Document bmqkZ8knVNRganx34q5dzOGo

file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 1 IN THE UNITED STATES DISTRICT COURT 2 FOR THE DISTRICT OF COLUMBIA 3 4 BETSY LAKIE, ) ) 5) ) 6 Plaintiff, ) ) Civil Action 7 -vs- ) No.: 93-0561 ) (HHG, DAR) 8 SMITHKLINE BEECHAM, et al. ) ) 9) Defendants. ) 10 11 12 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 13 14 DATE: March 14, 1996 15 TIME: 1:00 p.m. 16 LOCATION: SAN FRANCISCO AIRPORT MARRIOTT 17 1800 Old Bayshore Highway Suite 5096 18 Burlingame, California 94010 19 REPORTED BY: Barbara Friedman file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (1 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 Certified Shorthand Reporter License Number C-7845 21 22 23 24 25 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 2 1 2 3 A P P E A R A N C E S: 4 For the Plaintiff: LAW OFFICES OF HARVEY S. WILLIAMS 5 BY: HARVEY S. WILLIAMS, ESQ. 1019 19th Street, N.W. 6 Suite 800 Washington, D.C. 20036 7 (202) 857-0877 8 9 For the Defendant: HOWELL, GATELY, WHITNEY & CARTER 10 BY: DANIEL W. WHITNEY, ESQ. 401 Washington Avenue 11 Twelth Floor Towson, Maryland 21204 12 (410) 583-8000 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (2 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 Also Present: 14 15 16 17 18 19 20 21 22 23 24 25 Bettina M. Heusch, law clerk PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 3 1 INDEX OF EXAMINATIONS file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (3 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 2 EXAMINATION BY: PAGE 3 4 MR. WILLIAMS 4 5 6 7 INDEX OF EXHIBITS 8 9 10 EXHIBIT DESCRIPTION PAGE 11 PLAINTIFF'S 12 13 No. 1 Plaintiff's Amended Notice of 14 Deposition 7 15 16 No. 2 Report dated September 12, 1995, 17 Curriculum Vitae 7 18 19 No. 3 Current Curriculum Vitae 7 20 21 No. 4 Correspondence file 35 22 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (4 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 No. 5 Group of correspondence re 24 medical records 47 25 PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 4 1 I N D E X O F E X H I B I T S (cont'd.) 2 3 No. 6 "University of Pittsburgh 4 Mortality and Population 5 Data System" 67 6 7 No. 7 Group of articles authored 8 by Dr. Wong 69 9 10 No. 8 Two-page list of "Observed 11 Deaths by Cause" 110 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (5 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 13 14 15 16 17 18 19 20 21 22 23 24 25 PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 5 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (6 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 OTTO WONG, Sc.D., F.A.C.E., 2 called as a witness, after having been first duly sworn 3 by the Certified Shorthand Reporter to tell the truth, 4 the whole truth, and nothing but the truth, testified 5 as follows: 6 7 EXAMINATION BY MR. WILLIAMS 8 Q (BY MR. WILLIAMS): Would you state your name and 9 address for the record, please. 10 A Otto Wong. 181 Second Avenue, Suite 628, San 11 Mateo, California 94401. 12 Q Is that your work address? 13 A Yes. 14 Q Dr. Wong, I'll show you Plaintiff's Exhibit 1. 15 Did you receive a copy of the amended Notice 16 of Deposition? 17 A Yes. 18 Q Were you able to bring the documents requested in 19 the notice? 20 A Yes. 21 Q Why don't you tell me what you brought here today. 22 A I have a stack of documents that Mr. Whitney's file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (7 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 office sent me. It is right here. 24 Q Okay. 25 A And then I have a folder of articles that I PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 6 1 reference to in my report. 2 And, also, I have one folder with 3 correspondence and so on between me and Mr. Whitney's 4 office. 5 Q Let me take a look at the folder that 6 Mr. Whitney's office sent to you. And in the folder, 7 those are the articles you referenced? 8 A Yes. 9 Q Do you have any articles in there that you did not 10 reference? 11 A Only one additional article that I did not file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (8 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 reference in my paper. 13 Q What article is that? 14 A And a few pages from the IARC, the International 15 Agency for Research on Cancer, monograph on benzene, 16 published in 1982. 17 Q Okay. Anything else would be the articles you 18 already cited in your report, right? 19 A Yes. 20 Q Let me have one second. 21 Other than the materials you brought today, 22 do you have any other documents related to this case 23 that you did not bring? 24 A No. 25 MR. WILLIAMS: Plaintiff's Exhibit 1. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 7 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (9 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 (Whereupon, Plaintiff's Exhibit No. 1 is 2 marked for identification.) 3 MR. WILLIAMS: Let me show you Plaintiff's 4 Exhibit 2. 5 (Whereupon, Plaintiff's Exhibit No. 2 is 6 marked for identification.) 7 Q (BY MR. WILLIAMS): Can you identify that 8 document? 9 A The report that I wrote dated September 12, 1995 10 in this case. And also attached to that is my CV. 11 Q Is the CV current? 12 A I might have a couple more publications since 13 then. 14 I did bring a current copy of my current CV. 15 Q Oh, you did? Okay. 16 A And this has additional publications. I think 17 maybe just two or three. 18 MR. WILLIAMS: Let's add this as Exhibit 3. 19 (Whereupon, Plaintiff's Exhibit No. 3 is 20 marked for identification.) 21 Q (BY MR. WILLIAMS): I want to ask you some file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (10 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 questions about your training. Your degree is in 23 physics and mathematics, that was your undergraduate 24 degree? 25 A Yes. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 8 1 Q Then you studied epidemiology in private school, 2 correct? 3 A Well, actually, I also have a graduate degree in 4 physics, and I switched to public health in 1972. 5 Q Okay. Did you receive a master's degree in 6 physics? 7 A Yes. 8 Q You received that in '72. And then did you 9 actually receive a degree in public health? 10 A The copy -- I'm at a disadvantage. The copy you file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (11 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 gave me is missing a few pages. 12 Q Let me show you Exhibit 3 which is the most recent 13 one anyhow, correct? 14 A What I got twenty years ago and today has changed. 15 I received my master's degree in physics at 16 Carnegie-Mellon University in 1972. 17 Q Okay. And then following that you went into 18 epidemiology, is that -19 A I think I started at the Graduate School of Public 20 Health in either August or September of 1972. 21 Q Okay. And you subsequently went on to finish -22 once you finished the public health degree, then you 23 went to epidemiology? 24 A No. Epidemiology is part of the Public Health 25 School at the University. So I started -- you can say PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (12 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 1 that I started taking classes in epidemiology in 1972. 2 Q Okay. In your CV you indicate that you are board 3 certified in epidemiology? 4 A Yes. 5 Q What does that mean? 6 A The certification body is the American College of 7 Epidemiology. They have two groups of membership. One 8 is what we call Member. You have to have an advanced 9 degree in epidemiology or a related field, and then you 10 have to pass through a couple exams. 11 And the other type of membership is Fellow. 12 To be a Fellow you have to satisfy all the requirements 13 of regular member, and on top of that you also have to 14 have what they call significant contribution to the 15 Science of Epidemiology. 16 And in 1982 I sent in my CV and my 17 qualifications and so on to a committee, and they 18 admitted me as a Fellow. 19 Q Is that what the F.A.C.E. refers to in your title? 20 A Yes. Fellow of American College of Epidemiology. 21 Q Now, where is this committee that you sent this file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (13 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 to; is that something that's in California? 23 A It is not in California. The correspondence at 24 that time actually was at John Hopkins University, but 25 the officers of the College changed every few years and PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 10 1 it depends who has the office. That's where you write 2 to. 3 Q Okay. So you write to the committee and the 4 criteria is having an advanced degree in epidemiology? 5 A Or a related field. 6 Q And the advanced degree, would that be a master's? 7 A I don't remember all the details now, but you got 8 to have a doctoral degree, either a Ph.D. in 9 epidemiology or Ph.D. in a related field, or you can 10 have an M.D. degree plus an advanced graduate degree file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (14 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 that can be either an M.S., master level degree or Ph.D. 12 in epidemiology. 13 Q Okay. On your resume it doesn't indicate that you 14 are a Ph.D. in epidemiology? 15 A I have what is called a doctoral degree in 16 science, doctoral in science which is the same as a 17 Ph.D. 18 Q Does this committee consider that to be the same? 19 A Oh, absolutely. 20 Q With that doctorate of science, would that 21 automatically qualify you to be a member of the American 22 College of Epidemiology? 23 A No. 24 Q Not a fellow, but a member? 25 A Not even a member. You have to take some exams in PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (15 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 1 order to become a member. 2 Q So to become a member you take a test? 3 A Yes. 4 Q And the test is administered by this committee? 5 A Yes. 6 Q Is this a board that is recognized by the American 7 Medical Association? 8 A That I don't know. 9 Q After you become a member, do you then -- then I 10 take it you submitted some of your work, examples of 11 your studies to the committee in order to become a 12 fellow; is that the way it worked? 13 A No. The American College of Epidemiology started 14 in, I think, in 1981, so there were a couple hundred 15 Fellows at that time who were what we call 16 "grandfathered" into the college. If you can show or 17 demonstrate that you satisfy the requirements plus you 18 have made a significant contribution to the scientific 19 committee in terms of publications and so on, then they 20 can grandfather you into the college. And I was one. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (16 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 Q You were one of the grandfathered members? 22 A Yes. 23 Q Or fellows? 24 A Fellows. 25 Q So this board began in 1981? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 12 1 A The college started, I believe, in 1981. 2 Q And when were you grandfathered in? 3 A 1982. I submitted my application sometime in 4 1981, and I received notice from them in 1982. 5 Q And the notice indicated that you were admitted; 6 is that correct? 7 A Yes. 8 Q When did you take the test? 9 A Grandfather means you don't have to take the test. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (17 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 Q So you didn't have to take a test. You applied 11 and submitted evidence of your studies? 12 A Right. At that time there were two ways to get 13 into the college. One is you can take the test, or if 14 you think you have already met the requirement and also 15 have made significant contribution, you can ask the 16 committee to look at your CV and see whether they can 17 grandfather you in. And if you fail that, you can 18 always go back and take a test. 19 Q What is epidemiology? 20 A Epidemiology is the branch of medical sciences 21 that deals with the distribution and determinants of 22 disease in human population. So there are two 23 components in the definition. One is distribution. And 24 by that we mean which group or subgroup in the general 25 population have a higher rate of certain disease that we PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (18 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 1 are interested in. We want to identify the high risk 2 group. 3 And once we have identified the high risk 4 group, we want to find out the determinants of that, 5 meaning the risk factors associated with the high rate 6 of disease in that group. 7 Q Does epidemiology also include application of 8 information that you learned to alleviate health 9 problems? 10 A I'm not sure I understand that question. 11 Q Well, you indicated that you studied the 12 distribution of disease in a group. And you identify 13 risk factors. Do you use that knowledge, is part of the 14 definition of epidemiology to use that knowledge to help 15 to alleviate health problems? 16 A Absolutely. The relationship between, for 17 example, cigarette smoking and lung cancer was 18 discovered through epidemiologic studies. And certainly 19 we have been using that information to persuade people 20 not to smoke. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (19 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 Q So would that be a third component of epidemiology 22 in addition to the first two? 23 A In a sense you can call that. 24 Q Epidemiology doesn't study the biological or 25 pathological mechanisms by which disease develops in an PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 14 1 individual, does it? 2 A Yes and no because epidemiology really is very 3 useful in the sense that it doesn't matter what kind of 4 parameters you look at. As long as you set up the right 5 study design, then we can call it epidemiology. 6 You can use cancer as the health endpoint or 7 you can use some biomarkers as the endpoint. And by 8 setting up the right biomarkers to study, you can get an 9 understanding of the biological mechanism of a disease file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (20 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 process. 11 Q But you don't -- epidemiology doesn't study how 12 disease develops from a biological or pathological point 13 of view in an individual, does it? 14 A I think it does in the sense that if you define 15 your endpoint in such a way that you can call that a 16 biological -- well, certainly you can set up your study 17 in such a way that you can study any biological 18 mechanistic hypothesis. 19 Q But aren't you studying the incidence of a 20 particular endpoint in a population rather than the way 21 that that endpoint develops from a biological or 22 physiological point of view in that individual? 23 A That's true. In that sense it is not a study of 24 the mechanism, but you would certainly -- epidemiology 25 can be used to either refute or confirm hypotheses PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (21 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 15 1 suggested by biological experiments. 2 Q You don't have any other board certification other 3 than the one we discussed in epidemiology, do you? 4 A No. 5 Q So you are not trained in medicine? 6 A No, I am not. 7 Q And you are not trained in toxicology? 8 A No, I am not. Well, when you say when I'm 9 "trained" in something, I took courses in toxicology 10 when I was in school. It is a little bit different from 11 the previous question when you say are you board 12 certified in other disciplines. 13 Q You don't hold yourself out as a toxicologist? 14 A No, I don't. 15 Q And you don't hold yourself out as a physiologist? 16 A No. 17 Q Or as a biochemist? 18 A No. 19 Q I take it you are not going to offer an opinion in file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (22 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 this case, then, on the biological or pathological 21 mechanism of Mrs. Lakie's disease? 22 A No. 23 Q In general terms, tell me, in with causation, 24 isn't it true that epidemiology can determine whether a 25 particular agent is capable of causing disease; is that PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 16 1 correct? 2 A Yes. 3 Q An epidemiologist doesn't, in a general sense, 4 embrace determining whether a particular individual's 5 disease has been caused by a particular agent, does it? 6 A I think it does for chronic diseases. 7 Q You think that -- explain that if you would. 8 A One of the -- there are many problems associated file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (23 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 with the determination or causation in chronic diseases. 10 By chronic disease, I mean, there is a long 11 latent period between exposure to the disease and the 12 appearance of the disease, usually in terms of years or 13 even decades. 14 And most chronic diseases have more than one 15 etiologic agent. So when you look at a single case, you 16 would not be able to tell what that individual has been 17 exposed to. And you cannot distinguish biologically or 18 clinically that that case was caused by Substance A as 19 opposed to Substance B. In other words, just looking at 20 a leukemia you cannot tell. 21 If we don't have the employment history or 22 the exposure history, you cannot tell whether that 23 leukemia case was caused by iodizing radiation or 24 benzene exposure or simply a background case. So in 25 that sense you have to rely on epidemiologic studies to PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (24 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 17 1 determine the probability of causation due to each 2 exposure factor. 3 Q So in the absence of a case history, an 4 epidemiologist would be used to establish the 5 probability of causation based on epidemiological 6 studies; is that what you are saying? 7 A No, what I'm saying is if you do not know the 8 exposure or employment history of a certain patient, 9 clinically, you would not be able to say anything about 10 a causation because just by looking at the disease 11 itself you cannot tell whether the disease was caused by 12 A or caused by B. 13 Epidemiology is useful in the sense that if 14 you do know the employment history, we can assign a 15 probability of causation to each individual exposure 16 factor. 17 Q If you know the employment history? 18 A Yes. 19 Q I'll take it, then, if there was a case control file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (25 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 study of an individual or case, or clinical study of an 21 individual, if the person's medical history, employment 22 history was known, the clinician or medical doctor would 23 be able to also make a diagnosis as to the -- to render 24 an opinion as to causation of a disease; isn't that 25 true? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 18 1 A No, he cannot. 2 Q If the medical doctor knows the patient's prior 3 exposures and he diagnosed a disease, the doctor cannot 4 offer an opinion as to the causation? 5 MR. WHITNEY: Objection. Speculation. 6 THE WITNESS: When you use the term 7 "doctor," I assume you use a clinician as opposed to a 8 epidemiologist because the doctor can be a clinician and file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (26 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 epidemiologist at the same time. 10 Q (BY MR. WILLIAMS): I mean a clinician. 11 A A clinician cannot make any statements on 12 causation just by looking at that case without any 13 knowledge of the epidemiologic literature on the disease 14 and exposure that person has. 15 Q How was leukemia first discovered to be caused by 16 benzene? 17 MR. WHITNEY: Objection. 18 THE WITNESS: It started with some case 19 reports, but based on case reports we don't have a firm 20 conclusion at that time, okay? The association was 21 confirmed by epidemiologic studies. 22 Q (BY MR. WILLIAMS): But before the epidemiologic 23 studies, it was through case studies that the medical 24 community became aware that benzene caused leukemia, 25 wasn't it? PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (27 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 19 1 A Yes. 2 Q When you do an epidemiological study, what is 3 required to make sure the research methods are 4 trustworthy? 5 A I guess the most important thing would be to 6 define what group you want to study, what exposure you 7 want to study, and once you have defined your group, 8 then you have tried your very best to obtain a group 9 that's unbiased, that would fit your definition. 10 Q Anything else? 11 A Once you have the group, then I assume you have to 12 obtain some information on the health outcome you are 13 interested in. And again, you have to get complete 14 information on that. 15 Q Do you start typically with a particular question 16 that you are trying to resolve? 17 A Absolutely. 18 Q Do you call that a research question? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (28 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 A I would call that a hypothesis. 20 Q For example, if you wanted to study whether 21 benzene causes leukemia, that would be your hypothesis? 22 A That would be the hypothesis, but the way that you 23 just stated it would be a very nonspecific, general 24 question. 25 Q How would you state it if you were to embark on PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 20 1 such a study? 2 A If somebody comes to me and say, "I want to 3 sponsor a study to find out the relationship between 4 benzene and leukemia," let's say, then immediately I 5 would come up with at least two or three questions to 6 ask you. One would be what kind of exposure range we 7 are interested in because by just saying "benzene" is file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (29 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 not sufficient in terms of exposure. Are we talking 9 about very trivial exposure? Are we talking about very 10 heavy exposure? 11 And you say "leukemia." I need to know are 12 you interested in leukemias of all cell types or 13 specific types of leukemia. 14 Q If the answer to the first question was you were 15 looking at low-dose exposure, what would your next step 16 be in designing a study? 17 A Well, I would want to know how low. When you say 18 "low dose," I don't know what that means. 19 Q Okay. Why don't you know what that means? Is 20 there not a generally accepted standard for what low 21 dose is? 22 A Certainly, when you talk about occupational 23 exposure, low may mean less than one ppm. But if you 24 are talking about environmental exposure, one ppm may 25 not be low compared to what we come across on a daily PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (30 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 21 1 basis. 2 So when you say "low," I really would like 3 to know what range you are talking about. That would 4 direct me to the total population that I would like to 5 study, which group I would like to study. 6 Q How about if it was one part per million? 7 A One part per million, as one ppm, then I would say 8 some of the workers in refineries. At this point, 9 nowadays, I think, they are exposed to less than one 10 part per million, and would be the group that I want to 11 look at. 12 Q Would the level of exposure that you are looking 13 at also determine size of the sample? 14 A Once you know which exposure range you are 15 interested in, then you try to find some populations 16 that would fit into that criteria. And sometimes there 17 are lots of people out there that falls into that range, 18 and you can have a meaningful study. And sometimes you file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (31 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 just can't, you cannot find a group large enough to 20 provide you with any meaningful data. 21 Q You mentioned bias earlier. What is bias in a 22 research method? 