Day 8 – Not Drinking the Kool Aid
I have a friend whose adorable puppy died of lymphoma when he was 22 months old. Yesterday, I told her about this trial and my blog. She went a bit silent during our conversation, and shared that her husband diligently sprayed Roundup outside of their home to get rid of weeds on the patio. With no warning label or acknowledgment from Monsanto that this could cause cancer, how were they to know? This tragedy is that of the painted mouse but in beloved family dog form.
Now think of your children playing outside on playgrounds, school grounds and sports fields that have been sprayed with Roundup. In some pockets of New York City, some parents have stopped bringing their kids to the playgrounds altogether because they are catching on to the dangers of exposure. NYC, always a trend setter. (1)
DeWayne Johnson is here today, watching a doctor expert witness fight to prove that Roundup can cause Non-Hodgkins Lymphoma. The more that the story is eloquently painted and pieced together by the Plaintiff counsel, it seems like the causal association between glyphosate and NHL should be a slam dunk to anyone watching.
SHORT TESTIMONY SUMMARY
An expert clinician in treating NHL, Medical Oncologist and Hematologist Dr. Chadi Nabhan reviewed all scientific data and reports, and concluded that, without a doubt, glyphosate/RoundUp causes NHL. He is also very cute.
EXPERT TESTIMONY OF DR. CHADI NABHAN
Dr. Nabhan is invited into the courtroom. Oh wow, who is this gorgeous specimen of a man. He is tall, dark and oh-so-smart. His accent is hard to discern – some moments I think Italian, others South American. There is a British suggestion in his vowels as well. This international man of mystery smiles adorably to the jury and I can see that they already like him. Nice move Plaintiff counsel.
I have to look him up – he is Syrian. He went to Damascus University School of Medicine and is a member of the Syrian American Medical Society. I haven’t met many Syrians, and I am sure he has a multitude of stories to tell on that topic. He also has two sons.
I’ll stop pontificating about Dr. Nabhan’s personal life and get back to the case.
Delightful David Dickens conducts the direct examination of Dr. Chadi Nabhan. Dr. Nabhan is a medical oncologist from Chicago. He is also a hematologist, specializing on lymphoid malignancies. Because he is also perfectly philanthropic, Dr. Nabhan worked for a year in internal medicine in an underserved area of Chicago.
Dr. Nabhan had a fellowship at Northwestern for three years, the latter two years working both in the lab and clinic. He is board certified in five states, including California, and was recruited to be the medical director of the cancer center at University of Chicago. In 2016, Dr. Nabhan left the clinic and began work at Cardinal Health to serve as an intermediary between drug manufacturers and providers. He has published over 300 peer reviewed research studies, including several on T Cell Lymphoma.
The court names Dr. Nabhan an Expert in the Diagnosis and Treatment of NHL.
LAYING GROUNDWORK – FINER DETAILS OF NON-HODGKINS LYMPHOMA
Nabhan opens with Cancer 101, very articulately and authoritatively, but not quite with the professorial swagger that we saw with Dr. Neugut. Every organ in our body is composed of cells. We learn that when cells grow out of control, they can become tumors and some are malignant. As seen in clinic, the latency period between an exposure and onset of disease can be very rapid. For example, in 9/11 survivors who were exposed to the dusts upon building collapse, cancer is not uncommon. Here is a cited list of latency periods considered when accepting survivors into the 9.11 WTC Health Program, with a minimum latency of 146 days in developing lymphoma. (2)
In general, Non-Hodgkins Lymphoma is a cancer form that effects lymph glands. If the NHL is extranodal, the cancer is in organs that have nothing to do with lymph glands, like the skin, uterus, and thyroid. NHL can be divided into B Cell and T Cell subtypes. B Cell NHL is more common and treatments are more effective than T Cell NHL. There are at least 70 types of NHL, so doing an epidemiological study of each subtype is nearly impossible.
NHL can be either indolent (slow growth) or aggressive (rapid growth). The way that the T Cell Lymphoma is behaving in Johnson is aggressive, and he is not responding well to therapy. His prognosis is very grim.
