Deposition 3 - deposition of doctor in products liability case - Part 3
Q Could you have brought someone along who was licensed who could have done that, if you had wanted to?
A Could have, but then again, would have -- there would have needed -- we would have had to set up a patient-doctor relationship with somebody, and the powers that be in these instances didn't feel that was warranted.
Q Powers that be being the lawyers?
A They're the ones -- It's their dime, as they say, so--
Q In terms of MRIs, were any MRIs done to these 2,550 people that were the post Gulf Coast group?
A Not at our request, but a number of them brought MRIs that had been done earlier or in notes that I wrote to the doctor, we suggested that they should be done.
Q You also indicated that you had submitted to a journal the Gulf Coast examination -- or Gulf Coast work that you had done, correct?
A Right. There's two papers have been sent in.
Q I don't know where this is in terms of whether you're inclined to tell me, but can you tell me where you sent them?
A Neurotoxicology has the manuscript.
Q So did both go to Neurotoxicology?
A No, the paper on the physiologic measurements on the tremor went to a different journal, and I don't recall which one that was.
Q And then Neurotoxicology is where the other one went?
Q And that's been accepted subject to some revisions of some kind?
A Yeah. They wanted some minor wording changes and a little more elaboration on one aspect of the paper, and that was sent in probably six, seven weeks ago.
Q And do you have a copy of what you sent in?
A Yeah, oh, sure.
Q Can I have a copy of it?
A Well, I can't --
MR. McCOY: I was going to say, that part, I don't think the prepublication ones are being disclosed in any of these situations, I mean, involving this kind of litigation.
BY MR. GLOOR:
Q When it's accepted without condition, I take it we can have it at that point in time?
A I can ask the editorial board whether that's okay. The problem is that the journals are very touchy about something appearing in a public record that they have unique rights to as the journal that's going to disseminate that information.
Q In the course of this process of submitting -- How long ago did you submit the article; do you recall, roughly?
A Time flies when you're having fun. I suspect we sent that thing in in September, and then it took six weeks to come back, because we had submitted it to another journal last spring or last -- actually, end of the winter last year.
Q What journal was that?
A Annals of Internal Medicine.
Q And did they accept it, --
Q -- reject it, or what?
A They rejected it. They rejected it.
Q Do you know why?
A Oh, they always have their reasons. They --
Q What did they say?
MR. McCOY: Let me -- let me object here to the extent that, again, are we dealing with a research type paper, Doctor?
THE WITNESS: I would -- I would think that they -- they constitute research. They're -- they're clinical studies looking at a medical condition.
MR. McCOY: Right. And, again, these are -- these are the types of studies that would be done for the purposes, ultimately, at least in part of, of improving patient health care and reducing morbidity and mortality.
THE WITNESS: Right.
MR. McCOY: Okay. So we have, again, an Illinois Medical Research Studies Act, privilege, that I -- I don't think I'm in a position here to waive. I could talk to the doctor about it and others, but maybe at a break I could ask, but you can go ahead with your questioning. I will -- I would think that question, though, is privileged.
MR. GLOOR: I just asked if he knew why the Annals had turned down his article.
MR. McCOY: And I just said we've -- I just said I think that one -- that one would be privileged.
MR. GLOOR: So you're instructing the doctor, assuming he's instructible, not to answer the question?
MR. McCOY: Right. I can't -- I can't instruct him in that sense, but I can tell him that -- that that would be covered under the Illinois Medical Research Studies Act and would be -- would be privileged.
BY MR. GLOOR:
Q Mr. McCoy has said you shouldn't answer that. My only question to you is, are you --
MR. McCOY: I didn't say that he shouldn't answer; I said it's subject to a privilege.
BY MR. GLOOR:
Q Are you going to answer the question?
A I don't think it's any secret. I mean, and it's come up before in deps. It's this usual issue. One, it was that they felt that the -- this type of study needed a more rigorous epidemiologic approach, looking at a total population at risk, rather than reporting affected people, and that's come up before. They also didn't seem to think it was their kind of article specifically. I mean, and journals seem to have that bias.
