Balkinization  

Thursday, April 02, 2009

More on Sen. Gillibrand (and evaluating actions)

Sandy Levinson

The following letter appears in today's New York Times:

Gillibrand Defended the Unpopular. So Did Adams.

To the Editor:

Re “As New Lawyer, Senator Defended Big Tobacco” (front page, March 27):

Senator Kirsten E. Gillibrand of New York should be lauded, not criticized, for her representation of an unpopular client.

One of the great traditions of American law, dating at least from the time John Adams represented the British soldiers accused in the Boston Massacre, is that our best lawyers represent the despised and unpopular, particularly those accused of or investigated for alleged crimes.

Had these lawyers, in consideration of their political futures, chosen not to represent such people or entities, we Americans would not have many of the liberties we cherish.

Lawrence S. Goldman

New York, March 27, 2009

The writer is a former president of the National Association of Criminal Defense Lawyers.


Were I still teaching courses on the legal profession and professional responsibility, as I did over a period of twenty years, I would be tempted to use this for a final exam and ask students whether the analogy between John Adams and Kirsten Gillibrand is really cogent. I obviously think it is not, beginning with the fact that John Adams was genuinely putting his career at stake in doing the right thing by representing Major Preston. Ditto for Atticus Finch and other models of lawyers who stand up to represent vulnerable people against the potential loss of liberty. But what in the world does this have to do with a young, ambitious lawyer who self-consciously decides to cast her lot with the tobacco industry and to make lots of money and prepare herself for a fast-track partnership, should she have wanted to remain in private practice, by using her skills to help it continue to induce addiction and death in millions of people around the world?

I am curious whether Mr. Goldman or other defenders of Ms. Gillibrand would wish to "laud" her by presenting her the (hypothetical) "John Adams Award" given to those lawyers who provide exemplary models of lawyering. Should we invite her to our law schools and parade her before our students as an example of a well-lived life in the law? Indeed, should we admire Carl Schmitt for using his formidable legal talents to defend the Nazi takeover of the Prussian government in 1933 because, after all, we can never judge lawyers on the basis of the causes they commit themselves to in their role as lawyers?

Note that I certainly believe that all of the alleged war crminals at Nuremberg deserved vigorous defenses, and this would have applied to Hitler as well, had he lived. I also have no objection to Bernard Madoff receiving first-rate representation in defending himself against the criminal charges. But is that really the issue we're discussing? Would we be as eager to defend a Madoff lawyer who energentically did everything he/she could to sidetrack any SEC inquiries and the like, precisely in order to prevent discovery of the Ponzi scheme, especially if the lawyer, like Gillibrand, was fully aware of the "questionable" activities engaged in by the client? Are we to applaud the "Rambo litigator" so long as he/she doesn't move on to killing witnesses and the like? And so on.

Incidentally, should we be as reluctant to engage in any evaluation of lobbyists as Mr. Goldman would have us be of lawyers? After all, lobbyists do fulfill an important First Amendment function by effectively "petitioning" legislators for "redress of grievances." This is one of the reasons I am generally reluctant to support some of the restrictions on lobbying and oppose aspects of the McCain-Feingold bill. But does this mean that I must admire equally the lobbyists for the tobacco industry and those who work for the American Cancer Society?

Frankly, I hope that Mr. Goldman was a better lawyer when defending his allegedly-criminal clients than when defending Sen. Gillibrand. It will be interesting to see if a future edition of the Times will include letters from other criminal defense attorneys disassociating themselves from the "defense" offered of Sen. Gillibrand.


Comments:

Atticus Finch is a FICTIONAL lawyer. See also: Lubet, Steven. "Reconstructing Atticus Finch." Michigan Law Review 97, no. 6 (May 1999): 1339–62.
 

BTW: I am not going to defend lobbyists, but I think we lawyers SHOULD applaud the "Rambo litigator" so long as he/she doesn't move on to killing witnesses and the like ("like" Rule 8.4 in the Model Rules of Professional Conduct, which would include fraud and deceit, or other actual crimes).
 

