Opinion ID: 4198308
Heading Depth: 3
Heading Rank: 1

Heading: The Problems of Radiation Toxicity

Text: The Majority thoroughly and correctly explains causation as it applies to “toxic torts” under Pennsylvania law. However, the legal principle of causation has evolved from suits arising from exposure to manmade toxic substances such as asbestos. As the Majority notes, mesothelioma is caused by exposure to asbestos, and it is therefore a “signature” disease. The disease almost never occurs absent exposure to asbestos.11 The problems of proof in such cases are quite similar to problems of causation in cases involving polychlorinated biphenyls (PCBs)12 or 10 See George L. Voelz, Plutonium and Health: How Great is the Risk?, Los Alamos Sci. 83 (2000), https://fas.org/sgp/othergov/doe/lanl/pubs/00818013.pdf; Katherine Harmon, Health Risk Fears Escalate as Japan Nuclear Plant’s Radioactive Release Remains Uncertain, Sci. Am. (Mar. 18, 2011), https://www.scientificamerican.com/article/health-riskfukushima/ (“Plutonium is of graver concern because of its exceptionally long half-life (about 24,000 years) and its propensity to cause lung cancer if inhaled.”). 11 Maj. Op. at 50-51. 12 See In re Paoli R.R. Yard PCB Litig., 35 F.3d 717 (3d Cir. 1994). 4 4 pneumoconiosis (black lung disease),13 to name but a few of the pathological byproducts of modernization. In such cases, a pathology is caused by contact (usually ingestion) with a foreign substance that the injured person would not have otherwise been exposed to, or would have been exposed to only in relatively insignificant quantities, and that pathology almost never occurs in the absence of exposure to that toxic substance. Accordingly, causation can be established by showing that defendant made (or controlled) a substance, plaintiff has a disease that almost never occurs absent contact with defendant’s substance, and plaintiff had sufficient contact with defendant’s product (i.e. “frequency, regularity, and proximity of exposure”) to allow a fact finder to conclude that the defendant’s product was a substantial factor in the plaintiff’s death or injury.14 Radiation is different. In TMI II, we discussed the “scientific principles regarding the relationship between radiation and cancer.” 15 As the Majority explains, “[m]anmade ionizing radiation can damage human cells.”16 An ion is nothing more than an electron that has been displaced from its orbit.17 Unlike with 13 See Mancia v. Dir., Office of Workers’ Comp. Programs, U.S. Dep’t of Labor, 130 F.3d 579 (3d Cir. 1997). 14 See Rost v. Ford Motor Co., 151 A.3d 1032 (Pa. 2016). 15 Maj. Op. at 13-15; see TMI II, 193 F.3d 613. 16 Maj. Op. at 13 (citing TMI II, 193 F.3d at 639-40). Although we used the term “manmade” in TMI II, it is actually a misnomer that obscures some of the very important distinctions between environmental radiation naturally occurring and radiation from substances that are, in fact, manmade. The latter radiation is not actually “manmade.” It consists of natural elementary particles that are transformed by human activity. The resulting radiation is nevertheless the result of quantum mechanical processes. However, for the sake of convenience, we will also refer to this radiation as “manmade” as we did in TMI II. 17 TMI II, 193 F.3d at 639 (“[A]n atom is ionized when an electron is ejected from its orbit and expelled from the atom.”). It is actually a sweeping generalization to refer to all ionizing radiation as resulting from a single displaced electron. A very detailed description of the process of 5 PCBs, asbestos or tobacco byproducts, we are constantly exposed to radiation on a daily basis. We are exposed from numerous natural sources including the sun,18 or naturally occurring radioactive elements such as radon in the ground surrounding our homes.19 It is now beyond dispute that radiation can cause various types of cancer. However, unlike with asbestos and diseases, such as mesothelioma, radiation wreaks havoc with our bodies, not because it is a foreign substance (it is not), but because it transfers extra energy to our cells. This energy can, in turn, damage our DNA in numerous ways that are described in detail in TMI II.20 Asbestos fibers cause mesothelioma by damaging the “mesothelial cells that control cell reproduction. Some damaged cells die and tumor suppressor genes stop others ionization (including the all important Columb Force) can be found at TMI II, 193 F.3d at 632-38. However, the complex distinctions are not important for purposes of this discussion. Therefore, rather than attempt more precision by distinguishing between the different types of ionizing particles and ionizing energy as we did in TMI II, we will refer to all ions as if they only consisted of electrons without attempting to distinguish between alpha, beta or gamma radiation or between orbital electrons and electrons created through nuclear reactions. The important thing for purposes of this discussion is that “[w]hen a charged particle passes through matter, it excites and ionizes atoms in its path.” Id. at 635. This is what happens to human tissue that is exposed to radiation. 