Hammar Time

The Federal MDL's Magistrate Strawbridge has held that Dr. Hammar's opinion "that 'every occupational and bystander exposure to asbestos above background was a substantial contributing factor in causing [plaintiff's] mesothelioma' is sufficiently reliable to meet the admissibility standard of Rule 702 ..." See In Re Asbestos Products Liability Litigation Relating to: Anderson v. Saberhagen Holdings, Inc.

Because Dr. Hammar testified that his theory that every fiber is causative "could be (though it hasn't been) proven from carcinogenic theory (whatever that is) to a reasonable degree of medical certainty" and because "any of the occupational or bystander exposures could have been (though again they haven't been) sufficient to cause [plaintiff's] mesothelioma ..." his testimony ought not be excluded.

So Dr. Hammar gets to testify about legal duty (substantial factor causation) and base his opinions on unverified hypotheses. Oh, and in another case, plaintiffs get to recover money from the trust funds and then deny that their application forms don't establish substantial factor causation. See In Re Asbestos Products Liability Litigation Relating to: Taylor v. Lucent Technologies NC.

Wow. Just wow.

Reruns of The NORM Show

Yesterday the NYTimes published "Regulation Is Lax for Water From Gas Wells". It's the result of nine months of work and the review of 30,000 pages of documents, some of which were "leaked" by government insiders. The reporters' conclusion is that the gas exploration industry is inadequately regulated and that as a result people are at risk thanks mainly to radium (the biggest concern due to NORM, naturally occurring radioactive material) and to a lesser extent benzene from recovered drilling fluids being run through local waste treatment facilities.

The benzene levels were absurdly low (yes, it's a carcinogen and so is the sun but we're not vampires who burst into flames when exposed to the sun nor are we life forms that can do without the benzene ring). Meanwhile, the radon levels downstream of the waste plants were, well, undocumented. But that doesn't matter apparently because there were some data on the amount of NORM, recovered in fluids returned to the surface from gas wells, and some of the readings were up to 1,500 times higher than the permissible levels for drinking water. Thus, be afraid. Be very afraid because the waste is run through water treatment plants and so contaminates the water of those downriver who drink it.

But that's where the irony comes in. What's already one of the biggest sources of NORM (or TENORM, technologically enhanced radioactive material - i.e. concentrated NORM)? Drinking water treatment plants. According to EPA, thanks to regular old water wells 700 hundred treatment facilities produce lots of NORM already. Undoubtedly people on private well water, one flush at a time, have been producing NORM all by themselves and have been doing so since long before horizontal drilling and hydraulic fracking were invented (we're all frackers, actually).

According to the EPA's site on NORM from well water (Drinking Water Treatment Wastes) the amount of radionuclides in water treatment residue can vary by an order of six magnitudes. In all some 260,000 metric tons of TENORM are generated every year by U.S. water treatment plants. For a detailed overview of the issue see "A Regulators' Guide to the Management of Radioactive Residuals from Drinking Water Treatment Technologies".

So you see uranium has been decomposing into radon and dissolving into well water quite naturally and without causing alarm for as long as there have been wells producing water for humans.

Some other day I'll post funnies from the West Texas yellow cake litigation (teaser: "you mean there's uranium in the ground, around here?!" but for now I suggest you have a look at the Natural Gas Drilling Tip Line documents in the NYTimes article. There are lots of scared, lonely, confused and paranoid people out there (e.g. "Caller is the Wife of Jesus Christ and Billy Idol (the rock singer) is in fact Jesus Christ. Caller is thus co-owner of the earth and she is upset over the Marcellus Shale drilling..." What's more interesting are all the tips/calls from the media; several of which the NYTimes redacted extensively. It's obvious that the media is trying to fan the flames by provoking the sorts of people prone to be provoked. The question is, why?

