Document wDq2Dzd31BkBgJ7Laq7MwGB7d

1 II IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF OHIO western division US 11 Itff) MARY A. DENDINGER, et al. and ETTA M. WALLACE, et al., Plaintif f s , vs . CHRYSLER PLASTIC PRODUCTS CORPORATION, et al. , Defendants. : C /v?v Case No. C87-7117 (Hon. Nicholas J. Walinski) Deposition of RALPH MICHAEL KELLY, M.D., a witness of lawful age, taken on behalf of the defen dants under the Federal Rules of Civil Procedure, in the above-entitled cause, wherein Mary A. Dendinacr , et al,, are the plaintiffs, and Chrysler Plastic Products Corporation, et al., are the defendants, pending in United States District Court, Northern District of Ohio, Western Division, before Luke T. i Lavin, Registered Professional Reporter, a Notary Public in and for the State of Ohio, at the offices of the deponent. Suite 106, 2450 Kipling Avenue, Cincinnati, Ohio, at 10:05 o'clock a.m., on Friday, May 6, 1988. COPY 2 1 2 3 APPEARANCES: 4 On behalf of the plaintiffs: 5 Kirk J. Delli Bovi, Esq. of 6 Murray & Murray Murray Building 7 300 Central Avenue Sandusky, Ohio 44870 8 On behalf of the defendant A. Schulman, Inc.: 9 Larry P. Meyer, Esq. 10 of Manahan, Pietrykowski, Eamman & Delaney 11 404 North Erie Street P.O. Box 2328 12 Toledo, Ohio 43603 13 On behalf of the defendants The Goodyear Tire 4 Rubber Company? The BF Goodrich Company? 14 Firestone Tire & Rubber Company; Conoco, Inc.? Uniroyal, Inc.? Union Carbide 15 Corporation? Maxus Energy Corporation? Tenneco, Inc. and Occidental Chemical Corp.: 16 Robert A. Bunds, Esq. 17 of Fuller & Henry 18 One Seagate, 17th Floor P . O. Bx> x 2-0 8 8 19 Toledo, Ohio 43603 20 Also present: 21 Amy Ng, Esq., Legal Department, Conoco, Inc., 600 North Dairy Ashford, 22 McLean Building, Houston, Texas 77252. 23 24 j is i n u ii 3 1 Index 2 Cross-Examinationby: Page 3 Mr. Bunda................................................ . . . 3 4 Mr. Meyer .................................................... 240 5 Mr. Bunda...........................................................................242 6 7 RALPH MICHAEL KELLY, M.D. 8 called by the defendants under the Federal Rules of 9 Civil Procedure, being first duly sworn in the above 10 cause, testified on his oath as follows: 11 CROSS-EXAMINATION 12 BY MR. BUNDA: 13 Q Doctor, can you please state your name and 14 your business address for the record? 15 A Yes. Ralph Michael Kelly, 2450 Kipling, 16 Suite 106, Cincinnati 45239. 17 Q What is your home address. Doctor? 18 A Home address? 19 Q Yes, six. 20 A 7360 Kirkwood, Cincinnati. 21 Q Doctor, do you have any plans to be travel 22 ing or out of the country during January of 1989? 23 A No. 24 Q Doctor, I *ve got a curriculum vitae for you L8U"Vdn 4 1 that I received from you in another case. is that 2 current, or do you have an updated one? 3 A Fairly current. There's a couple of addi 4 tions. I have been a commissioned member of the 5 Sayer Commission, the state of Ohio, the EPA Super 6 fund, a statewide organization legislated in, I 7 think, the '86 legislation. 8 Another article has been accepted for publi 9 cation in Reproductive Toxicology, having to do with 10 methylene chloride. And another article's being 11 considered with respect to the CNS affects of methyl 12 ene chloride . 13 Q Other than that, is that current? 14 A Yes . 15 Q If I could have that back, please* 16 Well, Doctor, if we can go through your 17 background for just a minute. Do you want to have 18 reference to this, or do you have a copy of your 19 curriculum vitae? I need to look at this one, too. 20 A That's fine. 21 Q Okay. You graduated from the University of 22 Michigan with an undergraduate degree. Is that 23 right? 24 A That's right . H 8U iHo 5 1 Q That's in 1969? 2 Ayes. 3 Q When did you start medical school, then? 4 A 1971. 5 Q What did you do in the two years between or 6 the year and a half between undergrad and medical 7 school? S A 1 was a VISTA volunteer. North Platte, 9 Nebraska. I did some work in a laboratory as a 10 laboratory technician. 11 0 What company were you working for when you 12 were a lab tech? 13 A I think it was Saint Joseph Hospital in Ann 14 Arbor. 15 Q You went straight through in medical school, 16 or did you take time off? 17 A No. I went straightthrough. 18 Q You previously have told me that all the 19 courses in medical school are pass-fail. Is that 20 right? 21 A They were, yes. 22 Q Were there any that you had to take over 23 again? 24 A No URL 11815 6 URL 11816 1 Q After you graduated from medical school, 2 then you went to Detroit General Hospital as a resi 3 dent. is that right? 4 A That's correct. 5 Q When you began your course of study at the 6 University of Michigan School of Public Health, that 7 was vhile you were still working. Is that right? 8 A Yes . 9 Q Would you describe for me how that worked, c r 10 please ? c 11 A Yes. It's what's called a job-on-campus 12 program. You attend classes three days a month. 13 doing course work, reading, writing, research during 14 the month at home. So it's basically a full-time 15 master's program but tailored in such a way that I 16 could work as a physician during the day and then do 17 the study in the evenings. 18 Q Did you take the classes in the evenings. 19 too? 20 A The classes were over a weekend once a 21 month 22 Q How many years did you do that? 23 A The program was a two-year program. I took 24 some course work in *79 and *80, I think, maybe *80 7 1 and *81 independently, but the course was from '81 to 2 *83. 3 0 Was that full time through the year, or did 4 you take quarters? 5 A Full time through the year, 6 Q How many courses in all did that involve? 7 A I don't know. I think it was 60 credit 8 hours. It's hard because of the special nature of 9 the program. I never was clear, you know, when one 10 course was ending and another one was beginning, and 11 so it's hard to say how many different courses. But 12 they had to do with epidemiology, toxicology, indus 13 trial hygiene, some administrative law, occupational 14 medicine, biostatistics. I think that covers the 15 general course work. There was a thesis associated, 16 and computer work, but all that was incorporated into 17 the other courses. 18 Q Do you remember who you had as instructors 19 in epidemiology? 20 A Well, Larry Fein was the overall coordinator 21 of the course. There were a couple of different 22 epidemiologists that talked. 23 Q These were lectors? 24 A Yes. u stn b fi 1 8 1 Q Did you have a text that you used during the 2 course of this study, or several texts, or was it 3 mostly course materials? 4 A Mostly course materials. We had some 5 primers in epidemiology. You're still taking about 6 epidemiology? 7 Q Yes. Let's focus on epidemiology first. 8 A Okay. We had a couple of texts, but mostly 9 it was articles and material prepared for the course. 10 Q Do you remember any of the texts that 11 related to epidemiology? 12 A I think one was called a primer in epidemi 13 ology, but I don't remember who it was authored by... 14 I think there was one called Occupational Epidemiol 15 ogy, and I don't remember the author of that one, 1C eithe r . 17 Q Have you saved the course materials from 7.8 your epidemiology courses? 19 A Yes. 20 Q Do you still have them? 21 A Yes . 22 Q Do you have them here in the office? 23 A Some of them I do. 24 0 Did you have courses in occupational medi- URL 1) 818 i 1 cine? 2 A Yes. 9p *1I I 3 Q Do you remember who your lecturers were in 4 that area? 5 A Again, Larry Fein. I mean, he was the n 'i 6 overall coordinator of the course and he was the -- 7 and in fact, with occupational medicine did mostly 8 that. There was a Kelly Brecks that did some, and 9 some other guest lecturers. 10 Q Did you use a text there? 11 A Again, no. There was some suggested ones, 12 Rohm's text, Zins* text, and then a lot of course 13 materials . 6is i n a n 14 Q Have you received all your or the greater 15 extent of your course materials from all of the 16 courses you took during this master's program? 17 A I believe so, yes. IB 0 Do you remember who yourinstructors were 19 for toxicology? 20 A I'm remembering faces, but there was a Rory 21 somebody and -- I don't remember. These were all 22 faculty members of the University of Michigan. 23 Q And industrial hygiene, do you remember 24 anybody specifically? u' s u ian 10 1 A A Dr. Smith, Armstrong and, again, 1 don't '2 r emerabe r any othere, 3 Q That was Ralph Smith? 4 A Yes . 5 Q Did you ever have Ian Higgans coming in to 6 testify? 7 A Yes , yes . 8 0 Or, I'm sorry, not testify, but lecture. 9 A Yes . 10 Q That was on epidemiology? 11 A Yes , 12 Q When you went for your internship, how did 13 that work? You were at Detroit General Hospital as. a 14 resident. Is that right? 1 5 A Yes. 16 Q Then where were you working when you were 17 going for your master's degree? You were also work 18 ing at the time* right? 19 A Yes. I worked some at Wayne State Univer 20 sity supervising residents in an outpatient, seeing 21 patients myself. I was working for the City of 22 Detroit doing both internal medicine and occupational 23 medicine work, and for a portion of that time that I 24 was taking the course work in Ann Arbor I was the URL 11821 11 1 director of the Employee Medical Services at Detroit 2 Receiving Hospital* 3 Q Were those three jobs that you had in addi 4 tion? 1 realize that some of these are overlapping, 5 but were you doing those three that you mentioned all 6 at the same time at any point? 7 A Never quite all three at the same time. I 8 worked for the City from 1980 on, and so that over 9 lapped with both of the other jobs. 10 Q That was when you were at Herman Keifer 11 Hospital? 12 A At Herman Keifer, that's right. 13 Q Specifically, what were you doing there? 14 A Working in an internal medicine clinic, and 15 also doing occupational medicine, surveillance work 16 for the city health department. 17 C I*m sorry. For the city -18 A Health department. 19 Q What did that ' involve? 20 A We were involved with designing and deliver 21 ing a program for small businesses in the city to 22 help them better monitor employee health. We were 23 also involved with follow-up of patients, concern 24 about cancer cases arising in a particular location 12 1 of the city, helping to design studies , public 2 health, epidemiologic and otherwise on those situa 3 tions . 4 Q What was the department of the city that you 5 were working for? e A Health department. 7 Q What was your title? 8 A Physician . 9 Q You were a physician in the health depart 10 ment. Is that right? 11 A Yes. 12 Q Were you enforcing ordinances or regulations 13 of the City? 14 A I was no t. 15 Q How was it that the City was involved in 16 this type of work? c73 rr-'_w. 17 A Well, the City has, I think, some legal 18 responsibility for maintenance of health. They were 19 involved with some surveillance work. There's a long 20 history of a hygiene department at the City, and 21 partly it was what was felt to be the responsibility 22 of the city to provide services like this for busi 23 nesses and residents of the City. 24 Q Did you have legal authority to enter and 13 1 inspept the premises of businesses, or was this a 2 voluntary thing on behalf of the companies that you 3 were working with? 4 A Mostly voluntarily. i had no legal author 5 ity as an individual. The City does have some legal 6 authority in certain areas, I'm not quite sure what 7 those are right now. But mostly the legal authority 6 got -- you know, when OSHA was created in *70, most 9 of that legal authority was transferred .to MIOSHA, 10 Michigan OSHA. 11 Q Which was a state responsibility, is that 12 right? 13 A Right. 14 Q Was there any delegation of that responsi 15 bility from the state to the City? 16 A l don't think so, 17 Q In your job for the City, did you have a 18 responsibility for health other than occupational 19 matters? 20 A Internal medicine, yes. I saw adult medical 21 patients . 22 Q This clinic that you were working in was run 23 by the City? 24 A Yes. eeR tnan 14 URL 11324 1 Q Was this work overlapping the work that you 2 were doing at the University Health Center? 3 A For some, yes. 4 Q You understand what I mean by overlapping? 5 A Yes . 6 Q it was atthe same time? 7 A Right.During the year that I was director 8 of the health center, the employee medical depart 9 ment -- Employee Health Services/ I guess that was 10 the official name -- I was only working an afternoon 11 a week for the City. After and before I was doing 12 the employee health service work I worked more for 13 the City. 14 Q You worked in the Employee Health Services. 15 In other words , you were responsible for providing 16 medical care to the employees of the Detroit Receiv 17 ing Hospital. Is that right? 18 A That1s right. 19 Q You say you were director. How many doctors 20 did you have underneath you? 21 A There was one other doctor, a nurse, and the 22 the staff that went with that. 23 Q All right. The doctor was an intern? 24 A No, another staff physician. 15 1 Q How many days a week were you doing this *2 wor k? 3 A I did that full time. 4 Q You worked for Herman Keifer Hospital with 5 regard to the internal medicine clinic, and your 6 other responsibilities for the health department, 7 that was one day a week, you say? 8 A A half-day a week during that year, yes. 9 Q What year was that? 10 A I think it was most of '83 and a part of 11 *82. 12 Q Well, let's back up just a second so I can 13 get this in chronology. You got out of medical jS 14 school. Is that right? 15 A Yes . " ci 16 G Then you went as an intern to which hospi- 17 tal? 13 A Detroit Receiving, Detroit General. 19 Q Detroit General is different from Detroit 20 Receiving? 21 A Well, Detroit Receiving replaced Detroit General, and frequently the names were interchanged. 0 You were a resident in internal medicine. Is that right? 16 1 A That 6 right. 2 Q How long was that? 3 A I had a three-year residency, and then I was 4 chief medical resident for a fourth year. 5 Q Who was your supervisor as a resident? You 6 had a doctor supervising your activities? 7 A Carter Bishop was the head of the depart 8 ment . 9 Q The internal medicine department? 10 A Yes . 11 Q Do you know if he's still there? 12 A He's still at the university, yes. He's not 13 the head of the department now. -- 14 Q When were you chief medical resident? 15 A July '78 to June '79. 16 Q What did you do afterthat, then? 17 A That's when I began work at and for Wayne 18 State University in the internal medicine department 19 as an instructor tea'ching, supervising of residents 20 and also seeing patients myself. 1 began working for 21 the City sometime in early 1980. 22 Q Well, let's back up for just a second. 23 Okay? 24 A Okay. URL 11326 17 1 Q You were working for Wayne State University. 2 Is that right? 3 A Yes . 4 Q In what capacity? 5 A As an instructor in the medicine department. 6 Q Of the medical school? 7 A Yes . 8 Q The Wayne State University Medical School? 9 A That' s right . 10 Q And then what else were you doing? 11 A Umir. -- 12 C That was full time? 13 A That was full time. -c r:~d~ 2? rC-jC. 14 Q How long did you do that? 15 A I did that until I left Detroit in August of 16 1984. It became less than full time early in 1960, 17 and then continued at at least a part-time basis 18 until I left. 19 Q From 1979 until 1980 you were doing that 20 full time? 21 A Yes . 22 Q And you were also seeing patients? 23 A Yes 24 0 Is that when you began your work testifying 18 1 In workers' comp cases? 2 A No. I don't remember the first time I 3 testified. I think it was sometime in 1980# perhaps. 4 Maybe even later. 5 Q When did you, in addition to your responsi 6 bilities at Wayne State, then take on an additional 7 job at your next post? 8 A At the City? 9 C Yes, sir. 10 A That was early in 1980, 11 C When you say at the City, are you talking 12 about the Employee Health Services, or are you -13 A No. I'm talking about Herman Keifer. 14 Q That was part time.Is that right? 15 A That1s right. 16 0 When did that beginin 1982? 17 A In 1980? 18 Q Oh, I'm sorry. I thought you told me it was 19 part time in part of 1982, and I presumed that it 20 began -- let me just ask you. When did it start? 21 A In 1980. 22 Q And that was part time or full time? 23 A Part time. 24 Q How extensive was the part-time work? And URL 11 19 1 you understand what I'm asking. Was it one day a 2 week, or how often during a week's time? 3 A I actually forget. 2 think it was at least 4 three half-days a week. You understand that there 5 was, you know, some changes over the four-plus years, e and it's hard to remember exactly how much and when I 7 was working. 8 Q When you first began, were your responsi9 bi1ities at Herman Keifer as you have described them 1 0 earlier, or did they change over time? 11 A When I first began, they were primarily 12 internal medicine. The occupational medicine respon- 13 sibilities developed over time. 14 Q This was an internal medicine clinic that c XI r* 15 they had there? zl CO 16 A Yes. ^ 17 Q This was run by the City for the residents 18 of the City? 19 A That's right . 20 Q In 1980, then, you were working as an 21 instructor for the university and working at Herman 22 Keifer Hospital. Is that right? 23 A Yes . 24 Q Were you doing anything else at that time? 20 1 A No. ' 2 Q Your duties at that time for the university, 3 were they part time as well? 4 A Yes. * 5 Q How extensive were they? 6 A Well, again, it's hard to remember. I was 7 working full time divided between the two places. 8 Q Were you teaching classes or just supervis 9 ing clinical instruction? 10 A Some teaching in anoutpatientsetting. Not 11 a formal structure, but there was a weekly seminar 12 that I wouldn't have responsibility for every week? 13 maybe once a month. -- 14 Q You say in an outpatient setting. would you 15 have students come from the university to you? 16 A Res i dents. 17 Q I'm sorry. cLoj r--i 18 A As part of their training would be in an 19 outpatient setting, and there would be an hour's 20 seminar prior to the start of the clinic. 