Sunday, October 09, 2005

New York Times and Diagnosis of Silicosis and Asbestosis

BrooklynDodger posts this to a science blog because the silicosis-asbestosis litigation debate turns on science and diagnostic criteria.

Jonathan Glater has gotten major inches attacking the plaintiff’s bar and plaintiff's medical experts over silica litigation. In the article below, he at least left out his canonical attack on how long was spent reading x-rays ["a few minutes' - which is what a B-reader does], and on doctors making judgements based on "reading only reports" [which is what an internist should do with a radiologist report, or pathology.]

BrooklynDodger checked the NIOSH registry of B-readers for Drs Martindale and Harron attacked below. There is no Martindale at all in the registry, and no Ray Harron.

BrooklynDodger has no doubt that large scale screening of silica exposed workers would find substantial fractions of bad chest x rays among those with 20 year latency from first exposure. While the Times notes a decline in "silicosis" deaths, most of the xs respiratory mortality among foundry workers and likely others, comes from other diagnoses. Most is likely silica related.

Although B readers are adamant about distinguishing asbestos patterns from silica patterns, the Dodger wonders, and also wonders about a mixed picture.

The Dodger concedes there's something cheesy about these wholesale medical reports. Or diagnosing without interview on symptoms or history of exposure. It's like one cop signing the arrest reports of hundreds of people arrested at a demonstration, so only one has to show up in court.

The opinion is downloadable below.


The Tort Wars, at a Turning Point
Published: October 9, 2005
FOR the lawyers who file lawsuits against corporations, it looked like the next big thing - the next fen-phen, asbestos or even tobacco, the mother of all jackpots.
Like the lawsuits involving asbestos, the fire-retardant material that when inhaled can cause a horrible lung cancer, the new suits involved a substance that under certain circumstances could harm the lungs: silica, a purified sand used as a cleaning abrasive as well as in making glass, paint, ceramics and other materials. Silica dust, when inhaled, can lodge in the lungs, causing silicosis, a disabling and often fatal lung disease.

For the companies facing litigation, it looked like a repeat nightmare. After all, settling asbestos claims - more than 700,000 have been filed over the last 30 years - has cost more than $70 billion, according to the RAND Corporation. Of that amount, RAND estimates that nearly one-third has gone to plaintiffs' lawyers.

Judge Jack not only called for sanctions on one of the plaintiffs'-side law firms, but she also slammed the whole process that led to the claims landing in court in the first place. The medical findings underlying the claims, based on X-ray screenings paid for by lawyers looking for potential clients, were worthless, she wrote.

Mr. Krutz and Mr. Mulholland asked Judge Jack if they could question one of the doctors, George H. Martindale, of Mobile, Ala. Dr. Martindale had diagnosed more than 3,600 people with silicosis, according to court documents, and Mr. Mulholland had found that some of them had previously submitted asbestos claims.

The deposition, on Oct. 29, 2004, went better than the defense lawyers could have hoped. At one point, Mr. Mulholland asked: "Would it be fair to say that this appears to state a clinical diagnosis of silicosis when, in fact, that's not what you did?" Dr. Martindale answered: "Correct."

Under the questioning, Dr. Martindale said he never talked to any of the claimants whose X-rays he read, either to learn their work histories or to notify them if he determined that they suffered from silicosis. Pushing further, Mr. Mulholland asked Dr. Martindale whether he stood by the diagnoses. Dr. Martindale responded, "If another physician hadn't established a diagnosis of silicosis/asbestosis, I would withdraw that. I would - I would say that I am personally not making a diagnosis of asbestosis or silicosis."

Several doctors on the witness stand withdrew their diagnoses and said they had never interviewed the people whose X-rays, or in some cases just reports on their X-rays, they had analyzed. In some cases, doctors could not explain how they diagnosed asbestosis in a claimant at one time and silicosis at a later date, even when looking at the same X-ray.

It was a rare courtroom moment, one usually reserved for novels or movies. Mr. Mulholland recalled that when he asked one doctor about two differing diagnoses based on the same X-ray, the doctor, Ray A. Harron, explained the discrepancy by saying he made the diagnoses on "widely separated dates."

When Dr. Harron was asked about another case of a person who first received a diagnosis of one disease, and then of the other, Judge Jack interrupted the questioning to ask what happened to the first illness. "Well," she said, "where did it go?"

Dr. Harron responded, "Like I say, I don't know." Shortly after that, Dr. Harron cut his testimony short, citing the need to retain his own lawyer. He did not return calls seeking comment on the silica proceedings. In a deposition last year, Dr. Harron said he charged up to $125 for each case he reviewed; the amount was not affected by his diagnosis. If he had to travel to make a diagnosis, he said he might set a minimum fee to cover his travel costs and his time.

Diagnoses from Dr. Harron and one other doctor accounted for about 90 percent of the silica diagnoses, and they had previously diagnosed thousands of people - some of them the same people - with asbestosis.

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