Supreme Court on Homeopathy, Psychics and Satan

Brown

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A case now pending before the United States Supreme Court involves issues of science. The case is Matrixx Initiatives, Inc. v. Siracusano.

In the court of oral arguments, the Court gets into questions relating to psychics, science, irrational people, homeopathy, satanic influence, and perhaps the role of Satan himself.

First, a little bit about the facts of the case. Matrixx makes a reputed cold remedy called Zicam. Zicam is (supposedly) a homeopathic product, and Matrixx claimed that this product was clinically proven to reduce the severity and duration of the common cold. Even so, the product was not regulated by the FDA and had not been evaluated for safety and efficacy. Matrixx sold millions of Zicam products.

In 1999, Matrixx began to receive isolated reports about adverse reactions from people who took the product, notably loss of sense of smell. The total number of adverse reactions is unknown, but it is estimated to be about one to two dozen. Matrixx said it tried to follow up on the reports but could not. In any event, Matrixx deemed the reports to be of no basis, since loss of sense of smell was a well-known side-effect of the common cold itself, and the number of complaints was statistically insignificant.

It appears that Matrixx did NOT also assert that a homeopathic product cannot cause adverse pharmacological effects, due to the absence of active chemical elements.

It appears, however, that there is more to this so-called homeopathic product than one might think. Matrixx called its product homeopathic so that the company could avoid federal regulation. But there are indications that the product was not one in which total dilution was applied. Instead, Zicam used zinc gluconate, and zinc has long been touted as a cold remedy. And zinc ions, which have been linked to loss of sense of smell, may have been present in Zicam. At least, this is what the medical doctors concluded might be involved, when their patients reported losing their senses of smell after using a product that supposedly had an active ingredient of zinc gluconate. (For more information, see this thread and this thread.)

When it was reported that there were adverse effects to Zicam, the value of Matrixx stock dropped. In response, Matrixx issued a press release saying that statements linking its intranasal product and loss of smell are "completely unfounded and misleading." This apparently stopped the decline in stock price.

Unfortunately, troubles for Matrixx were just beginning. Stockholders sued, saying that the company misled them under the securities laws. It is the securities misrepresentation issue, not the scientific issue of whether the homeopathic product can actually do anything pharmacologically, that is at issue.

(After the securities suit, the FDA got after Matrixx, saying that even though Zicam was labeled as homeopathic, the FDA could exercise its discretionary enforcement against homeopathic products because there was evidence of a safety risk. Matrixx also got hit with a product liability lawsuit.)

At issue was whether there could be misrepresentation when the reported adverse effects were hearsay and statistically insignificant. Matrixx won at the lowest court level, but lost on appeal. The Ninth Circuit ruled that statistical significance is not determinative, but the question should be whether reasonable investors would have viewed the information about the link between the product and the purported effect as significant.

There has not been a trial in this case, or significant discovery of evidence. The issue was basically, if the reputed problems are statistically insignificant and a company does not report them because they are insignificant, can the company be liable for misrepresentation under securities laws? Given the way the case got to the Supreme Court, the statistical insignificance of the reports will be assumed to be true. With that assumption, can you legally have a misrepresentation, with materiality and scienter (basically, knowing that there is a falsehood that is going to be important)… for a concern that lacks statistical significance and might be purely imaginary??

The case was argued to the United States Supreme Court on 10 January 2011. Read the transcript here.

Jonathan Hacker argued on behalf of Matrixx. After Justice Ginsburg asked a question about procedure, Justice Alito asked:
JUSTICE ALITO: Can there be some situations in which statistically significant evidence would not be necessary?

MR. HACKER: Well, I think a distinguished physician would not conclude that there's a connection unless the clinical trials reveal a statistically significant difference between what they've seen and what they would expect to see were there no association.
Justice Scalia, perhaps unsatisfied with that answer, pointed out that there was studies connecting Zicam and loss of smell. Hacker said the studies showed no such connection. Chief Justice Roberts felt that it didn’t matter whether there really was a connection or not:
CHIEF JUSTICE ROBERTS: You're talking about -- you're talking about who's right or wrong about the connection between Matrixx and anosmia. But that's not the question. I'm an investor in Matrixx; I worry whether my stock price is going to go down. You can have some psychic come out and say Zicam is going to cause a disease, with no support whatsoever, but if it causes the stock to go down 20 percent, it seems to me that's material.
Now the Chief is just being hypothetical here, but the rule being toyed with is that maybe the law would require that some credence be given to psychics… as long as some people take them seriously, whether it is rational to do so or not.
MR. HACKER: But if -- that's precisely the point, Your Honor. If a psychic came out or a lunatic on the street corner is barking, you know, through a megaphone that there's a problem with the product, that's not the kind of information a -- a reasonable investor would rely on.