Q Do you know what that means, by their kind of article?
A We disclosed in the first paragraph the fact that this was funded by legal firms, which ultimately, I think, was honest, but not smart on my part, because it just raised an issue before anybody had time to digest the material.
Q Up until the submission to -- well, the Annals and then the Neurotoxicology -- Is that the journal's name?
Q Okay. When was the last time before that that you had had an article published in a peer-reviewed journal, if I've said that correctly?
A I don't know. I'd have to look at my CV. Peer reviewed? Oh, boy.
Q Here's one here. Is that your CV right there?
A A couple of years. Most of the stuff that's actually been peer reviewed the last couple of years --
Q Look at your CV.
A Yeah, it's probably -- probably -- Actually, this is incorrect. I went back like 2000 or 1999. It was a paper that Dr. Calne and I, one of the other guys at Vancouver, had about the -- about this young-onset Parkinson's patient whose autopsy we talked about.
Other than that, it probably goes all the way back -- this is probably correct -- to this one from, gee, 1991, a multi-authored one about MK-458.
Q What is MK-458?
A It was a Merck drug, a synthetic dopamine stimulant that we used in patients. There's some other multi-authored ones, which aren't -- they're peer reviewed, I'm one of the authors, but then I didn't write the paper. I'm one of the -- one of the authors because I did part of the clinical research that went into it. The other stuff, that's been published recently in non-peer-reviewed journal.
Q Going back to the Gulf Coast again for a second, Doctor.
Q I think you indicated that you looked at 2,000 or so people, correct?
A We actually examined, I can't give you an exact, but maybe 1,130 of 2,035 positive people from the first screen.
Q So the first screen then had a group of 2,000 and some, correct?
A The first screen looked at approximately 20,000 people.
Q And then -- But you didn't look at all 20,000, if I understand this.
A No. That was the purpose of the first screening, was to pare this number down.
Q And then it got down to 2,000 and some, correct?
A Right. About ten percent of the patients were found to have neurological findings. We examined a little over half of them.
Q And then someone else examined the other half?
A No. We're still working our way through the other half.
Q In terms of the 18,000, if my mathematics is correct, and the 20,000, less the 2,000, those who didn't make the screening.
Q Did you ever look at any of their records at all?
A Only in the sense that I was at a number of the primary screenings working with the resident physicians to make sure that we were all on the same page in terms of what they were looking at. Most of those are normal exams.
Q Do you know where those records are, the records of the normal exams?
Q Those are -- those are not here, I take it.
A I don't have them, no.
Q Are those with the lawyers?
A In the -- in the event that they retained them, they are; in the event that they didn't, they don't exist anymore.
Q Regardless, you don't know where they are as you sit here today, correct?
A That particular database was never under my control.
Q If you can go back to the post Gulf Coast screening of 2,550, how many were screened before they got to the 2,550, do you know?
A The vast majority. There's a few walk-ins that would come in who missed the first screening, who we then would see at the -- at the session we were at. Virtually like ninety -- 98 percent of them had been prescreened.
Q Let me try to -- I didn't make that clear, I'm sorry. In the Gulf Coast, you went from 20,000 who were screened, down to --
A 2,035 who had been positive on the first screen.
Q -- down to a universe of 2,000 some, correct?
Q In the post Gulf Coast screening, you got down to a universe of 2,550, I think. My question is, how many did you start with, 20,000, 15,000, 30,000, or what?
A I don't have that number. My assumption has been that it was actually a larger number. Less than ten percent of the individuals were reflected in the group who we saw. Exactly what percentage, I don't -- it's been quoted to me in a number of different values, you know, varying between six and nine percent. I don't know how accurate any of those numbers are.
Q Do you know who has the records of those participants who didn't make it to the 2,550 in the post Gulf Coast screening?
