[csda] Singer Recognizing Neurotoxicity mar, 2006 (fwd)

[Guest guest]

" Disease is the retribution of outraged nature. "

Hosea Ballou

" Some remedies are worse than the disease. "

Pubilius Syrus

" Toliet water was MEANT to be FLUSHED, not WORN! "

Angel

" If having endured much, we at last asserted our 'right to know' and if,

knowing, we have concluded that we are being asked to take senseless and

frightening risks, then we should no longer accept the counsel of those

who tell us that we must fill our world with poisonous chemicals, we

should look around and see what other course is open to us. "

Carson

" My toxicasa (world) is your toxicasa (world). "

Judith Goode

---------- Forwarded message ----------

Date: Wed, 12 Apr 2006 08:43:27 -0000

From: Silvia K. Mueller <silvia.mueller@...>

csda

Subject: [csda] Singer Recognizing Neurotoxicity mar, 2006

Recognizing Neurotoxicity

The symptoms of brain injury from exposure to hazards like lead paint

and toxic chemicals vary widely. But there are ways you and your

experts can pinpoint the damage and its cause.

Singer and Dana Darby

http://www.neurotox.com/Recognizing_Neurotoxicity.doc

Neurotoxicity—poisoning of the brain and nervous system— is a well-

documented effect of exposure to many widely used chemicals, yet

doctors (and lawyers) often fail to recognize it. Chemically injured

clients often report a confusing array of symptoms, with no medical

diagnosis. The symptoms may seem vague and unconnected, leading you

to wonder, " Could these symptoms really be caused by a chemical

exposure? " Once you recognize the signs and understand them in

context—as a constellation of symptoms resulting from a toxic injury—

you will have greater confidence in bringing your client's case to

justice.

A person who has suffered a serious chemical injury is likely to have

sustained considerable damage to his or her brain and nervous system.

This is important for a lawyer to know, because doctors often

recognize only the person's physical illness, not realizing that

serious brain and nervous system damage may have also occurred.

Neurotoxicity can be documented, but perhaps not in the way you might

think. A person's ability to think, perceive, control emotions, plan,

and manage his or her life can diminish drastically without anything

being visible to a radiologist or neurologist on an MRI or a CT

scan.1

The most reliable and widely accepted way to assess actual brain

function is through neuropsychological evaluation. (This is true for

head-injury patients and those suffering from dementia, as well as

those affected by exposure to toxic chemicals.)

Researchers have noted that imaging techniques are often of little

value in evaluating neurotoxicity.2 In our and others' experience,

imaging techniques can occasionally pick up abnormalities caused by

neurotoxicity and may be helpful for forensic purposes, but they are

not cost-beneficial for routine screening.3

Neuropsychological testing tends to be more sensitive to brain injury

than CT and routine MRI scans, which provide only a static and

relatively gross view of neural structure. In one study of six head-

injury cases, CT and/or MRI scans yielded little or no evidence of

neuropathology as detected by neuropsychological testing. Positron

emission tomography (PET) scans, however, corroborated the impaired

function.4 PET and SPECT (single photon emission computed tomography)

scans offer a more dynamic look at brain structure, but both of these

tests still need interpretation as to the cause of the abnormality

(which could be benign).

Common symptoms

What do chronic pain, anxiety, neurological problems, confusion,

psychiatric symptoms, and cognitive declines have in common? They can

all result from neurotoxic chemical exposure.

Symptoms of neurotoxicity include memory and concentration problems;

confusion; multiple sclerosis or MS-type symptoms; impaired control

of the limbs, bladder, or bowels; headaches or migraines; sleep

disorders, including sleep apnea; eye problems that are neurological

in origin; balance and hearing problems; muscle weakness; anxiety or

panic attacks; depression; and other psychiatric or neurological

symptoms.5

Other symptoms that could be caused by chemical injury include multi-

organ system malfunction; lower or upper respiratory problems, such

as chronic sinus problems; multiple chemical sensitivity (MCS); liver

or kidney problems; and fibromyalgia or other pain disorders.

