[00:00:02] Speaker 03:
This is an appeal from a decision of the Court of Claims in a Vaccine Act case.

[00:00:20] Speaker 03:
Ms.

[00:00:21] Speaker 03:
Chen Kaplan, you want just one minute for rebuttal?

[00:00:24] Speaker 03:
Yes, Your Honor.

[00:00:25] Speaker 03:
Okay.

[00:00:28] Speaker 02:
Go ahead.

[00:00:30] Speaker 02:
Thank you.

[00:00:32] Speaker 02:
May I please escort Sylvia Chain Kaplan for the petitioner appellant.

[00:00:36] Speaker 02:
The petitioners are alleging two legal errors.

[00:00:39] Speaker 02:
The first is that the lower court and the special master utilize a fact-finding from a proceeding that was not expected to have any precedential value and apply that fact-finding to preclude consideration of the effect of measles immunosuppression on mitochondrial function and its effect in contribution to the development of its autism.

[00:01:00] Speaker 02:
And the second legal error that they allege is that the decision was not based on the record as a whole.

[00:01:06] Speaker 02:
As this court may be aware, the autism omnibus proceeding was created to deal with 5,000 cases that were filed in the vaccine court.

[00:01:14] Speaker 02:
Three test cases of two theories were tried.

[00:01:19] Speaker 02:
None of those test cases succeeded.

[00:01:22] Speaker 02:
After those test case decisions issued, the court at that time indicated that these test cases were to have no precedential value

[00:01:29] Speaker 02:
The case is moving forward with a different theory.

[00:01:32] Speaker 02:
If they had a different theory, the petitioners were allowed to opt out of the OAP.

[00:01:38] Speaker 02:
The Andersons opted out.

[00:01:40] Speaker 02:
They complied with the procedure that was set forth by the trial court.

[00:01:43] Speaker 02:
What's the difference in theory?

[00:01:46] Speaker 02:
The difference in theory here, Your Honor, is that at the time of the OAP, mitochondrial autism was unknown.

[00:01:53] Speaker 02:
And the test cases at that time alleged that retained measles, RNA, in both the gut and the brain contributed to the onset of the child's autism.

[00:02:03] Speaker 02:
A totally different theory from what was presented in this particular, in this present case.

[00:02:08] Speaker 02:
Mitochondria are cells that provide energy to the body to function.

[00:02:14] Speaker 02:
The systems that require the most energy have the most mitochondria and therefore are most susceptible to damage.

[00:02:21] Speaker 02:
In this particular instance,

[00:02:23] Speaker 00:
The Andersons relate back a lot to the 2008 meeting with Dr. Schofner and Dr. Kendall, who say they're metabolic specialists.

[00:02:38] Speaker 00:
After the evaluation, those two individuals are recommended

[00:02:45] Speaker 00:
recommended whole exome sequencing, genetic testing to determine whether mutations in any of the RNA genes were contributory to their conclusion.

[00:02:57] Speaker 00:
Dr. Kendall, I'm quoting, Dr. Kendall found two variants of uncertain significance and acknowledged it as purely speculative as to whether or not they are causative for RA.

[00:03:11] Speaker 00:
So two questions.

[00:03:13] Speaker 00:
Uh, was autism diagnosed at that point?

[00:03:17] Speaker 02:
Uh, no, your honor, autism was diagnosed previously.

[00:03:21] Speaker 02:
Uh, the contribution of mitochondria to the development of that autism was what was under investigation in 2008.

[00:03:28] Speaker 00:
Given that the 2008 meeting was nearly seven years after the 1999, uh, uh, vaccination edition.

[00:03:37] Speaker 02:
That's correct.

[00:03:38] Speaker 00:
On what authority did the doctors note?

[00:03:40] Speaker 00:
quote, regression of skills at 17 to 18 months of age, which you cite as authoritative in your brief.

[00:03:49] Speaker 02:
To a certain extent, it was based on the testimony of the father.

