Patrick A. Tranmer, M.D. - Testimony Excerpts
24 PATRICK TRANMER
19
1 called as a witness on behalf of the Plaintiffs, being
2 first duly sworn, was examined and testified as
3 follows:
4 DIRECT EXAMINATION
5 BY MR. BRICKMAN:
6 Q. Could you state your full name for the
7 record, Doctor?
8 A. Patrick Anthony Tranmer.
9 Q. And where do you live?
10 A. I live in Oak Park, Illinois.
11 Q. And what is your current position or
12 employment?
13 A. I am the department head of family medicine
14 at the University of Illinois at Chicago.
15 Q. Are you, in fact, a medical doctor?
16 A. Yes, I am.
17 Q. And what are your responsibilities in your
18 position at the university?
19 A. As a department head, I am responsible for
20 the management of all departmental activities. In
21 addition, and I see patients two half days a week of
22 my own panel of patients, I teach in a variety of
23 formats approximately two half days a week, and I
24 spend the rest of my time in administrative activities
20
1 related to the management and running of the
2 department.
3 Q. How long have you been seeing patients as a
4 doctor?
5 A. As a doctor since I graduated from medical
6 school.
7 Q. Can you state when that was, please?
8 A. 1977.
9 Q. And during the course of your taking care of
10 your patients, have you counseled them on smoking and
11 health matters?
12 A. Yes.
13 Q. Up until a couple of years ago, have you
14 been counseling them on occasions to switch to light
15 or low tar cigarettes?
16 A. Yes.
17 Q. Why did you do that?
18 A. Because it was my feeling at the time that
19 lower tar cigarettes would be better for them than
20 regular levels of tar cigarettes if they couldn't quit
21 smoking.
22 Q. What made you think that?
23 A. Well, I believe the cigarettes were
24 advertised as being lower in tar and lower in
21
1 nicotine, and they carried the term "light" associated
2 with them, which gave me the impression that they were
3 indeed light, i.e., less potentially harmful.
4 Q. Dr. Tranmer, let's go back a little and
5 let's go through your background if we could, please.
6 A. Okay.
7 Q. Could you give us your educational
8 background?
9 A. Starting when? Let's see. I went to
10 college.
11 Q. Starting in college. You're giving me a
12 hard time now, Doctor. Work with me.
13 A. Okay. I spent my first year of college at
14 St. Thomas College in St. Paul, Minnesota, and then I
15 transferred to the University of Iowa in Iowa City
16 where I completed my four years of college, graduating
17 in 1972.
18 Q. Did you graduate with honors?
19 A. With highest honors.
20 Q. Highest honors. Summa cum laude?
21 A. Yes.
22 Q. Okay. Then what?
23 A. Then in 1973 I started medical school at the
24 University of Iowa, and I finished that program in
22
1 1977. From there I took a residency position at
2 Broadlawns Hospital in Des Moines, Iowa and completed
3 a three year residency training program.
4 Q. What was your residency in?
5 A. Family practice.
6 Q. Family practice. And during this time were
7 you seeing patients?
8 A. Yes.
9 Q. And you were counseling them on smoking and
10 health matters?
11 A. Yes.
12 Q. Are you board certified in any area of
13 medicine?
14 A. In family practice.
15 Q. After your residency, where did you go?
16 A. I went to Muscatine, Iowa, which for those
17 of you not familiar it's a town of about 25,000 people
18 on the Mississippi River, just north of here.
19 Q. And what did you do there?
20 A. I did a full-time clinical practice in
21 family practice.
22 Q. Were you associated with a university at the
23 time also?
24 A. Yes. I had what is called an associate
23
1 position at the University of Iowa. Generally people
2 with an associate position there have agreed to take
3 medical students and residents from their teaching
4 program at their practice site.
5 Q. And while you were there, were you seeing
6 patients?
7 A. Oh, yes.
8 Q. What percentage of your time was spent with
9 patients at Muscatine?
10 A. All my time. 100 percent.
11 Q. Counseling patients on smoking and health?
12 A. Yes.
13 Q. Were any of your patients when you were in
14 Muscatine from the State of Illinois?
15 A. Yes. Many. Well, several of them were.
16 Q. How did you happen to see Illinois patients?
17 A. They would cross the river to come to Iowa
18 because Muscatine was the largest town in the vicinity
19 and had a hospital and had access to several doctors
20 and specialists.
21 Q. Around this time were you licensed to
22 practice --
23 THE COURT: Excuse me. I think you
24 mentioned Mike Fruth is a witness.
24
1 MR. TILLERY: He is a plaintiff, your Honor.
2 THE COURT: Oh, he'll have to leave the
3 courtroom.
4 MR. TILLERY: As a plaintiff though?
5 THE COURT: Oh, plaintiff. I'm sorry.
6 Okay. If he's a plaintiff he can stay. I'm sorry.
7 Q. (By Mr. Brickman): Did you receive a
8 license to practice in the State of Illinois around
9 this time?
10 A. Yes. In 1984.
11 Q. And how long did you stay in Iowa or
12 Muscatine?
13 A. I left there in November of 1986.
14 Q. And where did you go?
15 A. To go to Chicago.
16 Q. And where did you go in Chicago?
17 A. I took a position as a faculty member at the
18 College of Medicine at the University of Illinois.
19 Q. And at that time what responsibilities did
20 you have?