Along with nervous system dysfunction, the temporal association of

any of these conditions with toxic chemical exposure tends to support

the theory that the overall cause of the client's injuries is a toxic

insult to the body.

1From: Singer & Dana Darby , Recognizing

Neurotoxicity, TRIAL, Mar. 2006, at 62. Reprinted [or posted] with

permission of TRIAL (March 2006). Copyright: The Association of Trial

Lawyers of America. Revised: February 28, 2006.

The illness you probably need to know the most about is MCS, both

because it is common among chemical injury patients, and because

doctors often don't recognize it in their patients. The MCS diagnosis

is still rejected by many doctors in part because it is difficult to

quantify objectively—but then, so are headaches.

-------------

Many doctors are not aware of the significant research that shows MCS

is common and quite real.6 MCS is similar to other disabling

illnesses. People who have it can become very ill from exposures to

everyday chemicals, such as perfumes, paint, pesticides, and cleaning

products.

Under some conditions, MCS is recognized as a potentially disabling

condition by the Social Security Administration, the U.S. Department

of Housing and Urban Development, and the Americans with Disabilities

Act.7

Documenting a chemical injury

There are various ways you can document the presence and course of a

neurotoxic injury. All of them will help you build your case.

Conduct a neuropsychological evaluation. This procedure reveals both

the most detailed view and the most subtle problems of the working

brain.

A forensic neuropsychological evaluation usually includes a full

battery of tests that can take up to 12 hours to complete. It can

assess brain function, including memory; concentration; the ability

to learn new information; executive function (the ability to plan,

manage, and carry out a plan); perceptual functions, such as spatial

awareness; motor functions, such as dexterity; and personality,

emotion, and motivation. This evaluation can often detect whether

changes have occurred that may be a result of toxic injury.

Be aware that some neuropsychologists consider someone impaired only

if his or her cognitive functioning is well below average. Such an

approach is inadequate when the person was once high-functioning.

For example, a client with a superior IQ—such as a doctor or

scientist—who now is unable to do his or her job will not benefit

from an evaluation that interprets an " average " level of intelligence

as " normal. " Or your client may be someone who previously functioned

at an average level but now is considered below average or has more

marked problems in particular areas of brain function, such as

emotion, personality, or executive function. These individuals

benefit from more complex and subtle evaluations.

Several red flags can signal that the brain is not working as well as

it should. For example, if a client's vocabulary skills are high but

his or her ability to process new information is at the 50th

percentile, this discrepancy suggests a decline in information-

processing skills. If the client was previously a successful

engineer, a neuropsychological evaluation will give you findings that

point to a decline in brain function.

Assess personality and emotional function. Chemically injured people

can suffer personality changes induced by brain damage. The

neuropsychologist needs to take a thorough history and conduct a

record review to determine whether any personality disorders were

preexisting or caused (or exacerbated) by the chemical injury.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is often

used to assess personality.8 But this instrument was not standardized

on brain-injured people or those with neurological disorders, so the

results must be interpreted carefully.

For example, if a " normal " person showed many neurological symptoms,

he or she might correctly be characterized as mentally ill. But it

would be normal for a chemically injured person to report an array of

neurological symptoms.

The patient with " too many " symptoms can get a diagnosis of " somatic

disorder " —that is, having physical symptoms caused by psychological

conditions. This misdiagnosis says that psychological problems are

the underlying cause of the illness.

Neurotoxicity patients may well have psychological problems, but

these are often the result, not the cause, of their condition. The

true cause—organic (physical) brain dysfunction, or neurotoxicity—is

too easily overlooked. When interpreting the MMPI-2, the expert must

consider the person's medical and neurological conditions before

reaching conclusions.

Also, some common interpretations of the MMPI-2 might over-diagnose

malingering.9 An improper diagnosis of malingering can make it

difficult to prove an injury.

It is not unusual for patients suffering from neurotoxicity to be

misdiagnosed as having psychological problems because of their

depression and anxiety levels, the sheer number of their symptoms,

and their belief that chemicals made them ill. To minimize this

error, choose among the most qualified experts you can find:

Psychologists, neuropsychologists, or psychiatrists who are familiar

with chemical injury, neurotoxicity, and MCS.