JUSTICE SOTOMAYOR: But wait a minute. These -- these weren't psychics. These were three clinical doctors in this area, one of them you knew poised to go to a society meeting to make this allegation. Doesn't it make a difference who the reports are coming from and what the substance of those reports may do to your product?

MR. HACKER: It may make a difference, Your Honor, and I didn't mean to suggest that, you know, these are psychics. The point simply is, following up on the Chief Justice's question, that it does matter what the basis of the allegation, and is the evidence, the facts available to the company, reliable? Does it create a reliable inference that a reasonable investor would be concerned about?

JUSTICE KENNEDY: Well, suppose -- suppose you stipulate, in response to the Chief Justice's question, that it's irrational, that it's probably baseless, but that the market will react adversely. Is there a duty then to address the claim?

MR. HACKER: Under the case law, it's not clear that that's true.
A pause may be due here, so that we may appreciate the surreal nature of the arguments.

A purported maker of a homeopathic product is arguing that it what matters is evidence, and there is a rejection of a sort of placebo effect that might be at work here (it’s not whether or not it’s true, what matters is that a lot of people BELIEVE it to be true). The surreal nature gets even stranger when the purported maker of a homeopathic product argues a solidly scientific principle:
MR. HACKER: … when the scientific panel said you can't make that claim, it's unfounded, there's no basis in the available science.

JUSTICE GINSBURG: They didn't say "unfounded." They said the evidence is not -- we can't say yes and we can't say no. That's different from completely unfounded.

MR. HACKER: Well, I'm -- with respect, Your Honor, I'm not entirely sure it is. When you're talking about science, you make a claim that's either supported in the science or it's without support.
Justice Scalia toyed with the notion of whether you need to make disclosures for the benefit of investors who are complete ignoramuses:
MR. HACKER: … we have to be very careful, as I said before, about a rule that requires a company to disclose false facts. I would say, second, that a reasonable investor doesn't want false information; a reasonable investor wants accurate information. And a reasonable investor would actually --

JUSTICE SCALIA: These are unreasonable investors who are relying on some talking head on Good Morning America who says that this is true … even though it isn't true.

MR.HACKER: -- the law doesn't respond to irrational, unpredictable, or unreasonable investors. It responds to a reasonable investor who wants accurate -- a reasonable investor is going to hold the stock --

CHIEF JUSTICE ROBERTS: A reasonable investor is going to worry about the fact that thousands of unreasonable investors are going to dump their Matrixx stock.

(Laughter.)

CHIEF JUSTICE ROBERTS: So -- but, I mean, there's nothing unreasonable about that.
Justice Kagan reminded everyone that the rationale of this case will apply not only to makers of homeopathic drugs, but to makers of (shall we say) more legitimate drugs as well. But Justice Breyer shortly thereafter weighed in on his understanding of scientific history, and whether having any evidence was really all that important:
JUSTICE BREYER: … Albert Einstein had the theory of relativity without any empirical evidence, okay?
Justice Breyer’s point, to which he eventually got, was to ask who had the right to decide whether an adverse effect was statistically significant or not.