(Sandy: thanks for turning the comments on)
 

Back to Finch for a moment (my wife and I actually met Gregory Peck at a screening of To Kill A Mockingbird but, at least, he was a real person to admire):

Monroe Freedman, a legal ethics expert teaching at Hofstra University Law School, published two articles in the LEGAL TIMES calling for us to set aside Atticus Finch as such a glorified role model. Freedman argued that Atticus is no hero, as he still worked within a system of institutionalized racism and sexism and should therefore not be revered. Freedman's article sparked a flurry of responses from attorneys who entered the profession because of the book. Critics of Atticus such as Freedman maintain that Atticus Finch is morally ambiguous and does not use his legal skills to challenge the racist status quo in Maycomb. The law review article I cited goes further and imputes "Gillibrand" tactics to Finch as well.
 

Did John Adams have a personal or professional career enhancement or financial motive in his offering to be defense counsel? In providing a defense, did Adams stray too close to or cross the ethical line that lawyers should not cross in client representation?

What if these same questions were applied to Gillibrand?
 

For instance, what if Tom Robinson is just as guilty as Big Tobacco: "Does our view of Atticus change if it turns out that he dragged Mayella through the mud for the sole purpose of freeing the guilty?"

http://tarlton.law.utexas.edu/lpop/etext/lubet/lubet.htm
 

Shag:

(From the diary entry of John Adams concerning his involvement in the Boston Massacre trials)

March 5, 1773:

"I . . . devoted myself to endless labour and Anxiety if not to infamy and death, and that for nothing, except, what indeed was and ought to be all in all, sense of duty.

. . .

Before or after the Tryal, Preston sent me ten Guineas and at the Tryal of the Soldiers afterwards Eight Guineas more, which were . . . all the pecuniary Reward I ever had for fourteen or fifteen days labour, in the most exhausting and fatiguing Causes I ever tried: for hazarding a Popularity very general and very hardly earned: and for incurring a Clamour and popular Suspicions and prejudices, which are not yet worn out and never will be forgotten as long as History of this Period is read . . . It was immediately bruited abroad that I had engaged for Preston and the Soldiers, and occasioned a great clamour . . . .

The Part I took in Defence of Cptn. Preston and the Soldiers, procured me Anxiety, and Obloquy enough. It was, however, one of the most gallant, generous, manly and disinterested Actions of my whole Life, and one of the best Pieces of Service I ever rendered my Country. Judgment of Death against those Soldiers would have been as foul a Stain upon this Country as the Executions of the Quakers or Witches, anciently. As the Evidence was, the Verdict of the Jury was exactly right.

This however is no Reason why the Town should not call the Action of that Night a Massacre, nor is it any Argument in favour of the Governor or Minister, who caused them to be sent here. But it is the strongest Proofs of the Danger of Standing Armies."
 

I myself find something like this better.

But, what politicians are doing now, and how they will legislate isn't really the point, is it?

I will wait and see who runs against her. Seriously, I'm more bothered -- given his importance NOW -- at some things Sen. Schumer has done in the last few years.
 

Sandy:

How precisely to you contend that Gillibrand assisted the tobacco industry to "induce addiction and death in millions of people around the world?" Any half aware moron during Gillibrand's defense knew that tobacco is addictive and will likely shorten their lives. For the rest, there were warning labels.

The fact that the tobacco companies denied this danger in legal proceedings to avoid civil liability to states and plaintiff's attorneys seeking to enrich themselves was irrelevant to the decision process of those choosing whether to start smoking. Some kid being offered a cigarette in high school is not thinking: "Hell, why not? Kirsten Gillibrand says that cigarettes are not dangerous."

Ms. Gillibrand's alleged earnings for her civil defense of the tobacco industry are hardly more ethically questionable than state governments imposing indirect taxes on low income smokers to finance ongoing spending programs and plaintiff's attorneys making literal hundreds of millions of dollars representing states in sweet heart arrangements with politicians to which they contributed money.

If tobacco is deadly and a public nuisance, then governments can ban it. Instead, they would rather soak low income smokers, rather than save their lives. The entire charade stinks like a filled ash tray.
 

This comment has been removed by the author.
 

Well, Bart, the government "could" ban planes, trains, and automobiles too, so that's irrelevant as well. Assuming that Gillibrand violated ethic rules and/or laws -- at least you and I agree that Yoo never crossed that line -- she is to blame for that and nonetheless shares some small responsibility for smoking-related deaths. Of course, I also think that allegedly-criminal defense attorneys share some small responsibility for murderers / rapists who they get off yet murder / rape again.
 

It should be the "National Association of ALLEGEDLY Criminal Defense Lawyers" (NAACDL)
 

Did Gillibrand solicit this particular client, or was she just doing her job?