" Image " the brain. It would be ideal to have an X-ray that would show

what's gone wrong in the chemically injured brain. Unfortunately,

brain scans are usually not helpful, because we don't have the

technology to " take a picture " of most brain injuries. (Even damage

caused by traumatic brain injuries, such as from an automobile

accident, may not show up in brain imaging.) A weak correlation

exists between neuroimaging findings and neurocognitive outcome.10

Neurotoxic damage does not necessarily affect brain structure at the

level we can see on a brain scan.

PET and SPECT scans are often more sensitive to brain injury than

either MRIs or CT scans, 11 but even if they show an abnormality,

they don't show what caused it. Such scans have limited utility in

court as proof of damage.12 The meaning of the abnormality still

needs to be explained via neuropsychological assessment. A brain MRI

often can be useful to rule out the possibility of another brain

disorder.

Test the body. Searching for physical evidence of a chemical injury

has been compared to searching for a bullet shot through someone's

body: The bullet may be gone, but the havoc it wreaked is still

there. Blood and urine can be tested for residue of the chemical in

question and its breakdown products, or for a range of chemicals, but

usually this testing is effective only while the client is still

being exposed or after recent exposure.

The body may store toxicants in the fat and tissues, longer-lasting

storage sites than the blood or urine. Tissue samples can be taken

and occasionally are helpful, but these procedures can be difficult,

painful, and expensive. Hair analysis may be helpful, but it is often

controversial.13 Immunological testing can determine whether the

client has elevated antibodies to some molds, suggesting high levels

of exposure to toxic mold.14

Test and analyze the exposure location. When analyzing an exposure

location for toxic substances (such as might be found in the air or

on surfaces), it is better to hire your own consultants to perform

the work. They can control many important variables that could be

ignored by other service providers.

Earlier tests conducted by the defendant may be available, but the

results might not be valid for various reasons, even if the tests

were conducted by a government agency. A potential defendant, after

discovering that its site would be tested, may have aired out the

building and washed down all the surfaces before testing.

Unfortunately, the tests that government agencies perform are often

woefully inadequate.

Analyze the site carefully. Is there adequate ventilation? Is there a

clean-air exchange? Is the ventilation system blowing contaminated

air into the client's breathing space?

Some toxic chemicals may be heavier than air, so ventilation in those

circumstances should exhaust air out of the room from the level of

the floor, not the ceiling. One of our clients suffered severe brain

damage after using solvents outdoors on his boat. Most people think

that applying solvents outside is safe. However, our client applied

them while lying on his back, under the boat. Because the solvent was

heavier than air, this amounted to lying in a dense cloud of

neurotoxic gas, and friends had to pull him out from under his boat.

The toxic exposure caused injuries that rendered him completely

disabled15.

Under Daubert v. Merrell Dow Pharmaceuticals, Inc., 16 the expert

should present published research showing that the chemical

implicated in the case has caused the same damage that your client

suffered. But there is room for some flexibility.

For example, in a 2001 federal toxic-tort case, the court admitted

testimony that experts do not always need extensive, specific

research on a particular product to arrive at an opinion.17 Instead,

the chemical's toxicity can be deduced from general toxicology and

basic logic: The substance was an organic solvent; organic solvents

are neurotoxic; therefore, this solvent is neurotoxic.

In our experience, neuropsychological testimony is routinely admitted

under Daubert rules.18 Its application to neurotoxicology is well

established but may be challenged. We are not aware of cases where

this testimony has been excluded on Daubert grounds, but individual

states' requirements will vary.

In one case, the Ohio Supreme Court unanimously ruled that a witness

who is not a physician, but who qualifies as an expert under state

evidence rules, may give evidence that would be relevant to diagnosis

of a medical condition if the testimony is within the expertise of

the witness.19

Usually, the statute of limitations does not start running until the

client has received a diagnosis stating that his or her condition was

caused by a chemical exposure. In many cases, it takes years for this

diagnosis to be made.