David Frederick argued on behalf of the folks suing Matrixx. Not long after he started, the question of psychics was raised:
CHIEF JUSTICE ROBERTS: … In other words, you're saying it's not simply the fact that some psychic would say something, that that is not sufficient, even if that has an impact on the market price, that there has to be some scientifically plausible link to the report.
Mr. Frederick basically responded that the science questions relate to scienter (basically, whether there was intent to deceive), rather than to materiality. After all, there are a lot of people who are moved by things that are irrational or that are unsupported by evidence. For example: Mr. Frederick referred to occult forces, a decision that he might later regret:
MR. FREDERICK: … I don't mean to be evasive, but if there is a product, say, that has some link to satanic influences, and there is some reason to think that a large body of followers in an irrational way might regard there to be satanic influences on the basis of a particular product, a cautious, reasonably prudent investor might want to know that on the basis of that information that most of us would regard as irrational, might affect the stock price.
Basically, Frederick argued that he had a slam-dunk win on the issue of whether the falsehood was material. Virtually ANYTHING is material, if dodos believe it. And he argued he ought to win on the guilty knowledge element as well because of the doctors and studies, which Matrixx dismissed.

The business about satanic influence did not draw any immediate comment, and it appeared that the Court might let it slide. Until:
CHIEF JUSTICE ROBERTS: So it matters whether -- I don't know what kind of product has particular satanic susceptibility --

(Laughter.)

MR. FREDERICK: Well --

CHIEF JUSTICE ROBERTS: -- but I mean, are you saying it matters if it's something that -- that Satan's not going to be interested in? I don't understand.

(Laughter.)

MR. FREDERICK: You're --

CHIEF JUSTICE ROBERTS: I don't mean to be facetious, but your way of distinguishing the satanic product is that it depends on whether people who follow satanic cults are going to be interested or not.

MR. FREDERICK: Well, Your Honor, there are people who follow those things, and they spend money and they buy stocks, but my second point is that scienter …is the other way around this problem, because even though information --

JUSTICE SCALIA: … it seems to me ridiculous to -- to hold companies to -- to irrational standards.
Justice Scalia might be sounding like he makes a lot of sense here, but he later returns to the question of Satan:
JUSTICE SCALIA: Mr. Frederick, I'm -- I'm not clear on why you can draw a distinction between materiality and scienter for purposes of the issue before us here. If, indeed, satanic effect is enough for materiality, you say, well, it may not be enough for scienter. Why? I mean, if the company knows that satanic effect is material, then the company … knowingly withholds it because it thinks satanic effect is irrational, why doesn't that company have scienter, if it's material? The scienter is withholding something that is material, that is known to be material, and once you say that -- you know, that Satan is material, if the company thinks Satan is involved here, it has to put it in its report, no?

MR. FREDERICK: And it would depend on what kind of stock effect occurred.
Pratik Shah argued the position of the United States. Get a load of Justice Scalia’s first question to him:
MR. SHAH: Mr. Chief Justice, and may it please the Court: For 35 years, this Court's precedents have instructed that information is material for securities fraud purposes if a reasonable investor would have viewed it as having meaningfully altered the total mix of information. Under the terms of their question presented, Petitioners propose to depart from that contextual inquiry in favor of a categorical rule that deems information about an adverse drug effect immaterial absent statistical significance.

JUSTICE SCALIA: Mr. Shah, … What do you think about Satan?

(Laughter.)
Shah answered seriously, but he treated the satanic business like any other scandalous rumor that a company might face. Justice Alito brought up satanic influence, and so did Justice Scalia, with perhaps the quote of the day:
JUSTICE SCALIA: Well, I mean, if Satan comes in, surely lousy science comes in as well, no?
 
I suppose we can take some comfort in the fact that the existence and influence of Satan were being used as examples of IRRATIONAL beliefs, and these beliefs were irrational in spite of the fact that many people believe in them.
 
Interesting case but it is very information-dense and complex so I'm not picking sides until I understand it better. That being said, my id wants Zicam to go down in flames.
 
JUSTICE SCALIA: Well, I mean, if Satan comes in, surely lousy science comes in as well, no?

Is he suggesting that if they use lousy science to promote their stock, they can't hide behind science to defend it?
 
Wow. Thanks for the very good summary.
You're welcome. I'm wondering how this case seemed to slip under everyone's radar. It's a weird one.

Although I've written formal articles about misrepresentation in general and financial misrepresentation in particular, it has been a while since I've delved into these issues. My guess is that the Court will say that no company, not even one that sells quack remedies, has to tell its stockholders about every goofy or unsupported charge made against the company. But they will say that there is at least a question for a jury here as to whether the misrepresentation was material (it almost certainly made a difference to investors, even Matrixx seemed to agree to that) and whether there was scienter (which may be indicated by the disregard of evidence on grounds of insignificance).