18 Id. at 644-47. 19 See Natural background radiation, Am. Cancer Soc’y, https://www.cancer.org/cancer/cancer-causes/radiationexposure/x-rays-gamma-rays/natural-backgroundradiation.html (last revised Feb. 24, 2015) (explaining that radon is but one source of the background radiation that we are potentially exposed to on a daily basis and is listed only for purposes of illustration). 20 See TMI II, 193 F.3d at 640. 6 6 from reproducing.”21 However, “[w]here suppressor genes do not stop the reproduction process, . . . the damaged cells divide, replicating the damage in the sister cells.”22 Over decades of continued growth of these cells, tumors develop. “This explains why mesothelioma has an extremely long latency period, as mesothelial cells have a very slow growth rate.”23 As expert testimony in a recent case from the Supreme Court of Pennsylvania established, “it is not scientifically possible to identify the particular exposure or exposures that caused a patient’s mesothelioma[.] . . . [I]nstead, the causative agent is ‘the series of exposures.’”24 However, even though it is not possible to identify a particular exposure as causing a given occurrence of the disease, there is now no dispute that asbestos is responsible for mesothelioma. Although the disease process described above for mesothelioma is quite similar to that which is triggered by radiation after the cell is irradiated, there is a key difference that is very relevant to our discussion. As noted above, we do not normally develop diseases such as mesothelioma in the absence of exposure to the manmade carcinogens that can cause it. Thus, if a plaintiff can produce evidence of sufficient frequency, regularity, and proximity of exposure to asbestos to establish that it is more likely than not that that exposure was a substantial cause of subsequent disease, the plaintiff then need only prove that defendant manufactured or controlled the substance that plaintiff had been exposed to in order to recover. The same is true with any other “signature” disease. Unlike products such as asbestos and PCBs, radiation is not a foreign substance. All of us are exposed to it every second of every day both inside of buildings and outdoors. Yet, radiation can “damage structures within the human body as cells are disrupted or killed by the ionizing radiation [energy] itself, and as energy is transferred to cells triggering 21 Rost, 151 A.3d at 1039 (citations omitted). 22 Id. 23 Id. 24 Id. 7 second-order chemical changes.”25 “Unlike a chemical product, which may be traceable to a particular manufacturer, different sources of radiation are not distinguishable, nor is there any noticeable difference between cancers caused by nuclear-power production and those caused by other sources of radiation.”26 [M]edical evaluation, by itself, can neither prove nor disprove that a specific malignancy was caused by a specific radiation exposure [or series of exposures]. Therefore, the primary basis to link specific cancers with specific radiation exposures is data that has been collected regarding the increased frequency of malignancies following exposure to ionizing radiation. In other words, causation can only be established (if at all) from epidemiological studies of populations exposed to ionizing radiation.27 However, epidemiological studies of exposed populations can only establish the percentage by which the incidence of given cancers in that population exceeds the rate for those same cancers in similar populations not exposed to the source of radiation. No study can determine whether the cancer of a given member of that population was the result of exposure to a defendant’s product or to radiation released from a defendant’s facility. As we explained in TMI II, “the task of establishing causation is greatly complicated by the reality that a given percentage of a defined population will contract cancer even absent any exposure to ionizing 25 William D. O’Connell, Causation’s Nuclear Future: Applying Proportional Liability to the Price-Anderson Act, 64 Duke L.J. 333, 348 (2014) [hereinafter O’Connell] (citing James E. Turner, Atoms, Radiation, and Radiation Protection 421 (3d ed. 2007) [hereinafter Turner], available at http://nuclear.dababneh.com/Radiation-Undergrad- 2/Atoms,%20Radiation,%20and%20Radiation%20Protection. pdf. 26 Id. at 350 (citing Turner at 468). 