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RJ Reynolds

Antonio Cipollone V. Liggett Group, Inc. Transcript of Proceedings. Trial Testimony of Stacey K. Mills.

Date: 18 Mar 1988
Length: 193 pages
507814450-507814642
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Jones Day
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Mills, S.K.
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27 Feb 1998
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Rjr4088
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Minnesota
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19970311
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TRIAL TRANSCRIPT
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hgn14d00

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1 a 3 4 S 6 7 Q 9 1J 11 12 13 14 Is 1S 1C 17 13 19 20 21 Y 2' 23 24 25 llills - 01c.at 5509 the tuaors to aelp ao learn mc• about tbes, b.cduas tAey ar• rolatively uncoaaon tuswrs aad I vaat to accwwlato a3 such ssaterl.i •s I ean, I a• interested in aeeiad the effect of ob.antAtcayy on tbe tuaots. Q Is that for your reooarch purposss? A Yej. I alto k.op th• aaterial •r an ongoing •ot of alida in casec that I aan uso and tot t.scbinQ porpo.e:, a: vell. Q Textor3ay you told os that you oaJ aaogt 47 ca.e,i tbat ysu bavs studiN botb ttom yJ Ur orn ti:... o: troa tha liieg of cttie UniversYty of Viryinis Ned:cal Csattr, or, and inc,uc3inj case.: that bavr bosn reforred to yo4 bit othsr , dorto:a, ia that corr.ctY A Cotr~ct. Q Md Yu4 bave aivo in.i:cateJ that 39 ot tnose 17 ce;ma yuj bave obtdinod aLwktmy Aistory? A Correct. Q Aii 39 ar• s113%orr? A Correct. Q Ir thec* anyonQ, any otnat paL4olo91at in the iioYntry that You ar• arars of Who eas aollsctod as rshy cases ar.3 atudiod as Mny 94004 of toli-ditt.centiatod arNro.nSw.:iac oarowose as yoo have? A To Irf Raovl.d,te, av. Ln m ~ 00 r Ln v tnYi.Lls T. Le+tl6, CsR i JoA.yra 1l. HOCSTO::, cSi:
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4 5 i 7 8 t Itills - dicoot 3517 !dt G4vRTr When you •tart vby don't you ask bim v4at Yo was looting at and ask bis to qiv It to you? 1t8. MALTBRSi I tbiak be baa crbatev.r be bad yeste:dar. TYS COJRTi Do you bave tbe eot.s? MS. NA:.TttAB o !ie can bave tboo. Want .o to asic bi.? Tu:: cour,r: Y.a. MR. COitNj I didn't thsnk it va3 Aece3sary in irun; 20 or tae jury. 11 KS. itai.?ERSe Just sanavri tten aote.:? 12 nR. COt!tIj 1tnat.vor be bad . . 93. IiaLTiR.4e lii,.thoc be co9etc.J to it or not7- 14 TtlE COJaTs ttnat he retorr .d to as vha: you ara ls enciti d t e o roe. 10 KR. CO"'Vj Hav do we know? 17 tlS. tlAisCR?: We viil tall You. is KR. C01fR I 1 vt l l•aa bis, TNE COURTI I thiax v o9q3t to do lt on tAo cecord. MR. BIRRZOGts Good •otnin8. I as Pat iitcidd.. • cKOSS-sxAn ZKAT Z,N .Y MR. srLR1010ts tflYLL18 T. LDi1j, C8A 6 JOAl1R'1 M. NJC9TOb. C8R
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0 1 2 3 4 S 6 7 20 21 22 23 2• 35 Milta - dlrect $516 tecords. There 1• a polnt of clarification. litE CoURTa t/ny 4on't re do It later, aubject to whatever that ts. KA. aIRRiDGRS aot realiy a probles. Tii6 COU1t"='t Jll 1 r iOat. i1.9. NA;.TER3t I vould like to otter the cAart Dr. Milla drew today into evtdenae, Piaintitt's 6s.hibit l000. TUC COORTs Any objectiont MR. GIRRIDCEs Sorry. T1t3 C~JR: # Tae chart -- KR. SIRR:D38i No. '!'Ub COURa t -- lo fvidence. Yvv aay CtOLi-etanine. (Plaintalf'e sYnibtt 8002 roceiv,*d in evldenca.) Mr. C03:4i CouIJ rQ havc a short siaQ barT Only Lor a aecond. tT:,e talloWing t.icea place at aid• bar. f (The to;loeiog takoa p:ace at aidt b.ir. ) Ha. S?RRIb:Cs Yesterday it vaa d.teraineJ that tho doccor bad aoteA to vG1ch he va8 reter riny. I taiot ve a:. entat:eJ to •ee ryat he had tbete. Ma. NJ4.YEleS: I don't knov it be hai ootes but. I bnow be has artlcles. /tX. COlit:s I would like to aee what Le ba3 y.aterday. Ln m -J 00 r ~ m ~ PRTLLIi T. bLif:S, Csk 6 JOJW:C: A. lWJL'TOti, CS8
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1 3 4 s i 7 Kill• - Ctoss SS13 p Good .ornioo, doctor. A Good .o=nins. Q Me eave sot betore baven•t we? A Yea, on several occasiona. Q At your deposition oovn tn C6ariottosvrlle the tirst t ia? A ltiQht. p oot an eaiy place to get to. A T4at ia Ooe vt its odvantaQea. Q Okay. Doctuc, durlnq YoQr to:.tiroDy You vore rtrarrin7 to somQ aot.a crt a= ieait: an outllne of !ltz. Cipol2one's care. Do yo4 have tos4e rattriole vitb yos tbat yo4 ver• reforring to? 0 A I ssy have a copy with at* it ts the same a.c ot suta., I tbtnk we entero;d at one of the very tir4t esliiblts dur&ncj my Je?4zttiap. Q i von't stcx it, but lot st aVk you tt tnis is tAt a.oe ontb ? A Ye.+, tna: 18 lt. I ba.e a co?y tbat ia •obztantlvely the aaSe, wy have . lsttie •crib5ltaa oa i:. I dida't bring oy copy vitb se. Q btW the other Yterlals? A ilote la .y oopf. p And tna otAer .atorsala that yo4 b.ve tbere could you tell the Court? are vhat, Ln m ~ 00 ~ ~ ~ oN m tHYi.:.I6 T. Lmi, CSR i .10Af1ii~ M. MOJSTa3~, CSR
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• 4 S i 7 i MiIl• • dic*ct $507 to.e other Qall,c brcaaN better ditt•r•nti•t.:! •nJ qiv• os the laa9e tbat vS reaoqniss sicroscopically aa • well-ditterentiated n.urdsndocrtm. caacsr. Ma knov tiooa •ap1• adtcal data that the ssall co:l component ls caus.d by asokiAq. Aad we Qan ttac, tDe oriqsn of tAat part ot the tuoot back np to the oriqtaal pareat ctll which is the ctil that gave riae to the traor bat t'ab au* call also gave cise to th• other population, the v.it-dlttorentiatej coerpoosnts ot the tvsor. It tnis liAe of the chart is oauued by sxcfcing, aa thR carc&nuq.n agent •ik] becaus• the iaaw cell gave ri&t to W4,l1 portions of the tusc.r, this line iurt bav• been due to tha carclnoqenic •gsn:. ' Q Doctor, you .ay return to your seat. A (Mitnosa caLpl iey. ) K5. M.R:.TCtc3i I Vili sark this chart Ptalnt.tt'z Bxhi01t 8008. tPlaintttf's Co.rt saikfd sshlolt 8001 toc 1dt-Itlf ioation. ) Q b1ow, Doctoc, You told ur. Yeat•rday that you b•y s a special lnte[eit •A the vell"'dlrt•rAAti•tAd asucOendc?:.riAe cacclaooas and that other patbolv4tsta have sent you cacfs to rwiSY. ttoy do other patboloyiata send rou c.ses to review? A Zs part, thsy vau:d send tb.r to as because they know PA'lLLtB !'. LaTji, C6A & .10AUR3 N. l10Z10?ON, CSR
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Mills - Ccoas 5525 1 wopl• and before it vaa in the toals of 104. Liut you have ~ 2 to be .oteo in. 2 0 You have to be vot.d !n? ~ A YlZO. S 6 0 Yoo aonaidered it an bonor vpeo yoa vare voted 1n in 'ts? 7 A Yea. a Q Oid you tnor Dr. adnnsers vas In the Acthur tuldy bcout s 10 iociety from 'e3 to '8s? A Yea. Uat way one of tbe r.yr I bad eeeA als M3s and 11 aeen bto sYaak. 12 Q You said ye:terday in talkinQ aboot the •ditot•ia: b;+ard.. 13 of sedtaol joutna:s -- do yoa c.are,abor discus;~ing ttiis , 14 lrejtstday? is 1S A Yea. lE 17 ~ xna: it reareeenta? A Ye~. 13 Q i beli*ve yo4 "1d that yuu folt it vaa an honar ba.-au..a » yoj v.r• s.lectee by the editor, becaus• the edstot teit bc 20 cuuld truz: you in analysiag and evalvatinQ researob 21 artlclen? 2: A Cortoct. 23 Q Dr. ioAsors is •n the •dttor iil ooard of a nuotr.r ot 24 Pro~etiqioua patho:o9ist joucnals? 2S A l~3. Ln m ~ . CO r ~ ~ ~ w t1tYLLIS T. LlitlB. CSR a JOA:a:'s: M. •*3iJS3'ou, CS:t
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0 4 s 6 7 Mklls - •itect 5510 Q pow do you tnow it? A I know it icor cevrev: of the literature and I also knwr in pact lroa dlseuas.inq t6.se tosocs witb co1l.aQaa tuat bave int.rest in this are• as weil and wwid be likely to be people to also be aceunulatinq tbea• eaeea. Q AnJ ace saa% of these patbolo9ists taat you ha+• aieCQsar3 today tbst yau woce awate o! In tbe litorature, tae same patnotoqi.ts •lcose acticles you oentioned to the jury yeoterc7ay? A Ye4. In patc. I did fail to rentlaa yesterday tvG otner utudit:. oa th:o topic. One Is by GeWhxrt an3 coi:eaQuez, published vacy cecently in Cancer tn 1908, anJ tae otaet one i& the otudy by McCaslin publsybe3 in the - Jo;jrnal Of Ca:Bio-rascu:ar aucp.cy tn '8S. Q Tell the ju:y abos•, those artieles? A Too CebaacL utudy iz a c.cent:y pa:ulishe.t •tudf alth:..,yn they ha.S an aLaltcacL. Kft. COa Na t:cs&.• aw. I do not be:ieve tLat e:tudf could have toc,.ed tire ba+:iu ot tAe Dactor's oyioton sir,ce be gave it in 'a7. TtiL MITUSS;.s Tae aDatraW4t eaS pul:iaaned Pr iO< <Q '47 witu the data. Q Go adead. A To• abstract, juat tor coswletsness, was pub:iabe:3 tn two places, "• in the citations In the A..tican iespitatc,ry tRYLLIS T. L.D428, C8R 4 JOAli%,Yl M, dOJST-I'a', C.S R
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~ , .. 1 s 3 4 f , . . ~. - - ~ ,,. . a:ssasascs•I ta.aiswA) : tuiVir. DM$ Az,ra.T.iM, sa~tS so ~ .. sf M.. . we rn . •,rua sLe. s.o... D?1 D0RALa J. COi/M. SiQ.. JAlV • ZiADl1!! • lM.. •Dmtl DKIKIR. 11900 Attorooy• tor po1..iast, LlMott.•: •lt01/11 i OOMRtRTs tSQI. • SY t DJIYNOMD t. 1ROS00Mett •M. • •ttoroors tot D.toadaot .*R11LD sottto. • !ls7itR. lu.1 • DZLLt !lOR. • srt wILLiRM a. ?OC[tR* iD.t tRO.• -sa0- ssoa9, .unY saol.. a , arsvrA PARRt.e. ss4.. ~a WauZ s. ~~es~as~. sso.. s ~ .asszct N: a ~~es .s:satme sso. lltt.rso~s tor D.ton4aota, RAitLy Dorci• sod Lo=lllatd. . . . . . •~ • ~ . . } .-_.. • . . , 0 a . Vi 'tLLti !. LN11O CiR R lOA~~ t. ~sl~OR• CRl . . F-~ ~ F~+ • ,. , , .
