Causation and disease: biomedical science in toxic tort litigation
Article Abstract:
The word 'cause' is interpreted differently in medicine and in the courtroom. The legal standard of proof in toxic tort litigation (concerning injury or disease caused by something harmful or toxic) is 'preponderance of evidence' to show a causal relationship between the exposure and the disease. The courts must understand the nature, strengths, and limitations of scientific evidence. The basis on which cases are decided is generally not the scientific validity of the data presented, but the credibility and persuasiveness of the expert witness presenting the data. Basic principles of cause of disease are discussed in the context of legal rules of evidence, and an epidemiologic evidentiary standard for toxic tort litigation is developed. In order for the courts to effectively evaluate scientific data presented in evidence, they should consider using uniform criteria, such as are used in science and medicine and epidemiology, to determine a causal relationship. These criteria include: a strong disease incidence ratio, such as relative risk or odds ratio from case-control studies; the exposure necessarily being prior to the disease; a reasonable biological association between exposure and disease; identification of other exposures that can cause similar effects; evidence that removal of the offending exposure will result in reduction of incidence of the illness; the association with different groups of people under different conditions; statistically significant data; and presence of a biologic gradient such that an increase in exposure results in an increase in disease. A 'preponderance of evidence' can be shown more easily if these criteria are fulfilled.
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1989
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Differential treatment of occupational disease v occupational injury by workers' compensation in Washington State
Article Abstract:
Workers' compensation programs were developed in the early 1900s in an attempt to provide income, health care, and rehabilitation to workers with a work-related injury or disease. More recently, it has become apparent that differences exist in compensation received for occupational diseases compared with occupational injuries. Problems associated with proving that a disease is related to a particular occupation include the length of time between exposure and development of the disease; the fact that many diseases have multiple causes; and difficulties in determining the amount of exposure to the hazardous substance. When an occupational injury or disease claim is filed it is judged for acceptance based on when the claim was filed (a claim must be filed within one year of the incident) and on whether the injury or disease is related to the specific occupation. This article describes the Washington State workers' compensation program for occupational diseases. Injury and disease-related claims filed in 1984 were reviewed and followed until 1988. In 1984 there were 11,356 disease-related and 178,927 injury-related claims filed. The most common claims were for trauma disorders, poisoning, skin conditions, and eye diseases. Many of the injury-related claims were for sprains, strains, cuts, fractures, bruises and burns. The rate of claim rejection was higher for disease-related claims (18 percent) than for injury-related claims (4 percent). It is concluded that efforts need to be made to improve the effectiveness of workers' compensation programs. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1991
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