Document jy4qoD0pmOwgq2QVXXvrbozV9

1 1 IN THE SUPERIOR COURT OF THE STATE OF DELAWARE 2 IN AND FOR NEW CASTLE COUNTY 3 4 5 6 IN RE: ASBESTOS LITIGATION 7 Civil Action No. 77C-ASB-2 8 9 10 11 BEFORE: HON. JOSEPH R. SLIGHTS, III., J. 12 13 14 15 TRANSCRIPT OF DAUBERT HEARING 16 PM SESSION 17 18 19 20 JOHN P. DONNELLY, RPR 21 MICHELE R. HONAKER SUPERIOR COURT REPORTERS 22 500 N. KING STREET WILMINGTON, DELAWARE 19801 (302) 255-0563 23 1 October 18, 2005 Courtroom No. 8B 2 2:00 p.m. 3 4 5 CHRISTOPHER J. PANATIER, ESQ. JOHN J. SPILLANE, ESQ. 6 BARON & BUDD, P.C. 7 CAMERON R. WADDELL, ESQ. LeBLANC & WADDELL, LLP 8 JOSEPH R. BIDEN, III, ESQUIRE 9 BIFFERATO, GENTILOTTI, BIDEN & BALICK 10 THOMAS C. CRUMPLAR, ESQ. JACOBS & CRUMPLAR 11 for Plaintiffs 12 SAMUEL L. TARRY, JR., ESQ. 13 McGUIREWOODS, LLP for Defendant Daimler-Chrysler 14 JAMES M. KRON, ESQ. 15 SOMERS S. PRICE, JR., ESQ. POTTER, ANDERSON & CORROON, LLP 16 for Defendant Daimler-Chrysler 17 STEVEN T. JOHNSON, ESQ. PEPPLE, JOHNSON, CANTU & SCHMIDT, PLLC 18 for Defendant OI, Inc. 19 20 21 22 23 2 1 ALSO PRESENT 2 David deBruin Joseph Gabay Erin Farris Christian J. Singewald 3 William A. Kohlberg C. Scott Reese Kathleen D. Hadley Miranda D. Clifton 4 Michael Angelides Gary Kaplan Melissa Crowe Mark Reardon 5 Perry J. Browder Amy Garrett 6 Christopher Lyon Bernard Kuery Kai Seelaus J. Michael Johnson Neal Glenn Christine Boyd 7 Francis J. Gribbin Eric Henry Margaret England Richard Wilson 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 3 4 1 (The trial resumed after the luncheon recess.) 2 THE COURT: Good afternoon. 3 MR. CRUMPLAR: Your Honor, one bit of good 4 news in terms of scheduling. I know Your Honor was 5 concerned we might have been losing a little time. I 6 understand from Mr. Terry I believe that Dr. Heintz 7 will not be called so that I think along with Dr. Lemen 8 he may not finish totally today, we hope so. We have 9 another witness I think that we probably will be 10 finished Wednesday at the latest Thursday morning. 11 MR. TARRY: We will try hard to be finished 12 tomorrow. 13 THE COURT: That means we should not be 14 waiting for a call on the deposition, is there some 15 plan to go forward? 16 MR. CRUMPLAR: No deposition either. I 17 want -- I know your office I think was making 18 arrangements. 19 THE COURT: I appreciate that. If we don't 20 complete Dr. Lemen today, he is available tomorrow to 21 continue. 22 MR. CRUMPLAR: After we went and bought him a 23 new shirt. In case that happens, I may have given him 5 1 a shirt if we finish up today. 2 THE COURT: He got that out of the deal. 3 Okay. I am ready to proceed, if you are. 4 MR. SPILLANE: Your Honor the plaintiffs call 5 Richard Lemen. 6 RICHARD A. LEMEN, PhD, 7 having been first called by the Plaintiff was 8 sworn on oath, was examined and testified as follows: 9 DIRECT EXAMINATION 10 BY MR. SPILLANE: 11 Q. Good afternoon, Dr. Lemen. 12 A. Good afternoon. 13 Q. We are here to talk about brakes or friction 14 products, chrysotile and disease. I want to go very 15 briefly through your background some of your 16 qualifications. Judge Slights has indicated he is 17 somewhat familiar with you. Touch on them briefly. 18 Can you give as brief overview of your -- very brief 19 overview of your working history what you do today? 20 A. I started out in public health in 1966, when I 21 started with the Missouri Division of Health as a 22 District sanitarian. Then I was drafted into the 23 United States Army, served another two years as a 6 1 preventative medicine specialist. After the Army I 2 went back to graduate school, and I applied for a 3 commission in the United States Public Health Service 4 Commission Corp. After I received my Masters Degree in 5 epidemiology. I went into the US Public Health Service 6 in 1970. I started out as a epidemiologist, industrial 7 hygienist. I worked -- started working in the area of 8 asbestos beryllium exposures during that time. For the 9 next two or three years, I spent most of my time going 10 into plants throughout the United States taking 11 measurements, conducting medical studies and conducting 12 epidemiological studies of workers in both beryllium 13 and asbestos plants. 14 I continued with public health services 15 studies but in other occupational groups throughout my 16 career, and foundries in smelters, and chemical plants 17 just to name a few. I then went more into 18 administration, kept practicing epidemiology, but went 19 more into administration and headed the Division of 20 Standard Development Technology Transfer, which was the 21 area within our institute that makes recommendations 22 for standards to protect workers in the workplace. 23 1988, I was named Assistant Director of NIOSH, National 7 1 Institute for Occupational Safety and Health, and moved 2 to Washington, DC where I represented our institute in 3 Washington, DC for the next four years. 4 In 1992, I was selected as Deputy Director or 5 the number two person in the institute, moved to 6 Atlanta, Georgia where the institute's headquarters 7 were there and the Centers for Disease Control and 8 Prevention, and in 1993, '94 Acting Director of the 9 Institute until a new director had been selected by the 10 Administration, and at that time I reverted back to my 11 permanent position as Deputy Director. 12 I retired from government service in 1996. I 13 started teaching at Emory University from 1996 to 2002 14 and I taught a course on international aspects of 15 occupational environmental medicine, and I also started 16 consulting at that time, and I started testifying 17 legislative -- litigation such as I am here today 18 testifying, and I retired again when I moved further 19 north of Atlanta from Emory because it was too far to 20 drive, and I have been pretty much just doing private 21 consultation in litigation testimony at the present 22 time. I did not mention I have a PhD in Epidemiology, 23 also . 8 1 Q. That is very briefly, Doctor, with regards to 2 your educational background you mentioned you have an 3 PhD in Epidemiology. Is it also true you have an MSPH 4 from the University of Missouri in Epidemiology and a 5 BS from Central Methodist College in Zoology and 6 Chemistry? 7 A. Yes . 8 Q. You and I have worked together many times 9 before, corre ct? 10 A. Yes, we have. 11 Q. You and I have been in rooms with Mr. Tarry on 12 several occas ions before talking about the very issues 13 we are going to discuss today? 14 A. Yes, we have. 15 Q. Have you been asked to - - back up a little 16 bit, I think you may have touched on this. You are, in 17 fact, a forme r Assistant Surgeon General of the Unit ed 18 States, corre ct? 19 A. Yes, I am. 20 Q. Is that a picture I have of you there holding 21 your certificate or diploma indicating that you are in 22 fact an Assistant Surgeon General? 23 A. That was taken the day I was promoted to 9 1 Assistant Surgeon General. 2 Q. Does your uniform still fit? 3 A. As a matter of fact, it does. 4 Q. Have you been asked to lecture and give 5 testimony regarding asbestos dangers in various parts 6 of the world? 7 A. I have. 8 Q. I have a picture on the screen. Can you tell 9 us a little bit about what this is, please? 10 A. This was several years ago I think 19 -- I 11 think 2002, or 2003, not quite sure. I testified 12 before a Senate committee on a bill that Senator Patty 13 Murray had put forth to ban the use of asbestos in the 14 United States. She had asked me to come testify in 15 support of her bill, and I did that at her request. 16 Q. Is much of the testimony that you are going to 17 give today, essentially, the same or similar to the 18 testimony that you give in the United States Senate on 19 that occasion? 20 A. Yes, it would be. 21 Q. Have you published articles in the peer review 22 literature with regard to asbestos and asbestos 23 hazards? 10 1 A. I have. 2 Q. In fact, you have published an article on 3 friction products and asbestos disease in the peer 4 reviewed literature? 5 A. Yes, I have. 6 Q. Doctor, the first thing I want to do is 7 briefly -- it is working. Talk about general concepts 8 of epidemiology. I don't intend for this to be an 9 exhaustive review of epidemiology. Touch on some 10 basics. On the slides I have general causation and 11 specific causation. Is it fair to say when we are 12 discussing general causation, that we are really 13 discussing association, or risk and maybe the term 14 cause is inaccurate? 15 A. I would say that's true . 16 Q. Is this concept of general association, does 17 it involve a determination of whether a particular 18 substance that's under consideration causes the effect 19 it's been studied? 20 A. That is one part. Yes, sir. 21 Q. And specific causation, however, is more of an 22 area, say, what Dr. Hammar was talking about when you 23 are discussing a particular individual's disease and 11 1 whether or not that exposure is attributable -- that 2 disease is attributable to a specific substance to 3 which an individuals is exposed? 4 A. Correct. 5 Q. You don't come into court and make specific 6 causation statements ever, do you? 7 A. No, I don't . 8 Q. You are not here today to discuss with Judge 9 Slights specific causation issues? 10 A. No, I am not . 11 Q. You are here today to discuss association and 12 risk; is that fair? 13 A. Correct. 14 Q. When discussing general association or risk, 15 what types of data do you evaluate? 16 A. Well, in addition to the actual 17 epidemiological data from epidemiological studies, 18 before you go into the epidemiological studies, you 19 need to know what is known about a particular substance 20 that you are looking at, or risk factor that you might 21 be looking at. You are going to want to look at that 22 substance from several perspectives, such as 23 mechanistic processes, is it feasible that there are 12 1 mechanisms that can introduce the substance into the 2 body, where it can actually cause disease. 3 You want to look at things such biological 4 principles. Is the body going to react to a substance 5 that may be introduced into it. 6 You are going to look at molecular studies 7 talked about by Dr. Dodson and Dr. Hammar. You are 8 going to talk about toxicological studies. What do we 9 know about the toxicity of material that you might be 10 looking at? And you are also going to be very 11 interested in what animal experimentation has taught 12 us. We do animal experimentation because that is a way 13 to learn something quicker than waiting for 14 observations in humans. We can actually dose the 15 animals at very high doses, and get reactions that are 16 much quicker time. That is something you can't do with 17 humans ethically or otherwise. 18 So an epidemiologist needs to have training in 19 all these other fields, at least to understand the 20 fields, not necessarily to be an expert in each of 21 these fields, but the epidemiologist must take into 22 consideration all of the these other aspects in 23 determining whether there is an association that can be 13 1 later brought in to specifics to look at causation. 2 Q. You mentioned earlier to the Court that when 3 you were employed previously in your career you did 4 field work when you were with NIOSH on asbestos 5 exposure and asbestos disease. When you were doing 6 that field epidemiology work, are these the types of 7 data and factors that you took into your evaluation 8 process? 9 A. Absolutely. 10 Q. When you come before this court today to give 11 opinions about friction products, association and 12 risks; is that the type of data that you include in 13 your evaluation process? 14 A. Yes, it is. 15 Q. Is your evaluation process any different than 16 the reasonable scientific methodologies that are used 17 throughout the world by other scientists? 18 A. I should think not. 19 Q. Doctor, before I go any further, I forget this 20 question, someone has to tell me to do it at the end. 21 When giving your opinions to the Court today, will you 22 agree to do so in terms of reasonable scientific 23 probability? 14 1 A. Yes, I will. 2 Q. I want to go on. Let's talk a little about 3 bit about what a few types of epidemiology studies are. 4 I want to focus on three things. First, let's talk 5 about case reports. Define for the Court what a case 6 report is? 7 A. Case report is really a report of an 8 individual case, a series of individual cases that a 9 clinician may find of interest. It may present new 10 data, new findings, and they feel that it's of 11 significance enough they want to publish it, put it 12 into the peer review literature so that other 13 clinicians can look at that data and it may bring them 14 to the point of saying well, I had a case lick that not 15 too long ago, and serves the basis of really helping us 16 to determine whether or not there is enough information 17 to go forward with looking for further association. 18 So the case report is kind of the basic 19 building zone upon which an epidemiologist starts in 20 looking at cause relationships. Now, there are some 21 cases I think in my presentation I put together for 22 this today we will talk about in rare situations where 23 case reports can have much greater meaning than in just 15 1 a case report of, say, a lung cancer, which is not a 2 very rare condition, but a more rare condition such as 3 mesothelioma, or angiosarcoma of the liver may elicit a 4 little more response. 5 Q. We will get to those slides in a moment. As a 6 trained epidemiologist who has practiced epidemiology 7 in the field, are case reports part of the world of 8 data that you must incorporate when trying to determine 9 if this is an association? 10 A. Absolutely. 11 Q. Talk next about case control studies. What is 12 a case control study? 13 A. Case control study is generally there is 14 several times, but generally a case control study is, 15 for example, if you have a group of disease -- you have 16 a disease. It is occurring in a group of people. You 17 may want you would pull all of these people together, 18 those would constitute your cases. Then you would try 19 and compare those cases with age, sex, race, and other 20 factors that would best describe comparison between the 21 cases, and the non-cases. Look for what the 22 differences are between the cases, and the non-cases. 23 This often times gives you the ability to sort out what 16 1 action may be the causation, or causing the case 2 because you are able to control out for the confounding 3 factors by matching these much as we do with the case. 4 So the case control studies are matching to 5 refine our causation and look more closely at what may 6 be the cause for control for external factors that can 7 sometimes contribute, but by matching we can do that 8 control much easier. 9 Q. You mentioned a term that I think is going to 10 be discussed quite a bit by both yourself and 11 Dr. Goodman. I want to define that you mentioned 12 confounding factors. What is a confounder; what did 13 that mean? 14 A. Confounder to me means anything that can alter 15 the results of your study, such as if you are looking 16 at a group of lung cancer cases. We know one of the 17 risk factors for that is cigarettes smoking. You would 18 want to try to control, if you were not looking for 19 cigarettes smoking, looking at other factors that might 20 cause lung cancer, can only control for the cigarette 21 smoking to eliminate that from being a contributing 22 factor. Anything that contributes to the cause of the 23 disease, and if you can eliminate those confounding 17 1 factors then you can have a much better idea of if 2 there is a true association, that true association 3 exists . 4 Q. Is it fair to say if the con founding factors 5 properly addressed or eliminated in an 6 demiological study, that a result of that study 7 whether it is positive, negative, or null can be 8 affected? 9 A. Oh, yes. Very much so. 10 Q. Now, we have discussed case control studies. 11 Contrast, what a cohort study is? 12 A. Basically what a cohort, this is what I 13 started out on when I came into Public Health Service, 14 large cohort studies identify a group of -- just use in 15 my case we identified a group of asbestos workers that 16 worked in a plant in Pennsylvania, over three thousand 17 of these workers. And we looked at those that had one 18 year of exposure between 1940 and 1968, and then we 19 trace all those people to see what their vital status 20 is; are they alive or dead, up to a certain point in 21 time. Such as say if you follow them through '68, what 22 was their vital status in 1968. 23 Once you have done that, then you pull their 18 1 death certificates and you try then to compare and in 2 this case it is mortality study. There can be 3 morbidity studies looking at the incidence of disease; 4 in this case talking about a mortality study. Then you 5 would compare the cohort, or the group of asbestos 6 workers mortality with a group of non-asbestos workers; 7 and they would be matched on age, sex, race and many 8 confounding factors as you could, and then you would 9 see if there is an elevation, or a decrease in their 10 mortality, compared to that of the comparison 11 population. We call that in epidemiology, at least for 12 the mortality study, a life table analysis. 13 In other words, we take them through the same 14 as we would the comparison group, and try and determine 15 what their expected numbers of death would be at 16 certain points in time, and then we are able to 17 determine whether or not they have an excess or an 18 decrease and then we measure that statistically to 19 determine whether or not that excess is an statistical 20 excess, or a statistical deficit. We go both ways. We 21 call that a two-tail-type analysis. So that is 22 basically what a cohort study is. You can do this 23 thing, as I said, for morbidity, as well as mortality 19 1 in a cohort study. 2 Q. I went to law school because I don't like 3 science. Forgive me if I oversimplify this. Is it 4 fair to say association in epidemiological terms is 5 essentially measured through risk, a mathematical 6 formulas? 7 A. Measured through an -- I wouldn't call it 8 risk. I would say its association is major through 9 mathematical formulas. We usually use a certain type 10 of formula which is pretty much standard technology and 11 looking at cohort studies we generally consider that 12 they reflect a puissant distribution. That comparison 13 group usually that comparison group will be the United 14 States population or a State population, have the same 15 type of characteristic. So that's what we do is try to 16 measure associations statistically. 17 Q. Go through, briefly, what some of those 18 measures of association are that may be discussed in 19 some of the reports that His Honor has read and have 20 been submitted. Tell us what an odds ration is; how it 21 is used, how it is calculated? 22 A. Odds ratio is the comparison of odds being 23 exposed if you have the disease as to the odds of being 20 1 exposed if you don't have the disease. Probably one of 2 the oldest of our measurements, and we use this 3 generally to express the association or lack of 4 association in case control studies. It is oftentimes 5 used, it is an approximation of the relative risk, and 6 we will go to what relative risk is in a minute. 7 Relative risk is the incidence rate ratio, and 8 it talks about what the incidence of disease is in the 9 exposed group compared to the incidence of disease in 10 the unexposed group. We generally speak relative risk 11 when we look at cohort studies. It may be expressed as 12 a standard mortality ratio, if it is a mortality study, 13 or a standard incidence ratio if it is a morbidity 14 study. We generally use the relative risk in that 15 format when we are looking at the cohort studies. 16 Q. When we come up with numbers in our 17 calculations for relatives risk, can you tell the Court 18 what those numbers mean? 19 A. Generally, this is a very simplistic analysis, 20 or a simplistic definition, but if the relative risk is 21 greater -- or equals one, generally we consider there 22 is no association. If it is greater than one, then 23 there is an association in a positive direction. If it 21 1 is less than one, there is association, but it is in 2 the negative direction. So that's a very simplistic 3 way to explain relatives risk. 4 Q. Now, we discussed previously with other 5 witnesses the disease mesothelioma, and the idea that 6 the expected rate of the disease for mesothelioma, 7 absent asbestos exposure, as Dr Hammar I believe said 8 is either zero or undefined? 9 A. Generally that's true. There are some 10 estimates that would bring it up to, I think Dr. Hammar 11 mentioned Huncharke Analysis that says it may be in the 12 neighborhood of less than one in a million. Others say 13 it could be high as one or two per million but in 14 general, until asbestos and the disease was identified 15 as being associated with asbestos, generally there was 16 no background, and I think a good example of this is in 17 Japan, the only place I know they have been looking at 18 comparing the relative risk or background of 19 mesothelioma by decades from as asbestos was 20 introduced. And as asbestos consumption went up in 21 Japan, so did the background level. 22 Q. When you have a rare disease such as 23 mesothelioma, is it unusual to find epidemiological 22 1 studies where a relative risk or some measure of 2 association was not calculated? 3 A. No. 4 Q. When you have a rare disease such as 5 mesothelioma, when the expected rate, absent exposure, 6 is zero, is it always a meaningful calculation or to 7 break it down in simple mathematical terms; do you have 8 a numerator divided by a denominator, which is zero? 9 A. You actually get, as I think Dr Hammar said 10 this morning, you are looking at Infinity. You really 11 can't make a measurement or come up with an accurate 12 relative risk. That is why the studies that 13 Dr. Selikoff and others have done do not express a 14 relative risk for mesothelioma. 15 Q. In fact, has it not been published in 16 literature by Dr. Selikoff and others in the studies 17 that the expected rate is, in fact, zero? 18 A. Dr. Selikoff has said that. Yes. 19 Q. Define for us, if you could, what a 20 Standardized Mortality Ratio is, or SMR is? 21 A. I think I did that already for you. It is 22 basically relative risk when we are looking at 23 mortality studies, comparison of the observed number of 23 1 deaths to the expected number of deaths. 2 Q. And what is attributable risk? 3 A. That is the amount of disease among exposed 4 workers that can be attributed to that exposure. In 5 other words, above what might be background, if there 6 is such a thing as background. 7 Q. Has it been published in the scientific 8 literature other witnesses in this area have testified 9 that attributable risk is also a key, or the key 10 measure of association for the relation between, say, 11 mesothelioma and asbestos? 12 A. I think that's true. Yes. 13 Q. Real quickly so I have built a complete 14 record. Define for us real quick what the statistical 15 significance, confidence interval, and P Value are? 16 A. Statistical significance is measured through 17 statistical tests to determine if, say the odds ratio 18 or the relative risk actually is happening by chance, 19 or it is very unlikely that it is happening by chance. 20 Usually we measure this at 95 percent confidence 21 interval. So if we Do that it is usually less than 22 five percent that it is going to occur by chance. That 23 is why we put a confidence interval in. We look at 24 1 what the confidence interval is surrounding the 2 relative risk and, generally, if the confidence 3 interval does not include one, it's either above or 4 below, does not include one, it can be considered as 5 statistically significant in what direction it's going; 6 either above. If you have a very wide confidence 7 interval, you generally have less confidence that it's 8 not occurring by chance. If you have a narrow 9 confidence interval, you can be more assured that it is 10 very unlikely it's happening by chance. But you have 11 to look, I believe in reality, at the confidence 12 intervals at both the bottom and the top in making an 13 association judgement, and you must say that a lot of 14 this is judgement. So the P Value then just measures 15 that confidence interval. 16 Q. I want to touch on something that was 17 discussed with Dr. Hammar before I go too far into your 18 testimony. 19 Mr. Tarry spend a lot of time asking 20 Dr. Hammar questions about accuracy, and he used a 21 reference from the textbook that Dr. Dodson and 22 Dr. Hammar have authored that recently came out, 23 specifically referenced page 241, which happens to be 25 1 part of Chapter 6, I believe which was authored by 2 yourself; is that correct? 3 A. Correct. 4 Q. Specifically, we were discussing the 5 references on page 241 to the Australia experience in 6 the 58 cases, et cetera, et cetera. You were present 7 in the courtroom. You remember all that? 8 A. Yes, I do. 9 Q. Were you present when Mr. Tarry was asking 10 Dr. Hammar questions about the inaccuracies of the data 11 presented in this textbook? 12 A. Yes, I was. 13 Q. I want to discuss that just briefly because if 14 we are going to discuss accuracies, let's make sure an 15 accurate record is presented to the Court. This book 16 just came out a little whileago. I just got my copy 17 less than ten days ago. Didyou just write this ten 18 days ago? 19 A. No, this was a chapter written over a year ago 20 and it usually takes some time for a chapter to be 21 printed after you have written it. So the data in the 22 chapter is usually dated by the time book comes out. 23 There is need for revision when a book comes out. It 26 1 is true in most scientific publications, unfortunately. 2 Q. We mentioned briefly you published in peer 3 review literature an article entitled Asbestos in 4 Brakes; Exposures and Risk of Disease. It came out in 5 2 0 04, correct ? 6 A. I did. 7 Q. Was this chapter written before you wrote your 8 paper? 9 A. This chapter was written before I wrote the 10 paper. 11 Q. When you wrote -- as you wrote the chapter, 12 you got more information, and you wrote your paper? 13 A. Right . 14 Q. The discussion between the 58 cases, 43 cases; 15 was that information included in your paper when you 16 published it? 17 A. Yes, it was. 18 Q. When you got the galley proofs back from the 19 publisher, when did that occur, approximately? 