In other situations, the client is so seriously injured that he or

she cannot seek out appropriate medical or legal help. The very

symptoms of neurotoxicity—memory problems, inability to concentrate

or think clearly, and difficulty processing information—impede the

injured person's ability to understand what happened to him or her

and can decrease his or her intellectual and emotional capacity to

pursue litigation. In such cases, you may need to file a statement of

mental incompetence to extend the statute of limitations.

What to expect from the defense

Invariably, the defense will seek to minimize the link between your

client's symptoms and the toxic substance he or she was exposed to

and will try to play down the product's harmfulness. Expect arguments

like these:

" This product cannot damage your health. " The Material Safety Data

Sheet (MSDS), required by law of every manufacturer, is a good place

to start when seeking documentation of a chemical's adverse health

effects, because often the MSDS lists them.20 But sometimes the MSDS

doesn't even hint at a product's real dangers, and you will need to

conduct further research. The neurotoxicity of common products is

discussed in various texts.21

" If this product caused ill health effects, it would not be

marketable. " In fact, hundreds of neurotoxic products are promoted

and sold. More than 850 industrial and commercial chemicals are known

to cause neurobehavioral disorders.22

" Ninety-five percent of the ingredients are inert, so what's the

problem? " There are two issues here. One is whether 5 percent of an

active ingredient is toxic enough to cause health effects—and often

it is, because toxic substances can be harmful in small amounts.

The other issue is the meaning of " inert. " So-called inert

ingredients can be more toxic than the " active " ones. By labeling an

ingredient " inert, " a company may be trying to avoid admitting that

there is a noxious ingredient in its product. The manufacturer may

call its formulation a " trade secret. "

Try to obtain a list of the inert ingredients by subpoena and have a

laboratory analyze the product. Once you establish what the inert

ingredients are, your consultants should assess their toxicity.

" But we didn't exceed government standards for exposure. " " Safe "

levels of exposure are a compromise between an industry's commercial

needs and consumer protection and do not guarantee that an injury

cannot occur. These standards generally become stricter with every

passing decade, and incidents of reported chemical injury are what

cause them to change.

Furthermore, safe levels are routinely set to protect a healthy male

worker. But some people are more susceptible than others. Women, for

instance, tend to be more sensitive than men, and different bodies

react differently to toxins.23 Variations in sensitivity are even

observable in rats. Also, there may be no safe level at which a

person can inhale a particular substance.

The MSDS typically will state that if a person shows signs of

illness, you must remove him or her from the area immediately. This

suggests that it is generally recognized that some people will become

ill even when they are working under the recommended safe-exposure

guidelines.

" This amount was far too small to damage anyone's health. " Chronic

exposure to low levels of some toxic chemicals can be even worse than

a single acute exposure, because brain damage is cumulative over

time.

" The plaintiff had preexisting conditions. " Plaintiffs in these cases

often do. It makes sense that people whose health is already

compromised are the most vulnerable to poisons, because their bodies'

detoxification systems—especially the liver and kidneys—are already

stressed. People with a preexisting condition suffer further

deterioration of their health. Your expert should document the

preexisting condition thoroughly—this may require extensive review

and analysis of the medical record—and document what new symptoms

emerged and what preexisting symptoms became worse.

" Just smelling the chemical could not have caused this. " Actually,

inhalation and skin contact are often more effective routes of entry

for a poison than swallowing. When something is swallowed, it is

partly neutralized by stomach acids. The body then attempts to

detoxify it through the liver, kidneys, and other organs. But

inhalation and skin contact allow a substance to enter the

bloodstream directly, without any filtering. For example, doctors now

use skin patches to administer morphine and birth control.24 And

sniffing glue (solvents) can produce an instantaneous high and cause

immediate and permanent brain damage.

" A neurologist found nothing wrong. " Few neurologists have training

in toxicology, and they rarely recognize the symptoms of

neurotoxicity. A patient who suggests his or her symptoms were caused

by a chemical exposure may encounter a brick wall of denial,

bordering on hostility.

