[00:00:02] Speaker 05: The first case for argument this morning is 155010 Crutchfield v. A.K. [00:00:26] Speaker 05: Jazz. [00:00:27] Speaker 05: Ms. [00:00:27] Speaker 05: McHugh. [00:00:29] Speaker 05: Is it McHugh? [00:00:34] Speaker 04: I just represent the petitioner here. [00:00:36] Speaker 04: And the petitioner in January of 2006 was a 35-year-old woman who was seeking to have a baby. [00:00:44] Speaker 04: And she was told that she needed an MMR vaccination. [00:00:49] Speaker 04: She had had measles, mumps, and rubella vaccine as a child. [00:00:54] Speaker 04: So this was a second exposure to all three of these. [00:00:58] Speaker 04: She had that vaccination on January 26, 2006. [00:01:02] Speaker 05: So let me ask you. [00:01:03] Speaker 05: I mean, you're here where you've lost this case before the special master, and then again, who was affirmed by the Court of Federal Plains. [00:01:11] Speaker 05: Accepting that there were credibility determinations, that there was an evaluation of the evidence, that there was a weighing of the evidence, how is there a sufficient basis for us to overturn the findings of the special master at this stage? [00:01:26] Speaker 04: The special master held that all [00:01:31] Speaker 04: diabetes takes over a year to become clinical after an insult. [00:01:38] Speaker 04: We have submitted substantial evidence and expert testimony that that is scientifically wrong. [00:01:44] Speaker 05: Well, maybe I'm thinking of something else. [00:01:47] Speaker 05: It seems to me there was a little bit maybe of confusion in the record, but the government did rebut this question. [00:01:52] Speaker 05: This is the LADA, is that? [00:01:55] Speaker 05: And the question of whether or not what the testimony is with regard to that. [00:02:01] Speaker 05: In essence, really, what was your proof that they were incorrect in their conclusions with respect to the two month period being too little for development? [00:02:12] Speaker 04: LADA is a condition that develops over a long period of time starting in youth and develops and comes clinical at some point in old age or not. [00:02:24] Speaker 04: Sometimes it won't. [00:02:26] Speaker 04: Fact of the matter is, however, LADA does not respond to insulin initially. [00:02:32] Speaker 04: Ms. [00:02:32] Speaker 04: Crutchfield's condition was controlled immediately by insulin. [00:02:36] Speaker 04: She got first insulin on June 23rd of 06, and her condition was under control by July 5th. [00:02:45] Speaker 04: LADA, that is impossible. [00:02:48] Speaker 04: All of the literature submitted by the government, not exceptions, [00:02:53] Speaker 04: says that LADA is insulin resistant, including the articles written by Dr. McLaren, their expert. [00:03:01] Speaker 04: His testimony in court and his writings in peer-reviewed articles are completely different. [00:03:07] Speaker 04: LADA does not respond to insulin. [00:03:09] Speaker 04: It can't be LADA. [00:03:11] Speaker 04: Now, they also said that Dr. Schoenfeld came in with tons of articles [00:03:19] Speaker 04: fulminant type 1 diabetes, which comes on like an express train within weeks or months of an insult. [00:03:26] Speaker 04: And he explained the reason Ms. [00:03:28] Speaker 04: Crutchfield was caught, this happened in her, was because she hadn't before. [00:03:32] Speaker 02: Did the government have other expert testimony that said that Dr. Schoenfield's claim that the diabetes one could develop as early as two months after the vaccination [00:03:47] Speaker 02: And the other experts in the case for the government, there's two of them I believe, rebutted that and said no. [00:03:55] Speaker 02: It takes much longer than two months under any situation to develop type 1 diabetes. [00:04:02] Speaker 04: They did not say that. [00:04:03] Speaker 04: They said LADA. [00:04:05] Speaker 04: That was the only evidence in the case by the government was LADA. [00:04:08] Speaker 04: This long smoldering thing. [00:04:10] Speaker 04: Where