20 A. That was several months before publication, I 21 would say, maybe five months or so, and I then added a 22 reference to the publication, 433, you can see in the 23 next paragraph. If you go to the reference in the 27 1 back, that refers to my new paper. So if the reader 2 were reading this, they would go to the new paper to 3 get additional information. They would see the new 4 numbers. 5 Q. In fact, when the language preceding reference 6 433 states that for a more detailed analysis, see 7 McDonald, et al and references your paper. Correct? 8 A. Yes. 9 Q. What was your purpose of including that 10 paragraph when you got the galley proofs back that you 11 had written some before? 12 A. You can't really change the galley proofs 13 substantially. What did I was added that sentence to 14 refer them to the new paper that I wrote that had more 15 updated information than was in the textbook. So the 16 reader could go, and as a matter of fact, I had over 17 700 references in this chapter, which is a lot of 18 references for a paper. It was to enable the reader of 19 this textbook where to go to get further information, 20 if they really wanted to study this in detail. That is 21 why the references are in there. That is why that new 22 reference was put in after I got the galley proofs 23 back . 28 1 Q. Since you published your paper in 2004, have 2 you gotten even more information about the data 3 included in the Henderson and Leigh study? 4 A. Yes, I have. I have been able to read the 5 deposition that was referred to this morning, and in a 6 recent affidavit that I did, a few weeks ago, I updated 7 that information and have put the new information in 8 that and if there is an update in this chapter, or if I 9 redo my paper, I will do that, but as I said, 10 scientific information is changing almost daily. 11 Q. We will get to your specific opinions, then I 12 believe Mr. Tarry was the one that was kind enough to 13 forward you Mr. Leigh's deposition? 14 A. Actually he was. It was from Mr. Tarry that I 15 was able to have the new information because normally, 16 the deposition would not be something that I would 17 normally read in the scientific literature. 18 Q. On your behalf when you wrote Chapter 6, there 19 wasn't any intent to mislead or leave out information, 20 was there? 21 A. No, sir. 22 Q. Your opinions with regard to the Australian 23 information have continued to evolve as you have gotten 29 1 more information? 2 A. Yes, they have. 3 Q. Let's go back, I want to get into the some of 4 the types of epidemiological evidence that you evaluate 5 when reaching your opinions and conclusions. We talked 6 about Dr. Checkoway's text earlier today. I want to 7 get back on the subject of case reports. 8 You say that case reports are information that 9 an epidemiologist should include in the evaluation 10 process. Tell us why, please? 11 A. I think case reports are important to include 12 because they give you a general idea of what's actually 13 being seen by the clinicians. And this information is 14 important for several reasons. One reason is that it 15 gives you a window in which to look at what the 16 clinicians are seeing that might be new and adds to the 17 information that you have already gotten from your 18 review of the past history of a particular disease, or 19 a particular substance. 20 Secondly, as Checkoway and his colleagues 21 point out in this textbook on research methods and 22 occupational epidemiology, that case reports when you 23 are looking at very rare diseases what we call Sentinel 30 1 diseases. That is a disease is caused -- generally has 2 one principal cause, maybe a few other causes, 3 generally recognized as one principal cause. The 4 institute I work for, NIOSH, actually I think kind of 5 invented that word sentinel disease. We put out a list 6 of occupational diseases that is were sentinel; for 7 example berylliosis is a sentinel disease for exposure 8 to beryllium. Asbestosis is a sentinel disease for 9 exposure to asbestos. Mesothelioma, because in men 10 about 80 percent of mesotheliomas have been traced to 11 an association with asbestos, is a sentinel disease for 12 looking at exposure to asbestos. 13 When you have very rare tumors like this, I 14 mentioned earlier angiosarcoma of the liver, that is a 15 very rare tumor that only a few cases have been 16 reported, all been reported and associated with vinyl 17 chloride exposures. When you get a case report of a 18 sentinel disease, they carry a lot more weight in the 19 epidemiologist's mind than do case reports of, say, a 20 very common disease. 21 Q. So is it fair to say then it is important to 22 make a distinction between the relative importance of a 23 case report in a rare disease, than the importance of a 31 1 case report when, say, a white Ford Taurus struck 2 someone and broke their leg? 3 A. In my opinion, yes. I think that's what 4 Dr. Checkoway and his colleagues were saying in their 5 textbook. 6 Q. We talked quite a bit today about Dr. Wagner 7 study in 1960 it was based on 33 case reports. I don't 8 want to revisit all that. I want to ask you about 9 something else Dr. Hammar talked about; therapeutic 10 radiation, that therapeutic radiation been accepted in 11 the scientific medical communities as a cause of 12 mesothelioma? 13 A. I think most of us that have been studying 14 mesothelioma for a good number of years would think and 15 accept that therapeutic radiation as a cause. When 16 they -- we don't have epidemiological studies, we have 17 enough significant case reports to allow us to make 18 that causation. If you look at textbooks in this area, 19 talking about therapeutic radiation as being associated 20 at least with the development of mesothelioma. 21 Q. So there is no epidemiological studies of 22 therapeutic radiation, only a series of 12 case 23 reports. Yet it is accepted within the scientific 32 1 community it is a cause of mesothelioma? 2 A. I think most would accept that. Yes. 3 Q. Let's touch briefly on the issue of specific 4 causation, which is not your area, but for a clinician 5 like Dr. Hammar. What is your understanding of the 6 type of information that a clinician has to look at in 7 order to make that causative statement? 8 A. Biggest information that a clinician needs to 9 look at is the epidemiological literature to start 10 with, what is known in the epidemiological literature 11 which are known in review publications, what do the 12 toxicological literature say. What does the 13 pathological literature say. What do the cellular 14 biologists say, then put that all in the context with 15 the epidemiology in putting together a determination of 16 specific cause. So epidemiology and these other 17 factors we talked about at the beginning of my 18 testimony today, are all important for the clinician to 19 look at. 20 Then the clinician needs to go into a history 21 of exposure. When a physician in the 1700s by the name 22 of Ramazini came about, he was what we call the father 23 of occupational medicine today. He added to the 33 1 Hypocrites had said about taking patient histories. He 2 said that you should add to take patient histories. 3 What occupation did you have, or what job did you do, 4 or what were you exposed to. It is important for the 5 clinician to look at history of exposure, and then to 6 look at latency of disease. I think Dr. Hammar talked 7 about that all of these things should be taken into 8 consideration by the clinician in making a specific 9 causation determination. 10 Q. You mentioned occupational history. Are you 11 familiar with the document called the Helsinki 12 Criteria? 13 A. Yes, I am. 14 Q. Can you tell us a little bit about that, 15 please? 16 A. Yes. The Helsinki Criteria was put together 17 by a group of scientists in Finland I think in 1998 or 18 somewhere in that neighborhood. I had previously been 19 asked by Finnish Government to chair a committee to 20 evaluate their asbestos program from 1990 to 1995 which 21 I did. One of our recommendations was to bring a group 22 of scientists together to look at what attribution 23 criteria should be put together for asbestos. Helsinki 34 1 Criteria did bring that a group together. I wasn't on 2 the group, it brought a group together out of our 3 recommendation to lock at attribution criteria. The 4 scientists that were brought together had 100s if not 5 1000s of publications on asbestos. What they did was 6 sit down for a few days and looked at what should we 7 put together for a clinician to use in making 8 attribution for specific causation what is what the 9 Helsinki Criteria was. 10 Q. What does that say is the most reliable method 11 of attributing mesothelioma to asbestos exposure? 12 A. Occupational history, history of exposure and 13 occupational history. 14 Q. I want to get into now just talk about 15 chrysotile asbestos, in general, in the Bradford Hill 16 criteria as that pertained to chrysotile asbestos. 17 What is the Bradford Hill criteria or I am using a bad 18 words, what are the Bradford Hill considerations, I 19 think Dr. Hill said we shouldn't call them criteria? 20 A. Correct. 21 Q. Tell us what are the Bradford Hill 22 considerations? 23 A. This was something put together in 1965 when 35 1 Bradford Hill, a bio-statistician gave a lecture and in 2 that lecture, he was asked to put together what an 3 epidemiologist should consider when looking at 4 associations. He listed nine different criteria and 5 the criteria listed in this slide plausibility, 6 coherent, strength of association, et cetera, are the 7 nine that he put together. What he said that is very 8 important is that none of these nine should stand alone 9 by themselves, but that they are important 10 considerations to look at. 11 In today's world, they are some that are more 12 important than others. But in 1965, this was what he 13 thought epidemiologists should look at. There are 14 other considerations that have been put out, the 15 Surgeon General of United States has a similar set of 16 criteria they establish for when the they put out the 17 smoking report in 1965, and others have put out 18 considerations, but I find this one to be rather an 19 exclusive one, and not the only one, by any means, but 20 one that you can use if you want to look at these nine 21 different areas. 22 Q. Are you the only epidemiologist in the 23 scientific community that's every used the Bradford 36 1 cons ide rations to determine association? 2 A. No , not at all . 3 Q. Is this a generally accepted reliable 4 scientific methodology within the scientific community? 5 A. I would say it is. I would say if Bradford 6 Hill were alive today, re-writing it he may make it a 7 little different with some of the associations, but in 8 general I think they would all hold up quite well, with 9 some modification. 10 Q. Have you published in the peer reviewed 11 literature your opinions applying the Bradford Hill 12 considerations to chrysotile asbestos? 13 A. I have. 14 Q. Just briefly tell us what is your conclusion 15 regarding chrysotile asbestos; does chrysotile asbestos 16 cause all asbestos diseases? 17 A. Yes. 18 Q. Let's run through them real quick. I do think 19 it needs to be in the record. Talk about plausibility. 20 I want to go through, let's define them then go through 21 and find out how they apply to chrysotile asbestos. 22 What is biological plausibility? 23 A. It's the assessment of whether or not the 37 1 theory that explains how an exposure causes a disease 2 is consistent with other known mechanisms of the 3 disease. I think as we look at asbestos and chrysotile 4 in particular, we will see how this fits. 5 Q. Tell us about coherence. What is coherence? 6 A. It addresses the issue of consistency and -7 Q. Sorry - 8 A. Then we have strength of association. 9 Q. What does that mean? 10 A. It looks at the power of the study. Is the 11 power sensitive enough to really show a difference if 12 there is a difference one way or the other. 13 Q. Now you used consistency in your definition of 14 coherence. Consistency of the observed association is 15 its own separate consideration. Tell us what the 16 difference between the two is? 17 A. In the consistency of the observed observation 18 or association, it inquires as to whether or not the 19 proposed effect has been or can be observed repeatedly 20 after different circumstances, and I think that's the 21 main difference. 22 Q. Tell us about what is biologic gradient? 23 A. This is looking at issues such as dose effect, 38 1 did the increase in dose cause more disease, decrease 2 in dose cause less disease. 3 Q. How about experiment or experimental evidence, 4 tell us what that is, please? 5 A. This is basically relating to animal studies 6 and the studies in the laboratory, that would look at 7 associations between the substance you are looking at 8 and reactions to cellular or animal mechanism. 9 Q. Same type of information you referenced 10 earlier when discussing the world of data that 11 epidemiologists should consider? 12 A. Yes . 13 Q. Analogy. What is that? 14 A. Take also into consideration the 15 epidemiological and other studies as they are 16 determined whether or not if an analogous substance 17 such as in the case of asbestos caused adverse health 18 affects, might be looking at other fibers, other types 19 of substances similar to asbestos; and do they cause 20 health affects . 21 Q. How about specificity of the association. 22 Tell us a little bit about that, please? 23 A. Specificity is one that Bradford Hill may have 39 1 want to change if he came back because here it says in 2 his criteria that each cause has a single or logically 3 related similar effects. We know that chemical 4 exposures and cigarette smoking is a good example, can 5 have multiple effects. We know cigarette smoking not 6 only caution lung cancer, but kidney damage, it can 7 cause neurologic problems. I think the later Surgeon 8 General's report lists about 15 different conditions 9 that cigarette smoking can cause. It is not like 10 bacteria, generally cause one disease, and only one 11 disease. But with the new chemical nature that we are 12 living in, we often get multiple diseases. 13 Asbestos is a good example because it causes 14 asbestosis, it causes lung cancer, causes mesothelioma 15 and there is associations of other diseases along with 16 asbestos exposure. So this is one when I was talking 17 earlier that I think would be one that Bradford Hill 18 would probably change in his criteria, were he alive 19 today. 20 Q. Lastly, define temporality for us? 21 A. That is easy. It just means does the effect 22 occur after the exposure. And in the case that we are 23 talking about today, it meets that very easily. 40 1 Q. What I want to do now let's go through and 2 apply Bradford Hill's considerations for determining 3 association to the questions of whether chrysotile 4 causes mesothelioma and other asbestos diseases. 5 We are going to focus on mesothelioma. What 6 essentially is the application of these factors be the 7 same for asbestosis and lung cancer? 8 A. Yes. 9 Q. Talk about plausibility, does the Bradford 10 Hill considerations -- does plausibility, is it 11 satisfied under the analysis of chrysotile? 12 A. Based upon the analysis I did, yes, it is. I 13 can read these or I don't know how you, sir, would like 14 me to do that, or - 15 THE COURT: I can see them here if you want to 16 highlight them. 17 BY MR. SPILLANE: 18 Q. What can I do, absent objection, we can submit 19 a copy of the Power Point presentation of these into 20 the record? 21 MR. TARRY: No objection. 22 THE WITNESS: I could sit here and read them. 23 THE COURT: No need for you to do that, sir. 41 1 BY MR. SPILLANE: 2 Q. Let's talk about coherence. Is coherence 3 satisfied under the application for chrysotile? 4 A. In my opinion, yes, and the bottom one that 5 there is no biological argument why chrysotile is 6 incapable of causing mesothelioma is one I would 7 highlight in this one. 8 Q. This slide, is there any question anywhere in 9 the medical or scientific literature that chrysotile 10 asbestos causes asbestosis? 11 A. No. 12 Q. Is there any question in the medical and 13 scientific literature that chrysotile asbestos causes 14 human cancer? 15 A. No. 16 Q. How about cellular damage, genetic damage, 17 animal fibrosis or animal cancer? 18 A. No. These have all been shown in the 19 scientific literature to occur with exposure to 20 chrysotile, as well as amocite and crocidolite. 21 Q. Does the literature say it causes animal 22 mesothelioma? 23 A. It does. 42 1 Q. And is it your opinion that the 2 medical/scientific literature shows that chrysotile 3 asbestos causes human mesothelioma? 4 A. Yes, it does. 5 Q. Come back on that in a little while. How 6 about strength of association, is the Bradford Hill 7 strength of association element satisfied? 8 A. For chrysotile, yes, it is. 9 Q. I left that out of my question. That was an 10 important part of the question. 11 I want to stop here and talk about this a 12 little bit. We have it in here on mixed exposures to 13 chrysotile and amphiboles. What is important about 14 that, Doctor? 15 A. I think this is important because I -- this 16 morning you heard Dr. Hammar talking about cigarette 17 smoking in its relationship to asbestos exposure, and 18 how when you smoke, cigarettes and exposed to asbestos 19 it increases one's risk of developing lung cancer. 20 What we found when we looked at exposures to different 21 types of asbestos, that there is probably no doubt for 22 mesothelioma that on a dose by dose basis amphiboles 23 are most potent than chrysotile. 43 1 But in looking at what happens when you have 2 amphiboles together with chrysotile or the serpentines, 3 it appears from the epidemiological literature this is 4 more than just an additive effect, it is synergistic. 5 In other words, that you get more disease when you have 6 mixed exposure then you do from the individual 7 exposures to each of the fiber types alone. 8 This is one example. There is another example 9 in my presentation, a study by Acheson that shows the 10 same thing. This is a paper that Dr. Stayner and I 11 wrote. I guess this -- this is one that Dr. Stayner 12 and I wrote in 1996 that talks about that issue. 13 Q. We will discuss the Acheson article in a few 14 minutes. Yesterday, Dr. Dodson was questioned about 15 the Hodson and Darden article that states the relative 16 potency between chrysotile, amocite to crocidolite is 17 one 100 to 500. Is that universally accepted relative 18 potency in the literature? 19 A. I don't think it is at all. I think this is 20 one that is out there. There are several out there. 21 They tend to be one of the higher ones. There are 22 others that are lower. And I think we heard yesterday 23 EPA had one that was higher -- not EPA, but the 44 1 contractor. 2 Q. Aren't there animal studies, injection studies 3 that show that in animals chrysotile asbestos is 4 actually more potent or carcinogenic than crocidolite? 5 A. Absolutely. 6 Q. Is it fair to say -- it is pretty universally 7 accepted that amphibole asbestos is more potent than 8 chrysotile, but what that relative potency is in 9 somewhat in dispute? 10 A. I think when you say that you have to keep in 11 mind that is only for mesothelioma. The evidence is 12 not for asbestosis, it is not for lung cancer, but it 13 is only in the area of mesothelioma that that potency 14 difference seems to occur. When we look add it we did 15 not find a difference in lung cancer, we didn't find a 16 difference in asbestosis. 17 Q. Thank you, Doctor. 18 Even without mixed exposures, are there 19 epidemiological studies of chrysotile with no 20 contamination, or no proven contamination that showed 21 elevated risks of mesothelioma? 22 A. There are very few. What few do exist would 23 indicate that even chrysotile alone, in the human 45 1 epidemiological studies, can cause mesothelioma. 2 Unfortunately or fortunately, I don't know just 3 neutrally, most commercial forms of chrysotile are 4 contaminated with amphibole, either tremolite 5 or anthophyllite type of asbestos. There are some 6 populations that shown on this slide here that have 7 looked at populations that are considered to be 8 amphibole contaminated free, very limited to their 9 contamination, if any. 10 Q. Are there studies of individuals who have had 11 mixed exposures but predominantly chrysotile exposure 12 that show an increased risk for development of 13 mesothelioma? 14 A. Yes, on this next slide lays out three of 15 those . 16 Q. How about biological gradient, is that 17 consideration satisfied for chrysotile asbestos? 18 A. Yes, it is. We do know that all of 19 mesothelioma tends to be a dose dependant disease. I 20 think as Dr. Hammar said this morning, it is recognized 21 that lower doses are capable of causing mesothelioma 22 then they are for causing asbestosis and lung cancer, 23 but even that, we know that it is dose dependent, I 46 1 think Dr. Rogers sums that up in this when he says 2 "like other forms of asbestos, there is an increased 3 risk of mesothelioma with increased exposure to 4 chrysotile." 5 Q. Next category is experimental. We talked 6 about experimental evidence. Is that consideration 7 satisfied for chrysotile asbestos? 8 A. Yes. 9 Q. How about analogy. Is analogy satisfied? 10 A. Yes. 11 Q. Specificity? 12 A. Yes. 13 Q. How about temporality? 14 A. Yes. 15 Q. You have to have exposure before you can have 16 the disease? 17 A. Correct. 18 Q. Is the United States the only country that 19 recognizes chrysotile asbestos is hazardous? 20 A. No, not at all . 21 Q. This is not a unique position taken by 22 scientists in the United States? 23 A. No, we have now seen some 30, I think the 47 1 latest is about 30 countries that have banned the use 2 of all forms of asbestos. The United States has not 3 done that yet. That is what Senator Murray's bill 4 would do, but this country is still allowing some 5 amount of asbestos to be used. I think that will stop, 6 but almost all of the western countries and Europe, as 7 you can see on this global map, and others, have 8 stopped the use of all forms of asbestos, including 9 chrysotile. 10 Q. Now, obviously you were withthe United States 11 Public Health Service. You were atNIOSH. The types 12 of information you were discussing, we briefly went 13 through the chrysotile asbestos. Did it include 14 toxicological studies? 15 A. Yes. 16 Q. Did it include experimental animal studies? 17 A. Yes. 18 Q. Did it include human data? 19 A. Yes, it does. 20 Q. Did it, in fact, include case reports? 21 A. Yes, it does. 22 Q. All of the information that you discussed 23 earlier, that you included in your analysis, is that 48 1 the same type of information and analysis that was 2 employed by scientist in regulatory agencies throughout 3 the world? 4 A. Yes, it is. 5 Q. In fact, Doctor, are there not all of these 6 governmental agencies that I listed on the screen, have 7 all of them issued statements that chrysotile causes 8 mesothelioma? 9 A. They have. 10 Q. Does that include OSHA? 11 A. It does . 12 Q. NIOSH? 13 A. Yes. 14 Q. International Agency for Research on Cancer? 15 A. Yes. 16 Q. United States Consumer Products Safety 17 Commission? 18 A. Yes. 19 Q. National Toxicology Program? 20 A. Yes. 21 Q. United States Department of Health and Human 22 Services? 23 A. Yes. 49 1 Q. American Cancer Society? 2 A. Yes. 3 Q. World Trade Organization? 4 A. Yes. 5 Q. Agency for Toxic Substances and Disease 6 Registry? 7 A. Yes. 8 Q. National Academy of Sciences? 9 A. Yes. 10 Q. Surgeon General of the United States? 11 A. Yes. 12 Q. World Health Organization? 13 A. Yes. 14 Q. How about the Environmental Protection Agency? 15 A. Yes. 16 Q. Now were you present in the courtroom 17 yesterday when this Eastern Research Group report came 18 up? 19 A. I was. 20 Q. There was discussion about that being prepared 21 for the EPA. It was acknowledged that is not the EPA's 22 position on chrysotile; is that true? 23 A. That is true. 50 1 Q. What is the EPA's current position on 2 chrysotile asbestos? 3 A. Well, the last I knew, is that they consider 4 all forms of asbestos, including chrysotile, capable of 5 causing asbestosis, lung cancer, and mesothelioma. 6 Q. Now, it is your opinion that chrysotile 7 asbestos causes all forms of asbestos disease, 8 including mesothelioma. Correct? 9 A. That is my opinion. 10 Q. In reaching your opinion, did you use the - 11 evaluate much of the same data, use the same 12 scientifically reliable methodologies that scientists 13 throughout the world have used in reaching their 14 conclusions? 15 A. I did. 16 Q. Is there anything unique about the information 17 you looked at, or your methodologies in reaching your 18 conclusions? 19 A. No. 20 Q. Is it the same type of information and 21 methodologies used outside of a legal context? 22 A. Absolutely. 23 Q. Real quickly, consistency; is that 51 1 consideration satisfied? 2 A. In my opinion, yes. 3 Q. And, again, consistency means has the proposed 4 affect observed repeatedly under different 5 circumstances? 6 A. Yes, that is why I have listed here, various 7 studies that have shown chrysotile causing disease in 8 various situations, such as among miners, textile 9 workers, friction products manufacturers and users and 10 cement manufacturers. 11 Q. You mentioned friction products manufacturers, 12 but also have there been reports in the literature 13 about friction products users, i.e., mechanics 14 developing mesothelioma? 15 A. Yes, there have, in my paper I listed some 16 over 165 I think at the time, different reports of that 17 occurring. 18 Q. In fact, was there not a letter that you 19 submitted to Dr. Tata, not, in fact, submit a letter to 20 the editor where she pointed in her letter there might 21 be an additional 40 reports that were not included in 22 your paper? 23 A. Correct 52 1 Q. Briefly, we will wrap up on chrysotile in 2 general, using and epidemiological analysis of 3 chrysotile, it is your opinion that chrysotile is, in 4 fact, a cause of all asbestos diseases, including 5 mesothelioma? 6 A. That is my opinion. Yes. 7 Q. Chrysler has come into court and argued that 8 absence occupation specific epidemiology standards that 9 meet a standard they have set forth, you can't say that 10 chrysotile from friction products causes disease. Do 11 you agree with their position? 12 A. No, I don't. I don't think that the job 13 category is the only factor to look at. I think that 14 what we are looking at, if there is exposure, and if 15 that exposure is to asbestos and that exposure is 16 respirable asbestos, it can added to the risk of your 17 body's burden of asbestos putting a person, or groups 18 of persons, in an increased risk. It is not the job 19 title, it is the exposure. 