I personally know a few lawyers who can't really choose their clients, even tho they are one-man shops. They take in whoever shows up on their doorstep.

And what other criteria should there be? If there is an internal conflict with current or previous clients, or if it the legal work contradicts some previously established principle which would impact an established expertise in an area of law, that would be a good criteria. But this is a decision you make in taking on new clients. Once you take their work, the decision is made. For a non-partner to decline work probably wouldn't go over very well, and shouldn't.
 

"There is one point in To Kill A Mockingbird where the novel starts to cross the boundary between romantic and ambitious fiction. This is at the very end, which is curiously ignored by those who invoke the book on behalf of conventional professional norms. The ending is the only point at which Atticus is portrayed as less than perfect. He loses an argument with the sheriff, and he collaborates on a project which today could only be called 'obstruction of justice.' He agrees with the sheriff to encourage the children to lie about Bob Ewell's death to make it appear an accident, when in fact, they think Finch's son has killed him. The killing was clear self-defense, but the sheriff's point is that the local system of justice has not proven itself so reliable that it can be trusted to vindicate him. Here is a portrayal of virtue that is intentionally complex (unlike the trial, where the complexity Lubet explicates is unintentional). Our role model was initially wrong (for resisting the sheriff's plan), even now is not certain he's doing the right thing, and is doing something that, though it seems likely to be the right thing, involves violation of the law. This tentative and compromised kind of virtue seems more interesting, and the portrayal of it more valuable, than the iconic virtue Finch has heretofore shown because it seems the only kind possible in many of the most morally compelling situations lawyers face in life."

http://tarlton.law.utexas.edu/lpop/etext/lubet/powell.htm
 

One correction: Boo Radley may have killed Bob Ewell, so it is Boo they are trying to protect.
 

It would be sort of amusing if the NYT received some letters that go like, "I've defended any number of accused murderers, rapists, child molesters and the like... but I hasten to disassociate myself from the idea that Big Tobacco deserves a defense!" However, I don't expect to see many letters of that sort.

Also, I wonder if I am alone in wishing that Charles could occasionally pause and attempt to mold his ideas into a single, coherent argument, as opposed to publishing every half-formed thought as a separate comment in what increasingly looks like an episode of blog Tourette's.
 

Good points, Steve M. I check in quite sporadically, but I will do my best to mold my ideas elegantly just for you.
 

Agreed.

I think one must think carefully about *why* one believes in the right to legal defense. In my view, there are two major reasons, depending on circumstances. If one is innocent, the purpose is to defend against false allegations. If one is guilty, the purpose is to explain one's perspective, hoping to convince the law is unjust, or the complexity of one's circumstance motivates leniency.

It is laudable for lawyers to do either of these. But it seems to me anything else is simply an attempt to thwart the law and avoid justice, and should be frowned upon.
 

Too bad Koppelman won't allow comments in his latest thread.
 


Mike said...
I think one must think carefully about *why* one believes in the right to legal defense. In my view, there are two major reasons, depending on circumstances. If one is innocent, the purpose is to defend against false allegations. If one is guilty, the purpose is to explain one's perspective, hoping to convince the law is unjust, or the complexity of one's circumstance motivates leniency.

It is laudable for lawyers to do either of these. But it seems to me anything else is simply an attempt to thwart the law and avoid justice, and should be frowned upon.


I would say I disagree with your premise. The reason I am aware of for legal defense is to place the burden on the government or the opposing side to prove its case. Innocent or not, unjust law or not, we require legal defense so the government or the plaintiff is forced to prove any charges it alleges against a person.

In the civil context, its the same. a defendant is entitled to legal defense because plaintiffs should not be able to simply take what they want just because they have a compelling personal case. If the law requires compensation, so be it. But there is no rational reason why a tobacco company, within the confines of the law, cannot defend itself from civil or criminal complaints. Otherwise we are simply picking sides based on personal preference.

Justice Jackson gets a whole lotta credit, as do the defense attorneys, for Nuremberg. As they should. Would Prof Levinson prefer Osama bin Laden not to get a defense in a court of law? How does the right of a defense for the innocent goat herder rounded up and thrown in Gitmo not necessitate a defense for OBL? And if the nazis and OBL get a defense, why not the tobacco companies? Obviously, ethical breaches and illegal maneuvers aside (I don't know about the specifics here), the theory that a civil defendant should not be allowed to defend itself is ludicrous.