the one year came from, I don't know. [00:04:13] Speaker 04: It's not in the record. [00:04:14] Speaker 04: The record says LADA and fulminant type 1 diabetes. [00:04:19] Speaker 04: There was spectacular amounts of evidence of fulminant type 1 diabetes. [00:04:23] Speaker 04: It is a well-recognized phenomenon. [00:04:26] Speaker 04: And Mrs. Hutchfield had had these vaccines before, so we have an animistic response. [00:04:31] Speaker 04: And the other thing that was sort of surprising in this case was the special master said he didn't know what that was. [00:04:36] Speaker 04: It wasn't properly explained. [00:04:38] Speaker 04: All vaccines are worked on the basis of an animistic response. [00:04:43] Speaker 02: Well, you say that there was no such evidence as I alluded to, but Dr. Barry Burcu testified that there's no relationship between type 1 diabetes and the MMR vaccine because type 1 diabetes takes years to develop. [00:04:58] Speaker 02: I mean, that's rebutting your... So there is evidence. [00:05:04] Speaker 04: That is medically wrong. [00:05:07] Speaker 02: You disagree with that expert testimony. [00:05:11] Speaker 02: But my question is, isn't there evidence in the record that rebuts your theory that type 1 diabetes can develop within months? [00:05:20] Speaker 02: And you said no. [00:05:22] Speaker 04: Well, because I'm referring to the fact that they're asking for years and nobody mentioned anything about months. [00:05:28] Speaker 04: The only thing about mumps was the fulminant type 1 diabetes comes on like an express train, very fast. [00:05:33] Speaker 03: What about all the medical studies, including the one by the Institute of Medicine, which all have concluded that they're all unable to find any link between diabetes and vaccines? [00:05:49] Speaker 03: Oh, first, as Andrew stated... Am I understanding the record correctly? [00:05:54] Speaker 04: Yes, you are. [00:05:56] Speaker 04: Andrew stated... [00:05:57] Speaker 04: that you cannot find a negative with a study of this kind because the very rare instances that you're going to get of something being caused by the vaccine are simply not going to be picked up on an epidemiological study. [00:06:11] Speaker 04: The second problem, as Dr. Shoneswell explained extensively, was measles of MMR is linked with the onset of diabetes very strongly so. [00:06:24] Speaker 04: So where a vaccine, [00:06:26] Speaker 04: basically stops the mumps from coming on. [00:06:31] Speaker 04: It will automatically cause the number of vaccines of diabetes cases following the vaccine to decrease. [00:06:38] Speaker 04: So you're going to have the vaccine will basically make it impossible to make that determination, because it is lowering the incidence of mumps. [00:06:47] Speaker 04: And so you are not going to see onset of diabetes rising. [00:06:53] Speaker 04: So as Dr. Schoenthal said, the studies can't prove it. [00:06:57] Speaker 04: The only way we could prove it was in a laboratory, and he did it with rabbits. [00:07:03] Speaker 04: And he was able to establish that if rabbits are exposed to mumps, they develop the antibodies to the aisle itself. [00:07:12] Speaker 03: Now, the other thing that happened here is... Your medical theory is based on some molecular mimicry idea, right? [00:07:18] Speaker 03: Yeah. [00:07:19] Speaker 03: That somehow [00:07:21] Speaker 03: the antigens that come with the vaccine are molecularly similar to the islet cells and then therefore once the antigens come in to the body that there's going to be some immune immunological response that attacks not just the antigens but the islet cells as well? [00:07:43] Speaker 03: Yes, that's the theory. [00:07:44] Speaker 03: So what evidence do you have that molecularly speaking [00:07:51] Speaker 03: the antigens are so close in structure or have such similar attributes to the islet cell that you could make that point? [00:07:59] Speaker 04: That was the major error below. [00:08:01] Speaker 04: There is no way to prove