Opinion ID: 1153595
Heading Depth: 1
Heading Rank: 9

Heading: the testimony fails to satisfy frye

Text: Having determined that testimony causally connecting trauma to fibromyalgia is subject to the Frye test, the next question I address is whether the evidence in this case satisfied the test. I conclude that the answer is no. Frye requires the proponent to show general acceptance by a clear majority of the members of the relevant scientific community. See, e.g., Brim, 695 So.2d at 272; Hodden, 690 So.2d at 576 n. 2. The majority here concludes that testimony causally linking trauma to fibromyalgia is admissible because some experts recognize an association between the two. Majority op. at 550. I cannot agree that such evidence satisfies Frye. As explained below, a review of the materials presented to the trial court, district court, and this Court, as well as opinions from other jurisdictions, demonstrate an ongoing debate on the issue of whether trauma can cause fibromyalgia. See, e.g., Ramirez, 810 So.2d at 844 (recognizing that a court may consider expert testimony, scientific and legal publications, and judicial opinions in determining whether a theory has been `sufficiently tested and accepted by the relevant scientific community' ) (quoting Brim, 695 So.2d at 272). No clear majority has emerged  either way. Therefore, Marsh, as the proponent of the evidence, has failed to meet her burden. The record in this case contains a large amount of material. However, the parties focused on six documents  three consensus reports  Frederick Wolfe et al., The Fibromyalgia Syndrome: A Consensus Report on Fibromyalgia and Disability, 23 J. Rheumatology 534 (1996) [hereinafter Consensus Report ]; Muhammad B. Yunus et al., Fibromyalgia Consensus Report: Additional Comments, 3 J. Clinical Rheumatology 324 (1997) [hereinafter Additional Comments ]; and Anil Kumar Jain et al., Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols  A Consensus Document, 11 J. Musculoskeletal Pain 3 (2003) [hereinafter 2003 Consensus Document ]  and three studies (Dan Buskila et al, Increased Rates of Fibromyalgia Following Cervical Spine Injury, 40 Arthritis & Rheumatism 446 (1997) [hereinafter Buskila study]; A.W. Al-Allaf et al., A Case-Control Study Examining the Role of Physical Trauma in the Onset of Fibromyalgia Syndrome, 41 Rheumatology 450 (2002) [hereinafter Al-Allaf study]; and Moshe Tishler et al., Neck Injury and Fibromyalgia  Are They Really Associated?, 33 J. Rheumatology 1183 (2006) [hereinafter Tishler study]). I address these documents below, along with others. The Consensus Report, supra, at 534, resulted from a 1994 conference of fibromyalgia experts. It specifically addresses the connection between trauma and fibromyalgia: Evidence that trauma can cause FM, a potential (or It Can) causal proposition, comes from a few case series or case reports and is insufficient to establish causal relationships. That trauma might cause FM sometimes, a predictive (or It Will) causal proposition, can only be addressed by epidemiological studies that measure the risk of potential exposures on the development of FM. Epidemiologic studies of trauma and FM needed to address potential or predictive causality are currently not available. . . . Overall, then, data from the literature are insufficient to indicate whether causal relationships exist between trauma and FM. The absence of evidence, however, does not mean that causality does not exist, rather that appropriate studies have not been performed. Id. at 534-35 (footnotes omitted) (emphasis added). In response to the Consensus Report, another group published the Additional Comments, supra. The authors recognized that [o]ur scientific understanding of FMS is still very limited. Id. at 324. However, with regard to causality, they disagreed with the Consensus Report, stating, [I]t seems more than 51% likely that trauma does play a causative role in some FMS patients. Id. at 325. [7] Later, another group published the 2003 Consensus Document, supra, which was primarily a summary of previous research. The 2003 Consensus Document recognizes that no known cause of fibromyalgia exists, but reviews numerous studies to conclude that [t]here is strong consistency in documentation that physical trauma such as a fall or motor vehicle accident, particularly a whiplash or spinal injury, can trigger FMS in some patients. Id. at 44. The