Is the theory that as long as it is one civilian taking only money from another, and not the government taking liberty, a defense is not necessary for those we don't like? Because I see absolutely no principled reason why that should be the case. If the tobacco companies and their attorneys conducted themselves improperly in their civil defenses, sue, charge or reprimand them for that. But saying someone shouldn't be defended because some people believe (with good reason) that they are bad is no different than Bush saying Gitmo prisoners need no defense because he has already determined they are bad. We are a nation of laws, or we are a nation of men.

Besides, think of the things that kill people - booze, red meat, cars, guns, ladders... the list goes on. if prof levinson can honestly say there is no good faith assumption of the risk defense for tobacco, then he's a better lawyer than I.

As I said, if Gillebrand did bad stuff, then fine. But if you breach your ethical duties defending the tobacco companies, mother theresa or prosecuting crooks like Ted Stevens, the client you represent or attack isn't what makes you a lawyer of questionable ethics, it is your actions that do. The quality of the moral fiber of your client is irrelevant.
 

"Is the theory that as long as it is one civilian taking only money from another, and not the government taking liberty,"

Which is scarcely an accurate description of the tobbacco litigation anyway, which involved collaboration between the litigants and governments to deprive the tobacco companies of the right to raise defenses which had long protected them in civil cases, in return for the government getting a cut of the loot.
 

"If one is guilty, the purpose is to explain one's perspective, hoping to convince the law is unjust, or the complexity of one's circumstance motivates leniency."

The right to a legal defense is much broader. Defending someone who is "guilty" in the sense that the client has admitted "guilt" to his attorney, still requires the guilt to be proved via the legal system. The lawyer defending such a defendant may take all lawful and ethical steps (and must do so) to challenge the prosecution's case. After all, the burden of proof is upon the prosecution. Let's make it clear. I'm talking about "guilt" in the sense of a criminal trisl; not a civil defendant who may be "guilty" in another sense, e.g, liability. In a civil case, the circumstances differ significantly from a criminal case. Adams was providing a defense in a criminal case, Gillibrand in a civil action. In evaluating Gillibrand's actions, first we have to identify them and then determine whether such actions comported with ethical requirements. Gillibrand should not be criticized merely for defending a tobacco company. If her actions crossed ethical lines, then she should be criticized, for which there are legal forums. But once Gillibrand decided to run for political office, it may be appropriate to criticize her even if her actions did not cross ethical lines in evaluating her qualifications for holding political office. That's the price an attorney pays, as do non-attorneys, when they seek public office. Voters are not limited by the rules of evidence in making their decisions.

Let's consider the lead attorney for Coleman of MN in the court battles over the senatorial election in that state. He said he had no problems defending Coleman even though a democrat but he wouldn't vote for Coleman. Sort of like Adams, in a milder sense.
 

OOPS! After just posting my comment, I noted that nerpzillious made similar points more eloquently.
 

Perhaps Koppelman hasn't read that Glamour Magazine interview of Dawn Johnsen (where's Tubbs when you need him?) in the same month that the nominee submitted the Webster brief, in which she is quoted as saying:

'Any move by the courts to force a woman to have a child amounts to involuntary servitude.'

You can't have it both ways. Ms. Johnsen (now) testifies to her opinion that the 13th Amendment does not apply to abortion. Were you lying then, or are you lying now?
 

Just to add a small comment to nerpzillicus's excellent post, a criminal defense lawyer also forces the government to show that it behaved consistent with the rights of the defendant. In the long run, that protects all of us.
 

This series of Gillebrand posts began with a comparison with Professor Yoo's work at DoJ and most posters opined that Yoo was the more "culpable."

The lynch Yoo mob might be interested in the latest developments in Spain. Apparently, a convicted terrorist practicing law in Spain filed a complaint alleging facilitation of (not commission of or giving orders to) "torture" against multiple members of the Bush Administration with the outlaw magistrate who fancies that he has universal jurisdiction over Americans in the United States and this magistrate is asking the prosecutor (who presumably is not a convicted terrorist) to file criminal charges.

What makes this farce even more interesting is that the convicted terrorist's complaint against Doug Feith is based upon Philippe Sands' discredited lies claiming that Feith argued that GCIII did not apply to prisoners in Gitmo.

Sandy, this begs the question of whether IYHO would Gillebrand be more unethical for representing Big Tobacco or if she ended up defending John Yoo in a Spanish court?
 

