Sunday, July 14, 2013

Medicine and Expert Witnesses: Part I

The State of Florida v. George Zimmerman case has definitely captured the attention of our nation.  The case is interesting for many reasons, but the underlying race issue is arguably the most important one.  In addition to the many social issues present, the use of expert witnesses has been a very influential component of this case.  Of special interest to me was the testimony of Dr. Vincent di Maio, the nation’s leading forensic pathologist and expert on gunshot wounds.  Dr. di Maio’s testimony helped to aid the defense in illustrating that Trayvon Martin was on top of Zimmerman when the latter discharged his firearm, going against the prosecution’s claims that the roles were reversed.  Dr. di Maio also indicated that Zimmerman had suffered head injuries from repeated blunt force trauma, furthering the defendant’s claims that he shot Martin in self-defense.

Dr. Vincent di Maio testifying during State of Florida v. George Zimmerman

Dr. di Maio’s testimony, while highly publicized, is not unusual.  Physicians and scientists are often called upon in legal matters to help analyze and interpret evidence.  Their expertise is often so invaluable that cases come down to the results of their inquiries.  The importance of scientific and medical witnesses has inspired curiosity in me.  What is the history of the use of expert witnesses in common law?  Where do scientific and medical expert witnesses fit into our legal code?  Most importantly, how are these witnesses used in current court proceedings, and what are the prospects for the future?

The Origin of Expert Witnesses

The origin of expert witnesses is in England.  Under English law, the first expert witness was used in a 1782 case involving the silting up of Wells Harbor in Norfolk.  In that case, renowned civil engineer John Smeaton testified, signifying the first use of an expert witness’ opinion in common law.  In the United States, expert witnesses were codified into US law in 1975, under the Federal Rule of Evidence (FRE) 702.  The FREs represented general rules passed by congress governing how evidence is presented in both civil and criminal cases.

Scientific and medical witnesses have greatly helped to shape the rules governing expert witnesses.  Prior to FRE 702, rules for admissibility of scientific evidence were established in Frye v. United States (1923).  In Frye, the question at hand concerned whether scientific evidence in the form of a systolic blood pressure deception test was admissible in court.  The Frye ruling indicated that such evidence was admissible as long as the test or theory was “generally accepted” among a meaningful portion of the scientific community.  To prove that something was “generally accepted” parties often put a number of scientific experts on the stand to verify certain tests or theories.  This rule for establishing the admissibility of scientific evidence is colloquially known as the Frye Test.

After the adoption of the FREs in 1975 they along with the Frye Test remained the seminal rules governing scientific expert witnesses.  However, in 1993 a new case would open those rules up to interpretation and eventual amendment.  In Daubert v. Merrell Dow Pharmaceuticals (1993), two citizens born with birth defects sued Merrell Dow Pharmaceuticals claiming that Dow’s drug Bendectin caused their conditions.  Both opposing parties relied upon scientific expert witnesses to prove their claims.  A district court ruled that the testimony from the citizens’ expert was inadmissible because the evidence came from methodologies, such as in vitro and in vivo studies, that were not “generally accepted” at the time.

After the Ninth Circuit Court upheld this decision, the citizens’ took their claim to the Supreme Court.  The citizens’ reasoned that the Frye Test was no longer the governing standard for admissibility of scientific evidence as soon as FRE 702 was passed.  The court agreed, reasoning that since FRE 702 made no mention of “general acceptance” that the Frye Test was not to be applied in discerning the validity of scientific evidence.

The implications of the Daubert ruling were significant in amending the rules for the admissibility of scientific evidence given by experts.  No longer was evidence only judged on its “general acceptance” among the scientific community. Under Daubert, scientific evidence can be admissible if it is “relevant to the task at hand” and “rest(s) on a reliable foundation.”  In determining what makes up a “reliable foundation,” conclusions made from evidence must be based on sound scientific methodology.  Sound scientific methodology rests in using proper scientific method, including empirical testing of evidence, peer review, proper controls, and determination of potential error rates.  In order to prevent the presentation of “pseudoscience,” judges are given the power to be the final arbiter of any submitted scientific evidence.  These guidelines outlined in the Daubert ruling were eventually added as amendments to FRE 702.