21 Q Would they assist you in this clinic? 22 A Actually, Iwas their supervisor. They were 23 directly seeing the patients themselves and would 24 come to me for advice and help. 21 1 Q On a particular patient? 2 A That * s right. 3 Q They were on a rotation basis? 4 A That's right . 5 Q You said you would have this seminar once a 6 week That would be discussing patients that they 7 would be seeing? 8 A Yes. And I wouldn't have the seminar once a 9 week. There was one once a week. 10 Yes, the seminars were either exhibiting 11 difficult problems, general outpatient problems, how 12 to handle them, and so on. 13 C Would there be a topic for each? 14 A Generally, yes. Z 15 Q How many of those did you present? ^ 16 A Over the time I was there, quite a few. 17 Q How many residents at a time would be 18 assigned to your clinic? 19 A Oh, ten to 15 20 Q You were never in a situation where you were 21 actually going and instructing or giving lectures to students in the medical school? A You're right. Q How did your responsibilities, then, in 1980 iM tt inn URL 11832 22 1 for supervising the residents and treating patients 2 at the clinic, when did that change and how did it 3 change? 4 A It really didn't change much during the 5 entire time that I was there. 6 Q In Detroit, you mean? 7 A In Detroit, that's right. 8 Q Eventually you picked up this responsibility 9 for employee health care at Detroit Receiving? 10 A Yes . 11 Q That was late in *82? 12 A Yes . 13 Q And that was in addition to your other 14 responsibilities that you've described? 15 A Yes, although during that period, I guess, ie the supervision of residents declined considerably. 17 Q Why was that? 18 A Because I was spending most of my time in 19 the Employee Health Service. 20 Q Now, you have down on your resume employment 21 at the University Health Center at Wayne State University, and then you also have as a separate category Herman Keifer Hospital. What is the difference between those? I 23 1 thought I understood your testimony to be that you 2 w**e supervising the residents actually at Herman 3 Keifer. 4 A At Herman Keifer, no, I was seeing patients 5 myself. There were no residents at Herman Keifer. 6 Q All right. You were seeing patients your 7 self at University Health Center? 8 A I was also doing that, yes. 9 Q And you were supervising the residents at 10 the University Health Center? 11 A That's right. 12 Q There was also an internal medicine clinic 13 at Herman Keifer? 14 A Yes . 15 Q And you would shuttle between those two? 16 A Yes. 17 Q And in 1981 you decided to get your masters' 18 degree in public health, Is that right? 19 A That *s right. 20 Q Has there a concentration that you had when 21 you were getting that master's degree, or was that a 22 general Master's of Public Health? 23 A Occupational medicine was the concentration. 24 Q Has that the concentration for everybody era i n a n 24 X involved, or were other people -2 A Yes * 3 0 -- concentrating? 4 A Yes. This was a course for physicians, and 5 it was in occupational medicine. 6 Q The thesis that you did for you master's was 7 then published in the Proceedings of the Society for 8 Prospective Medicine? 9 A Yes . 10 Q What is prospective medicine? 11 A Medicine in the future. Preventive medicine 12 is the general field. 13 Q Can you briefly describe yourthesisfor-me? 14 A Yes. We designed a questionnaire for use in 15 small businesses, and we tested that questionnaire 16 for its reliability. We invited some of the employ 17 ees into the health department at Herman Keifer, did IB more extensive testing, follow-up, and then used that 19 as a- basis to test the overall questionnaire for its 20 ability to give some surveillance, early monitoring, 21 early warning of possible problems, and the thesis was a description of that. Q Were there particularindustries that you were working with or designing this for? URL 11834 25 1 A Mostly small businesses of a vast majority, 2 a vast variety. 3 Q Among those businesses, they did many 4 different things, used many different chemicals? 5 A Yes . 6 Q You weren't focusing on, for example, metal 7 plating or something? 8 A No. 9 Q In the course of your work for the City of 10 Detroit did you have any experience in businesses 11 involving exposure to vinyl chloride? 12 A I don't think so, no. 13 Q In your course work as a student at medical 14 school did you have any courses strictly devoted to 15 epidemiology? 16 A No, not per se. There was about two hours 17 having to do with occupational diseases. 18 Q Two hours in your medical training? 19 A Yes . 20 Q Do you know who taught that? 21 A A hygienist at Wayne State. I don't remem ber his name now. Q When you say a hygienist, is that an indus trial hygienist? URL 11835 26 1 A An industrial hygienist, yes. 2 Q This two hours, that was two hours of lec 3 ture? 4 A Yes, yes . 5 Q Did you have any discussion of vinyl chlo 6 ride during those lectures? 7 A I don't think so. You know, vinyl chloride B made headlines in *74, and I know there was discus 9 sion during that time, but in the particular class, I 10 don 1t think so. 11 Q When you say you know there was discussion, 12 you know that there was discussion in the medical 13 coiDRiun i ty ? 14 A In the whole medical, right. That was big 15 news . 16 C Did you use a text when you had that two 17 hours of instruction? 18 A No. 19 Q He provided you with materials? 20 A Yes. 21 Q When you wereat the University of Michigan 22 what types of epidemiology, if I can call it an 23 instruction? I get the sense that your master's 24 program was not divided into real discrete segments URL 11836 URL 11837 27 1 of epidemiology and toxicology. I get the impression 2 that it was a continuum. Maybe you can explain to me 3 a little bit how that worked. 4 A Yes. It wasn't completely nonstructured, 5 and, you know, there was a here comes the epidemiolo 6 gist who's going to talk for an hour. But frequently 7 we and the general course director tried to weave the 8 same process through. So, for example, when we were 9 maybe talking about vinyl chloride in the occupa 10 tional medicine, we would be reviewing occupational 11 studies of vinyl chloride, critiquing, discussing 12 different modes, ways to do epi. projects, and so on. 13 So that's some of my difficulty in saying, well, this 14 course began here and ended there. But there were 15 nevertheless discrete hours or two-hour periods where 16 it was one subject or another. 17 Q To the extent that you're able, therefore, 18 can you describe for me the types of instruction that 19 you had in epidemiology? Was it broken down into 20 anything other than just epidemiology? A No, not really. I mean, there were two or three courses called epidemiology for which there was a grade going from, you know, beginning to more advanced. Much of the course work, in fact, involved <\ 28 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 -- projects for us to do as part of our ways to getting a better handle on what epidemiology was and how to use it and how to design studies. Q Do you remember the names of any of those courses? A They could have been Epi. I, II and ill. I dont know. Q Do you remember what your grades were? A No. I think my overall grade for the whole program was an A minus. C Was there a discussion of v i ny1 chloride during your master's instruction? A Yes . -- 0 Can you describe for roe what was said or what you recall? A That would be hard. Q sion? You just know that there was some discus* A Yes . Q After you graduated or received your degree from the Michigan School of Public Health as a master's r did you continue working on your other jobs in Detroit? A Yes . URL 11833 URL 11839 29 1 Q For how long did that continue? 2 A i guess it was about a year. 3 Q Were you looking for work other than what " 4 you were doing, or were you satisfied with what you 5 were doing after you got your master's? 6 A Well, I took another job, so I guess I was 7 looking. I wasn't real active, but, yes, I was 8 loo king. 9 0 Did you attempt to find an occupational 10 medicine job around Detroit? 11 A Yes. I was interested in getting something 12 going at Wayne State, for that matter, and this other 13 job came along that was more interesting and looked 1 4 like it was going to happen sooner, and that's when I 15 decided to take it. 16 Q This other job, you mean the Cincinnati job? 17 A That's right. 18 C Continuing along this line, then,.-with your 19 jobs, you came down to Cincinnati to run the Greater 20 Cincinnati Occupational Bealth Clinic. Is that 21 right? A Yes. Q Was that a full-time responsibility? A Yes, it was. 30 1 Q How was that structured? What exactly was w 2 or is the Greater Cincinnati Occupational Health 3 Center? 4 A It's a nonprofit corporation involved with 5 primarily treating, the treatment of patients. There 6 was some researching and teaching that went along 7 with it. There was grant money for doing some 8 research. Most of the monies came through patient 9 revenues. 10 Q Were you the first physician at this health 11 center? 12 A No. Another physician was there a couple of 13 months before I was. 14 Q And he was the first? 15 A Yes . 16 Q So it was a newclinic, essentially? 17 A Yes . 18 Q Who organit-ed the clinic? 19 A Several people were involved, but basically 20 the Central Labor Council of the AFL-CIO. 21 Q That's of the international union or of the local? A That's the local. Q Did it have aboardof directors? 31 1 A Yes 2 Q Without getting into specific names of the 3 people on the board of directors, did they represent 4 various groups? 5 A Yes. There are about 11 people, I think, 6 six represented unions. Five. There was a City 7 Council rep, a couple medical school faculties, an 8 administrative and hospital, epidemiologist from the 9 University of Cincinnati, a representative of the 10 Chamber of Commerce. 11 Q Who was the epidemiologist from Cincinnati? 12 A ~Ula Bingham. 13 Q Who were the representatives from Cincinnati 14 medical school? 15 A Well, actually it was Columbus, Ohio State, 16 and it was a Dr. Keller, Martin Keller. 17 Q 1 thought you said there were several medi 18 cal school faculty. Was Dr. Keller the only one? 19 A Yes , yes . 20 Q Was this center, if I can use the phrase, in 21 competition with or doing the same thing as the 22 University of Cincinnati health clinic or occupa 23 tional health center? 24 A Yes, I think it basically was doing the same URL 11841 URL 11842 32 1 thing. 2 C Were you working with the other physician 3 that was here at the center before you, or did you 4 replace him? 5 A No. We worked together. He left in June of 6 *85. 7 Q What was his name? 8 A David Egelmann. 9 Q Do you know where he went? 10 A He's in Providence, Rhode island. 11 Q Do you know what he's doing there? 12 A Not exactly. He's doing something at the 13 medical school ther e. 14 Q Do you know why he left? 15 A ne was interested in doing something differ16 ent. 17 Q Something different than what, working at 18 the clinic? 19 A Right. 20 Q Or occupational medicine? 21 A No. What he was doing atthe clinic, 22 although I don't think he's doing as much occupa 23 tional medicine work right now. 24 Q What was he doing at the clinic? In other 33 1 words, what was the relationship between the two of 2 you? 3 A Seeing some patients. Involved in some 4 research, but mostly we saw some patients. 5 Q Were you equals, or was there one -6 A We were equals. 7 Q You came in October of 1984. Is that cor 8 rect? 9 A Yes. 10 Q To the clinic, I mean. 11 A Yes. 12 Q And then he left in 1985? 13 A Yes. % _ J-- 14 Q How long after you came did he leave? JtsjJ 15 A Re left in June, so eight months. 16 Q And you were the only physician then? 17 A Yes. 18 Q You said there were other responsibilities 19 with regard to supervising interns. Is that right? 20 A I did, yes. I did some teaching of both 21 students and residents in occupational medicine at 22 the clinic. I also did instruction i-n outpatient 23 settings at the university. 24 Q Your teaching of students at the clinic. 34 m u im 1 what did that involve? 2 A Mostly the preceptor type situation, one-on- * 3 one teaching. Students or residents would spend a 4 month at the clinic in a rotation, mostly observing. 5. Doing some direct evaluations themselves, but mostly observation. 7 Q This would be the medical school, as part of 8 the course of teaching their students, they would 9 have the student go out into the community and work 10 with doctors. Is that right? 11 A Yes , yes . 12 Q Describe, then,your work withresidents. 13 A It's been on twolevels. Mostly, in faml_l_y 14 medicine department at the university in their out 15 patient program, quite similar to what I was doing in 16 Detroit: supervision, doing a monthly seminar on, in 17 this case, occupational, medicine. There has been t\ 18 inpatient supervision`*iij the internal medicine 19 department as well. 20 Q You had your own patients in the internal 21 medicine department at the University of Cincinnati? 22 A NO. 23 Q All right. Just explain for me the last part, then URL 1184 35 1 A it was as an attending for a month, and this .2 was at the veterans Administration Hospital, and 3 would supervise the residents in their care of their 4 internal medicine patients that are hospitalized. 5 Q You were anattending physiciaa? A Yes, yes . 7 Q At Veterans Hospital? 8 A Yes . 9 Q How often would you do that? 10 A I've done that once a year. 11 Q How long would thatoccur? 12 A A month 13 Q Would that be full time during the day? 1 4 A No. It's about two hours a day, although'., 15 of course, I'm available for consultation, but I'm 16 there two hours a day. 17 Q Were you doing this on a for-pay basis? 16 A' .Yes . 19 Q .And while you.were there, you would be 20 supervising residents? 21 A Yes . Q Was that your primary responsibility, or your primary responsibility was treating patients? A At the VA? URL 11846 36 1 Q Yes , sir . 2 A The primary is to supervise* I mean, ulti 3 mately the patients are under my care as a fully4 licensed physician, but in a resident program a lot 5 of the responsibility is given to the residents and 6 it is a supervisory type relationship. 7 Q When you would come in this once a month, 8 those wouldn't be -9 A Well, that's once a year* 10 Q I'm sorry. 11 A For an entire month. 12 Q I'm sorry. Once a year for that month, 13 would those per se be your patients in the sense that 14 you didn't place them in the Veterans Hospital, did 15 you? 16 A 1 No, I didn't. But they would come through 17 the emergency room or the clinics there at the VA. 18 They would come to the particular team that I was 19 supervisor* I would be the attending physician, and 20 they officially would be my patients during that 21 time 22 Q Were you working in the internal medicine 23 department or the emergency room, where, in the VA? 24 A This would be in the internal medicine URL 11847 37 1 depar tment. 2 Q This was in an inpatient or an outpatient? 3 A Inpatient. 4 Q what types of cases would you see? 5 A Typical inpatient internal medicine, myo 6 cardial infarctions, shock, respiratory failure, 7 cancer, hypertension, diabetes; you name it. 8 Q You have also down in your curriculum vitae 9 the fact that you were an assistant professor at the 10 University of Cincinnati family medicine department. 11 What was involved with that? 12 A That's the supervision of outpatient resi 13 dents that I talked about and doing the monthly 14 seminar s . 15 Q Would you physically go to the University of 16 Cincinnati? 17 A Yes, I would. 18 Q Do they have a family medicine clinic there? 19 A Yes, they do. 20 Q And that's where you would be doing this? 21 A Yes . 22 Q How much time would this involve? How fre 23 quently would you do it? A This was an afternoon a week. 38 X Q Are you still doing that? 2 A yes. 3 Q When you were at this clinic and doing this 4 supervision, did you have an emphasis on occupational 5 medicine, or was your responsibility general family 6 pr actice ? 7 A It was somewhat of a mix. The outpatient 8 department is a family medicine department, and 9 mostly it was a consultation, observation of, care of 10 general medical family problems. The seminars I 11 would give would be occupational medicine, and by the 12 nature of my speciality, you know, I would see that 13 each resident knew what each of their patients did.,~ 14 and I had some understanding of preventive or possi 15 ble things to be looking for. 16 Q That was steady one afternoon a week 17 throughout the year? 18 A Yes, yes. 19 C I asked you, you're still doing this. Is 20 that right? 21 A Yes . 22 Q What is your title now when you do that? 23 A I'm assistant professor. Adjunct assistant 24 professor, I think, is the -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 39 Q All right. The adjunct means that you're coming in. you're not -- A i'm not full time. That's right. Q How many physicians are doing that in the family medicine department, do you know? A NO . Q I presume you're not the only one doing that. A No. There are probably five to. ten. The majority are full-time faculty, but several of us come in an afternoon or so a week. Q Do you have any idea of how many full-time faculty there are in the family medicine department? A No. Q How many at the clinic? A When I'm there, there will be two others when I'm there. Q Full-time faculty? A That are precepting, doing the same thing I'm doing, yes. Q I'm sorry. I don't understand. Yes, there are full-time faculty there working with the resi dents while you are also doing that? A That's right. nan 40 1 Q You also have down on your curriculum vitae 2 that you are a clinical instructor at the University 3 of Cincinnati. What does that involve? 4 A I guess the only thing we haven't talked 5 about -- well, that's the internal medicine depart 6 ment. We haven't talked about my relationship to the 7 Environmental and Occupational Health Division. 8 Q I understand, but I'm going to get to that. 9 A Okay. 10 C But above that on the CV is something about 11 the clinical. 