Significant increases in mortality risk for some forms of leukemia has again been identified in a cohort of poultry workers. See "Update of Cancer and Non-Cancer Mortality in the Missouri Poultry Cohort". Given the profound changes in the demographics of the poultry industry in recent years it would be interesting to see if population mixing might have been responsible for some or all of the increased risk.
When it comes to cholesterol the thing to worry about is too little HDL. Your total cholesterol level can be high and your LDL can be high but if your HDL is up there you're swimming in the shallow end of the risk pool. That's what makes "Acute Decrease in HDL Cholesterol Associated With Exposure to Welding Fumes" so interesting.
The finding of a large decrease in HDL without effect upon other lipids following exposure to pm2.5 in welding fumes provides, if replicated, a biological mechanism for some of the maladies laid at the feet of pm2.5. Low levels of HDL lead to inflammation and chronic inflammation leads to a variety of illnesses like hardening of the arteries.
That's what a plaintiff's lawyer who's made a fortune filing asbestos claims in Texas announced recently. Could it be that the fifth decade of asbestos litigation in Texas will be its last? It's starting to look that way especially after a conversation I had over drinks last week.
I was talking with a long time adversary and asked what his firm's founder was up to and what he thought about tort reform, Borg-Warner v. Flores and the MDL. His response was an epiphany. He said that the old man is and has always been a businessman. He never had anything against the companies. "He just saw back when Texas was a blue state that the courts were going to start redistributing the wealth and that the middleman would get 1/3 of every dollar redistributed. Now that Texas is a red state he owns [several business interests] 'cause that's where the easy money is being made nowadays."
Whatever their original intent the courts created a huge, unregulated and readily exploitable market in asbestos litigation. The entrepreneurs only played their part. Nothing personal, it was only business.
It's very thorough and it's free, full text, in this month's Orphanet Journal of Rare Diseases.See "Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome".
SJS/TEN cases typically involve very high damages as the injury is akin to a severe burn. The article contains a list of known causative agents as well as standards for diagnosis and treatment.
A member of NIOSH's 1975 Benzene Task Force and long-time plaintiff expert, Infante has written essentially an editorial comment about IARC's determination that there is only limited evidence for benzene causing blood cancers other than AML (or ANLL or whatever it's called this week). It's published online first in the American Journal of Industrial Medicine as "The IARC October 2009 Evaluation of Benzene Carcinogenicity was Incomplete and Needs to be Reconsidered."
Infante was on plaintiff's team in the case that resulted in the biggest check ever written to a single plaintiff in a benzene case - Mason v. Texaco.
The growing controversy over a possible link between asbestos exposure and ovarian cancer is driven in large part by the fact that the two malignancies affect the serosal cavities and share a striking number of biomarkers. Does this mean that they both arise from the same sort of undifferentiated cell or that they're both caused by asbestos? See "Association of Malignant Mesothelioma and Asbestos-Related Conditions With Ovarian cancer: Shared Biomarkers and a Possible Etiological Link?"
The Washington Post is reporting "Probable Carcinogen Hexavalent Chromium Found in Drinking Water of 31 U.S. Cities". It's pretty much just the EWG press release "Chromium-6 is Widespread in US Tap Water: Cancer-Causing Chemical Found in 89 Percent of Cities Sampled".
So what to make of the claim that 74 million Americans are unknowingly bathing in, cooking with and drinking unsafe levels of "the carcinogenic Erin Brockovich chemical"? Well, as luck would have it there's a brand new (free!) paper that contains a very nice summary of the state of scientific knowledge concerning the impact of exposure to hexavalent chromium (Cr (VI)) in water. See "Application of the U.S. EPA Mode of Action Framework for Purposes of Guiding Future Research: A Case Study Involving the Oral Carcinogenicity of Hexavalent Chromium". EPA didn't think it posed a risk of cancer and epidemiological studies have, with one controversial exception, found no link between hexavalent chromium in drinking water and cancer. Nevertheless, when the National Toxicology Program gave lab rodents water containing Cr (VI) at hundreds of times the concentration of the highest levels found in human drinking water it detected a small but statistically significant increase in risk of a rare (for rodents) lower g.i. cancer. Lower doses, i.e. at levels only 300 times higher than those found in the drinking water of 95% of Americans, produced no increase in rodential risk.