authors recognize, however, that further research on [t]he etiology of FMS including genetic components and prodomal events such as physical trauma is needed. Id. at 61. Although not a consensus report, another recent document surveys physician opinions about the association between trauma and fibromyalgia. See Kevin P. White et al, Perspectives on Posttraumatic Fibromyalgia: A Random Survey of Canadian General Practitioners, Orthopedists, Physiatrists, and Rheumatologists, 27 J. Rheumatology 790, 794 (2000) [hereinafter White survey]. The authors randomly surveyed Canadian physicians to determine which factors were deemed most important in an individual with widespread pain following a motor vehicle trauma. Id. at 791. They found that the physicians surveyed were reluctant to ascribe primary responsibility for chronic widespread pain to the trauma itself. Id. at 794. If these documents demonstrate anything, it is the lack of consensus on the issue, and therefore the lack of general acceptance of the theory that trauma can cause fibromyalgia. The very fact that competing consensus reports exist, with experts on each side, demonstrates the lack of general acceptance by a clear majority of members of the community. As the majority notes, see majority op. at 550, some articles do suggest an association between trauma and fibromyalgia. But most of them are case reports and anecdotal accounts. [8] I recognize that to satisfy Frye epidemiological studies confirming a causal theory are not always required, see, e.g., Castillo, 854 So.2d at 1270; U.S. Sugar, 823 So.2d at 110, but if a majority of experts agrees about anything, it is that (1) the cause of fibromyalgia is unknown, [9] and (2) to determine the relationship between fibromyalgia and trauma, more studies are needed. [10] The parties primarily rely on three such studies: (1) the Buskila study; (2) the Al-Allaf study; and (3) the Tishler study. All three of these studies conclude that more research is needed to determine whether trauma causes fibromyalgia. The authors of the Buskila study, supra at 446, which was published in 1997, studied the relationship between cervical spine injury and the development of fibromyalgia. They recognized that to date the evidence that trauma can cause fibromyalgia had been equivocal and from a few case series or case reports . . . insufficient to establish causal relationships. Id. (footnotes omitted). They studied two groups of Israeli patients who visited an occupational clinic: (1) those with neck injuries (102 patients); and (2) those with leg fractures (fifty-nine patients). Id. at 447. The researchers found that twenty-two of the patients with neck injuries, and only one of the patients with a leg fracture, developed fibromyalgia. Id. at 449. The article concludes that [t]he present data in the literature are insufficient to indicate whether causal relationships exist between trauma and FMS. Our study, however, suggests that soft tissue trauma to the neck can result in an increased incidence of FMS compared with other injuries. Id. at 451. Despite this conclusion, a later article by two of the same authors states: Traumatic incidents have been suggested as a possible etiologic factor relating to the onset of FM. However, evidence that musculoskeletal injury or trauma can cause FM comes from a few case series or anecdotal case reports. Reviewing the current literature reveals that data are insufficient to indicate whether causal relationships exist between trauma and FM. Buskila & Neumann, supra, at 107 (emphasis added). Another study examining whether physical trauma precipitates the onset of fibromyalgia is the Al-Allaf study, supra, at 451, a retrospective study based on patient recall. The researchers found that 39% of the fibromyalgia patients reported a history of trauma, compared with 24% of the control subjects, suggesting that physical trauma was significantly associated with the onset of FMS. Id. at 452. However, they cautioned: Our own results are, of course, retrospective and may be influenced by recall bias, but if they are confirmed in a prospective study this would lead us to speculate on the mechanisms by which trauma might preciptitate FMS. . . . . In conclusion, our study suggests that physical trauma in the 6 months before the onset of symptoms is significantly associated with the onset of FMS in patients attending a rheumatology outpatient