Document dQ5OX93EvJqY7zvxpBajOpjbG

1 IN THE CIRCUIT COURT 2 THIRD JUDICIAL CIRCUIT 3 MADISON COUNTY, ILLINOIS 4 -------------------------------------------------------------------------------x 5 JOYCE APPELQUIST, 6 Plaintiff, 7 v. 05-L-1176 South Carolina Case No. 8 06-SP-1702 9 BONDEX INTERNATIONAL, INC., GEORGIA-PACIFIC CORPORATION 10 and INGERSOLL-RAND COMPANY, 11 Defendants. ---------------------------------------------------------------------x 12 13 14 Deposition of THOMAS A. SPORN, M.D. 15 (Taken by Defendants) 16 Durham, North Carolina 17 November 2, 2006 18 19 Reported by: Marisa Munoz-Vourakis - RMR, CRR and Notary Public 20 21 22 23 24 25 1 1 INDEX 2 Examination of: Page 3 THOMAS A. SPORN 4 EXAMINATION BY MR. JOHNSON ............................ 7 5 EXAMINATION BY MR. HARTLEY ............................48 6 FURTHER EXAMINATION BY MR. JOHNSON . . 67 7 FURTHER EXAMINATION BY MR. HARTLEY . . 69 8 9 DEFENDANT EXHIBITS 10 11 NO 12 1 DESCRIPTION Medical records PAGE 8 13 14 15 16 17 18 19 20 21 22 23 24 25 2 1 APPEARANCE OF COUNSEL: 2 For the Plaintiff Joyce Appelquist: 3 CHRISTIAN HARTLEY, ESQ. 4 Richardson, Patrick, Westbrook & Brickman, LLC 5 174 East Bay Street 6 P.O. Box 879 7 Charleston, SC 29402 8 843-727-6564 9 chartley@rpwb.com 10 11 For the Defendants Bondex International, Inc., 12 Georgia-Pacific Corporation and Ingersoll-Rand Company: 13 PAUL JOHNSON, ESQ. 14 Burroughs, Hepler, Broom, MacDonald, Hebrank & 15 True, LLP 16 103 West Vandalia Street, Suite 300 17 P.O. Box 510 18 Edwardsville, IL 62025-0510 19 618-656-0184 20 p.johnson@ilmolaw.com 21 22 23 24 25 3 1 APPEARANCES (Continued) 2 For the Defendants Riley Stoker Corporation, Union Carbide 3 Corporation, Amchem Products, Inc.: 4 ED JOHNSTON, ESQ. (By Telephone) 5 Heyl, Royster, Voelker and Allen, P.C. 6 103 West Vandalia 7 Mark Twain Plaza II, Suite 100 8 Edwardsville, IL 62025 9 618-656-4446 10 edjohnston@hrva.com 11 12 For the Defendant VW of America, Inc.: 13 LAUREN WIELAND, ESQ. (By Telephone) 14 Johnson & Bell 15 33 West Monroe Street, Suite 2700 16 Chicago, IL 60603-5404 17 312-372-0770 18 wielandl@jbltd.com 19 20 21 22 23 24 25 4 1 APPEARANCES (Continued) 2 For the Defendants Harcros Chemicals, Inc., TH Agriculture 3 & Nutrition, L.L.C.: 4 PETER MAGINOT, ESQ. (By Telephone) 5 Lathrop & Gage 6 10 South Broadway, Suite 1300 7 St. Louis, MO 63102 8 314-613-2500 9 pmaginot@lathropgage.com 10 11 For the Defendants John Crane and Cleaver-Brooks: 12 JACKIE MILLER, ESQ. (By Telephone) 13 O'Connell, Tivin, Miller & Burns, LLC 14 645 Tollgate Road, Suite 220 15 Elgin, IL 60123 16 847-741-4603 17 jmiller@djoalaw.com 18 19 For the Defendant Kaiser Gypsum: 20 DAVID SZLANFUCHT, ESQ. (By Telephone) 21 Rasmussen, Willis, Dickey & Moore 22 9200 Ward Parkway, Suite 310 23 Kansas City, MO 64114 24 816-960-1611 25 dszlanfucht@rwdmlaw.com 5 1 APPEARANCES (Continued) 2 3 For the Defendants DAP, Inc., Zurn Industries, Inc., 4 Foster Wheeler Energy Corporation: 5 JOHN DILLENBECK, ESQ. (By Telephone) 6 Segal McCambridge Singer & Mahoney 7 330 North Wabash 8 One IBM Plaza, Suite 200 9 Chicago, IL 60611 10 312-645-7800 11 jdillenbeck@smsm.com 12 13 14 Deposition of THOMAS A. SPORN, taken by the 15 Defendants, at Duke University Medical Center, Department 16 of Pathology, Durham, North Carolina, on the 2nd day of 17 November, 2006 at 10:10 a.m., before Marisa 18 Munoz-Vourakis, Registered Merit Reporter, Certified 19 Realtime Reporter and Notary Public. 20 21 22 23 24 25 6 1 PROCEED I NGS 2 Whereupon, THOMAS A. SPORN, having 3 been first duly sworn, was examined 4 and testified as follows: 5 EXAMINATION BY COUNSEL FOR DEFENDANTS 6 BY MR. JOHNSON: 7 Q. Could you state your full name, please? 8 A. Yes, my name is Thomas Arthur Sporn, 9 S-P-O-R-N. 10 Q. Are you a medical doctor, sir? 11 A. Yes, sir. 12 Q. Dr. Sporn, my name is Paul Johnson. I'm here 13 representing Georgia Pacific Corporation, Bondex and 14 Ingersoll-Rand in an asbestos lawsuit that's been filed in 15 the Madison County Circuit Court, which is housed in 16 Edwardsville, Illinois on behalf of Mrs. Joyce Appelquist 17 versus a whole host of purported manufacturers and 18 distributors and whatever of asbestos. You understand 19 that, correct? 20 A. Yes, sir. 21 Q. And you have been subpoenaed by our office to 22 appear here this morning at the Duke Medical Center, 23 Department of Pathology to give your discovery deposition 24 in this Joyce Appelquist asbestos lawsuit? 25 A. That's correct. 7 1 Q. And before the deposition began, I handed in 2 your direction documents -- medical records, which our 3 office had previously collected from the custodian of 4 records for Duke University Medical Center and the 5 Pathology Department, correct? 6 A. Yes, sir. 7 Q. And I've marked those as Defendant's Exhibit 1 8 with today's date, correct? 9 A. Yes, sir. 10 (The document referred to was marked 11 Defendant's Exhibit No. 1 for 12 identification.) 13 Q. Are those in fact a complete set of your 14 professional records concerning Joyce Appelquist in this 15 case? 16 A. Yes, sir,they are. 17 Q. And do you have any independent recollection 18 of Joyce Appelquist? 19 A. No, sir. 20 Q. You are a specialist inthe field of 21 pathology, is that correct? 22 A. That's correct. 23 Q. Generally speaking, what is thefield of 24 pathology? 25 A. Pathology is that branch of medicine that is 8 1 involved with the study and interpretation of disease 2 states and injury. And so we are essentially a 3 consultative liaison between patients and their treating 4 doctors. 5 We analyze tissue ranging from small biopsies 6 or fluid specimens to surgical specimens to the entire 7 human organism, trying to provide information to patients 8 and their treating doctors so that treatment and therapy 9 can begin. 10 Q. As I understand the situation and scenario as 11 it regards Joyce Appelquist, you are one of her treating 12 physicians or treating pathologists, correct? 13 A. Yes, sir. 14 Q. Before today'sdeposition and the lastseveral 15 days, for example, have you had an opportunity to review 16 your records involved in her treatment? 17 A. Yes, I have. 18 Q. Okay. And what do thoserecordsconsist of, 19 Dr. Sporn? 20 A. The records that I have reviewed and from Mrs. 21 Appelquist's case consisted of two separate surgical 22 pathology excisions; one is a left pleural biopsy, the 23 remainder is a left radical extra pleura pneumonectomy 24 specimen, in other words, the entirety of the lung and 25 pleura, along with some lymph nodes that were removed from 9 1 Ms. Appelquist following her diagnosis. 2 Q. And when was the first procedure done, the 3 left pleural biopsy? 4 A. The left pleural biopsy was done on or about 5 April 27, 2005. 6 Q. And the second procedure? 7 A. On or about May 12, 2005. 8 Q. And were you personally involved in both 9 procedures? 10 A. I was not actually involved in the actual 11 obtainment of the specimens. I'm not a surgeon. 12 Q. In the analysis? 13 A. Yes, sir. 14 Q. So you analyzed the specimens from both the 15 procedures you just described? 16 A. Yes, sir. 17 Q. And what were your conclusions based on your 18 review of the first biopsy done on 4-27-05? 19 A. My diagnosis and impression was that this 20 patient had a malignant pleural mesothelioma. 21 Q. And what was that diagnosis based on, based on 22 your review of the 4-27-05 records? 23 A. My biopsy or my diagnosis was based on 24 examination of the tissue microscopically, as well as some 25 ancillary studies histochemistry and immunoperoxidase 10 1 stains. 2 Q. And what specifically about those endeavors 3 led you to your diagnosis of malignant pleural meso? 4 A. Well, based on the morphology, the way the 5 cells looked like under the microscope, and what surface 6 antigens they were expressing, and especially in this site 7 led me to conclude that she had a mesothelioma basically. 8 So it's morphology and the immunophenotype. 9 Q. By using the procedures that you just 10 described in the examination that you just described under 11 the microscope, were you able to eliminate other possible 12 diagnoses that are sometimes confused or the like with 13 respect to meso? 14 A. Yes, sir, to a reasonable degree of medical 15 certainty, I excluded some other diagnostic 16 considerations. 17 Q. And then could you again repeat the second 18 procedure that you performed on 05-12-05? 19 MS. MILLER: Sir, can you please keep 20 your voice up. I'm having problems hearing 21 you. 22 BY MR. JOHNSON: 23 Q. Could you please complete the full description 24 of your 05-12-05 procedure? 25 A. My analysis, Monday May 12, 2005, was a 11 1 microscopic examination of lymph nodes and the left lung. 2 And, again, I concluded that Mrs. Appelquist had a 3 malignant pleural mesothelioma. 4 Q. And, again, were you able, based on your 5 experience and training, to rule out other possible 6 diagnoses that are sometimes interpreted as being meso? 7 A. Yes. 8 Q. Is that within a reasonable degree of medical 9 certainty? 10 A. Yes, sir, it is. 11 Q. As we sit here today -- those are the only two 12 procedures that you conducted with respect to examining 13 pathology on Mrs. Appelquist, is that correct? 14 A. Correct. 