Tags:

A Big Step Forward in Tracing Foodborne Illness Back to Its Source

Where pulsed-field gel electrophoresis failed to distinguish a strain of Salmonella enterica responsible for a major salmonellosis 2009-2010 outbreak from a strain isolated in a prior separate outbreak so-called next-gen DNA sequencing (NGS) has allowed researchers to pinpoint the source of the recent outbreak to a specific spice used on salami.  See Identification of a Salmonellosis Outbreak by Means of Molecular Sequencing.  Note however that traditional epidemiologic traceback techniques had lead investigators to the source of the outbreak.  NGS confirmed the outbreak and further demonstrated that endemic contamination of food facilities by pathogens can lead to the production of new strains thereby making more precise sequencing "essential to the traceback of bacterial pathogens as they emerge in the food supply."

Cell Phones, Rat Whiskers and Glucose Metabolism

The NYTimes set off another temblor in the interwebz with its story about a study showing that among a few dozen subjects with cell phones strapped to their ears those with an active set emitting microwave radiation showed approximately a 7% increase in brain metabolism of glucose in the area of the brain nearest the antenna. (The NYTimes' article came out the day before the paper was published and was full of quotes from long time cell phone worrywarts - both are obvious red flags). Anyway, the story quickly became its most popular and stories of how irrefutable "proof" that cell phones affect the brain is now available and that "biologic plausibility" - thanks to a couple of quotes in the NYTimes' article amounting to nothing more than rank speculation - is similarly established.

That living cells respond and adapt to their environment should not come as news to anyone yet it always does. So, for those surprised to learn of it, the finding that cells respond and adapt to microwaves (assuming the observation is confirmed) is in and of itself no biggie. Now about the two proposed mechanisms whereby increased glucose metabolism might lead to brain cancer.

One idea advanced was that extra metabolism might generate extra free radicals (molecular boogeymen to protect against which people have variously and at best ineffectually overdosed on vitamins). The other is that the extra metabolism might set off an inflammatory response (chronic inflammation being implicated in some forms of cancer). So the question that occurs is whether there are other forms of stimulation that set off increased brain glucose metabolism and, if so, whether any of them have been implicated in brain cancer.

As luck would have it there's a new study that answers part of the question. The title is entirely too long to type as I'm heading out the door so here's the link. Now if, by the same analysis (stimulation and PET scan), it turns out that stroking the whiskers of a rat produces an even bigger increase in brain glucose metabolism (which is exactly what the paper demonstrates) does it follow that one should hereafter forego stroking one's whiskers (or those of a loved one) lest the doing of it cause brain cancer?

Tags:

The National Childhood Vaccine Injury Act Preempts All Design-Defect Claims

Bruesewitz v. Wyeth has been decided. Though it starts out with a compelling pro-vaccine narrative the majority opinion quickly becomes a slog through proper grammar and the perils of reasoning from unproven premises. Breyer's concurrence at least digs into the danger to public health posed by the tort system though ultimately it's all about deferring to public health authorities rather than just acknowledging that you need neither a Ph.D nor an M.D. to understand that allowing the carrot of serial mega-verdicts to incentivize the trial bar into suing the vaccine makers out of business would be a catastrophe.

Things look to get interesting again once you get to the dissent. It begins by embracing the stick view of torts and economics. Specifically, that companies are not incentivized by the market to improve the safety of their products and thus they won't do so unless and until the stick of economic pain is applied to their backsides via the tort system. But then it too wanders off into an even more painful textual argument. The dissent only approaches the heart of the issue tangentially in footnote 25 when it touches upon but dismisses the risk to our vaccine system posed by something like the autism-vaccine hoax.

The dissent notes the 5,000 pending autism-vaccine claims but says that without "empirical data" worrying about such suits impacting the vaccine industry is purely speculative. The footnote goes on to happily imagine that state courts have decades of experience efficiently and effectively weeding out and disposing of meritless products liability claims summing up by saying that "doomsday predictions of ... a torrent of meritless lawsuits bankrupting manufacturers and causing vaccine shortages seems remote at best."

For some empirical data derived from past experiments with letting the tort system "regulate health care" the dissenters might try (gated) "The Negative Impact of Litigation on Women's Health Care" from the journal Gender Medicine (see also the Bendectin, breast implant and dozens of other product defect claims that drove safe and effective products off the market).