Thereafter the state of California proposed a "public health goal" for Cr (VI) in water of 0.06 parts per billion (ppb) or, exactly, 1/1000th the level the lowest level found to slightly increase the risk of cancer in lab mice and rats. Somehow that 0.06ppb level for Cr (VI) in water became the "safe level" according to the EWG (and thus, necessarily, The Washington Post). Assuming, without explanation, that any level above 0.06ppb is thus unsafe it's no surprise that the EWG discovered that 89% of our drinking water is probably carcinogenic.
The Washington Post quotes Max Costa who "chairs the department of environmental medicine at New York University's School of Medicine". He calls the EWG's findings "disturbing". The WaPo doesn't say why they emailed Costa for a comment but we can guess. He was a retained expert witness for the Erin Brockovich plaintiffs. He testifies that "[h]exavalent chromium is one of the most potent carcinogens known to man. It can produce any type of cancer depending upon genetic susceptibility, quantity and route of exposure."
Ok, if 89% of Americans are ingesting dangerous levels of one of the most potent carcinogens known to man, one that can cause any form of cancer, what would you think the National Cancer Institute's Annual Report to the Nation on overall cancer rates would show? Would you be surprised if it showed that the overall incidence of cancer to be declining significantly? Would you be surprised if it showed that colorectal cancer rates (the closest thing to what was slightly increased in mice) have been dropping for a quarter of a century and that their decline is accelerating? If so you need to read "Annual Report to the Nation Finds Continued Declines in Overall Cancer Rates; Special Feature Highlights Current and Projected Trends in Colorectal Cancer".
Assuming that when and in what number a word appears in Google's new database of "nearly 5.2 million digitized books" (h/t today's NYTimes) is a decent proxy for when and what society's talking about what do these graphs have to say about some popular mass tort topics? The x-axis runs from 1900 to 2008. The y-axis is the percentage or rate of appearance if you will of the word or phrase (e.g. mesothelioma). Try it yourself at Google labs.
Mesothelioma:
Silicosis:
Hormone Replacement Therapy:
And how the curve of "the next big thing" tends to look over time:
Interferon:
Apoptosis:
And the current big thing, the microbiome:
The Center for Science in the Public Interest (CPSI) has sued McDonald's over their Happy Meals. The complaint argues that Happy Meals are "unhealthy" and cause obesity, that its marketing is "unfair" because it makes six year old lead plaintiff Maya pester her mother with her "clamor for Happy Meals" and that McDonald's seeks by way of its Happy Meals, like James Dean before it, "to subvert parental authority".
There is much in the complaint to blog about. Far too much actually given that I've got a brief due in the Texas Supreme Court by Friday. For now though consider the claim that Happy Meals provide too many calories for the typical, which is to say sedentary, child. When and how did the typical child get to be sedentary and so at risk of obesity? I'd argue that it has everything to do with turning schools into warehouses for children.
Want some evidence that even moderate exercise protects children from overeating or too much TV/video-gaming? See "Health Status and Behavior Among Middle-School Children in a Midwest Community: What are the Underpinnings of Childhood Obesity?" See also "The Fat-Mass and Obesity-Associated (FTO) Gene, Physical Activity, and Risk of Incident Cardiovascular Events in White Women". Apparently the "fat gene" only causes problems when combined with inactivity.
All in all it looks like the solution to childhood obesity is more about revving up the body's engine than starving it of fuel.
Hexavalent chromium (Cr (VI)) turns well water yellow. Disgusting, sure, but is it harmful? Well, when inhaled Cr (VI) can cause lung cancer in humans; and that's all it took to launch a lawsuit on behalf of the citizens of Hinkley, CA whose groundwater had been contaminated with Cr (VI). The case settled for $333 million and spawned the movie Erin Brockovich.
