Viagra & Aggression

Read the groundbreaking research on the possible link between sildenafil citrate and aggressive behavior.  Write to us about your own experiences with sildenafil and contribute to this important ongoing research.

Neurological, Psychological, and Aggressive Disturbances with Sildenafil by Harry A. Milman and Suzanne B. Arnold.

Ann Pharmacother. 2002 Jul-Aug;36(7-8):1129-34.

Reference Manual on Scientific Evidence

The Federal Judicial Center in Washington, D.C. has published the revised, second edition of its Reference Manual on Scientific Evidence. The Manual, as Fern Smith, Director of the Center, notes in the preface to this new edition, assists "federal judges in recognizing the characteristics and reasoning of ‘science’ as it is relevant in litigation." This is not merely a re-printing of the 1994 Manual; several new chapters have been added. In a concise and very readable Introduction, U.S. Supreme Court Justice Stephen Breyer reviews the increasingly important role scientific evidence plays in litigation and the corresponding challenges trial courts must meet if science is to "find a warm welcome . . . in our courtrooms." The first edition of the Manual was published in 1994 largely as a result of the landmark 1993 Supreme Court case on expert testimony, Daubert v Merrell Dow Pharmaceuticals; in a new chapter by Margaret Berger, law professor at the Brooklyn Law School, "The Supreme Court’s Trilogy on the Admissibility of Expert Testimony," she helpfully summarizes Daubert as well as two subsequent cases, 1997's General Electric Co. v Joiner and 1999's Kumho Tire Co. v Carmichael. A likewise welcome addition to this revised Manual is "How Science Works" by David Goodstein, a professor of physics at the California Institute of Technology, who discusses the philosophy and practice of Science. New reference guides on medical testimony and engineering are also included, which should assist judges in their review for cases involving nonscientific expert testimony. One of the more requested portions of the first edition--the Reference Guides--remain but have been updated with new cases and additional material. The Reference Guide on DNA Evidence, however, has been completely revised to take account of the rapid changes that the last six years have seen in this field. To make room for these changes and additions, some of the material in the first edition on court-appointed experts has been condensed and rearranged into a new chapter, "Management of Expert Evidence," written by William W. Schwarzer, U.S. District Judge for the Northern District of California, and Joe Cecil, director of the Judicial Center’s Scientific Evidence Project.

 1. "Real experts don’t have to do any research to prepare for this case; they already know the answer, hence the name, expert."

 2. I only need an expert for the day of the trial.

 3. Experts charge too much. I can prepare the medical or scientific research myself using the Internet and save the client’s money.

 The Internet is certainly proving itself to be a wealth of information but also of misinformation and even, at times, disinformation. What is most positive about the Internet is that anyone can publish anything on the Internet. Unfortunately, this is precisely what is most negative about the Internet as well. Consequently, one needs to be very cautious about the credence one gives to information found online. Using an expert consulting service like MTI can save you thousands of dollars in lost time and money. By engaging professionals who are both thoroughly familiar with the credible medical and scientific resources available and who can selectively target and narrow the information to that which is material, you can have confidence that your evidence will pass the strictures of relevance and reliability which all scientific cases must meet as a result of the landmark Daubert v Merrell Dow Pharmaceuticals Supreme Court decision.

 4. I only use experts that are on faculty at universities; they are the best.

 5. Using only articles from peer reviewed journals as evidence ensures that we will get past the gatekeeper judge.

Recognizing the value of peer-review journals is, of course, laudatory and is certainly a step in the right direction to ensure that your case is grounded in sound science; however, as with relying on information on the Internet, you need to be wary here. Just because an article was published by a peer-reviewed journal does not mean that the science will meet the relevance and reliability standard set by Daubert. Part and parcel with the explosion in medical and scientific literature in recent years has been the growth in peer-reviewed journals. Most are trustworthy repositories of scientific information. However more than a few have been judged to have ideological agendas driving the "peers" on the journals’ review boards and, consequently, often feature dubious science. Having expert help that involves a team-generated, carefully prepared, documented opinion based not only on sound science but on an understanding of the workings of the contemporary scientific community is the best way to ensure that the keeper of the gate will accept your evidence.