Understanding the history of expert witnesses allows us to determine how science and medicine shaped one aspect of the US legal code.  In the next part of this series, I will provide an overview of current medical and scientific involvement in court proceedings.  I will examine not only common case-types in which physicians testify, but case types in which physicians are directly involved in.  Check back soon!

Tuesday, July 9, 2013

NBA: Are the Golden State Warriors Contenders With the Addition of Andre Iguodala?

Andre Iguodala congratulates Stephen Curry after the Warriors defeated the Nuggets in six games during last year's playoffs

At the conclusion of the NBA season, the Golden State Warriors had every reason to be optimistic for the upcoming 2013-2014 campaign.   The team was coming off of a spirited playoff run led by a budding superstar in Stephen Curry and solid supporting pieces in Klay Thompson and Harrison Barnes.  However, this playoff run, especially the series against the San Antonio Spurs, did expose some of the shortcomings of the team. The failure to defend Tony Parker and Kawhi Leonard showed that the Warriors lacked toughness and athleticism on the defensive end, especially against elite perimeter players.  Also, the team’s offensive struggles when either Curry or Thompson shot poorly indicated the need for a true second-option that could create their own shots and get to the rim with some frequency. In addressing these shortcomings, the Warriors went out and signed free-agent small forward Andre Iguodala to a contract worth $48 million over 4 years. This signing is significant in that it not only proves that the organization can lure big-money free agents, but also makes the Warriors legitimate contenders in the Western Conference.

The addition of Iguodala is significant in that it gives the Warriors a legitimate second-option.  Iguodala is a proven scorer in the league, with a career average of 15.1 ppg.  He is also a decent shooter, with a true shooting mark (TS%) of 55% and an effective field goal rate (eFG%) of 50.1%. The scoring ability of Iguodala will force defenses away from keying on Curry and Thompson, allowing those sharpshooters more time and space to get off open shots.  Iguodala’s all around game will also fit well with the Warriors’ other pieces, as he has averaged 4.9 assists and 5.8 rebounds per game over his career.  His ability to handle and pass the basketball, along with his propensity to chip in on the glass, will allow Iguodala to be deployed in a variety of lineups.  Some of these lineups will see Iguodala play as a point forward with the second unit, as the Warriors currently do not have a proven back-up point guard after the departure of Jarrett Jack to Cleveland.

Iguodala's top 10 dunks, showing off his ball-handling and athleticism

Another lineup in which Iguodala will have a major impact includes the “close-out” lineup during 4th quarters.  I envision the Warriors sending out a lineup including Curry and Thompson as guards, Iguodala and Barnes as forwards, and Bogut at center.  This lineup provides the Warriors both offensive and defensive flexibility.  Offensively, the addition of Iguodala gives the Warriors another ball-handler and shot-creator on the floor during 4th quarters.  This will take the pressure off of Curry to fight through potential double teams to try to make plays in crunch time.  Defensively, Iguodala’s presence gives the Warriors an elite wing defender to pair with Bogut’s rim-protection at center.  Iguodala’s role as the defensive stopper will also move Curry and Thompson off of the other team’s best player and will allow them to conserve energy for the offensive end.  The arrangement of this lineup should alleviate some of the problems the Warriors had in closing out games, and thus translate to more regular season and even playoff wins.

Time will only tell how successful the Warriors will be with Andre Iguodala on the team.  The lineup variability Iguodala provides certainly gives the Warriors a dimension they did not have during last year’s playoffs.  His offensive and defensive proficiencies are also important for a team that struggled to close out games down the stretch during the postseason.  If the other important pieces on the team remain relatively healthy, I can see the Warriors making a run at a top four seed in the Western Conference.

Thursday, June 20, 2013

Pre-M1 Summer: Insanity!

With all the free time I have now, I decided to start doing the Insanity Workout.  Hopefully I can make some good progress without dying from exhaustion.   I'm four days in, and I started at 160 lbs (5' 9" height - body fat % unknown).  Observations from the first few days:

1) There is no way anyone can complete these workouts without additional rest.  I think I'm in fairly good shape, and I can barely go 15 minutes without collapsing in a heap on the floor.  Even the stretches make me sweat.

