OF CANCER OF TS060IT BFG09793 EC EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 95 1 THE STOMACH IN A GROUP OF ABOUT 700 2 FABRICATORS, CANCER OF ANOTHER SITE. AND 3 FINALLY, WE FIND IN A SERIES OF 17 4 POLYVINYLCHLORIDE PLANTS LOOKED AT IN THIS 5 COUNTRY, AN EXCESSIVE CANCERS OF VARIOUS 6 SITES, GUTS, LUNG, LYMPHATIC SYSTEM AND 7 BREAST. SO, MY SECOND LINE OF EVIDENCE 8 I'VE ALREADY TOLD YOU ABOUT THE HUMAN DATA, 9 THE ANIMAL DATA. THE SECOND LINE OF EVIDENCE 10 RELATES TO THE OCCUPATIONAL DATA IN WHICH 11 ANGIOSARCOMAS AND OTHER MALIGNANCIES ARE 12 DESCRIBED IN WORKERS EXPOSED TO WHAT COULD IN 13 THIS CONTEXT BE CALLED RELATIVELY LOW LEVELS. 14 LET US NOW LOOK AT A THIRD 15 TYPE OF PIECE OF INFORMATION IN EVIDENCE; 16 THAT IS, COMMUNITY CANCER. COMMUNITY CANCER 17 18 Q. WHAT DO YOU MEAN BY COMMUNITY CANCER, 19 DOCTOR? 20 A. FINE. WHAT I MEAN BY COMMUNITY 21 CANCERS ARE CANCERS OCCURRING IN RESIDENTS 22 WHO LIVE IN -- PEOPLE LIVING IN CLOSE 23 PROXIMITY TO VARIOUS INDUSTRIES. AND THERE'S 24 A G-R OWING BODY OF INFORMATION SUGGESTING 25 SUGGESTING IS PERHAPS NOT A SUFFICIENTLY S060TTZ l* BfG09l94 EXAMINATION - SAMUEL EPSTEIN - MR. VASSAL0TT I 9S \ 1 STRONG STATEMENT -- INDICATING THAT 2 PROXIMITY OF RESIDENTS TO CERTAIN INDUSTRY IS 3 WHAT WE CALL IN THE TRADE A RISK FACTOR. IT 4 PUTS YOU AT EXCESS RISK OF DEVELOPING CANCER. 5 AND THE BASE FOR THIS STARTED IN -- WITH A \ 6 PUBLICATION OF SOME MAPS BY THE NATIONAL 7 CANCER INSTITUTE, WHICH SHOWED -- AND THESE 8 WERE -- WOULD SHOW THAT IN CERTAIN PARTS OF \ 9 THIS COUNTRY, YOU HAD HIGH LEVELS, LIVING 10 ENCOUNTERS IN CERTAIN PARTS OF THIS \ 11 THERE WERE VERY. HIGH LEVELS OF CANCER AS v 12 COMPARED TO OTHER PARTS OF THE COUNTRY. AND 13 THESE AREAS WERE THE HIGHLY INDUSTRIALIZED 14 NORTHEAST. AND IT'S NOT OVERALL CANCER 15 MORTALITY RATES, 8 UT IT'S CANCER FOR A WIDE 16 RANGE OF SITES. AND THESE STUDIES HAVE BEEN 17 AMPLIFIED AND VARIOUS STUDIES SHOWING AGAIN 18 IN CERTAIN PARTS OF AMERICA, IN CERTAIN 19 STATES IN CERTAIN COUNTIES, THERE ARE EXCESS 20 RATES OF CANCER. BEFORE I GET INTO THAT 21 AND IN SOME OF THESE INSTANCES, THERE HAVE 22 BEEN WHAT WE CALL MONITORING STUDIES. THE AIR 23 HAS BEEN SAMPLED AND IT HAS BEEN SHOWN THAT 24 THE INDUSTRIES CONCERNED IN THESE ARE4S WHERE 25 YOU HAVE HIGH LEVELS OF CANCER HAVE 3EEN BFG09795 1109053 EC EXAMINATION SAMUEL EPSTEIN MR. VASSALOTT I 97 1 PUTTING OUT CHEMICALS, CARCINOGENS INTO THE 2 AIR OF THE LOCAL COMMUNITIES. BUT LET US 3 RETURN NOW TO THE ANGIOSARCOMA. 4 THERE ARE EIGHT DOCUMENTED 5 CASES OF COMMUNITY ANGI 0SARCOMA; THAT IS, 6 PEOPLE GETTING ANGIOSARCOMA, LIVING IN THE 7 VICINITY OF VINYL CHLORIDE 8 POLYVINYLCHLORIDE PLANT. EIGHT CASES, WITH 9 MR. GRASSO, THAT'S NINE. LET'S TALK ABOUT THE 10 EIGHT CASES FIRST. 11 IN 1974, CHRISTINE REPORTED 12 ANGIOSARCOMA OF THE LIVER IN SOMEBODY LIVING 13 TWO MILES AWAY FROM A POLYVINYL CHLORIDE 14 PLANT IN CONNECTICUT. AND THIS WAS A MAN OF 15 AGE -- WHO DIED AT THE AGE OF 73 AND HE 16 LIVED -- INCIDENTALLY, HE DIED IN 19^7. AND 17 HE LIVED TWO MILES AWAY FROM A PLANT IN 18 CONNECTICUT. AND THIS PLANT WAS A FABRICATING 19 PLANT; THERERFORE, LESS LIKELY TO PUT OUT 20 LARGE CONCENTRATIONS OF PVC; IN THIS SAME 21 PLANT WHERE THIS MAN LIVED IN, THERE WAS 22 ANOTHER OCCUPATIONAL CASE OF ANGIOSARCOMA, A 23 WORKER IN THIS PLANT ALSO DIED OF 24 ANG I OSARCOMA. 25 CHRISTINE ALSO DESCRIBED 21109054 BFG09196 IEC EXAMINATION SAMUEL EPSTEIN MR. VASSALOTT I ? 1 ANOTHER CASE NEAR ANOTHER PLANT IN 2 CONNECTICUT. 3 Q. DOCTOR, LET ME INTERRUPT YOU FOR A 4 SECOND. YOU'RE TALKING ABOUT A REFERENCE TO 5 CHRISTINE. IS THAT AN AUTHOR OF A MEDICAL 6 ART ICLE? 7 A. YES, THAT'S AN AUTHOR OF A 8 SCIENTIFIC PUBLICATION WHICH I HAVE WITH ME 9 AND CAN MAKE AVAILABLE. 10 Q. 11 A. BUT THESE ARE MATERIALS . THIS IS PUBLISHED IN THE OPEN 12 LITERATURE. T H.ER-irr^fE^-E--I GWT--I WO-FC ?rT-|-^H5r-(>F 13 AN-&:i-Q^7rRr.(5KAt I PIJ BOSHED' TN IC 14 4.--L-Tc1R~fiTO Nil'' LEJ jffcfi IS 16 17 ~- -HOT-THCSE-vg rGHT CASES. THE V - ALL^riWD^" 18 I L ESS---T hAH^TWlD-H ML F R OM 19 \ 20 " ---------- -------------------i7n mem fA S:- B.tLtFP IX YF A-B-^--I-NL-AStP 21 L I KE MR^ GRA S SCF. A.N.QL-E LQi.mTl Il,firl'rlRlMWAlaWs^W^4WBCWWAWNW0WTW>w*wgw-'^R . V 22 Q. DOCTOR, WE'LL GET TO THE LATENCY 23 PERIOD IN A MOMENT. RIGHT NOW LET'S TALK 24 A30UT THE EVIDENCE OF THE DEVELOPMENT OF 25 ANGIOSARCOMA IN RELATIVELY LOW LEVELS OF S3060TT BFG09797 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTIgg 1 EXPOSURE? \ 2 A. WELL. WE'RE TALKING NOW ON THE THIRD \ 3 LINE OF EVIDENCE, NAMELY THE ACCOUNTS OF 4 ANGIOSARCOMAS' IN COMMUNITY RESIDENTS, THIS \ 5 REPRESENTING THE THIRD L I,NE OF EVIDENCE FOR \? 6 THE ACCOUNTS OF-. ANG I OSARCOMAS AT LOW LEVELS * 7 OF VINYL CHLORIDEVl EXPOSURE. I'VE ALREADY 8 MENTIONED TWO CASES. 9 THE THIRD CASE WAS DESCRIBED 10 BY BAXTER IN 1970, A MAN OF 61, WHO DIED IN 11 1970 WHO HAD LIVED FOR SIX YEARS NEAR A PLANT 12 AND IN THIS SAME PLANT WHICH HE LIVED NEAR, 13 THERE WAS ALSO A CASE OF A WORKER WHO DIED OF 14 ANGIOSARCOMA OF THE LIVER. 15 IN A PAPER BY BRADY IN 1977, 16 THERE WERE A TOTAL OF FIVE CASES OF WOMEN WHO 17 LIVED CLOSE TO PLANT. THE FIRST ONE DIED IN 18 1965. SHE LIVED LESS THAN A MILE FROM A PLANT. 19 THE SECOND WAS A WOMAN OF 45 WHO LIVED LESS 20 THAN A MILE FROM THE PLANT. THE THIRD WAS A 21 WOMAN OF 31 WHO LIVED A THIRD OF A MILE FROM 22 THE PLANT. THE FOURTH WAS A WOMAN OF 62 WHO 23 LIVED A THIRD OF A MILE FROM THE PLANT. AND 24 ThE FIFTH WAS A WOMAN OF 31 WHQ LIVED ABOUT 25 POINT ONE MILES FROM A PLANT. I SHOULD 9S060TT2 BFG09798 : E C EXAMINATION - SAMUEL EPSTEIN- MR. VASSALOTTI100 '"V. 1 MENTION THAT TWO OF THESE CASES, THE BAXTER 2 CASE, LIVED SIX YEARS, HAD ONLY SIX YEARS 3 EXPOSURE, WAS A SIX YEAR RESIDENT AND THE 4 BRADY CASE WAS AN EIGHT YEAR RESIDENT. 5 NOW, IN A 0 D IT ION TO THE 6 ANGIOSARCOMAS OCCURRING AS A COMMUNITY CANCER, 7 WE ALSO HAVE TWO OTHER KINDS -- WE ALSO 8 HAVE TWO OTHER REPORTS OF VINYL CHLORIOE 9 ASSOCIATED OR INDUCED CANCER IN COMMUNITY 10 RESIDENTS. AND THE PARTICULAR INTEREST OF 11 THESE IS AS FOLLOWS: THESE WERE BRAIN TUMORS. 12 NOW, WE KNOW THAT VINYL 13 CHLORIDE PRODUCES CANCER IN A WIDE RANGE OF 14 ORGANS ANO VINYL CHLORIDE IS RECOGNIZED BY IS THE INTERNATIONAL AGENCY FOR RESEARCH ON 16 CANCER AND VARIOUS OTHER GROUPS AS BEING WHAT 17 WE CALL A MULTI-SYSTEM CARCINOGEN FOR 18 PRODUCING CANCER IN A WIDE RANGE OF ORGANS, 19 NOT ONLY ANGIOSARCOMA OF THE LIVER BUT 20 PRODUCING CANCER OF THE LUNG, IN THE BRAIN 21 AND OTHER S ITE S. 22 NOW, IN THESE TWO COMMUNITY 23 CANCERS I'M TALKING ABOUT, NAMELY A STUDY BY 24 fLE_A_NJr_A NT~ P~^I 19 7 6, AN EXCESS IN BRAIN TUMORS 25 WAS DEMONSTRATED IN RESIDENTS IN OHIO BFG09799 21109037 E C EXAMINATION SAMUEL EPSTEIN- MR . VASSALOTTI 101 1 COMMUNITIES WHERE VC PVC PLANTS WERE LOCATED. 2 IN THE SAME YEAR, A STUDY `WAS -- A CANADIAN 3 STUDY WAS PUBLISHED OF EXCESSIVE BRAIN TUMORS 4 OF PEOPLE LIVING IN A CANADIAN COUNTY NEAR A 5 VC PVC PLANT. THAT, VERY BRIEFLY, IS THE 6 EVIDENCE FOR THE CARCINOGENICITY AT WHAT 7 MAYBE CALLED LOW LEVELS, ALTHOUGH I WOULD PUT 8 QUOTATION MARKS AROUND THE WORD LOW. 9 Q. NOW, DOCTOR, IN DEALING WITH CANCER 10 CAUSING AGENTS LIKE VINYL CHLORIDE,, THE TERM 11 LATENCY PERIOD HAS COME UP IN THIS CASE AND 12 YOU UUST MENTIONED IT YOURSELF. WHAT DOES 13 LATENCY PERIOD MEAN? 14 A. THE LATENCY PERIOD IS REALLY THE 15 TIME FROM THE FIRST EXPOSURE TO A TOXIC OR 16 CANCER CAUSING CHEMICAL TO THE DATE OF 17 DIAGNOSIS OR DEATH FROM A PARTICULAR ADVERSE 18 EFFECT. NOW, THERE ARE OTHER WAYS OF DEFINING 19 LATENCY PERIOD, BUT I THINK THIS IS PROBABLY, 20 FOR THE CONTEXT -- FOR OUR CONTEXT, 21 PROBABLY THE MOST EFFECTIVE AND BEST 22 DEFINITION. 23 Q. DOCTOR, HAS THE MEDICAL RESEARCH 24 LITERATURE DETERMINED OR SUGGESTED THAT A 25 CERTAIN MINIMUM LATENCY PERIOD IS REQUIRED 8S060TT BFG09800 EXAMINATION SAMUEL EPSTEIN MR. VASSALOTTI102 1 FOR THE DEVELOPMENT OF ANGIOSARCOMA IN 2 PERSONS EXPOSED TO VINYL CHLORIDE? 3 A. WELL, IN GENERAL, I TH!NK__IT_'S FAIR 4 TO SAY THAT THE AVERAGE LATENCY PERIOD IN THE 5 LITERATURE FOR ANGIOSARCOMA I S SOMEWHAT I N 6 THE RANGES OF ABOUT 20 YEARS , SOMEWHERE I N 7 THAT KIND OF BALLPARK, 20 YEA RS. r* . / 8 HOWEVER, THERE ARE REPORTS, A 9 WIDE RANGE OF REPORTS, OF ANGIOSARCOMAS AND 110 OTHER VINYL CHLORIDE INDUCED CANCER WITH 11 LATENCIES UNDER TEN YEARS. 12 Q. YOU'VE ALREADY MENTIONED, I THINK, 13 TWO OF THEM IN THE COMMUNITY CANCER CASES. 14 A. THAT IS CORRECT. LET ME JUST VERY 15 8RIEFLY RUN THROUGH THESE TEN -- THESE 16 REPORTS ON VINYL CHLORIDE INDUCED CANCER, 17 ANGIOSARCOMAS, UNDER TEN YEARS. 18 Q. AND AGAIN BEFORE YOU START, THESE 19 REPORTS THAT YOU'LL BE REFERRING TO ARE 20 MATERIALS THAT HAVE BEEN OUT IN THE PUBLIC 21 LITERATURE? 22 A. YES. IN 1975, THE ENVIRONMENTAL 23 PROTECTION AGENCY IN A PUBLIC DOCUMENT, 24 REFERRED TO TWO ANGIOSARCOMAS, ONE IN AN 25 ITALIAN WORKER, VINYL CHLORIDE WORKER, WHOSE e s o e o iT ; BFG09801 E C EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTT I 103 1 LATENCY PERIOD WAS SIX YEARS, SIX YEARS, THE 2 SAME AS MR. GRASSO; THE SECOND WAS AN 3 ANGIOSARCOMA IN A BRITISH WORK WITH A LATENCY 4 OF EIGHT YEARS. THE THIRD CASE IS CHRISTINE'S 5 CASE IN 1974; THAT IS, THE ACCOUNTANT WHO 6 WORKED IN,A FABRICATING PLANT WHO HAD A 7 \lATENCY OF TEN YEARS. il I 8 THE NEXT IS A CASE I , - / 9 *' MENTION &D ALREADY, THE ANGIOSARCOMA OF THE 10 LIVER, WHO HAD A LATENCY OF SIX YEARS. THIS 11 WAS A RESIDENT WHO LIVED LESS THAN HALF A 12 MILE FROM A VC PVC PLANT. THE NEXT CASE WAS 13 AGAIN A LIVER CANCER WITH A LATENCY PERIOD OF 14 EIGHT YEARS, PUBLISHED BY BRADY IN 1977, WHO 15 WAS A RESIDENT A THIRD OF A MILE AWAY FROM A 16 VC PVC PLANT IN NEW YORK. 17 OVER AND ABOVE THESE LIVER . 18 ANGIOSARCOMAS, THE LIVER CANCER, WHICH IS 19 ANOTHER KIND OF MALIGNANCY OF THE LIVER WHICH 20 IS DIFFERENT FROM ANGIOSARCOMA BUT IS LETHAL 21 TODAY, WAS REPORTED IN A WORKER IN A BRITISH 22 VC PVC PLANT WITH A LATENCY OF NINE YEARS, 23 ANOTHER WAS IN THE SAME PAPER BY FOX AND 24 COLLIER, A CANCER OF THE LUNG IN A WORKER IN 25 THE BRITISH PLANT WITH A LATENCY OF NINE BFG09802 09060TTZ EXAMINATION SAMUEL EPSTEIN MR. VASSALOTT1104 1 YEARS. IN THE SAME PAPER, ALSO CANCER OF THE 2 PANCREAS IN LESS THAN TEN YEARS IN A WORKER 3 IN A BRITISH PLANT. FINALLY, TWO BRAIN 4 CANCERS, A 8RAIN CANCER IN A WORKER IN THE 5 UNITED STATES, VINYL CHLORIDE WITH A LATENCY 6 OF THREE YEARS, WAXWEILLER IN 1975. AND 7 FINALLY, A WORKER IN A SWEDISH PLANT WITH A 8 LATENCY OF LESS THAN ONE YEAR. 9 Q. DOCTOR, HAS BRAIN CANCER BEEN LINKED 10 WITH VINYL CHLORIDE? 11 A. IT MOST CERTAINLY HAS. 12 Q. DOCTOR, ARE YOU FAMILIAR WITH 13 AS A PHYSICIAN AND A RESEARCHER, ARE YOU 14 FAMILIAR WITH THE ABILITY OF LUNGS TO BREATHE 15 IN PARTICLES OF VARIOUS SIZES? 16 A. YES, I WOULDN'T CLAIM PARTICULAR 17 EXPERTISE OF AREAS OF RESPIRAT0RY PHYSI 0LOGY, 18 BUT I'M CONVERSANT WITH SOME ELEMENTS OF THE 19 FIELD. 20 Q. DOCTOR, IF A PERSON WAS EXPOSED TO 21 ATMOSPHERE HAVING WITHIN IT PVC DUST 22 PARTICLES WITHIN A SIZE RANGE OF ONE TO TEN 23 MICRONS -- DO YOU KNOW WHAT A MICRON IS? 24 A. YES . 25 Q. WOULD THOSE PARTICLES BE RESPIRABLE, T9060TT BFG09803 EXAMINATION - SAMUEL EPSTEIN - MR. VASSALOTTI105 1 WOULD THEY ENTER INTO A PERSONS LUNGS? 2 A. SURE. THE SMALLER THE PARTICLE, 3 CERTAINLY, WHEN YOU REACH MORE THAN -- WHEN 4 YOU REACH TEN MICRONS AND A 8 0 V E, THE 5 PARTICLES TEND TO BE I RRESP I RAQLE. THE LOWER 6 YOU GO, THE GREATER THE ABILITY OF THE LUNG 7 TO RETAIN THESE PARTICLES, SO THE LOWER, THE 8 SMALLER THE PARTICLE, JUNK MORE RESPIRABLE IT 9 IS WITHIN THIS RANGE. 10 Q. AND WOULD THEY BE -- ONCE RESPIRABLE, 11 WOULD THESE SMALL PARTICLES -- WOULD ANY OF 12 THE5E SMALL PARTICLES BE SUBJECTED TO BE 13 RETAINED OR ENTRAPPED IN THE LUNG? 14 A. YES. AND THERE ARE VARIOUS STUDIES 15 ON THE EFFECTS OF POLYVINYLCHLORIDE PARTICLES 16 IN THE LUNG. THERE HAVE BEEN A WHOLE SERIES 17 OF PUBLICATION SHOWING THAT POLYVINYLCHLORIDE 18 CAN PRODUCE GRANULOMATOUS CHANGES IN THE LUNG 19 AND THERE ARE VARIOUS PUBLICATIONS ON THE 20 ABILITY OF PARTICLESS TO PRODUCE THESE 21 CHANGES IN THE PARTS QUITE APART FROM 22 INFORMATION THAT WE HAVE ON ITS 23 CARCINOGENICITY, ON THE CARCINOGENIC EFFECTS 24 OF POLYVINYLCHLORIDE. 25 the court: i think we'll 21109062 BFG09804 EXAMINATION - SAMUEL EPSTEIN - MR. VASSAL0TTI 105 1 TAKE OUR NOON RECESS, LADIES AND GENTLEMEN. 2 8 E BACK HERE AT 1:30. 3 CAT WHICH TIME THE JURY 4 LEAVES THE COURT ROOM.). 5 THE COURT: WE WILL STAND IN 6 RECESS UNT IL 1 : 30 7 (LUNCHEON RECESS ) . 3 THE COURT: PLEASE CONTINUE. 9 MR. VASSALOTTI: THANK YOU, 10 YOUR HONOR. 11 8 Y MR. VASSALOTT I : 12 Q. DOCTOR, YOU WERE NOT IN THE COURT 13 THIS MORNING WHEN I READ A HYPOTHETICAL FACT 14 SITUATION TO DOCTOR LAUCIUS, WERE YOU? 15 A. 16 _Q . . NO. DOCTOR, IN THAT CASE, I'LL HAVE TO 17 ASK YOU TO ASSUME THE FOLLOWING. FACTS WITH 18 REGARD TO THIS CASE: FIRST THAT MR. JOHN 19 GRASSO WAS BORN ON DECEMBER 27, 1927 AND THAT 20 UP UNTIL HIS LAST ILLNESS IN MAY OF 1976, 21 THERE WAS NO HISTORY, MEDICAL HISTORY OF 22 CANCER OR LIVER DISEASE IN MR. GRASSO, AND 23 THAT ALSO, THERE WAS NO HISTORY OF CANCER OR 24 LIVER DISEASE IN EITHER OF HIS PARENTS OR HIS 25 BROTHERS OR SISTERS. I FURTHER ASK YOU TO 11.09063 BFG09805 EXAMINATION - SAMUEL EPSTEIN - MS. VASSALOTT I 107 1 ASSUME THAT MR. GRASSO BEGAN WORKING AT THE 2 OUPONT CHAMBERS WORKS IN DEEPWATER, NEW JERSEY 3 IN APPROXIMATELY 1947 AND THAT EXCEPT FOR 4 PERIODS WHEN HE WAS LAID OFF FROM THAT 5 FACILITY, HE WORKED THERE UNTIL MAY OF 197S; 6 AND THAT IN THAT EMPLOYMENT AT THE DUPONT 7 CHAMBERSWORKS, HE DID NOT WORK WITH ARSENIC 8 OR ARSENIC COMPOUNDS OR WITH VINYL CHLORIDE. 9 DURING THE PERIODS THAT HE WAS LAID OFF FROM 10 THE DUPONT CHAMBERSWORKS, HE HELD SUCH JOBS 11 AS WORKING AT AN GROCERY STORE, AN AUTO PARTS 12 SALESMAN, A GAS STATION ATTENDANT, A 13 CONSTRUCTION LA30RER, AN AUTO MECHANIC AND A 14 SHEET METAL WORKER. I ASK YOU TO FURTHER IS ASSUME THAT DURING THE YEARS OF 1970 THROUGH 16 1975, MR. GRASSO WAS AWAY FROM HIS HOME 17 APPROXIMATELY 50 TO 55 HOURS PER WEEK; 18 therefore, he was at home or in the area of 19 HIS HOME APPROXIMATELY -- OR OVER 60 20 PERCENT OF THE TIME DURING THOSE YEARS. 21 IN ADDITION, I ASK YOU TO 22 ASSUME THAT IN FEBRUARY OF 19 -- BETWEEN 23 FEBRUARY OF 1975 AND SEPTEMBER OF 1975, MR. 24 GRASSO WAS AT HOME VIRTUALLY ALL THE TIME, AS 25 HE WAS RECUPERATING FROM CORONARY ARTERY BFG09806 21103064 :EC examination SAMUEL EPSTEIN - MR. VASSALOTT [ 1 0 8 1 BYPASS SURGERY. I FURTHER ASK YOU TO ASSUME 2 THAT DURING THE PERIOD OF MARCH OF 1970 3 THROUGH DECEMBER, 1975, MR. GRASSO LIVED 4 APPROXIMATELY ONE POINT SEVEN MILES FROM A 5 PVC PRODUCT ION\\ PLANT OWNED AND OPERATED BY 6 THE 3 . F . GOODRICH COMPANY. DURING THOSE YEARS, \ 7 IT HAS BEEN ESTIMATED THAT THAT PVC PLANT 8 EMITTED BETWEEN THE ONE POINT FOUR AND FOUR 9 POINT THREE POUNDS OF VINYL CHLORIDE INTO THE 10 ATMOSPHERE. AND IT'S BEEN FURTHER ESTIMATED 11 THAT DURING THOSE YEARS THAT THE PVC PLANT 12 ALSO EMITTED INTO THE ATMOSPHERE AMOUNTS OF 13 PVC DUST PARTICLES THAT RANGED IN SIZE 14 BETWEEN ONE AND TEN MICRONS AND THAT SUCH'PVC 15 DUST PARTICLES CONTAINED ENTRAPPED UNREACTED 16 VINYL CHLORIDE IN LEVELS RANGING FROM 40 17 PARTS PER MILLION.UP TO 2 , 0 00 PARTS PER 18 MILLION. 19 IT HAS BEEN FURTHER ESTIMATED 20 THAT DURING THE YEARS 1970 THROUGH 1975, THAT 21 there existed levels of vinyl chloride in the 22 AIR AND AROUND THE GRASSO HOME AND THAT THOSE 23 LEVELS HAVE BEEN ESTIMATED TO RANGE FROM ONE 24 POINT ONE PARTS PER MILLION TO 28 PARTS PER 25 MILLION, AND THAT THESE LEVELS OF VINYL 21109065 BFG09807 EXAMINATION SAMUEL EPSTEIN - MR. VASSALOTT I 109 1 CHLORIDE AT OR AROUND' THE GRASSO HOME WERE2 PRESENT FOR A TOTAL OF 1,503 HOURS OF 3 CONDITIONS WHEN THE WIND WAS FAVORABLE TO 4 BRING THOSE MATERIALS THERE DURING THE TEARS 5 IN QUEST ION. 6 FURTHER, ON -- IN HAZE OR 7 POLLUTION CONDITIONS, THE LEVEL OF EXPOSURE 8 AT THE GRASSO HOME RANGED AS HIGH AS FROM TEN 9 TO 90 PARTS PER MILLION. 10 FINALLY, DOCTOR, IN ADDITION 11 TO THOSE EXPOSURES OR THOSE LEVELS OF 12 EXPOSURE AT THE AREA OF THE GRASSO HOME, 13 THERE WERE IN ADDITION SHORT PERIODS OF TIME 14 DURING THE YEARS IN QUESTION RANGING ANYWHERE 15 FROM FIVE TO 15 MINUTES DURING WHICH IT. HAS 16 BEEN ESTIMATED THAT LEVELS OF VINYL CHLORIDE 17 EXPOSURE IN THE AREA OF THE GRASSO HOME 18 RANGED AS HIGH AS SEVERAL HUNDRED PARTS PER 19 MILL ION. 20 NOW, DOCTOR, BASED UPON THAT 21 INFORMATION, AND BASED UPON YOUR EXPERIENCE 22 AS A PHYSICIAN AND A TOXOCOLOG I ST, AND YOUR 23 KNOWLEDGE OF THE LITERATURE AND MEDICAL 24 EVIDENCE IN THE AREA OF CANCER AND CANCER 25 CAUSING CHEMICALS, DO YOU HAVE AN OPINION AS 21103066 BFG09808 iEC examination SAMUEL EPSTEIN MR. VA5SALOTTIII0 1 TO WHAT CAUSED THE ANGIOSARCOMA OF THE LIVER 2 THAT MR. JOHN GRASSO HAD? 3 A. YES. 4 AND WHAT IS YOUR OPINION, DOCTOR? 5 A. MY 'qmFuIVcIM- - 6 S L) &-ST ffitTYX t PflTO BAB ft f t r TH A T I $ HJ S 7 ANG F OS A R C 0 MA W AS 0 LIE -TO; RE S 10 E NT I A L EXPOS UR E- 1 1 1,1 -,, Min^mn-ir-j rI I ----------------- " ---- -- --> 8 to ^prrr^iTfWrSe' emitted . from the . b.f. J 1 *1- -. -Sti. W l i ^w IW'ftl** " " ,, 9 GO^&'^trfT'TLA N T . 10 Q. DOCTOR, WHY DIDN'T ANYBODY ELSE IN 11 THE GRASSO FAMILY GET THE ANGIOSARCOMA OF THE 12 LIVER? 13 A. WELL, I HAVE THREE RESPONSIVE 14 COMMENTS: FIRST OF ALL, I BELIEVE ON THE 15 BASIS OF THE EXPOSURE DATA THAT WE HAVE, THAT 16 THE GRASSO FAMILY IS AT RISK AND WHILE NOBODY 17 IN THAT FAMILY HAS DEVEL0PED CANCER SO FAR, I 18 BELIEVE THAT THE FAMILY IS AT RISK AND 19 THEREFORE ONE CAN'T ANSWER THAT QUESTION 20 UNTIL THE REST OF THE FAMILY AND LOCAL 21 RESIDENTS HAVE BEEN FOLLOWED UP FOR LIFETIME, 22 POINT ONE. 23 POINT TWO, M RT^G'RA^SiO MAY .,1A. -w.`v, 24 WELL -- AND 1M NOT PREPARED TO EXCLUDE THE 25 POSS I BILITY MAT"W 21109067 BFG09809 EC examination SAMUEL EPSTEIN- MR. VASSALOTTI111 1 i. ---- --^--' * SENS]_T I ZEp.,TJHE J,.WL...CHLaR:lOE ,BT OTHER * i ll ................... m----- " u, * 2 EXPOS UR ES.JC_-^.U&^.^-.L-CJtE.H,I C A L.S A W I 0 E RANG E OF 3 C H EMTgAcSaSENTC1*7. ANg JCARC I N0GEN T.'O 4 WAT .PUPQttT . 5 AND THIRDLY, IN ANY 6 POPULATION OF ANIMALS OR HUMANS WHO ARE 7 EXPOSED, THERE IS A DISTRIBUTION, WHAT WE 8 CALL A GAUSSIAN, TYPE OF DISTRIBUTION OF 9 SENSITIVITY. SOME INDIVIDUALS FOR GENETIC AND 10 OTHER REASONS HAVE HIGH SENSITIVITY; SOME 11 INDIVIDUALS ARE THE OTHER KIND -- END OF IT, 12 HAVE A LOW SENSITIVITY AND SOME HAVE 13 INTERMEDIATE SENSITIVITY. THIS IS A 14 CHARACTER IC, BIOLOGICAL SENSE, WHEN YOU TAKE 15 ANY POPULATION, RATS, HUMANS, THE SENSITIVITY 16 IS -- SOME ARE VERY SENSITIVE, SOME 17 RESISTANT, SOME INTERMEDIATE. AND IT MAY WELL 18 BE THAT MR. GRASSO FELL INTO THE -- THE END 19 OF THE SPECTRUM, REPRESENTING THOSE WHO, FOR 20 GENETIC AND OTHER REASONS, ARE MORE SENSITIVE 21 THAN OTHERS. 22 MR. VASSALOTTI: THANK YOU, 23 DOCTOR, NO FURTHER QUESTIONS, YOUR HONOR. 24 THE COURT: CROSS-EXAMINE 25 CROSS EXAMINATION 21109068 BFG09810 ^ IN OR. EPSTEIN MR. RENNE I SEN 112 1 8Y MR. RENNEISEN: 2 Q. OOCTOR EPSTEIN, YOU USED TERM 3 SUBSTANTIAL PROBABILITY. WHAT DO YOU MEAN BY 4 SUBSTANTIAL PROBABILITY? 5 A. I THINK THE TERMS ARE 6 SELF-EXPLANATORY, BUT I'M WILLING TO OFFER 7 YOU SYNONYMS FOR SUBSTANTIAL AND SYNONYMS FOR 8 PROBABILITY, IF THIS IS WHAT YOU WISH. 9 Q. IN OTHER WORDS, IT SHOULD BE 10 INTERPRETTED WITHOUT ANY MEDICAL SIGNIFICANCE? 11 IT'S SIMPLY WHAT THE WORDS MEAN IN AN 12 ORDINARY DICTIONARY MEANING; IS THAT CORRECT? 13 A. NO. IT IS A STATEMENT OF -- MY 14 MEDICAL AND SCIENTIFIC OPINION THAT THERE IS 15 A SUBSTANTIAL PROBABILITY THAT HIS 16 ANGIOSARCOMA WAS DUE TO RESIDENTIAL EXPOSURE. 17 Q. I UNDERSTAND YOU'VE SAID THAT, 18 DOCTOR . 19 CAN YOU EXPAND UPON THAT AND 20 EXPLAIN WHAT YOU MEAN? 21 A. CERTAINLY. I THINK THAT SCIENCE 22 Q. PROBABILITY MEANS MORE LIKELY THAN 23 NOT, DOES IT NOT? 24 A. YES. MEDICAL SCIENCE IS UNABLE IN 25 ANY PARTICULAR CASE OF AN ADVERSE EFFECT TO 21109069 BFG09811 CR DR . EPSTEIN MR. R E N N E I SEN 113 1 TALK IN ABSOLUTE TERMS. ONE CAN ONLY DEVELOP 2 POSITIONS, I NFERENTI ALLY AND ON THE BASIS OF 3 PROBABILITIES. WITH VERY RARE EXCEPTION 4 I'M GOING TO GIVE YOU AN EXCEPTION IN A 5 MOMENT THE RE IS NO S r NGLE ONE CAUSE FOR 6 ANY ONE DISEASE AND YOU CAN'T NECESSAR I LY I N 7 ANY ONE CASE TALK ABOUT ABSOLUTE CAUSALITY. 8 YOU CAN'T SAY, "I'M 100 PERCENT CERTAIN," OR 9 IF SOMEBODY SAYS THEY'RE 100 PERCENT CERTAIN, 10 THEY'RE ON SHAKY SCIENTIFIC GROUNDS. THERE 11 ARE CERTAIN KINDS OF CANCERS MESOTHELIOMA 12 THAT -- A CANCER INDUCED BY- ASBESTOS 13 WHICH FOR ALL INTENTS AND PURPOSES, HAS NEVER 14 ALTHOUGH THEY HAVE -- IT IS DANGEROUS 15 AT -- HAS NEVER, IF AT ALL BEEN INDUCED BY 16 AGENTS OTHER THAN ASBESTOS. THEREFORE, IF WE 17 WERE TALK ABOUT MESOTHELIOMA, THE L I KL t HOOD 18 IS ONE WOULD TALK IN MORE ABSOLUTE TERMS. 19 BUT IN A CASE LIKE THIS, I 20 THINK THAT IT IS SCIENTIFICALLY APPROPRIATE 21 TO TALK ABOUT THE MOST LIKELY AND THE MOST 22 PROBA8LE. AND THE TERM SUBSTANTIAL 23 PROBABILITY REALLY EXPRESSES WHAT ARE THE 24 MOST LIKELY EXPLANATIONS FOR THIS CONDITION. 25 Q. THANK YOU, DOCTOR. NOW, WITH RESPECT 21109070 BFG09812 DR . EPSTE I N MR. RENNE I SEN 114 1 TO ANGIOSARCOMA, I 8ELIEVE YOU HAVE ALREADY 2 TOLD U3 THAT THERE ARE FOUR AGENTS OR 3 CHEMICALS THAT HAVE 3EEN IDENTIFIED TO DATE 4 AS CAUSATIVE -- AS AGENTS WHICH WILL CAUSE 5 ANGIOSARCOMA. 6 A. WELL, I'M NOT ABSOLUTELY -- JUST 7 ONE SLIGHT CAVEAT IF I MAY. 8 WHEN IT COMES TO THE ANABOLIC 9 STEROIDS, I DON'T THINK ONE CAN DEFINITELY 10 INCRIMINATE THOSE. ONE CAN TALK ABOUT 11 PROBABILITY. THE AUTHORS OF THE PAPER, FAULK 12 ET AL WERE VERY CAUTIOUS ABOUT THIS. THEY 13 DIDN'T INCRIMINATE THEM UNEQUIVOCALLY IN THE 14 SAME SENSE THAT VINYL CHLORIDE IS 15 INCRIMINATED. THEY TALKED ABOUT PROBABILITY 16 AND TO USE THE LANGUAGE, IF YOU WISH ME TO 17 QUOTE FROM THE LANGUAGE THEY USED -- THEY 18 SAY IT IS SUGGESTED THAT LONG TERM ANABOLIC 19 STEROIDS IS THE FORTH CAUSE AGAIN. THE 20 SUGGESTED ASSOCIATION WITH THE ANA30LIC 21 STEROIDS AND ANGIOSARCOMA REMAIN TO BE 22 CONFIRMED. I THINK WHAT WE CAN SAY IS TH'ERE 23 ARE THREE CLEARCUT CAUSES AND A FOURTH 24 Q. 25 A. AND A POSS I BLE fourth? AND A POSS I BLE FOURTH WHICH IS T /.0 6 0 T T Z BFG09813 DR. EPSTEIN MR. RENNE I SEN 115 1 PROBLEMATICAL, POSSIBLE. 2 Q. THE ARTICLE BY HENRY FAULK AND HIS 3 ASSOCIATES YOU'RE REFERRING TO, IS THAT THE 4 ARTICLE IN THE LANCET, IS IT MOT, NOVEMBER 24, 5 1979? 6 A. YES. 7 Q* 8 13 * 9 percent afr~TAusrsr-- 10 -TTfA-r^nrrsTTfr yej^ i--warn* ICKW#--n i 11 q #t C'rt- W(SULp mla FTTS .percent oftHE^---- 12 C ASErS~'trV~" WT7T"----TeT' "TrrEWJ~T&'FS'f I FTEB TTTrVHfG"--:-- 13 14 E VS'- A 7VE R Y^r N TjR,E 15 P Q I C4X^a^A4^S6^XW^12*^f^^ THE Y^ v'~9 16 X 17 Q. WELL, LET'S LOOK 18 A. LET ME JUST COMPLETE MYANSWER. WHAT 19 THEY SAY IS AS FOLLOWS: THEY SAY THATOF THE 20 CASES DESCRIBED SOMETIME -- NAMELY BETWEEN 21 64 AND 74 -- THESE ARE THE ONLY RECORDED 22 CAUSES. THEY DON'T SAY THEY ARE THE ONLY 23 NECESSARY CAUSES. IN FACT, THEY GO TO POINT 24 OUT AT THE END OF THE ARTICLE 25 Q. SUPPOSE 2 2 .0 6 0 X 1 2 BFG09814 CR S 5 - DR. EPSTEIN - MR. RENME I SEN /z'' f^Jy1 / /11S 1 A. THE LAST SENTENCE READS. 2 THE COURT: LET THE DOCTOR 3 FINISH. YOU STARTED THE LINE OF QUESTIONING. 4 THE W I TNESS : THE LAST 5 SENTENCE READS: "THE MOST IMPORTANT PURPOSE 6 IN CALLING ATTENTION TO THIS RANGE OF 7 CONDITIONS IS TO ENCOURAGE THE SEARCH OR 3 ETIOLOGIC FACTOR ENDOGONOUS, MEDICAL AND 9 ENVIROMENTAL AND INDUSTRIAL, WHICH ARE 10 RESPONSIBLE FOR THE CASE CONSIDERED SO FAR TO 11 8 E IDIOPATHIC." 8Y IDIOPATHIC, ONE MEANS THE 12 CASES FOR WHICH THERE IS NO KNOWN RECORDED 13 ETIOLOGY. SO THE AUTHORS OF THIS PAPER SAY, 14 WE SHOULD LOOK A GREAT DEAL BETTER THAN WE 15 REALLY HAVE FOR CAUSES, FOR ANGIOSARCOMA 16 WHICH UP TILL NOW HAVE BEEN REGARDED AS 17 IDIOPATHIC. AND, IN FACT, THERE IS A 18 SUBSEQUENT LITERATURE, THE ARTICLE BY BRADY, 19 MAKES IT VERY CLEAR THAT THE -- THERE ARE 20 MORE KNOWN CAUSES -- OR AS MANY KNOWN 21 CAUSES OF ANGIOSARCOMA AS THERE ARE UNKNOWN 22 CAUSES . 23 Q. WOULD YOU READ THE FIRST SENTENCE OF 24 THE SUMMARY FOR ME, PLEASE? 25 A. CERTA INLY . 21109073 BFG09815 ca DR. EPSTEIN MR. R E N N E I SEN 117 l Q. THE VERY FIR5T SENTENCE IN THE 2 ARTICLE. 3 A. \ i \ A RETROSPECTIVE 4 EPIDEMIOLOGIC A^L STUDY OF DEATHS FROM HAPATIC 5 ANGIOSARCOMA HA^S IN THE U. S. SHOWED DURING 6 19S4-74 THERE WERE lo8 SUCH CASE, OF WHICH \ 7 37, 22 PER C E N T,\ WERE ASSOCIATED WITH 8 PREVIOUSLY KNOWN CAUSES, VINYL CHLORIDE, 9 THOROTRAST AND INORGANIC ARSENIC AND FOUR, 10 THREE POINT ONE PERCENT, OF THE REMAINING 131 11 CASES WITH THE USE OF ANDROGENIC-ANA30LIC 12 STEROIDS. 13 Q. AM I CORRECT, DOCTOR IN 14 UNDERSTAND I NG THERE IS NO DISCUSSION OF THE 15 CAUSE OF THE OTHER 75 PERCENT? 16 A. THAT'S NOT MY POINT. MY POINT IS 17 THAT THEY CONCLUDE THAT FOR THE OTHER CASES, 18 WE SHOULD LOOK FOR THE CAUSES AND THAT 19 LET ME REPEAT AGAIN. THAT WE SHOULD LOOK 20 THE MOST IMPORTANT PURPOSE, THE BOTTOM LIME 21 OF THE ARTICLE -- AND I REMEMBER -- THE 22 MOST IMPORTANT PURPOSE IN CALLING ATTENTION 23 TO THIS RANGE OF CONDITIONS IS TO ENCOURAGE 24 THE SEARCH FOR THE ETIOLOGIC FACTORS, 25 ENV I ROMENTAL, INDUSTRIAL, ENDOGONOUS AND 21103074 BfG09^6 cr SS OR. EPSTEIN MR. RENNEI5EN 11 1 MEDICAL, WHICH ARE RESPONSIBLE FOR THE CASES 2 CONSIDERED SO FAR TO BE IDIOPATHIC. FOR THE 3 CASES WHICH UP TO NOW WHICH HAVE been 4 CONS I D ERED TO HAVE NO CAUSE. H I S POINT IS FOR 5 THESE REMAINING CASES, WE SHOULD TRY TO FIND 6 THE CAUSE, SUCH AS COMMUNITY RESIDENCES, 7 WHICH TILL RELATIVELY RECENTLY, HAVEN'T BEEN 8 WELL DOCUMENTED. 9 Q 10 MY Q U Ttr~" i ii. 1 READ BAC K ' 11 ANSWERED;-- l F H-A-S^--BEE Vr*~F T t~~A P OLO G~I Z E'. !.iv?** l* mva lj .'gyr:y:va*T~ 12 B U T l1D L IKE- -THE- OUEST-FON - R EA BA C K. 13 14 QUESTION. THE COURT: READ BACK THE 15 C Q U Eit *' 16 BY MR. R E N NE I SN: , : ___ 17 Q . c I'll',*T H AT" QUEST I 18 19 20 21 22 Q. AND IS YOUR -- THE ANSWER YOU'VE 23 JUST GIVEN ME, THE DISCUSSION THAT EXISTS? 24 A. THAT IS THE 80TT0M LINE OF THE 25 ARTICLE, YES; THERE ARE OTHER REFERENCES TO 2X103075 BFG098T7 OR . EP5 TE1N MR. RENNEISEN 119 1 THIS PROBLEM THROUGHOUT THE PAPER. BUT THE2 I REPEAT, IT SAYS THE MOST IMPORTANT 3 PURPOSE. THE PAPER SAYS THE MOST IMPORTANT 4 PURPOSE IS TO L 0 0 < FOR CAUSES FOR THOSE 5 ANGIOSARCOMAS WHICH UP TILL NOW HAVE BEEN 6 CONSIDERED NOT TO HAVE A CAUSE. THAT IS WHAT 7 THE PAPERS SAYS. ' 8 Q. THE PAPER SAYS LOOK FOR CAUSES. DOES 9 THE PAPER DISCUSS P0SSI3LE OTHER CAUSES? 10 A. NO. IT DOESN'T. BECAUSE WE HAVE A 11 RANGE OF CAUSES, FOUR CAUSES, AND IN THESE 12 1S 4 CASES, WHAT HAVE YOU, IT IS IMPORTANT 13 THAT EACH OF THEM SHOULD BE CAREFULLY SERCHED 14 TO EXAMINE FOR THE POSSIBILITY OF EXPOSURE TO 15 THESE AGENTS. AND IN THE LITERATURE IN THE 16 PAST, THERE HASN'T BEEN DOCUMENTATION OF SUCH 17 EXPOSURES. IN THE SAME WAY AS SOME OF THE 18 COMMUNITY CANCER CASES HAVEN'T BEEN 19 RECOGNIZED IN THE PAST AS BEING DUE TO 20 angiosarcoma . AND THIS I S THE POINT OF THE 21 PAPER. IN CASES WHICH ARE CONSIDERED NOT TO 22 HA VE A CAUSE , LOOK FOR THE CAUSES, LOOK AND 23 SEE IF THEY LIVE CLOSE TO A PLAN T, LOOK AND 24 SEE IF THEY WORK IN A P VC FABRICATION PLANT, 25 LOOK FOR THESE CAUSES. 21103076 BfG098W CR 120 1 2 FOR W fC , ARE THERE CASE! f &T-AJ? L E F'OR THE 3 CENTER QF. ,,D. t_S. EA.SE-- WST*"!* OlT "' A N D' HE N RY: F A U L < AND 4 IS i>,*rrnmp,w^|______ ; ^ ......................... 5 A---- V. 6 Q. LX*, is^THXrTMxwmrr'~rs'^--~s 7 p e R^grtr^TTr"1 t r~c?rsc-s-?- 8 WITH THAT FIGURE 9 -vT^rr#r r?*< V-g.lYgtf .THE-.REAS.ONS. _FOR~ NQ.t 10 11 LET US TURN TO 12 THE COURT: LET ME SAY THIS, 13 DOCTOR: DO YOU WANT HIM TO CONTINUE ON. 14 MR. RENNEISEN: NO, SIR, 8 U T 15 EVERYTIME I CUT HIM OFF, YOUR HONOR, I'VE 16 SEEN 17 THE COURT: 18 MORE JJF 19 BROAD LATflTUDE. ~BUT 20 REM 21 RES PQHCf^t O H i 5 ANSWERS . WHEN IT COMES BACK 22 FOR REDIRECT, IF THERE'S SOMETHING THAT 23 COUNSEL FOR THE PLAINTIFF WANTS TO GET OUT OF 24 YOU, HE'LL GET OUT OF YOU. BUT, DO IT BY 25 QUESTION AND ANSWER AND SORT OF STAY AWAY 21109077 BFG09819 c ? SS - OR. EPSTEIN - MR. RENNJE I SEN 12 1 1 from the volunteering, go ahead. 2 MR. renneisen: what was my 3 LAST QUESTION? 4 (DESIGNATED QUESTION IS READ.) 5 BY MR. RENNEISEN: 6 q snr 7 P R E S.EMP---T MbKLEW>V-.O F'' .......................... , 8 THE --'C A SIS Q--T.T84-8.I^TfFV BY ? ****''>*'in<n\* y i **."**'if***-" w 9 TffE 'CENTE R,,^Iia~~a4.S-S-A-^e~- CW?^^-tO-.UAilCNA>VM4 -' 10 rtfusEs? IT 12 13 Q. DOCTOR, WHEN YOU TESTIFIED 14 CONCERNING YOUR QUALIFICATIONS, YOU GAVE US A IS GREAT DEAL OF BACKGROUND ABOUT YOURSELF. HAVE 16 YOU DONE ANY ANIMAL STUDIES YOURSELF WITH 17 RESPECT TO VINYL CHLORIDE? 18 A. I'VE DONE NO CARCINOGENICITY STUDIES, 19 I DID SOME MUTAGENICITY STUDIES ABOUT TEN 20 YEARS AGO, BUT I'VE DONE NO CARCINOGENICITY 21 STUDIES WITH THE WITH IT. 22 Q. YOU TESTIFIED THIS MORNING THAT 23 ANGIOSARCOMA IS A VERY RARE FORM OF LIVER 24 CANCER. HOW MANY CASES CAN WE EXPECT A YEAR 25 IN THE ENTIRE COUNTRY; DO YOU KNOW, DOCTOR? 21109078 BFG09820 -DR. EPSTEIN - MR. RENNE I SEN 122 1 A. WELL, THERE HAVE BEEN VARYING 2 ESTIMATES ON THIS, SOMEWHERE IN THE RANGES OF 3 ABOUT 25 TO 30 A YEAR, SOMEWHERE IN THAT BALL 4 PARK. THAT WAS A C.D.C. ESTIMATE OF A FEW 5 YEARS AGO. 6 Q. IN TALKING ABOUT THE HISTORY OF THE 7 LITERATURE SHOWING INFORMATION ABOUT VINYL 8 CHLORIDE, YOU, l BELIEVE, SAID THAT BACK IN 9 AROUND 1930, IT WAS FOUND THAT CONCENTRATIONS 10 OF FIVE PERCENT PRODUCED ACUTE TOXICITY IN 11 ANIMALS. FIVE PERCENT IS HOW MANY PARTS PER 12 MILLION? 13 A. 14 IT'S VERY HIGH, ABOUT 50 THOUSAND, 15 Q. AND^'nAT I ONALSN>H IGHER THAN IT IS 16 EXPLOSIVE LIMIT? 17 A. OH, YES, VERY HIGH CONCENTRATIONS 18 INDEED. 19 Q. AND AT THAT LEVEL, IT WOULD MAKE AN 20 ANIMAL UNCONSCIOUS POSSI9LY? 21 A. 22 Q. SURE, ABSOLUTELY. AND NOBODY -- NOBODY EVER WORKED 23 IN LEVELS THAT HIGH, DID THEY? 24 A. THERE HAVE BEEN RECORDED HIGH LEVELS 25 IN AUTOCLAVES. I CAN'T RECALL THE EXACT e io s o x rz BFG09821 C R SS - OR. EPSTEIN - MR. RENINE I SEN 123 1 LEVELS, BUT I WOULD AGREE WITH YOU THAT IN 2 ALL PROBABILITY, THIS IS AN EXTRAORDINARY 3 HIGH LEVEL, WHICH PROBABLY ISN'T COMMONLY 4 FOUND IN THE WORK PLACE. 5 Q. AND IF SOMEBODY STRUCK A MATCH IN 6 THAT LEVEL, BOOM, I T WOULD GO OFF, RIGHT? 7 A. I T WOULD GO OFF, SURE. 8 Q. I N YOUR REVIEW OF THE L I TERATURE 9 MB _ AND I THINK YOU SAID IT WAS MOSTLY 10 EUROPEAN LITERATURE -- TALKING ABOUT 11 TOXICITY, YOU DIDN'T FIND ANY REFERENCE TO 12 ANGIOSARCOMA, DID YOU, ABOUT THE PERIOD FROM 13 1949 TO 1970? 14 A. TO -- I MISSED 15 Q. IN THE PERIOD FROM 1949 UNTIL VIOLA 16 IN 1970 17 A. THAT'S RIGHT. 18 Q. -- THERE WAS NO REFERENCE TO -- 19 A. 20 Q. CORRECT. -- ANGIOSARCOMA. 21 NOW, I THINK YOU HAVE SAID 22 THAT THAT LITERATURE WAS AVAILABLE AND COULD 23 BE READ BY ANYONE WHO WAS INTERESTED IF THEY 24 DID A LITERATURE SEARCH; IS THAT CORRECT? 25 A . YES . 21103080 BFG09822 CR L)R . EP5TE IN MR. RENNE 1 SEN 124 1 Q. WERE YOU FAMILIAR WITH THE 2 LITERATURE BEFORE 1970? 3 A. OF VINYL CHLORIDE? 4 Q. YES . 5 A. I DON'T THINK SO. BUT THENI DIDN'T 6 HAVE RESPONSIBILITIES IN THE AREA. 7 Q. YOU WERE IN THE ENVIROMENTAL AREA AT 8 THAT TIME, WERE YOU NOT? 9 A. YES. I I WAS INTERESTED IN THOUSANDS 10 OF CHEMICALS. 11 Q. ALL RIGHT. DOCTOR, IS ITTRUE THAT 12 THERE WAS A PERIOD OF TIME -- I BELIEVE IT 13 WAS IN 1950'S BUT IT MAY HAVE BEEN IN THE 14 1960'S -- WHEN BECAUSE OF ITS NARCOTIC 15 EFFECT, VINYL CHLORIDE WAS -- WAS 16 EXPERIMENTED WITH BY THE MEDICAL PROFESSION 17 AS AN ANESTHET IC? 18 A. ABSOLUTELY. 19 Q. I KNOW THAT STUDY WAS ABANDONED, BUT 20 IT DIDN'T PRODUCE ANY CANCER RESULTS THAT 21 ANYBODY KNOWS ABOUT, DOES IT? 22 A. I HAVE NO IDEA WHETHER THE PEOPLE 23 HAVE BEEN FOLLOWED UP. I JUST HAVE NO IDEA. I 24 THINK IT WOULD BE AN INTERESTING THING TO DO. 25 THAT MAY BE ONE OF THE UNEXPLAINED CAUSES OF T8060TTZ BFG09823 C R S3 - DR. EPSTEIN - MR. REN ME I SEN 125 1 ANGIOSARCOMA. 2 Q. IT DIDN'T PRODUCE -- WHEN THE 3 EXPERIMENT TO USE IT AS AN ANESTHETIC STOPPED, 4 THERE WERE NO ACCOMPANING PAPERS DISCUSSING 5 CANCER, WERE THEY? 6 A. I DON'T THINK I DON'T THINK 7 THESE PAPERS HAVE BEEN FOLLOWED UP. I THINK. 8 IT'S AN EXCELLENT IDEA TO FOLLOW THEM UP TO 9 SEE HOW MANY OF THEM HAVE GOT ANGIOSARCOMA OR 10 IF ANY HAVE. SPLENDID CONCEPT. 11 Q. YOU MENTIONED THAT PRIOR TO 1971, 12 THERE WERE EIGHT CASES OF ANGIOSARCOMA IN 13 VINYL CHLORIDE WORKERS. 14 WHEN DID THAT KNOWLEDGE 15 WHEN WAS THAT KNOWLEDGE COLLECTED? 16 A. WELL, IT IS IT CAME IN TWO STAGES: 17 FIRST OF ALL, THESE WORKERS WERE KNOWN TO 18 HAVE DIED FROM CANCER OF THE LIVER. HOWEVER, 19 THE DIAGNOSIS OF ANGIOSARCOMA WAS ONLY MADE 20 AFTER THE B.F. GOODRICH ANNOUNCEMENT IN 21 JANUARY, 74, THAT SOME OF ITS WORKERS HAD 22 DIED OF ANGIOSARCOMA AND THIS WAS FIVE YEARS 23 AFTER THE VIOLA PUBLICATION OF THE 24 CARCINOGENICITY IF YOU RECALL. AND THE 25 REFERENCE TO THE -- THESE ANGIOSARCOMAS IS 28060TTZ BFG09824 C R 5 S - DR. EPSTEIN - MR. RENNE I SEN I25 1 THERE WERE T W_0 PAPERS, ONE BY' HEATH AND THE 2 OTHER BY BYRON,,-THE SEVEN CASES WERE REPORTED 3 BY THE--HEATH AND THE OTHER CASE WAS BY BYRON. 4 Q. DOCTOR, I DON'T WANT TO ARGUE WITH 5 YOUR ARITHMETIC. 3 U T VIOLA WAS 197 0? 6 A. THAT ' S R IGHT . 7 Q. AND THE B.F. GOODRICH ANNOUNCEMENT 8 WAS IN -- 9 A. 7 4. 10 Q. AM I CORRECT THEN IN UNDERSTANDING 11 THAT AFTER DOCTOR CREECH AND DOCTOR JOHNSON 12 WHO W E ftE--A C T U A L L Y HERE IN THE COURTROOM, MADE 13 THE ANNOUNCEMENT THAT THEY HAD DISCOVERED 14 THREE CASES IN GOODRICH WORKERS IN 15 LQUISVILLLE, THEN OTHER PHYSICIANS BEGAN TO 16 EXAMINE OTHER DEATH RECORDS AND FOUND OTHER 17 CASES OF MEN WHO HAD DIED OF WHAT THEY THEN 18 DISCOVERED TO BE ANGIOSARCOMA OF THE LIVER. 19 A. ABSOLUTELY. 20 Q. AND THEN THEY WERE LOOKING AT DEATH 21 RECORDS OF PEOPLE WHO WORK WITH VINYL 22 CHLORIDE AND THEY FOUND THESE OTHER CASES; IS 23 THAT RIGHT? 24 A. CORRECT . 25 Q. YOU TALKED ABOUTMATALONI. AND I GOT 21103B83 BFG09825 C R S 5 - DR. EPSTEIN - MR. RENNEISEN 127 1 A LITTLE MIXED UP ON HIS DATES 2 HIS FIRST STUDIES WERE 1972. 3 HIS FIRST STUDIES WERE DISCUSSED IN A PAPER 4 PRESENTED IN 1972; IS THAT CORRECT? 5 A. NO, SIR, NO, NO, NOT AT ALL. 6 MATALONI STARTED -- AFTER 7 VIOLA'S PUBLICATION AND PRESENTATION, 8 MATALONI WAS GIVEN A CONTRACT TO CONFIRM AND 9 EXTEND THE FINDINGS. BY OCTOBER OF 1972, HE 10 HAD CONFIRMED A CARCINOGENICITY AND EXTENDED, 11 HAD GONE TO MUCH LOWER DOSES. THREE MONTHS 12 AFTER THAT, THIS INFORMATION WAS PASSED ON TO 13 THE MANUFACTURING CHEMISTS ASSOCIATION. 14 Q. EXCUSE ME? 15 A. BUT. 16 THE COURT: JUST A MOMENT. 17 MR. RENNEISEN: I DON'T THINK 18 I ASKED HIM THAT. I ASKED HIM WHAT DATE 19 20 TELL YOU. THE WITNESS: I'M GOING TO 21 BY MR. RENNEISEN: 22 Q. LET ME ASK YOU FIRST OF ALL, ARE WE 23 CORRECT IN UNDERSTANDING THAT HIS STUDIES 24 WERE IN SOME SENSE COMPLETED IN OCTOBER OF 25 1 9 7 2 ? 21103084 BFG09826 L- * DR. EPSTEIN M R RENNE[SEN 123 1. NO, SIR, THAT'S NOT WHAT I SAID. 2 Q. WELL, WHEN WERE THEY COMPLETED? 3 A. 4 LET ME ANSWER YOU, IF I MAY HE STARTED A SERIES OF 5 ONGOING STUDIES IN ABOUT -- WITHIN SIX TO 3 6 MONTHS OF VIOLA'S COMMUNICATION. BY 1972, IN 7 THE ONGOING STUDIES, HE HAD DEMONSTRATED THE 8 CARCINOGENIC EFFECTS OF VINYL CHLORIDE AND 9 HAD EXTENDED VIOLA'S INDEPENDENT FINDINGS. 10 THE FIRST STATEMENT OF THIS CAME -- WAS 11 RELEASED IN JANUARY, 1974 ON THE SAME DAY AS 12 B . F'. GOODRICH AND ANOUNCED THE DEATH FROM 13 ANGIOSARCOMA. THE FIRST PUBLICATION OF 14 MATALONI CAME SUBSEQUENT TO THAT. SO, AFTER 15 74. 