Thomas P. Houston, M.D. - Testimony Excerpts
1 (Whereupon, the witness
2 was sworn at this
3 time.)
4 -- -- --
5 THOMAS HOUSTON
6 called as a witness by the Plaintiffs in this
7 cause, being first duly sworn, was examined and
8 testified as follows:
9 DIRECT EXAMINATION
__________________
10 By Mr. Horan
11 MR. HORAN: (Q) Would you be kind
12 enough to state your name and spell your last
13 name for me?
14 A. I'm Dr. Thomas Houston, H-o-u-s-t-o-n.
15 Q. And, Dr. Houston, are you a medical
16 doctor?
17 A. I am.
18 Q. And where are you employed?
19 A. At the American Medical Association in
20 Chicago.
21 Q. And what is the American Medical
22 Association?
23 A. The American Medical Association is the
24 nation's largest medical professional society
15
1 made up of about three hundred thousand member
2 physicians, medical students, resident
3 physicians, and comprising doctors in all
4 specialties.
5 Q. When you say all specialties, what do
6 you mean?
7 A. I mean all the medical specialties are
8 represented both as their professional societies
9 and membership of AMA and the doctors who are
10 both part of those societies and many who are not
11 part of those. So they're -- there's a wide
12 representation of doctors of all types across the
13 United States.
14 Q. So you're talking about doctors that
15 are in family practice, you're talking about
16 doctors who are in internal medicine, and all the
17 other specialties and subspecialties involved in
18 internal medicine and surgery, is that right?
19 A. That's correct.
20 Q. And does the American Medical
21 Association -- what do they do for those doctors?
22 Do they represent them?
23 A. The -- the AMA represents physicians in
24 a great many ways. Medical education, medical
16
1 ethics, professional standards which means issues
2 around medicine and public health, geriatrics,
3 adolescent medicine, issues in other parts of
4 science, legal matters for physicians, business
5 matters and economic matters for physicians.
6 We represent physicians in Washington with
7 our Washington office representing doctors in
8 Congress, and we have a variety of staff who are
9 links between the national organization and state
10 medical societies and the medical specialty
11 societies.
12 Q. And when the American Medical
13 Association -- when doctors want to express an
14 opinion that's as unified as doctors can express,
15 do they usually do it through the American
16 Medical Association?
17 MS. BAUER: Judge, I object to the
18 leading and the basis for the question.
19 THE COURT: Overruled.
20 Let's get to the substance.
21 MR. HORAN: Okay.
22 A. Yes, the American Medical Association
23 speaks for physicians and is the voice of
24 physicians across the country.
17
1 Q. Okay. Do they put out a journal?
2 A. Yes, we do, several journals actually.
3 Q. What is the main journal?
4 A. The Journal of the American Medical
5 Association.
6 And their specialty journal in a variety
7 of areas including internal medicine, surgery,
8 psychiatry and so on.
9 Q. And what is the Journal of American
10 Medical Association? Is that a very prestigious
11 journal?
12 A. That's one of the world's most
13 prestigious medical journals.
14 Q. What is your current position at the
15 American Medical Association?
16 A. My job title is Director of Science and
17 Community Health Advocacy and Patient Safety.
18 Q. And that's all for the American Medical
19 Association?
20 A. Yes.
21 Q. And what do you do in that position,
22 sir?
23 A. I have a wide variety of
24 responsibilities. I deal with issues in
18
1 community health and science, helping physicians
2 translate medical practice into the community
3 sector outside their basic office practice.
4 I work in areas of patient safety which has
5 to do with helping patients and doctors deliver
6 the most safe care that is possible to avoid
7 medical errors and those sorts of issues.
8 I work on other public health issues such
9 as tobacco control, and -- excuse me, clinical
10 preventive services.
11 I have in the last year worked on
12 bioterrorism and disaster preparedness and
13 miscellaneous sorts of issues that have come from
14 senior management.
15 Q. Okay. Are you appearing here today as
16 a representative of the American Medical
17 Association?
18 A. Yes.
19 Q. And are you aware of the fact that this
20 lawsuit involves the marketing of low tar and
21 light cigarettes?
22 A. Yes.
23 Q. And, Dr. Houston, does the American
24 Medical Association have an official position
19
1 with regard to low tar and light cigarettes?
2 A. Yes, it does.
3 Q. And what is that position, sir?
18 MR. HORAN: (Q) What's the official
19 position of the American Medical Association with
20 regard to low tar and light cigarettes.
21 THE COURT: Well, you better mark this
22 as an exhibit and have him refer to this. He can
23 testify to this document.
24 MR. HORAN: (Q) Let me just --
20
1 (Counsel confers
2 with co-counsel.)
3 -- -- --
4 We'll mark it as an exhibit, Your Honor. I
5 don't know what number we are on. Mark the --
6 THE COURT: All right. So he may
7 testify as to this document being the -- as he
8 indicated in the deposition.
9 MR. HORAN: (Q) Doctor, for the
10 official position of the American Medical
11 Association instead of reading from the document,
12 could you tell me and I'll just try to take you
13 through it a little bit.
14 Has the AMA endorsed Monograph 13?
15 A. Yes.
23
1 MR. HORAN: Thank you, sir. Thank you,
2 sir.
3 (Q) Let me ask you that again, sir. Is
4 the official position of the American Medical
5 Association that the American Medical Association
6 strongly endorses the conclusions of the National
7 Cancer Institute report known as Monograph 13?
8 A. Yes, it is.
9 Q. And is it the official position of the
10 American Medical Association that the American
11 Medical Association believes that low tar in
12 light cigarettes are not safer to consumers?
13 A. That's correct.
14 MS. BAUER: I object to the leading
15 nature.
16 THE COURT: Well, I have to allow him
17 to lead because otherwise -- this way I can
18 contain the scope of the examination on this --
19 on this paper.
20 MR. HORAN: (Q) And is it the official
21 position of the American Medical Association that
22 the American Medical Association believes that
23 the terms "light" and "low tar" misled consumers?
24 A. Yes.
24
1 Q. Thank you.
2 I want to go through your background if I
3 can, sir, and then I'll go through some -- in
4 more detail some of those opinions.
5 You live in Chicago, is that right?
6 A. I live in Wheaton, Illinois.
7 Q. That's a suburb of Chicago?
8 A. Yes, it is.
9 Q. And the American Medical Association is
10 located in Chicago, is that right?
