Mass Torts: State of the Art

Coronary Heart Disease: Neither Degenerative Nor Man-Made?

David Oliver — Tue, 09 Mar 2010 14:44:35 -0600

In "On to a Fifth Age? How About We Finish the Second?" we discussed a JAMA editorial wherein Dr. Michael Gaziano asserted we may be entering a fifth age of the so-called epidemiologic transition. These transitions are claimed to be changes in the primary causes of morbidity and mortality and Dr. Gaziano opined that we are moving into an era in which obesity and inactivity will drive preventable illness. We discussed the origin of the idea of epidemiologic transitions and questioned whether we'd ever finished the second age which would have required the conquest of infectious diseases.

The so-called third age was supposed to be the "age of degenerative and man-made diseases" but it keeps turning out that many illnesses thought to be due to wear and tear, lifestyle or pollutants actually have an infectious disease process at their core. Now there's growing evidence that coronary heart diseases (CHD) may in many cases have more to do with a number of infections, including influenza, than with lifestyle or the environment.

Here's a link to a letter published in the Reflections section of The Lancet: Infectious Diseases that nicely summarizes the pre-1970 thinking that pointed to infections as the cause of CHD, the subsequent predominating narrative of chronic diseases not being caused by infections, and the new evidence that chronic diseases are in fact often caused by previously undetected infectious processes: "Inflammation as the Cause of Coronary Heart Disease". And here's a link to a written debate about "this nascent field associating chronic diseases with infections" from 2002 with the author of the recent Lancet paper cited above: "Debate on the Paper by Maria Ines Reinert Azambuja & Bruce B. Duncan".

Given the enormous renewed interest in infections as a possible cause of chronic illness and the ease with which scientists can now find traces of bacterial, fungal and viral DNA (or RNA) at the scene of the suspected microbial crime it's fair to assume that we'll be seeing many more such stories in the future.

SCOTUS Grants Review in Vaccination Preemption Case

Paul B. Kerlin — Tue, 09 Mar 2010 06:49:19 -0600

Yesterday the U.S. Supreme Court granted a petition for writ of certiorari in Bruesewitz v. Wyeth, Inc. and will review the Third Circuit’s holding that a plaintiffs’ design defect claims against the manufacturer of a vaccination were expressly preempted by the 1986 National Childhood Vaccination Injury Act (“NCVIA”) and that plaintiffs failed to establish a manufacturing defect or a warning defect claim under the Act.

In a footnote in the Bruesewitz opinion the Third Circuit had distinguished the Supreme Court’s opinion in Wyeth v. Levine in which the Court held that federal law did not preempt state tort claims that alleged that a drug manufacturer failed to adequately warn of the dangers associated with a drug on the basis that unlike the NCVIA, there was no express preemption provision in the Food, Drug, and Cosmetic Act (“FDCA”). Another distinguishing factor was Congress’ silence on the issue of preemption in the FDCA “coupled with its certain awareness of the prevalence of state tort litigation” which was “powerful evidence that Congress did not intend FDA oversight to be the exclusive means of ensuring drug safety and effectiveness” as the Court stated in Levine. In addition, the Third Circuit noted that Levine recognized that under federal law, a drug manufacturer could strengthen a drug’s label without preapproval from the FDA, which “stands in contrast to the FDA’s far-more extensive control and oversight of the drug’s design and alternation.”

Also the Third Circuit had disagreed with the interpretation of the Georgia Supreme Court on this issue. In American Home Products Corp. v. Ferrari (in which a petition for writ of certiorari is pending), the Georgia high court had ruled that the Vaccine Act “clearly did not preempt all design defect claims against vaccine manufacturers, but rather provides that such a manufacturer cannot be held liable for defective design, if it is determined, on a case-by-case basis, that a particular vaccine was unavoidably unsafe.” The Third Circuit noted in Bruesewitz that if the NCVIA was interpreted to permit a case-by-case analysis of whether “particular vaccine side effects are avoidable, every design defect claim is subject to evaluation by a court.”

It will be interesting to see how the Supreme Court resolves the split between the Third Circuit and the Georgia Supreme Court on this issue.

Something to Think About When You're Thinking About Biomarkers

David Oliver — Mon, 08 Mar 2010 12:38:11 -0600

Mitochondrial DNA, or mtDNA, is increasingly assayed for early evidence of a disease which will eventually become manifest. Take a sample, amplify the DNA, examine it and look for change - makes sense, right? Your genes are the ones you're born with, right? And if they've changed that can't be good, right?