16 Q . I'M SORRY, OKAY. 17 NOW, WHAT LEVELS WAS HE USING 18 IN THE STUDIES THAT WERE RELEASED IN JANUARY 19 OF 1974? 20 A. WELL, THE -- BY THEN, HE WAS 21 WORKING WITH CONCENTRATIONS OF ABOUT 50 22 P.P.M.. WHEN -- 50 P.P.M. BALL PARK. TO THE 23 BEST OF MY KNOWLEDGE, WHEN 3.F. GOODRICH MADE 24 THE ANNOUNCEMENTS IN JANUARY, 1974, I DON'T 25 THINK THEY DISCLOSED DETAILS OF THE MATALONI 1103085 BFG09827 DR. EPSTEIN MR. R E N N E I SEN 129 1 TESTS. THE INFORMATION ON THE MATALONI TEST 2 CAME FROM THE SUBSEQUENT PUBLICATIONS NOT NEW 3 YORK ACCADEMY OF SCIENCE VOLUME ANO OTHER 4 PLACES. BUT IT WAS ABOUT 50 P.P.M. BY 1974. 5 Q. THEN LATER, HE CONTINUED STUDIES. IS 6 THAT RIGHT? 7 A. THAT'S CORRECT, YES. A SET OF 8 ONGOING STUDIES. 9 Q. AND THEY, ARE THEY STILL ONGOING? 10 A. TO THE BEST OF MY KNOWLEDGE, THE - n OVERWHELMING MAJORITY OF THEM ARE COMPLETE 12 AND HAD BEEN COMPLETED BY 1978. THEY WERE 13 INFLUENCED -- THEY WERE PRESENTED IN COLD 14 SPRING HARBOR SYMPOSIUM IN 1978. 15 Q. / I THINK YOU MENTIONED THAT IN ANIMAL 16 STUDIES, A SINGLE DOSE OF VINYL CHLORIDE DID 17 PRODUCE TUMORS OR DO I RECALL YOUR TESTIMONY 18 INCORRECTLY? 19 A. YOU RECALLED IT CORRECTLY BUT YOU'RE 20 LINKING IT NOW WITH MATALONI WHICH IS NOT 21 WHAT HE STUDIED. 22 Q. WHO DID THAT? 23 A. THAT WAS A CONSUMER PRODUCT SAFETY 24 COMMISSION ON STUDY ON BRIEF EXPOSURES TO 25 VINYL CHLORIDE. 21109086 BFG09828 C R 5 S - DR. EPSTEIN - MR. RENNE I SEN 130 1 Q. WHAT WAS THE DOSAGE FOR THAT BRIEF 2 KNOWLEDGE? 3 A. WELL IT WAS A RANGE OF YOUR DOSAGE 4 GOING FROM 50 P'..P . M. TO ABOUT, I THINK, 5,000 5 OR SO AND THE RANGE A T AT THE ONE HOUR 6 LEVEL, THE LEVEL -- THE LEVEL AT WHAT THEY 7 AT WHICH THEY GOT TUMORS AT ONE HOUR WAS 8 50 -- WAS 500 P.P.M.. SO, FOR THE ONE HOUR 9 EXPOSURE, THAT -- WHICH WASN'T A MATALONI 10 STUDY, WHICH WAS IT IS CONSUMER PRODUCT 11 SAFETY COMMISSION, THEY GOT EFFECTS AT 12 AT 500 P.P.M.. THE MATALONI STUDY, WHICH I 13 WAS REFERRED TO OF THE LOWEST LEVEL, THE ONE 14 P.P.M., THAT WAS AN INTERMITTENT EXPOSURE 15 OVER THE COURSE OF A YEAR, AT WHICH THE 16 BREAST CANCER WERE DEVELOPED FOLLOWING. 17 Q. WHEN YOU SAY INTERMITTENT, EIGHT 18 HOURS ON, EIGHT 19 A. NO, BASICALLY IT WAS A FOUR HOUR. 20 FOR THE ONE PART PER MILLION STUDY, IT WAS 21 TO THE 3EST OF MY RECOLLECTION, IT WAS 22 FOUR HOURS A DAY FOR FIVE DAYS A WEEK ON AND 23 OFF FOR THE YEAR. THAT WAS -- THAT WAS AN 24 INTERMITTENT LEVEL. 25 Q . FOUR HOURS A DAY 21109087 BFG09829 CR DR. EPSTEIN MR. RENNE I SEN 131 1 A. 2 Q. FIVE DAYS A WEEK. FIVE DAYS A WEEK. 3 A. 4 Q. YEAH. IS THERE A WAY TO RELATING DOSE IN 5 RATS AND DOSAGE IN MAN, TAKING INTO 6 CONSIDERATION THEIR RESPECTIVE WEIGHTS OR' 7 ISN'T THAT NECESSARY? 8 A. WELL, YOU KNOW, I CAN'T REALLY TELL 9 YOU WHETHER IT'S NECESSARY. IT'S POSSIBLE TO 10 DEVELOP A LOT OF PAPER CALCULATIONS ON THIS 11 RESPECT. AND RELATING, DOSEON THE BASIS OF 12 SURFACE AREA OR WEIGHT. THIS COULD BE DONE. I 13 DON'T HAVE -- I HAVEN'T MADE THESE 14 CALCULATIONS. 15 GENERALLY, I THINK IN 16 CARCINOGENESIS EXPERIMENT, ONE USES ANIMAL 17 DATA, NOT FOR MAKING QUANTITATIVE INFERENCES,- 18 BUT SIMPLY FOR SAYING WHETHER THE MATERIAL IS 19 CARCINOGENIC FOR NOT OR NOT."THAT'S WHY I 20 HESITATED A BIT ABOUT 21 Q. YOU MADE REFERENCE TO, I THINK, 22 TESTS CONDUCTED BY THE-CONSUMER PRODUCT 23 SAFETY COMMISSION, THAT PRODUCED 3REAST 24 TUMORS, IS THAT RIGHT?.'.-.. 25 A. NO. I'M AFRAID -- I APPEAR TO BE S8060TT2 BFG09830 CR OR. EPSTEIN .MR . RENNET SEN 13 2 1 CONFUSING YOU. 2 THE MATALONI STUDY AT ONE 3 PART PER MILLION PRODUCED BREAST TUMORS. 4 Q. WHAT DID THE C . P .5. -- THE 5 CONSUMER SAFETY PRODUCTS 6 A. FINE. THE CONSUMER. PRODUCT 7 COMMISSION PRODUCED PULMONARY ADENOMAS AND 8 THESE ARE SO CALLED BENIGN TUMORS OF THE LUNG 9 AND PULMONARY ADENOCARCINOMAS. 10 Q 11 A. AND THE ANGIOSARCOMA NO, NO . NO, THOSE WERE PULMONARY 12 TUMORS. 13 Q. DOCTOR, YOU HAVE REFERRED TO A 14 SERIES OF ARTICLES AND i THINK I HAVE COPIES 15 OF MOST OF THEM HERE. 16 IF I REFER TO AN ARTICLE THAT 17 YOU DON'T HAVE, I THINK I HAVE AN EXTRA COPY, 18 BUT IF YOU CAN LOCATE YOURS, THAT WOULD BE 19 FINE. 20 BUT BEFORE WE GET TO ARTICLES, 21 I HAVE A COUPLE OTHER QUESTIONS I'D LIKE TO 22 A S K Y 0 U . 23 I BELIEVE YOU ALREADY HAVE 24 TESTIFIED THAT ARSENIC IS A KNOWN CAUSE OF 25 ANGIOSARCOMA; IS THAT CORRECT? tMSC6OTT2 BFG09831 C R 5 S - DR. EPSTt IN - MR. RENNEISEN 133 1 A. YES, 5 IR . 2 Q. AND YOU KNOW THAT FROM LITERATURE 3 STUDIES THAT YOU HAVE READ; IS THAT CORRECT? 4 A. YES , S I R 5 Q. DO YOU KNOW THAT MR. GRASSO LIVED IN 6 SALEM COUNTY, NEW JERSEY AND THAT SALEM 7 COUNTY IS RURAL AND, FURTHERMORE, THAT 8 ARSENIC WAS USED AS AN INSECTICIDES IN SALEM 9 COUNTY. DO YOU KNOW THAT? 10 A. I DIDN'T KNOW THAT, BUT I WOULDN'T 11 BE SURPR I SED. 12 Q. I TAKE IT YOU KNOW THAT ARSENIC IS 13 AN INGREDIENT IN INSECTICIDES? 14 A. IDO. 15 Q. 16 A. ARSENIC IS A MINERAL, IS IT NOT? WELL, I ANYONE PERHAPS MORE 17 CORRECTLY CALL IT A METALLOID, BUT I CALL IT 18 A MINERAL BY ALL MEANS. 19 Q. WELL, I DON'T WANT TO BE 20 UNSCIENTIFIC. WHAT IS THE DIFFERENCE BETWEEN 21 A MINERAL AND A METALLOID? 22 A. I THINK THAT TECHNICALLY THE TERM IS 23 THE METALLOID, BUT I'D RATHER NOT GET INTO 24 25 Q. IN ANY EVENT, AFTER YOU SPRAY IT ON 0606OTTZ BFG09832 OR . EPSTEIN MR. RENNE I SEN 15* 1 POPULATION, YOU'D EXPECT TO SEE 20 YEARS BUT 2 IN SPITE OF T H A.T , THERE ARE A WIDE RANGE OF 3 ANGIOSARCOMAS AND OTHER CANCERS I N WH I CH IT'S 4 SEEN SEEN LESS THAN TEN YEARS AND IN FACT, 5 SOME SEEN AT SIX AND EIGHT YEARS. 6 Q. WHEN YOU SAY THE AVERAGE IS TEN TO 7 2 0-- 3 A." ...... NO, I DIDN'T SAY THAT. I SAID THE 9 AVERAGE IS 20. 10 -SV HQW many CASES' GO INTO MAKE UP THAT 11 AVERAGE? 12 A. THAT'S A GOOD POINT. HEATH'S FIGURE, 13 I THINK, WAS BASED ON ABOUT 40 -- I OFFHAND 14 CAN'T RECALL. I'LL SAY SOMEWHERE 40 OR 50. IS NOW, TO THE BEST OF MY 16 KNOWLEDGE, WHEN HEAT DEVELOPED HIS AVERAGE 17 PHYSICIAN, HE DIDN'T, AT THAT STAGE, HAVE 18 DOCUMENTATION ON THE COMMUNITY CASES WHICH WE 19 HAVE NOW. SO, THE LARGER THE NUMBER -- THE 20 LARGER THE NUMBER OF PEOPLE ON WHICH YOU BASE 21 AN AVERAGE, THE MORE MEANINGFUL IT IS. IF 22 YOU'RE TALKING ABOUT TWO PEOPLE, AN AVERAGE 23 OF TWO ISN'T VERY MEANINGFUL. WHEN YOU'RE 24 TALKING ABOUT 2,000, IT'S MORE MEANINGFUL, 25 2,000, STILL NOR MEANINGFUL. SO, WE'RE REALLY 21109113 BFG09833 OR. EPSTEIN NR. R E N NE IS E N i57 1 .TALKING ABOUT RELATIVELY SMALL NUMBERS. 2 Q. AM I CORRECT IN UNDERSTANDING THAT 3 THE CENTER FOR DISEASE CONTROL COLLECTS DATA 4 ON VINYL CHLORIDE CAUSED ANGIOSARCOMAS? 5 A. YES, THERE IS AN ONGOING REGISTRY AT 6 WHICH C.D.C. AND CENTER FOR DISEASE CONTROL 7 8 Q. AND AGAIN, THAT'S THE ORGANIZATION 9 DOWN AT 10 A. IN ATLANTA, WHICH IS THE PARENT 11 ORGANIZATION OF THE NATI.ONAL INSTITUTE OF 12 OCCUPATIONAL SAFETY AND HEALTH. 13 Q. AND WHEN THEY -- 00 THE DO ANY 14 SCREENING OR ANALYSIS TO DETERMINE INTO WHICH IS CATEGORY THEY PUT A -- LET'S SUPPOSE THEY 16 GET AN ANGIOSARCOMA DEATH. WHAT DO THEY DO TO 17 DECIDE WHETHER IT'S VINYL CHLORIDE, ARSENIC 18 OR UNKNOWN? 19 A. I CAN'T REALLY TELL YOU EXACTLY. I 20 THINK YOU SHOULD MORE APPROPRIATELY DIRECT 21 THE QUESTIONS TO THEM. 22 THE LISTINGS -- IF YOU LOOK 23 AT A PAPER BY SPERTAS, WHICH BASICALLY LISTS 24 THE CASES OF ANGIOSARCOMA, THESE ARE REALLY 25 OCCUPATIONAL ANGIOSARCOMAS WHICH THEY'RE 21109114 BFG09834 DR. EPSTEIN - MR. RENNE I SEN I 53 1 COLLECTING. SO, BASICALLY, THEY'RE CLERKING 2 ANGIOSARCOMAS IN THE WORK FORCE. 3 NOW, IT SO HAPPENS THAT SOME 4 OF THE C.D.C. PERSONNEL HAVE ALSO BEEN 5 INVOLVED IN PUBLICATIONS ON ANGIOSARCOMA 6 CAUSED 3 Y AGENTS OTHER THAN PVC. BUT THEY'RE 7 MAJOR PRE-OCCUPATION IS ENLISTING THE 8 OCCUPATIONAL ANGIOSARCOMAS. 9 Q. HELP LIST THEM ALL, ALL THAT THEY 10 GET, DO THEY IS NOT? 11 A. YES, SURE. 12 Q. AND FOR EACH ONE, THEY TRY USING 13 SCIENTIFIC PRINCIPLES TO DETERMINE WHAT THE 14 CAUSE IS. IS A. I DON'T KNOW WHETHER THEY HAVE 16 HAVE DONE THIS FOR ALL CASES OF ANGIOSARCOMA. 17 I JUST DON'T KNOW WHETHER THIS IS THE CASE. I 18 KNOW THAT FROM THE -- IN THE OCCUPATIONAL 19 ONES, THEY'VE LISTED THE SPECIFIES, WHETHER 20 IT WAS A VC OPERATOR OR PVC OPERATOR. 3 U T 21 "THERE ARE OTHER CASES, SUCH AS THE COMMUNITY 22 ONES WHICH HAVEN'T APPEARED IN THEIR LISTINGS, 23 BECAUSE THIS ISN'T THEIR RESPONSIBILITIES. IT 24 JUST SO HAPPENS THAT CHRISTINE PUBLISHED HER 25 RESIDENTIAL CASES IN AN OFFICIAL GOVERNMENT 21109115 3 S - D R. EPSTEIN - MR. RENNE I SEN 1 59 1 . P U B L ICATION. 2 Q. THAT'S MORTALITY AND MORBIDITY, TOO? 3 A. YES, MORTALITY AND MORBIDITY REPORTS, 4 YES . 5 MR. RENNEISEN: YOUR HONOR, 6 I'M GOING TO BE A WHILE. I HAVE THESE 7 ARTICLES LEFT TO GO THROUGH. 8 THE COURT: LET'S TAKE A 9 RECESS AT THIS TIME. LET'S TAKE A LITTLE BIT 10 EARL I ER RECESS. 11 TEN MINUTE RECESS, LADIES AND 12 GENTLEMEN. 13 CAT WHICH TIME THE JURY 14 LEAVES THE COURTROOM.) IS THE COURT: WE'LL STANDS ON 16 RECESS, TEN MINUTES. 17 (SHORT RECESS.) 18 THE COURT: MR. RENNEISEN, 19 YOU MAY CONTINUE, SIR. 20 BY MR. RENNEISEN: 21 Q. DOCTOR, I'M GOING TO GET TO THOSE 22 ARTICLES l WAS TALKING ABOUT. 23 THE CHRISTINE ARTICLE IS THE 24 ONE THAT'S ON MORBIDITY AND MORTALITY; IS 25 THAT CORRECT? 9TT60TTZ BFG09836 C R SS - DR*. EPSTEIN - 1 A. YEAH. MR. RENNE 1 SEN frt l6n 2 Q. AND I BELIEVE YOU HAVE TOLD `m! TH'IS 3 IS A GOVERNMENT PUBLICATION? 4 A. YEAH. I'M NOT ABSOLUTELY SURE. I 5 THINK IT'S A C.D.C. DOCUMENT, BUT I'M REALLY 6 NOT 100 PERCENT CERTAIN. 7 Q. WELL, AT THE VERY END, IT SAYS 8 "ADDRESS ALL CORRESPONDENCE FOR CENTER FOR 9 FOR DISEASE CONTROL." 10 A. YEAH, I'M PRETTY SURE, YEAH. 11 Q. AT THE ENDS OF THE CHRISTINE ARTICLE, 12 ON PAGE 215, THERE'S AN EDITORIAL NOTE. WOULD 13 THE EDITORIAL NOTE BE DOCTORS WITH C.D.C.? 14 A. I IMAGINE SO. SURE. 15 Q. NOW, AT THE TOP OF THE SECOND COLUMN 16 IN THE EDITORIAL NOTES, IT SAYS IN ABOUT THE 17 SIXTH OR SEVENTH LINE, "WHILE THESE FINDINGS 18 ESTABLISH NO CAUSAL CONNECTION BETWEEN 19 EXPOSURE TO PVC AND ANGIOSARCOMA OF THE LIVER, 20 THEY DO RAISE THE POSSIBILITY OF SUCH A 21 RELATIONSHIP." 22 A . SURE . 23 Q. DO YOU AGREE WITH THAT STATEMENT? 24 A. WELL, I DON'T THINK IT'S POSSIBLE TO 25 TALK ABOUT CAUSAL RELATIONSHIPS IN ABSOLUTE 21109117 BFG09837 DR. EPSTEIN MR. RENNE. 1SEN IS 1 1 TERMS. 1 THINK ALL YOU C AN TALK ABOUT IS 2 PROBABLE ASSOCIATIONS, THE MOST probable , THE 3 MOST LIKE L Y . THIS IS IT IS WAY IN WHICH ALL 4 CAUSAL I TY 1 S ATTRIBUTED 1 N MEDICINE. IF YOU 5 < N 0 W OF SOMEBODY WHO DIES OF LUNG CANCER AND 6 HE SMOKED FIVE PACKS OF CIGARETTES A DAY, IT 7 WOULD 8 E A RASH, A SCIENTIFICALLY RASH PERSON 3 TO SAY- HIS LUNG CANCER WAS ABSOLUTELY CAUSED 9 BY THE SMOKING. SO WE'RE TALKING ABOUT MOST 10 PROBABLE ASSOCIATIONS, AND THE STRENGTH OF 11 THESE ASSOCIATIONS BECOMES GREATER THE MORE 12 CASES THAT APPEAR IN THE LITERATURE. 13 Q. BUT HERE WE'RE TALKING ABOUT THE 14 WORD POSSIBILITY. I MEAN, YOU HAVE TALKED 15 ABOUT PROBABILITY 3UT HERE THE AUTHORS OF THE 16 EDITORIAL NOTE WHO YOU HAVE SAID ARE THE 17 DOCTORS AT CENTER FOR DISEASE CONTROL SAY," 18 "THESE FINDINGS ESTABLISH NO CAUSAL 19 CONNECTION BETWEEN EXPOSURE TO PVC AND 20 ANGIOSARCOMA OF THE LIVER, THEY DO RAISE THE 21 POSSIBILITY OF SUCH A RELATIONSHIP." 22 POSSIBILITY IS LESS THAN PROBABILITY, ISN'T 23 IT? 24 A. YES, IT IS. BUT I WOULDN'T USE THE 25 WORD POSSIBILITY. I WOULD USE THE WORD 8TT60TTZ BFG09838 DR. EPSTEIN - MR. RqNNEISEN 152 1 PROBABILITY AND, IN FACT, THE AUTHOR OF THE 2 REPORT GOES FURTHER THAN THIS. 3 Q. 4 A. DOCTOR CHRISTINE GOES FURTHER? YES. FOR INSTANCE, IF YOU LOOK AT 5 THE THIRD PARAGRAPH, TWO OF THE PATIENTS 6 Q. THIRD PARAGRAPH, THAT'S BACK ON PAGE 7 2 10? 8 A. LET'S GET THE APPROPRIATE PLACE. 9 Q. ALL RIGHT, I'M LOOKING AT IT. TELL 10 ME WHAT YOU MEAN OR READ IT TOO ME, IF YOU 11 WANT TO. 12 A . SURE . 13 Q. THEFIRST SENTENCE SAYS,"TWO OF THE 14 PATIENTS APPEAR 15 A. 16 NO, THAT'S OCCUPATIONAL. BUT ON PAGE 216, ANOTHER TWO 17 PATIENTS WHO HAD NO OCCUPATIONAL EXPOSURE HAD 18 BEEN LONG-TIME RESIDENTS. AND THEN IT GOES ON 19 TO SAY HAD LIVED FOR 35 YEARS, NO HISTORY OF 20 OCCUPATIONAL -- THEY ARE BASICALLY 21 REPORTING ANGIOSARCOMAS IN RESIDENTS NEAR VC 22 PVC PLANTS WHO HAD NO OCCUPATIONAL EXPOSURE. 23 THIS IS BASICALLY WHAT THEY'RE DOING. YOU'RE 24 NOT DISCUSSING IT'S A CASE REPORT, WHICH 25 IS EXACTLY -- THEY SAY THEY FOUND AN 21109119 BFG09839 SS - DR. EPSTEIN.- MR R E N N E I SEM 1S3 1 ANGIOSARCOMA IN A WOMAN WHO LIVED NEAR A 2 PLANT AND A COUPLE OF PEOPLE WHO LIVED NEAR A 3 PLANT WHO HAD NO OCCUPATIONAL EXPOSURE AND 4 THAT'S BASICALLY ALL THEY REPORT. 5 Q. SO, THE AUTHOR ISN'T REALLY 6 EXPRESSING AN OPINION ONE WAY OR ANOTHER OF 7 POSSIBILITY OP PROBABILITY. THEY'RE 8 DESCRIBING A CASE? 9 A. THIS IS A CASEREPORT, l THINK. 10 THAT'S THE BEST WAY OF DESCRIBING IT. \ 11 Q. I'D LIKE TO REFER YOU TO THE ARTICLE 12 IN THE BRITISH MEDICAL JOURNAL, OCTOBER *, 13 1977, WHERE PETER J. BAXTER IS THE FIRST 14 AUTHOR. 15 A. 16 Q. SURE. DO YOU HAVE THAT REPORT? 17 A. I THINK SO, HOLD ON A SECOND. I 18 THINK SO. YES. 19 Q. NOW, ON PAGE 18 AT THE BOTTOM OF - 20 YOUR -- NOT THIS REPORT BUT OF YOUR REPORT 21 OR YOUR PRELIMINARY REPORT TO THE TOP OF PAGE 22 19, YOU COMMENTED ON THIS ARTICLE BY PETER J. 23 BAXTER. AND YOU OBSERVED THAT A REVIEW OF 14 24 CASES OF ANGIOSARCOMA DIAGNOS I ED IN GREAT 25 BRITAIN, 1963 TO 1973 21103120 BFG09840 CR 55 OR EPSTEIN MR. RENNE I SEN 164 1 A. 2 Q. I'M SORRY, WHAT PAGE WAS THAT. I AM NOW 3 A. 4 Q. OH, 13, SURE, I'VE GOT YOU. DIAGNOSIEO IN GREAT BRITAIN INCLUDED 5 ONE CASE WHERE THE INDIVIDUAL INVOLVED WORKED 6 IN A PLANT THAT USED PVC AS RAW MATERIAL. AND 7 [ BELIEVE YOU ARE REFERRING TO THE BAXTER 8 ARTICLE FOR THAT INFORMATION; IS THAT TRUE? 9 A. YOU'VE LOST ME NOW. WE'RE TALKING 10 ABOUT THE BAXTER ARTICLE. 11 Q. FIRST I'M TALKING ABOUT YOUR 12 REFERENCE TO IT. 13 A. SURE. AND WE'RE TALKING NOW ABOUT 14 RESIDENTS. ARE WE TALKING ABOUT ANGIOSARCOMA 15 IN RESIDENTS OR ARE WE TALKING ABOUT LATENCY? 16 Q. WELL, LET'S FIR-ST GO TO YOUR REPORT. 17 A. 18 Q. OKAY, FINE. AUGUST 13, 1930. 19 A. YEAH. 20 Q. AT THE BOTTOM OF PAGE 13, YOU SAY, "A 21 REVIEW OF 14 CASES OF HEPATIC ANGIOSARCOMA 22 DIAGNOSIEO IN GREAT BRITAIN DURING 1953-1973 23 FOUND ONE CASE WHO HAD WORKED IN A PLANT 24 WHICH USED PVC AS RAW MATERIAL," AND YOU SAY 25 BAXTER 1977. 21103121 BFG09841 SS - OR. EPSTE-IN - MR, RENNET SEN I65 1 A. YEAH . 2 Q. AND THE BAXTER 1977 IS THE ARTICLE, 3 IS IT NOT, IN THE. BRITISH MEDICAL JOURNAL 4 DATED OCTOBER --! 5 A. THAT ' 5 RIGHT, YES . 6 Q 7 A 8 Q EIGHT RIGHT t\ \i j NOW , REFERRING TO THE BAXTER ARTICLE, 1 9 ISN'T IT TRUE, DOCTOR, THAT THE BAXTER 10 ARTICLE REPORTED ON THE FINDINGS OF A PANEL 11 OF DOCTORS WHO REVIEWED 14 -- I'M SORRY, 12 REVIEWED 41 DEATH WHEN THE DEATH CERTIFICATE 13 MENTIONED A DIAGNOSIS OF ANGIOSARCOMA OF THE 14 LIVER. 15 A. I THINK SO, YES, I THINK THAT WAS 16 WHATTHEYDID. 17 Q. ISN'T IT TRUE, DOCTOR, THAT THE 18 PANEL AGREED ON ANGIOSARCOMA OF THE LIVER AS 19 A DIAGNOSIS IN 14 OF THE CASES? 20 A. I THINK SO, YES. THAT'S TABLE TWO, 21 YES, ONE, TWO -- YES. 22 Q. NOW, I'M REFERRING TO PAGE 921 OF 23 THE ARTICLE, THE SECOND PARAGRAPH IN THE 24 RIGHT-HAND COLUMN. AND I ASK YOU, ISN'T IT 25 TRUE THAT THE PANEL AGREED ON ANGIOSARCOMA OF TZ TGOTTZ BFG09842 DR.- EPSTEIN MR. R E NNE I S E N 155 1 T ME LIVER DIAGNOSIS -- I'M SORRY. STRIKE 2 THAT QUESTION 3 ISN'T IT TRUE THAT ONLY ONE 4 CASE OF ANGIOSARCOMA OCCURRING 1953 TO 1973 5 COULD BE CONFIDENTLY ATTRIBUTED BY THE PANEL 6 TO VINYL CHLORIDE? 7 A. YES. 8 Q. NOW, IF WE LOOK BACK TO PAGE 920 IN 9 THE SECOND COLUMN, THE SECOND PARAGRAPH UNDER 10 CASES AGREED 3Y THE PANEL, IT SAYS ONE HAD 11 BEEN A PROCESS WORKER IN PVC MANUFACTURE 12 EXPOSED TO LEVELS OF VCM EXCEEDING 200 PARTS 13 PER MILLION OVER 20 YEARS. DOESN'T IT? 14 A . YEAH 15 Q 16 A. AND THAT ' S THE ONE CASE, IS I T NOT ? JUST TELL ME WHERE YOU ARE ON THE 17 ARTICLE NOW . I ' VE LOST YOU. 18 Q. I'M ON PAGE 920 OF THE ARTICLE. 19 A. 20 Q. YEAH. THE SECOND COLUMN, THE SECOND 21 PARAGRAPH UNDER THE HEADING, "CASES AGREED BY 22 THE PANEL." AND I'M READING ONE HAD BEEN A 23 PROCESS WORKER IN PVC MANUFACTURE EXPOSED TO 24 LEVELS OF VCM EXCEEDING 200 PARTS PER MILLION 25 OVER 20 YEARS. szT sa irz BFG09843 DR. EPSTEIN MR. RENNE I SEN 167 1 A. UM-HUM. AND. 2 Q. I'M ASKING YOU ISN'T THAT THE ONE 3 CASE TALKED ABOUT BY BAXTER? 4 A. NO, THIS IS A TABLE TWO WHICH HAS 5 W H [ C H HAS ALL THE CASES CLASSIFIED BY 6 THE PANEL AS ANGIOSARCOMA OF THE LIVER. 7 Q. THAT'S RIGHT. 3 U T AT THE CONCLUSION, 8 THEY SAID ONLY ONE CONFIDENTLY COULD 3E 9 ATTRIBUTABLE TO VCM? 10 A. YES, BECAUSE ONLY ONE WAS -- AT 11 THAT TIME TO HAVE LIVED -- TO HAVE WORKED 12 IN PVC AND VC KIND OF PRODUCTS. 13 Q. AND THE ONE THE AUTHORS CONFIDENTLY 14 ATTRIBUTED TO VCM WAS A MAN WHO HAD WORKED IN 15 PVC MANUFACTURE AND WAS EXPOSED TO VCM AT 16 LEVELS EXCEEDING 200 PARTS PER MILLION FOR 17 OVER 20 YEARS; ISN'T THAT TRUE? 18 A. THAT'S RIGHT, YES. 19 Q. SO, HE WAS NOT A PVC FABRICATOR, HE 20 WAS ACTUALLY A PVC MANUFACTURER WORKING WITH 21 THE RAW VINYL CHLORIDE; ISN'T THAT TRUE? 22 A. WELL, IN THIS -- IN THE TABLE, 23 THEY TALK ABOUT A FI3ER GAS WORKER WORKING 24 WITH PVC PASTE, THAT WAS THE MAN I WAS 25 REFERRING TO. frZT60TTZ BFG09844 L, '"V DR. EPSTEIN MR. RENME I SEN 1S 1 -Q. 3UT THE AUTHOR SAID ONLY ONE WAS 2 A. I UNDERSTAND YOUR QUESTION. BUT I'M 3 REFERRING TO -- T A 5 L E TWO GIVES A LISTING 4 OF ALL THE CASES OF ANGIOSARCOMA. ON THE 5 RIGHT-HAND COLUMN, IT GIVES STATEMENTS OF 6 EXPOSURE TO V C M , ONE OF WHOM WAS OBVIOUSLY A 7 PVC FABRICATOR, WHICH IS WHAT I REPORT. 8 Q. THAT'S RIGHT. BUT THAT GENTLEMAN, 9 ACCORDING TO THE AUTHORS OF THIS ARTICLE 10 COULD NOT CONFIDENTLY BE CONSIDERED TO BE 11 HAVE THE DISEASE CAUSED BY VINYL 12 CHLORIDE; ISN'T THAT TRUE? 13 A. I THINK THAT IT IS A PARTIAL TRUTH, 14 BECAUSE THEY GO TO SAY, THE POSSIBILITIES IS REMAINS THAT THE ANGIOSARCOMA OF THE LIVER 16 ASSOCIATED WITH -- WELL, IN THE LAST 17 PARAGRAPH, THEY SAY, ONLY ONE CASE COULD BE 18 CONFIDENTLY ATTRIBUTED. 19 Q. ALL RIGHT. 20 A. AND THEN THEY GO ON TO SAY. ONE 21 PATIENTS WAS SUSPECTED. HE HAD LIVED 22 THE COURT: DOCTOR, THE 23 QUESTION TO YOU WAS -- 24 BY MR. RENNEISENt 25 Q. WHICH CASE CONFIDENTLY CAN BE SAID 21109125 BFG09845 C R SS - DR. EPSTEIN - MR. RENNE I SEN 15 9 1 TO BE BY THESE TO BE ATTRIBUTED VINYL 2 CHLORIDE? 3 A. THEY CAME TO THE CONCLUSION THAT THE 4 ONE WITH VERY HIGH EXPOSURE LINES, THEY WERE 5 CONFIDENT OF THIS. BUT FOR OTHER CASES, THEY 6 CLEARLY RAISED THE POSSIBILITY OR PROBABILITY 7 OF A RELATIONSHIP SUCH AS COMMUNITY OR OTHER 8 KINDS OF EXPOSURE. THEY TALK ABOUT ANOTHER 9 HAD LIVED FOR SIX YEARS 10 Q. THAT'S TRUE. 11 A. -- NEAR THE PLANT. 12 Q. I RECOGNIZE THEY DISCUSS THE MAN 13 THAT HAD SIX YEAR EXPOSURE. BUT THE MAN THAT 14 THEY SAID CONFIDENTLY HAD A CAUSAL 15 RELATIONSHIP WAS A MAN WHO HAD 20 YEARS 16 EXPOSURE TO -- 17 A. THERE'S NO QUESTION AT ALL. IT'S 18 MUCH EASIER TO MAKE A CONFIDENT STATEMENT OF 19 STRONG PROBABILITY IF SOMEBODY HAD BEEN 20 WORKING INSIDE A PLANT. UNTIL RELATIVELY 21 RECENTLY, THE LITERATURE HAS ONLY JUST 22 RECENTLY RECOGNIZED THE WHOLE AREA OF 23 COMMUNITY HAZARDS. AND THIS IS -- THIS IS A 24 CASE IN POINT. THEY CONCLUDE THAT THERE WAS 25 ONE CASE WHO HAD NO OCCUPATIONAL EXPOSURE, 21103126 BFG09846 DR . EPSTEIN MR. RENNEISEN 1 70 1 .WHO LIVED NEAR A PLANT, HAD ONLY LIVED NEAR A 2 PLANT FOR SIX YEARS AND DEVELOPED 3 ANGIOSARCOMA. AND NO HISTORY OF OTHER 4 tXPOSURE TO THOROTRAST. 5 NOW, THIS ISN'T A CONFIDENCE. 6 THIS IS A STATEMENT OF WHAT I WOULD CONSIDER 7 PROBABILITY. 8 Q. THE AUTHORS DIDN'T EVEN SAY 9 PROBA3 ILITY, DID THEY? 10 A. WELL, THE AUTHORS MAKE IT CLEAR THAT 11 THEY CONSIDER THESE TO BE ASSOCIATED. THEY 12 SAY IN THE TABLE, EXPOSURE TO VINYL CHLORIDE 13 LIVED NEAR PVC PLANT. THAT IS FAIRLY EXPLICIT. 14 Q. THAT'S AN EXPLICIT STATEMENT OF 15 WHERE HE LIVED. BUT IT IS 16 A. NO, IT iSN'T. IT'S A STATEMENT OF 17 EXPOSURE TO VINYL CHLORIDE. THEY HAVE A TABLE 18 WHICH SUMMARIZES DETAIL -- TABLE TWO, 19 DETAILS OF ALL CASES CLASSIFIED BY THE PANEL 20 AS ANGIOSARCOMA OF THE LIVER. THEY HAVE ON 21 THE RIGHT-HAND SIDE COLUMN EXPOSURE TO VCM. 22 THEY HAVE ONE, YES, PROCESS WORKER, YES; THE 23 OTHER POSSIBLY PVC PASTE. HE WAS THE 24 FABRICATOR. THE OTHER, LIVED NEAR PVC PLANT. 25 THE AUTHORS MAKE IT VERY 2 1 IO S 1 2 7 BFG09847 C R SS - OR. EPSTEIN - MR. RE NMEI5EN 171 1 CLEAR THAT THEY REGARD HAD THESE AS SOURCES 2 OF EXPOSURE TO VINYL CHLORIDE. 3 NOW, HAVING SAID THEY WERE 4 EXPOSED TO VINYL CHLORIDE, THEY WENT ON TO 5 SAY, WELL, OBV I OUSLY, THE GUY WHO WORKED 6 The PLANT, WE CAN BE MORE CERTAIN ABOUT 7 MAKING INFERENCES THAN IT IS OTHERS. 3 Q. THE ONLY -- DOCTOR, AM I CORRECT, 9 THE ONLY MAN THAT THEY SPECIFICALLY IDENTIFY 10 IS THE MAN WHO HAD A 20 YEAR EXPOSURE OF 200 11 PARTS PER MILLION? 12 A. THAT IS NOT TRUE. ON PAGE 91, THEY 13 IDENTIFY ANOTHER WHO HAD LIVED FOR SIX YEARS 14 WITHIN A HALF MILE OF A PLANT MANUFACTURING 15 PVC AND.IN THE TABLE, THEY REFER TO THIS AS 16 EXPOSURE TO VCM, A CASE OF MAN AGED 70 WHO 17 AGE 61 WHO DIED IN 1970 WHO WAS A 18 CASHIER AND WHO HADN'T WORKED IN THE PLANT 19 BUT LIVED NEAR THE PLANT. AND THAT IS 20 FALLS INTO WHAT I THINK IS PROPER TO REGARD 21 AS A COMMUNITY CANCER CASE. 22 Q. CAN YOU POINT OUT TO ME ANYPLACE IN 23 THIS REPORT WHERE THEY SAY THE PASTE WORKER' 24 ANGIOSARCOMA WAS PROBABLY OR POSSIBLY CAUSED 25 BY VINYL CHLORIDE, WHERE THEY USE EITHER OF 21103129 BFG09848 CR DR. EPSTEIN MR. RENME I SEN 172 1 THOSE WORDS? 2 A. THE TABLE IS VERY EXPLICIT. OVER 3 AMD ABOVE THE TABLE, THEY HAVE A WHOLE 4 PARAGRAPH ON LEVELS OF VINYL CHLORIDE IN THE 5 ATMOSPHERE UP TO HALF A MILE AWAY FROM THE 6 FACTORY. THEY PRESENT MEAN LEVELS OF VINYL 7 CHLORIDE IN THE ATMOSPHERE UP TO HALF A MILE 8 AWAY FROM THE FACTORY FROM WHERE THE. 9 NEIGHBORHOOD CASE OF ANGIOSARCOMA OF THE 10 LIVER OCCURRED, WHERE THE NEIGHBORHOOD CASE 11 OF ANGIOSARCOMA ARE CONSIDERED TO BE SO AND 12 SO AND MAY HAVE 3EEN SEVERAL TIMES HIGHER IN 13 THE PASSENGER, INDICATING THE ORDER OF 14 EXPOSURE OF PEOPLE LIVING CLOSE TO FACTORIES 15 MANUFACTURING PVC. 16 Q. DOES THE ARTICLE 17 A. SO, IT IS CLEAR THAT THEY CONSIDERED 18 THIS TO BE A COMMUNITY CANCER CASE. 19 Q. IT'S CLEAR TO YOU. 20 A. THEY MAY NOT HAVE USED YOUR LANGUAGE 21 OF POSSIBILITIES OR PROBABILITY OR MY 22 LANGUAGE. THEY REPORT THEIR FINDINGS. 23 THE COURT: LET'S NOT HAVE 24 THE ARGUMENT. JUST ASK THE QUESTION, YOU 25 RESPOND. 21103129 BFG09849 DR . EPS TE IN MR. RE N N E I S E N 173 1 3 Y MR. RENNEISEN: 2 Q. DOCTOR, I DON'T THINK WE'RE GOING TO 3 ANSWER THAT QUESTION. WE'LL GO ON . 4 LET'S REFER TO THE 3RADY 5 ARTICLE FOR A MINUTE. 6 A. SURE. 7 Q. THAT'S THE ARTICLE THAT APPEARED IN > 'If ' / J A -- 8 THE JIEOR-G-E OF THE NATIONAL CANCER INSTITUTE, 9 NOVEMBER, 1977. 10 A. SURE, IHAVE IT. 11 Q. BEFORE WE GO ON, I WOULD LIKE TO 12 MARK AS AN EXHIBIT -- AND AGAIN I DON'T 13 HAVE A CLEAN COPY, BUT I'LL GET ONE -- AS 14 THE NEXT DEFENDANT'S EXHIBIT, THE BAXTER 15 ARTICLE. 16 THE COURT: DO YOU KNOW WHAT 17 NUM3ER THAT IS?. 18 MR. RENNEISEN: YOUR HONOR, 19 I'LL WRITE ON HERE, D-4 AND I'LL SUBSTITUTE A 20 CLEAN ONE FOR IT. I'LL WRITE D-4 AND I'LL 21 WRITE "SUBSTITUTE CLEAN." 22 BY MR. RENNEISEN: 23 Q. NOW, REFERRING TO THE 3RADY ARTICLE, 24 DOCTOR, THIS ARTICLE STUDIED 25 PATIENTS, DID 25 IT NOT? 21103130 BFG09850 I CR 5S DR. EPSTEIN MR. RENNE I SEN 174 1 A. CORRECT. 2 Q. ISN'T IT TRUE THAT 73 PERCENT OF THE 3 25 PATIENTS STUDIED HAD NO DOCUMENTED DIRECT 4 EXPOSURE TO VINYL CHLORIDE, ARSENIC OR 5 THORIUM DIOXIDE? 6 A. N0, S I R . 7 Q. ISN'T IT TRUE THAT THE ARTICLE SAYS 8 DIRECT EXPOSURE TO THESE CHEMICALS COULD NOT 9 3E DEMONSTRATED FOR 19 OF THE 26 PATIENTS? 10 A. THE ARTICLE SAYS THAT, BUT TABLE ONE 11 MAKES IT VERY CLEAR THAT THAT ISN'T THE CASE 12 AND LET ME EXPLAIN TO YOU MY MEANING, IF I 13 MAY . 14 IF YOU TURN TO TABLE ONE, YOU 15 WILL SEE SEVEN CASES, THE FIRST SEVEN CASES 16 FOR WHICH THERE IS AN EXPOSURE HISTORY, OKAY. 17 YOU WITH ME? / 1/8- Q . YES ? 19 A. FINE. HOWEVER,THERE'S ALSO ONE, TWO, 20 THREE, FOUR, FIVE, THE SUBSEQUENT FIVE CASES 21 BELOW WHO LIVED CLOSE TO A VC PVC FACTOR, 22 SEVEN PLUS FIVE IS 12. TWELVE OUT OF 26 IS 23 46 PERCENT AS OPPOSED TO 27 PERCENT. 24 WHEN YOU SAID THAT THERE'S NO 25 WHEN YOU INFER THERE'S NO ETIOLOGY IN IN TETGOTTZ BFG09851 cr - DR. EPSTEIN - MR. RENNE I S EN 175 1 /3 PERCENT IN 73 PERCENT OF THE CASES, 2 THAT MEANS THAT 27 PERCENT ONLY 2 7 3 PERCENT HAVE AN ETIOLOGY. MY PO I NT TO YOU I S 4 THAT LOOKING AT TABLE ONE, THEIR OWN TA8LE 5 MAKES IT CLEAR THAT IN 46 PERCENT, HALF OF 6 THE CASES, THEY DIO HAVE AN ETIOLOGY; SEVEN 7 OF THEM, THE FIRST SEVEN AND THE LAST FIVE 8 WERE COMMUNITY RESIDENTS, PEOPLE WHO LIVED 9 CLOSE TO VC PVC PLANT. SO, IN OTHER WORDS, 10 HALF OF THE CASES IN THIS PAPER HAD A HISTORY 11 OF EXPOSURE TO VINYL CHLORIDE. 12 NOW -- 13 Q. 14 DOCTOR, YOU SAY -- . THE COURT: JUST A MOMENT, 15 JUST A MOMENT. QUESTION. 16 BY MR. RENNEI SEN: 17 Q. DOCTOR, DO YOU SAY THAT IN SPITE OF 18 THE AUTHORS SAYING DIRECT EXPOSURE TO THESE 19 CHEMICALS COULD NOT BE DEMONSTRATED FOR 37 20 PERCENT OF THE 26 CASES? 21 A. WELL, IT'S DIRECT EXPOSURE. THE 22 POINT IS THAT IN THE TABLE, THEY TALK ABOUT 23 EXPOSURE HISTORY. AND IN THE TA3LE OF TABLE 24 ONE WHERE THEY TALK ABOUT EXPOSURE HISTORY, 25 IN 12 OF THE 26 CASES, THERE IS AN EXPOSURE 21109132 BFG09852 OR. EPSTEIN MR. R ENNE I S EN 176 1 . H I STORY . 2 NOW, WHETHER YOU WANT TO USE 3 THE WORD DIRECT FOR THIS IS NEITHER HERE NOR 4 THERE. THIS IS A REPORT OF 2 5 C 4 S E S IN WHOM 5 AT LEAST IN 12 OF THESE WE HAVE AN ETIOLOGY; 6 THE ETIOLOGY VARIES IN DIFFERENT ONES OF THEM, 7 3 U T THERE ARE FIVE CASES REPORTED HERE IN 8 WHICH THE ONLY KNOWN EXPOSURE WAS FROM 9 RESIDENTS IN THE VICINITY OF VC PVC PLANT. I 10 MAY ALSO POINT OUT THAT THIS IS -- THE 11 FIGURES SHOULD REALLY BE 12 OUT OF 25, WHICH 12 MAKES IT UP TO 28 PERCENT. BECAUSE IN ONE 13 CASE, THERE WAS NO RESIDENTS' HISTORY. SO, IN 14 FACT, IN 48 PERCENT OF THE CASES IN THAT 15 PAPER, THERE IS A KNOWN ETIOLOGY OR A 16 PRESUMPTIVE ETIOLOGY. 17 Q. IN OTHER WORDS, DOCTOR, YOU DON'T 18 AGREE WITH THE FIRST PARAGRAPH OF THE REPORT? 19 A. NO, THAT ISN'T THE CASE. IT HINGES 20 ON THE INTERPRETATION TO BE USED ON EITHER 21 EXPOSURE ON THE ONE HAND OR DIRECT EXPOSURE. 22 THE TABLE ONE GIVES A HISTORY OF EXPOSURE 23 GIVES A COLUMN MARKED EXPO5 URE- HISTORY. 24 Q. LOOK, DOCTOR, DO YOU ASSUME THAT 25 EVERY CASE OF VINYL CHLORIDE THAT OCCURS 2X109133 BFG09853 CR SS - DR.. EPSTEIN - MR. RENNEISEN 177 1 WITHIN A MILE OR TWO OF A PVC PLAN 2 THE COURT: YOU MEAN EVERY 3 CASE OF 4 BY MR. RENNEI SEN: 5 Q. I'M SORRY. DOCTOR, DO YOU EVER 6 ASSUME 7 MR. RENNEISEN: THANK YOU 8 JUDGE. 9 BY MR. RENNEI SEN: 10 Q. DO YOU ASSUME THAT EVERY CASE OF II ANGIOSARCOMA THAT OCCURS WITHIN A MILE OR TWO 12 OF A PLANT IS CAUSED BY EMISSION FROM THAT 13 PLANT? 14 A. LET ME ANSWER YOU THIS WAY CLEARLY. 15 IF ONE HAS AN ANGIOSARCOMA 16 OCCURRING IN AN INDIVIDUAL WHO RESIDES CLOSE 17 TO A PLANT FROM WHICH DEMONSTRABLE EMISSION 18 THERE HAVE BEEN DEMONSTRABLE EMISSIONS 19 PVC EMISSION AND THE LONGER AND THE MORE 20 INTENSE AND THE MORE INFORMATION YOU HAVE ON 21 THIS, THE MORE CONFIDENT YOU CAN BECOME. BUT 22 THE TWO REQUIREMENTS FOR A DIAGNOSIS OF A 23 COMMUNITY ANGIOSARCOMA ARE, ONE, THE 24 DIAGNOSIS OF THE DISEASE ITSELF; TWO, THE 25 HISTORY OF RESIDENTS CLOSE TO A PLANT; AND, 21103134 BFG09854 D R . EPSTEIN MR R E N N E ISSN 173 1 THREE, INFORMATION ON EMISSION FROM THE PLANT. 2 AND IN THE GRASSO CASE, WE 3 HAVE ALL THESE THREE REQUIREMENTS: 4 ANGIOSARCOMA, RESIDENTS CLOSE TO THE PLANT 5 AND DETAILED INFORMATION OF EMISSION RASED ON 6 MODELING AND OTHER DATA. SO, WE HAVE THESE 7 COMBINATION OF THREE FACTORS AND THIS IS 8 PRECISELY WHY IN SCIENCE ONE DEVELOPS A BODY 9 OF INFORMATION FROM WHICH YOU MAKE INFERENCES 10 AND YOU DEVELOP UPON THESE PARTICULAR 11 RELAT I ONSH I PS . THIS GOES THE WAY WE KNOW 12 ABOUT THE RELATIONSHIP OF SMOKING AND LUNG 13 CANCER; FROM PR08LEMISTIC RELATIONSHIPS, NOT 14 BECAUSE OF ANY ABSOLUTE TERMS. 15 Q. DOCTOR, WITH RESPECT TO THE FIVE 16 PEOPLE REFERRED TO IN THE BRADY REPORT WHO 17 LIVED NEAR A PLANT, DO YOU HAVE ANY EMISSION 18 DATA? 19 A. NO, EXCEPT WHAT THEY SAY IS -- LET 20 US SEE EXACTLY WHAT THEY SAY. OF POSSIBLE 21 IMPORTANCE IS THE FACT THAT THE AMBIENT 22 EMISSION R OF VC MONOMER FOR THE FACTORY 23 LOCATED 1,700 FEET FROM THE RESIDENCE OF 24 PATIENT NUMBER TEN WERE AS HIGH AS 92,000 25 P.P.M.. THEY ALSO GO ON TO SAY -- WHERE IS 21103135 BFG09855 OR. EPSTEIN MR . R ENNE IS EN 179 1 THIS? IN THIS STUDY, 35 PEOPLE WITH 2 ANGIOSARCOMA LIVED NEARER TO PULOMIZATION 3 PLANTS AND FABRICATION PLANTS. IN CASES, AS 4 YOU KNOW, THIS WAS KIND OF A CASE CONTROL 5 STUDY IN WHICH THEY MATCHED CONTROLS FOR ALL 6 CASES WITH THE CANCERS AND IN NONE OF THE 7 MATCHED CONTROLS DID THEY LIVE -- WHO HAD 8 OTHER CANCER, DID THEY LIVE CLOSE TO A VC OR 9 PVC FABRICATING PLANT 10 NOW, THIS ISN'T ABSOLUTE 11 LEGALISTIC PROOF. THIS IS A REPORTED CASE 12 A REPORTED COMMUNITY CASE OF 13 ANGIOSARCOMA AND AS I'VE INDICATED 3EFORE, 14 THE REQUIREMENTS ARE, MINIMALLY, DIAGNOSIS OF 15 ANGIOSARCOMA AND IN ADDITION TO THAT, 16 PROXIMITY OF RESIDENCE AND IF IN ADDITION, 17 YOU DO HAVE EVIDENCE ON EMISSION FOR MODELING 18 OR DIRECT MONITORING, THEN THE STRENGTH OF 19 YOUR ASSOCIATIONS BECOME ALL THE GREATER. AND 20 THIS IS THE BASIS OF WHAT WE MEAN WHEN WE 21 TALK. A80UT COMMUNITY CANCER. 22 Q. DOCTOR, ARE YOU SAYING THEN THAT IN 23 ANY SITUATION WHERE.YOU FIND AN ANGIOSARCOMA 24 NEAR A PVC PLANT, THERE'S A SUBSTANTIAL 25 PROBABILITY THAT THE PLANT CAUSED THE 21109136 BFG09856 CR DR. EPSTEIN MR. RENNE[SEN 180 1 ANGIOSARCOMA? 2 A. I'VE ALREADY ANSWERED THIS, I THINK, 3 3 U T I'LL REPEAT THE -- MY ANSWER: THAT THE 4 STRENGTH -- ASSURANCE OF MAKING STATEMENTS 5 OF PROBABILITY DEPENDS, APART FROM THE 6 DIAGNOSIS OF ANGIOSARCOMA, DEPENDS ON 7 PROXIMITY OF RESIDENCE, AND ALSO THE TIME 8 SEQUENCE AND FINALLY, INFORMATION ON EMISSION. 9 Q. BUT, DOCTOR 10 A. NO, I HAVE TO ANSWER YOU, BECAUSE 11 YOU'VE ASKED ME THIS THREE TIMES AND I. 12 BELIEVE I'VE ANSWERED THE SAME WAY. 13 IF YOU HAVE INFORMATION ON 14 EMISSION OF VINYL CHLORIDE FROM THE PLANT BY 15 MODELING OR BY MONITORING, THEN THE STRENGTH 16 OF A STATEMENT ON PROBLEMISTIC -- ON 17 PROBLEMATIC RELATIONSHIPS BECOMES STRONGER. 18 THIS IS EXACTLY WHAT WE HAVE IN GRASSO. WE 19 HAVE VERY DETAILED INFORMATION 20 THE COURT: I THINK THE 21 QUESTION HE'S ASKING YOU, DOCTOR IS A CAPABLE 22 OF A RESPONSE, YES OR NO. 23 READ THAT QUESTION. I THINK 24 THE DOCTOR CAN RESPOND YES OR NO. 25 MR. RENNEISEN: THANK YOU, 21103137 BFG09857 OR. EPSTEIN MR. RENNEISEN 181 1 YOUR HONOR 2 3 QUESTION.) 4 CCOURT REPORTER READS PENDING THE WITNESS: NOT IN ANY 5 SITUATION. IN SOME SITUATIONS. 6 MR. RENNEISEN: THANK YOU, 7 DOCTOR. 8 BY MR. RENNEISEN: 9 Q. AND IN THOSE SITUATIONS WHERE YOU 10 HAVE MORE DATA; IS THAT CORRECT? 11 A. IN PARTICULAR, WHERE YOU HAVE DATA 12 ON EMISSION. IF, FOR INSTANCE, YOU HAD A PVC 13 PLANT THAT WASN'T FUNCTIONING AND HAD NEVER 14 FUNCTIONED, THEN I WOULD SAY -- I WOULDN'T 15 BE WILLING TO ASCRIBE A RELATIONSHIP.. 16 Q. LET ME CHANGE THE QUESTION, DOCTOR. 17 ARE YOU SAYING THEN THAT IF YOU HAVE AN 18 ANGIOSARCOMA NEAR A FUNCTIONING PVC PLANT 19 WITH EMISSION, THERE IS A SUBSTANTIAL 20 PROBABILITY THAT THAT ANGIOSARCOMA WAS CAUSED 21 BY THE EMISSION FROM THE PLANT? 22 A. YES, ESPECIALLY IN THE ABSENCE OF 23 EXPOSURE TO -- KNOWN EXPOSURE TO. OTHER 24 AGENTS INDUCING ANGIOSARCOMA. 25 Q. NOW, I THINK WE -- WE BOTH AGREE, 8STSOTTZ BFG09858 CR SS - DR. EPSTEIN - MR. RENNE I SEN 182 1 DOCTOR, THAT IF YOU HAD A MAN LIVING OUT IN 2 WYOMING AWAY FROM EVERY PVC PLANT AND NEVER 3 USED A SPRAY CAN OF ANYTHING, HE COULD STILL 4 HAVE ANGIOSARCOMA? 5 A. CERTAINLY. I'VE ALREADY DISCUSSED 6 THE FOUR CAUSES. 7 Q. AND IF THAT GENTLEMAN WAS NOT 8 EXPOSED TO THOROTRAST, VINYL CHLORIDE, 9 STEROID OR ARSENIC, HE STILL COULD GET 10 ANGIOSARCOMA, COULDN'T HE? 11 A. WELL, IF HE GETS ANGIOSARCOMA, HE 12 GETS IT, SO, THEREFORE, THERE'S NO ARGUMENT 13 ABOUT IT. THE QUESTION IS WHAT IS THE CAUSE. 14 Q. WELL, YOU'VE ALREADY SAID, DOCTOR, 15 THAT THERE ARE MANY CARCINOGENS NOT YET 16 IDENT IFIED. 17 A. WELL, WE HAVE FOUR KNOWN CAUSES OF 18 ANGIOSARCOMA. I'M UNWILLING TO EXCLUDE THE 19 POSSIBILITY THAT AT SOME STAGE IN THE FUTURE 20 ANOTHER CAUSE -- I'M NOT GIFTED WITH 21 PROPHECY. ALL WE CAN SAY IS WE NOW KNOW OF 22 THREE DEFINITE CAUSES OF ANGIOSARCOMA ANO A 23 FOURTH POSSIBLE CAUSE OF ANGIOSARCOMA. 24 Q. AND TEN YEARS FROM NOW, WE MAY HAVE 25 TEN CAUSES; ISN'T THAT TRUE? 21103139 BFG09859 CP. OR. EPSTEIN MR. RENNEISEN 183 1 A. THAT IS POSSIBLE. BUT IT'S NOT 2 PROBABLE. I'M NOT WILLING TO EXCLUDE THAT 3 P 0 S 5IBILITY. 4 Q. IT'S NOT PROBABLE? 5 A. NO . 6 Q. HOW MANY YEARS AGO THERE WERE NO 7 KNOWN CAUSES? 8 A. THE REASON WHY IT'S NOT PROBABLE 9 THIS IS A VERY RARE CANCER AND THE 10 OF THE RARE CANCERS OF ANGIOSARCOMAS WHICH n WE'VE SEEN SO FAR, WE HAVE -- THE MORE WE 12 EXAMINE THEM, THE MORE WE'VE BEEN ABLE TO 13 DEVELOP INFORMATION ON ETIOLOGY. AND 14 BASICALLY, WHAT IS HAPPENING NOW IS THAT THE 15 CASES OF ANGIOSARCOMA THAT ARE DEVELOPING ARE 16 BEING EXAMINED MORE AND MORE CAREFULLY AND 17 CONSIDERATIONS SUCH AS PROXIMITY OF RESIDENCE 18 IS NOW BEING RECOGNIZED MORE AND MORE AND 19 OTHER SUCH FACTORS OF IT. 20 Q. WELL, DOCTOR, ARE YOU TELLING ME 21 THAT MORE AS AND MORE CASES ARE BEING 22 EXAMINED, PEOPLE LIKE YOURS ARE TRYING HARDER 23 AND HARDER TO FIT THEM INTO ONE OF FOUR 24 CATEGORIES? 25 A. THAT'S NOT WHAT I SAID. THE 21109140 BFG09860 DR. EPSTEIN MR. RENNEISEN 134 1 .SCIENTIFIC COMMUNITY IS PAYING PARTICULAR 2 ATTENTION TO THIS, AMONG OTHER ISSUES, 3 ESPECIALLY 3ECAUSE ANGIOSARCOMA HAPPENS TO BE 4 A RARE DISEASE AND THEREFORE, IT'S EASIER TO 5 STUDY. WHEN YOU HAVE A VERY COMMON CANCER 6 LIKE LUNG CANCER, IT 3EC0MES FAR MORE 7 DIFFICULT TO STUDY FROM THIS POINT OF VIEW OF 8 ASCRIBING CAUSALITY. WHEN IT COMES TO 9 RELATIVELY UNUSUAL CANCERS, LIKE MESOTHELIOMA 10 FROM ASBESTOS OR ANGIOSARCOMA, IT THEN 11 BECOMES EASIER TO TRY TO DEVELOP INFORMATION 12 ON CAUSALITY. 13 Q. DOCTOR, WAS THERE A TIME WHEN THE 14 MEDICAL PROFESSION HAD NO KNOWN CAUSES FOR 15 ANGIOSARCOMA? 16 A. CERTAINLY. THE TESTS HADN'T 3EEN 17 DONE IN ANIMALS AND THERE HAD BEEN THE FEW 18 CASES THAT HAD OCCURRED IN THE MID-SIXTIES 19 HAD BEEN MISS DIAGNOSIED. 20 Q. AND AS DOCTOR LAUCIUS WHO WAS HERE 21 THIS MORNING SAID THAT ANGIOSARCOMA OF THE 22 LIVER HAD BEEN KNOWN FOR 80 YEARS, DO YOU 23 AGREE WITH THAT? 24 A. I CAN'T TELL YOU THE DATE WHEN 25 ANGIOSARCOMA WAS FIRST RECOGNIZED. I WOULD Hfrl&OTTZ BFG09861 5 - DR. EPSTEIN - MR. RENNEI SEN 185 J .HAVE TO GO BACK TO THE LITERATURE. I KNOW 2 IT'S BEEN RECOGNIZED FOR SOME TIME, FOR 3 DECADES. BUT I CAN'T REALLY TELL YOU THE DATE 4 OF THE F IRST REPORT . 5 Q. DOCTOR, ISN'T IT FAIR IF THERE WAS A 6 TIME THAT IT EXISTED AND NOBODY KNEW ANY 7 CAUSES AND THEN ONE DAY THERE WAS ONE CAUSE 8 AND THEN THREE AND NOW POSSIBLY FOUR? 9 A. 10 Q. THAT'S CORRECT. ANO ISN'T IT REASONABLE TO ASSUME, 11 PARTICULARLY SINCE THERE SEEMS TO BE NO 12 RELATIONSHIP IN THE FOUR KNOWN OR SUSPECTED 13 CAUSES W T T H EACH OTHER, THAT THERE ARE 14 PROBABLY OTHER CAUSES; ISN'T THAT TRUE? 15 A. WELL, I'M NOT WILLING TO EXCLUDE 16 THAT AS A POSSIBILITY. ALL I CAN SAY IS THAT 17 AT THE MOMENT, THREE DEFINITE CAUSES HAVE 18 BEEN DEMONSTRATED AND A FOURTH POSSIBLE CAUSE 19 HAS BEEN DEMONSTRATED. THAT'S AS FAR AS AS 20 ONE CAN GO IN THIS LINE. 21 Q. DID YOU REFER TO THE -- I DON'T 22 THINK YOU REFER TO IT BY AUTHOR'S NAME. BUT I 23 THOUGHT YOU WERE REFERRING TO AN ARTICLE BY 24 CHIAZZE ENTITLED MORTALITY AMONG EMPLOYEES OF 25 PVC FABRICATORS? 