Anyway, that's it. No more design defect claims for childhood vaccines.

Tags:

More Media Coverage of Bacillus Cereus Lawsuits

MSNBC is reporting that another personal injury lawsuit has been filed arising out of a hospital-acquired B. cereus infection and that a number of would be plaintiffs are inquiring about their own claims. Meanwhile the difficulty in tracing the geneology of members of the bacillus family, and a new way forward, are coming into focus. See: "Bacillus Taxonomy in the Genomic Era Finds Phenotypes to be Essential Though Often Misleading".

Does Timing of Hormone Therapy Affect Breast Cancer Risk?

Initiating hormone replacement therapy before or shortly after the onset of menopause is associated with a greater risk of developing breast cancer compared to those women who started hormone therapy after living with menopause for a few years or more. That's according to (ungated) "Breast Cancer Risk in Relation to Interval Between Menopause and Starting Hormone Therapy".

Other findings include: (1) further confirmation of the observation that hormone therapy increases both false positives and false negatives on mammography; (2) obesity increases the risk of breast cancer in women not on hormone therapy though it has no effect on the risk of those undergoing hormone replacement therapy; (3) contrary to other observations, in this Million Woman cohort risks did not revert to background following cessation of therapy indicating that hormone therapy may not merely "fuel the fire" but may in some cases start it as well; and, (4) the highest risk of breast cancer was seen in women currently on estrogen-progestin who had begun the therapy less than 5 years after the onset of menopause.

But Why Is It So Difficult To Think Of It Again?

It being the "it" of the Goethe quote referenced in "Acne Vulgaris, Probiotics and the Gut-Brain-Skin Axis --- Back to the Future?" : "everything has been thought of before, but the difficulty is to think of it again".

Of late there has been considerable debate about a perceived stagnation in medicine. Advances came fast and furious in the first few decades of the 20th century (think antibiotics, the pill, the Salk vaccine, etc). Nowadays advances are few and what few there are seem little more than nibbles around the edges e.g. news of a treatment extending the life expectancy of patients with advanced pancreatic cancer from 24 weeks to 27 weeks made its way to the front page of the newspaper a while back. What happened to progress? Has all the low hanging fruit already been picked? Why aren't the drug companies discovering wonder drugs? Are none left to be found?

It's an old temptation that makes people think they understand the world and how it works. In 1874  Max Planck's physics professor told the future father of quantum theory not to bother with a career in physics saying "in this field, almost everything is already discovered ...". Ooops.

The peril, as Thomas Kuhn described it in "The Structure of Scientific Revolutions", is that researchers tend to get trapped within a worldview, a paradigm, that blinds them to possibilities beyond the perceived realities that they've spent their lives trying to comprehend. It's not until a scientific discipline is in crisis, a state brought about by a once elegant theory being turned into a Rube Goldberg contraption from the numerous tweaks made to explain away embarrassing inconsistencies, that blinders come off. It's only then that new ideas, or as Goethe might put it old ones thought of again, are tried.

And that, I think, is where we are today - In the middle of a crisis of medicine. The old deterministic model on which the small molecule pharma model was built i.e. add what's lacking, deplete what's in overabundance, turn off what shouldn't be on and turn on what shouldn't be off, doesn't work beyond a few now obvious exceptions.

So what old ideas are being reconsidered anew? Read the (ungated) paper on acne vulgaris referenced above. Seventy years ago a few people thought that the bacteria which live in our guts and on our skin (and maybe elsewhere) could explain the strange association between gastrointestinal illness, depression and acne vulgaris. They also thought that reforming the microbiota (terra-forming the gut or ile-forming) with different bacteria might ameliorate or even cure such complex disorders. Now there are lots of researchers opening their eyes to the possibility that most diseases are emergent phenomena far too complex to be dealt with one molecule at a time yet ones that might yield to complex cocktails of multiple drugs or, more complex yet, cocktails of bacteria, probiotics, to fight fire with fire.

If the past is any guide we're not in an era of stagnation in medicine; we're on the verge of a new age of discovery.