Just to make it perfectly clear: I believe that any and all criminal defendants, without exception, are entitled to a vigorous (zealous) defense by well-trained and competent lawyers, and I have never, and will never, demean a criminal defense lawyer for choosing to represent a given client. (It might be different with regard to "lawyers for the mob" who year after year show up to represent mobsters, but that's a different issue.) But it should be obvious, even to the most zealous defender of criminal defense lawyers, that Ms. Gillibrand really can't wrap herself in that particular mantle.

People generally wish to be evade being judged by others on the basis of the choices they make. I can understand that; I'm certainly not immune to such feelings myself. (Why have I lived a quite self-indulgent life rather than, say, modeling myself after the heroes who serve in such organizations as Doctors Without Borders?) But, surely, we can recognize the self-serving aspects of the ABA's "canon" that lawyers are immune from criticism regardless of the way they choose to live their lives. Ironically, the exception is if lawyers themselves break the law, but, of course course, it is sometimes highly moral to break the law, and there is no good reason to treat "law-abidingness" as the end all and be all of what is required to live a morally admirable life.
 

Sandy:

Why are civil defendants not entitled to just a zealous a defense as criminal defendants? By definition, civil defendants are less culpable (money damages) than criminal defendants (crimes against the People), so there is less for the ethically sensitive attorney to overlook.
 

Sandy, why are you drawing the line at criminal defendants? Losing a civil suit can also have serious consequences; civil and criminal sanctions can look pretty similar, although they frequently do not. So why wouldn't a civil defendant also be entitled to a vigorous defense by well-trained and competent lawyers?
 

As someone pointed out already, Big Tobacco litigation looks more like criminal law and civil law as GOVERNMENTS have deprived them certain defenses which had long protected them in civil cases, in return for the government getting a cut of the loot. Reminds me of "suspending" the statute of limitations against the Catholic Church molestation lawsuits.
 

Prof. Levinson,

But why is criminal defense so much more noble than civil defense? How about OJ's defense crew? Those defending Bush from war crimes charges? Would there have been nobility to being on the plaintiffs' side of the tobacco case, taking your 33% (because the plaintiff's side, that ain't about money at all)? There are very, very few attorneys who can honestly say all of their clients are upstanding and respectable individuals or companies, and the principles are what matter. Maybe people who work at legal aid, or public defenders, or ACLU types, or the guys who represented Raich or Kelo. But everybody else, the 95+% of lawyers out there, are providing a service, and trying to make a living. Are the janitors who work at Phillip Morris equally susceptible for criticism, since they "using [their] skills to help it continue to induce addiction and death in millions of people around the world?" Were the republican attacks on John Edwards fair, or because he represented injured people, he is noble?

I agree the tobacco companies did bad things. But that's the point of the justice system - it is a civil manner to resolve the rights and wrongs of others. You don't think the plaintiff homebuyers who got defrauded by the sellers on some important aspect of their home think the those defendants are just as big of scum as tobacco companies? The law exists to remove personal prejudice, and let justice be done. Otherwise, let's just pick up our pitchforks.

I'm not saying Gillebrand is in line for sainthood. But I have just as much contempt for the government and the plaintiffs' attorneys who got rich off of these cases. Are asbestos plaintiffs' attorneys noble as they take a third of the settlement from the mesothelioma suffering plaintiff? Class action lawyers who pocket millions while the class members get a check for $8.36 a piece? Plaintiff attorneys who get lay-down default or consent judgments so they can estop insures from contesting liability? Condemn the whole system, acknowledge everyone is entitled to a defense, or admit you are just committing unprincipled picking on tobacco. It's an adversarial system for a reason.

Mr. DePalma,

(from the transcript of the interview between Sands and Feith):

So the fact that they were outside the Geneva Conventions …

Absolutely. Hold on a second—you said outside the …

Sorry—they are not entitled to prisoner-of-war status?

That’s a big difference.

So let’s stick to your distinction, which I recognize. They are not prisoners of war; therefore, they are not entitled to the protections …

… of prisoners of war.

Which precludes protections against forms of interrogation?