23 A Technically, the definition of bias is a 24 systematic error that would produce a biased result. 25 Q Can you give me an example? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 22 1 A Okay. Let's try this one and see if -- let's say 2 there is a proposal to raise the tax rate in high income 3 brackets, and we want to find out what percentage of the 4 population is either for or against that proposal. So 5 we need to talk to a lot of people, include a sample of 6 people to get that information. 7 And one way to talk to a lot of people or at file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (32 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 least run into a lot of people is, I guess, going down 9 to the shopping mall. So we go down to the shopping 10 mall, set up a table. Let's say we set up a table in 11 front of Neiman-Marcus, and we try to persuade people to 12 give us an opinion on the question as they go into 13 Neiman-Marcus. And let's say they eventually would get 14 a hundred people who would agree to answer the question, 15 and it turns out that 95 percent of them, 95 out of 100, 16 said they are against raising the tax rate. 17 Now, I know I'm not supposed to ask a 18 question, but let me try to ask anyway. Would you think 19 that the 95 percent obtained through the sample is 20 valid, representative of entire population? 21 Q What would you think? 22 A No. The answer is no because it is a biased 23 sample. The people that walk into Neiman-Marcus are 24 more likely to come from high income bracket. 25 Certainly, that sample is not representative of the file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (33 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 23 1 underlying population. 2 Q Can you give me an example, using that as an 3 analogy to an epidemiological study where you are 4 studying exposure of workers in an oil refinery? 5 A I can give you a more general example than that. 6 There is something what we call the healthy 7 worker defect, and it refers to the observation that 8 working populations usually have a lower rate of 9 cardiovascular disease than the general population. 10 Okay? And that, basically, is the result of selection 11 bias, people who select themselves into the working 12 population. 13 In other words, if you have a cardiovascular 14 condition you may not pass through the employment exam 15 and, therefore, you would not be able to work in 16 industry. 17 So if we look at the employed population, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (34 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 their cardiovascular disease would usually be lower than 19 the general population. That is the bias. 20 Q The bias is because the workers you are studying 21 might actually be healthier than the general population? 22 A In terms of cardiovascular disease. 23 Q And you refer to a selection bias. Is the bias 24 also attributable to the fact that it may have better 25 access to health care? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 24 1 A That also may be true. So maintenance of health, 2 that's another component. 3 Q And would it also be true that part of the healthy 4 worker defect is that sick workers might be removed from 5 the study, from the population that you are actually 6 studying? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (35 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 A No. That's not true because normally how we 8 define a study -- well, let me give you an example. In 9 most of the refinery studies that we look at, the 10 definition for the study is anyone who works at the 11 refinery more than either six months or a year would be 12 included in the study. And once that worker is included 13 in the study, he or she will be in the study regardless 14 of how long he or she worked. 15 Q Is that true for all the studies you did, there is 16 a threshold duration of employment that's a requirement 17 to be in the study? 18 A Usually, there is what we call a minimum 19 employment requirement. And the reason for that is 20 otherwise you would be studying a lot of very short-term 21 workers, maybe a student who work there maybe one or two 22 summers. 23 Q And it is usually six months? 24 A Six months or a year. 25 Q I guess in general these are cohort studies? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (36 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 25 1 A The one that I just described would be a cohort 2 study. 3 Q And that's to be juxtaposed to a case-controlled 4 study which actually studies individuals and their 5 medical history with regard to exposures to whatever 6 agent might be the subject of the study? 7 A Well, both cohort and case control studies study 8 exposures. In a cohort study, you start with a cohort 9 of workers exposed to certain chemicals and observe them 10 over time to find out what disease they develop and 11 compare the incidence of disease to some other unexposed 12 group. That would be a cohort study. 13 A case-controlled study, like you said, is 14 more or less the opposite in terms of time direction. 15 You start with cases of the disease, patients of the 16 disease, and compare their exposure history to some 17 other group, what we call controls, without a disease. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (37 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 Q Is it true that because of the difference in the 19 approach that case-controlled studies can often detect 20 weaker associations than cohort studies? 21 A No. 22 Q They cannot? 23 A I think you may be referring to the power of the 24 study. I'm not sure what you are getting at. 25 Q Well, I guess in a general sense I am referring to PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 26 1 the power in that isn't it true that the case-controlled 2 studies are often more powerful than a cohort study 3 because they can detect weaker associations? 4 A If you are talking about very rare disease, is 5 true that cohort studying may not be practical because 6 you would need a large cohort in order to come up with file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (38 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 just a few cases of that disease. 8 A case-controlled study would avoid the 9 problem of having a study of tens of thousands of people 10 by concentrating on maybe ten or twenty cases that you 11 can obtain from a hospital. 12 So in that sense for rare disease, 13 case-controlled study may be more practical. But the 14 disadvantage of case control study is that normally the 15 documentation of exposure is very poor compared to 16 cohort study. 17 Q If the incidence of a disease is less frequent in 18 the general population, does that require a larger 19 cohort to study a possible association? 20 A I don't understand the first part of your 21 question. 22 Q If the incidence of a disease is infrequent in the 23 general population -- let me rephrase it. 24 Does the size of the cohort, is that 25 inversely proportional to the incidence of the disease file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (39 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 27 1 in the population? 2 A You are absolutely right. If the disease is rare, 3 infrequent, then you need a large cohort in order to 4 come up with some meaning or meaningful results. 5 Q When you say "rare disease," is there a generally 6 accepted definition of what is a rare disease? 7 A Well, certainly angiosarcoma or mesotheliomo, both 8 of them would be rare disease. A few cases per million 9 per year. That would be rare. 10 Leukemia, I don't think is what we call a 11 rare disease. 12 Q To detect a doubling of disease in a population, 13 if the incidence of that disease was one in a hundred in 14 a general population, what sample size would you need to 15 have to detect a doubling of that disease? 16 A You are overestimating my ability to be able to do file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (40 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 17 that right here. There are a couple of formulas that I 18 have to go to and look at. I can't just answer a 19 question like that. 20 Q Okay. Are these formulas published somewhere? 21 A Yes. They are all over. Any basic textbook. 22 Q What textbook would you go to? 23 A Any textbook that talk about basic statistics. 24 Q Is this a statistical concept or is it a 25 statistics-combined-with-epidemiology type concept? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 28 1 A The underlying concept is more statistical than 2 epidemiological because what you are talking about is 3 what sample size should I have in order to detect such a 4 difference. And the difference you just referred to is 5 a twofold difference. It doesn't matter whether it is a file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (41 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 6 disease that we are talking about or a matter of opinion 7 in the general population. So it is really a 8 statistical issue. 9 Q Okay. The example I gave, doubling of a disease, 10 would an example of that be if you studied a cohort, 11 let's say, in an oil refinery and found out that there 12 were twice as many leukemias as one would expect in the 13 general population. Would that constitute a doubling of 14 the disease in the population you studied; is that an 15 accurate way to phrase that? 16 A Yes. 17 Q And would the relative risk be two? 18 A Yes. 19 Q So to define relative risk, you divide the amount, 20 the incidence, in the cohort population with the 21 incidence in the general population? 22 A Yes. 23 Q Is there a relative risk that has to be present in 24 order to conclude that the association is statistically 25 significant? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (42 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 29 1 A The sample has to be sufficiently large for you to 2 make the statement whether the result is statistically 3 significant or not. Let me give you an example. 4 If you have a sample of three, and two out 5 of the three got a disease, okay, so your incidence rate 6 is 66 percent. But that doesn't tell you a whole lot 7 because you only have three people. 8 On the other hand, if you have 3,000 people 9 and 2,000 of them have that condition, you still have 10 the same incidence rate. But I'm sure you will agree 11 with me, in the second case with the larger sample, you 12 feel a lot more confident about your result than the 13 first one. 14 Q And with regard to the sample size; that is, 15 whether or not the sample size is sufficient, depends on 16 the incidence of the disease in the general population; file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (43 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 17 is that accurate? 18 A Those two are related. 19 Q So if you have an incidence that is relatively 20 small in the general population, and you study a small 21 cohort, your study is not going to be very useful; is 22 that a fair statement? 23 A By itself it would not be very useful. That's 24 correct. 25 Q Do you know what the incidence of myelodysplastic PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 30 1 syndrome is in the general population? 2 A Overall, in the older age group, about 60, I would 3 say I think it is around one per thousand. 4 Q One per 1,000. And that's in the older age group? 5 A I would say -- by "older," I mean above age 60. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (44 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 6 Q From age 60 on? 7 A Right. 8 Q Do you know what the incidence is below age 60? 9 A Would be lower. I don't know what that would be. 10 Q I'm still curious about the formula to determine 11 the sample size. Is there an authoritative text on 12 epidemiology that you would recognize in determining 13 that issue? 14 A There is a book that I can recall right now that I 15 go to from time to time, and I'm sure that one would 16 have the formula. It is a book by Harvey Checkoway, 17 C-h-e-c-k-o-w-a-y. I think it is called Research 18 Methods in Occupational Epidemiology, published by 19 Oxford University. 20 Q What other authoritative texts on epidemiology are 21 there? 22 A The classic, written by a former professor at John 23 Hopkins, Lilienfeld. L-i-l-i-e-n-f-e-l-d. 24 Q Lilienfeld is the author? 25 A Yes. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (45 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 31 1 Q Do you know the name? 2 A I think it is simply called Epidemiology. 3 Q Are you familiar with clinical trials? 4 A To some extent, yes. 5 Q What are they? 6 A Technically, clinical trials is part of the 7 epidemiology as well. The kind of studies that we just 8 talked about a few minutes ago are more or less 9 observational in the sense that you go to a refinery, 10 you study whatever people did. You have no control over 11 who works at the refinery. 12 A clinical trial is different. You have 13 some control over which group the patients go into, 14 either placebo group or group that would receive some 15 new medication. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (46 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 16 Q What's the purpose of a clinical trial? 17 A A clinical trial is to determine the safety and 18 effectiveness of some new, for example, medication. You 19 would organize the patients who come to the hospital 20 into either the placebo group or what we call the 21 treatment group, and you observe the two groups over 22 time and determine whether indeed the medication is 23 effective and indeed the medication is safe. 24 Q Is there a size of the group that's normally 25 tested in these clinical trials? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 32 1 A The different phases of clinical trial, in the 2 very first phase, Phase 1 or Phase 2, what you are 3 interested in is just to determine what kind of dosage 4 you would give to the patient without any acute file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (47 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 5 toxicity. So you would want to make the group as small 6 as possible. 7 Phase 3 is what we call comparative trial. 8 You would have multicenter, larger scale study. And 9 again, depends on what you want to find out. 10 Q So you don't know how large that third stage would 11 be? 12 A You use whole -- the same formula to determine the 13 sample size, that the same formula that we use to 14 calculate cohort. 15 Q Okay. And once a drug is shown to be not causing 16 adverse effects in these clinical trials, it is normally 17 marketed; is that correct? 18 A I don't know what kind of requirements you got to 19 go through in order to market a product. I don't have 20 that knowledge. 21 Q Okay. Isn't it true that sometimes after drugs 22 have been shown in clinical trials not to cause any 23 adverse effect that, once they are marketed, they cause 24 adverse effects in some people who eventually either get 25 sick or die? Are you aware of that occurring with file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (48 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 33 1 regard to clinical trials? 2 A I can think of some hypothetical scenario. 3 Clinical trials usually lasts maybe a few months or even 4 a few years. Some of the long-term effects you may or 5 may not be able to observe in a clinical trial. 6 So I would not be surprised that in some 7 cases you do see some adverse health effect that you did 8 not detect in the clinical trial. 9 Q So you are referring to a latency period for the 10 adverse effect which was not sufficiently observed 11 possibly in the clinical trial period? 12 A Depends on the chemical. Depends on the 13 medication. Sometimes it may take longer than the 14 duration of the clinical trial to observe that. 15 Q Can you think of any other reason why a drug might file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (49 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 16 cause adverse effects in the general population that 17 were not observed in the clinical trial? 18 A Well, another scenario I can think of now is the 19 medication, that the drug may interact with something 20 else that becomes more toxic than we study in the 21 clinical trial. 22 Q Is it also possible that the sample size was not 23 large enough to detect the adverse effects that were 24 later observed in the general population? 25 A Is possible, but in order to do a clinical trial, PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 34 1 you have to go through the issue of power calculation, 2 power consideration. You have to specify what kind of 3 risk you intend to detect and your sample size is based 4 on that. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (50 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 5 So if you conduct a clinical trial based on 6 the protocol, then supposedly, if you don't see any 7 effect with that sample size, that should be conclusive 8 as far as your hypothesis is concerned. You always stay 9 in your protocol, what kind of risk you want to detect 10 in the clinical trial. 11 Q So I guess the problem can also be with the 12 hypothesis in the clinical trial. If the hypothesis 13 were not correct, then the sample size might not be 14 sufficiently large to allow the adverse effects to be 15 observed. 16 Is that a fair statement? 17 A Yes. 18 Q When were you first contacted in this case? 19 A July or August 1995. 20 Q Who contacted you? 21 A I believe it was Mr. Whitney. 22 Q Was it by telephone or by correspondence? 23 A By phone first. 24 Q Had anyone called you from SmithKline and Beecham 25 prior to Mr. Whitney calling you? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (51 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 35 1 A No. 2 Q What was the extent of your initial phone 3 conversation? 4 A I think, basically, Mr. Whitney told me some of 5 the basic facts of the case and asked me whether I would 6 be interested in working with him. 7 Q Do you recall what he told you? 8 A Not really. 9 Q This file here, is this your correspondence? 10 A Yes. 11 MR. WILLIAMS: Let's mark this as Exhibit 4. 12 (Whereupon, Plaintiff's Exhibit No. 4 is 13 marked for identification.) 14 Q (BY MR. WILLIAMS): Does Exhibit 4 contain all file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (52 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 15 your billing to date on this case? 16 A Except for this month. 17 Q Okay. And all the correspondence from Mr. Whitney 18 is in Exhibit 4, except for transmittal letters in this 19 exhibit which we are going to mark as 5? 20 A Yes. 21 Q Is that right? 22 A Yes. 23 Q Did you have any other phone conversations? 24 A After, with Mr. Whitney, after the initial 25 conversation with regard to the facts of the case, we PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 36 1 had several phone conversations. 2 I cannot tell you today whether we discussed 3 in those subsequent conversations, whether we discussed file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (53 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 4 the facts of the case or not. I think we spend more 5 time discussing whether the deposition in general would 6 go ahead or not. 7 Q And those conversations were in January? 8 A I think it was in January. 9 Q But you wrote your opinion in this case on 10 September 12th, 1995? 11 A Right. 12 Q Has your opinion changed since you wrote your 13 opinion on September 12th, 1995? 14 A No. 15 Q You have received records subsequent to 16 September 12th, 1995, haven't you? 17 A Right. 18 Q When you rendered your opinion, what was your 19 understanding of the exposure of Ms. Lakie to benzene? 20 A That she was exposed to benzene through some 21 dental adhesive. 22 Q You didn't do any calculations, I take it, on the 23 amount of benzene that she was exposed to, did you? 24 A No, I did not. 25 Q And when you rendered your opinion in September, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (54 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 37 1 did you know what her total exposure was? 2 A I rely on some calculations done by Dr. Jacobus. 3 Q So your opinion is based on what Dr. Jacobus 4 calculated? 5 A For the exposure part, yes. 6 Q Does it affect your opinion if you do not consider 7 Dr. Jacobus' calculation, and you assume that Ms. Lakie 8 absorbed 98 percent of the benzene to which she was 9 exposed? 10 A I should really be more specific. 11 I say I rely on Dr. Jacobus' calculation. 12 It is not an exact number because all those are, 13 basically, calculated estimates. I really look at the 14 range, what kind of range of exposure we are talking file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (55 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 15 about, and compare that to what we know in epidemiology. 16 Q Do you recall what the range of exposure was that 17 you were looking at when you rendered your opinion? 18 MR. WHITNEY: You are free to look at your 19 report. 20 THE WITNESS: I remember. 21 Q (BY MR. WILLIAMS): I think all the pages of your 22 report are here, even if some of your CV was omitted. 23 A The range was in the neighborhood of 1 to 200 24 microgram per day. 25 Q 1 to 200 micrograms per day? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 38 1 A In that range. 2 Q That was the range you were considering? 3 A Yes. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (56 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 4 Q Was Mrs. Lakie's disease explained to you by 5 Mr. Whitney? 6 A He told me what it was. 7 Q What did he tell you? 8 A MDS. 9 Q And I know there are a lot of medical records in 10 here. 11 Did you have an opportunity to review this 12 in Exhibit 5? 13 A Yes. 14 Q What is your understanding of Mrs. Lakie's 15 disease, of what she has? 16 A It was MDS. 17 Q By that you mean myelodysplastic syndrome? 18 A Yes. 19 Q What is myelodysplastic syndrome? 20 A It is a disease of the blood and, as well, the 21 bone marrow. I don't know what else you want me to tell 22 you about it. 23 Q I want you to tell me what your understanding is. 24 It is a disease of the blood? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (57 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 25 A As well as the bone marrow. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 39 1 Q In what sense is it a disease of the blood? 2 A It usually affects a number of different 3 circulating elements in the blood in the sense that, for 4 example, white blood cell count would be depressed. 5 Q And would the red blood cell count also be 6 depressed? 7 A In most cases, that would be the case. 8 Q In what sense is it a disease of the bone marrow? 9 A The appearance of bone marrow would not look 10 normal. You cannot function -- it doesn't function as 11 normal bone marrow sometimes. 12 Q Do you know whether or not Mrs. Lakie has any 13 chromosome abnormality? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (58 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 14 A I think she did. 15 Q Do you know which ones? 16 A 5Q. Actually, she was diagnosed with a very 17 specific type of MDS, 5Q minus. 18 Q What is 5Q minus? 19 A 5Q minus simply means that one of the arms of the 20 chromosome five is absent. That's one of the benchmarks 21 of a specific type of MDS. 22 Q Do you know when the term "MDS" first came into 23 use? 24 A I believe it was in the early 1980s by the FAB, 25 French American British panel. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 40 1 Q So prior to the early '80s, the term 2 myelodysplastic syndrome was not in use in the medical file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (59 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 3 community for this type of disease? 