Testimony by otolaryngologists in defense of tobacco companies 2009-2014

Our plain-English summary of Testimony by otolaryngologists in defense of tobacco companies 2009-2014, by R.K. Jackler (The Laryngoscope, 2015).

The study

• Author: R.K. Jackler
• Journal: The Laryngoscope
• Published: 2015;125(12):2722-9
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives/hypothesis: To examine expert testimony offered by otolaryngologists in defense of the tobacco industry and to assess whether opinions rendered were congruent with evidence in the scientific literature.

Methods: Data sources include publically available expert witness depositions and trial testimony of board-certified otolaryngologists employed by the tobacco industry in defense of lawsuits brought by smokers suffering from head and neck cancer. The cases, adjudicated in Florida between 2009 and 2014, focused on whether smoking caused the plaintiff's cancer.

Results: The study includes nine legal cases of upper aerodigestive tract cancer involving six otolaryngologists serving as expert witnesses for the tobacco industry. Cancer sites included larynx (5), esophagus (2), mouth (1), and lung (1). Five of the six otolaryngologists consistently, over multiple cases, offered opinions that smoking did not cause the plaintiff's cancer. By highlighting an exhaustive list of potential risk factors, such as human papillomavirus (HPV), alcohol, asbestos, diesel fumes, salted fish, mouthwash, and even urban living, they created doubt in the minds of the jurors as to the role of smoking in the plaintiff's cancer. Evidence shows that this testimony, which was remarkably similar across cases, was part of a defense strategy shaped by tobacco's law firms.

Conclusions: A small group of otolaryngologists regularly serve as experts on behalf of the tobacco industry. Examination of their opinions in relation to the scientific literature reveals a systematic bias in interpreting the data relating to the role played by smoking in head and neck cancer causation.

Level Of Evidence: N/A.

Laryngoscope published by Wiley on behalf of the American Laryngological, Rhinological and Otological Society, Inc, “The Triological Society” and American Laryngological Association (the “Owner”).

In plain English

This article was an analysis of publicly available depositions and trial testimony. It did not study patients or measure asbestos exposure. The author examined nine Florida lawsuits from 2009 to 2014 in which six board-certified otolaryngologists (ear, nose and throat doctors) testified for tobacco companies against smokers with cancer of the larynx (5 cases), esophagus (2), mouth (1) and lung (1). Five of the six consistently testified that smoking did not cause the plaintiff's cancer, and the witnesses listed many other possible causes. Asbestos was one of them. A witness pointed to possible asbestos exposure in a cotton mill in one laryngeal cancer case, and another listed asbestos in an esophageal cancer case where the plaintiff had worked in the building trade. When the author compared the testimony with published research, the author cited a meta-analysis that concluded the weight of the evidence does not support a causal link between asbestos and laryngeal cancer, while noting that some studies suggest an additive effect with smoking. The author concluded that the testimony showed a systematic bias in interpreting smoking's role in head and neck cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Qualitative analysis of expert witness depositions and trial testimony, compared against published medical literature
• Who was studied: Nine Florida lawsuits (2009 to 2014) brought by smokers with upper aerodigestive tract cancer, involving six board-certified otolaryngologists testifying for tobacco companies
• Exposure: Cigarette smoking was the exposure at issue in the lawsuits. Asbestos was one of the alternative causes the witnesses cited, through possible work exposure in building trades, auto shops or cotton mills.
• Main results:
  • Cancer sites in the nine cases were larynx (5), esophagus (2), mouth (1) and lung (1).
  • Five of the six otolaryngologists consistently, over multiple cases, gave opinions that smoking did not cause the plaintiff's cancer.
  • In one laryngeal cancer case (Cooper v R.J. Reynolds, 2014), a witness emphasized marijuana and alcohol use and possible asbestos exposure in a cotton mill as causes.
  • In an esophageal cancer case (Brown v R.J. Reynolds, 2009), a witness listed asbestos among other possible causes; the plaintiff had worked in the building trade.
  • Reviewing the literature cited by the author (not new data from this study): some studies suggest asbestos has an additive effect with smoking, but a meta-analysis concluded the weight of the evidence does not support a causal association with laryngeal cancer.
  • One witness admitted in deposition that the law firm wrote the witness's written legal opinion on risk factors, which the witness then approved.
  • Together, the six otolaryngologists helped defend the tobacco industry in over 50 cases.
• The authors' conclusion: The author concluded that comparing these witnesses' opinions with the scientific literature reveals a systematic bias in how they interpreted the evidence on smoking's role in causing head and neck cancer.

Topics

Medical terms in this study, explained in our Lexicon: Expert Witness, Deposition, Plaintiff, Fluorescence In Situ Hybridization (FISH), Causation.

Related studies

• Were asbestos-filtered Kent cigarettes sold in Australia? — S. Chapman, A. Heidemann, et al. (1996)
• The joint effect of asbestos exposure, tobacco smoking and alcohol drinking on laryngeal cancer risk: evidence from the French population-based case-control study, ICARE — G. Menvielle, A. Fayossé, et al. (2016)
• Epidemiology of head and neck cancer — K.J. Rothman (1978)
• Asbestos burden in two cases of mesothelioma where the work history included manufacturing of cigarette filters — R.F. Dodson, M.G. Williams, et al. (2002)
• Arsenic, tobacco smoke, and occupation: associations of multiple agents with lung and bladder cancer — C. Ferreccio, Y. Yuan, et al. (2013)
• Expert witness testimony: A trial judge's perspective — J.B. Weinstein (1999)

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