What may be of interest is whether the materiality and scienter issues get mixed together, or whether they have to be considered separately. There was quite a bit of discussion about this during oral argument. My guess is that the two issues will be considered together. In particular, my guess is that the more materiality a scandal has (whether that scandal is instigated by medical doctors or by a purported supernatural entity), the more serious it becomes for a company to try to cover it up.

What also may be of significance is that there may be commentary that may try to deter misrepresentation suits under securities law when the grounds for the suit are based upon unsupported charges from talking heads, publicity hounds, loudmouth activists, and the like.
 
Great case summary as usual, Brown.

I know this is a case of divulging info to investors. Assuming the decision goes against Mattrix couldn't it also be a de facto precedent set on homeopathy? If the main object of scienter is withholding information that is relevant to a rational investor it seems the if the advertised mechanism is irrational it would fall under the umbrella of scienter.

It seems very difficult to separate the focus on the investors without letting the "facts" about homeopathy leak in.
 
Great case summary as usual, Brown.

I know this is a case of divulging info to investors. Assuming the decision goes against Mattrix couldn't it also be a de facto precedent set on homeopathy? If the main object of scienter is withholding information that is relevant to a rational investor it seems the if the advertised mechanism is irrational it would fall under the umbrella of scienter.

It seems very difficult to separate the focus on the investors without letting the "facts" about homeopathy leak in.
The issue is a slippery one, for two reasons. First, the record wasn't clear as to whether the stuff sold by Matrixx was diluted all to hell, as many homeopathic (supposed) remedies are. What WAS clear from the record was that Matrixx CALLED its concoction "homeopathic" for the particular purpose of avoiding federal regulations. In particular, Matrixx wanted to make claims about the product and make a ton of money from it without having to prove its claims to the satisfaction of the FDA.

Second, the rule that will be decisive in this case will, in all likelihood, have an effect upon legitimate drug companies, too. Justice Kagan alluded to this point several times in oral argument, and she was not the only one. Indeed, purveyors of legitimate pharmaceutical products are finding that they are allied with a producer of homeopathic remedies in this case.

An unspoken aspect of this case may be that there are some lawyers out there who make a tidy living from suing companies on behalf of stockholders. If the Supreme Court is not careful, then every corporation that has any concern with any of its products, even concerns that are imaginary, might have to disclose them to the stockholders, lest the class action lawsuits for damages begin. (For a discussion on class actions for damages, see this thread.
 
If the Supreme Court is not careful, then every corporation that has any concern with any of its products, even concerns that are imaginary, might have to disclose them to the stockholders, lest the class action lawsuits for damages begin. (For a discussion on class actions for damages, see this thread.

Being liable for damages on frivolous grounds does not mean that said damages will be awarded.

I think the stockholders have the right to sue. Winning the suit is another matter entiely.
 
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Interesting case but it is very information-dense and complex so I'm not picking sides until I understand it better. That being said, my id wants Zicam to go down in flames.
[side issue]
I'd be happy if the FDA closed the loopholes that let people make unsupported claims about their products through round about ways.

Clearly ZiCam was labeled homeopathic for the sole purpose of skirting regulations about making claims. And if ZiCam was on the market as a supplement and it claimed, "invented by a teacher who was tired of catching all the kids' colds", obviously they would be saying that because they intended that message to mislead the public into thinking the manufacturer was making the claim which would have been illegal to make directly.

And when are we going to end the grandfathered in snake oil like spinal adjustments and homeopathy anyway?

Why is it OK to mislead when it is so obvious the intent is to mislead. Who was it that decided the FDA could only regulate blatant claims?[/side issue]

Carry on....
 
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Just a point of trivia, tangentially related:

I own a pharmacological relic. I have a half a bottle of Tylenol capsules, the kind that you can take apart. Nearly 30 years ago, all Tylenol capsules of this type were pulled from shelves when seven individuals died after taking Tylenol capsules. Apparently a sup0posed human being, for purposes unknown, took some capsules from store shelves, pulled some capsules apart, put cyanide inside, reassembled the capsules, and put them back on the shelves. Random people bought the tampered capsules, and lives were taken indiscriminately.