20 Q. In fact, that is a phrase that is repeated 21 throughout the medical literature; you did not make 22 that, up did you? 23 A. No I think the first time I heard that was 53 1 probably from Dr. Selikoff when I was working on -- I 2 was when I was with NIOSH I was in charge of some of 3 the grants that he had. I think he was always talking 4 about not the job, it's the exposure. And I think 5 Dr. Selikoff is probably the first person that really 6 pounded that into my head, don't look just at jobs, 7 look at the exposure. 8 Q. You agree with that statement? 9 A. I do very much so. 10 Q. And would you agree with that statement that 11 is as it applies to users of asbestos-containing 12 friction products that it is not their job title that 13 will determines whether or not they have disease, it is 14 the exposure that they get from the use of those 15 products? 16 A. Yes, I think you can have, such as you have 17 with friction products where you have, in general, 18 exposures are fairly low compared to insulation workers 19 or other workers with asbestos. There are those few 20 friction workers that have high exposures. The 21 literature documents that these high exposures exist. 22 There are epidemiological studies that show people with 23 those exposure concentrations develop disease. 54 1 Q. Is the fact that maybe someone who uses 2 calcium silicate pipecovering on a daily basis may have 3 a higher rate of disease than someone that uses 4 asbestos-containing friction products, does that mean 5 that a brake mechanic is not at an increased risk for 6 disease? 7 A. No. 8 Q. Simply because his number is not as high as a 9 pipe insulator? 10 A. No. What it really means is that the pipe 11 insulators generally have been exposed to higher 12 concentrations, but so have some of the brake workers, 13 because in some cases where they have blown the 14 material with high pressure hoses, and their exposures 15 are quite high, but on average they happen to be lower. 16 Q. Now, have you talked about part of your 17 analysis includes looking at epidemiological studies. 18 Are all epidemiological studies the same? 19 A. No. 20 Q. Are there limitations on some epidemiological 21 studies? 22 A. Yes, most epidemiological studies do have 23 limitations. It is the exceptional epidemiological 55 1 study that does not have a limitation. 2 Q. Can some of these limitations also be 3 considered confounders? 4 A. Very definitely. 5 Q. Tell us some of -- describe or walk us through 6 some of the study limitations that you have put on this 7 screen slides you prepared for us? 8 A. Some of the most common ones you find in 9 occupational studies are inclusion criteria. I have 10 seen and where when you look at a job title, you may 11 include people that have that job title, but don't 12 actually carry that out of the plant. You might 13 include people that are in that occupational group that 14 are actually secretaries, or people that work on the 15 periphery. So unless you really observe what the job 16 title or the occupational category means, you may be 17 including people in your study that really are not at 18 the risk of developing disease. 19 In other words, they are not exposed. That is 20 why when we are doing these types of studies at NIOSH 21 we went into the field. We observed what the person 22 did during their work day. We knew whether or not they 23 were exposed or not exposed. So many epidemiological 56 1 studies don't cake that into consideration. They 2 include everybody that has the title of mechanic, for 3 example, or auto workers, and there are many sub-jobs 4 that fit into these categories of people that don't 5 actually have exposure to, in this case, brakes. They 6 might be an auto mechanic, they never have exposure to 7 brakes. 8 So inclusion criteria can often cause a large 9 confounders by including people that are not at risk, 10 because they are not exposed. Latency, another one, 11 looking at populations that have a latency of, say, 12 less than ten years. You wouldn't expect them to be at 13 risk of developing a disease like mesothelioma because 14 we know from previous epidemiology that it is a disease 15 that usually takes 20, 30, 40 years to develop. So why 16 would you look at a population that had 70 percent of 17 the workers with less than ten years latency. What 18 that would do would be to loop the overall effect 19 making your risk of disease very low, and would 20 obliterate really the small persons that had the longer 21 latencies by including shorter latencies with them. I 22 hope I am being clear on that. 23 Exposure is another group. It kind of fits 57 1 into the inclusion criteria, that is you don't want to 2 include people -3 THE COURT: Let me just -- are you saying that 4 the selection of the subjects for the study can be 5 skewed or can skew the results depending on the latency 6 period, meaning you include people who have a more 7 recent temporal exposure? 8 A. Correct. 9 Q. That will skew the results? 10 A. Yes, generally bringing results down lower. 11 BY MR. SPILLANE: 12 Q. Dr. Lemen on that subject, can you also skew 13 the results with regard to latency by not following 14 your study group long enough and allowing disease a 15 chance to develop? 16 A. Absolutely. I think a perfect example of that 17 is a study that I was an author on in 1971, that we 18 published of the friction textile plant in 19 Pennsylvania. We had when we published in 71, we had 20 zero mesothelioma. We updated that study and included 21 another ten years latency, and after that we had 17 22 mesotheliomas. So I think you have to make sure you 23 have enough latency to observe the effects. And so you 58 1 can do that by cutting off your observation period 2 before you have had enough latency to observe an 3 effect. 4 Q. I apologize, I interrupted as you were about 5 to move on and continue. 6 A. Next one power. Depending on the rarity of 7 the disease. I think power is very important in brake 8 studies. Here is a population in general have low 9 exposures to asbestos. You are going to need a much 10 larger population of people actually exposed to bring 11 the power up enough to actually show there is an affect 12 if there is an affect. In other words, if the 13 exposures are low, you have generally got to have more 14 people in your population that have actual exposure to 15 be able to determine if there is an affect, or not an 16 affect. Do you understand? 17 THE COURT: I am following. 18 THE WITNESS: Please stop me if I am not doing 19 it the right way. 20 THE COURT: Thank you. 21 THE WITNESS:: I think those are the things 22 that are really -- those are some of the things that 23 really come out as strong confounders that one must 59 1 look at in evaluating epidemiological studies. 2 BY MR. SPILLANE: 3 Q. You have evaluated the epidemiological studies 4 that have been purported to study exposures and 5 association of users of asbestos-containing friction 6 products; is that correct? 7 A. Yes, I have. 8 Q. Do many, if, in fact, not all of the studies 9 in that area suffer from some, or multiple of these 10 study limitations or confounders? 11 A. Yes, they do. 12 Q. We will go through those and discuss those. I 13 want to talk now next about the idea of lack of 14 epidemiological studies. Can you discuss with us why 15 there may not be as many or epidemiological studies as 16 one would like to see? 17 A. I think I have to go back in time and go back 18 into the history of work that I did at NIOSH. In 1975, 19 or thereabouts, Dr. Selikoff contacted our institute 20 about brake workers and brake exposures. At the time 21 he brought the brake manufacturers -- NIOSH brought the 22 brake manufacturers and people from Dr. Selikoff's 23 laboratory together for a meeting in Rockville, 60 1 Maryland. And at that meeting we asked them to present 2 the data that they had. Dr. Selikoff presented data 3 from his laboratory, I think we will discuss in a few 4 minutes. That showed there were exposures in the brake 5 mechanic area that should raise our concern about the 6 possibility of disease occurring in that population. 7 The brake companies did the same, and as a 8 result, NIOSH put out what we call a current 9 intelligence bulletin. We put out a warning to all the 10 brake mechanics in the United States, here is this 11 information. It looks like exposures can be quite high 12 in some areas of brake work areas and here is what we 13 think you ought to do to reduce exposures, because the 14 main thing in reducing asbestos disease is to reduce 15 the dust . 16 The lower you can get the dust that contains 17 the asbestos down, the lower the risk of developing 18 disease. We put out a brochure and sent that to as 19 many of the brake mechanics as we could. What we 20 didn't do is we looked at the feasibility of doing a 21 study because of, in general, lower exposures and the 22 fact that most brake workers were in small shops would 23 be -- they would suffer from so much difference in 61 1 homogeneity, each shop was different, each workplace is 2 different. 3 And we decided that we wouldn't do a study 4 because; one, the cost of the study would be 5 prohibitive; and secondly, if we put out what we knew 6 about asbestos already; that is reduce exposures, don't 7 use air hoses to blow out the dust, use vacuums to 8 vacuum it out with filters on it that would keep the 9 dust out, we could reduce the risk without having to 10 spend large amounts of money to do the epidemiological 11 studies to come up with evidence. In other words, we 12 did not want to wait and count the bodies or count the 13 people that had disease before we acted. 14 So what we did is put this out. I feel that 15 in 1975 by doing that we reduced exposures even more. 16 We reduced ability then to really find suitable cohorts 17 to really study this problem. I think we are suffering 18 today because if you look at the brake worker cohort 19 studies, the ones that started -- did not start until 20 after really, the majority that we talked about today, 21 in litigation, or once it started in the ' 90s or after, 22 most of those, I believe, were started due to 23 litigation activity, just because everybody said you 62 1 had to have epidemiology. I don't think you have to 2 have the epidemiology if you already have the proof 3 that asbestos causes disease at certain exposures. 4 That is what our institute took. 5 We don't do exposures because several reasons; 6 cost, inadequate personnel do the studies, lack of 7 suitable cohorts, because of the inability to control 8 for the confounders. These are all factors that are 9 resulted in very few studies of brake workers being 10 done. 11 Q. I want to make sure I am clear when you were 12 working with the agency, a decision was made not to do 13 an epidemiological study of brake mechanics, it wasn't 14 made because you did not expect to see disease in brake 15 mechanics? 16 A. No, we put out a bulletin showing that we did 17 expect to see disease, as long as these preventative 18 measures were not put in place . 19 Q. The fact that medical literature and peer 20 review literature binders at local medical schools are 21 not busting with epidemiological studies of occupation 22 specific brake workers; in your opinion does that mean 23 that they don't get disease or they are not at an 63 1 increased risk for disease? 2 A. No, not at all. 3 Q. Take a step back. We have been talking a lot 4 about mesothelioma and cancers. Let's talk about 5 non-malignant lung disease. Is it your opinion that 6 brake workers or users of asbestos-containing friction 7 products are n at an increased risk of developing 8 non-malignant disease? 9 A. Yes. 10 Q. Tell us why? 11 A. Several studies listed here, this is one from 12 Dr. Selikoff's group that first brought our attention 13 to this. This is a study about where they examined 104 14 vehicle maintenance workers, they found 29 percent or 15 little over a 4th with decreased vital capacity, 16 another 4th had chest x-ray abnormalities that were 17 consistent with asbestos-related disease, and both 18 chest x-ray, restrictive lung function tests showed 19 greater abnormalities after 20 years showing more 20 exposure they had in this work area, the greater the 21 disease symptoms and signs were increasing. 22 So this is one study that shows a nonmalignant 23 disease response in workers consistent with what we 64 1 know about asbestos-related diseases. 2 Q. It the Nicholson study also an additional 3 study that you rely on? 4 A. Yes, this is another one of the Selikoff group 5 of studies, showed greater prevalence and x-ray 6 abnormalities in garage mechanics who repaired brakes I 7 think that is important who repaired brakes because 8 many of the epidemiological studies that have been done 9 to date that have looked at so-called brake repair 10 workers looked at the rubric garage mechanic and they 11 never defined they do brake work or don't do brake 12 work. Selikoff's group actually looked at garage 13 mechanics who repaired brakes, and compared them to 14 blue collar controls, or to other garage workers that 15 did not repair brakes. 16 They found that this was greater prevalence of 17 x-ray abnormalities in that group that did the break 18 work. And we will talk about this, I think, a little 19 bit later, but the epidemiological studies that have 20 been done, as I said, generally don't define them down 21 that fine. They generally define them as garage 22 mechanics, or vehicle mechanics. They don't ever say 23 they did brake work. They just put them in that 65 1 category. 2 Secondly, Selikoff's group then found 3 significant excessive seen in workers who ground, and 4 machined the brake linings prior to their installation 5 on larger vehicles. We often hear that that does not 6 occur, but we found and Dr. Selikoff find, both of our 7 groups found, in going into the garages where brake 8 work was done, often times they did have to grind the 9 brakes to make them fit properly. They did not all 10 come ready made, even though supposedly they are 11 supposed to. 12 And then, lastly, the x-ray abnormalities 13 tended to occur in those that did have the asbestos 14 exposure. 15 Q. Not all of the studies that you rely on were 16 done by Selikoff in the time frame? 17 A. No, those are 2 that are done by the group. 18 Q. You have a slide prepared on a study that was 19 done in 2003? 20 A. Yes, this is a study that came out recently, 21 that showed evidence of asbestos exposure, and lung 22 function changes occurring in people that were exposed 23 to asbestos in brake linings. And, again, looking at 66 1 people actually working with the brakes, not putting 2 them in a category of vehicle mechanics, or motor 3 mechanics, but people that actually had hands-on work 4 with the brakes. 5 Q. Let's shift gears here a little bit. Talk 6 about the different types of epidemiological studies, 7 on the uses of asbestos. Can you tell us about the 8 different types of studies that do exist. 9 A. One of the things that I have done in my 10 career is looked at a history of asbestos usage, and by 11 all estimates there are at least three thousand 12 different applications. When we, at NIOSH, did our 13 occupational exposure surveys, we found 377 different 14 occupational groups that existed, and that of those 200 15 had exposures to asbestos in some form or another. 16 And each group had multiple specific job 17 titles. So there wasn't one job title for each of the 18 asbestos exposures but there were multiple job titles. 19 And we also found in looking at that that only a small 20 number of these have been studied epidemiologically. 21 When you look at asbestos you can probably break it 22 down and say that less than a dozen of the job 23 categories have adequately been studied; out of the 200 67 1 categories that we were looking at of job titles. 2 Raise that to 377 occupational groups, but probably a 3 dozen or a little bit more than a dozen have ever been 4 studied in the history of asbestos. That means there 5 are some, you know, 190 or 180 still out there that 6 have never been studied. 7 Q. As a trained epidemiologist who has practiced 8 field epidemiology, is it your opinion if an 9 occupational title has not been studied yet, those 10 individuals are exposed to asbestos in the workplace 11 above environmental levels, they are not at an 12 increased risk? 13 A. Not at all. That is why what I think what 14 Dr. Selikoff said earlier, what I have learned in my 15 career that it is not the job title, it is the exposure 16 within the job title. 17 Q. Talk briefly about the specific occupations 18 that you prepared slides on that have shown increased 19 risks. Now, I don't see friction workers or garage 20 mechanics on there. In your opinion, does that mean 21 that garage mechanics, or users of asbestos-containing 22 friction products that are exposed at levels above 23 environmental exposures where disease has occurred, has 68 1 been reported in the literature, they are not at an 2 increased risk of developing disease? 3 A. Not at all. They are not at the same 4 increased risk as say insulation workers, or 5 boilermakers, people that have traditionally the whole 6 work force exposed to extremely high levels of 7 asbestos. They just don't come up on the radar screen 8 that way. There are exposures in the brake area that 9 have high enough and get into the same levels of those 10 other exposures that develop disease. It does not mean 11 they are not going have disease because they don't fall 12 into this listing that we put together in our surveys. 13 Q. Last thing before we move on. Are there 14 epidemiological studies of specific industries that 15 show increased PMRs? 16 A. Same is true as with jobs, and these are from 17 that same survey where we looked at the 200 different 18 job titles, I think it was 377 different occupational 19 groups. And these are just the ones that came up with 20 the highest risks, but they had the highest exposures, 21 also, in general. And most people in those job 22 categories were exposed, compared to vehicle mechanics 23 where you have a lot that are not exposed. 69 1 Q. I want to touch briefly on something you have 2 on your slide ship and boat building and repair. That 3 is not talking about the guy that repairs the canoe on 4 the corner shop? 5 A. No, we are talking about major shipyards. 6 Q. Did the fact you don't have on your slides the 7 automotive industry mean, in your opinion, that users 8 of asbestos-containing friction products who are 9 exposed to chrysotile asbestos are not at an increased 10 risk of developing asbestos disease? 11 A. No, not at all . 12 MR. SPILLANE: This might be a good time to 13 break. 14 THE COURT: Take our afternoon recess. We 15 will break for ten minutes, return at 20 'til. 16 (A short recess was taken.) 17 18 19 20 21 22 23 70 1 MR. SPILLANE: Thank you, Your Honor 2 BY MR. SPILLANE: 3 Q. All right, Dr. Lemen, we have been spending a 4 lot of time mentioning exposures and doses, that's the 5 area I want to go to next is mesothelioma asbestos 6 disease and dose response. 7 Are asbestos diseases does response diseases? 8 A. Yes. 9 Q. What does that mean? 10 A. That means that the more exposure you have the 11 higher the risk of developing disease. 12 Q. And there's a paper that you and I have 13 discussed before the Watsonville papers published in 14 1998, can you tell us a little about what that paper 15 said and why that's significant for you? 16 A. This is one of the few papers that has looked 17 at low dose exposures for mesothelioma. This paper is 18 mixed exposures to asbestos. That is, it is not just 19 chrysotile but it is to amphibole also. 20 And what it has done is actually to break down 21 the exposure categories into relatively low dose 22 exposures. For example, the ranges are on the slide 23 are .001 to .495 f/cc, next .5 to .599 f/cc, etc., and 71 1 on up . 2 Very few papers have been able to do this and 3 the graph of the writing actually illustrates the 4 findings that they found as the exposure number of 5 fiber exposures per year went up, the odds ratios went 6 up. For example, in the 001 to .495 f/cc years, the 7 odds ratio was 1. 2. It didn't show significance 8 because the confidence interval was .8 to 1. 8. But as 9 the exposure then went up into the area of . 5 to 9.99 10 f/cc years, the odds radio increased to 4.2 with a 95 11 degree confidence interval being 2. 0 to 8. 8. 12 And the next exposure level 1 to 9.9 fibers, 13 the odds radio went up to 5.2. When it got greater 14 than ten fiber per cc years it went up to 8. 7. So this 15 is a very good graphic illustration, I think, of how 16 dose response works; and for mesothelioma how it works 17 at the lower concentrations. 18 Q. And this idea of dose and dose response, are 19 we talking just an individual dose or are we talking 20 about cumulative doses? 21 A. We're talking about cumulative dose. And 22 that's why it's measured in fiber per cc years as 23 opposed to fibers per cc. 72 1 Q. Now you mentioned that this was a mixed 2 exposure study, both amphiboles and chrysotile. What I 3 want to touch on is that concept, right now, of mixed 4 exposures. 5 Are you familiar with the paper that 6 Dr. Nicholson exposed in 1982 on occupational exposures 7 to asbestos? 8 A. Yes. 9 Q. In that paper, did Dr. Nicholson discuss the 10 average years of employment for somebody who works as 11 an automobile mechanic and is thus being exposed to 12 asbestos from those products? 13 A. Yes, he did. 14 Q. And I believe in the paper he says that in the 15 1940s the average years of employment in that industry 16 was about two and a half, 2.7 years before they moved 17 on to other trades? 18 A. Somewhere in that neighborhood, and he was 19 looking at garage mechanics in small job operations, 20 generally. 21 Q. Now I think he then went in the 50s it was 6 22 years, the 60s 7.7 and the 70s seven years? 23 A. Right. 73 1 Q. But is that important when we're discussing 2 exposures to users of asbestos products the fact that 3 they may only be in that industry on average a 4 relatively small amount of years, but then move onto 5 other trades where they add to their cumulative 6 exposure in other trades? 7 A. It's very important for that reason, because 8 not only do they have the brake exposure they could go 9 into other industries where other asbestos exposures 10 occur causing them to have exposures to other types of 11 asbestos or other types of materials. But it gives 12 them a greater opportunity of having mixed exposures as 13 compared to say an insulation worker that generally 14 stays in that career the majority of their working 15 life. 16 Q. Isn't it appropriate as a scientist using 17 scientifically reliable methodologies to ignore those 18 exposures that they got from asbestos containing 19 friction products if they develop a disease when 20 determining the association or causing that disease? 21 A. In my opinion not at all. And that's why I 22 think I wanted to put in my presentation, which we're 23 looking at today. The idea that studies have shown 74 1 that mixed exposures are very significant. 2 So a brake worker, if you take all the other 3 exposures out that's one exposure, but if you look at 4 the mixed exposures and add the other exposures, that 5 brake exposure is one area after exposure that adds to 6 the total body burden. 7 It may not be the only exposure, but it adds 8 to that. And without that exposure the body burden 9 would be less and therefore the risk would be less. 10 Q. And when we talked earlier, real briefly, you 11 mentioned the Acheson study is the Acheson study 12 another study that shows the idea of this mixed 13 exposure of increased risk? 14 A. I actually think the Acheson study probably 15 shows it graphically better than our own study that I 16 talked about in 1996. His study was in '79 where he 17 showed the relative risk was one for no asbestos in the 18 lung tissue; and the relative risk was six for 19 chrysotile in the lung tissue. 20 For amphiboles it jumped up to 12, but then 21 when you looked and found both chrysotile and 22 amphiboles that risk jumped up to 61, which, as I said 23 earlier, is much more than additive, it is actually a 75 1 synergistic effect. In other words, the two together 2 equal more than the sum of the two together. 3 So it is important that mixtures act in 4 increasingly exposure response. 5 Q. Now, we talked about the idea of whether it is 6 appropriate or not to ignore exposures say from 7 asbestos-containing friction products compared to other 8 exposures. Are you the only scientist that has that 9 opinion? 10 A. No. 11 Q. Now, we talked a lot about Dr. Henderson 12 earlier with Dr. Hammar. What does Dr. Henderson say 13 about whether or not it is valid to exclude one 14 exposure or the other? 15 A. Well, as it is quotes right here and I'll read 16 it: When one is faced with multiple exposures to that 17 asbestos the following points emerge: Specifically 18 from mesothelioma induction provided that the 19 characteristics and time for each exposure are 20 appropriate for a biological effect, one, it is not 21 valid to point to one exposure among the others and 22 incriminate it as the sole cause of mesothelioma with 23 exoneration of the other exposures. Two, it is not 76 1 valid to point to one exposure and exonerate it from a 2 causative role in the development of mesothelioma and 3 to incriminate all the others. 4 In such circumstances, it is not the presence 5 or absence of an effect that is in question, but the 6 magnitude of each effect and proportion to the others. 7 Q. Now, you were present in the courtroom when 8 Dr. Hammar testified is this kind of getting into the 9 area that he discussed that nobody can really say which 10 specific exposure or fiber actually started the 11 carcinogenic process but that they all in a cumulative 12 nature contributed to the disease? 13 A. Yes. 14 Q. On a very simplistic level, me as a lawyer, 15 have you heard it referred to as each and every 16 exposure contributes to the disease? 17 A. Yes. 18 Q. And is that -- not necessarily that phrase, 19 but that concept --something that you agree with? 20 A. It is . 21 Q. All right. Now, let's get into the types of 22 exposures that the medical and scientific literature 23 says that automobile mechanics actually receive when 77 1 using these products. 2 But before we want to get there, I want to 3 talk about how they are exposed. And I want to talk 4 about, as I understand it, there's two ways that they 5 are exposed. Can they be exposed both in installing 6 new linings as well as removing old? 7 A. Correct. 8 Q. Can you tell us a little about that and how 9 they are exposed? 