21 A. At that time when I first came on as a
22 faculty member, I was primarily a clinical faculty
23 person, and I spent about 70 percent of my time seeing
24 patients and about 30 percent of my time in teaching
25
1 and minimal administrative activities.
2 Q. Did you also seek an additional degree
3 during this time period?
4 A. Yes. I --
5 Q. What was that in?
6 A. I applied for the master's program in public
7 health at the University of Illinois.
8 Q. Did you, in fact, receive that degree?
9 A. Yes.
10 Q. And when was that?
11 A. Spring of 1990.
12 Q. Get it with honors?
13 A. Yes.
14 Q. Now, when you were -- you said you were on
15 the faculty at the university?
16 A. Correct.
17 Q. And you were teaching students?
18 A. Yes.
19 Q. Did you teach students about smoking and
20 health matters?
21 A. Yes. When I -- well, I specifically when I
22 had students with me in the clinical arena and they
23 would see patients with me and if a patient's smoking
24 history came up, we would talk about cigarette smoke
26
1 and the problems related to health and/or discuss ways
2 to recommend discontinuation of cigarette smoking.
3 Q. Did you also give classroom lectures that on
4 occasion touched on the matter?
5 A. Yes. We talked about preventive health
6 issues in general and smoking was included in that.
7 Q. And were you also seeing patients during
8 this time you said?
9 A. Yes.
10 Q. What sort of patients were you seeing then?
11 A. Anybody who walked in the door. As a family
12 physician we see all ranges -- excuse me -- we see all
13 ranges in age and whoever called to make an
14 appointment would be seen. Many of them were students
15 at the university, many were employees of the
16 university, but a lot of them were also community
17 members who lived in the city of Chicago or in the
18 suburbs.
19 Q. Were you seeing patients who were also
20 suffering from diseases or illnesses caused by
21 cigarette smoking?
22 A. Oh, yes.
23 Q. Over time has the percentage of time you
24 spent with patients changed?
27
1 A. Yes. As I guess moved up, I have had more
2 administrative responsibilities and, therefore, have
3 had less time to do patient care.
4 Q. But you are still seeing patients?
5 A. Yes, I am.
6 Q. When was the last time you saw a patient?
7 A. Monday.
8 Q. Monday?
9 A. Yes.
10 Q. All right. Let's go when you were at --
11 since you've been in Chicago, you've been seeing
12 patients in various different locations?
13 A. Yes.
14 Q. Could you tell us where?
15 A. Although I was -- I've always been a
16 full-time salaried faculty member -- well, I've always
17 been a salaried faculty member at the University of
18 Illinois, we would develop contracts with certain
19 agencies or groups to either provide clinical care and
20 teaching. These included staffing residents at St.
21 Elizabeth's Hospital in Chicago, Christ Hospital in
22 Oak Lawn. I also saw patients directly at Miles
23 Square Health Center, which is a community health
24 center on the west side of Chicago, and I saw patients
28
1 at the American Indian Health Services Clinic in
2 Chicago.
3 Q. Let's go back in time if we could a little,
4 Doctor, and let's go back to your medical school
5 training and your residency. Were you taught about
6 the hazards of smoking?
7 A. Yes.
8 Q. What were you basically taught about smoking
9 and disease?
10 A. Well, I was taught that cigarette smoking
11 was the greatest risk factor for certain pulmonary
12 diseases such as emphysema, chronic bronchitis, and
13 lung cancer. I was also taught that it had an
14 implicating factor in other diseases such as
15 hypertension and heart disease, among others.
16 Q. Were you taught in general terms what was
17 the primary constituent in cigarette smoking that was
18 causing the problem?
19 A. What was known as tar.
20 Q. Is the university or was the university that
21 you went to for medical school an accredited
22 institution?
23 A. Yes.
24 Q. Was your education, as far as you know,
29
1 consistent with that offered in other accredited
2 schools across the country?
3 MR. LOMBARDI: Objection --
4 A. Yes.
5 MR. LOMBARDI: -- to the form and
6 foundation.
7 THE COURT: Overruled.
8 Q. (By Mr. Brickman): Was the curriculum that
9 you undertook when you were in medical school, as far
10 as you know, consistent with the curriculum in other
11 accredited universities across this country?
12 MR. LOMBARDI: Objection. Foundation.
13 MR. BRICKMAN: Your Honor, we would be happy
14 to lay a basis -- lay a foundation.
15 Q. (By Mr. Brickman): Do you know how schools
16 get accredited?
17 A. Medical schools in the United States get
18 accredited by an agency called LCME which is a
19 licensing commission on medical education which gets
20 input from a variety of agencies, and they go through
21 a licensing process every seven years.
22 Q. And do you have to have at least a certain
23 minimum curriculum?
24 A. Oh, yes. It's very stringent.
30
1 Q. Okay. And was your school accredited by the
2 LCME?
3 A. Yes, it was.
4 Q. Okay. And is it on that basis that you have
5 the opinion that the curriculum was similar to all
6 other accredited schools?
7 A. Yes, that's part of the reason.
8 Q. Okay. Is the university you're now at
9 accredited?
10 A. Yes.
11 Q. And do you follow curriculum similar to
12 those across the country of other accredited
13 institutions?
14 A. Yes.
15 Q. Dr. Tranmer, let me ask you this. You have
16 practiced in the field of general medicine, correct?
17 A. Correct.
18 Q. How does a scientific principle, a new
19 scientific principle become the consensus for the
20 general medical community? How does that take place?