11 A. Downtown.
12 Q. Okay. And are you married, sir?
13 A. Yes, I am.
14 Q. And do you have any children?
15 A. One 14-year-old son.
16 Q. And where did you go to -- I want to go
17 through your education and then your training
18 here in just a minute.
19 Where did you go to medical school?
20 A. The University of Mississippi.
21 Q. And where did you receive the -- when
22 did you receive a medical degree?
23 A. 1977.
24 Q. And did you then go on to do a
25
1 residency?
2 A. Yes, I did at the University of
3 Mississippi.
4 Q. And what did you do a residency in?
5 A. In family medicine.
6 Q. Were you a chief resident in addition
7 to doing your residency? Did you then take a
8 chief residency year?
9 A. That was my third year. It was --
10 Q. Okay.
11 A. -- it was at the synonymous (s.i.c.)
12 with the last year of residency.
13 Q. And then after you finished your
14 residency in family practice, did you go on and
15 get Board Certified?
16 A. Yes, I did.
17 Q. And what did you become Board Certified
18 in?
19 A. In family practice.
20 Q. And what does it mean to be Board
21 Certified?
22 A. Board certification involves completing
23 successfully the residency program in a specialty
24 of choice and passing written and/or oral
26
1 examinations depending on the specialty that's
2 administered by national certifying body.
3 Q. Now, after you finished your residency,
4 what type of practice were you looking for?
5 A. I had always seen myself as being a
6 family doctor in a small town because I came from
7 a very rural part of Mississippi, and I did that
8 for a year in an unincorporated area south of
9 Jackson, Mississippi.
10 I was then invited to join the faculty at
11 the Ohio State University by a former medical
12 student teacher who had moved from Mississippi
13 back to Ohio where he had been a native and from
14 where -- where he had connections up there family
15 and had moved back and asked me to join the
16 department of family medicine there.
17 I was there for two years, and moved to
18 northern Georgia to a community-based family
19 medicine residency where I was an associate
20 residency director.
21 Q. Let me just stop you for just a second.
22 You -- you started out as a small practice
23 physician. Then you moved to Ohio State in a --
24 A. -- university setting.
27
1 Q. -- university setting?
2 Now, when you were teaching, you ended up I
3 think teaching -- just to move this along, you
4 ended up teaching I think at six different
5 medical schools, is that right?
6 A. No. I was on staff at six different
7 hospitals over those years, but there were only
8 three different medical school affiliations.
9 Q. All right. So three medical schools,
10 and who did you teach?
11 A. I taught medical students, family
12 medicine residents, and nursing and pharmacy
13 students who rotated through our practice.
14 Q. What were you teaching?
15 A. I was teaching family medicine
16 generally, care of the individual and his or her
17 family through the lifespan from cradle to grave.
18 Family medicine is the specialty that deals
19 with the broadest definition of medical care. We
20 delivered babies; we took care of people in
21 nursing homes, and everything in between.
22 Q. Okay. Could you just then tell us
23 about the six teaching positions you had?
24 A. I actually started while I was in solo
28
1 practice the year that I was south of Jackson. I
2 was an instructor in family medicine that year at
3 my alma mater.
4 I then went to the Ohio State University
5 where I was assistant professor of family
6 medicine at a very large medical center. Ohio
7 State is a huge complex, and was on staff at two
8 different hospitals because we've had clinical
9 practice sites at two different areas.
10 My responsibilities there included
11 curriculum design, research, seeing patients and
12 teaching residents and students both in lecture
13 and in the practice part of the residency
14 program.
15 I then went to Rome, Georgia. That's
16 affiliated both with the Mercer School of
17 Medicine and the University of Georgia where I
18 had appointments in -- at both schools. This was
19 a small residency program in a three hundred bed
20 county hospital.
21 I was the associate director for the
22 residency. I was in charge of the curriculum
23 design of the liaison with the other specialty
24 teachers, the obstetricians, internists and so
29
1 on, and was the second in command faculty person
2 on the staff dealing with residents, the
3 recruitment, evaluation, training; and in that
4 particular residency we also taught pharmacy
5 students who rotated through our practice and
6 nursing students.
7 Q. Okay. Now, sir, while you were on the
8 faculty of this medical school, were you also
9 practicing medicine?
10 A. Yes.
11 Q. Could you tell us about that just
12 generally?
13 A. Generally faculty and family medicine
14 and other disciplines practice depending on the
15 particular assignments of twenty percent to fifty
16 or sixty percent time because of the need to see
17 patients, not only to keep one's personal medical
18 skills but to have a large number of patients
19 coming through the practice for the benefit
20 financially as well as to have a stable base of
21 patients for the residents and students to
22 observe and assist with.
23 I would see patients generally thirty to
24 fifty percent time depending on the given month.
30
1 It varied from one month to the next.
2 Q. Now, did you counsel your patients
3 regarding smoke and health issues?
4 A. Yes, I did.
5 Q. Now, I kind of want to move it along a
6 little bit.
7 You -- when did you start with the American
8 Medical Association?
9 A. 1990.
10 Q. And since joining the American Medical
11 Association in 1990, have you seen any patients
12 on a regular basis?
13 A. I see patients with residents at the
14 Hinsdale family medicine residency in Hinsdale
15 where I'm on the hospital --
16 Q. Are you a voluntary faculty member
17 there at Hinsdale?
18 A. I'm a volunteer faculty member, and I
19 see patients with the residents. I occasionally
20 see patients on my own there in a pinch when
21 residents have been sick or faculty have been
22 sick, but for the most part I'm supervising
23 residents and students.
24 Q. How big a hospital is Hinsdale
31
1 Hospital?
2 A. It's about four hundred fifty beds.
3 Q. Okay. So about the same size as say
4 St. Louis University?
5 A. Uh-huh.
6 Q. It's -- now when -- why did you join
7 the AMA?
8 A. I was recruited by -- by the AMA to
9 help the AMA increase its visibility in
10 preventive medicine and specifically in tobacco
11 control prevention issue.
12 Q. Okay.
13 A. They have no expertise on the staff in
14 those areas at the time I was recruited.
15 Q. Now, you said earlier about -- the only
16 thing I want to add, ask you about about what you
17 said about your duties at the American Medical
18 Association is you said more recently you were
19 involved in bioterrorism and disaster
20 preparedness.
21 Is that also one of your -- has that been
22 since 911?