10 A. Well, in the new linings they are exposed by 11 manipulating the new brake pads. That is, they may 12 have to cut them, they may have to grind them, they may 13 have to Hammar them or shape them in ways to fit. 14 Sometimes they don't have to do anything to them, other 15 times they do. So there can be exposure from those 16 particular activities. 17 And the second area where they are removing 18 the breaks, often times they get stuck and they have to 19 pry them out, they have to Hammar them out, sometimes 20 chisel them out to get all of the used brake pad away. 21 And they also have to clean out the brake drum 22 itself, and through those two processes they can get 23 exposure to asbestos. Even though some have talked 78 1 about the changing nature of the fiber and to a 2 nonasbestos form fibers -- nonfibrous material called 3 fosterite. All of the studies have indicated that 4 there still is some of the asbestos left in tact in the 5 brake drum. 6 Q. And I want to touch briefly on this idea of 7 fosterite. During the exposure that occurs during the 8 grinding or beveling before the brakes are installed 9 has there been any conversion of any of the chrysotile 10 to fosterite? 11 A. No, you're talking about an asbestos that has 12 not been altered by heat and the only way fosterite 13 occurs in the first place is to be alterated by the 14 heat . 15 In other words, when the chrysotile is heated 16 up to a point that it dehydrates, loses its water from 17 the fiber itself, that's when it converts into the 18 fosterite. That usually occurs at about 600 degrees 19 and some have said lower, but generally that's the 20 range that it occurs at. 21 Q. Now, were you present in the courtroom when 22 Dr. Dodson was showing the slides of the asbestos that 23 he viewed under his transmission electron microscope 79 1 after the test, where he poured water on some brake 2 shoes? 3 A. I am. I was, sorry. 4 Q. Have you also seen other slides or images of 5 chrysotile asbestos fibers that have been omitted from 6 other products that weren't asbestos-containing 7 friction products? 8 A. Yes, I have. 9 Q. Was there anything unusual about the fibers 10 that Dr. Dodson showed in his slides from the slides 11 from other products that you have seen? 12 A. Not that I could tell. 13 Q. Now you're not a microscopist, though? 14 A. That 's correct. 15 Q. But based on your scientific training it 16 looked pretty much the same? 17 A. Yes, sir. 18 Q. Now, and I want to make sure that I understood 19 you correctly, this whole idea of converting to 20 fosterite, even when old brakes are removed and 21 exposure from blow outs or brushing the brake dust left 22 behind, that's not all fosterite? 23 A. No, no it s not . It varies from study to 80 1 study, but our studies, when I was with NIOSH, would 2 show that we could have quite a bit of chrysotile left, 3 some did convert to fosterite. 4 And my paper that I wrote in 2004 I went into 5 this in great detail about what we found and there's no 6 doubt that some of it changes to fosterite, but not all 7 of it. 8 Q. Now, let 's talk about some of the studies, I 9 think th is may be one that you touched on earlier that 10 lead to the OSHA or NIOSH warning. In the LLoyd study 11 from 197 5 tell us a little about the types of asbestos 12 exposures that he measured from doing brake and 13 friction product work. 14 A. First of all let me correct you, Lloyd is not 15 a study. 16 Q. Thank you, Doctor. 17 A. This is a report from NIOSH based upon what I 18 talked about earlier, when NIOSH brought together the 19 people from Selikoff's group and the brake manufactures 20 and put out an alert, the Current Intelligence 21 Bulletin. Dr. Lloyd signed the letter and the report 22 that went out, and what he reported were the 23 concentrations that were reported to NIOSH during that 81 1 meeting. 2 And in that we found -- we were reported to 3 that average peak asbestos air concentrations could 4 range as high as 10.5, 3.75, 37.3 fibers. These are 5 all greater than five micron in length or per 6 millimeter or per cc, which is the same as per 7 millimeter. And that the present findings indicate 8 that enough asbestos is present and preserved in the 9 brake to produce significant exposure during certain 10 brake servicing procedures. 11 It was these type of exposures that lead NIOSH 12 to put out its Current Intelligence Bulletin. And in 13 that bulletin, NIOSH recommended that labels be put 14 onto the material and labels be posted in the working 15 area. And this is what the label said. 16 Q. You said "current," is that still in effect? 17 A. Yes. Well, it is called Current when it went 18 out in '75 but it is still current, but it was also 19 current in '75. 20 Q. Now, there is a couple of words in here that 21 are in the call outs that I want to touch on and 22 examine. We're talking about peak asbestos 23 concentrations, are you familiar with the term 82 1 threshold limit value or TLV? 2 A. I am. 3 Q. Explain to us what that is, Doctor. 4 A. Well, a TLV is something that the American 5 Conference of Industrial Hygienists put out. It is the 6 same basic theory as the OSHA, PEL, which is 7 permissible exposure limit. And it measures what the 8 average exposures are over an eight-hour working shift 9 as compared to peak exposures, which are usually 10 measured over 15-minute or 30-minute periods of time 11 occurring during the work shift. 12 Q. Is the idea that an average exposure is 13 dangerous and a peak exposure is not or vis versa? 14 A. Neither. Neither, actually. The idea is that 15 if you contain your average exposure during a workday 16 to the PEL or the TLV that the risk of disease is going 17 to be low. But they also have peak levels that mean 18 that you cannot exceed these peak levels because even 19 if they average out to below the TLV or the PEL, they 20 are still dangerous. 21 So the peak levels do have a lot of 22 significance, in that they do add greater 23 concentrations of asbestos. And, two, the work 83 1 environment for short periods of time, which can 2 increase the exposure to the worker. 3 Q. And thus increase the risk? 4 A. Yes. 5 Q. Now, have these threshold limit values 6 continued to be adjusted over time as we learn more and 7 more about asbestos and disease? 8 A. Absolutely. 9 Q. And has the threshold limit value continued to 10 be lowered as time has gone on? 11 A. Yes, it has. 12 Q. What did it start out at and what is it 13 currently at today? 14 A. When first OSHA came into existence in 1972 or 15 '71 the first standard that went out was in '72 and it 16 was at 5 f/cc as an average. It has now gone down to 17 .1 f/cc. 18 Q. And have the peak exposure limits also been 19 adjusted over time? 20 A. They have. 21 Q. What did those start out at and what are they 22 at now? 23 A. They were much higher. The first standard 84 1 actually didn't have a peak exposure standard, it was 2 in the second, I think, that they put the peak in. 3 We do not have the peak exposures now, but - 4 or we didn't then, but the peak exposures are very low 5 now, like double the . 1 to . 2. 6 Q. Now when NIOSH came out with the threshold 7 limit values, what was their intent? Were they 8 protecting against asbestoses, cancer, what was their 9 intent to protect against? 10 A. Well, first of all I need to correct you again 11 NIOSH never pout out a TLV. 12 Q. That's why I need you here, Doctor. 13 A. NIOSH put out a recommended exposure level, an 14 REL. And this gets confusing. The recommended 15 exposure limit that NIOSH put out was to protect 16 against noncarcinogenic effects of asbestos. 17 In our criteria documents we always said that 18 we thought that this would eliminate the disease, 19 asbestoses, and reduce the amount of cancer. But in 20 1976 we said that the only way to eliminate cancer from 21 exposure to asbestos was to a ban the use of asbestos 22 in the workplace. 23 So NIOSH never put a standard recommendation 85 1 out that they felt was considered inclusive for the 2 protection against cancer. OSHA never put out a PEL 3 that they thought was all-inclusive for protection 4 against cancer. They felt the same way, it would have 5 lowered the risk but it would not have eliminated 6 entirely. 7 As a matter of fact, the current OSHA standard 8 of .15 f/cc OSHA still projects that the risk of 9 developing an asbestos-related cancer is about three, 10 three and a half per thousand workers. So it's not a 11 zero risk standard by any means. 12 Q. Let's move onto another study, Roll study are 13 you familiar with the Roll paper from 1976? 14 A. Yes; this is actually one of the papers that 15 NIOSH reported on and Roll continued looking at this 16 and these are the numbers that he found. 17 Q. And are these levels of exposure at which we 18 have seen disease occur? 19 A. Yes. 20 Q. How about the Capanin paper from 1987, are you 21 familiar with that? 22 A. I am. 23 Q. What type of exposures do they report, say on 86 1 the grinding of brake linings as it relates to trucks 2 and buses? 3 A. Well, their exposure range was .3 to 125 f/cc. 4 And then they go through the median being samples, etc. 5 But here again is just another example that during 6 certain parts of the operation you can get peak 7 exposures that are quite high and can add to the 8 overall body burden a significant a mount of an 9 asbestos. 10 Q. And because they add to the overall body 11 burden, is that significant since asbestos diseases are 12 dose response diseases? 13 A. Absolutely. And I think that's the difference 14 between the average concentrations and the peak 15 concentrations. You have to look at what is going into 16 the body. These peak concentrations mean that for a 17 certain period of time you're capable of breathing in 18 this amount of fiber, which is much higher than the 19 average amount of fiber, and the PEL or the TLV or 20 whatever you want to call it . 21 Q. And Capanin also found levels that ranged from 22 less than .1 to 8. 2 on the cleaning of brake drums -23 or drum breaks in passenger cars? 87 1 A. Yes. 2 Q. Back to the EPA. Are you familiar with the 3 EPA guidance for preventing asbestos disease among auto 4 mechanics or the Gold book? 5 A. Yes, I am. 6 Q. What type of information is reported in that 7 document from the EPA? 8 A. Similar type of information updated from what 9 NIOSH put out in 1975. EPA put out another document in 10 1986 with additional information, and in theirs they 11 were measuring numbers of 72 f/cc. They expressed it 12 was 72 million fibers, but that's what they are talking 13 about as compared to the 39 that NIOSH found, 4.8 14 million f/cc. 15 And they claim in their document that was sent 16 out to garage mechanics and other places where brake 17 work was done that all of these brake cleaning methods 18 can release enough asbestos into the garage so that an 19 average of over one million of the larger fibers can be 20 breathed each day by workers in the garage. 21 These brake cleaning methods can also cause 22 customers to be exposed since asbestos from brake work 23 can be spread 75 feet away from the mechanics. So here 88 1 we have got people that may not work directly with it 2 that could also be at risk of the disease in some 3 cases. 4 Q. And I believe that in your paper from 2004, if 5 my memory serves me correctly, you referenced some 6 documents from the Friction Material Standards 7 Institute that actually indicate just the handling of 8 brake shoes in the garage can in fact release asbestos 9 fibers? 10 A. Yes, I did. 11 Q. Would that in fact be consistent with the 12 study that Dr. Dodson conducted and discussed with His 13 Honor yesterday? 14 A. It would be, yes. 15 Q. Are you also familiar with the Faigout paper, 16 F-A-I-G-O-U-T, from 1985? 17 A. Faigout, yes. 18 Q. Faigout. 19 A. Yes, the studies shows that fibers are indeed 20 released when asbestos-containing brakes are ground. 21 That many of the released asbestos structures are 22 indeed fibers and not just bound into bundles, clusters 23 or matrixes. And that sufficient amounts exceed the 89 1 then 1985 OSHA 15-minute sealing of 10 f/cc. And the 2 current excursion limit -- they changed the name from 3 sealing to excursion limit -- had one fiber cc over a 4 30-minute period. And that was 1986, I guess, '84 OSHA 5 standard. 6 Q. And all of these papers that we have shown are 7 showing that measurements taken out in the industry are 8 revealing exposures at levels where disease can and has 9 occurred? 10 A. Yes, it has. -- I mean, yes, they do. 11 Q. Now, are there other papers that are in the 12 literature -- and let me back up a little bit. This is 13 not an exhaustive review of all the literature on 14 exposures? 15 A. No, not at all. 16 Q. Are there other papers in the literature that 17 in fact show smaller exposures? 18 A. There are. There are studies, and I have 19 reported in my book a study by Mr. Blake that showed 20 extremely low exposures that was done in the automobile 21 industry. So there are ranges going from virtually no 22 exposure up to ranges as high as what we're reporting 23 here . 90 1 I think the high ranges are important because 2 it shows there is that capability, while maybe small, 3 of having exposures that are clearly capable of causing 4 disease. 5 Q. And are you familiar with Dr. Paustenbach's 6 paper about exposures? 7 A. Yes, very much so. 8 Q. Now I want to take you through an exercise and 9 see if you can do this for me. I want to apply with 10 the idea of dose response, cumulative exposure -- let's 11 make some assumptions and apply the numbers that Dr. 12 Paustenbach reports to the Iwatsubo study. 13 But before we do that, let me ask you: 14 Dr. Paustenbach, his measurements in his paper, was he 15 saying that he was measuring every fiber that was in 16 the air? 17 A. No, actually Dr. Paustenbach didn't measure 18 any fiber. He took measurements about 200 samples that 19 had taken by NIOSH and other agencies and other 20 researchers and combined them all together in a review 21 paper. I don't think Dr. Paustenbach or his staff made 22 any of the measurements themselves, but they were 23 general measurements that represented about 200 91 1 samples. 2 Q. Were those measurements that they put together 3 made by polarized light microscopy? 4 A. They were. So they would have accounted for 5 not just asbestos but other fibers in the air as well. 6 Q. And because of the limits of light microscopy 7 that we discussed with Dr. Dodson, is it your opinion 8 that those measurements were counting every asbestos 9 fiber? 10 A. Well, they probably counted only the fibers 11 that were of regulatory nature, because they didn't 12 count those less than five micron, they didn't count 13 the real thin fibers that Dr. Dodson talked about 14 wouldn't be seen by the polarized light microscope. So 15 -- and I think you'll see later on in the presentation, 16 Your Honor, that about -- and I'll say that now about 17 90 percent of the fibers that we counted or that NIOSH 18 counted in the workplace, about 90 percent were all 19 less than five microns, only about ten percent were 20 above five microns when we went ahead and took the PCM 21 method and compared it by using the electron 22 microscope. 23 Q. And in fact were some of the number that 92 1 Dr. Paustenbach reviewed and put together were some of 2 those measures taken when dust control measures were 3 actually in place? 4 A. Yes . 5 Q. Would that have reduced the exposures? 6 A. Yes . 7 Q. And were those controls in place because of 8 the warning that we were discussing earlier to the best 9 of your knowledge? 10 A. I would hope that they were in place because 11 of the NIOSH warning in '75 as well as the EPA warning 12 in '86, and many of these samples were taken after that 13 period of time. 14 Q. Let's go through this exercise and see what 15 kinds of results we get in terms of cumulative exposure 16 in dose response if we assume some of Dr. Paustenbach's 17 numbers. Can you walk us through that exercise? 18 A. Yes. What I have done is I have taken the 19 Iwatsubo study and applied it to numbers that were 20 recorded in the Paustenbach study, the high range 21 numbers actually. If you look at the automobile 22 mechanics, I think he had a . 04 f/cc, which would give 23 your odds ratio of 1. 2, which was not significant, as 93 1 we remembered in looking at the '95 confidence 2 interval. But if you look -- and I think -- if you 3 look at the higher level, though, dropped down to the 4 third one of the auto mechanic, the . 68 fibers, that 5 puts it in that second category that it Iwatsubo - 6 I'll get it right in a minute -- stated, and that was 7 the odds ratio was 4.2, which was significant. 8 So at high range there was significant 9 exposure that certainly raised the odds ratio more than 10 you would expect in the general population. And 11 looking at the truck mechanics, looking at the bigger 12 brakes, at the higher level that went up to 5. 2 and 13 again significant. 14 So the average exposures, they weren't 15 significant. But when you got up to the higher range 16 as Dr. Hammar was talking about, you have to look at 17 the range of the confidence intervals, you do see that 18 there are some that get up into the high enough range, 19 above the average, that can cause a significant amount 20 of disease. 21 Q. And it's your opinion, as a trained and 22 practicing epidemiologist, that exposure analysis 23 should look not just at the average exposure but 94 1 consider the entire range of exposure including these 2 peak exposures? 3 A. I do. 4 Q. Now, you have had an opportunity -- I'm sorry, 5 did I cut you off? 6 A. No. I was just going to say the average 7 exposures give you some comfort, and I think that 8 comfort is that in general you can say the risk is 9 probable fairly low overall for brake mechanics. But 10 what it does when you look at the peak exposures tell 11 you there's still some brake mechanics that are going 12 to fall in that higher risk category, and it is those 13 few that you need to be worried about. 14 Q. Now you have had an opportunity to review the 15 epidemiological literature that at least has been 16 purported to report on associations or the risk of 17 brake mechanics? 18 A. I have. 19 Q. All right. I'm going to go through those and 20 let's talk about those. Let's talk about some of them 21 by themselves and then we'll get into talking about 22 them and others, particularly in the context of 23 Dr. Goodman's meta-analysis that he has published 95 1 recently. Okay? 2 A. Yes, sir. 3 Q. First, let's talk about the Rushton study. 4 Have you had an opportunity to review the Rushton 5 study? 6 A. I have. 7 Q. And what does that study tell us? 8 A. Well, this was a study done in 1983 of London 9 Transit Executive Bus Garages, so this is a large group 10 of people, unlike we normally see in garage mechanics, 11 this was a fairly large group. 12 What it founds was that they had traced these 13 people through 1975, but 89 percent, almost 90 percent, 14 was still alive at the end of the study. So they only 15 had 8 percent of the study population deceased. And 16 they didn't talk about what the brake exposures were, 17 they didn't discuss that. But their duration of follow 18 up, they said, was only six years. 19 So it's very hard from this study to make any 20 strong conclusions because of the fact that the 21 majority of the population was still alive and hadn't 22 died, so the risk could not really be measured in that 23 8 percent that had died. And that the duration of 96 1 follow up being so short made it very hard to really 2 exclude chance from any of the findings that they 3 reported. 4 And they did no analysis of brake mechanics as 5 they reported in their study, that I could find. 6 Q. Now I want to touch on one thing that you have 7 got on your slide. The duration of follow up is short, 8 an average of six years. Is this the idea of the 9 latency confounder that we were talking about earlier 10 when Your Honor asked you a question that if you don't 11 follow the cohort long enough you don't allow the 12 latent disease to develope, that is a confounder? 13 A. Yes. 14 Q. Now, I want to take one step back before I go 15 further, in your published paper on asbestos and 16 brakes, exposure and risk of disease, you state that 17 the results of -- that the epidemiological studies are 18 equivocal? 19 A. Yes, I did. 20 Q. And is that still your opinion? 21 A. That is still my opinion. By equivocal I mean 22 that they can be interpreted one way or the other, 23 basically. They don't tell you enough information to 97 1 let you make a decision one way or the other. 2 Q. And is that -- I may be over simplifying this, 3 but is that's essentially because of the confounders 4 from which these studies suffer? 5 A. Yes, it is . 6 Q. Now, I want to keep thatin mind as we're 7 going through these studies, ifyou would for me, 8 Doctor. 9 Let's talk next about the Teta study from 10 1983. Are you familiar with that? 11 A. Yes, I am. 12 Q. Can you tell us about that, please. 13 A. The Teta study was from the Connecticut Tumor 14 Registry. She and her coauthors looked at the category 15 for automobile repair and what they found was a 16 relative risk of .66, nonsignificant because you can 17 see from the 95 percent confidence interval. But the 18 authors themselves concluded that they had difficulties 19 in ascertaining the occupational histories, and that 20 the true number of occupational cases may be obscured. 21 In other words, they may not have been able to identify 22 all the occupational cases because they were having 23 difficult in ascertaining what the occupational 98 1 histories were. 2 So those were confounders that could not be 3 ignored when you're making a study. This may mean they 4 have either underreported or overreported, but you 5 can't find an answer because of these confounders that 6 they, themselves, pointed out. 7 Q. And as I understand you, these are -- are you 8 okay? 9 A. I'm just got something in my throat. I have 10 been drinking water, but it has not been helping much. 11 THE COURT: Do you want to take a break? 12 THE WITNESS: I'll keep going until I lose my 13 voice . 14 BY MR. SPILLANE: 15 Q. Doctor, if it would help, I have been handed a 16 small cough drop. 17 A. That might help, thank you. Okay. 18 Q. Let's next talk about Dr. Rodelsperger, are 19 you familiar with this paper from 1986? 20 A. Yes, I am. 21 Q. Can you tell us about that paper and what it 22 reports? 23 A. Dr. Rodelsperger and his colleagues reported 99 1 four cases of mesothelioma from their clinic in 2 Germany. In their paper they said that there were 3 about 300,000 automobile mechanics in Germany. 4 And this really could be considered more or 5 less a case report. These four cases that they found 6 in their clinic, because it certainly wasn't 7 representative of all of the other cases that may have 8 have occurred in other clinics throughout Germany, but 9 it is one report that they brought out of these four 10 cases. 11 Q. And that is something I wanted to touch on. 12 Th is is just a report of four cases from their clinic, 13 no t from the entire country? 14 A. Right. That's correct. 15 Q. Do you think that they have four to eight 16 mi llion patients in their clinic, Doctor? 17 A. No. No, not at all. 18 Q. Considering the background levels of asbestos 19 or of mesothelioma that we have discussed with 20 Dr . Hillerdahl and others, do you think that in your 21 op inion four mesotheliomas from just their clinic is a 22 si gnificant number? 23 A. I think it is a significant number. Now, 100 1 another observer of this paper, Dr. Wong, actually said 2 this is not about background. I don't know how he came 3 to that conclusion. But four cases, as we listened to 4 Dr. Hammar this morning and knowing what the background 5 is, I think, is a very significant finding. 6 Q. Next, let's talk about Neuman from 2001. Are 7 you familiar with that paper? 8 A. Yes. He looked at the German mesothelioma 9 registry and he reported 48 cases in the automobile 10 sector. Again, we don't know if those 48 did brake 11 work or whether they were automobile salesman or what 12 they were. They were just in the automobile sector, so 13 it really doesn't tell us a lot about the brake 14 workers. 15 Q. Would that be a limitation or confounder of 16 this study? 17 A. Absolutely. 18 Q. How about Woitowitz and Rodessperger from 19 1994, are you familiar with that? 20 A. Yes. 21 Q. Can you tell us a bit about that, please. 22 A. They did a case control study and found six 23 cases of mesothelioma among 324, who they says that 101 1 definitely had been engaged in brake work. And four of 2 those six had no other exposures but their exposure to 3 asbestos and brake work. 4 Q. In your opinion, Doctor, is that a significant 5 finding? 6 A. I think it's significant. Again, giving the 7 background of mesothelioma being -- if you want to take 8 the high figure one to two per million cases per year, 9 that's a fairly significant amount. 10 Q. How about Jarvholm and Brisman from 1998, are 11 you familiar with that paper? 12 A. Yes; they had one case of mesothelioma among 13 mechanics in a Swedish death registry. 14 Q. Were there any confounding factors in your 15 opinion in this study? 16 A. Well, I think the bottom line, you know, the 17 lung cancer cases indicated that there was exposures 18 probably to chemicals and smoking in that population, 19 so those are things that probably were unable to be 20 controlled for, so, again those are confounders that 21 obscured those results. 22 Q. How about Hansen from 1989, are you familiar 23 with the Hansen paper? 102 1 A. Yes. 2 Q. Can you tell us a little about that, please, 3 Doctor. 4 A. Well, this showed one mesothelioma and no 5 increase in lung cancer, but the authors reported 6 several confounders in this study being a short follow 7 up, just ten years; and that the next of kin interviews 8 they were done may have biased their responses; and 9 that the lack of adequate occupational histories was 10 another confounder; and that smoking could have been a 11 confounder, particularly to the lung cancer cases. 12 Q. Several things you touched on there I want to 13 talk about. First, this idea of next of kin 14 interviews, explain to us as an epidemiologist why 15 would an epidemiologist interview someone's next of kin 16 about their exposure instead of going to the person 17 that has the disease? 