Within a short time after these events, the anti-tampering packaging that is commonplace today (not just for drugs but for lots of items) found widespread acceptance.

Tylenol's stock took a hit, but it recovered. Today, the company is credited for acting (relatively) quickly in a crisis, knowing its profits would suffer.

The company COULD have responded with denial, saying something like, "These cyanide poisonings could not POSSIBLY be our fault! It's absurd! We don't have cyanide anywhere in our manufacturing plants at all! If we pull our products from the shelves, we would be as much as ADMITTING that we are to blame! And then we'd be an easy target for predatory lawyers. NO, thank you!! Besides, we sell millions of pills and only a handful of people were affected. There's clearly no correlation at all!" When it might be suggested to the company that it at least make an honest disclosure of the events, the company might have responded with Monty-Python-esque horror: "Our sales would PLUMMET!!"

The response from Matrixx seemed to be one of denial, rather than one in which there was an earnest effort to find out what the hell was going on (and if there WAS a problem, to fix it). Whether this denial is better addressed by securities laws or by product liability laws is open to debate.
 
Within a short time after these events, the anti-tampering packaging that is commonplace today (not just for drugs but for lots of items) found widespread acceptance.

It is really hard to imagine that time before anti-tampering packaging, but I remember it vaguely. Hard to believe that was only 30 years ago.
 
What are the good and bad possible outcomes of the court ruling?
 
Apparently a sup0posed human being, for purposes unknown, took some capsules from store shelves, pulled some capsules apart, put cyanide inside, reassembled the capsules, and put them back on the shelves. Random people bought the tampered capsules, and lives were taken indiscriminately.

Within a short time after these events, the anti-tampering packaging that is commonplace today (not just for drugs but for lots of items) found widespread acceptance.

Tylenol's stock took a hit, but it recovered. Today, the company is credited for acting (relatively) quickly in a crisis, knowing its profits would suffer.

As an aside, we covered this case in a class when I was getting my MBA. Perhaps it was a Business Ethics class, I can't recall. I'm 35 so don't remember it happening when it did. But it's now in the annals of academia of a company myopically saying "damn the bottom" and doing something right.
 
The New York Times reported today that zinc (including zinc gluconate) may be effective in treating colds. The zinc products were administered in lozenge form, rather than nasal spray. The report noted:
Some cold sufferers have been wary about using zinc since the Food and Drug Administration warned consumers to stop using Zicam nasal sprays and swabs, which contain zinc, after numerous reports that some users lost their sense of smell after using the product. The Cochrane report did not review any studies of nasal zinc products.
How this affects the (ahem) physiological "model" of like-cures-like is unclear.
What are the good and bad possible outcomes of the court ruling?
The immediate effect is that federal district court judges will have guidance in disposition--perhaps even rapid disposition--of securities fraud suits. The current state of the law is that a company does not have to disclose everything to its investors. The company does not have to disclose false information. The company does have to disclose "material" information, which is rather nebulously defined. Basically, a material fact is one where there would be a substantial likelihood that a reasonable investor would view it as significantly altering the "total mix" of information made available to the investor.

In addition, a failure to disclose must be made with a bad intent, which lawyers and judges call "scienter." (I leave it for another day whether a corporation--which lacks a physical brain--can form a mental intent. I also leave for another day the observation that many of those who think that corporations CAN have bad intentions do NOT think that corporations can have expressions, and therefore ought not to have the same constitutional right to expression that human beings do.)

So ... getting back to the typically overworked, underpaid federal district court judges who first see these securities misrepresentation lawsuits: the judges are almost always presented with a request at the outset of the case to throw the case out of court (a motion to dismiss for failure to state a claim). Basically, the district judge faced with such a motion asks: If the plaintiff could prove EVERYTHING being alleged in the complaint, would the plaintiff nevertheless LOSE?? Would the law not recognize the validity of the complaint, even if the plaintiff could prove it?