25TGOTTZ BFG09862 D R . EPSTEIN MR. RENNE I SEN 185 1 A. I DIDN'T LIST THAT IN THE COMMUNITY 2 CANCER* OR 'IN THE -- OR IN THE ONES WITH 3 LATENCIES UNDER TEN YEARS, NO, I DIDN'T LIST 4 THAT . 5 Q. DID YOU REFER TO IT WHEN YOU WERE 6 TALKING ABOUT CASES IN FABRICATORS 7 A. THAT ' S R I GHT. 8 Q. -- WHERE THERE WAS EXPOSURES OF 9 ZERO TO TWO PARTS PER MILLION? 10 A. YES, IN THAT CONNECTION, I REFER TO 11 CHIAZZE. 12 Q. AND ON PAGE 19 OF YOUR REPORT, 13 REFERENCE IS MADE TO A CROSS-SECTION, 14 MORTALITY STUDY OF 3,845 DEATHS AMONG 15 EMPLOYEES OF PVC FABRICATORS BY LEONARD 16 CHIAZZE; ISN'T THAT TRUE? 17 A. THAT'S TRUE. 18 Q. AND CHIAZZE IN FACT, WITH HIS 19 ASSOCIATES, NICHOLS AND WONG, DID, IN FACT, 20 STUDY DEATH OF PVC FABRICATORS, DID THEY NOT? 21 A. THAT'S RIGHT, YES. 22 Q. AND THESE ARE GENTLEMEN OR WOMEN WHO 23 TOOK POLYVINYLCHLORIDE AND IN SOME PROCESSES, 24 MANUFACTURED INTO PRODUCTS THAT WERE USED 25 TODAY? 211D9143 BFG09863 S DR. EPSTEIN MR . RENNE 1 S EN 187 1 A. CORRECT. 2 Q. ISN'T IT TRUE THAT DOCTOR CHIAZZE 3 FOUND NO ANGIOSARCOMA DEATH AMONG THE GROUP 4 THAT HE STUD I ED ? 5 A. THAT'S RIGHT, HE FOUND VARIOUS OTHER 6 CANCERS, BUT NO ANGIOSARCOMAS. 7 Q. ISN'T IT TRUE THAT THE PRIMARY 8 OBJECTIVE OF HIS STUDY WAS TO DETERMINE 9 RELATIVELY QUICKLY WHETHER OR NOT ANY 10 ANGIOSARCOMA DEATH COULD BE IDENTIFIED AMONG 11 THE STUDY GPsOUP? 12 A. I REALLY DON'T RECALL. IT'S QUITE 13 POSSIBLE HE TRIED TO DO THAT. BUT ESSENTIALLY 14 WHAT HE DID FIND WAS AN EXCESSIVE CANCER OF 15 DIFFERENT MALIGNANCY. AND THIS HAS BEEN 16 REPORTED IN SEVERAL OTHER STUDIES, TOO. 17 Q. WELL, IF YOU'LL TO PAGE 523 OF THE 18 BOTTOM OF THE CHIAZZE ARTICLE 19 A. I DON'T HAVE THAT IN FRONT OF ME, I 20 REGRET. 21 Q. I'M SORRY, I'LL GET YOU ONE. 22 THE COURT: YOU WANT SOME 23 MORE WATER, DOCTOR. 24 THE WITNESS: THAT WOULD BE 25 NICE, THANK YOU. W KOTTZ BFG09864 CR SS OR. EPSTEIN MR . PENNE I SEN 183 1 THE WITNESS: I DIDN'T, I SEE 2 THE POINTS YOU WERE MAKING. 3 3YMR. RENNEISEN: 4 Q. AND HE DOES SAY, DOES HE NOT, THE 5 PRIMARY STUDY OBJECT WAS TO DETERMINE 6 RELATIVELY QUICKLY WHETHER ANY - - WHETHER 7 OR NOT ANY ANGIOSARCOMA DEATH 8 A. CORRECT. 9 Q. COULD BE 10 Q. COULD BE IDENTIFIED AMONG THE STUDY 11 GROUP. 12 A. CORRECT. 13 Q. AND WHEN HE COMPLETED HIS OBJECT, HE 14 FOUND NONE, ISN'T THAT TRUE? 15 A. CORRECT. BUT OTHER CANCERS,WHICH 16 ALSO HAVE BEEN ASSOCIATED WITH VINYL CHLORIDE 17 EXPOSURE. 18 Q. NOW, YOU REFER TO A 8AXTER AND FOX 19 ARTICLE, DID YOU NOT? 20 A. YEAH. 21 Q. AND THAT IS IN THE LANCET, JANUARY 22 31, 19 7 6, ISN'T IT? 23 A. YEAH. HANG ON. OKAY. 24 Q. AND I BELIEVE YOU SUGGESTED THAT 25 BAXTER AND FOX FOUND LUNG AND BRAIN CANCER; 21109145 BFG09865 cr DR. EPSTEINI MR. R E NN E I S E M i8g 1 IS THAT TRUE? 2 A. I DON'T RECALL SAYING THAT. WHAT I 3 LET'S JUST REFRESH MY MEMORY AND YOUR . ** 4 MEMORY, IF I MAY. 5 Q. FINE, DOCTOR. 6 A. FIRST OF ALL, I REFER TO BAXTER AS 7 HAVING DESCRIBED ONE COMMUNITY CANCER CASE OF 8 A LIVER ANGIOSARCOMA WITH A LATENCY OF SIX 9 YEARS IN SOMEBODY WHO LIVED WITHIN A HALF 10 MILE FROM A BRITISH PVC PLANTS. THAT'S ONE 11 POINT I MADE. 12 Q. IS THAT REFERRED TO IN THIS BAXTER 13 AND FOX ARTICLE? 14 A. I THINK SO. SURE. WAIT A SECOND. 15 WE'RE LOOKING AT DIFFERENT BAXTER ARTICLES. I 16 THINK THAT'S THE BASIS FOR THE CONFUSION. I 17 WAS LOOKING AT BAXTER, ANTHONY, RODERICK, 18 MC QUEEN, ET CETERA, WHICH IS BRITISH MEDICAL 19 JOURNAL, OCTOBER, 1977. I'M SORRY I MISLEAD 20 YOU WITH THE REFERENCE. 21 Q. 22 A. I WAS TALKING A30UT BAXTER AND FOX. WELL, MY REFERENCE THIS MORNING TO 23 THE -- MY REFERENCE PREVIOUSLY TO THE 24 COMMUNITY CANCER AND THE SHORT LATENCY PERIOD 25 WAS BAXTER ET AL., 1977. I THINK THAT'S THE BFG09866 m e o rrz i ii I* M 09 . EP5TE IN MR. RENNEISEN 190 1 BASIS OF THE CONFUSION. 2 SO, T HAVE THE BAXTER AND 3 FOX ARTICLE HERE, SURE . 4 Q. AND YOU DID REFER TO IT IN YOUR 5 REPORT ON PAGE 19, DID YOU NOT? 6 A. I THINK SO. PAGE 19, NO. 7 I REFER TO BAXTER ET AL . , 77, 8 NOT -- AND THIS IS BAXTER 76, BAXTER ET AL. 9 77 IS THE -- IS THE ONE WITH THE COMMUNITY 10 CANCER CASE. 11 Q. YOU ARE FAMILIAR WITH BAXTER AND FOX, 12 ARE YOU NOT? 13 A. I HAVE BOTH OF THEM IN FRONT OF ME, 14 SIR. 15 Q. ALL RIGHT. NOW, IF WE TAKE BAXTER 16 AND FOX 17 A. YOU SEE, ON PAGE 19, THERE'S TWO 18 REFERENCES TO BAXTER. THAT'S THE PROBLEM. 19 Q. I AM REFERRING TO THE LANCET, 20 JANUARY 31, 1976 21 A. r! Q. FINE. BAXTER AND FOX TOWARD THE END. AND 23 IT SAYS, "VINYL CHLORIDE HAS BEEN SUGGESTED 24 AS CAUSING CANCER 01= THE LUNG AND BRAIN AS 25 WELL AS ANGIOSARCOMA OF THE LIVER AND OTHER L^TG O TTZ BFG09867 DR. EPSTEIN MR . RENNE I SEN 19 1 1 LIVER DISEASES. IN THIS STUDY, THE OBSERVED 2 NUMBER OF DEATHS FROM THESE CAUSES WERE NOT 3 IN EXCESS OF THOSE EXPECTED." 4 A. THAT'S RIGHT, THAT 5 CORRECT. BUT 5 THERE HAVE SEEN A WIDE RANGE OF OTHER STUDIES 6 SINCE THEN WHICH HAVE DEMONSTRATED THAT THERE 7 ARE TARGET ORGANS 3ESIDES THE LIVER AND THIS 8 IS WELL RECOGNIZED IN THE LITERATURE NOW. 9 Q. DOES THE DID THE PEOPLE AT THE 10 CENTER FOR DISEASE CONTROL CONSIDER LUNG AND 11 BRAIN CANCER TO BE CAUSED BY VINYL CHLORIDE, 12 IF YOU KNOW ? 13 A . WELL, ALL I CAN TELL YOU I 14 HAVEN'T SEEN ANY CATEGORICAL STATEMENTS ON 15 THIS. BUT THE INTERNATIONAL AGENCY FOR THE 16 RESEARCH ON CANCER, FOR WHICH C.D.C. IS 17 INVOLVED AS KIND OF A MEMBER ORGANIZATION, 13 CLEARLY RECOGNIZES LUNG, BRAIN AND VARIOUS 19 OTHER SITES AS TARGET ORGANS FOR VINYL 20 CHLORIDE INDUCED CANCER. 21 Q. YOU DO RECOGNIZE C.D.C. AS ANOTHER 22 AGENCY WHICH SERVES A PURPOSE FOR THE MEDICAL 23 COMMUNITY AND COLLECTS INFORMATION AND MAKES 24 CONCLUSIONS? 25 A. CERTAINLY, I'M VERY FAMILIAR WITH 21109148 BFG09868 DR. EPSTEIN MR. RENNE I SEN 192 1 THE OPERATION OF C.D.C. C.D.C., IN FACT 2 ISN'T -- ITS- PRIMARY EXPERTISE ISN'T IN 3 CARCINOGENESIS. NATIONAL CANCER INSTITUTE AND 4 NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY 5 AND HEALTH HAS GREATER EXPERTISE IN THIS AREA 6 AND THE INTERNATIONAL AGENCY FOR THE RESEARCH 7 ON CANCER IS BASICALLY THE INTERNATIONAL 8 AUTHORITY ON THE RECOGNITION ON RELATIONSHIPS 9 BETWEEN EXPOSURE TO CHEMICALS AND CANCER. AND 10 I SAID 3EFORE, THERE'S A WIDE RANGE OF 11 PUBLICATIONS DEMONSTRATING THE INVOLVEMENT OF 12 ORGANS LIKE LUNG AND BRAIN AS A CARCINOGENIC 13 RESPONSE TO VINYL CHLORIDE. ANO I HAVE MORE 14 THAN -- I HAVE LITERATURE HERE, IF YOU WISH. 15 Q. HENRY FAULK IS WITH THE CENTER FOR 16 DISEASE CONTROL? 17 A. THAT 'S RIGHT, YES . . 18 Q. AND DO YOU KNOW WHAT HIS POSITION IS 19 THERE? 20 A. I DON'T KNOW WHAT HIS POSITION IS 21 NOW. 22 Q. HAVE YOU HAD DEALINGS WITH HIM? 23 A. OH, YES, YES. 24 Q. WE TALKED EARLIER IN MY QUESTION OF 25 YOU ABOUT HIS ARTICLE WHERE HE TALKS ABOUT SfrYSOTTS BFG09869 OR. EPSTEIN -'MR . RENNE I SEN I93 I THE STEROIDS; IS THAT 2 A. SURE. IT'S THE SAME FAULK . 3 Q. THE SAME FAULK? AND JUST BRIEFLY 4 I'M GOING TO STOP, DOCTOR. 5 AMONG ALL THE CASES OF 6 ANGIOSARCOMA THAT HAVE BEEN IDENTIFIED, WHAT 7 PERCENTAGE HAVE SEEN ATTRIBUTED TO UNKNOWN 8 CAUSES? 9 A. I CANNOT GIVE YOU A FLAT ANSWER TO 10 THAT, BECAUSE IN THE DIFFERENT SERIES WHICH 11 ARE BEING REPORTED, SOME PEOPLE HAVE LOOKED 12 FOR CAUSATIVE FACTORS AND SOME HAVEN'T. AND, 13 THEREFORE, ANY FIGURE I COULD TROT OUT FROM 14 THE 8 A CK OF MY HEAD REALLY IS MEANINGLESS. 15 AND LET ME JUST REFER TO YOU A DISCUSSION WE 16 HAD BEFORE WHEN WE WERE TALKING ABOUT BRADY. 17 THE BRADY ARTICLE MAKES IT 18 VERY CLEAR THAT IN ABOUT HALF THE CASES THEY 19 LOOKED, THERE IS AN EXPOSURE HISTORY. 20 NOW, THE BASIS THERE IS AN 21 EXPOSURE HISTORY. I'M NOT WILLING TO GET UP 22 AND TELL THIS COURT THIS UNEQUIVOCALLY PROVES 23 THAT VINYL CHLORIDE WAS THE CAUSE. I'LL SAY 24 THAT THIS IS -- THIS REPRESENTS -- IF 25 THERE ARE EMISSION DATA, ALSO, THE CREATION 21109150 BFG09870 CR SS - DR. EPSTEIN - MR. RENNE I SEN 194 1 OF A SUBSTANTIAL PROBABILITY. THEREFORE, I 2 CAN'T ANSWER YOU AS TO WHAT PERCENTAGE OF THE 3 CASES HAS BEEN ATTRIBUTED IN THE SAME WAY AS 4 THREE OR FOUR YEARS AGO. NOW WE'RE BEGINNING 5 TO SEE MORE AND MORE OF THEM. WE'RE GOING TO 6 SEE MORE AND MORE LUNG CANCER, BECAUSE PEOPLE 7 ARE LOOKING FOR IT NOW. SO, THEREFORE, I'M 8 UNWILLING TO GIVE YOU AN ABSOLUTE FIGURE AS 9 TO THE PERCENTAGE OF CASES OF ANGIOSARCOMA IN 10 WHICH AN ETIOLOGY HAS BEEN DEMONSTRATED. THE 11 FIGURES IN THE LITERATURE SEEM TO SUGGEST 12 THE LITERATURE SEEMS TO SUGGEST ANYTHING 13 RANGING FROM 75 TO ABOUT 35, DEPENDING ON 14 WHAT SERIES YOU LOOK AT. 15 Q. DOCTOR, IN MAKING YOUR ANALYSIS OF 16 CAUSE AND EFFECT, OF PROBABLE CAUSE AND 17 EFFECT BETWEEN VINYL CHLORIDE AND 18 ANGIOSARCOMA, YOU BASICALLY ARE RELYING ON 19 DATA IN THE LITERATURE; ISN'T THAT TRUE? 20 A. CERTAINLY. DATA IN THE LITERATURE, 21 PLUS --PLUS, SIR, INFORMATION ON THE 22 SPECIFICS OF MR. GRASSO'S EXPOSURE AND WHERE 23 HE LIVED. 24 Q. BUT WITH RESPECT TO THE -- THE 25 CASES THAT YOU HAVE TOLD US ABOUT TODAY TST60TTZ OR. EPSTEIN MR . RENNE I S EN 19 5 1 NOT MR. GRA-SSO'S CASE, BUT THE ACCOUNTANT IN 2 CONNECTICUT AND THE 83 YEAR OLD WOMAN, 3 WHEREVER SHE LIVED, THOSE CASES YOU GOT FROM 4 THE LITERATURE. 5 A. CORRECT, SIR. 6 Q. YOU DIDN'T SEND OUT QUESTIONNAIRES 7 YOURSELF TO PATHOLOGISTS AROUND THE COUNTRY 8 AND COLLECT THE DATA YOURSELF? 9 A. NO. 10 Q. IS THAT RIGHT? 11 A. NO . 12 Q. SO THE PRINCIPAL SOURCE OF YOUR 13 INFORMATION ARE ARTICLES WRITTEN 8Y OTHER 14 REPUTABLE DOCTORS WHO HAVE THEM PUBLISHED IN IS REPUTABLE JOURNALS? 16 A. BUT LET ME MAKE IT CLEAR THAT WHEN 17 YOU GO TO THE SCIENTIFIC LITERATURE, YOU 18 DON'T NECESSARILY GO THERE LOOKING FOR 19 OPINIONS. YOU GO THROUGH LOOKING FOR FACTS. 20 WHAT I'VE GOT OUT OF THE LITERATURE ARE FACTS 21 AND THE FACTS ARE THIS: THERE ARE A WIDE 22 RANGE OF CASES OF ANGIOSARCOMA IN PEOPLE 23 LIVING CLOSE TO PLANTS, ONE, 24 TWO, THERE ARE ANGIOSARCOMAS 25 AND OTHER MALIGNANCIES IN PEOPLE LIVING CLOSE ZgXGOTTZ BFG09872 DR . EPSTE IN MR. RENNE I SEN 19S 1 TO PLANTS AND PEOPLE WORKING WITH INDUSTRIES 2 IN SHORT LATENCIES. 3 THREE, WE KNOW he LIVED HERE 4 A PLANT. WE KNEW THERE WERE A LOT OF 5 EMISSIONS. SO, WE KNOW NATIONAL ENVIROMENTAL 6 7 Q. EXCUSE ME, DOCTOR. DO YOU KNOW WHAT 3 QUESTION YOU'RE ANSWERING. BECAUSE I DON'T. 9 A. I CAN TELL YOU THE QUESTION THAT YOU 10 ASKED ME IS WHAT INFORMATION I GOT FROM THE 11 LITERATURE WHICH E N ARLES ME TO COME UP WITH 12 INFERENCES IN THIS AREA. 13 Q. MAY3E WE'LL GO BACK TO THE QUESTION, 14 DOCTOR. OR LET'S GO ON. 15 A. 16 Q. SURE. I THINK I ASKED, DO YOU RELY ON THE 17 LITERATURE. I DON'T THINK I ASKED YOU WHAT 18 19 A. I SEE. I RELY ON THE FACTS IN THE 20 LITERATURE. 21 Q. ALL RIGHT. YOU RELY ON THE FACTS IN 22 THE LITERATURE. 23 A . YES . 24 Q. THERE IS LITERATURE!? WHICH INDICATES, 25 SAY, A POCKET OF PEOPLE IN WISCONSIN WHERE 21103153 BFG09873 C R SS - DR. EPSTEIN - MR. RENNEISEN I97 1 THERE'S NO PLANTS AT ALL AND THERE'S AN 2 UNEXPLAINED GROUPING OF ANGIOSARCOMAS; ISN'T 3 THAT TRUE? 4 A. YES, THE MARSHALL FIELD CLINIC AREA . 5 Q. THAT'S RIGHT. AND THAT'S OTHER data 6 THAT YOU CONSIDER 7 A. .MOST CERTAINLY. 8 Q. AND AGAIN, THE DATA THAT YOU ARE 9 CONSIDERING, WHETHER IT BE OPINIONS OR FACTS 10 COMES OUT OF THE LITERATURE THAT YOU READ? 11 A. CORRECT. 12 MR. RENNEISEN: THANK YOU, 13 DOCTOR. THAT'S ALL I HAVE. 14 THE COURT: ANY REDIRECT? 15 MR. VASSALOTTI: JUST A FEW, 16 YOUR HONOR. 17 BY MR. VASSALOTTI: 18 Q. DOCTOR, THERE'S BEEN SOME TESTIMONY 19 A80UT THE STEROIDS. I DON'T' RECALL THE FULL 20 NAME OF THE STEROIDS? 21 A. ANABOLIC STEROIDS. 22 Q. THAT ARE A POSSIBLE -- IMPLICATED 23 AS A POSSIBLE CAUSE OF ANGIOSARCOMA OF THE 24 LIVER. 25 DOCTOR AS PART OF THE 2X109154 BFG09874 SE DR . EPS TE IN MR. VASSALOTTi 198 I MATERIALS THAT WERE PROVIDED TO YOU WITH 2 REGARD TO INFORMATION ON THE MEDICAL HISTORY 3 OF MR. GRASSO, DID YOU RECEIVE LETTERS FROM 4 THREE OF MR. GRASSO'S PERSONAL PHYSICIANS 5 THAT DA/ TE BACK TO 195G? 6 A. YEAH, I'VE GOT SEVERAL LETTERS ON 7 THIS AND, YEAH, I'VE GOT THREE LETTERS, 8 THAT S RIGHT. 9 Q. AND DO THOSE LETTERS PURPORT TO 10 DESCRI8E ALL THE MEDICATIONOR DRUGS THAT 11 WERE ADMINISTERED OR PRESCRIBED TO MR. GP.ASSO 12 BY THOSE DOCTORS? 13 A. THAT'S CORRECT. 14 Q. ARE THERE IS MR. RENNEISEN: I OBJECT TO 16 THIS LINE OF QUESTIONING. 17 THE COURT: I'LL SUSTAIN THAT. 18 MR. VASSALOTTI: EXCUSE ME, 19 YOUR HONOR. 20 the court: sustain the 21 OBJECTION. 22 MR. VASSALOTTI: YOUR HONOR, 23 MAY WE APPROACH THE BENCH? 24 THE COURT: SURE. h* s 25 (SIDE BAR ON RECORD.) BFG09875 Ol v\ 1 R c CT DR. EPSTEIN MR. VASSALOTTI 199 1 MR. VASSALOTTI: FIRST, I'D 2 LIKE TO NO WHAT THE BASIS OF THE OBJECTION IS. 3 THE COURT: I ASSUME IT'S A 4 HEARSAY OBJECTION OF THE CASES. 5 MR. RENNEISEN: IT'S HEARSAY 6 AND IT DOESN'T FALL IN THE MEDICAL RECORD 7 EXCEPTION BECAUSE THEY WERE NOT MADE FOR THE 8 PURPOSE OF TREATMENTS. THEY WERE GIVEN TO 9 THIS DOCTOR FOR THE TESTIFYING. 10 THE COURT: I ASSUMED THAT 11 WAS THE BASIS HE WAS OBJECTING ON. 12 MR. VASSALOTTI: THERE IS A 13 RULE, AS I UNDERSTAND, ON THE FEDERAL RULES 14 OF EVIDENCE, IF DOCTOR EPSTEIN SAID HE WOULD 15 RELY ON INFORMATION LIKE THIS, THEN 16 THE COURT: WELL, IT WOULD BE 17 USED NOT FOR THE TRUTH. HE WAS BEGINNING TO 18 ASK HIM 19 MR. RENNEISEN: IT'S -- IT 20 DOESN'T GET INTO EVIDENCE UNDER THE HEARSAY 21 RULE.- 22 MR. VASSALOTTI: I UNDERSTAND. 23 THE RULES -- AS AN EXPERT, IF HE WOULD RELY 24 UPON STATEMENTS BY A MAN'S PERSONAL PHYSICIAN 25 AS TO THE TYPE OF MEDICATION THAT WAS 9STG0TT2 BFG09876 R E RECT DR . EPSTEIN MR. VASSALOTTI 200 1 PRESCRIBED TO THAT MAN ON THE WAYS OF 2 DETERMINING WHAT CAUSED THE MAN'S CANCER, 3 UNDER THE FEDERAL RULES OF EVIDENCE, THAT'S 4 AN EXPERT'S REPORT UPON 5 THE COURT: LET ME ASK YOU 6 THIS: HAVE YOU SEEN THE LETTERS ? 7 MR . RENNEISEN: NO, SIR. 8 THE COURT: WHY DON'T YOU 9 SHOW HIM THE LETTERS 10 MR . RENNEISEN: THAT'S NOT 11 GOING TO CHANGE MY OPINION. 12 THE COURT: I UNDERSTAND. 13 MR. VASSALOTTI: JUDGE, I CAN 14 TE;; YOU, I WROTE TO THE PHYSICIANS, WILL YOU 15 PLEASE TELL ME EVERY DRUG YOU PRESCRIBED ON 16 THIS MAN. THE LETTERS WERE SENT TO ME. I SENT 17 THEM TO DOCTOR EPSTEIN. 18 MR. RENNEISEN: THAT CONFIRMS 19 THE BASIS FOR MY OBJECTION. IF YOU'RE GOING 20 TO PROVE HE HAD NO STEROIDS, YOU'VE GOT TO 21 BRING THOSE DOCTORS IN. 22 THE COURT: LET ME ASK YOU 23 THIS: INFORMATION WAS GIVEN TO THIS WITNESS 24 ON WHICH HE BASED HIS OPINION, TOO, FROM 25 EXPERTS WHICH IT'S TECHNICALLY HEARSAY ALSO, ASTGOTTZ BFG09877 RECT DR . EPSTEIN MR . VA5S4L0TT I 201 1 . TOO . 2 MR. renneisen: NOBODY 3 OBJECTED. 4 THE COURT: WELL/ I'M GOING 5 TO REVERSE MYSELF AND ALLOW IT 6 (THE FOLLOWING TAKES PLACE IN 7 OPEN COURT.) 8 BY MR. VASSALOTT I : 9 Q. DOCTOR, DID YOU REVIEW THE LETTERS 10 FROM/ I BELIEVE IT WAS DOCTORS ROZANSKI, 11 DE PERSIA AND GILPATRICK? 12 A. YES, SIR. 13 Q. WAS THERE ANY INDICATION IN ANY OF 14 THOSE LETTERS THAT MR. GRASSO RECEIVED ANY 15 STERO IDS? 16 A . N0, S I R . 17 Q. DOCTOR, DURING YOUR 18 CROSS-EXAMINATION, YOU MENTIONED THAT E.P.A. 19 ENACTED A NATIONAL EMISSION STANDARD FOR THE 20 EMISSION OF VINYL CHLORIDE IN -- I THINI^ JT 21 WAS OCTOBER OF 1975? 22 A. THAT'S CORRECT. 23 Q. ARE YOU FAMILIAR WITH THE FINDINGS 24 THAT THE ENVIRONMENTAL PROTECTION AGENCY MADE 25 AND RELIED UPON AND UPON WHICH THEY BASED 21109158 BFG09878 RE DR. EPSTEIN MR. VASSALOTTI 202 1 THEIR STANDARD? 2 A. YES, I WAS A MEMBER OF AN E.P.A. 3 ADVISORY COMMITTEE THAT CAME UP WITH THIS 4 RECOMMENDATION AT THE TIME. 5 Q. CAN YOU DESCRIBE FOR US THE FINDINGS 6 THAT WERE MADE 8Y E.P.A. AND UPON WHICH THEY 7 3 A S E THEIR CONCERN ABOUT EMISSION OF VINYL 8 CHLORIDE? 9 A. YES, I THINK I CAN . 10 MONITORING STUDIES BY THE 11 ENVIRONMENTAL PROTECTION AGENCY IN 1974 HAD 12 DEMONSTRATED AVERAGE LEVELS OF 17 PARTS PER 13 BILLION IN THE VICINITY OF A RANGE OF PLOTS. 14 IT WAS ASSUMED -- IT WAS BELIEVED THAT FOUR 15 POINT SIX MILLION PEOPLE IN THE UNITED STATES 16 WERE LIVING IN THE VICINITY OF PLANTS WITH 17 EXPOSURES ON THE AVERAGE -- I BEG YOUR 18 PARDON -- OF ABOUT 17 PARTS PER BILLION. 19 Q. THAT'S PER BILLION? 20 A. PER BILLION I'M TALKING ABOUT NOW. 21 THE ENVIRONMENTAL PROTECTION AGENCY ESTIMATED 22 THAT WITH THIS LEVEL OF EXPOSURE, ONE COULD 23 ANTICIPATE BETWEEN 24 MR. RENNEISEN: YOUR HONOR, 25 AT THIS POINT, I OBJECT. IT'S THE OPINION OF 21109159 BFG09879 ^& DR. EPSTEIN MR. VASSALOTTI 203 1 A REGULATORY AGENCY WITH -2 THE WITNESS: THESE ARE 3 FIGURES -- 4 MR. VASSALOTTI: YOUR HONOR, 5 IT'S EXACTLY THE POINT. IT'S A FINDING OF A 6 GOVERNMENT AGENCY AND IT CLEARLY FALLS WITHIN 7 THE EXCEPTION OF RULE 8038. 8 THE COURT: ALLOWED. 9 OVERRULED. LET'S PROCEED. 10 THE WITNESS: THE 11 ENVIRONMENTAL PROTECTION AGENCY CALCULATED 12 THAT WITH THIS KIND OF LEVEL OF EXPOSURE, 13 THEr COULD ANTICIPATE BETWEEN LESS THAN ONE 14 AND TEN ANGIOSARCOMAS A YEAR. FOR THESE IS GROUNDS, THEY FELT IT WAS ESSENTIAL TO REDUCE 16 THE LEVELS OF VINYL CHLORIDE EMISSION. THE 17 NEW STANDARD OF THE ENVIRONMENTAL PROTECTION 18 AGENCY WAS DESIGNED TO REDUCE THE EMISSION BY 19 90 PERCENT. 20 NOW, WE WERE TALKING THERE 21 ABOUT 17 PARTS PER BILLION. AND ON THE 17 22 PARTS PER BILLION LEVEL SPREAD OVER FOUR 23 POINT SIX MILLION PEOPLE, UP TO TEN 24 AN-GIOSARCOMAS A YEAR WERE ESTIMATED. WE'RE 25 NOW TALKING IN THIS INSTANCE -- WELL, 21109160 BFG09880 IRECT -OR. EPSTEIN -MR. VASSALOTTI 204 I PERHAPS THIS ISN'T -- THIS ISN'T IN 2 RESPONSE TO THE QUESTION. 3 THE COURT: WELL, LET IT RE 4 IN RESPONSE TO THE QUESTION, OR OTHERWISE YOU 5 CAN'T. 6 BY NR. VASSALOTTI: 7 Q. THAT WAS NY NEXT QUESTION, DOCTOR. 8 THE E.P.A. CONSIDERED LEVELS OF 17 PARTS PER 9 BILLION IN THEIR FINDINGS UPON WHICH THEY 10 BASE THEIR STANDARDS; IN THIS CASE -- AND 11 IS IT TRUE THAT BASED UPON THOSE LEVELS OF 12 EXPOSURE, THE E.P.A. CONSIDERED THAT THERE 13 WAS AN EXCESS RISK OF ANGIOSARCOMA AS A 14 RESULT OF THE VINYL CHLORIDE EXPOSURE? 15 A. CORRECT, SIR. 16 Q. AND THE LEVELS WE'RE TALKING ABOUT 17 IN THIS CASE ARE IN THE PARTS PER MILLION -- 18 WHEN I SAY THIS CASE WE'RE TALKING ABOUT 19 GRASSO -- THAT YOU'RE BASING YOUR OPINION 20 ON? 21 A. 3ASED ON THE DATA WHICH HAVE BEEN 22 SUBMITTED TO ME BY DOCTOR PESKIN, THAT 23 APPEARS TO BE THE CASE. EVEN THE DAMES AND 24 MOORE DATA WOULD BE CONSISTENT WITH THE 25 ESTIMATE OF THE E.P.A. 21103161 BFG09881 R E I RECT OR . EPSTEIN MR. V A S S A L 0 T T l 205 1 THE COURT: ANYTHING FURTHER? 2 MR. VASSALOTTI: YOUR HONOR, 3 EXCUSE ME. 4 BY MR. VASSALOTTI: 5 Q. DOCTOR EPSTEIN, THERE HAS BEEN SOME 6 MENTION OF ARSENIC BEING USED IN PESTICIDES. 7 DO YOU HAVE ANY INFORMATION RELATING TO 8 SHOWING THAT ARSENIC OR ARSENIC COMPOUNDS 9 CONTAINED IN PESTICIDES ARE CAUSEDLY RELATED 10 TO ANGIOSARCOMA OF THE LIVER? 11 A. ARSENIC CERTAINLY IS A CAUSE OF 12 ANGIOSARCOMA. AND IF THE ARSENIC IS 13 WHETHER IT'S CONTAINED IN A PESTICIDE OR ANY 14 OTHER PRODUCT, I WOULD CERTAINLY WISH TO 15 CONSIDER THIS. 16 Q. DOCTOR, IF -- AND I SAY IF BECAUSE 17 IT HASN'T BEEN SHOWN -- SOMEONE LIKE MR. 18 GRASSO HAD BEEN EXPOSED TO SOME UNKNOWN 19 LEVELS OF PESTICIDES THAT CONTAINED ARSENIC 20 AND WAS THEN EXPOSED TO THE VINYL CHLORIDE 21 THAT WE'VE TALKED ABOUT IN THIS CASE, IS 22 THERE ANY MEDICAL EVIDENCE OR SCIENTIFIC 23 EVIDENCE TO INDICATE THAT THE TWO CANCER 24 CAUSING AGENTS WOULD WORK TOGETHER? 25 A. WELL, LET ME ANSWER THIS GENERALLY Z9TSOTTZ BFG09882 R l RECT DR . EPSTE IN MR. VASSALOTTI 205 1 AND THEN SPECIFICALLY. FROM A GENERAL 2 STANDPOINT, WE HVE VERY, VERY SU3STANTIAL 3 LITERATURE TO SHOW THE EFFECTS OF A CHEMICAL 4 CARCINOGEN. IT CAN RE WHAT WE CALL SINOGISED. 5 THAT'S THE EFFECTS CAN 8E MULTIPLIED BY 6 EXPOSURE EITHER BEFORE OR AFTERWARDS TO 7 ANOTHER CHEMICAL OR TO ANOTHER CHEMICAL 8 CARC INOGEN. AND THERE'S A LOT OF LITERATURE 9 ON THIS PRACTICE 10 BUT LET ME BE MORE SPECIFIC 11 AS FAR AS VINYL CHLORIDE IS CONCERNED. 12 THERE'S ONE VERY CRITICAL 13 EXPERIMENT WHICH l VERY MUCH REGRET THAT I 14 NEGLECTED TO INFORM THE COURT ABOUT THIS IS MORNING WHICH YOU JUST TRIGGERED ME. AND THAT 16 IS A STUDY BY A DOCTOR RADICKE FROM 17 CINCINATTI WHICH WAS REPORTED AT THE 18 CONFERENCE, A GOVERNMENT CONFERENCE ON VINYL 19 CHLORIDE IN THE SPRING OF 1980. AND WHAT SHE 20 DID WAS QUITE FASCINATING IN THIS CONTEXT. 21 SHE TOOK SOME RATS, SPAYED OR NEUTERED RATS 22 AND DOSED THEM WITH ALCOHOL, NONE 23 NON-CARCINOGEN. SHE THEN GAVE THE RATS WHICH 24 WERE DOSED WITH ALCOHOL SOME VINYL CHLORIDE. 25 AND THE RATS WHICH HAD VINYL CHLORIDE WITH C9TG0iTTZ BFG09883 R E IRECT - DR. EPSTEIN - MR. VASSALOTTI 207 1 ALCOHOL PRE-TREATMENT GOT A SINOGISTIC EFFECT 2 IN RELATION TO TWO THINGS: A VERY, VERY, 3 MARKED INCREASE IN THE INCIDENCE OF 4 ANGIOSARCOMA AND AN INCREASE IN HEPATIC 5 CANCERS WHICH ARE DIFFER FROM ANGIOSARCOMAS. 6 SO, THE PRE-TREATMENT, THE MODEST 7 PRE-TREATMENT OF THE RATS WITH THE EQUIVALENT 3 OF A FEW DOUBLE MARTINIS AND WHAT HAVE YOU 9 I HAVEN'T TRANSLATED THE DOSE INTO EXACT 10 ALCOHOL CONCENTRATIONS -- MASSIVELY 11 rS I NOG IS ED THE INCIDENCE OF ANGIOSARCOMAS OF 12 THE LIVER IN RATE AND ALSO HEPATIC CANCER. 13 THE COURT: COULD YOU DEFINE 14 ' S I NOG I SED^O EVERYONE KNOWS WHAT THAT TERM IS. 15 THE WITNESS: I'M SORRY, I 16 SHOULD HAVE DEFINED MY TERMS. LET US SAY YOU 17 HAVE AN AGENT -- LET'S SAY YOU GIVE 18 SOMEBODY -- YOU GIVE A POPULATION OF RATS A 19 DOSE OF ONE CARCINOGEN WHICH GIVES THEM TEN 20 PERCENT CANCER, OKAY, AND A DOSE OF ANOTHER 21 CARCINOGEN WHICH ALONE WOULD GIVE FIVE 22 PERCENT. SO, YOU'D EXPECT WHEN YOU PUT THE 23 TWO TOGETHER, YOU'D GET 15 PERCENT, WOULDN'T 24 YOU. THAT WOULD BE AN ADDITIVE EFFECT. TEN 25 PERCENT OF CANCER IN ONE SET OF EXPERTS. YOU W TG 0TTZ BFG09884 a E UECT - OR. EPSTEIN - MR. VASSAUOTTI 203 1 GET TEN PERCENT FROM THE CHEMICAL. ANOTHER 2 SET OF EXPERTS, YOU GET ANOTHER FIVE PERCENT. 3 BUT, IN FACT, WHEN YOU PUT THE TWO TOGETHER, 4 IF YOU GET 15 PERCENT, THAT MEANS IT'S A 5 MULTIPLICATIVE ACTION OR SINOGIST EFFECT. SO, 6 A SINOGISTTS EFFECT IS GREATER THAN YOU COULD 7 ANTICIPATE FROM THE MERE ADDITION OF THE TWO 8 THINGS TOGETHER. SO, ALCOHOL BY ITSELF IS 9 THE LITERATURE ON THE CARCINOGENICITY OF 10 ALCOHOL IS COMPLEX WHICH I REALLY WON'T 11 DEVOTE ANY TIME TO. BUT A SMALL PRE-TREATMENT 12 WITH ETHYL ALCOHOL PROOUCEO A VERY, VERY 13 MAJOR INCREASE. IN THE CARCINOGENIC EFFECTS OF 14 VINYL CHLORIDE. 15 NOW, FOR THIS REASON, I THINK 16 WHAT WE -- WHAT WE NOW HAVE TO CONSIDER IS 17 WHETHER -- THE POSSIBILITY AS TO WHETHER IF 18 HE HAD EXPOSURE TO ARSENIC OR IF HE HAD 19 EXPOSURE TO OTHER CARCINOGENS OR SOME NON 20 CARCINOGENS AT DUPONT, WHETHER THESE MIGHT 21 POSSIBLY HAVE CONTRIBUTED SOMEWHAT. WE'RE 22 DEALING WITH A PRIME CAUSE WHICH IS THE VINYL 23 CHLORIDE. IN MY OPINION, THE VINYL CHLORIDE 24 IS THE AGENT FOR WHICH THERE IS A SUBSTANTIAL 25 PROBABILITY. BUT I'M UNWILLING TO EXCLUDE THE 21103165 BFG09885 R c I RECT DR. EPSTEIN MR. VASSALOTTI 209 1 FACT THAT AN EXPOSURE OF PRIOR EXPOSURE TO 2 ARSENIC OR PRIOR EXPOSURE'TO SOME OF THESE 3 OTHER AGENTS MAY HAVE HAD AN ADDITIONAL 4 CONTRIBUTORY ROLE . AND ONE REASON WE MAY WISH 5 TO CONSIDER THAT IS BECAUSE OF THE WHOLE 6 HISTORY. WE DO KNOW AT DUPONT, HE WAS EXP 0 SED 7 TO OTHER CHEMICALS, ALTHOUGH MY LEVEL OF 8 INFORMATION ON THE NATURE OF THIS EXPOSURE IS 9 NOT OF A HIGH ORDER. NONE OF THESE AGENTS 10 WHICH HE WAS EXPOSED TO AT DUPONT WERE KNOWN 11 TO INDUCE ANGIOSARCOMA OF THE LIVER, HOWEVER. 12 THE COURT: LET'S PROCEED. 13 MR. VASSALOTT I : I HAVE 14 NOTHING FURTHER, YOUR HONOR. 15 THE COURT: REDIRECT 16 RECROSS. 17 MR. renneisen:- THANK YOU. 18 RECROSS-EXAMINATION 19 BY MR. RENNEISEN: 20 Q. THERE, THIS SINOGISTIC EFFECT YOU 21 JUST TALKED ABOUT, THAT APPLIES TO EVERYBODY, 22 DOESN'T IT, NOT JUST MR. GRASSO? 23 A. WHAT APPLIES TO EVERYBODY? 24 Q. A SINOGISTIC EFFECT WHEN THERE'S A 25 CERTAIN COMBINATION OF CHEMICALS OR DRUGS IS 99TG0TTZ BFG09886 R OR. EPSTEIN MR. RENNEISEN 21Q 1 A CONDITION THAT IS PRESENCE IN RATS AND 2 PEOPLE AND CHIMPANZEES AND EVERYONE ELSE, 3 ISN'T IT? 4 A. YOU CAN DEMONSTRATE SINOGISTIC 5 EFFECTS. 6 Q. IN ANYBODY, ISN'T THAT TRUE? 7 A. IF ONE HAS THE APPROPRIATE 8 CONDITIONS FOR THE INDUCTION OF THE SINOGISM, 9 SURE. TOO MUCH EXPOSURE TO A PARTICULAR 10 CHEMICAL CARCINOGEN WHICH INDUCES A 11 CARCINOGENIC EFFECT AND IN ADDITION TO THAT, 12 SOME OTHER CHEMICALS CAN S I NOG I SE AND WE 13 HAVE THE LITERATURE ON THIS BOTH I N ANIMALS 14 AND HUMANS. I DON'T KNOW I F TH I S I S WHAT IS YOU ' RE ASKING ME. 16 Q. THAT'S FINE, DOCTOR. HOW MANY CASES 17 OF ANGIOSARCOMA DID THE E.P.A. FIND WITHIN 18 THOSE FOUR POINT SIX MILLION PEOPLE WHO LIVE 19 AROUND PVC PLANTS? 20 A. I DON'T THINK AT THE TIME THEY HAD 21 DONE ANY STUDIES. THEY WERE -- THAT 22 PARTICULAR -- THAT REPORT, THE SO CALLED 23 STAR REPORT IN 1975, BASICALLY DID TWO THINGS: 24 IT LISTED ALL THE KNOWN CASES OF ANGIOSARCOMA 25 AND IT INCLUDED ALSO THOSE TWO CASES WITH 21103167 BFG09887 DR. EPSTEIN MR. RE N N E I S E N 211 1 SHORT LATENCY PERIODS AND ALSO THEY REPORTED 2 ON MONITORING AND MODELING STUDIES. AND AMONG 3 OTHER THINGS, IT REPORTED ON A STUDY P, Y THE 4 AMERICAN PU3LIC HEALTH ASSOCIATION ON THE 5 NUMBER OF PEOPLE LIVING IN THE VICfNITY OF 6 PLANTS. THEY PUT ALL THE DATA TOGETHER AND 7 SAID ON THE BASIS OF OUR MONITORING DATA, WE 8 THINK THAT THE LEVELS OF VINYL CHLORIDE IN 9 PEOPLE LIVING CLOSE TO VINYL CHLORIDE PLANTS 10 IS ON THE AVERAGE 17 PARTS PER 3ILLION. WE 11 ESTIMATE ON THE BASIS OF THE AMERICAN PUBLIC 12 HEALTH ASSOCIATION DATA FOUR POINT SIX PEOPLE 13 LIVE IN THESE AREAS. THEY PUT THE TWO 14 TOGETHER AND THEY CAME UP WITH THESE IS EST IMATES. 16 NOW, I'M WILLING TO CRITICIZE 17 THESE ESTIMATES. I THINK IT'S VERY DIFFICULT 18 TO MAKE THESE QUANTITIES TAKE THE DIFFERENT 19 ESTIMATES. BUT THE BEST GOVERNMENT ESTIMATES 20 AT THE TIME WAS WE CAN ANTICIPATE IN THE 21 COMMUNITIES BETWEEN LESS THAN ONE -- HE 22 DIDN'T SAY HOW MUCH LESS THAN ONE UP TO TEN. 23 THAT'S A BROAD RANGE. WHEN IT'S LESS THAN ONE, 24 IT COULD BE ZERO POINT ZERO ZERO ONE. GOD 25 KNOWS. BUT THEY WERE CONCERNED ABOUT IT 21103168 BFG09888 ROSS OR. EPSTEIN MR. RENNEISEN 212 1 EN OUGH TO SAY ON THE BASIS OF these FINDINGS, 2 W E ARE DETERMINED TO LIMIT THE amount of 3 EMISSIONS from PVC 90 PERCENT. 4 Q. ANO YOU WEREN'T CONSULTANT AT THAT 5 T IME? 6 A. I WAS OPERATING ON E . P . A . AT SEVE RAL 7 -- -- I WAS A CONSULTANT AND EXPERT WITNESS I N 8 THEIR SPECIAL CANCER HEARINTGS ON PESTICIDES 9 BUT I WAS ALSO A MEMBER OF THE ENVIRONMENTAL 10 HEALTH ADVISORY COMMITTEE AND A SUBCOMMITTEE 11 WHICH WAS CONSIDERING SOME OF THE DATA WHICH 12 WE WERE LOOKING AT. 13 Q. AFTER THIS ESTIMATE WAS MADE, DID 14 ANYBODY GO OUT AND FIND OUT HOW MANY CASES 15 THERE WERE? 16 A. WE'RE DOING JUST THIS KIND OF THING 17 NOW, BECAUSE THERE HASN'T BEEN 18 Q. WHO IS WE? 19 A. WE ARE CONSIDERING HERE IN THIS 20 COURT 21 THE COURT: I THINK HE WANTS 22 TO KNOW WHO IS WE. 23 THE WITNESS: WE IN THIS 24 COURT, SIR, ARE CONSIDERING JUST ONE OF THESE 25 CASES, NAMELY A MR. GRASSO. 21109163 BFG09889 RE DR. EPSTEIN MR. RENNE I SEN 2I3 1 BY MR. RENNEISEN: 2 Q. YOU MEAN IN THIS ROOM? 3 A. WE ARE CONSIDERING ONE COMMUNITY'S 4 CANCER CASE. THERE HASN'T BEEN A SYSTEM IZED 5 STUDY OF THIS WHOLE PROBLEM OF COMMUNITY 6 CANCER. BUT THE ENVIRONMENTAL PROTECTION 7 AGENCY WAS CONCERNED SIX YEARS AGO BY THE 8 FACT THIS THIS LEVEL OF EXPOSURE COULD 9 PRODUCE UP TO 120 CANCERS EVERY YEAR. NOW, 10 IT'S INADDITION TO 11 Q. IT'S PRODUCED TEN CANCERS? 12 A. WELL, THIS WAS THEIR ESTIMATE. 13 SHORTLY AFTER THAT, LEVELS WERE PRODUCED. NOW, 14 THERE HAVE BEEN STUDIES WHICH I REFERRED TO 15 THIS MORNING,, QUITE APART FROM THE 16 ANGIOSARCOMAS OF EXCESS BRAIN TUMORS OF 17 LIVING IN THE VICINITY OF PLANT. NOW, I CAN'T 18 GIVE YOU ABSOLUTE CLEARCUT ANSWERS TO THESE 19 THINGS BECAUSE WE DON'T KNOW. ALL WE KNOW IN 20 THIS CASE IS SOMEBODY WAS EXPOSED TO LEVELS 21 OF VINYL CHLORIDE WHICH APPEAR TO HAVE BEEN A 22 GREAT DEAL HIGHER THAN THOSE WHICH CONCERNED 23 THE ENVIRONMENTAL PROTECTION AGENCY SO MUCH 24 AS TO ORDER INDUSTRY TO REDUCE ITS EMISSION 25 BY 90 PERCENT. THAT SPEAKS FOR ITSELF. OZ.TGOTTZ BFG09890 ROSS - OR E P S T E IN MR. R E N N E I SEN 214 1 Q. ALL RIGHT. I HEARD YOU SAY THAT. HAS 2 ANYBODY CHECKED THAT DATA? DO WE, THE 3 Informed public, the doctor epsteins of the 4 WORLD, The MEDICAL COMMUNITY, E.P.A., KNOW 5 HOW MANY ANGIOSARCOMAS ARE IN THAT GROUP OF 6 PEOPLE? 7 A. ONE OF THE THINGS IN THIS COUNTRY IS 8 WE DON'T HAVE A NATIONAL TUMOR INDEX. WE 9 DON'T KNOW THE CAUSE OF DEATH OF EVERYBODY IN 10 THIS COUNTRY. WE DON'T HAVE AN AUTOPSY OF 11 EVERYBODY IN THIS COUNTRY. PEOPLE -- IT'S 12 IMPOSSIBLE TO ANSWER THAT. WE DO HAVE SURVEYS. 13 FOR INSTANCE, THE THIRD NATIONAL CANCER 14 SURVEY OR THE SEARS PROGRAM. THESE ARE BASED 15 ON TEN PERCENT OF THE AMERICAN POPULATION. IN 16 CONNECTICUT, YOU HAVE A GOOD TUMOR REGISTRY. 17 I CAN'T ANSWER YOU THESE QUESTIONS, BECAUSE 18 WE DON'T HAVE A DATA BANK IN THIS COUNTRY 19 WHICH GIVES YOU INFORMATION ON BIRTH TO DEATH, 20 INCLUDING AUTOPSY ON EVERY SINGLE ONE OF THE 21 220 MILLION AMERICANS. 22 Q. I WAS ONLY ASKING ABOUT FOUR MILLION 23 FOUR POINT SIX MILLION PEOPLE THAT I 24 THOUGHT THAT YOU AMD THE E.P.A. WERE 25 CONCERNED ABOUT. CO BFG09891 Rc DR. EPSTEIN MR. R E N N E I 5 E N 21 5 1 A. SIR, WE DON'T HAVE A DATA BANK 2 COVERING THE WHOLE OF THE U.S.- THERE ARE 3 CONCERNS OVER A WIDE RANGE OF ISSUES, NOT 4 ONLY THE VINYL CHLORIDE ISSUE. THE CONCERN 5 THEN RELATED TO FOUR AND A HALF MILLION 6 PEOPLE AND I THINK I'M BEING REPETITIVE AND 7 THE CONCERN WAS ADEQUATE TO RESULT IN THIS 8 REDUCTION OF EMISSION. BUT THERE HASN'T BEEN 9 A SPECIFIC FOLLOW UP OF THESE FOUR POINT SIX 10 MILLION PEOPLE. THERE HASN'T BEEN A DETAILED 11 FOLLOW UP OF THEM. THERE HASN'T SEEN A FOLLOW 12 UP OF THE PEOPLE WHO WERE GIVEN VINYL ' 13 CHLORIDE AS AN ANES-THETIC AGENT. 14 Q. SINCE THERE'S NO FOLLOW UP TO FIND 15 OUT WHAT HAPPENS TO THIS FOUR POINT SIX 16 MILLION PEOPLE, IS IT FAIR THEN, DOCTOR, TO 17 SAY, WE DON'T KNOW WHETHER THERE'S A HIGHER. 18 INCIDENTCE OF ANGIOSARCOMA CLOSE TO POLYVINYL 19 PLANTS OR NOT? 20 A. I THINK ON THE BASIS OF THE ABSENCE 21 OF INFORMATION, THE ANSWER WOULD BE YES. 22 HOWEVER, AS I'VE INDICATED, I GAVE YOU A LIST 23 OF A WHOLE SERIES OF ANGIOSARCOMAS, WHICH HAD 24 OCCURRED IN PEOPLE LIVING IN THE VICINITY OF 25 PLANTS. THAT IS w BFG09&92 2110917; 1 i DR. .EPSTEIN MR. RENNE I SEN 21S 1 Q. YOU'VE GIVEN ME EIGHT OUT OF FOUR 2 POINT FOUR MILLION PEOPLE? 3 A. NO, SIR, I HAVEN'T. I'VE GIVEN YOU 4 EIGHT OUT OF A VERY SMALL NUMBER OF THE TOTAL 5 NUMBER OF ANGIOSARCOMAS WHICH ARE RECOGNIZED. 6 OF THE TOTAL NUMBER OF ANGIOSARCOMAS THAT ARE 7 RECOGNIZED, WE HAVE, I WOULD SAY, A FAIRLY 8 SUBSTANTIAL NUMBER OF COMMUNITY CANCERS. 9 Q. HOW MANY OUT OF FOUR POINT SIX 10 MILLION? 11 A. FOUR POINT SIX MILLION IS YOUR 12 DENOMINATION. 13 Q. THAT'S YOUR NUMBER. 14 THE COURT: LET'S NOT ARGUE 15 BACK AND FORTH. LET'S GO ON. LET'S MOVE ALONG. 16 MR. RENNE l S EN : [ HAVE NO 17 FURTHER QUESTIONS, JUDGE. 18 THE COURT: ANYTHING FURTHER? 19 MR. VASSALOTTI: JUST ONE 20 QUESTION. 21 BY MR. VASSALOTTI: 22 Q. DOCTOR, I FORGOT TO ASK YOU, WHEN 23 YOU REFER TO THOSE LETTERS OF DOCTOR ROZANSKI, 24 DOCTOR DE PERSIA AND DOCTOR GILPATRICK, 25 DOCTOR, IN YOUR POSITION AS A PHYSICIAN AND CZ.TSOTTJ BFG09893 R E REDIRECT - DR. EPSTEIN - MR. VASSALOTTI 217 1 TOXOCOLOG I ST STUDYING CAUSAL CONNECTIONS 2 CAUSAL RELATIONS 3ETWEEN CHEMICAL SUBSTANCES 3 AND CANCER, WOULD YOU ORDINARILY RELY UPON *44 THE REPORTS OF PHYSICIANS OF THE VICTIMS OF 5 CANCER THAT YOU WERE STUDYING IN FORMING YOUR 6 OPINION. 7 MR. RENNEISEN: OBJECTION. I 8 DIDN'T HEAR ONE QUESTION ASKED ABOUT THAT 9 SUBJECT . 10 THE COURT: I SUSTAIN THE 11 OBJECTION, UNLESS YOU REPHRASE YOUR QUESTION. 12 MR. VASSALOTTI: YOUR HONOR, 13 I'M REFERRING BACK TO -- I AGREE 14 WHOLEHEARTEDLY THAT MR. RENNEISEN DID NOT IS BROACH THIS SUBJECT IN HIS RECROSS. THIS IS A 16 MATTER THAT I OMITTED WHEN I -- WHEN I 17 EXAMINED DOCTOR EPSTEIN IN REGARD TO THIS AND 18 I WANTED TO TIE UP A LOOSE END. THAT'S THE 19 ONLY PURPOSE. 20 THE COURT: ALL RIGHT. I'LL 21 LET YOU DO IT. 22 BY MR. VASSALOTTI: 23 Q. DOCTOR, IN YOUR CAPACITY OR POSITION 24 AS A PHYSICIAN ENGAGED IN THE STUDY OF 25 TOXICOLOGY AND CONSIDERING THE QUESTIONS OF 'A T G O T T Zt BFG09894 R E REDIRECT - DR. EPSTEIN - MR. VASSALOTTI 218 1 THE CONNECTION BETWEEN CANCER CAUSING 2 CHEMICALS AND DEVELOPMENT OF.CANCER, WOULD 3 YOU ORDINARILY RELY UPON.LETTERS WRITTEN FROM 4 PHYSICIANS OF THE VICTIMS OF CANCER THAT YOU 5 W ERE CONSIDERING WHEN SUCH PHYSICIANS REPORT 6 TO YOU INFORMATION REGARDING THE 7 ADMINISTRATION OR PRESCRIPTION OF ANY 8 MEDICATIONS TO THE PAINT?. 9 MR . RENNEISEN: YOUR HONOR 10 I'LL ST IPULATE THE ANSWER IS YES, SO THE 11 DOCTOR DOESN'T HAVE TO ANSWER THE QUE S T I 0 N 12 THE COURT: ALL RIGHT 13 MR . VASSALOTTI: THANK YOU 14 THE COURT: THANK YOU 15 ANYTHING FURTHER NOW? 16 ALL RIGHT. DOCTOR, YOU MAY 17 STEP DOWN. 18 THE WITNESS: THANK YOU, SIR. 19 THE COURT: WHY DON'T YOU JUST 20 STAY RIGHT WHERE YOU ARE FOR THE TIME BEING. 21 THE COURT: LADIES AND 22 GENTLEMEN. GOOD TIME FOR STOP FOR THE DAY. 23 AS I HAVE CAUTIONED YOU 24 BEFORE AND WILL CONTINUE TO CAUTION YOU 25 DURING THE COURSE OF THIS TR I AL, UNT IL THIS h* h* o ca vj BFG09895 R E REDIRECT - DR. EPS TE IN - MR . VASSALOTT I 219 1 CASE IS SUBMITTED TO YOU FOR DELIBERATIONS, 2 YOU MUST NOT DISCUSS THIS CASE WITH ANYONE OR 3 REMAIN WITHIN HEARING OF ANYONE DISCUSSING 4 IT. NEITHER SHOULD YOU READ ANY NEWSPAPER 5 ARTICLE, LISTEN TO ANY RADIO BROADCOAST, NOR 6 VIEW ANY TELEVISION PROGRAM WHICH DISCUSSES 7 THIS CASE. 8 IF, HOWEVER, YOU SHOULD 9 3EC0ME AWARE OF ANY SUCH STORY, ARTICLE OR 10 NEWS REPORT, YOU ARE TO REPORT THAT MATTER TO 11 ME IN MY CHAMBERS AT YOUR EARLIEST 12 OPPORTUNITY SO THAT WE MAY DISCUSS IT. 13 NEEDLESS TO SAY, SHOULD YOU HAVE SUCH 14 EXPOSURE,YOU SHOULD NOT MENTION THAT FACT TO 15 ANY OF YOUR FELLOW JURORS. YOU ARE TO KEEP 16 AN OPEN MIND AND YOU MUST NOT DECIDE ANY 17 ISSUE IN THIS CASE UNTIL THE CASE IS 18 SUBMITTED TO YOU FOR YOUR DELIBERATIONS UNDER 19 THE INSTRUCTIONS OF THE COURT. 20 WE'LL STAND IN RECESS NOW 21 UNTIL TOMORROW MORNING AT 9:30. HAVE A 22 PLEASANT EVENING. 23 (RECESS FOR THE DAY . ) 24 25 21103176 BFG09896 MR VA S SALOTT I 10 1 ONCOLOGY. 2 Q. WHEN AMD FROM WHAT SCHOOL DID YOU* 3 RECEIVE YOUR MEDICAL DOCTOR DEGREE? 4 A. JEFFERSON -- THOMAS JEFFERSON 5 UNIVERSITY MEDICAL COLLEGE 1967. 6 Q. IS THAT IN PHILADELPHIA, H|D 7 PENNSYLVANIA? 8 A. YES. i 9 Q. UPON COMPLETION OF YOUR MEDICAL 10 SCHOOL TRAINING, DID YOU SERVE AN INTERNSHIP? 11 A. YES, I DID . 12 Q. WHERE DID YOU SERVE YOUR INTERNSHIP? 13 A. PHILADELPHIA GENERALHOSPITAL. 14 Q. AND HOW LONG DID YOU SERVE THAT? 15 A. ONE YEAR. 16 Q. AND COULD YOU DESCRI8E BRIEFLY THE 17 DUTIES THAT YOU HAD DURING YOUR INTERNSHIP?. , 18 A. I'D BE RESPONSIBLE FOR THE CARE OF 19 MEDICAL IN PATIENTS AND OUT PATIENTS. 20 Q. IN GENERAL MEDICINE? 21 A. YES. 22 Q. UPON COMPLETION OF YOUR INTERNSHIP, 23 DID YOU SERVE A RESIDENCY? 24 A. YES, I DID. 25 Q. WHAT IS A RESIDENCY? WHAT DOES THAT K BFG09897 - LAUCIUS - MR. VAS SALOTTI 11 1 MEAN? 2 A. WHEN ONE GRADUATES FROM MEDICAL 3 SCHOOL, ONE BECOMES -- IS REQUIRED TO SERVE 4 ONE YEAR AS A PHYSICIAN IN A HOSPITAL SETTING 5 AND THEN ONE GETS A LICENSE TO PRACTICE 6 MEDICINE. DURING INTERNSHIP, UNDER IMMEDIATE 7 SUPERVISION. A RESIDENT IS A FURTHER TRAINING 8 IN WHATEVER FIELD IS DESIRED. 9 Q. SO IT'S FURTHER TRAINING IN A 10 SPECIALIZED FIELD? 11 A. YES. 12 Q. WHERE DID YOU SERVE YOUR RESIDENCY? 13 A. 14 Q. THOMAS JEFFERSON UNIVERSITY HOSPITAL. AND HOW LONG WAS THAT RESIDENCY? 