18 A. Well, in most cases in mesothelioma the 19 persons are deceased so they don't have the opportunity 20 to go to the patient themselves. So they resort to 21 going to the next of kin and this is particularly 22 interesting because when you go to next of kin you 23 usually say, What was their normal occupation? The 103 1 next of kin can particularly underreport those people 2 that may have been brake workers early in their career 3 and just forgot about that. 4 In other words, the historical data you get 5 from next of kin interviews is often skewed to the most 6 recent occupations or the most general occupations, and 7 often neglects what you would have got from interview 8 from the actual person about what their work history 9 would have been earlier in their lives. So next of kin 10 interviews, while they are better than no interview at 11 all, do suffer some problems with their recall bias, 12 and that recall bias tends to the later occupations 13 being more prevalent in their mind than their earlier 14 occupations. 15 Q. Doctor, have you heard the term "shade tree" 16 mechanic? 17 A. I have, and that's -- again, I should have 18 said that, you know, from what we have heard and what 19 Nicholson said, a lot of mechanics have very short 20 periods of time that they do mechanic work or brake 21 work. And a lot of them may have reported they did it 22 only like a shade tree mechanic. That is, their home 23 changed their own brake shoes or something like that, 104 1 and that exposure was forgotten. 2 Q. Have you ever been asked to consult on cases 3 where a "shade tree" mechanic even may have had a 4 grinding machine in his garage? 5 A. I have, yes. 6 Q. Would there be anything different about the 7 asbestos being omitted from those brake shoes that he 8 ground at his house than from the ones that maybe he 9 would have done if he had worked for a GM, Ford or 10 Chrysler dealership? 11 A. No, there wouldn't, except I think he would 12 more than likely have controls on his exposure in 13 dealerships than he would in his home. 14 Q. If someone is conducting a study and they are 15 interviewing a next of kin about "occupational 16 exposures" would it seem reasonable that say these 17 shade tree exposures would be completely ignored? 18 A. Well, that's what I'm saying that if they were 19 asking about occupational exposures the next of kin may 20 not have even considered the fact that doing their own 21 brake work was something that might be useful for the 22 total review of the exposure that the person might have 23 had . 105 1 Q. Now, we also talked earlier about the idea of 2 cohort studies. When examining the disease population, 3 say in this case many of them who are deceased, to the 4 controlled population, often times is the control 5 population living? 6 A. Yes. 7 Q. Would you have - 8 A. In this case, I think that was true and so 9 they were able to interview more of the control 10 population firsthand than they were the mesothelioma 11 population. 12 Q. And, Doctor, as an epidemiologist, if you're 13 able to interview the person himself or herself that's 14 included in the control population, yet you have to 15 interview next of kin and may not be getting accurate 16 information for the diseased population, would that 17 have a tendency to skew the results towards a negative 18 or null finding? 19 A. Absolutely. 20 Q. And why is that? 21 A. Because the person themselves tend to have a 22 better memory of what they did then say their next of 23 kin. As I talked about, the next of kin might forget 106 1 those older exposures whereas the actual person may not 2 forget those. 3 Q. Okay. And also in the Hansen study they talk 4 about -- you indicate that one of the confounders is a 5 lack of an adequate occupational history. And I want 6 to go back to something that we talked about briefly 7 earlier, and that is the Helsinki criteria, and revisit 8 -- and first of all let me say this document is this 9 entitled Minority Opinion? 10 A. No, Consensus Opinion. 11 Q. What does that mean it's a consensus report? 12 A. It means the majority or the consensus of the 13 people at that conference had agreed upon the findings 14 of fact that are placed in this document. 15 Q. And what are they saying here, right in the 16 introductory paragraph, about -- let me read it to you 17 and you tell me if I read it right. It says, "In 18 general reliable work histories provide the most 19 practical and useful measure of occupational asbestos 20 exposure." Did I read that correctly? 21 A. Yes. 22 Q. So at least according to the Helsinki criteria 23 is the lack of adequate exposure or occupational 107 1 histories a confounding factor for the Hansen study? 2 A. Yes. 3 Q. And I want to direct you to one other comment 4 that the authors in the Hansen study make. Despite the 5 findings that they report, do they not in fact state in 6 their paper: "That asbestos exposure is known to occur 7 during the replacement of brake linings and the single 8 case of pleural mesothelioma is an indication that this 9 exposure has not been negligible." 10 A. I would agree with that. 11 Q. Now, let's move on next to a study that's just 12 part of the literature and it was discussed earlier 13 today with Dr. Hammar, and that's the Henderson study. 14 And you and I touched on it briefly today about how 15 some of your opinions have changed as you have gotten 16 more information. 17 A. Right . 18 Q. Walk us through, Doctor, what the numbers as 19 you think they should be and what the significance, if 20 any, this report has for you or this information has 21 for you. 22 A. Well, I think when we first saw the report in 23 2001, they reported the 58 cases, came up with a 108 1 tenfold excess over background. And the Lee and 2 Driscoll paper in 2003, that number had come down that 3 28 mesotheliomas and compared to the 58, which cuts the 4 risk estimate by half. 5 In other words, they are now at about a 6 fivefold excess. And as reported this morning, the 7 number for the lifetime risk that Lee and Driscoll 8 reported was about . 7, or in other words about twice 9 that, for the Australian population. 10 I think there's a table in there that compares 11 it to the Australian population for men, which was 12 about . 7 and about 14 times greater for Australian 13 woman. So the numbers are changing. The latest 14 numbers would indicate that we're down to this 15 neighborhood of about 28 of mesotheliomas or about a 16 fivefold access risk, according to the latest numbers I 17 have. And I believe that's from the deposition that 18 was given by Dr. Lee that was shown on the screen this 19 morning. 20 Q. And I'm showing a -- the front page of an 21 affidavit that you recently signed, just about a month 22 ago in another case, September 12th of 1995? 23 A. Right. 109 1 Q. And, in fact, I believe you state that after 2 having an opportunity to review Dr. Lee's deposition 3 and some of the issues, inaccuracies, mistakes, 4 whatever we want to call them, that you feel that upon 5 reexamination perhaps only 28 cases may have been 6 solely exposed to asbestos from brakes. Is that 7 accurate? 8 A. Right . 9 Q. Now, if your opinion does this -- would it 10 change the risk as originally reported by Henderson and 11 lee? 12 A. Well it changes the original risk, but it 13 still has an exceptionally high risk by being a 14 fivefold access. I mean, this is not a trivial risk. 15 Q. And is this just one of the studies that you 16 think is part of the overall epidemiological picture 17 with regard to friction products? 18 A. Yes, I never did not put all of my reasoning 19 on the epidemiology behind the Australian Tumor 20 Registry. I tried to take it as one part of many other 21 factors that I looked at in putting my summary paper 22 together and coming to my conclusions about the 23 potential for disease among brake repair workers. 110 1 Q. And I want to make sure I don't misrepresent 2 anything, even including this information included in 3 this recent affidavit, is it still your opinion that 4 the epidemiological studies purported to measure risk 5 or association with friction products is equivocal? 6 A. Yes, I still believe that to be true. 7 Q. Now, I want to touch on one issue we touched 8 on a little bit earlier with regard to one of the other 9 studies, perhaps the Hansen study. I want to touch on 10 something that Your Honor -- His Honor asked you a 11 question about earlier, and that was this latency 12 issue. As it relates to the Australian data, when we 13 were discussing this earlier, this idea of latency or 14 confounder, does it relate to the idea that if you 15 don't follow the subjects long enough you may not allow 16 time for disease to occur? 17 A. Yes; and that's what I was trying to 18 illustrate, I think, when I was talking earlier about 19 the study that we did published the first time in '71 20 and then again in the late '70 where he added about ten 21 years of latency. We saw no mesotheliomas in the 22 first, and then after we observed in for another ten 23 years we found 17 mesotheliomas. 111 1 So it is crucial to look at the cohort long 2 enough to have enough latency, particularly for these 3 long latency diseases, like mesothelioma. 4 Q. Now I want to turn to -- let's talk about - 5 Dr. Goodman is going to testify in this proceeding and 6 I want to talk about the meta-analysis that he and 7 others published in 2004, have you had an opportunity 8 to review that paper? 9 A. Yes, I have. 10 Q. Can you kind of overall summarize for us what 11 that paper reports? 12 A. Well, as I read his paper, and he's here, so 13 I'm sure if I make a mistake he's going to correct it 14 so I'll leave that up to him to correct, but I believe 15 that he used 17 studies to show that there was no 16 excess risk of mesothelioma. He broke that down to 17 17 of the 17 studies for mesothelioma at least, because he 18 was looking at lung cancer and mesothelioma. 19 And the mesothelioma area 7 of the 17 studies 20 had what he called positive scores in their scoring 21 system that they had set up to qualify the studies for 22 their meta-analysis. The score, as I read it, the 23 highest was a score of nine, and the tier one group, 112 1 which was his highest group for the meta-analysis, four 2 of the seven studies had scores between three and five 3 with nine being the highest and three of those -- three 4 then of the seven had scores that ranged between zero 5 and two. 6 So overall, he didn't find that the 7 meta-analysis supported a risk of developing 8 mesothelioma from exposure during brake work. And I 9 think the rest of these slides go into it in more 10 detail about each of the studies. But overall his 11 meta-analysis did not show an excess. 12 Now, I have some problems with meta-analysis 13 that I don't know if I should go into right now, but I 14 can go into those. 15 Q. Let's talk about that. So Dr. Goodman's paper 16 was not an original case controlled study or a cohort 17 study? 18 A. Not from my understanding, it was a 19 meta-analysis using other studies that had been done to 20 pull the data into one set of numbers. 21 Q. What is a meta-analysis? 22 A. Meta-analysis was first started some years ago 23 as analyses to be used in controlled pharmaceutical 113 1 trials. 2 In other words, when one group of patients 3 were given a drug and another group of patients were 4 maybe given a placebo to compare the ethicacy. In 5 other words the ability of the drug to take effect to 6 do what it was supposed to do whether it was to prevent 7 disease or cure disease, whatever it was supposed to 8 do. And the reason meta-analysis is used was because 9 we're looking at using individual patients that may 10 have a lot of different characteristics, but what the 11 meta-analysis could do would be control for the amount 12 of dose and other factors so that they would cut down 13 tremendously on the confounders. 14 And, therefore, they were comparing a 15 homogeneous population, that is with very few 16 confounders to their controls, which was always a 17 homogeneous population with very few confounders. And 18 that was the original purpose for the meta-analysis. 19 But meta-analysis then became used for 20 observational studies, and that's where we ran into 21 some problems of trying to control for the confounders. 22 And that's the big problem with meta-analysis is the 23 ability to control confounders. 114 1 Now, what Dr. Goodman did was try and control 2 for confounders by putting them in the categories and 3 ranking them by what he thought were the best studies 4 versus the worse studies trying to control for 5 homogeneity and eliminate the heterogeneity. 6 This paper by Dr. Bailar, who is the ex-editor 7 of the National Cancer Institute, and now a professor 8 at the University of Chicago wrote about the promise of 9 meta-analysis. I just wanted to share with you some of 10 his concerns, which I share also. 11 And that is major problems with implementation 12 of meta-analysis have been common. There have been a 13 wide variety of these, including failure of the 14 investigator performing the meta-analysis to understand 15 the basic issues: Carelessness and abstracting and 16 summarizing appropriate papers, failure to consider 17 important covariants, bias on the part of the 18 meta-analyst, and perhaps most often overstatements on 19 the strength and precision of the results. 20 It is not uncommon to find that two or more 21 meta-anlyses done at about the same time by 22 investigators with the same access to literature reach 23 income compare -- incompatible or even contradictory 115 1 conclusions. 2 Such disagreement argues powerfully against 3 any motion that meta-analysis offers an insured way to 4 distill the truth from a collection of research 5 reports. 6 I think that this is important because it does 7 point out, very concisely, Dr. Bailar has summarized 8 very precisely what some of the major problems with 9 meta-analysis are. 10 Q. And Dr. Bailar also discusses in his paper - 11 tell me if you agree with this: He says, Doing a 12 meta-analysis correctly demands expertise in both the 13 method and the substance and hence almost always 14 requires collaboration between clinicians and an 15 experienced statistician. Do you agree with that? 16 A. I agree with that. 17 Q. Now, let me make sure I understand. Does 18 method, does that mean experience in conducting 19 meta-analysis? 20 A. That and also an understanding of what the 21 methods were used in the studies that were being used 22 in the meta-analysis. 23 Q. And the substance that Dr. Bailar is talking 116 1 about in the area of chrysotile asbestos-containing 2 friction products, would the substance be chrysotile? 3 A. It would be chrysotile. It would be all of 4 those issues that we talked about earlier; that being 5 biological issues, the persistence, the coherence, all 6 of those issues that we listed earlier. 7 Q. And as a trained epidemiologist, would you 8 expect someone conducting a meta-analysis to have some 9 definitive opinions and conclusions about chrysotile if 10 they truly have expertise on the substance? 11 A. I would, yes. 12 Q. And would you think it would be in your 13 opinion, Doctor, is it scientifically sound and 14 scientifically reliable with someone conducting a 15 meta-analysis on chrysotile asbestos-containing 16 friction products actually have some definitive 17 opinions about the carcinogenicity of chrysotile 18 asbestos? 19 A. I think that would be useful, yes. 20 Q. Let's talk about Dr. Goodman's "tier one" 21 studies. The first one he discusses is the McDonald 22 and McDonald paper. Are you familiar with that paper? 23 A. I am. 117 1 Q. Can you tell me about that, please. 2 A. Well it is a case controlled study, as 3 Dr. Goodman points out, involving 11 cases of 4 mesothelioma. The Drs. McDonald -- Corbitt and 5 Allison, they are husband and wife team -- compared 6 mesothelioma cases with pulmonary metastasizes from 7 nonpulmonary malignancies. 8 They had 12 controls that all had garage 9 occupations, but they didn't explain in their study 10 what those garage occupations were, so we don't know if 11 they did brake work or not. They were garage 12 occupations. They came up with an overall odds ratio 13 of . 91 that was not significant, confidence interval at 14 95 percent of .35 to 2.34. 15 As I see the confounders, they are: One, 16 hospital based cancer cases may not be representative 17 of the general population. First of all because they 18 are in the hospital and they are sick, so using 19 hospital controls may not be a good control population 20 to use. And that has been discussed in various 21 epidemiological texts that I have looked at. So 22 probably could have used that as one population 23 control, but getting another nonhospitalization control 118 1 would be useful. 2 Secondly, the occupational category -- and I 3 think I hit on this already -- defined as garage was 4 not very specific as to brake exposure. 5 Q. And if garage workers say theoretically 6 includes the secretary in the garage, the guy that 7 cleans the toilets at night, etc., etc., 8 hypothetically, if that's included in this broad 9 insufficient definition, could that skew the results 10 toward a negative or null hypothesis? 11 A. It certainly could. They may have high 12 exposure, don't get me wrong, but their exposure is 13 going to be different than the brake mechanic himself 14 or herself. 15 Q. Hypothetically, a garage occupation could 16 include somebody that washes the car outside before 17 someone picks it up outside? 18 A. I believe so. 19 Q. So in your opinion there are some confounding 20 factors that make the McDonald paper equivocal, fair? 21 A. Yes, I do believe that. 22 Q. In your opinion do you believe that 23 Dr. Goodman's meta-analysis has properly controlled for 119 1 those confounders? 2 A. I didn't see how his meta-analysis did control 3 for those . 4 One of the problems, again in talking 5 generally about meta-analysis, is if you have problems 6 with the studies going into the meta-analysis you're 7 going to have problems with the data that are coming 8 out from the meta-analysis. Because the meta-analysis 9 is not going to be able to control for all the 10 confounders. They are still going to be some in there, 11 no matter what you do. 12 Q. So if you have problems going in, you're going 13 to have - 14 A. Have problems coming out, right. 15 Q. Next we touched a little bit on this study 16 earlier, the Teta study? 17 A. While I think, just briefly, we have already 18 talked about that, but nonspecific exposure, again, was 19 a problem with this analysis, and the inability to 20 eliminate other exposures due to small sample size. 21 And we also talked about the difficulty in 22 this study in giving occupational histories, so these 23 are three different things that are confounders here. 120 1 Q. And let me see if I can ask one question that 2 might cover each of these: In each of these studies 3 we're going to cover on the tier one and tier two 4 studies from Dr. Goodman's paper, do you have an 5 opinion about whether or not he appropriately 6 controlled for the confounders for any of these 7 studies? 8 A. Again, I didn't see how his analysis could 9 adequately control for these. I think he attempted to 10 control for these by ranking the studies, by putting 11 them in tier one and tier two, and that's appropriate 12 for what an a meta-analysis should try and do. But, 13 again, if you have got large problems with the studies 14 to begin with, those problems aren't going to wash out 15 in the meta-analysis itself. 16 Q. So with Teta we have problems going in and 17 problems coming out? 18 A. In my opinion, yes. 19 Q. Let's talk about the Hessel paper from 2004. 20 Can you tell us about the Hessel paper? 21 A. Hessel paper was another one that Dr. Goodman 22 included. Hessel was a follow up of a paper by Dr. 23 Robert Spiritus, who I used to work with, who was at 121 1 the National Cancer Institute, who looked at the SEER 2 data that Dr. Hammar mentioned, the surveillance data 3 that represented about 13 percent of the hospital cases 4 throughout the United States . 5 The SEER data originally reported, I think, 6 eight cases of mesothelioma. And, basically, what 7 Hessel did is go in and take out what Spiritus said 8 were the confounders before other exposures -- many of 9 them were shipyard workers and had other asbestos 10 exposures. And what they did is they eliminated all 11 these other exposures and came down to one case that 12 only had brake exposure. And as we have already talked 13 about, I don't think eliminating these other exposures 14 was the appropriate thing to do, because you eliminate 15 the fact that other exposures could contribute to the 16 overall burden of disease. So here we're left with one 17 case that actually had brake exposure. So one case is 18 really hard to work with. 19 And I think that from that you almost have to 20 say that this study really doesn't mean a lot because 21 they excluded every person with mixed exposures. 22 And, again, the data from the SEER database -23 in my paper I go into this in detail, but since it 122 1 represents about 13 percent, a paper that came out of 2 NIOSH by Dr. Wong and others, saying that the SEER data 3 is this small sample that it -- misses about 80 percent 4 of the mesothelioma cases in the United States because 5 of the coding system. 6 There's a coding system called the 7 International Classification of Diseases. Up to the 8 Tenth Edition, the Tenth Edition is the current 9 edition. Prior to that there was no specific codes for 10 mesothelioma, you had to code them in with other types 11 of pleural cancers. Now the Tenth Edition does have 12 individual codes and that went into effect in 1999. So 13 you have an actual code for the different types of 14 mesothelioma, whether it be pleural or peritoneal. 15 We hope that will increase the coding, will 16 increase the ability to report mesothelioma and bring 17 it up to about 80 to 90 percent of what it was before. 18 But the ICD coding system was a problem for 19 mesothelioma and the SEER data. Now, it wasn't a 20 problem for other cancers in the SEER data, but it was 21 for mesothelioma. 22 So working with the SEER data is a big under 23 representation of the total number of mesotheliomas 123 1 that are occurring in this country. 2 Q. Okay. With regard to Hessel, confounders, we 3 have a low response rate; we have potentially under 4 reporting all the mesotheliomas from the SEER data 5 base; and not really a scientifically real world point 6 of view by exposing mixed exposures. Is that fair? 7 A. Yes . 8 Q. So once again problems in, problems out? 9 A. Yes . 10 Q. Let's talk next about the Teschke study. Are 11 you familiar with Teschke? 12 A. Yes, it was the fourth of the seventh. 13 Q. Excuse me? 14 A. It was the fourth of the four studies in tier 15 one of the seven studies. And it was a case control 16 study, and it matched data from British Columbia cancer 17 agency with the voters in that area. Here again they 18 used the category Vehicle Mechanics. They had six 19 cases and 20 controls with an odds ratio of .8 that was 20 not significant. And then when they broke it down to 21 brake installation and repair cases, they had two cases 22 with 17 controls, again, nonsignificant. 23 This study -- if you go the next thing, 124 1 yeah -- I think had several confounders that concerned 2 me: One was the small size of the study, meaning that 3 the risk estimates would be imprecise for some of the 4 occupational groups. 5 Secondly, that the grouping of the occupations 6 were likely to result in a biasing risk estimate 7 downward towards the null. And that the major 8 occupations at risk would have been easily detected, 9 but that was because they had the high exposures. And 10 I think that the Teschke study did find those risks to 11 be quite well. But they would find the high exposure 12 ones but when they got to the low exposures that's when 13 they were having trouble trying to do this because the 14 confounding factors of the groupings of the 15 occupations, that's the way they did it, and because of 16 the number of cases that they had. 17 And here again we get into this next of kin 18 interview. A third of the cases were next of kin 19 interviews, when only one seventh of the controls were 20 next to kin, which it meant that a third of those that 21 had mesothelioma they didn't interview -- two-thirds 22 they didn't interview. They only interviewed a third 23 of those, whereas the majority of those that were in 125 1 the controls were able to be interviewed. 2 So there was a big differential between next 3 of kin reporting and the cases as compared to the next 4 of kin reporting in the controls. 5 Q. So once again we have problems in, we're going 6 to have problems coming out? 7 A. As I see it, yes. 8 Q. Now Dr. Goodman uses this is paper to say that 9 there's no association or risk between the use of 10 asbestos-containing friction products in mesothelioma. 11 But doesn't Teschke say that maybe you shouldn't use 12 the paper to say that? 13 A. Well, yes, Teschke makes a very good statement 14 at the end of the paper that says: That all, meaning 15 jobs and occupations, except nonasbestos mining, 16 involve small numbers; therefore, judgments about 17 whether these associations were causal would be 18 speculative. 19 And I think that's a good point that when 20 you're doing a meta-analysis you should look at what 21 the authors say about how you use the paper. And here 22 again the authors say you shouldn't use it for that 23 purpose, but it was thrown into the meta-analysis as 126 1 one of the higher scoring papers to be used in the 2 meta-analysis. 3 Q. In fact, Teschke also makes a statement that 4 seems pretty consistent with that Dr. Checkoway has 5 said when it is written that mesothelioma is a rare 6 cancer with one major etiologic exposure; therefore, 7 surveillance using each case as a sentinel event might 8 seem more reasonable for this disease than for cancers 9 with multifactorial causation? 10 A. I think that sums it up. And I think it sums 11 it up what Checkoway would say and I think it would sum 12 up what I would say. You have got a situation here 13 where you have got very little evidence in the 14 epidemiological literature. It is equivocal in what I 15 say. You do have evidence that exposures exist that 16 are high enough to cause disease. You probably have a 17 lower amount of disease in auto mechanics than you do 18 in say insulation workers or boilermakers or others 19 that have eight hours a day, five days a week exposed 20 to asbestos. 