 

Cherry Picking on My Cherry Coke

Today's scare du jour was just launched by the Center for Science in the Public Interest. They claim that the caramel coloring in Coke (and in dark beer and lots of other good stuff) is carcinogenic and ought to be banned. See "FDA Urged to Prohibit Carcinogenic 'Caramel Coloring'".

The claim can be summed up as follows: industrial caramel is unnatural and the product of scary-sounding processes involving scary-sounding chemicals; one of the resulting constitutive chemicals, 4-methylimidazole, has been found "in significant levels" of five brands of cola; 4-methylimidazole causes cancer in lab rodents; therefore, my Cherry Coke is a cancer hazard. Is there anything to it?

Well, sure enough there's a study of lab rats and mice that found small increases in the risk of lung cancer and leukemia that increased as doses (the rodents got the equivalent of thousands of cans of cola per day worth of 4-methylimidazole) increased. See "Toxicity and Carcinogenicity Studies of 4-Methylimidazole in F344/N Rats and B6C3F1 Mice". But something else very interesting happened along the way to a good health scare - something not mentioned by the CSPI.

It turns out that while there were small and at best equivocal indications that 4-methylimidazole might be associated with one or two rodent cancers there were big, statistically significant and dose-dependent associations between cancer prevention and 4-methylimidazole consumption. For example, compared to the rodents not given 4-methylimidazole the female rodents drinking cola by the barrel were essentially completely protected from mammary tumors as well as a host of other cancers. Overall, rodents on a cola binge experienced a greatly reduced risk of many cancers and saw some tumor rates reduced by orders of magnitudes compared to their cousin rats and mice not given 4-methylimidazole.

There was no call for research into the protective effects of caramel coloring. The great big silver lining wasn't even disclosed. Instead, the two insignificant bits of data showing a small risk of tumors in rodents were cherry picked from the forest of data and the big effect, a cancer-protective effect, was completely ignored.

I'll go out on a limb and predict that this scare, like the CSPI acrylamide in bread, chips and roasted coffee is going to give everybody cancer scare, is also headed for the dustbin of history.

 

A Deadly Hospital-Acquired Infection Becomes a Products Liability Claim

In today's news is a tragic story about the parents of a two-year old boy whose death from a nosocomial (hospital-acquired) infection they blame on alcohol wipes contaminated with Bacillus cereus.  According to the complaint filed February 13th in federal court here in Houston the Kothari's son developed bacterial meningitis following an otherwise uneventful craniotomy performed at Children's Memorial Hermann Hospital for a benign arachnoid cyst.  During the course of his treatment alcohol pads and swabs were used on his surgical wounds and within days he developed a B. cereus infection (established by positive cultures from cerebrospinal fluid) and died shortly thereafter. The next month Triad, alleged to have been the manufacturer of the alcohol pads and swabs, recalled the products saying they were potentially contaminated with B. cereus. Two days later the FDA announced a recall of all such Triad pads and swabs saying that their use "could lead to life-threatening infections, especially in at risk populations, including immune suppressed and surgical patients." 

It's estimated that in the U.S. two million patients are sickened and 80,000 are killed annually by nosocomial infections. Accordingly, it's a very big problem and so has the potential to be a very big mass tort.

Yet a big part of the problem, and the biggest impediment in the past to tort claims arising from these illnesses, are the twin issues of tracing the infection to a putative source and then establishing that the bacteria cultured from the victim are the descendants of bacteria found in the defendant's products or at its manufacturing facilities. Since most bacteria responsible for nosocomial infections, including B. cereus, are ubiquitous in the environment and were, until recently, impossible to distinguish phylogenetically, establishing causation has been essentially impossible. Now, thanks to epidemiology returning to its humble origins and genetic sequencing taking giant strides forward, it may be possible to trace an infection to its origin and conclusively establish ancestry.