 6. Using a consulting firm instead of an individual doctor will cost you more.

 7. Consultants always over-bill.

In general, this is as untrue as is the canard that attorneys always over-bill. Science is, as we noted above, expensive, and the amount billed by our doctors for legal cases involving scientific issues can be considerable. Consequently, it has been our experience that many experts actually bill fewer hours than the hours of work they actually perform out of a conscientious desire to hold costs down as much as possible. We seldom have to caution our doctors about putting in excessive hours for cases in which they serve as experts; more often than not we have to remind them to bill for all of the hours they work on the case, especially the MDs in private practice for whom time is at a premium.

 8. Real experts need ample trial experience to be effective.

This myth is often held by those who believe that university experts are superior to doctors who are in private practice. Here again, one needs to look beyond the superficial. When it comes to a case that involves scientific evidence, what is most important is having a seasoned expert, not necessarily a seasoned witness. Generally, it is more crucial that a legal case have an individual who is adept in his field and has been thoroughly prepared for the exigencies of the specific case. At MTI, our extensive experience with Science in the Courtroom allows us to prepare our experts thoroughly by providing them with the most up-to-date scientific information as it bears on the case and getting the experts ready for their testimony by consulting with them and the attorney frequently in the weeks, days, and even hours leading up to the trial.

 9. I want an expert from the same geographic location as the client; then I won’t have to pay exorbitant travel expenses.

With firms and attorneys trying to cut costs, this is a frequent assertion. However, it is shortsighted. First of all, this myth assumes the expert has to be present on a number of different occasions. With all of the new technologies, especially videoconferencing and taped depositions, there are ample opportunities to reduce travel costs and still avail yourself to high-level expert services. More importantly, however, the attorney who takes this position could be performing a grave disservice to the client in restricting expert options to only an in-state expert. Because of the collegial nature of the medical profession and the adversarial nature of the courtroom, medical doctors are frequently unwilling to testify against doctors from their state.

 10. I want one all around medical expert, so he can address a variety of issues.

This is an appropriate myth with which to conclude our examination of misconceptions about experts for it brings us back to where we began. Curiously, this request is often made by the same people who want an expert who does not have to research but "already knows everything." If "knowing everything" about just one narrow specialization is impossible, expecting an expert to have this facility about more than one subject of medicine and science or to be a modern day Leonardo Da Vinci is even more unrealistic. Requiring the expert to be a "jack of all scientific trades" does a disservice to the doctor and, ultimately, the client inasmuch as it spreads the expertise too thin to be of any real value for the case at hand.

U.S. Supreme Court justice Stephen Breyer, in the introduction to the second edition of The Reference Manual on Scientific Evidence, published by the Federal Judicial Center in 2000, wrote that the legal disputes that confront the highest court in the land "increasingly involve the principles and tools of science." Consequently, Justice Breyer added that "in this age of science, science should expect to find a warm welcome, perhaps a permanent home" in U.S. courtrooms. This, however, has not always proven to be the case, often as a result of the persistence of the above myths about Science in the Courtroom in general and about expert witnesses in particular. The discarded bones of arguments and testimony that have been disallowed by gatekeeper judges has littered the legal landscape in the eight years since the Daubert decision was handed down. If anything, the problem has only exacerbated itself since the Joiner (1997) and Kumho (1999) decisions which strengthened Daubert and provided judges with even more power in the exclusion of testimony which they deem to be "not even good enough to be wrong." The best defense to assure you that you will not fall victim to the evidentiary gatekeeper is to engage the services of a full-service medical and scientific information consulting firm. Not only will doing so improve the likelihood of your evidence being accepted, but you will also find that the sound science-grounded expertise a quality firm can bring to bear will make your case stronger. At Medical & Toxicological Information, we stand ready to help you with the sound science your complex cases require. We look forward to serving you.