15 Q. To your knowledge, there's been no subsequent 16 biopsies or fiber burden studies or the like with respect 17 to Mrs. Appelquist, correct? 18 A. To my knowledge, there's been no additional 19 testing of any type done on either one of these specimens. 20 Q. And you have not been asked by Mrs. 21 Appelquist's attorneys to do any further biopsies testing, 22 fiber burden analyses or the like, is that correct? 23 A. That is correct. 24 Q. And so as we sit here today on November 2, 25 2006, it is your conclusion above anything else with 12 1 respect to Mrs. Appelquist's diagnosis that she has a 2 malignant pleural mesothelioma? 3 A. Yes, sir. 4 Q. Now, with respect to analyzing how or under 5 what circumstances Mrs. Appelquist got the diagnosis or 6 contracted the malignant pleural mesothelioma, have you 7 had any conversations with any other plaintiff's attorneys 8 for Mrs. Appelquist in that regard? 9 A. No, sir. 10 Q. You are well-published and well-versed in 11 asbestos-related diseases, is that correct? 12 A. I think that's fair to say, yeah. 13 Q. With respect to mesothelioma, generally, 14 Dr. Sporn, would you agree that for females such as Joyce 15 Appelquist, that the idiopathic rate or percentage of 16 cases is much higher than a male suffering from 17 mesothelioma? 18 MR. HARTLEY: I just want to object to 19 any attempts to turn Dr. Sporn into an 20 undisclosed expert for the defense, but 21 carry on. 22 A. I think it's fair to say that the incidents of 23 idiopathic pleural mesotheliomas is higher in women than 24 in men. 25 Q. And based on your experience, knowledge and 13 1 training, can you put a percentage on such cases that are 2 in fact idiopathic in the female population? 3 A. I can't give you specific percentages. I 4 think if you look -5 Q. A range? 6 A. A range? Maybe between 40 and60 percent. 7 Q. So it's your testimony, within a reasonable 8 degree of medical and pathological certainty, based on 9 your knowledge, training and expertise, Dr. Sporn, that 10 between 40 and 60 percent of mesothelioma cases in the 11 female gender are in fact idiopathic? 12 MR. HARTLEY: Objection, leading. 13 A. Again, it's difficult to apply a blanket 14 statement. 15 Q. As blanket as we can be under the 16 circumstances? 17 A. As blanket as we can be, I think, yes, if we 18 were to take women, the female sex in its entirety, yes, I 19 think that's fair to say that the incidents of 20 mesothelioma, idiopathic mesos is in the range that I just 21 cited. 22 Q. And I understand the process that the word 23 idiopathic can mean different things to different people. 24 What does it mean to you as a practicing pathologist here 25 at Duke University? 14 1 A. It means that there can be no causative 2 ideology implicated. If you were to remove possible 3 environmental sources, possible radiation, possible 4 asbestos exposure, then you would be forced to compel to 5 conclude that the mesothelioma in this case was 6 idiopathic. 7 Q. All right. And are you aware -- you have 8 already told me that no, you, Dr. Sporn, have not done any 9 analyses on pathology, other than on 4-27 and 5-12-05, 10 correct? 11 A. Correct. 12 Q. Are you aware, on the other hand, of any 13 additional biopsies, fiber burden testing or other 14 advanced studies done with respect to determining the 15 ideology of this meso? 16 A. Maybe I didn't make that clear in my answer to 17 an earlier question. 18 No, I'm not aware of any additional studies of 19 any kind that have been done in this case. 20 Q. And so you are unable, as we sit here on 21 November 2, 2006, to state yes or state no whether there's 22 any testing or any indications from an objective source to 23 determine the cause of this meso? 24 A. Correct. 25 Q. And certainly such testing is available in 15 1 today's technology? 2 A. Oh, yes. 3 Q. In your experience, Dr. Sporn, as we get into 4 the 21st century in the calendar year 2006, has the 5 prevalence of mesothelioma in the male gender plateaued, 6 or does it continue to increase? 7 A. Well, it depends on which location. Certainly 8 here in the United States, I think mesothelioma -- pleural 9 mesothelioma incidents in men has plateaued and is 10 probably on the wane. 11 Q. What about forfemales? 12 A. I think that the incidents of mesothelioma in 13 women is probably static, reflected in the tendency of 14 mesothelioma in women to be idiopathic. 15 Q. And you anticipated the next question. 16 My next question would have been: How would 17 you explain your professional opinion, Dr. Sporn? 18 A. The difference in the prevalence rates in the 19 mail gender as opposed to the female gender? And did you 20 just answer that? 21 MR. HARTLEY: Let me just object 22 again. Paul, just to save time, I don't 23 want to object every time you start 24 asking -25 MR. JOHNSON: You can have a 16 1 continuing objection for the record. We 2 have a standard catch-all in our expert 3 disclosure reserving the right to call any 4 and all treating physicians of which 5 Dr. Sporn clearly is one so, but I 6 understand the nature of your objection and 7 it's continuing. 8 MR. HARTLEY: I won't object anymore. 9 MR. JOHNSON: Sure, it's continuing 10 throughout the entire deposition 11 A. Sorry, you are going to have to -12 Q. Yes. You were about to explain, again, 13 perhaps the explanation for why the female gender 14 prevalence of mesothelioma has remained static over these 15 years, and I believe that's where we left off. 16 A. Right. Well, if we don't know why 17 mesotheliomas -- why a significant report of mesotheliomas 18 are caused to women, then one can't logically infer that 19 that is going to decrease any time soon. 20 Q. There are in fact other causes for 21 mesothelioma, is that correct, other than asbestos 22 exposure? 23 A. Yes, there are. 24 Q. And in your experience, training and expertise 25 in this particular field, sir, what are some of those 17 1 other causes? 2 A. There are rare instances of patients 3 contracting mesothelioma following radiation therapy, say 4 for a childhood malignancy. 5 There are cases where people are exposed to, 6 asbestiform minerals, erionite for example, 7 E-R-I-O-N-I-T-E, which mineralogically resembles asbestos 8 and causes mesothelioma in areas of Turkey. But no, 9 there's -- other than that, that's a -- there are very few 10 other reasons for one to contract mesothelioma. 11 Q. As far as additional possible causes of 12 mesothelioma, what about scarring of the pleura? 13 A. Those are at the case report level. 14 Q. Peritonitis? 15 A. Again, I think that also would be at the case 16 report level. 17 Q. Chronic inflammation? 18 A. Those would be following the rubric of the 19 things that you mentioned. 20 Q. Oil refinery in petro chemical workers, 21 chemical carcinogens? 22 A. No, I don't dispute that oil workers and 23 refinery workers get mesothelioma, but I don't think it's 24 because they have been exposed to petro chemicals. 25 Q. Okay, SV40? 18 1 A. No, I think the SV40 linked to mesothelioma is 2 weak and tenuous at best and on its way to being 3 disproven. 4 Q. Genetic predisposition? 5 A. Yes, there are very definitely families where 6 there is a clustering of mesotheliomas. 7 Q. So that would be geneticpredisposition would 8 be much more significant in your mind than the previous 9 listings of SV40, scarring of the pleura, in your mind? 10 A. Yes, sir. 11 Q. True or false, I was reading some of your 12 materials on the flight down last night: A substantial 13 proportion of patients with malignant mesos have no 14 identifiable exposure to asbestos? 15 A. I think that's fair to say. That doesn't 16 mean -- if you don't mind me expanding -- that doesn't 17 mean they weren't exposed to asbestos, but they might not 18 have had an insidious or a cult exposure to asbestos. 19 Q. And thus the word identifiable, but just in 20 the general sense, you would agree with the notion that a 21 substantial proportion of patients with malignant 22 mesothelioma have no identifiable exposure to asbestos? 23 A. Yes, sir. 24 Q. And that's within a reasonable degree of 25 medical and pathological certainty, based on your 19 1 experience and training? 2 MR. HARTLEY: Objection, vague, 3 ambiguous. 4 A. Yes, sir. 5 Q. Do you agree with the notion that chrysotile 6 fibers shorter than five microns are not pathogenic for 7 mesothelioma? 8 A. Yes, I agree with that. 9 Q. And that's within a reasonable degree of 10 medical and pathological certainty, isthat correct? 11 A. Yes, sir. 12 Q. What are the various types of asbestos fibers 13 that you have come to know and study about and publish 14 about in your experience and training? 15 A. Well, asbestos minerals aredivided into the 16 amphibole asbestos, and the commercial forms being 17 principally crocidolite and amosite. The noncommercial 18 forms being tremolite, actinolite and anthophyllite. 19 The other major heading of -- mineralogically 20 of asbestos is serpentine asbestos minerals, principally 21 chrysotile. 22 Q. And what is it about your knowledge, 23 experience and training with respect to chrysotile fibers 24 that led you to answer in the affirmative a moment ago, 25 namely, that fibers of chrysotile that are less than five 20 1 microns in length do not contribute or cause to contribute 2 mesothelioma? 