4 A I don't know whether that term was ever used 5 before 1980s or not. What I said was FAB really come 6 up, developed a classification of the subtypes of MDS 7 and recommend the use of the term "MDS." 8 So MDS, the use of the term MDS became more 9 popular since the 1980s. 10 Q Would it be fair to say it became generally 11 accepted, a generally accepted term in the medical 12 community as developed by the FAB group? 13 A I would agree to that. 14 Q How does MDS differ from leukemia? 15 A They are different diseases. Different 16 International Classification of Disease code, certainly, 17 you would treat them differently and so on. 18 Q Well, does MDS have any relationship to leukemia? 19 A According to the literature, certain types of MDS 20 have a higher risk of progressing into acute myeloid 21 leukemia. 22 Q Do you know which types those are? 23 A I think it is the type that, with what they call 24 excess blast, b-l-a-s-t-s. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (60 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 25 Q Do you know whether Ms. Lakie has excess blasts or PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 41 1 not? 2 A No, she did not. 3 Q Isn't MDS also known as a preleukemia syndrome? 4 A Some people consider those subtypes, yes, 5 preleukemic. 6 Q The subtypes developed by the FAB group? 7 A The type of excess blasts would be considered as 8 preleukemic, yes. 9 Q You would agree, I take it, that benzene is a 10 carcinogen? 11 A I agree. 12 But at the same time, whenever we talk about 13 benzene and we call that a carcinogen, we need to know file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (61 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 14 what kind of exposure we are talking about because if 15 the exposure is low it is not carcinogenic. 16 Q Within those parameters, you would agree that 17 benzene is a known human carcinogen? 18 A Yes. 19 Q And do you have an opinion on whether benzene is 20 also a mutogent? 21 A That's outside of my area. 22 Q You have no opinion on that? 23 A I have come across papers indicating it is 24 mutogenic, but I have not done any exhaustive research 25 on analysis of the literature, so I won't be able to PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 42 1 offer you an opinion on that subject. 2 Q Okay. Do you have an opinion on whether benzene file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (62 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 3 is genotoxic? 4 A I would give you the same answer. 5 Q As the one you just gave? 6 A Right. 7 Q You came across papers, that is, but you have not 8 done any studies yourself? 9 A Right. 10 Q And do you have an opinion whether or not benzene 11 is cytotoxic? 12 A I will give you the same answer again. 13 Q You would agree that benzene is toxic to bone 14 marrow, would you not? 15 A Given enough exposure, yes. 16 Q How long has it been known that benzene causes 17 bone marrow toxicity in humans? 18 A I would say there are some case reports going back 19 to at least early part of the century. 20 Q Do you have an opinion on whether or not benzene 21 causes MDS? 22 A I think there is some evidence that benzene causes 23 MDS if the exposure is high. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (63 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 24 Q When you say "high," what do you mean? 25 A As I stated in my report, there are a couple of PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 43 1 studies, reports, indicating that when workers were 2 exposed to benzene levels above 100 ppm, they have an 3 increase result of MDS. 4 MR. WILLIAMS: Off the record. 5 (Discussion off the record.) 6 Q (BY MR. WILLIAMS): You've indicated that there 7 are studies which indicate that there is an increase of 8 MDS at exposure to benzene levels above 100 parts per 9 million? 10 A Yes. 11 Q And you noted, on page 3, two studies which I 12 think are the only two studies in your report that you file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (64 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 did not actually perform, one by Aksoy and one by Kipen? 14 A Yes. 15 Q Do you know whether or not there are any other 16 studies which indicate that there is an increased risk 17 of MDS at exposure to benzene levels below 100 parts per 18 million? 19 A I'm not aware of any. 20 Q What type of search did you do to determine 21 whether or not that was true? 22 A I did a search on MDS and benzene exposure and got 23 some classical case reports and so on. There aren't 24 really any. If you go and do a computerized database 25 search, you will not be able to find any study at all on PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 44 1 MDS and benzene exposure. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (65 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 2 MR. WILLIAMS: Will you repeat his answer, 3 please. 4 (Record read by the reporter.) 5 Q (BY MR. WILLIAMS): Dr. Wong, would you also agree 6 that benzene causes leukopenia? 7 A Again, within the parameter that we are talking 8 about sufficient exposure. 9 Q Do you know whether or not Mrs. Lakie has 10 leukopenia? 11 A I don't remember. 12 Q Do you agree that benzene also causes, with 13 sufficient exposure, pancytopenia? 14 A Yes. 15 Q And it also causes aplastic anemia? 16 A Yes. 17 Q Isn't it true that it is now recognized clinically 18 that acute leukemia is often preceded months or years by 19 abnormalities of the blood and bone marrow? 20 A I'm not a clinician, so I won't be able to tell. 21 Q You don't have an opinion? 22 A No. 23 Q Is it your opinion that one would have to be a file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (66 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 24 medical doctor to be able to respond to that question? 25 A I just don't think you can. I'm qualified to PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 45 1 review and critique the literature in that area to be 2 able to answer your question. 3 Q Okay. Let's see if you can answer this: 4 Do you agree that bone marrow suppression, 5 aplastic anemia and myeloid leukemia represents a 6 continuum or spectrum of blood dyscrasias rather than 7 separate or unrelated entities? 8 A Again, I won't be able to answer your question. 9 Q Have there been studies that have shown that 10 chemical workers occupationally exposed to benzene 11 experience significant mortality excess from leukemia as 12 well as the broader category of broad emphatic and file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (67 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 hematopoietic cancer when compared to workers who were 14 not occupationally exposed to benzene? 15 A I suspect you're quoting part of my paper, written 16 some time ago. In that paper I basically said if you 17 compare the workers who were exposed to benzene to 18 workers who were not exposed to benzene, you do see an 19 increase largely due to the absence of leukemia in the 20 non-exposed group. 21 Q But your statement went beyond just leukemia to 22 include all emphatic and hematopoietic cancer? 23 A That's true. 24 And the increases that I refer to in the 25 broader group -- in the paper, I already said that PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 46 1 increase was driven by the observation of leukemic cases file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (68 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 2 of exposed group and the lack of leukemia in the 3 non-exposed group. 4 I just want to be sure you read the entire 5 article and not just the paragraph. 6 Q Was this article submitted to OSHA or what was the 7 article that you are referring to? 8 A I'm referring to two articles that I published in 9 1987. Before the publication of the article, OSHA 10 invited me to testify at 1986 benzene hearing to talk 11 about my study. So I probably had made some statements 12 similar to what I stated in my articles. 13 Q So when you testified before OSHA, you actually 14 hadn't published your articles yet. And I believe you 15 are referring to two of the articles, in your opinion, 16 aren't you, regarding the industry-wide mortality study 17 of chemical workers occupationally exposed to benzene? 18 A Yes. 19 Q Did you actually testify before OSHA or did you 20 just submit a paper? 21 A I testified in front of what they call an 22 administrative judge. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (69 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 Q Do you have a transcript of that testimony? 24 A I don't have it, but I'm sure OSHA would have one. 25 I just want to make sure the record is PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 47 1 clear. Although the publications, the two publications 2 you refer to, have appeared in 1987, the manuscripts, 3 the papers were submitted to the journal long before 4 that. There is a latency between the submitting of a 5 manuscript and the appearance of the paper. I submitted 6 that way back in 1986. 7 Q A year before it was published? 8 A Lucky, if it is one year. 9 Q When were those studies actually done? 10 A Over a period of years starting from the early -11 either the late '70s or early 1980s. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (70 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 THE WITNESS: Good time for a break. 13 (Brief recess taken.) 14 (Whereupon, Plaintiff's Exhibit No. 5 is 15 marked for identification.) 16 MR. WILLIAMS: Back on. 17 Q (BY MR. WILLIAMS): Dr. Wong, on your letter or 18 your report you've already indicated this, that -- why 19 don't you state your opinion for the record with regard 20 to Ms. Lakie's causation of her disease. 21 A Basically, my opinion is that her exposure was 22 very, very low compared to the studies of the exposures 23 we have in studies of workers with an increased risk of 24 MDS. So based on that consideration, I do not think her 25 MDS was related to her exposure. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 48 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (71 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 Q And you are basing that in part on a comparison to 2 workers, studies of workers who inhale benzene in air; 3 is that correct? 4 A Yes. 5 Q Do you know how Ms. Lakie's exposure took place? 6 A Through injection. 7 Q Orally, correct? 8 A Yes. 9 Q It was not through inhalation, was it? 10 A No. 11 Q Do you plan on offering any opinion as to the risk 12 associated with using the Orafix in this case? 13 A I'm not sure I see the distinction between what I 14 just said and your question. 15 Q Well, it is your opinion that there is no 16 increased risk of MDS among workers exposed to benzene 17 levels less than 100 parts per million; is that correct? 18 A Yes, sir. 19 Q And the basis for your opinion is the studies 20 which you cited in your report, correct? 21 A The studies that I have done and also two studies 22 that were conducted by others, yes. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (72 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 Q Has a safe level of benzene exposure ever been 24 established? 25 A Safe for what? I guess that's the question PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 49 1 because -2 Q Safe from risk of disease. 3 A If we take leukemia, as an example, some studies 4 have indicated that exposure below 40 ppm years would 5 not increase the risk of leukemia. There are some 6 publications on that. I, myself, have also analyzed 7 from data from NIOSH, the National Institute for 8 Occupational Safety and Health. I analyzed the data 9 collected by them, and my conclusion is if we look at 10 the specific type of leukemia that's associated with 11 benzene exposure, and that is acute myeloid leukemia, it file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (73 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 would take anywhere between 300 to 500 ppm years to have 13 an increased risk. 14 Q Didn't one of your studies find a cases where a 15 worker was exposed to 0.5 parts per million for 1.2 16 years? 17 A When you try to determine what level is safe, you 18 cannot just look at one or two cases. 19 Q But that's true, isn't it, in one of your studies 20 there was a case of leukemia in a worker who was exposed 21 to 0.5 parts per million for one to two years? 22 A It is true, but in any industrial cohorts you 23 would have not only chemically related cases, but you 24 would also have the so-called expectant cases, the 25 background cases. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 50 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (74 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 When we say "background cases," those cases 2 are not related to the chemicals in question. And, 3 therefore, you would not be fair to pick one case with 4 the lowest exposure and try to attribute that to 5 chemical exposure. That case would be what we call a 6 background case. 7 Q Why do you say that that's a background case and 8 not a case of a person who perhaps is more susceptible 9 of the ill effects of benzene exposure? 10 A When you compare a group of chemical workers with 11 a group of people not exposed to the chemical, benzene 12 in this case, you will see cases in both groups 13 regardless whether that chemical can cause the disease 14 or not. It would be unscientific to simply pick one 15 case and say that case with the lowest exposure is 16 related to benzene exposure. 17 Q Wouldn't it also be not good scientific practice 18 to say that it is not related? 19 A You don't know. What you need to do is do what we 20 call an exposure response meta-analysis. In other 21 words, in your cohort, in your group, you divided people file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (75 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 up into several subgroups, smaller groups according to 23 the level of exposure they had, and see when the risk 24 was, when the risk would go up and at what level. 25 You cannot look at cases. You have to look PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 51 1 at the underlying population at risk. It can be the 2 entire population or it can be subgroups in the 3 population. 4 Q I want to get back to my original question which 5 started us on this. I asked you whether any safe level 6 of benzene exposure has ever been established. 7 You would agree that no safe level has ever 8 been established, would you? 9 MR. WHITNEY: Objection. 10 THE WITNESS: That's not true at all. I file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (76 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 just said that based on my analysis on the data directed 12 by NIOSH, if we look at AML, acute myeloid leukemia, as 13 the endpoint, you don't have an increased risk number 14 until you reach 300 to 500 ppm years. 15 Q (BY MR. WILLIAMS): That's for AML? 16 A That's for AML, yes. 17 Q Well, doesn't using AML as an endpoint 18 underestimate the risk associated from benzene exposure? 19 A I don't think by combining those two really makes 20 much sense, because we have a level that's safe as far 21 as leukemia is concerned. 22 And in my report I talk about MDS. The 23 level would be one hundred ppm. 24 Q What is your level to be safe for leukemia? 25 A For leukemia is either 300 or 500 ppm years, PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (77 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 52 1 depending on what exposure you are looking at. 2 Q What is the difference between saying 300 parts 3 per million and 300 parts per million years? 4 A 300 parts per million by itself is the average 5 concentration of benzene in the air. 6 Q Okay. 7 A 300 ppm years is what we call cumulative exposure. 8 In other words, you are exposed to benzene at a certain 9 level over a period. You multiply the concentration by 10 the duration and get ppm years. It is identical to the 11 concept of how many packs of cigarettes you smoke for 12 how long. 13 Q In your opinion, is there a safe level of benzene 14 in the air for industry? 15 A Yes. 16 Q What is that, not using parts per million years 17 but just using an average concentration? 18 A Again, going back to my analysis on AML, I come to 19 the conclusion that exposure between 300 and 500 ppm 20 years would not increase the risk of AML. 21 Let's just take the average, 400 ppm years, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (78 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 as the midpoint. That would be the cumulative 23 exposures. And if we assume someone who works or is 24 exposed at certain levels for 40 years, in order to get 25 the average concentration, we will simply divide 400 ppm PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 53 1 years by 40 years. That would be the total length of 2 somebody's working life. 3 Q Okay. 4 A And that would give us 10. 5 Q 10 ppm? 6 A I'm sorry? 7 Q 10 ppm would be the average concentration in air 8 for the worker who is going to work 40 years in that 9 air? 10 A Did you say 4 or 40? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (79 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 Q 40. 12 A Yes. 13 Q I want to make sure I understand what ppm years 14 is. 15 A You say 10 ppm multiplied by 40 years gives you 16 400 ppm years. 17 Q Now, this is your opinion on safe level. My 18 question really was: Has industry or the government 19 established a safe level of benzene exposure? 20 A Certainly OSHA has established. 21 Q And the OSHA is one part per million, is it not? 22 A One part per million. 23 Q Is that considered by OSHA to be a safe standard 24 or was that a compromise? 25 A You would have to depose OSHA. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (80 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 54 1 Q Didn't Peter Enfante and others argue for a level 2 of 0.1 part per million? 3 A I think we may be mixing a couple of things here. 4 One is what a safe level is based on scientific data, 5 and the other is what is the level that we should use, 6 in policy. Those are two different issues because in 7 policy you want to build in a huge safety factor. 8 Q Why is that? 9 A I don't know. 10 Q You don't know why? 11 A I don't know why. 12 Q Well, are you aware of what water standard is 13 established by the EPA for benzene? 14 A I run it from time to time. I don't know how they 15 arrive at that number. 16 Q Isn't it five parts per billion? 17 A I said I don't know what the number is. 18 Q Wouldn't the broader associated consideration be 19 that the general public is more susceptible, varying 20 levels of susceptibility, as opposed to workers in the file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (81 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 workplace? 22 A I don't think. As far as leukemia is concerned, I 23 don't think there is any selection criteria that when 24 you apply for a job somehow if you are susceptible to 25 leukemia you get kicked out. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 55 1 Q But, again, back to this question I'm struggling 2 with, the OSHA level of one part per million in the 3 workplace, that is not accepted to be a safe level for 4 benzene exposure, is it? 5 A Let's see if this would help you with your 6 question. A lot of times the standards are set based on 7 what we call risk assessment models. And those risk 8 assessment models would give us theoretical risk, not 9 necessary risk that we expect to see. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (82 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 In fact, if you apply the numbers provided 11 by risk assessment models back to some real studies, you 12 will see that those risk assessment models way 13 overestimate the number of cases you actually observe in 14 those studies. 15 Q But has OSHA ever said this is the level of 16 benzene exposure, as long as you are below that, there 17 is no risk for anyone getting ill? 18 A I don't know what OSHA said. 19 Q Are you aware of any government agency that ever 20 made such a statement or established a standard below 21 which that agency is suggesting that there is no risk 22 from illness from benzene exposure? 23 A I have never looked into nor tried to understand 24 the rationale behind proposing or setting a standard, a 25 number, because to me when they use risk assessment, PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (83 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 56 1 basically, they do not rely on science anymore. 2 Q So you don't think risk assessment is based on 3 science? 4 A It is based on mathematical modeling, not based on 5 real data. 6 Q I understand what you are saying, I think. 7 Isn't it true that OSHA, to the best of your 8 knowledge, has never said if you have benzene exposure 9 less than a certain level, there will be no risk from 10 disease due to benzene exposure? 11 A I don't know whether they have said that or not. 12 Q Do you know whether any government agency has ever 13 said such a thing? 14 A I don't know. 15 Q Now, your opinion is that the risk of AML occurs 16 at a threshold between 300 and 500 part per million 17 years and above; is that correct? 18 A Yes, sir. 19 Q And your opinion is that at a hundred parts per 20 million concentration in air, and below, there is no file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (84 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 risk of developing MDS? 22 A Yes. 23 Q And these are both, I assume, for workers? We are 24 talking about workers now? 25 A These are based on workers' studies. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 57 1 Q All right. Well, are you suggesting that if a 2 worker worked for 40 years in a plant where there was a 3 hundred parts per million concentration of benzene in 4 the air, let's say 99 parts per million benzene 5 concentration in the air -6 A How much? 7 Q 99 parts per million. 8 -- that worker would have no risk of 9 developing MDS, but would have a risk of developing file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (85 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 leukemia. 11 A I think you give too much confidence to the 12 industrial hygienist. When we say 100 ppm in the air, 13 we really mean in the neighborhood. I don't think we 14 can distinguish 99 ppm from 100 ppm. 15 Q We'll say 50. Let's get away from the hundred. 16 Let's say the concentration in the air is 50 17 parts per million, and we have a worker that works for 18 40 years. 19 A Yes. 20 Q I take it on what you state here today that your 21 opinion is that worker would have an increased risk of 22 developing leukemia because it would be 2,000 parts per 23 million years? 24 A Specifically AML? 25 Q AML. But that worker would have no risk of PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (86 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 58 1 developing MDS? 2 A No increased risk of developing MDS as opposed to 3 the risk that you and I have to. 4 Q The worker would have the increased risk of 5 developing leukemia, AML, but not an increased risk of 6 developing MDS? 7 A Yes. 8 Q That's your opinion? 9 A That's my opinion. 10 Q Okay. Now, in cohort studies, if there is an 11 absence of association found between an agent and a 12 disease, that doesn't mean that causation for that 13 disease does not exist by exposure to that agent, does 14 it? 15 A Depends on the study. If the study is large, the 16 people come from different places, and you have exposure 17 data, I think we are -- you are driving at what the 18 criteria for causation are in chronic diseases. 19 You cannot just simplify the whole situation file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (87 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 by saying if we see an increase or we don't see an 21 increase in the study we stop at that. We don't. 22 Q So a study alone, if one study alone does not show 23 an association, it is not the end of the inquiry; is 24 that what you are suggesting? 