21 A. Well, I would -- I would have to answer that
22 question in general from the way I observe things
23 happening. I think research is done about a
24 particular problem. In my area it's probably mainly
31
1 about a clinical problem. If a research shows a
2 particular outcome, then that information is
3 published. Other people around the country or the
4 world may use similar types of investigations and
5 publish research that supports or refutes what was
6 initially published. If there seems to be a lot of
7 research that supports a particular practice in
8 clinical medicine, that information is published in
9 journals, it's talked about at conferences, it's
10 discussed among colleagues, and it becomes the
11 standard of care.
12 Q. Dr. Tranmer, since the time you graduated
13 from medical school, finished your residency, and
14 begun taking care of patients, have you tried to keep
15 up with the medical literature in your field?
16 A. I certainly try.
17 Q. Have you done so so that you can take the
18 best care of your patients?
19 A. I believe I have.
20 Q. Where do you receive most of your
21 information that you use in the care of your patients?
22 A. In a variety of ways. I read journals, I go
23 to continuing medical education conferences, I discuss
24 with colleagues. I am now subscribing to a couple of
32
1 on-line listener CME data bases. I look at medical
2 records of patients treated by other physicians and
3 see how they're treating. I discuss with specialists,
4 et cetera.
5 Q. And do you do that in order to keep up?
6 A. Yes.
7 Q. Do you do that in order to take the best
8 care you can of your patients?
9 A. Yes.
10 Q. Do you care about your patients?
11 A. Oh, absolutely.
12 Q. Over time have you been receiving
13 information about smoking and health issues from these
14 various sources that you've just related to us?
15 A. Yes.
16 Q. You mentioned earlier that you were taught
17 in medical school that tar was the constituent in
18 cigarette smoking that was dangerous and caused harm.
19 Do you know what tar is?
20 A. Well, I know what I've read about what tar
21 is, and I've read that tar is a -- actually it's a
22 mixture of a lot of chemicals and chemical agents
23 including tars. But there's also other chemical
24 components including formaldehyde, arsenic, --
33
1 Q. Do you know all the chemical components?
2 A. No. Absolutely not. There's thousands I
3 believe.
4 Q. Do you know how much tar it takes to get
5 somebody sick?
6 A. No.
7 Q. Do you know how much a smoker has to smoke
8 to get sick?
9 A. No.
10 Q. Is there, however, a dose response
11 relationship in your opinion with regard to cigarette
12 smoking?
13 A. Yes. I believe that it was fairly common in
14 education that the more you smoke the higher your
15 risk.
16 Q. What was the significance of that in your
17 practice?
18 A. Well, I would try to -- first of all, I
19 would try to get people to quit smoking altogether.
20 And if they couldn't quit smoking, I would try to get
21 them to cut down on their smoking to do basically risk
22 reduction, harm reduction.
23 Q. Was one of the ways that you got them to
24 hopefully reduce their risk was by switching to lower
34
1 tar or light cigarettes?
2 A. Yes.
3 Q. Let me go back. Prior to 2000 or 2001, had
4 you been taught about a concept that smokers smoke in
5 order to achieve either a desired dose of nicotine per
6 cigarette or on a daily basis?
7 A. Not that I recall.
8 Q. Were you taught or did you know prior to
9 2000 or 2001 that smokers alter their behavior when
10 they switch cigarettes in order to get to that dose of
11 nicotine that they need?
12 A. No, I wasn't.
13 Q. Before 2000 or 2001, were you familiar with
14 what is known as the FTC testing method?
15 A. No.
16 Q. Did you understand how the tar and nicotine
17 numbers that were placed on advertisements on
18 cigarettes were done?
19 A. No.
20 Q. Had you been educated in any way about a
21 relationship, if any, between the tar and nicotine
22 numbers as advertised on the advertisements for
23 cigarettes and disease risks?
24 A. No.
35
1 Q. With regard to your patients when they would
2 come in, would you -- well, let me ask you this. Do
3 you now take smoking histories?
4 A. Oh, yes.
5 Q. How long have you been doing that?
6 A. Since I graduated from medical school
7 including while in medical school.
8 Q. Why do you do it?
9 A. I do it to assess, among other things, what
10 are the risks that a patient might be able to lower in
11 order to improve their health.
12 Q. A ballpark, how many people have you seen,
13 patients that you have seen that you have counseled on
14 smoking and health matters?
15 A. Oh, thousands.
16 Q. And are some of those thousands include the
17 State of Illinois?
18 A. Yes.
15 Q. (By Mr. Brickman): Let's talk about some of
16 the patients just in general terms.
17 A. Okay.
18 Q. When one of your patients came to you and
19 said they smoke cigarettes, what advice would you give
20 them?
21 A. I would -- I would ask them how much they
22 smoked, I would try to figure out what the triggers
23 were that they had for smoking, i.e., to understand as
24 best as possible why they smoked and under what
37
1 circumstances, and then I felt that I could use that
2 information to better counsel them about the most
3 successful way that they might quit smoking.
4 Q. And what are some of the approaches you used
5 to get them to quit smoking?
6 A. I -- first of all, I tried to get them to
7 quit altogether.