[00:03:54] Speaker 02:
And at that time, it was unknown that mitochondria could lead to autism and lead to a regression of skills in this manner.

[00:04:04] Speaker 00:
Subsequent publication... What was the other you say to a certain extent was based on

[00:04:09] Speaker 00:
the statements by the father.

[00:04:11] Speaker 00:
What was the rest of it?

[00:04:13] Speaker 02:
Well, at that time it was unknown.

[00:04:16] Speaker 02:
So the only factual record would have come from the father aside from what was stated to the treating physicians.

[00:04:23] Speaker 02:
And the treating physicians not knowing the significance of the symptoms that was being told to them by the parents simply did not record it in their medical records.

[00:04:33] Speaker 02:
And thus the absence of contemporaneous findings.

[00:04:35] Speaker 03:
But you're presupposing that

[00:04:38] Speaker 03:
there was a mitochondrial problem here.

[00:04:42] Speaker 03:
And yet, there was a specific finding by the special master that there was not sufficient evidence that this child was suffering from a mitochondrial problem.

[00:04:53] Speaker 00:
And you're also not answering my question.

[00:04:55] Speaker 03:
I'm sorry, Your Honor.

[00:04:57] Speaker 00:
I asked you on what evidence did the doctors rely.

[00:05:06] Speaker 00:
and for a regression of skills at 17 to 18 months.

[00:05:11] Speaker 00:
And you said, impart the father.

[00:05:13] Speaker 00:
And then you said, there's an absence.

[00:05:18] Speaker 02:
I'm sorry, Your Honor.

[00:05:20] Speaker 02:
The parents related the regression of skills at 17 to 18 months to their treating pediatrician.

[00:05:26] Speaker 02:
The treating pediatrician at that time indicated that because the child was a boy that they should wait a few more years to evaluate.

[00:05:34] Speaker 02:
They're always slower to develop.

[00:05:36] Speaker 02:
But she did make a referral to a developmental evaluation.

[00:05:47] Speaker 02:
And at that developmental evaluation, the testing revealed that the child's speech and language parameters were at 14 to 16 months when he, in fact, was already 23 months.

[00:05:57] Speaker 02:
So they indicated that there was a significant delay in the development of those skills.

[00:06:04] Speaker 00:
Doctors Schofner and Kendall rely on that?

[00:06:09] Speaker 02:
They had the records of the developmental evaluation, yes.

[00:06:12] Speaker 02:
And as far as I can tell, based on the history that Dr. Schofner related in his medical records, he noted that the loss of skills appeared approximately 17 to 18 months out.

[00:06:25] Speaker 03:
But didn't your own expert actually admit that there really wasn't evidence of regression at that point in time?

[00:06:32] Speaker 02:
Yes, he did admit that, Your Honor.

[00:06:35] Speaker 02:
However, subsequent publications have indicated that the regression that is seen in children who suffered mitochondrial autism is different from the regression that is seen in typical idiopathic autism.

[00:06:49] Speaker 02:
And in fact, Dr. Navio, another metabolic specialist who writes a blog for Autism 1, indicated that there are at least two different phenotypes.

[00:07:01] Speaker 02:
and there's probably more.

[00:07:03] Speaker 02:
And as more information is derived, they will probably be many different phenotypes appearing.

[00:07:12] Speaker 02:
Is that in the record?

[00:07:15] Speaker 00:
Where is that in the record?

[00:07:16] Speaker 02:
In the appendix, your honor.

[00:08:19] Speaker 02:
I'm sorry, Your Honor.

[00:08:20] Speaker 02:
I can't locate it immediately.

[00:08:21] Speaker 02:
I'd be glad to provide it to you after this oral argument, but it is definitely in the appendix.

[00:08:26] Speaker 03:
Let me just go back to the Snyder issue for a minute.