that. [00:08:04] Speaker 04: Medicine has not gotten that far. [00:08:07] Speaker 04: We know from laboratory experiments that measles will cause this kind of reaction. [00:08:14] Speaker 04: They theorize that it's molecular memory. [00:08:16] Speaker 04: Molecular memory is a theory to explain what doctors observe. [00:08:21] Speaker 04: Medicine has not been able to get into the cells to determine how it works. [00:08:25] Speaker 04: Now, there was a case... Is this a plausible theory? [00:08:31] Speaker 04: Dr. McClellan, in his out-of-court writings, indicated that molecular immigrate was the most common theory of autoimmunity. [00:08:39] Speaker 04: It explained all autoimmunity, including diabetes. [00:08:43] Speaker 04: So, yes, it's a plausible theory. [00:08:45] Speaker 04: As Dr. Schanzel said, [00:08:47] Speaker 04: It is the theory that explains autoimmunity across the board. [00:08:52] Speaker 04: So, and Dr. McCullough. [00:08:54] Speaker 02: Today, we can determine what kind of molecules are in a vaccine, correct? [00:08:59] Speaker 04: To a limited extent, but not entirely. [00:09:01] Speaker 04: Now, I will tell you there is a conflict. [00:09:03] Speaker 04: We have Andrew and, sorry about that. [00:09:10] Speaker 04: We have several cases in this court that say a petitioner need not show. [00:09:15] Speaker 04: how a vaccine actually causes the injury. [00:09:19] Speaker 04: We only have to show a plausible theory, a logical sequence of events, and timing. [00:09:24] Speaker 04: We have all three in this case. [00:09:27] Speaker 04: To go beyond that is to go beyond what medicine says. [00:09:30] Speaker 04: Both McClellan and Schoenfeld agreed that medicine has not determined exactly how molecular memory works in this case. [00:09:38] Speaker 04: Now, I will tell you there was one case from this court, WC. [00:09:41] Speaker 02: You've got to at least identify the component [00:09:45] Speaker 02: in the vaccine that does the mimicking. [00:09:47] Speaker 04: No, but we can't. [00:09:48] Speaker 04: They do not know how it works. [00:09:49] Speaker 04: We don't know what it is in the measles or mumps vaccine that causes this particular reaction. [00:09:54] Speaker 04: We do know that mumps cause it. [00:09:57] Speaker 04: Mumps cause it. [00:09:58] Speaker 04: We can prove that because that's been replicated in the laboratory. [00:10:01] Speaker 04: But we don't know how it happens. [00:10:03] Speaker 04: We just know it happens. [00:10:04] Speaker 04: So molecular memory is a construct made by doctors and scientists to explain what they see, to try and figure out what they're looking at. [00:10:12] Speaker 04: Now, I will tell you, there is a case in this court, WC, where they said that the petitioner had to be able to show what it was in the vaccine that caused it, because in that case, science had progressed. [00:10:26] Speaker 04: This was the measles, the flu vaccine. [00:10:28] Speaker 04: Science had progressed and identified four parts of the vaccine, four parts of the wild virus, which was flu. [00:10:40] Speaker 04: And they showed that one, just one, [00:10:42] Speaker 04: caused the reaction in that case, the WC case. [00:10:46] Speaker 04: Three did not. [00:10:47] Speaker 04: And the court held that in that case where science has progressed that far and does have that answer, the petition had to come in and prove that the one antigen that caused the reaction was in the vaccine as well as the wild disease. [00:11:03] Speaker 04: That's a different situation where in that case science had found the answer. [00:11:08] Speaker 04: Here they have not. [00:11:09] Speaker 04: Both the plaintiffs, the petitioner's experts, and the respondent's experts have reached the same conclusion. [00:11:14] Speaker 04: Molecular mimicry is the most likely explanation, but we don't know how it's done. [00:11:19] Speaker 04: To ask the petitioner in this court to prove conclusively how a vaccine causes a particular injury is to basically close the door