Opinion ID: 836272
Heading Depth: 2
Heading Rank: 3

Heading: Application of Legal Principles to this Case

Text: Plaintiff argues that the Brown and O'Key standards for admission of scientific evidence should not apply to Grimm's testimony, because his testimony does not involve the application of scientific tests or statistical calculation, such as polygraph machines or DNA testing, where concerns regarding unfair prejudice and usurpation of the jury's role require a showing of scientific reliability of an expert's underlying methodology or process. Plaintiff's concerns might be appropriate in determining to what extent to apply the Brown and O'Key factors. See O'Key, 321 Or. at 305, 899 P.2d 663 (multifactor inquiry is flexible; ultimate concern is scientific validity); Brown, 297 Or. at 417, 687 P.2d 751 (factors provide structure and guidance, but are not a checklist). However, plaintiff's concerns do not place Grimm's testimony entirely beyond the reach of Brown and O'Key. A jury is likely to believe that a doctor's testimony about medicine is a scientific assertion and, therefore, the proponent of the testimony must show that it is scientifically valid. Evidence is scientific when it draws its convincing force from some principle of science, mathematics and the like. Brown, 297 Or. at 407, 687 P.2d 751. Propositions that a court finds possess significantly increased potential to influence the trier of fact as scientific assertions, therefore, should be supported by the appropriate scientific validation. O'Key, 321 Or. at 292, 899 P.2d 663. Expert testimony regarding scientific evidence must bear a valid connection to the pertinent inquiry. The reliability of such expert testimony turns on whether it is scientific knowledge, which is determined by evaluating its scientific validity. Clinical diagnoses bear the marks of science. A medical doctor gathers information from a patient to develop a working diagnosis (a hypothesis), then uses that working diagnosis to gather further information or to specify tests that will confirm or refute the working diagnosis. Reference Guide on Medical Testimony at 463-64. The goal of the clinician is to arrive at a diagnosis that can be used to develop a rational plan for further investigation, observation, or treatment, and ultimately to predict the course of the patient's illness   . To do this, the clinician must verify or validate the diagnostic hypothesis. Id. at 464. See also O'Key, 321 Or. at 292, 899 P.2d 663 (The scientific method is a validation technique, consisting of the formulation of hypotheses, followed by observation or experimentation to test the hypotheses.). This court previously has indicated that scientific evidence is subject to the requirements of Brown and O'Key, even though the science involved is not hard science. The O'Key court held that the state's evidence in that case was scientific, because it involved the premise that alcohol affected the automatic tracking mechanisms of the eyes. 321 Or. at 295, 899 P.2d 663; see also State v. Milbradt, 305 Or. 621, 630-31, 756 P.2d 620 (1988) (psychological syndrome evidence is a form of scientific evidence). The question in this case is whether Grimm was entitled to testify about his opinion that silicone caused plaintiff's neurological conditions. In this inquiry, we focus on Grimm's methodology, not on his conclusions. See O'Key, 321 Or. at 305, 899 P.2d 663 (focus must be solely on principles and methodology, not on the conclusions that they generate). After reviewing the record in this case, we conclude that Grimm's methodology was scientifically valid. Thus, Grimm was entitled to offer his opinion. The process of determining whether a substance causes a disease overlaps numerous areas of study. Epidemiology [9] is informed by clinical medicine: `While epidemiologic information is at times derived from a much wider spectrum of biologic and medical disciplines, these three clinical medicine, pathology and biostatisticshave almost universal application in epidemiology. Indeed, epidemiology may be thought of as the joint application of the three in the search for further understanding of disease etiology.' George W. Conk, Against the Odds: Proving Causation of Disease with Epidemiological Evidence, 3 Shepard's Expert and Sci Evidence Q 103, 120 (Summer 1995) (quoting Brian McMahon and Thomas F. Pugh, Epidemiology, Principles and Methods (1970)) (emphasis added). Case reports based on clinical observations have recognized value in epidemiological research: Case reports lack controls and thus do not provide as much information as controlled epidemiological studies do. However, case reports are often all that is available on a particular subject because they usually do not require substantial, if any, funding to accomplish, and human exposure may be rare and difficult to study. Causal attribution based on case studies must be regarded with caution. However, such studies may be carefully considered in light of other information available, including toxicological data. Reference Guide on Medical Testimony at 475 (emphasis added; footnotes omitted). There plainly is a hierarchy to these different indirect forms of toxic effect evidence. Epidemiology is at the top, and structural similarity, in vitro testing, and case reports are at the bottom. Yet any one of these forms of evidence may have some utility in attempting to ascertain whether a causal connection exists. Michael D. Green, Expert Witnesses and Sufficiency of Evidence in Toxic Substances Litigation: The Legacy of Agent Orange and Bendectin Litigation, 86 Nw. U. L. Rev. 643, 658 (1992). An opinion drawn from only case reports can be troublesome, because it involves post hoc, ergo propter hoc (after this, therefore because of this) reasoning: [S]ome children who live near power lines develop leukemia; but does exposure to electrical and magnetic fields cause this disease? The anecdotal evidence is not compelling because leukemia also occurs among children who have minimal exposure to such fields. It is necessary to compare disease rates among those who are exposed and those who are not. If exposure causes the disease, the rate should be higher among the exposed, lower among the unexposed. David H. Kaye and David A. Freedman, Reference Guide on Statistics, 91, in Reference Manual on Scientific Evidence (footnote omitted). However, case