8 Q. Right.
9 A. And if they couldn't quit altogether, I
10 would try to get them to reduce the amount of
11 cigarettes that they smoked. I would recommend that
12 they cut down the total number that they smoked in a
13 day. I would recommend that they smoke the cigarettes
14 less far down. In other words, not smoke as much of
15 each cigarette. And if they were smoking a regular
16 brand of cigarettes or an unfiltered brand of
17 cigarettes, I would recommend that they switch to a
18 brand with a filter or a light cigarette to reduce
19 their risk.
20 Q. Now, this advice you were giving them on not
21 smoking as far down or smoke less cigarettes, that
22 applied no matter what type of cigarette they were
23 smoking too?
24 A. Yes.
38
1 Q. Now, you also mentioned earlier that you
2 also recommended they switch down to a lighter or
3 lower tar --
4 A. Uh-huh.
5 Q. -- brand? Did you have reasons for those
6 type of cigarettes being recommended?
7 A. Well, I was under the impression that if the
8 cigarette was a light cigarette or claimed to have
9 lower tar and nicotine that the patient would actually
10 ingest lower tar and nicotine when they smoked it,
11 and, therefore, it would be better for their health
12 than not to make any change at all.
13 Q. The fact that it had lower nicotine, what
14 import did that have in your recommending that type of
15 cigarette?
16 A. Well, a lot of patients don't have --
17 probably most patients don't have the ability to go
18 cold turkey, which is to just stop smoking. And it's
19 because of the nicotine in the cigarettes, they
20 develop a certain dependence to it. And I would say I
21 do this with other addicting substances as well, but I
22 would encourage them to reduce the dose of nicotine so
23 that they would thereby reduce their need to have the
24 cigarette and thereby also reduce the amount of tar
39
1 that they inhale when they did smoke.
2 Q. So let me get this straight. You were
3 telling them to reduce the amount of nicotine in order
4 to try to wean them off the cigarettes?
5 A. Yeah. The goal was to have them stop
6 smoking completely. It wasn't -- the goal wasn't to
7 switch to a lighter brand and stop there. The goal
8 was to stop smoking. And so I used it as a method to
9 assist in their discontinuation of smoking.
10 Q. And as I understand, you also hoped that by
11 lowering the tar, it would be hopefully a reduced risk
12 of getting a disease from it?
13 A. Sure.
14 Q. Was that your practice up until a year or
15 two ago, a couple of years ago?
16 A. Yes. I would say that's correct.
17 Q. Did you recommend any specific brand to your
18 patients within the light or low tar category?
19 A. No.
20 Q. Are, however, Marlboro Lights and Cambridge
21 Lights the type of cigarette, the general -- within
22 the general context of cigarettes that you would
23 recommend?
24 A. Yes. If they were light cigarettes, yes,
40
1 they are.
2 Q. Tell us specifically what was the basis or
3 what was your thought process, or where did you learn
4 about that these cigarettes might be better for you?
5 A. Might be better for you?
6 Q. Yeah. Might have lower tar and nicotine.
7 A. I think it was -- I certainly -- I don't
8 recall reading that in a journal or going to a talk
9 and hearing about that information. I -- it made --
10 it made logical sense to me that indeed if they were
11 advertising delivering lower tar and nicotine, that
12 the less tar and nicotine somebody inhaled the better
13 it would be for them. They were also advertising the
14 light, and I interpreted that, and I think most people
15 did, as being light on tar and nicotine. Therefore,
16 you smoke -- therefore, if you smoke a lighter brand
17 of cigarettes, you would be doing some risk reduction
18 as opposed to smoking a regular brand or an unfiltered
19 cigarette.
20 Q. Was it your understanding that a cigarette
21 such as a Marlboro Light or a Cambridge Light was
22 supposed to be lower in tar and nicotine because of
23 the use of the name light?
24 A. Yes.
41
1 Q. Was it your operative assumption in
2 recommending cigarettes in that category that they
3 were, in fact, safer?
4 A. Yes.
5 Q. Did you ever interpret the word "light" in
6 cigarettes such as a Marlboro Light or a Cambridge
7 Light to refer to taste?
8 A. No.
9 Q. Do you know if any of your patients took
10 your advice?
11 Q. (By Mr. Brickman): To your knowledge, did
12 at least some of your patients heed your advice and
13 switch down to lower tar or allegedly low tar and
14 light cigarettes?
5 Q. (By Mr. Brickman): Do you remember the
6 question, Doctor?
7 A. Yes. In general I believe some do.
8 Q. Did you stop that practice of recommending
9 allegedly lower tar or light cigarettes?
10 A. Yes.
11 Q. Why?
12 A. I think in the last couple of years, it's
13 become more of a common practice to understand that
14 there's no such thing as a good cigarette in terms of
15 health and risk reduction, so I don't recommend
16 switching to a cigarette purporting to be lower in tar
17 and nicotine anymore. I just try to get people to
18 reduce the number of cigarettes or stop smoking
19 hopefully completely.
20 Q. Is it now your understanding that those
21 allegedly lower tar and nicotine cigarettes and those
22 allegedly light cigarettes are not, in fact, lower in
23 tar when they are smoked?
24 A. Yes, that is -- that is my understanding.
45
1 Q. Is it now your understanding that those
2 cigarettes are not, in fact, any safer than regular
3 cigarettes?
4 A. Yes.
5 Q. If you had known that, Doctor, in the past,
6 would you have recommended low tar or light
7 cigarettes?
8 A. No.
9 MR. LOMBARDI: Objection. Speculation. It
10 calls for speculation from the witness.