A Again, there's a large number of firms involved. Whether one firm is responsible for holding onto all that information, I don't know.
Q Was Mr. Barrett's firm involved, I take it?
A Mr. Barrett's firm has been the primary organizing group in terms of all these additional screenings.
Q Let me just cover some things very quickly. 1974 and ‘75, doing hair samples, looking at records of 25 or 30 people, I think, in your clinic, do you recall that circumstance?
A Right, quite well.
Q And was there ever something published on that?
A No. The only some things published, they were subsequent papers that we had looked at. We looked at regional manganese levels in guinea pig brain following major tranquilizers.
Q But in terms of that 25 or 30 people, anything published about what your thoughts were, findings were, conclusions were, whatever the word might be, about those 25 or 30 people in 1974 and ‘5?
A No. The human data, no.
Q And why not?
A It seemed to me that we had kind of hit a dead end with it. When the -- when the investigator's levels were higher than the patient's, and high levels were supposed to predict the presence of the disease, it seemed to me we had made some error in the way we analyzed the information.
Q So as far as you're concerned, the ‘74 and ‘75 data was inconclusive?
A Inconclusive, I've got to think about the meaning of that.
Q I'll rephrase it.
A It was very confusing, to the point where I didn't know how to proceed with the work.
Q Would it be accurate to say that whatever information you obtained in the ‘74 and ‘75 study was not the kind of information that you could rely on to draw any conclusions about for opinions regarding welding exposure and manganese-related damage?
A Well, we didn't -- we didn't know anything about manganese being in welding materials then. If I had known that, it would have been a more interesting paper because I was welding at that time. I had no idea why my manganese levels were high.
Q I'm just trying to see if that ‘74-'75 data is anything that you rely on for opinions in Mr. Boren's case, for instance.
MR. McCOY: Well, let me again -- We've disclosed this as part of the basis for his opinions with his -- his past, and he's testified to this before, about all his past experiences and how they -- they're cumulative. Subject to that, he can answer, but it's been disclosed as part of the basis.
THE WITNESS: I mean, I think that's fair. I mean, it's a -- it certainly is a piece of information that has had newfound meaning to me in the last ten years.
BY MR. GLOOR:
Q And that newfound meaning is what?
A Well, that you can obviously get a substantial -- a significant amount -- elevation of manganese in your body fluids by welding, and it's -- that as someone who was knowledgeable about manganese, that finding out that the manganese was coming from the welding rods was not immediately accessible information.
Q Besides the level of manganese you had in your hair -- As I recall, it was in your hair, correct?
Q Did other people who were examining patients have high manganese levels as well; is that what you said?
A No one else had a level anywhere near as high as mine.
Q And I thought you said -- and I'm probably wrong -- that you said the examiners, with an S on the end, when they had higher manganese levels than the people they were examining, it was time to do something or other.
A Right. If I used -- It was the sole -- sole member of our -- of our control group that was elevated.
Q 1997, Doctor, you contacted a University of Wisconsin epidemiologist; do you recall that?
Q I think you did. If you didn't, then just say you didn't.
A It was probably earlier than that. About the groundwater issue, determining where the aquifers were in Wisconsin and identifying patient populations drawing from those aquifers?
Q I don't know.
A I thought it was earlier than that.
Q Was it about manganese?
A It was about any -- any potential neurotoxin that might be in the water supply. We were looking for -- to see if anyone had funds available to correlate our -- our data regarding zip codes of patients and then locations. We were doing a study of kindreds with multiple parkinsonians in them.
To look at those zip codes and then see whether the state had information about what aquifers supplied those zip codes and what industries or particular agricultural activities were prevalent in those areas, we wanted by decade, because we had epochs of exposure we were interested in.
And they -- they didn't have any money, and neither did I, so it didn't get very far, though they had the capacity to do what I wanted them to.
Q Do you know who you contacted, what person?