[00:08:29] Speaker 03:
So it's true, though, regardless of what you think they did with Snyder, they did not preclude you from developing the record with respect to your claim that mitochondrial autism is different, right?

[00:08:43] Speaker 03:
That is true, Your Honor.

[00:08:44] Speaker 03:
And as I read their reference to Snyder, it doesn't say,

[00:08:47] Speaker 03:
Okay, that was the end of all inquiry with respect to autism, but they just rely on it for the proposition that these vaccines were not generally immunosuppressive.

[00:09:00] Speaker 03:
That is true, Your Honor.

[00:09:01] Speaker 03:
And doesn't mitochondrial disease and immunosuppression go hand in hand to some extent?

[00:09:07] Speaker 03:
They do, Your Honor.

[00:09:08] Speaker 02:
However, at the time of the trial of the test cases,

[00:09:11] Speaker 02:
The fact that mitochondrial autism could occur was unknown.

[00:09:15] Speaker 03:
Therefore... I agree with that.

[00:09:17] Speaker 03:
But if what they're saying is all they're saying is we do know that immunosuppression is not evident from these vaccines.

[00:09:30] Speaker 03:
And then later say mitochondrial autism requires some conclusion of immunosuppressant activity, right?

[00:09:41] Speaker 02:
The mitochondria are actually present within the immune system as well.

[00:09:47] Speaker 02:
So with measles immunosuppression, it causes fever, it causes the development of opportunistic organ infections that could further stress the mitochondria, which includes the mitochondria within the immune system.

[00:10:00] Speaker 02:
So what happens is that a cyclical type of problem develops.

[00:10:04] Speaker 02:
You get more infections, you get more insult to the mitochondria, including the mitochondria within the immune system, and then you develop more infections, which further compromises the mitochondrial function within both the immune system and the rest of the body.

[00:10:16] Speaker 03:
So you're saying even if the vaccines are not immunosuppressive generally, they could be immunosuppressive vis-a-vis the mitochondria that's in the immune system?

[00:10:31] Speaker 03:
Yes.

[00:10:33] Speaker 03:
And that's what your expert said?

[00:10:36] Speaker 02:
Yes.

[00:10:37] Speaker 02:
Dr. Huck did indicate that.

[00:10:39] Speaker 02:
And with respect to the first question that you asked me, Your Honor, the special message did not preclude the introduction of this testimony.

[00:10:51] Speaker 02:
What he did not do and what we indicated in the brief was that he failed to consider it.

[00:10:57] Speaker 00:
And he failed to... He found Dr. Huck's heavy reliance on immediate

[00:11:03] Speaker 00:
post-vaccination or febrile illness at best inconclusive, right?

[00:11:12] Speaker 00:
What's your best response to that?

[00:11:14] Speaker 02:
That he found that the febrile illness after the immunization was inconclusive?

[00:11:20] Speaker 00:
That he found Huck's reliance on it was at best inconclusive?

[00:11:24] Speaker 02:
Well, I would suggest to this court that the evidence was that measles

[00:11:30] Speaker 02:
causes immunosuppression within one week after administration of the vaccine.

[00:11:36] Speaker 02:
And that immunosuppression continues and hits its lowest point at approximately five weeks.

[00:11:41] Speaker 02:
And depending on the antigen that caused the immunosuppression, could continue up to 10 to 12 weeks.

[00:11:47] Speaker 02:
That was the evidence.

[00:11:49] Speaker 02:
Now, the fever that occurred, according to even the CDC, fevers can occur in children seven to 12 days after a measles vaccination.

[00:11:59] Speaker 02:
It occurs in 5% to 15% of the population.

[00:12:02] Speaker 02:
And in this particular instance, the minor here suffered a fever of 105 one week out, which is precisely the time that you would expect to see a fever after measles infection, after measles immunization.

[00:12:15] Speaker 02:
So I'm not quite sure how the special master came to that conclusion.

[00:12:20] Speaker 00:
Well, I'm looking at 44 and 45 of the record, where the special master explains exactly that.