Unfortunately the Kothari complaint does not reveal whether or not anything beyond a post hoc ergo propter hoc inference supports their claim. One allegation is that B. cereus infections are rare in hospitals and yet the first thing that pops up on PubMed is "Bacillus cereus Bacteremia Outbreak Due to Contaminated Hospital Linens". And as to the proposition that B. cereus infection is somehow unusual and thus more likely due to something gone astray see "Bacillus cereus, a Volatile Human Pathogen". Finally, as to the claim that B. cereus meningitis in children is exceedingly rare see (ungated) "Bacillus cereus Bacteremia and Meningitis in Immunocompromised Children".

Did the hospital have a record of B. cereus infections? Were catheters employed that B. cereus could have used as an escalator to infection? Was the strain identified identical to the one that prompted the recall? Were there other sources of that strain? If so, how is one deemed more likely the cause than the other?

Efforts to identify strains of disease-causing bacteria and to trace them back to their origin have put us on the verge of being able to identify and hopefully thereupon eradicate the causes of an enormous portion of human suffering. But we're not quite there yet as demonstrated by tonight's report of the National Academy of Sciences on the 2001 anthrax attacks. B. cereus is a cousin of B. anthracis - the causative agent of anthrax. B. anthracis was long thought to be less promiscuous than its cousins and so less likely to vary widely thus making its origin easier to identify. But it ain't so. See Chapter 5.2 "Identification of the B. anthracis Strain". The very same difficulties will likely hamper any attempt to match strains of B. cereus.

Establishing a common strain of bacteria and tracing it back to a particular defendant remains a very high hurdle for any plaintiff to clear. But when the day comes that both are readily doable "Katy bar the door" because the number of deaths from cancer, heart disease, diabetes, etc being laid at the feet of infectious agents is staggering and rising every day. Worst of all, thanks to the ability of these ancient predators to evolve at a fantastic rate. there's little anyone can do to predict where and from which formerly benign little bug the next onslaught is likely to arise.

Infants on Antibiotics Experience a Big Increase in Their Risk of Developing Asthma

Even if neither parent had asthma, introducing antibiotics to a child less than six months of age produced a big increase in the risk that he or she would develop asthma five and a half years later. Do antibiotics prevent the establishment of bacteria in our gut that help us recognize good from bad in the outside world and modulate our immune system's response or do antibiotics nuke our gut microflora dysregulating our immune systems? Read all about it (free online) in "Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children" in the American Journal of Epidemiology.

Will the EPA Disclose Confidential Business Information?

For the first time since enactment of the Toxic Substances Control Act (TSCA) the US EPA is threatening to remove confidentiality claims on studies of 14 chemicals.

Under the TSCA companies may claim that information submitted to the EPA should be treated as confidential business information (CBI) and not disclosed to the public. Companies that manufacture, process or distribute chemicals are required to immediately notify the EPA if they learn a chemical presents a substantial risk of injury to health or the environment. The reports are available on EPA’s website, but when the identity of the chemical has been claimed confidential by a company, the name of the chemical has been removed from the copy of the report that is made public.

In May 27, 2010, the EPA said it planned to generally deny confidentiality claims for and the identity of chemicals in health and safety studies filed under the TSCA, except in specified circumstances.

The EPA has begun reviewing past CBI claims for chemical identity in health and safety studies. When the EPA determines that the information is not eligible for confidential treatment under the law, it will notify companies of the determination and that it will make the information public on the 31st day after receiving the determination unless the company properly challenges the disclosure.

On February 10, 2011, the EPA notified five companies that the identities of 14 chemicals associated with a number of health and safety studies under TSCA are not eligible for confidential treatment. The companies that submitted the data in question are: Givaudan Fragrances Corporation, Japan Technical Information Center, Inc., JSR Micro, Inc., Nalco Company and Promerus LLC.

Tags:

The Man Who Didn't Fall

On the matter of negligence in personal injury cases the first draft of the Restatement (Third) of Torts eliminated the element of duty altogether. After an uproar the authors eviscerated duty and stuck back in what was left. Ultimately, while they failed to restate the law as it pertains to duty they did manage to restate the era of unjustified fears and risk aversion that has persisted since about the time the Restatement (Second) was published.