Well, it turns out that you, or your mitochondria at least, evolve or mutate within the course of your lifetime - and it's perfectly normal. We may have started out with Mom's mitochondria but it looks like by the time we're adults mitochondria in different parts of the body don't just express different genes, they have different genes. That's the conclusion of "Heteroplasmic Mitochondrial DNA Mutations in Normal and Tumour Cells" just published in Nature.

There's a great write-up of the findings at TheScientist.com and it makes two very important points for those of us dealing with litigation involving mtDNA biomarkers.

1) "we have to keep in mind [that] some of the changes we see may not really be [disease-related] mutations." - quote from author Nickolas Papadopoulos

2) "there's a big question mark about how early this increase in mtDNA variation appears in the blood. If it's only apparent once the cancer is well established then it isn't much use as a biomarker." - email from molecular biologist Ian Holt to The Scientist

These Genes Determine Your Health: And They're Not Yours

David Oliver — Sun, 07 Mar 2010 02:12:38 -0600

The genes belong to bacteria living in your gut. They, along with their fellow microbes in and on "your" body outnumber human cells 10 to 1. But their genes collectively outnumber yours 150 to 1. These findings are just part of what you'll find in "A Human Gut Microbial Gene Catalogue Established by Metagenomic Sequencing" published in Nature and free online.

The authors conclude that this catalogue of bacterial genes found in the human gut "will lead to a much more complete understanding of human biology than the one we presently have." I think it's fair to say that the realization that the microbes we host have so much control over our lives will lead to a revolution in how we think of ourselves and how we prevent, diagnose and treat conditions like obesity, diabetes and cancer.

Will Your Jurors Decide the Case on Conduct or the Consequences of that Conduct?

David Oliver — Sat, 06 Mar 2010 02:13:58 -0600

Apparently it depends on where they fall along the powerful/powerless spectrum.

"In determining whether an act is right or wrong, the powerful focus on whether rules and principles are violated, whereas the powerless focus on the consequences." - from "How Power Influences Moral Thinking" published in the Journal of Personality and Social Psychology. Hat Tip: Barking Up the Wrong Tree.

West Virginia Asbestos Plaintiffs Must Disclose Bankruptcy Trust Information

Brent C. Taggart — Fri, 05 Mar 2010 23:38:59 -0600

Score one for transparency and fairness in the Mountain State.

The West Virginia Record reported in this article on March 3 that Circuit Judge Ronald Wilson has now ordered that all asbestos plaintiffs in West Virginia must henceforth disclose which bankruptcy trusts they have communicated with and against which trusts they might have a claim. The purpose of the order is to ensure that defendants in asbestos cases receive proper credit when plaintiffs are paid by trusts of bankrupt defendants.

Chemical Safety Board Issues Hot Work Safety Bulletin

David Oliver — Thu, 04 Mar 2010 23:55:35 -0600

The Chemical Safety Board (CSB) has developed recommendations following its investigation of a triple fatality accident that occurred when welding on a tank containing hydrogen, due to bacteria digesting organic matter within, sparked an explosion. The seven key lessons learned from CSB's recent hot work accidents are:

1. Use alternatives when possible

2. Analyze the hazards

3. Monitor the atmosphere even in areas where a flammable atmosphere is not anticipated

4. Test the area whenever work is done near other tanks containing flammable liquids or gases.

5. Use written permits (Editorial comment: there are places where Hot Work permits aren't used? In 2010?

6. Train thoroughly

7. Supervise contractors - Provide safety supervision for outside contractors conducting hot work. Inform contractors about site-specific hazards including the presence of flammable materials.

CSB notes that while OSHA does not explicitly require the use of a combustible gas detector it is good practice to do so. The American Petroleum Institute and FM Global both have long stressed the need for combustible gas detectors to prevent fires and explosions.

As an aside, your writer learned, shortly after being admitted to the practice of law in 1986, that the oil and chemical companies here in Southeast Texas were using such gas detectors by the 1960s. In fact, in the case of one of my clients, a major refiner, its very first recorded fatality occurred in the 1930s when a man was killed by a manhole cover thrown through the air as the result of an explosion caused by hot work near a sewer. After its investigation the company paid to have someone develop a gas detector and it instituted a hot work permitting system more than 60 years ago.