15 A. IT WAS TWO YEARS. 16 Q. AND WHAT FIELD OR AREA OF MEDICINE 17 DID YOU SPECIALIZE IN IN YOUR RESIDENCY AT 18 JEFFERSON ? 19 A. INTERNAL MEDICINE, WHICH IS THE NONE 20 SURGICAL TREATMENT OF ADULTS. 21 Q. IT IS INTERNAL ORGANS OF THE BODY? 22 A. YES. 23 Q. AFTER THE COMPLETION OF YOUR 24 RESIDENCY, DID YOU SERVE ANY ADDITIONAL 25 RESIDENCY OR FELLOWSHIPS TO FURTHER 2000TTTZ BFG09898 LAUC I US MR. VASSALOTTI 12 1 SPECIALIZED 2 A. I WAS A MEDICAL ONCOLOGIC FELLOW, 3 WHICH IS A SUBSPECIALTY OF MEDICINE. 4 Q. WHERE DID YOU SERVE THIS FELLOWSHIP? 5 A. I SERVED O.NE YEAR AT JEFFERSON 6 UNIVERSITY HOSPITAL AND ONE YEAR AT AMERICAN 7 ONCOLOGIC HOSPITAL, BOTH IN PHILADELPHIA. 3 Q. NOW, UPON COMPLETION OF YOUR 9 FELLOWSHIP, DID YOU BEGIN TO WORK IN THE 10 PRIVATE PRACTICE OF MEDICINE? 11 A. YES, I DID. 12 Q. IS THERE ANY PARTICULAR AREA OF 13 MEDICINE THAT -- IN WHICH YOU RESTRICT YOUR 14 PRACTICE OR SPECIALIZE IN? 15 A. 16 Q.. MEDICAL ONCOLOGY. CAN YOU DESCRIBE FOR US WHAT 17 ONCOLOGY IS AND WHAT AN ONCOLOGIST DOES? 18 A. IT COMES IN A GREEK WORD MEANING 19 CANCER, GROWTHS, AND IT HAS TO DO WITH THE 20 DIAGNOSIS, TREATMENT, PREVENTION OF CANCER. 21 Q. DOES ONCOLOGY -- DO YOU AS AN 22 ONCOLOGIST ALSO CONCERN YOURSELVES WITH THE 23 CAUSES OF CANCER AND THE GROWTHS OF CANCEROUS 24 TUMORS? 25 A. YES . 21110003 BFG09899 - LAUCIUS - MR. VA5SALOTTI 13 1 Q. IS ONCOLOGY AN AREA OF MEDICINE THAT *2 IS RECOGNIZED AS AN AREA SPECIALIZATION 3Y 3 ANY BOARD OR ORGANIZATION? 4 A. YES . 5 Q. HAVE YOU BEEN CERTIFIED BY -- 6 A. YES. 7 Q. BY SUCH BOARD OR ORGANIZATION? 8 WHAT IS THAT BOARD THAT 9 CERTIFIES SPECIALIST IN ONCOLOGY? 10 A. IT'S A SUBSPECIALTY OF INTERNAL 11 MEDICINES, SO THE CERTIFIER IS THE AMERICAN 12 BOARDS OF INTERNAL MEDICINE. 13 Q. 14 A. AND WHAT HAVE YOU BEEN CERTIFIED AS? FIRST I WAS CERTIFIED IN INTERNAL 15 MEDICINE IN 1972 AND I WAS THEN CERTIFIED IN 16 MEDICAL ONCOLOGY IN 1977. 17 Q. ' WERE THERE ANY REQUIREMENTS TO / 18 OBTAIN THIS CERTIFICATIONS THAT YOU RECEIVED 19 FROM THAT BOARD? 20 A. ONE HAS TO BE RECOMMENDED BY THE 21 HEAD OF THE TRAINING PROGRAM AND ONE HAS TO 22 PASS AN EXAMINATION. 23 Q. DOCTOR, WITH WHAT HOSPITALS ARE YOU 24 PRESENTLY ASSOCIATED? 25 A. CURRENTLY lM WITH FOUR HOSPITALS: 21110004 BFG09900 LAUC I US MR. VAS5ALOTTI 14 1 THOMAS JEFFERSON UNIVERSITY HOSPITAL, 2 METHODIST HOSPITAL, NAZARETH HOSPITAL, ALL IN 3 PHILADELPHIA AND OUR LADY OF LOURDES HOSPITAL 4 IN CAMDEN, NEW JERSEY. 5 Q. WHAT IS YOUR POSITION AT THE 6 JEFFERSON HOSPITAL? 7 A. I'M AN ATTENDING PHYSICIAN IN THE 8 HOSPITAL AND I'M ASSISTANTS PROFESSOR OF 9 MEDICINE IN THE MEDICAL SCHOOL. 10 Q. SO, YOU TEACH, IN ADDITION TO YOUR 11 MEDICAL PRACTICE, YOU TEACH AT THE MEDICAL 12 SCHOOL? 13 A. 14 Q. YES. AT JEFFERSON? 15 A. YES . 16 Q. WHAT IS YOUR -- WHAT DO YOU TEACH 17 OVER AT THE MEDICAL SCHOOL, WHAT AREAS OF 18 MEDICINE? 19 A. INTERNAL MEDICINE AND MEDICAL 20 ONCOLOGY. 21 Q. WHO DO YOU TEACH? 22 A. MEDICAL STUDENTS, RESIDENTS. 23 Q. 24 A. MEDICAL STUDENTS AND RESIDENTS? RIGHT. 25 Q. DOCTOR, HAVE. YOU WRITTEN ANY SOOOTTYZ RFnOQWl !EC - LAUCIUS - MR. VASSALOTTI 15 1 ARTICLES THAT HAVE BEEN PU3L I SHED IN ANY 2 MEDICAL OR SCIENTIFIC JOURNALS? 3 A. 4 Q. YES, I HAVE. APPROXIMATELY HOW MANY ARTICLES HAVE 5 YOU WRITTEN OR PUBLISHED? 6 A. SEVENTEEN ARTICLES AND TWO CHAPTERS 7 IN BOOKS. ^ 8 Q. AND GENERALLY, WHAT OF THESE 9 ARTICLES AND CHAPTERS IN THE BOOKS DEALT WITH? 10 A. MAJOR EMPHASIS HAS BEEN ON 11 IMMUNOTHERAPY OF MALIGNANCY. 12 Q. THAT'S THE TREATMENTS OF CANCER? 13 A. TREATMENT OF CANCER. 14 Q. IN ADDITION TO THE DUTIES THAT 15 YOU'VE JUST DESCRIBED TO US, DO YOU ALSO 16 ENGAGE IN AT ANY TIME AS A CONSULTANT FOR ANY .17 OUTSIDE AGENCIES? ..... 18 A. WELL, NOT -- NOT USUAL USUALLY. 19 I'M A PARTICIPANT IN A CANCER RESEARCH GROUP, 20 BUT IT'S NOT A CONSULTANT, I DON'T THINK. 21 Q. NOW, DOCTOR, IS IT TRUE THAT I'VE 22 ADVISED THAT OUR OFFICE WILL BE PAYING YOU 23 FOR THE TIME YOU'RE USING TO TESTIFY IN THIS 24 MATTER? 25 A. YES. 9U00TTTZ BFG09902 LAUC I US MR. VASSALOTTI 16 1 Q. DOCTOR, WHEN DID YOU FIRST COME TO 2 TREAT MR. JOHN GRASSO? I'M SORRY, DOCTOR. 3 8EFORE WE GET INTO THAT, YOUR HONOR, I'D LIKE 4 TO MOVE INTO EVIDENCE AS PLAINTIFF'S EXHIBIT 5 TEN THE RECORDS OF FOUR HOSPITALIZATIONS OF 6 MR. GRASSO AT THE JEFFERSON HOSPITAL, THE 7 FIRST HOSPITALIZATION PERIOD BEING JUNE 15, 8 1975 THROUGH JUNE 30, 1975; THE SECOND 9 HOSPITALIZATION BEING JULY 28, 1976 THROUGH 10 AUGUST 21, 1976; THE THIRD HOSPITALIZATION 11 BEING DECEM8ER 23, 1976 TO DECEMBER 24, 1976; 12 AND THE FINAL HOSPITALIZATION BEING DECEMBER 13 29 -- DECEMBER 29, 1976 TO JANUARY 8, 1977. 14 THE COURT: THEY'RE ALL 15 MARKED AS ONE EXHIBIT. 16 MR. VASSALOTTI: THEY'RE 17 ALTOGETHER AND TABULATED AND I' BELIEVE MR. 18 RENNEISEN HAS NO OBJECTION TO THIS. 19 THE COURT: ARE THEY 20 PREMARKED. 21 MR. VASSALOTTI: THEY'RE 22 PREMARKED. 23 MR. RENNEISEN: YOUR HONOR, I 24 HAVE AGREED ALL ALONG THAT I WOULD NOT 25 REQUIRE THE CUSTODIAN TO BE CALLED TO AOOOYYYZ BFG09903 LAUC I US MR. VASSALOTTI 17 1 AUTHENTICATE THEM. I THINK THAT THE DOCTOR 2 CAN REFER TO THEM AND, THEY WOULD 8E 3 ADMISSIBLE OTHERWISE;! I'M NOT AGREEING ON THE 4 ADMISSIBILITY TO THE ENTIRE RECORD. 5 THE COURT: LET'S HAVE THEM 6 MARKED FOR IDENTIFICATION AND THE DOCTOR MAY 7 REFER TO THEM. 8 MR. VASSALOTTI: IT'S BEEN 9 PREMARKED YOUR HONOR AS PLAINTIFF'S E X-H IB I T 10 TEN . 11 CAT WHICH TIME THE AFOREMENTIONED EXHIBITS 12 WERE MARKED FOR IDENTIFICATION. ) 13 BY MR. VASSALOTTI: 14 Q. NOW, DOCTOR, DID THERE COME A TIME 15 HAD YOU TREATED A MR. JOHN GRASSO? 16 A . YES . 17 Q. 18 H I M? DO YOU RECALL WHEN YOU FIRST TREATEO 19 A REFERRING TO THE RECORD, IT WAS 20 AUGUST 6, 1975 21 Q 22 A AND WHERE WAS THAT? THOMAS JEFFERSON UNIVERSITY HOSPITAL 23 Q 24 A AND DID YOU EXAMINE HIM AT THAT TIME? YES 25 Q AND WHAT WERE HIS PHYSICAL 11100Q8 BFG09904 EC LAUC I US MR. VASSALOTTI 13 1 COMPLAINTS WHEN YOU FIRST SAW HIM AT THAT 2 TIME? 3 A. HE HAD COUGHED UP BLOOD, PAIN IN HIS 4 ABDOMEN, FEVER. 5 Q. DID YOU INQUIRE AS TO WHETHER HE HAD 6 BEEN AT THE JEFFERSON HOSPITAL BEFORE THE 7 TIME THAT YOU -- THE HOSPITALIZATION WHEN 8 YOU FIRST TREATED HIM? 9 A. I WAS AWARE, YES. 10 Q. DID YOU REVIEW THE RECORDS OF THAT 11 PREVIOUS HOSPITALIZATION WHEN YOU WERE CALLED 12 IN TO SEE MR. GRASSO? 13 A. 14 Q. I DID . NOW, DOCTOR, YOU'VE JUST BEEN HANDED IS THE MEDICAL RECORDS FOR THE HOSPITALIZATIONS. 16 THOSE RECORDS INDICATE THAT MR. GRASSO WAS 17 FIRST HOSPITALIZED AT JEFFERSON IN JUNE OF 18 19 7 6. 19 FROM YOUR REVIEW OF THOSE 20 RECORDS, CAN YOU TELL US WHAT MR. GRASSO'S 21 PHYSICAL COMPLAINTS WERE WHEN HE WAS TREATED 22 DURING THAT FIRST HOSPITALIZATION? 23 A. 24 Q. HE COUGHED UP BLOOD. AND WHAT TESTS OR TREATMENT WAS 25 UNDERTAKEN DURING THAT FIRST HOSPITALIZATION 6OO0TTTZ BFG09905 LAUC I US MR. VASSALOTTI 19 1 OF MR. GRASSO TO DETERMINE WHAT MIGHT RE 2 CAUSING HIS PROBLEM? 3 A. WELL, HE HAD A CHEST -- CHEST 4 X-RAY; HE HAD BRONCHOSCOPY, WHERE ONE LOOKS 5 INTO THE LUNG, THE BRONCHI TO SEE WHETHER 6 THEY WOULD FIND A TUMOR. THEY DIDN'T. AND HE 7 WAS DISCHARGED WITH A DIAGNOSIS OF 8 HEMOPHTHISIS, WHICH IS A COMPLAINT, 9 8RONCH I ECTASIS AND POSSIBLE 10 Q. EXCUSE ME, WHAT IS HAD I MONTHS /TEU 11 CYST? 12 A. CAUGHING UP BLOOD. 13 Q. 14 A. AND WHAT WERE THE OTHER AND POSSIBLE ASBESTOSIS. 15 Q. WAS THERE ANY DIAGNOSE MADEOF WHAT 16 MR. GRASSO'S CONDITION WAS AT THAT TIME? 17 A. . ... NO. THERE WERE LABORATORY TESTS THAT 18 WERE ABNORMAL. BUT A CLEAR CONCLUSIVE 19 DIAGNOSIS WAS NOT REACHED. 20 Q. WERE ANY TESTS OF THE LIVER DONE 21 DURING THAT FIRST HOSPITALIZATION? 22 A. HE HAD ON PHYSICAL EXAMINATION, HIS 23 LIVER WAS OF NORMAL SIZE. LIVER ENZYMES WERE 24 PERFORMED AND ONE OF THEM WAS ABNORMAL. 25 Q. WHILE YOU THERE THERE WAS NO OTOOTTTZ BFG09906 LAUC 1 US MR. VASSALOTTI 20 1 DIAGNOSIS AT ANY -- OF ANY SPECIFIC 2 CONDITION AFTER THAT FIRST HOSPITALIZATION? 3 A. 4 Q. NO. WHEN WAS HEDISCHARGED FROM 5 JEFFERSON THAT FIRST TIME? 6 A. JUNE 3 0 , 1 9 75 . 7 Q. AND THEREAFTER, WAS HE 8 REHOSPITALIZED AT THE JEFFERSON HOSPITAL? 9 A. YES. 10 Q. WHEN WAS THAT? 11 A. JULY 28, 1976. 12 Q. THAT WAS THE HOSPITALIZATION WHEN 13 YOU FIRST CAME TO TREAT MR. GRASSO; IS THAT 14 CORRECT? 15 A. YES. 16 Q. _ WHAT WAS HIS CONDITION UPON 17 ADMISSION TO JEFFERSON HOSPITAL THE SECOND 18 TIME? 19 A. THIS TIME,HE HAD RIGHT UPPER 20 QUADRANT PAIN, THAT'S IN THE ABDOMEN, COUGHED 21 UP BLOOD, FEVER. 22 Q. WERE ANY TESTS CONDUCTED ON MR. 23 GRASSO DURING THE SECOND HOSPITALIZATION IN 24 AN ATTEMPTS TO DETERMINE 25 A. YES. TTOGTTTZ BFG09907 - LAUCIUS - MR. VASSALOTTI 21 1 Q. 2 A. -- WHAT CAUSED HIS PROBLEMS? YES . 3 Q. CAM YOU GIVE ME A DESCRIPTION OF 4 SOME OF THE TESTS THAT WERE ADMINISTERED TO 5 HIM? 6 A. WELL, A PHYSICAL EXAMINATION 7 REMEMBER SEALED HE HAD A LARGE LIVER,.A MASS. 8 Q. YOU MENTIONED IN THE FIRST 9 HOSPITALIZATION THE PHYSICAL EXAMINATION DID 10 NOT REVEAL A ENLARGED LIVER? 11 A. YES. 12 Q. AND THE SECOND HOSPITALIZATION DID 13 REVEAL AN ENLARGED LIVER? 14 A . YES . 15 Q. WHAT OTHER FINDINGS OR TESTS WERE 16 DONE? 17 A. A LIVER SCAN WAS ABNORMAL. IT WAS 18 CONSISTENT WITH METASTATIC DISEASE, OR CANCER 19 BRONCHOSCOPY WAS REPEATED WHICH SHOWED HE HAD 20 DIFFUSE PULMONARY BLEEDING. CHEST X-RAY NOW 21 SHOWED TUMOR NODULES. 22 Q. IN THE LUNG? 23 A. IN THE LUNGS. 24 Q. THEY WEREN'T PRESENT BEFORE IN THE 25 X-RAY ? BFG09908 LAUC I US MR. VASSALOTTI 22 1 A. NO, THEY WERE NOT. 2 Q.- THOSE TUMOR MODULES DID NOT SHOW IN 3 THE X-RAYS IN THE FIRST HOSPITALIZATION? 4 A. THAT'S CORRECT. THELIVER 3IOPSY 5 WASPERFORMED. 6 Q. WHAT IS A BIOPSY? 7 A. WELL, BIOPSY IS TAKING ASAMPLE OF 8 SOMETHING. IT'S USUALLY SURGICAL. 9 Q. WAS A SURGICAL BIOPSY DONE WITH MR. 10 GRASSO OR WAS IT DONE BY ANOTHER MEANS? 11 A. IT WAS DONE BY A NEEDLE. 12 Q. HOW IS THAT ACCOMPLI SHED ? 13 A. ONE PUTS IN A LOCAL ANESTHETIC AND 14 PUTS A NEEDLE, WHICH HAS A HOLLOW CORE, AND IS ONE STICKS IT IN AND TAKES -- SUCKS OUT A 16 PIECE OF LIVER FOR MICROSCOPIC EXAMINATION. 17 Q. AND AS A RESULT OF THE NEEDLE BIOPSY 18 THAT WAS DONE ON MR. GRASSO, WAS A DIAGNOSIS 19 OF HIS ILLNESS MADE? 20 A. YES. 21 Q. WHAT WAS THAT DIAGNOSIS? 22 A. ANGIOSARCOMA. 23 Q. WAS THE ANGIOSARCOMA LOCATED IN ANY 24 PARTICULAR PLACE? 25 A. IT WAS IN HIS LIVER. 21110013 BFG09909 LAUC I US MR. VASSALOTTI 23 1 Q. WHAT IS ANGIOSARCOMA OF THE LIVER, 2 CAN YOU TELL US? 3 A. IT'S A SMALL -- ANGIO MEANS 8LOOD 4 vessel. Sarcoma means malignancy derived from 5 MESOTHELIUM; CARCINOMA AND SARCOMA ARE THE 6 TWO MALIGNANTS TUMORS IN HUMANS. COMA COMES 7 FROM SURFACE OF ORGANS, LIKE THE SKIN. 8 SARCOMAS ARE SOLID ORGANISMS LIKE BONE, 9 MUSCLE, BLOOD VESSELS. ANGIOSARCOMA IS 10 DERIVED FROM BLOOD VESSELS. 11 Q. AND HIS CANCER APPARENTLY DEVELOPED 12 IN THE LIVER? 13 A . YES. 14 Q. WHEN YOU WERE CALLED IN TO SEE MR. 15 GRASSO, DID YOU PROVIDE ANY COURSE OF 16 TREATMENT FOR HIS CANCER? 17 A. YES, I DID. 18 Q. BEFORE WE GET TO THAT, IS 19 ANGIOSARCOMA OF THE LIVER ATYPE OF CANCER 20 WHICH CAN BE CURED UNDER KNOWN MEDICAL 21 METHODS? 22 A. ALMOST ALWAYS WHEN THEY OCCUR IN THE 23 LIVER, THERE INOPERABLE. ONE CAN'T REMOVE THE 24 ENTIRE LIVER. IN OTHER SITES, WHICH ARE RARE, 25 THEY CAN BE SURGICALLY REMOVED AND ARE trT O O T T T Z BFG09910 .EC LAUC I US MR. VASSALOTTI 24 1 CURABLE. HIS SITUATION WAS NOT A CURABLE 2 SITUATION. 3 Q. OIO YOU TELL MR. GRASSO ABOUT THE 4 SEVER I TY OF HIS D I SEASE? 5 A. YES . 6 Q. OID YOU TELL HIM THAT HIS CONDITION 7 WAS TERMINAL? 8 A. I TOLD HIM IT WAS POTENTIALLY FATAL. 9 Q. AND 00 YOU RECALL WHEN YOU TOLD HIM 10 THAT ? 11 A. I BELIEVE I TOLD HIM DURING THIS 12 HOSPITALIZATION WHERE I FIRST SAW HIM. 13 Q. WHAT WAS -- WHAT WAS MR. GRASSO'S 14 CONDITION, PHYSICAL CONDITION, AS HE 15 PROGRESSED THROUGH THAT SECOND 16 HOSP I TAL IZATI ON AT THE END OF AUGUST OF 1 9 7 5 ? 17 A. WELL, HE HAD -- HIS MAJOR SYMPTOMS 18 WERE PAIN IN HIS LIVER, COUGHING UP BLOOD, 19 FEAR. 20 Q. YOU SAY FEAR? 21 A. OF DYING; ANDANGER THAT HE WAS 22 DYING. 23 Q. DID HE EXPRESS THOSE FEELINGS TO YOU? 24 A. YES. 25 Q. NOW, YOU MENTIONED THAT YOU STARTED BFG09911 01 EC LAUC 1 US MR. VASSALOTTI 25 1 A COURSE OF TREATMENT FOR MR. GRASSO'S 2 ANGIOSARCOMA OF THE LIVER. 3 CAN YOU DESCRIBE WHAT TYPE OF 4 TREATMENT YOU ADMINISTERED TO HIM? 5 A. . YES . BAS IC. -- 6 Q. WHAT -- I'M SORRY, GO AHEAD. 7 A. BASICALLY, WHEN HE WAS DIAGNOSIED, 8 WE HAD LIMITED ABILITY TO USE OF ACTIVE 9 CHEMOTHERAPEUTIC AGENTS. AND HE WAS INVOLVED 10 IN A STUDY THAT COMPARED GIVING ADRIAMYCIN OR 11 WHICH IS A CHEMOTHERAPEUTIC AGENT VERSUS 12 CYTOXAN, VINCRISTIN AND ACTINOMYCIN D. 13 Q. ARE THESE DRUGS ALL KNOWN AS 14 CHEMOTHERAPEUTIC DRUGS? 15 A . 16 Q. YES . WHAT IS CHEMOTHERAPY, HOW DOES IT 17 WORK AGAINST CANCER? 18 A. WELL, SOME CASES, WE DON'T KNOW WHY. 19 SOME SPECIFIC DRUGS DO. BUT IN GENERAL, IT'S 20 DESIGNED TO KILL GROWING CELLS AND HOPEFULLY 21 GET A PREFERENTIAL EFFECT OVER THE CELLS THAT 22 ARE MALIGNANT THAT ARE GROWING VERSUS THE 23 NORMAL CELLS THAT ARE GROWING IN THE BODY 24 THAT ARE NORMALLY REQUIRED FOR SURVIVAL. 25 Q. SO, THE CHEMOTHERAPEUTIC AGENTS HAVE 21110016 BFG09912 - LAUC I US MR. VA5SALOTTI 26 1 ANY EFFECTS ON OTHER PART5 OF THE PATIENTS 2 BOOY IN ADDITION TO THE CANCEROUS TUMORS? 3 A. YES. 4 Q. WHAT TYPE OF EFFECTS DOES THE 5 CHEMOTHERAPY^HAVE ON THE REST OF THE PATIENTS 6 BODY? WHAT ARE THE SIDE EFFECTS? ' 7 A. WELL,'- THE MOST SERIOUS MEDICAL SIDE 8 EFFECTS ARE SIDE EFFECTS UPON GROWING CELLS \9 THAT ARE NORMALLY REQUIRED. AND THE GROWING 10 CELLS THAT ARE NORMALLY REQUIRED ARE THE BONE 11 MARROW, WHICH MAKES RED CELLS AND WHITE CELLS 12 AND PLATELETS. 13 Q. 14 A. THAT'S BLOOD CELLS? YES. AND THEN SORE THROAT, SORE 15 MOUTH, G.I. TRACT, NAUSEA AND VOMITING, WHICH 16 MR. -- JOHN HAD A FAIR AMOUNT OF THAT; 17 HAIR LOSS . ' -V . 18 Q. PATIENTS WILL LOSE ALL THEIR HAIR AS 19 A RESULT OF THE CHEMOTHERAPY? 20 A. THE ADRIAMYCIN, YES, AND TO A LESSER 21 EXTENT, THE CYTOXAN. 22 Q. DID MR. GRASSO LOSE ALL OF HIS HAIR? 23 A. YES, HE DID. 24 Q. HOW MANY TIMES AND HOW OFTEN WAS 25 CHEMOTHERAPY GIVEN TO MR. GRASSO WHILE HE WAS 4.TOOTTT2 BFG09913 LAUC I US MR. VASSALOTTI 27 1 HOSPITALIZED DURING THAT SECOND TIME IN 1975? 2 A. I believe he received it once during 3 THE HOSPITALIZATION. THE ADRIAMYCIN WAS GIVEN 4 EVERY THREE WEEKS. 5 Q. AFTER HE WAS DISCHARGED FROM THE 6 HOSPITAL THAT TIME, DID YOU CONTINUE TO SEE 7 MR. GRASSO? 8 A. YES. 9 Q. AND TREAT HIM? 10 A. YES. 11 Q. HOW OFTEN WAS THECHEMOTHERAPY 12 ADMINISTERED AFTER HE GOT OUT OF THE HOSPITAL 13 IN AUGUST OF 1975? 14 A. WELL, THE REMAINDER OF HIS LIFE HE 15 CONTINUED ON CHEMOTHERAPY. THE AGENTS CHANGED. 16 Q. HOW OFTEN DID HE RECEIVE THE DOSAGE? 17 A. THE ADRIAMYCIN WAS EVERY THREE WEEKS 18 AND LATER WHEN HE WORSEND, HE RECEIVED 19 CYCLOPHOSLOMID, ADRIAMYCIN, VINCRISTIN. AND 20 DURING HIS LAST HOSPITALIZATION, HE RECEIVED 21 TWO OTHER AGENTS. THAT'S JUMPING AHEAD. 22 Q. DID YOU CONTINUE TO TREAT MR. GRASSO 23 UP UNTIL THE TIME OF HIS DEATH? 24 A . I DI0. 25 Q. DURING THE COURSE OF YOUR TREATMENT STOOTTTZ BFG09914 - LAUCIUS - MR. VASSALOTTI 28 1 OF MR. GRASSO, DID HE EVER COMPLAIN OF PAIN 2 TO YOU RELATIVE TO HIS CONDITION? 3 A. 4 Q. YES . WHAT TYPE OF COMPLAINTS DID HE MAKE 5 TO YOU? 6 A. HE HAD FAIRLY CONSISTENT LIVER PAIN. 7 HE HAD 8 Q. WHEN YOU SAY LIVER PAIN, WHAT DO YOU 9 MEAN BY LIVER PAIN? 10 A. IT'S A -- THE LIVER IN THE 11 BETWEEN THE CHEST AND THE ABDOMEN AND IT'S 12 ON THE RIGHT SIDE. SO, IT CONSISTENT 13 Q. 14 A. PAIN ON THE RIGHT SIDE OF THE BELLY? YES. SOMETIMES IT'S REFERRED AS 15 THAT THE SHOULDER, TOO. 16 Q. HE COMPLAINED OF THAT PAIN. DID HE 17 HAVE ANY OTHER COMPLAINTS OF PAIN? 18 A. THAT WAS HIS MAJOR PAIN COMPLAINT. 19 Q. DID YOU ADMINISTER OR PRESCRIBE ANY 20 MEDICATIONS FOR MR. GRASSO FOR THE PURPOSE OF 21 RELEAVING HIS PAIN? 22 A . YES . 23 Q. WHAT TYPES OF PAIN RELIEF 24 MEDICATIONS DID YOU PROVIDE TO HIM? 25 A. WELL, HE WAS -- HE WAS ON A e io o m z BFG09915 EC LAUCI US MR. VASSALOTTI 29 1 NARCOTIC CODEINE UNTIL -- I BELIEVE, UNTIL 2 DECEMBER. AND THEN HIS PAIN WORSENED AND HE 3 WAS ON PERIDIN, WHICH IS DEMEROL. AND LATER 4 5 Q. IS THAT A STRONGER PAIN RELIEF 6 MEDICATION THAN CODEINE? 7 A. YES. AND HE ALSO RECEIVED MORPHINE, 8 WHICH IS STRONGER YET. 9 Q. WERE THESE PAIN RELIEF MEDICATIONS 10 COMPLETELY EFFECTIVE IN RELEAVING HIS PAIN? 11 A. IN GENERAL, THEY HAD REASONABLE 12 CONTROL, I SUPPOSE. ALTHOUGH ONE ALWAYS HAS 13 PAIN. IT'S NEVER TOTAL RELIEF. 14 Q. YOU MENTIONED THAT MR. GRASSO 15 EXPRESSED FEAR AND ANGER TO YOU, AT LEAST AT 16 ONE POINT. DID HE EVER EXPRESS THOSE EMOTIONS 17 TO YOU AGAIN AS YOU WERE TREATING HIM UNTIL 18 THE TIME OF HIS DEATH. 19 A. NO, -- FEAR, CERTAINLY. -- YOU 20 KNOW, HUMAN REACTION, HE DIDN'T WISH TO DIE. 21 HE WAS AN ACTIVE, ENTHUSIASTIC PERSON THAT 22 WAS NOT LIKELY TO GIVE UP, BECOME PASSIVE. 23 Q. CAN YOU DESCRIBE HOW MR . GRASSO'S 24 ILLNESS PROGRESSED DURING THE MONTHS OF 25 SEPTEMBER, OCTOBER AND DECEMBER OF 1975? 21110020 BFG09916 LAUC I US MR. VASSALOTTI 30 1 A. WELL, HE HAD A CONTINUED 2 DETER IORATION OVER ALL H I S HE HAD SOME 3 RELIEF OF HIS PAIN W I TH THE CHEMOTHERAPY 4 WHILE HE WAS GETTING THE ADRIAMYCIN UNTIL 5 DECEMBER. THE PULMONARY NODULES, THE SPREAD 6 OF THE CANCER HAD NOT CHANGED APPRECIABLY. SO, 7 HIS IMPROVEMENT WAS MARGINAL. 8 IN DECEMBER, HE FAILED 9 TOTALLY ON THE ADRIAMYCIN AND WAS SWITCHED TO 10 DIFFERENT CHEMOTHERAPY, WHICH WAS INEFFECTIVE. 11 AND FROM DECEMBER UNTIL HIS DEATH IN JANUARY, 12 HE DID PROGRESSIVELY WORSE, NO APPETITE, NO 13 STRENGTH, NO VIGOR, PAIN, SHORTNESS OF BREATH. 14 Q. DOCTOR, YOU HAD MENTIONED BEFORE 15 THAT CHEMOTHERAPY DRUGS THAT YOU ADMINISTERED 16 HAD EFFECTS UPON PARTS OF THE BODY THAT MAKE 17 OUR BLOOD CELLS. WAS MR. GRASSO?S BLOOD- 18 CONSTANTLY MON I TORED DUR I NG THE TIME HE WAS 19 GIVEN CHEMOTHERAPY? 20 A. YES. THE MAJOR PROBLEM WE HAD WAS 21 WITH HIS RED CELL COUNT. HE LOST BLOOD 22 WHETHER HE COUGHED UP BLOOD. CHEMOTHERAPY 23 PREVENTED HIM FROM MAKING IT WELL AND HIS 24 DISEASE ALSO HAS AN EFFECT. AND HE WAS 25 CONSISTENTLY ANEMIC, WHICH WOULD MAKE HIS m tO T Y T Z BFG09917 LAUC I US MR. VASSALOTTI 31 1 SHORTNESS OF BREATH WORSE AND HE REQUIRED 2 MULTIPLE BLOOD TRANSFUSIONS. 3 Q. AND DID HE RECEIVE A CONSIDERABLE 4 NUMBER OF B-LOOD TRANSFUSIONS DURING HIS 5 TREATMENT? 6 A. YES, HE DID. 7 Q. NOW, WAS MR. GRASSO REHOSPITALIZED 8 IN DECEMBER OF 1976? 9 A. YES, HE WAS. 10 Q. WHAT WAS THE DATE OF HIS FIRST ' 11 HOSPITALIZATION IN DECEMBER? 12 A. 12-23 TO 12-24. 13 Q. AND WHAT WAS HIS CONDITION UPON 14 ADMISSION AT THAT TIME? 15 A. HE WAS WORSE. HE WAS SEVERLY ANEMIC. 16 DURING THE HOSPITALIZATION, HE RECEIVED BLOOD 17 TRANSFUSIONS. HIS LIFE WAS LIMITED. HE WAS 18 DETERMINED TO GO HOME FOR CHRISTMAS. 19 Q. AFTER CHRISTMAS, WAS HE 20 REHOSPITALIZED AGAIN? 21 A. 22 Q. YES, HE WAS. AND WHEN WAS THAT? 23 A. IT WAS 12-29, 1976. 24 Q. AND THAT WAS HIS LAST 25 HOSPITALIZATION, WASN'T IT? Z20OTTTZ BFG09918 .EC LAUCI US MR. VASSALOTTI 32 1 A. 2 Q. YE S, IT WAS . DIO HIS CONDITION CONTINU-ED TO 3 DETERIORATE AT THAT POINT? 4 A. Q. i YES, ITDID. DId\hE EVER THE SAME TYPES OF 5 6 COMPLAINTS? \ 7 A. YES. \ 8 Q. WAS IT\ AT THIS POINT THAT HE BEGAN 9 TO RECEIVE MORPHINE FOR CONTROL OF PAIN? \ 10 A . YES . 11 Q. DURING THE COURSE OF THAT LAST 12 HOSPITALIZATION, WAS MR. GRASSO -- YOU SAW 13 MR. GRASSO, I PRESUME, ON A DAILY 8ASIS THEN? 14 A. YES. 15 Q. WAS HECONSCIOUS FOR THE MOST PART? 16 A. YES.DROWSY ATTIMES, WEAK. 17 Q. " HE WAS VERY WEAK? 18 WHEN DID HE DIE, DOCTOR? 19 A. 20 Q. JANUARY 8, 1977. WAS AN AUTOPSY PERFORMED, DOCTOR? 21 A. YES, IT WAS. 22 Q. AT JEFFERSON? 23 A. YES. 24 Q. WHAT DID THE AUTOPSY REPORT INDICATE 25 WAS THE CAUSE OF MR. GRASSO'S DEATH? 21110023 BFG09919 EC LAUC I US MR. VASSALOTTI 33 1 A. he had massive intra-abdominal 2 HEMORRHAGE WITH ANGIOSARCOMA OF THE LIVER. 3 Q. WAS THE INTRA-ABDOMINAL HEMORRHAGE, 4 WAS THAT INTERNAL BLEEDING IN THE AREA OF THE 5 ABDOMEN? 6 A. YES, FROM THE L IVER. 7 Q. IT WASFROM THE LIVER? 3 A. YEAH. 9 Q. WAS THAT AS A RESULT OF THE 10 ANGIOSARCOMA OF THE LIVER? H A. YES . 12 Q. DOCTOR, I'D LIKE YOU TO REFER TO THE 13 NARRATIVE SUMMARY RECORD IN THE SECOND 14 HOSPITALIZATION, THE ONE OF JULY, 1975. 15 DID YOU PREPARE THAT 16 NARRATIVE SUMMARY? 17 A. I DID. 18 Q. AND THEREIS A REFERENCE IN THAT 19 SUMMARY TO THE FACT, AMONG OTHERS, THAT MR. 20 GRASSO HAS HAD EXPOSURE TO A VARIETY ORGANIC 21 CHEMICALS AT PEDRICKTOWN, MARYLAND. 22 APPARENTLY, THERE WAS A VINYL CHLORIDE PLANT. 23 OF WHAT SIGNIFICANCE WAS IT 24 TO YOU THAT MR. GRASSO LIVED IN THE VICINITY 25 OF A VINYL CHLORIDE PLANT? 2 IU 0 0 2 4 BFG09920 -LAUCIUS-MR. VASSALOTTI 34 1 A. BECAUSE ANGIOSARCOMA IS A RARE TUMOR 2 AND THERE'S BEEN A LINK WITH VINYL CHLORIDE 3 EXPOSURE. 4 Q. DOCTOR, BASED UPON YOUR REVIEW OF 5 MR. GRASSO'S HOSPITAL RECORDS AND ALL OF THE 6 TESTS STUDIES THAT WERE DONE ON HIM AND YOUR 7 TREATMENTS OF HIS ILLNESS FOR APPROXIMATELY 8 FIVE MONTHS AND BASED UPON YOUR EXPERIENCE AS 9 A PHYSICIAN SPECIALIZING IN THE TREATMENT OF 10 CANCER, DO YOU HAVE AN OPINION, BASED UPON A 11 REASONABLE DEGREE OF MEDICAL PROBABILITY AS 12 TO WHETHER -- AS TO WHEN MR. GRASSO'S 13 ANGIOSARCOMA OF THE LIVER FIRST DEVELOPED? 14 A. I WOULD SUSPECT WITHIN THE LAST SIX 15 MONTHS -- AT THE EARLIEST SIX MONTHS PRIOR 16 TO HIS BRONCHOSCOPY . SO, I WOULD SUSPECT IT 17 DEVELOPED IN THE SAME YEAR, 1976, ALMOST 18 CERTAINLY. I BASE THAT 19 Q. FOR MY OWN CLARIFICATION, DOCTOR, 20 ARE YOU SAYING THAT HIS TUMOR PROBLEM 21 DEVELOPED WITHIN A PERIOD SIX MONTHS FROM 22 WHEN HE FIRST STARTED COUGHING UP BLOOD IN 23 MAY OF 1976? 24 A. YES . 25 Q. WHAT IS THE BASIS FOR YOUR OPINION 21110025 BFG09921 -LAUCIUS-MR. VASSALOTTI 35 1 THAT THE TUMOR DEVELOPED WITHIN THAT PERIOD 2 OF TIME? 3 A. BASICALLY, IT HAS TO DO WITH ITS 4 GROWTH RATE. 5 Q. CAN YOU EXPLAIN TO ME WHAT YOU MEAN 6 BY THAT? 7 A. WELL, IN JUNE OF 1976 WHEN HE HAD 8 HIS FIRST SYMPTOMS, HIS X-RAY WAS NEGATIVE, I 9 HAD SHOWED NO NODULES AND HIS X-RAY WAS NONE 10 REMARKABLE. HIS LIVER WAS NOT ENLARGED. BY 11 JULY, HE HAD CLEAR PULONARY TUMOR NODULES ON 12 HIS CHEST X-RAY AND HIS LIVER WAS 13 DRAMATICALLY ENLARGED. 14 Q. AND WHAT CUT FROM THE GROWTH RATE OF IS A TUMOR. IS THIS KIND OF TIME MORE A RAPID 16 GROWING TUMOR AT ALL STAGES OF ITS LIFE OR 17 DOES IT GROW MORE RAPID AT THE BEGINNING OR 18 THE END? 19 A. THE EVIDENCE SUGGESTIONS THAT FROM 20 ANIMAL AND HUMAN EXPERIENCE THAT THEIR 21 GROWTHS RATE IS GREATEST AT THE BEGINNING AND 22 SLOWEST AT THE END. 23 Q. AND BASED -- YOU TREATED MR. 24 GRASSO AT THE END OF HIS DISEASE; IS THAT 25 CORRECT? 9 2 0 0 IT T Z BFG09922 EC LAUC I US MR. VASSALOTTI 36 1 A. TO THE END , yes 2 Q. TO THE END . AND DID YOU 08SERVE THE 3 GROWTH RATE OF H I S TUMOR DURING THE END 4 PERIODS OF H I S L I FE o 5 A. YES, IT SLOWED. 6 Q. IT SLOWED. BUT WOULD YOU 7 CHARACTERIZE IT AS A RAPID 8 A. YES, VERY RAPID. 9 Q. VERY RAPID. AND DID THAT INDICATE TO 10 YOU THAT PRIOR TO THE TIME THAT HIS DISEASE 11 WAS FOUND THAT THE TUMOR WAS GROWING EVEN 12 MORE RAPIDLY? 13 A. 14 Q. YES . BASED UPON WHAT YOU JUST TOLD US? 15 A. 16 Q. YES. AND BASED UPON THAT, IT'S YOUR 17 OPINION THAT.HIS TUMOR PROBABLY DEVELOPED 18 SOME TIME APPROX IMATELY SIX MONTHS BEFORE HE 19 FIRST COUGHED UP BLOOD IN MAY OF 1976? 20 A. YES. 21 Q. DOCTOR, IN YOUR PRACTICE OF ONCOLOGY 22 AND YOUR TEACHING OF ONCOLOGY TO -- AT THE 23 JEFFERSON MEDICAL SCHOOL, ARE YOU CONCERNED 24 AT ALL WITH THE CAUSES OF CANCER? 25 A. YES. iz m x x x z BFG09923 LAUC I US MR. VASSALOTT I 37 1 Q. WHY ARE YOU CONCERNED WITH THE 2 CAUSES OF CANCER AS AN ONCOLOGIST? 3 A. WELL, PART OF THE JOB IS NOT JUST 4 INDIVIDUAL PATIENTS. IT'S AN ATTEMPT TO 5 PREVENT CANCER AS MUCH AS POSSIBLE. OFF TIMES 6 WE HAVE PATIENTS WE CURE WITH DRUGS WHOM 7 WE' VE -- WE GIVE CANCER TO BY GIVING THEM 8 THE CHEMO THERAPY, BECAUSE OFF TIMES, THE 9 AGENTS ARE CARCINOGEN. SO, NATURALLY, WE HAVE 10 AN INTEREST. 11 Q. WOULD YOU CONSIDER YOURSELF AS ONE 12 WHO KEEPS A BREAST OF SCIENTIFIC DEVELOPMENTS 13 IN THE AREA OF CANCER CAUSATION? 14 A. YES . 15 Q. DOCTOR, THERE'S BEEN A CONSIDERABLE 16 AMOUNT OF TESTIMONY SO FAR IN THIS CASE 17 REGARDING WHERE MR. GRASSO LIVED, ITS 18 PROXIMITY OR ITS RELATIONSHIP TO THE GOODRICH 19 PVC PLANT. I'M GOING A -- YOU WEREN'T HERE 20 TO HEAR THAT TESTIMONY, SO I'M GOING TO ASK 21 YOU TO ASSUME CERTAIN FACTS AND THEN I'M 22 GOING TO ASK YOU FOR AN OPINION. 23 24 25 8 zboT T T 2 BFG09924 EC LAUCI US MR. VASSALOTTI 33 1 2 AND THAT HIS PARENTS AND BROTHERS AND SISTERS 3 ALSO HAD NO PRIOR MEDICAL HISTORY OF CANCER 4 OR LIVER DI SEASE. 5 I FURTHER ASK YOU TO ASSUME 6 THAT MR. GRASSO BEGAN WORKING AT THE DUPONT 7 CHAMBERS WORKS IN DEEPWATER, NEW JERSEY IN 8 APPROXIMATELY 1946 OR 1947; AND THAT EXCEPT 9 FOR PERIODS DURING W++ICH HE WAS LAID OFF, HE 10 WORKED AT THAT FACILITY UNTIL MAY OF 1976. 11 I ASK YOU TO FURTHER ASSUME 12 THAT IN HIS EMPLOYMENT AT DUPONT, HE WAS NOT 13 EXPOSED TO ARSENIC OR ARSENIC COMPOUND OR TO 14 VINYL CHLORIDE; AND THAT DURING THE PERIODS 15 WHEN HE WAS LAID OFF FROM DUPONT FACILITY, HE 16 HELD VARIOUS JOBS RANGING FROM A GROCERY 17 CLERK, AN AUTO PARTS SALESMAN, A GAS STATION 18 ATTENDANT, AS A CONSTRUCTION LABORER ON A 19 HIGHWAY JOB, AS AN AUTO MECHANIC, A BUS 20 DRIVER AND A SHEET METAL WORKER; AND IN 21 CONNECTION WITH HIS POTENTIAL EXPOSURE TO 22 VINYL CHLORIDE IN THE AREA OF HIS HOME, I ASK 23 YOU TO ASSUME THAT DURING THE YEARS OF 1970 24 THROUGH 1975, MR. GRASSO WAS AWAY FROM HIS 25 HOME APPROXIMATELY 50 TO 55 HOURS PER WEEK, *4 BFG09925 DIRECT LAUCI US MR. VASSALOTTI 39 l rv \ \ \_ \ \ \ c L 1 AND THAT -- AND THAT, THEREFORE, HE WAS 2 HOME OR IN THE AREA OF HIS HOUSE 3 APPROXIMATELY 50 PERCENT OF THE TIME FOR 4 THOSE YEARS. IN ADDITION TO BEING HOME 50 5 PERCENT OF THE TIME GENERALLY, DURING THE 6 PERIOD OF FEBRUARY, 1973 TO DECEMBER OF 1973, 7 MR. GRASSO WAS AT HOME OR IN THE AREA OF HIS 8 HOME CONTINUOUSLY AS HE WAS RECUPERATING FROM 9 A CORONARY ARTERY BYPASS SURGERY. 10 NOW, I FURTHER ASK YOU TO 11 ASSUME THAT DURING THE PERIOD FROM MARCH OF 12 1970 TO DECEMBER OF 1975, THAT MR. GRASSO*S 13 HOME WAS LOCATED APPROXIMATELY 1.7 MILES FROM 14 A POLYVINYL CHLORIDE PLANT OPERATED BY THE 15 B.F. GOODRICH COMPANY AND THAT DURING THE 16 YEARS IN QUESTION, IT HAS BEEN ESTIMATED THAT 17 THE GOODRICH PLANT EM ITTED BETWEEN 1.4 AND 18 OVER 4.3 MILLION POUNDS OF VINYL CHLORIDE 19 INTO THE ATMOSPHERE ON AN ANNUAL BASIS; AND 20 IT HAS ALSO BEEN ESTIMATED THAT DURING THE 21 YEARS, THE PVC PLANT ALSO EMITTEO INTO THE 22 ATMOSPHERE DUST PARTICLES THAT RANGED IN SIZE 23 FROM ONE TO TEN MICRONS AND THAT SUCH PVC 24 DUST PARTICLES CONTAINED IN THEM ENTRAPPED 25 LEVELS OF VINYL CHLORIDE THAT WOULD SLOWLY BFG09926 OCOOTTTZ i l LAUC I US MR . VASSALOTT I 40 1 DISSIPATE AND THOSE LEVELS OF ENLARGED VINYL 2 CHLORIDE RANGED FROM ANYWHERE FROM 40 PARTS 3 PER MILLION UP TO AN ESTIMATED 2,000 PARTS 4 PER MILLION. 5 IT HAS BEEN FURTHER ESTIMATED 6 THAT DURING THE YEARS 1970 THROUGH 1975, THAT 7 THE LEVELS OF VINYL CHLORIDE IN THE AIR 8 AROUND THE GRASSO HOME RANGED FROM A LOW OF 9 1.1 PARTS PER MILLION UP TO 28 PARTS PER 10 MILLION FOR A TOTAL OF 1,508 HOURS DURING 11 THAT FIVE AND A HALF, SIX YEAR PERIOD; AND 12 THAT DURING THOSE YEARS, IN ADDITION TO THE 13 RANGE OF EXPOSURES AT THAT TIME, DURING A 14 NUMBER OF HAZY POLLUTION DAYS, THAT THE IS LEVELS OF EXPOSURE IN THE AREA OF GRASSO HOME 16 RANGED AS HIGH AS FROM TEN TO 90 PARTS PER 17 MILLION; AND FINALLY IN ADDITION TO ALL OF , 18 THAT, I ASK YOU TO ASSUME THAT DURING THE 19 PERIOD FROM MARCH OF 1970 TO DECEMBER OF 1975, 20 THERE WERE PERIODS DURING WHICH SHORT PERIODS 21 OF EXPOSURE OF VINYL CHLORIDE IN THE AREA OF 22 THE GRASSO HOME, RANGING FROM FIVE TO FIFTEEN 23 MINUTES WOULD HAVE OCCURRED IN LEVELS UP TO 24 SEVERAL HUNDRED PARTS PER MILLION. 25 N.1 T fiO O T T T Z BFG09927 LA UC I US MR. VASSALOTTI *1 1 2 *mw..,W* .VM-T*- ., i--~ l. r c 3 c" -------- - -- - oFENCE firHD :` ,.; 4 y^^'rrbr^-5^ c-ea.l-1 rt Kg^.i 5 6 tv Ta;:wnir. c^rLuc 7 8 9 10 11 MR. RENNE1SEN: YOUR HONOR, I 12 OBJECT TO THE QUESTION. THERE IS NO EVIDENCE 13 WHATSOEVER THAT IT IS DUST PARTICLES THAT MAY 14 HAVE BEEN' EMITTED FROM THE PLANT REACHED THE 15 GRASSO HOME. THERE'S BEEN TESTIMONY AS TO 16 DUST AND IT WAS WHITE, BUT THERE IS NO 17 TESTIMONY THAT DUST WAS POLYVINYL CHLORIDE. 18 FURTHERMORE, ANY ESTIMATES 19 MADE BY THE WITNESSES CONCERNING THE VINYL 20 CHLORIDE CONTAINED IN THE DUST IS SO 21 SPECULATIVE BECAUSE IT DEPENDS ON THE AGE AND 22 THE DUST AND SO FORTH, THAT I THINK THAT PART 23 OF THE QUESTION CLEARLY IS ADMISSIBLE. 24 MR. VASSALOTTI: YOUR HONOR, 25 FIRST WITH RESPECT TO THE ADMISSION OF DUST 21110033 BFG09928 EC LA UCI US MR. VASSALOTTI 42 1 AND THE TRANSPORT TO THE AREA OF THE GRASSO 2 HOME, PROFESSOR DAVIDSON TESTIFIED THAT THE 3 PLANT WOULD CAUSE EMISSION OF PVC DUST 4 PARTICLES AND SPECIFICALLY DUST PARTICLES 5 WITHIN THE RANGE OF ONE TO TEN MICRONS, AS HE 6 DESCRIBED IT. PROFESSOR DAVIDSON -- I'M 7 SORRY, PROFESSOR PESKIN ALSO TESTIFIED THAT 8 PARTICLE SIZES OF PVC DUST IN THE RANGE OF 9 ONE TO TEN MICRONS WOULD BE CARRIED IN THE 10 ATMOSPHERE IN A SIMILAR MANNER TO THE VINYL 11 CHLORIDE GAS TO WHICH HE MODEL HAD -- AND I 12 RECALL HIS TESTIMONY SPECIFICALLY THAT THOSE 13 MATERIALS WOULD REACH THE AREA OF THE GRASSO 14 HOME UNDER THE WIND CONDITIONS THAT HE 15 DESCRIBED. 16 IN ADDITION, WE HAVE THE 17 OBSERVATIONS OF MRS. GRASSO AND HER SON 18 CONCERNING THE WHITE DUST AND I 19 THE COURT: I'LL OVERRULE THE 20 OBJECTION. I'LL ALLOW IT. LADIES AND 21 GENTLEMEN, IT'S YOUR RECOLLECTION OF THE 22 TESTIMONY, NOT WHAT COUNSEL MAY SAY AS THEIR 23 RECOLLECTION. IT'S YOUR RECOLLECTION OF THE 24 TESTIMONY. YOU MAY PROCEED. 25 BY MR. VASSALOTT I : tm 0TTT2 BFG09929 EC LAUCI US MR. VASSALOTTI ^3 1 Q. DOCTOR. WH/ 2 g. rC.AAU.HJi'?Tjl 3 --XMGYIS&Aii ft irmfri.oir ' 4 *'** 5 6 7 8 9 10, 11 Q. DOCTOR, THERE ARE OTHER ARE 12 THERE OTHER KNOWN CAUSES OF ANG 10 SARCOMA OF 13 THE L I VER? 14 A. YES. 15 Q. WHAT ARE IT IS OTHER KNOWN CAUSES, 16 t TO .YOUR KNOWLEDGE? 17 A. ARSENIC,ARSENIC COMPOUNDS AND 18 i THOROTRAST. \ 19 Q. IS THAT THOROTRAST? 20 A. YES. 21 Q. IN MY HYPOTHETICAL FACT SITUATION, 22 DOCTOR, I D I DN 'T MENTION TO YOU T HOROTRAS T. 23 8 U T LET ME ADD FURTHER THAT .THERE I S NO 24 KNOWLEDGE THAT MR. GRASSO NO ONE STRIKE THAT. THERE'S NO EVIOENCE THAT MR. 21110034 BFG09930 ;ec LAUCI US MR. VASSALOTTI 44 1 GRASSO HAD ANY DIAGNOSTIC X-RAYS IN WHICH A 2 DIE OR RADIOACTIVE DIE WAS USED. 3 WHAT IS THOROTRAST USED FOR 4 OR WHAT WAS IT USED FOR? 5 A. IT WAS A RADIOACTIVE DYE THAT WAS 6 USED FOR BLOOD FLOW STUDIES TO -- FOR 7 X-RAYS, ARTERIALGRAMS. 8 Q. AND HOW LONG HAS IT BEEN SINCE THAT 9 MATERIALS BEEN USED FOR THAT PURPOSE? 10 A. I SUSPECT IT'S BEEN -- IT WAS 11 KNOWN TO CAUSE DIFFICULTY IN THE THIRTIES AND 12 ITS BEEN DISCONTINUED. 13 Q. DOCTOR LAUCIU S, YOU'VETESTIFIED 14 THAT VINYL CHLORIDE IS A KNOWN CAUSE OF 15 ANGIOSARCOMA OF THE LIVER? 16 IF A HUNDRED PEOPLE WERE 17 EXPOSED TO VINYL CHLORIDE IN A GIVEN 18 CONCENTRATION AT ONE TIME, WOULD YOU EXPECT 19 EVERYONE TO DEVELOP CANCER? 20 A. NO . 21 Q. WHY IS IT THAT SOMEPEOPLE ARE 22 SUSCEPTIBLE OR DEVELOP CANCER AS A RESULT TO 23 EXPOSURE TO CANCER CAUSING MATERIALS AND 24 OTHER PEOPLE DON'T? 25 A. THEORY OR EVIDENCE? SSOOTTT2? BFG09931 tc LAUCI US MR. VASSALOTTI 45 1 Q. 2 SURE? WELL, DOES ANYONE NO INFORMATION FOR 3 A. IT'S UNKNOWN. 4 Q. IS IT KNOWN FOR SURE THOUGH THAT NOT 5 EVERYONE REACTS THE SAME WAY TO A CANCER 6 CAUSING MATERIAL? 7 A. 8 * Q. YES . WHY IS IT THAT MR. GRASSO WOULD HAVE 9 DEVELOPED ANGIOSARCOMA OF THE LIVER AND MRS. 10 GRASSO HAS NOT? 11 A. ONE SUSPECTS CHANCE, CHANCE EVENT IS 12 A POSS I BIL I TY . 13 Q. DOES IT HAVE ANYTHING TO DO WITH THE 14 SUSCEPTIBILITY OF INDIVIDUALS TO -- FOR THE 15 SENSITIZATION OF INDIVIDUALS TO THESE 16 PARTICULAR TYPE OF CANCER MATERIALS? 17 A. THAT'S YOUR UN IFYING HYPOTHESIS FROM 18 ANIMALS. 19 Q. DOCTOR, TO YOUR KNOWLEDGE, HAS ANY 20 LEVEL OF EXPOSURE TO VINYL CHLORIDE 8EEN 21 ESTABLISHED AS BEING SAFE? 22 A. NO. 23 MR. VASSALOTTI: ALL RIGHT. N s24 THANK YOU DOCTOR, I HAVE NO FURTHER QUESTIONS. s25 THE COURT: CROSS-EXAMINE. CO BFG09932 :ro EXAMINATION LAUC I US MR. RENNEI SEN 46 i CROSS EXAMINATION BY MR. RENNEISEN. 2 Q. DOCTOR, HAVE YOU WRITTEN ANY PAPERS 3 CONCERNING VINYL CHLORIDE ITS RELATIONSHIP TO 4 ANGIOSARCOMA? 5 A. 6 Q. NO, I HAVE NOT. HAVE YOU MADE ANY STUDIES OF VINYL 7 CHLORIDE IN ITS EFFECT AND ITS RELATIONSHIP 8 TO ANGIOSARCOMA? 9 A. WELL, THIS MAN, JOHN I DID -- I 10 DON'T KNOW WHETHER IT'S A STUDY. I HOPE TO 11 INITIATE ONE. I DID CALL, WHEN I FOUND OUT HE 12 HAD AN ANGIOSARCOMA, I DID CALL THE 13 CARCINOGENESIS BRANCH OF THIS COMMUNICABLE 14 DISEASE CENTER. 15 Q. IS THAT IN ATLANTA, GEORGIA? 16 A. YES. 17 Q. YOU HAD SOME CORRESPONDENCE WITH 18 DOCTOR FAULK, DID YOU NOT? 19 A. HE NEVER RETURNED ANY OF MY CALLS. I 20 FOUND OUT A30UT THE SUBSEQUENTLY, I GUESS 21 THROUGH PLAINTIFFS ATTORNEY. 22 Q. YOU ARE -- YOU ARE FAMILIAR WITH 23 HENRY FAULK, ARE YOU NOT? 24 A. YES, I AM. HE'S THE PERSON I CALLEO. 25 Q. AND HE IS ASSOCIATED WITH THE CENTER 21110037 BFG09933 EXAMINATION LAUCI US MR. RENNEISEN 47 1 FOR DISEASE CONTROL IN ATLANTA, GEORGIA, IS 2 HE NOT? 3 A. YES, HE IS. 4 Q. HAVE YOU READ ARTICLES THAT HE'S 5 WRITTEN ABOUT VINYL CHLORIDE IN CANCER? 6 A. YES, I HAVE. 7 Q. ARE YOU FAMILIAR WITH AN ARTICLE IN 8 THE LANCET, L-A-N-C-E-T, DATED NOVEMBER 24, 9 1 979 8 Y DOCTOR FAULK DISCUSSING ANOTHER CAUSE 10 OF VINYL CHLORIDE? 11 THE COURT: ANOTHER CAUSE OF 12 VINYL CHLORIDE. 13 BY MR RENNEI SEN: 14 Q- I'M SORRY, CAUSE OF ANGIOSARCOMA. 15 A. UM-HUM, YES, I AM. 16 Q. 17 A. ARE YOU FAMILIAR WITH THAT ARTICLE? UM-HUM. > - V 18 Q- AND THAT ARTICLE DISCUSSES A FOURTH 19 KNOWN CAUSE OF ANGIOSARCOMA, DOES IT NOT? 20 A . YES, IT DOES. 21 Q. AND WHAT IS THAT FORTH KNOWN CAUSE? 22 A. 23 Q. ANDROGENIC ANABOLIC STEROIDS. AND DOES THAT ARTICLE SAY FROM A V* 24 GROUP OF CASES STUDIED BY DOCTOR FAULK AND 25 HIS ASSOCIATE WHAT'S THAT APPROXIMATELY 25 2A11003S BFG09934 EXAMINATION LA UCI US MR. RENNEISEN 48 1 PERCENT OF THE CAUSES OF ANGIOSARCOMA WERE 2 KNOWN AND, THEREFORE, APPROXIMATELY 75 3 PERCENT WOULD BE UNKNOWN? 4 A. ' YES. 5 Q. DO YOU AGREE THAT MANY CAUSES OF 6 ANGIOSARCOMA OR -- MANY CASES OF 7 ANGIOSARCOMA ARE OF UNKNOWN ORIGIN? 8 A. WELL, THERE AREN'T THAT MANY CASES. 9 Q. HOW MANY CASES ARE THERE A YEAR? 10 A. I'M NOT AWARE, BUT I THINK IN 1975 WHEN HE WAS DESCRIBED, I THINK THERE WERE^^ 11 12 IN A YEAR IN THE UNITED STATES. 13 Q. IN THIS ARTICLE, DOCTOR FAULK IS 14 STUDYING ANGIOSARCOMA DATA REPORTED FROM 1954 15 TO 1974 AND HE REPORTED 158 SUCH DEATHS AND 16 HE'S CONCLUDED 22 WERE ASSOCIATED WITH 17 PREVIOUSLY KNOWN CAUSES, VINYL CHLORIDE, 18 THOROTRAST AND ARSENIC AND 3.1 WITH THE 19 STEROID THAT YOU MENTIONED, WHICH WOULD MEAN 20 75 PERCENT B.F. UNKNOWN CAUSES, IS THAT TRUE? 21 A. THAT'S WHAT HIS -- THAT'S WHAT HE 22 STATES. 23 Q. AND HE IS CONSIDERED TO BE AN 24 AUTHORITY IN THE FIELD, IS HE NOT, OF CANCER *0 ti 25 AND THE CAUSES OF CANCER? / BFG09935 RO examination LAUC I US MR. RENNEISEN 49 1 A. YES, HE IS. 2 Q. HAVE YOU DONE -- FROM YOUR 3 LITERATURE THAT YOU'VE READ -- AND I THINK 4 YOU SAID YOU KEEP UP TO DATE, DO YOU HAVE AN 5 OPINION AS TO WHAT THE LATENCY PERIOD IS FOR 6 ANGIOSARCOMA? WELL LET'S FIRST DEFINE LATENCY 7 PERIOD. HOW DO YOU DEFINE LATENCY PERIOD? 8 A. LATENCY IN CARCINOGENESIS? 9 Q. YES. 10 A . HAS TO DO WITH TIME TO EXPOSURE TO A 11 CARCINOGEN TO THE DEVELOPMENT OF CANCER. 12 Q. FROM THE FIRST EXPOSURE TO 13 DEVELOPMENT? 14 A . RIGHT. 