on almost all claims, because medicine has not advanced that far. [00:11:33] Speaker 04: Medicine is essentially the study of observed phenomena. [00:11:38] Speaker 04: In most cases, they know this does this, but they don't know how it does it. [00:11:43] Speaker 04: They just know it does it, and it does it repeatedly. [00:11:46] Speaker 04: So medical science is essentially a collection of surveys of how many times this happens, followed by that, and that's how we get an answer. [00:11:55] Speaker 04: But medical science at this point has not been able, in most cases, to close that loop. [00:11:59] Speaker 04: If this court is going to impose that on the petitioner, there's no way that anybody can come out. [00:12:06] Speaker 02: What about Dr. Burchill's testimony that there's absolutely no evidence, he said, no evidence that molecular mimicry plays any type of role in type 1 diabetes? [00:12:16] Speaker 04: Well, then he disagrees with McClellan, he disagrees with Schoenfeld, and he disagrees with the incredible pile of literature that we've filed at this court. [00:12:25] Speaker 04: He's just plain wrong. [00:12:27] Speaker 04: And this is Rousseau. [00:12:30] Speaker 04: Rousseau is not even a dietitian. [00:12:32] Speaker 02: He's not referring to the theory. [00:12:33] Speaker 02: He's saying evidence. [00:12:35] Speaker 02: What evidence? [00:12:37] Speaker 04: The only evidence we have is that she had a background. [00:12:41] Speaker 04: And as Dr. Schoensoll and Dr. Levy, her endocrinologist, found. [00:12:47] Speaker 02: So you don't have to prove it absolute, but you do have to prove that you have a plausible theory. [00:12:52] Speaker 02: You seem to be arguing a possible theory. [00:12:54] Speaker 04: No, he has a plausible theory. [00:12:57] Speaker 02: Autoimmunity... To make it possible, you have to point to at least a shred of evidence. [00:13:02] Speaker 04: We have lots of evidence. [00:13:04] Speaker 04: She had very heavy background of autoimmune disease in her family. [00:13:09] Speaker 04: Autoimmunity runs in families. [00:13:11] Speaker 04: She had the vaccine as a child. [00:13:14] Speaker 04: She had it a second time as an adult and it came on like an express train. [00:13:19] Speaker 04: That's an animistic response. [00:13:20] Speaker 04: That is a plausible theory. [00:13:22] Speaker 04: That is an accepted theory of medicine. [00:13:24] Speaker 04: And Dr. Schoenfeldt is one of the leading experts on autoimmunity. [00:13:28] Speaker 04: Now, the two experts produced by the government basically denied too much knowledge of autoimmunity. [00:13:34] Speaker 04: One had no experience in autoimmunity or diabetes. [00:13:38] Speaker 04: And the other had experience only in diabetes. [00:13:40] Speaker 03: This theory is contingent on this fulminant diabetes theory, right? [00:13:44] Speaker 03: It is. [00:13:45] Speaker 03: And then to drill down further, it's [00:13:51] Speaker 03: Your theory is dependent on some kind of molecular structural similarity between the antigens and the islet cells. [00:14:01] Speaker 04: That part is the part we cannot close the loop on because science hasn't gotten that far. [00:14:06] Speaker 04: We can say that molecular mimicry is the most accepted theory of auto-mimicry. [00:14:12] Speaker 03: So obviously you can't expect the special master to rest on speculation. [00:14:19] Speaker 03: What can you point to? [00:14:21] Speaker 04: There is no speculation here. [00:14:24] Speaker 03: Autoimmunity is background. [00:14:25] Speaker 03: Is there anything in the joint appendix that is evidence that we can look at and conclude and overturn why all the experts on the other side were wrong about your particular theory? [00:14:42] Speaker 04: In the appendix is the baby book that establishes that she got the vaccines as a child. [00:14:47] Speaker 04: We have Dr. Levy's report on the 23rd of June of 2006 that she had a very heavy background in autoimmunity in her family. [00:14:59] Speaker 04: And we have