23 A. That was since 911. We have since in
24 the last two months hired a person who is full
32
1 time working on that particular issue. Former
2 military medicine two star general actually, but
3 in the interim between 911 and his hiring, I was
4 working with a team of people on the staff to --
5 to deal with related issues.
6 Q. All right. And what other positions
7 have you held in the AMA?
8 Could you just take us through 1990 through
9 today, sir?
10 A. When I was hired my title was Director
11 of the Department of Preventive Medicine, and in
12 that context I dealt with clinical preventive
13 services of tobacco control issues almost
14 exclusively.
15 Reorganizations at the AMA have occurred
16 about four times since I was been there for about
17 thirteen years, and in that period different
18 departments have been merged so that my duties
19 have changed and the job title has changed.
20 At one point I was called the Director of
21 the Department of Public Health Preventive
22 Medicine and Public Health. Another job name was
23 Science and Public Health, and now it's Science
24 and Community Health and Patient Safety.
33
1 Because of the mergers of some of those
2 units, I have also been in charge of things such
3 as the Guide to the Evaluation of Permanent
4 Impairment which is an AMA book that deals with
5 disability determination, and I worked with other
6 staff on those issues very closely and actually
7 was the co-editor of a major book on that issue a
8 few years ago. That is an example of some of the
9 source of things that I have done.
10 Q. And today, sir, are you kind of the man
11 on health issues for tobacco for the American
12 Medical Association?
13 MS. BAUER: Objection to the form,
14 Judge.
15 THE COURT: Overruled.
16 A. Yes, I am.
17 MR. HORAN: Okay.
18 (Q) I mean you're the top guy?
19 MS. BAUER: Objection.
20 MR. HORAN: (Q) For tobacco issues in
21 health in the American Medical Association,
22 right?
23 A. That's correct.
24 Q. Okay. Thanks.
34
1 THE COURT: Overruled.
2 MR. HORAN: (Q) Could you tell us
3 about your professional organizations, what you
4 belong to other than the American Medical
5 Association?
6 A. I belong to several. The American
7 Academy of Family Physicians which is the
8 national body for family doctors; the American
9 College of Preventive Medicine of which I'm a
10 fellow, the American Public Health Association,
11 the American Cancer Society, and a variety of
12 other private sector voluntary health groups that
13 I have worked with off and on from time to time.
14 I'm a fellow of the Institute of Medicine
15 of Chicago, and I work with in liaison with a
16 whole host of public and private health
17 organizations.
18 Q. Now, I saw in your curriculum vitae,
19 which we'll offer here in a minute as an exhibit,
20 that you were on the Board of Directors of the
21 Illinois Chapter of the American Cancer Society,
22 is that correct?
23 A. That's correct.
24 Q. Could you tell us the years and what
35
1 your duties were as a member of the Board of
2 Directors of the Illinois Chapter of the American
3 Cancer Society?
4 A. The Cancer Society for Illinois is one
5 of the larger divisions of the American Cancer
6 Society. It's one of the only divisions that is
7 remaining in fact as a state. Most of the other
8 divisions encompass several states. Illinois is
9 important enough in itself, if you will, to
10 remain its own state division.
11 The Board of Directors is concerned not
12 only with the fiduciary and financial fitness,
13 fundraising and other duties for that part of the
14 cancer society but also concerned with issues
15 such as research, prevention, and education
16 around cancer both from the point of view of
17 cancer prevention and control but also in
18 treatment and aftercare.
19 So there's a wide variety of things dealing
20 with cancer that we engage in. The Board of
21 Directors then involve themselves in a variety of
22 issues ranging from research to public affairs to
23 education and publicity.
24 Q. And you held that position from 1993
36
1 through 2001, is that correct, sir?
2 A. That's correct.
3 Q. And did you deal with tobacco issues at
4 all as a member of the Board of Directors of the
5 American Cancer Society in Illinois?
6 A. Yes, I did.
7 Q. Okay. Sir, have you received certain
8 awards, and I don't want you to go through all
9 the awards you received?
10 Could you just hit any highlights that you
11 want to discuss with the Court?
12 A. In 1988 I receive the Surgeon General's
13 medallion from C. Edward Koop which was awarded
14 because of my activities in tobacco control.
15 I also received before I came to the AMA an
16 award from the AMA the national award titled An
17 Award in Adolescent Medicine on Behalf of
18 America's youth, a long name for a national award
19 for the work that I and my other colleagues in a
20 group called Doctors Ought to Care with dealing
21 with adolescent smoking prevention and education.
22 Q. Could you tell us a little bit about
23 that Doctors Ought to Care, and it was
24 adolescent?
37
1 Could you just explain to the Court what
2 that is?
3 A. Doctors Ought to Care was an
4 organization that was founded in 1977 by another
5 family physician named Alan Grum (phonetic
6 spelling) who began with a concept that it was
7 not just one-on-one relationship between doctors
8 and smokers that made a difference. That in
9 fact, physicians needed to be active in the
10 community countering the activities of the
11 tobacco industry.
12 Q. What kind of money did you have to try
13 to counter the tobacco industry with D-o-c?
14 A. D-o-c was an entirely voluntary
15 organization led by physicians working out of
16 their garages, and closets, and kitchen tables
17 over the years. I became national coordinator
18 for that organization in 1980, and over the years
19 I guess for -- for a good year our donations
20 would be about five thousand dollars from
21 individual doctors, contributions to us.
16 MR. HORAN: (Q) One of the things I
17 wanted to point out though is the Surgeon General
18 medallion that you received, that is the most
19 prestigious award of the Surgeon General, is that
20 right?
21 MS. BAUER: Judge, I object to the
22 form.
23 MR. HORAN: (Q) Is that the perception
24 in the medical community?
39
1 THE WITNESS: Yes, it is.
2 THE COURT: For what it's worth.
3 MR. HORAN: Thanks.
4 (Q) And who has received the Surgeon
5 General medallion award in the past?
6 A. A variety of people within both the
7 public health service and the private sector that
8 have in the opinion of the Surgeon General
9 contributed to the good of the public health and
10 the support of his office.
11 Q. Has General Colin Powell received that
12 award?
13 MS. BAUER: Judge, I object; relevance.
14 THE COURT: You say Colin Powell?
15 MR. HORAN: Yes, Colin Powell.
16 THE COURT: I will sustain your
17 objection. Let's get on to a different line.