11 THE COURT: Overruled.
12 A. No, I would not have.
13 MR. BRICKMAN: I beg the Court's indulgence
14 one minute.
15 Q. (By Mr. Brickman): It's a problem when you
16 go ask other lawyers questions, Doctor. They always
17 seem to have more.
18 Doctor, you reference the fact that you have
19 recently changed your opinion on low tar and light
20 cigarettes. Is that in part at least related to the
21 introduction of Monograph 13 by the International
22 Cancer Institute?
23 A. Yes.
24 Q. And what does Monograph 13 represent as far
46
1 as your understanding as to general medical thought --
2 A. Well, Monograph 13 was published by the
3 International Cancer Institute and presented a variety
4 of evidence based research on the health benefits --
5 health risks of cigarette smoking. And the
6 information that I understand to have come from
7 Monograph 13 was -- is that what we had talked about a
8 little bit before, that no cigarette really is safe,
9 that cigarettes purportedly lower in tar and nicotine
10 actually don't reduce risk because oftentimes patients
11 will compensate by altering their smoking behaviors to
12 get the same dose of nicotine if you will and thereby
13 increase their dose of tar and other harmful
14 substances as well.
15 Q. How did you learn about the substance or the
16 basic facts within Monograph 13?
17 A. The various significance of Monograph 13 or
18 discussions about these new findings have been in a
19 variety of informational resources, whether they be in
20 journals or handouts or talked about by colleagues.
21 Q. And do you now follow the basic tenet that
22 you understand from Monograph 13 in taking care of
23 your patients?
24 A. Yes.
47
1 Q. And do you do that because you want to give
2 the best care of your patients?
3 A. Oh, sure, yes.
4 Q. And have you always wanted to give the best
5 care of your patients?
6 A. Yes.
7 MR. BRICKMAN: Thank you, sir. That's all
8 we have.
9 THE COURT: You may cross-examine.
10 MS. BAUER: Thank you, Judge.
11 CROSS-EXAMINATION
12 BY MS. BAUER:
13 Q. Good afternoon, Dr. Tranmer.
14 A. Hi.
15 Q. Do you remember me? My name is Julie Bauer.
16 A. I sure do.
17 Q. And you remember that I represent Philip
18 Morris in this case; --
19 A. Yes.
20 Q. -- is that right?
21 A. Uh-huh.
22 Q. Let me go back and talk a little bit about
23 your medical school days. You mentioned that the
24 University of Iowa was an accredited medical school --
48
1 A. Yes.
2 Q. -- when you were there; is that right?
3 A. Uh-huh.
4 Q. And the education that you received at the
5 University of Iowa College of Medicine, do you think
6 would be consistent with that that med students would
7 receive at accredited medical schools the same as
8 Illinois at that time; is that right?
9 A. Yes.
10 Q. And you would also expect the education that
11 you received at the University of Iowa to be
12 consistent with the education that medical students
13 were receiving at accredited medical schools across
14 the country at that time; --
15 A. Yes.
16 Q. -- is that right?
17 A. Yes.
18 Q. And so what you were learning about the
19 association between tar and cigarette smoke and
20 disease was learned by medical students across the
21 country at the time; is that right?
22 A. That was my presumption, yes.
23 Q. Okay. And since you've graduated from
24 medical school, if I understand correctly, you
49
1 continue to receive information about smoking and
2 health; is that right?
3 A. Yes.
4 Q. And one of the places that you've received
5 that information is through medical journals that you
6 read, right?
7 A. Correct.
8 Q. And those journals include things like the
9 New England Journal of Medicine?
10 A. Yes.
11 Q. Is that right?
12 A. Uh-huh.
13 Q. And the Journal of the American Medical
14 Association?
15 A. Yes.
16 Q. And the Journal of Family Practice?
17 A. Yes.
18 Q. Things like that?
19 A. Yes. The American Family Physician.
20 Q. American Family Physician. Thank you,
21 Doctor. And you've also received a master's in public
22 health since the time that you graduated from medical
23 school; is that right?
24 A. Correct.
50
1 Q. Do you consider yourself to be a member of
2 the public health community?
3 A. I consider myself to be a member of the
4 medical community with an understanding of public
5 health.
6 Q. Okay. During the course of your
7 professional career, you've never received any
8 information about smoking and health from Philip
9 Morris, have you?
10 A. No. Well, no. Not in -- not in my
11 professional career.
12 Q. Okay. While you were in medical school you
13 learned that there was a relationship between smoking
14 and disease; is that right?
15 A. Yes.
16 Q. Did I understand your testimony correctly?
17 A. That's true.
18 Q. And you understood in particular that
19 cigarette smoking was related to certain diseases of
20 the lung like lung cancer and emphysema and chronic
21 bronchitis; --
22 A. Yes.
23 Q. -- is that right?
24 A. Uh-huh.
51
1 Q. And you also learned that cigarette smoking
2 had been implicated in high blood pressure and heart
3 disease?
4 A. Uh-huh.
5 Q. And you learned this back in your second
6 year of medical school in about the mid '70s; is that
7 right?
8 A. I can't say exactly when I learned it. It's
9 things that I came out of medical school with.
10 Q. Okay. So some time prior to 1977 you were
11 aware of these things; is that right?
12 A. Probably, yes.
13 Q. Okay. And you learned that these particular
14 health risks resulted from the tar that was in
15 cigarette smoke; is that right?