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Mill• - dlrtct lS0S I A When w• talked about tbN four aajor types of lonU cancer ~ 2 yesterday, we taliced about tbia dcoup w call eegroendocrine 3 carcanoasa. Under that specitic 9roup of aancerr are better 4 ditterentiateJ tuaor:, wbicb we oall Well-atttsrOntiats3 5 Aeuco.lWocrtns caccisoaas, snd .or• poorly dltfsrentlat.d 6 onei, 1I,1 ch IIe call aaall Call YnOitterantlated or iome of 7 tne other tera3e • what we ar• talkinq about ia tundaaentally the saWe 9 type, aeurooM3JctlAe aarclnoao. 10 it wo louk at the other typei. ot cancsr, iQuaaoJa ll 12 cell carc:ao" haee dlttstentiationr. Tovre ar• better dltfscent:ia;.+2 syu.aous ce:l or we11-difte,rsntistsd oneo and 13 aiso ponriy diftsretttiated. 14 Tat aaw ta true toc qlanda:ar or adenu carcino",:. 15 ?nere are tnnoro tbas are poorly dittetantlats.i ans tacot s 16 that are we::-dttfsren:isted adenw carCinoaaa. In o«aor 17 [n6tance., to%sce io no data to su2vest there ts any 19 dift.reocs In cau:.ation toc the tu.ors at the poocly suJ t;#: 19 the ipectrYSf. 20 A;, to tu4ora at the well-dttletant:at.d •nd crt the 21 spectrua and the saae is true toc the neuto.ndocrinc 22 tanceca, •rA an additional tsature waicn I sentione.! 23 Yeaterday about tbe asuroendocrins cancers ih taa;' trey ace 24 ottsn •iaed. It is not so such that all of che tweorA are 2S ws/l-dittsrastiatoJ aeurotnd7ctiAe carclnoltas and other lByLLIS T. l.Cif2S, CSR 4 JOA'~iI:: t1. 1i4iU9'1'Dli, Cilt
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1 3 4 5 6 7 ~ 3 10 11 12 13 11 ~ 15 16 17 1$ 1! 20 21 22 23 24 2S S Mi11a - direct SSOG tuaorz ace all small cell neuro.adocctne -- i4 a biqn ptrconta9e one finds •ixtdroa of the two types and that 16 furtber •vid.pce •e att talkin9 about 2uadaaeAtally the wa• typ.. doae cells are batta d/ti.cantiatod and otbers are aot as s.ll-diftec.ntiat.d. it va have a tw,or and this is a cosaon, oonwn case that Aar :at us say 53 percent of ltr Cancer ca:ls lootiinq like s.all cell oaditf.t.atiated oarclnoar.a, and the oLher 45 Potc.nt of tAe cella at• aIltt:* better aiff.centiat.s a:W tbojo 1oaA lite s v.21-dlff.c.ntiated nouroendocrine aarctaoaa. Taeaa o:x.d patte.r.s ar• very eoanon and psovldo luctbo: latoraation tsqardiriy Causatlon in theor twwts, ' pacSULa tb.rt io a tttosndoua asoOnt of data on tbest very cor..on arxtl C.ll diffet.ntiattJ caccinoasis to a.e that they aco cauL.J by cigarette saoicf. A vall-diifer.otiate3 •ndocriae carciaosa are 1ej3 eossaon a+id we don't bave a sarqe a ewmbec of eat.r to study. i4t in the aix+d twtocs rba: baa obvioesly bap;oaned !4 that the aoll that tarat deeosS saliynant d/vi.leg aa:! 9tv.: tiao to nev oells aad tbeUe 00110 divide and fjiva 9160 tO fu:thor c.lls. And ia t4• ptoasss sost of tbe cells ctma,n poorly altfa .ntiat.d aad 9ive us the laaqe tbat oe see •iecoseopically a3 a aaall aoll asditteroatlated oancec. VdYLLIS t. L6Y2 S, CSX i J011Nti:. N. NWST0aO CSR
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4 s 6 7 • 9 11 12 13 14 Is 2S f Mi11s • Ccos3 5520 patholoqy? A ltt9ht. 0 You iai0 you •pent aboat one•tbtra to one-nali of ywc tioa doing sutqica: patbo1oqy? A bi9bt. Q And )e that prdctice of one-tbitd to on.-half of yoar tio.# you don't do autopsios anyaat• do You? A eave Aot done tbe• tor several yoa:o. I-- rarelj I vill be coaauit*d on a caa• usually to 1ooC at the alidoa that have baan prtpaced atter tee autopsy. Q Ysu have not don• auto'gaies te-juiar:y zinc• you asr anat"lca: traininy? A Riqht. I,r:qnt save Ei1ied in once or tvAcs va.n we. ab*rt statfcs. d Yau duA't do tAo bcon.:hoscu;n• ptoc.Jvctr yoo di:~:~:.oJr A Nz. I bavo beeh tb:rr arny tisaa, tout I do:.'t do tna. Q Y:+j doz't du cbea t iurqory? 11 .7et:nittlf iIGL. Q AnJ actub.i+y, Doctoi, you don't direct:y treat patic:ltso do you? A I ao a doctor of medicine ari2 I bave •- I aa lio.nte,l to trea: pati.nta. I have a t.r yationts that I treatedd tcoc alao: ir.Jical ProLleas troY tiao to tins, tri*n.i4 who aeo,lQa soos ..Jieal attootion, but 1 don't treat bospitaiieMd lGY:.L2Z T. Lt'+t16, CSR 6 JOANKL M. 07JS?ON, C::::
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3 4 S 6 7 0 11111a - CtOSi 55:3 A iwt an ta• •sna of 9ivin9 tbe dtOqs, ao. Q Nut I asked you at rour depositton wA.tber yoU bad esptcttss, •od you told ss you didn't? A Riqnt. Q You don't bav• txperttse in ruryery7 Q Ycw don't o.vM •xp*r:i.o in pulmonary •e3actnMT A lQo. Q llor do you Aav• •spetti6• la rad:oloqy or s-rays? A Tbat ta tiqat. p AnJ you don•t bavs •apsrtisa in tbe dlsaipllae cailel apidestoluqy thsL v ta:keJ aLsut here? A Corttct. . Q You don't bava aaperci.e an b1ostatl3tJcz and otatizt;cs in gsneral? A Cos rsct. Q Or. Ni;is. Wheu vt ti:st ast daati ta C4irlottaa.r;lie in Janusry ut 'd7, you tu2J sw a: tbat tioa iha;L y.rs bsJ *paa: aDuut; 3,0 bou:c pre;~arinq and voilcihy and rsvievinq th:nyv. for this Caao. aov snlch tisw bov• you iyent atnos Janua ry ut 87? A I vould say, siu.• January of '67, I probad2y apsnt -anotber 40 to 45 boars, Q And you •xp.ct tv b. pe W fot the ti.e you sp.nc vc+t k i ng on lt? tNYLL13 T. LEN:S, CCR i JOA:d3» N. /O;7MK, CSR ~ ~ ~ 1
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! ~ • ! • 7 • ! 10 11 12 13 14 ~ 1! 17 to 1• !0 21 :is s: _! 34 ss 1, e .* tnlsotssioo Sold ott tw eosert)• . !!t CLaR e Al l i! sO. tNrrsb 1t, iltt.l ` T8t CLt~Rs ~teats ~/oatai. . Tlt! COQSl~ Mt,r t s~ s~aolt i..,. •s pi.as.d to aoo that we aso. • T R C i T S. M I L L i. t*arssd 0s stsAd aad ttstitt0d torte.t os toli~rsi • OIRSC'i' iZJINIKATtO• CO!!llwM •Y as. tJ1LTtRa I Q Oosd sorais9f Nst.r. Yesterday rw .rrs dasriRiat tor the jartr •tlw dittaraooos Mtw.a oaall~dttht.otLstod •wto..doocl.. sareiao.as a.d s.all M11 tasost. ic• tMos we distiowtly dittoreat ttpss ot .aao.r? •r0 Wt. . TMy are Nt tlati.stit dtttor4sts fboro •rt .1dMroos s,! Q1ttoie/ltiattM *t the .amt tM a! wilCOr. I , f S1M~s~. • • ' .. . . .. Wry presfAtJ ploas• a'Mat.d. 'i'raeak rw lK Miot oA ti.a. I TRE OOtlllO OiOd rsroiM: ' .. llty" I Nil sMv r.Y ss tIN *lort. . •. Ln m . . ~ .P!li.LiR T. wlfti. CU i #OAM R. WCOM OR
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4 S 6 7 v 13 12 13 14 ~ 1e1G 17 16 19 20 21 22 23 24 as 0 Mill• - Crosr SS2S Q tditotial boscd of buwn patholoOy, ya:? A T.aA. Q On the boscd of ultra st[uctural pathology? A Yo:.. 0 Editoc of tatholo6y Annual toc twenty Teara? A Correct. One of .y aollea4ue• ls the sditoc of tbat o.W, one of thea. Q You vsts avacs, -- In lac:t -- re talked ye:stecday abcwt the 7m-mscican Journat of Surqica: Patholo9Y? A Ytv . Q You conGider that the tost pcestiQio,a to: sutq.cai Yatho:oqicta7 A Ce: taiuly one of thea. Q Do y:.u kno.r Joctor Rc.arats vas on tbe oti9inii edito:ial Gaacd vhon that joucnai va3 tNJndCd in '76 or '77? A Ye:. Yn tact, he vai on the od;totial boarJ tilt ju.,: lii: ysac anJ I noticoJ the othsc day he vaL nu iun9ar oa it. Q AnJ you sontione3 pr. Victoc Csuld yootecJoy in you: aiscussSoA abouc nsuroenJocttne tucwcs? A Yea. Q oe :s on toe Rush M":Qa1 Colleoe in Chicago? A Ysa. Q AAd be is a v.li-toopacted pathologist? A toblisbsd •Icsat deal in the atsa of asutosn.3occine tdY:.:.Ii T. LCA'aG. CSR i JOANNi: M. IIJJ.SZ'J::, C.~'++t
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Mills - Cross S,=2 1 You dav• Ao •spertist io inttraal ..dicina, do pou? • 2 A Only the d.oc.• ot tra:einq that anyone who la • d0Ctor 3 ~ S t of ft.diczso would Oot. i•. oot board •liqiois io iut.rnai •tdickn., po. 0 You told ss at your d.yo,ltioA You MaJ no •xp.rtis• in Internal s*dicint? 7 A Aioht. Aa a tarsal d.fieltton, no. • 0 You don't tteat psup,• vata bypertoasion? ~ A 8av• on occaalon. Q ror trisnds •nJ callaaquast 11 A lrisn;is, col:s.que:., nsiqtbors, Yoo. Hot bospita:t:a3 12 paople. 13 ? In Virqini• whets you are lictns.d? - 24 A ltiyht. ~ is 0 You don't Aave •xperri.e in oncaloqy? 16 A I tbink I do havv -- not so ooch In tbo drejs tbac ate 17 uuod tu treat and bow taa d:dqs ar• dallve:td anJ whst the ls rrslstns ar• tor adrainistsring tbs&, out in td• soA:r tha: 19 the psrson tbat aotaaily gives the druV4 invariavly c avQj 20 and discusse• the oaao vitL so or uos of sy Colltayue;., and 21 I as d,rectty Involved in tbe troacaant of po:i.nts wicA 2= CaAClr. 23 0 Ny qoootion wasn't toat. _• My aeoction vase Did you bav tsp.rtia an3 didn't =S we drsous: it at Your d.position? . tBYLLtB T. L6W:S, CSK 4 JrrA2IN: !!. M1J3TON, C6k
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• 4 s 6 7 ltills - Ccoss 3537 Q iaters.diate vacta5les, eat cell type? A Yea. Q Tanotg you called 23107 A 2260. 0 2240? A Yes. Q Taey ace • aiscure oi' bath? A Aiybt. Q M3 I think you 3ndicated that soaetiseo aceas of •:ypica: uicinoid can 1ook llke' small ceil ciccla0A4ti and converzely 63411 cell carcanoaa.: can luok tike atypicai crrrdinold? A Ys i. p In your atticle ir, '07 with Ysiataon, do yoJ rtcall the acticla? A Yej. Q You f:rund it txtteas:ly datfiCU:it to te.i tiso dif:o.•.ncu between •typicai ca:csno:d and rsa:i ce12 on one caba of •typical caroinoiQ A sijut. 0 lE I cead tt ctgLt, yc.u could not d+atingaish one tyNc of saai i cel i carclOoWi f t oA atyyiu2 aarc laold7 A ?uat rar a oaae with a saall aoount of wat.tial. Q Yau couldn't toll the difference? A* I taikeJ ab7ut it yesterday, and tt •ai•:,aslsts the ta~:: l131'LLSB T. LtAIS, C9R 4 J011KXS K. OOJS?Jt~, C.cift Ln
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I • 2 3 4 S 4 7 18 • Kllia - Cross ssza Q Mcd also oltra •arQtcal oatAoloqy? A I thiM associate .Q,toc. Q AW the Archivo: of tatboloqy, did you tnovr thaL? A Y*o. Q AnJ, of courue, ye.iterday la alscssvin8 Dr. Guold, i propojsJ iet '83? A Ysa. pe:i*ve you said ue actively «s.arcbes the aaoe ar.a o! AfvrOfAd0Crlnf tlLaorY OE tAa 1VRg? A Don't know ho+r active awr but in the past. Q Yu9 cited bis arLioissr in your rork? A Yes. Q Yo-4 usnjQr:+tand the diffetsnt clayiciticataoa syzteal (jQ Q Puie, you kuw altio tbat or. toe.auers •n3 Dr. Gu4ld are •xpcrc:: Lor the deEense? A YQ3. Q Yoj kno.r thej boad differenc opinioRC tbsI you ba6eJ on their revi#+r of tDo stides? A We buth •yr.e this -- a:l three a9ree this ia an neurosndocrine oaroinows, We disaqr*e on tbe rinor p,4inc teqarainy diffsreAtiation ot the tuaor. Q Yoa said aiaor polnt tbat you disaqra on the type 91 cancer tbat Nr.. Cipollone bad: A bot tbe type. Ne disaQree on tt+e deqree of deviation of tbe oancer. tfsY:.LIS !. LlitT2r, CS8 i JOAl1NL Il. r.1J.:".'Oti, CS?