3 A. That is based upon my personal experience 4 dealing with mesotheliomas, measuring asbestos in 5 patients' lungs and reading what other experts have to say 6 in this regard. 7 Q. And certainly you, as a practicing pathologist 8 and a well-published pathologist in issues relating to 9 asbestos diseases, you make it a point to keep up with the 10 literature concerning those topics and subjects, correct? 11 A. I try to. 12 Q. And your opinion, as stated a moment ago, that 13 chrysotile fibers less than five microns in length do not 14 cause mesothelioma, that opinion that you have espoused 15 already in this deposition, that's consistent with the 16 well-reasoned literature that you are aware of out there? 17 MR. HARTLEY: Objection, leading, 18 vague. 19 A. I think that that opinion is one that has been 20 published in a variety of different venues. 21 Q. What are some other -- well, relative to 22 amphiboles, the crocidolite and amosite, the fibers that 23 you described a moment ago, do you have an opinion with 24 regard to the relative toxicity or potencies of the 25 various asbestos fibers? 21 1 MR. HARTLEY: Objection, vague, 2 outside his area of expertise. 3 BY MR. JOHNSON: 4 Q. You understand my question? 5 A. Yes, I did. 6 Q. First of all, did you understand my question? 7 A. Yes, I did. 8 Yes, I think it's recognized that the 9 commercial amphiboles, specifically amosite and 10 crocidolite are more mutagenic, carcinogenic, injurious 11 than say chrysotile and possibly some of the noncommercial 12 amphiboles. 13 Q. And I processed what you just said. Now, my 14 follow up to that is: Can you put some sort of numerical 15 figure on how much more times crocidolite is carcinogenic 16 than chrysotile, and then the same question with respect 17 to amosite? 18 A. No. I would have to say many times, but very 19 many times. But I can't -- I'd rather not be pinned down 20 to a numerical value. 21 Q. But at least so I get this straight, and that 22 the transcript is straight, you did state a moment ago 23 that it's your opinion within a reasonable degree of 24 medical and pathological certainty, that crocidolite and 25 amosite are "very many times more carcinogenic than 22 1 chrysotile fibers"? 2 MR. HARTLEY: Objection, leading, 3 misstates his prior testimony. 4 BY MR. JOHNSON: 5 Q. Did I misstate that in any way, shape or form, 6 sir? 7 A. I don't believe you did. 8 Q. That's what you said, right? 9 A. Yeah. 10 Q. And what is it about the chrysotile fiber that 11 leads you to that opinion, namely, that crocidolite and 12 amosite have very many more times carcinogenic than 13 chrysotile fibers? 14 MR. HARTLEY: Objection, leading. 15 A. If you wouldn't mind just repeating the 16 question? 17 Q. Yeah. What is it about -- deriving from your 18 background, training and experience in the field of 19 asbestos-related diseases, and your many publications in 20 that field, what is it about chrysotile fibers relative to 21 amphibole fibers, for example, that lead you to conclude 22 that crocidolite and amosite are "very many times more 23 carcinogenic than chrysotile"? 24 A. Well, there's two components to my answer. 25 One is the biopersistence of the amphiboles, which hang 23 1 around the human body for decades following inhalation, 2 where as that's not the same for chrysotile. In fact, not 3 only do they biopersist, but we measure them, we see them 4 when we do asbestos analyses. 5 Q. The fiber burdens? 6 A. Yes. It's not just something that we know 7 from reading that there's biopersistences. It is quite 8 long. But we actually see this when we do the injections, 9 where we don't see a chrysotile. 10 Q. Now, you tell me if I'm wrong, and I probably 11 will be wrong. Is your use of the word biopersistence in 12 your answer a few seconds ago, is that the same way of 13 saying that the body's defense mechanism, so to speak, 14 with regard to chrysotile expel most of the chrysotile 15 from the human lungs and pleura? 16 A. Yeah, that's another way of looking at it 17 that. 18 Q. Whereas amphiboles don't? 19 A. That terminology, I think, is better termed as 20 clearance, where chrysotile has high clearance, low 21 biopersistence, amphiboles have low clearance, high 22 biopersistence. 23 Q. What are the body's mechanisms that expel a 24 very much higher percentage of chrysotile fibers than the 25 amphibole fibers? 24 1 MR. HARTLEY: Objection, vague, 2 ambiguous. 3 BY MR. JOHNSON: 4 Q. First of all, in deference to the objection, 5 did you understand my question? 6 MR. HARTLEY: Same objection. 7 A. I think I did, yes. 8 Q. I thought you did, so go ahead. 9 MR. HARTLEY: Same objection. 10 A. The body clears chrysotile fibers through the 11 ciliary apparatus, through expectoration, through -- some 12 very long fibers might not get deposited in small airways 13 at all, and there's also additional biochemical breakdown 14 of chrysotile, to my knowledge. 15 Q. Is it your opinion, within a reasonable degree 16 of medical and pathological certainty, that these body 17 defense mechanisms that you just described do a very good 18 job naturally in expelling a very high percentage of 19 chrysotile fibers from the human lungs and pleura? 20 A. I think they do -- I think the body's defense 21 mechanisms are quite adequate in clearing chrysotile. You 22 can't look back at a field where you don't see any 23 chrysotile and say oh, there could have been X amount of 24 fibers there. I can't answer that question, but I do 25 think the body's defense mechanisms are able to clear 25 1 fibers with the physical chemical attributes of 2 chrysotile. 3 Q. And on the flip side of that same coin, can 4 you also now comment about the relative difficulties of 5 those same defense mechanisms of the human body to expel 6 amphibole fibers? 7 A. They are inferior. 8 Q. In what ways are they inferior, and to what 9 degrees are they inferior? 10 A. Well, I think they are inferior due to the 11 confirmation of the asbestos fibers, which tend to be 12 short, or, excuse me, not short, but slender and pointed 13 and less able to be trapped in the ciliary apparatus and 14 tend to resist biochemical degradation. 15 Q. Staying with mesothelioma, but talking now 16 about latency period, what's your opinion, based on your 17 experience, knowledge and training, as to a normal latency 18 period for mesotheliomas, such as the pleura meso that Ms. 19 Appelquist has in this case? 20 A. For asbestos-related mesotheliomas the latency 21 period is measured in decades from time of exposure, 22 typically. And there's not -- the only thing that we can 23 say with certainty is that it's long. There are some 24 patients who might have it measured in 15 years, and some 25 people who I think in our literature have developed 26 1 mesothelioma 70 years after asbestos exposure. 2 Q. That answer you gave was for asbestos-related 3 mesos, correct? 4 A. Yeah. 5 Q. What is the lowest latency period that you are 6 aware of in your professional appearance and expertise 7 with respect to an asbestos-related meso? 8 A. I never really pondered to think what the 9 shortest duration. 10 Q. Now, you prefaced your last answers, as far as 11 latency periods, by pointing out that your answers were 12 for asbestos-related mesotheliomas. Now, what about 13 idiopathic mesotheliomas, based on your knowledge, 14 training and experience as far as the latency period is 15 concerned? 16 MR. HARTLEY: Objection, vague and 17 ambiguous. 18 A. I would have to say you can't have a latency 19 period if you don't have an exposure, so. 20 Q. Nothing to judge it by? 21 A. Exactly. If you don't know what you are being 22 exposed to, you can't measure latency period, what, if 23 anything, you are exposed to. 24 Q. Correct. And, therefore, the term idiopathic, 25 no explanation? 27 1 A. Yeah, like I said, the concept of the latency 2 period I don't think applies to idiopathic diseases. 3 Q. Okay. And, again, light reading on the plane 4 last night, going from yours, Dr. Roggli's book, true or 5 false, amosite is the most common fiber associated with 6 mesothelioma in United States workers? 7 A. Yes, sir. 8 Q. And based on your experience, training and 9 expertise in pathology and in studying asbestos-related 10 diseases, industries such as ship building, service in the 11 United States Navy, construction industry, insulation 12 industry, have had the most meso cases, in your 13 experience? 14 A. In our experience, yes, sir, they have. 15 Q. And similarly, it's true to say, Dr. Sporn, is 16 it not, that occupations such as pipefitting, welding, 17 boilermaking, maintenance workers, machinists and 18 electricians have had the most meso cases, based on your 19 experiments and studies? 20 A. Well, based on the populations that we've had 21 available for us to analyze, yes, sir. 22 Q. Is it your opinion, Dr. Sporn, within a 23 reasonable degree of medical and pathological certainty, 24 that low-level exposures to chrysotile are not likely to 25 increase one's risk for contracting mesothelioma? 28 1 MR. HARTLEY: Objection, vague, 2 ambiguous. 3 A. Yes, sir, I think that that's fair to say. 4 Q. Now, again, the term low-level exposures can 5 mean one thing to one pathologist as to another 6 pathologist, correct? 7 A. Correct. 