The Restatement (Third) takes the position that case law as well as scholarship pertaining to duty is largely incoherent. The essence of the claim is that limits to liability couched in terms of relationships or foreseeability are nothing but ad hoc justifications for taking the real question, whether defendant breached a duty of reasonable care owed to society, out of the hands of the jury where it belongs. Thus, dismissing as insupportable judicial inquiries about the connectedness of plaintiff and defendant (the relational approach) as well as those as to the proximity of cause and effect (proximate cause), the Restatement (Third) of Torts, Liability for Physical and Emotional Harm Section 7(a) reads "[a]n actor ordinarily has a duty to exercise reasonable care when the actor's conduct creates a risk of physical harm." It goes on to add that save in "exceptional cases" judges "need not concern themselves with the existence or content of this ordinary duty." In other words, once it has been established that a defendant created a risk the court's work regarding duty is finished and the question of whether defendant's conduct was reasonable is exclusively for the jury to decide.

That's a very long way from either position taken in  Palsgraf v. The Long Island Railroad Company . On one side Chief Justice Cardozo for the majority wrote "[t]he risk reasonably to be perceived defines the duty to be obeyed, and risk imparts relation; it is risk to another or to others within the range of apprehension". On the other Justice Andrews dissented writing both that "[e]very one owes to the world at large the duty of refraining from those acts that may unreasonably threaten the safety of others" and yet that "there is one limitation (on liability). The damages must be so connected with the negligence that the latter may be said to be the proximate cause of the former." He continues "[w]hat we do mean by the word "proximate" is, that because of convenience, of public policy, of a rough sense of justice, the law arbitrarily declines to trace a series of events beyond a certain point."

Cardozo marks the boundary of liability by a circle of close if fleeting relationships while Andrews bounds it within a circle of causes that are close to the injury producing event. Whether measured by the remoteness of the relationship or of the cause from effect both sides agreed that there was a limit to the duty of reasonableness even when a risk has been created. It's that idea of a limit on the duty of reasonableness that was cut out of duty in the Restatement (Third). Consequently foreseeability, the catchall for the various efforts to limit the scope of the duty of reasonable care, is said to have been purged from duty.

The objection that the collection of limitations on the duty of reasonable care (whether Cardozo's or Andrews' or the many iterations based on foreseeability) is incoherent is based, I suspect, on an understandable misunderstanding of what these jurists are trying to say. What I think they've been trying to say is that risk is an inevitable part of life and that some risks are so small that liability isn't warranted even if an injury should follow their creation.

But foreseeability doesn't sound much like risk. Isn't it about predicting the future; about foretelling future events based on what's already known? Yes, but that ex ante calculation of the effects that likely follow causes is what risk is all about.

But why limit liability by the degree of risk? And if a boundary is drawn how can it be done other than arbitrarily? Isn't it better that we follow the Precautionary Principle? Aren't we Addicted to Risk? Wouldn't the world be a better place if we quit taking risks?

To answer those questions let's go back to the railroad guards who created the risk that caused Ms Palsgraf's injury. As a train began to leave the station two men ran to catch it. One safely boarded but the other, "carrying a package, jumped aboard the car, but seemed unsteady as if about to fall. A guard on the car, who had held the door open, reached forward to help him in, and another guard on the platform pushed him from behind. In this act, the package was dislodged, and fell upon the rails." What might the future have looked like had the guards taken the time to consider all of the possibilities that might follow from their effort to keep the man from falling? What might the future have held for him assuming gravity acted upon him as it did upon his package? And what about the rest of us, if inaction were the only way for our fellow citizens to avoid being hauled into court?

For several decades now the merchants of fear have been telling us that everything we thought was progress is instead the cause of human suffering. Vaccines? Autism or worse. Electricity?  Electromagnetic fields, migraines, MS, cancer. Internal combustion engines? Global warming, pm2.5, etc. Plastics? Endocrine disruption, heart attacks, cancer. Pesticides (e.g. DDT) and herbicides? Sterility, cognitive deficits, cancer, overpopulation. Cars? Runaway acceleration, rollovers, fireballs. Computers? ADHD, too many choices, too little control. Shouldn't we have waited until all the kinks were worked out before acting? Click on the vaccines link in this paragraph and also consider the price of fear of regret as expressed by Benjamin Franklin.