[00:12:31] Speaker 00:
Dr. Huck struggled to identify evidence from the records substantiating it.

[00:12:37] Speaker 00:
And then there's a discussion of that.

[00:12:39] Speaker 02:
Dr. Huck's explanation of what occurred after the measles immunosuppression was that first the fever occurred of 105 at one week out.

[00:12:52] Speaker 02:
Then days later he was seen in his pediatrician's office with additional fevers and

[00:12:59] Speaker 02:
was diagnosed with conjunctivitis.

[00:13:02] Speaker 02:
A couple of weeks later, he was again seen at his pediatrician's office, and they noted a rash, and they noted fever previously, and they also indicated that he had tonsillitis, exative tonsillitis, which essentially is another infection.

[00:13:18] Speaker 02:
And that period, approximately January 28, would be about five weeks after the immunization.

[00:13:26] Speaker 02:
And that is the point in which you would expect to see the lowest or the most immunosuppression after measles vaccine.

[00:13:34] Speaker 02:
And at that point in time, the majority, the vast majority of children, their immune function will start to rise.

[00:13:40] Speaker 02:
But depending on the antigen that causes immunosuppression, that may not happen until 10 to 12 weeks after the introduction of the antigen.

[00:13:50] Speaker 02:
And we do know that towards the end of this time,

[00:13:53] Speaker 02:
approximately March, he was seen again for further infection.

[00:13:57] Speaker 02:
That would be roughly at nine to ten weeks out.

[00:14:00] Speaker 02:
And while the special master did relate this, because he did not consider the testimony on measles immunosuppression, he would not have been able to link the immunosuppression to the child's history.

[00:14:20] Speaker 02:
Okay, we've got just about a minute left.

[00:14:23] Speaker 02:
So based on the fact that the special master did not accord this testimony any reliability, he also failed to consider the record as a whole.

[00:14:35] Speaker 02:
He failed to consider, he found the respondent's expert more credible, but yet failed to cite instances where his opinion was in opposite to his written articles and was inconsistent and at some point was actually contradicted by some of his own authored articles.

[00:14:52] Speaker 02:
And I see my time is up.

[00:14:55] Speaker 02:
Thank you.

[00:14:55] Speaker 02:
Okay.

[00:15:02] Speaker 01:
Good morning.

[00:15:03] Speaker 01:
May it please the court?

[00:15:04] Speaker 01:
I'm Lynn Rickadelos, the respondent at the Department of Health and Human Services.

[00:15:08] Speaker 01:
Your Honor, as we stated in our brief, this appeal is simply petitioner's disagreement with the Special Master's evaluation of the evidence in the case.

[00:15:15] Speaker 01:
and with his conclusion that the preponderance of the evidence simply did not weigh in favor of vaccine causation.

[00:15:21] Speaker 01:
He did exactly what the Vaccine Act required him to do, and he looked at the record as a whole.

[00:15:26] Speaker 01:
And he concluded that Respondent's expert, Dr. Cohen, was simply the more persuasive expert in this case, that Dr. Cohen was far more experienced in terms of mitochondrial diseases and disorders, and that, frankly, Special Master said this was not a close case.

[00:15:45] Speaker 03:
I mean, the reference to Snyder, while I think you make a good argument that, well, he still went back and allowed the information, it does seem to be a prejudice.

[00:15:54] Speaker 03:
It does seem to be the attitude of, look, we looked at autism and, you know, any kind of autism is never going to fall within the best scenario.

[00:16:03] Speaker 01:
But that, Your Honor, with all due respect, that's not why he cited to Snyder in this case.

[00:16:07] Speaker 01:
He's not saying that we looked at an autism there for any autism that comes down the pike after that is going to be precluded.

[00:16:13] Speaker 01:
He looked at it specifically for the issue of

[00:16:15] Speaker 01:
whether or not the measles vaccine itself is immunosuppressive.