Dr. Schoenfeld's expert testimony. [00:15:01] Speaker 04: Remember, he is one of the leading experts of autoimmunity on the earth. [00:15:05] Speaker 04: And he says that when the lady has autoimmunity in her family and she has had a second vaccination of this stuff, she is a sitting duck for an autoimmune attack. [00:15:16] Speaker 04: based upon an animistic response, which explains the speed. [00:15:21] Speaker 04: And then we have all this literature indicating that we do have a fulminant type of diabetes that comes on in a month or two, not a year, or two years, or late. [00:15:32] Speaker 04: And we also have the government resting on the latence, which cannot apply in a case where [00:15:41] Speaker 04: insulin solve the problem in a few days. [00:15:43] Speaker 02: Well, what you're missing, though, is any type of literature or evidence that a molecular component in a vaccine is similar to an insulin cell. [00:15:51] Speaker 04: But that is exactly the evidence that we're not required under the law to produce. [00:15:56] Speaker 04: Remember, the legislative history of the Vaccine Act indicated quite clearly that we're in a mysterious era, but we don't know all the answers, and they expect the Vaccine Act to evolve as science does. [00:16:10] Speaker 04: We don't have an answer to that question. [00:16:12] Speaker 04: We had it in the WC case. [00:16:14] Speaker 02: We've managed to map the DNA in the entire human genome. [00:16:19] Speaker 02: And you're saying that we cannot understand or see what type of molecules are in a vaccine. [00:16:26] Speaker 04: I'm saying exactly that. [00:16:27] Speaker 04: We can see, and have to realize, there's a big difference between mapping a human genome and seeing what's there and understanding what it does. [00:16:37] Speaker 04: We can see it, but we don't understand how it's working. [00:16:40] Speaker 04: If we could figure out how it was working, we could solve a lot of problems. [00:16:43] Speaker 04: We haven't reached that point yet. [00:16:46] Speaker 04: We are stuck with the science we have today. [00:16:49] Speaker 04: And we cannot ask a petitioner in this court to go out and solve a problem that medicine hasn't solved. [00:16:57] Speaker 05: Thank you. [00:16:57] Speaker 05: And I appreciate you've gotten a lot of questions. [00:17:00] Speaker 05: You exceeded your time. [00:17:01] Speaker 05: There are two minutes of rebuttal. [00:17:02] Speaker 05: Thank you. [00:17:07] Speaker 01: I think the Chief Judge's first question really shows the problems with this case. [00:17:23] Speaker 01: In this particular case, the Special Master reviewed all of the [00:17:28] Speaker 05: But there is some support in the literature, as your friend said, for an association between mumps and type 1 diabetes. [00:17:36] Speaker 05: You've got the rabbit studies. [00:17:37] Speaker 05: You've got some study in Japan. [00:17:39] Speaker 05: So why isn't that sufficient to at least set out a plausible case for the other side? [00:17:46] Speaker 01: Well, as an initial matter, I would say that it has to be more than a plausible case. [00:17:50] Speaker 01: I think my colleague referred to making that the often test requires a plausible theory, medical theory. [00:17:57] Speaker 01: I think it has to be a reliable medical theory. [00:18:00] Speaker 01: The Special Master looked at all of that evidence. [00:18:02] Speaker 01: He reviewed all of the articles, and based on the evidence as a whole, he was persuaded by the articles, including the IOM, which Judge Braden considered to be nearly as positive, that there isn't an association between those two. [00:18:20] Speaker 01: I think it's important to remember two things. [00:18:24] Speaker 01: One is that the Special Master said, this is not a close case. [00:18:27] Speaker 01: The evidence was overwhelming on behalf of the government and underwhelming on behalf of the petitioner. [00:18:34] Speaker 05: What about Donald Dr. Schoenfeld's testimony and the reliance of, you