Physician Qualify Thyself: The Latest On Irving Selikoff

Brent C. Taggart — Thu, 04 Mar 2010 23:42:37 -0600

This just in from the British journal, Occupational Medicine (2010 60(1):53): “The Strange Case of Irving Selikoff.” The author traces Selikoff’s 1941-45 educational odyssey from the U.S., to Scotland, to Australia, back to Scotland, and back to the U.S. He concludes, “it is apparent Selikoff had an early struggle to qualify, but qualify he did.” That, and many of the other conclusions and suggestions of this paper may find their way into the asbestos courtroom, if they have not already.

A Promising Vaccine for Mesothelioma

David Oliver — Thu, 04 Mar 2010 18:31:08 -0600

You can read about a new vaccine based therapy for mesothelioma that is both safe and, in some at least, effective in "Consolidative Dendritic Cell-Based Immunotherapy Elicits Cytotoxicity Against Malignant Mesothelioma"

You Know Those Mass Screenings for Prostate Cancer? Nevermind.

David Oliver — Thu, 04 Mar 2010 00:29:35 -0600

According to the Houston Chronicle the American Cancer Society has finally come to grips with mounting evidence that indiscriminate screening for prostate cancer causes more harm than good thanks to (a) the inevitable morbidity resulting from needless biopsies and surgeries due to false positive tests; (b) the realization that an awful lot of people who consider themselves "cancer survivors" would never have known they had cancer but for the screening test as their cancers would have gone away on their own or would have grown so slowly that they'd have died of something else before the prostate cancer became threatening; and, (c) the unfortunate fact that early detection, despite what everybody has been led to believe, does not mean that aggressive cancers can be cured - it just means that we get to be treated for them, and worry about them, longer.

Here's a link to the new screening recommendations: "Revised Prostate Cancer Screening Guidelines: What Has -- and Hasn't -- Changed"

Also of interest may be the readers' comments over at the Chronicle and elsewhere. Predictably there are two dominant camps. One sees this change as a nefarious plot by Big Pharma and Big Medicine to prevent early detection so they can make more money by making people wait until they need more expensive medicines and surgeries. The other one sees the new guidelines as a nefarious plot by Big Government to save money by preventing early detection so it can save money on treatment and hasten the deaths of Americans thereby saving money on Social Security payments as the cherry on top. I've run across veniremen able to hold both views simultaneously. But that's a discussion for another day.

Toe Bone Connected to the Foot Bone ...

David Oliver — Wed, 03 Mar 2010 23:31:08 -0600

In May of 2006 PLOS One published an excellent paper summarizing the evidence that the reductionist approach embraced by medicine over the last century or so had done about as much as it could and was actually hindering further advances. You can find a free copy of that paper, "The Limits of Reductionism in Medicine: Could Systems Biology Offer An Alternative?" at PLOS One.

Modern medicine, the authors wrote, tends to assume (a) that each disease has a single cause; (b) that any deviation from homeostasis requires beating down levels of whatever is up and pumping up levels of whatever is down; (c) that a risk factor for disease in one person is a risk factor for disease in another person; and, (d) that in the case of multiple disease states they can each be treated separately rather than cumulatively. While this approach has been quite successful, particularly for certain diseases, the view of the body and its functions as a bunch of disconnected parts to be dealt with by hyperspecialized parts doctors is beginning to give way to a view that a deeper understanding of disease will occur only when when the complex systems governing the whole organism are understood.

Now there's another paper advancing this idea that afflictions of the body are more than just the sum of their signs and symptoms. In "Systems Biology as a Paradigm Shift in Clinical Research" available free at Oxford Journal of Nephrology Dialysis Transplantation. In particular the authors note the failed promise of biomarker identification to uncover either the causes of illness or effective treatments.

"Simply stated, molecules in a living cell are involved in networks of interactions that regulate the cell's basic functions ... [d]isruption of a partner in these interactions does not result in linear and definable effects but rather in global and often unpredicted perturbations of the whole network." The authors conclude with an overview of the systems biology approach and its promise particularly with regard to understanding and treating chronic diseases.

Alzheimer's: The Result of an Unnoticed, Chronic Low-Grade Infection?

David Oliver — Wed, 03 Mar 2010 01:31:44 -0600

Beta amyloid, aka abeta, builds up dramatically in the brains of patients with Alzheimer's. So, beta amyloid causes Alzheimer's, right? Or has something to do with causing it, right? At least it needs to be eliminated because people who don't have it don't have Alzheimer's so it must be bad somehow, right?