[00:16:19] Speaker 01:
And we heard some testimony from Mr. McCathlin just now about the alleged immunosuppressive effect of MMR.

[00:16:27] Speaker 01:
I'm not even sure, five days, 15 days.

[00:16:30] Speaker 01:
That was not on this record.

[00:16:34] Speaker 01:
Yes, we have evidence that MMR can cause a fever within 15 days.

[00:16:37] Speaker 01:
That's not immunosuppression.

[00:16:39] Speaker 01:
That's evidence that your immune system is actually working.

[00:16:42] Speaker 01:
We have no testimony really about the alleged immunosuppressive effect of MMR.

[00:16:46] Speaker 01:
I will refer the court to really the extent of the evidence on immunosuppression of MMR.

[00:16:52] Speaker 01:
It is one sentence in Dr. Huck's expert expert report, which unfortunately, their second expert report, which unfortunately doesn't seem to be in the appendix.

[00:17:00] Speaker 01:
But if I may proffer to the court what he said, one sentence.

[00:17:04] Speaker 01:
The combination of MMR immunosuppression along with a deficient immune response

[00:17:09] Speaker 01:
more probably than not contributed to the frequent infections that filed his vaccination.

[00:17:14] Speaker 01:
And that's exhibit 29 at 2.

[00:17:15] Speaker 01:
That's it.

[00:17:16] Speaker 01:
And then after that sentence, he had a parenthetical with three articles that he filed.

[00:17:22] Speaker 01:
Those are the Munyer, the Smedman, and the Hussey articles.

[00:17:25] Speaker 01:
No discussion of those articles whatsoever.

[00:17:27] Speaker 01:
We get to trial.

[00:17:29] Speaker 01:
And I will direct the court's attention to the extent of the testimony at trial about the alleged immunosuppressive effect of the vaccine.

[00:17:38] Speaker 01:
It's appendix 349.

[00:17:39] Speaker 01:
through 40, transcript page numbers 140 through 142.

[00:17:43] Speaker 01:
Dr. Huck just talks about the alleged immunosuppressive effect of the vaccine in broad brush strokes.

[00:17:49] Speaker 01:
And to be fair to him, he's not an immunologist.

[00:17:51] Speaker 01:
He doesn't have the requisite credentials to talk about whether or not the vaccine was immunosuppressive.

[00:17:57] Speaker 03:
Why there's no... Why it seems like the special master said that unless they actually prove regression, that somehow there's not going to be any ability to show that this condition existed.

[00:18:10] Speaker 03:
Why was that required?

[00:18:11] Speaker 01:
I'm sorry, which condition are you talking about, the autism?

[00:18:14] Speaker 01:
The mitochondrial autism.

[00:18:15] Speaker 01:
Well, first of all, I would like to correct the record that there's no such thing as mitochondrial autism.

[00:18:20] Speaker 01:
I know the petitioners used that in their brief, and that is not a recognized term of art in the medical community, in the mitochondrial community specifically.

[00:18:28] Speaker 01:
Whether or not mitochondrial disease causes autism is still being explored, but it is by no means shown.

[00:18:34] Speaker 01:
And Dr. Cohen was very, very straightforward and very persuasive on that issue.

[00:18:39] Speaker 01:
No, the Special Master didn't say that unless they show regression that they're out.

[00:18:48] Speaker 01:
We've had other cases in the program where the petitioners do.

[00:18:51] Speaker 01:
Their child has regressed and they still haven't been able to show that the vaccination caused an aggravated mitochondrial disorder to show autism because the evidence just simply isn't there to show that vaccines can aggravate mitochondrial disorders, regression or not.

[00:19:08] Speaker 01:
But in this case,

[00:19:10] Speaker 01:
All the evidence that the petition relied on, that Dr. Huck relied on, had to do with regression, with developmental regression.