8 Q. What do you mean when you use the term 9 low-level exposure? 10 A. To me, it's an exposure that is not likely to 11 result in a tissue -- in the individual so exposed getting 12 a level of asbestos in their lungs before that of control 13 populations. 14 Q. On the flip side, do you have an opinion, 15 Dr. Sporn, with respect to whether low-level exposures to 16 commercial amphiboles might or could cause mesotheliomas? 17 MR. HARTLEY: Objection vague, 18 compound. 19 A. It's my opinion that any exposure to amphibole 20 asbestos that is likely to result in one sustaining an 21 increase in tissue asbestos above controls will contribute 22 to mesothelioma. 23 Q. And certainly if in this case the evidence 24 suggests in front of the jury in Madison County that Mrs. 25 Appelquist's father was in fact a pipefitter, electrician, 29 1 a boilermaker, what would that indicate to you, sir? 2 A. That would indicate to me, without knowing the 3 details of the family dynamics of the Appelquist family, 4 that there would at least be a possible scenario where 5 under the right circumstances, where Mrs. Appelquist could 6 have been exposed to asbestos through her father who was 7 so employed. 8 Q. Based on your knowledge, experience and 9 training in conducting of experiments in the field of 10 asbestos-related diseases, and your publishing of books 11 and articles with respect to asbestos-related diseases, 12 and asking you to assume that Mrs. Appelquist's father was 13 in fact a boilermaker, was in fact a welder, was in fact a 14 pipefitters and also performed electrician activities and 15 has a work history sheet going through the 1940s and '50s 16 and '60s at various steel mills, refineries, plants and 17 the like, first of all, is that the type of work history 18 that you and your colleagues in your published materials 19 take into consideration in determining ideology or causes 20 for mesos? 21 A. Yes. 22 MR. HARTLEY: Objection, vague, 23 ambiguous. Assumes facts not in evidence, 24 incomplete hypothetical. 25 Q. So you are used to, along with your 30 1 colleagues, of hearing and digesting work histories, such 2 as what I just asked you to take into consideration, 3 right? 4 MR. HARTLEY: Same objection. 5 A. Yes. Whenever we are asked to weigh in about 6 possible means of exposure to asbestos, we take into 7 account work histories of other family members, yes. 8 Q. And so asking you to take into consideration 9 and asking you to assume it's true that Mrs. Appelquist's 10 father in the 1940s, '50s and '60s was in fact a 11 boilermaker, welder, pipefitter and electrician at various 12 steel mills, refineries around the United States, and that 13 further, Mrs. Appelquist testified in her deposition that 14 in her adolescent ages, she was asked to do the laundry 15 and clean her father's clothing from those work sites and 16 from those work activities, is that a type of scenario 17 that you and your colleagues have analyzed before? 18 A. Yes, it has. 19 Q. First of all, with respect to the work 20 activities and the occupations that I described, that Mrs. 21 Appelquist's father was involved in, what sort of 22 exposures does that connotate to you, based on your 23 experience, knowledge and training? 24 MR. HARTLEY: Objection, calls for 25 speculation. 31 1 A. We have identified that those occupations have 2 potential for significant asbestos exposure. 3 Q. And when you say significant asbestos 4 exposure, what type of exposure are you referring to? 5 A. Exposure to amphibole asbestos. 6 Q. And without asking you to assume anything more 7 at this point in the deposition, based on the hypothetical 8 I have asked you to assume, the status of Mrs. 9 Appelquist's father as a boilermaker, welder, pipefitter 10 and electrician for over 30 years at various steel mills, 11 refineries and factories throughout the United States, 12 without any other information at this point, do you have 13 an opinion within a reasonable degree of medical and 14 pathological certainty as to what type of exposure? And 15 further assume, I'm sorry, that Mrs. Appelquist during her 16 adolescence did the laundry at home and would wash her 17 father's clothing, do you have an opinion as to whether or 18 not what type of exposures she would have been exposed to? 19 A. That's a hard -20 Q. Assuming any? 21 A. That's a hard question for me to answer. I 22 think that -- I think it is reasonable for me to state 23 that Mrs. Appelquist's father would have belonged to a 24 cohort of patients or of individuals that we have 25 identified as having significant asbestos exposure. 32 1 It is also reasonable to place Mrs. Appelquist 2 in a cohort of individuals who may have sustained asbestos 3 exposure through exposure to a primarily exposed 4 individual. 5 Q. And, again, as we sit here today, and as we 6 have already established in this deposition, there are no 7 objective testing that has been done with respect to Mrs. 8 Appelquist that would help you answer the questions I'm 9 asking? 10 A. No, there haven't been. 11 Q. And such testing would help you, if you were 12 asked to answer that question? 13 A. Well, I think such testing would, I think, 14 would provide significant information as regard what, if 15 any, type of exposure to asbestos Mrs. Appelquist had. 16 Q. If any. Because she certainly could within a 17 reasonable degree of medical and pathological certainty, 18 based on your experience, knowledge and training, be part 19 of that 40 to 60 percent or so of those mesos which are in 20 fact idiopathic? 21 A. She could be, but if you superimpose the 22 additional bit of information that her household contact 23 may have had significant asbestos exposure, I think that 24 might place her, might tend to place her less in an 25 idiopathic cohort. 33 1 Q. Again, going through some of your written 2 work, Dr. Sporn, it is true and accurate to state that 3 there is no convincing evidence for a causative 4 relationship between peritoneal mesothelioma and exposure 5 to chrysotile dust? 6 A. In my opinion, yes, that's true. 7 Q. What's the basis for that opinion as stated? 8 A. It's my experience and training and my 9 personal experience. 10 Q. Doctor, do you have any reason to agree or 11 disagree that there are no signs of pleural plaques or 12 interstitial fibrosis in Mrs. Appelquist's testing? 13 A. I did not see any evidence of pleural plaques 14 or interstitial fibrosis, no. 15 Q. And what significance, if any, do you attach 16 to that fact? 17 A. Pleural plaques are emblematic of asbestos 18 exposure. 19 Q. So if in fact some of Mrs. Appelquist's 20 testing had evidenced the presence of pleural plaques 21 and/or interstitial fibrosis, what would that have 22 indicated to you? 23 A. That she was exposed to asbestos. 24 Q. And in the absence of any such signs or 25 indications? 34 1 MR. HARTLEY: Objection, vague. 2 A. Well, no, I think that not everyone who is 3 exposed to asbestos or has asbestos-related mesothelioma 4 will have plaques. 5 Q. But certainly that would be one confirmatory 6 fact for you, if in fact there are signs of pleural 7 plaques or interstitial fibrosis that would indicate some 8 asbestos exposure? 9 A. Oh yes, and that would be enough for me to 10 state -- if we saw plaques here, not so much interstitial 11 fibrosis, because interstitial fibrosis is very common, 12 but if I had seen pleural plaques in there, I would have 13 stated in my report that the mesothelioma was caused by 14 asbestos. 15 Q. But to be fair, what you are saying is just 16 because there's an absence of pleural plaques, doesn't 17 mean you can conclude that there was no asbestos exposure? 18 A. That is correct. 19 Q. Also in the notes, there's an indication of 20 asbestos bodies not identified on routine or in special 21 stains for iron. What significance is that finding in 22 your notes? 23 A. Well, I, again, if they were present there, 24 that would help me be comfortable saying this was an 25 asbestos-related mesothelioma. The fact that we didn't 35 1 see any, again, that does not mean that this is not an 2 asbestos-related mesothelioma. 3 Q. Again, forgive my naivety here, but you 4 already indicated and testified and confirmed that there 5 were no signs of pleural plaques and interstitial 6 fibrosis. And then I just read this part of your notes 7 stating asbestos bodies not identified by routine or in 8 special stains for iron. 9 Are those asbestos bodies to which reference 10 was made in your notes different from pleural plaques 11 and/or interstitial fibrosis? 12 A. Yes. 13 Q. What would they be referring to? What type of 14 asbestos bodies? 15 A. Well, you never see, for example, asbestos 16 bodies inside pleural plaques. Pleural plaque is just a 17 scar caused by asbestos inhalation. 18 Asbestos bodies themselves are the actual 19 asbestos fibers in the lung. 20 Q. And what sort of testing was being done here 21 on this surgical path report such that you can make that 22 conclusion in your note, asbestos bodies not identified? 