25 A I would say most likely not, unless the study is PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 59 1 so huge that we can make exception. 2 Q How huge would the study have to be with regard to 3 MDS, for example, and being caused by or to show an 4 association between benzene and MDS? 5 A I would say if we end up observing at least ten or 6 fifteen cases of MDS, and we have some good exposure 7 data for everybody in the study, then I would say that 8 study is pretty definitive. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (88 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 Q Let me give you a hypothetical. If you studied 10 110,000 workers, okay, and 75,000 of the workers were 11 exposed to benzene and 35,000 were not exposed to 12 benzene, and assume that the study is age-adjusted and 13 sex-adjusted, and also assume that the workers were 14 employed during the same period of time and at the same 15 factories, in doing such a study, if you discovered an 16 increase or if you discovered in the exposed workers 17 that there were several cases of MDS and in the 18 non-exposed workers there were no cases of MDS, would 19 that be a significant finding? 20 A If they have exposure data, and we can believe in 21 the exposure data, I think that study would add to the 22 literature, but I don't think that study by itself would 23 have sufficient information for me to say yes, I'm going 24 to look at this study only and nothing else. 25 Q Okay. But the study would indicate, would it not, PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (89 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 60 1 that there was an association between benzene exposure 2 and MDS? 3 A Yes, it would, but I thought the more important 4 question is at what level of benzene exposure. I don't 5 think we are -6 Q Well, assuming the exposure data is well 7 chronicled, such a study would be a significant finding, 8 would it not, in the inquiry whether there was an 9 association between benzene and MDS, benzene exposure 10 and MDS? 11 A I would think so. If the study is done properly, 12 then I think we should look at that, yes. 13 Q As a corollary, my first question really was, if 14 you have a cohort study and there is an absence, you 15 find an absence of association between an agent and a 16 disease, that study alone does not mean that causation 17 does not exist between that agent and that disease? 18 A I think I answered that question by saying it 19 depends on how good the study is, how large the study file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (90 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 is, and how diversified the study is in the sense that 21 do you study only one location or do you have different 22 locations. 23 When we talk about causation there are a 24 number of things that we should look at: How strong an 25 association is, how consistent the result is, and how PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 61 1 specific the result is and so on. 2 Q Do you know what the actual level established by 3 OSHA is? 4 A No, I don't recall at this point. 5 Q Have you read the recent OSHA regulation? 6 A What's the date of the most recent OSHA? 7 Q Probably '96. 8 A '96? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (91 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 Q I'm sorry. July '95. 10 A No, I have not. 11 Q Now, the basis of your opinion is the studies 12 you've cited, all of which you conducted except for the 13 one by Aksoy and Kipen? 14 A Yes. 15 Q And your studies were all mortality studies, 16 weren't they? 17 A Yes. 18 Q How do you conduct the mortality study? How do 19 you conduct -20 A That's the six-million-dollar question. 21 Q Is it a hard question to answer? 22 A (No response.) 23 Q Are there some basic steps to follow? 24 A Are you referring to a typical mortality study we 25 do in this country as opposed to someplace else? I PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (92 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 62 1 mean, narrow it down for me. 2 Q Well, ones that you did in this case or not in 3 this case, but the ones you referred to in this case. 4 A The studies that I have done, and I refer to in my 5 report? 6 Q Yes. 7 A Okay. Most of them would fit into what we call 8 historical cohort study. What we do is we identify the 9 group of people we want to study through historical 10 employment records by going to a company, go through all 11 their employment records to identify the people exposed 12 to certain chemicals who work there for a minimum of six 13 months or year. That's how we identify the cohort. 14 Once we have identified the cohort, then we 15 want to find out what happened to them. If it is a 16 mortality study, we would want to find out whether they 17 have died, and, if they died, what they died from. 18 And there are a number of places we can go file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (93 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 to to find out whether people are still alive or not 20 such as the Social Security Administration, the National 21 Death Index. 22 Once we find out who has died, then we have 23 to write to each state health department to get a copy 24 of the death certificate. 25 We get the death certificate, we find out PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 63 1 what the cause of death was and, basically, compile the 2 statistics, compare how many cases of certain cancer 3 that we have in the study, compare that to what we 4 expect to see in the general population. 5 That's more of the essence of a cohort 6 study. 7 Q Okay. Do you actually get, you yourself, get the file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (94 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 death certificates? 9 A Yes. 10 Q And do you send those to the nosologist? 11 A I look at them, but the actual code is assigned by 12 the nosologist. 13 Q The nosologist reviews the death certificates that 14 you procure and assigns a code from the International 15 Classification of Disease; is that correct? 16 A I think in essence you are correct, but let me 17 just supplement that. Usually, on a death certificate 18 you have more than just one cause of death. You have 19 several causes of death, and the trick is really to be 20 able to identify the underlying cause of death. It may 21 not be the first one on the death certificate or the 22 second one. There is a very compact set of rules that 23 you have to follow to determine which the underlying 24 cause of death is, and, basically, that's the job of a 25 nosologist. PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (95 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 64 1 Q So the nosologist has to look at the certificate 2 and whatever is written there and try to ascertain which 3 is the underlying cause of death? Only the underlying 4 cause of death as determined by the nosologist is coded; 5 is that correct? 6 A In most of my studies, we would code all of the 7 causes of death on the death certificate, and then the 8 nosologist will identify, make a decision as to which 9 one he or she would call the underlying cause of death. 10 In the analysis, at least in most analyses, 11 we would use the underlying cause of death. 12 Q Who typically fills out the death certificate of 13 the individuals that you are looking at? 14 A I guess that would be the physician, the examiner. 15 Q I understand there is a fair degree of inaccuracy 16 in a lot of death certificates in terms of listing the 17 causes of death; is that a fair statement? 18 A I would say it is a fair statement for certain file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (96 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 diseases. For cardiovascular disease, sometime the 20 subgroups -- there may be some misclassification based 21 on death certificates. But for most cancers, the 22 diagnosis is pretty accurate based on the death 23 certificate. 24 Q You have read articles that suggest that 20 to 50 25 percent of death certificates are inaccurate with regard PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 65 1 to the listing of causes of death. 2 A But that's an overall statement. That talks about 3 all death. What I just said is that applies -4 Q So you agree with that, but you are distinguishing 5 between certain types of diseases that in your opinion 6 are more common in errors such as cardiovascular 7 diseases? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (97 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 A Right. 9 Q Any other disease groups that you would suggest as 10 having a wide degree of error in it? 11 A Probably some ill-defined conditions due to old 12 age. I think at certain points the physician may not be 13 really interested or want to spend the time to find out 14 what the actual causes of death is. 15 Q Okay. Now, myelodysplastic syndrome is not listed 16 in the International Classification of Disease, is it? 17 A Different subtypes may be listed under different 18 numbers, different code. 19 Q But MDS is not considered a cause of death, is it? 20 A I'm not sure I understand. MDS is not considered 21 to be a cause of death? 22 Q Correct. That's my question. I'm asking you 23 whether you agree with that. Isn't that true? 24 A If I understand your question, I don't think it is 25 true because MDS -- certainly, you can put down MDS on file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (98 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 66 1 the death certificate and the nosologist, based on that, 2 can assign a code, an ICD code, to that. 3 Q So your opinion is that myelodysplastic syndrome 4 is a cause of death? 5 A Yes, certainly can be cause of death. 6 Q Well -7 A I'm missing something. You cannot be asking that 8 question. I must be missing something. 9 Q Well, MDS is not listed, is not given a number in 10 the International Classification of Disease, is it? I 11 think you already answered that it's not. 12 A But the subgroups are. For example, refractory 13 anemia, I know it has a specific code in the 14 international classification of diseases. 15 Q Okay. But MDS does not have a code? 16 A That, I don't know. 17 Q You don't know whether it does or does not? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (99 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 A I don't know whether it does or does not. 19 Q Do you know what most people that have MDS die 20 from? 21 A I don't. 22 Q So you also wouldn't know the various diseases or 23 conditions that people with MDS die from? 24 A No. 25 Q Now, after the nosologist codes the underlying PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 67 1 cause of death, are these codes then placed into a 2 computer? 3 A Eventually they are, yes. 4 Q And don't you use a computer program to group the 5 various codes of causes of death as they have been put 6 in by the nosologist? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (100 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 A Sometimes we do and sometimes we don't. Depends 8 on what kind of analysis we are talking about. If we 9 are looking at cardiovascular disease, yes, we are going 10 to group some of those individual ICD codes into broader 11 category. But for cancers, sometimes we look at 12 individual codes. 13 Q For cancers? 14 A Yes. 15 Q Okay. In the studies that you noted in here in 16 your report in this case, didn't you use a computer 17 program by Marsh, primarily, to group these various 18 causes of death? 19 A Yes. 20 MR. WILLIAMS: And let me get you to 21 identify this document if you would. This will be 22 Exhibit 6. 23 (Whereupon, Plaintiff's Exhibit No. 6 is 24 marked for identification.) 25 THE WITNESS: Is there a question file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (101 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 68 1 outstanding? 2 Q (BY MR. WILLIAMS): Yes. Can you identify the 3 stuff? 4 A What is that? 5 Q Exhibit 6, can you identify the document? 6 A It is a table. Title of the table is "University 7 of Pittsburgh Mortality and Data System, 1995. ICDA 8 Elements of Default Cause of Death List - 63 Causes." 9 Q Is this the breakdown of causes of death that the 10 Marsh computer program recognizes? 11 A It is one of the many different systems that he 12 has. If you don't specify it, that would be the 13 default. 14 Q What does that mean? 15 A That means when you run your program, you ask 16 if -- you have a number of choices. If you decide not 17 to make a choice, this is the one you end up with. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (102 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 That's what we mean by "default." 19 Q But this is one of the Marsh breakdowns of 20 disease, correct? 21 A It is one of the available type of analyses you 22 can get out, yes. 23 Q Is this one that you used in your mortality 24 studies? 25 A No. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 69 1 Q You did not use this one? 2 A I did not use this particular one. 3 Q On this one, is MDS listed as a cause of death? 4 A No. 5 Q Is refractory anemia? 6 A No. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (103 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 Q If a nosologist saw a death certificate that had 8 MDS listed as a cause of death and nothing else, how 9 would the nosologist know how to code that? 10 A I don't know. I'm not trained as a nosologist. 11 MR. WILLIAMS: Let's turn to your studies 12 which will be Exhibit 7. 13 (Whereupon, Plaintiff's Exhibit No. 7 is 14 marked for identification.) 15 Q (BY MR. WILLIAMS): The first one I have, 16 "Critical Review of Cancer Epidemiology." 17 A Is this the one published in the American Journal 18 of Industrial Medicine, 1989? 19 Q Correct. 20 Is this one of the studies you rely on for 21 your opinion in this case? 22 A Yes. 23 Q I'll state the whole title for the record: 24 "Critical Review of Cancer Epidemiology in Petroleum 25 Industry Employees, With a Quantitative Meta-Analysis by file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (104 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 70 1 Cancer Site." 2 Now, this study looked at the incidence of 3 cancer, did it not? 4 A Yes. 5 Q And it wasn't looking specifically at exposure to 6 benzene, was it? 7 A Only in the sense that refinery workers would be 8 exposed to benzene. 9 Q What was the research question? 10 A The research question was to look at a number of 11 cancer sites that have been indicated in the literature 12 to see what sites are elevated. 13 Q What cancer sites were you looking at in this 14 study? 15 A Basically, we looked at all. 16 Q So I take it you were not looking for file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (105 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 17 myelodysplastic syndrome? 18 A No, we were not. 19 Q And you weren't looking for other cytopenias? 20 A No. 21 Q And you were not looking at the increase of MDS as 22 a result of benzene exposure in this study? 23 A No. 24 Q And this study did not also look at women, did it 25 not -- or did it? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 71 1 A Off the top of my head, I cannot tell you whether 2 some of the studies that I include in this analysis have 3 women or not. I have to go back and look at individual 4 studies. 5 Q If you can read this sentence here. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (106 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 6 A What page? 7 Q Page 304. 8 In the last paragraph, middle of the last 9 paragraph where it says, "The issue of whether 10 benzene" -- I'll just read it, and you tell me what it 11 means -- "or other petroleum hydrocarbons can affect 12 only acute myelogenous leukemia or other cell types as 13 well remains unresolved." 14 A Yes. 15 Q Is that contradictory to your earlier statement 16 that in your opinion there has only been an association 17 between benzene and AML? 18 A I'm glad that you did not depose me six months or 19 whatever earlier because that statement was true at that 20 time because, when we looked at all the data in 1989, we 21 did not have cell-type-specific data. And that's why we 22 make that statement. 23 Subsequent to that, we looked at that issue, 24 we collected data on cell-type leukemia, and we 25 published our analysis last year. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (107 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 72 1 Q Is this one of the new articles that you brought 2 with you today? 3 A No. It is one of the articles that I reference in 4 my report. 5 Q Okay. Would that be the cell-type-specific 6 leukemia analysis? 7 A Right. 8 Q This study, you know, you indicated -- this is a 9 meta-analysis where you basically have reviewed other 10 studies? 11 A Are you talking about the 1989 paper? 12 Q Yes. 13 A It is a critical review plus a meta-analysis of 14 all of the refinery studies ever done in this world, 15 including some of them that I have done. 16 Q What relevance does the study have to your opinion file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (108 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 17 or to this case? 18 A To this case? 19 Q Yes. 20 A Because we know that it takes more -- it takes a 21 high concentration of benzene to induce MDS and 22 leukemia. And if we don't see an increase of leukemia 23 in the population exposed to certain levels of benzene, 24 then we can safely conclude that we do not expect to see 25 MDS in that group as well. And we can make some PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 73 1 judgment as to people exposed to benzene at those levels 2 where they would have an increase of MDS or not. 3 Q Okay. Even though these studies were not directed 4 to find instances of MDS, correct? 5 A That's true. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (109 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 6 Q And they were directed to find instances of cancer 7 which Mrs. Lakie does not have; is that true? 8 A Let me clarify that. This is a 1989 paper, it is 9 a critical review of refinery studies, individual 10 refinery studies. Okay? 11 Some of those studies, in fact, all of those 12 studies, look at more than just cancer. But the topic 13 of analysis in our 1989 paper was cancer. I just want 14 to make it clear that those studies, the individual 15 studies themselves, did look at more than just cancer. 16 Included in them would be disease of the blood and that 17 would include some of the subtypes of MDS. 18 Q Okay. But this paper, this '89 paper that you are 19 relying on didn't look at the association of MDS and 20 benzene? 21 A No. 22 I missed the last part of your question. 23 Did not look at? 24 Q Did not look at the association of MDS and 25 benzene? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (110 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 74 1 A That's correct. 2 Q In fact, it wasn't specifically even looking at 3 benzene, it was looking at cancer sites in refinery 4 workers. 5 A Right. 6 Q And on page 304 didn't you also conclude that, in 7 the middle of that same paragraph: 8 "Third, diagnostic specificity (or 9 lack of) for lymphatic and 10 hematopoietic diseases on death 11 certificates, particularly on 12 older death certificates, may 13 result in inaccuracy of underlying 14 cause of death classification." 15 A In some of those death certificates in the 1940s, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (111 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 16 1930s, I would say yes. 17 Q When did most of the people die that you were 18 looking at in these studies? 19 A These studies cover a period from 19 -- I think 20 way back from the 1930s all the way to the 1980s. I 21 won't be able to tell you when most people died. 22 Q Didn't you also conclude in your study that the 23 incidence of cancer was actually less in the population 24 you studied than in the general population? 25 A For certain cancer, yes. For lung cancer, for PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 75 1 example. 2 Q Anything else? 3 A There is a small decrease in lung cancer, there is 4 a small decrease in digestive cancer. Those were the file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (112 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 5 two major sites. 6 Q So you found that these workers were actually 7 healthier than those in the general population? 8 A In terms of lung cancer, yes. 9 Q Is it important when you do a cohort study, and 10 try to apply that result to a case, to have a 11 correspondence of the age group involved in the case you 12 are analyzing? 13 A I don't think so unless we know that the 14 biological mechanism would be different depending on the 15 age. 16 Q Well, earlier I asked you what the incidence of 17 MDS in the general population was and you told me that 18 the age group from 60 up was one in a thousand. 19 Why did you confine yourself to the age 20 group of 60 up? 21 A I run into that statement someplace. I don't know 22 what that -- I mean, if somebody asked me the question, 23 and I have the time to look it up, I can give you the 24 incidence for every age group. It is just something 25 that I remember. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (113 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 76 1 Q You didn't tell me that because Ms. Lakie is in 2 the 60 age group? 3 A No. 4 Q Who engaged you to perform this particular study? 5 A Who what? 6 Q Engaged you. 7 A Engaged me, okay. 8 Mobil Oil Corporation. 9 Q How much did they pay you for this? 10 A I don't remember the number. 11 Q Do you remember approximately? 12 A I spent a lot of time on that over a period of 13 three or four months. Beyond that, I really don't 14 remember what the contract figure is. 15 Q Did you do it by the hour or was it a contract file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (114 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 16 amount? 17 A I think it was by the number of hours I spent and 18 my staff. 19 Q And your staff? 20 A It is not a fixed amount, if that's the question. 21 Q So it was an hourly rate? 22 A Depends on -- it was a time and material kind of 23 contract. 24 Q What did you charge per hour? Was it the same 25 thing that you charged today? I think your rate is 330 PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 77 1 an hour. 2 A No. That was back in 1989. 3 Q Do you know what your hourly rate was? 4 A I don't know now. Would be less. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (115 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 5 Q How much staff did you have working on this? 6 A On this? 7 Q How much staff do you have? 8 A What was your question, now? 9 Q Back then, what was the size of your staff? 10 A 1989, probably about 30, 40. 11 Q And they all work here in San Francisco? 12 A No. We used to have an office in the East Bay. 13 Q Alameda? 14 A East Bay, Alameda. 15 Q Who would have those figures as to how much you 16 made on this particular study? 17 A I would not know. Let me tell you why. In 1987, 18 our company, at that time I own a company by the name 19 Environmental Health Associates. Together with a couple 20 other people, we own the company. 21 We merged our company in 1987 around that 22 time with a much larger environmental engineering 23 consulting firm by the name ENSR, E-N-S-R. And based on 24 the merge agreement, I would work for them for another 25 three years. And I worked for them for three years. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (116 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 78 1 In 19 -- the end of 1990, I left ENSR. And 2 that project was done when I was at ENSR. So I have no 3 idea what happened to all the files. 4 Q Did they pay ENSR or did they pay you? 5 A At that time? 6 Q Mobile Corporation. 7 A When I did the study? 