Maybe not. In a new report that demonstrates perfectly two (re-)emerging views about chronic diseases researchers at Massachusetts General Hospital have shown that beta amyloid is a potent antibiotic effective against fungi like Candida albicans and bacteria like Staphylococcus. They go on to hypothesize that far from being bad, beta amyloid may in fact be very good. It may well save you from brain infections that would otherwise kill you at a much younger age. An excellent write up can be found at Bloomberg and the article itself, "The Alzheimer's Disease-Associated Amyloid beta-Protein is an Antimicrobial Peptide", is at Plos One.

Oh, and those two (re-)emerging views about chronic diseases? The first is that too often scientists and physicians fall into the trap of assuming that the arrow of causation runs from biomarker to disease when in fact the body, with millions of years of fine tuning under the hood, has almost certainly some mechanism to deal with the build up of the by-products of its defenses such that fooling with that immune system, given our level of ignorance about how it works, is perilous at best. The second is that microbes, thought to have been essentially conquered 40 years ago, are in fact at the root of many if not most maladies commonly thought to be caused by man. Microbes it turns out have not been asleep over the eons nor even over the last 40 years. Almost weekly as new ways to culture and identify them are developed, new and heretofore unsuspected infections are identified. We're only beginning to understand the nature of the microbes that help us and prey upon us and so for now perhaps it's enough to consider the fact that in our own bodies they outnumber our human cells nine to one.

One last thing, isn't it interesting that many of the drugs currently being tested to determine their anti-aging potential are also potent anti-fungals? Correlation isn't, of course, causation, but it might be worth pondering.

Review Of 2008 Articles On Toxicity Of Metal And Carbon Based Nanomaterials

Brent C. Taggart — Tue, 02 Mar 2010 23:07:55 -0600

Since 2007, the results of certain animal studies have fueled speculation that certain nanomaterials may behave in ways suspiciously similar to asbestos. In this article published in the journal Nanotoxicology this month, the authors report on their review of 746 articles published or pre-published in 2008 on the possible health effects of carbon- and metal-based nanomaterials. These particular types of nanomaterials are produced and used worldwide. The authors conclude: “Unfortunately, due to the large variability in materials used and methods used conflicting data are generated hampering the risk assessment.”

Be Careful What You Wish For...[Texas Arbitration Edition]

Joseph M. Schreiber — Tue, 02 Mar 2010 10:05:11 -0600

The case of Cull v. Perry Homes is long and winding and fits the old adage of being careful what you wish for; especially in litigation. Robert and Jane Cull of Mansfield, Texas bought a home from Perry Homes for $233,730. They alleged it had serious structural problems. They sued Perry Homes and two warranty companies in Texas District Court. One of the warranty companies moved to compel arbitration with the American Arbitration Association pursuant a contract clause. The Culls responded with a 79-page objection which called the AAA, among other things, “incompetent, biased, and fails to provide fair and appropriate arbitration panels.” The case proceeded in court. There was extensive discovery conducted, including 14 depositions and five motions to compel by the Culls. Four days before trial, the Culls moved to compel arbitration. The trial court agreed. The Supreme Court denied a petition for writ of mandamus blocking the move to arbitration.

The arbitrator gave the Culls an $800,000 award, including punitive damages and damages for mental anguish (things arbitration panels are supposed to protect litigants from versus jury trials).

Perry Homes appealed. The Texas Supreme Court reversed; not the arbitration award itself – for which the law is extremely deferential – but the trial court’s decision to go to arbitration.

The Supreme Court stated that the key issue was whether the party moving to compel arbitration had substantially invoked the litigation process. In this case, it clearly had. There is not much more that the Culls could have done to invoke litigation short of going through the trial itself. The plaintiff’s 79-page objection to the AAA seemed to have a large part in the Court’s decision.

On retrial, the jury awarded the Culls $51 million.

Perry Homes has incrementally gotten what it wished for (an arbitration set out in its contract, a new trial after the arbitration gave a bad result), with increasingly bad results. The Supreme Court’s 2008 opinion received lots of press for its seeming favoring of a well-connected defendant over even its historical favor of arbitration.

The case continually made for favoring arbitration is that it reduces cost and time. This frequently does not occur. Perhaps we should go back to favor arbitration only in cases where experts are needed to determine the outcome, not for run-of-the mill private litigation that has until recently been the purview of our public courts.

No Employment Intentional Tort Liability For Occupational Exposures Prior To 1982? A Potential Emerging Trend In Ohio Law

Brent C. Taggart — Tue, 02 Mar 2010 00:57:39 -0600

We have been watching with interest recent developments in a solvents case currently pending in Summit County, OH: Widican v. Bridgestone/Firestone North American Tire, LLC, et al. A summary judgment order entered in that case may portend a serious body blow to employee "intentional tort" claims against Ohio employers for occupational illnesses with long latencies.