23 A. Asbestos bodies can be observed just on 24 routine sections if they are present. And to make it a 25 little bit easier on ourselves, because they can be tricky 36 1 to find, we will do an iron stain, because the coating for 2 asbestos bodies contains iron, and that helps light them 3 up a little bit, if you will. 4 Q. Is that the reason that you -- is that the 5 reason that you did a stain test for iron? 6 A. Yes. 7 Q. Is that the only purpose that you would have 8 done a stain test for iron? 9 A. Yes. 10 Q. And does the fact that there are no pleural 11 plaques, does the fact that there is no interstitial 12 fibrosis, and does the fact that you found no asbestos 13 bodies even though you did a special testing stain for 14 iron, does that make you less comfortable in making any 15 sort of asbestos-related conclusion here with respect to 16 Mrs. Appelquist's meso? 17 A. Well, for the basis of this reporting, it 18 does. But, again, the fact that we're not seeing plaques 19 and that we are not seeing asbestos bodies, I don't think 20 that exonerates asbestos. I think to exonerate asbestos, 21 we would have to do additional testing. 22 Q. What would you have to do? 23 A. We would have to do a fiber burden analysis. 24 Q. With regard to fiber burden analysis and the 25 methodology for doing such testing, I'm assuming, and 37 1 correct me if I'm wrong, that you would agree with 2 Dr. Roggli's methodology, as evidenced in his publications 3 and books, as you are part of them? 4 A. Yes, the technique that he taught me. 5 Q. And that would include counting only fibers 6 five microns or longer? 7 A. Correct. 8 Q. And the reason you do that, the reason 9 Dr. Roggli does that is because only the fibers longer 10 than five microns are carcinogenic based on your 11 experience, training and expertise? 12 A. Correct. 13 Q. Do you agree or disagree with the notion that 14 only 20 percent of female pleural mesotheliomas are 15 conclusively related to asbestos exposure, based on your 16 knowledge and the studies and literature out there in the 17 pathological community? 18 MR. HARTLEY: Objection, vague, 19 ambiguous, asked and answered. 20 A. Again, please? 21 Q. Yes, sir. Do you agree or disagree with a 22 study in the pathological literature, which concluded that 23 20 percent of pleural mesotheliomas in the female gender 24 are conclusively related to asbestos exposure? 25 MR. HARTLEY: Same objection. 38 1 A. Again, I'm not sure that fewer than 2 20 percent -- you run into problems in some studies, 3 because of different laboratories having different control 4 levels. So. 5 Q. Well, I won't hold you to that number. 6 Approximately? 7 A. I think I may have already stated that 8 earlier, at least, you know, a sizable majority of mesos 9 are idiopathic, a sizeable number. 10 Q. But I was asking the flip side of the 11 question, as you probably have gathered, and that is: Can 12 you put a reasonable percentage, based on your experience, 13 knowledge and training, as to which ones are in fact 14 related to asbestos exposure? 15 A. I think across the board, women I think it's 16 the minority, and, again, I can't -- I would rather not 17 get pinned down to numbers. 18 Q. Are you aware of the Spirtas study, 19 S-P-I-R-T-A-S, in that regard? 20 MR. HARTLEY: Objection, vague. 21 A. I would have to see it. 22 Q. Okay, fair enough. 23 I didn't see any other indications of any 24 other studies, other than the iron study, in your notes or 25 in the Pathology Department's notes at Duke to indicate 39 1 the absence of asbestos bodies. Were there other studies? 2 A. No, sir, there weren't. 3 Q. Have you, in conjunction with Dr. Roggli or 4 for that matter in conjunction with medical/legal matters 5 before 2006, been asked to analyze or study joint 6 compound? 7 A. No. 8 Q. Nothing with respect tojoint compound and its 9 alleged, alleged causation of mesothelioma? 10 A. No, we haven't. 11 MR. JOHNSON: That's all thequestions 12 I have, Doctor. Thank you very much. 13 MR. HARTLEY: Anyone on the phone have 14 any questions for the doctor? 15 MS. MILLER: No, questions. 16 MR. DILLENBECK: I need to enter my 17 appearance, I'll wait. 18 MR. HARTLEY: Anyone else have any 19 questions? 20 We will let you know when we're done. 21 Paul has another question. 22 BY MR. JOHNSON: 23 Q. Dr. Sporn, are you familiar with the EPA 2003 24 study with respect to asbestos-related disease in 25 chrysotile? 40 1 MR. HARTLEY: Objection, vague. 2 A. I would have to see the actual document. 3 Q. It's called peer consultation workshop on a 4 proposed asbestos cancer risk assessment? 5 MR. HARTLEY: Objection, misstates 6 what it is. 7 A. I'm sure I've seen it. 8 Q. In any event, to save time here, what I'm 9 asking you is: Do you agree with the notion and the 10 conclusion of that study that the possibility that pure 11 chrysotile is nonpotent for causing mesothelioma cannot be 12 ruled out by the epidemiological data? 13 MR. HARTLEY: Objection, 14 mischaracterizes the document as a study, 15 and it's outside his area of expertise. 16 A. No, I don't think that pure chrysotile - 17 there are instances of mesothelioma caused by inhalation 18 of pure chrysotile. 19 Q. I'm sorry, I didn't understand your answer. 20 A. I may have misunderstood your reading of the 21 letter, but it's -- if I understand the phraseology, I 22 would be hesitant to say that pure chrysotile is across 23 the board noncarcinogenic. 24 Q. In terms of causing mesothelioma though? 25 A. That's what I mean, yes. 41 1 Q. Put another way, you recognize in your 2 training, experience, I believe what you are saying, tell 3 me if I'm wrong, that in certain high dosages, you are of 4 the opinion that chrysotile can cause or contribute to the 5 cause of meso? 6 A. Yes. 7 Q. But if I heard what you said in process with 8 what you said earlier, at least in your definition of low 9 exposure versus high exposure, it would take a very high 10 exposure of chrysotile, in your medical opinion, in your 11 pathological opinion, to contribute to cause a meso, is 12 that - 13 A. Correct. 14 Q. And what would youconsider, Dr. Sporn, to be 15 a very high exposure? 16 A. Again, I can't come upwith ascenario, other 17 than sticking one's head in a bag of chrysotile and 18 breathing it in. Beyond that, I lack the -- I'm not an 19 occupational hygienist. I can't -20 Q. Would you have to take it on a case-by-case 21 basis? 22 A. Yes. 23 Q. All right. Then am I free to assume in this 24 particular case, Mrs. Appelquist's husband claims that he 25 was employed by a high school, and that on several 42 1 occasions per month, as part of monitoring a, for lack of 2 a better term, vocational occupational program implemented 3 by the school, he would have to leave the school grounds 4 and go out in the community and supervise some students 5 that were taking jobs in the community. And that Mr. 6 Appelquist claimed that in monitoring these kids a few 7 times per month, he would observe them sanding joint 8 compound on a wall. He would wear a suit and tie to these 9 endeavors, to make sure that the kids were doing what they 10 were supposed to do and reporting to the sites where they 11 were supposed to report, and he claims that on occasions, 12 he would get stuff on, you know, materials on his suit and 13 tie, but that his suit and tie would be dry cleaned, and 14 the rest of the laundry would be taken home on these 15 occasions per month when he would observe these students 16 of his. 17 Is that the type of activity, that I just 18 described, is that what you would consider to be a high 19 exposure, using your definition of high exposure for 20 Dr. Sporn? 21 MR. HARTLEY: Objection, vague, 22 ambiguous, incomplete hypothetical, outside 23 of his expertise. 24 A. I would think that the scenario that you just 25 described would be unlikely to result in either an 43 1 occupational or paraoccupational exposure to chrysotile. 2 Q. And what do you mean by occupational or 3 paraoccupational? 4 A. I mean, I think the supervising of others, the 5 gentleman supervising that was his occupation, so I 6 think -7 Q. Several times per month. It wasn't full time 8 out there in the field. 9 A. No, but that was still in the course of his 10 job description. So it is an occupation. 11 So I think that type of occupation, 12 supervising several times a month in a suit and tie from a 13 distance is not likely, either for an individual so 14 employed or any of his household contacts to result in 15 asbestos exposure. 16 Q. And what about in this particular case? 17 Assume that there was a time in the '60s where some - 18 their own home was improved. They put in an archway and 19 used some joint compound and had to sand it down, and then 20 chipped some joint compound out because the originally21 applied joint compound wasn't working, and Mr. Appelquist 22 and perhaps his father-in-law put in another batch of 23 joint compound to make the archway look aesthetically 24 pleasing as far as the home improvement was concerned. Is 25 that the type of scenario that I just posited that you 44 1 would consider to be a very high exposure, potentially so, 2 to chrysotile asbestos? 3 MR. HARTLEY: Same objection, 4 incomplete hypothetical. 5 A. I would have to say no, that's not likely to, 6 I think, result in significant exposure to asbestos. 7 Q. And why is that, sir? 8 MR. HARTLEY: Same objection. 