Some neurologists won't pay attention unless a patient's symptoms are

extreme: For example, the patient cannot tell what day it is or walk

in a straight line. Even then the neurologist may misdiagnose the

patient as normal, even if neuropsychological testing shows serious

functional deficits. Still, a neurologist's exam may help rule out

non-toxicological causes of a neurological illness or document

certain physical signs, such as seizures or gait disturbances.

" Chronic pain is not a symptom of brain or nerve damage. " The

term " chronic pain " may seem vague, outside the realm of most

doctors, and potentially confusing to a jury. But chronic pain can

certainly be a symptom of brain damage and toxic exposure.

Damage to the brain and nerves can disrupt the nerve signals

themselves or the way the brain interprets those signals.25 Resulting

sensations can be tingling, burning, or debilitating pain, which one

of my chronic pain patients described as " like a thousand razor

blades. " Chronic pain can be a terrible ordeal and may require strong

painkillers whose side effects could cause more damage.

" It is ludicrous to believe that neurotoxic chemicals can cause such

disparate symptoms as insomnia, chronic fatigue, and gastrointestinal

problems. " On the contrary, the brain and nervous system control all

bodily functions. The autonomic nervous system controls the

involuntary part of bodily processes, including digestion, blood

circulation, and the " fight or flight " response.

" Multiple chemical sensitivity does not exist. " Studies indicate that

almost 16 percent of the U.S. population report having unusual

reactions to common chemicals.26 About 6.3 percent have been

diagnosed with MCS or declared disabled from it.27 There is

considerable research on, and international recognition of, this

condition.

" The plaintiff is malingering. " Every competent forensic

neuropsychological assessment includes tests for malingering. When

assessing a potential client, consider that a chemical injury would

be one of the most difficult injuries to fake. Doctors who recognize

the symptoms are few and far between.

You will probably find that your client has tried to find a cure,

sincerely wants to return to work, and is seeking litigation as a

last resort. The " invalid " label is profoundly depressing to most

people. Nevertheless, you must always rule out the possibility of

malingering and psychosomatic disorders.

" The plaintiff has a personality disorder (or is mentally ill). "

Ironically, a plaintiff's personality disorder may be evidence of

injury, not a reason to dismiss the case. Brain damage can result in

such disorders, psychiatric symptoms, and even schizophrenia.

Establish the patient's mental health before the exposure to help

determine whether the exposure caused or exacerbated the psychiatric

symptoms. In any case, it is not surprising when a person with a

chronic illness, adjusting to a devastating life change, develops

what may be diagnosed as a personality disorder.

On the other hand, some patients with a diagnosis of a psychiatric

disorder don't actually have one. A patient may have received that

diagnosis precisely because he or she claimed to be hurt by chemicals

and was labeled " delusional. "

Compensation and cure

There is no standard medical cure for chemical injury, but

conventional medical treatments may help some symptoms and promote

modest improvement. Alternative medicine treatment for neurotoxicity

is controversial, but in our experience, nutritional therapy

(including natural foods diet) and natural medicines (including

acupuncture and holistic exercises, such as Tai Chi and Chi Gong) may

be the only methods that help neurotoxic and extremely sensitive

patients. Your clients should receive enough compensation to pay for

continuing treatment, including less conventional approaches, such as

medically supervised detoxification, infrared saunas, visits to

rehabilitation centers, and possibly hyperbaric oxygen treatments.

Compensation should include lost salary, lost savings, and medical

bills that will probably continue for a lifetime. It should cover

counseling or psychotherapy to help patients adjust to being

chronically ill; losing their jobs, their friendships, and possibly

their homes; straining their marriages; and being unable to continue

with hobbies. But they generally should avoid psychiatric drugs.

Chemically sensitive patients may react to pharmaceuticals (usually

petroleum derivatives) as they do to chemicals.

Your familiarity with neurotoxicity and chemical injury will help you

guide your client to the clearest assessment of his or her

disability. Choosing the right experts and testing will contain

litigation costs and further your goals of obtaining justice and

compensation.

Singer, Ph.D., is a forensic neurobehavioral toxicologist and

neuropsychologist in Santa Fe, New Mexico, with additional offices in

New York City. He handles cases on a nationwide basis. Dana Darby

is an associate in his practice.