12 A That's my job description. That has me 13 rounding at the VA Hospital and has me supervising -or 14 doing preceptors for medical students and internal 15 medicine residents in my office. 16 Q Are youstill doing both of those? 17 A Yes . 18 Q That is, having responsibility for -- is it 19 students or residents at the VA? 20 A Both. Well, at the VA there's -- yes. The 21 team consists of mostly residents, and I think there 22 are two students now on the team. 23 Q when you doyour work at the VA? 24 A Yes. URL 11850 URL 11851 41 1 Q Then you also have both coming here? 2 A Yes, yes . 3 Q When I say "here," I'm talking about your 4 office now. 5 A That's correct. 6 Q Then describe for roe, please, your relation 7 ship to the Environmental and Occupational Health 8 Division of Kettering Laboratory. 9 A Much the same as it is with the-roedicine 10 department. I have had residents in that program 11 under roe in an outpatient setting in a preceptor type 12 situation. I've done some lecturing in that depart 13 ment, seminars as well. 14 Q Well, when you say in an outpatient set 15 ting -- 16 A That's in my offices. Residents will spend 17 a month with roe in the offices. 18 Q The Environmentaland Occupational Health 19 Division of Kettering Laboratory, is that a, for want 20 of a better word, public health school? 21 A Well, it's not a public health school, but 22 it's quite close. I mean, if you ask what's the 23 difference, I'm not sure what the difference is. I 24 know it's not an accredited public health school, but URL 11 42 1 they have industrial hygiene, toxicology# occupa 2 tional medicine program. 3 Q Well, okay. pardon me for interrupting, but 4 I'm just trying to get it clear in my own mind what's 5 going on. You and I both know in Michigan they have 6 the medical school and they have the public health 7 school. 8 A Fight . 9 Q And down here the situation is the same. 10 You're getting in students from the medical school 11 and also Kettering Laboratory. Is that right? 12 A That1s correct. 13 Q So the type of relationship you have with 14 the students and the residents at the University of 15 Cincinnati in the internal medicine department, that 16 type of relationship you also have with students 17 coming.from Kettering Labs? IB A-'- Yes. 19 Q How many a month come from Kettering Lab to 20 work with you? 21 A It's probably been, since I've been here, less than ten overall. Q Bow long do they stay here? A A month. 43 1 Q With you? 2 A Yes. 3 Q And they work a full day with you? 4 A Generaliy. 5 Q Do you receivecompensation for the fact 6 that they come here? 7 A No . 8 Q This is theservice thatyou do as part oi. 9 the medical community? 1 0 A Yes. I guess the remuneration for myself is 11 contact with students, stimulation, keeping up with 12 events and, you know, research and medical litera 13 ture, and so on. 14 Q What about with the medical school? Do you 15 receive any remuneration for having them come into 16 your offices? r- 17 A No. I am paid for going to the family 18 medicine department. I do get paid for that. *3 _ J 19 Q Is that on a salary basis? Do you receive a 20 salary as an adjunct professor? 21 A No. It's a per hour basis. 22 Q Your title is assistant professor with 23 regard to your responsibilities at Kettering Labora 24 tory. Is that the same thing they classify you as. 44 1 an adjunct professor? 2 A well# although i don't get paid, so that 3 means I'm not an adjunct* 4 Q What do you call yourself, or what do they 5 call you? 6 A I think that's where the clinical comes in. 7 Clinical means you don't cet paid. 8 Q Your CV identifies yourself as an assistant 9 professor in connection with the Kettering Labora 10 tory. Is that incorrect, then? i 11 A Well, I guess it should say clinical assis- j 12 tant professor. Believe me, I remain confused as to i I 13 all the different nuances as to what each title 14 means . 15 Q Well, you and me both. But in any event, 16 you don't get paid, so they don't give you the full 17 title? 18 A Right. 19 0 Finally, let's talk about the entry on your 20 resume with regard to your acting as a consultant to 21 the National Cancer Institute. Describe that for me, 22 please . 23 A Yes. From September of *84 to June of '86 I 24 served as a consultant with several other occupa- URL II 45 1 tional physicians with NCI, National Cancer Insti 2 tute. we were all involved with advising the 3 Institute as to how to go about identifying, control 4 ling and developing preventive strategies with 5 respect to occupational cancers. 6 Q What is the Central Clinical Research 7 Network? Do you see that? 8 A Yes. That's what we sort of called our 9 selves as part of it. 10 Q The letters that you wrote to the editor in, 11 for example, Journal of American Medical Association 12 on asbestos-related diseases, you wrote that with a 13 bunch of other people, didn't you? 1 4 A Yes . 15 Q Are they part of this Central Clinical 16 Research? 17 A Yes. Many of us were, yes. ie Q Bow many people were part of the Central 19 Clinical Research Network? 20 A There may have been 14 or 15 clinics, groups 21 seeing, evaluating and treating patients with possi 22 ble occupational diseases, and that meant there were 23 maybe 20 of us altogether. 24 Q Row did the clinics get together? URL 11K^ I 46 1 A I wasn't involved with that# so I'm not sure 2 how the process got started. Many of us are part of 3 the American Public Health Association# and I think 4 that perhaps, you know, the occupational health 5 section of the association is how we came to meet each other . 7 Q I'm sorry. I still don't have a real clear 8 understanding about what type of consulting work you 9 did for the NCI. 10 A Well, it was very preliminary work on how to 11 identify occupational cancers; how to design programs 12 to prevent; doing a lot of stuff with asbestos in 13 terms of how to identify cohorts, groups of asbestos 14 exposed individuals; what could we design in terms of CwOH 15 prevention and/or treatment that would prevent the 16 development of occupational cancers. 17 My view, in fact, was that it was similar to 18 the work that was done 25 years ago with tne develop 19 ment of the cancer treatment centers, to what was 20 initiated by the NCI in the '60s. I'm not sure that 21 everyone shared that view, but that was sort of my 22 conception of what we were about. 23 Q Were you working on a grant to this group? 24 A Yes. URL n 47 1 Q What was the description contained in the 2 grant as to what the group was supposed to do, if you 3 can recall? 4 A Pretty much what I've said. 5 Q The grant came from the NCI? 6 A Yes . 7 C And it was specifically granted to the 8 Central Clinical Research Network? 9 A Yes . 10 Q What did you provide back in response to the 11 money that you received? 12 A Development of questionnaires, some prelimi 13 nary papers with respect to how to design RFPs, 14 request for grant proposals. I think generally those 15 were the things provided. 16 Q Did you do an actual report, final report? 17 A I don't think there was an actual final 18 report, because Graham-Ruddman came along then and 19 stopped the program sort of in its -- not even in 20 midstream; just as we were getting started. The 21 general cutbacks in all the departments eliminated 22 this program . 23 Q Did you produce anything in connection with 24 this grant? URL 11857 n 48 1 A Other than what I've talked about? 2 Q Hell, let's back up. I'm not quite sure 3 what you've talked about. Did you sit down and 4 actually do a penci1-to-paper for anything? 5 A Yes , 6 Q What? 7 A These questionnaires and these initial pro8 posals for RFPs. And, again, it wasn't done entirely 9 by myself. We had committees that were 'involved with 10 different aspects of developing these programs. 11 Q The questionnaires, were they derivedfrom 12 the work that you had done on your master's thesis? 1 3 A To some extent. Others have done the same, 14 sort of thing, so it was not a question of totally 15 designing a questionnaire but pulling from the vari 16 ous bits and pieces that all of us had been develop 17 ing. 18 Q So all of you '&& your own questionnaires 19 that you gave topatients or people out there? 20 A Right. 21 Q And then you justsynthesised these to come 22 up with one that you thought was good? 23 A That's correct. 24 Q I don't understand the RFP work that you URL 11858 49 r 1 were talking about. You got a grant and you used 2 that money to make more requests for grants? 3 A Hell, in any program to prevent something 4 like occupational cancer, there is preparatory work 5 as to, you know, what are the questions, what do we 6 need to decide, what are the general issues, and 7 that's basically what we were involved with. 8 The next stage would be to actually develop 9 programs, trials, and there would have to be requests 10 for proposals, requests for grants to do that, and 11 the NCI was asking for our help in how to develop 12 such proposals. 13 Q How much money was the grant? 14 A I don't recall. I think the Occupational 15 Health Center got about 25,000. 16 Q The Cincinnati Health? 17 A Yes . 18 Q You don't recall what thetotal amount of 19 the grant was? 20 A No, I don't. 21 Q Do you have copies of the -- what do you 22 call them -- RFPs? 23 A That's what they're called, and I don't 24 think I do. 2 have copies of some of the statements esavnun URL 119613 50 1 of principles and purpose of the work we did, that 2 brought us together, but any of the work that we did, 3 I don't think I have copies of those. 4 Q That would be at the Occupational Health 5 Center here in Cincinnati? 6 A No. I think that's with the NCI. 7 Q If you can bear with me for a second, these 6 RFPs were what, again? What were they proposing that 9 the NCI do? 10 A They were going to be RFPs from the NCI. 11 Q All right. 12 A And were going to be used to identify 13 groups, cohorts of individuals at risk for occupa 14 tional cancer, and then mechanisms for prevention of 15 all types . 16 Q That sounds like epidemiology work, doesn't 17 it, identifying cohorts of people? 18 A Yes. In many ways, yes. 19 Q Was the proposal that you clinics would get 20 involved in that type of work? 21 A We were hoping to, yes. 22 Q Was this spanning all occupational cancers, 23 or are you focusing on asbestos or a particular type? 24 A Well, there was nothing in it to limit which 51 URL 11861 1 occupational cancers, but asbestos looked to us to be 2 something to get started with. 3 0 Are you still continuing today in your 4 responsibilities with the family medicine department 5 in Cincinnati? 6 A Yes . 7 Q And the work atthe VA? 8 A Yes. 9 Q And the work with the Kettering Laboratory 1 0 residents? 11 A Yes . 12 Q Or students. What arethey, residents, 13 students, or both? 14 A Both. _. 15 Q Are those MDs coming out of that program at 16 Kettering, or are they others? 17 A They've already received their -- oh, you 18 mean the people? 19 Q Yes. 20 A The students are not physicians. They're 21 more, they've been hygienists. The residents have, 22 you know, finished medical school. 23 Q And then they decide to gothrough this 24 Kettering program? 52 g iu n u n 1 A Yes . 2 Q Have youbeen involved in any lecturing or 3 anything at the Kettering Laboratory program? 4 A Yes . 5 Q Other than what you've done here in your 6 office? 7 A Ves . I've given some seminars for the occu e pational medicine residents. 9 Q What were the subjects of the seminars? 10 A One of them had to do with criteria for 11 asbestos diagnosis, and the others have been inter 12 esting case discussions. 13 Q Interesting cases? 14 A Cases , yes . 15 Q I don't understand whatyou mean by seminar. 16 How, was this a continuing program where they would 17 meet once a week for an hour or something, or was it 18 just a one-shot lecture? 19 A This is a continuing program. I did not 20 have responsibility for the vast majority of them, 21 but would attend many of them and made several 22 presentations. 23 Q And these you've alreadydescribed? 24 A Yes . URL 1)863 53 1 Q In the course of this, have you had any 2 contact with the faculty at Kettering Laboratory? 3 A Yes . 4 Q Who have you worked with? 5 A Grace LeMasters, Jim Lockey, probably the 6 most. 7 Q Grace LeMasters? 8 A Yes . 9 Q I understand you've terminated your rela 1 0 tionship with the Greater Cincinnati Occupational 11 Health Center . 12 A Yes . 13 Q When did that occur? 14 A September * 87. 15 0 Would you describe your activities now after 16 that point in time? 17 A Primarily private practice, although the 18 teaching responsibilities have continued. 19 Q Private practice in what? 20 A Occupational, internal medicine. 21 Q Why did you leave the Greater Cincinnati Occupational Health Center? A We had differences about primary care, that is, the treatment of individuals for their problems. 54 1 They were interested more in evaluations, primarily. 2 Q What were you interested in? 3 A Doing both. I felt that it was important to 4 offer treatment as well as just doing evaluations. 5 Q Did the quality of your work have anything 6 to do with the severance of the relationship? 7 A I don't believe so. 8 Q Do you think, in the opinion of the clinic, l i 9 that1s true? j 10 A I don't believe so. | i 11 Q Did the board of trustees ask you to leave? 12 A Yes, they did. 0 C CO 13 Q This came after an audit of some of the 14 files of the clinic. Is that right? 15 A We had been through a fairly long discussion 16 about primary care issues, and, yes, they were con 17 cerned by the amount of primary care that was being 18 done. Z, frankly, didn't realize that they felt so 19 deeply about it, but Z feel pretty deeply about it as 20 well, that primary care is important. 21 Q I don't understand what you mean by primary 22 care. Perhaps you can describe that for me. 23 A Treatment of people's problems. 24 Q Were they concerned about the quality of the 55 1 care or diagnoses that you were rendering? 2 A I don't believe so. 3 Q It was the University of Cincinnati that did 4 the audit, or people from there? 5 A Well, there was a nurse that was'through, 6 and actually 1 think she works for the City, the 7 health department, and she was involved with auditing 8 charts, yes. 9 Q Was there anybody else? 10 A There was a physician with the occupational 11 medicine department that came and discussed cases. 12 C That was Channing Meyers? 13 A Yes . 14 Q What opinions did he express? <r. s 05 ^ 15 A It was sort of your general type chart 16 discussion, going over cases. Sometimes we agreed; 17 sometimes we disagreed. IB Q Did he express criticisms to you? 19 A On occasion, yes. 20 Q What was the nature of those criticisms? 21 A Well, we disagreed on many occasions as to 22 what diagnostic criteria were useful in making deci 23 sions. 24 Q Be disagreed with some of the diagnoses that 56 1 you rendered? 2 A Yes . 3 Q Do you know whether he made any recommenda 4 tions to the board of trustees of the clinic? 5 A 1 don't know. 6 0 You have no knowledge about that one way or 7 the other? 8 A I don 1t, 9 Q You've done consulting work with attorneys 10 since you've been here in Cincinnati. Is that right? 11 A Yes . 12 Q You were doing that up in Detroit, too. Is 13 that right? 14 A Yes . 15 Q You've told me before that you've done over 16 a hundred workers' compensation cases when you were 17 in Detroit. ie A Probably. 19 0 Is that number accurate? 20 A I think so. 21 Q All of these were on the claimant's side? 22 A I think the vast majority were, yes. 23 Q The work that you've done down here in 24 Cincinnati, those are primarily on the plaintiff's 57 URL 11ye7 1 side. is that right? 2 A Yes . 3 Q You understand the plaintiff bei.ng the 4 person who claims he's injured? 5 A Right. I mean, that sort of stands to 6 reason in someone doing primary care. If I'm going 7 to be diagnosing a problem, then they're the ones who 8 are going to go on to seek legal assistance if they 9 feel they need it. 10 Q Well, whether or not it stands to reason, 11 you've also worked with attorneys who send patients 12 to you. You are not their primary treating physi 13 cian? 14 A That's true. 15 Q Again, that work that you've been doing has 16 been for the plaintiff's side. Is that right? 17 A Yes, I think so. That's the definite minor 18 ity of all of the patients I see, but, yes, that's 19 tr ue 20 Q And then that happens that you have attor 21 neys sending patients to you to be evaluated. Is that right? A Yes . Q The plaintiffs' attorneys in this case. URL 11868 58 I 1 Murray and Murray# have done that sort of thing with 2 you, haven't they? 3 A Yes, they have. 4 0 You did not see Mr. Wallace or Mr. Dendinger 5 in this particular case, though, have you? e A No, I haven't. 7 Q You were involved with seeing patients 8 arising out of this Celanese factory in Columbus? 9 A I have , yes . 10 Q Have you had any other cases where the 11 attorneys from Murray and Murray have been involved? 12 A Yes, there have been a couple of others. 13 Q What were those cases about? Without giving 14 names, 1 just want to know the diseases. 15 A Yes. Scleroderma, and 1 think some hyper ie sensitive lung disease. 17 Q The Celanese cases, were you a primary care 18 physician? Did you see the people before you knew 19 the attorneys were involved? 20 A No. 21 Q These people came to you; they were sent by 22 the attorneys? 23 A That1s right 24 Q And the other cases that were involved with 59 1 Murray and Murray, was that the same situation? 2 A Yes . 3 Q What percentage of your practice now or 4 since the time that you left the Greater Cincinnati 5 Occupational Health Clinic is involved with consult 6 ing with attorneys on cases that are sent to you? 7 A Basically about the same; about five 8 percent, I think. 9 C That's five percent of time or five percent 10 of the money that you're making? 11 A Probably yes to both. 12 Q When you were with the Greater Cincinnati 13 Occupational Health Clinic, how much time was spent 14 in consulting with attorneys and consulting with ~ ' 15 patients with regard to medical legal claims? 