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Fong v. Johnson & Johnson

Dr. Richard Attanoos Details Asbestos Exposure Related to Mesothelioma, EnRoute to Defense Verdict in Talc Trial


The Expert: Dr. Richard Attanoos, a pathologist based in Wales, testifies that he believes plaintiff did not develop mesothelioma from talc products.


By Dr. Gary F. Gansar, MD, FACS
Senior Physician Medical Director, AMFS

Dr. Richard Attanoos, who specializes in pulmonary pathology with a special emphasis on occupational lung disease,  is seen here testifying with remarkable effectiveness and authority for the defense in a 2019 California product liability trial against Johnson & Johnson. The plaintiff in the case claims asbestos in talc-based products caused her mesothelioma.

This video begins with the doctor’s discussion of naturally occurring mesotheliomas, those unrelated to environmental conditions and exposures, which are “absolutely recognized in the scientific literature.” These naturally occurring tumors are more prevalent in women because men are more exposed to commercial sources of environmental asbestos in the fields of construction and ship building. Thus, female rates of mesothelioma have persisted at a low, steady level, while male rates have mirrored the usage of asbestos in the construction industries. Women exposed to asbestos to the same degree as men develop mesothelioma at the exact same rate as men do, but since so few are so exposed, their rates of disease development overall reflect a more natural development.

The expert notes mesothelioma has a latency period of 30 to 40 years from the time of exposure. Using visual displays, he demonstrates how the rates of mesothelioma in men have increased substantially from 1975 to the mid 1990’s, when the rates begin to fall. This curve is mirrored by a graph of asbestos consumption, which began increasing after World War II and peaked in 1971, when it began decreasing markedly. This is entirely consistent with the development of tumors related to asbestos exposure. During this same time frame, the rates of mesothelioma development in women were far lower and remained steady, showing no peak or decline with overall asbestos use. This represents natural development of the disease unrelated to asbestos exposure.

Mesotheliomas arising in children or those younger than the 30-to-40-year latency period, are considered to have been naturally occurring, or unrelated to asbestos exposure, since they have not lived as long as the latency period demands. The expert notes that animals develop more cancers with age, as do humans. These diseases are caused by cell mutations that become more difficult to correct or eliminate as the subject becomes older.

The pathologist found “no evidence in [the plaintiff’s] tissue that she had been exposed to above background levels of asbestos.” The plaintiff was in Hong Kong from 1971 to 1984. Epidemics from previous exposure to commercial forms of asbestos have occurred in Hong Kong, so the doctor took this into consideration in formulating his opinion. This is further explored later in the trial, though not in this clip.

The testimony then addresses the finding of anthracosis in a mediastinal lymph node of the plaintiff and what that might imply. Anthracosis is also known as “black lung” and is found in coal miners due to their breathing in of black coal dust. This finding in a non-coal worker is indicative of exposure to substantial urban pollution and is commonly seen in older individuals after an accumulation of pollution products within the lungs over a long lifetime. Seeing this in a 45-year-old woman is unusual and indicates exposure to a significant amount of urban pollution which was taken into her lungs. The implication is that the plaintiff had been chronically exposed to other substantial lung toxins.

The testimony was authoritative, simply explained, and convincing. The jury ruled for the defense.

About the Author Dr. Gary F. Gansar, MD, FACS

Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.

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