18 MR. HORAN: Absolutely.
19 THE COURT: Look, you have established
20 expertise of the witness. Let's get on with the
21 --
22 MR. TILLERY: I'll move on then, Your
23 Honor.
24 THE COURT: All right.
40
1 MR. HORAN: At this time, you know
2 what? I'll just move way on, and, Your Honor, at
3 this time I would like to offer Dr. Houston in
4 his capacity as a representative of the American
5 Medical Association as an expert in the area of
6 tobacco control.
7 THE COURT: Yeah, I'll -- I'll accept
8 that.
9 MR. HORAN: Okay, thank you, Your
10 Honor.
11 And --
12 THE COURT: And allow it.
13 MR. HORAN: Great.
14 (Q) The -- doctor, I just want to ask you
15 a couple other things about your background here,
16 and I want to explain one thing. That when a
17 medical theory becomes a consensus, a medical
18 consensus, can you explain the process?
19 A. Generally speaking medical theories
20 begin with the idea of a researcher or a
21 physician interested in a particular issue based
22 on observation and clinical practice or in the
23 laboratory experiments are done or clinical
24 trials are done on a particular medication or
41
1 procedure or investigation of the causation of
2 illness, of those procedures or experiments or
3 treatments are then taken from the laboratory to
4 -- through a series of steps including clinical
5 trials weighed against placebo treatments that
6 have no known effect on a particular condition,
7 then taken into larger clinical trials and
8 practice replicated by a variety of investigators
9 under different conditions, and at some point
10 they emerge depending on the issue at hand from
11 being investigation or theoretical or belief by a
12 few in the community to have a wide acceptances.
13 Q. So what happens just to explain is that
14 you get a theory, a doctor gets a theory or a
15 hypothesis and then there's a process in which
16 other doctors participate in that until this
17 becomes a consensus?
18 Is that what happens?
19 MS. BAUER: Judge, I object to the
20 leading.
21 A. That's correct.
22 THE COURT: Yeah, this is -- he's
23 already testified as to the --
24 MR. HORAN: The -- all right.
42
1 THE COURT: -- the process that's
2 evolved.
3 Let's get on with the next.
4 MR. HORAN: (Q) Now, I want to ask
5 you, were you a part of that process in the terms
6 of the development of the consensus that was
7 found in Monograph 13?
8 A. Indirectly.
9 Q. Okay. Did you write articles for
10 instance, in the '70's in the 1980s about
11 compensation and about things having to do with
12 light cigarettes?
13 A. I wrote two articles in which that was
14 mentioned in 1984. I had observed in the medical
15 literature as I was keeping up with
16 tobacco-related issues, discussions of this issue
17 that -- that people who smoke light and low-tar
18 cigarettes might smoke them differently and might
19 have compensated for some in some way, and I put
20 that into an editorial in the Journal of the
21 Medical Association of Georgia and included it as
22 a part of another editorial that I wrote.
23 Q. And were you then -- do you feel as
24 though what you were doing at that point was
43
1 explaining what you had read in the medical
2 journals and Dr. Benowitz and others to try to
3 get that out to doctors?
4 A. Yes.
12 MR. HORAN: (Q) Is that what you were
13 trying to do, sir, those articles, was reading
14 what you had read from Dr. Benowitz and others on
15 compensation trying to explain that to family
16 practitioners?
17 A. That's correct.
18 In my job as a family medicine educator
19 that's what you do with teaching medical students
20 and residents is taking information that you as a
21 teacher know more than they do and explain to
22 them in the application of clinical practice, and
23 that was what I was doing with those journal
24 articles.
44
1 Q. And in those journal articles, did you
2 talk about the false promise of light cigarettes
3 and compensation?
4 A. I talked about the issue that in my
5 opinion light cigarettes were -- were not a safer
6 product and were not an alternative to quitting.
7 Q. Did you feel as you were talking about
8 it and you were giving these opinions, that you
9 were like a voice in the wilderness?
12 MR. HORAN: All right.
3 (Q) When you were giving these opinions,
4 did you feel as though you were trying to fight
5 against anything? Any other types of opinions
6 that were coming out?
7 MS. BAUER: Judge, object to the form
8 of the question and the foundation from the
9 answer.
10 THE COURT: I'll overrule that. As
11 closer, I'll overrule it.
12 A. Yes, I did.
13 The medical community at the time was
14 fighting and still is was fighting against
15 enormous advertising budget by the -- the tobacco
16 industries, and so what we were saying related to
17 tobacco and health was thwarted by information on
18 the other side that continued to perpetuate
19 smoking as enormity behavior in society.
20 Q. Were you --
15 MR. HORAN: I'll move along.
16 THE COURT: Why don't you try to lay
17 some foundation with regard --
18 MR. HORAN: (Q) Were you aware,
19 doctor, of the advertisements that were being
20 published and put out by the tobacco industry
21 throughout the time that you were writing your
22 articles in the '70's and the '80's and the
23 '90's?
24 A. Yes, I was.
47
1 And one of the particular issues of Doctors
2 Ought to Care, one of the particular reasons why
3 this is germane is that we were looking very
4 closely at advertising and promotion and trying
5 to generate ways to counter those messages, and
6 obviously the amount of resources that we had and
7 that physicians generally had to do so were --
8 were minuscule compared to the billions of
9 dollars being spent by the industry.
21 MR. HORAN: (Q) Now, you were aware
22 that when you're writing these articles and
23 talking about light cigarettes and the false
24 promise, that doctors around the country were
49
1 telling their patients to stop smoking, and if
2 they couldn't stop smoking to switch to light
3 cigarettes; right?
4 A. Yes, I knew that was the case.
5 Q. But you didn't do that, right?
6 A. I personally did not.
7 Q. And that's why you were writing these
8 articles and trying to get the word out, and you
9 were part of that process of developing a theory
10 into a consensus?
11 THE COURT: Yeah, be sustained on the
12 basis of leading.
13 MR. HORAN: Okay.
14 THE COURT: Did I anticipate you
15 enough?
16 MS. BAUER: Yes, absolutely, Judge.
17 MR. HORAN: (Q) And the -- you did not
18 give that advice to your patients, correct?
19 A. I did not.
20 Q. And why didn't you give that advice to
21 your patients?
22 Was it part of this process?
23 A. The reason -- the reason I personally
24 didn't give the advice to my patients is that I
50
1 didn't consider switching to be safer than
2 stopping altogether.
3 For me, cigarettes are cigarettes, and tar
4 was tar, and nicotine was nicotine. And the
5 continued use of whatever brand of cigarette and
6 whatever product in my opinion was so injurious
7 to health that talking about patients switching
8 from a high tar to a low-tar cigarette was for me
9 not a behavior that -- that I thought was
10 clinically useful.