16 A. Yes.
17 Q. And that there was a relationship between
18 the amount of tar a smoker received and their risk of
19 disease; is that right?
20 A. Yes. The amount of the -- right.
21 Q. Okay. So that if someone say smoked more
22 cigarettes, they would have a greater risk of getting
23 one of these diseases than someone who smoked fewer
24 cigarettes; --
52
1 A. Correct.
2 Q. -- is that right? And, generally speaking,
3 the less tar that you got, a smoker got in his or her
4 body, the better off they would be; is that right?
5 A. Correct.
6 Q. And you also believed that cigarettes that
7 were branded as low tar or light would deliver less
8 tar to a smoker?
9 A. Yes.
10 Q. And because those cigarettes delivered less
11 tar, they would present less of a health risk to a
12 smoker; is that right?
13 A. That's correct.
14 Q. And these were the bases for the advice that
15 you gave to your patients; is that right?
16 A. Yes.
17 Q. You mentioned, Doctor, that you're a family
18 physician, was that right?
19 A. That's correct.
20 Q. And that's one of a type of primary care
21 physicians?
22 A. Yes.
23 Q. And one of the things that primary care
24 physicians do is look at behaviors their patients
53
1 engage in that increase the risk of disease; is that
2 right?
3 A. Yes.
4 Q. And one of those behaviors includes whether
5 the patient smokes?
6 A. Yes.
7 Q. And if they smoke, how much they smoke?
8 A. Yes.
9 Q. And so you routinely ask all of your
10 patients whether they smoke and if they smoke how much
11 they smoke; is that right?
12 A. Yes. I routinely ask those patients that
13 I'm seeing for a preventative health kind of an issue,
14 yes.
15 Q. Okay. And you've routinely asked those
16 patients those questions say since the mid to late
17 1970s; is that right?
18 A. Yes.
19 Q. You've asked those questions of thousands of
20 patients over the years?
21 A. Correct.
22 Q. And you've asked those questions of
23 thousands of patients who live in the State of
24 Illinois; is that right?
54
1 A. I presume so.
2 Q. Okay. And let me ask you a little bit about
3 where your patients get advice about smoking and
4 health. Based on your experience, patients get that
5 advice from their doctors; is that right?
6 A. Yes. That's one of the sources.
7 Q. And another one of the sources is media,
8 such as newspapers or television or today the
9 Internet; is that right?
10 A. Yes.
11 Q. And they also get information on smoking and
12 health from people they know like family members and
13 friends; is that right?
14 A. Yes.
15 Q. Let's talk about the advice that you were
16 giving to your patients who smoked, say from the time
17 you completed your residency up until a year ago.
18 Now, first, as I understand it, your first
19 recommendation was that if they smoked, they should
20 stop smoking; is that right?
21 A. Yes.
22 Q. And if they weren't able to do that, to stop
23 cold turkey, you recommended ways that they could
24 reduce the amount of smoke they would get; is that
55
1 right?
2 A. Yes.
3 Q. And you would recommend that they reduce the
4 number of cigarettes they smoked?
5 A. Uh-huh.
6 Q. Is that right?
7 A. Yes.
8 Q. And you would recommend the amount of the
9 cigarette they smoked?
10 A. Yes.
11 Q. And you would recommend that they switch to
12 a cigarette that was light or low tar; is that right?
13 A. Yes.
14 Q. You were basically looking to reduce the
15 amount of tar and nicotine that those patients got; is
16 that right?
17 A. That's correct.
18 Q. And one of the reasons that you recommended
19 to them was you thought if they could switch to a low
20 tar or a light cigarette, they could gradually wean
21 themselves off of the nicotine; is that right?
22 A. That might be one step of the process to
23 help them, yes.
24 Q. Okay. You did not recommend, as I
56
1 understand, any specific brand of cigarettes to your
2 patients; is that right?
3 A. No, I didn't.
4 Q. And you didn't recommend that they smoke a
5 cigarette that had a particular tar level, did you?
6 A. No.
7 Q. You didn't recommend that they reduce their
8 tar level by any certain percentage, did you?
9 A. No.
10 Q. You used the word "lights" when you made
11 this recommendation?
12 A. Yes.
13 Q. And you believed that using the word
14 "lights" would help your patients identify the
15 cigarettes that you were recommending that they
16 smoked?
17 A. I wasn't recommending that they should still
18 smoke. I was recommending that patients would reduce
19 their risk. I thought that if they smoked a cigarette
20 with lower tar and nicotine delivery, that they would
21 reduce their risk.
22 Q. That's fair enough, Doctor. And in using
23 the word "lights" you thought you were helping your
24 patients identify the cigarettes that you wanted them
57
1 to smoke if they were going to continue to smoke?
2 A. That were safer to smoke if they continued
3 to smoke.
4 Q. Right. And my question, Doctor, is that you
5 were using the word "lights" because you thought it
6 was helpful to the patients in identifying those
7 cigarettes?
8 A. I think the patients understood what I was
9 referring to when I used the term "lights" in
10 relationship to cigarettes, yes.
11 Q. Okay. When you gave that advice to your
12 patients, you were intending that they rely on it?
13 A. I was intending that they would listen to
14 what I had to say, yes.
15 Q. Okay. And hoping that they would rely on
16 it?
17 A. And hoping, of course.
18 Q. And some of those patients, in fact, took
19 your advice?