It is, I'm afraid, a duty to stop and not act until you've considered all the possible consequences of every action, however improbable, that the Restatement (Third) ultimately embraces. It is an embrace of the Precautionary Principle - an embrace therefore of a political viewpoint; not a restatement of the law regarding duty.

When you think of foreseeability as risk you see what the law really has to say about the duty of reasonable care and the analysis of any claim that it was breached. What it truly says is that the court, taking an ex ante perspective, is to decide whether the risk created was one for which, if found unreasonable and causative by a jury, liability may fairly be imposed. Thereafter, for any act amenable to liability, it's for the jury to express their community's tolerance for risk. Risk, or foreseeability, is thus sensibly in two places. First in the law where the limits of liability are drawn and thereafter with the fact finder who considers the reasonableness of the conduct given the context in which the various factors played out. 

Is there some bright line that can be drawn? Not always though we're certainly arguing down here that in cases where good quantitative risk assessment is available it can be. For example, in one case involving a minute exposure to a carcinogen we can take the plaintiff expert's epidemiology studies and show that the exposure his industrial hygienist calculated produced, at most, a 1 in 13 million risk of death. Compared to other known risks you're much more likely to slip and fatally hit your head on the toilet than to die from the exposure of which plaintiff complains. Our argument is that it make sense then to have the law, i.e. the court, set some reasonable outer limit on liability - perhaps at the 1 in 1 million level. Otherwise we either open up toilet makers and everyone else to ruinous liability for creating risks running towards the impossible end of the spectrum or we without any sound reason decide that some one in a million risks of death are fine while others aren't.

Unsurprisingly it didn't take long for the simplicity and predictability arguments advanced in support of the new and hollow version of risk to run off the rails. Consider Feld v. Borkowski. Iowa's supreme court eagerly adopted the new conception of duty in 2009  (see Thompson v. Kaczinski) only to start tortuously creating exceptions to it less than a year later. (Slow pitch softball is a contact sport? Who knew? By the way, with all due deference to the Creighton coach I suspect angular momentum and early application of torque rather than recklessness answers the question). Rather than clarifying duty I'm afraid the Restatement (Third) has only created a risk of even more obscure and incoherent formulations of exceptions so as to avoid the consequences of duty without limit.

Anyway, whatever the facts and whatever the content of duty courts will in the end have to recognize the wisdom of another famous American, Henry David Thoreau, who wrote "A man sits as many risks as he runs." And that "if a man is alive, there is always a danger that he may die ..." It's exactly that essence of the inevitability of risk that the courts, if not the Restatement (Third), have been trying to express when they talk about duty.

 

 

 

Population Mixing, Childhood Leukemia, Viruses and Vaccines

There's good epidemiological evidence that population mixing is responsible for several clusters of childhood leukemia (acute lymphocytic leukemia, or ALL). Some have hypothesized that viruses are to blame but there hasn't been much evidence to support that hypothesis; at least not until now.

In the current Journal of Pediatrics you'll find "Associations Between Vaccination and Childhood Cancers in Texas Regions" which compares the risk of ALL to vaccination rates in different public health regions. With all the caveats that must go along with hypotheses generated by statistical analysis it is nevertheless quite intriguing to see that children vaccinated against a wide range of viruses had a large and consistent reduction in their risk of ALL; so much so that it leading the researchers to conclude that "[s]ome common childhood vaccines appear to be protective against ALL at the population level."

Be sure to also note that 4 doses of diptheria-tetanus-pertussis, 3 doses of polio, 1 dose of measles-mumps-rubella, 3 doses of H. influenza, type B, 3 doses of hepatitis B and one dose of Varicella, the 4-3-1-3-3 vaccine regimen claimed by some anti-vaccine activists to be capable of "overloading young immune systems" and thereby (some-unstated-how) causing autism, produced a 38% decrease in the risk of a child developing leukemia.

Hopefully the anti-vaccine crowd is paying attention. The list of harms to children for which they may be made to answer is apparently growing.