11 Q. And you then tried to get that word
12 out, right?
13 A. Yes, I did.
14 Q. And you were part of the process that
15 eventually developed into a consensus? Do you
16 agree or not?
17 MS. BAUER: Judge, I object to leading
18 the witness.
19 THE COURT: Yeah.
20 MR. HORAN: (Q) Were you a part of the
21 consensus?
22 THE COURT: There you go.
23 MR. HORAN: (Q) Were you a part of the
24 development of the consensus?
51
1 A. I hope that I was; I try to be.
2 Q. Okay, and is Monograph 13 a consensus
3 document?
4 A. Yes, it is.
5 Q. What does it mean to be a consensus
6 document?
7 A. It's a document that's widely held to
8 be fact by a wide range of groups within the
9 medical community. It's been reviewed by a host
10 of organizations both in the federal and private
11 sectors, and there's been unanimity agreement
12 within the community about its veracity and
13 findings.
14 Q. Now, just to make clear that the
15 opinions you are expressing here today, your
16 opinions, those opinions are to a reasonable
17 degree of medical certainty, is that correct?
18 A. (No response)
19 MS. BAUER: Judge, I object. I didn't
20 think that was the basis on which he was
21 qualified as an expert.
22 THE COURT: Overruled.
23 A. I try to be, yes, sir.
24 MR. HORAN: Okay. Thank you.
52
1 (Q) They are, correct?
2 THE WITNESS: I hope so.
3 THE COURT; well, tries to be I would
4 presume.
5 MR. HORAN: (Q) What I would like to
6 do I'm going to move this right along, and I'm
7 just going to use from that exhibit. I just want
8 to cover then all the opinions here, all right?
9 A. That's fine.
10 Q. Now, --
11 THE COURT: Oh, you mean was this
12 related to the opinions coming?
13 MR. HORAN: Yes. Yes, sir.
14 THE COURT: Overruled. Okay, I'm
15 sorry. I misunderstood you, your question.
16 MR. HORAN: No problem, sir.
17 (Q) Now, is it the official position of
18 the American Medical Association that in the
19 nearly forty years since the U.S. Surgeon
20 General's Report linking cigarette smoking to
21 lung cancer and other diseases, tobacco companies
22 have rolled out all sorts of marketing gimmicks
23 and deceptive advertising to convince American
24 smokers that light cigarettes were somehow safer?
53
9 MR. HORAN: (Q) Is that the official
10 AMA position that I just read?
11 A. Yes, it is.
12 Q. And did you help write that position?
13 A. Yes, I did.
14 Q. And, sir, is it the official -- oh, by
15 the way, I want to move back just a little bit.
16 When we said that the official position of
17 the AMA believes that low tar and light
18 cigarettes are not safer, do they -- that include
19 Marlboro Lights and Cambridge Lights?
20 MS. BAUER: Judge, I object. He can
21 lay a foundation on that.
22 A. That applies --
23 THE COURT: Hold it.
24 A. I'm sorry.
56
19 (Q) Was it your intention, sir?
20 A. I was -- when we wrote this document it
21 was intended to include all brands of cigarettes
22 that fell into that category.
23 Q. Does that include Marlboro Lights and
24 Cambridge Lights?
57
1 A. Yes, sir.
2 Q. Okay. Sir, is it the official position
3 of the American Medical Association that sadly
4 and reprehensibly their sales pitch have worked
5 light brands currently represent the vast
6 majority of cigarettes sold today?
7 The new data in the NCI report reveals the
8 popularity of these brands has resulted in a
9 sustained increase in lung cancer among older
10 smokers?
11 Is that the official position of the
12 American Medical Association?
13 MR. LOMBARDI: Excuse me, doctor.
14 A. Yes, sir.
5 MR. HORAN: Thank you, sir.
6 A. It is our opinion.
15 MR. HORAN: Thank you, Your Honor.
16 (Q) Is it the official position of the
17 American Medical Association that it is both
18 absurd and tragic that the tobacco industry
19 continues to manufacture and pitch its deadly
20 wares without any concern for the health of its
21 customers?
22 A. Yes, it is.
23 MS. BAUER: I object.
24 THE COURT: Be sustained. It's not
62
1 hearsay.
2 MR. HORAN: Is it -- pardon me? Okay.
3 THE COURT: I presume -- overruled.
4 MR. HORAN: Okay. Thank you, Your
5 Honor.
6 (Q) Is it the official position of the
7 American Medical Association that the tobacco
8 industry has directly caused the death of
9 millions of Americans?
10 A. Yes, it is.
11 MS. BAUER: Judge, I'm sorry. Are you
12 finished?
13 MR. HORAN: No.
14 MS. BAUER: I'm sorry.
15 MR. HORAN: Go ahead.
7 MR. HORAN: Okay.
8 (Q) Is it the official position of the
9 American Medical Association that light and mild
10 cigarettes raised the hopes of many smokers
11 keeping them from quitting and enticed nonsmokers
12 to start, most of whom did so before the age of
13 18?
14 MS. BAUER: Judge, --
15 A. Yes, it is.
23 MR. HORAN: (Q) And what is the
24 answer to that question, sir?
64
1 A. Yes, it is.
2 Q. Okay.
3 MR. HORAN: Your Honor, we would like
4 to offer that position of the AMA into evidence.
12 MR. HORAN: Thank you, Your Honor.
13 THE COURT: What number was it?
14 MR. HORAN: 45.
15 CROSS EXAMINATION
_________________
16 By Ms. Bauer
17 MS. BAUER: (Q) Good morning, Dr.
18 Houston?
19 A. Good morning.
20 Q. The document that you were discussing
21 with Dr. Horan (s.i.c.) which has been marked as
22 Plaintiff's Exhibit 45 is a press release by the
23 American Medical Association, is that right?
24 A. Yes, it is.
65
1 Q. And it was issued on November 27th,
2 2001, is that right?
3 A. That's the date on it.
4 Q. It was timed to coincide with the
5 publication of Monograph 13, is that right?
6 A. That's correct.
7 Q. You're not suggesting that the press
8 release that has been marked as Exhibit 45 is an
9 official scientific document, are you?
10 A. No, it's a policy statement of the
11 American Medical Association.
12 Q. It's not a peer-reviewed document of
13 the press release that's been marked as Exhibit
14 45, is that right?