16 A 1 set aside an afternoon a week for deposi 17 tions, and that didn't occur, that was not every 18 week. Probably two or three afternoons a r.onth were 19 spent like that. 20 Q The money that you made from that type of 21 work, did that go to the clinic or did that come to 22 you? 23 A That went to the clinic. 24 Q Was that type of work involved at all with URL 11869 60 1 the differences between you and the clinic? 2 A I don't think so. I think the issue, again, 3 was primarily one of ongoing treatment, of primary 4 care type medical problems. 5 Q If you could, can you explain that for me a 6 little bit more? What were the differences? You 7 wanted to treat these people after they came to you? 6 A Yes. 9 Q And the clinic didn't want you to? 10 A Right. 11 Q Did the differencesthat you had with Dr. r-- 12 Meyers with regard to the accuracy of diagnoses have CO --J 13 anything to do with the severance of the relation- - 14 shi p? 1 5 A I don * t think so. 16 0 Do you think the clinic thought so? 17 A I don't think so. 18 Q Do you know who was involved with the deci19 sion to ask you to leave? 20 A Well, I think it was primarily Dan Radford. 21 0 Dan Radford? 22 A Yes . 23 Q Who was he? A Re's the executive secretary of the AFL-CIO \61 URL 11871 1 and chairman of the board. 2 Q Was he on the board of trustees for the 3 clinic? 4 A Yes. He's the chairman of the board, the 5 chairman of that medical board. 6 (Recess taken .) 7 Q Doctor, are you currently getting any refer 8 rals of people to you from the unions, or has that 9 stopped after you left the clinic? 1 0 A No, I continue to get some referrals. 11 Q From the unions that were sponsoring the 12 clinic before? 13 A Yes . 14 Q How many people wouldthat be,approxi 1 5 mately? Is that a large numberof people, or has the 16 number dwindled? 17 A It's still the bulk of my new patients. 18 Q Bow many would that be? 19 A I really don't know. I probably am still 20 getting about three to five new patients a week as 21 part of an evaluation, and three or four are from a 22 union, but I guess 75, 80 percent. 23 Q What union is that? A There are several the machinists, the URL 11872 62 1 building trades, asbestos workers, transit workers, 2 postal. i guess those are the main ones. 3 Q When you say evaluations, these are evalua 4 tions of people that have physical complaints, or do 5 they come to you just for a regular checkup? A There's some of all. Some are involved, you 7 know, are concerned about some exposures and wanting 6 some screening. Some have injuries. Some have ill 9 nesses that they're not sure of the cause. Some just 10 want treatment of a problem. 11 Q Are you currently involved i r. working with 12 patients on or in connection with lawsuits either as 13 a primary treating physician or as a consulting 14 physician? 15 A I guess I'm not sure what you mean. 16 q Let me back up with that. It's a poor 17 question. As I understand it, you have two ways to 18 get involved with testifying in connection with a 19 lawsuit that may be brdught by one of your patients. 20 One is to see the patient and evaluate him after he 21 has been diagnosed as having some disease, and you 22 can testify at trial about your opinion. And my 23 understanding is the other way is that you see the 24 patient just because he is brought to you to be 63 1 evaluated. You are treating him for a particular 2 condition or diagnose the original condition, and 3 then you get involved in a lawsuit that way. Is that 4 accurate? 5 A Yes, I think that's right. 6 Q In either of those or even apart from that, 7 without you ever having seen the patient, if you were 8 just asked to testify ir a particular matter in a 9 lawsuit, how many matters are you currently involved 10 in like that, like those three types of involvements? 11 A I'm not sure I could tell you, because I 12 know, by the nature of the business, many of the 13 patients have either work comp or third-part law- ^ 14 suits, and, frankly, I don't even know who does or- - cc 0-` 15 how many or whatever. 16 Q There comes a point in time when you're 17 contacted by an attorney in connection with those. 18 Is that right? 19 A Yes. 20 Q How many contacts, approximately, have you 21 had since you left the clinic? And by contacts I 22 mean from attorneys. 23 A My schedule of depositions has been about 24 the same. I try and save a half a day a week to do URL11B74 64 1 that, and most weeks there is one. Again, maybe two 2 to three of them is what it usually works out to be. 3 Q Two to three weeks a month or two to three 4 depositions? 5 A Two to three depositions a month. 6 Q Can you give me some sense about how many 7 cases you've been involved in since you left the 8 clinic? 9 A Kell, four months last year, four months 10 this year. 20, 25. 11 Q You've indicated that's approximately the 12 same rate as when you were at the clinic. Is that 13 right? 14 A I believe so, yes. 15 Q I'm trying to get some sense now about when 16 you were at the clinic what your involvement was 17 with -18 A Again, about the same. Two to three times a 19 month there would be a deposition, I think. 20 Q Bow many times have you testified in trial 21 since you've come to Cincinnati? 22 A I think four times. 23 Q The Scott case was one. That was an asbes 24 tos case. 65 1 A yes . 2 0 What were the others? 3 A There was another asbestos case. There was 4 a case involving asbestos exposure to inmates. 5 Q When you say inmates, that's a prison? 6 A Prison, yes, in Kentucky. The people 7 weren't sick but were concerned about exposures. And 8 a third involved a postal worker, I think, who was 9 being disciplined for lost time as a result of an 10 injury. 11 Q This was a traumatic injury? 12 A Yes . 13 Q The inmate case was, what, a fear of cancer 1 4 type of thing? URL 11 15 A Well, I wasn't testifying even about that, Co 16 but what I felt was, you know, appropriate hygiene ^ 17 and what the risks of disease were per se. 18 C The Scott case was a pleural plaque minimal ' 19 asbestos case. Is that right? 20 A I believe so, yes. 21 Q What was the other asbestos case? What was 22 the claimed injury? 23 A The asbestosis. I think there was both 24 plaque and interstitial fibrosis. 66 1 Q Can I ask you to -- yes, I obviously can ask 2 you. Can you give me some sense about how many 3 depositions you've given since you came to Cincin 4 nati ? 5 A Well, I've been here four years or nearly four years. I suppose it's 25 to 30 a year times 7 four . 8 Q So we're talking between 100 and 120 deposi 9 tions? 10 A Yes . 11 Q Just for my records, what are you charging 12 these days? o 13 A 250 an hour. -It o --j 14 Q That's for testifying at trial and deposi- 05 15 tion? 16 A Yes . 17 0 Do you have a different rate for evaluating 18 cases for lawyers? 19 A That generally depends upon -- yes. It's 20 not a straight fee. It depends upon the -- I utilize 21 the fees that I normally charge individuals. 22 Q whatare those? 23 A A limited visit is $30. Intermediate -24 actually for a new patient, limited is $40. An 67 1 intermediate is 80* A comprehensive is 120. If 2 there's pulmonary function, there's charges for that. 3 If there's chest X ray, there's charges for that. * 4 0 When you have this limited, intermediate and 5 comprehensive, does that correlate to any period of time? 7 A Yes. Generally comprehensive is an hour. B Q So it's about $80 an hour? 9 A 120. Comprehensive is 120. 1 0 Q Getting back, if I can, to your curriculum 11 vitae for a moment, you have down there publications. 12 The first one is listed as Occupational Disease Sur 1 3 veillance for the City of Detroit. You indicated URL U S 14 that's the thesis you did for your master's program. 15 Is that right? ie A Bas i ca 11 y , yes . ^ -.j ~~J 17 Q And that was printed in the Proceedings of IS the Society for- Prospective Medicine. You were 19 invited to submit that? 20 A Yes . 21 Q How big is the Society for Prospective Medi22 cine? 23 A I don't know. 24 Q Do you know where it's headquartered? 68 1 A 1 think Washington, D.C. 2 The Proceedings, that's not a regular jour3 nal, is it? 4 A Well, the Society has a yearly convention, 5 and the proceedings of the convention get published 6 in this journal. 7 Q But the Proceedings don't have a subscrip 8 tion to that journal other than becoming a member of 9 the Society? 10 A I think you're right. 11 Q Do you know whether or not, for example, if 12 I go down to the University of Cincinnati medical 13 school library they will have a copy of the Proceed 14 ings? 15 A 1 don't know. I haven't looked for it 16 there. 17 Q You don't know what the distribution is of 18 that? 19 A 1 don't. 20 Q Do you know whether that was subject to any 21 sort of peer review process before it was published? 22 A I don't know. There was probably some peer 23 review process of some sort prior to the invitation to make the presentation, but after that I don't 69 1 think so. x think what was presented got published. 2 Q You made an oral presentation at the meet 3 ing? 4 A Yes. We submitted printed material# but# 5 yes# mainly oral presentation. 6 Q In connection with that# then# as part of 7 the proceedings, the speech that you gave was then 8 printed in the Proceedings? 9 A Yes . 10 Q How many other people gave presentations 11 like that at the meeting that you attended? 12 A I don't know. 13 Q How did you come to have this presentation 14 made# do you know? 15 A No# I don't; no, I don't. 16 Q You don't know whether one of your profes 17 sors suggested that to someone or -18 A Well, no. It wasthrough thehealthdepart 19 ment for the city# and that'sbasically --well# my 20 thesis was the basis for two other people# also, who 21 worked ana contributed to the presentation which was 22 the published. So there's two other names on the 23 article 24 Q Those were people at the City of Detroit? 6L8 U l n 70 1 A Health department, yes. 2 Q Were they listed as the primary authors, or 3 were you? 4 A i was the primary author. 5 Q The next listing on your CV is for Long-term 6 Health Effects Following Isocyanate Exposure, to be 7 found in thu Journal of Occupational .Medicine. I 8 think we've established before that's a letter to the 9 editor. Is that right? 1 0 A Yes. 11 Q And your next entry, the Journal of American 12 Medical Association for Septemi>er 13, 1985, entitled 13 Asbestos Related Disease, that also is a letter to". ' 14 the editor. Is that right? 15 A Yes. 16 Q You mentioned when we began that you had one 17 article that had been accepted by a publication. 18 What was the topic of that article again? 19 A Oligospermia and Methylene Chloride Expo 20 sure 21 0 That's in Reproductive Toxicology? That's the name of journal? A Yes. Q Was that a peer review? ijflL 11880 URL 113 71 1 A Yes 2 0 And you have one that has been submitted. 3 Is that right? 4 A Yes . 5 Q What is the topic of that again, please? 6 A Central nervous system effects of methylene 7 chloride. 8 Q Have you submitted any others that are pend 9 ing? 10 A No i 11 Q Have you had any that are rejected? 12 A Well, both of these have taken some time. 13 Q Have they been rejected by other journals! 14 A Yes . 15 Q Have you submitted any others besides these 16 particular two involving methylene chloride -17 A No. 18 Q -- that were submitted for publication? 19 A No. 20 Q The topic of bothof these papers that you 21 have written, did that information arise out of your 22 involvement with a lawsuit? 23 A No. 24 Q How did your interest inmethylene chloride 72 URL 11 1 arise? 2 A i saw about a hundred people with exposure a 3 to methylene chloride. 4 Q This is the Budd Company situation? 5 A Yes . 6 0 All right. And there is litigation arising 7 out of that. Is that right? 8 A There is litigation, yes. 9 Q You're involved as, I guess, a treating 10 physician in that? 11 A Yes, although I don't think I've had any 12 depositions - ^ 13 Q It's coming, believe me. 14 Now, you have listed current research. One 15 is asbestos prevalence in exposed workers. That's in 16 connection with the people that you saw at the 17 clinic, is that right? 18 A Yes, and continue to see. 19 Q When you talkabout current research, am I 20 correct in presuming that what you're really talking 21 about is observations that you make in the course of 22 your evaluation and treating of these people? 23 A well, more than that. I'm continually in 24 the process of trying to, you know, develop data. 73 1 process it so that 2 can report what 1' m finding. So 2 it's more than just I'm seeing, but an interest in "3 collecting that and making it in presentable form. 4 0 What data are you collecting on asbestos 5 prevalence in exposed workers? 6 A Particularly a facility where there's a 7 mixture of several different exposures/ and seeing if 8 there's some synergism between asbestos and other 9 materials. 10 Q What would be the other materials? 11 A Some tars; pitches in particular. 12 Q This would be the Celotex facility? CU r- 13 A Yes . 14 Q Are they roofing materials? S 15 A Yes . 16 Q Bladder cancer screening. What kind of 17 research are you doing on that? 18 A Not much at the moment* I did some initial 19 surveillance work and have not done much on that 20 recently. 21 Q Okay. If I can back up for a second, the 22 asbestos prevalence research that you're doing, 23 you're also involved in lawsuits from time to time 24 involving asbestosis. Is that right? 74 1 A Yes. 2 Q Were you Involved in any lawsuits involving 3 bladder cancer? 4 A I don't believe so. 5 Q What Kind of screening was that that you 6 were doing? 7 A Basically cytology and urine analysis 8 screening. 9 Q What chemicals were you looking for? 10 A individuals exposed to some of the dyes. 11 Q Was that involving aparticular company here 12 in town? 13 A No. 14 Q The research you weredoing on skin cancer 15 prevalence in sun, tar, pitch, arsenical and PCP 16 exposed workers -17 A Yes. 18 Q _ -- what is the PCP? 19 A The pentachlorophenols that are used as an 20 herbicide 21 Q What kind of research were you doing there? 22 A Basically review and examination of individ 23 uals that have either some of those exposures, all or 24 none, and looking for rates of skin cancer. m i l ifcjfi 75 1 0 Then the next one you have down is central 2 nervous system effects of methylene chloride. That 3 came out of the Budd population? 4 A Yes. 5 Q And metals and chronic renal disease n i 6 research that you were doing, what did that involve? 7 A Individuals with exposures to a variety of e metals, looking at specific metals that correlate 9 with markers of renal disease. 10 Q What metals would we be talking about? 11 A Several. Nickel, cadmium, lead, titanium. 12 Q These would be from people that you would URL 11885 13 see in your practice? 14 A Yes. 15 0 Would they be particular jobs that they 16 would be doing or particular occupations that they 17 had? 18 A Mostly machinists, but there's a scattering 19 of others. 20 Q And, finally, you have oligospermia -- 21 A Yes . 22 Q -- and methylene chloride. Again, that's 23 involving the Budd population? 24 A Yes . 988 U W i 7 1 Q All of these research areas arose out of 2 your practice as an occupational physician screening 3 and evaluating workers. is that right? 4 A Yes. 5 Q When we're talking about research, we're not 6 talking about animal experimentation, are we? 7 A No. 8 Q Are we talking at all about formalized 9 epidemiological studies? 10 A Well, with the one with skin cancer, yes. 11 Q Is that currently pending? 12 A That's still ongoing, yes. 13 Q Are you working with anybody else in thatj?. 14 A Yes. Grace LeMasters Is the epidemiologist 15 on that case. 16 Q What's the relationship between you and her? 17 A Well,she's the principal investigator. 18 0 Andyou're just gathering information for 19 her? 20 A Yes . 21 Q Other than that, there are no formalized 22 epidemiologic studies that you've structured? 23 A Hot in the sense of prospective. I would 24 like to give credence to these through epidemiologic 77 1 measures, case controls, and so on. But in terms of 2 prospective or retrospective studies, that's the only 3 one, 4 0 When you say you would like to give cred 5 ence, you are not currently doing either prospective 6 or retrospective epidemiologic? 7 A Right* My work has been, it's mostly cross8 sectional stuff. 9 Q Well, by cross*sectional stuff, what you're 10 talking about is you're looking at the files that you 11 have on your individual patients and developing 12 these. Is that correct? 1 3 A That's right, yes. 14 C Have you made any research proposals to any 15 schools or any government agencies? 1 6 A Not recently, no. 17 Q Well, have you made any in the past other 18 than what you've indicated in connection with the 19 NCI? 20 A Yes. I had made some to March of Dimes, 21 looking at reproductive effects in hospital workers. 22 Q That was in connection with your work in 23 Detroit? 24 A Yes. URL 11887 78 1 Q That wasn't accepted? 2 A It was not. 3 Q In connection with your deposition here 4 today, Doctor, have you reviewed any materials? 5 A Yes . 6 Q Describe for me briefly, if you would, what 7 types of things you've looked at. 8 A Medical records on Herman Dendinger. and Fred 9 Wallace, including some work records, depositions 1C that they've given, and I've reviewed some of my 11 literature on vinyl chloride. 12 Q When you say you reviewed your literature on CO CO 13 vinyl chloride, you're talking about medical journals 14 and texts and things? 15 A Yes . 16 0 Have you reviewed any materials that have 17 been supplied to you by plaintiffs' counsel? 18 A Yes . 19 Q These are medical journals and articles and 20 things. Is that right? 21 A Yes. 22 Q Which is the larger in bulk? Did he supply 23 you with more stuff, or did you get your own stuff to 24 a greater extent? i 79 A At this point 11m not sure. I*m looking at 2 two inches here of literature, and I know I had quite 3 a bit. 4 Q Prior to being consulted in this case? 5 A Yes . 6 Q How about prior to being involved in the 7 Columbus case? How much material did you have on 8 vinyl chloride? 