[00:19:17] Speaker 01:
But even he, at trial, now it's important, up until trial he kept saying this child regressed, but at trial he acknowledged that the evidence simply didn't support the allegation that the child in this case regressed.

[00:19:29] Speaker 03:
Did he say that there isn't current evidence of regression versus there wasn't some regression earlier that he has recovered from?

[00:19:36] Speaker 03:
No.

[00:19:37] Speaker 01:
I mean, if you look at the Special Master went through a very detailed description of the medical records that he cited each time the child went to the pediatrician, and there is no evidence of regression.

[00:19:47] Speaker 01:
In fact, when the child eventually did get to be seen by a developmental specialist, both of those specialists made a note in their notes that there is no evidence of regression here.

[00:19:57] Speaker 01:
So at no time did any medical provider diagnose this child with regression, except for Drs.

[00:20:05] Speaker 01:
Bradstreet and Drs.

[00:20:06] Speaker 01:
Rosengold, but they are medical providers who espouse the belief that vaccines can cause autism, which is why when Dr. Schaffner saw the child eight years later, he based in part his diagnosis of mitochondrial disease on an incorrect factual predicate that the child had regressed at 17 to 18 months.

[00:20:27] Speaker 01:
But if you actually look at the medical records, the child did not regress at 17 to 18 months.

[00:20:33] Speaker 01:
And even their own expert acknowledged that there is no evidence of regression in this case.

[00:20:37] Speaker 00:
Well, your opposing counsel is pretty limited in what she could provide as the basis for those two individuals.

[00:20:44] Speaker 01:
And I think it's quite telling that her first answer to you was the father's testimony.

[00:20:48] Speaker 01:
It's anecdotal testimony.

[00:20:50] Speaker 01:
Mr. Anderson obviously loves his child.

[00:20:55] Speaker 01:
and believes that there is a certain sort of clinical course.

[00:20:58] Speaker 01:
But if you look at the contemporaneous medical records, and as this court said in Kokuris, the contemporaneous medical records do hold a more evidentiary weight, especially when oral testimony conflicts with that.

[00:21:08] Speaker 03:
But who else other than a parent is going to know whether the child has regressed?

[00:21:11] Speaker 01:
It's not like the doctor's living with them.

[00:21:13] Speaker 01:
Well, the doctors, the developmental specialists who specifically are trained in asking the appropriate questions of parents

[00:21:23] Speaker 01:
What is regression?

[00:21:23] Speaker 01:
What is not regression?

[00:21:24] Speaker 01:
Both of the developmental specialists who looked at this child specifically made mention that there was no evidence of regression in this case.

[00:21:32] Speaker 01:
And if you just look at the medical records, Your Honor, they just do not bear out that the child lost any skills.

[00:21:39] Speaker 01:
They never say that he had a certain amount of words and then lost them.

[00:21:42] Speaker 01:
We typically see in cases where there is evidence of regression.

[00:21:45] Speaker 01:
This record is simply devoid of evidence of any kind of developmental regression.

[00:21:52] Speaker 03:
The problem was, though, that back in 2000, the doctors weren't actually looking for regression, right?

[00:21:57] Speaker 03:
I'm sorry?

[00:21:57] Speaker 03:
They weren't really looking for regression.

[00:21:59] Speaker 01:
They certainly were.

[00:22:00] Speaker 01:
Absolutely.

[00:22:00] Speaker 01:
The developmental specialists?

[00:22:02] Speaker 01:
Absolutely, Your Honor.

[00:22:08] Speaker 00:
That's true.

[00:22:08] Speaker 00:
Within their ambit, they certainly were.

[00:22:13] Speaker 01:
Correct.

[00:22:13] Speaker 01:
Absolutely.

[00:22:15] Speaker 01:
And if I just may get back to the citation to Snyder.

[00:22:19] Speaker 01:
If you look at the citation to Snyder, the special master just didn't give one page with a parenthetical.