15 Q. FROM YOUR LITERATURE, STUDIES, DO 16 YOU KNOW WHAT THE LATENCY PERIOD IS FOR 17 ANGIOSARCOMA? 18 A. GENERALLY, THE CASES THAT HAVE BEEN 19 DESCRIBED HAVE BEEN LATENCY PERIODS OF TEN TO 20 20 TO 30 YEARS . 21 Q AND WITH RESPECT TO MR. GRASSO, IT 22 WOULD BE LESS THAN SIX YEARS, WOULD IT NOT? 23 A . YES, IT WOULD. 24 Q. YOU MENTIONED THAT ARSENIC WAS A 25 CAUSE OF ANGIOSARCOMA; IS THAT CORRECT? 3 0ft)OTT! BFG09936 EXAMINATION - LAUCIUS - MR. RENNE I SEN 50 1 A. YES . 2 Q. DO YOU KNOW THAT ARSENIC IS USED IN 3 INSECT IC IDES? 4 A. YES . 5 Q. DO YOU KNOW THAT ARSENIC 6 INSECTICIDES CONTAIN ARSENIC WERE USED OVER A 7 LONG PERIOD OF TIME IN SALEM COUNTY ON THE 8 FARMS DOWN THERE? 9 A. I DON'T KNOW, OF COURSE. 10 MR. VASSALOTTi: YOUR HONOR, 11 MAY WE APPROACH THE BENCH? 12 A . Y E S , S I R .. 13 CSIDE BAR DISCUSSION ON RECORD) 14 MR. VASSALOTTI: YOUR HONOR, I 15 ASK FOR AN OFFER OF PROOF FROM THE DEFENDANT 16 AT THIS POINT WITH REGARD TO THE REPEATED 17 STATEMENTS THAT ARSENIC IS USED IN 18 INSECTICIDES AND WAS USED HEAVILY IN THE 19 SALEM COUNTY AREA. 20 THE COURT: LET THE RECORD 21 REFLECT THAT MR. RENNE ISEN HAS GIVEN TO 22 COUNSEL FOR THE PLAINTIFF SOME DOCUMENT TO 23 READ. 24 MR. RENNEISEN: IT'S A STUDY 25 PERFORMED OF THE NEW JERSEY AGRICULTURE 1110041 BFG09937 EXAMINATION - LAUCIUS - MR. RENNE I SEN 51 1 DEPARTMENT, I BELIEVE. 2 MR. VASSALOTTI: THERE'S NO 3 THIS IS AN EXTRACTION OF SOMETHING 4 WITHOUT ANY TITLE, AUTHOR, DATE. 5 MR. RENNEISEN: YOUR HONOR, I 6 WOULD LIKE TO ASK JOHN BULEY, MY ASSOCIATE TO 7 COME UP AND IDENTIFY ON THE RECORD WHERE THIS 8 DOCUMENT CAME FROM. SINCE MR. VASSALOTTI DOES 9 NOT ACCEPT IT AS AN OFFICIAL DOCUMENT. I CAN 10 IDENTIFY WHAT IT IS, BUT I'D RATHER IT BE 11 CORRECT IN STATING WHERE IT CAME FROM. 12 THE COURT: WELL, I'M SORT OF 13 HESITATE SOMEBODY SITTING IN THE AUDIENCE. 14 MR. RENNEISEN: HE'S FROM MY 15 OFFICE. I .CAN PUT IT ON THE RECORD. WE GOT 16 THIS DOCUMENT FROM THE STATE OF NEW JERSEY. I 17 CAN FIND IT IN MY NOTES, BUT I DON'T WANT TO 18 BE INACCURATE. THERE IS NO DOUBT THAT ARSENIC 19 WAS USED IN SALEM COUNTY IN OLDSMANS TOWNSHIP. 20 MR. VASSALOTTI: YOUR HONOR, 21 THIS APPEARS TO BE 22 THE COURT: LET ME SEE IT. 23 MR. VASSALOTTI: 35 PAGE 24 DOCUMENT OR 25 PAGE DOCUMENT. 25 THE COURT: WHY DON'T YOU 2 to BFG09938 E XAM I NAT I ON LAUCI US MR. RENNE I SEN 52 1 CONFER W I TH H I M AND GET THE YOU MAY 2 CONFER WITH H I M AND GET THE CORRECT TITLE 3 THIS. 4 MR. RENNEISEN: YOUR HONOR, 5 THIS DOCUMENT WAS PREPARED BY THE PESTICIDE 6 PROJECT -- D F T -- NEW JERSEY 7 DEPARTMENT OF HEALTH, TRENTON, NEW JERSEY. IT 8 WAS SUPPLIED TO JOHN 8ULEY FROM MY OFFICE L 9 FROM DOCTOR TERRY SCHULTZ, S-C-H-U-L-T-Z, WHO 10 IS EMPLOYED BY THE NEW JERSEY DEPARTMENT OF 11 HEALTH. 12 MR. VASSALOTTI: JUDGE, I'M 13 AT A COMPLETE LOSS. ARE YOU GOING TO OFFER 14 THAT? 15 MR. RENNEISEN: IF YOUR 16 WITNESS CONTINUES TO DENY THAT THEY 17 CONSIDERED ARSENIC AS A CAUSE, THEN AS : . i 18 REBUTTAL, I'LL OFFER THAT INTO EVIDENCE. IF 19 YOUR WITNESS ADMITS THAT ARSENIC IS A 20 POSSIBLE CAUSE AND HE WAS EXPOSED TO ARSENIC, 21 THEN I WON'T OFFER IT. 22 THE COURT: WELL, WHAT'S YOUR 23 POSITION RIGHT NOW? HE HAS IDENTIFIED THE 24 DOCUMENT WHICH HE'S USING FOR PURPOSE OF 25 CROSS-EXAMINATION, WHICH HE -- NOW 21110043 BFG09939 EXAM [NAT ION LAUC I US MR . RENNE [SEN 53 1 MR. VAS SALOTTI : I WOULD 2 OBJECT TO HIM USING THAT DOCUMENT AT THIS 3 POINT TO CROSS EXAMINE THE WITNESSES. 4 I WOULD LIKE A COPY OF THE 5 DOCUMENT. THE REASON I WOULD 08JECT TO HIM 6 USING THE DOCUMENT IS 8ECAUSE WE DON'T EVEN 7 KNOW WHAT IT IS. BUT MORE SO THAN THAT, IF HE.. 3 WANTS TO QUESTION THE WITNESS REGARDING 9 POSSIBLE ARSENIC EXPOSURES, FINE. BUT I WOULD 10 I WOULD NOT WANT THAT DOCUMENT USED TO 11 CROSS EXAMINE THIS WITNESSES. 12 MR. RENNEISEN: RIGHT NOW HE 13 SAID HE DOESN'T KNOW. 14 THE COURT: THE POINT IS THIS: IS HE HAS A RIGHT TO UTILIZE'A DOCUMENT ASKING 16 QUESTIONS, BUT, OF COURSE, YOU'VE GOT TO 17 IDENTIFY THE DOCUMENT AND ASK SOMEBODY IF , 18 HE'S FAMILIAR WITH THE DOCUMENT. 19 MR. RENNEISEN: I SAID DO YOU 20 KNOW WHETHER OR NOT ARSENIC WAS USED. AND HE 21 SAID, NO, HE DIDN'T NO, AND THAT'S THE END 22 OF IT. THE NEXT QUESTION, WAS THAT USED, DID 23 YOU MAKE ANY EFFORT TO DETERMINE WHETHER 24 ARSENIC WAS USED. 25 THE COURT: THAT'S THE END SrWKlTTTS BFG09940 E XAM I NAT I ON LAUCI US MR. RENNE I SEN 5'+ 1 OF THAT. IF HE WANTS TO -- IF HE'S CROSS 2 EXAMINED, GET AN EXPERT BASED ON THAT 3 DOCUMENT, HE'S GOING TO DOCUMENT ASSESS A 4 WITNESS, WHETHER HE CONSIDERS THAT AN 5 AUTHORITATIVE SOURCE, THAT WHOLE BIT HAS GOT 6 TO BE GOTTEN INTO. 7 MR. RENNEISEN; THAT'S TRUE, 8 BUT I HAVEN'T GOTTEN TO THAT POINT. 9 (THE FOLLOWING TAKES PLACE IN OPEN COURT.) 10 BY MR. VASSALOTT I : 11 Q. DOCTOR, I WAS ASKING YOU WHETHER OR 12 NOT YOU KNEW IF ARSENIC INSECTICIDES HAVE 13 BEEN USED IN SALEM COUNTY IN THE AREA WHERE 14 MR. GRASSO LIVED. IS A. 16 Q. I OBVIOUSLY DON'T KNOW. DID YOU MAKE ANY EFFORTS TO FIND OUT? 17 A. 18 Q. - NO, I DIDN'T. ' ' ` FOR HOW LONG MEDICALLY HAS THE 19 DISEASE OF ANGIOSARCOMA OF THE LIVER BEEN 20 KNOWN AND IDENTIFIED? 21 A. I CAN'T ANSWER THAT. 22 Q. WELL, IS IT -- IS IT A SHORT 23 PERIOD OF TIME, TEN YEARS, ARE WE TALKING 24 ABOUT 50 YEARS OR A HUNDRED YEARS? 25 A. I SUSPECT IT'S BEEN SINCE PATHOLOGY SKKHTT2 BFG09941 R0? EXAMINATION LAIIC I US MR. RENNE I SEN 55 1 STARTED, PERHAPS 80, 90 YEARS WOULD BE MORE 2 L I ICE LY . 3 Q. SO THAT ANGIOSARCOMA OF THE LIVER 4 EXISTED BEFORE THERE WAS VINYL CHLORIDE OR 5 THOROTRAST, ISN'T THAT TRUE? 6 A. THAT'S CORRECT, PROBABLY CORRECT. 7 Q. HAVE YOU DONE ANY STUDIES CONCERNING 8 STRIKE THAT QUESTION. 9 ARE YOU FAMILIAR WITH THE 10 LITERATURE WHICH DISCUSSES THE CASES OF 11 ANGIOSARCOMA WHICH THE MEDICAL PROFESSION HAS 12 ATTRIBUTED TO VINYL CHLORIDE? 13 A. I'VE READ SOME OF THE ARTICLES, YES. 14 Q. AND GENERALLY SPEAKING, DO YOU KNOW IS WHAT JOB -- WHAT TYPE OF WORK THE MEN HAD 16 WHO GOT ANGIOSARCOMA WHO WERE REVIEWED ANO 17 DISCUSSED IN THOSE ARTICLES? 18 A. YES. 19 Q. WHAT KIND OF JOBS DID THEY HAVE? 20 A. GENERALLY THE ONES THAT WERE FIRST 21 LINKED HAD HIGH EXPOSURE JOBS WORKING ON THE 22 PLANT, CLEANINGOUT THE PLANT. 23 Q. THEYWORKED ON PVC PLANT, DID THEY 24 NOT? 25 A. YES. 21110046 BFG09942 S EXAMINATION - LAUCIUS - MR. RENNE I SEN 5S 1 q. And they were people who within that 2 CATEGORY HAD HIGH EXPOSURE, DID THEY NOT? 3 A. YES, THEY DID. 4 Q. IS IT TRUE THAT THEY HAD EXPOSURES 5 FOR - -- WELL, DO YOU KNOW THE LENGTH OF 'V 6 THEIR EXPOSURES? 7 a. Newell, some of them had exposures for 8 VERY LONG LENGTHS OF TIME. 9 Q. X DO YOU^HAVE ANY -- DO YOU HAVE ANY 10 KNOWLEDGE AS TO THE DEGREES OR THE n CONCENTRATION TO WHICH THOSE GENTLEMEN WERE 12 EXPOSED? 13 A. THEY WERE EXCEEDINGLY HIGH, HUNDREDS 14 OF PARTS PER MILL ION. IS Q. MUCH HIGHER THAN MR. GRASSO'S; IS 16 THAT CORRECT? 17 A. ... YES . ...... . ;. 18 Q. WHAT -- WHAT IS YOUR REASON FOR 19 DECIDING THAT VINYL CHLORIDE IS THE CAUSE 20 WHAT IS YOUR REASON OR REASONS FOR 21 DECIDING THAT VINYL CHLORIDE IS THE CAUSE OF 22 THE ANGIOSARCOMA THAT MR. GRASSO HAD? 23 A. WELL, I SUSPECT I WAS LOOKING FOR A 24 CAUSE OF CARCINOGENS. I TOLD DOCTOR NEELD. HE 25 TOLD ME THERE WAS A B. F. GOODRICH. I LOOKED 4.WOTTTZ EXAM I NAT ION LAUCIUS MR . RENNE I SEN 57 1 IT UP IN CHEMICAL ENGINEERING NEWS; THERE 2 WAS. I CALLED THE COMMUNICABLE DISEASE CENTER. 3 THAT THEY HAD A POTENTIAL EIPDEMI 0L0G I CAL 4 PROBLEM THERE. I SUSPECT IT WAS HYPOTHESIS, 5 WHERE IS HIS EXPOSURE, FINDING AN EXPOSURE 6 AND ATTRIBUTION; IS IT MERE COINCIDENCE THAT 7 THE ONLY CASE OF VINYL CHLORIDE -- WELL, I 3 TAKE IT BACK. THE ONLY CASE OF ANGIOSAR COMA I 9 SEE AND MY PARTNERS SEEN IN TEN YEARS HAPPENS 10 TO BE THE PERSON WHO LIVES NEXT TO A VINYL 11 CHLORIDE PLANT. THAT'S ONE WAY OF LOOKING AT 12 I T . 13 Q. OF COURSE, THERE WERE MANY PEOPLE 14 WHO LIVE NEAR THE VINYL CHLORIDE PLANT WHO 15 DON'T HAVE AN ANGIOSARCOMA; ISN'T THAT TRUE? 16 A. THAT'S TRUE. 17 Q. AND FROM THE LITERATURE, DO,,YOU. KNOW 18 THAT THERE ARE PEOPLE WHO LIVE NOWHERE NEAR 19 VINYL CHLORIDE PLANT WHO GET ANGIOSARCOMA, 20 TOO, ISN'T THAT TRUE? 21 A. THAT'S TRUE, ALSO. HOWEVER, THEY 22 POTENTIALLY DO HAVE SOME EXPOSURES THAT HAVE 23 NOW BEEN LIMITED ELSEWHERE, LIKE THE AIR 24 FLOWS -- I MEAN THE PRODUCTS. 25 Q. IN OTHER WORDS, A PERSON LIVING IN 8W)0TYY3 BFG09944 \ S EXAMINATION - LAUCIUS - MR. RENNEISEN 53 \ \ 1 WYOMING NOWHERE NEAR A VINYL CHLORIDE PLANT \\ 2 COULD HAVE EXPOSURE TO VINYL CHLORIDE BECAUSE A 3 IT WAS L?SED AS A PROPELLANT IN SPRAY CANS, IS THAT CORRECT? 4 5 A. THAT'S CORRECT. 6 Q. SO,, WHEN YOU SAID THE CAUSE OF MR. 7 GRASSO'S DI[SSEEASE WAS VINYL CHLORIDE, YOU 8 DIDN'T NECESSARILY MEAN IT WAS IN THE B.F. 9 GOODRICH PLANT*. IT COULD HAVE BEEN FROM 10 AEROSOL CANS, I\S THAT TRUE? 11 A. IT COULD HAVE BEEN, BUT YOU'RE 12 ASKING WHY I BELTEVE WAS MOST PROBABLE. WE 13 HAVE NO WAY OF DOING THE KIND OF STUDY YOU 14 PROPOSE AND THAT IS EXPOSING EVERYBODY TO IS DIFFERENT PARTS PER MILLION OF VINYL CHLORIDE 16 TO HUMANS AND WAITING FIVE YEARS AND SEEING 17 HOW MANY END UP WITH ANGIOSARCOMA. 1 MEAN, 18 ONE CAN'T SAY WITH CERTAINTY, BUT YOU CAN SAY 19 WITH A DEGREE OF PROBABILITY. 20 Q. YOU FOUND A CASE ANO A CAUSE AND YOU 21 LINKED THEM TOGETHER; IS THAT RIGHT. 22 A. THE LITERATURE HAS LINKED THEM 23 TOGETHER, THE MEDICAL INFORMATION. 24 Q. BUT THE MEDICAL LITERATURE AND THE 25 FIRST ARTICLE I TALKED TO US, THAT 75 PERCENT t: 1110049 BFG09945 EXAMINATION - LAUCIUS - MR. RENNE I SEN 59 \l \ 1 OF THE CASES ARE OF UNKNOWN ORIGIN? WHY DO \ 2 YOU PICK QNE OF FOUR KNOWN* ORIGINS INSTEAD 3 SAYING, IT'WAS OF UNKNOWN ORIGIN? 4 A. BECAUSE -- 8ECAUSE I THOUGHT 5 THOUGHT IT WAS MOST LIKELY DO TO VINYL \ 6 CHLORIDE. I S^ILL 8ELIEVE THAT. I MEAN, HOW 7 WOULD YOU PROPOSE TO -- HOW WOULD YOU 8 REASONABLY ASK E TO CHANGE MY OPINION? 9 Q. WELL, LET ME ASK YOU THIS, DOCTOR. 10 THE COURT: WELL, LET ME SAY 11 THIS. YOU CAN'T ASK QUESTIONS OF COUNSEL. 12 THAT'S GETTING INTO AN A R G U M E N T I T I V E 13 SITUATION. YOU ASK THE QUESTIONS, YOU ANSWER 14 THEM . 15 THE WITNESS: OKAY. 16 BY MR. RENMEISEN: 17 Q. LET ME ASK YOU THIS, DOCTOR:. IN 18 MAKING YOUR DETERMINATION, DID YOU CONSIDER 19 THAT THE MEDICAL LITERATURE INDICATES LATENCY 20 PERIODS MUCH LONGER THAN MR. GRASSO'S? 21 A. 22 I T. IS THERE A QUESTION THERE? I MISSED 23 Q. I THOUGHT IT WAS A QUESTION. LET ME 24 ASK AGAIN. 25 IN MAKING YOUR DECISION THAT SOOTTTZ BFG09946 EXAMINATION - LAUCIUS - MR. RENNE I SEN SO 1 IT'S VINYL CHLORIDE THAT CAUSED -- DID YOU 2 CONSIDER THE FACT THAT THE MEDICAL LITERATURE 3 INDICATES LATENCY PERIODS GREATER THAN MR. 4 GRASSO'S LATENCY PERIOD? 5 A. I DID . 6 Q. IN MAKING YOUR DECISION, DID YOU 7 CONSIDER THE FACT THAT OF THE KNOWN CASES 3 WHICH THE MEDICAL PROFESSION HAS ATTRIBUTED 9 TO VINYL CHLORIDE EXPOSURE TO ANGIOSARCOMA, 10 THE PEOPLE WHO CONTRACTED ANGIOSARCOMA HAD 11 INTENSE EXPOSURE IN THE WORK PLACE? 12 A. YES. 13 Q. AND, DID YOU CONSIDER THE FACT THAT 14 MR. GRASSO DID NOT HAVE INTENSE EXPOSURE IN 15 THE WORK PLACE; IS THAT CORRECT? 16 A. I CAN'T TESTIFY TO WHAT EXPOSURE HE 17 REALLY HAD, WHERE HE WORKED. BUT I -- IF 13 YOU TAKE THAT AS A GIVEN AND HE DIDN'T HAVE 19 ANY EXPOSURE WHERE HE WORKED 20 Q. THE EXPOSURE 21 A. THEN I DID CONSIDER IT, YES. 22 Q. THE EXPOSURE YOU KNEW ABOUT WAS 23 LIVING APPROXIMATELY TWO MILES FROM THE PLANT? 24 A. AND BEING TOLD BY DOCTOR NEELD AT 25 DUPONT THAT THEY DIDN'T MAKE QUANTITIES OF TSOOTYT BFG09947 cro: EXAMINATION LAUCIUS MR. RENNE I SEN 61 1 2 3 4 5 6 7 8 )i 14 15 16 17 18 19 20 21 22 23 24 25 V INYL CHLOR IDE. Q. HE ACTUALLY TOLD YOU THEY HAD SOME, DIDN'T HE? A. HE TOLD ME THEY HAD NONE, 8 U T I SUBSEQUENTLY LEARNED THAT THEY HAD SOME IN A DIFFERENT AREA WHERE HE DIDN'T WORK. I THINK IT WAS TO FILL FILL OUT THg^AIR SOL Es), I BELIEVE . Q. DID YOU '-- AND I THINK YOU'VE ALREADY TOLD ME THAT YOU DIDN'T MAKE ANY VESSELS TO ELIMINATE ARSENIC AS A CAUSE? A. WHERE 8LOOD ARSENIC LEVELS DONE ON HIS AUTOPSY, NO, BUT THE POSTMORTUM DIDN'T SHOW ANY EVIDENCE OF CHRONIC ARSENIC COMPOST AS FAR AS WE CAN TELL. Q. __ INCIDENTALLY, DOCTOR, JUST SOMETH I NG THAT YOU SAID EARLIER, WHEN MR. GRASSO WAS WAS (CAUGH i'nG^. UP 8LOOD, WAS THAT BECAUSE IT IS LIVER CANCER HAD SPREAD TO HIS LUNGS? A. YES, I 8ELI EVE . Q. SO THAT EVEN THOUGH THERE WERE NO TUMORS ON THE X-RAYS IN MAY OF 1976, IT WOULD HAVE MEANT THAT THERE WERE SOME BLOOD INVOLVEMENT 8Y THAT TIME; IS THAT CORRECT? A. I HAVEN'T GOT A X-RAY. JUNE IS THE N s $ BFG09948 * u EXAMINATION LAUC I US M .9 . 9ENNE I SEN S2 1 EARLIEST X-RAY I'VE SEEN. 2 Q. WELL, HEW A S' C A UGH! nJ)uP BLOOD IN 3 MAY, I BELIEVE. 4 A. YES . 5 Q. ACCORDING TOTHE TESTIMONY WE HAD 6 HERE. 7 A. ONE WOULD SUSPECT THAT THE TUMOR IS 8 PRESENT. 9 Q. IN THE LITERATURE THAT YOU WERE 10 FAMILIAR WITH -- I GUESS THIS IS A 11 VIOLATION OF THE COPYRIGHT LAWS -- BUT ARE 12 YOU FAMILIAR WITH THIS DOCUMENT WHICH 13 WHICH WAS A PUBLICATION OF THE NEW YORK 14 ACADEMY OF SCIENCE, TOXICITY OF VINYL 15 CHLORIDE, POLYVINYL CHLORIDE? 16 A. NO, I'M MOT. 17 18 8 E LONG. 19 THE COURT: ARE YOU GOING TO MR. RENNEISEN: NO, I'M VERY 20 CLOSE TO BEING FINISHED. 21 THE COURT: BECAUSE I'M 22 HOLDING UP THE RECESS. WILL THERE BE REDIRECT, 23 MR. VASSALOTTI? 24 MR. VASSALOTTI: JUST A 25 COUPLE OF QUESTIONS, YOUR HONOR. 21110053 BFG09949 EXAMINATION LAUCIUS MR. RENNE I SEN 53 1 BY MR. RENNE I SEN: 2 Q. WHEN YOU S A I 0 THAT YOU WERE FAMILIAR 3 WITH SOME LITERATURE IN THE FIELD THAT 4 DISCUSSED THE RELATIONSHIP BETWEEN VINYL 5 CHLORIDE AND ANGIOSARCOMA, DO YOU RECALL NOW 6 WHO THE AUTHORS OF THAT LITERATURE WERE? 7 A. WELL, I HAD SOME OF THE LITERATURE 8 OVER THERE THAT I BROUGHT ALONG THAT 9 Q. I WON'T TEST YOUR MEMORY. 10 A. BUT I MEAN THE BASIC REVIEW ARTICLE 11 IN THE MEDICAL COMMUNITY IS THE ANDERSON 12 INTERNAL MEDICINE. AND I READ THAT. 13 Q. AND THESE ARE PUBLISHED 8Y ACCEPTED 14 PUBLISHING HOUSES THAT KEEP THEM APPRISED OF 15 LATEST DEVELOPMENTS; IS THAT RIGHT? 16 A. YES . 17 Q. AND THAT LITERATURE INDICATED TO YOU 18 THE LONG LATENCY PERIODS THAT YOU AND I HAVE 19 BEEN TALKING ABOUT; IS THAT CORRECT? 20 A. IT INDICATED THERE WAS A LATENCY 21 PERIOD, YES. 22 Q. AND THAT SAME LITERATUREDISCUSSED 23 THE CONCENTRATION LEVELS TO WHICH 24 ANGIOSARCOMA -- ANGIOSARCOMA PATIENTS HAD 25 BEEN EXPOSED WHEN THEY WERE EXPOSED TO VINYL frSOOYTTS BFG09950 : ro EXAMINATION LAUC I US MR. RENNEISEN S4 1 CHLORIDE; IS THAT TRUE? 2 A. YES, IT HAD SOME NUMERICAL PHYSICIAN, 3 YES . 4 Q. AND THOSE FIGURES, AGAIN, WOULD YOU 5 TELL ME WERE AGAIN IN HUNDREDS OF PARTS PER 6 MILLION? 7 A. YEAH. 8 Q. ON A REGULAR BASIS IN THE WORK PLACE; 9 IS THAT CORRECT? 10 A . YES . 11 MR. RENNEISEN: THANK YOU, 12 DOCTOR 13 THE COURT: REDIRECT. 14 MR. VASSALOTTI: NO, YOUR 15 HONOR . 16 THE COURT: I HAVE NO FURTHER 17 QUESTIONS. 18 THE COURT: LADIES AND 19 GENTLEMEN, LET'S TAKE OUR MORNING RECESS, TEN 20 MINUTES. 21 (JURY LEAVES THE COURTROOM. ) 22 THE COURT: TEN MINUTES RECESS. 23 YOU MAY STEP DOWN. 24 (RECESS.) 25 (THE FOLLOWING TAKES PLACE IN OPEN COURT WITH SSOOTTT; BFG09951 RO EXAMINATION LAUC I US MR . RENNE I SEN 55 1 THE JURY PRESENT.) 2 THE COURT: CALL YOUR NEXT 3 WITNESS. 4 MR. VASSALOTTI: THANK YOU, 5 YOUR HONOR. DOCTOR SAMUEL EPSTEIN. 6 SAMUEL EPSTEIN SWORN. 7 DIRECT EXAMINATION BY MR. VASSALOTTI. 3 Q. DOCTOR, BY WHOM ARE YOU PRESENTLY 9 EMPLOYED? 10 A. THE UNIVERSITY OF ILLINOIS MEDICAL 11 CENTER IN CHICAGO. 12 Q. AND WHAT IS YOUR POSITION WITH THE 13 UNIVERSITY OF ILLINOIS MEDICAL CENTER? 14 A. I'M PROFESSOR OF OCCUPATIONAL AND 15 ENVIROMENTAL MEDICINE. 16 Q. CAN YOU DESCRIBE THE AREA OF 17 MEDICINE AND/OR TO X ICOLOGY THAT YOU ARE 18 INVOLVED WITH IN THAT POSITION? 19 A. MY MAJOR PROFESSIONAL INTERESTS 20 RELATING TO THE TOXICS AND CANCER CAUSING OR 21 CARCINOGENIC EFFECTS OF CHEMICALS IN THE 22 ENVIRONMENT WITH PARTICULAR REFERENCE TO 23 POLLUTANTS IN AIR, FOOD, WATER AND THE WORK 24 PLACE. 25 Q . YOU ARE A MEDICAL DOCTOR? S90OTTT: BFG09952 1 1 i - i j - \ T YA 2 r~ _i \ - r I - G':" S 15 : ? J. = - 3 1 j L 1 " i '*N '3 = ^ 4 HAT VTH'CT? 5 4 -H H j ,[; 45 AL_ : 6 y 'J -i A 'LA T E 3 TO 7 I A r L 7 C HLCP I CE E X J0 3 L E . 8 7. lv ELL, WHEN YOU SAY => E L A T 5 0 TO 7 [ \ Y L 9 C H L 0 => I DE EXPOS'JRt , ./ A S IT < E A L L v DELATED TO 10 v I NY L CHLOOIOE EXPOSURE 0? '/ I N Y L CuLOEIOE 11 EXPOSURE 0~ ? V C 0 ^ .< E 7 S ? . 12 A. 0 0. T-JE -- T'-tc rsv.i ?70 -- i'!0 I 13 Y I < I. : or y L 0 'J L SITE, I USE, I T'h f a 14 4" A ' L Y . f - E A C C J " ' E '< 0 15 l yA. A -Y A * 0 C C ! ' THE 16 P 2 0 J U C 7 ION, THE : .A < I i G j r VINYL CHL ST ITS . IT 17 ri -A 4 a c. c 'l A S S G C 1 . EG WITH VINYL CHLORIDE 8EING 18 JS ED TO P 0 :T ,! TO- POL'MET, PVC. AND [T -AS NOT 7 n '*7 . *\ i 'J . . T ' \J I 20 3 E I N G JOED FCT E A ? 9 I C A T I 0 N S . A \ D A i_ l The ) : : c ~21 A N G I OSATCO.MA CASES THAT i'S 5H0 rv IN T m c a ? 22 atethose w hose d - v e l o p -i - n t o e *ys t j 1 > s a o 23 The. I ,'V OAK H f $ T -) 3 J - 3 - _! ,> .. - ' S (V? >' A ' V [ ' 24 5 0 f* V A 3 < . - ; .1 T ; r\ r "> S' >/ = "> C { 1 \ ' ? ( >; Y 25 IT E T.' a i / > < r y : 0 - i 0 I ~ . ^ sootttz BFG09953 7. v^33-L.''T'l 1 OUP .v AS THAT YOU i "U0 I 7 2 PIOEMIOLOGICAL 5 T J 0 [ 5 . 'IT'S C4LL50 A 3 C 0 - 0 7 7 , [ j 1 7 [ T ? [ 3 7 - A T u :J A 7 YOU CALL 4 5 A. 7^ JS WAS LOT A C ? h 0 7 ' 3"U0Y. T - 1 C 6 S [ , -1 p I. Y [-'.l`r I ~ I " S ALL T HP C A S L 3 7 ha T !- - A v 7 that WE .< M 0 vi OP I '! THE L I T E 3 4 T 'J ? E , F 9 0 M O 'J ? 3 3.o: X P E I-ruCS, =7n-'' OTh = -> P^V'S, '-A; W "`RE 9 L 3 0 0 ! U 0 AT THESE A'. r, ! 3 3 : 7 C 0 :A A 3 A ': 0 10 EHA A ACT0 ! E l 4 0 GO IMG 0\ THE IE CLIl I CAL, 11 hISTolOGICAL, PHYSICAL C U A fl A C T c 3 I 3 T I C 3 , 7 H E I 12 : Ar'Oi w.3E A I j T 0 3 I - 5 . 13 v . O < 7 . I ,% YOUR O 1 3 6 C T T 5 7 I : 1 0 NY , YQ J 14 I L T [ 3 i < E j That 0 OC 7 0S OATALOMi ~! - 0 00 ME 5 0 X E 15 5 7 J 0 [ E S 0 >1 16 V I M Y L C H L 0 0 17 F 0 U N 0 A N G I 0 3 H 18 P A < T S PEP - 19 \ il :h = i_ o >; - 7 O : 20 /. A 1 CH rl c c ; > 21 - o: 22 0 T ."1 \ XI , i 0 3 CHANGE-3 Y-, 3(7 OF 23 * . 7 24 25 1i F i 7 = C A L L COOT" 1110058 BfG09954 ) 1 2 l~ r* t 4 5 : i 0 T-- wi7GPA7U%Z G A i . 1 T -.AO E1THE9 iT 6 0 c OP - T FlVc. 7 C. LET'S 3 SjFl, 0 0 C T G 0 . LET -i 5 AO *' 8 Y'juh.N .IT 1Cl.E HAT 'S EM I T',E 3 "VINYL 9 0 H L 0 P I J E C A .P C I N 0 G E 'i I C l T Y AND EXPEP l '-.E-.'TAL 10 iY '} 0 c L FOR C A F C I 'l 0 G IN I C STUDIES." IT'S AY C. 11 . 1 A T A L 0 \ [ . IS THA T THE 3 9 0 - E 3 3 0 7 - T A !_ p N [ T A 12 WE'VE 'EE' T'LWIWG ;10'JT? 13 A . vE3 . 14 n . PAGE 177 ^ - T :j [ 7 a'.! 5 L I C ^ T P N , 15 THEWE'5 a cN 4 P " THAT 1 P [CAT'STHE LEV EL; 0c 16 EAPOS'J-PE TO WHICH MW. MATA LOW l -- 0 OC TO-. 17 A A T A L D M I EXPOSED THESE Ai-: PALS. 18 ~ . WIGHT. 19 < IS TiiElc A TEST F 0 0 -- V A, S A 5 T J D Y 20 00 X E AT OWE P A P T PEW PI I L _ l 0 W ? 21 A . YES, T H E P E WAS. 22 Q. A \ 0 W l~.E ANY GANCE 0 -- 0 AN CEP IvS 23 FINDINGS LOCATED? 24 A. p A 1 T 1 2 , "O'JP = ?. h i 'H T h E P S TTES v;c 25 E I G'-'T IV THIS c * -V T T-iT -= bso o titj: BFG09955 i 1 ^ L_ .'1 V O t 'v n T U J ': a 12 0 A Ni 1 A L i T H A 7 2 A TOTAL OF 1 C a : c c R 3 ') F H I C i F 0 J A 3 S r c C I .* I E J SITE! .) EIGHT ERE E l A T1 /. ! LL A ACE 7 5 <- 'i i VC D > E E l LL [ : A ? 6 ^ IS C G 9 9 S C T . 7 0. OOC'93, IN 4 LOT 0 p the ARTICLES 8 That [ > ye 9 E a D WO I i r " c 'IP V i : 9 TEST I H z -. E T GOA/, -- \i r t 10 ACE- A EE i] ^T C 7 YO'J A '' 0 11 ? < j F E 5 5 IGA " A V EEEA COACE'AEO W 0 U T 12 EAHwS'jxEi OR J 7 z 9 ! I N I NO . ' "he X P C 2o 9E OF hN EMPLOYEE /AS TO / l \ Y L CHLORIDE, IT '3 14 L 0 , -i -i 0 . i L Y i c. E ^ L A T 1 F [ E j I T h < " S 0 F - -> T i j 15 PER MILLION; 15 THAT C 0 7 C T 16 A. THAT'S CORRECT. 17 C; . 5 0 3 A 9 T 5 PER M I LL ION MEASURED AT 18 ACTUALLY WHAT THE W09<E9S ViOULO HAVE "'FEN 19 EXPOSED TO; IS T H A T C O 9 9 E C T , 0 9 E S T I H, * T = 0 at 20 WHAT THE ;i 0 !J L O HA V E 3 E E V EXPOSED 21 a. TH t S E A 9 E 5 T ! M A T c S that , CC 79E C 22 O. IN OTHER WOODS, A "A'-; ' E O E 23 C L E.h'i l':G * 0 E C " j 9 , A S E 0 UP OHT' " E 24 L ' c -J \ '! M I I ._< * Y _/ \J J ^ v ^ 1 -'f - w A j T j ~ ' ;, ' I A' - ^ 25 U l T E ;i 1 N E 0 T T ;i E -.AS E X ? 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G P A 5 S 0 '! uS_* 3 C^ E X J 0 5 = 0 AT A, n LEVEL OF T H p EE PAR TS P ~ 9 '1 1 L L r o\ o UR FUG T^JS 12 E '! T [ P c TIME, *H4T THAT >,* r, ULO 3 T 7 E T A = 13 r :\ - r - -> 14 1 l~ ' vi 15 Y 3J 1 \; 1EEG LE 3 5 . 16 rl.j. ?. E '-IMS I 3 E s : I A SPED TK1 17 jOCTCP lr PLAINTIFF PROVED TAPES PAPT3 PEP 18 4 I L !_ 1 0 '1 ON .A 19 THE COURT: I1M G 0[\G TO 20 ALLOW THE C U C 3 T I 0 \ . YOG HAY ->OCcD . 21 0 3 J S C T [ 0 H 0 V E 7 9 U L S 3 . 22 =5 Y A ~ . V A S 3 A L 0 T T I : 23 3 . I 5 TH A T vj H 3 P F yn;j GO T T u - T J o H 24 A ' I i 25 BFG09962 9900TTT2 ! Ii f! rfw^tllAANfif "WJL&. 3 17. fswsWBF rm JIiji43E^ 18 .... j,,, m 1 11 w y, Ml 1 ii| >-| rnq -i|n|T --r-rr r i U M 4900TTT BFG09963 1 2 3 l 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 t: 23 24 25 BFG09964 8$OOTTT <. 1 fTaITpARD P 9;~C~CS~?Trir- FhO * 2 i ,__~r^i mil j p | -w**" 4 .DR m'^TOI'!jlIl."! w> 5 Q. DOCTOR, a 9 E YOU c A '! I L 1 A 0 >/ 1 T H 4 6 - -J 0 -J 3 K\0 AS T^E 1 '1 T G 9 A C E N C Y ^ G G U L 1 T h ~ v 7 LIAISON G 9 0 0 = W HIGH ? U 9 L I S u E 0 A - - .;h!Ch [c 3 A URDU? C "> 3 I 3 T [ NG 0 = *4 ENTERS OF thf .j tj 9 v 0 = 9 Tap CONSUMER ^OOJC'S 5J"TY C 0 N t 5 3 10! , " - G 10 V t . J a | ^ "i r\ T ct, rL-, l I ^ `~ K' r Y , T - " - ^ ^ A : ") 11 l> 90S A G -i t i I 5 T A T I 0 N AMO THE 0 C C J 0 A T I ON A l 12 5 A F ~ T Y A sO E a l T 0 A D ' I \ [ 5 T 9 --7 I 0 A . 13 ^ 14 i ' v E ic A 9 0 0 F T H E G R 0 ,j ? . YOU ILIA.9 i i T-i 15 AJiL I C A T I J L, SCIENTIFIC OASIS F 07 16 identification of potential c-vrc Imogens and 17 EMISSIONS -- I'M SORRY, AND ESTIMATIONS 0p 18 RISKS? 19 A . '! 0 , 1 ' V '! n T ~ A V) I L I A V I T H t H A T 20 PiN-'L I CAT ! O'1. 21 0 . IS THAT A G 0 '/ ,E ? '! E N T ? 0 0 Y nu; } I 0 22 THAT STUDY? 23 A . Those ar ft 0 V E A N '4 E `9 T a 0 DIES. I CON' 24 ,'t'j ,-i THAT T n .\T'S A STUDY 25 . 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I 3 E ? b i L . 20 The I T N 5 5 : THE It 3 P 4 5 T 3 21 uF THIS JOCUAELT THAT HAVE T:E'i 3 A - L I 3 H El 0 22 OTHER PLACES, 8 U T I'VE `1E V T 7 3 = " H T '-* ! 3 23 A ^ 1 i I a 'J l. ^ i\ C w vi ^ .7 24 3 Y 3 . /A 3 3 A L 0 T T I : 25 0. LEr *" z 1 zs 11 YOU " h = AOS 2'- A CZOOTTT BFG09966 1 > C ' o 4 i__ Y IT ' 5 P H KD o u . I ' 1 T I f L E 'LAC < OF P 7 0 I C r 3 L E 7 ; 3 ii j L 0 3 F j.\ . : a F E : ; / P ,, P -J L T I 0 : . 11 4 J0CTC7, DOES it 7 77 5 4 Y '.7 5 7 . i 7 0 ? j F PAG; 2 S 5 THAT THE 7 f. I 4 7n L I - 3 L 6 ACCEPT 4 3 L E -AY 70 D E T E 7 -1 I N E 7 E L I A H L Y -- l'1 7 5 07 7 Y . 5 T7 I < TPiT. LET -f ES T A a7 0 '' E 9Q AIL. 3 T LJ E 7 c 13 P 7 3 E \ T L Y ': 0 9 A C. CEP" EL' i A V TO 0 T " - I V F 7 E L I A PLY A 10 T i-j -j - - m r, l 0 F 0 7 A C A C I N 0 0 V F 0 7 A \|'' " I 7 11 P G F U L A T 10 N ? 12 - r T 0 0 5 5 5 AY 70*7. ? J7 Y C J 1 / 13 l3 i i coin 5.4 Till .v 0 3 J I 3 PREDICTABLE. 14 HA 7 I ./AS P j [ \ T [ , G OUT T y 0 J 15 5 P I D c * . 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AO, THAT'S SCIENTIFICALLY A A 11 m C C A 7 4 A PROCESS A `! 0 AS EACH S 'J C C Z 5 3 I t /A < 12 a 0 ,1 j 3 , > I ' 0 iSLO TRUE . YOU E E 7 I 3 R E A E I 0 13 THAT. IT SAYS PASO IC T I H G IT. : Z 1 ^ ~ 'J ' 14 IS PAST \i G IT 0'! 15 CP EXPERIENCE A .J r\ 3 v r H A 3 A C 7 E R I Z T I 0 OF ~ '-J r 16 DISEASE. A m 0 YOU 'PE SAY IMG ON THE 'AS 15 0c 17 this past EXPERIENCE, THIS VAST PAST 13 EXPERIENCE, That I ["LOGICALLY, E SHOL". ) HOT 1 <3 - 4 A r 0 T f. - 7 -- I M A T 0 0 H h '3 r1 . A H 0 THAT 1 S 20 PREDICTABLE, cut n ; T THEY'RE S ^ Y I j IS, TO j 21 a a * 'iu T j . T 'J . i Y STOUT E I 7 n E -* H I .-SAL - I 3 t , 22 ri Ur-; Am - W lit O' P 1 J z. H I 0 L j 0 I C A L - m I S ; 3 c = 0 R c ' 23 FnC T Art J r .vi 3 I C f ..HE T-H ER 0 R N ) T a C h l ' I C A L 24 ILL OF HOT HOT f 103UCF. C A N C E R (H ThE ~ U T -J A E 25 Amo THAT'S 'TOE, 21110072 BFG09968 1 2 iiCTIO'.. 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'MY = 7 5 SET j -> ao7 ( - 25 A; D ; - me 2 E C 0 ` v E 0 ' T : 0 *: . 21110073 BFG09969 ] . ti C j . E A JhIT!' 4 3 2 C G J 3 5 c .. E 2 n 'j J L 0 3 l N a* a : 0 L IMG T A :< .1 5 6 T T*c?1 7 0 '; L Y P'\< iT 3 1 fj 9 .; T l 7 L E J " 7 Ga I C C it'.-: I C 4 L5a .MO P 'j 3 i_ i C 10 ? Tcu 7 1j--:, ME POET TO T-`.1 P '. S 5 i 3' I='. y 7 ; j i- t i T 0 a I C i U 3 S T A ACES 2T7A7EGY C j '1 I 7 7 E . 12 7 r, E F 1 E S I 2 . '. 7 ,jr 7 HE !J;< 1 7'" j `37 A 7 E 5 3 ,< A Y 13 M i , 0 It * J A i C. J 'i m 7 t~ 1 J J 14 I ,, a %! 7 7 3 -."AO 'A y 2 ? 15 'iz 0 ME 3 J 16 ii= t -_i n 3 <; I 3 7 5 13 0 * T : H r. ' E t T S T A T 7 I :< E THAT. 17 .*1E T H 0 0 3 '! 0 '< i V a [ L A 3 13 ; 18 j U A , T [ F Y I 1 A 7 E E5rr-47E7 -ISMS p . 19 GIVE .1 EXPA307E T 4 ^T`< 1 A L C A ? C I \ C } ' 20 J I 21 , A A '2 0", ' i 'i J i '> L 22 'j J A \ 7 ME T C 7 r AD 23 't J lJ A A i N t 24 .) p [ "t II .1 n M 7 'f J 2 a 1 J i 25 : i ; I 21110074 BFG09970 1 2 3 . r,,U I 4 5 6 1 ' 7 \ *. T I '/ E -w .E ' , [T, r1 5: < '-> J u r: -- -- Y J S E i-7. THAT'S 7 /. p.Y I ' A 3 .< I - YOU 3 A. IF ! lOJVi v 1 7 l: T E rl -1 I v 3 3 A S c 0 ' N 9 P-1C1MILITY, -55. 10 o. '> 05 = A I L I a ? i ry t )- " -i " ' T 7F 0 0 C ! 1 3-7 T [ 1 11 PECULATIONS ~ = "HE D 12 5 A e ; T y A 'I 0 i: V 1 ': Y I. H - [ r "3 13 U 15 1 , i V j _ v '5 OAT ^ i- --. c - 16 S T A \ D A ,< 0 S r 0 i V EL 5 ; Y i . T c 3 3 T Ur 17 C J .n I 0 L 3 0 A i L d '7 d L . d ;< A o S J 3 E T 0 V I 'i Y 13 C H !_ 0 7; i j 3 1 1 T .V 0'T < A 19 MO, : v; A 5 M:: 20 ape * :u 17 A:-',' : ' J3 ? 3 0 7 T 21 the national ; 3 t it u A T m A !_ 5 A = 22 A '! 0 HE A i_th T ' ViA 5 ' T - 0 I V r H M V SJTjy - i T ' o-'iT r ^ 3 > 23 t Th T h E ? ? E = AT I ON 24 T - " 3 A F E T v "i -- \ ' T . I y T 25 : -loti : e ? S400TTT BFG09971 1 . L 2 ".A--: Y 7 L F OH 7 i . IF Y 7 1J ' S S 2 vl\ HE FACT T i- A T Th; OTlnl^L 3 \ H A 0 Tj a I Z E 17 pi 1*3 - 7 7 4 LUOY, YES. 5 ,/ac THE LEVEL A F V ! v Y L 6 ' ; ' r p voncili: ' ' u r r j [ c " i n y r 7 $ -r & \j o \ a oc THE 0 C C U 3 4 T I .3 A HEALTH A v 3 SAFETY i 0 ^ I ! S T 7 a 7 I A \ ? 9 I 3 E L I 5 v E IT to 3E 0 n E PEP 10 1 L L i 3 V . 11 y . J 'J C T 0 < , Ax E Y 0 -J F .A f L i - x | T -1 12 = -4v 11< g i-i<* i'i\ t a l protect i oh agency's ~ego 13 1YG On THE EM 155 I 0 K OF 7 14 SHcLiiAE GAS F 1 0,1 VI.-,VL CxLC'l 1 0 17 PVC 15 plants ? 16 A. TO A LESSEE 0 EGPEE, YES. 17 0 . APE YOU c A m I l_ [ A 9 W t T H T M ~ PACT H 4 T 18 THE E N V I T 0 >! " E H T A L PPOTS-rTIO '! A C- ~ v r y [ \; 19 STUDIES *F 'T THEY HADE PE POPE ISSUING T: 20 STANDARD, OETEPHINEO 'HA* THE0 E ' E 0 E 21 A-'PIOX i .*i A 7 E L Y u.' 'ILL I 07 PEOPLE ' H Z L! 22 n i T IH I n P I Y a i 1 L E 3 OF 1 "J Y u h t L 1 \ l c ^ : 23 plants 1 i t 1; c j j n y 24 H l n A V if c A < -j T H A T ; E ? 0 2 25 h N J T n A T THIS a 0 PoL.AT 1 0 7 ..AS z A h . 0 21110076 BFG09972 ... ; ' T _ : 1 \/ c. : r r \ * r - * 2 : - L 7 I 1 = I 3 4 5 6 SUV 1 3 0 Eo T-. L 0TE0T lOU -- ( ' SOOTY. -Hi 7 -4 V [ 2 0 i : = . TAL r 1 j T E C " ! 0 ^ G S N C Y , 7 - l S IS TH: 8 .= E),<AL A G c . C Y , - 3 . - L 3 A "EG A S T a ': ; a 0 a . - i 0 9 i Er.-:CT, INTENDED TO 'EDUCE E I 3 S 10 OS OF 10 VINYL CHLOMOE TOO" 3 VC "> L A \ T 3 LITE " E ` '. I 11 12 A vrq 13 y *; v o 11 n '.i t*. -s c r. rue *> c r "i t /" - 14 r *1 P a \j Y f -- ` 7 \ v 7* y - 7. 7 . . " r 7 -- \ T T --4 - v 7.*./ 15 YOU M the G7V1T5, 010 "HE 0 0 0 3 3 I C - O' ' - - Y 16 P 0 0 V [ 0 5 YOU WITH a >1 Y STijMES 3EGA 20 IvG r ' E 17 TOXICITY OF. CACCINOGE'ilCTY OF VINYL C H L 0 3 IDE 18 THAT THEY H a j C 0 4 DUCTED J E = 0 3 E THEY 3 e t A [ E 0 19 YOU? 20 A . N 0 , THEY DIO not.. 21 22 5 OC H STUDIES " A 0 '.i E E U 'J 0 E 0 T A < E 1 ? 23 A. YES, ,vE ' /r Of TOUTS"' 7 : [ ' 24 v; 0 9 0. T -! \ T yuey '-i i ^ *\ v C \ . rs .! I i T ''T'Jd 25 r O' p \ [ - r vi . ^ *> s r 24110077 BFG09973 1 v. E _ L, I ' i _ t .[TING IT TO 0 331 [ C H 4. -1 ( jhT -i -j ,, , A 0 THE y 0 J '< z A A V T H [ G n ~J E THEY 3 t;ct: i \ T: - ; s i-Ei? 4 si1j 71 e:s 7 e>_ a ~e o t 5 J 7 A '! 3 , 3 U 7 0 T "7 A 'i '1 A L 5 . 6p r h 0 S F S T U 0 I E 3 r ^' V 7 !_ '/ c 0 T E ^ u h ~ E 7 CASE 3 C F A Y G f 3 S A A C 0 M A THAT '/ E9z 0 T 5 C 7 V E = E 3 ? 8 H 7 -- - Y HAH. 3 = n . t . ^ 9 3 C 7 E l '! 3 =7307 A v , u4' OEE I G N E 0 THE ECEEE'i [AG 10 P70S7AM, H A ? [ Mp i_ M EM E 0 A S 0 7 " E ^ !'! G => 7 a G 7 A H , 11 :i A J L J o i\ 13 A ; A J :'! 3 z 7 Or- I A 0 I V ! J * L s > '' h * - 12 AO C H M I C A L AjN07 !ALfT I E5, HAD 1 c 0 l C A L L Y 13 .(UrlAEj TriE.-i jP; T H c I 7 INITIAL SC75EN MG 14 ? .7 0 G 7 A -1 W A S E E A 5 J ALLYi T A 7 T A 3 Y THE T [ : E [ IS A ,7 7 I VcO AT THEJ.4 l VERS I TY OF LOUISVILLE. 16 C . THAT ';! AS I \ 1 0 7 A ? 17 A. 1776. HAT WAS BETWEEN JANUA7Y A NO 18 S E P T E Hi 7 E 7 . 19 M 7. V A S S A L 0 r T [ : I HA VE 20 \! 0 T ,J I *' G " U 7T <i-'B " T >' H , ? u A N K Y 7 1! . 21 t _( c <- -i 11 o t i j v ) it ri [ 7 r ^ r i 22 17. 7 E A \ E r S E N : I ay HA 7 E 23 j -j j T j i. l. v o E j i I 0 n . 24 7EJ17ECT E X A .'-1 I N AT [ J ^ 3 Y . 7E\NEI5E\ 25 j Y . i 3 c. i i z I z z 1 BFG09974 21110078 i .; ~ * . . L j . * j -a ^ J . C-1055 - = X \ [ :! A " f 0 fi ~ H - 7 C , Yrt 7) - \ C ' = -) ' - 'H i AN E . P . i . ~ r. U L A 7 I " `' '"-'-7 ? h ! ^ - : [ c s r h - ^ ^ ' ?. >! v ' y ! r '-ai ^ "5 | ^t j \. * - 1 V -> | / T-iz 'J ATE 0 F r-AT ! V: ? 0 , t 0 0'i ,T . ^ 30 Y 0J . n03 ~ Ii * E H T 5 7 1 a [A TO c.A.RL i z.X M TH I S CASc THAT 0 \ P -A 7 T UUIO.M .v G R A PLACE REQUIRE N T v;AS, I T H I '; < , i;. LnTE 7A; / A 5 THE OTHER REGULATION .BEFORE n OR AFTER THAT? 12 A . 13 ! T H I '! < IT W A 5 AFTER . 1 c> o c v v t [-cm. | u ^ yer > i 14 FGRT-ER 0 i; S 3 T ! 0 v 3 . 15 TMr C 0 J ' ANYTHING 16 MR. VA S 3 A L C T T I ; NOTHING, 17 YOUR nOt'lOR 18 THE COUR T; LL RIGHT 19 YUU VERY ,'LCh, DOCTOR . TOO 1A Y GTE? 0 Ova. 20 any further w i t \ e s s e s ? 21 1 E . R \ 5 (SEN: 1 HAVE N0 22 FURTHER ,ilT I\ E 5 5. 1 HAVE EXII 0 1 TO TO CFF. 23 IN 1 G EVIDENCE, RUT i BELIEVE AFTER THE JURY 24 IS DISMISSED. i: 25 T j" r Hip T I | TM r -.jt 4110073 BFG09975 1 i . i l i *- 2 -STS; 15 3 "v "1 4 5 6 R E5 U 7 7AL ? 7 3 YOU'. YO \ 0 9 JO Y 01; i M,: ' : V 1 . v a 3 s 4 l o 7 r i : \> o t -* { x r,, T H r 0! j ? ~ A I_ L ' 1 3 ^ ~ , 10 H A 7 E 11 .1 < . VA S 3 4 L 0 7 T I ; ? S 5 70 0 . 12 jmc C 0 UR 7 : l ' J [ E 5 -- '! 'j 13 j E . 7 L : L r. , I 7 i ! . 4 -OH A 7 0 'LL JO ! 5 7015: 14 "n 1 ; C a j L , o0 7 -'LL I : I c H 7 j A X M P J 7 4 j : U i - a 15 F A .< .A 5 TEST! - 0 . v AND E 7 1 0 i VC 5 15 0 )\ 0 O' .5 5, 16 i S F i ,N [ S 0 5 D . 0 .-1, T H E R EARE C E R T A I *4 LEGAL 17 ARGUMENTS I A J S T HEAR AND CERTAIN PROCEDURES 18 I M U S 7 FOLLOv, A 7 THIS TIME. AND THAT MAY tA <c 19 S QM 5 7 I M c . SO RATHER 7 HA V{ c l y -) Y OLf R S E L V r S [ \ 20 THE PCS I T I 0 >< HP HA V I w 0 S J M vi A T T 'j V c ^ V f> U A 3 21 LA 7 E I n T H E 0 AY, I ' 3 0 I \ :7 ' " v * ; 1 ", r. V /'*! 1 " ^ T 22 The ' J j\ [_ u rp r, ~ 7 H = ' A v \j r', > - L L r. OmC r ' 23 -' sj ,\ , "1 -> : vi -J -\.1 .. yT >1 f 1 ri [ ^ ^ - r . - -- , - , '` " 24 I L. L J. 5 J.v. A T [ "MS 'v CO :j \ 5 E L , r ** i L 0 0 J Y 25 I i A Ni O ---- ^ 5 TO T -t E LA' j T -i , y *. : j | -- _i * ' 0900T7T BFG09976  . ta 1 HAVE T |J E CASE M -3 >/ILL T A < E THE C V E - .% I 7H YOU 2 TO THEJU7Y 0 E L I ? E T I 0 N9 r> D m A N 3) 0E L ! " E 1 T E 3 U A T [ LYOU HA 7 E - E 0 1; - 7 - r - ^ ; f - a " r` . 4 TO'* 5 "'ILL 7 5 i ~ e : : n 7 .< f U 0 o 4 v . T Ij -> 2 - "> , ^ ", 1 n ^ i ` y ;'n ' ? ' 0 "> 6 EALLY 350 ! '!$ . SO, I T :J [ N ; That t h r S 13 TH5 7 3 E 3 7 C 0 U 7 S E OF ACTION 70 F 0 L L C . 8 00 7, L A 0 I Z 3 ANDGENTLE-" 50, -3 9 I HAVECAuT I j'.3 YOU 3 t F u 9 E - \ N 0 ILL C 0 N T I N U a 10 TO - - V; ELL,,\0 L 0 N G 5 0 , 3 u T AS I ' 7 E 11 C A U T I ONE u YOU 3 E r 0 < t , U N T I L T.1I 5 CA3c I $ 12 S U 3 'A I TTE i) T 0 YOU =07 Y 0 U 7 0 E L I 7 E 7 A T I 0 N 3 , 'YOU 111 o >x' 13 N U S T NOT :> I 3 C US 5 THIS CAS E W I T H C7 14 ^ - M A l '! 7 l T J I n H E A ^ I V 0 0 F A v Y " :) E ? [ " C 11 S ~ I - 0 IT. 15 NEITHER S-iOULO Y D j 7 E A 0 AMY N EOS3 A PEE ,.ArKLc, 16 LISTEN TO 7 4 o J 0 0 F ' A 0 A 3 T NO7 '/ ( E ' s! Y 17 TELEVISION P 9 0 G 7 A: THAT DISCUSSES THIS CASE. 13 I F , HO ! EVE 7 , YOU SHOULD 19 3ECG.1E a.AIE OF ANY SUCH ST07Y, A7TICLE 07 20 NEWS 7EP0 7T, Y 0 j A7E TO ?EP07T T - T - A 7 T E 7 TO 21 He IN NI' C H A ,-i i l 7 S AT YOU 7 A 7 L i E 3 T 22 0 P P U ,< T (J \ 1 T Y 3 0 T H A f V E -1 A Y 0 I 5 C U 3 3 IT. 23 needless to say, should you 24 HAVE. SUCH E :> P 0 5 U 7 E , YOU 3H0UL0 NOT Y ENT 10 N 25 TUT =ACT to A.\Y CF YHij? c L L C J J 7 0 7 3 . V0U T800TT7 BFG09977 1 \'- 2 3 t 'i J . 4 \ T 13 Y ` - r, ? y 1 y r. r [l 5 I :j - \ i V 7 Y CRITIC 6 S TAoE I \ THIS CASE, 30, 3 L 3 A 3 E , ! W4Y7 TO 7 EMPHASIZE AGM\, DOM'T DISCUSS THIS W F T H 8 i'iYT'-lS, :0T TVS'! AHOUOS- Y 0 U ''SELVES . ? E 0 A -j S 9 THE T I'-'f TO DISCUSS T UE CASE '.'OP 0 Sr 10 YOU"? SELVES IS ! V JT' Y ? 00h '/ ( Tu i i_ i_ ^er v-wj 11 T 0 G.E 7H :'t A .' 0 ' C 3 V ^ ' ! '-I , 12 u v A T r o A 13 IL TO 0 < S "1 ,i 14 ir- - r 2 T-JE -J JOY 15 L 2 A >/ d j T He CO U Y T < 0 0 . j 16 THE CO*JOT: ALL OIOhT. 17 A R . .2 = M.\c 1 SN: I'LL T 1 <3 THi 18 EXrf 13 I TS IM 0 0 J E 3 , Y 0 U 0 H 0 W 0 0 , I T H I \ .< . 19 THE C 0 LOT: YES. 20 HP. PE'! HE IS EH: Y 0 tj 0 HO HO?, 21 0-1 IS A SCOTCH I iOF. S H ,0 '> I ! G V.* f '1 0 22 0 I 0 E C T I 0 m S ':! u I C H W AS P 9 E A ? E 0 OiJ1 I ">! G T h E 23 CO 0.3 5-EX A < 1 \ A T f O'! O' ? * 0 * ? S S O'* :J E 3 ' ! " . 24 T ~ c P H ? T : ANY 0 ~ . j S sT I A 1 "0 25 0 -1 ? 21110082 BFG09918 z, i j i ~ y \ 1 a u ' r 7 I : 2 'J VJ .9 U C U T [)>. 3 V ) -v 4 C ? - 1 [3 * -> .< ' - f 5 6 1 1 I - - 7 r f ' 7 U 7 I -I G T -i E E ' * I " - 7 I 7 ") F 8 a-A 1 l i 9 v !: 10 T C j J 1 7 : ! - V ! 0 H C 11 CO-2 Li OAR AEG i M 7 [ J- ,3 E . ) 12 A R . '.En.Nc I 3 >4 : 0-3 I 3 13 PTCFE530R P E 5 K l N ' 3 REPORT v, PICA I V [ 7 H 3 ' 7 . 14 _ ?i r r \ ,','T { = THAT c '/ r ^ 15 GOT A STICKER 0 \ ITTEC-'JSE THE h M Ly C^Y I 16 HAG './ A 5 U M 0 E R L I M E 0 AMO f HAVE vOT TEE N A R L E 17 7 ~) LOCATE A C L E A M COPY 0 - IT. IT IS A REPORT 18 T'-.\t I MAS V 5 I M,- /HEM [ : ' ' 3 3 - r ' T ME~37 7 ' ' 19 EPSTEIN 0 Y J3T;' -iXTE ; -7 I *1 7 E0 f M THE 20 3(1713,-; --EO f CAL J 0 ;j :AL, 7 :: 7 0 ' .E , 1-77. 21 C0ULJ -J7 3 T I C \ E ' 1N I r , . 22 v A. 3 j X L 7 T I t Y 3J 23 TO Gr F L < That I > T, V 1 0 MCE? 24 R . A M "> E 1 3 E M : YES, 25 1 . V ' 3 5 - L 0 T 7 [ : I 7R m I1I0083 BFG09979 i T""T, v 2 3 3AY: 4 3 H.'J .1 <r T r-i 7 > : j |_ ? 5 - -\ P l ' \ - 7 i J,, F C ?- ! 7 , <`i H T [ -U~ 2 1 I 6 IS 3:C^v'j: T ii >- \ E W m S m .0 I F ^ E "1 E '. G E '.j F 0 - [ l 1 0 ! 7 ] c T ,v 3 : N M c A\t0 l) 0 C T 0 7 E ? 3 7 I [ N AS TO 'WHAT THE 3 .-? CRT SAYS. 9 T,J E COURT: W ELL, Mar 10 '-A? PENS ALL TyS T [HE. 11 V A 3 5 \L<',TT [ 12 }N THE 13 14 . ' 7 1 -- \ \ C T -7 T 1 > JC 15 REP 0 7. T l-i I C H [ TH [MX \ ? L` 0 1 F ~ E H E T 'He 16 u -a \ juAjc C 0 i\ T A l N E 0 I N THE TEE 0 7 T .A \ 0 I T H I < 17 THE jJ:ir 3HOULO HAVE THE RIGHT TOLOOK AT TKi 18 L A aiisu: [ Ni F H z Y ; ? 0 T A S J 2 E E - -- 19 THE C OUP T : Y0 >J 3 H0 w N E THE 20 FEDERAL RULE CF E VILE MCE THAT SAVE ( C A': 21 A DHIT ! T . [ \ th; = 4NT1 ' ' E, ! 0 E N Y r 0 U 7 22 APPLICATION UNTIL YO'J CAN 3 H 01.' " EJ' DEO THE 23 FEOE7 4L 9ULE3 T-iir k a h h 1 3 S I n L E . ' y h ij a 0 I' T 24 T H P : Jtf j p [ c 1 i i i c v > i r am :ic" [ T - p n 25 CROSS- E A ; I \ T I 0 N , '-i0 CUE 3~1 ON A '1 h U T ' H A T . 