Beginning in 1939, worker's compensation was the exclusive remedy that Ohio workers could seek against their employers for injuries suffered in the course of their employment. That is to say, workers' compensation preempted employer tort liability. This involved the trade-off typical of most workers compensation systems: the employee received reliable compensation for workplace injuries without having to prove fault, and the employer in return received a predictable and reasonable cap on its liability for such injuries.

All that changed in 1982. That year, the Ohio Supreme Court held in Blankenship v. Cincinnati Milicon Chemicals, Inc. that there was an exception to worker's compensation preemption. If the employee could prove that the employer intended to harm him/her, he/she could recover both workers compensation and the full range of tort damages against his/her employer. Two years later, the Ohio Supreme Court in Jones v. VIP Development Company further expanded the exception, holding that "intentional tort" could be established by showing that the employer knew that injury to the employee was "substantially certain." The requisite "intent," the Court later explained in Fyffe v. Jeno's, Inc., was something more than "reckless" or "willful and wanton" conduct, but something less than specific intent to harm.

In the ensuing two decades, more and more Ohio workers sought (and often received) "intentional tort" recoveries against their employers. Indeed, such claims came to be known to most attorneys practicing in the area as “Blankenship claims.” Most cases involved sudden traumatic injuries, but at least a few began to crop up claiming occupational disease. Perhaps most notable among these claims were claims of asbestos-related occupational disease, with latencies typically in the range of 20 years or more.

Since Blankenship, Ohio's General Assembly has made three attempts to legislatively re-interpret the "intentional tort" standard. To date, two of those statutes have been resoundingly rejected by the Ohio Supreme Court as unconstitutional. The third is at issue in two cases currently pending before the Court.

In 2008, the Ohio Supreme Court decided DiCenzo v. A-Best Products Company, Inc. That case had nothing to do with employment intentional tort. Rather, it analyzed the question whether strict liability of non-manufacturing suppliers, which the Court had recognized for the first time in 1977 in Temple v. Wean, could be retroactively applied to exposures prior to the date of that decision. The Court held that such liability could not be retroactively applied.

Utilizing the same reasoning applied in DiCenzo, Summit County Common Pleas Judge Judy Hunter held last year in Widican that employer intentional tort liability can not be applied for exposures prior to the first recognition of that type of claim in 1982 by Blankenship. Because other defendants remain in the case, the summary judgment for the employer in Widican is not yet subject to appeal. However, if and when it makes its way to the Ohio Supreme Court, the case could spell the end of employment intentional tort claims arising from exposures prior to 1982.
This potential trend in Ohio law may also be of interest to mass tort litigants in other states, since the test applied by DiCenzo and Widican is the same as that applied by the U.S. Supreme Court in Chevron Oil Co. v. Huson.

Second Court of Appeals' Interpretation of Borg-Warner

Paul B. Kerlin — Mon, 01 Mar 2010 22:40:18 -0600

In a perplexing opinion the Second Court of Appeals affirmed a summary judgment granted in favor of a manufacturer of asbestos-containing joint compound in a mesothelioma case. As we mentioned in our prior posting on this case, the appeal involved the review of the Texas asbestos MDL pre-trial court’s ruling that qualitative testimony of Dorman Smith’s use of a Kelly-Moore product “on a regular basis” was insufficient.

In Rosemary Smith, et al v. Kelly-Moore Paint Company, the appellate court first addressed and rejected plaintiffs’ contention that Borg-Warner only applied to asbestosis cases and did not apply to mesothelioma cases.

Second, in contrast to the pre-trial court’s ruling that plaintiffs’ qualitative evidence was insufficient, the appellate court reviewed the exposure testimony of fact witnesses, the opinions of plaintiff’s expert, and the opinion of a defense expert that opined that Dorman’s cumulative total exposure to asbestos amounted to 9 to 15 fibers/cc years over the course of his career and stated that “the Smiths at least raised a genuine issue of material fact as to the aggregate dose of Kelly-Moore asbestos-containing joint compound (and total asbestos fibers) to which Dorman was exposed.” The appellate court held that “the Smiths raised a genuine issue of material fact as to the Lohrmann factors.”

This holding is puzzling as the Texas Supreme Court made it clear in Borg-Warner that “proof of mere frequency, regularity, and proximity is necessary but not sufficient, as it provides none of the quantitative information necessary to support causation under Texas law.