Under the Geneva Convention they are not entitled—that’s the point. I didn’t want anybody saying the Geneva Conventions don’t apply. There is an interesting coincidence here, which is: what do the al-Qaeda people get, since they’re not covered, their conflict is not covered by the Geneva Conventions, and all the president said, “Humane treatment.” And I thought that was O.K., that’s a perfectly fine phrase; it needs to be fleshed out, but it’s a fine phrase—“humane treatment.” Then you get into this very interesting question which is a lacuna in the Geneva Convention. The Geneva Convention says you get combatant/P.O.W. status if you obey the four rules—uniform, insignia; carrying arms openly; chain of command; obey the rules. If you do those four things you get combatant status, and if you get caught you get P.O.W. status. The Geneva Conventions are silent on “what if you don’t,” and people have accused us of making up the term “unlawful combatant” …

I am one of those people.

You’re just wrong.

There is a big debate about it, there is a review of my book in the latest American Journal of International Law, and I was told I was wrong by a very decent friend of mine—Steve Ratner—who I respect …

It is so obvious that you are wrong—because what the Convention …

I am happy to be told I am wrong …

I will tell you when you are right, and I will tell you when I think you are wrong. There are very few things that I speak as categorically about as this—I know this.

But the consequence of this is crucial—either you are an individual to whom the Geneva Convention doesn’t apply, or you are an individual to whom the Geneva Convention applies, but you are not entitled to P.O.W. status. What is the difference in the purpose of interrogation?

It turns out, none. But that’s the point. That’s a coincidence. The point is that the al-Qaeda people were not entitled to have the Convention applied at all, period. Obvious. I don’t see a lawyer that could make an argument to the contrary. Although our Supreme Court kind of got close to that in the Hamdan case—but that’s another story. It is clear from the high-contracting-party language that al-Qaeda is not a high contracting party.

http://www.vanityfair.com/politics/features/2008/07/feith_transcript200807?printable=true&currentPage=all

Yeah, he didn't exactly say Article 3 didn't apply, he said none of the articles applied. And he is dead wrong.

Be careful when you cite Douglas Feith for anything. He is, let's say, truth impaired.
 

By definition, civil defendants are less culpable (money damages) than criminal defendants (crimes against the People), so there is less for the ethically sensitive attorney to overlook.

Uh, no. Some criminal defendants are not culpable at all, and I would suggest that it is their rights we are principally concerned with. An innocent man facing the loss of his life or liberty is more worthy of protection than an innocent man facing the loss of money, if for some reason we could only protect one of them.
 

I have an enormous amount of respect for Prof. Levinson's work on this site. But these last couple of posts are mystifying.

If Gillibrand committed ethical violations in defending big tobacco then she should be punished by the NY State Bar. If she hasn't committed any ethical violations (and I don't think she has), it would seem that Sandy's complaint boils down to his belief that she should not have defended Big Tobacco. This view is premised on the apparent belief that rich but unpopular corporations do not deserve the same kind of zealous representation as a indigent criminal defendants.

The ethical rules do make some distinctions between defendants in civil and criminal trials and I suppose it's fair to second-guess Gillibrand on the cases she took (although I would not because I see little distinction between defending Big Tobacco or a Nazi war criminal). Query whether Sandy would feel the same way about Gillibrand's representation if Big Tobacco industry were on the verge of bankruptcy.

Let's not lose sight of the prize here...John Yoo was not an advocate in any way share or form. His sole job was to interpret the law for the executive branch. Instead of performing his duties responsibily, he drafted horribly one-sided memos to justify crimes that he knew were already taking place. For this, he is likely to be sanctioned by the office of professional responsibility and perhaps eventually find himself on trial for his complicity in torture.

Gillibrand & Yoo = apples and oranges.
 

Levinson conflates two very different criticisms of Gillibrand: (1) who she represented and (2) how she represented.

With respect to who she represented, I am somewhat sympathetic to Levinson's position. We all make choices and it is fair to judge us by those choices. If we choose to represent reprehensible people or companies, it is fair to judge us harshly for using our legal talent in an ignoble cause. But, I am mystified that Levinson seems blind to the implications of this position. Just as someone who despises big tobacco is fair in harshly judging someone who represents big tobacco, it is equally fair for someone who despises murderers and rapists to harshly judge someone who represents murderers and rapists. You cannot criticize someone for representing big tobacco and then turn around and defend someone who represents murderers and rapists on the principle that everyone is entitled to competent legal aid in our advesarial system. Given this, it is hardly surprising to see a former president of the National Association of Criminal Defense Lawyers defend Gillibrand. Of course, you still might say one cause is ignoble but the other is not. But that's a judgment call and do not be surprised when others have the opposite opinion about which cause is noble.