HIGHLIGHTS OF THE DIRECT
- Dr. Nabhan stands in front of jury with a poster sized prescriptive pad to scribble out – with a dry-erase marker – what risk factors he looks at when determining what might have contributed to the development of cancer. He self-deprecatedly apologizes for his handwriting. Nabhan writes a mighty fine list of risk factors, including age, race, use of immunosuppressant drugs, autoimmune disease, occupational exposure, sun exposure, viruses/bacteria, and alcohol/tobacco use.
- He concludes that (1) Johnson is unusually young to have this form of NHL, (2) NHL of this kind is more commonly seen in the African American racial group and (3) there was occupational exposure to an agent that has been classified by IARC as a carcinogen. Nabhan says of IARC: “I can’t think of (an) any more impartial organization.”
- Delightful Dickens spends a great deal of time going through a chronological timeline that Nabhan put together from thousands of pages of medical records and by consulting with Johnson. This timeline is critical in proving that the Roundup exposures caused Johnson’s NHL.
- Nabhan concluded that without exposure to Roundup, Johnson would not have developed cancer.
MONSANTO CROSS EXAMINATION
Lombardi is back at the helm! He is definitely pissier during this cross than that of Neugut. I think of why this would be so. Maybe because the case is starting to so heavily favor the Plaintiff. Perhaps it is Nabhan’s staggering confidence and hot looks driving some insecurity.
Regardless of cause, Lombardi questions Nabhan as though he is a child who stole a cookie from the cookie jar. Nabhan rebels soon into questioning: “Is it ok if you don’t interrupt me please? I prefer not to be interrupted.” Judge Bolanos – who, by the way, is wearing a bright pink collar today, because why not go crazy on Friday – says that he has to just listen and answer.
Nabhan is given an enormous, Peewees-Playhouse-sized binder of studies to page through. (3) Arguments ensue surrounding Nabhan’s claim that clinicians look at logistic regressions, not hierarchical regression models. Feathers ruffled, Lombardi asks: “Have you polled them (all clinicians)?” Nabhan confidently responds: “I can guarantee it to you.” The pettiness of this cross doesn’t appear to be sitting well with the jury. Of course I am biased, but the supportive body language with each of Nabhan’s retorts is evident.
I have a highly educational video clip for you readers. This scene of Duckie Takes a Stand comes to mind, as the Plaintiff arguments are tidily falling into place and the jury is digging it. (Duckie’s Stand)
POINTS FROM THE CROSS
- Epidemiological studies are once again discussed. Lombardi attempts several “gotcha” moments that are unsuccessful. Just as the previous expert witnesses have stated, when it comes to clinical application of research, positive but non-statistically significant results are still taken under consideration. A clinician would never say that a cause of a disease “can’t be” just because the positive association found on a study was not statistically significant. Statistics are much more flexible in a clinical and biological application.
- Medical records and opinions of other physicians are debated. Lombardi wants to show that Johnson developed a rash in the Fall of 2013, prior to one mega-exposure to Roundup, but nearly all medical records point to the Spring of 2014.
- The high level of medical reputation of Stanford Hospitals is confirmed. GG Sidebar – I am a Stanford alum, so I like Stanford. Stanford is also my local hospital. I can tell you that, like at any hospital, some doctors are fabulous and others are far from it. There are many stories of misdiagnosis to tell here, of which I will spare you. Monsanto points to Stanford’s Dr. Kim, who said that she is unaware of the correlation between glyphosate and NHL. I would not take this opinion as an absolute, undeniable fact just because it is from a Stanford physician.
- Dr. Nabhan is a thirsty guy. During the cross, he asks for more water, and Mr. Lombardi brings him his personal waterbottle. Nabhan accepts the water and wryly asks, “No glyphosate in there?” Big laughs from the jury and crowd.
- In an effort to paint Nabhan as a big business sell-out, Lombardi points out that Nabhan’s department at current employer Cardinal Health has $11 billion in revenues. Nabhan immediately stabs back, “Significantly less than Monsanto.”
- Very hot drinks cause esophageal and stomach cancer. Those cancers are higher in Eastern cultures because of they tend to consume more VERY hot teas and coffees. IARC confirmed this to be so – so don’t drink insanely hot drinks. I’ll stick to my metal-laden iced teas, but Dr. Nabhan says that Starbucks and Dunkin Donuts hot beverages are safe as well.
Mr. Johnson will testify. I hope that Ms. Edwards does the cross-examination because she seems the kindest of the bunch.
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