Next, the appellate court considered whether the total dose of chrysotile asbestos to which Dorman was exposed exceeded a minimum dose above which mesothelioma does not occur. The appellate court refined the issue presented as whether plaintiffs had specific causation evidence for Dorman’s exposure to chrysotile that demonstrated an increased risk of developing mesothelioma. The court reviewed the opinions of plaintiffs’ expert Dr. Maddox that “proof of significant exposure to asbestos dust is proof of specific causation” for mesothelioma and that there is no minimum level of exposure to asbestos “above background levels” below which adverse effects to not occur.

The appellate court noted that the epidemiological studies upon which the experts relied were inconclusive regarding the effect of exposure to only chrysotile fibers and that those were “mixed dust” studies that hypothesized as to the effect of other fiber types to which the workers were exposed. Furthermore the studies that did show an increased incidence of mesothelioma did not attempt to extrapolate any minimum dose of chrysotile to which the populations were exposed. The court dismissed the expert’s reliance on the Selikoff studies which measured the amount of fibers for activities similar to Dorman because those studies failed to correlate the exposure to any incidence of mesothelioma among the subjects. The court then rejected studies by Iwatsubo and Rodelsperger cited by plaintiffs expert because the cumulative exposures in those studies (0.0 and .15 fibers/cc year) failed to provide the minimum dose evidence required under Borg-Warner and neither study differentiated among fiber types.

In conclusion, the appellate court stated that “even though the Smiths raised a fact issue as to the Lohrmann factors (whereas evidence as to those factors was lacking in Stephens), the Smiths’ evidence ultimately suffers the same defect as the plaintiff’s in Stephens: “[w]ithout . . . scientific evidence of the minimum exposure level leading to an increased risk of development of mesothelioma” from exposure to chrysotile-only asbestos, such as that contained in Kelly-Moore’s joint compound, Dr. Maddox’s opinion lacks “the factual and scientific foundation required by Borg-Warner” and, thus, is insufficient to raise a fact issue as to specific causation. Consequently, the appellate court affirmed the summary judgment.

We’ll keep you posted on this case as it works its way up to the Texas Supreme Court.

What, Exactly, is an "Untainted Juror"?

David Oliver — Sun, 28 Feb 2010 22:58:36 -0600

In "Finding Untainted Jurors in the Age of the Internet" The New York Times examines one of the issues raised by former Enron CEO Jeffrey Skilling in his appeal to the U.S. Supreme Court - whether someone, anyone, can get a fair trial in an age when jurors can download a torrent of information once they get back home from a long day of tedious and vexatious "trial". The article presents no solution but that is, I suspect, because there isn't one.

No one comes to jury duty untainted by life; there are no blank slates to be found among your venire. If they find something relevant online it's just going to be something that confirms what they already believed. Your job then, as always, is to uncover their worldview in voir dire and to thereafter present a narrative that accommodates both their perspective and your facts.

Loves Safranin, Hates People

David Oliver — Sun, 28 Feb 2010 22:33:48 -0600

The New York Times has an alarming article about the rise of gram-negative bacteria as the cause of a staggering amount of morbidity and mortality among hospital patients. The rogues' gallery of gram-negative "wretched beasties" includes Klebsiella pneumoniae, Legionella pneumophila, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae and Helicobacter pylori.

For more on the problem see: "How Can We Stem the Rising Tide of Multidrug-Resistant Gram-Negative Bacilli?" wherein you'll read: "... we know much less about how best to detect and prevent transmission of multidrug-resistent gram-negative bacilli. These organisms are relative newcomers to the healthcare-associated infections arena ..."

Does Estrogen + Progestin Increase the Risk of Lung Cancer?

David Oliver — Sun, 28 Feb 2010 01:35:25 -0600

According to "Lung Cancer and Hormone Replacement Therapy: Association in the Vitamins and Lifestyle Study" published in the Journal of Clinical Oncology, long term use of estrogen and progestin (> 10 yrs) produced a 48% increase in lung cancer and typically advanced disease at that. Interestingly, those taking estrogen alone experienced no increase in risk.

The hazard ratio was only 1.48 with a confidence interval from 1.03 to 2.12 meaning the reported result suggests at best a hypothesis for further testing and not a presumed causal relationship.

JAMA Names 2009 Peer Reviewers

David Oliver — Fri, 26 Feb 2010 17:16:13 -0600

Inquiring defense lawyers will be wondering what article(s) plaintiffs' expert Phil Landrigan refereed for JAMA.