A No, that's -- that -- Boy, I'm trying to remember how we even did that. There was a whole series of contact people involved in the -- in the politician's arena, and I don't recall.
Q Do you recall anyone's name that was involved in that whole process?
A No. I -- I can't remember. It's a long time ago.
Q 1999, I think you sent material to a person at Stanford or some university in California. Do you recall that?
A Give me -- give me another hint about what we said.
Q I thought it was an epidemiologist you had contacted in 1999 or thereabouts. You sent materials to that person and --
A When we were sent materials, we were trying to get ahold of Carly Tanner to do some work with us. That wasn't ‘99. That was later, though. That was 2001.
Q And what were you trying to get her to do?
A Well, Carly Tanner -- Carolyn Tanner, M.D. -- Ph.D. these days -- was one of my residents, and she had a particular interest in epidemiologic issues and Parkinson's and had published some stuff about Parkinson's in China and Parkinson's among certain occupations, and I thought it would be logical, since I knew her and had had her speak at some of our meetings, our conferences here, to help -- help me with this. And so we were going to send her our information and see what she thought of it.
Q The information about the Gulf Coast, you mean?
A Well, this would have been preliminary stuff with the Gulf Coast. I think I was just going to ask her about how one might approach that data. We were just starting this, and I wasn't exactly sure how best to collect the information or whether the information was going to be interpretable once we had collected it, so I wanted some help.
Q This is -- this is Gulf Coast -- preliminary Gulf Coast information?
A 2000, 2001 would have been the time we started looking at that, so that would have been when her name would have come up.
Q What -- Did you contact her, and what did she say? Just give me the specifics.
A Well, the contact was made by -- by someone in Ranier's office in New Orleans, and they were told that they couldn't talk to her. And, actually, she didn't respond to their calls initially.
And I called, and she didn't respond to my call. And then we got a call -- I didn't get a call. Lang -- Bill Langston, who's her boss, called Sarah Ranier, as I recall, and said that they couldn't -- she couldn't contact them or speak to them because they had been retained by your folks. The welding industry, in fact, had paid them money to do some work of theirs.
MR. McCOY: Silence is golden. Can I -- can I ask for just about a two-minute break --
MR. GLOOR: Absolutely.
MR. McCOY: -- at this point in time?
MR. GLOOR: Fair.
THE VIDEOGRAPHER: Going off the record at 3:25 p.m.
(A recess was taken.)
MR. McCOY: For the record, we've -- we had agreed to delete my inadvertent mention of the Patient B name, and instead we'll just refer to that as Patient B.
MR. GLOOR: That's fine.
MR. McCOY: Something like that. So that would be something that in the transcript, --
MR. GLOOR: And I agreed, that's fine.
MR. McCOY: -- as edited, it would -- or as transcribed, we would delete the reference to that name.
MR. GLOOR: We're going to go try to get the file on this, but at the same time, that's not worth fighting about, so that's fine.
(There was discussion off the record.)
THE VIDEOGRAPHER: Back on the record at 3:38 p.m.
BY MR. GLOOR:
Q Just a few more questions about the Gulf Coast, and then I'll move on. The journal, the -- Was it Neurotoxicology?
Q That journal, can you tell me what -- what documents or articles or information or data, whatever it is, you submitted to them for the purpose of having your article published?
A Well, I didn't send any -- I mean, it's a summary of the results, so that it's a compilation of what the findings were, a statement of the problem. There's a question of whether manganese is toxic. We looked at a group of people exposed to manganese.
Q Did you give them any information about the group of people besides what was contained in the proposed article?
MR. McCOY: You know, again, this same -- same question comes up about this being something relating to research and privileged under -- under Illinois law. So, I mean, the doctor's free, I think, to talk about it because it's his research, but I will say that he does have a right to put -- put a privilege on it.
MR. GLOOR: Recognize --
MR. McCOY: Subject to that, he can answer.
MR. GLOOR: Recognize the judge actually directed us to seek out this kind of information when we were seeking documents. Having said that, --
MR. McCOY: No.