8 Q Yes. 9 A They pay ENSR. 10 Q Were you an employee of ENSR? 11 A I was an employee of ENSR at the time. 12 Q And it also indicates you were executive vice 13 president. Were you a part owner of ENSR? 14 A It was -- at that time ENSR was a public company. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (117 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 15 I own some shares. 16 Q And they still exist, I take it, ENSR? 17 A I think so. 18 Q You know better than I. 19 A I think so. 20 Q And on this particular study your opinion of why 21 this is relevant is related to the amount of leukemia 22 you found? 23 A Well, the reasoning is we all know that it takes 24 more benzene to induce MDS than to induce leukemia. And 25 if I don't see increase of leukemia in this group of PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 79 1 workers, then I know that they will not have an excess 2 of MDS. And knowing something about the exposure level, 3 that would let me say something about what level would file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (118 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 4 be safe as far as MDS is concerned. 5 Q And if your hypothesis was shown to be incorrect 6 or if you use a different hypothesis, your hypothesis 7 being that it takes more benzene to induce MDS than 8 leukemia -9 A Right. 10 Q -- if you use a different hypothesis, that it took 11 less benzene to induce MDS than it does to induce 12 leukemia, your opinion would change in regard to this 13 article? 14 A Oh, yes. If it takes less benzene to induce MDS, 15 and if I'm convinced of that, then the study on leukemia 16 would not give us any useful information regarding MDS. 17 Q And your sole basis for your hypothesis that it 18 takes more benzene to induce MDS than leukemia is the 19 two articles which you cited by Aksoy and Kipen, 20 correct? 21 A Those two, plus any articles' summary on benzene 22 toxicity would tell you that it takes more benzene to 23 induce MDS than leukemia. 24 Q When you say "summary of benzene toxicity," are 25 you referring to a textbook? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (119 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 80 1 A Yes. Or even review documents by maybe even OSHA 2 or EPA. 3 Q Can you give me an example of an authoritative 4 medical textbook which would indicate what you've 5 suggested? 6 A I have to go back and take a look at what 7 specifically says that. I mean, I come across that all 8 the time, and I can't give you the name of the book 9 today. 10 Q When was the last time you recall reading that 11 statement in a medical textbook? 12 A Long time ago. 13 Q More than five years ago? 14 A I won't say that long. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (120 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 15 Q You don't know -16 A Over the years maybe on and off I would come 17 across that. 18 Q If I showed you a published peer review article 19 that stated that acute leukemia is often preceded by 20 months or even years of functional abnormalities of the 21 blood and bone marrow, would that cause you to question 22 your hypothesis? 23 A No. 24 Q Why? 25 A Because you may see some cases of leukemia with PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 81 1 MDS, but then there may be some cases of leukemia that 2 does not require the development of MDS. 3 So what I'm saying is you may see a higher, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (121 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 4 high number, larger number of leukemia than MDS. 5 Q But if the bone marrow disorder preceded the 6 development of leukemia, isn't that contrary to the 7 hypothesis that you have asserted that it requires more 8 benzene exposure to induce MDS than leukemia? 9 A Yes. But simply, the simple fact that you have 10 abnormal bone marrow doesn't mean that you have MDS. 11 Q Well, you do agree that MDS was called and still 12 is called a preleukemia syndrome, don't you, in the 13 medical community? 14 MR. WHITNEY: Objection. 15 THE WITNESS: I guess that goes back to the 16 previous answer I gave you. Not every leukemia has that 17 occurring before the diagnose of leukemia. 18 Q (BY MR. WILLIAMS): Okay. But if MDS is known in 19 the medical community as a preleukemia, doesn't that 20 indicate that its development is a precursor in those 21 instances to the development of leukemia? 22 MR. WHITNEY: Objection. 23 THE WITNESS: In some of them, not in all of 24 them. Are you saying that every leukemia's got to have file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (122 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 25 MDS? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 82 1 Q (BY MR. WILLIAMS): No, I'm not saying that. I'm 2 trying to obtain an understanding and reconciliation of 3 the description of MDS as preleukemia with your 4 hypothesis that it takes more benzene exposure to induce 5 MDS than it does to induce leukemia. 6 A I guess what I'm saying is that some forms of MDS 7 is. Even if we agree that some forms of MDS is 8 preleukemic, I don't see how that can answer the 9 question, either confirm or refute the observation that 10 the toxologist and epidemiologist have observed that it 11 takes more benzene, higher concentration, to induce MDS 12 than leukemia itself. I don't see a connection. 13 Q Okay. What toxicologists have concluded that? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (123 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 14 A In a lot of textbooks and review articles, 15 basically, they list at what level you receive what kind 16 of symptoms. For example, if you are exposed to 17 benzene, tens of thousands ppm, one of the adverse 18 health effect is immediate death. Very, at very low 19 level you can feel lighted-headed. There is a 20 continuum. 21 And when you look at that, look at those 22 review articles, the level of exposure associated with 23 MDS is much higher than leukemia. 24 Q But you can't show me a textbook that shows that 25 today? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 83 1 A I did not anticipate your question. I did not 2 bring a textbook with me to answer your question. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (124 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 3 Q Okay. Well, wouldn't you agree that the 4 development of aplastic anemia would require less 5 benzene exposure than the development of leukemia? 6 A I don't know that. 7 Q You don't know the answer to that? 8 A I don't know the answer. 9 Q And wouldn't you agree that the development of 10 leukopenia would result from less benzene exposure than 11 that which would be required to induce leukemia? 12 A No. I think more. 13 Q You think leukopenia, reduction of white blood 14 cells, requires more benzene exposure than development 15 of leukemia? 16 A I think so. 17 Q And what articles suggest that? 18 A Well, again, I can't give you the name of the 19 articles today. 20 Q Let's go to the industry-wide mortality study. I 21 think parts one and two. 22 What was the research question in these 23 studies? 24 A Basically, to look at the relationship between file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (125 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 25 benzene exposure and leukemia. And when we first PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 84 1 started the project, we were also interested to get some 2 information on specific leukemia cell types. 3 Q Now, this study didn't include women, did it? 4 A No. 5 Q And it included all young males, did it not? 6 A All young males. I'm not sure. What do you mean 7 by "young"? 8 Q 20s to 30s. 9 A Are you saying that in my study there was no one 10 older than age 40? 11 Q I'm asking you, really, 12 A We have lots of old people. 13 Q In this study? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (126 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 14 A Yes. 15 Q In this study, to be included in the cohort 16 required employment of at least six months, correct? 17 A Exposed for at least six months. 18 Q The study -- but you don't know how long these 19 people in the cohort actually worked in the refinery, do 20 you? 21 A These are not refinery studies. 22 Q These are chemical workers from seven plants. You 23 don't know how long they worked at the plants? 24 A Yes, I do. 25 Q Where is that listed? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 85 1 A When you say "where is it listed," you mean you 2 expect to see a table of the length of employment of all file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (127 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 3 7,000 workers? 4 Q You say -5 A I mean, the question can mean anything. I mean, 6 what are you looking for? 7 Q Well, conceivably some of the people in the cohort 8 could have worked eight months and then left employment? 9 A We have that information. We would know that. 10 Q That information is included in one of these 11 tables, I take it? 12 A Okay. If you go to the second article, page 384, 13 Table 3, that would give you the distribution of the 14 workers by length of exposure. 15 Q In other words, the majority of workers worked for 16 less than four years, didn't they? 17 A When you say "majority," I assume you mean more 18 than 50 percent, and if that's the case it is not true. 19 Q I mean -- okay. The majority worked for less than 20 nine years or less? 21 A Yes. 22 Q Is that right? 23 This study, I take it, does not allow you to file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (128 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 24 make any statistical conclusions with regard to the 25 effect of benzene on women. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 86 1 A Why not? 2 Q There are no women included. It is all men. 3 A Do we have any evidence that women would behave 4 differently when they are exposed to benzene? 5 Q Well, are you aware of no differences between the 6 development of MDS in men and women? 7 A As a result of benzene exposure? 8 Q In general. 9 A I thought we are talking about benzene-related 10 MDS? 11 Q Well, in general, are you aware of any differences 12 between the development of this disease, MDS, between file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (129 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 men and women? 14 A I'm not aware of any paper that talks about 15 biological differences or mechanisms in terms of 16 developing MDS. 17 Q Well, this paper doesn't allow you to make any 18 statistical correlations between the effect of benzene 19 exposure on men and women, does it? 20 A I think it would be a mistake to say that if the 21 study is based on men alone that the result would not 22 apply to women. 23 Q That's not what I'm asking. 24 A Can I finish my answer? I haven't finished. 25 MR. WHITNEY: You can certainly finish PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 1 answering the question. 87 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (130 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 2 Let him finish his answer. Don't cut him 3 off, please. 4 THE WITNESS: The very first study on 5 smoking and lung cancer was based on men, and certainly 6 you would agree that simply because the first study was 7 done on men alone that we can't say, "Hey, you are a 8 woman, you can smoke, the result doesn't apply to you." 9 MR. WILLIAMS: Thank you. 10 Now, if you can answer my question, I would 11 appreciate it. 12 Q (BY MR. WILLIAMS): My question was: This study 13 doesn't allow you to make any statistical correlation 14 between the effects of benzene on men and women, does 15 it? 16 A It does because there is no scientific evidence to 17 say that females react differently than men when it 18 comes to benzene. 19 Q But this study didn't study women, does it? 20 A It does not. 21 Q So based on this study, you cannot make a 22 statistical correlation between the effect on men and 23 women because you didn't study any women? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (131 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 24 MR. WHITNEY: Objection. That question has 25 been asked and answered three times now. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 88 1 Q (BY MR. WILLIAMS): Do you understand the point 2 I'm trying to make? 3 A I understand the point you are trying to make, but 4 by the same token, we are studying people in New Jersey, 5 we are studying people in Texas. Does that mean that 6 the result does not apply to people in the Bay Area? 7 Q You can take my deposition at a later time. 8 A I just want to see the logic of your question. 9 Q It is really a simple question: You didn't study 10 women? 11 MR. WHITNEY: I object and I'll instruct him 12 not to answer. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (132 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 You are arguing with him. He is not going 14 to give you the answer that you want. 15 MR. WILLIAMS: I don't know what the answer 16 is. Let's try one more time. 17 Q (BY MR. WILLIAMS): This study did not study 18 women, correct? 19 MR. WHITNEY: Objection. It's been asked 20 and answered. Go on to your next question. 21 MR. WILLIAMS: I want an answer to this 22 question. 23 MR. WHITNEY: He's answered it. 24 THE WITNESS: I can give him the answer one 25 more time. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 89 1 I did not study women in this study. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (133 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 2 MR. WHITNEY: Let's take a little break. 3 (Brief recess taken.) 4 Q (BY MR. WILLIAMS): Now, this study, the one we 5 have been discussing, the industry mortality, I and II, 6 that was studying the benzene exposure in leukemia, 7 correct? 8 A Lymphatic and lymphopoietic causes of death. 9 Leukemia was the focus. 10 Q You were looking for the relationship of benzene 11 and MDS, were you, in the study? 12 A No. Other than we do look at disease of the 13 blood, and some of the subtypes of MDS would be included 14 there. 15 Q What subtypes would be included there? 16 A Refractory anemia would be included for sure. I 17 know that's included. 18 Q And what else? 19 A I have to look at an ICD book to tell you. 20 Q Now, the dates of death in the study I believe are 21 from 1946 to 1987; is that your recollection? I'm 22 looking at page -- file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (134 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 A December 1977, yes. 24 Q Okay. And in the ICD, I think you used number 25 eight. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 90 1 A I forgot whether it was eight or seven. Eight. 2 Q And MDS was not listed as a cause of death in that 3 version of the ICD, was it? 4 A No. 5 Q The computer program you used to group the causes 6 of death was the Marsh version, was it not? 7 A (No audible response.) 8 Q If you look at Footnote 32 on page 380 -9 A What page? 10 Q 380. I'm looking at Number 1. General result. 11 A Page -- file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (135 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 Q 380. 13 A 380? 14 Q Yes. 15 A Yes. I'm looking at that page. 16 Q Footnote 32. 17 A Right. 18 Q Was that the Marsh program you used -19 A Yes. 20 Q -- to code or to group the causes of death? 21 A Yes. 22 Q Is that the same program that's been identified as 23 Plaintiff's Exhibit 6? 24 A Yes and no. It is known by the same name, but the 25 program has been modified over the years. They are PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 91 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (136 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 different versions just like WordPerfect 5.0 and 5.1 2 version. 3 Q Which version did you use? 4 A I forgot the version. The most current version at 5 that time. If you ask me what number, I don't know. 6 Q Isn't the only difference between the version you 7 used, which was 1980, and this one was the addition of 8 AIDS in number 63? 9 A No, that's not true. 10 Q What are the other differences? 11 A If you look at one of the mortality tables, for 12 example, Table 6 on page 371 in part one. 13 Q Yes. 14 A And very specifically I would like to point you to 15 one of the causes of death in the table. About midway 16 through, you will see "Diseases of blood." ICD code 280 17 to 289. Do you see that? 18 So in that version of the program that I 19 used at that time, it's a specific cause of death called 20 diseases of blood. 21 Q And -22 A In the table that you gave me, that is not there. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (137 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 Q So the version you used corresponds to only the 24 causes of death as listed in this Table 6? 25 A No. It has more causes of death than this, but PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 92 1 these are the ones that we present in the paper. 2 Q Okay. And the number in parens next to it, all of 3 these, those were the ICD codes, correct? 4 A In that paper those are the eight ICD codes. 5 Q And for Diseases of blood, 280 to 289, none of 6 them include MDS? 7 A It includes some subtypes. 8 Q But none say myelodysplastic syndrome, do they, 9 280 to 289? 10 A Because that term was not in common use, or 11 accepted use, at that time. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (138 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 Q Okay. Now, at the top of this table it says "All 13 causes"? 14 A Yes. 15 Q Then "Observed Deaths, 1,036." Is that supposed 16 to be a summation of what everything is below it, or is 17 that a separate category? 18 A The answer to both questions is no, and the reason 19 being all causes of death that would be the number of 20 all the deaths. 21 Q Okay. 22 A But as I said, I have not presented all the 23 causes, all different causes of death in the table 24 simply because of space limitation. So if you add up 25 all the numbers, it would not give you that number. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 93 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (139 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 Q Okay. Well, the number I'm looking at is 1,036. 2 A That would be the total number of deaths that we 3 observed in our study. 4 Q Well, when I start adding these numbers below it 5 quickly in my head, it exceeds 1,036. 6 A Oh, okay. If you ask me first, I would save you 7 some trouble. For example, if you looked at "Cancer of 8 digestive system." 9 Q Yes. 10 A The 4th line. The ICD code is from 150 to 159, 11 right? 12 Q Yes. 13 A And for that group of deaths we have 49 as 14 observed. 15 Q Yes. 16 A And under that we have five additional cancer 17 sites within the digestive system and also indented. 18 Q Okay. 19 A So that simply means that within the digestive 20 system we also have the number of cancers of the 21 esophagus, number of cancers of the stomach, number of file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (140 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 cancers of the liver and so on. And if you add those 23 numbers and also the number for the total digestive 24 system, then you are adding some numbers twice. 25 Q Okay. So the ones that are indented are PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 94 1 subcategories? 2 A Exactly. 3 Q Thanks for explaining. 4 "All cancers" was 214 and everything under 5 that up to "Benign neoplasms"? 6 A The best way to look at that is to look at by 7 comparing the ICD code. If the ICD code is already 8 included in one of the ICD codes above, then you assume 9 not to add that one again. 10 Q Now, if a person had MDS and died of another file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (141 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 cause, that would not be reflected in this table, would 12 it? 13 A If it is the underlying cause of death. Because, 14 for example, leukemia, nobody dies of leukemia as the 15 immediate cause of death. Most of the time people would 16 die from the infection and so on. That would be the 17 immediate cause of death. 18 But as I said, the nosologist would be able 19 to pick it up. 20 Q For example, somebody had MDS and developed an 21 infection and died of pneumonia and the death 22 certificate saying underlying cause of death would say 23 pneumonia? 24 A No. The death certificate would not say the 25 underlying cause of death. That would be the immediate PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (142 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 95 1 cause of death. 2 Q How do you know? 3 A Because I have seen some death certificates, 4 including on leukemias. 5 Q But you didn't prepare the death certificates in 6 these cases, physicians did? 7 A I did not, but I look at them. 8 Q And some of these people died back in the '40s and 9 '50s, correct? 10 A Yes. 11 Q And if the physician was unfamiliar with MDS, 12 which didn't start to be used until the early '80s, the 13 physician might, in fact, have listed pneumonia as the 14 cause of death; isn't that a distinct possibility? 15 A I think we are mixing up several things here. One 16 is we all agreed that MDS, the term itself MDS was not 17 used, at least not widely used, before the 1980s. So 18 part of your statement is correct. 19 But the subtypes, the terminology for 20 different types of MDS have been used for a long time. 21 If it is a refractory anemia, then the physician would file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (143 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 put down refractory anemia as one of the causes of 23 death. 24 Q But if the cause of death was pneumonia, the 25 physician might also put down cause of death, pneumonia? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 96 1 A Absolutely. It is the job of the nosologist. 2 When you see a combination of different diseases, 3 symptoms, once you have gone through the training you 4 will be able to pick up the pneumonia is the result of 5 the infection as a result of the underlying cause of 6 death. The nosologist's job is to be able to pick up 7 the underlying cause of death. 8 Q And that depends on the accuracy of the death 9 certificate, doesn't it? 10 A Absolutely, yes. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (144 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 Q And if we take a hypothetical: The death 12 certificate did not say refractory anemia, it just said 13 pneumonia, then the nosologist would list it under here 14 as pneumonia, would he not? 15 A In your example, yes. 16 Q Now, in the second part of this article, I believe 17 we already discussed this earlier, this was the article 18 where you concluded that there was a significant 19 increase of risk of leukemia and for lymphatic and 20 hematopoietic cancer as compared to workers with no 21 occupational exposure; isn't is that right? 22 A Can you refer me to where I said that? 23 Q Sure. Well, the last page on 395, it says: 24 "Despite these limitations, the 25 study has shown that chemical PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (145 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 97 1 workers occupationally exposed to 2 benzene experienced significant 3 mortality excess from leukemia as 4 well the broader category of all 5 lymphatic and hematopoietic 6 cancer, when compared with 7 chemical workers who were not 8 occupationally exposed to 9 benzene." 10 A I'm looking for the place where I said that. 11 Q I'm not sure if your page number is the same as 12 mine. I have the top of page 395, very last page. 13 A Yes, I have that page. I know where. I found the 14 place where you read that. I'm just looking for -15 Q The abstract? 