know, his reliance on the studies that were out there? [00:18:44] Speaker 01: Again, I think the Special Master explained completely why Dr. Schoenfeld's testimony was not persuasive. [00:18:54] Speaker 01: He used words like poorly explained, flawed, unpersuasive on its face, disjointed, confused. [00:19:01] Speaker 01: He couldn't explain, I think going to Judge Rainer's question, I think he couldn't explain the similarities between the molecules in the vaccine and the petitioner's isocells. [00:19:14] Speaker 01: Without that, the entire theory of molecular memory falls apart. [00:19:20] Speaker 01: Dr. Schoenfeld put forth a couple of different theories in his initial report, but he relied on the molecular memory theory that Special Master Hastings looked at, considered, asked questions about. [00:19:33] Speaker 01: He was in the best position to make those decisions because he was at the hearing and had the opportunity to question Dr. Schoenfeld and the respondents' experts. [00:19:43] Speaker 01: I think the petitioner's case really is that you should have believed Dr. Schoenfeld. [00:19:50] Speaker 01: But I don't think the Special Master made any error when he relied on Dr. McLaren. [00:19:55] Speaker 01: And Dr. Burkeau, Dr. McLaren, has exceptional credentials in the field of diabetes one. [00:20:02] Speaker 01: He's practiced medicine for 50 years. [00:20:04] Speaker 01: He's studied type 1 diabetes for 30 years. [00:20:08] Speaker 01: He has seen 20,000 patients with diabetes, 5,000 of which have [00:20:15] Speaker 01: has type 1 diabetes. [00:20:16] Speaker 01: He's authored 80 articles and book chapters. [00:20:20] Speaker 01: He's eminently qualified. [00:20:21] Speaker 01: He's one of the nation's top leading specialists in type 1 diabetes. [00:20:26] Speaker 01: So for the special measure to credit his credentials, especially when Dr. McLaren's testimony was buttressed by epidemiological evidence, we acknowledge that the petitioner did not show or rely upon epidemiological evidence to prevail. [00:20:43] Speaker 01: But when that evidence is present in the case, it's very hard to overlook. [00:20:47] Speaker 01: It's that when combined with the findings of the prestigious Institute of Medicine, as Judge Brazen said, that's nearly as positive. [00:21:02] Speaker 01: The Special Master gave numerous reasons. [00:21:05] Speaker 01: He wrote a very detailed 27-page comprehensive report with six separate subparts. [00:21:12] Speaker 01: explaining all the flaws in the petitioner's case, he just didn't find Dr. Schoenfeld's testimony to be reliable. [00:21:20] Speaker 01: For that reason, he found that the petitioner could meet their burden. [00:21:24] Speaker 01: They couldn't meet any of the three Alton prongs. [00:21:29] Speaker 01: His factual findings and his credibility and determinations were key in dismissing the case for petitioners. [00:21:37] Speaker 01: In our view, those [00:21:39] Speaker 01: factual findings and those credibility terminations are entitled to great deference and are, according to the case law from this circuit, are virtually unreviewable, plausible, not implausible, rational, and supported by the record. [00:21:58] Speaker 01: And all of those things are true in this case. [00:21:59] Speaker 01: I think Special Master Hastings [00:22:01] Speaker 01: wrote very detailed and excellent decisions. [00:22:03] Speaker 03: Is it true that the government's experts didn't really respond to the possibility of fulminant diabetes? [00:22:12] Speaker 01: I don't believe they were ever asked. [00:22:14] Speaker 01: I think the article that Mr. McHugh relies upon, from my reading of the transcript and from my looking at the Joint Appendix here, I don't believe there was a single question about those articles ever raised at the hearing. [00:22:29] Speaker 01: So I don't believe that issue ever came up. [00:22:32] Speaker 01: Dr. McLaren, on the other hand, based his testimony on his experience and his, you know, like I said, 30 years of