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0 I 2 3 4 S 6 7 8 Mllla • direct SSlt de7osition i.cords and the a.d:cal se,cords indicate that a>>e b.9an suoking In about 1961, •be .aoked ontiltered cigarett•as by 1963 ab• was .aoking a pacK • day. She otat.d that abe saokod the ciyar.tt.a down to tbe •n,i. Oceas;onally she obaia•aaoktd particularly, wben abe van playing cards or •nyaped ia otis.r oocial activiti.c. Mie did not sritcb to tilter ci9arett.a till 19550 There is evadeno• In the itterature in awserou8 rourceS to &uyrye.t that the tariiet one beylaU s.oltn9, tho •or. aigniilcant is tbo r1Sk tbat one incurr to eonueauen:iy d.velop tanc:Qr. Onr vaf to think of thi` iz taat tae longer you liv• vitt, an inju:y to yoursel! cau:W by amsking, tba, . lon9.t yuJ are at :i&r tc+ too sub6oqurnt J•vQlopsent of a cancoc , an;d the inlurY that yog produc• ttos a.ok.ng •as ly on i. an irilury tbat har amny ror* yeara !or too yat.ntla: oL deve~orin;, lunq cancor than an injury thac yOU /nc:Ic lator ir your :ite, d.cauae later in you: ltta you a;e noc Ooinq to llve as loaL. A patient who started aaokiny at 80 y.ara uid vaj:,: be unl ikQly to die of lung oansor but would d:e of ar.a::,e: oa us• bato:• th.y d•veloWd lung QanQ•r. A way to look at it, it is iik• pvttin9 •oney In a •avinga accr.unt. if you start.d savinq when you were yaun;, aa1 put aoney in it, the aoner you put in early vou:d t.ava a tflYLLiS T. L.~.1+tiS, C6il & JVANKC M, il,7USTO-N, CSa
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4 s i 7 f Kill* - Cross $339 tryinq to iznd out .rb1cL it Ls, and tb.y will d.teraine what people call the prognosis? A Yea. It has the ispact on det.tatoinS proynosls, but it la tb• stage of the tusur tnat is the slost i.portaAt proyaostic t.aturo. 0 Tber• is a marted dittorence in survival between atyDical and s.ali 0ell? A Depends how you look at it, staye tor staqe, ar taiinfl all the tuaoro toQetb.r. 0 Dtdn't you write in 1982 Lt is isportant to tell the dtttvr.nc• between the two, b..:ause tAere la a mariced airt.ceAQV in syrvival between the two to.ors? A I did •es3 that ret:.cted .y thinking at that tsme. AL: I 0 told you, It rou luap all the oas.a toqether, taQre ta a ditler.nce. 0 You have vbaa0ed your inJ since 'i2 about the 9ene:a: stateaent? A I have not looked at tb*o on a rtaqo for ataye ba6ii. That statewont is srbstantiv.ly wOaa you are talicinQ -- iC you are talking about all well dirrerentiated •wruenJo:rine oarcinoatias v.rsus all asall oell Darcin;tw.. Q i.ot us talk so.e aots about that artici.. voy don't I ask you tbis, Doctot. Musld you aqree stat• on• s.al: 0.l2 carc,no4&s 1. •xeetdio9ly rat.? tQTLL18 T. L0QIt, CiR 6 JOA.`1N1: K. INUS"~-3, C6!t
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i 3 s 4 7 I ! 10 11 12 13 14 ~ 1S 16 17 ls 1S 20 21 23 23 24 2S Nill. - direot Ssoi it's an area ot interest tor s. Rut a/so and ysrhapa predosinantly people that don't knov petsonally but know at because they have s.en .y articlas io tbe litersture on st, sent me case. bscauae they are bavinq a dittisolty asLin9 a diagnonis on the ease. They sernS It to se be"use they know I have s:peri+ aoe i4 tbis area and they Waat 6y opinloo, not only on rhat type of turor the patient Aas, but also on tteat.ent that the patientt sboula recsive. Q aw do the casea coos to you? A They tyMicslly cwta by oai2. Core tross all o+er tbe country a»d they are acco+apaased by a letter and a set of slidea, or tbay also s.nd a little vax pacattip blucL that cowe with tAQ case as vell 0 1s tbat thv only lntoraatton teat you qet with yout teferral oaaea? A b.cause I a• intere:cod in the caseu •nd learning aa awch as I p,ssibly tan about the well-dittetentiated eeuroendscrine aanoecs, it I don't have a eop'f ot thc pacssnt's clinical recordi vith the case, typically wbcn I send LASat ay dtaqnoii• " the slids. I v:11 ask it they cau rend so a copy of as siny sutdical re.ordo ai they have on tbe pattent. Q Nbf do Yow qet all the intoraation? A so I aan acouwu:ate as awch data as I possib:y call on 1NYLLIb !. LUti, CtR 4 j0~•'I:irr K. !lOJSTON, CSZ
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1 3 4 3 i 7 . Kills - Ccoss SS29 0 You ars teilipf tb• 3ury You do not dtsa9cs• oa the type o1 cancer sbe bad? A We all agree •be Oad neYroettducrllls oatoino.a. 0 And bc. dosoety and Dr. Gould associated that •!th atyplcal carclnoAa oC the lnnf and You oyuate it vjtp saAll cell carcinoaa? A I s.juatf ssall Qeil carclnoaa, that asuroendoctine deviatton sa I sbcrirQd yeiterJay. Q You agra with oe that Dr. ioasecs and Gould and otaera in tbd caat, and Yoa are looking at the sare slids+ and sakinq n dittece11 L sub typar aiaVnos.is, 1sn't that truc? A buto tyr* i vlll a9re., yeu. Q I va:I: to talk •bc:+ti a rvnaep: ln aatnoioyf vhich rc- tovcdad on yoac dsp&:ltton callts inteioD-~ervtr vaita5:iity? A Ysa. 0 Taat oosny basica:iy tr%i Natboloqisti~ ol dur• can ob4arvt the s.av s:idvs, *am* waterisl and ss ach dttte:er1: diaqhoasa. Iin't tbat cotrs^t? A Cocte..t. Ynter-obatrver. 2 Tbere 14 414,2 a aoncept ealiod tntra. ?hat la rilub ths aae. Wiiervsr looka at the aaao aaterta: on dlttar.at occasiono but ooosa op with different elws on ditt.rent 0QCastona? . A si;ht. I have bosn lAvolvod io tt -- at l.ast ons stuJy leoRiny at it. 1NYLLIS T. LfWli'i, C34 6 J4A1ili~ M. WU8,60ii, CiR
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• 1 3 4 5 6 7 Rilla - Cress $335 fuass 1 dfal with the •icroaeopio tea=urei, of Canc.t. Q ?n• Aturoendo:ctne tuoort, atypical oatcinoi0i, a typical aull cell, they bav• different chac.cteciaticu? A Y.s. Q You puLliaAeJ articia talkiny •bout toe different cbiractettotlcs of tAose tuzorat A Yer. Q And it ir difficult toc •oro patbol69istE to dlagno;;s thosc tuaoro, ttil one lron another? A Tbat io trmt. Tbat ia onv of the roaions I q6t ti,oap tn consuit.tion. Q Btit yao aah tor tnao. I don't rant to oay •ol:cit, bat yoo .aka it knovtt you ate interoitQd? . A Yoa. I have a.4o it known. ioae ptrconta?e of eagei I qot are b;tcaube peoylo know of ey fnt.rest. Others ar• bacajr.c poo;~:• hava reeJ ry arttc1ti. Q Yoj a3kod tor tbey? A I a3keJ for aooe. Q "at patls:r/o9ista tind it difficult to dlAtinaoiau between typical carcinoid aud saa:l e.li arCLAoi&? A I don't knov of any that do. I suppose it'a poa4ib:c *oae do. Q You wcot• ln your asticle that oan be wen ditficu:t when dealing with a ssatl diopay or -- A I•otee. It rou oave a.rall etopcl•. it can be tKYLLIS T. LRitZi, CiR 4 .10JW:Y9 M. 6Ws2VN, C+R
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1 2 3 • s 6 7 Kitla - Ctob: 5547 actlai• that You talkod about oo sev.ral occa;:iony aA3 rtt.zce3 to an yo4r 17 ca.e actic:.. A RtObt. Q iack In Ifl=? A Yea. Q !'hodt v.r• all cases of the Oaivtrsity of Vir9iala? A That'• ooctact, y.s. Q I want to •sk Tou, doctor, i! You can ceseaber bow aany of tao4e 17 cases of atypica: catcinocsi In 1912 w.re ot:yinally disqao.*d as •typical caceinuiJ at the Un:v.ra:ty uf Ytry,nia? A I don'L 4ove an eYact r,uai*c. We loakva 3r Lbe papec at toe diagna;o.c tbaL ha:d been rendeteJ bolort. Aaj, a: : oantiorsoc: yeit.rday, tbat'f on• of toe t.acons I out tnt.ceated in the+t tuaai6 pocauo• It vas a new subtyj4 Of n.uto.nJocrins cancec that people atr• boqlaninp to c.coqniso. Q You.d tt t.fresh You, doctot, at I toid yua s.ru oa: ot 17. zero -- A I talak tbat -., p •- vsr• Initially •iaqoosed atYyioal carciaolal A I taink t4at'a tZ9ht and It polAtt up the ae44, that t?tc attiel• served at that ti.e particular ti... Q lbat's rigbt. Let'a do tbrooyb what kind oW diaOnoser ttNrt Ye:o tE.'Y'uLZS T. LMS, CSR 4 JOA.y'iL• M. 80JS:•:0:i, CSR Ln