27 TMI II, 193 F.3d at 643 (citations omitted). 8 8 radiation.”28 This probability conundrum is even more of an issue when we try to compare members of a population who have only been exposed to natural radiation with members of the same population who have been exposed to that radiation plus radiation emanating from a defendant’s product or facility. Plaintiffs who must prove that exposure to a particular source of radiation was a substantial cause of their injuries therefore face an insurmountable task that the law has yet to satisfactorily address. The task is further complicated by the fact that radiation includes different kinds of particles (i.e. alpha, gamma, beta), each with different properties including different levels of energy and thus having a different capability of damaging human cells.29 As the NRC has explained: [N]atural radiation . . . is always present in the environment. It includes cosmic radiation which comes from the sun and stars, terrestrial radiation which comes from the Earth, and internal radiation which exists in all living things. The typical average individual exposure in the United States from natural background sources is about 300 millirems per year.30 Yet, although there is general scientific agreement that radiation can cause cancer, we are still at the rudimentary stages of understanding the etiology of cancers. 31 As if this does not make plaintiffs’ task in such cases difficult enough, two additional considerations further complicate inquiries into causation. First, as has already been mentioned, not all radiation has the same energy level. Some radiation can be filtered out by barriers no more substantial 28 Id. at 643-44. For a detailed explanation of the two major sources of natural radiation and average doses, see id. at 64448. 29 For a detailed discussion of this, see id. 30 U.S. Nuclear Regulatory Comm’n, Background radiation, https://www.nrc.gov/reading-rm/basic- ref/glossary/background-radiation.html. 31 See TMI II, 193 F.3d at 644-48. 9 than sunscreen, or surface tissue, yet some radiation is capable of penetrating lead.32 Thus, mere proximity to a source of radiation does not necessarily establish a sufficient “absorbed dose” to link an individual’s illness to that proximity.33 This point is illustrated in the extreme by the fact that “[c]rews of nuclear submarines have possibly the lowest radiation exposure of anyone, despite living within a few meters of a nuclear reactor, since they are exposed to less natural background radiation than the rest of us [(the ocean shelters them)], and the reactor compartment is well shielded.”34 Second, the difficulty of linking a potentially radiation-related pathology to a defendant instead of to background radiation is made exponentially more difficult by the fact that some people have a genetic predisposition to diseases associated with radiation exposure, while others have a genetic composition that seems to protect them from the otherwise harmful effects of radiation. Indeed, more than one physician has counseled that the best way to guard against contracting cancer is to “choose your parents carefully.”35 Genetic research has even led researchers to conclude that: [P]erhaps a fortunate genetic endowment protects some lifelong smokers from lung cancer, while a genetic mischance induces lung cancer in some non-smokers. Both environmental and genetic differences between individuals appear responsible for at least some 32 See id. at 637 n.36. 33 Id. at 637 (“The absorbed energy per unit mass of material is termed the ‘absorbed dose.’”). 34 World Nuclear Ass’n, Nuclear Radiation and Health Effects, http://www.world-nuclear.org/informationlibrary/safety-and-security/radiation-and-health/nuclearradiation-and-health-effects.aspx. 35 See, e.g., Huber R. Warner, If You Wish to Live a Long Time in Good Health, Choose Your Parents Carefully, 62A J. of Gerontology: Biological Scis. 575 (2007), available at https://www.ncbi.nlm.nih.gov/pubmed/17595411; see also Steve C. Gold, When Certainty Dissolves into Probability: A Legal Vision of Toxic Causation for the Post-Genomic Era, 70 Wash. & Lee L. Rev. 237, 259 (2013) [hereinafter Gold]. 10 10 of the variation in individuals’ responses to toxic exposures. For the most part, it has been impossible (or at least impractical) to identify, quantify, and tease apart these possibilities using the investigatory tools of toxicology, environmental epidemiology, conventional biochemistry, and classical genetics.36 Yet, Plaintiffs such as those here, must produce evidence that will establish that their injuries are more likely than not caused by effluents from Defendants’ uranium plant. I simply do not see any way they can do that given the current state of the law.