21 But the point is the studies, as I see it, 22 don't mean there's no risk. There is some risk because 23 of the exposures and there's enough data to show that 127 1 what you need to do is take these on an individual 2 case-by-case basis and look at them. 3 I don't think you can throw out the whole 4 category and say there's no risk, but I think each case 5 has to be taken on an individual by individual basis 6 and evaluate the exposure, the findings and the tissue, 7 the occupational histories, and not to throw it out. 8 In other words, if you take the meta-analysis 9 and you take just the epidemiology, I think you're kind 10 of throwing the baby out of the bath water, so to 11 speak. You're throwing out some cases that might 12 really have existed because the exposures did occur in 13 those few cases. 14 Q. Doctor, in your opinion, should you also 15 consider chrysotile epidemiology in general in this 16 equation? 17 A. Well that's what I was saying when I was 18 talking because I think the chrysotile epidemiology is 19 critical. I don't think there's any doubt that 20 chrysotile is capable of causing mesothelioma. I don't 21 think there's any doubt that exposures that we have 22 shown in these slides are capable in causes asbestos 23 related diseases. 128 1 And that's why I made the statement I just 2 made . 3 Q. Let's move onto the tier two studies - 4 THE COURT: Mr. Spillane, is this a good 5 time to break, do you think? 6 MR. SPILLANE: This would be fine. I 7 probably have maybe another 20 to 30 minutes, 8 maybe this would be a good time to break. 9 THE COURT: All right. Why don't we do 10 that then for the day. We'll return back here 11 at nine o'clock. I still have us down going 12 till five tomorrow and still have Thursday 13 available if we need it. So it sounds like 14 we're back on schedule as of today. 15 If there are any issues that we need to 16 discuss before nine, I'll be upstairs before 17 that. If you want to come up and get me, I'd be 18 able to do that, just let me know. Okay. 19 (Whereupon, Court is in recess.) 20 21 22 23 CERTIFICATE OF COURT STENOGRAPHER 129 We, Official Court Stenographers of the Superior Court, State of Delaware, do hereby certify that the foregoing is an accurate transcript of the proceedings had, as reported by us, in the Superior Court of the State of Delaware, in and for New Castle County, in the case herein stated, as the same remains of record in the Office of the Prothonotary at Wilmington, Delaware. WITNESS our hand this 18th day of OCTOBER, 2005. Cert. # 161-PS 156-PS John P. Donnelly, RPR Michele R. Honaker Official Court Stenographer 1 ' '68 - 17:21 '70 - 110:20 '71 - 57:19, 83:15, 110:19 '72 - 83:15 '75 - 81:18, 81:19, 92:11 '79 - 74:16 '84 - 89:4 '86 - 92:12 '90s - 61:21 '94 - 7:8 '95 - 93:1 0 001 - 70:23, 71:6 04 - 92:22 1 1 - 71:12, 83:17, 84:5, 86:22 1.2 - 71:7, 92:23 1.8 - 71:8 10 - 89:1 10.5 - 81:4 100 - 43:17 1000s - 34:5 100s - 34:4 104 - 63:13 11 - 117:3 12 - 31:22, 74:20, 117:8 125 - 86:3 12th - 108:22 13 - 121:3, 122:1 14 - 108:12 15 - 39:8, 85:8 15-minute - 82:10, 89:1 156-ps - 129:14 161-ps - 129:14 165 - 51:16 17 - 57:21, 110:23, 111:15, 111:16, 111:17, 111:19, 123:22 1700s - 32:21 18 - 2:1 180 - 67:5 18th - 129:12 19 - 9:10 190 - 67:5 1940 - 17:18 1940s - 72:15 1960 - 31:7 1965 - 34:23, 35:12, 35:17 1966 - 5:20 1968 - 17:18, 17:22 1970 - 6:6 1971 - 57:17 1972 - 83:14 1975 - 59:18, 61:15, 80:11, 87:9, 95:13 1976 - 84:20, 85:13 19801 - 1:22 1982 - 72:6 1983 - 95:8, 97:10 1985 - 88:16, 89:1 1986 - 87:10, 89:4, 98:19 1987 - 85:20 1988 - 6:23 1989 - 101:22 1990 - 33:20 1992 - 7:4 1993 - 7:8 1994 - 100:19 1995 - 33:20, 108:22 1996 - 7:12, 7:13, 43:12, 74:16 1998 - 33:17, 70:14, 101:10 1999 - 122:12 2 2 - 65:17, 84:5 2.0 - 71:11 2.34 - 117:14 2.7 - 72:16 20 - 56:15, 63:19, 69:15, 123:19, 128:7 200 - 66:14, 66:23, 68:17, 90:18, 90:23 2001 - 100:6, 107:23 2002 - 7:13, 9:11 2003 - 9:11, 65:19, 108:2 2004 - 26:5, 28:1, 80:4, 88:4, 111:7, 120:19 2005 - 2:1, 129:13 241 - 24:23, 25:5 255-0563 - 1:22 28 - 108:3, 108:15, 109:5 29 - 63:14 2:00 - 2:2 3 3 - 86:3 3.75 - 81:4 30 - 4-6:23, 47:1, 56:15, 128:7 30-minute - 82:10, 89:4 300,000 - 99:3 302 - 1:22 324 - 100:23 33 - 31:7 35 - 117:14 37.3 - 81:4 377 - 66:13, 67:2, 68:18 39 - 87:13 4 4.2 - 71:10, 93:7 4.8 - 87:13 40 - 51:21, 56:15 43 - 26:14 433 - 26:22, 27:6 48 - 100:9, 100:10 495 - 70:23, 71:6 4th - 63:15, 63:16 5 5 - 70:23, 71:9, 83:16 5.2 - 71:13, 93:12 500 - 1:22, 43:17 50s - 72:21 58 - 25:6, 26:14, 107:23, 108:3 599 - 70:23 6 6 - 25:1, 28:18, 72:21 600 - 78:18 60s - 72:22 61 - 74:22 66 - 97:16 68 - 93:4 7 7 - 108:8, 108:12, 111:19 7.7 - 72:22 70 - 56:16 700 - 27:17 70s - 72:22 72 - 87:11, 87:12 75 - 87:23 77c-asb-2 - 1:7 8 8 - 71:8, 95:15, 95:23, 123:19 8.2 - 86:22 8.7 - 71:14 8.8 - 71:11 80 - 30:10, 122:3, 122:17 89 - 95:13 8b - 2:1 9 9.9 - 71:12 9.99 - 71:9 90 - 91:17, 91:18, 95:13, 122:17 91 - 117:13 95 - 23:20, 71:10, 97:17, 117:14 A ability - 15:23, 61:16, 113:5, 113:23, 122:16 able - 16:2, 18:16, 28:4, 28:15, 58:15, 71:2, 97:21, 105:9, 105:13, 119:9, 125:1, 128:18 abnormalities 63:16, 63:19, 64:6, 64:17, 65:12 absence - 52:8, 76:5 absent - 21:7, 22:5, 40:18 Absolutely - 13:9, 15:10, 44:5, 50:22, 57:16, 83:8, 86:13, 100:17, 105:19 abstracting 114:15 Academy - 49:8 accept - 31:15, 32:2 accepted - 31:10, 31:23, 36:3, 43:17, 44:7 access - 108:16, 109:14, 114:22 according - 106:22, 108:16 accounted - 91:4 accuracies - 25:14 accuracy - 24:20 accurate - 22:11, 25:15, 105:15, 109:7, 129:6 Acheson - 43:9, 43:13, 74:11, 74:14 acknowledged - 49:21 act - 75:3 acted - 61:13 Acting - 7:8 action - 16:1 Action - 1:7 activities - 77:16 activity - 61:23 actual - 11:16, 58:14, 103:8, 106:1, 122:13 add - 33:2, 44:14, 73:5, 74:4, 82:22, 86:7, 86:10 added - 26:21, 27:13, 32:23, 52:16, 110:20 addition - 11:16 additional - 27:3, 51:21, 64:2, 87:10 additive - 43:4, 74:23 addressed - 17:5 addresses - 37:6 adds - 29:16, 74:5, 74:7 adequate - 102:9, 106:5, 106:23 adequately - 66:23, 120:9 adjusted - 83:6, 83:19 administration 6:18, 6:19 Administration - 7:10 adverse - 38:17 affect - 51:4, 58:11, 58:12, 58:15, 58:16 affected - 17:8 affects - 38:18, 38:20 affidavit - 28:6, 108:21, 110:3 afternoon - 4:2, 5:11, 5:12, 69:14 age - 15:19, 18:7 agencies - 48:2, 48:6, 90:19 agency - 62:12, 123:17 Agency - 48:14, 49:5, 49:14 ago - 9:10, 14:15, 25:16, 25:17, 25:18, 25:19, 28:6, 108:22, 112:22 agree - 13:22, 52:11, 53:8, 53:10, 76:19, 107:10, 115:11, 115:15, 115:16 agreed - 106:13 ahead - 91:20 air - 61:7, 81:3, 90:16, 91:5 al - 27:7 alert - 80:20 alive - 17:20, 36:6, 39:18, 95:14, 95:21 all-inclusive - 85:3 Allison - 117:5 allow - 31:17, 96:11, 110:15 allowing - 47:4, 57:14 almost - 28:10, 47:6, 95:13, 115:13, 121:19 alone - 35:8, 43:7, 44:23 alter - 16:14 alterated - 78:13 altered - 78:12 American - 49:1, 82:4 amocite - 41:20, 43:16 amount - 23:3, 47:5, 73:4, 84:19, 86:8, 86:18, 86:19, 93:19, 101:9, 113:11, 126:17 amounts - 61:10, 88:23 amphibole - 44:7, 45:4, 45:8, 70:19 amphiboles 42:13, 42:22, 43:2, 72:2, 74:20, 74:22 Amy - 3:5 analogous - 38:16 analogy - 46:9 Analogy- 38:13 analyses - 112:23 Analysis - 21:11 analysis - 18:12, 18:21, 20:19, 27:6, 40:11, 40:12, 47:23, 48:1, 52:2, 54:17, 93:22, 94:23, 96:4, 111:6, 111:22, 112:1, 112:7, 112:11, 112:12, 112:19, 112:21, 112:22, 113:8, 113:11, 113:18, 113:19, 113:22, 114:9, 114:12, 114:14, 115:3, 115:9, 115:12, 115:19, 115:22, 116:8, 116:15, 118:23, 119:2, 119:5, 119:6, 119:8, 119:19, 120:8, 120:12, 120:15, 125:20, 125:23, 126:2, 127:8 analyst - 114:18 Anderson - 2:15 Angelides - 3:4 angiosarcoma 15:3, 30:14 animal - 12:11, 12:12, 38:5, 38:8, 41:17, 41:21, 44:2, 47:16 animals - 12:15, 44:3 anlyses - 114:21 answer - 98:5 anthophyllite - 45:5 apologize - 58:4 application - 40:6, 41:3 applications 66:12 applied - 6:2, 92:19 applies - 53:11 apply - 36:21, 40:2, 90:9, 90:11 applying - 36:11 appreciate - 4:19 appropriate - 73:16, 75:6, 75:20, 114:16, 120:11, 121:14 appropriately 120:5 approximation 20:5 area - 6:7, 6:21, 2 10:22, 23:8, 31:18, 32:4, 44:13, 59:9, 60:5, 63:20, 68:8, 70:5, 71:9, 74:5, 76:9, 77:17, 81:15, 111:19, 116:1, 123:17 areas - 35:21, 60:12 argued - 52:7 argues - 115:2 argument - 41:5 Army - 5:23, 6:1 arrangements 4:18 article - 10:2, 26:3, 43:13, 43:15 articles - 9:21 asbestos - 6:8, 6:13, 9:5, 9:13, 9:22, 10:3, 13:4, 13:5, 17:15, 18:5, 18:6, 21:7, 21:14, 21:15, 21:19, 21:20, 23:11, 30:9, 30:11, 30:12, 33:20, 33:23, 34:5, 34:11, 34:15, 34:16, 36:12, 36:15, 36:16, 36:21, 37:3, 38:17, 38:19, 39:16, 40:4, 41:10, 41:13, 42:3, 42:17, 42:18, 42:21, 44:3, 44:7, 45:5, 45:17, 46:2, 46:7, 46:19, 47:2, 47:5, 47:8, 47:13, 50:2, 50:4, 50:7, 52:4, 52:15, 52:16, 52:17, 53:11, 53:19, 54:4, 58:9, 59:5, 60:14, 60:17, 61:6, 62:3, 63:6, 63:17, 64:1, 65:13, 65:21, 65:23, 66:7, 66:10, 66:15, 66:18, 66:21, 67:4, 67:10, 67:21, 68:7, 69:8, 69:9, 69:10, 70:5, 70:7, 70:18, 72:7, 72:12, 73:2, 73:9, 73:11, 73:18, 74:17, 75:7, 75:17, 77:23, 78:4, 78:11, 78:22, 79:5, 79:6, 80:11, 81:3, 81:8, 81:22, 82:23, 83:7, 84:16, 84:21, 85:9, 86:9, 86:11, 87:3, 87:18, 87:22, 88:8, 88:20, 88:21, 91:5, 91:8, 96:15, 99:18, 101:3, 104:7, 106:19, 107:6, 109:6, 116:1, 116:15, 116:18, 121:9, 125:10, 126:20, 127:22 Asbestos - 1:6, 26:3, 39:13 asbestoscontaining - 53:11, 54:4, 59:5, 63:6, 67:21, 69:8, 75:7, 79:6, 88:20, 116:1, 116:15, 125:10 asbestos-related 63:17, 64:1, 85:9 asbestoses - 84:8, 84:19 asbestosis - 39:14, 40:7, 41:10, 44:12, 44:16, 45:22, 50:5 Asbestosis- 30:8 ascertaining - 97:19, 97:23 aspects - 7:14, 12:22 assessment - 36:23 Assistant - 6:23, 8:17, 8:22, 9:1 associated - 21:15, 30:16, 31:19 association - 10:13, 10:16, 11:11, 11:14, 12:23, 13:11, 14:17, 15:9, 17:2, 19:4, 19:8, 19:18, 20:3, 20:4, 20:22, 20:23, 21:1, 22:2, 23:10, 24:13, 30:11, 35:6, 36:1, 37:8, 37:14, 37:18, 38:21, 40:3, 42:6, 42:7, 59:5, 73:20, 110:5, 125:9 associations 19:16, 35:4, 36:7, 38:7, 39:15, 94:16, 125:17 assume - 92:16 assumptions 90:11 assured - 24:9 Atlanta - 7:6, 7:19 attempted - 120:9 attention - 63:12 attributable - 11:1, 11:2, 23:2, 23:9 attributed - 23:4 attributing - 34:11 attribution - 33:22, 34:3, 34:8 Australia - 25:5 Australian - 28:22, 108:9, 108:11, 108:12, 109:19, 110:12 author - 57:17 authored - 24:22, 25:1 authors - 97:18, 102:5, 107:4, 125:21, 125:22 auto - 56:3, 56:6, 87:3, 93:4, 126:17 automobile - 72:11, 76:23, 89:20, 92:21, 97:15, 99:3, 100:9, 100:11, 100:12 automotive - 69:7 available - 4:20, 128:13 average - 54:15, 72:10, 72:15, 73:3, 81:3, 82:8, 82:12, 82:15, 82:19, 83:16, 86:14, 86:19, 87:19, 93:14, 93:19, 93:23, 94:6, 96:8 B baby - 127:10 background - 5:15, 8:2, 21:16, 21:18, 21:21, 23:5, 23:6, 99:18, 100:2, 100:4, 101:7, 108:1 bacteria - 39:10 bad - 34:17 Bailar - 114:6, 115:7, 115:10, 115:23 Balick- 2:9 ban - 9:13, 84:21 banned - 47:1 Baron - 2:6 base - 123:5 based - 31:7, 79:15, 80:17, 117:16 Based - 40:12 basic - 14:18, 82:6, 114:15 basics - 10:10 basis - 14:15, 42:22, 54:2, 127:2, 127:5 bath - 127:10 became - 113:19 begin - 120:14 beginning - 32:17 behalf - 28:18 behind - 79:22, 109:19 below - 24:4, 82:19 Bernard - 3:6 berylliosis - 30:7 beryllium - 6:8, 6:12, 30:8 best - 15:20, 92:8, 114:3 better - 17:1, 74:15, 103:10, 105:22 between - 15:20, 15:22, 17:18, 23:10, 26:14, 30:22, 37:16, 38:7, 43:16, 86:14, 112:2, 112:4, 115:14, 125:2, 125:9 beveling - 78:8 bias - 103:11, 103:12, 114:17 biased - 102:8 biasing - 124:6 Biden - 2:8, 2:9 Bifferato - 2:9 big - 113:22, 122:22, 125:2 bigger - 93:11 Biggest - 32:8 bill - 9:12, 9:15, 47:3 binders - 62:20 bio - 35:1 bio-statistician 35:1 biologic - 37:22 biological - 12:3, 36:22, 41:5, 45:16, 75:20, 116:5 biologists - 32:14 bit - 4:3, 8:16, 9:9, 14:3, 16:10, 31:6, 33:14, 38:22, 42:12, 64:19, 66:5, 67:3, 80:2, 89:12, 100:21, 110:8, 119:15 Blake - 89:19 blow - 61:7, 79:21 blown - 54:13 blue - 64:14 boat - 69:2 bodies - 61:12 body - 12:2, 12:4, 74:6, 74:8, 86:8, 86:10, 86:16 body's - 52:17 boilermakers 68:5, 126:18 book - 25:15, 25:22, 25:23, 87:4, 89:19 bottom - 24:12, 41:4, 101:16 bought - 4:22 bound - 88:22 Boyd - 3:6 Bradford - 34:15, 34:17, 34:18, 34:21, 35:1, 35:23, 36:5, 36:11, 38:23, 39:17, 40:2, 40:9, 42:6 brake - 54:5, 54:12, 58:7, 59:20, 59:21, 59:22, 60:4, 60:7, 60:10, 60:12, 60:19, 60:22, 61:18, 62:9, 62:13, 62:14, 62:22, 63:6, 64:9, 64:11, 64:23, 65:4, 65:7, 65:23, 68:8, 73:8, 74:2, 74:5, 77:11, 77:20, 77:21, 78:5, 79:1, 79:21, 80:12, 80:19, 81:9, 81:10, 86:1, 86:22, 87:16, 87:17, 87:21, 87:22, 88:8, 94:9, 94:11, 94:17, 95:16, 96:4, 100:10, 100:13, 101:1, 101:3, 103:2, 103:20, 103:23, 104:7, 104:21, 107:7, 109:23, 112:8, 117:11, 118:4, 118:13, 121:12, 121:17, 123:21 Brakes - 26:4 brakes - 5:13, 56:5, 56:7, 64:6, 64:7, 64:13, 64:15, 65:9, 66:1, 66:4, 78:8, 79:20, 88:20, 93:12, 96:16, 109:6 break - 22:7, 64:17, 66:21, 69:13, 69:15, 70:20, 98:11, 128:5, 128:8 breaks - 77:18, 86:23 breathed - 87:20 breathing - 86:17 brief - 5:18 Briefly - 52:1 briefly - 5:15, 5:17, 8:1, 10:7, 19:17, 25:13, 26:2, 32:3, 36:14, 47:12, 67:17, 69:1, 74:10, 78:6, 106:6, 107:14, 119:17 bring - 14:13, 21:10, 33:21, 34:1, 58:10, 122:16 bringing - 57:10 Brisman - 101:10 British - 123:16 broad - 118:8 brochure - 60:18 broke - 31:2, 111:16, 123:20 brought - 13:1, 34:2, 34:4, 59:21, 63:12, 80:18, 99:9 Browder - 3:5 brushing - 79:21 Bs - 8:5 Budd - 2:6 building - 14:19, 69:2 built - 23:13 Bulletin - 80:21, 81:12 bulletin - 60:9, 62:16, 81:13 bundles - 88:22 burden - 52:17, 74:6, 74:8, 86:8, 86:11, 121:16 Bus - 95:9 buses - 86:2 busting - 62:21 C cake - 56:1 calcium - 54:2 calculated - 19:21, 22:2 calculation - 22:6 calculations - 20:17 Cameron - 2:7 cancer - 15:1, 16:16, 16:20, 39:6, 39:14, 40:7, 41:14, 41:17, 42:19, 44:12, 44:15, 45:22, 50:5, 84:8, 84:19, 84:20, 85:2, 85:4, 85:9, 101:17, 102:5, 102:11, 111:18, 117:16, 123:16, 126:6 Cancer - 48:14, 49:1, 114:7, 121:1 cancers - 63:4, 122:11, 122:20, 126:8 cannot - 82:18 canoe - 69:3 Cantu - 2:17 capability - 90:2 capable - 45:21, 50:4, 86:17, 90:3, 127:20, 127:22 capacity - 63:15 Capanin - 85:20, 86:21 car - 118:16 carcinogenic 44:4, 76:11 carcinogenicity 116:17 career - 6:16, 13:3, 66:10, 67:15, 73:14, 103:2 Carelessness 114:15 carry - 30:18, 55:12 cars - 86:23 case - 4:23, 14:5, 14:8, 14:14, 14:18, 14:23, 15:1, 15:7, 15:11, 15:12, 15:14, 16:1, 16:3, 16:4, 17:10, 17:15, 18:2, 18:4, 20:4, 29:7, 29:8, 29:11, 29:22, 30:17, 30:19, 30:23, 31:1, 31:7, 31:17, 31:22, 38:17, 39:22, 47:20, 56:5, 99:5, 100:22, 101:12, 105:3, 105:8, 107:8, 108:22, 112:16, 117:2, 121:11, 121:17, 123:15, 126:7, 127:2, 127:4, 129:9 Case - 14:7, 15:13 case-by-case 127:2 cases - 14:8, 14:21, 15:18, 15:19, 15:21, 15:22, 16:16, 25:6, 26:14, 30:15, 54:13, 88:3, 97:20, 97:22, 99:1, 99:5, 99:7, 99:10, 99:12, 100:3, 100:9, 100:23, 101:8, 101:17, 102:11, 3 102:18, 104:2, 107:23, 109:5, 117:3, 117:6, 117:16, 121:3, 121:6, 122:4, 123:19, 123:21, 124:16, 124:18, 125:3, 127:11, 127:13 Castle - 1:2, 129:8 categories - 56:4, 66:23, 67:1, 68:22, 70:21, 114:2 category - 46:5, 52:13, 55:16, 65:1, 66:2, 93:5, 94:12, 97:14, 118:2, 123:18, 127:4 causal - 125:17 causation - 10:10, 10:11, 10:12, 10:21, 11:6, 11:9, 13:1, 16:1, 16:5, 31:18, 32:4, 33:9, 34:8, 126:9 causative - 32:7, 76:2 caused - 30:1, 38:17 causes - 10:18, 30:2, 37:1,39:13, 39:14, 40:4, 41:10, 41:13, 41:21, 42:3, 48:7, 50:7, 52:10, 62:3, 127:22 causing - 16:1, 41:6, 45:21, 45:22, 50:5, 51:7, 73:10, 73:20, 90:3, 127:20 caution - 39:6 cc - 71:14, 71:22, 71:23, 81:6, 89:3 cellular - 32:13, 38:8, 41:16 cement - 51:10 Centers - 7:7 Central - 8:5 Cert - 129:14 certain - 17:20, 18:16, 19:9, 62:3, 81:9, 86:6, 86:17 certainly - 93:9, 99:6, 118:11 certificate - 8:21 Certificate - 129:1 certificates - 18:1 certify - 129:5 cetera - 25:6, 35:6 chair - 33:19 chance - 23:18, 23:19, 23:22, 24:8, 24:10, 57:15, 96:2 change - 27:12, 39:1, 39:18, 109:10 changed - 89:2, 103:23, 107:15 changes - 65:22, 80:6, 109:12 changing - 28:10, 78:1, 108:13 Chapter- 25:1, 28:18 chapter - 25:19, 25:20, 25:22, 26:7, 26:9, 26:11, 27:17, 28:8 characteristic 19:15 characteristics 75:19, 113:10 charge - 53:2 Checkoway - 29:20, 31:4, 126:4, 126:11 Checkoway's - 29:6 chemical - 6:16, 39:3, 39:11 chemicals - 101:18 Chemistry - 8:6 chest - 63:16, 63:18 Chicago - 114:8 chisel - 77:20 chloride - 30:17 Christian - 3:2 Christine - 3:6 Christopher - 2:5, 3:6 Chrysler - 52:7, 104:10 chrysler - 2:13, 2:16 chrysotile - 5:14, 34:15, 34:16, 36:12, 36:15, 36:21, 37:3, 40:3, 40:11, 41:3, 41:5, 41:9, 41:13, 41:20, 42:2, 42:8, 42:13, 42:23, 43:2, 43:16, 44:3, 44:8, 44:19, 44:23, 45:3, 45:11, 45:17, 46:4, 46:7, 46:19, 47:9, 47:13, 48:7, 49:22, 50:2, 50:4, 50:6, 51:7, 52:1, 52:3, 52:10, 69:9, 70:19, 72:2, 74:19, 74:21, 78:9, 78:15, 79:5, 80:2, 116:1, 116:2, 116:3, 116:9, 116:15, 116:17, 127:15, 127:18, 127:20 cigarette - 16:20, 39:4, 39:5, 39:9, 42:16 cigarettes - 16:17, 16:19, 42:18 circumstances 37:20, 51:5, 76:4 Civil - 1:7 claim - 87:15 Classification 122:7 clean - 77:21 cleaning - 86:22, 87:17, 87:21 cleans - 118:7 clear - 56:22, 62:11 clearly - 90:3 Clifton - 3:3 clinic - 99:1, 99:6, 99:12, 99:16, 99:21 clinician - 14:9, 32:4, 32:6, 32:8, 32:18, 32:20, 33:5, 33:8, 34:7 clinicians - 14:13, 29:13, 29:16, 115:14 clinics - 99:8 closely - 16:5 clusters - 88:22 coauthors - 97:14 code - 122:10, 122:13 codes - 122:9, 122:12 coding - 122:5, 122:6, 122:15, 122:18 coherence - 37:5, 37:14, 41:2, 116:5 coherent - 35:6 cohort - 17:11, 17:12, 17:14, 18:5, 18:22, 19:1, 19:11, 20:11, 20:15, 61:18, 96:11, 105:2, 111:1, 112:16 cohorts - 61:16, 62:7 collaboration 115:14 collar - 64:14 colleagues - 29:20, 31:4, 98:23 collection - 115:4 College - 8:5 Columbia - 123:16 combined - 90:20 comfort - 94:7, 94:8 coming - 109:22, 119:7, 119:14, 120:17, 125:6 comment - 107:3 commercial - 45:3 commission - 6:3 Commission - 6:4, 48:17 committee - 9:12, 33:19 common - 30:20, 55:8, 114:12 communities 31:11 community - 32:1, 35:23, 36:4 companies - 60:7 compare - 15:19, 18:1, 18:5, 113:4, 114:23 compared - 18:10, 20:9, 53:18, 64:13, 68:22, 73:13, 75:7, 82:9, 87:13, 91:21, 108:3, 117:5, 125:3 compares - 108:10 comparing - 21:18, 113:14 comparison 15:20, 18:10, 18:14, 19:12, 19:13, 19:22, 22:23 complete - 4:20, 23:13 completely - 104:17 concentrations 53:23, 54:12, 71:17, 80:23, 81:3, 81:23, 82:23, 86:14, 86:15, 86:16 concept - 10:16, 72:3, 76:19 concepts - 10:7 concern - 60:5 concerned - 4:5, 124:1 concerns - 114:10 concisely - 115:7 concluded - 97:18 conclusion - 36:14, 100:3 conclusions - 29:5, 50:14, 50:18, 95:20, 109:22, 115:1, 116:9 condition - 15:2 conditions - 39:8 conducted - 88:12 conducting - 6:11, 104:14, 115:18, 116:8, 116:14 Conference - 82:5 conference 106:13 confidence - 23:15, 23:20, 23:23, 24:1, 24:2, 24:6, 24:7, 24:9, 24:11, 24:15, 71:8, 71:11, 93:1, 93:17, 97:17, 117:13 confounder - 16:12, 96:9, 96:12, 100:15, 102:10, 102:11, 110:14 Confounder - 16:14 confounders - 55:3, 56:9, 58:23, 59:10, 62:8, 97:3, 98:2, 98:5, 101:20, 102:6, 106:4, 113:13, 113:16, 113:17, 113:21, 113:23, 114:2, 117:15, 119:1, 119:10, 119:23, 120:6, 121:8, 123:2, 124:1 confounding - 16:2, 16:12, 16:23, 17:4, 18:8, 101:14, 107:1, 118:19, 124:14 confusing - 84:14 Connecticut - 97:13 Consensus - 106:10 consensus 106:11, 106:12 consider - 19:11, 20:21, 35:3, 38:11, 50:3, 94:1, 114:16, 127:15 consideration 10:18, 12:22, 33:8, 37:15, 38:14, 45:17, 46:6, 51:1,56:1 considerations 34:18, 34:22, 35:10, 35:14, 35:18, 36:1, 36:12, 40:2, 40:10 considered - 24:4, 45:7, 55:3, 85:1, 99:4, 104:20 Considering - 99:18 consistency - 37:6, 37:13, 37:17, 50:23, 51:3 Consistency - 37:14 consistent - 37:2, 63:17, 63:23, 88:11, 126:4 constitute - 15:18 consult - 104:2 consultation - 7:21 consulting - 7:16 Consumer- 48:16 consumption 21:20 contacted - 59:19 contain - 82:15 containing - 53:11, 54:4, 59:5, 63:6, 67:21, 69:8, 73:18, 75:7, 79:6, 88:20, 116:1, 116:15, 125:10 contains - 60:16 contaminated 45:4, 45:8 contamination 44:20, 45:9 context - 32:14, 50:21, 94:22 continue - 4:21, 58:5 continued - 6:14, 28:23, 83:6, 83:9, 85:15 contractor - 44:1 contradictory 114:23______________ Contrast - 17:11 contribute - 16:7, 121:15 contributed - 76:12 contributes - 16:22, 76:16 contributing 16:21 control - 15:11, 15:12, 15:13, 15:14, 16:2, 16:4, 16:6, 16:8, 16:18, 16:20, 17:10, 20:4, 62:7, 92:2, 100:22, 105:4, 105:9, 105:14, 113:11, 113:21, 113:23, 114:1, 114:4, 117:19, 117:23, 119:2, 119:9, 120:9, 120:10, 123:15 Control - 7:7 controlled - 101:20, 105:4, 112:16, 112:23, 117:2, 118:23, 120:6 controls - 64:14, 92:7, 104:12, 113:16, 117:8, 117:19, 123:19, 123:22, 124:19, 125:1, 125:4 conversion - 78:9 convert - 80:3 converting - 79:19 converts - 78:17 copy - 25:16, 40:19 Corbitt - 117:4 corner - 69:4 Corp - 6:4 correct - 8:9, 8:18, 25:2, 26:5, 59:6, 79:14, 80:14, 84:10, 99:14, 111:13, 111:14 Correct - 11:4, 11:13, 25:3, 27:7, 34:20, 46:17, 50:8, 51:23, 57:8, 77:7 correctly - 79:19, 88:5, 106:20, 115:12 Corroon - 2:15 cost - 61:4, 62:6 cough - 98:16 count - 61:12, 91:12 counted - 91:10, 91:17, 91:18 counting - 91:8 countries - 47:1, 47:6 country - 46:18, 47:4, 99:13, 123:1 County - 1:2, 129:9 couple - 81:20 course - 7:14 court - 11:5, 13:10, 52:7 Court - 1:1, 1:21, 4:2, 4:13, 4:19, 5:2, 13:2, 13:21, 14:5, 20:17, 25:15, 40:15, 40:23, 57:3, 58:17, 58:20, 69:14, 98:11, 128:4, 128:9, 128:19, 129:1, 129:4, 129:5, 129:8, 129:16 courtroom - 25:7, 49:16, 76:7, 78:21 Courtroom - 2:1 covariants - 114:17 cover - 120:2, 120:3 Criteria - 33:12, 33:16, 34:1, 34:9 criteria - 33:23, 4 34:3, 34:16, 34:17, 34:19, 35:4, 35:5, 35:16, 39:2, 39:18, 55:9, 56:8, 57:1, 84:17, 106:7, 106:22 critical - 127:19 crocidolite - 41:20, 43:16, 44:4 Crowe - 3:4 crucial - 111:1 Crumplar- 2:10, 4:3, 4:16, 4:22 cumulative - 71:20, 71:21, 73:5, 76:11, 90:10, 92:15 cure - 113:7 current - 50:1, 60:8, 81:16, 81:18, 81:19, 85:7, 89:2, 122:8 Current- 80:20, 81:12, 81:17 customers - 87:22 cut - 77:12, 94:5, 113:12 cuts - 108:3 cutting - 58:1 D daily - 28:10, 54:2 Daimler - 2:13, 2:16 Daimler-chrysler 2:13, 2:16 damage - 39:6, 41:16 dangerous - 82:13, 82:20 dangers - 9:5 Darden - 43:15 data - 11:15, 11:17, 13:7, 13:12, 14:10, 14:13, 15:8, 25:10, 25:21, 28:2, 38:10, 47:18, 50:11, 60:2, 103:4, 110:12, 112:20, 119:7, 121:2, 121:5, 121:22, 122:2, 122:19, 122:20, 122:22, 123:4, 123:16, 126:23 database - 121:22 date - 64:9 dated - 25:22 Daubert - 1:15 David - 3:2 days - 25:17, 25:18, 34:6, 126:19 Dc - 7:2, 7:3 dead - 17:20 deal - 5:2 dealership - 104:10 dealerships 104:13 death - 18:1, 18:15, 101:13 deaths - 23:1 debruin - 3:2 decades - 21:19 deceased - 95:15, 102:19, 105:3 decided - 61:3 decision - 62:12, 97:1 decrease - 18:9, 18:18, 38:1 decreased - 63:15 Defendant - 2:13, 2:16, 2:18 deficit - 18:20 Define - 14:5, 22:19, 23:14 define - 16:11, 36:20, 39:20, 64:20, 64:21 defined - 64:11, 118:3 definitely - 55:4, 101:1 definition - 20:20, 37:13, 118:9 definitive - 116:9, 116:16 Degree - 6:4 degree - 71:11 degrees - 78:18 dehydrates - 78:16 Delaware - 1:1, 1:22, 129:5, 129:8, 129:11 demands - 115:12 denominator - 22:8 Department - 48:21 dependant - 45:19 dependent - 45:23 deposition - 4:14, 4:16, 28:5, 28:13, 28:16, 108:17, 109:2 Deputy - 7:4, 7:11 describe - 15:20, 55:5 Despite - 107:4 detail - 27:20, 80:5, 112:10, 121:23 detailed - 27:6 detected - 124:8 determination 10:17, 32:15, 33:9 determine - 14:16, 15:8, 18:14, 18:17, 18:19, 23:17, 36:1, 58:15 determined - 38:16 determines - 53:13 determining 12:23, 40:2, 73:20 develop - 53:23, 56:15, 57:15, 68:10, 73:19 develope - 96:12 developing - 42:19, 51:14, 55:18, 56:13, 60:17, 63:7, 68:2, 69:10, 70:11, 85:9, 112:7 development 31:20, 45:12, 76:2 Development - 6:20 died - 95:22, 95:23 difference - 37:11, 37:12, 37:16, 37:21, 44:14, 44:15, 44:16, 60:23, 86:13 differences - 15:22 different - 13:15, 35:4, 35:21, 36:7, 37:20, 39:8, 42:20, 51:4, 51:16, 61:1, 61:2, 66:6, 66:8, 66:12, 66:13, 68:17, 68:18, 104:6, 113:10, 118:13, 119:23, 122:13 differential - 125:2 difficult - 97:23 difficulties - 97:18 difficulty - 119:21 diploma - 8:21 direct - 107:3 Direct - 5:9 direction - 20:23, 21:2, 24:5 directly - 88:1 Director - 6:23, 7:4, 7:8, 7:11 director - 7:9 disagreement 115:2 discuss - 8:13, 11:8, 11:11, 25:13, 25:14, 43:13, 59:12, 59:14, 60:3, 72:9, 95:17, 128:16 discussed - 16:10, 17:10, 19:18, 21:4, 24:17, 47:22, 70:13, 76:9, 88:12, 91:7, 99:19, 107:12, 117:20 discusses - 115:10, 116:21 discussing - 10:12, 10:13, 10:23, 11:14, 25:4, 38:10, 47:12, 73:1, 92:8, 110:13 discussion - 26:14, 49:20 Disease - 7:7, 26:4, 49:5 disease - 5:14, 10:3, 10:23, 11:2, 12:2, 13:5, 15:15, 15:16, 16:23, 18:3, 19:23, 20:1, 20:8, 20:9, 21:5, 21:6, 21:14, 21:22, 22:4, 23:3, 29:18, 30:1, 30:5, 30:7, 30:8, 30:11, 30:18, 30:20, 30:23, 33:6, 37:1, 37:3, 38:1,38:2, 39:10, 39:11, 43:5, 45:19, 46:16, 50:7, 51:7, 52:10, 53:13, 53:23, 54:3, 54:6, 55:18, 56:13, 56:14, 56:19, 57:14, 58:7, 60:6, 60:14, 60:18, 61:13, 62:3, 62:14, 62:17, 62:23, 63:1, 63:5, 63:8, 63:17, 63:21, 63:23, 67:23, 68:2, 68:10, 68:11, 69:10, 70:6, 70:11, 73:19, 73:20, 76:12, 76:16, 82:16, 83:7, 84:18, 85:18, 87:3, 88:2, 89:8, 90:4, 93:20, 96:12, 96:16, 102:17, 105:2, 109:23, 110:16, 113:7, 121:16, 126:8, 126:16, 126:17 diseased - 105:16 diseases - 29:23, 30:1, 30:6, 36:16, 39:12, 39:15, 40:4, 52:4, 64:1, 70:7, 86:11, 86:12, 111:3, 127:23 Diseases - 122:7 dispute - 44:9 distill - 115:4 distinction - 30:22 distribution - 19:12 District - 5:22 divided - 22:8 Division - 5:21, 6:19 Doctor - 8:1, 10:6, 13:19, 42:14, 44:17, 48:5, 80:16, 82:3, 84:12, 97:8, 98:15, 99:16, 101:4, 102:3, 103:15, 105:12, 107:18, 116:13, 127:14 document - 33:11, 87:7, 87:9, 87:15, 106:8, 106:14 documents - 53:21, 84:17, 88:6 Dodson - 12:7, 24:21, 43:14, 78:22, 79:10, 88:12, 91:7, 91:13 done - 17:23, 22:13, 47:3, 62:10, 64:8, 64:20, 65:8, 65:16, 65:17, 65:19, 66:9, 70:20, 87:17, 89:20, 92:18, 95:8, 102:8, 104:9, 112:19, 114:21 Donnelly - 1:20, 129:15 dose - 12:14, 37:23, 38:1, 38:2, 42:22, 45:19, 45:23, 70:6, 70:17, 70:21, 71:16, 71:18, 71:19, 71:21, 86:12, 90:10, 92:16, 113:12 doses - 12:15, 45:21, 70:4, 71:20 double - 84:5 doubt - 42:21, 80:6, 127:19, 127:21 down - 22:7, 34:6, 57:10, 60:17, 64:20, 66:22, 70:20, 83:16, 93:3, 108:2, 108:14, 111:16, 113:12, 121:11, 123:20, 128:11 downward - 124:7 dozen - 66:22, 67:3 Dr - 4:6, 4:7, 4:20, 5:11, 10:22, 12:7, 16:11, 21:7, 21:10, 22:9, 22:13, 22:16, 22:18, 24:17, 24:20, 24:21, 24:22, 25:10, 29:6, 31:4, 31:6, 31:9, 32:5, 33:6, 34:19, 42:16, 43:10, 43:11, 43:14, 45:20, 46:1, 51:19, 53:1, 53:5, 57:12, 59:19, 59:22, 60:2, 63:12, 65:6, 67:14, 70:3, 72:6, 72:9, 75:11, 75:12, 76:8, 78:22, 79:10, 80:21, 88:12, 90:5, 90:11, 90:14, 90:17, 90:21, 91:7, 91:13, 92:1, 92:16, 93:16, 94:23, 98:18, 98:23, 99:20, 100:1, 100:4, 107:13, 108:18, 109:2, 111:5, 112:15, 114:1, 114:6, 115:7, 115:10, 115:23, 116:20, 117:3, 118:23, 120:4, 120:21, 120:22, 121:2, 122:2, 125:8, 126:4 drafted - 5:22 drinking - 98:10 Driscoll - 108:2, 108:7 drive - 7:20 drop - 98:16 dropped - 93:3 Drs - 117:4 drug - 113:3, 113:5 drum - 77:21, 78:5, 86:23 drums - 86:22 due - 61:22, 119:20 duration - 95:17, 95:23, 96:7 during - 6:8, 55:22, 78:7, 80:23, 81:9, 82:11, 82:15, 86:5, 107:7, 112:8 During - 78:7 dust - 60:15, 60:16, 61:7, 61:9, 79:21, 92:2 E early - 103:2 