9 A. Again, my answer to this is based on we have 10 never seen individuals like this in our practice, nor do I 11 believe that -- I guess it would have to be the main, as 12 someone who is not an occupational hygienist, someone who 13 is not going out and evaluating job sites, I would just 14 have to say that intuitively, and the fact that we have 15 not seen, you know, people employed in this type of 16 activity all across the country, we have not seen this in 17 our practice as folks who are coming in with mesothelioma. 18 So that's one of the main thrusts here of my opinion. 19 I don't work with joint compound. I'm not an 20 occupational hygienist. 21 Q. You know what it is though? 22 A. Yeah, I know what it is. 23 Q. What is it? 24 A. It's something that's employed in seams and 25 joints in construction. 45 1 Q. And then I want to throw back into the mix 2 here in this conversation we were just having in these 3 last several minutes, the aforementioned history of Mrs. 4 Appelquist's father in his work career in the '30s, '40s, 5 '50s and '60s and being a boilermaker, welder, pipefitter 6 and electrician at various work sites throughout these 7 United States. In your previous testimony, that would 8 connotate amphibole exposure of a high nature, correct? 9 MR. HARTLEY: Objection misstates his 10 prior testimony. 11 BY MR. JOHNSON: 12 Q. Does that misstate your prior testimony? 13 MR. HARTLEY: Same objection. 14 A. I think that would place him without detailed 15 knowledge of an individual, would sort of place him in a 16 cohort that we have described as having significant 17 asbestos exposure. 18 Q. In the order of magnitude of things, when you 19 compare and contrast what I asked you to assume was true 20 as far as Mrs. Appelquist's father's career is concerned 21 on the one hand, and her husband working as a vocational 22 supervisor several times per month, going out to work 23 sites to make sure students are where they are supposed to 24 be and observing them from time to time using some 25 products involving joint compound. In the order of 46 1 magnitude of things, what's the more significant exposure? 2 A. I think clearly the exposure to a 3 paraoccupational exposure to someone who has been exposed 4 to commercial amphiboles would be much more critical. 5 Q. And given the facts that I posited to you as 6 far as the husband, Mr. Appelquist's work history and 7 alleged exposure to joint compound products, that would 8 certainly not fit within your definition of a significant 9 exposure to chrysotile, correct, without knowing more? 10 A. I certainly would be very surprised, based on 11 that, whether the gentleman would have significant 12 exposure to asbestos or any type of asbestos-related lung 13 disease. 14 Q. And, therefore, based upon the information 15 I've asked you to assume as true, you would not have an 16 opinion within a reasonable degree of medical and 17 pathological certainty, would you, Dr. Sporn, that this 18 alleged exposure to chrysotile containing joint compound 19 product would even be a contributing factor to any 20 mesothelioma contracted by his wife, correct? 21 A. Correct. 22 MR. JOHNSON: That's all the questions 23 I have. 24 MR. HARTLEY: Second try for anyone on 25 the phone who has questions? 47 1 EXAMINATION BY COUNSEL FOR PLAINTIFF 2 BY MR. HARTLEY: 3 Q. Dr. Sporn, you have been asked about the 4 importance of doing further testing on Mrs. Appelquist's 5 tissue, is that correct? 6 A. Well, yes, I have. 7 Q. Did you recommend any further testing as part 8 of your work as a treating physician in this case? 9 A. No, I didn't. 10 Q. Would doing a fiber burden analysis do 11 anything to help treat Mrs. Appelquist's mesothelioma? 12 A. No, sir, and that's why it was not performed 13 in this case. 14 Q. In fact, it's normal not to do that sort of 15 thing if you are not trying to identify the ideology of 16 the cancer, isn't it? 17 A. Yes, that's correct. 18 Q. There is no reason for you to do that in this 19 case, was there? 20 A. No, sir. 21 Q. There was no implication here that any lawyers 22 prevented you from doing any fiber burden analysis here in 23 this case? 24 A. No, absolutely not. 25 Q. You haven't been asked to be an expert in this 48 1 case by anyone, have you? 2 A. No, sir. 3 Q. You came here today thinking you were going to 4 give your knowledge about the facts of this case, correct? 5 A. That is correct. 6 Q. You did not anticipate beingoffered as an 7 expert in this trial in any way? 8 A. No, I didn't. 9 Q. You were asked about some of the potential 10 causes of mesothelioma. And one of things you mentioned 11 was radiation. Is there epidemiology supporting radiation 12 as a cause of mesothelioma in humans? 13 A. There have been review articles, and I think 14 one I think I cited this in my chapter on mesothelioma in 15 our textbook, the one study that radiation didn't appear 16 to play a role. But in my own practice, we have seen 17 these mesotheliomas developed in a radiated chest of scar 18 tissue. 19 Q. So you are willing to accept that under 20 certain circumstances, radiation can cause mesothelioma 21 because of what you know about radiation's effect on the 22 human body, correct? 23 A. That is correct. 24 Q. Even though there's no epidemiology to support 25 that? 49 1 A. Correct. 2 Q. When it comes to exposures to various 3 carcinogens, let's talk about it as a concept: Lung 4 cancer. Does cigarette smoking cause lung cancer? 5 A. Yes, it does. 6 Q. Do Marlboro cigarettescause lung cancer? 7 A. Yes, they do. 8 Q. How do you know that if there's no 9 epidemiology in people who only smoked Marlboro 10 cigarettes? 11 A. Well, I think it's -- I mean, I think that you 12 have to infer that there's a tremendous amount of data 13 regarding the potential for cigarette smoke to be 14 carcinogenic. Marlboro is a brand of cigarette that 15 produces -- I don't know of anything that would argue 16 against the smoke from Marlboro cigarettes as being any 17 different from the smoke produced by Camels or Lucky 18 Strikes, whatever. So it is a logical inference that 19 Marlboro brand is a form of cigarette that causes lung 20 cancer. 21 Q. And that's because the active ingredient or 22 the carcinogenic ingredients in tobacco are in more than 23 one kind of cigarette, correct? 24 A. Correct. 25 Q. Now, what would you think if I told you, if I 50 1 were to argue to you that there's no way we can prove that 2 joint compound that contains chrysotile and contaminant 3 tremolite causes mesothelioma, because there are no 4 studies showing that dry wall workers who were exposed to 5 heavy levels of that material have suffered mesothelioma 6 at an excess rate? 7 MR. JOHNSON: Objection to the form of 8 the statement. 9 A. Again, you lost me there. I'm sorry. 10 Q. Okay. When it comes to asbestos-containing 11 products, it's the asbestos in those products that has the 12 potential to cause mesothelioma in humans, correct? 13 A. Well, no, I think there you have to decide 14 asbestos as an injurious agent isn't completely analogous 15 to cigarette smoke. I think all of -- I think you have to 16 look at the actual fiber types of asbestos and the 17 mineralogy before -- as part of your analysis. 18 Q. Okay. And I think you wereasked some 19 questions about fiber length. Is that one of the issues 20 you are talking about? 21 A. Yes, correct. 22 Q. And also theamphibole versus the chrysotile 23 distinction, correct? 24 A. Correct. 25 Q. Tremolite is an amphibole that is found in a 51 1 lot of chrysotile fibers, isn't it? 2 A. Yes. 3 Q. You know from your own work that tremolite 4 that contaminates chrysotile products is found in people 5 exposed to chrysotile products who have mesothelioma, 6 correct? 7 A. Correct. 8 Q. That is a contaminate in chrysotile products 9 that you believe causes mesothelioma in humans, correct? 10 MR. MAGINOT: Object to the form of 11 the question. Assumes facts not in 12 evidence, overly broad. 13 BY MR. HARTLEY: 14 Q. How is it thatscientists know that Canadian 15 chrysotile contains a contaminate of tremolite? 16 MR. JOHNSON: Object to the form of 17 the question. 18 A. I think by mineralogic analysis and by 19 analyzing the lung tissue of people who have been so 20 exposed. 21 Q. There are studies of theairaround Canadian 22 chrysotile mines that show tremolite in the air around 23 those mines, correct? 24 A. Correct. 25 Q. That's one of the bases on which we know that 52 1 Canadian chrysotile is contaminated with tremolite, isn't 2 it? 3 A. Correct. 4 MR. MAGINOT: Object to the form of 5 the question. 6 Christian, so we have a clear record, 7 can one objection for one be one for all? 8 MR. HARTLEY: Sure, it's easier that 9 way. 10 Q. Any kind of -- any brand of asbestos as far as 11 you know contains a wide variety of fiber lengths, 12 correct? 13 A. I don't know if that's true or not. 14 Q. I want to talk to you a little bit about how 15 mesothelioma is caused by asbestos. 16 Can you explain that to me? 17 A. There's a variety of different, I mean, huge, 18 not easily I can. It involves recruitment of inflammatory 19 cells, of free -- oxygen free radical generation, all of 20 which acts to damage the DNA of the mesothelial cells, is 21 the short answer. 22 Q. Does the asbestos have to contact the pleura 23 for it to cause mesothelioma in the pleura? 