Author Affiliations: Tufts University School of Medicine, Boston, Mass, and Yale University School of Medicine, New Haven, Conn (Dr Kassirer), and Federal Judicial Center, Washington, DC (Dr Cecil).
Health Law and Ethics Section Editors: Lawrence
O. Gostin, JD, Center for Law and the Public's Health at Georgetown University,
Washington, DC, and the Johns Hopkins University, Baltimore, Md; Helene M.
Cole, MD, Contributing Editor, JAMA.
Several recent decisions by the US Supreme Court have strengthened the
ability of federal courts to consider medical testimony regarding injuries
associated with exposure to toxic substances. Judges are expected to examine
the basis of all expert testimony before it is introduced at trial to ensure
that it meets the same standards of intellectual rigor that professionals
use outside the courtroom. However, courts have been inconsistent in measuring
this testimony against the standards of medical practice, especially when
courts consider testimony that is not supported by clinical trials or epidemiological
studies. A number of courts have required standards for expert testimony that
exceed those that physicians use in ordinary clinical decision making. In
this article, we illustrate such inconsistencies across federal courts by
contrasting different decisions in cases involving similar facts and expert
testimony. We argue that there may be good reason to require a standard of
admissibility that exceeds the standards of ordinary clinical decision making,
but such requirements are not faithful to the mandate of the Supreme Court.
Courts with especially demanding standards are misled if they believe that
they are fairly representing medical practice. Physicians should respond by
correcting courts' misinterpretations of medical practice and assisting in
the development of legal standards that encourage thoughtful and informed
consideration of medical testimony by judges and juries.
Kassirer JP, Cecil JS. Inconsistency in Evidentiary Standards for Medical TestimonyDisorder in the Courts. JAMA. 2002;288(11):1382-1387. doi:10.1001/jama.288.11.1382