1.See, e.g., Bernhard Voller et al., Neuropsychological, MRI, and EEG

Findings After Very Mild Traumatic Brain Injury, 13 BRAIN INJURY 821

(1999) (finding only 3 of 12 patients with brain dysfunction

demonstrated an abnormal MRI).

2.See, e.g., ph C. Arezzo & Herbert H. Schaumburg, Screening for

Neurotoxic Disease in Humans, 8 J. AM. C. TOXICOLOGY 147(1989); see

also Pamela Gibson, Disability-Induced Identity Changes in

Persons with Multiple Chemical Sensitivity, 15 QUALITATIVE HEALTH

RES. 502, 503-04 (2005).

3.See generally RAYMOND M. SINGER, NEUROTOXICITY GUIDEBOOK (2d ed.

2006, expected; 1st ed., 1990).

4. M. Ruff et al., Computerized Tomography, Neuropsychology,

and Positron Emission Tomography in the Evaluation of Head Injury, 2

NEUROPSYCHIATRY, NEUROPSYCHOL. & BEHAV. NEUROLOGY 103 (1989).

5.See generally SINGER, supra note 3. The Neurotoxicity Screening

Survey provides a complete checklist of possible signs and symptoms,

available at http://www.neurotox.com/files/Q1_9.pdf (last visited

Feb. 27, 2006).

6.See, e.g., Stanley M. Caress & Anne C. Steinemann, Prevalence of

Multiple Chemical Sensitivities: A Population-Based Study in the

Southeastern United States, 94 AM. J. PUB. HEALTH 746 (2004);

Fiedler et al., Responses to Controlled Diesel Vapor Exposure Among

Chemically Sensitive Gulf War Veterans, 66 PSYCHOSOMATIC MED. 588

(2004); M. Kipen et al., Prevalence of Chronic Fatigue and

Chemical Sensitivities in Gulf Registry Veterans, 54 ARCHIVES ENVTL.

HEALTH 313 (1999); Kreutzer et al., Prevalence of People

Reporting Sensitivities to Chemicals in a Population-Based Survey,

150 AM. J. EPIDEMIOLOGY 1 (1999); J. Meggs et al., Prevalence

and Nature of Allergy and Chemical Sensitivity in a General

Population, 51 ARCHIVES ENVTL. HEALTH 275 (1996).

7.See, e.g., letters and memoranda to and from Department of Housing

and Urban Development, available at www.usdoj.gov/crt/foia/tal105.txt

(last visited Jan. 23, 2006).

8.The MMPI-2 is available at

www.pearsonassessments.com/tests/mmpi_2.htm#norms (last visited Jan.

23, 2006).

9.See, e.g., N. Butcher et al., The Construct Validity of the

Lees-Haley Fake Bad Scale: Does This Scale Measure Somatic

Malingering and ned Emotional Distress? 18 ARCHIVES CLINICAL

NEUROPSYCHOL. 473 (2003).

10.See, e.g., Voller et al., supra note 1; A.M. Hofman et al.,

MR Imaging, Single-Photon Emission CT, and Neurocognitive Performance

After Mild Traumatic Brain Injury, 22 AM. J. NEURORADIOLOGY 441

(2001); Shelli R. Kesler et al., SPECT, MR, and Quantitative MR

Imaging: Correlates with Neuropsychological and Psychological Outcome

in Traumatic Brain Injury, 14 BRAIN INJURY 851 (2000) (finding a

modest but significant correlation between memory and intellectual

impairments and number of brain abnormalities evidenced by

quantitative magnetic resonance, magnetic resonance (MR), and all

imaging studies combined (but not SPECT alone) and noting a positive

correlation between psychological distress and MR abnormalities, most

frequently in the frontal lobes).

11.See J. Nolan & Tressa A. Pankovits, High-Tech Proof in

Brain Injury Cases, TRIAL, June 2005, at 26.