9 A Quite a bit. 10 Q And you gathered additional information 11 after that time? 1 2 A Yes . CO CO 13 Q At the time that you were -- well, let me ^ 14 back up just a second. I was going to say at the 15 time you were asked to be involved in the Columbus 16 case. Do I recall your testimony correctly that you 17 were asked to become involve in the Columbus case? 18 A I'm not sure that I have been. I was asked19 to see some individuals that worked at the Celanese 20 facility. 21 Q These people had been making complaints of 22 ailments arid things before, and then they were sent 23 to see you. Is that right? 24 A Yes. URL 11890 80 1 Q You just didn't happen to see them in the 2 normal course of seeing them on a regular basis? 3 A Ho . 4 Q At or about the time that you saw these 5 people on a consulting basis, were you collecting 6 material on vinyl chloride from the medical litera 7 ture? 8 A No. I'd had the files before then. Yes, 9 I've collected additional stuff since then, but I had 10 a considerable amount before. 11 Q Have you talked with anybody in preparation 12 for your deposition here today about the topic of 13 vinyl chloride and the types of cancer it can cause? 14 A Specifically in preparation for this deposi 15 tion? 16 Q Yes. And I'm talking about other than 17 discussions with the attorney for the plaintiffs. 18 A Well, I've had discussions with Channing 19 Meyer before his death on vinyl chloride. I don't 20 think I specifically talked about these individuals. 21 Since I was asked if X would review this material, I 22 don't think I specifically talked to anybody. 23 Q When you had these discussions with Channing 24 Meyer, what was involved? What was said, to the best l 68U 1bO 81 1 of your recollection? 2 A i think just general discussions about vinyl 3 chloride, its nature, what each of us knew about the 4 literature, epidemiology, and so on. 5 Q Were there any disagreements with regard to 6 your opinions? 7 A I don't think so. I mean, generally I don't 8 think we ever really disagreed in theory about what 9 certain exposures in chemicals could do or be or what 10 have you. There were disagreements occasionally on 11 did symptoms, signs, meet criteria for cause and 12 effect. But I think in theory, I don't think there 13 was much disagreement. 14 Q So his disagreements with you arose more -out 15 of the diagnostic criteria and whether those were met 16 for a particular disease? 17 A Yes, and that by no means was all. It was 18 just on some occasions. 19 Q How about anyone else? Besides Dr. Meyer, 20 either in preparation for this deposition or involv 21 ing any preparation for testifying in either this or 22 the Columbus case involving vinyl chloride, did you 23 have discussions with other medical people? 24 A 1 don't think I have in the last several 82 URL 11892 1 months . 2 Q Have you consulted any medical texts in 3 connection with your preparation for this deposition 4 here or in connection with the Columbus case? 5 A Well, I know I have been back through the 6 literature. I think, in fact, the -- well, clearly 7 there's no single source. I'm sure I've looked at i 8 Rohm's textbook, but mostly I think it's been litera- 9 tur e . 10 Q How did you go about doing your research 11 through the literature? 12 A Well, I usually review the files that I have 13 to start when I'm looking at a fresh topic. _. 14 Q If I can stop you there for just a second. 15 I presume when you say your files, you keep your own 16 files on medical articles. Is that right? 17 A Yes. Then I go to the medical index. Index 18 Medicus, and look at most recent articles and then 19 work backwards from there, especially when there has 20 been a gap in terms of most recent review of the 21 literature 22 Q Did you do any computer research? 23 A I don't think I did on this situation. 24 Q Do you have access to computer research here 83 1 in your office? 2 A No, but I can call up NIOSH quite easily and 3 ask them to do one. I can do one in the family 4 medicine department at the university and will 5 frequently use that as well. 6 0 NIOSH provides that as a service to people? 7 A Yes . 8 Q You pay them a fee, and they go through and 9 do it? 1 0 A Yes. Usually I don't have to pay them a 11 fee . 12 Q Did you keep any notes during your review of 13 the 1iteirature? c _. _ xr~ 14 A NO . " cXc 15 0 At this time is there any way to segregate 16 what you had in your files prior to the time that you 17 became involved in the Columbus case or this case and 18 what you have reviewed? 19 A I don't think so, 20 0 Where did you get your articles once you 21 determined which ones you wanted to see? 22 A You mean which journals? 23 Q Well, no, physically. I mean, did you go to 24 the University of Cincinnati library? 1 I 84 URL 11894 1 A Usually, yes, that's where I go. 2 Q Doctor, you're licensed both in Michigan and 3 Ohio. Is that right? 4 A Yes . 5 Q And you're board certified in internal medi 6 cine and preventative medicine. is that right? 7 A Yes. It's the occupational division of 8 preventative medicine. 9 Q Did you pass both boards on the first go10 round? 11 A Occupational medicine, yes. I took internal 12 medicine twice. 13 Q You flunked the first time? __ 14 A Yes. 15 Q Do you have towait a period of time before 16 you can take it again? 17 A There's one test a year. I took it before I 18 had finished my first three years of internal medi 19 cine residency, taking it again after I had completed 20 it during my chief medical year. 21 C Have you taken any other boards that you 22 have not passed? 23 A No. 24 Q Gave you taken any other certification exam- 85 n 1 inations that you have not passed? 2 A No. 3 Q Have you ever had privileges denied or 4 revoked at any hospitals? i 5 A No . e Q Have you ever had any privileges restricted? 7 A No . 8 Q Have you had any problems in the past with 9 any substance abuse? 1 0 A No. 11 Q A lawsuit was brought against the Greater 12 Cincinnati Occupational Health Clinic, is that right, 13 at some point? 14 A Yes . 15 Q Tell me about that. r" - -co (JD <_n 16 A A foundry, Dayton-Walther, sued the clinic, 17 and it basically was dismissed at all levels and most ie recently has been dismissed at the Supreme Court 19 level. 20 Q What was the basis of the claims in that 21 lawsuit? 22 A The claims were silicosis. i Q What were claims against the clinic by Dayton-Walther? 86 g fis u ia n 1 A That an incorrect diagnosis was made. I 2 think they also claimed that there was some, I don't 3 think they used the word conspiracy, but something 4 along that line. 5 Q Okay. 1 don't quite understand that. 6 A Well, I didn't pay much attention to the 7 entire process, so I'm not sure I understand, either. 8 Q That was filed here in Cincinnati? 9 A Yes . - 10 Q In state court or federal court? 11 A State , I think. 12 Q Were you ever deposed in connect ion with 13 that? 14 A No . __ 15 Q Those were your diagnoses of si1icosis? 16 A Yes . 17 Q Were there ever any other lawsuits brought 18 against the clinic as a result of your activities? 19 A No. 20 Q Any lawsuits against you personally? 21 A No. 22 Q Can you describe for me, please, whether or 23 not you have any medical texts in your office here 24 that serve as your own quick consulting library, if 87 1 you would? 2 A Yes . 3 Q Do you have some? 4 A Yes . 5 Q What types of texts do you have? 6 A i have an internal medicine text, a toxicol 7 ogy text, a hygiene, industrial hygiene, text, a text 8 of biological monitoring, the AKA's Guide to Perma 9 nent Partial impairment Ratings. I can run back and 10 look. I think there's a pulmonary text too. t-fe 11 Q Do you have Paddy'shere? 12 A No, I don't . 13 C Do you ever use that? 14 A Yes . < r -Qa -' 15 0 You use that where, at the University of 16 Cincinnati? 17 A Yes. 18 Q Do you have any tests that you regularly 19 used at the clinic that stayed at the clinic? 20 A No. 21 C Do you understand what I'm saying? 22 A No. Those were all mine. I said occupa 23 tional medicine, didn't I? A Rohm textbook, I also 24 have that. 88 Q I'm not sure you said that. A No. Yes, all of the textbooks were mine. Q Do you have the Zins textbook on occupa- tional medicine? A Yes# but not here. Q Where is that? A I think it's at my home. ** 0 use? Do you have any other texts at home that you - URL 11898 A Not much. 0 What i6 the toxicology textbook? c Co -e A Xasserette and Dottalls. <z XI GO c Q And the industrial hygiene text? A I think it's the NXOSH industrial hygiene, the white text* 0^ What is the pulmonary text that vou have? A The orange one. X forget the authoc^o it. 0 Where do you go* to whan you want to know whether a chemical causes cancer? A And I'm not already familiar with it, you mean? Q Yes , sir. A Well, several sources. One would be Medical 89 1 Index or Index Medicus. Another would be R text, the 2 Registry of Toxic Effects of Chemicals* Those would 3 both be starting points. 4 Q By starting points, the Index Medicus indi 5 cates medical articles* Is that right? 6 A Yes. There's a number of -- it also 7 includes toxicology as well and not necessarily 8 health effects on humans. 9 Q I understand that. But I guess what I'm 10 asking is, do you ever go to something as a starting 11 point, an encyclopedia or that type of text, to give 12 you a summary of the literature that's out there? 13 A Kell, occasionally I'll go to the Chemical 14 Index, but I find the Index Medicus generally most 15 suitable 16 Q Then what do you do after you go there? 17 A Pull out articles, read articles, look at 18 their references, and basically that opens up the 19 whole field of literature. 20 Q That involves looking up the articles, then? 21 A Yes . 22 Q Do you physically do that, or do you order 23 copies? 24 A Usually I do it myself URL 11899 90 1 Q Row often do you do this? It involves some 2 time, doesn*t it? 3 A Yes. I spend, oh, a couple hours a week. 4 Q Do you have any oncology texts here? 5 A No. 6 0 Any of your -- well, let me see, your occu7 pational medicine texts will involve carcinogenesis, 8 won * t they? 9 A Yes . 10 0 what do you consider to be an authoritative 11 text in the area of occupational medicine? 12 A Well, I use several, really. I don't think 13 any single source by itself meets all those criteria. 14 Q Which would you use? 15 A Well, I think I've mentioned some of them. 16 Q Rohm's? 17 A Rohm's. Zins'. Then I like the NIOSH book18 let. I think that's a fairly good one. 2 guess 19 there * s a couple others, but I can't remember editors 20 at this point. 21 Q What about industrial hygiene texts? Would 22 you consider any of those to be authoritative? A Well, again, I mean, I guess it's hard to beat Paddy's, it's so all-inclusive. But , again, URL 11900 91 1 that's certainly not the only text that's available. 2 Q What about epidemiology? Where would you go 3 to get an authoritative text on epidemiology? 4 A I think that's an area that's perhaps weak 5 est of all of these in any single text. Mostly, you 6 know, the texts are describing methodologies, and you 7 really need to review several different methodologies 8 to get what you need sometimes. 9 Q How extensive is your knowledge of epidemi 10 ology? You mentioned your two or three courses in 11 your public health training. Have you had any train 12 ing in epidemiology since then? 13 A No, other than, you know, review of litera 14 ture and conferences, and so on. 15 Q In your opinion, are there universities or 16 public health schools that are stronger in epidemiol 17 ogy than others? Research, I'm talking about now. 18 A I think probably most of the 14 or so public 19 health schools are fairly comparable. You know, I 20 wouldn't say they're all the same for sure, but don't 21 ask me to rate one or the other. 22 Q All right. Would Harvard rank up there? 23 A I think that's the -- the Harvard, Michigan, 24 the research triangle, Alabama. There are a number. URL 11901 92 1 Q Next let me ask you about national experts 2 in some of these areas. in epidemiology who would 3 you recognize as a recognized authority? 4 A Well, I guess I go with, stick close to 5 where I am when I need some advice. So I really 6 don't think of them, well, this is the person to 7 answer all questions. But, you know, Ula Bingham or e Grace LeMasters are people that I'll ask. 9 Q Well, I understand that they're right here 10 and they're accessible to you. Are there others in 11 the country that you would recognize in the field of 12 epidemiology? 13 A Yes. I'm not sure I would, you know -- not 14 many names come to hand immediately. With asbestos 1 5 you recognize Selikoff, of course; Ian Higgans at 16 Michigan. Again, there are a number of people. 17 Q What about internationally? Does any name 18 come to mind? 19 A Well, certainly Doll has an international 20 reputation 21 Q You're familiar with his reputation? 22 A Yes . 23 Q What about Richard Monson? Have you ever 24 heard of him? ?.fihW 93 A Monson? Q Yes, at Harvard School of public Health. A Actually, no Q You've heard of the Harvard School of Public Bealth? A Oh, yes. Q That has a pretty good reputation? A Yes . 0 Now moving to the area of occupational medicine. who would you view as being a recognized authority in that area? A Depending upon the particular area, there j5 .06W IH fi might be several different people. g Q Give me some ideas of names. A Again, asbestos, Selikoff is obvious. Q Well, Selikoff is more of an epidemiologist. isn't he? A Yes, although he's specifically concentrated on asbestos and occupational disease. Just about, you know, the most of the heads of NIOSH, for exam ple, would fall into that category. Many of the individuals at the clinics, part of the network that I have belonged to Z would look to for advice. Q Well, again, we have to understand that I'm '1 94 1 y1 m 1 asking about not necessarily just the people you were 2 going to for advice. 3 A But 1 think they would also be recognized. 4 Q Are there people that you wouldn't go to for i i 5 advice but that you nevertheless recognize as being \ 6 national experts in the eyes of the medical community 7 in the area of occupational -- 8 A Probably not. But I mean, I*m allowed to 9 disagree with them any time I want, I suppose. | I 10 Q Toxicology, do you view that as being dif- j 11 ft rent than occupational medicine? 12 A Yes . 13 Q What types of authorities do you recognise 14 in toxicology? 15 A I don't know as many people in toxicology, 16 and the practice has generally been to utilize people 17 that are close. 18 Q Again, for your own information? 19 A Yes . 20 Q Are there names that are appearing in the 21 literature that you recognize as authorities that are 22 not close to you physically? I mean here in proxim 23 ity. 24 A There are a few. I, frankly, don't recog- URL 11905 95 1 nize a lot of names. 2 Q What about experts in the field of carcino 3 genesis, if i can classify that in that way? I * in not 4 sure that that's a unique medical speciality, but you 5 understand what I'm talking about, experts in the 6 cause of cancer? 7 A Yes, I understand what you're saying. 8 Q Do you have any that spring to mind? 9 A Not offhand. Again, I'll utilize people 10 that are in close proximity, but I don't necessarily 11 recognize names. 12 Q In your practice at the clinic and your 13 practice here, can you give me some percentage of the 14 cases that you have consulted with that involve 15 cancer as opposed to dust diseases and other things? 16 A Well, the vast majority of the individuals I 17 see have lung problems or back problems, and that's 1R probably 80 percent and perhaps evenly divided. And 19 then the remaining 20 percent is a mix, and neuro 20 logic is probably the third highest. Then the 21 remaining would be a mix of heart, liver, kidney 22 cancer. So we're down about, you know, a portion of 23 ten or 15 percent, five percent cancer perhaps. Q You expressed an interest in your CV with 96 1 regard to skin cancer. Have you treated people with 2 skin cancer? 3 A No. I've seen people with it, and I refer 4 to a dermatologist. 5 Q All right. Well, perhaps my question was 6 bad, then. Have you evaluated people that have had 7 skin cancer? 8 A Yes. 9 0 And that's within this five percent? 10 A Yes . 11 C Have you treated people with cancer? 7T 'oC. cr. 12 A Not directly. Several of my patients have 13 cancer. I refer to an oncologist. I will, of 14 course, follow along but will rely on their choice of 15 chemotherapy and mode of therapy. 16 Q You say several. I presume that means two 17 or three. What is the number? 18 A Since I've been in Cincinnati how many 19 patients have I had with cancer? 20 C Yes , sir. 21 A At least ten. 22 Q Do you recall what kind of cancers were involved? A Lung, laryngeal, breast, oral, colon, 97 1 kidney, skin. 2 Q That's seven right there. 3 A Yes. I mean, these are different types, not * 4 just individuals, so quite a few. 5 Q I understand. Have you had any experience 6 with vinyl chloride or polyvinyl chloride exposures 7 other than those people that you saw in connection 8 with the Columbus case and this case? 9 A Yes. 10 Q Describe that for me, then. 11 A Individuals working with some of the resins, 12 the PVC resins, outside of these situations; individ 13 uals with vinyl chloride exposure outside of these. 14 Q Well, what were they doing? What kind of 15 exposur es? 16 A One was working a press. In fact, there 17 were several individuals who were press operators IS handling the green, resin. Another was a design engi 19 neer working withdesign of a facility using vinyl 20 chloride 21 Q He was designing a facility? 22 A He was involved with, yes. Well, I guess 23 not design. He wasn't the architect, but was a 24 mechanic. But more of a technical, skilled, than URL 11907 98 1 simply a maintenance mechanic, 2 Q This was an operating facility? 3 A Yes. 4 Q His exposure was to what? 5 A Vinyl chloride. 6 Q What was his complaint? 7 A He had oral cancer. 8 Q When you say oral, that's in the mouth? 9 A Yes. 10 Q Where was he working? 11 A I think these were in Kentucky. 12 Q And the press operators, what were they 13 doing? 