15 A. It was reviewed by the executive
16 committee of the American Medical Association and
17 approved by them.
18 Q. It was not peer-reviewed in the sense
19 that peer-reviewed journal articles are reviewed,
20 Dr. Houston?
21 A. That's correct.
22 Q. It was a document that was intended to
23 be released to the popular media, is that right?
24 A. And to the physician and public as
66
1 well.
2 Q. And that's right. And including the
3 popular media, is that right?
4 A. Yes.
5 Q. Now, the AMA does have an official way
6 to make policy, is that right?
7 A. There are -- there are actually two
8 ways by which policy is made at the American
9 Medical Association.
10 THE COURT: That was -- just say yes or
11 no. Let's get on with this.
12 MS. BAUER: (Q) One of the ways, the
13 usual way is through the House of Delegates, is
14 that right?
15 A. That's correct.
16 Q. And the House of Delegates is the
17 policy-making body of the AMA. It's an elected
18 group of physicians that represent these various
19 medical special societies that you talked about
20 earlier today; is that right?
21 A. Yes, it is.
22 Q. And the House of Delegates did not
23 issue the press release that we've looked at as
24 Exhibit 45, is that right?
67
1 A. That's right.
2 Q. They didn't pass on Exhibit 45 before
3 it was released?
4 A. That's right.
5 Q. And I think you told me, doctor, that
6 the House of Delegates didn't take any position
7 with respect to NCI Monograph 13, is that right?
8 A. The House of Delegates did not.
9 Q. Okay. The press release that we've
10 looked at as Exhibit 45, did I understand on
11 direct examination that you told me that you had
12 a hand in writing Exhibit 45?
13 A. Yes.
14 Q. In fact, Dr. Houston, didn't you review
15 the draft of it after it was written?
16 A. No. There was a process by which I
17 just came about. I'll be happy to explain it to
18 you. We received a copy of --
19 Q. Dr. Houston, all I want to know is --
20 MR. HORAN: Let him answer.
21 THE COURT: No, no. She's asking the
22 questions.
23 What was your question?
24 MS. BAUER: My question, doctor, I
68
1 believe was whether he had previously told me he
2 was not involved in the writing of the press
3 release.
4 MR. HORAN: That wasn't the question.
5 THE COURT: Wait a minute. Read the
6 question back. Let's see what the question was.
7 (Whereupon, the court
8 reporter read back
9 the previous question
10 of defense counsel
11 at this time.)
12 -- -- --
13 Wait a minute.
14 MR. HORAN: He was going to explain
15 the practices.
16 A. The answer to that would be, yes,
17 that's correct, I reviewed it, edited it and
18 assisted in writing it from that point of view.
19 MS. BAUER: (Q) You reviewed it after
20 it was written and prior to the time it was
21 released, is that right?
22 A. I reviewed the first draft. I rewrote
23 it. It was then reviewed by the executive
24 committee of the American Medical Association and
69
1 adopted as policy and then was submitted to the
2 public.
3 Q. Well, Dr. Houston, in fact didn't you
4 -- you don't recall whether you had any comments
5 on the draft of Exhibit 45 that you saw, is that
6 right?
7 A. No, I did in fact have comments. I got
8 the first -- I got the first draft from Ross
9 Fraser, the public information officer. I
10 reviewed it and edited it. And then it went up
11 through the process that I described.
2 MS. BAUER: (Q) Let me ask Dr.
3 Houston. The draft of Exhibit 45 that was shown
4 to you was written by Mr. Fraser, is that right?
5 A. The first draft, yes.
6 Q. He's the public information officer for
7 the American Medical Association?
8 A. Yes.
9 Q. And he gave you a draft of that to
10 review, is that right?
11 A. That's correct.
12 Q. And isn't it true that you don't recall
13 whether you had any comments on that draft?
14 A. I'm sure I did. I generally do make
15 comments and edits related to things that are --
16 that are given to me in my area of expertise.
17 Q. Have you testified prior to this that
18 you don't recall making any comments on the draft
19 that Mr. Fraser gave to you?
20 A. I can't recall precisely how many
21 comments I may have made.
22 Q. Have you testified previously that you
23 don't recall making any comments on the draft of
24 Exhibit 45 that Mr. Fraser gave you?
71
1 MR. HORAN: Asked and answered.
2 MS. BAUER: I don't have an answer to
3 the question.
4 A. I don't remember precisely the words I
5 used in my depositions.
6 MS. BAUER: (Q) If I showed you your
7 deposition, would that refresh your recollection
8 about the words that you used?
9 A. Yes, it would.
72
1 (Q) Dr. Houston, I'm handing you a copy of
2 your deposition in this case, and I direct your
3 attention -- do you need a copy?
4 I direct your attention to page 151 which
5 is in the second -- the smaller of the two
6 volumes I have handed you.
7 A. Yes.
8 Q. You do, Dr. Houston, recall having your
9 deposition taken in this case?
10 A. Yes, I do.
11 Q. And you recall that one of the days
12 that your deposition was taken was on September
13 23rd, 2002?
14 A. Yes.
15 Q. And let me direct your attention to
16 page 151.
13 (Q) Dr. Houston, have you turned to page
14 151 of your deposition?
15 A. Yes.
16 Q. Have you had an opportunity to read
17 page 151 of your deposition?
18 A. Yes.
19 Q. And does that refresh your recollection
20 that you previously testified that you do not
21 recall making any changes to Plaintiff's Exhibit
22 45?
23 A. My answer was I don't recall, and I may
24 have but I don't remember.
74
1 Q. Thank you.
2 Is your recollection now refreshed that
3 that was your testimony?
4 A. Yes.
5 Q. Thank you.
6 You testified I believe, Dr. Houston, that
7 Monograph 13 represents the consensus of the
8 medical -- of the scientific community on a
9 particular issue, is that right?
10 A. Yes, it is.
11 Q. Okay. And is that true with respect
12 to the prior monographs that were issued by the
13 National Cancer Institute as well?
14 A. The other monographs were consensus
15 documents and were -- were brought together in a
16 fashion consistent with the consensus process,
17 yes.
18 Q. Okay, and so at the time that they were
19 published, they represented the consensus of the
20 scientific community and the issues that they
21 address?