16 A -- the place where I said that. 17 That finding was driven by the fact that we 18 saw some leukemia cases in the exposed workers and none 19 at all in the non-exposed workers. And that's one of 20 the major problems in the study. If you rely on a small file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (146 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 comparison group, when you observe an increased risk 22 based on a ratio, you don't know whether you are seeing 23 an increase in the exposed group or you are actually 24 seeing a deficit in the unexposed group. I just want to 25 clarify that point. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 98 1 Q And this is substantially the same statement you 2 made to OSHA, was it not? 3 A Yes. 4 Q And these were the studies that you were referring 5 to? 6 A Yes. But by the same time, I also said, remember, 7 whenever there is an increase reported in that study, 8 that increase may be a reflection of the fact that we 9 did not see any leukemia at all in the non-exposed file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (147 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 group. 11 And, in fact, I have two comparison groups 12 in the study. One, the small group of non-exposed 13 workers and another comparison group is the general 14 population. And when I use the general population as 15 the comparison group, I do not see an increase. 16 Q You saw an increase with the non-exposed workers, 17 but not when comparing the group to the general 18 population? 19 A Right. And in the study I said we were hoping for 20 a much larger comparison group than the three thousand 21 or so we ended up with, and we ended up with a much 22 smaller group than we anticipated. 23 Q Was the group large enough to make any kind of 24 conclusion from, the group you studied? 25 A The comparison, we are getting confused now. The PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (148 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 99 1 risk estimates based on the internal comparison group, 2 the group of non-exposed workers, I don't think that's 3 reliable because the sample is just too small. 4 Q The sample of non-exposed workers? 5 A 3,000 is too small. 6 Q And how many exposed workers did you look at? 7 A About 4,000. 8 Q And there were also problems with the problems 9 associated with death certificates, correct? 10 A In general, yes. I mean, that -11 Q That problem being diagnostic accuracy? 12 A Yes. In death certificates in the '40s and '50s, 13 yes. 14 Q And there was also a lack of in-depth clinical 15 information as well; is that correct? 16 A Well, certain questions you want to answer, the 17 study may not be able to answer the question, yes. 18 Q And this study was funded by the CMA; is that 19 correct? 20 A The Chemical Manufacturers Association. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (149 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 Q Did they pay for this? 22 A Yes. 23 Q And you were working at that time for 24 Environmental Health Associates? 25 A Yes. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 100 1 Q What was your interest in that company? 2 A That was basically our company. "Our company" 3 meaning the company was owned by the three of us. There 4 were two other principals in that company. 5 Q Who were the other principals? 6 A One was by the name Robert Morgan, and the third 7 one is Donald Whorton. 8 Q Are they scientists? 9 A One is. I better say they are scientists. One file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (150 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 is. 11 Q What were -12 A One is an occupational physician. 13 Q Which one is that? 14 A That is Donald Whorton. Bob Morgan, Robert Morgan 15 has an M.D. degree and also a degree in epidemiology. 16 So he's kind of both. 17 Q His M.D. and -18 A M.D. degree and Master degree in epidemiology. 19 Q Does the company still exist? 20 A No. We merged with ENSR, E-N-S-R. 21 Q And that occurred, I guesses, in 1981; is that 22 right? 23 A No. It occurred in 1987. 24 Q Okay. It looks like you started working for ENSR, 25 E-N-S-R, Health Sciences in 1981. Maybe you can clarify PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (151 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 101 1 the way that's set out there. 2 A We started a company around 1981, Environmental 3 Health Associates, and that entity continue until 1987 4 when we merged with ENSR. Then in 1987 it became part 5 of ENSR. 6 Q Okay. And do you recall what CMA paid you to do 7 this study? 8 A I don't remember. 9 Q Who would have those records? Where would those 10 records be located? 11 A Maybe ENSR. 12 Q Okay. So all the financial records related to 13 these studies would still be at ENSR? 14 A I left everything there. 15 Q Okay. The Marsh computer program we were 16 referring to, is it possible to retrieve a copy of the 17 one that you used in the study? 18 A I'm not clear exactly what you want to get. 19 Q A copy of the Marsh program, hard copy is fine, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (152 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 that you used in classifying the cause of death in this 21 industry study. 22 A When you say "the program," what do you mean? 23 Q You say this is a default program for causes of 24 death unless you choose another one? 25 A I guess things are a little bit confusing. What PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 102 1 we are looking at, Exhibit 6, is not a program per se. 2 It is simply the grouping of the causes of death that 3 Gary Marsh used in the 1995 version of the program. 4 If you don't specify which grouping you 5 want, that is not the program. When you say "the 6 program," to me is more than just the grouping of the 7 causes of the death. You would have all the Fortran 8 languages, the software packages. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (153 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 Q Do you have a copy of the grouping that you used 10 in this industry study? 11 A I think I may have a copy of the user's manual for 12 the version of the program that I used. And if I still 13 have that, most likely in that manual there would be a 14 table similar to this. 15 Q Do you think it will show you the various tables 16 or options that one has in using the groups? 17 A At that time there may not be options. 18 Q There must be just one grouping? 19 A Yes. Just one grouping that I used. As we get 20 more sophisticated, it provided more options. 21 Q Can I get a copy of the user's manual? 22 A Well, I don't know whether I still have a copy or 23 not. You are talking about 15 years ago, a program that 24 I used. I can check. 25 Q If you still have a copy of it, can I get a copy PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (154 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 103 1 of it? 2 A I would not make a whole copy of the manual. I 3 would just copy the grouping for you. 4 Q That's fine. But groupings are listed in the 5 manual? 6 A Sure. 7 Q Thanks. 8 A Now, what I will do is, if I find it, I will make 9 a copy and give that to Mr. Whitney. 10 Q Exactly. 11 Proceeding right along here. "Cell-Type 12 Specific Leukemia Analysis"? 13 A Yes. 14 Q I believe you referred to this earlier. This is 15 related to the first meta-analysis that we discussed. 16 A Yes, because one of the questions that we raised 17 was the 1989 analysis that we did, did not really answer 18 the question regarding specific leukemia cell types. 19 Q So was the purpose of this study to determine file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (155 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 which types of leukemia had an elevated risk from 21 exposure to benzene? 22 A Yes. 23 Q And -24 A Well, a more limited question than that. 25 Q Tell me. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 104 1 A Within the petroleum industry. 2 Q Within the petroleum industry to determine which 3 types of leukemia were elevated due to exposure to 4 benzene? 5 A Yes. 6 Q And this paper does not address the association 7 between MDS and benzene? 8 A Not directly, but I will give you the same answer, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (156 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 again, and that is, to me, in my opinion, the level of 10 benzene required to induce MDS is higher than that 11 required to induce leukemia. 12 Q I understand your hypothesis. But MDS was not 13 what you were looking for when you did this 14 meta-analysis? 15 A No. 16 Q As a matter of fact, you were only looking at 17 leukemia, correct? 18 A Different kinds of leukemia, yes. 19 Q You weren't looking at any other cytopenias? 20 A No. 21 Q And who engaged you to perform this study? 22 A This was a continuation of the 1989 research. It 23 was funded by Mobil. 24 Q Okay. And do you recall what they paid you for 25 this? PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (157 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 105 1 A I think it is somewhere less than 50,000. I'm 2 pretty sure it is less than 50,000. 3 Q Was that for time and expenses? 4 A Time and expenses, yes. 5 Q And this was paid to your current company, Applied 6 Health Sciences? 7 A Yes. 8 Q Are you the sole owner of Applied Health Sciences? 9 A Yes. 10 Q I see it is incorporated. Are you incorporated in 11 California? 12 A Yes. 13 Q Let's move to another article you cited which was 14 another study called "Health Effects of Gasoline 15 Exposure." 16 A Okay. 17 Q What was the research question in this study? 18 A There were two primary questions. One was does file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (158 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 exposure of gasoline increase the risk of kidney cancer. 20 And the second primary question was at that time, since 21 we are going to spend a lot of time and money studying 22 this question, the kidney cancer question, and since 23 gasoline has about anywhere between two to six or seven 24 percent benzene in it, we might as well look at the 25 question of leukemia as well. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 106 1 Q So the primary focus was kidney cancer? 2 A Both. Kidney and leukemia. 3 Q And it wasn't specifically aimed at benzene 4 exposure? 5 A Well, for the leukemia question, it was, in the 6 sense that the only chemical substance that we know in 7 gasoline that causes leukemia is benzene. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (159 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 Q Okay. But there were other qualities in gasoline 9 that might cause kidney cancer; is that your 10 distinction? 11 A Okay. Let me go back one step. 12 For kidney cancer, we don't know what cause 13 kidney cancer or what we expect in gasoline cause kidney 14 cancer. The reason we want to study gasoline and kidney 15 cancer was based on some animal data. Animals in the 16 lab exposed to gasoline have some renal cancer. And 17 based on that, we say we better look at whether we see 18 the same effects in humans. So as far as kidney cancer 19 is concerned, we don't have any specific chemicals in 20 gasoline that we suspect. 21 For leukemia, for example, when I did the 22 gasoline study, it was in the late 1980s. We already 23 have a lot of information on leukemia and benzene, and 24 we know that benzene is the chemical in gasoline that we 25 should be concerned with as far as leukemia is PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (160 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 107 1 concerned. 2 Q This study did not look at the relationship 3 between benzene or gasoline and MDS, did it? 4 A Not MDS. Again, this is a longitudinal cohort 5 study and you cover a period of 30, 40 years going back 6 all the way to the 1940s. So when you use the term 7 "MDS," I have to say no, because that term was not used. 8 But, again, some of the subtypes of MDS were 9 included in the category that we discussed before, 10 disease of the blood. ICD code 280 to 289. 11 Q The dates of death studies were up to what time; 12 do you recall? 13 A '85. End of '85. 14 Q So MDS was used by '85, wasn't it? 15 A Maybe for the last part of 1985. But most of the 16 deaths would have occurred in the earlier -- well, I 17 shouldn't say "most." But the studies covered from 1946 18 to 1985. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (161 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 Q But the research question, the focus of this study 20 was not on MDS or diseases of the blood, was it? 21 A Disease of the blood, to some extent, yes, because 22 we know that benzene at high enough level can induce 23 different kind of disease of the blood, so we did look 24 at that. 25 Q Now, it didn't look at the relationship of benzene PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 108 1 or gasoline and other cytopenias? 2 A No. 3 Q And I take it the tables in here were categorized, 4 causes of death. They were also taken from the Marsh 5 program? 6 A Yes. 7 Q Was that accurate? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (162 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 Wouldn't that program be similar to this 9 Exhibit 6? 10 A No. 11 Q No. Do you know what the data of the category you 12 used in this program was? 13 A The one that you have in Exhibit 6 is the one that 14 I believe Gary Marsh revised toward the end of 1995, and 15 my study was done before that. 16 Q Was it only revised to add Aids, those in category 17 Number 63? 18 A Gary Marsh has four different revisions of ICD 19 code in the table that you have in Exhibit 6, and, 20 basically, he wants to show you the correspondence 21 between different revisions for certain diseases. 22 Q Your study was published in '93? 23 A Yes. 24 Q So I take it you used a Marsh category that was 25 being used in what, 1991? Is that when you submitted file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (163 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 109 1 this article? 2 A That's exactly right. The article was submitted 3 in 1991. 4 Q So whatever Marsh's breakdown was, that was 5 available in 1990? 6 A I don't know whether he has a new breakdown in 7 1990, but whatever the current version we had at that 8 point, we used that. 9 Q Is it possible to get a copy of that version that 10 you used in this study? 11 A Again, I will try to go back and see if I have 12 that. 13 Q Okay. Thanks. 14 Looking at Table 3 in this study. I don't 15 see diseases of the blood listed on that table. 16 A I knew you would ask the question, and I have 17 something for you. At the conclusion of this study we file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (164 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 submitted a report, the technical report to the sponsor. 19 In that study the sponsor was the American Petroleum 20 Institute. 21 In the technical report, we don't have any 22 limitation on space, how long or how much we can 23 include, so we have very detailed analysis. And in that 24 technical report we have disease of the blood, whereas 25 for journal they want to cut down on the size of the PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 110 1 article. 2 In fact, large journals will have space 3 limitation, and they are saying for some causes of 4 death, if you only have two or three it is not very 5 conclusive anyway, don't report them. 6 So it is their policy. Either you agree file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (165 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 with that or you don't get it published. So we did not 8 include the full table. We were not able to include the 9 full table in the publication. 10 But since before coming here today, I 11 suspect we may talk about this, so I make copies of the 12 two tables that you may be interested in. 13 Q Okay. This is a -- thanks. 14 MR. WILLIAMS: Let's mark these as an 15 exhibit. 16 (Whereupon, Plaintiff's Exhibit No. 8 is 17 marked for identification.) 18 Q (BY MR. WILLIAMS): One of these two pages 19 represents Deposition Exhibit 8. 20 A The first page in Exhibit 8 would correspond to a 21 more complete version of Table 3 in my 1993 article. 22 And the second page of Exhibit 8 would correspond to a 23 more complete version of Table 11 in the publication. 24 Q So when you read the published report, you'll see, 25 for example, in Table 11 all the causes of death, 2695. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (166 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 111 1 But when -2 A Which table are you looking at? 3 Q I'm sorry. Table 11. 4 A Okay. 5 Q Which will exceed the listings underneath it 6 because you haven't listed all the causes of death in 7 the published article, right? 8 A Also, there is some overlapping numbers within the 9 table that we discussed earlier. 10 Q Right. Let me see Exhibit 8. 11 So I take it the relevance of this study for 12 this case is the inclusion of the category of all 13 diseases of blood and blood forming organs in your 14 initial analysis? 15 A Right. 16 Q Again, this was a death certificate study, was it 17 not? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (167 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 A Yes. 19 Q And would be subject to the same limitations that 20 surround the study of death certificates, in other 21 words, diagnostic accuracy? 22 A Yes. 23 Q Let's look at the epidemiological study of 24 petroleum refinery employees. 25 A 1986? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 112 1 Q Yes. Now, this was not a study of benzene, the 2 effects of benzene, was it? 3 A Yes, to the extent that refinery workers are 4 exposed to benzene. 5 Q What is the research question in this case? 6 A To find out whether there is any elevated file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (168 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 mortality in this group of refinery workers. 8 Q From any cause? 9 A From any cause of death, yes. 10 Q So was this to determine whether there was an 11 elevated mortality rate in these refinery workers, but 12 it wasn't directed at finding whether there was an 13 association between benzene and disease in these 14 workers; is that correct? 15 A Well, certainly the interest is to look at some of 16 the diseases that have been implicated with benzene 17 exposure. 18 Q Okay. But the specific focus of this study was 19 not to study the effects of benzene exposure, was it? 20 A I would say yes, because that's the right group to 21 study. If you want to study benzene exposure, where do 22 you find people exposed to benzene? One place would be 23 the refinery. 24 Q Well, I understand that, but I'm just getting at 25 your research question. Is there an association between file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (169 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 113 1 benzene and a particular disease in this study? 2 A The study would be able to answer at least part of 3 the question. If we see an elevated mortality from 4 certain disease, then we would look at what kind of 5 substances those people were exposed to, looking at 6 their job titles and so on to try to make some sense out 7 of the finding. 8 Q So then benzene would be a subcategory of that 9 inquiry; is that a fair statement? 10 A Oh, yes, right. 11 Q So the main focus of this study was not to look at 12 the effects of benzene on workers, it was to look at the 13 mortality of workers from any cause? 14 A I would say benzene was one of the major interests 15 in doing the study. Certainly benzene is the chemical 16 that is most obvious to study in a cohort of refinery file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (170 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 17 workers. 18 Q This was a mortality study, wasn't it? 19 A Yes, it is. 20 Q And this study was primarily of men, was it not? 21 A Out of the 14,000 workers in the study, a little 22 bit less than 700 were female. 23 Q Which would be a very small percentage, correct? 24 A Yes. 25 Q And I take it that that percentage would be too PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 114 1 small to make a statistically significant statement or 2 conclusion with regard to the effects of benzene on men 3 as opposed to women? 4 A I'm not so sure we need to make the distinction. 5 Q Okay. But if one were to want to try to draw a file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (171 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 6 correlation between gender and incidence of disease, 7 this study would not allow one to do that? 8 A No. 9 Q When did this study end? 10 A When you said "study end," you mean when I 11 stopped, finished doing the study or when the 12 observation ended? 13 Q Observation, yes. 14 A December 1980. 15 Q And at the end of the study, 78 percent of the 16 people in the cohort were still alive, weren't they? 17 A Did you say 78? 18 Q Yes. 19 A Yes. 20 Q So that for 78 percent of the cohort, this study 21 will not indicate whether that person may have acquired 22 a benzene-related illness; is that true? 23 A Up to that point they have not, but we don't know 24 what happened after 1980 in that study. 25 Q You don't know because all you're studying is the file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (172 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 115 1 death certificates, correct? 2 A I don't think it has to do with either death 3 certificate or medical reports. If you end your 4 observation in 1980, whether it is based on death 5 certificate or based on medical examination, you don't 6 know what happened to that person after 1980. 7 Q Well, if you did a medical examination of the 8 person in 1980 and you found that they were suffering 9 from pancytopenia or refractory anemia or leukopenia, 10 that would correlate in the tables of December, would it 11 not? 12 A I guess we misunderstood each other. 13 Q Okay. 14 A If we do a study and at the endpoint of the study 15 is some clinical findings, medical examinations rather 16 than death certificates, what I'm saying is, whenever file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (173 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 17 your observation ends you don't know what happened 18 afterwards. Whether it is death certificate or medical 19 examination, it would be the same. 20 Q Okay. So in this case you were studying only 21 death certificates,? 22 A Yes. 23 Q Isn't that right? 24 A Yes. 25 Q So you didn't do any studies in 1980 of the 78 PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 116 1 percent of the people who were still alive to determine 2 whether or not they had developed a blood disease? 3 A No, we did not. But we did update the study since 4 we published the last article. 5 Q That's the next one? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (174 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 6 A That's the next one. 7 Q But at this point you didn't do that, correct? 8 A No. 9 Q And this study was funded by whom? 10 A Chevron. 11 Q This is 1986. Do you recall what they paid for 12 this particular study? 13 A No. 14 Q Would those records be with ENSR? 15 A Yes. 16 Q And I forgot to ask you about this "Health Effects 17 of Gasoline Exposure." That was funded by the API; I 18 believe, you indicated that? 19 A Yes. 20 Q Do you recall what they paid your company for 21 that? 22 A When you say "my company," you may be misleading 23 because the study started in either early or mid 1980s, 24 and when I left, the contract stays with ENSR, but I 25 continue to work on the project. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (175 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 117 1 Q I see that on your footnotes here. 2 Do you recall what they paid for the study? 3 A That was a longitudinal study, very decentralized. 4 I think it cost about a couple million dollars. 5 Q Oh, is that right? 