MR. GLOOR: -- you can do what you want, but let me ask the question again.
MR. McCOY: I disagree with the interpretation of the judge's -- The judge made only one ruling on the Medical Research Studies Act, and he said, in the one instance that it came up for Washington University, it was the university's decision as to what was and was not researched, and he was going to be abiding by that. That's what I'm telling Dr. Nausieda, in essence. And this is the judge in Madison County.
MR. GLOOR: I believe what the judge --
MR. McCOY: Same judge in Morin case.
MR. GLOOR: I believe what the judge said -- and I'll move on because why argue about it -- I believe what the judge said is that in terms of documents you can obtain, they're the documents that Dr. Nausieda would or might or could submit to a journal for the journal publishing his article.
Q So with that background -- and you don't have to answer the question, but we might be back -- can you tell me what you submitted to the Journal of Neurotoxicology along with this proposed article?
MR. McCOY: Again -- again, I'm -- I'm just disagreeing with what -- what the judge ruled. The judge ruled you could inquire about his methodology, and that's what the inquiry was allowed as to Dr. Nausieda's Gulf screening work, but he didn't -- he didn't mandate any document production.
BY MR. GLOOR:
Q Let me read review from the -- Just so the record's clear. If we have to come back, there's a reason we're coming back.
There was a motion before Judge Byron, who's the judge in Madison County, Doctor, and it was dated on July 20th of this year, and Judge Byron, among other things, said, we have to go back to your -- for these studies to be accepted in these journals, you have a peer review board. You go back, and you see what their standards are, and this Court will abide by those standards. Whatever they require, he has to produce short of, it's that simple, so we don't need the commission. Commission was something about getting a subpoena served out of state.
And so what I'm asking -- And, again, if you don't want to answer it or Mr. McCoy says you shouldn't or suggests you shouldn't, that's fine, but what I'm asking is what documents of any kind, data, whatever might have been, did you submit to the journal Neurotoxicology -- Is that the name of it, Neurotoxicology?
Q -- in order to have this article published?
A I didn't submit --
MR. McCOY: My -- my objection, again, is, you know, the judge said what the journal requires. He didn't say anything about the production of documents. So the doctor is free to talk about what standards they -- they hold him to.
THE WITNESS: The answer is, A, nothing, they didn't ask for anything in addition to the manuscript. What they asked for was -- was some minor explanations for certain comments in the paper, which was kept brief, they wanted elaboration on. Other things they thought were redundant, they wanted condensed.
BY MR. GLOOR:
Q Do journals sometimes, when you submit an article, seek underlying data, the peer reviewers, for instance?
A I've published quite a few papers. I've never had them ask for my actual data. I mean, that would be -- that would be questioning your integrity as a -- as a scientific writer, and that would be very unorthodox, I think.
Q And they didn't do it in this case, and to your -- to your knowledge, it's never been done, as far as you're concerned.
A Not as far as I'm concerned. I mean, my own personal history, no, I've never had anybody ask for my core data.
Q You've been a peer reviewer, haven't you, from time to time, Doctor?
A Yeah, sure.
Q Have you ever asked someone whose article you were reviewing as a peer for any underlying data?
A Not in writing, no. That's the sort of thing that happens at the meetings. That happens verbally.
Q Do you ever -- Did you ever ask for orally, not in writing, but orally, underlying data?
A Oh, yeah. It's usually not phrased that way. It's usually phrased, I believe that you made that up, that's how we usually phrase that. And then you have to respond to that in some meaningful way.
Q As a peer reviewer, have you ever said something like that and then received underlying data --
Q -- for someone to show you he didn't make it up?
Q Have you requested underlying data, but they just haven't produced it, and the submission was withdrawn?
A That's usually what happens. I mean, if you -- It's come up in certain situations where the results seem to be so out of kilter with what -- This is usually regarding laboratory procedures. The numbers are off by a factor of ten, for instance.