12.Brickford Y. Brown et al., Are We Out of the Gray Area Yet? Recent

Developments in the Use of PET and SPECT Scans to Prove Causation and

Injury in Toxic Tort Litigation, available at

www.morankikerbrown.com/CM/Articles/Articles67.asp (last visited Jan.

23, 2006). For an alternate perspective, see Garo Mardirossian &

ph Barrett, The Use of Functional Brain Imaging of Organic

Brain Injury: A Primer, available at www.caala.org/DOCS/3-

98mardirossian.pdf (last visited Jan. 23, 2006); see also G.

Monnett III & M. Jordan, Scientific Evidence Following

Daubert vs. Merrell Dow: Are PET Scans Admissible to Establish

Traumatic Brain Injury?, available at

www.carolinalaw.com/CM/Articles/article-scientific-evidence.asp (last

visited Jan. 23, 2006).

13.See generally SIDNEY A. KATZ & AMARES CHATT, HAIR ANALYSIS:

APPLICATIONS IN THE BIOMEDICAL AND ENVIRONMENTAL SCIENCES (1988).

14. Singer, Clinical Evaluation of Suspected Mold

Neurotoxicity, in BIOAEROSOLS, FUNGI, BACTERIA, MYCOTOXINS & HUMAN

HEALTH: PROC. OF THE FIFTH INT'L BIOAEROSOL CONF. 78 (2005); see also

Singer, Forensic Evaluation of a Mold (Repeated Water

Intrusions) Toxicity Case, 20 ARCHIVES CLINICAL NEUROPSYCHOL. 808

(2005).

15.Singer, R. (1996, March). Neurotoxicity from outdoor, consumer

exposure to a methylene chloride product. Fundamental and Applied

Toxicology, Supplement: The Toxicologist, 30, 1, Part 2.

16.509 U.S. 579 (1993).

17.Bonner v. ISP Techs., 259 F.3d 924 (8th Cir. 2001); see also

www.daubertontheweb.com (last visited Jan. 23, 2006).

18.See generally Bruce H. Stern, Admissibility of Neuropsychological

Testimony After Daubert and Kumho, 16 NEUROREHABILITATION 93 (2001).

19.Shilling v. Mobile Analytical Servs., Inc., 602 N.E.2d 1154, 1156-

57 (Ohio 1992).

20.See www.msds.com (last visited Jan. 23, 2006).

21.See, e.g., Singer, Neurotoxicity Guidebook, in

NEUROTOXICITY OF INDUSTRIAL & COMMERCIAL CHEMICALS ( L.

O'Donoghue ed., 1985).

22.Kent Anger & Barry , Chemicals Affecting Behavior, in

NEUROTOXICITY OF INDUSTRIAL & COMMERCIAL CHEMICALS ( L.

O'Donoghue ed., 1985).

23.See, e.g., Mark R. Cullen & A. Redlich, Significance of

Individual Sensitivity to Chemicals: Elucidation of Host

Susceptibility by Use of Biomarkers in Environmental Health Research,

41 CLINICAL CHEMISTRY 1809 (1995); T. Iyaniwura, Individual

and Subpopulation Variations in Response to Toxic Chemicals: Factors

of Susceptibility, available at

www.riskworld.com/Nreports/2004/Iyaniwura.htm (last visited Jan. 23,

2006); K. , Intra-Individual Variations in Acute and

Cumulative Skin Irritation Responses, 45 CONTACT DERMATITIS 75

(2001); K. , Population Differences in Acute Skin

Irritation Responses: Race, Sex, Age, Sensitive Skin, and Repeat

Subject Comparisons, 46 CONTACT DERMATITIS 86 (2002).

24.See, e.g., Mayo Clinic Med. Servs., Birth Control Patch, at

www.mayoclinic.com/index.cfm?id=PR00075 (last visited Jan. 23, 2006).

25.See Nat'l Inst. Neurological Disorders and Stroke, Pain: Hope

Through Research, at

www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm

(last visited Jan. 23, 2006).

26.See, e.g., Caress & Steinemann, supra note 6; Kreutzer et al.,

supra note 6; see also Meggs et al., supra note 6 (finding 33

percent).

27.See, e.g., Kreutzer et al., supra note 6.