So what was the cancer burden from Cr (VI) in Hinkley? According to a new study reported on in the LATimes (Fewer Cancers Found in Hinkley Than Expected) the answer is none whatsoever. In fact, while 224 cancers would have been expected in an unexposed population of similar size and demographic make up, only 196 cancers were identified in Hinkley - more than a 12% decrease in cancer.
There's not much new in the literature on Cr (VI) and the claim that hexavalent chromium in water causes cancer is at best controversial. The newest paper supporting a link, "A Quantitative Assessment of the Carcinogenicity of Hexavalent Chromium by the Oral Route and its Relevance to Human Exposure" found that long suffering lab mice exposed to many times the levels in Hinkley developed cancer of the small intestine (not among the complaints chronicled by the panicked residents in the LATimes' report). The finding was said to provide further support for the claim that Cr (VI) is "likely to be carcinogenic to humans". Nevertheless, epidemiologists have yet to identify a clear case in which it actually has been carcinogenic to humans.
The idea that a known cause of cancer, e.g. ionizing radiation, poses a risk of cancer at any dose, no matter how small, is a central thesis informing modern environmental and occupational regulations and modern, which is to say low dose, toxic tort cancer litigation. In the toxic tort context plaintiffs regularly employ the logical fallacy of the appeal to ignorance (argumentum ad ignorantiam) to prove that even the slightest exposure was risky. They say that because defendants cannot establish a safe level of exposure it follows that every exposure is necessarily unsafe. The formal name for the idea that risk doesn't drop to zero until exposure drops to zero is the linear no-threshold dose theory or LNT. The LNT theory, always longer on theory and politics than evidence is increasingly under attack. Now even NIOSH has had to concede that at least in some circumstances there is indeed a safe dose for a carcinogen.
In "Checking the Foundation: Recent Radiobiology and the Linear No-Threshold Theory" the author states "a large and rapidly growing body of radiobiological evidence indicates that cell and tissue level responses to [radiation damage], particularly at low doses and/or dose-rates, are nonlinear and may exhibit thresholds ... this evidence directly contradicts the assumptions upon which the microdosimetric [LNT] argument is based". The idea that a substance that is harmful at high levels can be harmless or better yet beneficial or protective (the idea of hormesis) at low levels is discussed at length in this month's issue of Human & Experimental Toxicology.
The claim that "if it takes an ounce to kill ten men then a drop will thousands" was itself just a theory based on the idea that carcinogenesis was a stochastic process. Getting cancer was sort of like hitting the anti-lottery and the more tickets you bought (exposures you sustained) the more likely you were to lose yet if you were unlucky enough just one ticket could do it. Like black box epidemiology LNT was simply a way to ignore the formerly incomprehensible molecular biological mechanisms responsible for cancer. Now that those mechanisms are being uncovered and understood they can no longer be ignored as they shatter one paradigm after another.
I was local counsel for a pesticide manufacturer in a cancer case some years back and got to be good friends with national counsel from New Jersey. He's a great guy with a razor sharp wit that left the other side's notorious pitbull of a toxicologist neutered and yelping at his deposition. However, when we mock tried the case to three different groups of southeast Texans they decided they all hated national counsel and most sympathized with the expert, parts of whose videotaped deposition had been shown. What happened?
What happened was that national counsel's slashing style had been perfected in a part of the country where sarcasm and irony are relished. Over in Beaumont the mock jurors clearly understood the points he was making but as one of them said "we just couldn't get past the fact that he was such an seven-letter-word-that-begins-with-a". And that pretty well summarized their deliberations.
National counsel was mortified, of course, and while he worked on toning down the sarcasm he never really understood their reaction. Could it be that that the use and perception of sarcasm varies geographically? Check the link. The answer is: apparently so.
Now I must explain the Subtle Approach. There are three occasions on which we cannot use the Direct Opening, and these we must consider carefully: (1) when our cause is discreditable, that is, when the subject itself alienates the hearer from us; (2) when the hearer has apparently been won over by the previous speakers of the opposition; (3) or when the hearer has become wearied by listening to the previous speakers.
- Cicero "Ad Herennium"
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