They say, could you please send me your protocol for how you did this, because I can't figure out how you got numbers that are this different than ours. And then either you find out they made a mistake or you've been making a mistake or they withdraw the paper, which is the usual pattern.
Q But that's not -- I mean, at least that is a question that can, in certain circumstances, be asked, the question being send me your protocol or your underlying data, correct?
Q All right. In terms of conclusions you are drawing from the Gulf Coast's information, I think you've indicated you thought that the -- there was ten percent of those examined had a manganese-related injury. Do I recall that correctly? And if I'm wrong, tell me.
A That's the number you applied. I mean, out of 20,000 people, 2,000 had a positive exam. That's essentially ten percent of the total number.
Q The documents that allowed you to come up with that ten percent figure, that roughly ten percent figure, are those documents available?
A No, and that's why I didn't use that ten percent figure in the manuscript.
Q Who has those documents that would allow the ten percent figure to be discussed, if not in the journal, certainly somewhere else in terms of testimony?
A Well, those were -- those -- that's a summary of the total head count from the prime -- from the princi -- the primary screenings, okay? These are how many people came to the primary screenings, and the law firms had that information.
The problem that we -- was we were -- we couldn't fully rely on that because it became apparent later that we were seeing the same people more than once, and that, in fact, the chance for redundancy and repeat -- Because there were a number of mechanisms whereby someone might be invited to a screening, and some people apparently liked coming to them, and so they would show up more than once. And so it became -- There was no way to go back and track that, and so the number was left -- There was a certain amount of plus or minus error involved that we couldn't get rid of because we didn't have enough information to do it.
Q If I wanted to look at the documents myself and figure out where -- what the percent was, ten percent, nine percent, eleven percent, --
Q -- whatever it might be, are -- is that universe of documents available where I could put my hands on it and look at it?
A I am told it is available, but I have never seen it myself.
Q And who told you that?
A I've been told that repeatedly by attorneys working through the Ranier firm.
Q Do you know the name of anyone who've told you that?
A Well, I've been told that those numbers exist by -- I mean, by Andy Hill, and he is apparently reporting that from Drew Ranier.
Q Would it be accurate to say that without that universe of documents that someone has, Mr. Ranier or someone, that it would be impossible for a defendant or defendant's lawyer, like me, to verify that -- that ten percent figure?
MR. McCOY: Let me object -- object to this -- to this question because, again, this deposition was limited to whether the methodology itself-- itself is proper. As far as those documents is concerned, the judge specifically said you are not getting those documents. So you can -- you can question him about whether the methodology is fine, and that's the extent of the questioning for this deposition.
BY MR. GLOOR:
Q You can answer the question.
A Again, I mean, unfortunately, you would have to go through the same process I have, and I haven't seen all that data.
Q This is -- You know, you heard the story it takes a village to raise a child, it takes a village to take a deposition apparently. All this?
MR. KOPRIVA: No, it's just -- you can just review it and ask if you want.
MR. GLOOR: Is that on this issue, the Gulf Coast issue?
MR. KOPRIVA: No, it's not.
BY MR. GLOOR:
Q In terms of drawing conclusions from the Gulf Coast people that you examined, is it necessary that the people you examined be representative of the population in general in order to draw conclusions about the prevalence or the incidence rate, or whatever the proper term is, in terms of those who may have a manganese-related injury from welding?
A You've lost me. That --
Q I'm sorry.
A -- second phrase took me by surprise.
Q Okay. Let me go back and try it again. And I'm clearly outside anything that's my expertise, so stick with me.
Q My question is, if you examine these 2,000.
Q And from this 2,000 you see, you conclude it's a ten percent rate, hypothetically for the moment, okay? To have that be significant in terms of that rate, seems to me that the 2,000 you examined must be representative of the population in general, otherwise it would be impossible to draw conclusions from what you observe from looking at the 2,000. Does that make -- that question make sense to you?