easier - 16:8 easily - 39:23, 124:8 Eastern - 49:17 easy - 39:21 Edition - 122:8, 122:11 edition - 122:9 editor - 51:20, 114:6 educational - 8:2 effect - 10:18, 37:19, 37:23, 39:21, 43:4, 56:18, 58:3, 75:1, 75:20, 76:5, 76:6, 81:16, 113:5, 122:12 effects - 39:3, 39:5, 57:23, 84:16 eight - 82:8, 99:15, 121:6, 126:19 eight-hour - 82:8 either - 4:16, 21:8, 24:3, 24:6, 45:4, 98:4 electron - 78:23, 91:21 element - 42:7 elevated - 44:21 elevation - 18:9 elicit - 15:3 eliminate - 16:21, 16:23, 84:18, 84:20, 114:5, 119:20, 121:14 eliminated - 17:5, 85:5, 121:10 eliminating 121:13 emerge - 75:17 Emory - 7:13, 7:19 employed - 13:3, 48:2 employment 72:10, 72:15 enable - 27:18 end - 13:20, 95:14, 125:14 engaged - 101:1 England - 3:7 entire - 94:1, 99:13 entirely - 85:6 entitled - 26:3, 106:9 environment - 83:1 environmental 7:15, 67:11, 67:23 Environmental 49:14 Epa - 43:23, 49:21, 87:2, 87:3, 87:7, 87:9, 92:11 Epa's - 49:21, 50:1 5 epidemiological 6:12, 11:17, 11:18, 17:6, 19:4, 21:23, 29:4, 31:16, 31:21, 32:9, 32:10, 38:15, 43:3, 44:19, 45:1, 52:2, 53:22, 54:17, 54:18, 54:20, 54:22, 54:23, 55:23, 59:1, 59:3, 59:14, 59:15, 61:10, 62:13, 62:21, 64:8, 64:19, 66:6, 68:14, 94:15, 96:17, 109:16, 110:4, 117:21, 126:14 epidemiologically 66:20 epidemiologist 6:6, 12:18, 12:21, 14:19, 15:6, 29:9, 35:3, 35:22, 67:7, 93:22, 102:14, 102:15, 105:12, 116:7 epidemiologist's 30:19 epidemiologists 35:13, 38:11 epidemiology - 6:5, 6:18, 10:8, 10:9, 13:6, 14:3, 15:6, 18:11, 29:22, 32:15, 32:16, 52:8, 56:14, 62:1, 62:2, 67:8, 109:19, 127:9, 127:15, 127:18 Epidemiology 7:22, 8:3, 8:4 equal - 75:2 equals - 20:21 equation - 127:16 equivocal - 96:18, 96:21, 110:5, 118:20, 126:14 Eric - 3:7 Erin - 3:2 Esq - 2:5, 2:7, 2:10, 2:12, 2:14, 2:15, 2:17 Esquire - 2:8 essentially - 9:17, 19:5, 40:6, 97:3 establish - 35:16 estimate - 108:4, 124:6 estimates - 21:10, 66:11, 124:3 et - 25:6, 27:7, 35:6 etc - 70:23, 86:4, 118:7 ethicacy - 113:4 ethically - 12:17 etiologic - 126:6 Europe - 47:6 evaluate - 11:15, 29:4, 33:20, 50:11, 127:6 evaluated - 59:3 evaluating - 59:1 evaluation - 13:7, 13:13, 13:15, 29:9 event - 126:7 evidence - 29:4, 38:3, 44:11, 46:6, 61:11, 65:21, 126:13, 126:15 evolve - 28:23 ex - 114:6 ex-editor - 114:6 Examination - 5:9 examine - 81:22 examined - 5:8, 63:13 examining - 105:2 example - 15:15, 21:16, 30:7, 39:4, 39:13, 43:8, 56:3, 57:16, 70:22, 71:6, 86:5 exceed - 82:18, 88:23 except - 104:11, 125:15 exceptional - 54:23 exceptionally 109:13 excess - 18:17, 18:19, 18:20, 108:1, 108:6, 111:16, 112:11 excessive - 65:3 exclude - 75:13, 96:2 excluded - 121:21 exclusive - 35:19 excursion - 89:2, 89:3 Excuse - 123:13 Executive - 95:9 exercise - 90:8, 92:14, 92:17 exhaustive - 10:9, 89:13 exist - 44:22, 53:21, 66:8, 126:15 existed - 66:14, 127:12 existence - 83:14 exists - 17:3 exonerate - 76:1 exoneration - 75:23 expect - 56:12, 62:14, 62:17, 93:10, 116:8 expected - 18:15, 21:6, 22:5, 22:17, 23:1 experience - 25:5, 115:18 experienced 115:15 experiment - 38:3 experimental 38:3, 46:5, 46:6, 47:16 experimentation 12:11, 12:12 expert - 12:20 expertise - 115:12, 116:10 Explain - 82:3 explain - 21:3, 102:14, 117:9 explains - 37:1 exposed - 11:3, 19:23, 20:1, 20:9, 23:3, 33:4, 42:18, 54:11, 55:19, 55:23, 56:10, 58:10, 65:22, 67:10, 67:22, 68:6, 68:22, 68:23, 69:9, 72:6, 72:11, 77:3, 77:5, 77:9, 77:10, 87:22, 109:6, 126:19 exposing - 123:6 exposure - 11:1, 13:5, 17:18, 21:7, 22:5, 23:4, 30:7, 30:9, 30:12, 32:21, 33:5, 34:11, 34:12, 37:1, 39:16, 39:22, 41:19, 42:17, 43:6, 45:11, 46:3, 46:15, 52:14, 52:15, 52:19, 53:4, 53:7, 53:14, 53:23, 56:5, 56:6, 57:7, 58:14, 63:20, 65:14, 65:21, 66:13, 67:15, 70:10, 70:21, 71:4, 71:9, 71:12, 72:2, 73:6, 73:8, 74:3, 74:5, 74:7, 74:8, 74:13, 75:4, 75:14, 75:19, 75:21, 76:1, 76:10, 76:16, 77:15, 77:23, 78:7, 79:21, 81:9, 82:7, 82:12, 82:13, 82:15, 83:2, 83:18, 84:1, 84:13, 84:15, 84:21, 85:17, 86:3, 89:22, 90:10, 92:15, 93:9, 93:22, 93:23, 94:1, 96:16, 101:2, 102:16, 104:1, 104:12, 104:22, 106:20, 106:23, 107:6, 107:9, 112:8, 118:4, 118:12, 119:18, 121:12, 121:17, 124:11, 126:6, 127:6 Exposure - 56:23 Exposures - 26:4 exposures - 6:8, 30:17, 39:4, 42:12, 42:20, 43:7, 44:18, 45:11, 53:18, 53:20, 53:21, 54:14, 58:9, 58:13, 59:4, 59:20, 60:4, 60:11, 60:13, 60:21, 61:6, 61:15, 62:3, 62:5, 66:15, 66:18, 67:23, 68:8, 68:10, 68:20, 70:4, 70:17, 70:18, 70:22, 71:5, 72:4, 72:6, 73:2, 73:9, 73:10, 73:12, 73:18, 74:1, 74:3, 74:4, 75:6, 75:8, 75:16, 75:23, 76:22, 80:12, 81:11, 82:8, 82:9, 84:3, 84:4, 85:23, 86:7, 89:8, 89:14, 89:17, 89:20, 90:3, 90:6, 92:5, 93:14, 94:2, 94:7, 94:10, 95:16, 101:2, 101:17, 104:16, 104:17, 104:19, 106:1, 119:20, 121:8, 121:10, 121:11, 121:13, 121:15, 121:21, 123:6, 124:9, 124:12, 126:15, 126:23, 127:12, 127:21 express - 20:3, 22:13 expressed - 20:11, 87:11 external - 16:6 extremely - 68:6, 89:20 F f/cc - 70:23, 71:6, 71:10, 83:16, 83:17, 85:8, 86:3, 87:11, 87:14, 89:1, 92:22 faced - 75:16 fact - 8:17, 8:22, 9:3, 10:2, 22:15, 22:17, 27:5, 27:16, 47:20, 48:5, 51:18, 51:19, 52:4, 52:20, 54:1, 59:8, 60:22, 62:19, 69:6, 73:2, 85:7, 88:8, 88:11, 89:17, 91:23, 95:20, 104:20, 106:14, 107:5, 109:1, 121:15, 126:3 factor - 11:20, 16:22, 52:13, 107:1 factors - 13:7, 15:20, 16:3, 16:6, 16:12, 16:17, 16:19, 17:1, 17:4, 18:8, 32:17, 40:6, 62:8, 101:14, 109:21, 113:12, 118:20, 124:14 Faigout- 88:15, 88:16, 88:17, 88:18 failure - 114:13, 114:16 fair - 10:11, 11:12, 17:4, 19:4, 30:21, 44:6, 118:20, 123:6 fairly - 53:18, 94:9, 95:11, 101:9 fall - 68:11, 94:12 familiar - 5:17, 33:11, 72:5, 81:23, 85:13, 85:21, 87:2, 88:15, 90:5, 97:10, 98:19, 100:7, 100:19, 101:11, 101:22, 116:22, 123:11 far - 7:19, 24:17 Farris- 3:2 father - 32:22 feasibility - 60:20 feasible - 11:23 feet - 87:23 felt - 85:1, 85:4 few - 6:17, 14:3, 28:6, 30:2, 30:15, 34:6, 43:13, 44:22, 53:19, 60:3, 62:9, 70:16, 71:2, 94:13, 113:15, 113:17, 127:13 fiber - 43:7, 71:5, 71:14, 71:22, 76:10, 78:1, 78:17, 86:18, 86:19, 89:3, 90:15, 90:18, 91:9 fibers - 38:18, 71:12, 71:23, 78:2, 79:5, 79:9, 81:4, 87:12, 87:19, 88:9, 88:19, 88:22, 91:5, 91:10, 91:13, 91:17, 93:4 fibrosis - 41:17 field - 13:4, 13:6, 15:7, 55:21, 67:8 fields - 12:19, 12:20, 12:21 figure - 101:8 filters - 61:8 findings - 14:10, 71:4, 81:7, 96:2, 106:13, 107:5, 127:6 fine - 64:21, 128:6 finish - 4:8, 5:1 finished - 4:10, 4:11 Finland- 33:17 Finnish- 33:19 first - 5:7, 10:6, 52:23, 53:5, 63:12, 78:13, 83:14, 83:15, 83:23, 84:10, 106:8, 107:22, 110:19, 110:22, 112:22, 116:21 First- 14:4, 80:14, 95:3, 102:13, 117:17 firsthand - 105:10 fit - 9:2, 56:4, 65:9, 77:13 fits - 37:4, 56:23 five - 23:22, 26:21, 81:5, 91:12, 91:19, 91:20, 112:2, 126:19, 128:12 fivefold - 108:6, 108:16, 109:14 focus - 14:4, 40:5 follow - 17:21, 95:17, 96:1, 96:7, 96:11, 102:6, 110:15, 120:22 following - 57:13, 58:17, 75:17 follows - 5:8 force - 68:6 Ford- 31:1, 104:9 foregoing - 129:6 forget - 13:19, 105:23, 106:2 Forgive- 19:3 forgot - 103:3 forgotten - 104:1 form - 66:15, 78:2 format - 20:15 former - 8:17 forms - 45:3, 46:2, 47:2, 47:8, 50:4, 50:7 formula - 19:10 formulas - 19:6, 19:9 forth - 9:13, 52:9 fortunately - 45:2 forward - 4:15, 14:17, 28:13 fosterite - 78:3, 78:7, 78:10, 78:12, 78:18, 79:20, 79:22, 80:3, 80:6 foundries - 6:16 founds - 95:12 four - 7:3, 99:1, 99:5, 99:9, 99:12, 99:15, 99:21, 100:3, 101:1, 112:1, 123:14 fourth - 123:12, 123:14 frame - 65:16 Francis- 3:7 free - 45:8 friction - 5:13, 10:3, 13:11, 51:9, 51:11, 51:13, 52:10, 53:12, 53:17, 53:20, 54:4, 57:18, 59:5, 63:6, 67:19, 67:22, 69:8, 73:19, 75:7, 79:7, 80:13, 109:17, 110:5, 116:2, 116:16, 125:10 Friction- 88:6 front - 108:20 function - 63:18, 65:22 G Gabay - 3:2 galley - 26:18, 27:10, 27:12, 27:22 garage - 64:6, 64:10, 64:12, 64:14, 6 64:21, 67:19, 67:21, 72:19, 87:16, 87:18, 87:20, 88:8, 95:10, 104:4, 117:8, 117:10, 117:11, 118:3, 118:5, 118:6, 118:15 Garages - 95:9 garages - 65:7 Garrett - 3:5 Gary - 3:4 gears - 66:5 general - 10:7, 10:10, 10:12, 10:16, 11:14, 21:14, 29:12, 34:15, 36:8, 52:2, 53:17, 58:8, 60:21, 68:21, 90:23, 93:10, 94:8, 103:6, 106:18, 117:17, 127:15 General - 8:17, 8:22, 9:1, 35:15, 49:10 General's - 39:8 generally - 15:13, 15:14, 19:11, 20:3, 20:10, 20:14, 20:21, 21:15, 24:2, 24:7, 30:1, 30:3, 36:3, 39:10, 54:11, 57:10, 58:13, 64:20, 64:21, 72:20, 73:13, 78:19, 119:5 Generally - 20:19, 21:9 genetic - 41:16 Gentilotti - 2:9 Georgia - 7:6 German - 100:8 Germany - 99:2, 99:3, 99:8 given - 4:23, 108:18, 113:3, 113:4 Glenn - 3:6 global - 47:7 Gm - 104:9 Gold - 87:4 Goodman - 16:11, 111:5, 114:1, 117:3, 120:21, 125:8 Goodman's- 94:23, 112:15, 116:20, 118:23, 120:4 Government- 33:19 government - 7:12 governmental 48:6 gradient - 37:22, 45:16 graduate - 6:2 grants - 53:3 graph - 71:3 graphic - 71:15 graphically - 74:15 great - 80:5 greater - 14:23, 20:21, 20:22, 63:19, 63:20, 64:5, 64:16, 71:13, 73:12, 81:5, 82:22, 108:12 Gribbin - 3:7 grind - 65:8, 77:12 grinding - 78:8, 86:1, 104:4 ground - 65:3, 88:20, 104:8 group - 15:15, 15:16, 16:16, 17:14, 17:15, 18:5, 18:6, 18:14, 19:13, 20:9, 20:10, 33:17, 33:21, 34:1, 34:2, 55:13, 56:23, 57:14, 63:12, 64:4, 64:12, 64:17, 65:2, 65:17, 66:16, 80:19, 95:9, 95:11, 111:23, 112:1, 113:2, 113:3 Group - 49:17 grouping - 124:5 groupings - 124:14 groups - 6:15, 52:17, 65:7, 66:14, 67:2, 68:19, 124:4 guess - 43:11, 89:4 guidance - 87:3 guy - 69:3, 118:6 H Hadley - 3:3 half - 72:16, 85:10, 108:4 Hammar - 10:22, 12:7, 21:7, 21:10, 22:9, 24:17, 24:20, 24:22, 25:10, 31:9, 32:5, 33:6, 42:16, 45:20, 75:12, 76:8, 77:13, 77:19, 93:16, 100:4, 107:13, 121:2 hand - 129:12 handed - 98:15 handling - 88:7 hands - 66:3 hands-on - 66:3 Hansen - 101:22, 101:23, 106:3, 107:1, 107:4, 110:9 hard - 4:11, 95:19, 96:1, 121:18 hazardous - 46:19 hazards - 9:23 head - 53:6 headed - 6:19 headquarters - 7:6 health - 5:20, 6:14, 38:17, 38:20 Health - 5:21, 6:3, 6:5, 7:1, 17:13, 47:11, 48:21, 49:12 hear - 65:5 heard - 42:16, 43:22, 52:23, 76:15, 103:15, 103:18 Hearing - 1:15 heat - 78:12, 78:14 heated - 78:15 Heintz - 4:6 help - 98:15, 98:17 helping - 14:15, 98:10 Helsinki - 33:11, 33:16, 33:23, 34:9, 106:7, 106:22 hence - 115:13 Henderson - 28:3, 75:11, 75:12, 107:13, 109:10 Henry - 3:7 hereby - 129:5 herein - 129:9 herself - 105:13, 118:14 Hessel - 120:19, 120:20, 120:21, 120:22, 121:7, 123:2 heterogeneity 114:5 high - 12:15, 21:13, 53:20, 53:21, 54:8, 54:14, 54:15, 60:11, 68:6, 68:9, 81:4, 86:7, 89:22, 90:1, 92:20, 93:8, 93:18, 101:8, 109:13, 118:11, 124:9, 124:11, 126:16 higher - 43:21, 43:23, 54:3, 54:11, 70:11, 83:23, 86:18, 93:3, 93:12, 93:15, 94:12, 126:1 highest - 68:20, 111:23, 112:1, 112:3 highlight - 40:16, 41:7 Hill - 34:15, 34:17, 34:18, 34:19, 34:21, 35:1, 36:1,36:6, 36:11, 38:23, 39:17, 40:10, 42:6 Hill's - 40:2 Hillerdahl - 99:20 himself - 105:13, 118:13 historical - 103:4 histories - 33:1, 33:2, 97:19, 98:1, 102:9, 106:18, 107:1, 119:22, 127:7 history - 5:19, 29:18, 32:20, 33:5, 33:10, 34:12, 34:13, 59:18, 66:10, 67:4, 103:8, 106:5 hit - 118:3 Hodson - 43:15 hold - 36:8 holding - 8:20 home - 103:22, 104:13 homogeneity 61:1, 114:5 homogeneous 113:15, 113:17 Hon - 1:11 Honaker - 1:21, 129:15 Honor - 4:3, 4:4, 5:4, 19:19, 70:1, 88:13, 91:16, 96:10, 110:10 hope - 4:8, 56:22, 92:10, 122:15 hoses - 54:14, 61:7 hospital - 117:16, 117:18, 117:19, 121:3 hour - 82:8 hours - 126:19 house - 104:8 Human - 48:21 human - 41:14, 42:3, 44:23, 47:18 humans - 12:14, 12:17 Huncharke - 21:11 husband - 117:5 hygienist - 6:7 Hygienists - 82:5 Hypocrites - 33:1 hypothesis - 118:10 hypothetically 118:8 Hypothetically118:15 I Icd - 122:18 idea - 17:1, 21:5, 29:12, 59:13, 71:18, 73:23, 74:12, 75:5, 78:6, 79:19, 82:12, 82:14, 90:10, 96:8, 102:13, 105:1, 110:13, 110:14 identified - 17:15, 21:14 identify - 17:14, 97:21 ignore - 73:17, 75:6 ignored - 98:3, 104:17 Iii - 1:11, 2:8 illustrate - 110:18 illustrates - 71:3 illustration - 71:15 images - 79:4 implementation 114:11 importance - 30:22, 30:23 important - 29:11, 29:14, 30:21, 32:18, 33:4, 35:8, 35:9, 35:12, 42:10, 42:13, 42:15, 58:7, 64:7, 73:1, 73:7, 75:3, 90:1, 114:17, 115:6 imprecise - 124:3 inability - 62:7, 119:19 inaccuracies 25:10, 109:3 inaccurate - 10:14 inadequate - 62:6 Inc - 2:18 incapable - 41:6 incidence - 18:3, 20:7, 20:8, 20:9, 20:13 include - 13:12, 24:3, 24:4, 29:9, 29:11, 47:13, 47:16, 47:18, 47:20, 48:10, 55:11, 55:13, 56:2, 57:2, 57:6, 118:16 included - 26:15, 28:3, 47:23, 51:21, 57:20, 105:14, 110:2, 118:8, 120:22 includes - 54:17, 118:6 including - 27:9, 47:8, 50:4, 50:8, 52:4, 55:17, 56:9, 56:21, 94:1, 110:2, 114:13 inclusion - 55:9, 56:8, 57:1 inclusive - 85:1, 85:3 income - 114:23 incompatible 114:23 incorporate - 15:8 increase - 38:1, 83:2, 83:3, 102:5, 122:15, 122:16 increased - 45:12, 46:2, 46:3, 52:18, 54:5, 63:1,63:7, 67:12, 67:18, 68:2, 68:4, 68:15, 69:9, 71:10, 74:13 increases - 42:19 increasing - 63:21 increasingly - 75:4 incriminate - 75:22, 76:3 indeed - 88:19, 88:22 indicate - 44:23, 81:7, 88:7, 106:4, 108:14 indicated - 5:16, 78:3, 101:17 indicating - 8:21 indication - 107:8 individual - 14:8, 43:6, 71:19, 113:9, 122:12, 127:1, 127:5 individual's - 10:23 individuals - 11:3, 45:10, 67:10 induction - 75:18 Industrial - 82:5 industrial - 6:6 industries - 68:14, 73:9 industry - 69:7, 72:15, 73:3, 89:7, 89:21 Infinity - 22:10 information - 14:16, 26:12, 26:15, 27:3, 27:15, 27:19, 28:2, 28:7, 28:10, 28:15, 28:19, 28:23, 29:1, 29:8, 29:13, 29:17, 32:6, 32:8, 38:9, 47:12, 47:22, 48:1, 50:16, 50:20, 60:11, 87:6, 87:8, 87:10, 96:23, 105:16, 107:16, 107:20, 110:2 injection - 44:2 inquires - 37:18 installation - 65:4, 123:21 installed - 78:8 installing - 77:5 instead - 102:16 institute - 6:21, 7:2, 7:5, 30:4, 59:19, 62:4 Institute - 7:1, 7:9, 88:7, 114:7, 121:1 institute's - 7:6 insufficient - 118:9 insulation - 53:18, 68:4, 73:13, 126:18 insulator - 54:9 insulators - 54:11 insured - 115:3 intelligence - 60:9 Intelligence - 80:20, 81:12 intend - 10:8 intent - 28:19, 84:7, 84:9 interest - 14:9 interested - 12:11 interesting - 102:22 international - 7:14 International 48:14, 122:7 interpreted - 96:22 interrupted - 58:4 interval - 23:15, 23:21, 23:23, 24:1, 24:3, 24:7, 24:9, 24:15, 71:8, 71:11, 93:2, 97:17, 117:13 intervals - 24:12, 93:17 interview - 102:15, 103:7, 103:10, 105:9, 105:13, 105:15, 124:18, 124:21, 124:22 interviewed 124:22, 125:1 interviewing - 7 104:15 interviews - 102:7, 102:14, 103:5, 103:10, 124:19 introduce - 12:1 introduced - 12:5, 21:20 introductory 106:16 invented - 30:5 investigator 114:14 investigators 114:22 involve - 10:17, 125:16 involving - 117:3 issue - 32:3, 37:6, 43:12, 110:7, 110:12 issued - 48:7 issues - 8:12, 11:9, 37:23, 109:3, 114:15, 116:4, 116:5, 116:6, 128:15 itself - 77:22, 78:17, 120:15 Iwatsubo - 90:12, 92:19, 93:5 J Jacobs- 2:10 James- 2:14 Japan- 21:17, 21:21 Jarvholm- 101:10 job - 33:3, 52:12, 52:18, 53:4, 53:12, 55:10, 55:11, 55:15, 66:16, 66:17, 66:18, 66:22, 67:1, 67:15, 67:16, 68:18, 68:21, 72:19 jobs - 53:6, 56:3, 68:16, 125:15 John- 1:20, 2:5, 129:15 Johnson- 2:17, 3:5 Joseph- 1:11, 2:8, 3:2 Jr- 2:12, 2:15 Judge- 5:16, 11:8 judgement - 24:13, 24:14 judgments - 125:16 jumped - 74:20, 74:22 K Kai - 3:5 Kaplan - 3:4 Kathleen - 3:3 keep - 44:10, 61:8, 97:6, 98:12 kept - 6:18 key - 23:9 kidney - 39:6 kin - 102:7, 102:13, 102:15, 102:21, 102:22, 103:1, 103:5, 103:9, 104:15, 104:19, 105:15, 105:23, 124:17, 124:18, 124:20, 125:3, 125:4 kind - 14:18, 28:12, 30:4, 56:23, 76:8, 111:10, 127:9 kinds - 92:15 King - 1:22 knowing - 100:4 knowledge - 92:9 known - 11:19, 32:10, 32:11, 37:2, 107:6 Kohlberg - 3:3 Kron - 2:14 Kuery- 3:6 L label - 81:15 labels - 81:13, 81:14 laboratory - 38:6, 59:23, 60:3 lack - 20:3, 59:13, 62:6, 102:9, 106:5, 106:23 language - 27:5 large - 17:14, 56:8, 61:10, 95:9, 95:11, 120:13 larger - 58:10, 65:5, 87:19 last - 50:3 Last- 68:13 lastly - 65:12 Lastly- 39:20 late - 110:20 latencies - 56:21 latency - 33:6, 56:11, 56:17, 57:5, 57:13, 57:21, 57:23, 58:2, 96:9, 110:11, 110:13, 110:21, 111:2, 111:3 Latency- 56:10 latent - 96:12 latest - 4:10, 47:1, 108:13, 108:16 law - 19:2 lawyer - 76:14 lays - 45:14 lead - 80:10, 81:11 learn - 12:13, 83:6 learned - 67:14 least - 12:19, 18:11, 31:20, 66:11, 94:15, 106:22, 111:17 leave - 28:19, 111:14 Leblanc- 2:7 lecture - 9:4, 35:1, 35:2 Lee- 108:1, 108:7, 108:18 lee - 109:11 Lee's- 109:2 left - 42:9, 78:4, 79:21, 80:2, 121:16 leg - 31:2 legal - 50:21 legislative - 7:17 Leigh- 28:3 Leigh's- 28:13 Lemen- 4:7, 4:20, 5:5, 5:6, 5:11, 57:12, 70:3 length - 81:5 less - 21:1, 21:12, 23:21, 24:7, 25:17, 38:2, 56:12, 56:17, 66:22, 74:9, 86:22, 91:12, 91:19, 99:5 letter - 51:18, 51:19, 51:20, 80:21 level - 21:21, 71:12, 76:14, 84:13, 93:3, 93:12 levels - 67:11, 67:22, 68:6, 68:9, 82:17, 82:18, 82:21, 85:17, 86:21, 89:8, 99:18 lick - 14:14 life - 18:12, 73:15 lifetime - 108:7 light - 91:3, 91:6, 91:14 likely - 104:12, 124:6 limit - 82:1, 82:7, 83:5, 83:9, 84:7, 84:15, 89:2, 89:3 limitation - 55:1, 100:15 limitations - 54:20, 54:23, 55:2, 55:6, 59:10 limited - 45:8 limits - 83:18, 91:6 line - 101:16 linings - 65:4, 65:23, 77:6, 77:10, 86:1, 107:7 list - 30:5 listed - 35:4, 35:5, 48:6, 51:6, 51:15, 63:11, 116:6 listened - 100:3 listing - 68:12 lists - 39:8 literature - 9:22, 10:4, 14:12, 22:16, 23:8, 26:3, 28:17, 32:9, 32:10, 32:12, 32:13, 36:11, 41:9, 41:13, 41:19, 41:21, 42:2, 43:3, 43:18, 51:12, 52:21, 53:21, 62:19, 62:20, 68:1, 76:22, 89:12, 89:13, 89:16, 94:15, 107:12, 114:22, 126:14 Litigation- 1:6 litigation - 7:17, 7:21, 61:21, 61:23 liver - 15:3, 30:14 lives - 103:9 living - 39:12, 105:5 Lloyd- 80:10, 80:14, 80:21 Llp- 2:7, 2:13, 2:15 local - 62:20 lock - 34:3 logically - 39:2 London- 95:8 Look- 15:21 look - 11:21, 12:3, 12:6, 13:1, 14:13, 16:5, 20:11, 23:23, 24:11, 29:15, 31:18, 32:6, 32:9, 32:19, 33:5, 33:6, 33:22, 35:10, 35:13, 35:20, 37:3, 38:6, 44:14, 52:13, 53:6, 53:7, 55:10, 56:16, 59:1, 61:18, 66:21, 74:3, 86:15, 92:21, 93:2, 93:3, 93:16, 93:23, 94:10, 111:1, 125:20, 127:2 looked - 17:17, 34:6, 42:20, 45:7, 50:17, 60:20, 64:9, 64:10, 64:12, 66:10, 68:17, 70:16, 74:21, 79:16, 97:14, 100:8, 109:21, 117:21, 121:1 looking - 11:20, 11:21, 12:10, 14:17, 14:20, 16:15, 16:18, 16:19, 18:3, 19:11, 20:15, 21:17, 22:10, 22:22, 29:23, 30:12, 35:3, 37:23, 38:7, 38:18, 43:1, 52:14, 54:17, 56:11, 65:23, 66:19, 67:1, 72:19, 73:23, 85:15, 93:1, 93:11, 111:18, 113:9 looks - 37:10, 60:11 loop - 56:18 lose - 98:12 loses - 78:16 losing - 4:5 low - 53:18, 56:19, 58:8, 58:13, 70:17, 70:21, 82:17, 84:4, 89:20, 94:9, 123:3, 124:12 lower - 43:22, 45:21, 54:15, 57:10, 60:16, 60:17, 60:21, 71:17, 78:19, 126:17 lowered - 83:10, 85:5 luncheon - 4:1 lung - 15:1, 16:16, 16:20, 39:6, 39:14, 40:7, 42:19, 44:12, 44:15, 45:22, 50:5, 63:5, 63:18, 65:21, 74:18, 74:19, 101:17, 102:5, 102:11, 111:18 Lyon- 3:6 M machine - 104:4 machined - 65:4 magnitude - 76:6 main - 37:21, 60:14 maintenance 63:14 major - 19:8, 69:5, 114:11, 115:8, 124:7, 126:6 majority - 61:20, 73:14, 95:21, 106:12, 124:23 malignancies 117:7 malignant - 63:5, 63:8 manipulating 77:11 manufacturers 51:9, 51:10, 51:11, 59:21, 59:22 manufactures 80:19 map - 47:7 Margaret - 3:7 Mark - 3:4 Maryland - 60:1 Masters - 6:4 matched - 18:7, 123:16 matching - 16:3, 16:4, 16:7 material - 12:9, 54:14, 78:2, 81:14 Material - 88:6 materials - 73:11 mathematical 19:5, 19:9, 22:7 matrixes - 88:23 matter - 9:3, 27:16, 85:7, 119:11 Mcdonald - 27:7, 116:21, 116:22, 117:4, 118:20 Mcguirewoods 2:13 mean - 16:13, 20:18, 37:9, 54:4, 62:22, 67:20, 68:10, 69:7, 70:9, 82:17, 86:16, 89:10, 96:21, 98:3, 106:11, 109:14, 115:18, 121:20, 126:22 meaning - 14:23, 57:6, 124:2, 125:14 meaningful - 22:6 means - 4:13, 16:14, 35:19, 39:21, 51:3, 54:10, 55:16, 67:4, 70:10, 85:11, 106:12 meant - 124:20 measure - 18:18, 19:16, 22:1, 23:10, 23:20, 90:17, 106:19, 110:4 measured - 19:5, 23:16, 71:22, 80:12, 82:10, 95:22 Measured - 19:7 measurement 22:11 measurements 6:11, 20:2, 89:7, 90:14, 90:18, 90:22, 90:23, 91:2, 91:8 measures - 19:18, 24:14, 62:18, 82:7, 92:2 measuring - 87:11, 90:15 mechanic - 54:5, 56:2, 56:6, 60:5, 64:10, 72:11, 93:4, 103:16, 103:20, 103:22, 104:3, 118:13 mechanics - 51:13, 60:10, 60:19, 62:13, 62:15, 64:6, 64:13, 64:22, 66:2, 66:3, 67:20, 67:21, 68:22, 72:19, 76:23, 87:4, 87:16, 87:23, 92:22, 93:11, 94:9, 94:11, 94:17, 95:10, 96:4, 99:3, 101:13, 103:19, 126:17 Mechanics - 123:18 mechanism - 38:8 mechanisms - 12:1, 37:2 mechanistic - 11:23 median - 86:4 medical - 6:11, 31:11, 41:9, 41:12, 52:21, 62:19, 62:20, 76:22 medical/scientific 42:2 medicine - 6:1, 7:15, 32:23 meet - 52:9 meeting - 59:23, 60:1, 81:1 meets - 39:23 Melissa - 3:4 memory - 88:5, 105:22 8 men - 30:9, 108:11 mention - 7:22 mentioned - 8:2, 13:2, 16:9, 16:11, 21:11, 26:2, 30:14, 33:10, 51:11, 72:1, 74:11, 121:2 mentioning - 70:4 mesothelioma 15:3, 21:5, 21:6, 21:19, 21:23, 22:5, 22:14, 23:11, 31:12, 31:14, 31:20, 32:1, 34:11, 39:14, 40:4, 40:5, 41:6, 41:22, 42:3, 42:22, 44:11, 44:13, 44:21, 45:1, 45:13, 45:19, 45:21, 46:3, 48:8, 50:5, 50:8, 51:14, 52:5, 56:13, 57:20, 63:4, 70:5, 70:17, 71:16, 75:18, 75:22, 76:2, 99:1, 99:19, 100:8, 100:23, 101:7, 101:12, 102:4, 102:18, 105:10, 107:8, 111:3, 111:16, 111:17, 111:18, 111:19, 112:8, 117:4, 117:6, 121:6, 122:4, 122:10, 122:14, 122:16, 122:19, 122:21, 124:21, 125:10, 126:5, 127:20 Mesothelioma 30:9 mesotheliomas 30:10, 57:22, 99:21, 108:3, 108:15, 110:21, 110:23, 122:23, 123:4 meta - 94:23, 111:6, 111:22, 112:1, 112:7, 112:11, 112:12, 112:19, 112:21, 113:8, 113:11, 113:18, 113:19, 113:22, 114:9, 114:12, 114:14, 114:18, 114:21, 115:3, 115:9, 115:12, 115:19, 115:22, 116:8, 116:15, 118:23, 119:2, 119:5, 119:6, 119:8, 120:12, 120:15, 125:20, 125:23, 126:2, 127:8 Meta - 112:22 meta-analysis 94:23, 111:6, 111:22, 112:1, 112:7, 112:11, 112:12, 112:19, 112:21, 113:8, 113:11, 113:18, 113:19, 113:22, 114:9, 114:12, 114:14, 115:3, 115:9, 115:12, 115:19, 115:22, 116:8, 116:15, 118:23, 119:2, 119:5, 119:6, 119:8, 120:12, 120:15, 125:20, 125:23, 126:2, 127:8 Meta-analysis 112:22 meta-analyst 114:18 meta-anlyses 114:21 metastasizes 117:6 method - 34:10, 91:21, 115:13, 115:18 Methodist - 8:5 methodologies 13:16, 50:12, 50:17, 50:21, 73:17 methodology - 36:4 methods - 29:21, 87:17, 87:21, 115:21 Michael - 3:4, 3:5 Michele - 1:21, 129:15 micron - 81:5, 91:12 microns - 91:19, 91:20 microscope 78:23, 91:14, 91:22 microscopist 79:13 microscopy - 91:3, 91:6 might - 4:5, 11:20, 12:9, 16:19, 23:5, 29:16, 38:18, 51:20, 55:12, 56:6, 69:12, 98:17, 104:21, 104:22, 105:23, 120:2, 126:7, 127:11 millimeter - 81:6, 81:7 million - 21:12, 21:13, 87:12, 87:14, 87:19, 99:16, 101:8 mind - 30:19, 44:11, 97:6, 103:13 miners - 51:8 mining - 125:15 Minority - 106:9 minute - 20:6, 93:6 minutes - 43:14, 60:4, 69:15, 128:7 Miranda - 3:3 mislead - 28:19 misrepresent 110:1 misses - 122:3 Missouri - 5:21, 8:4 mistake - 111:13 mistakes - 109:3 mixed - 42:12, 43:6, 44:18, 45:11, 70:18, 72:1, 72:3, 73:12, 74:1, 74:4, 74:12, 121:21, 123:6 mixtures - 75:3 modification - 36:9 molecular - 12:6 moment - 15:5 money - 61:10 month - 108:21 months - 26:20, 26:21 morbidity - 18:3, 18:23, 20:13 morning - 4:10, 22:10, 28:5, 42:16, 45:20, 100:4, 108:6, 108:19 Mortality - 22:20 mortality - 18:2, 18:4, 18:6, 18:10, 18:12, 18:23, 20:12, 22:23 most - 6:9, 26:1, 31:13, 32:2, 34:10, 42:23, 45:3, 54:22, 55:8, 60:22, 61:22, 68:21, 102:18, 103:5, 103:6, 106:18, 114:18 motion - 115:3 motor - 66:2 move - 58:5, 68:13, 73:4, 85:12, 107:11, 128:3 moved - 7:1, 7:5, 7:18, 72:16 Msph - 8:3 multifactorial 126:9 multiple - 39:5, 39:12, 59:9, 66:16, 66:18, 75:16 Murray - 9:13 Murray's - 47:3 must - 12:21, 15:8, 24:13, 58:23 N name - 6:17, 32:21, 89:2 named - 6:23 narrow - 24:8 National - 6:23, 48:19, 49:8, 114:7, 121:1 nature - 39:11, 76:12, 78:1, 91:11 Neal - 3:6 necessarily - 12:20, 76:18 need - 11:19, 25:23, 40:23, 58:9, 84:10, 84:12, 94:13, 127:1, 128:13, 128:15 needs - 12:18, 32:8, 32:20, 36:19 negative - 17:7, 21:2, 105:17, 118:10 neglects - 103:7 negligible - 107:9 neighborhood 21:12, 33:18, 72:18, 108:15 Neuman - 100:6 neurologic - 39:7 neutrally - 45:3 never - 56:6, 64:11, 67:6, 84:11, 84:23, 85:2, 109:18 New - 1:2, 129:8 new - 4:23, 7:9, 14:9, 14:10, 27:1, 27:2, 27:3, 27:14, 27:21, 28:7, 28:15, 29:16, 39:11, 77:6, 77:10, 77:11 news - 4:4 next - 6:9, 7:3, 15:11, 26:23, 45:14, 59:13, 70:5, 70:23, 71:12, 97:9, 98:18, 102:7, 102:13, 102:15, 102:21, 102:22, 103:1, 103:5, 103:9, 104:15, 104:19, 105:15, 105:22, 105:23, 107:11, 123:10, 123:23, 124:17, 124:18, 124:20, 125:2, 125:3 Next - 46:5, 58:6, 100:6, 119:15 Nicholson - 64:2, 72:6, 72:9, 103:19 night - 118:7 nine - 35:4, 35:7, 35:8, 35:20, 111:23, 112:3, 128:11, 128:16 Niosh - 6:23, 13:4, 30:4, 47:11, 48:12, 53:2, 55:20, 59:18, 59:21, 60:8, 66:12, 80:1, 80:10, 80:17, 80:18, 80:23, 81:11, 81:13, 84:6, 84:11, 84:13, 84:15, 84:23, 85:15, 87:9, 87:13, 90:19, 91:17, 92:11, 122:2 nobody - 76:9 non - 15:21, 15:22, 18:6, 63:5, 63:8 non-asbestos 18:6 non-cases - 15:21, 15:22 non-malignant 63:5, 63:8 nonasbestos 78:2, 125:15 noncarcinogenic 84:16 none - 35:8 nonfibrous - 78:2 nonhospitalization - 117:23 nonmalignant 63:22 nonpulmonary 117:7 nonsignificant 97:16, 123:22 nonspecific 119:18 normal - 102:23 normally - 28:15, 28:17, 95:10 north - 7:19 null - 17:7, 105:18, 118:10, 124:7 number - 7:5, 22:23, 23:1, 31:14, 54:8, 66:20, 71:4, 91:23, 97:20, 99:22, 99:23, 108:2, 108:7, 122:23, 124:16 numbers - 18:15, 20:16, 20:18, 27:4, 85:16, 87:11, 90:11, 92:17, 92:19, 92:21, 107:18, 108:13, 108:14, 108:16, 112:20, 125:16 numerator - 22:8 O o'clock - 128:11 oath - 5:8 objection - 40:18, 40:21 obliterate - 56:20 obscured - 97:20, 101:21 observation 37:17, 58:1 observational 113:20 observations 12:14 observe - 55:15, 57:23, 58:2 observed - 22:23, 37:14, 37:17, 37:19, 51:4, 55:21, 110:22 observer - 100:1 obviously - 47:10 occasion - 9:19 occasions - 8:12 occupation - 33:3, 52:8, 62:21, 102:23, 118:15 occupational 6:15, 7:15, 29:22, 30:6, 32:23, 33:10, 34:13, 55:9, 55:13, 55:16, 66:13, 66:14, 67:2, 67:9, 68:18, 72:6, 97:19, 97:20, 97:22, 97:23, 102:9, 104:15, 104:19, 106:5, 106:19, 106:23, 118:2, 119:22, 124:4, 127:7 Occupational - 7:1, 34:12 occupations 67:17, 103:6, 103:12, 103:14, 117:9, 117:10, 117:12, 124:5, 124:8, 124:15, 125:15 occur - 23:22, 26:19, 39:22, 41:19, 44:14, 65:6, 65:13, 73:10, 85:18, 107:6, 110:16, 127:12 occurred - 67:23, 89:9, 99:8 occurring - 15:16, 24:8, 51:17, 60:6, 65:22, 82:11, 123:1 occurs - 78:7, 78:13, 78:18, 78:20 October- 2:1, 129:12 odds - 19:20, 19:22, 19:23, 23:17, 71:5, 71:7, 71:10, 71:13, 92:23, 93:7, 93:9, 117:12, 123:19 Odds- 19:22 offers - 115:3 Office - 129:10 office - 4:17 Official - 129:4, 129:16 often - 15:23, 39:12, 56:8, 65:5, 65:8, 77:18, 103:5, 103:7, 105:4, 114:18 oftentimes - 20:4 Oi - 2:18 old - 77:6, 79:20 older - 106:1 oldest - 20:2 omitted - 79:5, 104:7 Once - 17:23 once - 61:21, 123:8, 125:5 one - 4:3, 10:20, 16:16, 17:17, 20:1, 20:21, 20:22, 21:1, 21:12, 21:13, 24:3, 24:4, 28:12, 30:2, 30:3, 35:18, 35:19, 35:20, 37:12, 38:23, 39:10, 39:16, 39:17, 41:4, 41:6, 41:7, 43:8, 43:11, 43:17, 43:20, 43:21, 43:23, 56:10, 58:6, 58:23, 59:16, 