14 A They were involved in the manufacturing of 15 seat coverings, floor panels. 16 Q What were their complaints? 17 A They had problems with some respiratory i'8 complaints, but primarily hand and finger problems. 19 Q What kind of band and finger problems? 20 A There was some arthritic problems, also some 21 circulatory problems. 22 Q This wasn't acroosteolysis? 23 A I don't think it was, and I don't think it 24 was scleroderma, either, but in some cases there was URL 11908 URL 11909 99 1 some hint of at least perhaps earlier problems. But 2 I didn't diagnose scleroderma or the osteolysis on 3 either one of them. 4 Q That has been your extent, then, with 5 involvement with polyvinyl chloride or vinyl chlo 6 ride? 7 A I think so, yes. 8 Q What were you doing, evaluating these people 9 or treating them? 1 0 A Both. 11 Q Were you involved in any lawsuits arising 12 out of these cases? 13 A Well, the one with the oral cancer was 14 awarded a workers' compensation claim. There was no 15 lawsuit. And I don't think the others had any -16 well, I wasn't involved if there were any lawsuits or 17 work comp claims. 18 Q You saw these when you were down here in 19 Cincinnati? 20 A Some were in Detroit; some were here. 21 Q The Kentucky case was down here? 22 A Yes. 23 MR. BUNDA: Doctor, if we could, I would 24 like to ask you some questions about the -- well, URL 11910 100 1 let me stop for a second. Let's go off the 2 record. 3 (Discussion off the record.) 4 Q 1 would like to talk to you now about the 5 types of information that appears in a published form 6 with regard to medicine. You have medical texts. Is 7 that right? 8 A Yes, 9 Q What is that information used for in the 10 general practice of medicine# if you understand my 11 gues tion? 12 A Sort of generalknowledge bases. They are 13 generally organized into chapters by organ system,-, 14 and then within each chapter or division of organs 15 will be a division by disease, disease process. So 16 they're basic information. Some may be more -- if 17 it's medicine, it's primarily on treatment sugges 18 tions, a diagnosis. If it's toxicology, it's more 19 review of what's known'-about a specific material. 20 Q It's an overview of the information avail 21 able? 22 A That's right. 23 Q Have you everheard theterm "casereport"? 24 A Oh , yes. . 101 1 Q What 16 that? 2 A Well, case report is reporting of an indi 3 vidual or group of individuals without direct claim, 4 if it's by itself, of proof of cause and effect, but 5 interesting situations, and quite useful in all areas 6 of medicine, including occupational medicine. Some 7 of the earliest observations are called that, for 8 example, before you've had time to make comparisons 9 to cohort prospective studies. 10 Q When you say useful, useful for what? 11 A Alerting individuals to possible new 12 diseases, new relationships, or, in some setting 13 where there might be animal data about cause and 14 effect, similar situations in humans where there 15 hasn't been a full epi. study. 16 Q Would Z be correct in saying that case 17 reports are not used for establishing cause and 18 effect? 19 A By themselves^ You know, in some settings, 20 if that's all the information that's available for 21 humans, that might be enough. If there's lots of 22 bacterial and laboratory data, for example. 23 Q They can be used for triggering hypotheses? 24 A Oh, definitely that. URL 11911 URL n y i< 102 1 Q That's their primary role? 2 A Yes* Take, for example, formaldehyde where * 3 there is bacterial evidence for carcinogenicity, 4 laboratory evidence and the human epidemiology is 5 still ongoing. There are case reports of the nasal6 pharyngeal cancers, and that's being utilized as a 7 basis for making some additional standard settings, B monitoring, and so on. 9 Q Well, if we can stay away from -- 10 A That's what I'mtalking about in terms of 11 not only then are they useful for hypotheses gene 12 rated, but definitely that they are useful for that. 13 Q Well, if we can stay away from the standard 14 setting, because you will and I will agree there are 15 political implications in setting standards. You 16 have a factor of safety you want to maintain. You 17 know, safety for the population is designed. It's 18 not purely an issue of cause and effect in a stan 19 dard. Would you agree with something like that? 20 A Well, I agree that there are political 21 considerations* I don't think that safety is a 22 political consideration, but you're right, standard 23 setting does involve more than just straight science. Q Well, I didn't mean to imply that standards 103 * 1 were purely political, but it has that element to 2 them. Correct? f 3 A Yes . 4 Q What I'm trying to establish is some sort of n 5 hierarchy in the medical literature for providing A 6 information that you as a doctor or others in the 7 medical profession will use and rely upon in estab 8 lishing cause and effect. Okay? 9 A That's fine. 10 Q Case reports are something that you can 11 refer to in that hierarchy. Is that right? 12 A Yes . 13 Q If you have epidemiologic literature or 14 animal or laboratory information available to you,, e vfiin u n 15 that is of a higher degree of quality than case 16 reports. Is that right? 17 A Yes . 18 Q What would be next onthat hierarchy of 19 information that you would look to. as being valuable 20 to you or to the medical profession in general? 21 A Well, perhaps taking case reports and estab 22 lishing a control group, and either using, in most 23 situations, a standard mortality or morbidity ratios, 24 SMRs, you might be able to take those case reports 104 1 and do a pmr, a proportionate norbidity/mortality# 2 based upon the total exposed group or possibly 3 exposed group or work force or what have you. You 4 night be able to do either a prospective or# you 5 know, historical retrospective# what have you# of a group# of a cohort# again based upon those case 7 records . 6 Q So you're taking a bunch of case reports# 9 conglomerating them together and then --10 A And following them through time or going 11 backwards in time. And all of those would strengthen 12 and upgrade the simple case reporting. 13 Q So now you're shading into the area of 14 epidemiology. Is that right? i 15 A Kell, and in the broadest sense, case 16 reports are epidemiologic# for that matter, as well. 17 Theirs perhaps were just scratching the surface in 18 some of the *si<np.lest forms that can be done. 19 Q You're using them In a broad sense# though? 20 A That * s right. 21 0 What is epidemiology? 22 A It's the study of disease as it exists in a 23 population. 24 Q What do epidemiologists do# to your under- 105 1 standing? 2 A Okay. Study that disease and its relation3 ship to the population as a whole. Like Z say, case 4 reports fall under an epidemiologic job and exper5 ti se . 6 Then the other things that I described. 7 designing studies as to how would you either seek to 8 prove causality or disprove it with respect to some 9 case reports, or even when there are no case reports, 10 where there's animal data, how would you' go about 11 designing a study to prove or disprove a relation12 ship. 13 Q Epidemiologists don't work with case reports 14 per se. though. They attempt to design their own ... 15 studies if they have the ability to do so. Is that 16 right? 17 A Yes . (.i 18 Q Okay. When you say designing a study, am I 19 correct in understanding that epidemiologists, when 20 they do a study, they look at large groups of people. 21 Is that right? 22 A Okay. That's certainly part of the thing that they do, yes. Q And in looking at these large groups of 106 1 people, they try and determine whether there is a 2 difference between two groups of people depending on 3 various factors. is that too broad? 4 A No. That's fine. 5 Q And if I can make this more concrete, you 6 have one group of people that is exactly alike, theo 7 retically, to the other group of people except for 8 one particular factor? 9 A That would be the ideal setting-, yes. 10 Q And they attempt to determine whether that 11 particular factor has any bearing on the health of 12 those people, then. Is that right? 13 A That's right, or any other measure that 14 you're seeking to look for, yes. 15 Q One of the reasons they use this is because 16 you can't do experiments on human beings. Is that 17 right? 18 A That's right. 19 0 Nhat are animal experiments? 20 A It can be of a variety of different types, 21 both acute and chronic toxicity experiments: dosing 22 animals with a specific substance, giving different 23 doses to different amounts of animals; looking for 24 grossly observable effects, death, abnormal neuro- io n 107 1 logic behavior, respiratory function? looking for 2 microscopic abnormalities, again, with those 3 responses 4 There are more chronic types of animal 5 experiments: give longer term exposures, probably 6 less exposures, again looking for differences based 7 upon the amount, duration, extent, intensity, what e have you, of exposure; look for cancers; any one of a 9 number of different things. 10 0 Science uses animals because, again, you 11 can't use humans to experiment on? 12 A That's right. And you can far better con 13 trol for the variety of different factors that are 14 involved. 15 Q And that information is taken and there is 16 some analysis done in an attempt to extrapolate that 17 information in animals to the use with humans? 18 A Yes . 19 Q There are problems with doing that, aren't 20 there? 21 A The whole field of, yes, occupational medi 22 cine, epidemiology has great difficulties because of 23 controlling for different factors, and so on. 24 (Discussion off the record.) 108 URL 11918 1 Q Is there any other type of medical litera 2 ture that you look to for information? 3 A Well, we haven't talked about bacterial 4 studies. 5 Q What are those? 6 A Well, these would be some of the easiest, 7 simplest, first type of studies of toxicity, seeing 8 the effect upon bacterial systems of various chemi 9 cals. Particularly genetic mutations are the easiest 10 sample with these kinds of testing. . / 11 C You're talking about things like the AltTS 12 test now? 13 A That's the historic test, yes. 14 Q Anything else? 15 A Well, certainly hygiene is important in 16 terms of the mechanisms of generation of fumes, dust, 17 particulates. Mechanisms of measurements are also 18 important. 19 Q Okay. I'm thinking more in the area of 20 cause-and-effect relationships now 21 A Okay. Yes. There are a number of things 22 you can do with statistics, too, but I think we've 23 talked mostly about cause and effect. 24 Q When you say -- I'm sorry. I didn't mean to 109 1 interrupt you. Are you finished? 2 A Yes . 3 Q When you saystatistics,you're talking 4 about biostatistics? 5 A Yes. 6 Q And that is a category ofepidemiology? 7 A Well, I don't think either field would agree 8 to that. Biostatistics has to do with how do you 9 take data and analyze it to show causation, relation 10 ships that didn't just happen by chance, and there's 11 obviously quite a science involved with that as to 12 what particular test and testing procedures to use. 13 Q You said you had some training in your 14 master's program in biostatistics. Is that right? 3D 15 A Yes. XT' 16 Q How many courses did you have? UZ> 17 A Three or four. 18 Q Did I ask you how many occupational medicine 19 courses you had in the program? 20 A No. 21 Q I'm asking you now. 22 A I'm not sure. Yes, I'm reallynot sure, 23 because that format was probably -- Ihate to say 24 least structured, but there would be seminars on each 110 1 weekend that we were there, and there would be 2 usually a stack, two-inch stack, of articles that 3 were handed out, and within each of the different 4 sections specific diseases would be dealt with, so 5 that's really hard to say how many different occupa 6 tional medicine courses there were. 7 Q What about toxicology courses? How many did 8 you have? 9 A Three or four . 10 Q These courses, how long did they last? I 11 mean, my understanding was you had a weekend a month, 12 right? 13 A Yes. And so they would last three to six 14 months. They were basically -- I think the equiv 15 alent in toxicology would be three or four semesters 16 of a course a semester, and that was what they based 17 the courses on. But since they would stretch out, we 18 weren't really in semesters. It's hard to, you know, 19 tell you how long they -.lasted. 20 Q Each course went three to six months? 21 A Yes. 22 Q And you met one weekend a month? 23 A Yes . 24 Q Within that weekend, how much time was URL 11920 URL 11921 111 1 devoted to each course? ? A Well, it was three days, so we would go 3 eight hours each day and we'd generally have two to 4 three hours each day on the courses that we were on. 5 Q Two to three hours each day? 6 A (Nodding.} 7 Q Is that right? 8 A Yes . 9 Q And you would spend threedays? 10 A Yes . 11 Q So that would be six to nine hours a month? 12 A In formal coursework, yes. 13 Q On one particularsubject? 14 A In one, yes, when we were taking epidemiol 15 ogy courses. Actually, I think there was an epi. 16 course almost the whole time. 17 Q Then you would keep that same focus of study 18 for three to six months? 19 A Yes. 20 Q How many courses in all did you have? 21 A I don't know. I mean, there were courses in 22 administrative law, biostatistics, toxicology, indus 23 trial hygiene, occupational medicine, epidemiology. 24 There was some computer time, and I think that was 112 1 nixed into one of the other -- that was maybe part of 2 biostatistics or epidemiology. 3 Q How many courses did you have in industrial 4 hygiene? 5 A i took three or four. Basically, most of 6 these are pretty much equally divided. 7 Q Those courses in industrial hygiene, do you 8 remember what any of them were? Was one testing? 9 A I think we had a ventilation caurse. There 10 was the testing, sampling course, and 1 don't know 11 whether it was called beginner's, beginning -- URL 1192 12 Q You received instruction in threshold limit 13 values , then? r-o 14 A Yes . 15 Q So you're familiar with the American Confer16 ence of Governmental Industrial Hygienists? 17 A Yes . 18 Q They issue the threshold limit values? 19 A Yes. 20 Q They're here in Cincinnati, right? 21 A Yes . 22 c Do you subscribe to the theory of threshold 23 limit values? 24 A I guess I don't understand. They're here URL 1192 113 1 They 1 re real. 2 Q Okay. There is a dose to which you can be 3 exposed and there's no effect? 4 A Okay. Now, that's not implied. I mean, the 5 ACGIH will not tell you that if you're under a stan 6 dard you're either safe or what have you. If you're 7 asking about safe levels with respect to disease, I 8 think there are safe levels. If you're asking about 9 safe levels with respect to cancer, I think that's 10 another s tory. 11 Q Well, we'll get to that story in a little 12 bit. 13 A All right . 14 Q With regard to developing scientific infor 15 mation regarding cause and effect between a chemical 16 and its effect on humans or animals, can you describe 17 for me how, when you are faced with a chemical and 18 you don't know what it does, and when I'm speaking 19 about "you," I'm speaking about the medical profes 20 sion in general, what happens? Bow do they gather 21 information then? 22 A Well, there could be several, levels. One is 23 monitoring of individuals with exposures. 24 Q What will that tell you? 114 i 1 A You can develop symptoms, characteristics, 2 look for dose response. You know, do people with 3 more symptoms have more exposures, those with less 4 symptoms have less exposure? 5 Q Historically, that has been a way of deter 6 mining whether chemicals cause an effect on humans. 7 Is that right? 8 A Yes. 9 Q Epidemiology, Doctor, animal experimenta 10 tion, these are all fairly recent developments? C h in a n 11 A Thet1s right. Now, of course, all of those 12 are involved with some of those initial evaluations, 13 but, yes, the sciences have developed to utilizing 14 laboratory animal data, bacterial systems, the study 15 of the physical chemical properties of chemicals, how 16 do they behave, what's their metabolism, a variety of 17 different ways 18 Q When you have this observed cause and effect 19 on people actually subject to the exposures, what 20 type of information do you need to determine whether 21 there is the cause and effect relationship? Do you 22 have to look at the dose? 23 A Yes. I mean, a lot of times you don't have 24 all the data, you don't have dose, and that's partic- 115 1 ularly true in occupational medicine. Doses, you 2 know, weren't available in a specific setting. If 3 you were to design something, then you would want to 4 be able to measure dose if you were going to test it 5 out . 6 Q You would also want to look to the repro 7 ducibility of that? You want a consistency in a 8 reaction. Is that right? 9 A That's right, yes. 10 Q You want to look at other causes of a 11 particular effect and try to rule those out, right? 12 A That * s right. 13 Q Animal experiments are another way to give 14 you information. Is that right? 15 A Yes. 16 Q That is a tool that has beendeveloped by 17 science to determine cause and effect in humans. Is 18 that right? 19 A Yes. 20 Q Looking atanimalexperiments, you can more 21 closely control factors such as dose, outside causes 22 of a particular effect and things like that. Is that 23 right? A Yes. And you can do it over shorter periods URL 119 116 1 of time. You can give higher doses and then make 2 your extrapolations based upon that, yes. 3 Q You also have problems because you have to 4 decide whether the animal will react in the same way 5 that a human will. Is that right? 6 A That * s right . 7 Q You have to decide whether the dose given to 8 the animal is somehow proportionate to how a human 9 being will react? 10 A That's right. 11 Q And you want to make sure that the animals 12 are not, or the effect that you see in the animals is 13 not due to some other cause particular to the animal? 