1110084 BFG09980 2 3I 4 i 5: i 6! i 7 3 9 10 jwT c.\M ,l r : r ' 5 - r i g c - l 3 ' i:i ..y fid T.HER IT CAN 5 E * A ON I T T D 4 3 T XM I '5 1 ; -. < = w-: i $ z ' : .ill, I C 2 05 3 -~ X I '-i r m c I S T E '! C Y "5 " T '.! ~ c " \ RU ^ T^? r 2^ r- j 1 " T E 3 T I Y 0 N Y 4 '] 0 THE R E ~ 0 R T , t h ALLOYED TO 0 E T E '1 1 0 E 3 :j 0 U L 0- EE '! '1 ' T H E 0 E IE .N I '. C J \ 5 I 3 T E M C Y . [ 1 GOING TO GIVE YOU T' i^POiTo'iur. you :heCa the rule and y o j 3 : 11 i u , a Z 'LL rIOLJ ThAT IN A > fc Y A MC L . 12 .< c ! : i C 1 J Z \ . L L EIGHT 13 j - 5 15 A C ~iR 7 E N T i T L c i> "Ai<GOL m . *- R a .* E 14 EXPOSURE L E / E L 5 0 U E TO 7!33iOvS -Hi T E 15 3.F. GOODRICH PLANT, YODEL AMD 0AT A RASE 16 COO PA P. ISON" PREPARED 3Y 17 THE COURT: AMY OBJECTION? 18 .S . VA3 5 ALRTT I : '!0 OBJECT 10 19 THE CO U R T : _ r [ ~ v [ R - '> C E 20 CO-; IS 1A A t\ c R ? V I 'F MCc . ' 21 rs 22 A :* C I ' i L R c M A R T I' :< E ?A R ED 5 Y : R . 23 A -1 'i J LAV: R \ 'j L V 1 N Y l C H L G.RIDE l X P 24 o .1 A Gao Dll Tw E :'i I i 3 I J 'i G r R C V 25 G 0 } J R I C "i J L -* T . 1110085 BFG09981 - 3 . t a 'in'* 1 2 3 4 5 6 i AC a C "THIS 3 0 A 9 0 A ?`i 0 I 5 E N T I 7 L E 3 "SHORT 7 FEkM cPISOCIC CO N CENTRA! IONS AT G .7 A S S 0 8 a ss i oenc c calculated by < a r .n 5 a a l l 1 t u' --i 9 I T A A 0 J A 0 r 0 ? Y 0 U Hi 7 . V A 3 5 A L 0 T T 1 . -A .' R . V A <5 S A L 0 T T 1 : \ 0 , I HAVE 11 NO OBJECTION. 12 THE COURT: ['] EVIDENCE 13 D - 7 15 C : A D < E D I `! E V ! C E : C E . ? 14 - v \| !T | " rr i i- . w .. ' ' r -r i_i - | \ qT - -- "" - 15 T-70 0 C A v; I \ G 5 AHICH ..'ERE CADE HAVE `-E VET BEE >! 16 mARXED. ONE w A S MADE BY -- I CUE 5 5 THEY 17 0 E A E EOT.H MADE 3 Y AR. GUTFREJMQ. I'LL CALL 18 THE f UST ONc E I '-j H T , ;i HIGH : i E w A 3U 3 l A G T 0 19 ILLUSTRATE THE A L u l E OF -- OF A I'i E A I S 3 I 0 L 20 FROM A -- F 7 0. ! A 3 T A C < , a D ! U -1 3 E R NINE 21 22 THE COURT: FIRST 0= ALL, A v y 23 C 3 J E C T I 0N TO 0 - 7 . 24 V 4 5 3 A L o T T I : N 0 0 B ,j EC7! : 25 - .1 I i o T ; [v "VH"'Cv .. 9800TTTZ BFG09982 LI 1 LJ- ' [ i - A % LI I! I 1 V CF . A 2 U JE X i [ , 3 i sG7 i Sr* X J z 3 Y R . VJT*'; J D 4 3 rs : .V [ G >; ( -i ) D I EC T i ONE A J \ L 3 C S ~ 0 ' / i 5 C n A R AC TEA L S T I CS OF A PLUME WHE!-; YOU *.I 6 O'! I T A3CVE . 7 HR . 7A S 0 A L 1 T T I : \ 0 -3 ! jr r T T ^ V 3 r-s o - - iE\'i~c` 9 r ^ I 3 V, E: iv EVIDENCE.'' 10 : o ;5 t 14 t t 4 f 11 I . " 12 <. 7 E A E I 3 E .. : YES, YD; 13 1 \j *4 \J 14 r-iz ccu it : i: t -ece - i :g IS FuXlr.cR m T T A [ 3 T l' 1 E , G E' i T L E A E A . 16 MR. VA SSALOTT I : YOUR HONOR , 17 ONLY T A AT [F IP. RENNS I SEN FINDS THE FAS IS TO 18 A D '-i I r THE - - IS IT THE E A X T F R ARTICLE, !.' M 20 ARTICLE A D M I T T = o? 21 ' 3 . RE \' \ e I 5 ~ ! ; Y - S 22 HR. ' VASSAL') r T I : ! 0 U L 0 lire 23 an 0 r> A U < T U : I T Y T > jF'S ; IN R E - U T T A l T -< E ' !1 24 xcPv t T 5 TnAT i OF = 3 RED DOCTOR f A M 1 U ; R 0 ;! I T 25 .< ii [ 3 * n E 1 1 j ' G .7 E E j . 21110087 ^G0998^ I 2 -I o -) 3 i 5 A 13 ; -i* tI 7 tL / JL i 8 9 I -- .1 -j `J ~i -3 - i . i I- C 9- 10 A ' ) 9 11 < . 55AlDTTi: hT, j:j: 12 1: 9 " : A L L 7 13 l 4 i - - - ru I T 3 14 ' >- 7 - ~ ' ' 15 a 9 . ~ E \:s i 5 5 " : tha'-k rrj, 16 I'LL JJ5GLE .M tH IT. 17 THE C " J 9 T : ': J : , 13 T H 3 " 3 18 A . Y Tn IAG L 5 L AT T -i [ -j ?G l .'! T? . 19 i. 3 E : i _ I S EM : :-.-i , 5 13. 20 THE C -j ;j A T : ALL 3 l j H T . -LA 21 A d <j J T IF .I 2 J T H I 5 , V E MLc M 22 Li L H A :. l> IF Y i) J * L L L .'i "1 * . ^ C 23 L I < E TO 5 EE < Oj l'l -Y C HA 1 24 IMG THE 9ULE c 1 h [ v` G / [ TH > - ; o r r 25 C u A 9 z.? . 21110088 BFG09984 1 0 z2 > sj 3 4 : i j . i ? j U<I . 6 'I 0 T 1 01\ F OR OP.:CT!0 '/ E R D I C T U M 3 E - 7 'J L E 5 7 S U ? .0 I T T E 0 T j THE r q u,t. ! ' L L C-1 V E v 0 'J T ; 3 o: 9 iJ E C " U ' T : ,J U S r A r T 10 0 N 0 . 11 ,LL S I GH" . I 1 L i -i ~ r> v 12 jJ I ') . 13 R EN\E I T 0j l HO MOT, 14 O I U ' !_ i O L J 15 J I RECTcJ VE-5.J1C7 13 -- . a 3 5 U m, n: A R I I G 3 ./nEN 16 I Ml ADS A i': 0 T I 0 F 0 R DIRECTED VERDICT AT Th 17 END OF THE PLAINTfFF'3 CASE. DURING THE 18 COURSE Or 0ec >i 0 A M T * S CASE, IT HA-3 BECOME, I 19 T H I N < , 0 J I T E CLEAR THAT ,/ [TH R E S P E C T TO 20 NEGLIGENCE, T M E R E S IMPLY IS '! 0 \' , 21 THe 'AM7T > r M *: 3 ,< H. ? ; 22 YOU R= REPEATING THE E A '*E A R 0 J N E N r 3 Y " J "OI 23 'AT T r C C 0 C L J 3 i -3 N -- 24 y R . R a \j - I 3 r *; ) [ 0 D o T 25 icnL-.r ..a.nt to :d;:E\ ,j; cvjrt ith 21110089 BFG09985 -- .> \ S 1 3 c. '-I 1 th: couot: - - of r '-1 e 2 J L A I '! T I F c ' S C11E. 3 '7 t - \! y c I 7 c : ` - / d P .3 r T 4 7 - r ^ r- r \ 7 7 7 7 r f - 1 n 7 -1 t - j r 7| c c -- : > 5 C 4 5= Hi:-1 [ ; ANY Y C - 4 NOS S 6 THhT [ vi A D 4'IEYIOUSLY, 4-ID IN C4C7, 30L: 73 7 T-I03E A ?. G U -i E h T S [ T H ASPECT "0 NE G L I 11".' 8 ,i.w T .-i L -\ C T i V I 7 Y CONDUCTED 4T T ^E ^ . F , 9 'a D G D \ I C H 'P L ^ N 7. 10 THE COURT: ALL TIGHT. : =- O 7* / 11 OF COJ:15E, 7 HE COURT riAS HEAPD 75 3 T 1HOHY 12 vi HIGH IT GIG GOT HAVE AT THE T I* IT 13 C 0 M5 IDE R E 3 THE PLAINTIFF'S - - Tm mcT l 0NS 14 N AGE AT The C C N C L1J S ION 0 F TH p L a [ v 7 I ~ - ' ~ 15 C H A 7 . 16 'IP. P E N '! E l 3 E v ; 7 H a T ' C r o ;j p 17 THE I; ' S SEEN A 3 0 l T I 0 M A L TESTIMONY. ? IJ 7 T"4T 18 ADDITIONAL TESTIMONY, I 7 h I'' < , STRENGTHENS 19 THE DEFENDANT'S POSITION, IF WE ' 7E GO I MG TO 20 T A L .< Ad GUT NEGLIGENCE. IT'S CLEAT NON TV A T 21 T n - -- THE ALA N 7 AS 0 S 5 1 G E 0 <* N 0 22 CONSTRUCTED 3Y CONPETEnT, : A L l p I ED PEOPLE 23 v> n 0 TOO .a [N TO CONS I DEPAT I ON INDUSTRY 24 STANDARDS at r.HE TINE, GHAT / A S <NOv/N A POUT 25 TOXICITY AND, I v FACT, THE 3L''!T "AS = = N 660OTTTZ BFG09986  ~i 1 v - i" 2 - < jTu:r i 0 -I ' 7 -i \ C Y 1 3 4 T-i C 3 U ' T : 1 j N 1 7 5 UPY 6 7 ASS A LOTT!: JUDGE 7 DON 1 T CONTEND THAT THE P L .A H T WAS N E 0 L I 0 E \ T 3 ,v H E N T 0 ( L T . WE DIDN'T ?*JT f V ANY 39 OOF r A 9 THE PLANT A S N T 1 '.J ! L T O' Vi A ? 0 0 I L T [ N 10 NEGLIGENT a : i n\! # m ? =Vv= t "C I 11 T U E , IT A 3 0 U T i_ " 12 r i j ; V1J i ; : T A L < l 13 A j j J T NSGL I GENT P E A T ! , 4':'! T Y O U . 14 7 j \ - i ! . y r f - i i c 15 T m L l . 7 'j A _ H 0 i 16 THE CGJ<T: W HAT IS Y D U P 17 3 A 5 IC NEGLIGENCE CLAIM? WHAT DO YOU SAY- WAS 18 THE NEGLIGENCE OF THE GOO DP. I CH COMPANY ? 19 MP . VAS SALCTTI: that THE 20 GOOD? I CH C 0 M P A NY FAILED TO CO*: 0 U 0 T A N y ~ E S T 3 21 CP STUD I 53 T E a. 1 D I V -JI I 1.1 c C A p c I v O G E I c r T V ^ "l 22 T 0X (CITY 0 F VINYL CHLOP IDE , " VEM Th -vtj* 1 23 ANEW UNTIL T -IS CONS t- i)CT ! OP T r 3 o i_ \ 24 HIT I X 1Y PU I L -rc r= r= 25 TG, EVE . ('. H T J ~ Y V I-hl T600TTT2 BFG09987 a . t- i 3 1 ^ L. A t C . A -i j j [ A ! r t-- 2 C A :R * r j V E 9. TH: = = \' = L I ': = . 3 r --i" ""'Mtt- r-^i; 4 .4 f 5 r ^ r> c r T ? 6 \/ ^ \ L ^ r T I : 7 T M C w !J % T : r K 0 T ;J ; 8 I L i o '): :j c r s T rj: i i 9 3 w I Li The / T. 10 / H i j A ]_ , I l 1 - :H 11 rhmT 1 s i r, rnar r y fa i lej to z d'.o jc r tics: 12 5 T J D I = 5 . T rf Y FAILED TO C 0 N D J C T A -i Y TESTS 13 3 t r G iR OR AFTER. THEY JUST W \ T AHEAD A \ 3 3 I 14 i T . 15 THE COURT: FM OTHER /OR 03, 16 YOU'RE SAYING THAT 3 . =. GOODRICH Wa S 17 NEGLIGENT IN NOT CONDUCTING 0 R 0 ? E R TESTS OR 18 STUDIES I T H E 3 E F 0 9 E IT OPENED T m g 19 POLYVINYLCHLORIDE PLANT IN P E D R r C < T o n n? 20 HE PLANT; IS T-AT 21 DIRECT? 22 R . VaSjALOTT I ; 23 G A "* C w N C A j j l N :j OR T J a I' '.) i'\ A-i l 24 25 h s -z 2/110092 bFG09988 1 r* T ~ I v n4 2 INCLUDING ilHl rA I L -4 ~ = T-t !.";1T^ 3 4 rI: [ ' 5 5 T .** E C 0 U R T 1 ! ;ifa:-:, I ' 6 R if A D I n 3 R 0 . T ri f A L L f G A T I OF T H z PL f A 0 1 0 G 7 -,D T H G 5 E GET FO^Tr 14 YOUR TRIAL Y E M 0 R A 0 U M a M> R . V A S S - L 0 T 7 I ; I 1 , S 0 -7 ? Y , 9 Y 3 J < -HONOR. 10 X H - C R- Ij 9 T I ? c yvi .a \: n T x 11 r H E 5 AYE WAVELENGTH OR HAVE W" 12 3 3 '-1 E W HAT. 13 M R. VA S 3 AL-3TT I : T ^ E R E - R F 14 ;)'i[rn a i 3 M T E T 1 0 *' 3 "HAT ARE '1 15 RELATED, the ONE I ; THAT They 0 I .0 ! ' T .'ION 1 TOR 16 i \ THE R E 3 1 a 1 i\ T [ A L AREAS. T H f OTHER 15 T H A T 17 THEY I-.EVER WARNED OR ADVISED THE .PEOPLE OF 18 PEDR IC.<T0W.\ AS TO WriAT -i A 5 3 I NG EMITTED OR 19 I 7 3 CANCER CAUS ING 20 THE COURT: THE r A CT RE--'. INS 21 YOU'RE NOT '", A ;< 1 N G ANY CLAIM T '-HA T THE 22 DEFEND A NJ T WAS NEGLIGENT IN ANY NAY I N THE 23 CONSTRUCT ION -- I N T^E a L A N` r "G . ~R 24 CONSTRUE 'TON OF Trat 3 L a N 7 . 25 *R . 5 5 A L 0 * r I : UNLESS v 0 N 1110093 t: BfG09989 _ T ;i . , z ; : ; - j 3 . I OJAS i 0 z 3 r LAC IN J <-i . 0 A IT03 [ .. T --* E 3 E 3 ! 0 E A 7 I A L 2 AREAS as a A 3 T Or 7 H E 3 L A A A I AG A AO 3 0 0 A 5 7 3 U C 7 I 0 >: C " T ~ r: c L A A T . 4 T -r" C 0 U 9 7 : a l l 3 r o j T . e * > VASSAL 0 7 7 I : [ i"FE V 17'-* 6T 7 T i-J ~ c o u 3 7 : ALL 3 ! G J . Y7 U 3 : a y c o \ ~ ia J E , ; 7 ? E A A E f SE 9 i O 3 E A A E I 3 E 1 TJ 3E3 3EC T 10 f 0 A. - , 1 V C, T -! E / *I L L LHI 7 Y ; I S C J S 5 I 0 A 7 0 11 7 n 0 5 c -- .! n-i7 i J A 0 E 3 5 I A AO 7 0 3 7H3EZ 12 7 ri c 0 3 I c o Oi.z, AjO 7 E S T 3 W E .3 E C 0 A 0 0 C 7 E 0 7 0 13 0 E T E 3 Hi I N E C A 3 C l N 0 'a Z N 1 C I T Y . THEY 010V'7 14 hi J i i T 0 3 F 3 OM i w 7 ; T 0 17 77 A ' I 0 SO `.'EH GO, 7riEY 15 0I ON 'T WAR N THE pc Q RLE IA THE ? E 0 3 r C 7 0A 16 A .3 E A . 17 SI M CE 7 H 1 3 IS - - 7 HIS IE A 18 OEOL I GE'ICE C OU A T ; u F ' 9 E 7 A L ;< r AG A > 0 U 7 W H A 7 IS 19 3 E A S 0 N A 0 L E A N 0 J 3 U "> E\'7 MAO - 1 THf 20 C 1 3C J.-AS TAN /* r I \ 1 f* 7 o PL A 1 A 7 I c F ' - CASE - A - 21 SHOW A ?LA 1 1T[P F ' CAS HA3 5 '! 'i \ ? 3 0 22 i ;f 3 T J1 <} 7 U , T Hz O'.LY < A 0 . 1 L z 0 u L - 3 0 0 7 7 - z 23 H A \ :-i F i; L EFFECTS OF 1 ! Y L C l L 3 3 I 0 i E 3 E , 0 OE , 24 I J A l I i f -a i --j f 7 !/ , T J F l j H L E 1 A 7 ^ E 0 3 A 25 F L -41 c . 0 7 o '(1_ Y .1 AS THE 7 - A 0 3 , 0 .-i L E 0 0 E 0 = 21110094 BFG09990 1 / ~1;i 7 7 ' r ' -i ^za- ; i 6 :i i - s* J r j 7 L XT I 3 P -> 9 T l C J L n < L Y ,7 i ThE 5 L 1 3 T A : C E -AD DEED 9 EXPE1 TED t TH 7Y THE -1 = 1 I CAL ? 9 0 F 3 3 I 0 \ 10 5 3 T h : ~ | C .7! > ij T A Y C A C 7 9 0 J 3 SIDE i i L Y IT A 3 ~ 7 I*' 0 J 3 7 12 j n m rr | $ p > A Y r A \ 3 - L L P V r. ~ T J 7 13 ^ A ' j M T a y J, '' , ; I T H ' ^ it r\ ' AT T U r ^ r*v 15 16 J 3 T E C L Y 5 13, PLUS 7 X J L j 3 I 7 >.| AND D 9 C W S ! 7 3 3 , 17 :r;ic,- /. E \l T A A 7 C A 1C OF .-.'HEN T7 18 i N T '.m3 D d 5 I 3 .m t1 .7 t hat 1 D.r: ' T r - i a ; 19 THAT IT'3 1c j U .A j L E TO EXPECT That X I \ D 20 13 3 1. 21 The 5 A .-1 7 PAUHEMT 30=3 -s -r ; 22 i rox I MERE ' 3 XC < IT. J <J - vor *t 23 O A *. X 7 9, T H E < i ' T \ C A; 24 ' ` 0 N I T 7 . ';D fMc 25 T H T 3 = I ' . 1 c <; ,' 21110095 BFG09991 i 1 i 5 'ij J o T Y l 3 -< A. , :\ . r 'J .7 T ~J 7 .9 0 ; , T i; -I E 7 z 2 r ACT 7 H A T -77 3 . 3 S A 5 5 C 3 T i L l LIVES t ' I 3 4 TO . A 7\ IS v 0 T THEA P P 7 3 X I v ATE C A :j 3 E >' 5 A N Y T i I '! G . SHE HAS 6 . v-- sr-LiTTi: i o-jec~ to 7 THAT, YOU 7 - 0 0 1 . 8 A ? . z E N " - r c = ' i ; " '-i r - A " < '' 0 :/' 9 10 1 ? . Y.A S3 1L ,TT r ; : TACT 11 E X C z A T i 3 \ T 0 T H A T 7 E C A u 5 E H E I ' ? LIES T a T 12 : *1 ^ S J \ A fi i 0 15 FINANCIALLY AIL: TO ''Ov'E 13 .V .1 L < Z V r_ :S, 5 1c W .A NT'; T 0 lOV: . A N J THAT . i A Y ; r 14 j c 7 r-i L A W d 15 THE COURT: E L L , EITHER A Y , 16 Y KJ J `a I Vz M THAT ASSUME NT AFTER HE'S F In l 5U: 0 . 17 HR. VASS A LOTT I : W ELL, Y 0 UR 18 HOMO 0, T HAT REALLY H aS NOTH I V G TO 0 0 I TH THE 19 CASE. 20 ~ 'j c r ") i : n t r T 1 A Y " "> m i v >.; z -- 21 HUT THAT'S H c n:j OE;JOHO TO IT. 22 'U. 7 E v H E 1 S E N : 1 . A y f EVENT, 23 TnE ;uTY T C . V": 1 ELITES T 0 A N N L E A C E '= : 24 AA S j- < S0U T i- I C ' iTHE A ~ A [A3 3 'H 0 U L j 3 z 25 j 1 ^L < 1 n .`j l. w z H L Y 1 n z 7 z * A; "j . Z : 0 H 0x * z z ssocm iz BFG09992 i 1 7 IC' 2 CHL07 I 0E -HY ncu''" '/ I '; v _ ;"UL7 '! a v: % 3 v ? ~ r r-v , 4 -1 a r > 7 the r. c [ 5 6 7 I _L Vj W -- - ' A 7 C- J 5 7 T i T He HOI M T / n E 3 if 8 .* c ' Ic T AL.viNj about THE CHA-iOE TO THE JU-l r 9 iiCAuo: i I" -< c. L A T E S T C L t 3 4 l. T H e 0 7 Y J '! D t ? 10 ,;HiCH "He CASE IS SUE-: i T T E 0 TO THE J J 7 v 0 T H ? 11 T n A H :'j E G L I GE.yCE. I r 'S u i 5 A A C 1 13 STILLI \ THE 12 CASE, THE LAY I 7 E A 0 T - E 7 E S T -\ T E M E N! T [S THAI 13 THE C 0 V 0 L C T `'US" ? EI '7 T E `-I T [ o v a l A 7 0 14 U O' 7 E A 3 c v: 13L: A vj 0 u \i 7 E A 3 h v a i i_ *[3 a ms 7 LITE H 0 E 15 : T-iE .1.* \* c: it E L a C T" ^ 16 <; 7<="1L A 1 ; 0 3 E ' A T 10 ' T'O 17 a l h H T . 18 al'CE TALAiHO 19 CITY OF THE 3 .< I 0 0 E T 0 H THE 07 Y A HU THE THH07Y 20 THAT ' a i;T FCAT- Ih SECT !)', 5 l 0 OF ThE 21 .< c S T h T E .'i E T OF T 0 ATS, FT I . P 0 5 E S LIABILITY 22 A iM A E H 0 7 /! ALLY CUE A C T 1 ViT Y . IT SEE. 23 HE T H A T THE C ! J '. S T :< u C T I 0:. A N J 0 Pc 7 AT 1 ) 7 F 24 r 0 L Y 7 I *-i r L C n L 0 7 I 3 E A L A \ T "<Ar; 7 0 T SEE H P * 0 7 25 TO ; E `; - H 0 a ! ^ y A r.ejc uc F " I 7 I " v , F sK H* to Si BFG09993 1 ir < -J'J - , ,, 0 ; 2 CAj 3 4 Y 'H AL i7 5 -ACTIVITY c f V T V , . ' 1 Y 5 . c: - i -i I : TI3AS: ^-s l-L VO \0T i.iT'/f 3_ V r 6 A 3 3 7 .'TALLY V Oi v ~, 7 5 l '1 G _ S E E 5 U L 3 3, Oil ! 9 ': I S 5 I 0 , T -l F'MSSiO'l 0= TE '/ I v L C 1J LOT I 'V F , 10 THE ALLOWANCE O? -U-'T E'! f S S 1-0*1? . 11 - . ' CONE ISOM 12 The Y J :3 1 T [ 00 I 5 13 -1 1 1J ' : V i\ >l M w T V i J I - v u O )\ l I 14 [7 VI ; Y _ 15 C ~ L I -J i_ 16 a j ,j7-iA.L'f HR. 9 COWE [3 EH I V l N YL 17 COLOR ICE -- VINYL CHLORIDE IS A H Y D R 0 C A R 3 0 18 AND AS SUCH, IT'S ? R 0 A A ? L Y LIKE 0 A S L I N ? AMD 19 AS NOR.''.ALLY DANCE VI US IF I T X 3 L 0 E S . 20 TL-7 C 'VI'? T : - D ':l H-llJT [r: 21 ITK I OH A LED 0Y ITSELF I. I T a-j -*r S T A - S , 22 IT's inhaled? h a s \< - t^ere =:* ew: s-t 23 TEST i . } \ Y h - E b TI \ D I C A T ~ T H A T I T. ''s 24 o z \ 0 u S r: 25 860OTTT BFG09994 1 5 T A T E 1 0 M - L _ 1 , 1 T ' : J7> .A ,< E Y 7 U 2 C 7 'J !_ 0 < ILL I- v 3 IT r 4 "r ! T7 1 T' 5 T r7 r 6 ;- ' E : ,E 07 1 . 7 \ - /. i ; i --i t ~ 7r 8 9 _ l_ L , i J 10 ;e t i l .. he j ,, 9 t r3 n . r 11 A yu:37iO \ ~ z .7 z r1 R 'c 5 N i i 0 3 Y T T 5 7 i 00 Y ? I 12 1 4 i., 0 H 5 I .) 5 4 Y 3 0 0 3 T H I 0 0 , j T H 5 7 3 1 0 3 13 0 ' 0 ' 7 A 0 7 E 3 V' I 14 Y ) J - q Ji m p, Y 'J 3 v'.'l I T ' - [ r\ -- c * 15 T 0 4 T ? 7 E 3 - ' 'r 7 J J T v n ;J -r - 7 r /> \i 7 7 c ^ I - J-17 16 J U 7 Y H A V ~ 0 F I 0 7 T 4 I S ? 17 THE C 0 0 7 T : Y 0 -J ? 73707, THERE 18 A 7- THREE 4 L T E 7 ': A T [ V E S . YOU F [ 0 0 IT Y0U 19 F I 0 0 THE AC - I 10 YOU -100 I '1 A H7 t r [ 20 ^ ,< T t~. z ;< i ; ' T 0 ^ T E J ^ 7 Y = I , 0 S IT. a \ 0 I - 21 -- A 0 0 1 7-- i - 7 T il A T u 0 J '7 T '7 s A C T S O F T -- E 22 Ch j, THERE i j 5 J F F i C I O' T E V i 0 E 0 C E - 0 A Y 3 j T 23 r i .o u ? 1 J THAT \ 'J I /`AA S '* I J v ri A L L '| 24 'J A *-J a j J S 5 J ! rn: A L T 5 E ?' A T I V E IS T 0- :J A V E 25 C A s s 'J ^ I T T E : * 0 7-iE J :! 7 v * r - A T A 5 I j , 6600TTT2 BFG09995 1 '1 - Jo [ 0 2 r 9 0?. 3 a. _ / 4 .. o -lie o: - o j 5 9 -1 T o 6 I ' _L 1i 7 j J 0 / , 0 '< . 4L JT 7 I . Y0 J4 T l 8 ~\n, . V- S5AL0 7T ! : 70 IJ ? 4 0 0V?, 9 ' ;h F OLIGEOC7 T4=09Y, I 7H!*.<IT'S C L = 4 ? 10 T - \ 7 T - t = <5 7 i m O'y j;:j 4 nv t - T ? ? ^ ' E 7 r ! E 11 - U I L r , 7h E 0 E .45 ; ` E 0 I C 4 l L I T = 7 A 7 U ? = 12 0 X o * = 0 = ~7 0 ~ r r h ' " >\. ./ [ rEE?- 7 13 -C ; .0.;l:)5:0 74 IS, Th AT = ;< I 3 T 2 0 ! N 0 [ C " I o 3 14 ! -! h T 7 l i Y L C 4 L -J 7 1 ; c *. 4 4 7 :.j X 10 j J ? 5 T ` C E i 3 15 5 -j - j . L . u 'i i T7 , l. Y , 7 4 V3 5 5 7 0 0 10 5 0 5 A L 7 ! 7 i 16 ,i o 0 x 4 9 5 . 7 .4 E 9 t .i .*\ 5 .s L 3 0 - - ./ i__ , 7 4 E < .< 4 5 17 Li I m3 0 G.'WAL I 7 1 E 5 ,4 N 0 7457c V.' 45 7 4 18 AC.7 0 OSTEOLYS I 5 0? ..'hATE'/E? 17 IS, A'JO 74c 7 E 19 ,;? SEVERAL 07 he? STUDIES. 20 ovx r o' 1^74, ooc r vj l \ 21 \ v > sj '] c j) HIS(_ [ m < a";E E 0 7 f '! Y L 0 '4 L ' ( 7 " ' v O 22 C A '! c E l F ; 7;4? 0 I 0 4 T T H c 3 - , T Cl i 7 i c ~ 23 ( r7 A 0 7.iE P L A 0 7 4 ? ? 7 = .0 . ;.J i- 7 0 7 HE " 0 10 ~ , 24 Deo? lex : . ' t r. -T 70 -ect t^is 25 WiV . T ! v - .\ V V; 0 1 L I SA 7 1?'., .)= :'o'~00 CUTOUT BFG09996 1 \ , ; u - a . u r ^ o i j i 7. 2 T A ~ T - :T f 3 \'/ i f s rj f -r, a ,'; r' t 5 6 T r> 1 c L\ 3 * r i i ^ T ~ a v V *> O ^ v iC A 7 : f ,j ; i 3 8 - I C - I .^ A :3 4 Z 9 / I J.: <Ci I 7 H A C 4 5 : 7 ; i A T I -i; 1 - 7 -n: 10 n?E J 3 53 TO CO'D.CT 7 h 0 3 f 733 i 1 it a V 4 1 u a 'j l i jbrj'c. T n ; 2 ; '5 t -i 0 i C h 7 jj 0 Y 5 12 [ ' ;': J 3. Y . 13 Th;26 1 3 T 5 T I ' 0 'i Y I '; 14 i , r - - 3 c---- 15 0 M 17 0 4 T.H I 3 4 A T E - I 4 L 1 U C 7) P 11 16 - E A L T A H A Z A 7 r, # THE G ' 0 0 ? [ C H C ov 5 a Y 0 ! ' 17 0 7 W [ V| G AMO a S A . 9 c M V E [ 9 E M 3 H [ T 0 0 L 7 , Y 0 J 18 HA V P T 0 E 4 s U 7 E YU-P [ ? CO': 0 (J C 19 CONDUCT OP THE G00D7 ( C * C CM P* N y !'; LIGHT 0s 20 :h-U i :1 E-v 3 0 ; .AO LE ?E4EV; I -E [ 30 [ T ! 0 Y 21 .. -OLD HAVE 00 n E 22 [ILL 23 h '1 C M A -J . , h O L. L. 7L o 24 C H E M I c a L C 0 1 r A '! Y 25 A Li!', `j -\ ' 0 J 7 .= H ? - HA >!-- m ToTOTTT BFG09997 1 : i ~ 2 i.J 4 .i . \ j c C 1 : e "i vs -i: 9: l 4<ly x jJjJ i 6 l ! 0 -, [4 A OLE ,44':.; .17 I 0 CO iST^UC'iYi 7 nib N i _ L 0 l';G THE E.i I S S I ON5 T o c r v = 8 U T i T H -0 'J T V I \ G 0 0 N E A Y G 7 OUM 0 0 ? < , 9 ST ! . . 0 0 7 0 I -S T0 0 E T 5 7 ! \E IF t T ; 0 U L 10 my HA 7M . II Ml j, -! - ~ ' * : r r-< ?;S5;C: ' 12 T T H ?!<: Ti ? : !_i < r v A ? 3 i T ~ * 13 -* 7- I > T 'j T 1 I | I j *5 r T ^ "M 14 T - X T './ [ \ = ') !j ' ^ ` f ~ -J r 15 T S ' [ A L CAUSED C A 1 C E 7 . Tr;Y 0 i 3\ it r v 16 A:.Y TESTS them f I T H E . T m Y DIDN'T ? U T ANY 17 -I 0 >\ [ T 0 .7 5 j U T TH: TO J E T E 7 : > [ `>i E HO w ' 1J C H 0 F 18 T H 1 S /. A T E R I A i_ w AS GETTING OoT, E V E N T H 0 J G H 19 THEY AMEN IT HAS GETTING OUT. THEY DIDN'T 20 TEuL THE PEOPLE AT P E 07 I C<T0oN, 11 '-i' --- v' / t - *r 21 STUFF GE'TE PUTTING OUT HA S FEE \` D E T E 7 f - E " 22 to Cause cancer, hut ocn't y. op^y \o ^ur i T. 23 T H E Y 0 1 0 !-i ' " E V E "! r E L L T ^ r " T H ' T T 0 L ' 1 24 -EO-LE L I E VP. 0 * a S 5 0 Tn T A .< 5 ::-a -FV= - n 25 1110102 BFG09998 1 , v '5 7 A 5 ' A " 7 J 2 . 0 7 - i I 9 LAC ,< aVLJ'O.iCK 3 T :- [ 3 9 2 : .j E C r . 4 I Vi r? 5 6 \; n -i , [ 7 ? r- c 1 ' 0 7 9 [ CT LU'IL IT Y, i D f S [ t 8 T J - 9 5 5'" A r 5 r ! ~ ? 1 9I 10 z 9 [ j .0 - 7 J r; C a 5 ~ 11 h I 7 na 7 1 5 17 .-i j J r i z. 12 .7 I C 7 I A. 5 I L I 7 9 J L !_ U 7 E 7 h . 2 1 Z C C 1:' 1 l Z S 13 (Z i v i A w t Z. \ T A l T j < T j I 7;iou7 you7 n 14 !; Y 0 L 3 A U L 1 j ; P 9 L 1 '; r [ = 1 S C -- 3 ~ 15 i \ J 1 C A T 3 3 7 H A 7 YOU '3 3 L 1 5 V ~ 0 THAT TH 16 ! E 7 3 E Y S'J?7E 1c C 0 U 7 T V/ 0 U L 0 E A ? ~ A C i ' r :-i i 17 D C C 7 7 I N E . AS 'J \ 3 E 7 7 H F 7 U L E 5 [ M T 9 0 S E CASES, 18 TuE E S 7 A 3 L ! 5 :-U'1 E 7 OF, 0 , 7 -i -\ T V 1 0 VL 19 C A L r' 7 ! 0 5 IS A *-i A I 4 7 0 0 U S 4 TO f A : TWO, T 20 v.! A S E 0 l 7 7 E 0 c 9 ~ ' 7 HE ~ L - 21 77 -a : j ' j 22 EXPOSES CAUSED -IS ANG 1 ; 2 A = CO A 0~ (nr I2 23 THE 9 L A t \7 I 9 24 T n A T ' - j7\1C" I .a 1 1 l. i 7 Y 25 'tj r ALA A 0 '> U 7 EoTOTTT BFG09999 1 I - .: \ 0 ~> <= m "> I 2 g 3 o o o i cm ; \: ! ' - T h i ' ` i r - - i - l ; e r1 o 3 4 ; 0 Z 0 G'j 3 ; " T . ~~~ : . T " >- A T ~ ' 4 : . r-'3i t : o c a sec. r - : 7? [: t l c -> ; re i 7 v ? c . : 5 0 P 7 ~ 3 l ; 7 5 T . 0 CASES '-AS T A < E J ? 0 `. 7-> 6 j I E H 7 i 'i C I J A L 5 A; S 7 5 [ C 7 L l A i [ L I T Y j - '7 E L 0 J E 0 7 1 ; < T - E r i j j u J 7 j 3 I TJ A 7 1 j ;T SAT IS, i ri - 3 lAMUr .-,C TJ 7E3 0 9 THE P L A s T 7 i5 I A "EST 9 ACS I 7 i j i'i 7 0 < 0 A .HAT'S C 0 ' ' 1 M G OUT OF H [ 5 10 P L A -'j T AMD -7'3 TAX" 0 0 ? 3 F C T I 7 E ACTIO 4 "EGA 00 TOO 11 THAT. 17 f SA L .i AYS I \ Tui '3 E a T P 0 S I 7 I 0 V 470 12 C E 7 T \ I M LV IS SCC I ALL 7 Z 3 P CM S l L E TO = a v :a? 13 5. ; y ) :j A i j c -J v T - n p = f "r _ A / [ \ 0 14 C -E ' I C --V L L 4 ' " S . 15 HE COUOT: ' L L MG7T. 16 A E YGJ SAY IN.! T; - A T THE -- THAT THE 17 i ATc I i Al ! H I C !*i <' I T H W E ' E CO '< C E 7 N E 0 A 3 0 U 7 15 18 E ,i i 5 S [0 0 OF VIinYL CHLCOIOE GO JOS 00 POLYVINYL 19 P 0 L Y V I A Yl C'JST. 20 c' 9 . V A S 3 A L >j T T i : c L L , Y 0 J 7 21 iJNOl, WE 'OS COMCEOWED WITH HE V l M Y L 22 H L 0 ?. 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V A 3 S AL A 7 7 [ : 0 0 7 A [ 0 G 19 F J 7 A 5 P. . 20 7 Ac ) J < Iu7 ! j ! 2 21 JF..i 12 J, OR. ; o E l 3 E N , P OR 704 IE \ v'!,2 537 22 F 0 7 7 H A E 0 Y 0 J M .A 0 E 7 hi 5 A M E 0 7 10 0 4 7 7 :: u 23 C 0 0C L 45 100 L A ( A T I F F 1 5 CAGE. 7 A E7 - A 7 n 24 JO 3 Y 0 0 E 3 T [ 0 3 - E 3 E T A A - -3 O P C - 25 7 0 r A ~ J 7 v . 21110106 BFG10002 I 2 3 r :* u r 3 4 i J 5 6 7 8 9 10 11 12 13 14 15 16 17 13 19 20 21 22 23 24 25 l SEE 3 L 15 BFG10003 4-OTOTTTZ i 1 r r~ ic 2 y cI 7 \*n v J ?L I C 3 .1 ni o T - C "A T - 4 "'A t -i 3T f=y 5 6 7 - w : 'y T3 y 3y J0 8 c 0 ^ i :;ul: 9 rT 10 TAA T1 * u'iPLOY 11 i4 U S. C 0 u \ S L OP A Y OF THE ?44 T l E 5 TO THIS 12 aCTIO'1, A \ ~> AT I A.-; != I 7H = P A PEL-MI VS MG' 13 c .1PLO YEE 14 3 UCi A T T C 7. 'i E Y OP CTT'A "L MO A -: r r i Y r-.:T='-'rcT-') r T '.j i ; 15 16 17 18 P . L YMlS PELL, C . S . > . 19 ;OTAPY PUBLIC, S T A r E OF .) - ,j 20 .; Y 3 3 '!; i 1 6 5 I ) >i F x P I 0 r 3 /1" / 1 21 A I L . J i \ O W Y t- ! p 1 ' I 22 23 M 24 25 BFG10004 2 3 i I - 1 CA' ! -v 5 7~ C r r T ^I 6 ; 0 .J ' T .3 c 3 a ^ r 7 c 7 - r ' ^ r 7 ^[CT^T^ 7 n :j *> r - 0? Tu.~ "5 i 3 r ? i r# t .c 7 C r y 3 :I q r- ?. Y C < T ; r V T 9 ; r> T 3 7 ^ c v 10 w -J \ 11 PiuMa rU E I ' 4 3 i: r ^ r r1 j r u <. " 12 13 $ 14 / '/vy -/ ,7 15 16 5 T = P - 5 '! J . DAVE , C-3, 533 17 OFFICIAL U . 5 . 9 ET = 09 T E 9 18 19 20 21 22 23 24 25 BFG10005 60T0TTTZ IISTl I r T r --y I I t T _ r r - \, " , j v ' q - y iR. ? ,-tR -i N E I 5 5 N .1R . R E NNE I 5 N : 0 0 CTO0, ii C 2 TAM3 URR0 3 PREVIOUSLY S W 0 R N . 4 DIRECTION EXAMINATION. 5 M R . ,R E N N E I SEN; MAY I PROCEED, 6 YOUR HONOR. 7 THE COURT: YES, SIR. 8 0. DOCTOR T A M 3 U R R 0 , WOULD YOU TELL US 9 W HAT ANSI 05 ARC 0 M A OF THE LIVER IS ? 10 THIS IS 4 CANCER OF THE SUPP0RT ING 11 CELLS OF THE LIVER, MAINLY THOSE CELLS H IC H 12 LIME THE VASCULAR SEGMENTS OF THE LIVER. 13 Q. AND ri 0 W IS IT DIAGNOSIED? e 14 A. Vi ELL, I THINX I COULD 3EST 15 ILLUSTRATE WITH SLIOES. 16 THIS IS SIMPLY AN 17 ILLUSTRATION TO POINT OUT WHERE THE LIVER IS. 18 THOUGH MOST PEOPLE I THINK HAVE A CONCEPT, IT 19 IS A VERY LARGE ORGAN WHOSE MAJOR P U R P0 S E IS 20 SOME SYNTHESIZE OR MAKE 3 COY PROTEIN, BODY 21 CATS, 30DY HYOROCARIONS, IT'S THE ENERGY 22 SYSTEM FOR IT IS 9 0 D Y. IT ALSO HAPPENS TO 23 havl as a major function the removal- of wast; 24 PRODUCTS a,\Q TOXIC MATERIALS. IT IS T H MAJOR 25 DETOXIFYING OR TOXIC REMOVING ORGAN OF THE OTTOTTTZ BFG10006 T M J R R C - 7 . R ENNE l SE N 10 1 7 00 r. 4 10 0 [T 1L30 HAS' A DUAL c Y 3 T F`` 0 7 2 GETTING 7 I D 0p THESE T 0 X I C XITE' ULS, MOT 3 ONLY 3 Y 3 URN 1 '! G THEM OR 3 Y M T A R 0 [_ t Z I NS TWM 4 OR ALSO 3 Y c X T R U 0 I N 0- THE 0 TO THE 0- 4 L L 3 L A D D E 7 5 into the intestines. in addition to this, it 6 HAS A iL 0 0 D SUPPLY SYSTEM, ONE COMING eROH 7 ARTERIES OF TrlE 3 JOY AND A 3 0DY SUPPLY SYSTEM 8 THAT COMES FROM THE GASTROINTESTINAL TRACT 9 THAT CARRIES OXYGENATED 3LOOD TO THE LIVER. 10 NOW, IF ONE >/ILL TAKE A L 0 0 < 11 AT THE VASCULAR SYSTEM SPREAD OUT THROUGHOUT 12 THE LIVER, IT LOOKS DIFFERENTLY AND THE LIVER 13 CUT I N SL ICES. AND UP H E P E P! THIS COP NER 14 A N A R T I 5 t S VIE'.; of the LIVE ? ,! H E N IT'S CUT 15 IN SLICES AND THESE RED CUBOIDAL OR 16 PEC T A N G U L AR CELLS ARE THE LIVERS MA IN CELLS, 17 T He CELLS THAT DO ALL THE 3UILDIMG AND ALL 18 THE DETOXIFYING. 3 U T THE SPACE IN BETWEEN 19 HERE, THIS AREA IN HERE (INDICATING) IS THE 20 3 L 0 0 0 PASSAGEWAYS, AND THERE C AL L E D 21 SINUSOIDAL. AND IT IS THESE CELLS INSIDE HRE, 22 IF YOU CAN1 SEE THIS BETTER HERE (INDICATING) 23 THESE 3LOOD VESSELS THAT LINE THESE CORDS OF 24 LIVER CELL? THAT HAVE -- t/-|AT ARE MADE UP 25 OR CONSTRUCTED OF WHAT WE CALL ENDOTHELIAL tr* Vjr >- BFG10007 I '-I J * 0 - R M E N is'E I 5 - I1 1 CEL L S . A H 0 I T I S these cel LS THAT ARE HE"IE ' 2 -- I TH I :N< TH I S IS 3 E S T, I'LL -- THESE ARE 3 THE LIVER CEL LS . AND THESE ARE THE CELLS OF 4 THE 3LOOD VESSEL WALL THAT LINE THE BLOOD 5 PAS SAGE CENTER. AND THESE ARE the CELLS THAT 6 3 EC A M E M A L I G M A NT IN angiosarcoma. THAT'S HY 7 THE TERM, ANGIO WHICH MEANS BLOOD VESSEL AMD 8 SARCOMA WHICH MEANS A T,JMOR FROM tijc 9 SUPPORT ING STRUCTURE OP THE GROAN AMO THERE'S 10 WHERE THE TERN CONES FROM. THERE HAVE SEEN 11 OTHER TERMS USED WHICH ARE ALSO 3 L 0 0 0 RELATED 12 i N THE PAST, 3 U T THEY ALL MEAN THE SANE T HI MG. 13 THEY'RE IN ADDITION, OTHER CELLS INSIDE THE 14 3 L 0 0D SYSTEM THAT C Q N 3 U M E, EATS UP 15 PARTICULATE 30DY THAT THE 30DY MAY HAVE 16 CIRCULATING IN ITS 3LOOD AND THESE ARE CALLED 17 MACROPHAGES OR CUPFFER CELLS. NOW, THESE 18 LIVER CELLS ALSO CAN BECOME MALIGNANT, BUT 19 WHEN THEY DO, THEY FORM A DIFFERENT TYPE OF 20 LIVER TUMOR CALLED PRIMARY LIVER CELL T U M 0 R . 21 AND THAT'S THE DIFFERENCE BETWEEN THE 22 ANGIOSARCOMA AND LIVER TUMOR. 23 N 0 W, WHSN 0 ME GOES T 0 24 DIAGNOSE THIS, YOU NEED TO TEST THE SYSTEM 25 That TESTS FOR THE 3L00D VESSELS AND HOST. ZTTOTTT2 BFG10008 M R M E [SEN 12 1 NED I CAL TEST SYSTEMS ONLY T E S T FOR THE LIVE2 CELL . AMD SO, THE DIAONOSIS OF ANG I OS ARC DMA 3 !N ITS EARLY DEVELOP M ENT IS V E 0 Y DIFFICULT. 4 IN -ACT, IN THE EARLIEST STAGES, A PE 7 SON MAY 5 HAVE MO ABNORMALITIES OF AMY TST that WE 6 N 0 R M ALLY USE. AND SO, ONE HAS TO USE VEP Y 7 SPEC I A L I ZED TE STS WHERE YOU A C T U ALLY INJECT 3 M A T E R I A L INTO THE 5 l 0 0 D VESSELS AND 0 U T LIN 5 9 TutM AN0 S H G W THAT THERE'S BEEN A DISTORTION; 10 3LOOD VE S5EL5 AT A TIME W HEN ALL THE TESTS 11 THAT WE USE FOR THE LIVER AND HOW IT 12 FUNCTIONS A P P E A ?. N 0 R M A L . 13 0. ALL RIGHT. AT ITS LATER STAGES, CAN 14 A N G I 0 5 A E C D A OF THE L I VE? OF OtAGNOSIED FRO:-' 15 OTHER TYPES OF LIVER CANCER BY A TRAINED 16 PHYSICIAN? 17 A. IT CAN. THIS REQUIRES A PATHOLOGIST 13 AND A LIVER 3IOPSY TO 3E OBTAINED. 19 Q. AND WHAT DOES THE PATHOLOGIST DO 20 THEN? 21 A . .WELL, HE ACTUALLY L 0 0 ,< S AT THE LIVER 22 TISSUE AND DISTINGUISHES WHICH CELL IS 23 ABNORMAL. AND I HAVE SOME ILLUSTRATIVE SLIDES M 24 THAT SHOW THE PROGRESSION OF THIS FROM ITS 25 NORMAL STAGE TO THE ACTUAL STAGE 0 p THE CTTOTTT BFG10009 A J ^ 0 -MR. RE X N E 1 S E N I3 1 A I v) S A R C C ri A . 2 3 YOU a A NT TO S H 0 W THOSE to US, THEN? 3 H. ;N \j w f THIS IS THE R E A L THIS IS 4 MOT AM A.IT I STS DRAWING, 3UT THIS 15 THE REAL 5 LIVER FROM A NORMAL INDIVIDUAL SHOWING THE 6 LIVER CELLS HERE. EACH ONE OF THESE CIN DIC A T I N G ) 7 IS THE NUCLEUS OR THE CENTRAL CONTROL CENTER 8 FOR EACH Op THE CELLS. AN0 THEY ARE IN CORDS, 9 ONE ATTACHED TO THE 0 T H E R. A N D ON BOTH SIDES 10 OF THE CELL, THERE ARE THESE LOOD VESSELS 11 ',vH IC H ARE LINED WITH CELLS THAT ARE THE 12 ENDOTHEIAL LINING CELLS OR THE CELLS THAT 13 3 E C A M E MALIGNANT IN A N GI 0 5 A R C 0 MA. 14 - NOW, THESE SLIDES COME FROM A 15 COMPOS IT OF INDIVIDUALS WHO HAD TO HAVE 16 3I0PSYS FOR MEDICAL REASONS OR BECAUSE IN OUR 17 SCREENING PROGRAM, THEY HAD SOME ABNORMALITY 18 WHICH MEDICALLY INDICATED OUR GETTING A LOOK 19 AT THEIR LIVER TISSUE. 20 NOW, THIS IS THE EARLIEST 21 CHANGE THAT ONE SEES WITH CHEMICAL EXPOSURES 22 TO VINYL CHLORIDE AND ONE BEGINS TO SEE THESE 23 LINING CELLS HERE 3EGIMNING TO CHANGE IN , 24 THEIR SHAPE AND IN THEIR SIZE WHILE THE LIVER 25 CELL ITSELF DOES NOT. SrTTOTTTZ BFG10010 M3 RiNNt I 5cN 1 '4 1 AT A LATER STAGE, The CELLS 2 BECOME EVEN M 0 R E CHAN GEO AND OI5TOR TED IN 3 THEIR CONFIG U * A T ION, I N T h p i ? RHAPE . N 0 W , A T 4 this t I M 5 , THERE A R c ONLY THE M0 5 T 3 c IT 5 AND SENSITIVE TESTS 0 F ABNORMALITIES, THE 6 things that .we would use for only research 7 PURPOSES. THESE ARE VARIOUS TESTS. IT MEANS 3 WE n A V c TO INJECT things a n d L 0 0 K A T PEOPLE 9 A N D I tS THE S T A ,N D A R D PRACTICE OF MEDICINE, 10 these W GOLD NOT 3 E DETECTED. AT THIS 5 TAGS, II THE PEOPLE WERE " S Y.MPTOMAT I C IT M E A N S 12 THEY HAD NO COMPLAINTS. THE REASON WE 13 DISCOVERED THIS, BECAUSE AT THAT TIME, WE 14 WERE DELIBERATELY LOOKING cO* POSSIBLE 15 PROBLEMS. 16 THIS IS A MUCH LATE* STAGE IN 17 WHICH THE CELLS THAT LINE THE SINUSOIDAL OR 18 THE VESSEL SURFACE HAVE NOW BEGUN TO 19 REPLICATE, GROW, SO, THIS IS THE EARLIEST 20 STAGES OF. MAL I GNANCY. AND AT TH I 5 PARTICULAR 21 STAGE, THE X-RAYS, THE LABORATORY TESTS THAT 22 ARE COMMONLY USED WERE NORMAL. AND AT THIS 23 POINT, THE PATHOLOGIST WAS REASONABLY SURE 24 THAT THIS WAS A MALIGNANCY, BUT STILL HAD 25 SOME CONCERNS BECAUSE THESE ARE VERY 'TYICAL STTOTTTZ BFG10011 r '1 P U P 3 C - M P . E M N t 15- * 15 i CELLS. HERE, THIS NUCLEUS HAS 3 ESN 3RD KEN UP 2 A.'JO THE CELL Is i30UT TO DIVIDE.- AND "OP. THIS 3 PARTICULAR P E A 5 j N, ONE SEES THE D E V E L 0 M E N T 4 0 F A \ G I 0 5 A P C 0:-! A P P E 5 E N T I N G ITSELF IN 5 COMPLAINTS 3 Y THE PATIENT VEPY, VEPY LATE IN 6 THE STAGE OF THE DISEASE PROCESS. 7 AND FINALLY, THIS IS THE 8 MALIGNANCY ITSELF. AT THIS STAGE, T h = PERSON 9 IS SYMPTOMATIC, LABORATORY TESTS APE ABNORMAL 10 AND THIS IS ONE OF THE LATER PHASES 0 c THE 11 DISEASE PROCESS. 12 N 0 W, I F W E W ERE ALSO 13 FORTUNATE IN HAVING THE OPPORTUNITY TO FI NO 14 X-PAY5, VASCULAR X-RAYS, IN SOMEONE HAD BEEN 15 MEDICALLY EXAMINED FOP ANOTHER REASON AND 16 THOSE X-RAYS, .WHEN WE LOOKED AT THEM 17 RETROSPECTIVELY, HAD THE SAME VASCULAR 18 CHARACTERISTICS AS WE FOUND IN THE SAME 19 INDIVIDUAL FOUR YEARS LATER WHEN HE HAD THE 20 TUMOR IN THE EXACT SAME SPOT. SO, FROM THESE 21 TWO GROUPS OF STUDIES, WE HAVE EVIDENCE THAT 22 THE TUMOR MAY RE PRESENT AS EARLY AS "OUR 23 YEARS RE FORE THE INDIVIDUAL BECOMES 24 SYMPTOMATIC OR ILL OR AS LATE AS n\ = YEa R . 25 AND THIS IS REASONABLE WITH WHAT WE 21110116 BFG10012 T '* 3 :J .< ? 0 - M R . x N N c I 3 E N 13 1 J N D E R S T A N 0 THE GROWTH' OF TUMORS TO RE; THAT 2 THEY ARE PRESENT FOR A CONSIDERABLE AMOUNT OF 3 TIME RE FORE THE PERSON IS AFFECTED E Y IT. AND 4 ESPECIALLY w HEn [T INVOLVES THE L ! v S R , SINCE 5 IT IS SUCH A ENORMOUS ORGAN, HAS SUCH GREAT 6 RESERVE, THAT IT TAXES A CONSIDERABLE AMOUNT 7 OF TIME BEFORE ONE REDUCES THE RESERVE IN 8 ORDER FOR SOMEONE TO 3ECOME -- HAVE 9 5YMPTOM S. 10 q . DOCTOR, WHAT ARE -- OTHER THAN 11 VINYL CHLORIDE, WHAT ARE OTHER KNOWN CAUSES 12 OF ANGIOSARCOMA OF THE LIVER? 13 A. I 8ELIEVE YOU'VE HEARD THF.M ALL, 3 U T 14 MOW R E P E A T [N G THEM, OTHER THAN VINYL CHLORIDE, 15 WE HAVE GOOD BIOLOGICAL EVIDENCE THAT ARSENIC, 16 A MINERAL, CAUSES ANGIOSARCOMA; THAT A 17 RADIOACTIVE ISOTOPE CALLED THOROTRAST 18 PRODUCES THIS, AMO I THINK WF HAVE VERY GOOD 19 EVIDENCE THAT A MALE HORMONE CALLED 20 ANDROGENIC ANABOLIC STEROIDS ALSO CAUSES 21 A N G I 0 S A R C 0 M AS. 22 q . FOR THESE FOUR KNOWN CAUSES, ARE 23 THERE ANY PHYSICAL OR CHEMICAL SIMILARITIES 24 IN THE CAUSATIVE AGENT OR ARE THEY ALL 25 DIFFERENT OR ALL THE SAME? 2111014.7 BFG10013 \ j -l ^ - C 7 - T M J ^ 3 0 - 3 ? >: \' * ( S M l7 c ir > L. 1 A. MO, -HE 5 E IRE ALL D I F c F R E M T 4 C- E v T S AND WE HAVE 30 M E E V I 0 E N C c THAT THE ',:CU A N [ S M 3 BY WHICH THEY CAUSE THE TUMO? 0? THE 4 tcC HAH ISM .i HELIE7E CAUSE THE TUMOR 15 5 DIFFERENT. FOR I N 5TAN C E, IN THE CASE OF 6 THQRQTRAST, this is a radioactive HATE R I AL 7 THAT IS ATTACHED. TO A PROTEIN THAT IS 8 INJECTED INTO THE INDIVIDUAL AND IS TAKEN U? 9 3 Y THOSE BLOOD VESSEL LINING CELLS AND HELD 10 THERE. AND THEN' ONE IS ABLE TO TAKE A FILM OR 11 A X-RAY 0p ONES LIVER WITH THESE RADIOACTIVE 12 MATERIALS OUTLINING ON IT. 13 IN THE EARLY DAYS Oe RADIO 14 I S 0 T 0 P E 5 , ,v E DID NOT REALIZE THE LIFE OR THE 15 DURATION OF THESE RADIATION EMITTING 16 MATERIALS AND THE THOROTRAST HAPPENS TO BE 17 500 YEARS. SO, IN THIS PARTICULAR CASE, ONE 18 RETAINS THE RADIOACTIVE MATERIAL AND THE 19 RADIATIONS THAT WE BELIEVE CAUSES THE 20 ANGIOSARCOMA IN THAT CASE; WHEREAS, THE 21 VINYL CHLORIDE 15 BECAUSE OF THE WAY THE BODY 22 METABOLISES IT. IN THE CASE Oc ARSENIC*, WE'RE 23 NOT AS CLEAR ON WHAT THE MECHANISM IS. IN ThE 24 CASE OF THE STEROID, TM E S E APE STIMULATORS 25 FOR GROWTH AND WE CEEL THAT' HAS -- 0 L a Y S A } k-k 'W <30 8TT0TTT2 BFG10014 T 3 J R < 0 - .1R. < : n N : 1 j E '! 17 1 R 0 u c IN ;inY THE CELL DEVELOPS INTO A TO M 0 R . 2 Q. APPROXIMATELY HOW MANY CASES OF 3 ANGIOSARCOMA ARE 0 [ASVOS f EO IN THE YEAR IN 4 the united states? 5 A. WELL, THE ESTIMATES HAVE VARIED 6 ANYWHERE FROM ONE CASE IM EVERY FOUR VILLI 0N 7 PEOpLE TO AS CEW AS ONE CASE IN EVERY 20 8 MILLION. 3 0 T ROUGHLY 25 TO 30 CASES A YEAR 9 HAVE 3 E n DOCUMENTED IN VARIOUS SURVEYS. 10 Q. ARE ALL CASES OF ANGIOSARCOMA 11 ATTRIBUTED TO ONE OF THE FOUR CAUSES YOU JUST 12 DISCUSSED? 13 A. NO. ONLY ABOUT A QUARTER, 25 PERCENT 14 CF THEM ARE. 15 Q. DO YOU HAVE AN OPINION AS TO WHETHER 16 OR NOT ADDITIONAL CAUSES WILL RE DISCOVERED 17 AS MORE RESEARCH IS DONE? 18 A. FROM WHAT WE UNDERSTAND ABOUT 19 3IOLOGY AND OUR EXPERIENCE WITH OTHER TUMORS, 20 I WOULD SUSPECT THAT WE WILL FIND AT LEAST 21 0 N E; MOST LIKELY MANY MORE CAUSES FOR A TUMOR. 22 1 KNOW OF NO TUMOR THAT DEVELOPS BECAUSE OF A 23 SINGLE CAUSE. THE MECHANISM BY WHICH IT MAY 24 EVOLVES MAY 3 E THE SAME, 3 U T THERE ARE MANY, 25 NUMEROUS, l SHOULD SAY, AGENTS WHICH WILL 21110119 T 3 U R R 0 - .'19. ^ M N IS *! 1A 1 . CAUSE THE SAME K f N D S Of TUMOR S . 2 0. "FRO M YOUR -- M Y 0 U 9 STUDIES 3 I T H INK YOU SUGGESTED That [O an: EARLIER 4 AN5WER DO YOU HAVE INF 0 RM A T I 0 N 5 C 0 N C E 9 N I NG HCW V 14Y L CHLORIDE 15' ACTUALLY 6 HANDLEJ by the LIVE?? 7 A. W ELL, WE'VE CONDUCTED 3 0 T H ANIMAL 8 AND HUMAN STUDIES DELATED TO THIS. AND I'M 9 IT IS, I THINK, NECESSARY TO EXPLAIN A 10 LITTLE BIT ABOUT HOW TE BODY HANDLES 11 CHEMICALS TO UNDERSTAND WHY WE SEE VARIATION 12 AND WHY WE THINK W= 'RE CORRECT IN WHAT WE SEE. 13 AND AGAIN, l ' D L I K E TO USE, I c I MIGHT, SOME 14 ILLUSTRATION TO DE M 0 N S T R A T E t h r s AND MAKE IT, IS I HOPE, CLEARER. 16 THE LIVER IS A VERY, VE R Y 17 INTEREST I NG OR GAN IN THE S ENSE THAT IT IS 18 3 IOLOGIC IALLY designed to GET RID OF A 3 N 0 R M A L 19 PRODUCTS. BUT the cr EAT OR MAY OR MAY NOT HAVE 20 ANTICIPATED THAT WE' D USE SYNTHETIC AGENTS. 21 BUT IT IS DESIGNED EVOLUTI 0NARY-WISE TO 22 HANDLE NATURAL AGENTS. NOW, WHEN IT GETS A 23 SYNTHETIC PARTICULATE, IT HAS A LIMITED 24 NUMBER OF MECHANISMS BY WHICH TO HANDLE THESE. 25 AGENTS. 1110120 BFG10016 M '3 R .R 0 H R It'Vic i 3L N 20 1 NG W, THIS SIMPLY ILLUSTRATES 2 the chemical- formula for vinyl chloride down 3 MERE. IT'S A VERY SIMPLE MOLECULE. IT HAS TWO 4 C A R 3 C \ ATOMS A NO TKc'i A CMLQPIDc. A N 0 THE 5c 5 ARE JUST S r M I L A R STRUCTURAL AND SYNTHETICS. 6 NOW, IT'S THESE TWO CARSONS 7 THAT ARE ATTACHED BY BONDS, AND THESE BONDS 8 CAN RE 3 R 0 ;< E N, IN FACT, THAT'S HOW YOU 9 NET A 3 0 L I Z E SOMETHING, YOU BREAK THE BONDS OF 10 A MOLECULE IN THE SUBSTANCE DEGRADATEO. 11 NOW, THE CHEMISTS AT DOW AND 12 AT SOME OF THE UNIVERSITIES IN NEW YORK HAO 13 BEEN GOING SOME CHEMICAL STUDIES ON HOW VINYL 14 CHLORIDE MULTIPLYS. AND THESE ARE THREE STEPS 15 3 Y WHICH IT IS METABOLIZED. THE FIRST STEP 16 .AND THIS IS VINYL CHLORIDE. 