24 A. I think so, yes. 25 Q. Now, there are a lot of other researchers who 53 1 do fiber burden analysis like you and Dr. Roggli do here 2 at Duke, is that correct? 3 A. Correct. 4 Q. Who are some of the people that you believe 5 are well-respected in that field? 6 A. Sam Hammer; Dodson, down at the University of 7 Texas. 8 Q. That's Ronald Dodson? 9 A. Yeah. 10 Q. Those two gentlemen disagree with your 11 position on fiber length and its relative -- and its 12 carcinogenicity, isn't that true? 13 A. I think they have published things where they 14 have different opinions regarding the carcinogenicity of 15 chrysotile, yes. 16 Q. Now, have youspecifically researchedthe 17 literature in order to form an opinion, your opinion about 18 fiber length, or are you just generally taking that from 19 what you've seen? 20 A. I have in the past looked at what the 21 available literature has to say. 22 Q. And have youpublished any articles in that 23 area? 24 A. No. 25 Q. Is that area discussed in your textbook, your 54 1 most recent version of your textbook? 2 A. Is what discussed? 3 Q. Your belief that fibers, chrysotile fibers 4 shorter than five microns don't cause mesothelioma in 5 humans? 6 A. I don't think that statement was made in our 7 text. 8 Q. 9 That's something that's open to debate? You believe that based on your experience, but 10 many others believe otherwise, correct? 11 A. Others believe otherwise, yes. 12 Q. And those others would be people who are well 13 respected, like Dr. Dodson and Dr. Hammer, correct? 14 A. Correct. 15 Q. They too, like yourself and Dr. Roggli, have 16 spent a good part of their lifetime studying the ideology 17 of asbestos-related disease? 18 A. Yes. 19 Q. One article -- Dr. Dodsonhasactually 20 published an article on that topic, hasn't he? It's a 21 review article about short fiber chrysotile or short 22 fibers and its ability to cause mesothelioma? 23 A. Right. 24 Q. And his conclusion is that the evidence is 25 that you can't rule out short fibers, right? 55 1 A. That's what he says, yes. 2 Q. And that's based on a whole host of things, 3 most importantly, that there isn't a whole lot of 4 information out there of people exposed only to short 5 fiber, correct? 6 A. Yeah. 7 Q. Switching topics, you were asked about a 8 genetic predisposition to mesothelioma. There are 9 families that where it seems that they get mesothelioma 10 more easily than others, right? 11 A. Yes. 12 Q. In those people with genetic predispositions 13 to mesothelioma, you can't rule out that asbestos caused 14 those mesotheliomas in those families either, can you? 15 A. No, absolutely. 16 Q. In fact, just because -- well, all people have 17 different abilities to resist various toxins, isn't that 18 true? 19 A. Absolutely. 20 Q. Some families may have a weakened ability to 21 resist a kind of cancer, but that doesn't mean the cancer 22 wasn't caused by a particular agent, such as asbestos, 23 right? 24 A. Correct. 25 Q. Do you know who Dr. Kent Pinkerton is? 56 1 A. No. 2 Q. How about Arnold Brody? 3 A. Yeah. 4 Q. Is Arnold Brody a well-respected scientist who 5 studies asbestos-related disease? 6 A. Yes. 7 Q. He once was at Duke here, correct? 8 A. Yeah, before my time, yeah. 9 Q. And you know Dr. James Crapo? 10 A. Yes. 11 Q. He was -- is he still here at Duke? 12 A. No. 13 Q. Have you ever heard of coalinga chrysotile? 14 A. No. 15 Q. Do you believe that the longer the chrysotile 16 fiber or any of the asbestos fiber, the more propensity it 17 has to cause mesothelioma as long as it is something that 18 is respirable, correct? 19 A. Yeah. Beyond a certain point, things can get 20 so big, they are not respirable or deposited in the airway 21 at all. 22 Q. Let me talk to you about a lot of your 23 testimony, which makes sense, was based on your 24 experiences here at Duke. 25 You do a lot of work with the electron 57 1 microscope here at Duke, correct? 2 A. Yes. 3 Q. You use a scanning electron microscope, 4 correct? 5 A. Yes. 6 Q. That has less resolution than a transmission 7 electron microscope? 8 A. Yeah, I think that's fair to say. 9 Q. Transmission electron microscope can see 10 fibers that are thinner than a scanning electron 11 microscope, correct? 12 A. I really don't have much experience with TEM 13 to comment on its use in asbestos analysis. 14 Q. You recognize that others have indicated that, 15 correct? That the TEM is able to see asbestos fibers that 16 are thinner than can be resolved by the scanning electron 17 microscope? 18 A. Again, that's not a body of literature that 19 I've spent a lot of time reviewing. 20 Q. There are several researchers out there who 21 have made it their business to look at the lung tissue and 22 the pleura of people who have suffered from mesothelioma, 23 correct? 24 A. Correct. 25 Q. Here at Duke, you don't investigate the 58 1 pleura, correct? 2 A. No. 3 Q. Why not? 4 A. That's something that we just -- that hasn't 5 come into our field of investigation. 6 Q. There's nothing wrong with looking at the 7 pleural tissue, along with the lung tissue, in trying to 8 research the causes of mesothelioma, is there? 9 A. No. 10 Q. And the pleura isactually the tissue where 11 the mesothelial tumordevelops, correct? 12 A. Correct. 13 Q. And that's where the asbestos has to get to 14 cause mesothelioma, as far as you know? 15 A. Right. 16 Q. And I don't mean that in any rude way. I 17 mean, as far as you know, because science hasn't developed 18 a hundred percent to figure out how mesothelioma is caused 19 in humans, correct? 20 A. Correct. 21 Q. There isstill some stuff we need to learn, 22 and that's why you are continuing to research? 23 A. Correct. 24 Q. No one has given you anyinformation about 25 Mrs. Appelquist's actual exposures to asbestos? You have 59 1 just heard some lawyers ask you some questions, you know, 2 assume this, that, right? 3 A. That's correct. 4 Q. In order to really get a feel for what level 5 of exposure she would have had, you would need to look 6 at -- you would need to either talk to her or read her 7 depositions, read her husband's depositions, isn't that 8 true? 9 A. Correct. 10 Q. Asbestos-relateddisease and the probability 11 of developing it is based on the dose of asbestos over a 12 lifetime, isn't it? 13 A. Again, please? 14 Q. I've heard and otherdoctors call 15 asbestos-related diseases dose-response diseases. What 16 does that mean to you? 17 A. I don't -- I think that's -- it's a little bit 18 of an ambiguous term, because I don't, for example, yes 19 development of lung cancers, not mesothelioma, but lung 20 cancers and asbestosis is a dose response type of disease 21 scenario. It takes a lot of asbestos to result in 22 asbestosis, scarring of the lung and from bronchogenic 23 carcinomas. I don't think that's true for mesotheliomas. 24 Q. Okay. When it comes to a given population, 25 the greater the exposure to asbestos, the higher the 60 1 probability that a person would suffer an asbestos-related 2 disease, wouldn't you agree? 3 A. That's hard to know, because -- and the reason 4 for that is is that there are hundreds of thousands of 5 people who have sustained lots of asbestos exposures, and 6 mesothelioma is, by contrast, a rare disease. 7 Q. Let me, I guess, in those -- you've indicated 8 from your own work, and I think I have seen it in your 9 book, that there are certain populations where you see 10 higher rates of mesothelioma than in others? 11 A. Right, correct, in insulator population. 12 Q. And you would attribute that to the higher 13 exposures of asbestos of those people? 14 A. I see your point, yes. 15 Q. And using common logic, it's -- the higher the 16 exposure, the higher the propensity to suffer a disease in 17 a population, isn't that true? 18 A. Yes. The greater your exposure, the greater 19 likelihood of you being placed in the at-risk group is. 20 Q. Just like the more you smoke cigarettes, the 21 greater your risk of getting a lung carcinoma, correct? 22 A. In general, yes. 23 Q. It's the dose? 24 A. Yes. 25 Q. Quickly about your report, the iron stains 61 1 that you did, can you tell from your report where you got 2 the tissue? 3 A. If you look at my report, it says that there 4 are sections upper lobe and lower lobe, and generally, we 5 analyze an iron stain section from each, from the upper 6 and lower lobes. 7 Q. When you are trying to determine whether a 8 mesothelioma is asbestos-related, do you subscribe to any 9 criteria? Do you use the ATS criteria, for instance? 10 A. To say that something is asbestos related? 11 Q. Yes. 12 A. Well,generally, I'm not sure what the ATS 13 criteria is. Our criterion out here at Duke, are 14 demonstration of either plaques, demonstration of asbestos 15 bodies, demonstration of asbestosis or increased fiber 16 burdens. Those are our criteria. 17 Q. I think Dr. Roggli told me that he subscribed 18 and actually was -- maybe I'm confused. I will move on 19 from there, because I'm just remembering what Dr. Roggli 20 said is probably a bad way to go. 21 Are you familiar with the Helsinki criteria? 22 A. Yes. 23 Q. Do you subscribe tothat? 