reports sometimes are sufficient in and of themselves to establish causation. Occasionally, when the effect of the agent is powerful enough, scientists will tentatively accept case reports as sufficient to establish a causal relation. Green, 86 Nw. U. L. Rev. at 658. Such was the case with the drug Thalidomide, which caused an enormous increase in birth defects. Id. at 658 n. 68. The Vaccine Safety Committee of the Institute of Medicine, National Academy of Sciences, also confirms that case reports may serve as a basis for finding causation: Although Can It? causality is usually addressed from epidemiologic studies, an affirmative answer can occasionally be obtained from individual case reports. Thus, if one or more cases have clearly been shown to be caused by a vaccine ( i.e., Did It? can be answered strongly in the affirmative), then Can It? is also answered, even in the absence of epidemiologic data. In several circumstances, for example, the committee based its judgment favoring acceptance of a causal relation solely on the basis of one or more convincing case reports. Kathleen R. Stratton, Cynthia J. Howe, and Richard B. Johnston, Jr., eds., Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality, 22 (1994) (last emphasis added). On this record, the testability, or falsifiability, factor is met. [10] Any scientist can check Grimm's testing methods and the clinical history of each of his patients. Moreover, Grimm's results also can be tested (another neurologist could test women with silicone breast implants to see if they had the same neurological conditions identified by Grimm). Grimm's hypothesis is capable of being falsified; that is, evidence may be introduced to disprove his hypothesis. See O'Key, 321 Or. at 303, 899 P.2d 663 (science is based on testing hypotheses to see if they can be falsified). Although Grimm's hypothesis has not been tested by others, that is, in part, because his work is new. OEC 702 does not preclude the admission of novel scientific evidence. If it is otherwise scientifically valid, a novel conclusion is admissible. O'Key, 321 Or. at 302, 899 P.2d 663. The chief difficulty with novelty as a limitation is    that it too strongly suggests a focus upon the subject matter of the testimony as opposed to the real matter of concern, the particular general propositions relied upon by the witness. O'Key, 321 Or. at 293 n. 9, 899 P.2d 663 (quoting John William Strong, Language and Logic in Expert Testimony: Limiting Expert Testimony by Restrictions of Function, Reliability, and Form, 71 Or. L. Rev. 349, 367 (1992)). Grimm testified that he performed a classic neurological examination on each of the women in his study group. Grimm's hypothesis is based on his own experiences and observations, as well as on scientific methodology. It was tested by his evaluation of about 50 patients, most of whom exhibited unique symptoms and conditions similar to those of plaintiff. All had been exposed to silicone from breast implants. Grimm conducted his evaluations by using neurological examination techniques generally accepted by the scientific community and with an error rate of five to seven percent. In each case, Grimm made personal observations and conducted a medical record review. He proceeded in conjunction with other specialists involved in the women's care. Grimm also studied the scientific and medical literature about silicone-related subjects. Grimm eliminated other potential causes of plaintiff's conditions through differential diagnosis, which is a generally accepted form of scientific inquiry. The trial judge expressed concern that Grimm had not use a questionnaire. A medical doctor does not need to use a questionnaire to develop a patient's clinical history. In allowing Grimm to testify at length about his study, the trial judge at least implicitly recognized that fact. Grimm's study and conclusions had not been subjected to peer review and had not been published. However, neither peer review nor publication is a sine qua non for the admissibility of scientific evidence. See O'Key, 321 Or. at 304, 899 P.2d 663 (In some cases valid but innovative theories or propositions will not have been published, either because they are too particular, too new, or of limited interest.). Publication or lack thereof in a peer-reviewed journal is a relevant, though not dispositive, consideration in assessing the scientific validity of a particular technique or methodology on which an opinion is based. Id. The study underlying Grimm's opinion about causation had not been accepted by the scientific community, but that is not to say that the scientific community had rejected that study. A conclusion about causation ultimately is a qualitative decision. See, e.g., Reference Guide on Epidemiology at 375 (While the drawing of causal inferences is informed by scientific expertise, it is not a determination that is made by using scientific methodology.). The rate-of-error factor does not always require the introduction of statistical evidence. See O'Key, 321 Or. at 313, 899 P.2d 663 (concluding under that factor that the HGN test is a fairly reliable indicator of alcohol impairment); cf. Brown, 297 Or. at 433 and 438, 687 P.2d 751 (polygraph evidence was probative despite fact that there could be no judgment of validity or potential rate of error). The trial court expressed concern that Grimm could not explain the mechanism causing patterns and complaints of tingling in [the] fingers and so forth    of his study group. But, as Sir Austin Bradford Hill stated regarding the causation of disease, this is a feature I am convinced we cannot demand. What is biologically plausible depends upon the biological knowledge of the day. Hill, The Environment and Disease: Association or Causation?, 58 Proc. R. Soc. Med. 295, 298 (1965). There are many generally accepted hypotheses in science for which the mechanism of cause and effect is not understood fully. Grimm's inability to explain the mechanism of plaintiff's condition goes to weight, not to admissibility. The trial court also expressed concern that Grimm declined to label the two conditions that plaintiff suffered as a disease. However, Grimm adequately explained his reluctance to label plaintiff's conditions prematurely, and his explanation in no way cast doubt on the existence of the neurological conditions that he found in plaintiff.