clinic. Further prospective studies are needed to confirm this association and to determine whether trauma has a causal role or if there are more important factors in the development of FMS. Id. at 453 (emphasis added). Thus, both the Buskila study and Al-Allaf study suggest an association between trauma and fibromyalgia. However, they also indicate that before a causal connection can be found, more research is needed. It has been noted that a call for further research does not necessarily indicate uncertainty, and that the purpose of a study is not to fix a cause but to assess the existence and strength or absence of an association between an agent and a disease. Berry v. CSX Transp., Inc., 709 So.2d 552, 567, 568 n. 12 (Fla. 1st DCA 1998). In this case, however, despite finding an association between trauma and fibromyalgia, the authors specifically recognized that insufficient data existed to find a causal relationship. The majority nevertheless deems the studies finding a mere association between trauma and fibromyalgia sufficient to satisfy Frye. Majority op. at 550. Yet a recent study, the Tishler study, supra, at 1183  a prospective study published in 2006  suggests the absence of even that. The Tishler study involved 153 car accident patients who had been discharged from the emergency room with a whiplash injury, and a control group of forty-eight car accident patients hospitalized because of severe trauma. Id. The researchers found: The issue of trauma and FM remains controversial. . . . Several studies in the past, most of them retrospective, have reported that up to 50% of patients with FM can recall an event, most often physical trauma, that immediately preceded their symptoms. An extensive review of the literature failed to yield solid conclusions concerning this issue. The only prospective study that found a causative link between trauma and FM is by Buskila, et al. In this study, which was not followed by others, the authors found that 21.6% of patients with neck injury developed FM shortly after a work accident. These data are impressive since in their control group of patients with leg fractures, the rate of FM was much lower. . . . We could not confirm these earlier findings; after a mean followup of 14.5 months, only one out of 153 patients with whiplash injury developed FM. . . . . In conclusion, the results of our prospective study do not support earlier observations about a link between neck trauma and FM. Id. at 1184-85 (footnotes omitted) (emphasis added); see also, Shir et al., supra, at 1046 (We now have a single, but large and well designed prospective study with a surprising conclusion. . . . Tishler's conclusion should be upheld.). Let me be clear: I do not argue that these studies demonstrate that trauma does not cause fibromyalgia. My point is that no clear majority exists either way. Instead, the scientific community is in the middle of an ongoing and intense debate. See, e.g., Shir et al., supra, at 1045 (Opinions regarding an association between trauma such as whiplash injury (WLI) and subsequent FM are emotionally charged and highly polarized.); McLean et al., supra, at 97 (The ability of physical trauma . . . to trigger the development of FM remains the subject of intense debate.); White survey, supra, at 790 (There may be no issue more contentious in FM than the causative role of trauma.); Winfield, supra, at 62-63 (recognizing that [t]rauma as a `trigger' or cause of fibromyalgia is an important and contentious issue in modern American society and that [d]ebate, which actually has raged for much of this century, continues) (footnotes omitted). The very existence of this debate precludes Marsh from satisfying the requirement that this novel scientific principle be generally accepted. See, e.g., Castillo, 854 So.2d at 1268 (The proponent of the evidence bears the burden of establishing by a preponderance of the evidence the general acceptance of the underlying scientific principles and methodology.). My conclusion is consistent with cases from other jurisdictions considering this precise issue under both Frye and Daubert (or a Daubert -type analysis). See, e.g., Vargas v. Lee, 317 F.3d 498, 502-03 (5th Cir.2003) (applying Daubert and excluding testimony that a car accident caused fibromyalgia); Food Lion, 171 F.3d at 314 (applying Daubert and finding testimony linking a slip-and-fall to fibromyalgia inadmissible); Maras, 