17 'THE COURT: DOCTOR, WHAT DO 18 YOU MEAN 3 Y METABOLIZE, SO THE JURY WILL KNOW. 19 THE WITNESS: metabolism is a 20 WAY OF BREAKING DOWN A SUBSTANCE, BURNING IT 21 UP. THE SAME THING ONE WOULD 'DO IN BURNING 22 COAL. YOUR C 0 N S U M I N G I T OR CHANGING IT IN ITS 23 STRUCTURE. AND IT'S 4k GE NERAL TERM FOR THAT. 24 THE ALCOHOL -- THE FIRST 25 STEP IS THE SAME ROUTE THAT IS TAKEN' FOR 21110121 BpGVOM r 3 j r to - mr . remne i 3 5 ?i i ^T430L!ZIMG 0 9 ` 9UNI N'G UP ALCOHOL, W M t Cu IS 2 ANOTHER CHEMICAL. AMD THIS OCCURS 0 M L Y AT 3 VERY LOW LEVELS OF VINYL C'-!LOR I OE EXPOSURE. 4 [ T APPEALS THAT AS ITS LEVEL " E C- I N 3 TO RISE 5 OR THE EXPOSURE IS INCREASED, THE LIVER CELL 6 TALES ON ADDITIONAL MECHANISM [v ORDER TO 7 j R A < 0 0 W A. THE PRODUCT. NOW, THE T H I R D STEP 8 OCCURS AT Trie HIGHER LEVELS, PROBABLY IN THE 9 R A N G c OF 2 0 0 PARTS PEP1 MILLION IN WHICH THE 10 L I VE R ITSELF CONVERTS TO VINYL CHLORIDE INTO 11 WHAT WE CALL AN APOXSIDE. IT MEANS SIMPLY 12 THAT OXYGEN IS ATTACHED TO WHERE THE DOUBLE 13 BONDS ARE. NOV/, THIS MOLECULE IS VERY, VERY 14 REACTIVE A N D H AS BE EN S H 0 '/ N BY A N I M A L 15 E X P E R I M E NTS tc IN JU o c -- IT IS GEN STIC 16 MATERIAL OF A CELL SO THAT IT C A N BE 17 DISTORTED WITHOUT KILLING THE CELL. AND IN 18 THAT WAY, ALLO M THE CELL TO BECOME 19 .MUTAGEN 1 0 A L L Y CHANG ED, THAT IS TO FORM 20 ABNORMALITIES OR E V EN TO GO ON TO MAL I GNANC Y. 21 AnD THE PRESENT LIFE THAT THIS METABOLISTIC 22 15 THE SOURCE OF THE ANGIOSARCOMA AND THAT 23 THE LIVER NORMAL CELLS, THE LIVERS MAIN CELLS, 24 ARE RESPONSIBLE FOR THAT CONVERSION. SO THAT 25 THE LIVER ACTUALLY IS TAKING 3 0 M E T HIN G WHICH 21110122 BFG10018 r -i i J > R 0 l i S A S T A 3 L c. S u 3 S-T A N C 6 4 AMO '1 A X [ N G IT i N T 1 A . 2 C A N CES ? A 0 JUC I N G SU3 STANCE. 3 N 0 ;i , THE L I V t R , ALSO HILL 4 IT '3 0 0 l MG THIS, GETS RID OF IT BY A 5 HE CHAN I S M OF GO N VERGING ON THIS W I T H W T E R 6 AMD THEN BEING ABLE ~0 RELEASE IT OR EXCRETE 7 IT INTO THE BODY. AND THIS BALANCE BETWEEN 8 HOW MUCH IS MADE AMD HOW MUCH IS GOTTEN RID 9 0 F WE BELIEVE IS A CRITICAL = A0 T 0 R IN W H E T hE R 10 THE TUMOR IS DFVELDED. 11 NOW, THIS IS JUST A DBA WIN G 12 ILLUSTRATING DMA LIVER CELL, THAT SQUARED 13 CELL AMD THEN THE'LINING CELL, THAT'S AT THE 14 SURFACE. IT IS OUR PRESENT BELIEF THAT VINYL 15 CHLORIDE AMD POSSIBLY OTHER CHEMICALS SIMILAR 16 TO IT ARE TAKEN UP 3Y THE MAJOR LIVER CELLS 17 AND THERE THE INTERMEDIATE ACTIVE SUBSTANCE, 18 THE APPOXY, IS FORMED. AMD DEPENDING UPON HOW 19 WELL THE LIVER CAM GET E I D OF THAT I S A 20 CRITICAL FACTOR IN WHETH ER OR MOT LIVER 21 CELLS BECOMES MALIGNANT OR W H E T H E ? I T a c q r\ -t c 22 INJURED AND DIES. 23 NOW, THIS ALSO HAPPENS TO 24 HOLD TRUE FOR ThE LINING CELLS. IN FACT, FOR 25 AMY CELL IN THE BODY. IT DEPENDS DM THEIR 1110123 UJ X BFG10019 i j R 0 - /' < . 1 ; N .''I; [ S : N 2 1 AGILITY T 3 GET ''13 OF T Y ! S S U 3 5 T 1 M CE THAT'S 2 MA3E . A N 0 3 E ? E N 0 ! Y G UPON that CAPABILITY, ONE 3 F I - OS THE S< OF C. A v C E ? I C 9 E 4 5 I M 0 \'lTLi T - = 4 DECREASED 4 3 [ L I TY op REVERSE. 5 NOh, ';? RELIEVE This CON 6 ACCOUNT 01 w Y 5 0 E J 3 P L E DEVELOP YALI G'!ANCV 7 A n 3 0 T ri E 1 5 DON'T AT V E 7 Y , V E 1 Y L 0 W LEVELS. 3 THE LlvCR CELL CAM HANDLE THE METABOLISM OF 9 this coihoud and also its removal of the 10 I N T 1 M ED I ATE MATE UAL. AT A M ORE M 0DE1ATE 11 LEVEL, IT MAY3E OVERWHELMED AND ALLOW THE 12 A P 0 X S l D E TO EE AROUND AND DO DAMAGE TO THE 13 NUCLEUS OR TO THE GENETIC MATERIAL AND THEM 14 THAT INJURED CELL CAN GO I N THE P'JT U R E AMD 15 DEVELOP CANCER. AT VERY HIGH LEVELS, IT 16 ACTUALLY KILLS THE CELL AND THEN THE a 0 D Y 17 REPLACES IT WITH ANOTHER ONE AND THERE IS 18 THE N NO D E VE L0 PM EN T OF CANCER 3 EC A U S E THE 19 CELL THAT WAS injured HAS die:) . AN D SO, THESE 20 MAY 3 E PEOPLE W Hi CD C A N GET T HE SAME L E V E L 0 ? 21 EXPOSURES IN WHOM THERE'S CELLS THAT HAVE 22 3E 5 N GENETICALLY T 1 A N S F 0 R M E D > DIE D AND 23 therefore, though they've seen exposed in the 24 SAME LEVELS, THEY DC NOT DEVELOP TUMORS. 25 Q. DOCTOR, HAVE YOU ACTUALLY TREATED 21110X24 BFG10020 1 A "i 5 [ 0 S A -1 C CMA PAT I ENT S? 2 A. Y 3 , E HA 7E . 3 v A M3 N 0 MANY AND -- 4 A. .i i n A V E T :< E A T E 3 5 1 X /X N 5 1 0 5 A 5 C 0 M A , 5 FIVE A .< E VI N Y L C H L 0 A I 0 EEXPOSED INDIVIDUALS 6 A N D A SIXTH ,1 A S ONE W E DON'T REALLY HAVE THE 7 SOURCE OF THE A N GI 0 S A R C 0H A. 8 q. W I T H R E S 3 E C T TO THE V I N Y L C h L 0 R I 0 E 9 E X? 0 S E D PATIENT S, DO YOU < M OV; W h A T THE 10 ESTIMATED LEVEL 0- VINYL 0 H L o RIDE W AS? 11 A. [N ALL FIVE CASES FROM OUR DETAILED 12 OCCUPATIONAL RECORDS, THEIR EXPOSURES LEVELS 13 W ERE ABOVE 50 PARTS PEP M I L L I 0 N AND v; E 14 cSTIXATE S 0 M, E W HERE IN THE PA N S E OF 2 U J TO 5 3 ') 15 DURING A GREATER . PRO PORT I ON OF THEIR WORK 16 H I S T G R Y . 17 q. DOCTOR , WHAT IS EPIDEMIOLOGY? 18 A . T H I S IS THE STUDY OF THE DEVELOP./ ENT 19 OF DISEASE IN POPULATION. WE CAN STUDY IT I N 20 AM l N D I V I D U A L , BUT THERE A nA ek. ALSO T I E S W H C >1 21 WE WANT TO S TODY 'THE OCCURRENCE OP DISEASE T N 22 GROUPS OF INDIVIDUALS, WHERE WE 1R E NOT 23 ACTUALLY STUDYING THE INDIVIDUAL -DISEASE 24 PROCESS ITSELF. AND IT IS THIS AREA OF 25 MEDICINE That i L L 0 W S US TO 0 E r E R M I N E T ~ E s jn ro T T T BFG10021 .T .-I j ^ x 4 G - R R c n l 5 E N 25 1 < Q U E N C Y w IT-. H i C H DISEASES A?S OCCURRING 2 AND CHANG I NG AND 'ALSO ALLOWS US T C D E T E R M INS 3 w M E T A E R 05 N'OT 7 -*! ? R 0 R L Em TU&T A DISEASE IS 4 0 C C 'J 7 R I Ni \j a C E ' 7 A I N AREA, IS D J E T D 0 7 5 Cjjld 3e 'elated to some enviromental o' 6 SOCIAL 0 < V PAL C A U S E . 7 0. AMO GENERALLY, .-j 0 U L 0 YOU DESCRIES 8 H 0 w EP IDE M I 0 L 0 G I C A L STUDIES -ARE DO N E ? 9 A. WELL, T !i I S IS DONE ;v I T H THE BASIS 10 3 c I iN G IN STATISTICS OR PROBABILITY. AS YOU'VE 11 HEARD 3EFGRE, IN MEDICINE, WE REALLY DO NOT 12 D E A L WITH THE ABSOLUTE. THERE IS SO MUCH 13 natural variation between humans that we 14 C AMNOT 3 E A 3 S 0 L 'J T E PREDICTORS . A N D SO, WE 15 DEAL W l T H W HAT W E CALL "ROB ABILITY; THAT IS, 16 WHAT IS LI<LIH0 0 0 THAT AN EVENT f DEVELOPMENT 17 OF A DISEASE WOULD OCCUR l P CERTAIN 18 E N V I R 0M E NT A L THINGS WERE CHANGED. WE DO THIS 19 illTH VIRUS - - IF YOU HAVE A CERTAIN VI R y S 20 PRESENT, THERE'S A CERTAIN ~ R E 0U NC Y, OR A 21 CERTAIN OCCURRENCE OF THIS DISEASE PROCESS. 22 W TAKE T HE VIRUS AWAY, THAT DOESN'T HA ?P EN 23 isO'.v, YOU MAKE THOSE STUDIES 3 Y LOOKING AT A 24 POPULATION OF PEOPLE WHO HAVE THAT PARTICULAR 25 AGENT OR MATERIAL PRESENT AND YOU LOOK AT A 1110X26 BFG10022 .4 0 V 0 3 3 '1 E 1 5 E N 1 C 0 M P 4 7 A 3 L z PO? IJ i_ a. T I O m TU4T 0 .* = $ ''i C ~ . 4 n ~ -i = N 2 YOU F[;jo O'JT ;>- THE3. THE 0 C C 'J R P E N C 5 0= THE J<> 3 1 5 z 5 z 0 C C u R 5 'N Y S R 5 A T F I'-: ONE ? 1 2 J L A ~ I 0 ' 4 VERSUS ANOTHER . NO,.' , IF IT DOES , T T E N YOU 5 H A V A VERY HIGH P R 0 3 A 3 [ L ! T Y ; 05 Cri A U C E 3 OUT 6 OF A HUNDRED, THAT THAT 15 RELATED TO THE 7 E N V I R 0 N ,'i E N T OR TO THE AGENT YOU'VE IDENTIFIED 8 IN ANOTHER. AND 3Y REPEATING THAT SAME STUDY 9 in ,;h ic:h population and bindings the same 10 RESULTS, YOU I N CREASE THE RELIABILITY THAT 11 THAT'S A TRUE EVENT, THAT-DID NOT HAPPEN by 12 CHANCE. 13 0. ARE YOU f Am I L I A R WITH 14 E P I 0 E M I 0 L 0 G I C AL STUDIES D 0NE U I TH RESPECT TO IS VINYL C H L 0R ID E AND A N G[0 SA RC 0 HA ? 16 m . M GST I Ail 17 Q. AND HAVE YOU DONE STUDIES YOURSELF? 18 A. WE HAV. 19 D WITH RESPECT TO T H STUDIES THAT 20 YOU'VE DONE YOURSELF, WHAT GROUP 0<= PEOPLE 21 DID YOU - - WHICH G R 0 U S OF 3 E 0 13 L E DID YOU 22 COMPARE? 23 A. WELL, IT IS NOT ALWAYS EASY. o \. = OF 24 THE MAJOR LIMITATIONS TO EPIDEM [0L00 I CAL 25 STUDIES IS T M A T y E HAVE 0 I F = E R E N T 3 0 P 'J L A T [ 0 N . iz x in x r BFG10023 ! j J .i w -- iiR . . i ~ ' i i -( E i 5 1 ; E HAVE D I F F E R E M T .RACES, OF 0 t F F = R E N T SEX, V E *L1 HAVE D I F F E 3 E N T EAT IMG PATTERNS, DIFFERENT -D -IV! MG PA T T E 9 S , D I F = EREN7 E V V I R OMENTAL 4 PATTERNS. SO, YO'J T 2v T0 0, E T A MATCH IV T- = 5 P 0 PUL A T I 0 V AS 5 E 5 T YOU 0 A \' . 6 V 0 W , THE VARIATION T r\ T -! [ S , 7 YOU CAN TAKE ONE P-0 ? U L A T l 0 V AND 0 t V [ DE Ir 8 IV TO TWO G 9 0 SJ 3 $ A MO --AXE A COM9AR I 30V IV THAT 9 WAY, OR YOU CAN GET TwO GROUPS PROM D I p F E' E '-1T 10 AREAS AMO -! A ,< E A 0 0.-1 P A R I S 0 V . .-.-HAT WE /" E 11 A d L E AMO w ERE F.O R T U N A T E E N 0 :J G H TO 0 0 IS T 0 i 12 HAVE A POPULATION OF I N D I V I 0 U A L S w H 0 vi ERE exposed for a very - long time at what is 14 3 E L lE V E 0 TO 3 E THE 'HIGHEST LEVELS AMO ALSO IS THE LOWEST LEVELS OF VINYL CHLORIDE. AMO 16 A 3 0 U T 1 , 2 0 0 OF THESE INDIVIDUALS AND A 3 0 U T 17 300 RETIREES WHO HAD WORKED IN A PROLONGED 18 P E R I 0 D OF TIME AND WE WATCHED THEIR T9 DEVELOPMENT. AN 0 W E WERE A 3 LE TO SEPERATE IV 20 THAT GROUP BETWEEN THE GROUP THAT W 0 R < E 0 WITH 21 VINYL CHLORIDE AMD THE GROUP THAT WORKED WITH 22 SYNTHETIC R U 3 3 E R 0 R W AS A3 LE TO SHOW THE 23 n A S A DIFFERENCE I N THE T y u E 5 OF D I S E A S E 24 i H E 5 E TwO -j R 0 U P 5 AND THAT IT WAS RELATED 25 WORK. N E *-. c R l ALSO DOING STUDIES I N t-s 8ZTOTTT BFG10024 /3'JRRO - M' . R .5 N 5 [ S F M 9 1 : 1 n ['i TA3 ; -I H 9 s ~ a -- -a ' ;_i r 5 9 m ^ * ' m h, 2 LOOKING = 0 o TH -0 C C 'J R R r N C E 0 c LIVE"? DISEASE 3 4' 0,3 T-E1 4 3 "VI 05`.'Cl op EXPOSURE T0 - 5 4 0-5/ I C XL I COMPAQ I SON TO 3IUE1 GROUPS WHO 5 WORKED w I T.-i D I F - 5 R E N " < I NO OF AGENTS. AN D 6 T115 NAY, n E ' V 5 3 SEN A 5 L 5 TO FIND OUT W H E T H E R 7 GK NOT THERE w A 5 A GREATER OCCURRENCE OF 8 LI VE R DISEASE OR OTHER KINDS OF DISEASE AMONG 9 THESE WORKERS. LET'S TAKE THE HIGHLY EXPOSED 10 GROUP. DID YOU c I N Q A HIGHER INCIDENCE THAN 11 EXPECTED> I N ANGIOSARCOMA AMQMG THAT GROUP? 12 A . YES A N0 W F wF z A1L- TO IDENTIFY 13 THE AGE'vl T 3 Y THESE EPIDEMIC L 0 G I C A L STUDIES. 14 A V; H w ^ A * 'AS THE = P ^ 7 <j rj " t f \> c [_ ,9 c 15 THAT G R 0 U 3 ? 16 0 . EX 0 S !J R E LE GAL OF VINYL CHLORIDE ? 17 A . A E HA VE TO DO TH I S ON THE BASIS OF 18 nISTORY, 3E CAUSE WE DO NO T HAVE ABSOLUTE DATA 19 SO, I WOULD LIKE, I F I CAN, TO ILLUSTRATE 20 WE WENT A 3 0 U T DOCUMENT ING THAT THE EXPOS U R E 21 /AS H I G H A N D THEN TO S H C W 'WHAT EVIDENCE W E 22 HAD AND WHAT THAT EXPOSURE -- THAT, QUOTE, 23 HIGH EXPOSURE WAS, IF I might. WHEN DOCTOR 24 CREECH AND DOCTOR JOHNSON MAO DISCOVERED "HE 25 A N G I 0 S A ? C 0 / A T 'i m A N H ' D A UN I n U E 21110129 or BFG10025 I JRRu - 3 * 'Enn E [ s - 1 S 1 T unT I G N D E C A U S E W E HAD A ''j I r i A L STUDIES EVE V 2 3EFORE T ,H A T OR AT THE SAN c T [HE, . H1CH HAD 3 S H G V. N T H A i IF YOU USE 0'1 L V V I Y L C H L 0 R I D = , 4 YOU PRODU rL, r- THE J U MOR. EU T1 IN THE EARLY 5 STAGES, I T WAS UNO LEAR Wh E T H E R 0 R N 0 T IT ./ A S 6 the vinyl r H L 0 R IDE I TS EL = THE M 0 -! 0 11 E R T H A - 7 YOU HEARD A ^ r) ij T rs ij i-| tr t u ER IT W a 3 THE 8 POLY ME R 0 "D THE POL Y V T N Y L 0 HL nn r1 --\"- , t1 u-c- D5 H v ' , 9 THAT CAUS ZD THIS. .4 N 0 SO, A 5 a a q 7 Qf HUP 10 N A T I 0 M A L C a NO SR I N S T ( T U T E 7 RANT, E WE NT 11 A-3jLT Sc TT Hi U* A SYSTEM T * A T w QJLD ALLOW US - 12 TO 0 E T E 9 M I NE EXPOSURE 3 A S E D 0N Wn E 4 E PEOPLE 13 n A J U R K c D , H 0 L 0 NG THEY HAD W 0 2 K E D A N 0 14 v H t T H E R OR N OT THOSE JO 3 S '-(ERE A S 5 0 C I A TED 15 .* I T ;h VINYL chloride IN A what w e CALL A 16 .RANK ORDER! -IS; THAT l 3 , THAT Wc WOULD TAKE A 17 SETS OF INDIVIDUALS, S I X THAT WE TOOK, MAKING 18 ZERO PEOPLE vi HO WERE OUfV^FOE THE P LAM 19 ALTOGETHER, ONE WOULD re The m INI I y UM A'^UNT 20 of PO 3 S [RLE EXPOSURE OWE COULD H A V c , AYO SIX 21 REIN-G THOSE -PEOPLE WHO WERE INTIMATELY 22 INVOLVED WITH. THAT. AND 3Y THE USE Op T'-! [ 3 23 RANK ORDER f NG AND THE KINDS CF j 0 3 S THAT T-*E 24 INDIVIDUALS HAD, wE -W ERE A 3 L E TO DESIGN AN 25 ESTIMATE THAT DID (WOT HAVE AN A 3 S 0 L U T E FIGURE i o e im iT z BFG10026 T M 3 j R R 0 - M R . R E 'iN E I S - *: ^ r, 1 0 N v; HO HAS T 'J 'I MOST F X ? n S u R E RELATIVE TO 2 T H E I R CCM?4 NY 0 R '< E R S . * '! 0 a Y 0 0 IMG T -< [ 3 , ty E 3 E 3 E a a l E TO E " E / - E T H E 7 0 R NOT r - 0 ; E 4 I V0 I V I 0U \L5 ! T H THE H [ 0 h E 5 T 0 E j \ E E ^ a 5 EXPOSURE on THEEE ESTIMATES WERE 0 R E 6 ASSOCIATED .* I T H AXG I OSARCOMA THA N THOSE 7 HO 7 HAD LESS. AND 0 HAT TH I S 0 E .'10 N S T .9 A T E D >/ A S THE 8 EOLlOWIM'G: each of these columns has MADE u? 9 OF little stacks, each stack is ah individual 10 < n 0 HAS a WORK HISTORY ESTIMATE OF THE I R 11 EXPOSURE TO A CHEMICAL CALLED ACRYLONITRILE. 12 WE EXAMINED 22 CHEMICALS. THIS IS JUST SIMPLY 13 ONE TO ILLUSTRATE THIS. THIS IS THE EASE 14 CHEMICAL FOR T ME FOR M A T I n \i OF 5 y m t m = T I C 15 RUSHER. 16 N 0 '.-I, WE HAD F 0 U M 0 F 0 U R 17 ANGIOSARCOMAS OUR IMG THIS TIME OF 1 0 7 4 TO 18 1 0 7 7 . A N D EACH ANGIOSARCOMA CASE IS 19 ILLUSTRATED IN RED. NOW, THE POSITION THE 20 ANGIOSARCOMA HAS IN THESE GROUPS OF 21 INDIVIDUALS IS RELATIVE TO THEIR EXPOSURE TO 22 THIS PARTICULAR CHEMICAL. AND WHAT THIS 23 SIMPLY ILLUSTRATES l S THAT FOR MEN OF Tu E 24 SAME SEX, ROUGHLY the SAM E AGE, PLUS OR 'MM US 25 A YEAR '-/HO WORKED FOR The SAME n; ij h a = a 0 " m om z BFG10027 l.iJ? 50 1 YEARS, Tn; 15 TOTAL 5 5 T [MATEO EXPOSURE TO' T A I 5 2 past i cola* c hem i c al put them soo ehhere i n the 3 I 1 J 0 i_ E CO The L 0 ,v E R E \ 0 C F THIS CHEMICAL, 4 1 0 J [ C A T I .'-i 0 T n A T THE A .0 0 I 0 3 A 9 C C M A CASES 0 I D 5 NOT HAVE A HI GH ASSOCIATION WITH. THIS 6 CHE m I C AL. 7 N 0 W , W HEN WE LOOK AT VI 3 CHLORIDE, 'WE SEE THAT THE ANGIOSARCOMA 9 APE' THE H [ G H Z S T n? T u E HIGHEST I n THE I 7 10 EXPOSUPE tq VINYL C H L 01 I 0 E, I LLUSTR AT [NG ON 11 then from an e p i dem i o l c g i c a l point oc 12 VTErt, THAT IT IS VERY HIGHLY PR 03 A OLE THE 13 C H A N C E 5 OF u 5 i A K I NG the ERROR I W THESE 14 P \ .< T 1C JL A R CASES S T A T 1 S T I C A l L Y l S ONLY OnE IN 15 a THOUSAND, 5 0, I T ' S A 9 9 0 0 0 -09 CHANCES 16 W E ' R R I G pi T .V I T H THIS HYPOTHES IS AND ONE 17 CHANCE WE'RE WRONG, THAT THIS PARTICULAR IB TUMOR IS ASSOCIATED WITH VINYL CHLORIDE 19 EXPOSURE. 20 N 0 W , OF THE 22 C H E M I C A L S ~ H A T 21 WE HAVE A CHANCE TO LOOK AT, ONLY FOUR S H0W E 0 22 THIS ASSOCIATION. NOW, ANY TINE YO'J TRY TO 23 TAKE A LARGE N JM 8 E R 0~ POSSIBILITIES AND 3UT 24 THEM TOGETHER, BY CHANCE, YOU'LL C 0M UP W[ 25 AN ASSOCIATION. IT'S ESTIMATED TnAT IF YOU M J.UOX32 BFG10028 jT 10 - \ 3 ?, z \' N E I SEN 1 HAD 2d ?-c s s r * i L I T IE S, ' YOU 1 D HAVE AN AT LEAST 2 ONE 9 Y CHANCE, M E A N I N G r t WASN'T REAL, J'J 5 r 3 HA? ? - ' V - r\ tv c -) A N C E that y s AW m u i T 4 ASSOCIATION. WELL, V E CV-E U ! T h =0lP. F 5 ./ E * E 7 A T H E E S 'J x ? 7 I 3 E D 9 E C A J S E 7 '-I A 7 W AS 6 than w e w q j l d HAVE EXPECTED. AND h A V E SOURCE 7 .V E DID EXPECT Thp VINYL CHLORIDE, 3 UT W E H A D 8 T ,, 0 0 T H; E l -- ThREE.OThER -G E N T S ; ONE 3 F 9 WHICH WERE CATALYSTS THAT WE USED WITH VINYL 10 CHLORIDE TO CONVERT IT INTO THE POLYM E R . THE 11 SECTION WAS A SOLVENT, SOMETHING TO D IS OL VE 12 The catalyst, and the third, which is 13 SPECIALIZED CATALYST USED r M VINYL CHLORIDE. 14 SO, ALL Of7 THE SYNTHETIC R U S 9 E3 CHEMICALS, 15 THE ONES USED POP RU99ER MANUFACTURING DID 16 NOT SHOW ANY ASSOCIATION. 9'JT THE AGENTS 17 THAT WERE USED WITH VINYL CHLORIDE SHOWED 18 THAT IT DID. AND THIS FURTHER DOCUMENTED THAT 19 OUR ESTIMATES, OUR WORK E S T I M A T E S A 10 U T THE l R 20 EXPOSURE WERE CORRECT EPIDEMIOLOGY AND THIS 21 A S ASSOC IA TED . j I T H THE DEVELOPENT OF C A W C E R . 22 NOW, WHEN WE WENT TO LOCK AT 23 LUNG CANCER, 'WHICH IS ALSO HIGHLY SUSPECTED 24 OP 3EING ASSOCIATED WITH VINYL CHLORIDE, wE 25 WERE UNA3LE AMONG OUR SEVEN1 OASES OF LUNG 1110X33 BFG10029 r 3URR0 3 E '!N 5 ( 3 : N ' 1 C A<C ^ T3 5;THAT THERE .MS A A Y a S 5 7C ! - " 1 7 V 2 n 1 TH A.\r- OF THE R U i 3 E R CHEMICALS AS 3 U-JST.RATED i Y -C R YL )N l T R l ;_E AND ALSO T~AT 4 THERE ;t A3 f'i ' T A N Y T H l 4 G A 5 5 q c [ .A T = o . j [ T ri VI N Y L 5 C A L 0 R I 0 E . 0 w , This HAS LED US TO SIMPLY 6 CONCLUDE THAT THERE IS AN INCREASE IN CANCER 7 OF THE LUNG, BUT THAT IT IS MOT ASSOCIATED 3 E ?I D E M I 0 L 0 GY WITH THE CHEMICALS W E LOOKED AT 9 AND THAT -1E A ,V S WE STILL HAVE TO FIND THE 10 AGENT. 11 0. DOCTOR, IN YOUR SIX CATEG DRIES 0" 12 EXPOSURES -ROM PEOPLE OUTSIDE THE PLANT J13 THROUGH THE VARIOUS LEVELS, IN WHICH CATEGORY 14 DID Y ) v R -- T H E A i G I 0 5 A R C 0 1A CASES T H A T 15 F 0 U N D FALL? 16 A . T ri E Y /(ERE i 10 5 T L Y IN C A T G 0 R I E S OF 17 FOUR, FIVE AND SIX. WE FOUND N 0 N E WHO FELL 18 INTO THE CATEGORIES OF Z E R 0 , ONE, TW 0 OR 19 T H R E E . 20 0. AND WHAT T YB E S OF JOBS DID POUR, 21 FIVE'AND SIX HAVE? 22 A. hflL, THE INDUSTRY -LVD A 23 FORGIVE ME FOR USING THE WRONG TER'*, I ASS JM:f 24 T H E Y HAD S 0 M E SORT QP S E N I 0 R I TY 0 R 0 E R . 25 EVERYONE WHO CAm= TO WORK DID ONE JOB r I 3 5 T 21110134 BFG10030 - i _; r iH 3 j3 5;.l - ,-i . ;; "Nj [ j ; 1 A A D THAT ,-i A 5 ! 0 3 .< ! N G [ \ The CLEANING on 2 The 3 I G V 4 T S . AND 50, / T < A 8 AS THE A0 9 A 3 then v 3 U L 3 3 t-- 1jo' ,^-' < n ti~t ."> / HE A 0 U L 0 LEAVE 4 JO* . 3 >*. 3 3 T A Y E 0 0 -i T H A T J 0 0 L 0 V G E 0 T I:' 5 T m A 'J n;yp?s - U T ALL C c T u E V1 u \ - nn ^p > 6 C ') "' 5 rO^A3L: A E 9 f 0 0 S 0 p T[,JI: IN T H 5 S E V 7 A TO U O T^ESc VATS. 8 9 ':N.C.TXaAi fttSd-g *Cr P.LAN.T. ..t HAT. MAS.. SWffSW 10- tefcsse? .j 11 12 r i *~s SgTO L BFG10031  ' ' 'J R R Pi - R 3 C 1 2 Then QMS V/ OUL7 ;J1V: EXPECTED "HAT D I D i ' T . N 3 IT - - I T 3 EC 0 M C S SUSPICIOUS H E N ) ,N 5 SEES 4 a \ j T rt A T IS H Y 0 V E COES 5 EPIC c .'i I 0 L 0 G I C A L S T J DIES, TO F l NO 0 U T rc ther 6 YOUR SUSPICIONS A ;2S C H A In C E H A P P E :> I N G S OR 7 WHET HER 0 R N 0 T 5 I !\ C E YOU RE REALLY SEE! M O Z III D. 8 SOM E T H [ N G THAT' S ALLY HAP 9 0. DOCTOR EPSTEIN TEST IF I E D C 0 NC E R M t MG 10 A MG I 0 3 A R C OH A AT LOW LEVELS OF EXPOSURE. I 11 3ELIEVE HE DISCUSSED ?VC F A 3 0 I C A T E c 0 R 0 E 12 E::OSED to LEVELS n~ NONE DETECTABLE TO t;p 13 PARTS PEP A ILL I ON. AS A RESULT op STUDIES 14 0 ONE ? Y Y 0 U 0 0 YOUR RESEARCH, 00 v ) U < N 0 W I F 15 TrtERE IS ANY HI.SHE A t \>C I OEHCE CF .ANGIOSARCOMA 16 ANON'S PVC FABRICATE FORCE? 17 m. . BOTH BY OUR STUDIES AND THOSE THAT 18 HAVE BEEN PUBLISHED, WE HAVE NOT FOUND ANY 19 EVIDENCE THAT THE PVC PRODUCTION WORKERS OR 20 FABRICATORS HAVE ANY INCREASED INCIDENCE OF 21 EITHER INJURY ASSOCIATED WITH CHEMICALS OR 22 WITH A N G I 0 S A ? C 0 M A. 23 0. IF AM AGENT IS KNOW* T0 CAUSE A 24 PARTICULAR -- f "< SORRY. IF AN AGENT. IS 25 KNOWN TO CAUSE CANCER IN A J 4 3 T l C U L A R 'ART OF 9CT0TTT2 BFG10032 I \j 1 ( < 0 LL BODY, , ILL IF N ECZSSARILY CAUSE r A N CE < T 2 0 T H r parts of the 3 0 0 Y ? 3 ^ ONE HAS TO J IOSFSTAMD T- A T z 7E 0 LL 4 H A 5 A DIFFERENT JO* A N 0 JAS DIF F E RE m r 5 C A ? A S I L I T [ E S . AND THE REASON WE ^ E L I F VE - 6 CELL DEVELOPS C A N C E R A mn another do E S ,v ' T I 5 / DE PE NDENT UPON1 TH ES E CAPABILITIES. AN D AS Y OU 8 5 A ./ ILLUSTRATED IN r H E LIVER I TS E LF , .j I ~ M T 0 9 JIFF ERE NT CELLS, DE pending on the ir. A B I l_ [ T Y / 10 THEY E I T H E R J E V E L 0 P CANCER OR THEV )0 N 1 T I J 11 GENE RmL, YOU CAN BE H I GHL Y S US P 1 C I 0 u'S T --i T 12 0 N E CHEMICAL, IF IT D E V E L 0 P 3 4 C A N C ER I Vf 0 N 13 TISSUE MAY DO IT IN OTHERS. 3 u t YOU r AN AN' ON.' 7 14 SAY S E C A U 3 E IT J E 7 E loped it in one T I S 3 !J = / I T 15 W I L L DEVELOP IT IN OTHERS. AND ONE u AS TO 16 T A <E INTO CONS HERAT ION HOW THAT A R T ICJLA? 17 AGENT IS. HANDLED 3Y THE CELLS A.ND WHETHER THE 18 CELL HAS THE CAPABILITIES OP DEPENDING ITSEL= . 19 A 'ID THOSE CELLS THAT DON'T, THEN T h* E 20 PROBABILITY IS CREATE0 THAT T E v ' L L cAsai'i, 21 A -ID IE IT DOESN'T, IT WON T. AMD SO, YOU 22 CAN'T JUST M A n A SIMPLE STATE I-i ENT THAT 23 cancer developments in one tissue will 24 definitely develop in another. YOU can 3E 25 suspicious, sut you have to demonstrate it. 21110137 BFG10033 1- 3 ij 3 o '1 9 7 7 SI m e J 7 7 \l 77 1 3 0 C T ^ 3 E 3 3 T T N HAS 0 I S C J S 3 E 0 EIGHT2 CASES 0- A \ G f 0 3 A R C 0 M A t N ['OIV13UH3 L I f N 3 3 V I T h I \i r ,V C ' r L 5 3 o - V C P L A T s AND ME 4 RE=ERRED t," ARTICLE 5 5Y CHRISTIAN, BAXTER viO 5 3 R A 0 Y . F I .< 5 T OF ALL, ARE YOU FAM ILIAR WITH 6 T ri0 5 E ARTICLES? 7 A. YES. 8 Q. DOES THE EXISTENCE OF THESE EIGHT 9 CASES -H E AN THERE IS A SUBSTANTIAL V. E 0 I C A L 10 PROBABILITY THAT THEIR ANGIOSARCOMAS v; ERE 11 CAUSED BY VINYL CHLORIDE? 12 '* R . V A S F A L 0 T T [ : EXCUSE *' <= . 13 ARE YOU ASKING THE DOC TO? IN H IS OPINIO N. 14 4 5 . !) V \; " f c; P m ; y c AH, I N *H I S IS OPINION, I'M S 0 R R Y. SHALL I REPHRASE THE 16 QUESTION? 17 HR. VASSALOTTI: NO, I JUST 18 t i\ T ll D I T CLEAR. 19 B 1 A iR . RE NNt isen: 20 Q. IN YOUR OPINION, D 0 C T 0 R , DOES THE 21 EXISTENCE OF THESE EIGHT CASES MEAN THAT 22 THERE IS A SUBSTANTIAL MEDICAL PROBABILITY 23 THAT THOSE INDIVIDUALS HAD ANGIOSARCOMA 24 CAUSED BY VINYL C H L 0 R [D E ? 25 A . NELL, 7 '-1 E P R E S E N C E O= THESE r A S E S 8 T0TTTZ BFG10034 1 HA V - . ! A Jc J S aL!_ 5 U 5 P I C I 0 OS T h \ T T -1 I S P 0 S S I 3 I L I T r M I G H T EXIST A N D T n A T 1 3 .i H Y TH - 3 c P I : I 0 L -/ vj [CAL STUDIES N E 1 C A R R I ED 0 UT. '; 0 .v 4 those E PI ' 1 I 0 L 0 G f C A l 5 T U DIES HAVE '' 0 T 5 V A L I 0 A T E D T HAT THERE IS A CAUSAL R ELAT I 0 N SHI3 O 111 6 ? I D E M l 0 L 0 0 Y , wE r i v v q t PR OVE A 7 N E G A T I V E . V OJ PROVE ONLY A P 0 5 [ T I V E . A ^ 0 c- r, t 3 W H A T WE H A V E IS 1N C R E A S I N G A r r R 0 T S TO 3 "3 0 v c 9 THE POSIT I V E CO MIN G U P W I T H THE N E GAT I VE. A N D 10 SO L 0 N G AS THAT C 0 N T [ L ; S 0 N, W E 0 0 N 0 T HAVE 11 SC I ENT IF IC DATA THAT SAYS T r A T T h E 3 E C ASE 5 12 W ERE 0 ID WOT HAPPEN 3Y CHANCE 13 Q [ ' 0 L I ;< E T 0 A S A YOU A HYP OTHE t re A L 14 QUEST 10 N: D 0 C T 0 R , A S S U M E T -1 AT u 0 H H C G R A 3 5 0 15 /I AS HORN ON- DECEMBER 2 7, 1927 AND WAS 16 EMPLOYED AT THE DUPONT CHAMBERS W0R K S F ROM 1 0 17 UNTIL 197" WITH A PERIOD AROUND '9 5 0 WHEN 18 HE H A 0 OTHER TYPES OF EMPLOYMENT; ASSUME T H A T 19 MR. GRAS SO LIVED 1.7 MILES FROM Tm? E.F. 20 GOODS f C H P E 0 R t C < T O '/ n p L A NT FROM th? 0 1 t = [ r 21 OPENED IN -13 7 0 UNTIL HIS DATE OF 0E A T H IN 22 1 9 7 7 . ASSUME FURTHER THAT THE PE OR ICKTOa n . 23 i3 La T IS In SALE M C 0 U N T Y , W H I C m G E N c: R. ALLY I 3 24 a rural area a n d ass u m t that w h e n m >r . grass c 25 .J a S AT DUPJ.iT, JJPO N T USED A GREAT NUH3E.R OF J.U0X39 BFG10035 r 3 J '7 1 0 - ,-i R . R G N N E ( 3 S 1 CHEMICALS; 4 3 3 'J P Tmat m r . GRASS 0 ; a " 2 m 0 3 P I T A L I Z 3 D I ''1 J 'J \'= 0 = 1 A 7 R ,-! hem '-*E 3 so A `: 3 COUGH [v", .JO el 0 00 i'!0 4 D n T _! = 3 a 4 0 I - r 0 \; DESCRIBED 10 opr; 5 3. C : 0 3 S WHIG' [ 1 VS Su RM [ r TED 70 YOU " 1 v0U3 6 R V I c >/ . .A S 3 U V1 THAT M3. G R .4 3 5 0 :v 4 3 7 HOSPITALIZED AT THOMAS JEFFE3S0N M z0 l CAL 8 C 0 L L E 3 c IN AUGUST OF 10 7 3 AMO THAT O N A y O :j 5 7 9 5, 1 9 7 3 , THE D IAGNOS IS OF ANGIOSARCOMA OF THE 10 LIVER w A S MAOS . ASSUME THAT THE P L A N T [n 11 PEDR ICKTO ! \ 0(0 OPE N 0 K MARCH 25, 1 ? 7 0 A M 0 I T 12 A A M 'J F A C T U 3 E 0 3 0 L Y V l N Y L C M L 0 R IDE. CURING THE 13 COURSE 0s THE MANUFACTURING PROCESS, VI NHL 14 CHLORIC'S G\S -/AS E1ITTSC I M T 0 THF A TMOS PHSR F . 15 ASSUME THAT CONCENTRATIONS OF VINYL CHLORIOS 16 HERE' FOUND IN THE AREA OF TH? GRASS') H 0 E TN 17 THE 'RANGE OF SIX TO NINE PARTS PER BILLION 18 AND THAT MR. GRASS!) C '! AN ANNUAL AVERAGE THAT 19 MR. GRAS SO HIMSELF HAD AN ANNUAL AVERAGE 20 EXPOSURE OF FIVE TO EIGHT PARTS 3ER 3 ILL I ON. 21 ASSUME That THc HlGn 24 HOUR AVERAGE FOR MR. 22 GRAS S 0 WOULD HAVE 3 E'EN 2 3 0 PARTS PER 3 I L L I 0 N 23 AND ON AN .HOURLY BASIS ON TOG TO FOUR T [ME S A 24 YEAR, AN HOURLY AVERAGE wo U L 0 HAVE REE N *S 25 HIGH AS FI V E TO SIX PARTS PER MT L L I 0\. A $ 3U uE o y to x tT z BFG10036 1 T H A T -l R . C- -3 3 C .v 4 i E X ? 0 5 : J A S A 3 ~ 3 J L " 1 " 2 urliJJIC M I S 5 1 J 'J SOCCURR I MG A P R C .'< [ ' i A T E L f 2 :j 3 T IN-; IN Sis TE.o FJ2 PERIODS OF T0 T' 15 4 i 1u F E 5 A N 0) J [ N j T 0 0 3 E A A P 3 S U R E P a l 0 0 5 , 5 T ,-i V I 4 Y L C HL 0 R I 0 E LEVEL - - THE VI N Y _ 6 C H L OR I DE CONCENTRATION WAS S EVE :R A L 7 PAR TS PER M I L L I 0 N . 8 SPST rased ,0 M "HR 9 facts AND Y 0 u < 0 '.v LEO GE OF thf MM Pp 0 f C A L 10 2 E C 0 3 ^ J DO Y 0 U HA VE A M 0 3 I N I 0 N ; r 11 5 'J 7 3 T \ N T I A L MEDICAL R 0 o A 1 t i_ I TY A 3 12 TPS LIVER TUMOR 0 I A 0'1 0 5 I E 0 0 \ .A U G U 3 T 14 7 0 13 14 r A 5 , 15 V AND .-HAT l 5 THAT 0 P I N I 0 N ! 11.1 16 A . III 0 V FROM 0 U R 0 W N . R I E NC E W I T H THE 17 0IS EASE AND FROM T H A T THAT '5 IN THE 18 LITERATURE, I v/OULO SUSPECT THAT THE TUv 0R 19 HAD SEEM PRESENT AT A MINIMUM OF A YEAR AND 20 POSSIBLY UP TO FOUR. 21 0 . AND THAT'S - - Y VJ'Vr ~ F S TI * rE ^ A 1 22 TO YOUR EXPLANATION OF THAT PREVIOUSLY, AV: 23 Y 0 U H 0 T ? n 24 A. a ELL, TH= REASON w E' CHARACTERIZED 25 J i S E A 5 E IS SEC A. U S E ,< I T H .A Cn CASE OF A s BFG10037 o in ZHOTTT: T 1 3 J R R C - H R . 3 N N I 3 5 '! 1 3 I 3 E 4 S E THAT ' E SEE, ' E C 0 H T I ': !j E D 7 0 C ' L L : r T 2 I MFORMAT [O'l S TO 'HE ATONAL 3 R O G ? E S 3 I * N ~ - 3 r j h DISEASE. - ': 0 r j i t 3 c ,- ? ! s : p* 1 4 - T:--i rr q p r j ; c nr - : 5 _ r '-i \ ~ t c -i <> \ . 5 DISEASE IS 0 I = F = 7 E \ ' ! A TED = R CM VpTHl". A ; 6 ^ C C !J -H U L -i T {T S THIS *Y TH s CASE? T m >\ T - 7 SEE z, 3 0 T HA T the c i r s t C A 3 E -- 7 i = I R 2 j 8 A N 0 0 i'i ^ Y C A 5 c j F A N E W D I S E \ S E 'AY NO" 3 "* 'j 9 YOU ALL THE V A '< I m T I 'J : S . BUT AS ONE R E G I M S TG 10 C 0.4 T I N U E TO INCREASE THE MUM BE*. 0 * CASES 3 ME , 11 ONE 3 E G INS TO MORE CLEARLY DEFINE THE 12 VAR l A T I 0 N . A N 0 S 0 W E M 0 W HAVE A N U M 3 E R 13 CASE 5 5 H 0 W I MG US A VARIATION IN THE T I 14 THE T IJ M 0 R 0 C C. `J R R E N C E . IT'S ON THAT T:JA 15 base that opinion'. 16 0. DOCTOR, DO YOU HAVE AM OPINION WIT h 17 3U3STANT I AL MEDICAL P 0 0 ABILITY AS TO WIETHE* 18 OR 'NOT VINYL CHLORIDE EMITTED BY THE A . F . 19 GOODRICH PLANT I 1 P E 0 R f C K T OW N CAUSED vt O 20 G R A S S 0 ' 5 A N o I 0 SARCOMA IN? 21 r\ YES, I DO . 22 Q 23 A , WHAT IS YOUR DPI \ I 0 N BASED ON OUR MED I cal < N 0 W L E 0 G E , I 24 MOT i E L t EVE T H AT THAT IS THE SOURCE 0 f u R . 25 G R A 5 S 0 ' S A N G I 0 S A R C 0 M A . BFG10038 1 Q. -WO CAM YOU E X P L -W .V =0? THE JURY -* 0 2 C 3 U ANALYZED THAT S I T J ' Tl ON ' l N 7 7 0 7 TC ! 7 3 i T ;-i rt T A 5 E R . 4 A. I'D LIXS TO. I'D LIKE AGAIN TO USE 5 5 vi'-iE SLIDES TO I!__ U 3 T .7 A T E A HAT w .< M 0 A 3 0 U T 6 the angiosarcoma from all the cases that have 7 SEEN 03 TA INA3LE IN THE WORLD RELATED TO VINYL 8 CHLORIDE. 9 THIS IS A CHART illustrating 10 ALL Tu E REPORTED C a S E S THAT h.a VE SEEN 11 VERIFIED 1Y PATHOLOGISTS AND MEDICAL EXPERTS 12 THAT THESE ARE TR-JLY A N G I 0 S A R C ON A S , NOT SOME 13 OTHER .< I N D 3 OF TUMOR, AND WE ALSO KNOW the 14 EXPOSURES Or THESE [NDIVIOUALS AND ALL C F 15 THEM HAD 3 S N WORKING WITH VINYL CHLORIDE FOR 16 VhRYIhG PERIODS Or T IrlE. THERE IS ROUGHLY 3u 17 SOME CASES WITH AN ADDITIONAL TWO IN 1979 AND 18 ONE IN 1930. THAT IS NOT ON THIS CHART. 19 THE ONES THAT ARE IN RED ARE 20 those from the united states and the ones in 21 WHITE ARE FROM THE NORTH AMERICA, CANADA AND 22 FROM ALL OF EUROPE a \j n ASIA. 23 N 0 '! , { P 0 M E LOOKS AT W H E N 24 WHEN THESE C AKC E R 0CCJRRSD, THAT IS, 25 i hen they w ere o i agno 3 i ed in the various mOTTTZ BFG10039 i-I 3 J < R 0 - 'I 3 sC'ii'ld 1 5 5 N 1 1 COUNT* US, I'VE I Li.'JS T UTzO FOUR C 0 U N T R I E $ , 2 BECAUSE THESE ARE THE COUNTRIES THAT HAVE O' 3 ACCOUNT FOE "3 P E R C = ' T OF ALL TH" 4 AN G I 0 5 A = C 0 A S A M PNG VINYL C M L 0 2 ! ' ~ W 0 R < E R $ . 5 HHAT YOU SEE HERE IS THE NAME OF THE C 0 !J N T ^ Y 6 AND THE DATE -- '* = 4Y IMG 1 0 V 1 IS ROUGHLY T H E 7 EARLIEST EXPOSURE OF ANY OF THE INDIVIDUALS 8 IN THIS G R 0 U A 0 F INDIVID 'J A L S . 9 L. DOCTOR, AS YOU GO THROUGH, TELL US 10 THE ;m A M OF THE COUNTRY, EEC AUSE 11 h. SURE, CANADA IS AT TnE TOP. ThEIR 12 PLANT STARTED IN 1939, 1 9 '+ Q ' 5 . THE A .N f R I C A \ 13 PLANTS -- THIS IS AN ERROR, THAT SHOULD 14 HAVE SEEN 19 4 1 - - IS - - I 1 m S D R R Y . THAT IS IS NOT AN ERROR. THERE IS A PLANT IN THE 16 UNITED STATES THAT 3 E GA N ITS EXPOSURES IN 17 1939, FORGIVE HE. THEN FRANCE, THEY STARTED 18 IN 1941, BUT THE MAJORITY OF THEM HERE IN THE 19 FIFTIES. AND IN GERMANY, THEY STARTED IN THf- 20 MID 1 9 5 0 * S AND LATE 1 9 30 ' S. SO THAT THE 21 COUNTRIES ARE LISTED IN THE OLDEST PLANTS TO 22 the more recent ones, and you ll notice that 23 THE OLDER, OR TnE PLANTS T rt A T u 5 R E S T4R T ) I ' 24 the earlier times have the earliest 25 DEVELOPMENT OF ANGIOSARCOMAS, STARTED IN THE 21110144 BFG10040  j j o ? n - y ? . ~ ~ \j \ z I 5 " ; 1 0 A T l E $ , = GUN TC I" IDENTIFIED j . :h = 2 " IFTI5S, A m D THG3 :: T H A T STARTED I N THE LATE 3 i r T I L S 3 E l N : ! ') = . T I F l Z 3 f : r-E S [ X T ! E S . 3 0 4 NAT T hi 5 7 < E I ID, `5 HeL L a 5 THE p - A X N U i E R 5 T H .A T IS, THE I US T ".? 0 U E N T OC C L R R E N Ci OF 6 A N G I 0 5 A R C 'J N A 5 -- A L 5 0 S H 0 W 5 -- 5 H 0 v; N I N 7 ViLlO'w, HE SAME OCCURRENCE. NOW, THIS TELLS 8 US THAT THE ON SET OF EXPOSURE AMD WHEN OWE 9 3 E GINS TO DEVELOP The T U mq q, AS WELL AS ONE 10 REACHES THE MAXI MUM N U MRE? OF CASES A P E A R S 11 TO 3E THE S A i , W H E T H E R THEY ARE IN C A N A DA, 12 THE UNITED STATES, FRANCE OR GERMANY. SO, 13 THIS GIVES US AN IDEA A ROUT T'-'E DISEASE 14 PROCESS AS HAVING CERTAIN CHARACTERl ST ICS 15 .(IlC H A R E C 0 N 5 I STENT. 16 THIS TAKES NINE S A; 1 = CASES 17 SuT DISTRIBUTES THE! -l UNDER DIFFERENT 18 CIRCUMSTANCES. THIS HAS TrtE TOTAL NUM3ER OF 19 YEARS Or EXPOSURE OF EACH OF THE CASE WHO 20 DEVELOPED HEPATIC ANGIOSARCOMA, LIVER 21 ANGIOSARCOMA, IN THESE VINYL CHLORIDE workers. 22 AMD THIS INDICATES THEIR NUN 3 E R tot^l 23 N U '! 3 a P C F YEARS OF EXPOSURE. A m AS YON SFE, 24 this ranges anywhere from - arout three year? 25 TO A S MUCH AS 3 3 YEARS OF EXPOSURE. 21110145 BFG10041  i 3 'o \ \ `j " \z i z i o~ I is 0 :!, I PUT A NilK E E R OF ESz 2 IS PSD. A ,'i J THAT'S 3ECAUSH THE'.c APPEALS TO 3 i E TwJ P E A S . T H c RL ARE A G A 0 U P, H j 3 U i . i J 1 1 ' ^ 4 W H 0 D E V E L 0 P E 0 A N G I 0 5 A R c 0 N A U I T H o Nj L v T 7 = T 0 5 SIX YE APS OF E X P 0 SURE AND THF M 7 H E ITY 6 OF CAS E S That h A 0 T = M T A * 0 v E i 7 5 w [ T T '-! E 7 "1 SAN 3 I '! G AROUND 15 TO 20. IN = A C T, THERE 8 . -1A v PE THREE PEAKS . ?JT, THIS 510U5 A S 9 thought to re possiply a jmioue group. and i 10 Illustrate them in another context. s . e 11 DtSCRl-SED -- AS w HERE J r 0 IN T M E N L '0 0.< AT THE 12 S A i-i THING, w E LOOK NOW AT LATENCY. AS YOU 13 A t\ U-/i, THAT'S T H E TIME FROM THE FIRST EXPOSURE 14 Tu T H t T l H E THE JAT1: .N T S " f! I AGN0 3 I E 15 AS HA VI 'i G THE T U M OS. A N 0 THIS IS C 0 M S 1 D - < = D A 16 VERY IM ?0R T A N T FACTOR IN CANCER, S I -N! C E 7 w E 7 c 17 APPEARS TO RE A TIME RECKj f R E M F\!T f=OQ T HE 18 DEVELOPMENT OF CANCER AND TK1S IS U3UALLV 19 FELT TO 3 E 0 5 L a T E r> to the OOSE OF EXPOSURE. 20 THE LOWER THE JOSE OF EXPOSURE, IT'S RELIEVED 21 22 THEY THOUGHT THAT THESE LuW EXPOSED G*R< vj L H a 23 5 H 0 U L 0 THE it HAVE ThE LONGEST LATENCY'. AND -\ S 24 YOU SEE, THAT'S N0T 0U l 7E TPUE . THESE El ShT, 25 .in IC,U. ARE S 110 v(N [ N .RED, HA Vi LATENCIES H I C H 9&TOTTTZ BFG10042 , "J "> w : E I ] = :"N ' I 1 v - 2 3 ' 2 j!+ v C A ' 3 . - \ D I OLL J r i ^ j ) r r. 4 / 5 a 0j J R / h Y i , I T 5 7 l i A 0 'J IRES- 4 7 l - j 6 4 I 'i: ~D T N Y A R S FOR T rt 0 I 5 A S E T 0 V 0 L / 7 A h13 J 4 V E l 0 ? ; A N 0 T HAT SC A PC 0 Pis R 0 U I R E A 3 i`: 4L_;-1 .. P 0 5 ^ < 0 0 S ! M ORDER TO SET THIS i i 9 PROCESS I H MOT [ 0.\ THAN OTHERS, BUT THAT THE 10 LATENCY 0 0 E S AST S T R ICILY E 0 L L 0 vi THOSE 3 0 L " 11 0. DOC 7 OP, WHAT IS T-*E AVERAGE LATENCY 12 . -J o | 0 D ? 13 A THE V ERASE L A T W C Y 3 E R I n .0 HERE IS 14 j ; a 4 7 = r\* 2 *7 T 0 7 e vc.ij? - j ? < i u 3 3 15 'ERE. 16 AND L \ T E : C Y IS DEFINED AS HOW? 17 a . : A 5 THE T I ME INTERVAL FROM THE FIRST 18 EXPOSURE T 0 THE T I ''I E the o i a g 4 0 3 IS IS ! A D E . H* 19 I Fir < C. , Than a you. 20 A. ! NOW, THE LAST SLIDE S H0 V5 OUR 21 0 E P I C 7 I kNG> OH ALL OF THESE CASES OP 22 RCOMA EASED 0 ?; the YEAR TREY 3 EG AN 23 XROS U RE A ND a, ; r> \; c SEES, ^LL >? 0 A S E 24 H E f R EX 3 OS UR E A F T E "> THE 1 0 '+ ') INTERVAL 25 ;-i=r3 1 ? 3 - -j \vr\ *un'J'',H Tue QL\' TS frT O T T T Z BFG10043 n a v ii j L j v . 3 a ER -- T I i 3 I ; 1 ' 5 v , '. j ,--i 3 0F T HE V 2 < 7 l \ .ji H >- 0 ... iv 3 [_ J ? ED A G 1 0 3 A:1Cj.mA I ' I 3 [ C a T S j 3' T E I '< <> r 3 - ij ' E 0 < T u I [ *C R .< R 2 C 0 R 33 4 i INDICATED THEY HAD 2 =>!J:X :033!33 9 E = C 1 E 1 3 A 0 . i 5 ii 0X, IT ALSO 5 T 0 3 S at 1 q " 5 . i 6 ! D E S 3 I T E THE "1CT '1! 0 THAT IT I S A l M 0 3 T 1 *? , 1' 7 years, there uave r = " \| .'J O li' N; - A vi Q I 0 S A.9 r 7 HAS 3 i H 0 5 E E '< P 0 3 !J R E 3 G A " \ - T E 3 1 0 3 c . N 0 1 = D N E 9 LOOKS A T THE N J H 3 9 3' THAT 9 E G A `! , ~,n 3 E G I \ 5 10 TO 5cE T.-i.AT T ! S 9 E '3 " SECT EASE I N THE \"J HE 9 3 11 3 E 1 N G Ex ? j 3 ED Hi 0 'i E GOES ON I A T I M c 12 ..OvJ, FRO.-1 THE -3 E 3 T DATA THAT r 13 C a i\ G A T .1 E 9 , THE EXPOSURE LEVELS T n A T A E 9 E 14 C 0 N 3 I D * R U TO 3 : C ON .A 0 X A A 0 J ri j T H E PL A \ T 5 [ N 15 Tn 1 3 AO ' S AND 19A? HAD BOTH EUROPE AND !'! 16 THE UNITED STATES :l E 9 E THOUGHT TO 3 E AROUND 17 ThE ra NGE OF 2, >10 0 PARTS P C 0 ?*, I LLI ON ; THAT 18 THIS "! A S G R A D `J A LLY REDUCED c 0 R E N G I N E E R I M G 19 R E A S 0 ,m S 30 THAT [ V T p C L t T F p I PT [ CS A v 0 20 S I X T I E S , IT v; A S ESTIMATED \ D 1? P p 'R 1 T E 0 21 0 0 C A S I 0 N A L L Y C = "SING ROT TO 5 q 0 "> A 7 Tv T c .? 22 1 I L L I 0 \ AND T H A T IN THE LA TE S I X T I E 5 A N D 23 E A ;< L Y S E v E ;'i T I E S HAD SEEN R E 0 u C ED TO 3 T TO 2 24 PARTS PER TILL I 0 N ABOUT T H - T I HE THE i 25 A C r< J U S TijLYS I S OR THE RONE I 5 5 ;_V I N G P 3 Q. S E j/L fi/O U W BFG10044  1 u R R C - 4 R . REN HE I S E N T 1 IN THE FINGERS W AS 0 I S C 0 V E RED. 2 \: n , ~ H I S GIVE 5 'U S S R>/! E 3 e0! : em i ologic; L [ .v o I c A T I 0= M -/t ij ;-| 4 EXPOSURE IS RE 0 'J I R E 0 I N 0 - DPR TO START T h I s 5 3 a .R T i C J L 4 R 0 I S c 4 S A PROCESS IN 4 V Y AREA IN 6 PROCESS A \ D IT APPE A R S T H A T T H E R E ARE N0 7 cases un d cr 5 j PARTS PER M ILL I ON AND T H A r 8 Inc Y C AN ,0 Li b ON U ? TO 2 , J j 0 PARTS J E R 9 M I L L I 0 N . AND THIS, WOULD, AGAIN, GOING ON 10 A L 0 M G W I T H -i H A T w 5 < N 0 W IN ANIM A L STUDIES . IN 11 ANIMAL STUDIES , wE ' VE NOT BEEN ABLE TO IN DUCE 12 THE TIME M 0RE UNDER 25 PARTS PER MILLION A N D 13 HAVE iNOT BEEN able TO INC"? EASE THE NUM? E^ *> ~ J 14 TUMORS W H E M WE G 0 B Dr Y 0 \' c i \/r Mo n pa X 1> 15 P = R MILLION. AND l tm i \t :< T U| I S C A N ac 16 E X P L A [MED AGAIN AY T H E BIOLOGICAL FACT THAT 17 AN AGENT IN SMALL QUANTITIES CAN BE HANDLED 18 3 r THE NORMAL BODY TISSUE; THAT AS IT 19 R EACriES A N IN TERMED I A TE STAGE, THAT THE BODY 20 A A Y not ha : D L E A D E 0 U A T E L Y , BUT THAT THE CELLS 21 may Survive i tm the injury and then later go 22 ON TO DEVELOP CANCER. AND THEN AT THE HIGHER 23 LEVELS, THE CHEMICAL OR AGENT MAY THE'REcORE 24 .