24 A. I subscribe to its sphere, if you will. I 25 don't think it's a one-size-fits-all document. Otherwise, 62 1 you can say that everybody on the planet has mesothelioma 2 I think if you applied the Helsinki criteria 3 across the board, you could make an argument to get rid of 4 all of the classification idiopathic mesotheliomas. 5 Q. Okay. Well, there are certainly -- everyone 6 in, for instance the United States, when you talk about 7 idiopathic -- rates of idiopathic mesothelioma, you have 8 to choose an area where you are talking about the rate, 9 correct? 10 A. Correct. 11 Q. There's no population? 12 A. Correct. 13 Q. In the United States, everyone is exposed to 14 some level of asbestos, aren't we? 15 A. Right. 16 Q. That's because there's asbestos in the air 17 from many sources, both man made and natural, correct? 18 A. Correct. 19 Q. There's what's called a background exposure or 20 background or ambient level of asbestos in the air in any 21 given area, correct? 22 A. Correct. 23 Q. You mentioned, I think, that you look in your 24 labs when you are trying to determine whether a 25 mesothelioma is asbestos related for elevated levels of 63 1 mesothelioma, isn't that true? 2 A. Correct. 3 Q. And do you use -- do you look at the 4 geographic location where the patient comes from to 5 determine what is elevated? 6 A. No. 7 Q. Isn't it true that in some areas, the airborne 8 concentration of asbestos is much higher than in others, 9 so that someone living in one place and someone living at 10 another place would have a different burden of asbestos in 11 their lungs? 12 A. No. I think that was all looked at with what 13 our control populations, our control levels were, were 14 establish. We don't have one control level. We have a 15 range of values for a control population taking that into 16 account. 17 Q. How does therange work? 18 A. Our range for background is zero to twenty 19 asbestos bodies per gram. That takes into account that if 20 you live in an area where there might be a little bit more 21 asbestos, either from environmental or man made or 22 environmental reasons, as you state, you might be closer 23 to 20. Whereas, if you come from an area where there is 24 no asbestos at all, you would be expected to not have any 25 asbestos in the lungs. 64 1 Q. And asbestos bodies are typically found around 2 or with amphibole fiber at their core, correct? 3 A. Correct. 4 Q. And that's because chrysotile, as you 5 mentioned, spends less time in the lung over the lifetime 6 of someone in their lungs, correct? 7 A. Correct. 8 Q. If you foundchrysotile in thelungs of 9 someone today who was last known to have been exposed to 10 chrysotile 30 years ago, would you -- where would that 11 chrysotile have come from, in your mind? 12 MR. JOHNSON: Object to the form. 13 BY MR. HARTLEY: 14 Q. Would it bean historicalartifact from 30 15 years ago, or would it have been there since yesterday, or 16 could you tell? 17 MR. JOHNSON: Object to the form. 18 A. I don't know if you could tell. Certainly it 19 would be reasonable if a person had a documented exposure 20 and didn't have anything in the interim, that the 21 chrysotile would have been there from an historical 22 exposure. 23 Q. A lot of times I see lawyers asking about the 24 half lives of chrysotile. How could there be -- if a 25 chrysotile has a very short half life, in a matter of 65 1 days, how can there be chrysotile from 30 years ago in 2 their lungs today? 3 A. That all depends. A lot of it is host 4 dependent. I think it all depends on the lung's natural 5 ability to clear the fiber. 6 Q. There are some researchers who have published 7 extensively on the causes of mesothelioma, who have looked 8 at the pleura and the fiber burden in the pleura, correct? 9 A. Yes. 10 Q. Who are some of those people? I think you 11 mentioned Dr. Hammer and Dr. Dodson. Anyone else? 12 A. Suzuki. 13 Q. Suzuki? 14 A. Yes. 15 Q. Who else? 16 A. No one else comes to mind. 17 Q. Isn't there somebody Vignon from Europe? 18 A. There may be,yeah. 19 Q. Do you discount the research that indicates, 20 that looks at the fiber burden of the pleura and finds 21 predominantly chrysotile and short fibers in the 22 mesothelial tissue? 23 MR. JOHNSON: Object to the form of 24 the question. 25 A. Again, I have not sat down and looked at that 66 1 critically. 2 Q. Okay, fair enough. 3 Are you aware of anyone who has written and 4 published in the peer-reviewed literature on that topic, 5 where they have critically analyzed the methodologies of 6 Dr. Hammer, Dr. Dodson and Dr. Suzuki, looking at the 7 pleural tissue where mesothelioma happens? 8 A. No, I'm not aware of it. 9 Q. Okay. If before you would discount that, that 10 would be something that you would either want to look at 11 carefully yourself, or you would want to see someone else 12 publishing on that in a peer review format, wouldn't you? 13 A. Yeah, I would think before I would make a 14 statement regarding a pleural short fiber chrysotile 15 levels, I would want to take a close look at that. 16 MR. HARTLEY: I appreciate your time. 17 I don't have any further questions at this 18 time. 19 FURTHER EXAMINATION BY COUNSEL FOR DEFENDANTS 20 BY MR. JOHNSON: 21 Q. Just by way of quick follow up, Dr. Sporn, 22 when Mr. Hartley was asking you questions in the last 23 several moments, you mentioned some criteria that you use 24 here at Duke University. What specifically was that 25 criteria for again, sir? 67 1 A. For assigning or implicating asbestos exposure 2 and the causation of mesothelioma. 3 Q. All right. And those four criteriawere 4 again? 5 A. Would be in the form of recognizable pleural 6 pulmonary asbestos-related disease, plaques or asbestosis, 7 or asbestos bodies in the lung tissue, even if the absence 8 of fibrosis, or an increased tissue asbestos level. 9 Q. As per a fiber burden? 10 A. Correct. 11 Q. And so when you are called upon here at Duke 12 University to assign or implicate asbestos exposure as 13 being causative of a mesothelioma, Duke University uses 14 four criteria. I hope I wrote these down. 15 Number one, the presence of plaques. 16 Number two, the presence of asbestosis. 17 Number three, presence or indications of 18 asbestos bodies. 19 And number four, indications of asbestos 20 exposure as per fiber burden studies, correct? 21 A. Correct. 22 Q. Now, as we sit here today on November 2, 2006, 23 and as it regards the plaintiff in this particular 24 lawsuit, Joyce Appelquist, none of the four criteria that 25 Duke University uses has any indication or implication of 68 1 asbestos exposure as causing Ms. Appelquist's 2 mesothelioma, is that correct? 3 A. That is correct. 4 Q. And that opinion is within a reasonable degree 5 of medical and pathological certainty, is that correct? 6 A. That is correct. 7 MR. JOHNSON: Thank you, sir. 8 FURTHER EXAMINATION BY COUNSEL FOR PLAINTIFF 9 BY MR. HARTLEY: 10 Q. You didn't do the fiber burden analysis, so 11 you don't know whether there was elevated fiber burden in 12 Mrs. Appelquist's pathology, correct? 13 A. That is correct. 14 Q. And that's because you weren't looking at this 15 case as a treater? You weren't asked by the people who 16 sent you the pathology to do that, were you? 17 A. Correct. 18 Q. There was no reason to do it? 19 MR. JOHNSON: Object to the form of 20 the question. The people that sent the 21 pathology were you. 22 MR. HARTLEY: No, that's not true. It 23 was her treating physician here at Duke. 24 BY MR. HARTLEY: 25 Q. Let me make sure. 69 1 Isn't it true that you received this -- Ms. 2 Appelquist's pathology, referred to you by her treating 3 physician here at Duke? 4 A. All of my involvement with this case was as 5 one of Mrs. Appelquist's doctors, not as a retained expert 6 for mesotheliomas medical or legal purposes. 7 MR. HARTLEY: Okay. Thank you. 8 MR. JOHNSON: Anyone else on the 9 phone? 10 (Whereupon the deposition was 11 concluded at 11:34 a.m.) 12 (Signature reserved.) 13 14 15 16 17 18 19 20 21 22 23 24 25 70 1 SIGNATURE PAGE 2 3 4 5 6 7 8 THOMAS A. SPORN 9 10 11 SUBSCRIBED AND SWORN to before me this 12 day of, 2006. 13 14 15 16 17 NOTARY PUBLIC 18 19 My Commission expires: 20 21 22 23 24 25 71 1 TRANSCRIPTION 2 MMV 3 CASE NAME: Appelquist vs. Bondex, et al. 4 5 6 WITNESS NAME: THOMAS A. SPORN 7 DATE: November 2, 2006 8 9 PAGE LINE READS SHOULD READ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 72 1 STATE OF NORTH CAROLINA ) 2 COUNTY OF WAKE ) 3 CERTIFICATE OF REPORTER 4 I, MARISA MUNOZ-VOURAKIS, an RMR, CRR and Notary 5 Public in the State of North Carolina, the reporter by 6 whom the foregoing deposition was taken, do hereby certify 7 that the testimony of the witness appearing in the 8 foregoing deposition was taken by me in Stenotype and 9 thereafter reduced to typewriting under my direction, 10 pages 1 through 73; that I am neither counsel for, 11 related to, or employed by any of the parties to the 12 action in which this deposition was taken; and further, 13 that I am not a relative or employee by the parties 14 hereto, nor financially or otherwise interested in the 15 outcome of the action. 16 IN WITNESS WHEREOF, I have hereto set 17 my hand, dated this 3rd day of November, 2006. 18 19 20 MARISA MUNOZ-VOURAKIS, RMR, CRR, Notary Public in and for 21 County of Wake State of North Carolina 22 23 My Commission expires November 23, 2008. 24 25 73