2) Your calves take a beating.  With all the jumping and quick transitions between exercises, your calves burn like no other pretty much all day.

3) Shaun T. is a freaking insane monster.  At the beginning of every video there's a clip of him yelling like a dinosaur. Said clip is terrifying.  I keep doing this workout in part because I'm afraid of what Shaun T. will do to me if I try to stop.

4) Tania, one of the people in the video working out, is demented.  She has perfect form on all the exercises, she never takes a break, and she smiles the whole time.  She must get some sort of sick satisfaction out of pain...

I will post my stats after 60 days (assuming I finish), hopefully with some good progress.  I'm hoping to drop ~10 pounds from this, while also following my usual clean diet plan.

Monday, June 10, 2013

Pre-M1 Summer: MLK Jr. Memorial

Having lived in DC the past two years, I've seen my fair share of memorials and museums.  However, one that opened recently and that I had not seen was the MLK Jr. Memorial.  Seeing as my fellowship has ended and I have a glut of free time, I decided to trek down to the National Mall this morning and have a look.  Notable pictures below:

Entryway to the memorial

Architect's Inscription

Panorama of the Tidal Basin View from the Memorial

Thursday, June 6, 2013

Pre-M1 Summer: Annapolis

Took a trip out to Annapolis a few weeks ago to check out the Maryland State House and the United States Naval Academy.  The Maryland State House is the oldest active state house in the country, which is pretty cool.  Annapolis itself is a nice little town with a lot of charm, and I would recommend everyone go there. Pictures below:

Thurgood Marshall Memorial

Front Entrance to State House

House Floor

Senate Floor

Deliberation Room


Thursday, May 30, 2013

Dolphin-assisted Birth Comes Under Fire From Science Experts

As profiled in an article in the Daily Mail (, a North Carolina couple is planning a birth "aided" by dolphins.  Yes, you read that correctly, dolphins.  Some of my observations:

  • Since when are marine animals necessary for something humans have been doing successfully for thousands of years?  Did a regular midwife not cut it?  Why dolphins and not some other friendly creature like say, a porcupine?
  • Expert Christine Wilcox, writing in Discover, claims that dolphins are known to "toss, beat, and kill small porpoises or baby sharks for no apparent reason other than they enjoy it."  So, dolphins regularly kill things that can breathe underwater, but this couple think their air-breathing newborn will be fine?
  • Neither parent has a job, and they have no idea where they will live or how they will make money after the birth.  Yeah....on second thought, the baby may be safer with the dolphins.
  • Neither parent has washed their hair in at least a year.  Maybe they should try a birth aided by shampoo.  I hear that they are all the rage in Portland.
If these people don't win a Darwin award, I am going to lose all faith in humanity.

Wednesday, May 22, 2013

New Series: Pre-M1 Summer

With medical school starting soon, I think it's time to start my inaugural blog series focused on my Pre-M1 summer activities.  As part of this series, I'll try to post photos of and provide commentary about what I am doing with the ~2 months of free time I have before medical school starts.  For this first post, I'm going to do an "About Me" so you all can get to know me.

About Me:


- 24 year old male
- Grew up in the SF Bay Area
- Graduated from UC Berkeley in 2011, majored in Molecular and Cellular Biology (Immunology emphasis)
- Spent the last two years doing biomedical research at the NIH near Washington DC
- Attending The Johns Hopkins School of Medicine starting August 2013


-Avid SF Bay Area sports fan (Niners, Giants, Warriors, Sharks)
-Technology and tech journalism (#TeamAndroid)
-Movies/film (especially neo-noir, favorite film of all time is The Usual Suspects)
-Fitness/weightlifting (amateur level, no steroid-infused meat head shenanigans)

The Origin of "401"

No, 401 does not refer to the area code in which I grew up.  It refers to a story amongst my high school friends about creative ways to deal with insomnia that frequently keeps you up until 4:01 AM.  Eventually, we ended up using 401 as a sort of group call sign that made us feel cool and cliquey.  401 didn't actually help us become cool or achieve any significant high school related social status, but it was our thing.  It has stuck since then, and any reunion of high school friends involves a lot of yelling of "401!" and bro-hugging.  It's all very cute, actually.