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1 • 2 2 4 S 6 7 0 ! 10 11 12 13 14 go 1S 16 17 13 29 20 Z1 22 23 24 =S 0 Mill• - Ctoss $541 0 t..t us look. IID. KAL?tR;s Mr. 8ltttdpo, do You eava a oopy tor a.? 1RR. BIARID'v6t lo83ibly. MD. KALTZASi What paso? MR. bIltRIXCc Lsst pa9t. Q Didn't rou vtite bore, this au99aata tbat sta9o one atypical aarciaoiJ is tat soro ooaaon than staQ• one z,aall call unditfecenLiato.9 CarClAwQa -- talkinq about -- a Kot talk,n9 ab*ut tl.st. Tatlctny aLout in tera,r of Pationtz that vave atypical carctnoid3 veraMs patientu vjt:1 small aell carcioooa. p I won't call It a coijoanton article, but I vttl ca:i*it another artlcl* taat occucrod in the aaae y#ac! A te4. An arti.:r vitb Dt. Ccoet:e. 0 Of the 323 pdtiant4, that sd b4w aany vere invo:veci? A T'riat ia bav aany we •saaineJ tioau• soction4 on. Ne actuallY statto5 out vitn-2,003 caaas. Q M3 tke qaa/ vas to try to tind oat bow abny staj* onc r.R,a:l cell carcinosas tb.re vor• at tee Qnivs:4ity ot Vityinia? i1 Mo were ttying to tiAJ out bor atny of tLost bod oeon •Ytqlcally sos.ctod and bad spsciafas 14990 onouya tor us to •a,aalno. Q You narrowed tbe awobor to 323? PBYLLIZ T. LLit:Q. C8R 6 JOAli:4:. K. K7JSTOhi. C:::
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1 • 2 3 4 S 6 7 i ! 10 11 12 13 34 ~ 16 ~ 17 1a ~ , ~ 2! 20 21 22 23 24 25 111116 - Crons $519 A There ia a Qopy ot sy C.Y, and soas aoce,c that I tefacted to yesterday reyardipa raterencea that dtfinitoly vece surrival ta people that have rssecttd saall c.il caaaets and pationt& with neuro.ndoccins aarcinoaaa ttiat have eadocrino aCtivity. Q Wber did You saks tbe aotes? A Prior to. I believt, out first day ot dcpouitlon. Q And the otber bandvritten noteu on tbt typed scr iyt, you aadQ tbo:e when? A ;.aot -- aott of tbo4e I.ade laat vsvk when I vaj r.viawtn9 ay tocordu for cooiny h+tr• today and ysat.rasy. p Did you bava a ehanc• to discuas tAis aaterial witn Mo. walter* betote you testiiis3? . A In qenrra,i ters:., yr.:. Me discc4ssed roa+a fact& rojardinj the history. Q Ct. Ktllu, you 9radiat.c1 troa a*,llca: schoo1 in '77? A Correct. p And you did a rs:ldeac:y in anxt:.aical p.ttb4:,;oyl tto:a '77 to '4d? A CorrMCt. 4 !ow didn't do any ,r.aidsnate4 or didn't ba+s any training in clinical patboloQy, is that true? A !to foraal trainiay but I did rotation tb:ouQb t4• isb::, but I was •ot Quatifi.d to be boatd eertitie4 in t wt arra. Q You ars not s:iyible to tate the board •saa tn olinica.i •1tYLLIS S. Lt9:3, CSR 6 Ji1"2:: !t. AOO3TJt:. Cf•R
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i 2 3 4 S 6 7 Milts - Cross SS3a that they art closely r.lat.d taaoco, aa;4 ve are talking about sbade:: of Oc.y in the n.urosndocrino oarcinor.a 9roup. Q That ia your opioton teat they at• shadeo ot grayT A I think Lt is pr.tty aucA aootpt.d. 0 At• Yoa sp.arteg toc all acrgioal pataologista Of the coiintryt A Not all of tbet. I vouldn't preauoo to do it, but I•a sp.aking for asny ot the on.s I rnov •r• interestea in the Q aoctor, it i: iayortant tu to;1 the ditt.r.nce bcrtween theue tbr.e dlttarent tusura b.c:ause ot a atiabbr of rravuna. Pir4L ot:, it is ioportant oo the propec tres:.eent can be qiveri, iy that true? , A Me yuu talkiag •b4it tbre• dilter.nt tyjrta ot tuaor.sT Q Y.U. I am sayini It ts iap,.rzant to pro;.erly cla::.:ity tb44f tumoro ao that the projnt treataent Can ae qiven7 A In gensrra:, Saat lr ri9ht. It is vsry loportanc to roccrqnise the typical oarciA:+id. M-ja, I tlwugbt !n the paat it vaS •uch .or• la;~,>rtaaL to t.c,gniso the atyNical or w:l •lLWontiat.d aouro.naocrin• and diatinQuisb tpQa lrwa saall coli, but I don't think it'a iaportant •nyior.. Q Th.r• ar• doctors who think lt's SaportaAtT A soa.. ' Q It ta laportant to itaoy how a psrson vill do if yojj are •lIYLLSi ?. LNqI3, CSR 6 JOAZiNI'. M. r0a7LT31i, CSR
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I 2 3 • 3 i 7 a ! 10 M111~ - Croa~ SSS1 A Yt:. Q I didn't do wca talking Ye.terday, Thet! tfarr a111o tbe pbfAarlRON or ocCQtcCnC• Ot whit is sailed peripheral palisadiaq7 a lbat's siObt. Q we saw that Yoatetdayt A Yas. 0 and the abapo of tbe aucl.t was by aad large sval or oval-like7 A Which tuaoc4 are we talking ahoUt? Q Atypica- carcanold is that 'i2 study? A Yes, that's Cotsoct, Q And the •uc:si of tbob. styyi.:al catcino:dZ were descciwd a. •oJ.cate2i bypeccb:osatIc. Iortft that rtpht7 A YQa, toatoa a teasonab:e ttru. Q Toe:e wet• vbat are *&il.d tldroaz wotaitasai ot ccli divisions? A laat•s ri9nt. p 11nd alio vaat to oaltod Aecro.i., trpjen: secto:id, tbtre is o.ll death at ditt.r.nt lscationio7 A Tbat'a ti9bt. 0 Jul ot tDose tsatucas of tbose atyptoal aaroinoids can be t.yn0 io 0641 cell earolno.a, can't they? A .!bey san re tNfud to wli •csai. Again, that )s:t pists wt hey elos.lY tslat.d tMs* twsrs aro. iar:.Lis T. LIMa, Cez a JoAM+:: M . RouMH, csR
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-- = '~ . ' s. t'ot o2ZSW aatsm iZmuc'!r ,.VORs !0R "t DI!MIt;! 01 /pM jlRflT ~ CioL1 Aotioa ms. t3-liil (tA) . , . _ • :•~ . • • . ~ • . . . • .. • ... . ,,.' . • - . . ,.~ J .. f ~~'lbMIO CIpOLIAM=~ Ls~loltrallt~ •ad as C:oastor ot tM istato. •• ot &"• !. CtpollMll. ' . , .- ~ 1N+r. t~, wv J. c sat L IoaesT tROOr. 111C.. a . * O.lararo Cosp0[atlen# !Sn!• .1 ~ lfss Mrcb lo, MOtttS* tMQOW0NAli0• • •ic9tAl• Oscporatioas aM ~ ~ sullen ~ . LOW '• l1iSAltl1# ZW. • i ~ . . ~ Nw TecK Cocfoc.tiea. ' a o.t.saets. ~ --••------•-•----- ssF oa ss . .oMO"sss so wt .hotln •uTm ftam SIMIC! JODOd ~P t s AA A r C t•o sQao, LARMea, GROtl, ttCILLOO Nofat1~ON, aUtift[RC i iol, aw. • • M MW t. @DiLbt SiO. rlLSrt=, o0ir~t i :!i'ett~t, i~.. 811 ALU Me bu11iLL. SiO. v AttocaoYs tor the plaiatItl. ARSO& i !OtltC. 880690 aYa •lTil t0 iLaxiGlY. i/O•t iT t ltONA! S. i I Lri li. SiQ. Attoroosy• tor the petoaisat, ptllip ftorcis* wrsasnt to hoti.w 763 lW. 08 onstod Scates Coae, tm tolioviap tcassalrt ls s.rtitlod to be ae ooeecsto saoere as tama sta"ca"taallr la ths abwo-fttltlo0 *s.oo.diass. PUlLLts !. biMZSP C.t.t. ~ 0[tlslol Cerct aspottoff - Iftitod •totos Oistc/ot Coert ~ ~.4. asn !lfti. Mmrkv SIRr Jota.t •1101 , : MLLZ• !. LaICa. CtJ L.f0AaR N. /000'!0!i• CoA .. . r • • t :
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1 ~ 3 4 S i 7 • f 13 21 12 13 14 ~ _ 1S 16 17 10 » YC+ 21 22 23 !• as Killo - Crvss $549 to use the anszber ton p.rcent. I'a sot uncvofurtabi• vitA tbat. Tbat'i an otder ol .ayAitud• I vo42d consider corr.ct, so it you talk about ton percont of saalt ce:1 caAaara aAd •aall ct11 caocors aoaoatac tor 30 psraoAt ot luAq aaocars, tDat's a toa.oaabl• tiqur.. ?h.r• la, obvtoualy, aoaN cootrovortr aboot vDaz the •sact ti9ni• !s. Q ii you tlip tlop tAat, rould Yod •qro• that ptobably about 90 porc.nt of sa.il oall oarcinoaas prosoat at the tiao o: J:asno:=z vitu aetastatic 4100416 that is •:seajy ou:eic3t tt:e lsnq7 A Aqsin, as an %~rder ot aainitcado thtt•s a toasonablo ns:+Lc:. Q Triat'a a tfa;.:i=UtVl• AJlobet7 1. YWJ Ca!1 1044 at Stlii>>e+i tllat suqqeat •ore. p T.,1t's the au:w+ee you orc.d in yogc Apsit, 1907 tape? A Tha0s tiqizt. It's isportarat to tao.ober we Oon't dtagna:e euacere Oas.d on vbat stay• they're .n, ve dsoynocls th.a by vhat they look at •icro.cop:ca:iy. V btaye l,& very imyportanL eoaceyt !or the rurgeon, i:n': itT A I.portant concept !or sotg.on aRd erecroa. •lss bocaiA,v it's tb. moat lapottant toatoro !a pto9ftosis. Q And .aerrOn• •laoe i'd liko t• ut you a tNr iror• ryostioss about tt+e p:M41s i. M:s. CsA 4 JoA:a~.t" x. NoUSTU, CsH
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1 2 3 • ! i 7 B Mllls - Cross $544 subaedu.Atly lt bay been sbo.m in other studies wh3 c:s i rof.rred to Yaat.rday, that if you look at oati.nts vao art lonq-terb uurvieors of staqe one carcioo"*# you do ltn.f , larQe nuabar8 of pat:ents vith s.ali 0011 s.uroeaaocrine carcs aosaa wLo have snreivedo a• wbad that concern at tbat tie.. 0 Ito;lld you aQr.s that aa3all ce:l -- stril• it. Mou1d yoc aqrea atypical caroisoid olt.n occurL anJ small ee2: carcinostia rarely does? A I vou:d agree tbat atyFicai cacclooid, voicb t. an un.oason tuouc, wt+en ic do.c occur is treywontiy a atayc one tuZo:. Saoil cell oauroen3vcrln~c c,rclnosraa ts s very c"Mun t4ao:. Sone:ainy on the or,ler a: 25 to 30 pQrcent ot a:, lung cancer:a are soali coi: neuroendo,:rina carciow"s. zh. porc.ntags of tnoa t:kat present a at.gi One tuuv: varle: dopenaln„ con Wbo ruu cssJ. Oat the •ors recer,: studlfs ,ruQjest it'a so.evhect be:vesn ten percent an.i aL hi9y ar 30 per:snt. p i'a qoinq ta aak you about not vt.o Yos read 5ut vbac yoj think. /tw, isn't it root opinlon -- lot sa see lt Yo, aBro: oitb tbioo Oa2y siu to toA Percont of oaali sell oarcino.am ar• low stage aAd opersbl• at toe tioe of dia4AoaisT A i•ooldp't disaqr.e by an •r0or of r9nlt.ds rita that tal'LLl S :. Lt`d:3, C.ZR 6 JOAii .C N. it:3i+w?'J::, C5 Z