6 A Yes. 7 Q How many people worked on that? 8 A That study took almost ten years to complete, and 9 depending on the stage of the study, sometimes we need 10 to have a lot of people. For example, when we collect 11 the data, basically, we send out a lot of research 12 assistants out to different areas to microfilm the 13 employment records, exposure history and so on. We must 14 have at one time 20 or 30 people working on the project. 15 But toward the end when we do the analysis, we don't file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (176 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 16 have that many people. 17 Q So over the ten years it cost a couple million 18 dollars to do the study; they paid a couple million 19 dollars to do the study? 20 A At least that much, yes. 21 Q And you left ENSR in '90? 22 A End of 1990. 23 Q Do you recall how much they paid your new company, 24 AHS, after you left ENSR? 25 A A much smaller number compared to the $2,000,000, PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 118 1 because at that time we were down to analysis and 2 writing the report. It was strictly based on how many 3 hours I worked. I would say may be 20-, $30,000 for 4 those couple of years. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (177 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 5 THE WITNESS: Off the record. 6 (Discussion off the record.) 7 Q (BY MR. WILLIAMS): We already mentioned the 8 updated study. 9 A Yes. 10 Q Did that study study the same workers that have 11 been studied in the previous one? 12 A Yes. 13 Q And at the conclusion of that study, 71 percent 14 were still alive; is that correct? 15 A Roughly, yes. 16 Q Which was about 10,000 people? 17 A Yes. 18 Q And this was also a death mortality study? 19 A The same method as the previous one. 20 Q Okay. I take it, then, there was no analysis or 21 examination done of the workers who were still alive at 22 the conclusion of the observation period? 23 A No. 24 Q And was this study funded by the same group? 25 A Chevron. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (178 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 119 1 Q Chevron? 2 A Yes. 3 Q What did they pay for this updated study? 4 A Actually, the study, most of the activities were 5 done by the people at Chevron. 6 Q Most of the activity? 7 A I should have made it clear. For example, 8 obtaining death certificates, finding out whether people 9 died or not, all those tasks were performed by the 10 in-house people at Chevron. I was involved in analysis, 11 in writing the report. 12 Q You don't recall what they paid for your 13 involvement? 14 A Maybe a few thousand dollars. 15 Q All right. The next study I have in my stack is file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (179 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 16 called "Long-Term Mortality Study of Oil Refinery 17 Workers. Exposure to the Lubricating-Dewaxing Process." 18 Now, this study did not include any women, 19 did it? 20 A No. 21 Q And this was not a study of benzene as an agent? 22 A No. 23 Q So that means it was also not a study of the 24 association between benzene and MDS? 25 A No. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 120 1 Q What is the relevance of this study to your 2 opinion? 3 A This is a subgroup in a much larger refinery study 4 that we have done. Although these people work at the file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (180 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 5 lubricating-dewaxing units, the fact that they work in 6 the refinery, the fact that they might also have worked 7 at other units before they come to the lubricating 8 department, they might have some exposure in the past to 9 benzene. 10 Q But this paper does not examine what that exposure 11 is, does it? 12 A Not specifically. 13 Q So you have no idea of knowing what their exposure 14 was or was not to benzene? 15 A No. Well, we can read the statement that they 16 were exposed to benzene to some extent. 17 Q But you don't know how much or how long or when? 18 A That's correct. 19 Q Who commissioned this study? 20 A Gulf Oil Company, but now it became part of 21 Chevron. 22 Q At the time of the study it was Gulf? 23 A Correct. 24 Q And that was when you were with EHA? 25 A Yes. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (181 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 121 1 Q Do you recall what they paid for it? 2 A No. 3 Q Those records would be with ENSR? 4 A I would think so. I don't know for sure. 5 Q But you don't have them? 6 A I don't. 7 Q You don't have records of what they paid for the 8 studies? 9 A No. 10 Q Next study I have is "Retrospective Mortality" 11 study. 12 Before we get to that, there is a letter to 13 the editor which you also submitted. This was not a 14 peer review submission, was it? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (182 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 15 A Most letters to editors are also subject to review 16 by the editors or maybe by one or two reviews. 17 Q Do you know whether this one was? 18 A I'm pretty sure it was because we sent a 19 manuscript and it came back and we had to make some 20 changes. 21 Q That process would be different than peer review 22 of an article for publication, wouldn't it? 23 A I'm not sure there would be any major difference. 24 A peer review article is usually something that is based 25 on your study. A letter to the editor is something that PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 122 1 you want to talk about regarding either somebody else's 2 study or you want to supplement somebody's paper. And 3 another major difference is the length of the article. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (183 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 4 Q This letter apparently deals with lung cancer, 5 doesn't it? 6 A No. If you look at Table 2 we have quite a few 7 causes of death. 8 Q None of the causes of death include MDS or blood 9 disorder, does it? 10 A That was not the focus of this paper. In fact, if 11 you look at Table 2, there is one column called 12 "Richmond Refinery" and the numbers in that column 13 basically are the same as those in 19 -- the paper 14 published in 1986. 15 Q You mean it is a repeat of those numbers? 16 A Yes. 17 Q Which paper are you talking about? 18 A The Chevron study, the title of that article is 19 "Epidemiological Study of Petroleum Refinery Employees," 20 published in 1986. 21 Q Okay. The next article is the "Retrospective 22 Mortality and Medical Surveillance Studies of Workers in 23 Benzene Areas of Refineries." 24 This was a study of all male workers, 25 correct? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (184 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 123 1 A The reason it took me so long to answer your 2 question, there are two parts in the study. 3 Q My question was directed to the first part, but go 4 ahead. 5 A The mortality? 6 Q Yes. 7 A The mortality part, you are right. They are all 8 male workers. 9 Q There were women in the second half of this? 10 A I'm not sure. The second half was on morbidity, 11 on blood cell counts and so on. Those were based on 12 medical records since the 1970s and '80s. So by that 13 time we should have some female workers at the refinery. 14 So there may be a small percentage. I'm not sure. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (185 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 15 Q The actual article does not say; is that right? 16 A I tried to go through that quickly and see if I 17 can answer you. I cannot at this point. 18 Q Okay. Referring to the mortality aspect of this, 19 the causes of death identified in the article do not 20 include diseases of the blood, MDS or other cytopenias, 21 do they? 22 A No. 23 Q There are only 34 deaths total, right? 24 A It was a very small group. 25 Q Isn't that too small to draw any conclusions from, PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 124 1 34 deaths? 2 A It is a very small study because we are focusing 3 on the people who work specifically at the benzene unit. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (186 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 4 That's all the people we have from that refinery. 5 And in answer to your question, yes, it is 6 very small. 7 Q And the smaller a study, the less power the study 8 has; is that a fair statement? 9 A Yes. 10 Q Now, in the second half of this, the medical 11 surveillance program, I believe 303 workers were 12 observed? 13 A (No audible response.) 14 Q Is that right? 15 A It was a question? 16 Q Yes. You observed 303 workers, correct? 17 A Where do you get that number? 18 Q I got that from page 690, in the right-hand 19 column, halfway down. 20 A On the left-hand column? 21 Q No. Right-hand column. Sorry. 22 A 303, yes. I found that number. 23 Q Okay. And what was the research objective of this 24 aspect of the program? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (187 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 25 A This paper was more focused on the issue of PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 125 1 benzene. But the first part of the study, the mortality 2 study of a small group of people who work at the benzene 3 unit, as you pointed out, that part was just too small 4 to make any definitive statement. 5 But this study also tells us all the blood 6 chemistry results of refinery workers over a period of 7 at least two or three decades. So that's the part that, 8 that's the kind of data we don't have in most mortality 9 studies. In this study we do have blood study chemistry 10 results. 11 Q Does the study indicate how long the 303 workers 12 worked at the plant? 13 A No, it did not. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (188 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 14 Q And it also doesn't indicate how many times each 15 worker was tested, does it? 16 A We should have an average because we know how many 17 individual results we have. We have multiple testings 18 on the workers. 19 Q On all the workers? 20 A Yes. 21 Q Well, the total number of examinations was 1404, 22 correct? 23 A Yes, about 1400. 24 Q So if you had 300 workers, that would be a little 25 over four, that would be less than five tests per PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 1 worker, correct? 2 A Yes. 126 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (189 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 3 Q And this study says that the blood tests were 4 performed on each benzene worker up to four times a 5 year? 6 A Up to, not everybody test for four times a year. 7 Up to four times, but not everyone was tested four 8 times. 9 Q So with regard to the medical testing, this 10 article doesn't indicate how long workers were at the 11 plant or how many times they were actually tested; isn't 12 that correct? 13 A The report does not tell you that on an individual 14 basis. But we know the total number of tests, we know 15 how many were included in the sample, so we know the 16 average. 17 Q The average would be four tests? 18 A About four, yes. 19 Q And if all the workers were tested four times the 20 first year, that would comprise all the tests done? 21 A That's correct, but not everybody was tested four 22 times. 23 Q But this doesn't show when they were tested or how 24 long between tests they were or any other types of data, file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (190 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 25 does it? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 127 1 A Not to that detail. 2 Q Doesn't that present a problem in reaching any 3 conclusions in regards to this test? 4 A No. Basically, what we want to find out is do we 5 have any findings that indicate that we have a major 6 problem. Do we have a lot of low counts. 7 Q Wouldn't you agree that the sample is too small to 8 make any definitive statements about causation between 9 benzene and MDS? 10 A No. We are talking about 1400 measurements. 11 Q Sample people, 300 people? 12 A Yes, 300 people. 13 Q Isn't that sample too small to make any definitive file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (191 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 14 statements with regard to causation between benzene and 15 not MDS, but any cytopenias? 16 A No, not at all because we have 1400 blood 17 chemistry measurements, and if those measurements were 18 depressed, we should be able to see that. 19 Q But you have 1400 measurements that you don't know 20 when they were done or who they were done on; isn't that 21 true? 22 A It doesn't matter. If we see a lot of the results 23 were depressed, if there is a major problem, we would 24 expect to see that. And we can identify which group, 25 where the depression come from and so on, but in this PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 128 1 case we don't see that. 2 Q We just found one multiple myeloma in this group? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (192 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 3 A So, we find multiple myelomas in lawyers and 4 epidemiologists. 5 Q How many cases of depressed red blood cells would 6 you expect to find among 300 people to consider that to 7 be a significant finding? 8 A Well, you look at the average. If we have any 9 major depression, the white blood cell count would be 10 low compared to what we know. And in this case it is 11 about 7,000. I'm looking at page 10. 12 Q Table 2, right? 13 A Table 10, yes. 14 Q So you are looking at the average of 1400 tests 15 for your conclusion; is that right? 16 A Yes. 17 Q So you have no way of knowing whether someone was 18 tested once or never tested again? 19 A True. 20 Q Well, if someone was tested once and left four 21 years later, and not having been tested again, and in 22 fact had reduced, had anemia, microcytic anemia, that 23 wouldn't show up in your test, would it? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (193 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 24 A That's true. 25 Q I think that's the end of your articles. I think PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 129 1 that's all of the articles you cited; is that correct? 2 Do you have any articles of your own studies 3 that you relied upon? 4 A The Kipen article we talked about. 5 Q No. Any of your articles? 6 A Oh, any of mine. Are you implying that I haven't 7 done that much? 8 Q Too much. I had to read stuff on the plane this 9 morning. 10 A That's all the papers that I have cited, that I 11 have done. 12 Q Let's turn to the next paper which is the Aksoy file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (194 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 paper. This paper is dated 1972, correct? 14 A Yes. 15 Q This is well before the nomenclature has changed 16 with regard to MDS; is that right? 17 A Yes. 18 Q Now, reading your statement on page 3 of your 19 report, you state that you cite Aksoy as an example, and 20 you say that in this study Aksoy reported: 21 "blood-related disorders including 22 decreased WBC in Turkish 23 shoemakers who were exposed to air 24 benzene levels as high as 150 to 25 650 parts per million." PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 1 Is that right? 130 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (195 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 2 A Yes. 3 Q Does the Aksoy article state that exposure to 4 levels less than one hundred would not result in 5 blood-related disorders? 6 A The cases that he observed all have exposures in 7 that range. 8 Q Yes. So the exposures he was studying were 9 between 150 and 650? 10 A Yes, according to his paper. 11 Q So did he conclude that if you were exposed to 12 less than 150 ppm that would not result in blood-related 13 disorders? 14 A I don't think he has any case with exposure less 15 than that. 16 Q But did he conclude in this study, this study is 17 on people who were exposed to the levels that he found 18 which was 150 to 650; isn't that right? 19 A Right. 20 Q He doesn't conclude that if you had exposure at 21 less than this level that you would not acquire a 22 blood-related disorder, does he? 23 A That's true. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (196 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 24 Q But you concluded that from this article? 25 A Well, the statement I make regarding the Aksoy PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 131 1 study was that Aksoy reported blood-related disorders, 2 including decreased white blood cell count, among people 3 who were exposed to benzene levels as high as 150 to 650 4 ppm. That's what I said. 5 Q But you agree that this study does not mean that 6 exposure, this study by itself, does not stand for the 7 proposition that exposures of less than that, you won't 8 develop blood-related disorders? 9 A This study alone would not tell us exposure below 10 the range that he didn't observe. 11 Q Aksoy had some other studies on leukemia and 12 cytopenias and shoe workers, doesn't he? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (197 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 13 A Aksoy has written many, many papers based on 14 different combinations, permutations of the cases that 15 he saw in his clinic. So if you are asking different 16 publications, I would say yes, he has written most 17 likely more publications than the number of cases he 18 has. But are they all different studies? I don't think 19 so. 20 Q Well, have you read the other studies? 21 A I have read some of his other papers. 22 Q Did you read the "Follow-up study on the mortality 23 and the development of leukemia in 44 pancytopenic 24 patients with chronic exposure to benzene"? 25 A If you can let me see, maybe it will help me. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 132 1 I think I have seen this paper before. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (198 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 2 Q Do you recall reading that? 3 A I think so. 4 Q Why didn't you cite this particular paper? 5 A No particular reason. I mean there is some 6 measurements, he makes reference to some benzene 7 exposure in the one that I cite. 8 Q Okay. 9 A And the one I cite would be more closer to the 10 case that we have because we are talking about -- well, 11 he talked about blood changes in the 1972 paper as 12 opposed to mortality in the 1978 paper. 13 MR. WHITNEY: Actually, would you mind 14 making that an exhibit, so we have a complete record? 15 MR. WILLIAMS: You have the paper. I think 16 it is in Callendar's. 17 MR. WHITNEY: Okay. 18 MR. WILLIAMS: If that's what you are 19 wondering. I'm sure it is in Callendar's. 20 MR. WHITNEY: Okay. 21 Q (BY MR. WILLIAMS): Do you recall reading the 22 other publication he had in 1974, "Leukemia and shoe file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (199 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 workers exposed chronically to benzene." 24 Let me show you this also. 25 A Yes. I've read this as well. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 133 1 Q Did you read that recently or in preparation for 2 this case? 3 A Probably not in preparation of this case because 4 the paper, the focus of this paper is really leukemia. 5 Q Well, doesn't it say at the top "26 patients with 6 acute leukemia or preleukemia"? 7 A Yes. It doesn't say MDS either. 8 Q Well, as we already established, MDS has been 9 called preleukemia, hasn't it? 10 A No, we have not established that. 11 Q You didn't agree with that statement? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (200 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 A Only certain types. Not all MDS. I don't think I 13 ever said today that I agreed to the statement that 14 every type of MDS. 15 Q Isn't MDS, 5Q minus, hasn't it been referred to as 16 a preleukemia syndrome in the medical literature? 17 A I mean, are you including everything under the 18 sun? I don't know what that means. All I can tell you, 19 that is specifically for 5Q minus. The type of percent 20 of patients who actually get acute leukemia is very low 21 compared to other subtypes of MDS. 22 Q But are you saying you don't know what my 23 statement meant, my question? My question was hasn't 24 MDS 5Q minus been referred to as preleukemia in the 25 medical profession? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 134 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (201 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 MR. WHITNEY: Objection. He answered this 2 question many times. 3 MR. WILLIAMS: He said he doesn't know what 4 I mean. 5 MR. WHITNEY: He answered the question many 6 times already. 7 THE WITNESS: I'm not aware of any statement 8 or publication that refer 5Q minus as preleukemic, and 9 even if that was the case, I would disagree. 10 Q (BY MR. WILLIAMS): But you don't have training as 11 a medical doctor, do you? 12 A No, I don't. But on the other hand, if you look 13 at 5Q minus patients, you don't see a majority of them 14 transforming into leukemia. That means it is not. 15 Q What did the majority of them die from? 16 A I don't know. 17 Q Okay. Let's turn to the next article that you 18 cited which is the Kipen article. 19 Now, why did you cite this article? 20 A Well, you are provided with, for one thing, 21 measurements of white blood cell count in connection 22 with benzene exposure. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (202 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 23 Q And were the authors able to reach any definitive 24 conclusion in this study? 25 A Okay. What they are saying is they see a very PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 135 1 good relationship between benzene exposure and, for 2 example, white blood counts before 1948. 3 Q Do you take that to mean reduction in white blood 4 counts? 5 A Yes. The benzene exposure goes up, the blood 6 count, the blood count goes down, yes. 7 Q Wouldn't that indicate the opposite from what you 8 cited in your report? 9 A Absolutely not. 10 Q Why not? 11 A Because if you look at Table 2 -- file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (203 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 12 Q Wait a second. Figure 2 with the graphs? 13 A Table 2. 14 Q Okay. 15 A For workers exposed to air benzene levels above 16 100 ppm, white blood counts would be slightly reduced at 17 about 7,000. And if you look at that, the numbers in 18 Table 2, you see that there may be a slight depression 19 for the first two or three years. And the exposure 20 associated with that is around 100 ppm. 21 So that study actually supports the 22 statement that -23 Q I'm not looking at the same table as you. Let me 24 walk over there and see. 25 A Either we are looking at different articles or you PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 136 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (204 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 1 are too tired or I'm too tired. 2 Q Or all three. 3 A Table 2. Table 2. 4 Q Okay. 5 A Table 2. You look under the column of white blood 6 count. There are three years where the white blood cell 7 count were below 7,000. 8 Q Okay. I see that. 9 A And if you go across you will to look at the 10 exposure involved in those years, it will be above 100 11 ppm year. 12 Q But the exposure in Approach A is much less than 13 that, isn't it? 14 A Well, the study also concluded that Approach A is 15 not valid. 16 Q Don't they actually conclude that this analysis 17 does not conclusively establish that the Approach B 18 estimates are superior to the A estimates? If you look 19 at page 204. 20 A Where on page 204? 21 Q Third paragraph from the right side. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (205 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 A Okay. Well, the very last sentence of that 23 paragraph says that Approach A estimates seem 24 exceedingly low during the 1940s. And the generally 25 higher Approach B estimates are likely to be more PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 137 1 accurate during those years. 