393 F.Supp.2d at 808-10 (finding testimony that motor vehicle accident caused fibromyalgia failed to meet the general acceptance factor, among other factors, of Daubert); Hultberg v. Wal-Mart Stores, Inc., No. CIV. A. 97-2858, 1999 WL 244030, at  (E.D.La. Apr.22, 1999) (applying Daubert and excluding testimony that a slip-and-fall accident caused fibromyalgia); Schofield. v. Laboscam, Inc., No. CIV. A. CV-00-197, 2002 WL 1335867, at  (Me.Super.Ct. June 6, 2002) (granting motion in limine to exclude testimony that a vehicle accident caused fibromyalgia); Jones v. Conrad, No. CA2000-12-257, 2001 WL 1001083, at -4 (Ohio Ct.App. Sept. 4, 2001) (finding testimony linking work accident to fibromyalgia inadmissible and the theory that trauma can cause fibromyalgia not generally accepted); Grant v. Boccia, 133 Wash. App. 176, 137 P.3d 20, 24 (2006) (citing with approval the district court's decision in Marsh and holding inadmissible under Frye testimony linking a car accident to fibromyalgia where [n]one of the authorities presented by either party has the effect of persuasively establishing acceptance in the relevant community as to the cause of fibromyalgia or the causal role of trauma in the development of fibromyalgia), review denied, 159 Wash.2d 1014, 154 P.3d 919 (2007); cf. Washburn v. Merck & Co., 213 F.3d 627, 2000 WL 528649, at  (2d Cir. May 1, 2000) (No. 99-9121) (affirming exclusion of testimony that vaccination caused fibromyalgia and other conditions under Daubert because it was based on little more than temporal correlation between the vaccination and onset of symptoms); Allison v. McGhan Med. Corp., 184 F.3d 1300, 1321-22 (11th Cir.1999) (affirming exclusion of testimony that breast implants caused fibromyalgia); Wynacht v. Beckman Instruments, Inc., 113 F.Supp.2d 1205, 1209 (E.D.Tenn.2000) (finding testimony linking a chemical spill to fibromyalgia and other conditions inadmissible under Daubert); Gross v. King David Bistro, Inc., 83 F.Supp.2d 597, 602 (D.Md.2000) (granting motion in limine to preclude testimony under Daubert that shigella infection caused fibromyalgia); Bushore v. Dow Coming-Wright Corp., No. 92-344-CIV-T-26C, 1999 WL 1116920, at  (M.D.Fla. Nov.15, 1999) (applying Daubert and excluding testimony that breast implants caused fibromyalgia); Minner v. Am. Mortgage & Guar. Co., 791 A.2d 826, 855 (Del.Super.Ct.2000) (excluding evidence that a sick building caused fibromyalgia because there appears to be a consensus that there is no known cause of FM). I recognize that a few courts applying Daubert have admitted testimony causally linking trauma to fibromyalgia. See, e.g., Epp v. Lauby, 271 Neb. 640, 715 N.W.2d 501, 509-11 (2006) (recognizing a professional controversy regarding the causal relationship between physical trauma and fibromyalgia and that there is not a sufficient scientific consensus to say that the theory is generally accepted, but noting that general acceptance is not determinative under Daubert and finding admissible testimony causally linking plaintiffs car accident to fibromyalgia); Reichert v. Phipps, 84 P.3d 353, 364-65 (Wyo.2004) (finding causation testimony admissible because differential diagnosis is an acceptable method of diagnosing fibromyalgia and because the proffered expert opinions were given in the overall context of a professional controversy over the link between physical trauma and FM, in which some experts take the position that there is, indeed, a causal connection); cf. Alder v. Bayer Corp., 61 P.3d 1068, 1085 (Utah 2002) (holding admissible testimony linking chemical fumes to fibromyalgia where it was based on differential diagnosis). These are in the minority, however, and they apply a different test. Other than the Second District's recent decision in Johnson, 880 So.2d at 721, however, I have found only one case applying a Frye -type test to testimony linking trauma to fibromyalgia that has found the testimony admissible. See Byrum v. Superior Court of Los Angeles County, No. B153001, 2002 WL 243565, at  (Cal.Ct.App. Feb.20, 2002). Even that case seems to conflict with another case within the same appellate district. See Pflum v. Sears, Roebuck & Co., No. B161862, 2004 WL 348783, at  (Cal.Ct.App. Feb.25, 2004) (concluding the issue was not preserved, but addressing the merits and finding a lack of a reasonable degree of medical certainty that trauma can exacerbate fibromyalgia).