61:4, 63:11, 63:22, 64:4, 66:17, 70:16, 74:3, 74:5, 74:17, 9 75:13, 75:16, 75:20, 75:21, 76:1, 80:9, 85:14, 87:19, 89:3, 93:4, 96:6, 96:14, 96:22, 97:1, 99:9, 101:8, 101:12, 102:4, 106:4, 107:3, 109:15, 109:20, 110:7, 110:8, 111:23, 112:20, 113:2, 116:20, 116:21, 117:22, 120:1, 120:3, 120:11, 120:21, 121:11, 121:16, 121:17, 123:15, 124:19, 126:1, 126:6 One - 29:14, 33:21, 66:9, 117:15, 119:4, 124:2 one's - 42:19 ones - 43:21, 55:8, 61:19, 68:19, 104:8, 124:12 operation - 86:6 operations - 72:19 Opinion - 106:9, 106:10 opinion - 31:3, 41:4, 42:1, 50:6, 50:9, 50:10, 51:2, 52:3, 52:6, 62:22, 63:5, 67:8, 67:20, 69:7, 73:21, 75:9, 91:7, 93:21, 96:20, 96:21, 99:21, 101:4, 101:15, 109:9, 110:3, 116:13, 118:19, 118:22, 120:5, 120:18, 127:14 opinions - 13:11, 13:21, 28:11, 28:22, 29:5, 36:11, 107:15, 116:9, 116:17 opportunity - 73:12, 94:4, 94:14, 95:4, 102:19, 109:2, 111:7 opposed - 71:23 order - 32:7 Organization - 49:3, 49:12 original - 109:12, 112:16, 113:18 originally - 109:10, 121:5 Osha - 48:10, 80:10, 82:6, 83:14, 85:2, 85:7, 85:8, 89:1, 89:4 otherwise - 12:17 ought - 60:13 outs - 79:21, 81:21 outside - 50:21, 118:16, 118:17 overall - 56:18, 86:8, 86:10, 94:9, 109:16, 111:10, 112:6, 112:10, 117:12, 121:16 overreported - 98:4 oversimplify - 19:3 overstatements 114:18 overview - 5:18, 5:19 own - 37:15, 74:15, 103:23, 104:20 P pad - 77:20 pads - 77:11 page - 24:23, 25:5, 108:20 Panatier - 2:5 paper - 26:8, 26:10, 26:12, 26:15, 27:1, 27:2, 27:7, 27:14, 27:18, 28:1, 28:9, 43:10, 51:15, 51:22, 70:12, 70:14, 70:17, 72:5, 72:9, 72:14, 80:4, 85:13, 85:20, 88:4, 88:15, 90:6, 90:14, 90:21, 96:15, 98:19, 98:21, 99:2, 100:1, 100:7, 101:11, 101:23, 107:6, 108:2, 109:21, 111:8, 111:11, 111:12, 112:15, 114:6, 115:10, 116:22, 118:20, 120:4, 120:19, 120:20, 120:21, 120:22, 121:23, 122:1, 125:8, 125:12, 125:14, 125:21 papers - 70:13, 70:16, 71:2, 85:14, 89:6, 89:11, 89:16, 114:16, 126:1 paragraph - 26:23, 27:10, 106:16 part - 10:20, 15:7, 25:1, 42:10, 54:16, 107:12, 109:16, 109:20, 114:17 particular - 10:17, 10:23, 11:19, 29:18, 29:19, 37:4, 77:16 particularly - 94:22, 102:11, 102:21, 103:1, 111:2 parts - 9:5, 86:6 passenger - 86:23 past - 29:18 pathological 32:13 patient - 33:1, 33:2, 102:20 patients - 99:16, 113:2, 113:3, 113:9 Patty - 9:12 Paustenbach 90:12, 90:14, 90:17, 90:21, 92:1, 92:20 Paustenbach's - 90:5, 92:16 Pc - 2:6 Pcm - 91:20 peak - 81:3, 81:22, 82:9, 82:13, 82:17, 82:18, 82:21, 83:18, 84:1, 84:2, 84:3, 84:4, 86:6, 86:14, 86:16, 94:2, 94:10 peer - 9:21, 10:3, 14:12, 26:2, 36:10, 62:19 Pel - 82:6, 82:16, 82:19, 85:2, 86:19 Pennsylvania 17:16, 57:19 people - 15:16, 15:17, 17:19, 53:22, 55:11, 55:13, 55:14, 55:17, 56:4, 56:9, 57:2, 57:6, 58:10, 58:14, 59:22, 61:13, 65:22, 66:1, 66:3, 68:5, 68:21, 80:19, 88:1, 95:10, 95:13, 103:1, 106:13 Pepple - 2:17 per - 21:13, 71:5, 71:14, 71:22, 71:23, 81:5, 81:6, 85:10, 101:8 percent - 23:20, 23:22, 30:10, 56:16, 63:14, 91:17, 91:18, 91:19, 95:13, 95:15, 95:23, 97:17, 117:14, 121:3, 122:1, 122:3, 122:17 perfect - 57:16 performing - 114:14 perhaps - 109:5, 110:9, 114:18 period - 57:6, 58:1, 86:17, 89:4, 92:13 periods - 82:10, 83:1, 103:20 periphery - 55:15 peritoneal - 122:14 permanent - 7:11 permissible - 82:7 Perry - 3:5 persistence - 116:5 person - 7:5, 52:17, 53:5, 55:21, 102:16, 103:8, 104:22, 105:13, 105:21, 106:1, 121:21 personnel - 62:6 persons - 52:18, 56:20, 102:19 perspectives 11:22 pertained - 34:16 pharmaceutical 112:23 Phd - 5:6, 7:22, 8:3 phrase - 52:20, 76:18 physician - 32:21 picks - 118:17 picture - 8:20, 9:8, 109:16 pipe - 54:9, 54:10 pipecovering - 54:2 place - 21:17, 62:18, 78:13, 92:3, 92:7, 92:10 placebo - 113:4 placed - 106:14 places - 87:16 Plaintiff - 5:7 Plaintiffs - 2:11 plaintiffs - 5:4 plan - 4:15 plant - 17:16, 55:12, 57:18 plants - 6:10, 6:13, 6:16 plausibility - 35:5, 36:19, 36:22, 40:9, 40:10 pleural - 107:8, 122:11, 122:14 Pllc - 2:17 Pm - 1:16, 2:2 Pmrs - 68:15 point - 14:14, 17:20, 29:21, 75:21, 76:1, 78:16, 115:7, 123:5, 125:19, 126:21 Point - 40:19 pointed - 51:20, 98:6 points - 18:16, 75:17, 117:3 polarized - 91:3, 91:14 population - 18:11, 19:14, 56:16, 58:8, 58:10, 58:14, 60:6, 93:10, 95:15, 95:21, 101:18, 105:2, 105:4, 105:5, 105:10, 105:11, 105:14, 105:16, 108:9, 108:11, 113:15, 113:17, 117:17, 117:19, 117:22 populations - 45:6, 45:7, 56:11 position - 7:11, 46:21, 49:22, 50:1, 52:11 positive - 17:7, 20:23, 111:20 possibility - 60:6 posted - 81:14 potency - 43:16, 43:18, 44:8, 44:13 potent - 42:23, 44:4, 44:7 potential - 109:23 potentially - 123:3 Potter - 2:15 pounded - 53:6 poured - 79:1 pout - 84:11 Power - 40:19 power - 37:10, 37:11, 58:6, 58:7, 58:11 powerfully - 115:2 practical - 106:19 practiced - 15:6, 67:7 practicing - 6:18, 93:22 preceding - 27:5 precisely - 115:8 precision - 114:19 predominantly 45:11 prepared - 49:20, 55:7, 65:18, 67:18 presence - 76:4 Present - 3:1 present - 7:21, 14:9, 25:6, 25:9, 49:16, 60:1, 76:7, 78:21, 81:7, 81:8 presentation 14:21, 40:19, 43:9, 73:22, 91:15 presented - 25:11, 25:15, 60:2 preserved - 81:8 pressure - 54:14 pretty - 7:20, 19:10, 44:6, 79:16, 126:4 prevalence - 64:5, 64:16 prevalent - 103:13 prevent - 113:6 preventative - 6:1, 62:17 preventing - 87:3 Prevention - 7:8 previous - 56:14 previously - 13:3, 21:4, 33:18 Price - 2:15 principal - 30:2, 30:3 principles - 12:4 printed - 25:21 private - 7:20 probability - 13:23 probable - 94:9 problem - 61:17, 113:22, 119:19, 122:18, 122:20 problems - 39:7, 103:11, 112:12, 113:21, 114:11, 115:8, 119:4, 119:5, 119:7, 119:12, 119:14, 120:13, 120:14, 120:16, 120:17, 123:8, 125:5, 125:6 procedures - 81:10 proceed - 5:3 proceeding - 111:5 proceedings 129:7 process - 13:8, 13:13, 13:15, 29:10, 76:11 processes - 11:23, 77:22 produce - 81:9 product - 80:13 products - 5:14, 10:3, 13:11, 51:9, 51:11, 51:13, 52:10, 53:12, 53:15, 53:17, 54:4, 59:6, 63:7, 67:22, 69:8, 72:12, 73:2, 73:19, 75:7, 77:1, 79:6, 79:7, 79:11, 109:17, 110:5, 116:2, 116:16, 125:10 Products - 48:16 professor - 114:7 program - 33:20 Program - 48:19 prohibitive - 61:5 projects - 85:8 promise - 114:8 promoted - 8:23 proof - 62:2 proofs - 26:18, 27:10, 27:12, 27:22 properly - 17:5, 65:9, 118:23 proportion - 76:6 proposed - 37:19, 51:3 protect - 6:22, 84:9, 84:15 protecting - 84:8 protection - 85:2, 85:3 Protection - 49:14 Prothonotary 129:10 proven - 44:20 provide - 106:18 provided - 75:18 pry - 77:19 public - 5:20, 6:14 Public - 6:3, 6:5, 17:13, 47:11 publication - 26:20, 26:22 publications - 26:1, 32:11, 34:5 publish - 14:11 published - 9:21, 10:2, 22:15, 23:7, 26:2, 26:16, 28:1, 36:10, 57:18, 57:19, 70:13, 94:23, 96:15, 110:19, 111:7 publisher - 26:19 10 puissant - 19:12 pull - 15:17, 17:23, 112:20 pulmonary - 117:6 purported - 59:4, 94:16, 110:4 purpose - 27:9, 113:18, 125:23 put - 9:13, 14:11, 14:21, 23:23, 27:22, 28:7, 30:5, 32:14, 33:16, 33:23, 34:7, 34:23, 35:2, 35:7, 35:14, 35:16, 35:17, 55:6, 60:8, 60:9, 60:18, 61:5, 61:14, 62:16, 62:18, 64:23, 68:12, 73:22, 80:20, 81:12, 81:13, 82:5, 84:2, 84:13, 84:15, 84:23, 85:2, 87:9, 91:2, 92:1, 109:18 puts - 93:5 putting - 32:15, 52:17, 66:1, 109:21, 114:2, 120:10 Q qualifications 5:16 qualify - 111:21 questioned - 43:14 questions - 24:20, 25:10, 40:3 quick - 23:14, 36:18 quicker - 12:13, 12:16 quickly - 23:13, 50:23 quite - 9:11, 16:10, 31:6, 36:8, 54:15, 60:11, 80:2, 86:7, 124:11 quotes - 75:15 R race - 15:19, 18:7 radar - 68:7 radiation - 31:10, 31:15, 31:19, 31:22 radio - 71:10, 71:13 raise - 60:5 Raise- 67:2 raised - 93:9 Ramazini- 32:22 ran - 113:20 range - 78:20, 81:4, 86:3, 92:20, 93:8, 93:15, 93:17, 93:18, 94:1 ranged - 86:21, 112:4 ranges - 70:22, 89:21, 89:22, 90:1 ranking - 114:3, 120:10 rare - 14:22, 15:2, 21:22, 22:4, 29:23, 30:13, 30:15, 30:23, 126:5 rarity - 58:6 rate - 20:7, 21:6, 22:5, 22:17, 54:3, 123:3 rather - 35:18 Ratio- 22:20 ratio - 19:22, 20:7, 20:12, 20:13, 23:17, 71:7, 92:23, 93:7, 93:9, 117:12, 123:19 ration - 19:20 ratios - 71:5 ray - 63:16, 63:18, 64:5, 64:17, 65:12 re - 36:6 Re- 1:6 re-writing - 36:6 reach - 114:22 reaching - 29:5, 50:10, 50:13, 50:17 react - 12:4 reactions - 12:15, 38:8 read - 19:19, 28:4, 28:17, 40:13, 40:22, 75:15, 106:16, 106:17, 106:20, 111:12, 111:22 reader - 27:1, 27:16, 27:18 reading - 27:2 ready - 5:3, 65:10 real - 23:14, 36:18, 74:10, 91:13, 123:5 Real- 23:13, 50:23 reality - 24:11 really - 10:12, 14:7, 14:15, 22:10, 27:12, 27:20, 37:11, 53:5, 54:10, 55:15, 55:17, 56:20, 58:22, 58:23, 61:16, 61:17, 61:20, 76:9, 95:22, 96:1, 99:4, 100:13, 121:18, 121:20, 123:5, 127:12 Reardon- 3:4 reason - 29:14, 73:7, 113:8 reasonable - 13:16, 13:22, 104:16, 126:8 reasoning - 109:18 reasons - 29:14, 62:5 receive - 76:23 received - 6:4 recent - 28:6, 57:7, 103:6, 110:3 recently - 24:22, 65:20, 95:1, 108:21 recess - 4:1, 69:14, 69:16, 128:19 recognized - 30:3, 45:20 recognizes - 46:19 recommendation 34:3, 84:23 recommendations 6:21,33:21 recommended 81:13, 84:13, 84:14 record - 23:14, 25:15, 36:19, 40:20, 129:10 recorded - 92:20 redo - 28:9 reduce - 60:13, 60:14, 61:6, 61:9, 84:19 reduced - 61:15, 61:16, 92:5 reducing - 60:14 Reese- 3:3 reexamination - 109:5 refer - 27:14 reference - 24:21, 26:22, 26:23, 27:5, 27:22 referenced - 24:23, 38:9, 88:5 references - 25:5, 27:7, 27:17, 27:18, 27:21 referred - 28:5, 76:15 refers - 27:1 refine - 16:5 reflect - 19:12 regard - 9:22, 28:22, 57:13, 109:17, 110:8, 123:2 regarding - 9:5, 36:15 regards - 8:1 registry - 100:9, 101:13 Registry- 49:6, 97:14, 109:20 regulatory - 48:2, 91:11 Rel- 84:14 relate - 110:14 related - 39:3, 63:17, 64:1, 85:9, 127:23 relates - 86:1, 110:12 relating - 38:5 relation - 23:10 relationship - 42:17 relationships 14:20 relative - 20:5, 20:6, 20:10, 20:14, 20:20, 21:18, 22:1, 22:12, 22:14, 22:22, 23:18, 24:2, 30:22, 43:15, 43:17, 44:8, 74:17, 74:18, 97:16 Relative- 20:7 relatively - 70:21, 73:4 relatives - 20:17, 21:3 release - 87:18, 88:8 released - 88:20, 88:21 reliable - 34:10, 36:3, 50:12, 73:17, 106:18, 116:14 rely - 64:3, 65:15 remains - 129:9 remember - 25:7 remembered - 93:1 removed - 79:20 removing - 77:6, 77:17 repair - 64:9, 64:15, 69:2, 97:15, 109:23, 123:21 repaired - 64:6, 64:7, 64:13 repairs - 69:3 repeated - 52:20 repeatedly - 37:19, 51:4 replacement 107:7 report - 14:6, 14:7, 14:18, 15:1, 30:17, 30:23, 31:1, 35:17, 39:8, 49:17, 80:17, 80:21, 85:23, 94:16, 99:5, 99:9, 99:12, 106:11, 107:5, 107:20, 107:22, 122:16 reported - 30:16, 68:1, 80:22, 80:23, 81:2, 85:15, 87:6, 89:19, 96:3, 96:5, 98:23, 100:9, 102:5, 103:21, 107:23, 108:6, 108:8, 109:10, 121:5, 129:7 Reporters- 1:21 reporting - 89:22, 123:4, 125:3, 125:4 reports - 14:5, 14:23, 15:7, 19:19, 29:7, 29:8, 29:11, 29:22, 30:19, 31:7, 31:17, 31:23, 47:20, 51:12, 51:16, 51:21, 90:12, 98:22, 111:11, 115:5 representation 122:23 representative 99:7, 117:16 represented - 7:2, 90:23, 121:3 represents - 122:1 request - 9:15 requires - 115:14 research - 29:21, 115:4 Research- 48:14, 49:17 researchers - 90:20 resort - 102:20 respirable - 52:16 response - 15:4, 63:23, 70:6, 70:7, 71:16, 71:18, 75:4, 86:12, 90:10, 92:16, 123:3 responses - 102:8 rest - 112:9 restrictive - 63:18 result - 17:6, 60:8, 124:6 resulted - 62:9 results - 16:15, 57:5, 57:9, 57:10, 57:13, 92:15, 96:17, 101:21, 105:17, 114:19, 118:9 resumed - 4:1 retired - 7:12, 7:18 return - 69:15, 128:10 revealing - 89:8 reverted - 7:10 review - 9:21, 10:9, 14:12, 26:3, 29:18, 32:11, 62:20, 89:13, 90:20, 94:14, 95:4, 104:22, 109:2, 111:8 reviewed - 10:4, 36:10, 92:1 revision - 25:23 revisit - 31:8, 106:7 Richard- 3:7, 5:5, 5:6 risk - 10:13, 11:12, 11:14, 11:20, 16:17, 19:5, 19:8, 20:5, 20:6, 20:7, 20:10, 20:14, 20:17, 20:20, 21:3, 21:18, 22:1, 22:12, 22:14, 22:22, 23:2, 23:9, 23:18, 24:2, 42:19, 45:12, 46:3, 52:16, 52:18, 54:5, 55:18, 56:9, 56:13, 56:19, 60:17, 61:9, 63:1, 63:7, 67:12, 68:2, 68:4, 69:10, 70:11, 74:9, 74:13, 74:17, 74:18, 74:22, 82:16, 83:3, 85:5, 85:8, 85:11, 88:2, 94:8, 94:12, 94:16, 95:22, 96:16, 97:16, 108:4, 108:7, 108:16, 109:10, 109:12, 109:13, 109:14, 110:4, 111:16, 112:7, 124:3, 124:6, 124:8, 125:9, 126:22, 127:4 Risk- 26:4 risks - 13:12, 44:21, 67:19, 68:20, 124:10 Robert- 120:23 Rockville- 59:23 Rodelsperger98:18, 98:23 Rodessperger100:18 Rogers- 46:1 role - 76:2 Roll- 85:12, 85:13, 85:15 rooms - 8:11 Rpr- 1:20, 129:15 rubric - 64:10 run - 36:18 Rushton- 95:3, 95:4 S Safety - 7:1, 48:16 salesman - 100:11 sample - 119:20, 122:3 samples - 86:4, 90:18, 91:1, 92:12 Samuel - 2:12 sanitarian - 5:22 satisfied - 40:11, 41:3, 42:7, 45:17, 46:7, 46:9, 51:1 saw - 107:22, 110:21 schedule - 128:14 scheduling - 4:4 Schmidt- 2:17 school - 6:2, 19:2 schools - 62:20 science - 19:3 Sciences - 49:8 scientific - 13:16, 13:22, 23:7, 26:1, 28:10, 28:17, 31:11, 31:23, 35:23, 36:4, 41:9, 41:13, 41:19, 76:22, 79:15 scientifically 50:12, 73:17, 116:13, 116:14, 123:5 scientist - 48:2, 73:16, 75:8 scientists - 13:17, 33:17, 33:22, 34:4, 46:22, 50:12 score - 111:22, 111:23 scores - 111:20, 112:2, 112:4 scoring - 111:20, 126:1 Scott - 3:3 screen - 9:8, 48:6, 55:7, 68:7, 108:18 sealing - 89:1, 89:3 second - 77:17, 11 84:2, 93:5 secondly - 61:5 Secondly - 29:20, 65:2, 118:2, 124:5 secretaries - 55:14 secretary - 118:6 sector - 100:10, 100:12 see - 17:19, 18:9, 26:22, 27:3, 27:6, 37:4, 40:15, 47:7, 59:16, 62:14, 62:17, 67:19, 90:9, 91:15, 92:14, 93:17, 95:10, 97:17, 117:15, 119:2, 120:1, 120:8, 125:7, 126:21 seeing - 29:16 Seelaus - 3:5 seem - 104:16, 126:8 Seer - 121:1, 121:5, 121:22, 122:2, 122:19, 122:20, 122:22, 123:4 selected - 7:4, 7:9 selection - 57:4 Selikoff - 22:13, 22:16, 22:18, 53:1, 53:5, 59:19, 60:2, 64:4, 65:6, 65:16, 67:14 Selikoff's - 59:22, 63:12, 64:12, 65:2, 80:19 Senate - 9:12, 9:18 Senator - 9:12, 47:3 sensitive - 37:11 sent - 60:18, 87:15 sentence - 27:13 Sentinel - 29:23 sentinel - 30:5, 30:6, 30:7, 30:8, 30:11, 30:18, 126:7 separate - 37:15 September - 108:22 series - 14:8, 31:22 serpentines - 43:2 served - 5:23 serves - 14:15, 88:5 Service - 6:3, 6:5, 17:13, 47:11 service - 7:12 Services - 48:22 services - 6:14 servicing - 81:10 Session - 1:16 set - 35:15, 52:9, 111:21, 112:20 seven - 72:22, 112:2, 112:4, 123:15 seventh - 123:12, 124:19 several - 8:12, 9:10, 11:22, 15:14, 26:20, 29:14, 43:20, 62:5, 102:6, 124:1 Several - 63:11, 102:12 sex - 15:19, 18:7 shade - 103:15, 103:22, 104:3, 104:17 shape - 77:13 share - 114:9, 114:10 shift - 66:5, 82:8, 82:11 ship - 69:2 shipyard - 121:9 ^hipyard^^9^^ shirt - 4:23, 5:1 shoes - 79:2, 88:8, 103:23, 104:7 shop - 61:1, 69:4 shops - 60:22 short - 69:16, 83:1, 96:1, 96:7, 102:6, 103:19 shorter - 56:21 show - 37:11, 44:3, 45:12, 53:22, 58:11, 68:15, 71:7, 80:2, 89:17, 111:15, 112:11, 126:23 showed - 44:20, 60:4, 63:18, 64:5, 65:21, 74:17, 79:10, 89:19, 102:4 showing - 62:16, 63:19, 78:22, 89:7, 108:20 shown - 41:18, 45:6, 51:7, 67:18, 73:23, 89:6, 108:18, 127:22 shows - 42:2, 43:9, 63:22, 74:12, 74:15, 88:19, 90:2 sick - 117:18 signed - 80:21, 108:21 significance 14:11, 23:15, 23:16, 71:7, 82:22, 107:19 significant - 24:5, 31:17, 65:3, 70:15, 74:1, 81:9, 86:8, 86:11, 92:23, 93:7, 93:8, 93:13, 93:15, 93:19, 99:22, 99:23, 100:5, 101:4, 101:6, 101:9, 117:13, 123:20 signs - 63:21 silicate - 54:2 similar - 9:17, 35:15, 38:19, 39:3 Similar - 87:8 simple - 22:7 simplifying - 97:2 simplistic - 20:19, 20:20, 21:2, 76:14 Simply- 54:8 Singewald - 3:2 single - 39:2, 107:7 sit - 34:6, 40:22 situation - 126:12 situations - 14:22, 51:8 six - 74:18, 95:18, 96:8, 100:22, 101:2, 123:18 size - 119:20, 124:2 skew - 57:5, 57:9, 57:12, 105:17, 118:9 skewed - 57:5, 103:5 slide - 35:5, 41:8, 45:6, 45:14, 65:18, 69:2, 70:22, 96:7 slides - 10:10, 15:5, 55:7, 67:18, 69:6, 78:22, 79:4, 79:10, 112:9, 127:22 Slights - 1:11, 5:16, 11:9 small - 56:20, 60:22, 66:19, 72:19, 73:4, 90:2, 98:16, 119:20, 122:3, 124:2, 125:16 smaller - 89:17 smelters - 6:16 smoke - 42:18 smoking - 16:17, 16:19, 16:21, 35:17, 39:4, 39:5, 39:9, 42:17, 101:18, 102:10 Smr - 22:20 so-called - 64:9 Society - 49:1 sole - 75:22 solely - 109:6 someone - 13:20, 31:2, 54:1,54:3, 104:14, 116:8, 116:14, 118:17 Somers - 2:15 sometimes - 16:7, 77:19 Sometimes - 77:14 somewhat - 5:17, 44:9 somewhere - 33:18 Somewhere - 72:18 Sorry - 37:7 sorry - 79:3, 94:4 sort - 15:23 sound - 116:13 sounds - 128:13 specialist - 6:1 specific - 10:11, 10:21, 11:2, 11:5, 11:9, 28:11, 32:3, 32:16, 33:8, 34:8, 52:8, 62:22, 66:16, 67:17, 68:14, 76:10, 118:4, 122:9 specifically - 24:23 Specifically - 25:4, 75:17 specificity - 38:21 Specificity - 38:23, 46:11 specifics - 13:1 speculative 125:18 spend - 24:19, 61:10 spending - 70:3 spent - 6:9 Spillane - 2:5, 5:4, 5:10, 40:17, 41:1, 57:11, 59:2, 69:12, 70:1, 70:2, 98:14, 128:4, 128:6 Spiritus - 120:23, 121:7 spread - 87:23 staff - 90:21 stand - 35:8 Standard - 6:20 standard - 19:10, 20:12, 20:13, 52:9, 83:15, 83:23, 84:1, 84:23, 85:7, 85:11, 89:5 Standardized 22:20 Standards - 88:6 standards - 6:22, 52:8 start - 32:9, 61:19, 83:12, 83:21 started - 5:20, 5:21, 6:6, 6:7, 7:13, 7:15, 7:16, 17:13, 61:19, 61:21, 61:22, 76:10, 112:22 starts - 14:19 state - 96:16, 107:5, 109:1 State - 1:1, 19:14, 129:5, 129:8 statement - 32:7, 53:8, 53:10, 125:13, 126:3, 128:1 statements - 11:6, 48:7 states - 27:6, 43:15 States - 5:23, 6:3, 6:10, 8:18, 9:14, 9:18, 19:14, 35:15, 46:18, 46:22, 47:2, 47:10, 48:16, 48:21, 49:10, 60:10, 121:4, 122:4 Statistical - 23:16 statistical - 18:19, 18:20, 23:14, 23:17 statistically - 18:18, 19:16, 24:5 statistician - 35:1, 115:15 status - 17:19, 17:22 Stayner - 43:10, 43:11 stays - 73:14 Stenographer 129:1, 129:16 Stenographers 129:4 step - 63:3, 96:14 Steven - 2:17 still - 9:2, 47:4, 67:5, 78:4, 81:16, 81:18, 82:20, 85:8, 94:11, 95:14, 95:21, 96:20, 96:21, 109:13, 110:3, 110:6, 119:10, 128:11, 128:12 stop - 42:11, 47:5, 58:18 stopped - 47:8 Street - 1:22 strength - 35:6, 37:8, 42:6, 42:7, 114:19 strong - 58:23, 95:20 struck - 31:1 structures - 88:21 stuck - 77:18 studied - 10:19, 66:20, 66:23, 67:4, 67:6, 67:9 studies - 6:11, 6:12, 6:15, 11:17, 11:18, 12:6, 12:8, 14:3, 15:11, 16:4, 17:10, 17:14, 18:3, 19:11, 20:4, 20:11, 20:15, 22:1, 22:12, 22:16, 22:23, 31:16, 31:21, 38:5, 38:6, 38:15, 44:2, 44:19, 45:1, 45:10, 47:14, 47:16, 51:7, 53:22, 54:17, 54:18, 54:21, 54:22, 55:9, 55:20, 56:1, 58:8, 59:1, 59:3, 59:8, 59:14, 59:15, 61:11, 61:19, 62:6, 62:9, 62:21, 63:11, 64:5, 64:8, 64:19, 65:15, 66:6, 66:8, 68:14, 73:23, 78:3, 80:1, 80:8, 88:19, 89:18, 96:17, 97:4, 97:7, 105:2, 109:15, 110:4, 110:9, 111:15,_______ 111:17, 111:19, 111:21, 112:2, 112:10, 112:19, 113:20, 114:3, 114:4, 115:21, 116:21, 119:6, 120:2, 120:4, 120:7, 120:10, 120:13, 123:14, 123:15, 126:21, 128:3 study - 15:12, 15:13, 15:14, 16:15, 17:6, 17:11, 18:2, 18:4, 18:12, 18:22, 19:1, 20:12, 20:14, 27:20, 28:3, 31:7, 37:10, 43:9, 55:1, 55:6, 55:17, 57:4, 57:14, 57:17, 57:20, 59:4, 59:10, 60:21, 61:3, 61:4, 61:17, 62:13, 63:13, 63:22, 64:2, 64:3, 65:18, 65:20, 72:2, 74:11, 74:12, 74:14, 74:15, 74:16, 79:23, 80:1, 80:10, 80:15, 85:12, 88:12, 89:19, 90:12, 92:19, 92:20, 95:3, 95:5, 95:7, 95:8, 95:14, 95:15, 95:19, 96:5, 97:9, 97:13, 98:3, 100:16, 100:22, 101:15, 102:6, 104:14, 106:3, 107:1, 107:4, 107:11, 107:13, 110:9, 110:19, 112:16, 112:17, 117:2, 117:9, 119:15, 119:16, 119:22, 121:20, 123:10, 123:16, 123:23, 124:2, 124:10 studying - 31:13 sub - 56:3 sub-jobs - 56:3 subject - 29:7, 57:12 subjects - 57:4, 110:15 submit - 40:18, 51:19 submitted - 19:20, 51:19 substance - 10:18, 11:2, 11:19, 11:22, 12:1, 12:4, 29:19, 38:7, 38:16, 115:13, 115:23, 116:2, 116:10 Substances - 49:5 substances - 38:19 substantially 27:13 suffer - 59:9, 60:23, 97:4, 103:11 suffering - 61:17 sufficient - 88:23 suitable - 61:16, 62:7 sum - 75:2, 126:11 summarize - 111:10 summarized - 115:7 summarizing 114:16 summary - 109:21 sums - 46:1, 126:10 Superior - 1:1, 1:21, 129:5, 129:7 support - 9:15 supported - 112:7 ^upgose^^5:^^^ 12 113:6, 113:7 supposedly - 65:10 Surgeon - 8:17, 8:22, 9:1, 35:15, 39:7, 49:10 surrounding - 24:1 surveillance 121:2, 126:7 survey - 68:17 surveys - 66:13, 68:12 Swedish - 101:13 sworn - 5:8 symptoms - 63:21 synergistic - 43:4, 75:1 system - 111:21, 122:5, 122:6, 122:18 T table - 18:12, 108:10 tact - 78:4 tail - 18:21 talks - 20:8, 43:12 Tarry- 2:12, 4:11, 8:11, 24:19, 25:9, 28:12, 28:14, 40:21 Tata- 51:19 taught - 7:14, 12:11 Taurus- 31:1 teaching - 7:13 team - 117:5 technology - 19:10 Technology- 6:20 temporal - 57:7 temporality - 39:20, 46:13 ten - 25:17, 56:12, 56:17, 57:21, 69:15, 71:14, 91:19, 102:7, 110:20, 110:22 tend - 43:21, 105:21 tended - 65:13 tendency - 105:17 tends - 45:19, 103:12 tenfold - 108:1 Tenth- 122:8, 122:11 term - 10:13, 16:9, 81:23, 103:15 terms - 4:4, 13:22, 19:4, 22:7, 92:15 Terry- 4:6 Teschke- 123:10, 123:11, 124:10, 125:11, 125:13, 126:3 test - 79:1 testified - 5:8, 9:11, 23:8, 76:8 testify - 9:14, 111:5 testifying - 7:16, 7:18 testimony - 7:21, 9:5, 9:16, 9:18, 24:18, 32:18 tests - 23:17, 63:18 Teta- 97:9, 97:13, 119:16, 120:16 text - 29:6 textbook - 24:21, 25:11, 27:15, 27:19, 29:21, 31:5 textbooks - 31:18 textile - 51:8, 57:18 texts - 117:21 theirs - 87:10 themselves - 35:9, 90:22, 94:21, 97:18, 98:6, 102:20, 105:21 theoretically 118:5 theory - 37:1, 82:6 therapeutic - 31:9, 31:10, 31:15, 31:19, 31:22 thereabouts - 59:19 therefore - 74:9, 113:14, 125:16, 126:6 thin - 91:13 third - 93:4, 124:18, 124:20, 124:22 thirds - 124:21 Thomas- 2:10 thousand - 17:16, 66:11, 85:10 three - 6:9, 14:4, 17:16, 45:14, 66:11, 85:9, 85:10, 112:2, 112:3, 119:23 threshold - 82:1, 83:5, 83:9, 84:6 throat - 98:9 throughout - 6:10, 6:15, 13:17, 48:2, 50:13, 52:21, 99:8, 121:4 throw - 127:3, 127:7 throwing - 127:10, 127:11 thrown - 125:23 Thursday- 4:10, 128:12 tier - 111:23, 116:20, 120:3, 120:11, 123:14, 128:3 tissue - 74:18, 74:19, 127:6 title - 52:19, 53:12, 55:10, 55:11, 55:16, 56:2, 66:17, 67:9, 67:15, 67:16 titles - 66:17, 66:18, 67:1,68:18 Tlv- 82:1, 82:4, 82:16, 82:19, 84:11, 86:19 today - 4:8, 4:20, 5:1, 5:19, 7:17, 8:13, 9:17, 11:8, 11:11, 13:10, 13:21, 14:22, 29:6, 31:6, 32:18, 32:23, 36:6, 39:19, 39:23, 61:18, 61:20, 73:23, 83:13, 107:13, 107:14, 128:14 today's - 35:11 together - 8:8, 14:21, 15:17, 32:15, 33:16, 33:22, 33:23, 34:1, 34:2, 34:4, 34:7, 34:23, 35:2, 35:7, 43:2, 59:23, 68:12, 75:1, 75:2, 80:18, 90:20, 91:2, 92:1, 109:22 toilets - 118:7 tomorrow - 4:12, 4:20, 128:12 took - 13:7, 62:4, 90:18, 91:20 top - 24:12 total - 74:6, 104:22, 122:23 totally - 4:8 touch - 24:16, 32:3, 69:1, 72:3, 78:6, 81:21, 96:6, 99:11, 110:7, 110:9 Touch- 5:17, 10:9 touched - 8:16, 80:9, 102:12, 107:14, 110:7, 119:15 toward - 118:10 towards - 105:17, 124:7 Toxic- 49:5 toxicity - 12:9 toxicological 12:8, 32:12, 47:14 Toxicology- 48:19 trace - 17:19 traced - 30:10, 95:12 Trade- 49:3 trades - 72:17, 73:5, 73:6 traditionally - 68:5 trained - 15:6, 67:7, 93:21, 116:7 training - 12:18, 79:15 transcript - 129:6 Transcript- 1:15 Transfer- 6:20 Transit- 95:9 transmission 78:23 tree - 103:15, 103:22, 104:3, 104:17 tremendously 113:13 tremolite - 45:4 trial - 4:1 trials - 113:1 tried - 109:20 trivial - 109:14 trouble - 124:13 truck - 93:11 trucks - 86:1 true - 8:3, 10:15, 17:2, 21:9, 23:12, 26:1, 49:22, 49:23, 68:16, 97:20, 105:8, 110:6 truly - 116:10 truth - 115:4 try - 4:11, 15:18, 16:18, 18:1, 18:14, 19:15, 114:1, 120:12 trying - 15:8, 110:17, 113:21, 114:4, 124:13 Tumor- 97:13, 109:19 tumor - 30:15 tumors - 30:13 turn - 111:4 twice - 108:8 two - 5:23, 6:9, 7:5, 18:21, 21:13, 37:16, 72:16, 75:1, 75:2, 77:4, 77:22, 82:23, 101:8, 112:5, 114:20, 120:3, 120:11, 123:21, 124:21, 128:3 Two- 75:23 two-tail-type 18:21 two-thirds - 124:21 type - 13:12, 18:21, 19:9, 19:15, 32:6, 38:9, 45:5, 48:1, 50:20, 81:11, 85:23, 87:6, 87:8 types - 11:15, 13:6, 14:3, 29:4, 38:18, 42:21, 43:7, 47:11, 55:20, 66:6, 66:8, 73:10, 73:11, 76:21, 80:11, 122:10, 122:13 U unable - 101:19 uncommon 114:20 undefined - 21:8 under - 10:18, 40:11, 41:3, 51:4, 78:23, 122:22, 123:3 underreport - 103:1 underreported 98:4 understood - 79:18 unexposed - 20:10 Unfortunately- 45:2 unfortunately - 26:1 uniform - 9:2 unique - 46:21, 50:16 United - 5:23, 6:3, 6:10, 8:17, 9:14, 9:18, 19:13, 35:15, 46:18, 46:22, 47:2, 47:10, 48:16, 48:21, 49:10, 60:10, 121:4, 122:4 universally - 43:17, 44:6 University - 7:13, 8:4, 114:8 unless - 55:15 unlike - 95:10 unlikely - 23:19, 24:10 unusual - 21:23, 79:9 up - 5:1, 8:15, 17:20, 20:16, 21:10, 21:20, 22:11, 36:8, 46:1, 49:18, 52:1, 52:22, 58:11, 61:11, 68:7, 68:19, 71:1, 71:5, 71:6, 71:9, 71:13, 71:14, 74:20, 74:22, 78:16, 89:12, 89:22, 93:12, 93:15, 93:18, 95:18, 96:1, 96:7, 102:7, 107:23, 111:14, 111:21, 117:12, 118:17, 120:22, 122:17, 126:10, 126:11, 126:12, 128:17 Up - 122:7 update - 28:8 updated - 27:15, 28:6, 57:20, 87:8 upstairs - 128:16 usage - 66:10 useful - 104:21, 106:19, 116:19, 118:1 users - 51:9, 51:13, 53:11, 59:5, 63:6, 67:21, 69:7, 73:2 uses - 54:1, 54:3, 66:7, 125:8 V vacuum - 61:8 vacuums - 61:7 valid - 75:13, 75:21, 76:1 value - 82:1, 83:9 Value - 23:15, 24:14 values - 83:5, 84:7 varies - 79:23 variety - 114:13 various - 9:5, 51:6, 51:8, 117:20 vehicle - 63:14, 64:22, 66:2, 68:22 Vehicle - 123:18 vehicles - 65:5 versa - 82:13 versus - 114:4 view - 123:6 viewed - 78:23 vinyl - 30:16 virtually - 89:21 vis - 82:13 vital - 17:19, 17:22, 63:15 voice - 98:13 voters - 123:17 W Waddell - 2:7 Wagner - 31:6 wait - 61:12 waiting - 4:14, 12:13 walk - 55:5, 92:17 Walk - 107:18 warning - 60:9, 80:10, 92:8, 92:11 wash - 120:14 washes - 118:16 Washington - 7:2, 7:3 water - 78:16, 79:1, 98:10, 127:10 Watsonville - 70:13 ways - 18:20, 77:4, 77:13 Wednesday- 4:10 week - 126:19 weeks - 28:6 weight - 30:18 western - 47:6 whereas - 106:1, 124:23 white - 31:1 whole - 68:5, 79:19, 127:3 wide - 24:6, 114:13 wife - 117:5 William - 3:3 Wilmington - 1:22, 129:11 Wilson - 3:7 window - 29:15 Witness - 40:22, 58:18, 58:21, 98:12, 129:12 witness - 4:9 witnesses - 21:5, 23:8 Woitowitz - 100:18 woman - 108:13 Wong - 100:1, 122:2 word - 30:5 words - 18:13, 23:5, 34:18, 43:5, 55:19, 58:12, 61:11, 75:1, 78:15, 81:20, 97:21, 103:4, 108:5, 108:8, 113:2, 113:5, 127:8 workday - 82:15 worker - 61:18, 73:13, 74:2, 83:2 workers - 6:12, 6:22, 17:15, 17:17, 18:6, 23:4, 51:9, 53:18, 53:19, 53:20, 54:12, 56:3, 56:17, 59:20, 60:22, 62:9, 62:22, 63:6, 63:14, 63:23, 64:10, 64:14, 65:3, 67:19, 68:4, 85:10, 87:20, 100:14, 103:2, 109:23, 118:5, 121:9, 126:18 workplace - 6:22, 61:1, 67:10, 84:22, 91:18 works - 71:16, 72:10 World - 49:3, 49:12 world - 9:6, 13:17, 15:7, 35:11, 38:10, 48:3, 50:13, 123:5 worried - 94:13 worse - 114:4 wrap - 52:1 write - 25:17 writing - 36:6, 71:3 written - 25:19, 25:21, 26:7, 26:9, 27:11, 126:5 wrote - 26:7, 26:9, 26:11, 26:12, 27:14, 28:18, 43:11, 43:12, 80:4, 114:8 X x-ray - 63:16, 63:18, 64:5, 64:17, 65:12 Y year - 17:18, 25:19, 71:5, 101:8 years - 5:23, 6:9, 7:3, 9:10, 31:14, 56:12, 56:15, 56:17, 57:21, 63:19, 71:6, 71:10, 71:14, 71:22, 72:10, 72:15, 72:16, 72:22, 73:4, 95:18, 96:8, 102:7, 110:21, 110:23, 112:22 Yesterday - 43:14 yesterday - 43:22, 49:17, 88:13 yourself - 16:10, 25:2 Z zero - 21:8, 22:6, 22:8, 22:17, 57:20, 85:11, 112:4 zone - 14:19 Zoology - 8:5 13