2 Q You would agree that the authors are unsure of the 3 accuracy of either one of these exposure estimates, 4 would you? 5 A They are more sure about B than A. 6 Q But they are actually unsure about both? 7 A It is not black-and-white type of answer. When 8 you talk about historical exposure, nothing is 100 9 percent accurate. That's why when you ask me the 10 question this morning or earlier this afternoon, instead file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (206 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 of using 100 ppm that I used in my report, I remember 12 you used the number 99. It is not accurate to that 13 extent. 14 Q There were also some problems in the study with 15 collecting the blood data, weren't there, if you look on 16 page 205? 17 A Okay. Will you direct me? 18 Q On the top of the first full paragraph on the left 19 side. 20 A Yes. Specifically, it talk about some of the 21 problems in using hemoglobin or red blood cell count and 22 that's why in my report I refer to the white blood cell 23 count. 24 Q Don't they also indicate that there was some 25 potential surveillance problems of the workers as well PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (207 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 138 1 as estimates of exposure after 1946? 2 A Well, I'm sure in any study you have some problems 3 in the data, but by and large this is a larger scale 4 study as opposed to some case report that we have seen. 5 Q Wasn't the results of this evaluation used in part 6 to support the one-part-per-million OSHA standard? 7 A I don't know. This was published in 1989, and are 8 you referring back to the hearing in 1986? 9 Q Well, didn't Kipen and Goldstein have an earlier 10 report in this same study? 11 A No. If that's the case, most likely they will 12 cite that in their paper. Biggest one reference, 13 Number 7, it may be based on the same data. I'm not 14 sure. 15 Q Okay. So you don't know whether the valuation in 16 this study was used in part to help set the OSHA 17 standard of one part per million? 18 A No, I don't. 19 Q I want to ask you about the last sentence in the 20 report and ask you what you think it means. 21 "We are unable to say that file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (208 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 22 individuals will not experience 23 significant blood dyscrasia at 24 these lower benzene exposures, but 25 based on this data overall PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 139 1 population averages cannot be 2 relied upon to detect reasonable 3 deviation from currently permitted 4 exposures." 5 A Remember, "lower" is relative. Here, what we are 6 talking about, people exposed to -- if you go back to 7 Table 2, again, the level of exposure we are talking 8 about range from 32 ppm all the way to 37 ppm. 9 I think we are referring to after 1941 or 10 '42. When the level drops below 100, they don't see any file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (209 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 11 depression of while blood cell counts. In that context 12 "lower" means anywhere between 32 up to 100 ppm. 13 Q So you think that's what they are referring to 14 when they say "lower"? They are referring to the lower 15 end in that scale in the Approach B? 16 A The lower range of exposure in their study. I can 17 tell you for sure that by "lower" the authors in this 18 article do not mean the kind of exposure we see in this 19 case. 20 Q You think they are referring to the amounts in the 21 table? I understand what you are saying. They are 22 referring to the amounts found in Table 2 or identified 23 in Table 2? 24 A Yes. 25 Q And what they are saying, aren't they, is that PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (210 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 140 1 they, the authors Goldstein and Kipen, are unable to say 2 that individual will not experience significant blood 3 dyscrasias at these lower benzene exposures. Isn't that 4 what they are saying? 5 A I can see why you are having a problem, but when 6 you look at the data, clearly it shows that after 1942 7 when the exposure level was below 100, you don't see any 8 white blood cell depression. 9 But I have to agree with you, I don't know 10 what the "lower" means. 11 Q So you are unsure also with the last? 12 A I'm not sure what that statement refers to. I 13 thought when you say "lower" in your own study that 14 would refer to the lower range of the exposure that you 15 observe. But if that's the case, the data that they 16 have would contradict that statement. 17 Q Do you agree that some people are more susceptible 18 than others to the effects of benzene toxicity? 19 A I don't know. 20 Q You don't know whether they are or not? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (211 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 A I haven't seen any scientific evidence to support 22 that. 23 Q You are unfamiliar with any studies which discuss 24 the variance in susceptibility of individuals to benzene 25 toxicity? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 141 1 A No, I am not. 2 Q Assuming that some individuals are more 3 susceptible to benzene toxicity, wouldn't that have an 4 effect on your opinion in this case? 5 A I would say no. 6 Q Your opinion is based on studies of occupational 7 industry workers, correct? 8 A Yes. 9 Q And it is not based on studies of the general file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (212 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 population? 11 A But there's no selection criteria of individuals 12 in the general population into the working population 13 based upon so-called sensitivity to benzene. It doesn't 14 make sense, because when you apply for a job to work in 15 the petrochemical industry, they don't test you for 16 sensitivity to benzene. If you have a cardiovascular 17 condition you may not get a job. I can understand that. 18 Q So you have no opinion on whether some people are 19 more susceptible than others to the effects of benzene 20 toxicity? 21 A I haven't seen any scientific evidence to offer 22 that. 23 Q Do you plan to offer any opinion at trial on the 24 susceptibility on individuals? 25 A Just as I said, I have not seen any scientific PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (213 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 142 1 evidence to demonstrate that's the case. 2 Q In preparing for this case, have you looked for 3 that particular point in the literature? 4 A Not in particular with this case, but in general, 5 the healthy selection, in fact, the selection problem, 6 I'm always interested in that. 7 Q Could you do a study, an epidemiology study where 8 you took a group of people and put Orafix Special with 9 benzene in it in their mouths and study that group, and 10 then another group of workers or individuals that you 11 did not apply this substance to and compare the effects 12 of that exposure between those two groups? 13 A Can I do a study like that? 14 Q Could one? 15 A Theoretically, yes. 16 Q Practically? 17 A Basically, you are talking about almost a clinical 18 trial. 19 Q I guess that's true. 20 A So you can design such a study. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (214 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 21 Q Would it be profitable for a scientist to design a 22 study? 23 A Depends on what question you want to ask. I mean, 24 when you do a study, you have a question in mind and 25 whether we want to do such a study or not, whether it is PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 143 1 appropriate or not, depends on the question. 2 Q Well, the question is is there any adverse effect 3 from benzene in a product that's placed in people's 4 mouths? 5 MR. WHITNEY: Objection. 6 Q (BY MR. WILLIAMS): Use that as a question. Would 7 it be proper for a scientist to conduct such a study 8 placing benzene in peoples' mouths to study the effects? 9 A If somebody asked me that question, what I would file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (215 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 10 do is to analyze the range of exposure you would get 11 from using Orafix. 12 Q But you wouldn't actually put benzene in someone's 13 mouth to do such a study; is that what you are saying? 14 A When you say "put benzene into somebody's mouth," 15 it sounds horrible. 16 Q Why? 17 A But in reality, whenever you put something foreign 18 into somebody's mouth, that doesn't sound kosher to me. 19 But we ingest benzene all the time. I don't know what 20 breakfast you have, if you have scrambled eggs you have 21 benzene. There is a substantial amount of benzene in 22 scrambled eggs, in fish and everything. It is a natural 23 occurring chemical. 24 Q How much benzene is in eggs? 25 A I don't know. The number is actually pretty high. PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (216 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 144 1 In fact, I may know. 2 In eggs, this is according to U.S. EPA, 3 cited by the International Agency for Research on 4 Cancer, in eggs, 500 to 1900 micrograms per kilogram. 5 Do you drink Jamaican rum? 120 micrograms 6 per kilogram. Beef, 19 microgram per kilogram. 7 Q Just so I have a point of reference. 500 8 micrograms per kilogram, how many parts per billion 9 would that be? 10 A Kilo, that's 10 to -- it is 6 o'clock. The 11 numbers are getting fuzzy. 12 Anyway, I'm not going to put myself on risk 13 doing some numerical calculations at 6 o'clock. 14 Q Would you agree that humans should avoid exposure 15 to benzene? 16 A If it does not have any health consequence, I 17 don't think -- number one, I don't think you can avoid 18 benzene if you want to live in this world. 19 I don't see what that question will get you. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (217 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 Q To the extent possible, should a person avoid 21 exposure to benzene? For example, would you avoid 22 washing tools with gasoline in a closed room for long 23 periods of time? 24 A No, because the exposure resulting from that kind 25 of activity would be high. PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 145 1 Q It would be a high exposure and you would want to 2 avoid that? 3 A I would like to avoid that. But if you say do you 4 want to avoid benzene by not eating any more eggs or 5 drinking any more rum, my answer is no. I'm going to 6 eat scrambled eggs and drink rum. 7 Q My question is, to the extent possible, should 8 humans attempt to avoid exposure to benzene? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (218 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 I'm not talking about eating food that 10 people eat all the time. 11 A It is possible for me not to eat scrambled eggs. 12 I guess I don't follow your question. 13 Q Well, the exposure is so low you are not worried 14 about the risk? 15 A Exactly. I think you get it. 16 Q But the same is not true for using gasoline to 17 wash tools in a room. Exposure is high? 18 A Right. 19 Q So don't you think it is wise to avoid those types 20 of exposures? 21 A Absolutely. 22 Q You work as a consultant for several of the oil 23 companies; is that accurate? 24 A Yes. 25 Q Who do you work as a consultant for? PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (219 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 146 1 A Who? 2 Q Which companies, which petroleum companies? 3 A Over the years or now or -4 Q Over the years. 5 A Over the years, Mobil, Chevron, Gulf before it 6 became Chevron, part of Chevron. Texeco, Amoco, Shell. 7 Q Do you work -- I'm sorry. 8 A Most likely I worked for Exxon, too. Basically, I 9 have done a lot of studies in the petroleum industry. 10 Q Have all the studies you done in the petroleum 11 industry been at the behest of either the API or 12 Chemical Manufacturers Association or petroleum 13 companies? 14 A Yes. 15 Q How many studies do you think you have done in the 16 petroleum industry? 17 A How many studies I have done in the petroleum 18 industry? 19 Q Yes. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (220 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 20 A I don't remember. Twenty, thirty. I don't 21 remember. 22 Q Do you currently serve as a consultant for any of 23 these companies? 24 A When you say "currently," it is difficult to 25 answer the question because -- PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 147 1 Q I would say in the last -2 A Go ahead. 3 Q In the last four years? 4 A In the last four years, for sure not Gulf because 5 it is no longer there. I would say Chevron, Mobil, 6 Amoco. At least those three. 7 Q Do they pay you on a per-job basis, or do they pay 8 you a retainer? What's your relationship with those file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (221 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 9 companies? 10 A It is based on time and materials. 11 Q So they may call you to ask you to do something, 12 and you bill them on time and materials; is that right? 13 A Correct. 14 Q I'm looking at the case that you indicated that 15 you have testified in. 16 A Yes. 17 Q There were two in 1995? 18 A Can I take a look? I don't have them in front of 19 me. 20 Q Exhibit 2. 21 A Okay, I have it. Yes. 22 Q Okay. Were those the only two cases in 1995 or 23 were there others? 24 A Those were the ones that I could remember when I 25 compiled this list. I don't have a place to go to. PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (222 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 148 1 Whatever I remember at that time when I prepared the 2 reports. 3 Q So when you prepared the report, you just thought 4 off the top of your head? 5 A As many as I could remember. 6 Q You don't have a record of the cases you testified 7 in? 8 A No. 9 Q And I notice the Lakie case isn't on here. 10 A The Lakie case? I'm sorry. 11 Q Yes. 12 A At that time I don't think I had testified in the 13 Lakie case, have I? Today's the first time I've 14 testified in the Lakie case. 15 Q I notice another case here. 16 A I'm getting confused. I thought I understand the 17 term "testify" meaning in deposition or trial. 18 MR. WHITNEY: You got it right. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (223 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 THE WITNESS: Because he is the lawyer, I'm 20 not. 21 Q (BY MR. WILLIAMS): in '94, I see on here, you 22 have Girdry versus SmithKline Beecham. 23 A Yes. 24 Q I believe you testified in that case, at least in 25 deposition? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 149 1 A They took a deposition, yes. 2 Q Do you recall what you submitted to SmithKline 3 Beecham on that case? 4 A No. 5 Q Do you have records that indicate that? 6 A 1994, no. 7 Q You wouldn't have records that would indicate it? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (224 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 A No. 9 Q What happened to them? 10 A They pay all their bills. 11 Q And you threw everything away? 12 A Yes. 13 Q So you don't keep records of what you did or the 14 bill you sent in 1994 for SmithKline Beecham? 15 A No. 16 Q How about for Cavanaugh versus SmithKline Beecham? 17 A That was also last year's. That was last year. 18 Q '95? 19 A '95, yes. And I think a deposition was taken 20 after I had prepared this report. 21 Q Okay. Do you recall what you billed SmithKline 22 Beecham in that case? 23 A I did not work on that case that long because it 24 was a very short -- I don't remember how much. But if 25 it is 1995, we may still have the invoices. PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (225 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 150 1 Q Can I get a copy of what you billed in that case? 2 A I'll go back and find them, yes. 3 Q How much of your time is spent in litigation 4 matters? 5 A On the average I would say about 25 to 30 percent. 6 Q Has that changed over the last five years? 7 A It fluctuates. Sometimes it is less and sometimes 8 it is a little bit more. 9 Q So your estimate is about 25 percent? 10 A 25 to 30. 11 Q Are these probably for defense, defendants? 12 A Yes. Once in a while I testify for plaintiffs, 13 too. 14 Q Would you estimate what, 90 percent for 15 defendants? 16 A I would say so, yes. 17 Q I take it you have an accountant that does your 18 tax returns? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (226 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 19 A Yes. 20 Q How do you report the amount you made from 21 litigation matters to him? Is it broken down into 22 categories? 23 A No. 24 Q You just send him bills that have been paid and he 25 figures out your tax returns? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 151 1 A I'm not sure I understand your question. 2 Q You have an accountant that does your tax returns, 3 correct? 4 A Yes. 5 Q For you and your company? 6 A Yes. 7 Q How is income that you received from litigation file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (227 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 8 matters sent to your accountant? How is it provided to 9 your accountant? 10 A We report the total number of -- total income for 11 a specific period of time. 12 Q So it is not broken down? 13 A No, it is not. 14 Q Have you read, do you plan on offering any 15 opinions in this case on rebuttal to any of plaintiff's 16 experts? 17 A I'm not sure exactly what that means. Depending 18 on what questions they ask me. I'm looking to 19 Mr. Whitney for guidance. I don't know what else he 20 would ask me to do. 21 Q Have you been asked to render any opinions in 22 rebuttal to any of plaintiff's experts? 23 MR. WHITNEY: In other words, we have the 24 right to have you speak regarding the basis of opinions 25 of the various causation experts of plaintiff. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (228 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 152 1 Q (BY MR. WILLIAMS): Up until today have you been 2 asked to do that? 3 A No. 4 Q Have you reviewed any of plaintiff's experts' 5 reports in this case? 6 A Yes. 7 Q Do you know which ones you reviewed? 8 A I don't remember their names. I did that several 9 months ago. 10 Q I'll assume it is in here, the ones you reviewed. 11 A I see two names here. Dr. Blanke and Dr. Saady. 12 Q What did you review from them? 13 A Deposition transcript. 14 Q Anything else? 15 A Dr. Jacobus' notes -- oh, that's our guy. Okay. 16 Okay. Blanke's report. 17 Q What date is that? file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (229 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 A July 20th, 1995. Dr. Callendar's, August 15th, 19 1995. And Dr. Swerdlow, S-W-E-R-D-L-O-W. And I'm not 20 sure whether there is a date here. The report is not 21 dated, but the fax says August 17, '95. 22 I think that's it. 23 Q Okay. Do you have any opinions today with regard 24 to the materials you reviewed from those experts, other 25 than what you stated in your deposition thus far? PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 153 1 A Other than, obviously, we have different opinions 2 overall. 3 Q Anything additional to what you already stated 4 today? 5 A I have not done any detail critique of their 6 report, if that's what you are asking. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (230 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 Q I want to know if you have any additional opinions 8 with regards to the reports other than what you stated 9 in your report and what you testified to today at this 10 time. 11 A I don't recall. Not at this point because I 12 reviewed those documents almost six months ago. 13 Q You haven't seen them since? 14 A I have not read them again. 15 Q Other than the articles which you referenced, are 16 there any other articles that you are relying on for 17 your opinion that you stated today? 18 A Those are the major ones. Of course, there are 19 articles on the general issue of epidemiology or on 20 benzene and leukemia and so on. I'm not so sure I can 21 answer your question with a yes or no. 22 Q Any particular ones that you haven't discussed 23 today that you plan on relying on? 24 A No. Unless the question requires me to go to some 25 other documents, rely on some other documents. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (231 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 154 1 Q You had one other document, I believe, that -- I 2 just want to take a quick look at. The IARC document? 3 A That's the document that you should really have. 4 It tells you how much benzene you have when you eat your 5 scrambled egg. 6 Q You didn't list it in your report. 7 A To be quite honest with you, I think last week 8 Mr. Whitney called me and said do I know of any data, 9 handy data that talks about benzene exposure, 10 non-occupational exposure. And that's a very convenient 11 place to go to. 12 Q And this is, this document entitled "IARC 13 Monographs on the Evaluation of the Carcinogenic Risk of 14 Chemicals to Humans," and there is a chapter on benzene, 15 is what -- that was your response to that inquiry? 16 A Right. 17 Q Okay. I'm just going to leave that with your file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (232 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 18 other articles and have the whole thing on an exhibit. 19 MR. WILLIAMS: Let's just go off the record 20 for a minute. 21 (Discussion off the record.) 22 Q (BY MR. WILLIAMS): One other clarification. Do 23 you mind checking to see what Marsh printouts you have 24 of the various disease classifications that you used in 25 all of the reports that you cited? I'm not sure if I PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 155 1 asked you on each one whether you could provide that or 2 not. 3 A I will go back and look through and see how many 4 different versions I have that use this menu, and 5 whatever copies I have, I will make copies of the 6 disease groups for you. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (233 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 7 Q Okay. Just the ones you used in your reports. 8 A I will. 9 Q That will be great. 10 MR. WILLIAMS: No more questions. 11 MR. WHITNEY: Mr. Wong will want to read his 12 deposition transcript and sign it. 13 (Whereupon, the deposition of OTTO WONG, Sc.D., F.A.C.E. was concluded 14 at 6:30 p.m. this date.) 15 --- oOo --- 16 17 I certify under penalty of perjury under the laws of the State of California that the foregoing is true and 18 correct. 19 Date 20 OTTO WONG, Sc.D., F.A.C.E. 21 22 23 24 --- oOo --- 25 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (234 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt PULONE & STROMBERG (408) 280-1252 DEPOSITION OF OTTO WONG, Sc.D., F.A.C.E. 156 1 2 3 STATE OF CALIFORNIA ) 4 ) ss. COUNTY OF SANTA CLARA 5 ) 6 7 I, BARBARA FRIEDMAN, a Certified Shorthand 8 Reporter in and for the State of California, hereby 9 certify that the witness in the foregoing deposition, 10 OTTO WONG, Sc.D., F.A.C.E., 11 was by me duly sworn to tell the truth, the whole truth 12 and nothing but the truth in the within-entitled cause, 13 and that the foregoing is a full, true and correct 14 transcript of the proceedings had at the taking of said 15 deposition, reported to the best of my ability and 16 transcribed under my direction. file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (235 of 236) [7/1/2010 10:57:29 AM] file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt 17 18 19 Date 20 , 1996. CSR Number C-7845 21 22 23 24 25 PULONE & STROMBERG (408) 280-1252 file:///C|/Users/MadeK42/Desktop/EXPERT%20TRANSCRIPTS/wong.o.96.03.lakie.txt (236 of 236) [7/1/2010 10:57:29 AM]