studying diabetes. [00:22:44] Speaker 02: He also based it, and I think this is important, on the blood test that was... Did he explain anything that would cause this sudden onset of diabetes one after the vaccination? [00:22:57] Speaker 01: He did not, your honor. [00:22:59] Speaker 01: He believed that this was a typical case of diabetes which takes a year or more to develop. [00:23:09] Speaker 01: Part of that opinion came from the blood test which was run after the symptoms developed in the petitioner that showed that the level of destruction of the islet cells was so dramatic that it couldn't have started a month or two. [00:23:24] Speaker 01: It had to start long before [00:23:26] Speaker 01: the vaccination question here. [00:23:31] Speaker 01: So I think his opinion is based on good science, and it's also buttressed by his experience, epidemiological evidence, and the IOM. [00:23:46] Speaker 01: If the court has no other questions, I'll just conclude by saying the Special Master reviewed the voluminous record in the case, evaluated the testimony of both science experts, [00:23:56] Speaker 01: And it's now that the petitioners proved they did not come close to proving that the petitioner's diabetes was caused by her MMR vaccine because the special measures findings are well supported by the record. [00:24:05] Speaker 01: Thank you very much. [00:24:08] Speaker 04: Thank you, Your Honor. [00:24:17] Speaker 04: First, the issue of credibility. [00:24:19] Speaker 04: As we say, the support held in the [00:24:22] Speaker 04: Credibility is not to be used to determine whether a qualified expert's theory of plausibility is legitimate or not. [00:24:32] Speaker 04: Here, Dr. Schoenfeld, yes, his testimony on Stan was a little disjointed. [00:24:36] Speaker 04: His native language is Hebrew. [00:24:38] Speaker 04: He comes from Israel. [00:24:39] Speaker 04: His expert opinion, and in our brief we cite largely from his written opinions that were submitted beforehand, [00:24:46] Speaker 04: which, and all his written material, is not only there and it's clear, and it also refers to, it's supported on every point by literature. [00:24:54] Speaker 04: He refers to much of which he did himself, because he is, of course, the leading expert in the world on this field. [00:25:01] Speaker 04: Unreliability, therefore, has nothing to do with this. [00:25:05] Speaker 04: The theory is a well-understood, plausible theory of causation of diabetes. [00:25:12] Speaker 04: And in Dr. McLaren's own writings, [00:25:14] Speaker 04: He agrees that molecular mimicry is how diabetes is caused. [00:25:19] Speaker 04: And he also agrees that we don't know exactly how that works. [00:25:22] Speaker 04: So we cannot close that loop. [00:25:27] Speaker 04: As to the theory of fulminant diabetes, that was submitted to the court. [00:25:34] Speaker 04: And Dr. McLaren did respond after the fact in a letter, which is part of the record. [00:25:39] Speaker 04: And in each case, he just says that the [00:25:42] Speaker 04: the doctors who wrote the peer-reviewed articles saying it was Spalman and Type 1 diabetes were wrong. [00:25:49] Speaker 04: That was it. [00:25:50] Speaker 04: That was his answer. [00:25:51] Speaker 04: They were just wrong. [00:25:52] Speaker 04: These are peer-reviewed articles by experts in the field, and everybody's wrong but Dr. McClaren. [00:25:58] Speaker 04: But of course, when you look at his articles, they're not so wrong after all because his articles do not support his testimony. [00:26:05] Speaker 04: And on the issue of LADA, all the articles [00:26:09] Speaker 04: say it does not react to penicillin, insulin. [00:26:14] Speaker 04: So it's simply not LADA. [00:26:18] Speaker 04: It does come on in less than a few months or a few years. [00:26:22] Speaker 04: And there's substantial support for Dr. Schoenfeld's testimony. [00:26:28] Speaker 05: Thank you. [00:26:29] Speaker 05: Thank you. [00:26:29] Speaker 05: We thank both counsel and the cases submitted.