When Matrixx got sued, it moved to dismiss the case, and won. From Matrixx's brief:
Matrixx moved to dismiss the complaint for failure to state a claim for securities fraud under § 10(b) and Rule 10b-5. The district court granted the motion, concluding that respondents had failed to sufficiently plead the elements of materiality and scienter.
The district court, seeing that the number of affected persons was statistically insignificant (no more than 23 people, although the exact number was not alleged, and there was likely some double-counting involved), did not think a failure to disclose was material. In addition, the district court determined that the scienter was absent, because facts were not pleased in the complaint that Matrixx knew that there was a definitive and statistically significant link between Zicam and anosmia that was sufficiently serious and frequent to affect future earnings.

Instead of fixing their complaint to plead more facts, the plaintiffs chose to appeal. The Ninth Circuit found in favor of the plaintiffs, saying that materiality and scienter had been sufficiently pleaded. There was evidence of a problem with Zicam, maybe not much evidence, but it was not up to the district judge (or to Matrixx) to decide whether this evidence would affect reasonable investors or not. (Justice Breyer's questions during oral argument hit upon this theme.) In addition, there was enough matter in the complaint from which one might infer that Matrixx had pretty good reason to believe that there might be a connection between its product and loss of sense of smell.

So what this comes down to is this: by what standard does the district court judge determine whether a suit should be dismissed or not? Is every potential allegation against a company's products material, even if it is false or unfounded or merely rumored, if some nervous investors might actually believe it to be true? (Chances are, the Supreme Court will NOT say so.) If not, how can a district court sort out the unsupported charges from the more serious and substantial charges without the enormous expense of litigation? Similar questions apply to issues of scienter. Is there a way that the weak cases (not to mention the cases in which the outrage is fabricated) can be thrown out, and the more substantial cases can proceed?

So the effect of the case will probably be to give guidance to the district courts.

Having said that, there are several opinions in recent history in which the Supreme Court gave what it thought was guidance to the district courts, and the district courts found themselves even more confused than before.
 
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The case was decided today (opinion here).

The decision was unanimous. Basically, Matrixx COULD be sued for securities fraud.

There was no mention of Satan in the opinion. Psychics were not a part of the opinion. Homeopathy was not discussed, either.

A few excerpts:
Matrixx's argument rests on the premise that statistical significance is the only reliable indication of causation. This premise is flawed: As the SEC points out, "medical researchers ... consider multiple factors in assessing causation." ... Statistically significant data are not always available.
...
A lack of statistically significant data does not mean that medical experts have no reliable basis for inferring a causal link between a drug and adverse events.
...
Given that medical professionals and regulators act on the basis of evidence of causation that is not statistically significant, it stands to reason that in certain cases reasonable investors would as well. ... This is not to say that statistical significance (or the lack thereof) is irrelevant—only that it is not dispositive of every case.

Application of [the] "total mix" standard does not mean that pharmaceutical manufacturers must disclose all reports of adverse events. ... The fact that a user of a drug has suffered an adverse event, standing alone, does not mean that the drug caused that event. ... The question remains whether a reasonable investor would have viewed the nondisclosed information "'as having significantly altered the "total mix" of information made available.'" ... For the reasons just stated, the mere existence of reports of adverse events—which says nothing in and of itself about whether the drug is causing the adverse events—will not satisfy this standard. Something more is needed, but that something more is not limited to statistical significance and can come from "the source, content, and context of the reports...."

Applying [the] "total mix" standard in this case, we conclude that respondents have adequately pleaded materiality. This is not a case about a handful of anecdotal reports, as Matrixx suggests. Assuming the complaint's allegations to be true, as we must, Matrixx received information that plausibly indicated a reliable causal link between Zicam and anosmia.
...
These allegations, "taken collectively," give rise to a "cogent and compelling" inference that Matrixx elected not to disclose the reports of adverse events not because it believed they were meaningless but because it understood their likely effect on the market. ... "[A] reasonable person" would deem the inference that Matrixx acted with deliberate recklessness (or even intent) "at least as compelling as any opposing inference one could draw from the facts alleged." ... We conclude, in agreement with the Court of Appeals, that respondents have adequately pleaded scienter. Whether respondents can ultimately prove their allegations and establish scienter is an altogether different question. (citations omitted, emphasis by the Court)
Basically, the specific facts associated with this case led to the outcome. The law established in a previous case was reaffirmed and applied.
 

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