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I 2 3 4 S 4 7 • Itilla - Cco,c:+ $S53 a Variety of -- Q Boutn's ts dAtt.renL ttom tor"ldaiWdt? A YeJO tt l,r, It's difttcont, 0 Containy aaretbin9 oalloa Oioctc •ald, doasn't it? A I daa't YN It bwlt I think tb.t's Ooicoot. It doasn't contain torsald8byd.. 0 6/.co tou orage Pictio aetd oan d.stcoy ~- A for.alYn lo also dasa9in9 and oeatroys seos. Q llrs yos aware •ooiA'a ear? A Yea. AOf ty,W o! ti1ced tiasue yoo typicilly loso tLc ataininy oc av+cw of t4s sonsitivity, tbst's si9A:. Q Mot You've never allesr stalnod a1t0ea ot Mad tbs 4046 x i« a case of roura on tlea4e that Oas 1r.en tase0 !a nooWd. isio a roa ? A y.rt an the csae.. tros the Oniracrity of Yatqinis, ioao of cye ones+ 1 cecei.ei in the .rnii rere tisad that ray. Q You d:d sase aryyoot,l:Iic or silver staining ia your cay.:: in the lia2 study? A Y*::. Q Ta.t vaf •ol a os9hlY reliable way to dlati89VisA thv sasoa# var it? J1 Mo. it'• just a•spportiv• ovtdo.ae, lt's sot a win way that you sate the di.tinctlon, 0 Is taat, t0e au.b.cs wc• -- r.'ce talRio9 aboat a tAae of ardyopail itai• called a9oditiod Ocisoilas •taZn, do you lMYLLlf T. LaWls. CSA 4 JOAItNt' M. pJJ:+rC.::. C3R
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I 2 3 • S i 7 20 11 12 13 14 ~ 1S 1L 17 10 13 20 21 22 23 24 2S • N,ll. - dir.oc $515 cw :h aore ai9aiticaat ooatridutlon to the awunt of •on.y yoa voiid baveat tbo •nd aa aovyared to money you puL in later ln lite. The daraay• ab• did to her lunqs troa secking .aclitc in lite ba3 amucb lonyet ti.e pertod to vAicb it baJ a potential to develop oancec. Q Oo:tor, on the opinioac that you have given bore today, aionq vith the opinions yoa provadoJ to the jnry yeat.rdsy, ace psovided vithin a raasonable de%rec of •edioat probabiiityT A Yarr. U. Vi.:.: CRvS I Lav• no turthoc 9ue4tiOn4 of th:.~ vitne..a0 wo,rever, I vou/d iilc• to oLts r aii of p:aintittu swJl4a: recorJy trou ae: treatoeat b.qian:ng in lool un:i1 the dato of dvatZ aad includan9 her death certiti%;ate in:o tviaeaCe at tbib tiW. I oe.iovf ve have a stipulation and we bsoe a typed-up list of •:l the re.:orda that we could give tj tue cojrt tt,Po: ter. TtiC COUEtTs No ob)actlon. MR. iIRRIV;i2t Juyt a Quick •- CoulO we have a astiok a ide ba r T TdB COURTs I don't think ve bavo to du it nov. MR, diRRiDC:.a We bav•'Ao objection to ts• oadical aaY:.:.is ^. LVu:9, CSR & JoAt1XZ K. aOUSraN, CZR
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1 2 3 4 s 4 7 8 f 10 Ilill. - Croo: 5541 tsqurs. Zt•s protrably a iitta biqber than t.n percent nw. Q Tnat Was a tiqcr• tdst you Oave A tn tbe Cbopla4 paper, I he:ieve. Q Jlctoally it wasn't t4• Chopltn trspet, but it •as vlooe. It wa a tape twat you dia, May ot 10871 A out yes. Q tras:tiea1 ltovtera o! patbo1oqy, Oo rMa rs.nbst tdaz tapot A hs I aaid, I don't d:aaqtee as an ordsr of isanltuds. Q 5ia t:o ton percent but you to:d tbo jury yexte:dey tbore were 30 perc.at. I am tryrng tc, tiyure out LoY yuu qat t:oa six to ten percent 1n Jp: i1 of 1987 to 30 percent ya.tcrasj? A I qQt thQto becauLe, •i rs've leirne3 •ore and .cre atwut twrbe tur4r;, the •ore recont studia. Aao• pro0r..icive=y aaown a biqher psLcentaqs. Tnir& proiisbAy rs2atoj tu the tacc tbat sin:e the •a:2y '800 Wo'v baa bstte: seans of detsctinq aancers, we've bad b+ttter rad1oqrapt+ic tecbaiQues tor dottctinq st. 0 There vas only oAr paFe1 tbat you ta:Red •bygt yo4terdey that poat-dattd your 11pri1, 1087 •rticia, only oae, ao Y"'v• le.ro.d •:l that S• niae .oatos, v• Io tc.o sis to ton percent to 30 p.roo"t7 A I don't oonsi4or -- tbat'• sot a bu9• dittoraaca. YQJ talt about sar• a t.w •lnut.s ago a,Kf i doa't oonsid.r trn V.raeat tato, t doa't •oastder 30 p.roent :art. If Yois wsnt •bYLLi6 7. Lict1S, C8k 6 JOAHr:" M. O»sTfJ::, CG:e
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1 2 3 4 S i 7 Nilla - Ccoss SSSO this tunor aay cepreaent a•a)ipnant oarcinoiJ-:ike tu0oc. Anj, aQai&, tDii vas at the ti.d vhto we v.c• tica: getting ready to lo" at tbess cases. Q Ar,d, in lact, you just would have ttelrbed Your ttsideacy ia June of that Ydat7 A M,at's ttobt, ros. Aqaio, as I0o1ktlon.d Y.st.rday, tbat's one ot the toasoa I got Latotastod in lookiog at these casei la tbat they do eauw diaOAOSt10 Probloai. It did eoNcciaiiy at that ti.e. . ?bey can bave 9laaular aroar- in tbs:n an:i that'a ono reason why thQy vere Oe«inq iaG:.cs aq adens:.arcin:+4aso tpay caa oav• srali ceil anu tlsat':; v:,y t5ey'te cai,aos asali aeli oancer. . Q UnJtflerentiate,l areas ia tbe27 A ?iiat's bseiea:tY wnat I gieant, Yos. Q sut at ccoa* patnt acW probay:y '21 oc 'aZ, yWJ pkI: 1s,: t5Q oroJp of cealu toq.tbet and divy4osfd the 17 aa atyNicai cs: c inosd and publ i sW yoat ar t icia? A ?Z64t'a cortect. Q pov, Y4u wer• briefly taikiAq al+oat tht cl~ar.c;cr~ 3_ t,c: ot tbase tu+rQrs and 6or they vete ditteraot sorta ot indioatiens ia the patholo" aatesial •s to the aell tY^. AoJ tn tbose •asea, dooto[s asiw of tbeie 04464 bad what 1. oai1.0 etu.b atritaott A luat'a risbt. 0 Ne talked about that yesterday -- ron •14? lDYLLZS ?. LlM:B, CYR s JU4:Ei:: K. Y1•JM•., C,r.
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K:ll6 - Ccos* SS52 ln la.a, yos saicS iA that study tbere were a nuewec ot A Yo.. T4at': aort of a bruaJ terv tor all cf tLO:+e utalnu. Q 00 you kno+r vaat -- strike tAat. Mast 13 a timative? A A liYative !s urudily toraald.byde but not aivsy., tt'6 vLac a ttyaws ss put in betore it's pro3esse;i, baiic.4:y Prevonts the tissa* i=oo Moayiw9. Q t.u aas LorsaldsArdo dovn at the Oaieer.ity ot Wir4,nia? b Oenera2lt w do* y.s. Q 1paat ttastLv* dld L.Mos alll as*? A Zdola't two11 1lbetbet they rNd jorMldoAfdf o[ bou1n' t.. •BYI.;.ZS ?. LlNIS, CSR a JOAAtt:t Mt. wOJS'TVt., CS:: ~ ; ~xi You vo;tid ca1l s.all co:1 carcinooaa? r way to look at tboyt, they were aistr tioA of sa,.l2 0011 carclnoras aad .1at.d a4rucoewdoctlae oarcinacas •r •tyyica, A ~ i '°%dved abodt tbs staiainq of ilido• in this a partioulac case rtst.raay? ! 1~ ~ aoss F.:.~io r.ai: tAoiot sllvet atair4s, dor.'t taey? A U.. 10 Q Yos calie4 Lbobr ap.clai IcCoan4? 11 A Talicinj 400411. tbe ar9yoNhil staAn.+t 2s Q Yea. 13 A Yej. y t~-
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4 s 6 7 ! ~ 10 13 14 ~ 1S 1G 17 19 19 20 21 22 23 24 25 Mille - Ctosa oa&cinoeas. 0 Yo1 iikea his work yesterday? A Yor. I r.sptct bia work and vollaborated with hi.. 5527 Q You have collabarat.d vith ois on a studr ot ollactury tw.ora? A Yea, fusori in the poat. Q Thty Aad kind of an nturo co.ponent to tdes? A Yes. Thsy ace different tcom the aorts o: tunors we art talking about in the lwny, but they have sont nouro f.atutO4. Q You tnow tbat ar. Go;jld ia on the •di:oriel o-aa:d ot a nuub.r 4: presti9iou6 acd:cal journa:s? A Ytj. , ? Oi: the editoraal b4arJ of Laboratory Inve4tiqation? A I didn•t a;reritacslly resaalier taat, b.it I tpinK it. i:P coz rt.:t, yez. 0 knd yoa con"iJor Laburatory tnve,ctiQal,on ai pcabab:y the bost journal tor baeit research rrtiCtess ia tuat truc? A A pr.att4tou:> >ourna: tor re.earcD. Q Masi.: rtiearch articies :n pateo:oqy and reiatej dlacil+2iAest A Yea. Q Dr. Coa 14 Lb on tt~s e3,torial board of seminars In piaq*ostio Pathology? A Ye:. ~ m ~ ~ oO ~ ~ ~ ~ ~ lZiYLLIS T. Lb12$, CSR i .ZOA.~i1rE M. NOna"1'0:3. CSit
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i 2 3 4 S 6 7 Kill,c - Cross SSS• knoar that one? A Ye~. a ?bat'a tae oat you 0atd? A Yos. 0 Alonq with aaotbor, aclMlius taat's tb• one u.td in this oase? ono Q CCiWe11uA MQthoJ was Y:ued !i1 thls Qaa4, Aii3! Cipa:1ai1o'i btije? Q YQJt tinisa9 tcda tua: s:ain wr• 9049 ootltlle, Iav0 n.ya:ivt, sevth *quivocal? A-I'd havt to look at that to tettssb .f ssa,aty, ye:. o 1t;+t thor• oste inur out of 26 that were w4itlv., &~ you r.resb.L ebat? A Me caa looic at the psp.r. Tast soanda cutc.ct Dut lot a0 jusl. C11fC[ 1t. 0 It's i• tbO tirst lie• tb.ro ta spociai otasaGe to,:: wro positive? A llcat'• rlgat. 0 11ttb attstlims? A ftst's t1tAt, lhat's .ot as sensitive a t.cUni2u• ai A tto Y.Nd tiat aAd tLe ChYtvttsM. 0 1 ean't probs+saor Lbat so I didn't say tdat. Tbe that was usod in this aas• ras atqyopAtl? A Taty'r• lrcth arOyop5ilu, taYLLIS T. LL'+tiS. C39 i JOAMC Ri, C3r.