14 I mean spontaneous cancers peculiar to that type of 15 animal. 16 A Tha t * s right. 17 Q And you want to make sure that the effect 18 seen in the animals is reproducible. is that right? 19 A Yes. 20 Q Now, in epidemiology that's another tool 21 that has been developed by science to determine cause 22 and effect. Correct? 23 A Yes . Q Would you agree with me that epidemiology is URL 11926 117 n 1 not too able to determine cause and effect but can i .l 2 only establish association? Have you ever heard that 3 before? 4 A Well, I've heard that, yes. I'm not sure I n .i 5 necessarily agree with that, but I guess in the 6 strictest sense, epidemiology does not study what 7 happens at the tissue level. It is just looking at 8 events that are occurring. So that, I think, is a 9 basis of a statement, for the statement it looks for 10 associations. However, there comes a point that 11 associations become real enough that that, in fact, 12 is proof enough. 13 Q Do you know where that point lies, in gene 14 ral? URL 1192 15 A You mean how -- 16 Q How you can go from an association to say 17 that epidemiology actually establishes cause and 18 effect 19 A I don't think*there' s any one set, ironclad 20 rule that says if you have A, B or C, then that's 21 sufficient 22 Q Have you ever heard of a term referring to 23 the power of an epidemiologic study? 24 A Yes. 118 1 Q What is your understanding of that? 2 A Well, that has to do with sample size, how 3 many people or individuals or whatever are being 4 studied. It has to do with how common, prevalent a 5 particular disease process is, and then the cnarac6 teristics of that, what you're looking for. If you 7 have small numbers of participants and a common 8 disease, the power would be relatively low. If you 9 have a large number and a common disease, well, the 10 power goes up, and as simile for rare diseases, you 11 can get by with smaller numbers in a group with rare 12 disease for the same sort of reasoning. And power is 13 how we describe that. 14 Q So when you're referring to an epidemiologic 15 study with a high degree of power, you're talking 16 about ones that you can place a great deal of reli 17 ance on? 18 A That's right. And the converse is, too, if 19 you have a lower power-study, and it particularly has 20 to do with studies that don't show relationships, if 21 you have a lower power study that shows a relation 22 ship, that speaks to the strength, because the 23 chances of showing that were fairly low. A high 24 power study means that a negative study, a study that URL 11928 129 1 Q Specifically focusing on the salivary gland# 2 do any of these, leaving aside vinyl chloride, but do 3 any of these others, are they recognised specifically 4 as attacking the salivary gland or the parotid gland? 5 I'n\ using those terms equivalently. e A That's fine. 7 Q Is that your understanding? 8 A Yes. Well, probably cigarettes and alcohol. 9 Some associations with other chemicals, but I don't 10 think they're as strong. 11 Q Are there salivary gland cancers that arise 12 that people don't know what the cause is? 13 A Yes . 14 Q What percentage or proportion of that? 15 A Those are the majority. 16 Q You're in occupational medicine. Do you 17 have an idea about approximately what proportion of 18 cancers are occupationally related? 19 A Someplace between ten and 20 percent, I 20 would say. 21 Q Where did you get this information? 22 A Through a review of the published litera 23 ture. You know, the low end, I think, is five 24 percent, and I think Doll will talk about five per- URL 11939 URL 11940 130 1 cent. The high end is about 20 percent, and it gets 2 someplace in between there, although I think Doll is 3 conservative. 4 Q You're talking about Doll and Peto's study? 5 A Yes . 6 Q That's the one they did for the National 7 Cancer Institute? 8 A Yes. 9 Q Which one is the 20 percent? 10 A Well, several. I don't recall the authors 11 for those that have suggested it. 12 Q That was the President's Advisory Board? 13 A That * s one. 14 Q The one that Doll says is trash? 15 A I don't know that he said it wastrash. If 16 you say so, all right. 17 Q Well, you're not familiar with that, in 16 other words. Is that right? 19 A I'm not familiar with Doll's comments on it, 20 no 21 Q You're not familiar with the study itself 22 that says 20 percent, either, are you? 23 A Not that, no 24 0 So you would agree with me that at least 60 131 1 percent of the cancers have or are thought to have .2 origin other than arising from the workplace? 3 A Yes, at this point. We may be proved wrong 4 in the future, but data today will tell us that, yes. 5 Q Can you describe for me your knowledge about cancer? What is cancer? 7 A Well, cancer has to do with altered genetics 8 such that the cell no longer behaves normally and 9 will spread, divide in a bizarre and unusual fashion, 10 essentially disrupting normal physiology to the 11 extent that life is not possible. It implies that 12 the cancer will spread past the site of origin to a 13 site some distance from that original site. 14 Q What is the word used for that? 15 A Metastatic disease; metastasis. 16 Q What causes the cell to do this? 17 A Well, probably several stages, several 18 steps. We know a fair amount, although still the 19 precise mechanisms aren't well worked out, but what 20 likely happens is several different events change, a 21 change in the DMA, the basic genetic code, such that 22 the cell affected no longer either makes proteins, 23 enzymes or goes about body growth repair normally. 24 then followed by additional changes in other portions I.IRL VI M l URL 11942 132 1 of the genetic code, the DNA, so that the either 2 control, regulation of that particular area, that 3 particular gene, no longer occurs appropriately, 4 allowing for additional and more rapid growth. 5 We're basically talking about liKely several 6 different steps involved with clones of cells growing 7 at first not necessarily malignant but abnormal, 8 becoming progressively more abnormal until they 9 attain malignant status, that is, the ability to 10 spread beyond the local source. 11 Q We're talking about the loss of a control 12 mechanism in the cell for reproduction. Isn't that 13 right? 14 A That certainly occurs, yes. 15 Q When you say there's a DNA alteration, do 16 you know why that occurs in cancer? 17 A In some cases it's quite clear what happens. 18 A chemical, because of its reactivity, makes what's 19 called an adduct. It attaches to the DNA permanently 20 in such a fashion that that cell and all the other 21 cells that come after it don't behave properly or normally. In other instances, it's not clear. some situations, pieces get added, deleted, but it's not clear, the process. URL 11943 133 1 Q You're familiar with research on altered 2 genes? 3 A Yes . 4 Q There are a lot of theoriesgoing around 5 about carcinogenesis. Is that right? 6 A Yes. 7 Q And research is going on at this time? 8 A Yes. 9 Q But it's not exactly established how that 1 0 occurs in all instances? 11 A No. 12 Q Do you know the phraseologyor the. terms 13 promoters" and "initiators"? 14 A Yes. 15 Q Describe for me your understanding of those. 16 A Well* that's basically what I was doing. An 17 initiator is that chemical that will start the ball 18 rolling# so to speak# has ability to attach to the 19 DNA# change the DNA# f6rm a DNA adduct in such a way 20 that they have a permanent change. 21 The promoter has to do with a chemical or a 22 substance that will make alterations at some other 23 part that will enhance the growth# development of 24 this initiated cell or cellae. URL 11944 134 1 Q Do you know how vinyl chloride acts as a 2 carcinogen? 3 A Probably in both of -- many of the initia 4 tors are also promoters. Either vinyl chloride S through its metabolism forms this epoxide that's 6 quite reactive, retrofilally attaching to DNA, chang 7 ing it, forming adducts. This is fairly typical of 8 many of the carcinogenic materials. 9 Q You say it forms an epoxide? 10 A Yes . 11 Q So what ycu're talking about is the vinyl 12 chloride is metabolized. Is that right? 13 A Yes. 14 Q Vinyl chloride is not a carcinogen, but it's 15 processed by the body to form a carcinogen. Is that 16 correct? 17 A Yes. That may be a real shade of difference 18 there, but that's right. It's probably a metabolite 19 that causes the problem. 20 Q The metabolite has been found to be formed 21 in the liver. Is that right? 22 A Well, anyplace where there's cytochromes. And the liver is not the only site. The liver is the primary site for metabolism, and most of the cyto- URL 11945 135 1 chromes are there, but the process, the ability to 2 metabolize materials/ exists elsewhere in the body, 3 too. 4 Q Have you heard the term "metabolic pathway"? 5 A Metabolic pathway, yes. 6 Q What is that? 7 A It speaks to what we've justbeen talking 8 about, that is, the steps and the changes that occur 9 in a specific substance, chemical, that either 10 renders them active or inactive. Life makes many 11 different things, proteins, enzymes, and there's a 12 metabolic pathway that starts with building blocks 13 and makes those. Or, with respect to synthesized 14 chemicals, proteins in the body, or exogenous chemi 15 cals, outside the body, they get integrated through a 16 pathway. 17 Q It refers to a mechanism through which an 18 outside chemical comes into the body and arrives at a 19 certain part of the body where it does harm. 20 A That also may be included, yes. It has more 21 to do with pharmacodynamics. The pathway specifi 22 cally has to do with what -- has to do with its 23 degradation or anabolic process. 24 Q If I can back up for just a second, the fact t URL 11946 136 1 that, for example, sunlight is known to be a cause of 2 cancer, skin cancer specifically, you know that to be 3 true. Is that right? 4 A Yes . 5 Q The fact that sun causes cancer of the skin 6 does not necessarily mean that sun can cause lung 7 cancer. is that right? 8 A That's right. 9 Q And that's because you have these metabolic 10 pathways, and there's no explanation for how the sun 11 could cause any changes in the lung, because the 12 lung's inside the body. is that right? 13 A Yes, although I'm not sure I understand t"he 14 metabolic pathway, what you're driving at in terms of 15 that. The sunlight does not reach the lungs. It's 16 stopped by the skin. The energy is absorbed by the 17 skin, so -- 18 Q There's some pathway between what happens on 19 the skin once it's exposed to the sunlight and the 20 effects of the sunlight, the chemical changes that 21 occur and the eventual development of cancer. That's 22 what I'm getting at. 23 A All right. I wouldn't call that a metabolic 24 pathway. 137 1 Q Well, there's some relationship between 2 what's known to be a cause of cancer and the place 3 where the cancer arises. is that right? 4 A That's right. Energy is absorbed and the 5 energy from sunlight, ultraviolet radiation, produces e genetic DMA alterations in some of the skin cells, 7 and that's what occurs. 8 Q You'd agree with me that the fact that 9 something is known to be a cause or suspected to be a 10 cause of cancer in one particular part of the body 11 doesn't mean that that particular substance will 12 cause cancer in any part of the body? 13 A No. You have to be able to demonstrate that 14 that substance can get to -- I mean, that would be15 vital. The substance or the metabolic product or 16 some such has to reach an area for that to be a 17 primary site for cancer. 18 Q A more specific example, there is knowledge 19 that vinyl chloride can cause angiosa'rcoma of the 20 liver. Zs that right? 21 A Yes . 22 Q That doesn't necessarily mean that vinyl 23 chloride is known to cause skincancer? 24 A That's right. m i nan 'n 138 1 Q Let's talk now about the effect that dose 2 has on the formation of cancer. What are your 3 thoughts on that? 4 A That's a difficult area. From a statistical 5 point you can talk about dose having an effect upon 6 the prevalence, the amount of cancer that occurs in a 7 population. The higher the dose, the more cases 8 you're going to develop. But by the very nature of a 9 carcinogenic material, it's very difficult to find a 10 dose that doesn't cause some problem, i.e., poten 11 tially cancer. We know that the body has the ability 12 to repair potentially carcinogenic events. In other 13 words, a DMA adduct gets made that the body is able 14 to cut out. But in terms of threshold dosage, for 15 example, I don't think that we can talk about safe 16 doses, safe exposures for materials that are carcino- ; 17 genic. i ! 1 18 Q why. flo you say that? 19 A Because of what I've just talked about. In j 20 other words, if something is carcinogenic, it means 21 by definition that it has the ability to alter DNA 22 and, therefore, that ability can occur at almost any 23 dose. Thus, you can't really talk about safe levels. 24 Q Why do you say that ability can occur at am nan URL 11949 139 1 almost any dose? 2 A Because all that it takes is one molecule at 3 the right site to cause a problem. Now# statisti 4 cally you can talk about the more molecules you have, 5 the more likely you're going to cause that. That's 6 absolutely true. But we know that one molecule can 7 produce the problem. 8 Q Theoretically, you're talking about? 9 A That's right. 10 Q . That is, as a practical matter it doesn't 11 work that way. Is that right? 12 A Well# with many substances -- we can show 13 that single asbestos fibers are sufficient to produce 14 mesotheliomas, and that's probably the easiest exam 15 ple, because it's very difficult to give a person one 16 molecule of a substance. But you can give them one 17 fiber in a laboratory setting. 18 Q ' Well, all of us are exposed to sunlight and 19 all of us don't have skin cancer. 20 A That * s right. 21 Q Correct? 22 A That * s right . 23 Q All of us are exposed to vinyl chloride, for 24 that matter, and all of us don't have cancer of the 140 1 liver. correct? 2 A You'd have to go some to prove how much 3 we're all exposed to vinyl chloride* 4 Q Well, would you accept the theorem that all 5 of us are at least exposed to a molecule of vinyl 6 chloride ? 7 A That may be so, yes. 8 C so there are at least thedefenses in the 9 body to fight off exposures like this? 10 A That's right. 11 Q So it's not necessarily going to happen that 12 you get cancer just because you're exposed to a 13 molecule of a carcinogen? 14 A Right, yes. I didn't mean to imply by 15 anything that I said that that was the case. 16 Q And, in fact, the U.S. Government -- again, 17 we're getting into areas of policy -- but permits 18 exposures to known carcinogens at levels which the 19 scientific community, or at least the government, 20 believes are acceptable. 21 A That's right. You know, cases at about one 22 in a million have been ruled -- you know, exposures 23 that cause, one in a million have been ruled to be 24 safe, basically. 141 1 Q What do you know about the exposures that 2 Mr* Wallace and Mr* Dendinger had in the factory? v 3 I * in talking now about materials other than vinyl 4 chloride or polyvinyl chloride. 5 A There were some solvents of the ketone type, 6 methyl ethyl ketone, MIBK, methyl isobutyl ketone, 7 some tetrahydrofurans , I believe, some toluene, 8 perhaps some trichloroethylene, some dyes. I don't 9 know the specific names of those. 10 Q Now, did you analyze these exposures in your 11 considerations of cause, potential causes, of their 12 cancers? 13 A Yes, I've taken them into account. ! 14 Q What about MEK? Is this known to cause any 15 cancers of the mouth and throat or the colon cancers? j 16 A Not known to be. I.S6H TdO 17 C Not known to you to be? 18 A That's right. And I don't think to the 19 medical connunity 20 Q What about the MIBK? 21 A Yes . 22 Q What about that? 23 A I don't think so for that, either. 24 Q For either type of cancer? URL 119! 142 1 A That's right. 2 Q What about THF? 3 A Not known to be. 4 Q What about toluene? 5 A Toluene may be a promoter. 6 C But in your opinion, it's not an initiator? 7 A I don't think it's an initiator, that's e right . 9 Q What about the relationship between those? 1 0 You can have initiation and never have it grow into a 11 cancer. Isn't that true? 12 A That's part of the theory. I don't think 13 the answer's in on that. But in the one sense I 14 think the answer's no. It may be a very benign, 15 slow-growing type of cancer. On the other hand, that 16 may be, you know, the initiation may produce the 17 benign growth, for example, although, to my point of 18 view, to be an initiator of cancer really has to be 19 something more than something benign, but depending 20 upon which particular theory you're holding as to how 21 you would answer whether a cancer can develop without 22 a promoter. And, of course, many initiators are pro 23 moters themselves. 24 Q I'm not sure I got an answer to my question. 143 URL 11953 1 My question is if vinyl chloride# in year opinion, is 2 an initiator and you qet another chemical as a pro 3 moter, an initiator can change the DNA characteristic 4 in the cell. is that right? 5 A Yes . e Q That cell can die if it doesn't reproduce. 7 Is that right? 8 A That's right. 9 Q And that's the job of promoters, is to 10 promote the reproduction of those cells. - Is that 11 right? 12 A Hell, all right. I mean, it's not quite 13 that simple. If, in fact, the initiated cell dies, 14 then no promoter is going to bring it back. okay? 1 5 Q That's right. 16 A So the scenario would be that an initiator 17 causes abnormalities that in theory ultimately would 18 lead to a cancer. The promoter brings that cancer 19 forward in time. 20 Q And if you don't have a promoter, then you 21 don't have the cancer growing? 22 A Or maybe it's growing more slowly and isn't 23 going to develop for some time, a longer time down 24 the road W61 l in n 144 X Q Or it may never develop? 2 A Or possibly that individual could die from 3 something else first, right. 4 Q So if you have toluene, which is a promoter, 5 the toluene could have been promoting the cancers in 6 these gentlemen? 