MR. McCOY: I object. I don't understand the question. It's vague.
THE WITNESS: Well, I mean, rather than spend another half hour killing it, why don't we -- I know what you're getting at, and the issue is how do you know that those numbers are relevant?
BY MR. GLOOR:
A You found a thousand people with something wrong with them, --
Q So what?
A -- how do you know what that means?
Q The question is so what? Does that somehow mean anything to us?
A And that's -- that's -- that's a good question. And, I mean, I think there's -- If I can just tell you how we approach that.
There's three ways to -- I think to deal with this kind of a problem. One is to do this according to strict -- this epidemiologic criteria that we look at a population at risk, and we look at all individuals exposed and non-exposed and then chart the rate of the development of a disease over time.
You can't do that in this case. I mean, this is a -- this is a historical event, and it's not -- I think given the known nature of the toxin, you can't put people at risk and then wait to see how -- when they get sick, because it's unethical.
So we're stuck with, well, what if we looked at everybody in a shipyard? Well, we -- the ship -- half the shipyards have gone out of business, and no union or no private industry group was going to let us come in and examine everybody because there was the whole -- the whole issue of litigation was involved. So couldn't do that.
So the third problem was, well, we could just call as many people as we could to come in and -- and see how many people showed up who had a problem and compare those numbers, the numbers of affected individuals, to, A, the known -- the general population, and, two, the known and reported data on the prevalence of Parkinson's disease in various age groups, if there was, in fact, an age differential in the people that we saw who had neurologic symptoms.
We chose to do the latter, only because that was the data that seemed, one, was it became apparent that our patients were younger than the -- than the patient population in this clinic, which is, I mean, is one of the largest clinics in the country.
Our mean age in this clinic is 73. The mean age of the people in the Gulf screen was 49. So we said, there's a difference there. Now, how often does Parkinson's disease occur in a group of people under 50? And the answer is not too often, probably about 15 per hundred thousand.
If you then took the numbers -- And we made no attempt to go further in the analysis. We said, you know, if you figure that -- that this group we saw reflected 2,000 positives, we didn't see all of them, but let's assume we saw all the positives, and that's culled from 20,000, that we actually ended up seeing that the rate in our group was approximately 2,900 per hundred thousand of a disorder that's reported to occur in 15 in 100,000 people. And we will let you make your own decisions about whether that's significant, because this is not a strict epidemiologic study.
Dr. Racette did it the other way. He said, well, what if I saw everybody in the whole state, and let's just take the positives I saw, and their numbers said there were too many of them even if he had seen everybody in the whole state.
We could have done that analysis, but I was sure it wouldn't have been significant. I'm surprised it was.
Because the bottom line is that these are not strict epidemiologic studies, as you'll be quick to point out to me. And so we've used an approach that's been used previously as if something -- something that occurs at a low rate of frequency, suddenly appears at a high rate of frequency in a -- in a group that's identifiable on the basis of some other variable. That has -- That's, I guess, that's clinically significant from a public health standpoint, although it may not fit the criteria of hard science that I think is sometimes easier to apply to experimental animals than humans.
That's really kind of the crux of the paper, and that's why some of the vagueness of some of these other numbers becomes irrelevant, because we really didn't, you know, we didn't really care how many we culled them from or how accurate that number was, it was -- it was -- it was the prevalence of parkinsonism in the age distribution that created the data that I thought was -- was impossible to overlook. It's too significant.
Q If a number, instead of being 20,000 and some, whatever that figure is in the Gulf Coast study, had been a hundred thousand, hypothetically.
Q That would impact, I take it, the kind of conclusions you can draw from that; is that correct?
A Well, then, yeah, you would have had a 100-fold increase instead of a 2,000-fold increase.
Q So what if the number was 200,000? I mean, at some point in time, it does make a difference in terms of how many you're taking them from, correct?
A Well, it makes a difference in terms of the overall prevalence, but it wouldn't explain the age difference.