[00:22:26] Speaker 01:
He cited to three pages where the special master in that case went through a very detailed discussion of the evidence that was put before the court in the OAP, both from the petitioners and the respondent, as to the alleged immunosuppressive effect of the vaccine.

[00:22:41] Speaker 01:
And the special master didn't just have to cite to Snyder.

[00:22:43] Speaker 01:
There were two other test cases on that theory.

[00:22:46] Speaker 01:
And both of the other special masters in those two test cases

[00:22:49] Speaker 01:
came to the same conclusion with respect to that issue.

[00:22:53] Speaker 01:
The special master never said that he was bound by any of the test case decisions.

[00:23:00] Speaker 01:
He cited to Snyder simply as he went to any other case, as we all do when we cite to cases that are not necessarily that presidential, but are definitely persuasive.

[00:23:09] Speaker 01:
And he said, given the very limited evidence that Dr. Huck put before me on this issue, particularly in light of the fact that this issue was discussed

[00:23:19] Speaker 01:
ad nauseum in the OAP, I simply am not persuaded that the vaccine itself is immune-depressed.

[00:23:25] Speaker 00:
This case rises and falls on purely on a question of evidence, an evidentiary way.

[00:23:29] Speaker 01:
Yes, yes, Your Honor, that's correct.

[00:23:31] Speaker 01:
And this case rises and falls, as the Special Master said, the central deficiency in this case is the finding that the child didn't have a mitochondrial disorder, absent that, I mean, the case really falls, really, it can be closed there.

[00:23:43] Speaker 01:
He said just, you know, for purposes of completeness and the interest

[00:23:47] Speaker 01:
of just being as thorough as possible.

[00:23:49] Speaker 01:
He then went ahead and analyzed the case under the three health and prongs.

[00:23:52] Speaker 01:
He didn't have to do that.

[00:23:53] Speaker 01:
But he said that not only the case has multiple evidentiary problems, not just the fact that the child doesn't have a mitochondrial disorder.

[00:24:06] Speaker 01:
Any other questions?

[00:24:07] Speaker 01:
I will.

[00:24:08] Speaker 01:
Thank you.

[00:24:10] Speaker ?:
OK.

[00:24:12] Speaker 03:
We have 36 seconds for Rapata.

[00:24:16] Speaker ?:
Thank you.

[00:24:17] Speaker 02:
Your honor, the Navio citation is at appendix 252 to 257, and I would direct you to appendix 254, where it indicates the flare and fade response, and says, follow a flare response that can be a gradual evolution of other problems from persistent GI problems and diarrhea, a gradual loss of language over two to three months with the onset of repetitive movements to gaze avoidance and social avoidance.

[00:24:40] Speaker 02:
This is exactly what happened to the minor Anderson here.

[00:24:43] Speaker 02:
And your honor, also,

[00:24:45] Speaker 02:
The decision that this child did not have a mitochondrial disorder was based on the weight of the evidence that the special master accorded to respondent's expert.

[00:24:53] Speaker 02:
However, his expert testimony was contradicted, virtually inconsistent with his published articles, which the special master did not comment upon.

[00:25:05] Speaker 02:
Therefore, if he had considered the record as a whole, would he have accorded greater weight to this testimony when, in fact,

[00:25:14] Speaker 02:
It was being contradicted by his own authored articles.

[00:25:19] Speaker 02:
And that's a petition's position on the fact that he did not consider the record as a whole.

[00:25:24] Speaker 02:
OK, your time's up.

[00:25:25] Speaker 00:
Yeah, I have one more question.

[00:25:27] Speaker 00:
Restate.

[00:25:28] Speaker 00:
This time's not up.

[00:25:29] Speaker 00:
What pages?

[00:25:32] Speaker 02:
Appendix 252 to 257.

[00:25:34] Speaker 02:
OK, OK.

[00:25:36] Speaker 00:
Thank you.

[00:25:37] Speaker 02:
You're welcome.