22 A. For the most part.
23 Q. That's right?
24 A. That would be correct.
75
1 Q. Okay. Is that also true for the
2 Surgeon General's Reports?
3 A. The Surgeon General's Reports are
4 drafted more closely by the Public Health
5 Service, but they are reviewed by a variety of
6 persons outside the Public Health Service, and
7 they are the standard, if you will, of the Public
8 Health Service's opinion on issues of smoking and
9 health.
10 Q. So they represent the public health
11 community standard at the time that they're
12 issued on various issues, is that right?
13 A. The Public Health Service, the
14 Department of Health and Human Services, Office
15 of Surgeon General, and the CDC is where it comes
16 from.
17 Q. The answer to my question is yes with
18 respect to those bodies, is that right?
19 A. Yes.
20 Q. And you're aware that the Surgeon
21 General's Report has recommended over the years
22 from time to time that for smokers who do not
23 quit smoking they would be well advised to switch
24 to low-tar cigarettes, is that right?
76
1 A. I'm aware of that, that's correct.
2 Q. And that's been true also in some of
3 the monographs that were issued by the NCI prior
4 to the issuance of Monograph 13 in the fall of
5 2001?
6 A. I haven't read that in the monographs
7 personally. It may be there.
8 Q. Okay. You just don't know one way or
9 the other as I ask you?
10 A. I don't know one way or the other about
11 the other monographs.
12 Q. You also testified this morning that
13 you did not personally give the advice to any
14 patients that they should switch to low-tar
15 cigarettes, is that right?
16 A. As an option to quitting, that's
17 correct.
18 Q. Okay. And you didn't give that -- any
19 advice with respect to low-tar cigarettes other
20 than they should quit smoking them, is that
21 right?
22 A. I used low-tar cigarettes in only one
23 context. As patients came close to their quit
24 day, that is the method that I used in talking to
77
1 patients about stopping smoking was to have them
2 set a day, a specific day, at which they would
3 quit altogether.
4 For some smokers I advised, and this was
5 just generally in the time before the advent of
6 nicotine replacement therapy, I advised smokers
7 to switch to a very very low tar and ultra light
8 Carlton or Now or one of the most low tar, low
9 nicotine brands on the market at the time, for a
10 period of about two weeks before the quit date.
11 I did that to try to ameliorate the
12 withdrawal effects on the quit day so that the
13 burden of nicotine would be lower for a few days
14 before stopping altogether.
15 Then at the quit date I advised them to
16 stop smoking altogether, but I never advised
17 people to use low-tar cigarettes as an
18 alternative to quitting altogether.
19 Q. Over what period of time did you give
20 the advice that you just described to us about
21 using ultra light cigarettes just prior to a quit
22 date?
23 A. That would have been in -- in the
24 period of the early 1980s to mid 1980s.
78
1 Q. Do you know whether any patients
2 followed your advice to do that?
3 A. You know, it's my recollection that
4 some of them did.
5 Q. So your experience that patients
6 followed the advice of their doctors on issues of
7 smoking and health sometimes?
8 A. Sometimes. Unfortunately many of them
9 don't for a variety of reasons including the
10 problems that the addictive power of nicotine as
11 a drug and the inability of patients to stop
12 smoking.
3 MS. BAUER: Thank you.
4 (Q) Now, Dr. Houston, you're aware though,
5 and I believe you testified on direct, that some
6 physicians gave advice to patients of theirs who
7 smoked that if they could not stop smoking they
8 should switch to a low tar or light cigarette, is
9 that right?
10 A. That's correct.
11 Q. And you're aware of that from talking
12 to physicians who gave that advice over the
13 years?
14 A. Yes.
15 Q. And you're also aware of that from
16 historical materials, articles that you have
17 reviewed over the years; is that right?
18 A. Yes.
19 Q. Okay. You don't know how many doctors
20 gave that advice over the years, do you?
21 A. I don't.
22 Q. You don't know how many doctors gave
23 that advice to patients here in Illinois, is that
24 right?
80
1 A. I don't.
2 Q. And you couldn't tell me how many
3 smokers here in Illinois took that advice from
4 their doctors that they should switch to a low
5 tar or light cigarette if they were unable to
6 quit?
7 A. No.
8 Q. You couldn't help me quantify the
9 number of people who received that advice?
10 A. I can't.
11 Q. You couldn't help me identify the
12 people that received that advice?
13 A. That's correct.
14 Q. You couldn't tell me whether there are
15 people who switched to Marlboro Light cigarettes
16 in Illinois based on the advice of their
17 physicians to switch to a lighter or low-tar
18 cigarette?
19 A. No.
20 Q. And you couldn't tell me how many
21 people switched to Cambridge Light cigarettes
22 based on the advice of their physicians and
23 switched to a lighter, low-tar cigarette?
24 A. No.
81
1 Q. Is it -- it's also your opinion, Dr.
2 Houston, that there are some people who were
3 understood that the public health community was
4 recommending that if they couldn't quit smoking,
5 excuse me, they should switch to a low-tar
6 cigarette and they heard that advice not directly
7 from their doctor but through popular media, the
8 Surgeon General's report say?
9 A. I don't -- I haven't read any of
10 popular media accounts of the Surgeon General's
11 Report about what the popular media may or may
12 not have said about that particular piece of
13 advice.
14 Q. Okay, but you're aware that the public
15 health advice was also communicated to the public
16 through press reports, for example, about the
17 findings of the Surgeon General?
18 A. Yes, it was.
19 Q. And those press reports in turn were
20 reported on the evening news and in various
21 newspapers throughout the country?
22 A. They may have been. I don't know.
23 Q. And so there would be people who were
24 aware of the recommendations of the public health
82
1 community even if they didn't hear that
2 information directly?
3 MR. HORAN: Objection, Your Honor;
4 speculative.
5 THE COURT: Well, he didn't answer
6 sufficiently. He said he didn't know. And you
7 are presuming that. So inasmuch as it's a fact
8 that you're presuming as part of your question,
9 I'm going to sustain the objection.
10 MS. BAUER: (Q) And, Dr. Houston, you
11 can't tell me one way or the other whether there
12 are people in Illinois who read in the popular
13 media the recommendations of the public health
14 community with respect to low-tar cigarettes, is
15 that right?
16 A. That's correct.
17 Q. You don't know any way that I could
18 identify people who got that advice say from
19 their doctors?
20 A. You'd have to ask the people.
21 Q. One by one I would, wouldn't I?
22 A. No. It's an issue of -- of whether
23 there was general understanding in the public of
24 this issue. I don't know whether there was or
83
1 not.