20 A. I believe some of them did, yes.
21 Q. Okay. And based on your advice, they
22 switched from a full flavored unfiltered cigarette to
23 a low tar or light cigarette, right.
24 A. I think that some of them might have, yes.
58
1 Q. Can you tell me how many of your patients
2 took the advice to switch to low tar or light
3 cigarettes?
4 A. No, I can't.
5 Q. Is there any way I could identify who they
6 are?
7 A. No.
8 Q. And you can't tell me who they are; is that
9 right?
10 A. I could tell you the name of one patient.
11 Q. What's the name of that one patient?
12 A. That patient is named David Eckert.
13 Q. And where does Mr. Eckert live?
14 A. Well, he doesn't -- he's dead now.
15 THE COURT: Well, excuse me. Is Mr. Eckert
16 involved in this lawsuit?
17 MR. TILLERY: I think he's expired now.
18 THE WITNESS: He's expired now.
19 THE COURT: Oh, I just wanted to know with
20 respect to his claim.
21 Q. (By Ms. Bauer): And, Dr. Tranmer, the
22 advice that we've just talked about that you gave to
23 your patients about quit smoking or if not to take
24 these various steps to reduce the amount of tar and
59
1 nicotine that you gave them, you gave that advice --
2 and I'm going back to the time that you were a
3 resident in Iowa.
4 A. Yes.
5 Q. And you gave that same advice to patients
6 that you were seeing when you were practicing in
7 Muscatine, Iowa; is that right?
8 A. Yes.
9 Q. And as I understand it, your practice in
10 Muscatine, Iowa involved both patients who lived in
11 Iowa and some patients -- some patients who lived in
12 Illinois; is that right?
13 A. Correct.
14 Q. And you also gave this advice after you
15 moved to the State of Illinois and practiced here from
16 1987 up until about a year or two ago; is that right?
17 A. Correct.
18 Q. So you gave this advice consistently
19 throughout your professional career until the last
20 couple of years; is that right?
21 A. Yes.
22 Q. And you would estimate that you gave this
23 advice to thousands of patients over that time period?
24 A. No. I just talked to thousands of patients
60
1 about smoking. I would not be able to estimate the
2 number of patients that I actually told to smoke light
3 cigarettes. Or I didn't tell them to smoke light
4 cigarettes. I said if you have to smoke, switch to a
5 lower tar brand.
6 Q. Okay. The advice that you gave to patients
7 to switch to light cigarettes if they could not stop
8 smoking, represented the common consensus and a method
9 to decrease patients risk of smoking related disease
10 during that period; is that right?
11 A. Whether it was a common consensus or not,
12 it's what I did, and I know that some of -- that
13 others of my colleagues did.
14 Q. Okay. You know that other colleagues of
15 yours in the State of Illinois gave similar advice to
16 their patients during that same time period; is that
17 right?
18 A. I presume they did, yes.
19 Q. And most likely some of their patients
20 followed that advice?
21 A. They might have.
22 Q. And you would have no way of identifying for
23 me any of those patients; is that right?
24 A. Correct.
61
1 Q. Is there any way that you can quantify the
2 numbers of patients who took that advice from their
3 physicians --
4 A. No.
5 Q. -- during this time period?
6 In the last couple of years you mentioned
7 that your advice to patients has changed; is that
8 right?
9 A. Correct.
10 Q. Okay. And that's partly because you now
11 understand that some smokers might compensate when
12 they smoke the low tar cigarettes; is that right?
13 A. Correct.
14 Q. Okay. But you still understand that if a
15 patient switches to low tar cigarettes and doesn't
16 engage in compensatory smoking behaviors that they
17 might have a reduced risk of disease; is that right?
18 A. I don't know that.
19 Q. You don't have any understanding one way or
20 the other on that?
21 A. No, I don't know that at this point in time.
22 Q. When you advised your patients who smoked
23 that if they could not smoke, they should switch to
24 low tar cigarettes, you were not trying to mislead
62
1 your patients in any way, were you?
2 A. No.
3 Q. And when you gave your patients that advice,
4 you were not trying to deceive them in any way, were
5 you?
6 A. No.
7 Q. Okay. You don't believe you should be held
8 liable for giving that advice, do you?
9 MR. BRICKMAN: Objection.
10 THE COURT: Be sustained.
11 Q. (By Ms. Bauer): You believe that that
12 advice was proper even if the consensus on whether
13 that advice should be given that came subsequent to
14 that time; is that right?
15 A. I believe that I was doing the best job I
16 could.
17 Q. And you were giving -- doing the best job
18 you could by giving that advice?
19 A. I was doing the best job I could by trying
20 to get people to quit smoking.
21 Q. You mentioned during your direct testimony,
22 Dr. Tranmer, that you take a smoking history from your
23 patients; is that right?
24 A. Yes.
63
1 Q. And one of the reasons that you do that is
2 to determine whether your patient is addicted to
3 tobacco?
4 A. I do that to determine how much a patient
5 uses and to get an idea of what approach to take to
6 get them to reduce.
7 Q. Do you also use that smoking history to make
8 the assessment that a patient is addicted to tobacco?
9 A. That they might be addicted to tobacco.
10 Q. And sometimes you do make a diagnosis that a
11 patient is addicted to tobacco; is that right?
12 A. Yes. I would say now that I do.
13 Q. And you make that diagnosis on the basis of
14 a patient's smoking history; is that right?