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Kills - Cross SS21 I pationts. 2 Q •robably your klds on • t.u oocas&ons? 3 A SoAetisfj •y /kids, •o"tise:. my oolloaQuti' kid• late at 4 tliyht. S ~ 0 Lats at Ai9at. Riqbt. You don't conaid.r yoursolf a trsat:nS 7 pbyrician ot hospital aatientz? a f A Mo: boapitsiis*d pitisuto. Q Ri9ht. 30 And you ac• foot an •spart In anisai •apsrfaentc or Il 22 tosicologY, tpese areas, you at• sot •ap.rt in tboae? A I thave been involved in a nuabtc of anisal •xps: iWent: 13 in soste of sy puylications t.:ateJ to anisai •:POri%.nts, 14 Tusy ba4Q to do tuada:aentaliy with studyie9 tiasu• skudtss. It 1S Q sut you nevec conduc:t.J an3 a.ziqA.d a study in a16i.al 16 •aptc imonts? 17 A TLai is not qsite ri91t. I bavs 1Mta involv.d in tts• ia 2t d.:+i9n of s4mae, not baving to dcr vitb cancer but otDor diuoad.a . 23 Q You dav• not been lAVOlvod iA lotsalatton •ap.ciaer,taT =1 A Uo. 22 0 ooctor, there vad a lot of discus`ion ys3tsrday •baut 23 tee ditt.r.at sNdical tap.rtis• that var• ievolvod in Mra. 24 C1Oo:loae's car• voea abe was at Woos Bill aAd otb.c !S hoipitals. I would likt to ask rou about tboas. • PAYLLIB T. L!'•i18, CSR a JO1W::S ti. MO.7.3TOW CSit
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I 2 3 4 i 6 16 17 10 20 21 22 23 34 !S Iliits - C8O46 SSS6 A TAat'b rtqAt. Q Msce you avaro taat hs actualiy pDoto9ra0od 25 4411664? A Tei., I think I aaw tGose 46 veil. 0 SUt You aidn't tall the 2ury tbat you only U&ed tAree out ot tDe 2S, did you? A ito, ivsn toozs vould be aot -- tAey voul0 )s.t ba a lraQtion ot tbe su.ber of 166904 that you could bave Sotten trom all of the illa.s slides. Q 7nat'a true, but you didn't tell tbem yog osod tbres of the 2!#T A I d:dn't wint to burden tLw viewing all 25 or tbem. Q Yoj albo dAda't tell t4• jury that rog vere uatnq dLtt.ren; maqniticationc wLsn roo ead yovr ap1it icr.oa, tunut;4 trot the Univaraity o: Yir9lnla on one •id+, Dr. sa:.»era' c11ae oa the other, thets vere dttterent arqnif3cation, on tbo4c alidsj, vsrsn't they? A I'+s aucs t:-4ey weren't •:.:t:y the sa0e. ? ::iey veren't •ven cloaa, we:s tbey? A No, I tt,ink thsj vere fairly eioso. G Thoy were oatse.e:y lov power on ths iads ot yojr o.rcinol,3 oassa aW Dt, po.aeri, I tbiat the alids aays, va4 aertsinlY higher than very low pov.r. !ou'il a9tee that the slidss that You showed were of l.ve: Fever tba• •z• pictUrsT A !'m sot sore that i aIcs with tMt. 0 Tbsy vsr• •iltocent sa9Aitioatiosst . tRYLodT. b1is, CSR !ie p7JS':.7::. CS3: I
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• 1 _ 3 4 5 6 7 i 9 10 11 12 13 24 ~ is 16 17 iQ 0 Nills • Ctosrt $934 A Cosrgat. Q You didn't have 41 caioa tn 19QS. ald You? A Ptobably !!ot• ClOif to it. Q You don't know bov many aasos they bay• eoid, do ycw, in 33 additional yeats sinc• toon? A No. I don't know it thoy ar• lat.*rostod tA the toyic anysor.. 0 I t41Ac tbey •co intorostod. We ta2k.d a lot ys.t.tJay or I listonad to a 1oL ct your tatiwny, O:,a;or, abQut buv canc.rs begio, novi ce :.:, chz :qc, tb,s sort of th:ng, and yov d.»onatrato3 your iJc3.: .b.jat hov c+ i1s bt9in to d„rad. and qo dittvr.nt p:acc2, saa.uber tAat? J% Yts. 0 Ti:ar iy aa ar.a of intonst royaarch ttyiny to dQC:J* aw crlli b+rcar.• can~:*covs in a caoi+:ox atta? A Ytj. Q You noraally don't 44 thsL worK? A I a• not a.oltcular bro:oC,st. Q Moto of a surgical eiologist? A Raqht. Q tour roioarch is wr* c:inical pathologic? A I d.al witb the •nd to4ulta of aanc.r. 0 ltot tb• bo91AOi4g? A tigbt. In so.o conc.rno i d+al witb the btQinnin3. 1 Pi3YLLt3 ?. LQWlS, C6R 4 JOJ~:1t.L M, it00STJii. _SI:
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1 2 3 4 s d 7 MiLls • Ctosy SS4:1 and the.re aro aateo tbe jury boacd the last tev day4, tvo sma11 ce:l CafCiAOiiLO one large coli unalttOr.ntiatp.l, two adeno.:arc:noaay, two syuasous cell oarctaoioms, two or teri gatb.r Poorly ditter.attat.4 os rndttt.c.nti.t.d diaSAO.038 the tirst tis+O arourA that tboa• 4asea vara •oao at tbe University of Vicqiaia. Does that sound ti9At? A Y.s. It points up the taat that pathologists at out inQ:1tut1o:e and •irovhs:e veisn't very taai1:at vita th.:e tuaar:. a: that tiae. lhey'te not vary coalrsvn tum4rio. 0 aw, doct ot, you sade a couple of tbooe d:asnost:6 o,ic of . Q Tt,e.;c ate aw" Mat.tta:i yoQ gave sM at yo4Ji d.p,jition. ?.tiia 1L, yoJ: paC:9coJa3 mterill and a s.ICqiia: te,+oc: frox t:,e UntvfcLity ot Vicyinta aboat ono of tyo.se cas.c tbat yo-i diaqro~e,~. Do rJm YaAL to i et t AS1b YoV r Mrieor f V1 tA Lb.1:? A Yea# tLat'• cot «ct. Q llov, in that patbaloyr to;port ycwr troseA secc:on diaqnoois of teat vaea vas Pootly dittoroAtiatod "o,moeareino.ae. probably adanooareiao.ast A lbatIs tiIbt. Q Ri4bt. And then on the Mts.aont sootioa, P.taaoeAt 1?, didn't you? A Yes. I've aeatne3 a lot sioCt tbecs. sr1Y:,;,:s r. s.Zw:s. C3~: i J011x7: N. •war3N, csz
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1 2 3 4 S 6 7 e Itills - Ccoss as~o aifficult to tell anythin9 froe apytoin9. Q A lot of pataoloqy Is based on biopsy vock. Toat is your first shot to •at• a dtaqnosis, ••iopsy? A Aiqtst. Q Taat can be a problea for so.e patholoqistz? A Yee. ltay rejusce getting •or• tlssue. 0 Aad It roally b.cooe3 a problea when you are trying to distinquie.A betwen atyyicai caroiROid2 •nd saall csll 9 earcinww •speaialiy a typo called lAteresdiats7 A Tru,. Q ?ciat ts ta• sub type o: saall otll cacctin"a that y..,u 12 bav* diaqnossd in this Cabe? 13 A Riqnt. I don't typscally cse that tocd aL we d.icusced •xcQp: tor taachiny pvrpow•r. You aakod so lf 1 bad to ~ 1S ciasaify 1t, bo.r woald I, •nJ I put It in tde iALscWeJ:ace 16 roi ) . q b 17 Q You know that !b It in the who o:asstf isJ syLtsT? 19 A T sa. 19 0 YQw kno.r it ia -- tDs inter•sdiatv? 23 A Y•J. 21 Q TLat ia your diaqnojia tn this ata.? 22 A Ri9ht. 23 Q Jujt tot the iurors' aaks, s.ali eoll caicinuw Aaa- a 24 •omboc of suL typsc? 2S A Us. . OD r ~ ~ 00 ~ tYY:.LIB !. LWIb, CER & JOANnC !i. BOJS:O:3, C31:
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0 S 6 7 llilis - d,roct 5512 typical carcinotd tuaors, lt you loou at to• bioto6lcal p.havior, you can &.e tbe oancera oacurcin9 In the ssoi:er: aro the tuvors -- tusois that occut In aookers at• the tumars that behave in a rraliqnaat tarbion, I shosld say. Q A killing faabion? A Cxactly. Q Doctor, are the two articles that Yuu bav• juot •:plalAed to the jury, wou:d you ooosider those actlc2ei ce2iab:• an3 authoritative? A Yea. Q Du yoa bave an opinton ss to whetASC Nrs. Cipoilur.e's ube of clyarettetl fron 1962 throuqh 1lG6, tba: ia for tnu first 24 years of aer asiMir~q bistocy, was a swtiutantsa:' castr:bitinq cause In the deveio,7aent of bec lun9 can:er? A I do bav• an opialon and .j opinion ii that it ras a al14nit icapt cauif. p Doctor, do you bave an opinion as to wbetner IIr.. Cipollone's Y3• of ciqar.tt.: tro. 1466 tbrouqh lsti, that is, tbe last 1S ycara of b6r uu• of eloorettes atoce th• ae•:elopod 1unQ canoer, vas a substantial contribcstinq cagd• in ths dev.lopsenc of aes 1ung oanuor? A Ye.:* my opinioo was lt was also a•19aitlcan: oause. 0 lsplaln that opiaion or tboa• opioibnd to the yucy, A In rogard to the first ti.e petiod, tror approsisat.ly 1561 wuen Mrs. Cipollone began saokinq till 1f6G, her *liYl.:.Ta s. L6"rlti, Csr. & JDAtia: K. BZIUSZ`Oi:, CSR
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1 • 2 3 4 5 6 7 a • MI:ls - Ctosa 5533 A R.iativ.ly t.ceatly. 0 in fact, tbere is an article we talked about pub/ishea in eancer in 1983? A That is the Palladiqo artiele. Q M.i didn't they call typical earctnolda iu:chitsicy eell 0 sp.*akinq ot ttiia article, DQcto:, I beaid you zar tn:;; r,>:ninq yos r.:* not arat• ot anyl>csdy vha hsd soen a:: &4n;• ia:n4ritativr journol? A Yab, t aQht. carCinoaa on., atyFical carcinola vas called tulchitcky c.ll ea:cinocaa, soa:l cei: carclaoaa, Ru2thttaky tbree? A Ye3. Q Thoy said tl+at was to retleot the cosmtrn cell origin of the apectrum tbreQ tWiotut A That vas thelr thenry. Q It va4 puyitLatc3 in crneer and th.t iL • tespec•.ed csae:+ of aLyp:cal caccinoid as Yoa nave. 00 you recall in toa article 18 1085 tbat tbr P.lladu9a atntield qtoup troo California had •iready soen 41 In 1985 of what they cali Rulcbitaky ca11 tvo, which we call atypical carciaoidst A flhich I prerer, rsil-ditterentiated aeuroendo m 0 I pceter •typioai -- w• sili kiave a lot of Oiscus4ioa A but I aIr se they had •l. 0 41 sasas in 'S5? - PHYZ.:.1a T. LSN19, CaR 6 JOAb1W3 M. !MSSO?:, CSR