7 A That's possible. 8 Q nave you sorted out in your own mind the 9 relationship between these two? 10 A I think so. I'm interested in more informa 11 tion as to how much toluene and so on was involved. 12 Q Well, let me suggest that at times the 13 toluene exposure was in excess of the threshold limit 14 values. In your opinion, would the toluene have been 15 a substantial contributing factor to the cancers that 16 arose in one or both of these gentlemen? 17 A It depends upon how much, how often that was 18 occurring 19 Q Hell, explain.that for me. How much would 20 be enough? 21 A Well, was this once that it was over the TLV? Has this every day, constantly, eight hours a day, five days a week, it was over the TLV? All of those things. I mean, the more of the exposure, the 145 1 more likely that it became important in terms of 2 pr omotion * 3 Q Well, tell me how much exposure would be a 4 significant and enough for you to decide in your own 5 mind that it was a substantial contributing cause to 6 the cancers. 7 A I think that if there was constant exposure 8 to a hundred parts per million, for example, of 9 toluene, you know, eight hours a day, five days a 10 week, through most of these particular men's employ 11 ment, that would be an important role. 12 Q What if it was less than that in terms of 13 the length of time? How about a couple of years* 14 exposur e? 15 A That also could be possibly important. It 16 would depend upon which years, what else was going on 17 at the time, and so on. 18 Q You don't have that information yet. Is 19 that right? 20 A No. 21 0 That'sinformation that you would need 22 before you make a decision? 23 A Yes . 24 Q Have you beenprovided with information URL 11955 146 concerning exposures in the factory? A No. Q Rave you been provided with information concerning exposures to vinyl chloride? A Not specific measurements. I have general knowledge of the types of exposures that would occur in this type of situation, but I have not seen specific numbers, Q Tell roe your general knowledge about types of exposures like this. A Generally, conservative would be one to five parts per million generally with peak exposures prob ably occurring daily, peak exposures of 25 to 100 . parts per million, although both of these individuals remarked that they could smell vinyl chloride, which would mean probably considerably higher exposures. You know, the ability to detect vinyl chloride, some say, can be done as low as 400 parts per million, but many think it's much higher than that. Q In your experience, has anybody in a fabri cating situation documented that they could smell vinyl chloride and it actually was vinyl chloride? A This is the most descriptive detection that I've seen. 9j6 i-1 iy n iS6 n nan 147 1 Q Have you expressed an opinion as to whether, 2 in fact, they were smelling vinyl chloride as opposed 3 to something else? 4 A All I have is their description of it, so I 5 can ' t say , Q What about if you were supplied with infor 7 mation that an industrial hygienist from the State of 8 Ohio received that information, checked it out and 9 concluded that they were smelling the ketones or 1 0 something else? Would that have any bearing on your IX analysis? 12 A Yes . 13 MR. DELLI BOVIj I'm going to object. You 14 can go ahead and answer. 15 Q Okay. What effect would that information 16 have ? 17 A If a hygienist had made an evaluation, that 18 would certainly speak to the opinion at the time of 19 the evaluation. These gentlemen are dead, so it's 20 hard to question. 21 Q It's hard to ask them what they smelled? A Yes. All we have is their description that they smelled this sweet type odor. Q If you had your choice between the analytic 148 1 measurement done by the State and by Chrysler versus 2 their opinion, which would you place more emphasis 3 upon? 4 A It would depend upon the timing of that. I 5 mean, if they're smelling this and saying "I'm smell 6 ing vinyl chloride" and someone is there measuring 7 and says, "No, it's this," then it's much more on 8 what's being measured. If it's a historical thing, 9 "We used to smell this all the time; we haven't 10 smelled it in a while," and measurements are done 11 :hen and say, "Yes, you're right; you're not smelling 12 vinyl chloride," then the historical observation 13 would have more credence. 14 (Recess taken .) 15 Q Doctor, we were talking about exposure 16 levels in the Sandusky Chrysler Plastic Products 17 plant. You have not seen those figures. Is that 18 right? 19 A That's right . 20 Q If, in fact, the exposure levels were below 21 the level of .5 parts per million, would that have a 22 bearing on your opinion? 23 MR. DELLI BOVI: Objection. You can answer. 24 A If someone can demonstrate, yes, that expo- URL 119 149 V 1 sures throughout the whole period were never above 2 5, yes , that way. 3 Q How would that affect your opinion? 4 A Well, that would mean there would be essen i 5 tially little or no exposures to vinyl chloride. 6 Q And that would affect your opinion about 7 whether these cancers were caused by vinyl chloride, e then. Is that right? 9 A Yes. 10 Q You would have to change your opinion and 11 conclude that they were not caused. Is that right? 12 A It would be much less likely, yes. 13 Q We weren't finished going through some of 4* 14 the other exposures. You thought there was some 15 trichloroethylene there. 16 A It seems likely, yes. 17 Q What about the effect of that exposure? 18 Would that have any effect on the cancers? 19 A Possibly. There's some evidence that 20 trichloroethylene is carcinogenic. 21 Q If there was exposureto thatchemical at 22 the plant, in your opinion, would that have played a 23 contributing role to the cancers in these gentlemen? 24 A It's possible. URL u ssy 150 1 Q What about the dyes? There were numerous 2 dyes used in the ink room where both of these gentle3 men had exposures. Have you analyzed any role that 4 these dyes may have played in the cancers? 5 A I don't know which ones they were. Dyes, 6 you know, bladder cancer's associated with some dyes 7 for sure. So it would be valuable to get information e about that, about those dyes. 9 Q Don't you need that information-before you 10 can form a conclusion as to the cause of the cancers? 11 A Well, except that the vinyl chloride is 12 fairly striking here and that sticks out in terms of 13 causality. 14 Q But you haven't ruled out any other possi 15 ble -- these particular possible causes? 16 A For completeness I should get the informa 17 tion about the dyes, yes. IB Q Khat about their exposures to other sub 19 stances and materials in jobs other than at Chrysler? 20 Have you analyzed that? 21 A Yes, I have some job descriptions of other 22 employmen t. 23 Q Have you found any exposures in those jobs 24 that are of significance to you? 09f-1 n a n 151 1 A i don't think so. No, I don't think so. 2 Q What about their lifestyles? Anything other 3 than their occupations? Have you analysed that for 4 both of these gentlemen? 5 A Yes . 6 Q Have you found anything there that, in your 7 opinion, would be a factor for contributing to the 8 cancers? 9 A I don't think so. Neither one of them. Mr. 10 Wallace was not a smoker. Mr. Dendinger smoked a 11 pipe, claimed not to inhale it. So both have very 12 little smoking history. Alcohol is not a problem. 13 Diet looked like there's nothing special there, 14 either. So I don't think there's anything socially 15 that's in vo1ved . 16 Q Well, let's stop for a second, if we could. 17 The discussion of diet is in particular connection 18 with the colon cancer* Is that right? 19 A Yes. 20 Q Isn't it also a fact that there is not a 21 full knowledge by the medical community about what 22 particular factor in diet causes the cancer? 23 A That's right. 24 Q So the fact that Mr, Dendinger ate like the UfiL 11961 ;96Vn a n 152 1 rest of us or, if I can back up on that, the fact 2 that Mr. Dendinger had a diet and it's not entirely 3 clear what that diet is, how can you rule that out as 4 a cause of the colon cancer? 5 A it basically means that the risk of diet is 6 probably awash with the background; in other words, 7 that there's nothing that sticks out. Fibers seemed 8 fairly normal, nonexcessive fat, you know, meat diet. 9 So there's nothing that sticks out in it* and you're 10 left with, well, there's some hint that diet may be 11 involved, but given other exposures that we do know 12 about, my opinion would then be more for the vinyl 13 chloride . 14 Q Well, let's get into the meat of it here. I 15 am correct, am I not, that in both the colon cancer 16 involved in this case and the parotid gland cancer 17 involved with Mr. Wallace, neither one of those 18 cancers had any particular characteristic which is 19 known by the medical community to be associated with 20 vinyl chloride caused cancer? 21 Do you understand the question? 22 A By cell type you're referring to it? 23 Q Yes, sir. Or by any other characteristic. 24 A Well, there's several pieces of information 119 1 shows no relationships, may, in fact, have more 2 weight to it. 3 Q Or conversely, a low power study that shoes 4 relationships, if it has a lower power, that implies 5 that that relationship that is seen could be due to 6 chance alone? 7 A Well, not truly, because you've already 8 taken into account the chance association through the 9 use of your statistics. So if you have a lower power 10 study that shows a positive relationship cause and 11 effect, statistically you've already gone through the 12 calculations to show that this was not likely to be 13 by chance. And in fact, if it's a lower power study, 14 that lends more weight to it because your chances/ 15 your predictive chances of finding an association P 16 were really low when you started, and if you found rh X-i 17 one, that makes it perhaps stronger. IB Q Would you describe for me your understanding 19 of the different types*o epidemiologic studies? 20 A Well, why don't you name -- I mean, there's 21 a list a mile long of different names. I think we've talked about a number of them. Q Well, maybe you can give me yours that you recall, and then we'll work from there. 1 120 1 A All right. Well, we talk about case 2 studies, would be a simple study, a case control. 3 Q You view a case study as an epidemiologic 4 study? 5 A It falls under the purview of epidemiology, 6 yes, case control, nested case control. 7 Q Well, wait a second. What is a case con 8 trol? 9 A Well, that would be a study where you have 10 found individuals -- you look at a disease, for exam 11 ple, and you find individuals who match those with 12 the disease in all characteristics except for that 13 disease, and then you look for a particular factor or 14 factors to see if there's a relationship. 15 And you can design that in any one of a 16 number of different ways. You can either do it 17 cross-sectionally. You can follow a group through 18 time. You can go backwards in time and follow them 19 up to the present. You can do that in a number of 20 different ways. 21 We've mentioned the PMR, SMR studies, pros 22 pective studies. 23 Q Well, what's a proportionate mortality 24 study? URL 11930 URL 11931 121 1 A It's where you take a group of individuals, 2 and you compare the disease rates in that group based 3 upon exposures in that group. By definition, then, 4 the total of the diseases, the total percentage of 5 diseases, has to total a hundred percent. And it may 6 not have all the strength of an SMR study, but 7 frequently it's easier or shorter and less expensive 8 to do . 9 Q What are some of the weaknesses of a study 1 0 like that? 11 A Well, you frequently have a smaller size 12 group. You can't necessarily control for some out 13 side factors, other community exposures, for example, 14 or if it's in a similar community, perhaps some 15 ethnic peculiarities. So there can be several weak 16 nesses . 17 Q Within that type of a study, the numbers 18 have to add up to a hundred percent. Is that right? 19 A That's right. 20 Q And if some of those, the categories within 21 that factor, are less than what is expected by the 22 standardized rate, then that necessarily means that 23 other factors are going to be at a higher than 24 expected rate? 122 1 A That's right. And that may or may not 2 reflect what you're looking for. 3 Q What is a standardized mortality rate? 4 A Well, that's probably the next step past the 5 PMH. In other words, you take disease rates, death 6 rates, what have you, in a specific group, specific 7 exposure, and you compare them to a larger popula 8 tion, either the U.S. as a whole or a community, a 9 city, country, state, death rates, disease rates that 10 you know in the larger population, and then you make 11 your comparison to that group. 12 Q You do that with the proportionate mortality 13 s tud y, too? 14 A Well, proportionate, right, but it's in the 15 particular group. The control group is the group 16 itself, as opposed to in the standardized. The 17 control group is a group not exposed, not being 18 studied in this particular process. 19 Q Any other groups? 20 A Of epidemiologic studies? 21 Q Yes , sir. A Well, numerous variations of the above. Q And in those variations they all have an effect on the accuracy or the strength of the data 123 1 that you get. Is that right? 2 A Yes . 3 Q Can you rank them in terms of some of those 4 that we've mentioned with regard to how important or 5 how significant you consider the data to be once they come? 7 A Well, a lot of it depends upon the data 8 itself so that I could say in general, with all 9 things being equal, you know, your prospective study 10 is probably the strongest and best, and case control 11 or case reports are probably the weakest. But all 12 things aren't equal, and so that ranking can change 13 based upon the data itself. 14 Q Are you saying that what the results are V* 15 from the particular studies determines how you view 1G the accuracy of the information? 17 A No. No, but it's the data that you have 18 that forms -- - that you have to form the basis, of the 19 study, not the outcome*. For example, if you .do a 20 prospective study but don't have specific data, for 21 example, don't have industrial hygiene measures, can't get them, or patients are lost to follow-up, you know, then that prospective study isn't as valua ble. That's what I'm driving at. URL i 193 URL 119 124 1 0 What you're saying is within each one of 2 these categories you have to meet specific criteria 3 to establish whether or not that's a good prospective 4 study or a bad prospective study. You have to catch 5 all the follow-up. You have to determine that the 6 exposures, for example, are closely defined. is that 7 what you're talking about? 8 A Yes. And I'm not trying to, you know, say 9 they're good or bad. Sometimes you can't get it. 10 That's all I'm saying. 11 Q But those are variables that you have to 12 look inside within each study? 13 A Yes . 14 Q But as a general matter yourprospective 15 study would be the one that you would like to, that 16 you generally would rely on if you had a difference 17 between that or you had to choose between that and a 18 proportionate mortality study, is that right? 19 A Yes. 20 Q And then between aproportionate mortality 21 study and a case study, you would prefer to have the 22 proportionate mortality study and you would rely on 23 that more than the case study. is that right? 24 A Right,yes. 125 1 Q Have you ever heard the term "background 2 rate" before? 3 A Yes. 4 Q What is that? 5 A Well, that generally refers to the rate of a 6 process disease, death that's occurring in the gene 7 ral community, a situation where you assume no expo 8 sures or equal exposures, something, some variable of 9 that. 10 Q There are causesof disease, orspecifically 11 with regard to cancer, that we don't know about. 12 They occur either spontaneously or they're common to 13 the population. is that right? 14 A Well, there's always a cause, but we don.r.t' 15 know what it is, yes. 16 Q You try and distinguish those from the 17 cancers that are caused by a particular chemical or 18 exposures when you do an epidemiological study. Is 19 that right? 20 A Yes . 21 Q Is that what wearereferring to when we talk about a standard mortality rate? A Yes . Q And thosethings are taken from anationwide URL 11935 URL 1193b 126 1 study sometimes? '2 A Some group, yes. They can either be nation, 3 state, city, county. 4 Q With regard to cancer, those figures are 5 available nationwide from, what is it, the American 6 Cancer Society. Is that right? 7 A Yes. There are several reporting systems 8 that will generate that data for you, yes. 9 Q Do you know what that information is for 10 Erie County, Ohio? 11 A For Erie County, Ohio? 12 Q Yes , sir. 13 A No , I don't. 14 Q Can I talk to you for a second now about 15 your knowledge of cancer in general. Can you give me 16 some idea of the most prevalent cancers among males 17 in the United States? 18 A Lung, probably the most common; is the most 19 common. 20 Q A lot of that is ascribed to cigarette 21 smoking. Is that right? 22 A Yes. 23 Q Ones below that, then, what is the next most common? 127 1 A i think colorectal, although prostate is 2 about the same, I think. 3 Q Colorectal is a very common form of cancer 4 in males. Is that right? 5 A Ves . 6 Q What about cancer in the salivary glands? 7 Where does that fall? 8 A Pretty low . 9 0 In terms of frequency you'retalking about 10 now ? 11 A Yes. It's low in frejuency. 12 Q Would you tell me your understanding con 13 cerning what the medical community knows about the p 14 cause of colon cancer? . % 15 A Yes. There's some feeling that diet is 16 involved, asbestos, some chemical associated other 17 than asbestos 18 0 What chemicals? 19 A Some of the polycylic aromatichydrocarbons, 20 some tars and pitches, acrylonitrile, some familial 21 forms of cancer 22 Q You're talking now about genetics, right? 23 A Genetics, yes, some association of cancer 24 with a disease like ulcerative colitis. That's prob-