< I LL THE CELL AND, THSRE'^RE, NOT EVOLVES 25 INTO A TJMCR. 4MO THAT WOULD EXPLAIN WHY ONE 8WOTTTZ BFG10045 is t 'l 1 sees i -sc rw ucc j * pence "" rr ,,=: p ? 2 F .P C .i j J PASTS T 0 A j OUT 2 , 0 0 0 ' P 3 , J >1 AM"; 3 t ~1 ^ i c ~ o T n " .j L -- ^ \ z . _ 'I -- j ~ r * 4 N 0 W , T -* l 3 .. C J L 3 ALSO E X 3 L A I " 5 W -i Y T-E PEAK. OP THE ANGIOSARCOMAS CASES PEI HO 6 R E P 0 R T E D a A 5 PEACHED [ H 1 7 5 . './HE N v E PEG A N 7 GUP STUDY, GUP PPOTOTYPE STUDY IN ln7 5, WE 8 AMT [r I RATED THAT THE 3D - ULATT0\ WE W E ' E 9 STUDYING SHOULD C 0 N T 1 N U P> T0 DEVELOP 10 A N G I 0 3 A P C n m ?. s EASED 0 M T h E I 7 PAST E X 0 5 U P E 11 FGP AT LEASTANOTHER T E N YELPS, 3 EC A USE THE 12 EXPOSURE WAS 3 T REDUCE 0 TG Owt PA - T PEP 13 W l L L I 0 N U ,N T I Li } 7 t , I 0 7 5 ; A 'ID THE'/ E -t A D 14 STILL ALL THOSE PEOPLE a H 0 H A 0 PEE N EXP USE0 15 BEFORE THAT T l .A c . 16 NOW THIS HAS S J P P R I S = 0 US, 17 BECAUSE THERE ' s seen a m a P KE D, A RAPID DROP 18 IN THE N U MSEP OF CASES RE POP TED I f! THE UNITED 19 STATES, IN GE p y, A NY, IN F= ANC E AND OTHER 20 COUNTRIES. AH 0 T u A T ! T IS NO W FUR T h E P 21 SUPPORTIVE DA TA THAT 'J AY HAVE V* HAT .,= C 1 L L 22 A BIOLOGICAL T HP E S H 0 L D - THAT IS, A LEVEL 23 a T ';! H I C il i 0 5 T p = 0 RLE C 0 U L D H ANGLE. the AGENTS 24 I T H 0 U T I '; D J C I G THE C A N C - ~ :i I T H ; 'j their 25 i_ I F T LO'.v / v` E / I L<N "'i `. .'OPE A P 0 Ut this i i 6frTOTTT2 BFG10046 W W W0 1 1 AS Y E A S GO 0 , DECAUSE AS EACH YE A A GOES O' c 2 IT IS OOCUMM T A T IOM THAT THIS 1 S A T R A I L T U G 3 jc p :e::ry !,: I L L ? 5 T U 0 " H F R 0 r C U S Mr E D . 4 ^~ . n n <*- T- H- ? >[ = ! M "- T " A ~- H "a M I I A I _ 5 EXPOSURES OF SIX TO NINE a A 0 T 5 3 E ~ 1 I L U I 0 N , 6 IF YOU E 7 E TO ASSUME THE WE 9 AGE ANMUAL 7 S A P C S u I i S WERE 2 v TO 25 PARTS P E 7 PILLION, 8 9 m ;'s N w, IT o 0 w 0 1 v to T . 10 Q. NO./, -- NON, YOU i/EPE PRESENT 11 YESTERDAY WHEN DOCTOR JOHNSON .TESTIFIED AND 1 12 think you mere present when doctor epsteim 13 HAS TESTIFIED -- TESTIFIED,AMD EACH ONE OF 14 them we> f r fad a long jypothetical oijss t r qv . 15 I * A MOT GOING TO 9 S 0 = A T THAT 0 U E 5 T I 0 N . I. 16 WOULD LIKE Y 0 U TO ' ASSUME THE FACTS THAT w E 0 E 17 IN THE LONG QUESTION THAT l READ TO DOCTOR 18 JOHNSON YESTERDAY AMD THAT MR. VA SSALOTTI 19 READ TO DOCTOR EPSTEIN LAST WEEK AMD 20 PARTICULARLY ASSUME THAT THE C0MCENTRATI 0NS 21 r\T Tn i, .R A S 3 0 HOME ./ R FROM 1.1 TO 2 C PARTS 22 PERMILLION F 0 R 1 , 5 0 3 H 0 J R 3 , FOR FIVE AMO A 23 HALF YEmRS AND THAT THE EXPOSURE -- TnE 24 CONCENTRATION LEVEL WAS TEN TO 00 PARTS PER 25 MILLION AMD 11 ON 11 TO 1< HAZY DAYS A YEAR 0ST0TTT2 BFG10047 i R " j - HR . R 5M.ME 1 i EM 1 FOR A PERIOD Or A ;3 3 1 0 X l M A T L Y F OUR HO U R S A 2 DAY. 3 ASSUMING Thq5= =acT3, 4 IT CHAM Crz YOUR 0 a 1 I 0 N C0VCE?M'I MG ^ : 7 u : : r. 5 MOT M . G RA 3 S 0 ' S OISE A S E ' AS CA'JS s y __ v n !' ? 6 0 3 r \ t 0M 1 Tu - - L E T HE GET T hS w 0 R 0 S T H c 7 SANE SO THE QUESTIONS A R A L L L . 8 W 0 U L ) T H A T C H A N GE Y 0 U R 9 0 P I \ I J -i AS TO A H ETHER OR MOT MR. G R 4 S S C '5 10 0 1 3 E A 5 A 5 CAUSED 3 Y VI . i Y L C HLOR IDE WITH 11 5 J 3 S T A n T I A L D I C A L P R C 3 A 3 1 L I T Y ? 12 A C , IT WOULD MOT C H AN G E M Y DPINI0\ . 13 U U A. A M j Y 0 J 0 0 ? I N I 0 H AGAIN IS / H A T ? 3 A S E 0 ON ;! HAT W E .MOV/ FROM ALL THESE 15 CASES AMO THE C H A R A C T E R I Z A Tl0M OF THE DISEASE, 16 IT DOES MOT HAVE THOSE CHARACTERISTICS AMO, 17 therefore, i oo mot th im< that this is the 18 SOURCE OF The A M G I o S A R C 0 ** A IN T - I S CASE. 19 1 . DO YOU '< M 0 W WHAT !D I 0 CAUSE HR . 20 G R A 3 S 0 ' S A N G 10 SARCOMA? 21 A . I H A V c SOME T H E 0 R l E S , 3 J T 1 22 vj 01J 0 i't E 0 1 C A L DATA TO SUPPORT THAT. 23 y I S this unusual with res pec T, TO 24 V I w Y L C A L 0 :R l os and angiosarcoma, not TO have 25 A N DP l N I 0 N ? X +> 111 o TSTOTTTZ BFG10048 ' 'J * R 0 - . 7 " . ! ~ 1 1 [ 1 " T 3 J I 'J ' "> " " " r ' : 2 0. LET THE 0 J E S t I ."I.-; THIS AY: 3 ij IT J N J S J A L rl: -J " V T 'A * r |_ P P . ; - E 3 5 I T T - 4 3 E v L A 3 L E TO ~) 1 T 3 < ` ! I J -I T H - C A U 5 E 0 " 5 M H I J 3 ^ R L O i.-i :} r Trie LIvE2 7 6 A. NO. AS I r 7 E 5 T A T 3 E F 0 R E , AN 0 AS 7 OTHER PEOPLE A A V I NO [CAT E 0 , the M AJORITY 0 F 8 A N G I 0 5 A R C 0MA 5 E O O NOT < NO W THE ETIOLOGY TO 9 Q. W HAT A 3 0 y T 0 T H E R C AVCER, 00 HE < N 0 W 10 THE etiology f f} T '-j pa C AN r c R ? 11 A. NO, THE MAJORITY hp C A N C F R = I ? = NO 12 SURE 0 = THE E T I 0 L O G v . T w E 7 = ARE A p E w H I c H 13 C A USE 15 CL5A rly o h C U m E n T F r> , RUT N H T r 14 > H M 1 T .0 \ O V/ O AMY c - L C ~ ~ r- .A T HP' \ 3 I i G L E 15 5 0 J R C E . 16 Q . | AND i O U L 0 ro J TE LL M E 4 G AIN THE 17 PERCENTAGE OF A N G I O S ARC ON! A 5 v;h i ch ARE 18 A T T R [ MUTED 3 Y the . i E 0 I C A L PROFESS l 0N TODAY T 19 J N < Own C A j 5 l s ? 20 A . I T I 5 E 5 T I M A T E 0 3 E T W E P '! 73 TO 75 21 PER Cl NT OF THE'!. 22 . M R . 0 E \ M = I 5 F M : T.-i A '1 < YOU, I 23 HAVE NO FURTHER 0 U E S T I n \i = . 24 THC COURT; MR . V A s 5 A L T T ! . 25 0 Y MR. V -> S 3 A L 0 T 7 [ : Z9TOUTS BFG10049 - J .< r a -I 5 R R 0 -- i 11 v . VA jj'iL jT i t 1 u 0 OCT 0 R T A MBURR 0, A 3 0 U T TH AT 7'J TO 7 5 2 PERCE NT CF J N < N 0 4 K CAUSES, H0 W 4 E R THOSE 3 3 I J D I E 5 C 0 \ DUCT ED TO DETERMINE r I R ST TUC 4 N U MBS R OF CASES OF ANGIOSARCOMA AN 0 THEM 5 T RY ING TO ATTRIBUTE A CAUSE? ARE YOU c A Y 1 L [ A - 6 W I TH '404 TUEY FRF C O N 0 IJ C T E O ? 7 A. WHICHEVER TWO OF THEM, YES. 3 0. A N 0 .4 H O C 0 N 0`JCTF ) THE STUDIES? 9 ONE v< A 5 CONDUCTED IN NEW YORK AND 10 THE 0 T - E R i' A S - - 11 Q . ..ELL, ,vhO CONDUCTED THAT 0NE ? 12 A . v. c L L, YOU'LL FORGIVE . Q N E C F THE 13 THINGS I HAVE N OT A T E NDENCY TO 0 0 I S 14 REMEMBER NAMES. 3 U T r C AN GET Y OU T H E 15 literature for THAT l F YOU D 0 v ' T HA V 5 IT 16 THEY CONDUCTED A SURVE Y [ \> __ BY US I MG 17 REGISTRY IN NEW YORK 18 '4 HAT REGISTRY IS T HA T ? 19 A. THERE'S A CANCER REGISTRY IN TH; 20 STATE OF NEW Y 0 R :< OH t CH RECORDS THE CAUSES 0 F 21 DEATH due to C A N C E R . T H F R E ' 5 A registering I N 22 CONNECT I CUT. THERE A RE A N UM3 ER 0 - STATE -3 23 That r-tM'VE C A 4 C E R -- 24 Q n 0 W DOES A CANCER GET REGISTERED t M 25 this lancer registry? 1110153 BFG10050 3 3 - 7 1 . T .4 l !J 0 _ v,f> . V 4 5 S A L 0 1 A. E V ' Y [ N 0 1 V t 0 'J A L '-i O H [F 5 IS 2 R E 0 U I R E 0 I N T H c STATE TO HAVE A 0 E A t h 3 C 3 ' T I - I C A 7 c . ;mo *. L L r -j 0 S S 0 5 A T H C E ' T [ - [ C A T E A 4 -I [ C H ARE 1 E C 0'0 E 0 AS 3 E l \ 0 0 '} 1 T 0 0.3 5 AS S DC l A 7 j i T ,i A MAL i GNA\CY ARE T !! E ' 6 .< E C 0 R 0 E 0 I ft Trie CANCER 'REGISTRY. 7 j. rIO.s 0055 SO M c 0 N A M A K c A 8 DETER M l NAT l ON THAT A DEATH IS CAUSED 3 Y A 9 MALIGNANCY? 10 A . S IN C E EVERY DEATH CERTIFICATE IS 11 SIGNED 3 Y A PHYSICIAN, THE PRESUMPTION IS 12 MADS THAT THE DOCTOR, n N 0 V/ I M G THE DOCTOR 13 DIAGNOSIS, r 5 THE MOST [ N F 0 "? M ED r N D I V I D U A L AS 14 f q j u f j u i : n R N 0 T THE P R E S E N C = OR A 3 S E M C r 0 e 15 A DISEASE IS PRESENT?. 16 0. SO, AN AUTOPSY ISN'T DONE IN EVERY 17 CASE? 18 * . THAT'S CORRECT. 19 Q. IN APPROXIMATELY -- APPROXIMATELY 20 .j HAT PERCENTAGE OF THE CASES IN THE REGISTRY 21 HAS AN AUTOPSY 3 c EM DONE, DO YOU KNOW? 22 A. THE SMALLER' NUMBER, PR 03 A3LY IN THE 23 RANGE, DEPENDING ON THE AREA. AND IT IS 24 LOCATION, ANYWHERE FROM 5 TO Ma Y 3 e 3 = O E R C E N T . 25 0 . FIVE TO 35 3 E R C E N T W 0 'J LD F F T R U L Y 21110154 ^pGl0051 1 2 A. HISTOLOGIC ALL PROVE! E I T n E R TO HAv'E 3 0 < 0T TG nAVE A TJ M0 R . 4 ; . MC.v, wE'VE HAD SOME TESTIMONY IN 5 THIS CASE THAT IT WASN'T R E A L L Y ' U N T I L 1 " 7 5 OR 6 10 7 4 VHERE T H E MEDICAL COMMUNITY R E C AM E 7 CONCERNED ARQUT THE RELATIONSHIP E T w E E N 3 VINYL CHLORIDE AND A NCIOS A R C 0 M A IP T M = LIVE 9 A\0 A S A MATTER 0 = c1 A r- / I T H [ N < DOCTOR 10 JOHNSON TESTIFIED that a COUPLE 0c THE CASE 11 THAT 3.F, GOOD RICH ,i ERE n I S S D I a G N 0 S I E D AS 12 PR I il A R Y LIVER C A N C E R . ARE YOU A W ARE Or THA T 13 14 y . YES. THOSE ,-i ERE CASES WHEREAUTOPSIES 15 WERE PERFORMED, WEREN'T THEY? 16 A. THAT'S CORRECT. 17 0. AND THEY WERE STILL MISS DIAGNOSIED. 18 A. THAT'S CORRECT. 19 C. I 3 THERE A CHANCE I ' LL J 0 S T ASM 20 YOU TH l S : IS THE? E A CHANG E THAT t N T ME S E 21 C A N CER A E 5 I S T R I E S T H A T NOT ALL ART, I 0 S A R C 0 M A S 22 0 F THE L I V E R T H A T ACTUALLY H A P P E N R Cl LIST "T D 23 M ELL, IT' S NOT A C H A M C E . T H AT I S - 24 FAC T . 25 Q T HAT'S A c A C T . BFG10052 h- M cn \3\ j5 J ' . TA 1 A. THAT '3 TRUE OF FV'kY C A': 0" " . 2 'D AS A '(ATT^ ~VT Z ^ ^ T f THAT'S T " ! j T ^ S 3 r \ z t v ^- : -* r-* -- ? / c o R R z 2 T ? 4 WE .;OU LR 5 JF 0 i S E A 0 E UNLESS : 5 - A A" A :j " 0 P 3 Y 6 EACH ,4 D EVERY ['-1:1 VHUAL WHO DECIDE. A GAIN, 7 7 h A 7 ' 3 .v n Y EPIDEMIOLOGICAL STUDIES ARE USED 8 7 0 DETER l .'j E , EASED 0 N 7 -I E X 0 M j E R 0 F 9 A L T 0 P S I E S , .-i A T 7 H E P0S3 I *3 I L l 7 Y 13 7 H A 7 7 Hi E 10 Dm 7 A YOU HAVE CAN DRAW A CORRECT CONCLUSION. II Q. WELL, YOU JUST TALKED A 3 C U7 CANCER 12 REGISTRIES THAT INCLUDE DATA THAT IE 0 r> r i [m = o 13 FRON OTHER THAN! AUTOPSIES. 14 A . I GHT . IS 0 . THAT WAS I N ELUDED IN YOUR 16 EPIDEMIOLOGICAL STUDIES, CORRECT? 17 A . WOULD YOU KINDS P. E M E 1 PER REPEAT THE 18 Q J _ ^ T1J N I 1 1 NOT -- ~ 19 . TheDATA FROM THE CANCER HANKS OR 20 R z G I 3 T R 11 S -- 21 A. YES . 22 Q . --T H A T 1 3 w h A T THE SE 23 cPIOEMIGLOGICAl STJDIES THAT YOU REFER T0 24 W ERE RASE 0 U ? 0 N , W ERSVT 'Hiy? 25 A. YES. NOT TOTALLY, th at / a S ONE BFG10053 9STOTTT2 i! : -- : j * - " ** -v 5 5 L * M 47 1 X \ .T ; i i ; - r : /-* cr j uj ^ 1r ; .; r a ej A 7 0 N ? 2 r\ 3 ^ R I -j 1 T , Bu T THE " E ARE 0T H E 1 S N Q, ,'i , r.-Er T:-f 5 - THIS 4 STUDY l \ 5 Y 0 R .< THAT Y 0 U P A i T i C U L - R L Y REFER 5 T C .. E;. T i A u A N 0 L 0 0 < 5 D T H R 0 U G M T Ul c r \ ^ n " ^ 6 REGISTRY A ,'i D [ ASSUME T H E Y L G 0 < E 0 F 0 R A L L 7 A A GIGS ARC C ' 1 A CASES? 8 A. YES. 9 0. I ALSO ASSUME -- I G 0\ 'T VF VJ T0 10 8 E FACETIOUS T - A T THESE PEOPLE ATE A L E A 0 Y 11 D E A 0 I n THERE IN THE CANCER REGISTRY. HO W 0 G 12 THEY GO A 3 0 J T ATTRIBUTING A CAUSE TO THESE 13 P E G P i_ E C AN C E .< ? 14 A. UNFORTUNATELY, AS YOU ? R 0 3 A 0 L Y H E A R 0 15 F R 0 i-i OThER SOURCES, THE 0 C C U P A T I 0 M IS A 16 REQUESTED PIECE OF INFORMATION, 3UT NOT A 17 REQUIRED ONE ON DEATH CERTIFICATES. SO IT IS 18 REQUIRED THAT THE INDIVIDUAL WHOS INTERESTED 19 IN DETERMINING WHAT 3 0 5 S ISLE CORRELATIONS ARP, 20 WILL GO 3 A C < TO EACH AND EVERY CASE, 5 I THE R 21 3 Y DIRECT, VISITING THE RELATIVES OR The 22 HOSPITAL OR THE DOCTOR WHO CARED FOR THEM, 23 A H D Jc T E R 1 I ?1 f W HAT THE I xi DIVIDUAL DIG AS AN b* 24 0 C C u P A T I 0 N . A N 0 THE N FRO M THAT DATA, ONE THEN 25 a T T = . 1 H r s t o DR A.. SOME CON CLJS I ONS AS TO ** CJI BFG10054 3 5 - J R . T A 'l 2 j 3. ?. - wi P . V A 3 3 A L 0 T T [ 1 ,-Jd T H 3 R TH5R; 1 S A 1 L i T ! 0 v S H [ 3 3 = 7 w SEN T A = [ 3 2 W 0 7 :< t S 3IST1R CZS AND THE DISEASE M'y ha VE . 3 ' . ~ C , [ \i r u Z / J ^ v [ \|*:c\ C - C > ; T f C " 4 ' 7 0 3 L E ./ f R " C 3 C 2 0 '! - 3 A ? q h t -.j ~ o <3 r i 3 i t 5 people 5r . d v ; ' the e=>ide>'Idldgical 6 3 I S X- [ F I c A N c E OF 4 N 3 I 3 3 p 1 C 0 '-1 4 WERE 0 3 N C E P 0 E 3 7 -.i l Til THE OCCUPATIONAL HISTORY OP THE 3 0CC0PAT l On, I T H [ 'I < YOU SAID, 0 <= THE PEOPLE 9 :: hO l) 1 c 0 Or A 'i G 1 0 5 A P C 0 M A ; 15 THAT CORRECT? 10 A . YE5 . 11 Q . N 0 W , WHEN DATA IS GIVE M ON A DEATH 12 CERTIFICATE AS TO OCCUPATION, THAT'S ONLY T H 13 LAST OCCUPATION 0c THE PERSON, ISM'T FT? 14 That is a 3 3 G L 1J T E L y C r| ~ P E C T . YOU 15 THAT'S USUALLY THE THING. 16 0. I N Tur v { \\ I N E T E p S E V E N T I E S 17 There A N Y 0 N E C 0 M C E 9 n D A 3 0 U T PR OX I M I T Y 18 LOCATION Of THE PEOPLE WHO DIED O' 19 ANG I 0 5 ARCOHA TO A PVC OR VC PLANT I THE 20 STUDIES THAT YOU PEL I E u JPDW? 21 A. YES, THEY WENT AND LOOKED AT WHERE 22 ThE HEOPlE ACTUALLY LIVED TO DETERNINE 23 W HETHER OP NOT 24 0. AT WHAT POINT IN THEIR LIVES-DID 25 THEY - - AGAIN, W F 1 3 E RE L Y I NG 0 N L a S T 9ST0TTT2 BFG10055 )?. r i > - ; ? . 3 -L 1 * * ! 1 ADDRESS; I S T h a T C ') ' R'E C T ? 2 ONE jQJL D H4vE T 0 DEPEND Q\ L A 5 T 3 OOxIJS. I 7 ,E)jU AGA [ ; CEPEND -- 4 J?Z N D 7 - [ 5 I 5 NOT I THE STUDIES. I i;;\ OH 5 00=3.'. ' T K N 0 IN A PU3L l CAT 1 ON THE 4CTUA. 6 EXTENT of THE INVESTIGATORS' E'" FORTS TO 7 DETERMINE all LOCATIONS. IN 5 OWE CASES, (THEY a 1 A Y HAVE .< N 0 N N ALL THE LOC A T I 0 N S THE 9 I N 0 I V I 0 U A L LIVED AT AND I N S 0 ME CASES N IT CO 10 ONE PRESUMES T H A T v F 1 R E OE A l_ T NG R E 0 o' I I -! A N T L v 11 w I T H the last L 0 C A TI 0 N . 12 Q DOCTOR, ISN'T I T F A I R T 0 SAY T -1 A, T 13 ? = RC ENT OF THE AN G I 0 S A R C 0 A 3 THA T HAVE JEER 14 F 0 j N 0 SO FAR T Hi 5 I S 0 A S Z <J u p o ;u AT ,i-E 15 J J S T T A L K E D A 3 0 U T HAVE I E = \ ASSIGN ED AN 16 ji'i.<no an causes 3scause a e don t have enc jgh 17 INFORMATION TO OETERM I NE WHAT THE CAUSE WAS? 18 A. YES, THAT IS A POSSIBILITY. BUT I 19 THINK ONE has TO LOOK AGAIN AT THE FACT THAT 20 SINCE 1374, PEOPLE HAVE ACTIVELY BEEN LOCKING 21 TO LINK 'J ? ALL THE I 9 AMS I C S A R C 3'! A S W I TH "'HE 22 KNOWN CAUSES, SO THAT IT IS UNLIKELY THAT AN 23 ANSI OS A'COMA DIAGNOSIEO AFTER 1^74, HAVING 24 ANY POSSIBILITY OP BEING ASSOC I A TED WITH ANY 25 OF THE F j j 4 CAUSES, : U L 0 NOT R ; A f T E H T E 0 T ) 6ST0TTTZ BFG W056 35 - jl io 1 d: L 1 \ E J . T--\T'S J J5T A \ A 7 U 3 A L T = N 3 E N C Y . . 2 you <now .-/hat r r is a\o rou try ro l r t r v9 13 .1 I T _j ... j -J- V n j ' .1 ' T r r 7 *44 7 - u c t f = i iT [1 1 ; :? r t - t '-J ' T \ ; i .: .-5 c t 5 A ': G I 0 S A R CD ` A 5 t,jU '> ? C i \ : 0 7 LI'1'. C w ! TH i' v 6 9 E A S 0 v A 3 L E 1 0 ^ o 7 ! L I T 7 ^ = ,:l E I '1 A C D 9 9 E C 7 , 7 INDICATES THAT W EHAVEN'T YET E X C L U DEO A L L 3 THE SOURCES OF A 3 10 3 A ' C 0 ' I A , 9 U. DOCTOR, I :> A S 5 J P 1 L I E D 3 0 M E 10 l w r G R -'1 A T I 0 ' ri 1 C Hl D l C A T ? D THAT -- I'LL 11 ^ u 0 T E IT TO YOU: YOU WILL TESTIFY THAT EVE'. 12 AT THE -- EVEN IF THE EXPOSURE LEVEL A T THE 13 GRASS 0 H 0 H E .< A S A Y EARL Y A V E R A G E C F THREE 1A I *4 PARTS =ER HILL I OH, THAT THAT DOSE WOULD PE 15 INSUFFICIENT TO CAUSE HR. GRASSO'S 16 ANGIOSARCOMA. 0 I 0 YOU TELL A M Y 0 0D Y THAT? 17 A. I'VE SAID THAT A M U V3 E R OF TIMES. 18 0 . THAT'S T H > E E PARTS E R MILLION, 24 19 H 0 U R S A D A Y ? 20 -- I r "HAT A 5 3 'J M P T I 0 vj : AS MADE 3 \ 5 : / v ` - 21 T nl C h A R ACT L: r i s r I c s OF HIS DISEASE, HIS ONSET, 22 P R 0 G R E S S I 0 \ 0 F THE D I 5 E A S E, I'D STILL 23 D\m > TnAT CO . C L U 5 I 0 \ 24 0 . NOW , SE TT I N ijr ^ A C is. T 0 H 0 W V I N Y 25 C iL GRIDE IS H A >: LED IN- THE 3 0D Y, YOU ' VE --1J 111 09TOTTT2 BfGl005l '-1 I 1 SHOWED US 50 " E ACTUAL 'ISSUE SLICES, ! 2 SEL lE'/E . WE"? E T;-i">SE SLICES 'A KEN ~ ' 0 3 S ] J "j R I C H , C SEES 3 , H0 Ei] A WG [ '} 3 A = C 0 ' A ? 4 a. AND T-iLSE WITHOUT ANGIOSARCOMA. 5 0. 3 J 7 T i E Y W E 9 E FRO;-; GOO OR I CH ; C SEES? 6 A. those particular slides, yes. 7 Q aND WHEn you WERE TALKING A 3 0 U T H Q 8 THE LIVER H E T A 3 0 L I S E S OR C A N G E S V I N Y L 9 C H L 0 R IDE, YOU -- AMD YOU HAD A S L IDE ON 10 there s HO W IMG THREE 0 I " p E 3 E M T LEVELS 0 F 11 M E T A 1 0 L I Z AT ION. YOU KEPT R E F E 3 P I M G T 0 E u A V E 12 D E V E L 0 P E 0 THIS a 3 P * * r w :.j ui o IS T M = WE T ,J A T 13 YOU R E = Z 9, TO ? 14 A . W ELL, IT'S SO-9 T 0= U'lFUS T 1 S - v [ IS DID IT, SI MCE WE ARE MULTIPLE WORKER S IN THE 16 AREA AMO ALSO THE FACT THAT THERE AR E OTHER 17 COuLEGuES AT OTHER I MS T I T UT I QMS 'WHO HAVE DONE 18 IT. SO, l USE WE IN AM EDITORIAL SEN S E . IT'S 19 SIMPLY INDICATING THAT WE'VE DOME SO M E V/ 0 R .< 20 OURSELVES. 21 0. WHO IS THE WE WE'VE DONE 22 A . MYSELF, MY "5 1 0 C H E M 1ST?, MY 23 IMMUNOLOGISTS, MY L A 0 R A 7 O 9 Y T = C H ; [ 0 I A v S , MY 24 COLLI SUES WHO DO THE '-J T S T 0 L 0 0 Y . \OT M H* 25 E V E R Y T H I N G THAT W E R E S E N T IS 3 c R S 0 '! A L L v DO v C M C5R BfGA05% .j 3 - v . T . -i 5 s0 R . V " i : 4 L ) ' T 1 1 S Y M . I M E A N, I ' H -. C T CAPA 3 LE -- 2 y l U N Of R S T A N D T H A T . 1 JUST / A N T TO IE 3 C L E A R . 3 E C A U Si YO U :M E N T I 0 N S 0!1 E W ORA AS RONE 4 3 Y THE DO/; C - E I C A L C 0 ,M P A N Y -) 5 6 0. DIO v 0 U '/ n R < W f T*-t T H E ka- ? 7 A. THEM i'.E 7 M 0 V F.'Y p r> 0 ' I '! E: 3 CHEMISTS H n HAVE DONE A ORE A T DEAL 9 oroAcrjv: .3 01 ISM OF VI-iYL CHLORIDE, ALL 10 UGMT.', AND THEY HA/E PUBLISHES THA I AL . 11 A J N H p M u L Y THEY'VE DO M E- THE C 0 R w 0 0 ,< \ 12 DELATED TO THAT. 13 q. they *ve dome the primcipal wor< i n 14 THY I N 0 TO SHOW THAT AT LO'.ic" LEVELS, VINYL 15 CHLORIDE IS \N0 T A CANCER CAUSING AGENT; IS i 16 THAT CORRECT?, 17 A. FROM 'A METABOLIC POINT \ \ OF VIEW. FROM 13 A HISTOLOGY ?Ol'\!T 0= VIEW, OTHERS UA'/E DONE 19 M ORE. 20 q . THAT W AS IT THE 0 o ,jM f r i_ r a m ? A N Y 21 MG DIO THAT? 22 A. DOCTOR MATACRY, THAT'S CORRECT, 23 u rt,AJ THu STUDIES THAT YOU DID 24 AMD WHEN I ,i5hN YOU, I DON'T MEAN YOU 25 PERSONALLY, t MSA-: YOUR ..HOLE CRO'JP -- .. I T H 9T0TTT2 BFG10059 fj ~ 3 33 -DR. TV? * JR 0 - * 9 . V ' S 3 M Tr T I * 1 5. C? A 9 D T0 T ! E 7 A 1 '' L I 3 '' 7 f >; / i CUL'1'1 ! 75 [ \ 2 THE LIVEE, v; H 0 ~ U N R F A THOSE S T h 1 E S ? 3 -. ' -AT CAYS "M T--3E SOURCES: 4 jRI7hTE ENDOWMENT, .-'A':3' AC T vj 9 [NG C-S' I STS' 5 A 3 3 0 C 1 A T I C '. , AND THE NAT I 0 N A L INSTITUTE 0 F 6 H E -h l T ri . 7 q. D I J IMS GOODRICH COMPANY PROVIDE AMY 3 f J N DING FOR THOSE STJ3I53? 9 A. NOT THE 0 N E S 9 ELATE 0 TO E T A '3 0 L 1 S M . 10 THEY PROVIDED SOvE OF THE ORIGINAL HATER ! 1L 11 THAT WE USED FOR DEVELOPING SCREENING TESTS 12 FOR 0 E 7 E C "r I v G The A V G I 0 S A R C C M A . 13 0. THAT WAS TO DETER M T N E WHETHER T'n; I i 14 EMPLOYEES A C T !j A L L v u A !? A 'i 0 I 0 S A C C m A t TRYING 15 TO GET IT IN AM EARLY STAGE. IS THAT * H A T Y 0J 16 :-! E A N 3 y SCREENING TESTS? 17 A . NO, NHAT WE WERE WORKING ON IS 18 ,t ri d T n R 01R r, 0 T w E C 0 J L 0 IDENTIFY GENETIC 19 MARKERS WHICH WOULD TELL US WHICH PEOPLE DO 20 not handle chemicals well, specifically VINYL 21 CHLORIDE. SO, wE WERE SETTING UP A SYSTEM FOR 22 L 0 0 .< I N G AT WHAT IS CALLED H L A TISSUE T Y P I \ G 23 THAT IS, THERE ARE CERTAIN 0 L E CU L E S ON CELLS 24 THAT IDENTIFY IT AS HAVING CERTAIN :< I N D S OF 25 GEN'ETfC 0 H A R a " t m r 5 t [ r S A A! 0 5 ARE C E T A [ C9TCHTTZ BFG10060 1 DISEASES T.-imT OCCUR WITH !UCn G R E A T E R 2 r R c 0 :J E N C Y ! '. ? i*0 ?L: THAT H A V THAT Cl '! 0 5 c 3 j Z : i i: T 1C SETUP. A A A W E W ERE T R v I N 0 TO SEE IE -i i E COUl) 0 E 3 I G N A 3 Y S T E TO I 0 E T I " v WHO 5 ; 0 U L D 3 E AT HIGH I 3 < 6 The SECOND 3ET OP STUDIES 7 ALSO TO L 0 0 \ 8 a L < A 3 n U T T -> 1 T F p ; T p'i~ 9 IT'S Fin TO SAY THAT 10 j EFFERENT PEOPLE HAVE 0 I F i= = R E A T 3 E \ S I T I V [ T I E S iI i i 11 TO CA\CER CAUSING C H ivi I C A l S ; ISN'T IT ? 12 a . THAT'S CORRECT . 13 u . 3 0H E P E J ? L E HAY 3 E A 3 LE TO /. 0 R K A I T H 14 IT 4 0 Y E A R S A M 0 NEVER HAVE ANY EFFECT A\0 15 5 OWE PEOPlE ,4 A Y 3 E A 3 L E T C W 0 ;R < W I T H IT FOR 16 T H R E E Y E A R S AMD DEVELOD AN GI0 S A R C 0 M A OF THE 17 OF THE LIVER; ISN'T THAT CORRECT? 18 A . THAT' S A P 0 S S I 3 I L I T Y . 19 .0. AS A M A T TER OP c A C T, PEOPLE WHO got 20 THE A N G I 0 S A = C 0 M A r\ c rue: LIVER AT r w c G 0 o D R I C 21 PLA'iT -- AMO I RELIEVE AT THE OTHER ?VC 22 PLANTS -- WERE, AS I THINK YOU SAID, 23 REACT I CN CLEANER S, REACTOR CLEANERS? 24 A . ROST 0 F TrIE.-l WERE. 25 G. . HO'i MANY OTHER PEOPLE I THOSE N K C G) BFG10061 1 z i T c ' r ? c i p j < t 3 r l E 4 ' i - n ~ 0 9 ! 0 7 -/ - 7 ' 3 2 5 FACTOR CLE 'MS 47 S A 4 7 n p nt'Ti !': T-1: P 3 L ! VP 3? 4 4. ,v EL'-, I `! 7 -i E : L ! ' E 3 S - 3 : 1 5 Ti: P;GEX "4 333 r. RE 3, EYE-Y 0'! E T -J 3 3 E 6 i j 1 ' : % 3 , 2 c C - J j E 7 H 0 3 E I '< 2 I 7 I 3 J A L 5 v E 71 z 7 MATCHEO F0'. ThEI.R u 0 R .< E X P 0 3 U R E AAE-S. A'O 8 5 I Y C E A L _ or 7 ri E .---i -- 3 1 A C E 17 3 7 rt E 9 POL lCYi OF Tnc COAPANY THAT EVERYONE rAD r0 10 COHc WHEN THEY F I 1 5 7 : 0 < t D IN HE PLANTS 7 3 11 .vOR< AS A POLY GLEAM ER, ALL OF THEM HA 3 3 CMS ' 12 EX PER l ENCS -i 0 r< < I X 0 I ' 1 T^E 7 E A C T 0 7 3 . 13 3 0, ALL OF THE PEOPLE ! ?L *vT U 4 T 0 vi E 3 0 f T 0 o A '! 0 T '-i p 7 33 Z p 7? 3) f V .i \ 15 E X P E R I E X C E E < P F ? [ E V C = } CL* A \ I v G -7 - 1 ~ T T: 7 3 ? 16 A . YES, 7 U T THE RE 4 C T 0 r ~ V e 3 - -r i o t Y -3 ~ 17 YOU '* / THEY or 0 HA VG 7 E A r TORS T H 4 7 HAO TO 18 0 0 ,v ITh s Y N T H T I C A U 7 HER A.MO THOSE 001X3 I T 19 S Y A T H E T [ c PLASTIC s. s o. T ri .) o GH SOME CF THEM 20 A ERE I N THE PLANTS W I TH VINYL CHL0 7 I OS l THE 21 A T M 0 5 P H E A E , THEY ERE ,n 0 R K I \ G AT 0 IFFEREMT 22 - - vi 0 R K I iN G .- i ORE I M T l M A T L Y .1 I 7 w 3 I F F E R E 7 23 SETS C F CHE M [CALS. 24 0 . H 0 U '* 4 M Y 3 E 0 P L 5 f-1 r 0 7 A L AT ' 3 E h* 11(1 25 G 0 0 0 R I 0 'J 3I_ V ; T 3 1-1 E 7 E E X 3 H 3 r 0 7 '-'HAT Y H 1 < CD tn G10062 B? 1 L. L _ ./ - 1 _ i 7 S L 3 -'r ' v I : YL C H L 0 R I E . 1 T h r. ; c2 YOU 3 A 1 0 5 ) T 0 2 J 0 3 T : ? 3 [ L 1 3N . i 5 HERE IN T-f 7 J '!; 0= ilOuT VK , 4 5 j u Jr T n l! 1 , 4 'J j 5 Q. AND -IQ :i MANY CAS 3 OF A \ S l 0 5 A R. C 0 .-l A 6j ;i E < T H E 9 -I I T H J THAT G 9 0 'J ? ? 7 A. I THE TIMS './ E L 0 0 < F 0 AT r T , "0 U R . 8, A ''! 3 T H c t ^ :v: S d : \; F 'J 9 T H = 9 _ 9 A. 1: 9 . 10 0. -- CASES IDENTIFIED? 11 A. YOU'RE ASK I NG ME A A 0 U T THE 1,2 0 3 12 PEOPLE E 1 v' E S T ` J 0 I E 0 . THOSE -ERE 3 E 0 9 L S 13 c. P _ G Y I j -c ii j f-` 19 7+ U N T I l i'-i 0 V.' . K 0 TOT 0 , 14 T rt S R S ' 3 jEEN A 3 0 U T 5 3 H j \ 3 7 E J EMPLOYEES T 15 3.F. GOODRICH 5 I \C THE START OF THE PLANT 16 AND HAVE THEM, THERE'S SEEN 11 CASES OF 17 A N G I OSAR COMA. 18 q. SO, 5' HUN OPED PEOPLE HAS RELATIVELY 19 H I G H EXPOSURES and 11 DEVELOPED V l G l 0 ^ ? C 0 M A 20 OF THE L l VER ? 21 A. . I T H [ N < IT WOULD E F A r R TO ?AV T H -A 22 P .1 0 3 A 3 i_ y R 0 'J G H L Y half. 23 q 24 OKAY. 20 SAY 2 " . 25 2 3 t U M 0 RED, 11 DEVELOPS) 99T0TTTZ BfGl0063 0- .< . TAHB UR RO - .13. V A 3 3 -Vi.:- T T l 1 ';G 1 OS A*COM a 2 I H Y 0 [ r>' r T 3 ii 4 2 z 7 7 rj 5 . i7. V4S 3AL^TT I ; [' S 9 y . 6 3 Y M3, vassalotti: 7 Q. . T h; 0 T H 7 0 . 2 , 5 0 0 . 1 2 , 3 03 8 L L , AS 1 ? 0 I -A T il A OUT, T iE3 13, A3 9 YOU'VE I 0 j ! C A T 1 A 5 A A 0 3 S I 3 I L I T Y , THAT THERE 10 13 A o IGLOO [CAL. VARIATION I M PEOPLE f M H 0 Vi 11 T ri Y ri A >1 D L E T H E CHEMICAL. THERE IS, ALSO, A 12 DIFFERENCE BY WHICH THE CHEMICAL HAS THE 13 CHAMCE TO PRODUCE T M E GENET I C INJURY. NO/, U 5 [ vi p I v 7 P r \ ;j c rr yOJ p 1 '1 H J 0 r T H - A G " `! T R c 3 ; {* 7 15 NECESSARILY MEAN YOU'RE GOING TO PRODUCE 16 THOSE GENET IC INJURIES W HIGH A = E G 0 I V G T 0 17 LEAD THE CELL TO EVENTUALLY DEVELOP A 13 w A L I GNANC Y . N 0W, EVEN I N T HE A N I.MAL STUDIES, 19 TH = - ARG E S T PERCE N T A G E T H A T W AS A RLE TO ' 20 I A DUG ED W I T H V I -i Y L r H L 0 I DE E X P 0 3 JRc v A S 1 2 21 H E R C E NT . THAT M E A N T THAT THE M A J 0 < IT Y OF ri ni *-* 22 A H I ; IA LS W ERE ABLE TO ri A N J L THAT ,7 H 0 L E R ^ .'li u c 23 uF EXPOSURE .WITHOUT THAT MULT I ?L E C 0 M P 24 25 I N J U R E 0 . A9TCfTTT: B^G10064 1 IT'S THAT -> - . t \r j- '2 REA lLY LAC < A DEODATE KNOW LECCE TO 3 AY 3 r l ' r Y . T M i R E 15 A L ! ! I A3 TC Hj, 4 - : o .a A A c f 5 U A '-I A A C- E 7 n c l 7 T R i ? F R C 5 7 n E C E L L T-j THE GENETIC MATERIAL. AO A, ThOSE 6 TriAT 0 E T THROUGH HAVE THOSE POSSIBILITIES Or 7 DEVELOPING THE TJY03. AMD I THINK THAT 3 EXPLAINS, AT LEAST GIVES I'i IDEA OF W H Y . 9 /*> T H i T ' c MY p 0 I'; T 10 H ! i NOR ED 3 E R C E N T 0 = T H F O 11 A ATTER OF FAC T > T1 H E M1AA.JHOITY OF THE 3 E 3 L E 12 E 3 0 3 E D TO this C H F ' ICAL 13 A i 0 oSARC ON A CT THE L I V E 14 i M DILATION THAT T H [ 3 CHE 0 z S A 0 T L - J 3 C 15 I HMT r\ ^ Ll X 16 A. OH, THERE'S A3SOLUTELY NO DOUBT IN 17 ANYONE'S MINDS, AT LEAST NOT FROM A 18 SCIENTIFIC POINT OF VIE:.', THAT VINYL CHLORIDE 19 DOES CAUSE ANGIOSARCOMA. THE GUEST ION THAT 20 ONE I S ' ASKED IS IN EVERY CASE OF A N G I 0 S A R C 0 a A , 21 IS I T V I N Y L CHLORIDE. AND THAT, I T u I "-I '< , ^ A 3 22 T 0 BE -PROVEN Y EPIDE'BIOLOGICAL 00 0 Y 23 EX PER I MEN T'L D A T A . 24 0 . NOW, YOU'VE INDICATED, [' THINK, THAT 25 THE _ CvJ -- LOWER LEVEL. OF E X ? ' 3 U 0 E THAT THE S9TOTTT BFG10065 J3 L 0T r i 1 uiV:4 'A 7 A 3 0 L I 5 5 T- E A.-OUNT Op VINYL 2 CHLORIDE THAT GETS INTO THE U109STUV',; [5 3 TT T P Q 3 O C p ? 4 M. Y 5. 5 C. Y 0 U u4Vn TO GIVE 03 V E R 3 - L ' N 3 ' E ~ , 6 0 0 0 T GO. 7 YES, YES, I'M SORRY. 3. H D0 ! 4 YOU DS7ERM l OE 7 ^ I S ? DID YD 9 j l T 7 /. I .'J 4 THAT 0 R .-/AS THAT THE DOW CM EH. I CAL 10 A vJ Hi H H iS Y 7 11 a. these WERE STUDIES D U N E AT DO W A N D 12 3 Y 0 J P 0 V; N C H E: i T 5 T 5 AT THE UN I V = S 5 I T Y OF 13 LOUISVILLE, DOC 7 0S 0 N G . 14 Q . A N D E 9 E THESE I N H IJ -i AN ST U DIES "3 15 I N A M I M A L S T U D I E S ? 16 A . THESE W i-- z ^~ fc" ALL I N AN I MAL 3 TUD I ES . 17 0. HOW DID Y 0 U DO THESE A N I M A L ST U DIES? 18 A . TAKE AN AN I `I A L 0= A certain se c r e 19 .A i\ D GENETIC 3 P E E D I G ON AND LET THEM DDE A T H E 20 I N VINYL C H L 0 R I U E AT 0 I F F E R r. \ T LEVELS OF 21 H A ;2 T 5 HER i-i [ L L i ) i'. AND THE N 0ETES.il w a 3 Y 22 R m j I J A C T I V cly Tagging the V I >i Y L C H L U RIDE 1ON H 23 im U C n u r I T IS CONVERTED IN TO ITS SYP ,1 0 D U C T 3 24 A N D ( H I C H ROUTE. AND THIS I S D 0 N 0 N ThE 25 T ISSUE CF The a N [ - AL AFTER the animal is 69TOTTT: BFG10066 2 "5 I > 1 2 3 4 5 6 7 Tnt AGENT ANj T ri -V W A T C A [ m THE r L U I 3 TEAT 3 The CELLS aRS LlVt'.G AMD HQ,; M u C h R E Th = 9 P A 0 D U C T IS 3,0 0 lJ C Z C . 10 c . so, Y.rj exposed animals, oats, 11 HA.IS TFT s , M ICE, W H i T ; V Z 5 , ''0 A [ ? 0 N D V I M Y L 12 C H L 0 9 IDE, ' E A S U 0 E D /-AT A J 3 E E 0 " 0 T H E V 1 N Y 13 CHLCXIDE. AMD THESE STUDIES 3 H 0 '! E 0 THAT A T 14 L 0 : SR LEVELS LOS' T H ~ S " S [ T U 0 T I D N S AT L'V::: 15 LEVELS OF EXPOS-JOE -- AMD './HAT DS .!! HEA.y 16 3Y LOWER LEVELS OF EXPOSURE? 17 A. 3Y LOWER LEVELS, I'M USUALLY 18 SPEARING A 3 0 U T UNDER 25 PARTS PER I LL 1 OM . 19 0. AND AT LOWER LEVELS OF EX P0SURE, THE 20 LIVER OF T rt E S I M A L S METABOLIZED LL 0 HE 21 VINYL C H L 0 RIDE AN 0 RESUL TED IN N0\ C A MCEE 22 CAUSING METABOLITES; 15 THAI CORRECT? 23 A. THAT S THE C A M 0 L U SI'"1 a< h 9 a 24 D '1 THE p A S I S Hr T H = = A C T 1^5 T M 0 v c re r '-i r 25 V4 I ' 1 A L S EXPOSE 0 A '! 0 ERF A L L 0 W ED TO LI V E H* H M O BFG10067 1 j L -J 4 L 0 FEU T HAT v [ 0r 2 vlv) E V [ 0 - \ v- C T H A T E A rt e s ~ animals v, e 3 E ~ - s E -- r Th a 7 TE L [ V E 4 -i' r s 7 o i_ 0 G [ C A L E V I :? r v r c 5 0 F i U u; r > A N D T H AT T H 6 s u ? ST1 C E s T -) A T 0 p T ox r i I '! 7 3 Ur - i C I E \' T OU A \ T I T I 5 3 That LIVE' CELL 8 0 I 0 M I T HA VE T 0 A a /\ . * 0 9 TTweE C 0o v * t : -i ^ . v'iSSALorri, 10 ,v A E , Y u E A C A A 3=>J0 I NNT /HER 3 YOU W AMT TO 11 vv E 1 L L T A < - OU < 3 E C E 5 S . 12 Y 7. . VA 13 i '0 J U i 7 L i \ ^ T 0 G 0 ON 14 v' U S T I 0 \ 5 T T A I 5 A 0 I Y 15 T u p C 0 16 YOU 0 D i SC IE T I 0 N . 17 3 Y Y . V A SS a LO TT I 18 0 . DOCTO 0 / Y 0 'J s 19 OF Y 0 V ? T E S T I v ON Y *r H I 3 20 Th 4 T YHE '1 .4 0 3 F U * f c r r o 21 JET ::< i r Y C i E I C A L y G E 0 NOT SO Y'J*' 22 CHE M 1 c A L A G EOT 5, A N Y F 23 30 J o; 1 S T i-i m T C U3 A E C T ? 24 A . "i C L L / 1 T I 3 T 25 I T I s H J T 7 H Z 0 a L y 0 >. E i H* BFG10068 ' -3 ; i *5 -) ' _ : 23 1 ?. Tu T 1 3 2 !_ [ v ~ S [ e T ^ [T d * z r 3 ' " ' i r i : o . - t r r 4 1r 5 A 7 > y '-AT I" T -j [ A ` T - A T ' - ; j : " r 7 7 ' a L r7 r. 6 A. ; E3 . 7 Q. j .v , F70.1 Y 0 'J S a 14 I A L 3 7 U 0 l A 3 , 1 l 3 APPEALS a 3 T HOUGH THE -i 0 S E V I A Y L C H LOS I 4 9 THAT AS uIVEM TO THESE A M I Y A L 5 -- AS H 03 E 10 VINYL C-1L07 I D - S GIVEN T0 THESE A M 1 A L S , 11 THE LIVES ? E A C H S 0 A L E V EL W HESS IT C 0 U L 0 T 12 H E T A 3 0 L I Z E IT E VAU AH ; [5 T 1 ` \ t C 0 S S E C T ? 13 A. 7 w 4 T r CO'SECt. 14 0 . IS THAT 4 - A I 3 C - A 3 A c ~ E A I z A T I A '^ ? 15 A . THAT'S : 0 S S E C 7 . 16 A M 0 T H ~ 5 - A 'i I 17 M Y L C H L 0 S I i"s T 1 18 that 1 s r OS S E C 19 I N :*i r 3 S A SSO 20 THAT ri E 0 S < E J ATT AAMM A CHEM-ICAL PLAMT 13 OS 21 2 0 r E A S S / d E S E \ ' T 22 YES . 23 A E S E Y 0 :j - V; A S 24 E D T 0 V A S I . 1Su1l S Tv p 25 A '! I r rue -1 I C L3 T -1 * BFG10069 - ^ V . . -- 1 \ _ " 1 A V -> 0. u ' - ' : 1 0 1 YES. 2 < 3 TO \ J u D N ' T J0 i ZE T E H i S LIVE R -1 A T E 0 [ \ L 3 5= V. < [ .0 TRY.:,; j i T u A T HE .v A S ! 4 C. \ r j S I J T N AT 0 :J P I N T ? 5 V- 1 ! j 6 0. AND THAT'S DI FFF3 - M t c 3 0 M T^c 7 A'M :^LS THAT YD J P T !J d [ or -) w i-i n v ~ o ~ n, '; i v i i i 1 3 r :( 3 ^ ; r } TO V f N YL C H l_ 0 R IDE; IS ' u A T c ^ R 3 c c 7 ? o YES. 10 y HAVE Y D ;j EVE A M A 0 E ANY A'1 I M AL n 3 TyO i 5 .v HERE, IN A D D I T i 0 f'i T 0 EXPOSURE T -Z - 12 V [ ''! Y L C H L C A I D E, THE AN [HAL S WERE EXPOSE D TO 13 T l PL ! C N. I C Ai_ 4 3 : >, T 3 ? 14 A. OUR GROUP HAS P A R T I C I ? A T D I .v SUCH 15 STUDIES. ;V IS HAVE OT CONDUCTED THE M . 16 0 . AND IS N ' T IT A FACT THAT ;1R . G R A 3 3 0 17 C R THE ANIMALS IN THE ST'JDY ARE EXPOSED TO 18 OTHER CHEMICAL AGENTS, IM THIS CASE TO VINYL 19 CHLORIDE, AFFECT THE WAY THE LIVER -- THE 20 LIVER IS A ALE TO CLEAN O'JT 0 U R SYSTEM AND 21 MET A SOLIZS THIS MATERIAL? 22 A. YES. 23 IN OTHER WORDS , THE V I Y L C - L R IDS 24 . a 3 E A P 0 S E D TO .i 0 U L D H A v TC S TA ND I 25 u I :'j E Ai'.j A I T P 0 R 3 PATE 'V E 1 0 T :-i R TO '> 1 \ 3 ERE tLZtoTIT BFG10070 - 07 . i -> 1 [ N m t 3 SYS T " '1 ' ' E 2 `R E ^ OR E IT ICIJI.O ^ E ! 3 4 II T 7 - -) 5 r: A' f; I - . : I ''fc 6 J J J I 3 3 iay \or c 07 7 WE L L, i DON'T MEAN. 8 IN LINE. I'M A LAY . A 9 AND EXACTLY nO V, the 10 A. .v ELL, WHAT YOU'RE SAYING 15 THAT 11 THERE WAS A C G M P E T IT 10 M FOR THE A 3 IL f T Y OF 12 ThE l I V E 0 CELL TO GET PIT ' " T m E S E S L; ^ S t a '! C E S 13 AND THAT'S TRUE OF ALL S U => S T a v C E S . 14 ~ H r L 1 '/e 7 S = ' = C T ' c L " T` ' < " S r \ ? p ~ p 15 ONE A GEM OR ANOTHER, THAT yoij c A -V T TE 4 S 16 SIMPLISTIC ASOUT IT. THE LIVER WILL 00 7m t 17 A T T I M E 5 . 18 0 . 0 0 E 3 IT 00 THAT WITH V 14 Y L C H L 0 R ICE? 19 A. PARDON? 20 A. JOES IT DO THAT WITH VINYL C.HLO ; IDE Y 21 m. IT WOULD hAVE TO DEPEND C\ A GREAT 22 DEAL WHAT AGE ri T S IT WASCO M PET! N G -`i I T H . 23 CERTAIN AGENTS WOULD IMPEDE IT, CERTAIN 24 AGENTS >/ 0 ULD DO N 0 T H [ nj G 4 NO C E R T A I N A G E'1 T 3 25 WOULD SPEED IT 21110174 BFG10071 ' 3 -J 7 ~ V - 1 i_ -j i > A I7 57f 2 'j 7 A S 3 0 1 i c 9 j 3 u R z T 0 T H E 3 E CHE i I C A !_ S v 0 J L C 3 0 F l .m I T L Y F F C T T H < ATE AT U h I c H T -< V( Y L 4 i L 0 x I J E,-i A 5 ,M E T A 3 0 L I Z E 3 I HIS L I V E 9 ? 5 A. IC A. m ORLY speculate TO THAT, 6 q. 7 WHAT WOULD YOU3 SPECULATION 3E. HR. R F N E I S E N : 0 R J E C T I 0 N , 3 V r-> I | T -j Q V n R 9 THE COURT: S U S T A I E 0 . IS IT 10 ' o => < R , V A S 5 A L n T T I . i= n r h j r :R - C 17 S S ? 11 " R . 7 A 5 S A L 0 T T ! : 0 A A Y , Y 0 'J 9 12 - o o r . 13 THE COURT: LET'S T A < E \ T E. 14 -i i is j i A c C E 4 4 , L A 0 I E S .A R 0 0 c'.TL E E v . 15 C AT TnlS T l A E THE JURY LEAVES COURT;- 0 0 -1 . ) 16 THE COURT: WE'LL STAND I 4 17 RECESS FOR TEA MINUTES. 13 C 3 H 0 R T RECESS.) 19 THE COURT: MR. V !i S 5 A L 0 T T I , 20 YOU MAY COM! IN U E WIT H YOUR C R 0 S S-E Y A m!M A T I 0 N. 21 3 Y M R . V A S S A L O T T I : 22 0 . DOCTOR T A -* R U R R 0 r "-1 r v ~ R R R < ~ f ~ 23 ;iElz TALA I NO AROUT m=TAROL I SM ' ' T LIVER 24 AMO HON THE- V a R ( 0 i J S I M 3 U R I T I E S -i I T H [ \ ~h = M 25 sour woulo have, to comaete with each other to 6/LTOTTT BFG10072 1 3 :1E TAOOL l ZSO V\D P'J-R rc r = 0 FRO T -1 F L ! '/ - P ; 2 IS that correct? 3 A. YES. 4 -1 P ' t [ n s T 1 T v f *: Y L r H * '*1 ! ' : f 5 \ t . V > [ ~ 7 -i a t r r\ j o ~ 7 ? 6 ^ I 3'.Vi T HI '-! :< F 'ID, " U 7 l T [ S . 7 I H j'JiHT YOU TZ3! I:l;3 T A ThAT 3 YJUROIREC7. 9 "Rc ALL Or J 5 E X ?05 E 0 TO 10 ri Y 0 R 0 C m j 0 S 1\ -- F * 0.-1 0 THEE SOURCES T H A '-j 11 7 I A Y L C ,H L 0 R I 0 E ? 12 A . 1 THINK THAT'S A RE4SQ M A ALE 13 ASS U,-i p T I 0 N . 14 Q. AS A v A T T E 7 0 = -ACT, E! S S I 0 N S ^7" 15 A \j T 0 :/0 3 1 L E S ARE H Y 0 1 n C A R ~ 0 MS? 16 A . CORRECT. 17 0 . A M 0 v HEM T H E 5 E H Y 0 0 C A R R 0 '! S ARE 18 1 %E A THE 0 I N 0 R r -V H A L E D A M 0 A 3 S OR R E 0 I M THE 19 SLOODSTPE A M , THEY, TOO, HAVE REE N H E T A R 0 L I Z E 0 20 3Y THE LI V E 7 ; I S T HAT CORRECT ? 21 YES. 22 W D IJ YOU GIVE THE -- YOU 0 I 0 N ' T 23 IT. 0 I j THE PEOPLE .-.HO STUDY . THE M E T a E 0 L l S -l 24 OF VINYL C H L 0 A I DE Is T H E RATS EX J 0 5 E THE R ' T h* 25 TO ANY 0TuER HYDROCARBONS? BFG10073 cn - : R . 7 -1 ' - J ' ' 0 - - 3 . '.MSI L------- i 1 a. t c ; r c::. l s' ,i V'D.-; one 2 5'OUP THAT HAS DONS ANY LONS TEA: -i E '< E R I M E '-1 T S 3 jr . A L f ! r L A a G - N T 5 . 4 Y C '*j R 1j P 0 U P 0 I 3 \ IT, 5 NO, COLLAR 0 R A I T H t:-; 6 THAT J! 7 q. AND DID THOSE RESULTS SHO W THERE W A S 8 A C 0r-1 PETITION BETWEEN THE VARIOUS 9 H Y D R 0 C A R 8 0 M 5 *= 0 A M T A B 0 L I S T ? 10 A . ': C , THfS V! AS A STUDY n DOCTOR 11 R A D I 0 < E . WHAT THE STUDY 3 w 0 W ED / A 5 T H ~ T^E 12 COHO l NED ASSOCIATION 0" A LC-OWO!. A no V I N Y L 13 CHLDR IDE INCREASED THE MU * 3 E R r- E TUTORS I ' 14 THE ALCOHOL treats D GROUP In COMPAA ISDN TO 15 THE v I N Y L CHLORIDE T A E A T E 0 0 A T H E A LCCii 0 L 16 TREATED ALONE OR THE .NONE-TREATED TREATS ,D 17 ALONE. 18 q. LET'S TALK ABOUT THAT. THAT'S THE 19 RAOICKc WORK THAT DOCTOR EPSTEIN TALKED ABOUT 20 Y 0U W E R E HERE WUEN HE T3TIPI9. 21 A. THAT'S CORRECT. 22 0 . I THINK HE M E N T I O N r0 THAT In A 23 DISCUSSION OF SYNERGISTIC Fe SC T 5 Oc 24 Chemicals, again, synerg i.s t i c r"scTs oc 25 A. THAT AG MIS INTERPRETATION. '; * A T A 44TO TTTZ BFG10074 jj T m ' 5 j 0 - ' A . ' -o 3 A L J 7 ' I / 1 S Y N E R G 1 S T 1 C EFFECT [ S THAT ONE AGENT, V h p N 2 ADDED TO ANOTHER AGENT { N C R'E A S E S THE MU 11 EF 3 0 F E V ENTS That 0 'j l D C C C U 9 THAT '3 G T E A r E ' 4 T' '_i ,-\5 \Mi Jl ? I N G T HE'-' 7-1 "I G E T h E ? . ' 0 , IF ONE AGENT 5 C A j D ? 3 0 D U 0 E c I V E E V E '' T S , A v Q T h E R AGENT 6 COULD P 0 0 0 U C E FIVE EVENTS, r n S r e a d OF e 'i D I G 7 JP I T m TEN, YOU END UP V/ I T H IS OP 2 0 0* SOME 8 BE? G R E T 1 T H A N T -t E 9 w 'N 0 j j r t q R , T H t 5 _ STUD l ES THAT YOUR 10 GROUP HAS C r"S . 0 J CT:j 0 N THE SETAE OL 1 3M OF 11 V 1 n 7 L C ri l o R 1 D c p *v A S THAT IN A N Y A Y F J < D D - 12 THE /iCA GRANT? YOU M AY HA V 5 A \> 5 W c R E D THIS. 13 I ' NOT SURE. 14 A. IN THE past, IT has. P P E S E''TLY , IT'S IS NOT. 16 C. AND THAT ---- THAT WAS THE 'ICA 'S3 ANT 17 THAT YOU TALKED AFQ1JT YESTERDAY TAT WAS 18 S 2 5 0 , f) Q 0 =ER year FOR THREE YEARS? 19 A . THE A. A J 0 R RESEARCH THAT '! AS O P ME 4U WITH THAT G R ANT W A S RELATED TO THE H L A 21 ati'iST I C TISSUE TYPING AND A S A a L L " 3. 22 PROPORTION st A S STARTED FOR THE MET A VOL I S -1 23 .. H I C r, ,-ic 'V E. S U >3 S E 0 U E N T L Y CONTINUED W ! 7 ri 24 PRIVATE RESEARCH FUNDS. 25 G. DOCTOR, THE SLIDES THAT -- SOME 94T0TTTZ BFG10075