2 Q. Okay. And to find out whether an
3 individual heard that information directly from
4 the doctor, I would have to go talk to all of
5 those patients one by one, wouldn't I?
6 MR. HORAN: Objection, Your Honor.
7 THE COURT: Be sustained.
8 MS. BAUER: (Q) Doctor, you testified
9 earlier today, I believe your comment was in
10 reference to Exhibit 45, you testified that
11 lights -- it was the position that lights and
12 mild cigarettes kept many smokers from quitting.
13 Is that right?
14 A. Yes.
15 Q. Now, you don't believe that to be true
16 yourself, do you, Dr. Houston?
17 A. Yes, I do.
18 Q. You believe I think that nicotine is a
19 very addictive drug?
20 A. That's correct.
21 Q. And you believe it's very difficult for
22 smokers to quit?
23 A. Yes, I do.
24 Q. And that only a small portion of
84
1 smokers are able to quit?
2 A. Yes.
3 Q. And it's also your opinion that whether
4 light cigarettes were on the market or not on the
5 market would not have made any difference on the
6 success rate of cessation because of the
7 addictiveness of nicotine, is that right?
8 A. Nicotine is a very addictive drug, and
9 patients smoke cigarettes to receive that drug.
10 And in looking at what brands they might smoke,
11 they achieve a level of nicotine from lights as
12 well as from -- from Marlboro Reds. So the
13 existence of the brand per se has a couple of
14 effects.
15 It has the effect of having the patient on
16 the one hand believe that he or she might be
17 getting less of the harmful substance the tar,
18 for example, but when it comes to the addictive
19 potential of a light cigarette brand that
20 addictive potential is sustained so that it's no
21 easier for somebody to quit Marlboro Lights as
22 opposed to Marlboro Reds.
23 Q. So whether light cigarettes were on the
24 market would not have made any difference to the
85
1 success rate of cessation in your opinion?
2 A. To the success rate of cessation, no.
3 The issue, however, has to -- equally to do
4 with whether the patient makes up his or her mind
5 to quit, and whether he or she believes that
6 there is an alternative to quitting that reduces
7 the health risks involved with smoking.
8 That is, in my opinion light cigarettes
9 gave patients -- gave smokers an out, gave them
10 something on which they could assuage their fears
11 of smoking-related disease and allowed them to
12 keep smoking without feeling as guilty or as
13 worried about their health.
22 MS. BAUER: (Q) Judge, -- and just so
23 the record is clear, Dr. Houston, you -- so I
24 understand you correctly, you don't believe that
86
1 lights affected cessation rates although you have
2 other opinions with respect to --
3 MR. HORAN: Objection, Your Honor.
4 THE COURT: Be sustained.
5 MS. BAUER: (Q) And, Dr. Houston, you
6 have from time to time as in your practice as a
7 family care physician, you've seen patients that
8 are addicted to various substances, is that
9 right?
10 A. Yes, I have.
11 Q. And you make that diagnosis sometime
12 with respect to your own patients, is that right?
13 A. Yes.
14 Q. And before you make that diagnosis you
15 take a history from them?
16 A. Yes.
17 Q. You inquire of the patient about their
18 individual smoking history, is that right?
19 A. Yes.
20 Q. And things like which cigarette in the
21 day is the most important to them, is that right?
22 A. Uh-huh, that's correct.
23 Q. And how many attempts they have made at
24 quitting smoking and questions like that?
87
1 A. That's correct.
2 Q. And you would not make a diagnosis of
3 addiction without taking that type of a history
4 from a patient, is that right?
5 A. Generally speaking, most patients who
6 smoke are addicted by definition. The reason
7 that those particular questions are asked is to
8 determine the degree of addiction and to help in
9 many cases in methods that are useful in
10 cessation.
11 Q. But, doctor, my question is you would
12 not make the diagnosis of addiction without
13 taking that history from an individual patient,
14 is that right?
15 A. That's part of the -- a standard
16 history in talking to a patient who smokes. By
17 definition, somebody who is smoking more than
18 about ten cigarettes a day is addicted.
19 Q. By your definition or by someone else's
20 definition?
21 A. It's a commonly accepted level of
22 smoking that science and health community the
23 tobacco control community has seen empirically
24 over the course of decades we have come to the
88
1 conclusion that smoking between ten and fifteen
2 cigarettes a day or more is sufficient on its
3 face to make the definition of somebody who is
4 addicted for the most part.
5 Q. Now, you have not met any of the
6 individual plaintiffs in this lawsuit, is that
7 right?
8 A. I have not.
9 Q. And you have not reviewed any --
10 anything that reflects on their smoking history,
11 is that right?
12 A. That's correct.
13 Q. You haven't read their depositions?
14 A. I have not.
15 Q. You have not read their medical
16 records?
17 A. No.
18 Q. You have not talked to their
19 physicians?
11 MS. BAUER: (Q) Dr. Houston, do you
12 know whether any of the five individual
13 plaintiffs in this case are addicted?
14 A. No, I don't.
15 Q. Thank you.
16 REDIRECT EXAMINATION
____________________
17 By Mr. Horan
18 MR. HORAN: (Q) Just two things, Your
19 Honor.
20 On the addiction to nicotine, is that the
21 reason that patients aren't able to follow their
22 doctor's advice to stop smoking?
23 A. Yes, for the most part.
24 Q. Okay, and on Exhibit Number 45, who is
90
1 Randolph D. Smoak, Jr.?
2 A. At the time of that statement, Dr.
3 Smoak was the Immediate Past President of the
4 American Medical Association. He's a surgeon
5 from Orangeburg, South Carolina, and has been on
6 the Board of Trustees of the American Medical
7 Association for about a dozen years before that
8 time.
9 He's now off the Board, but at the time he
10 was the past president he was the person on the
11 Board who had been the spokesman for the AMA on
12 tobacco issues for I suppose eight or nine years
13 prior to this statement.
14 Q. And Dr. Smoak put his name on this
15 statement; it's attributed to him as well,
16 correct?
17 A. That's correct.
18 Q. Thank you.
19 MR. LOMBARDI: And just emphasize the
20 hearsay nature of the document. Dr. Smoak is not
21 here and just my same objection.
22 THE COURT: Overruled.
23 MR. HORAN: Thank you, Your Honor.
24 That's all we have.
91
1 THE COURT: Are we done with the
2 doctor?
3 MR. HORAN: Yes, we are.
4 THE COURT: All right, doctor. Thank
5 you very much.
6 You'll be excused, sir.