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Y Aills - cross Ssij I 1 Q A Osc~ra ln c.• riadaat Ys. ) p !ho psacr.asT 4 A Yos. s 0 Salivscr J1sTMT 6 A lrorarly kCtcs just s10Yt wsrrirlscs. 7 0 Lst M go tdisu4b Us list. • A t.o1 lrel. ~ 0 •c'east? 10 A Ya. 11 0 C*rv/s? 12 A is$. lI 1S Q Q 1aranas.1 sisw.s? lAywsT H 17 Jl Q Y~. ~aelawt~ lw? 1s A Yss. ls 20 Q A •tos.cb? Ys~. 21 Q t.na1 pelvta? 22 A Yes. tt•s •.rY sar• la may ot tbo" wsaslsas, 23 •aaisriwlr escso rut It ias bsso dasclrsd •c 1049%. onc:• in !• all ot tMss 16"tlo.ss as p Mre tAaa Nrae le ssvaal 0o4sstMs1 tITLLiE T. i.Wis, C/• i i0AM11i N. WO/'i'0M, Caw
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1 2 3 • S i f 8 9 10 1: 12 13 14 ~ 15 16 17 li 19 20 22 22 23 24 23 0 Nllls - Cross $531 p Aiso the concept ot dittorantiai diaynosis lo 1c.py.atn9 too? A Ripbt. Q Tyat .aanb aowbody looks at a alide, tbinks b• baa • qood idea what it !s, tiit tDere are otber tbings to coniider, otber toinqs to rule lo or *ut? A Right. ?ust ls what va vean by ditt.ranti.l diagnoats. 0 Doctor, I oo41d like to talk about the aeuro.rrJocrinrt tWozs o: tpa lung t4at you spent so swcD tiao on y.zte:day an;d a little bit thaa oornin9. isOc it true sove paopl• considor it t* be a c?sctrun o: t:tirrc twoorb. :ypicai oarcinGid, atypica: cacr:nc+id and •risli celi carciQO+u? A Booa P40010 m I aqroe ail three are Aeuroendoccins typr& of toaoco anJ in taot -- i aa oae ot the psopie ttia;, init:di:y propva.d that the typical oarcinoido vece ;slL oL it. Q I vac qetting tAece. A Z knov you M.rf. Q Yua btat ao to it, but you ta:kod about 0:. Dartyt Carter troa Ya:e, a rtll known ratholoqist yciu consiJe: ia the area of lnn9 tu.ora? A Us. Q •o oonsidere all of tAose teaors swcoen;iacrla• cancdc, doemn't be? lBY:.LIS T. LBM1S, CSR i JOAb1C.r. K. itJO' .DY., C8/t ----
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• 1 2 3 4 S 6 7 t ! 10 11 12 13 14 ~ 1S 16 17 18 13 Za 21 22 23 24 2S 0 ll:ll• • Ciosa SS32 A Tbinh he does taMe tbe opinaon that the typaca:. oarolnolds are alao cancer. ttot everybody baa the vi.v. 0 Bs cal:s.tb.a carcinoua •a in ths articl• la 'aS? A Also of the view that tbsy probabiy have a different cell oI oriqin tban the other nearooadvcrtno e.reinoaao. Q We vill ta:k abaut that becau`e tRat is an arsa ot controveray Lc, the tield of p.tholo9Y# tbe wnol• area of laiatoysne4s67 A Yss. ?her• is conttoversy. Q In tne vhvl• aroa of oeyroen9outine toror3 of the lu.N, tn •i6 tbect vai: an artic:• puoli9bad that solc we know hoti tbsae tLin9;; are causrd. It la a aiqration of csilc trol tr,e neurv crsst to ths lunys, wasn't that a theory in th• 63'0 or 73's? A Yhat was tne Piecce thsc:ry. Q Actualiy 8arb.:L pJo:s3hej it? T. Y.~. Q Vc ta:kod aboQt APl) doaab? A Riqht. p Dun't astc w• to define it. Ut oettin9 bsca to Dr. itonch, tban later crro a tDOory that .ay aot be si9bt. ?Ae6s tbin4s cune lron the tulobitsky os:l or the ft cell. Taat was • prostntnt tbo4iY? A Ytj. Q Till very recently? PHY:.LIb T. LC•'J:6, C: R 4 .lOAaN'3 q. iiJJ$a.71:, C5A
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0 i 2 3 4 S i 7 I ! 10 11 12 13 14 ~ 1S 1G 17 lo 41 Millo • Csosa 5530 Q It h.pj>ani in patholo0y A Aecoqnisad •vents. p it is iecoQnised one i.or• tban observer can look at tiue sase slides and develop ditteraat dtaynoaea and tbat eappens A Yea. Q -- bapp.ns at the OriversLty of Vir9tats? A Happe4s •vetYvAere. 0 tiappeas •v.rywbere. Cach patbolo9iot brinqs a different sct of undarston3ing and vierr., about i.it discapltne when he looRel at siidea, no two aro alike, are they? A No two people bave eaactly t5e sanQ ttainir.3, riQnt.' ?bers are a lot of taCtoca I thir,k account tot interon:etver accointabiaity. Yuuc ovn cri teria for looktog a: a a:iJd. Anotber is tht tact tbst lun9 canzfr:4 in pac ticu:a: and all ior ta of. cancer bav• a beteroq.naoua or var,e:S appearance, and soM patbalo9ists •i9bt toous on oaa yortion snd rely on that ar.a for iis diagr.osis and othecs .i4:it overly weiyt,t soo" other pottaori of the f sndinq. Q ftat bappens? N Yaa. Q iatetobi.rver .atiaLility La what is Oa,pp*ninS in ti,,:. caae? A lbat would be ent way to eayreas lt. ao •yYLLiS ?. LL''KIZt CSR a JOAiiU N. NONS7O14, CSR
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4 S G 7 a 9 Nills - Ccoss SS42 A ltiqht, That Aad •tseaUi• a.ouats of tisss• to b. exaolned. 0 Ot tbo 323 eaaes bov sany vet• staye on• spa2: c.:l csrcinosaz? a Don't tsaoabat the •jcact auauet. Taink tb.ie Wate lAree wbere ve Questionw. One, ve sald tor sure, anj one, probs"yO iWt We Can look at the •ttiale. 0 L.c u& look at toe artict.. rAac was the artic/e vttb Ccoaa? ~l Rtyl,t. 0 ~sa ds a 0ocac&c sucyeo,-n dovn at too tinirersity of Vlcqin:a? A Yrs0 ffv tW. 1sZ#. MA::tRrs Do yo.: bav• a copy toc ttm wttn.s:: • aoJ tor ae 1 Rr. , SIRR10:3Ea Not suto Yhich Is sl3rkeJ. M3. NA:.TtR3t Do yoj bave ont tor tho vi:nes:•? p In ta.t studr, or+otor, you talked about 323 ca.du that You haj narroved your study to try to detetsini Lw .any vQr• •ma:1 staq• oarcinau? A R3 q2.t. 0 I believe all rou tound va,; one and tAere vas • d:spate atiout anotbet one •- uever teally d.cideJ •- RaybM yoa con r.tt.aA your «.ory tros -- A It aounds sotr.ct, but lot ar cqeck. PtiTLL26 T. LlNIS# CSR JOA-4ca M. C:.1:
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4 s a 7 Mills - direct sS12 A Atttt the initial ttosen section dia9nosis, that i` {'ior t ect. Q Could you coAtinue to •xylaln that artial• to the )ucyT A Yes. In tbat study they bive • series ot pationts tbat have v*lA-dittsrenttated eeUroondoctiAe oatcinew asd tbe1r data on sooRin9 1s c.aplealy prtuented lo the paper# bgt it you look at the papec, you san dsvluce that at least srvsn of tbsit tfn patients with •tyyieal eacciAoids had to be a.okers. Csaid have oeen blqhtr, but the •ini.al liquce is: seven oat of ten. Also. ttiey have .aJ• a very AntereatinQ obaervatlon. Rejardl.ss of v:4at you call Lhs tuoocb, vbetbec it You iust looxe,i at all of the ossee:, they aaae th• ob:ervation that tbs patients who vere sroketa vete the patl.ntL that pre,l0atnant:Y developed M.ta.tic diuc.ase and I tbinK that is an toportant polnt. You can qet boqqed dovn to the tor.inciloRl t+jL it you look at the bioloqical b.havior, vAat Aappens to patients t:,at dav.lop Qancsc and are .aaters and tooc• dev.lop -- spreading of the diaeaso and die of tee diaease. Q Mna: to the slqniticanc• of that t.odioqt ~ I think the significance is tbat it t.iatea to tbia fact tbat the wll-dittersntlated aevrooWdocrine oaccinWa4 are full-tledqed sacelAoaas. And aitaouqa ao" artlcita osY noL _, _. .. ~- -•-- t:eii e:o:x :n- ~,oa sal paa-~apy:~aoD a m:y ibrov in some of the m ~ 0 0o ~ PUYLLIS T. LLWIie CiA 4 JOANl+iE0 N. DlJISTJN, CSR
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1 , 3 ~ 5 6 7 1tiils • Croas SS7T p DWt yoa aiJn't *Qe tbe ono tres January of 1980? A lC,2. 9 '31 rAChsc? A iJo. 0 dwr, yo:+ reterred yos,terdaY, Doc:tor, to tbe btonchuscopf prcc.Jlrr vhich vas dono on Krs. Cipcrlione in Aujuit of l~al~ A Har tScW-t btonCAO::copy? 0 Correct. A Yes. p At Lenox Uili ao,cpital? A Ycs. ~ 1 ba;te•re you naiJ it vaz done by Dr. 3teichen brt tC va3 really donr by Or. ScrriftT A I believe tLSt is corr.ct. 8teactien vaa. a suryevn aru a puisorulogi.t, an tntorniat, v'3o o?ecia:asee. :n :uag Jis+eaaa, bst nut a ,tur9cun. Q oK.y. DOct:rt t i aa qoing to hanr] yciu a copy of Dc. 8e;iit'b r.port on tua bcoacboacopy. I ao goang to put the •xbjbtt up for the )ury to tollov alonq vitb •oie vf the parts. Lat a. •xplein to the Jury tbat tt,ii is a ao1yy of th• topvrt itseli, ana I dave biqnii9htt3 certain tbiny4, twt thir is the repo:t fcwc Leeos tiill Yo0pita: and you bave 0 tdYLLtB T. LEItIt. C."+R & JOAIQM M. •4U91"JNo C9R
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I 2 3 4 5 G 7 8 31 Z , I! 13 13 14 ttiil` - Cco~x SS7C ceaA.ly un:oLte3. Thsy bo:d u1 prettY vell in teco;i of vAwt you knaw, b.it you r.a:ly can•t -- you aan M.ke 9ues&ea when tye tua4: oc lqtnste.r. Q out it i& r.alsy ipyo:~aabi• tor a doctor or ocientiut t:Q realiy pinyoinL tAa ixact t3eQ vben a tuawr beqin:.1 iWc ttiau tcua? A 3n;y in very thearetical terro. It :s tmaicaliY trus except for tbeoretical conatJaratioa:.. Q TaozC 1flYaivo tQt l1g1 liIto 4oailllnV tfiler triat aot t Oi La:ay? A RA S::•.. Q YoQ ta:ics:3 a;pout the Y-ray o: Mrs. C:potaons In Janullry ot 19z1. i'oj so:d taat that vag an anLlacatiofl tbat It vaa a ts.aid:y qrow:nj tuasi beceu,:e it vaa r:oan tLat Ju:yT A Y.:; . 0 Dld yau •vd: IieQ tAat x-r4y? A Yw,:, I d:j. 0 2s 20 21 22 23 24 25 0 Y3u sav tha: vetY Y-ray? A 1 saw tht a-ray tbat bai tbe iealan on tt. Q Tnat was sn July. Dld yo;~ se• the x-tay [roo January of •81T A Ho. Yu .y kno.tl.dqw, the a-ray riY sontba pxevioti4 ia lor.t. I sav on• lro. on• year pzevioua, vbich is aoap:ete1 y etyattvo. ~ m V 0D 6 + ~ N 4b riiYLLIa Y. L.SwI3, C+d 4 JoANIC N. rosMU, Ca1"