15 A. Yes, I do.
16 Q. You would not make --
17 A. Not -- yes. Yes, I do.
18 Q. You would not make that diagnosis without
19 knowing a patient's smoking history?
20 A. No.
21 Q. Okay. Not all smokers are addicted to
22 tobacco; is that right?
23 A. My understanding is that there is a broad
24 spectrum of tobacco use by individual patients. I
64
1 don't know that there is a clear definition of the
2 term "addiction" as in tobacco addiction. If I make a
3 diagnosis of tobacco addiction, I make it on the basis
4 of the patient's report of how difficult it is to quit
5 smoking and whether or not they've tried to quit
6 smoking and been unsuccessful.
7 Q. And basically you do that on a patient by
8 patient basis; is that right?
9 A. Uh, --
10 Q. You need to inquire of the individual
11 patient before you make a diagnosis; is that right?
12 A. Yes.
13 Q. And when you say that there's a broad
14 spectrum, you mean there's a great deal of variation
15 in people's use of tobacco; is that right?
16 A. Correct.
17 Q. And you understand that not all smokers are
18 addicted?
19 A. I think that not all smokers are necessarily
20 addicted, but it also depends on how you define the
21 term "addiction", and I think in the realm of tobacco,
22 it's not clear what that definition is.
23 Q. Would you agree with me that no one is
24 addicted to a particular brand of cigarettes, Dr.
65
1 Tranmer?
2 A. If someone uses tobacco I'm not -- it is my
3 understanding that there is no difference in terms of
4 which particular brand name might be used.
5 Q. Okay. So you've never heard someone is
6 addicted to this cigarette versus that cigarette; is
7 that right?
8 A. No.
9 Q. And you would agree with me, sir, that even
10 smokers who are addicted to tobacco can quit smoking;
11 is that right?
12 A. I think that anybody who smokes cigarettes
13 can quit smoking, yes.
14 MS. BAUER: May I have a minute?
15 THE COURT: (Nodding.)
16 MS. BAUER: Thank you, Dr. Tranmer.
17 MR. BRICKMAN: Dr. Tranmer, --
18 THE COURT: Redirect.
19 REDIRECT EXAMINATION
20 BY MR. BRICKMAN:
21 Q. Where did you learn about the word "lights"
22 in conjunction with a cigarette?
23 A. I would have learned it through the media.
24 Q. Did you learn it from your medical journals?
66
1 A. No.
2 Q. Where did you learn about cigarettes being
3 lower in tar?
4 A. From cigarette advertising.
5 Q. Did you learn that in any medical journals?
6 A. No.
7 Q. Did the medical journals tell you that
8 lights or lower tar were better for you?
9 A. No.
10 Q. The source of your information with regard
11 to lights and lower tar came from the advertising from
12 the tobacco companies?
13 A. Yes. I would have to say it did.
14 MR. BRICKMAN: That's all I have.
15 MS. BAUER: Judge, just very briefly.
16 THE COURT: Recross.
17 MS. BAUER: Thank you.
18 RECROSS-EXAMINATION
19 BY MS. BAUER:
20 Q. Dr. Tranmer, you didn't learn about the dose
21 response relationship between tar and disease from
22 advertising, did you?
23 A. I did not learn that from advertising.
24 Q. You learned that back in your medical
67
1 education and training; is that right?
2 A. That's correct.
3 Q. And you've never heard any statement from
4 Philip Morris that light cigarettes were safe
5 cigarettes, have you?
6 A. Not that I recall.
7 Q. And you've not heard any statement from
8 Philip Morris that light cigarettes presented a less
9 risk of disease than other cigarettes, have you?
10 A. I have not --
11 Q. You've never --
12 A. -- heard that.
13 Q. Okay. You've never seen that in any
14 advertising for Marlboro Lights or any other brand of
15 cigarettes, have you?
16 A. Not that I recall.
17 Q. Okay. You've heard those types of things
18 and learned about the dose response relationship
19 between tar and disease through your medical training;
20 is that right?
21 A. Correct.
22 MS. BAUER: Okay.
23 MR. BRICKMAN: Your Honor, just one
24 follow-up question.
68
1 THE COURT: Well, hold it. As long as it's
2 included in --
3 MR. BRICKMAN: Absolutely.
4 RE-REDIRECT EXAMINATION
5 BY MR. BRICKMAN:
6 Q. The word "light", the word "lower tar" that
7 were on their advertising, was that an euphemism for
8 you for safer?
9 MR. LOMBARDI: Objection, your Honor.
10 MS. BAUER: Objection.
11 MR. LOMBARDI: If I can be formal about it,
12 a foundation for him to testify to what is or is not
13 an euphemism, --
14 MR. BRICKMAN: I'll use a different word if
15 he doesn't like euphemism.
16 THE COURT: Why don't you -- well, I'm going
17 to sustain the objection as to the form of the
18 question at this time.
19 Q. (By Mr. Brickman): Did those words mean
20 safer to you?
21 A. It was my understanding that a lighter
22 cigarette was a safer cigarette.
23 MR. BRICKMAN: Thank you, sir.
24 THE COURT: Okay. I believe we're done.
69
1 All right. You may step down, Doctor.
2 MR. BRICKMAN: May this witness be excused?
3 THE COURT: Sir?
4 MR. BRICKMAN: May he be excused?
5 THE COURT: Yes, you may be excused.
6 MR. BRICKMAN: Thank you.
7 (Witness excused.)