Q In order for conclusions drawn from the Gulf Coast study to be relevant, the assumption -- the assumption must be that the group you looked at is representative of the population in general, the one -- 150 per thousand, or whatever the number you use, correct?
A What, you're asking whether welders represent the general public? Well, I mean, they obviously -- there's a male bias. It's a -- it's a male occupation. I guess physiologically, the assumption is that welders don't differ from bankers, lawyers, and doctors in terms of their physiologic make-up or susceptibility to a toxin.
THE VIDEOGRAPHER: Excuse me, counsel. We're near the end of Tape 2. Can we move to a tape change?
MR. GLOOR: Sure.
THE VIDEOGRAPHER: Thank you. It's the end of Videotape No. 2. We're going off the record at 3:56 p.m.
(There was discussion off the record.)
THE VIDEOGRAPHER: Let the record show that the previous tape was Tape No. 1. That was the end of Videotape No. 1, and this is the beginning of Videotape No. 2 in the continuing deposition of Paul Nausieda, M.D. We're back on the record at 3:58 p.m.
BY MR. GLOOR:
Q When was it you first knew that, in your opinion, the prevalence or incident rate, whatever the proper term is, of neurological problems among welders was maybe ten times as high as it was among the normal population?
MR. McCOY: Is it opinion in a lawyer's terms, as more likely than not?
MR. GLOOR: We're going to go beyond --
MR. McCOY: To a reasonable degree of scientific certainty more likely than not? He can answer.
MR. GLOOR: Bob, I got to tell you, I will think I'll make the timing on this -- this deposition, but you have spent 20 minutes with objections that don't make any sense.
Q In any case, go ahead, if you can answer the question. Do you recall the question?
A Yeah. When did I decide --
Q When did you know, decide, that you had a much, much higher incidence of neurological problems among welders than in the general population?
A Probably about a year-and-a-half ago, two years ago. Probably after we had seen the first -- you know, we worked our way through the first 900,000 people. It was something -- Clearly, it was something funny about this. The numbers were wrong, the ages were too low, and we were picking up all kinds of odd symptoms that you normally don't encounter in untreated Parkinson's patients.
Q So up until a year-and-a-half-- year or year-and-a-half ago, you had not drawn that conclusion from the Gulf Coast study, correct?
A You know, there was a -- there was a suggestion that this was true going all the way back to 1993, when we surveyed our own clinic, and we were doing -- we were looking at that in addition.
I don't know. You know, when did I make up my mind? I think it's not a good idea to make up your mind in our business too early because you're frequently, when you finally analyze the data, you realize you're not right.
Q Let me rephrase the question. When did you believe that the incidence or prevalence of neurological disorders among welders was much higher than among the general population?
A You see, that's a hard question. I'm not trying to evade the question, but, I mean, we realized that there were more welders than any other significant -- There was something funny about welders in our clinic.
If you used welder as the question, you pulled out a very strange group of patients, very young patients with very severe parkinsonism And we knew that back in the early ‘90s, and that's the first time we'd ever done an occupational cross-reference that gave any kind of interesting results.
And I guess I've always been biased by the fact that having worked with welding equipment and knowing I could get my own manganese level up and knowing manganese was toxic, this -- this struck me as a significant issue because we knew manganese was a problem.
How often -- Let's see, when did we decide -- I mean, welders aren't a very healthy bunch of guys to begin with.
Q My focus is narrow, though, Doctor.
A I know.
Q When did you know, not to a moral certainty, but when did you know or suspect -- you use the phrase you're more comfortable with -- that welding was posing a neurological threat to welders?
MR. McCOY: The question might have just changed because you say the word “suspect” in there.
THE WITNESS: I don't know how you guys use the word “suspect.” It seemed to me that after spending, you know, like I said, a year down screening these patients, probably doing like 15, 20 screens, and having other neurologists, whose opinion I respected, come down and see these people with me, probably about that time, it seemed to me that we were looking --