With respect to how Gillibrand represented big tobacco, Levinson stoops to false accusations ("using her skills to help it continue to induce addiction and death in millions of people around the world?") and suggestions of improper conduct. There is no factual basis for any suggestion that Gillibrand did anything illegal or unethical or even close to crossing the line in her representation of her client. Once she agrees to represent a client, she should zealously do so within the rules. With respect to how she represented her client, it seems rather disingenuous for a professor of law to criticize a lawyer for doing so ethically and zealously.
 

On the other thread, there were plenty of links to source documents PROVING that Philip Morris executives lied under oath. Gillibrand (among others) covered that up and, indeed, broke ethical rules. Whether she (or Yoo for that matter) violated any specific law, I am not certain. I don't care if you believe me. Maybe jpk can convince you.
 

http://balkin.blogspot.com/2009/03/karen-gillibrand-and-john-yoo.html

In particular, take a look at the fraud involved with INBIFO.
 

I agree with several other posters that Prof. Levinson’s distinction between the importance of a committed criminal defense and that of a committed civil defense seems unpersuasive. Certainly, we make no such distinction between the right to have counsel for criminal and civil defendants. I also think his suggestion that Gillibrand contributed to enticing people to smoke cigarettes stretches any basic understanding of causal connection beyond the point of meaningfulness.

However, I think Prof. Levinson is correct to criticize Goldman’s likening of Gillibrand’s service to big tobacco to Adam’s defense of the British soldiers. Goldman wrote:

Senator Kirsten E. Gillibrand of New York should be lauded, not criticized, for her representation of an unpopular client.
One of the great traditions of American law, dating at least from the time John Adams represented the British soldiers accused in the Boston Massacre, is that our best lawyers represent the despised and unpopular, particularly those accused of or investigated for alleged crimes.


But, as Goldman himself recognizes, she was not defending anyone “accused of or investigated for alleged crimes.” Her clients may have been “despised and unpopular,” but they did not belong to the class of criminal defendants implied in both the reference to the soldiers defended by Adams and in Goldman’s final phrase in the quoted paragraph.

So, while I think Prof. Levinson has taken the bait too strongly, I also think Goldman set the bait by conflating Gillibrand’s services for a tobacco company in a civil suit with the defense of accused criminals.

The approbation by association that Goldman attempts is the kind of argument by distraction that clever lawyers often use. I think Prof Levinson was trying to point out the deceptiveness of that tactic.
Chris
 

This is the last time I will point out that Gillibrand was PART OF AND FURTHERED the criminal enterprise that Big Tobacco used (and is being punished for using). There are more than enough links on the prior thread for anyone actually interested in the truth. Also, we do indeed make some distinctions between the right to have counsel for criminal and civil INDIGENT defendants.
 

Thank you, Charles, for that opaque response. I am quite aware of the difference in our system's responses to indigent (why caps?) defendants. That was not my point.

I will wait for Prof. Levinson or someone else who can respond informatively to do so.

On the other hand, it is nice to see you on the side of reality-based justice.

Chris
 

Did the British soldiers pay Adams the equivalent of $305 an hour?

Was Adams's specialty helping his clients engage in racketeering?

Did Adams conspire to hide evidence against his clients?

No?

Didn't think so.

Not so cogent an analogy.

If analogies are what Goldman is looking for, try consigliori.
 

Very nice conversation. I am newbie in this situation. Thanks for this.

LLC
 

A better analogy would be the property litigation that made many old time politicians rich, clear fraud notwithstanding. But, they aren't tobacco litigation, so not worthy of our special scorn.

As to what evidence Adams used, I doubt many here know, and as to what he made an hour, such is not always the point when dealing with such celebrity trials.
 

Today's NYTimes has an interesting editorial on Gillibrand and tobacco.
 

mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
. have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
. exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
. exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of . exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. . has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
.treated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.
 

HD kaliteli porno izle ve boşal.
Bayan porno izleme sitesi.
Bedava ve ücretsiz porno izle size gelsin.
Liseli kızların ve Türbanlı ateşli hatunların sikiş filmlerini izle.
Siyah karanlık odada porno yapan evli çift.
harika Duvar Kağıtları bunlar
tamamen ithal duvar kağıdı olanlar var
 

Post a Comment

Older Posts
Newer Posts
Home