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I 2 3 4 5 6 7 g 9 10 17 13 14 ~ 1S 26 17 ia is 20 21 22 23 24 25 • Nills - Crocr 5580 poLOtbis? A tt,qbt. ?bers ai• lots of ptobias. Soo+tlisa you ss tha aocials ba; can't qst a piscu ot tt. Q Sj hs lott the procedur• sayrio3 dis9noats probably aancsr, but lot us ass vAat the PatAoloyy sboara? A Corrsct. Q And the patho:oyy abovod Ao canCSr? A Correct. Q You lookQd at that s]lde? A Ye:., I did. QaA Q Attar that z6i va.: rofoirsal to Dt. atsicbon tor aursQSy, lu that your rf:alle:tion? A To4. ' Q Jlnd yu0 taikec3 Y.LLS:dsy about bo+r be did a lob.:tooy? A Yd,. Q And .rhen that apecioon vas rwovtcl by Dr. •tica:.n in tnt o0ora:ing rooZ, :t vaA atnt dcwn to the patbolo9y dt'Portsent? A Yoa. Q i vi11 9ivs yoQ s aopyt of taat too, Doctor. A t•isef a21 the patb rspurts vrts that es4y to tsad. Q Riqht. Mow rbsn tdat ap"i0sn vns ssat down to the pabo2oqy lab, they would eave •ont tAs oAtirs sps::imen that t4ey s.aoved? tUTt.uL6 T. L.iNiS. CSA 4 JOIIl2R.: M. r008T05• CBR
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I 2 3 4 S 4 7 i M/lis - Ctoa SS4; speclsen, tatasr, it vo4 adenocaccinv".v, pooriy d1ttersnCiated aaJ tt,s dats on that wsa Dscsml.et S, 1070, Yusc lattiais on the back tbs=s, uecona paQ+? A Yeo. Q lbat was rdeA yow INi• iQ rer[ residency tcaiMisq, 1979? A lAat'• riqrt. At taat tis• I baan't rsaliy bevsa to looR at tbess tu.or` .*a .zudy thsa. Q Yov, tDsr• was •aotbsr cass that you diagnosed le that qrnmp, too, wasn't tbec., doctor? Lst os r.trs4t, yu4c s.mwry witt, it. 1:'s A littl• coM;.1*x ot a c.p4rt. A Somstloes tneyOre very lonq. Q But !n tba: ca.• your fcaxeA sectlon d:aqnutlv w.z po,,r2y dltterentiate3 oascinoss, toali cell vsrcuz adenocirctnuw, that ts,st3 2tnt? A-TAat's correct, Ye:.. We tslksj sLout wAat a fruren section diayno:.iz la Ytat.rc3ay. Q TLut'6 riqht. O:.ctor, the lraal ai.qnosls is • coupt• of paye3 ov.r. Ltt sr point it ou- to You. It's the -- that ou•. Twt llual aisInaiis ras w"ilt.r.fitiatt:t oasalnosa? A lbat's rlgbt. Q And the date ot that ws jo2y 17. 19901 A *h•t's cight. lioct ls a aoLO tAat alsoUsass the ta:t rHY:.L15 T. s.DIis, CsR a JOAM K, eJ;iSt7A, CSR
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1 2 3 • S G 7 C 9 11 13 cc 13 26 17 13 19 20 21 22 23 24 25 ' Mtlls • Cross clu3a tu :uc90ry .oae liwt? A Riqi3t. S58• Q And tua f'anal diaqnoais in thii: report va:4 done Ly 8betdon BGao4ce? A CortQC:. ~ Ke ta:koj a5ojtL hiu? A 7ez. H* ii an •xpact in this case •u vvli •a btlns invo2ved iiI the to"• eacly oa. p c:otrvct. R&r a:.;pir,~,:o va:& a+ruroendocr:nr c.arrtao:.s, qusi i[ieJ foL explanuturl pucpoie;; to ba atypical car%;ia:.id or arrllqnant cartinu.d7 A Rijht. Q Do yos agLer vith that? ' A I aVree xltt, the Arlourornducr;oe psct, bct not Lt,e po=t irn l+atan:iiv..1:. 0 Z t wou1d be :31 t tu ney. yoj diaaqt oe rh tt, thtr ty;.e? A Tae aob typb. I agreo W.th the ty}k oautoonJocrine. Tacre iu a line in there from petaandor' d.acr iytion that ,raya when he disse.:ted the leslon he aor a eatiaii bronchus 14adAny itraiqbt into the 8944 aad tba: it tbe bcoocbu:: I showed irt the pboto2rayt, anJ in laa aiicrnocopic alidoa yesterday. Q Out a a.Oaonta: btoacbu. vould not be a a&all btoacuu:.l would It? A trancbus you rooid sae 9roc`ly can't be that sttoaq. Ln m J OD Fr A Ln W N titYLLIS T. t.EKtSs CSR JOAIiNS N. BOJ3?J6'. CSR
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I • ' 3 4 s i 7 8 9 10 21 12 13 14 a 1S 1G 17 18 19 20 21 22 23 24 ZS • Millr - Ccoso Q Tbat vas in an artirlt you p+iblisbed Ln 1982, You k4ow -- sS40 A :Uat repr.ionts anota.r ohan9e lo-ay tnouqhts on the tusoca, anJ it iz due in part to the accuvulattn9 dats base t:,at we havs oor tbat auc9.oAa are beqinnlnq to resect ti,e4a tusor*. Q D"tc,r, You a2so -- sea it you agree with th• ststeaeat that atage one atypicai earcinoid is lar .ote aoaaon tbsc& otaGo one ain,12: cell earatnae.a, did yvs vr ite that statoment? A IL you are ta:king aQ:w t tusors to 9sn+ ral, taik3aj a,yoQt the percenta9• o! atypteai oareiQotde tbst are ata%a oae vacsua the percenta9s ot sosll es:: earesno:r.a6 tba: are otaq• on.. Yes, that ts rlqht. 0 I an talkiny aL.wt raat Yon wrote ata9• ons atypicsl caccana;d ic a tar •ore -- A That is true, b4t I aa trying to •sp:ain to you, if yoj tai:e all pattents vitn a•- all patisnt• Witn att`tca: earcinoids alco and pt.rerc.d by as, tae tor I proCsr ia ve2l-di![ecantiatsd o.urotndocrtn. earelnoars. If yog taj6Q all ot tboaa patients, aoro of tbsa will be •tajs one, tayrn all pstiontr vitu aaall c.ll v4dittstantiatod carolno:ox. 0 Taat to sot vAat you vere talking about In 1827 A lbat to vbat I war tslkiaq abodt. PiiY:.L1S ?. L8WIG, CSR i JOANNE M. BJVSTv:~o CER - -, - -- __
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0 1 2 3 4 5 6 7 0 9 1R 25 bi12: - CrOay $578 • co,.y, tQ2. And •:: we telked aboat Ynaterddy, • bconcboGca? y pcocedure /o vnQCe they pst a flexidle tube down the nose an4 tYaaina t:,t •icvayn dvvn into tbe iunSa and the broaci,i? A Itiyat. Q And you roies t eJ to .t hovinj a kind of ci•A device on the ea.i, sr. if nQQ,! Do, tney eouid take aas;+:ex of tiseue to bt in,; bac'r, uh to tbo patt,oloqy iab? A Cvrtact. Q :bey can do oiher tbinib liko vaab an are: •n.i pick up cvii.: ani dv little azsii brusain~i:: with a btu:h an:d brinj chat s.u:.• our to aa sxalined al a pa:uoloyietT A Co: Cc:t. •J It ssys in thiL rc.port, Dor.tor, that Dt. iieritf vi.ve3 thg v:,cal cor3a and the eriLite tcachoei bronchsal tt.e an:2 z:: aeq:,.c.•nts: A Ir ady5 that. I ttrinK it ra •i4leadiny. Cou:dn'z go43ltalY have gone all the vay out toto tAe entire tete vitit t b e br oncho.:.opa. Q id4;ira'c Lay the vho:e tree. I•aid all -- A TDe note aays the entir• tracDeal bronchial tcee. Tiat irt siileaJinq Ime"uee YoJ can't aee it •1:. Q Tru*. Mcaase by the tia tt gets out te,ere it 9e;.x "uller and usaller, but you caa laak at the atqtenta; bt oncn 17 lU7;.:.IS !. LfAiSO CSR 4 a. AOJSTJq, CSR
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1 2 3 4 S i 7 • 13 1G 141118 - Ccoss SSSt A ?uat's corc*Ct. Q Doe4n't Doctor Oa:rYl Carter say tbat vnueual •,itbe:fa1 atypiaz acs eoaaoniY 10610 ln cacelAoid tucwcs? A I•• eot sp.citically avac• ot vb.r• that quote la sc>oing tro:r, i'd have to se• the Qontext you're taking It trosti. Q All ti90t. A •r• rou talking about typical earciaoid tooors or vsll-ditt.rsnttat.d •~ure.~doorin~ eacainosast Q I tbink it app:lsa to bvtd, but lot o• show you cae attic2e. Tt,iri is an actic:e In tAe pathology annosl. In tact, dos;ar, I think in tbe sata issue you ba3 an article? - A Yr.. i L4J an a: t sc:le. '1 ooctoc, DarrjA Csrter bad an actic:e oaliod •Yat:14lor,:c 1:Yaalno:son ai tls3o4 Pulaonaiy epeclraiena Aonecteo !o:• b.ecaia;ti: Dlsea&6.• You probablr c.aJ tb.t artici• at the tiue, d.Jn': Yo:r? A I don't sp.citically recall tbat. I•s p:a:ty s;t:r I did. Q tret .o aall roer attsntion to tao p.rt on sareinoad t1Mo[s them it•s bs.n 1ti9blight.d. it say. tbat, •go oarciaosa la situ i• Ocsssat, altbwob thoc• act Stoqu.ntlY sauseal •trplas ot tNs bro.ab/al opitbslira.• lUYLLS? T. LCNtj, CSR 6 .TOJWkLr No mOU!=YJt:. CS[K
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I 2 3 4 5 6 Milli - Ccoss $5,85 5eqAentss btonctrus ls sosll In comi+atieon to the •atn atQar but it is a laryo bconcAtiz, in co.yariaon to what it Qut;4 ost iac tY« •- 0 g,;t you vouidn't desetioe a•eq'eAr..1 bron:hus 44 being a aaall one, aac •s a sajesntai one? A I vvu:.d probably glve the dlaastert, say wuat it war in Oia lima:frli. q nut yoa vould idontttj it az seyrenta1l A it I c:c:uiu idcntify it au sucb, it ooula depenJ on tttc uoociwea, bov i: va:: t.sa+rod, how It ras orisat.a, j Okay. Q A:t.r Arw. Cipoltonz tott t4Q ho4yital In 1Wgurt ot 19n1, 840 retucne3 :n xtey ot 1982 twith puiuoiiary ayaptor+~ or :un4 sy.%;04:0ni;q tan't that tr.teT A Ttta:' a ay reccol:ect ion, ya. a Astd at taat tihcr Or. 3ticb:en did o broncho3-Wopy, tae car.,c y+rusrsclura w• taikacl aboat bttota7 A Y.~. 0 Took a saaple of t:siua, sant it to the patbo:uqy .ab tat dlay:lovla? A Co: t eCt. 3 1 beliove lrou ltilZs. sitAtlon.d tbib tspott r.at.cday, Oc. lteavsu.r teat, wtien you talked aLo1t biopsy dia9nusi4 at Lenox ntll? • tAY:...15 T. L°AIS. CSR 4 JOA70RO", !R. LtOU.yTON* Cbfi
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N:lla - C=OsG SS79 I 2 3 4 S 4 7 Q > 11 12 13 14 9- . 1' 26 17 13 19 20 21 22 23 24 2s A Ondez tdo bsat m yo4 can see ta tne sepacrntal broncr.i, . A4 r4a:,i ys:.tacday, when dtaliny vitiu btunchi that cona oat at a &.2acp angle to turn it bach up, tor tt::inica: reasons, it iL hard to +1st into thoss. Aleu, it you •vor :ooked through ona ot thoue, it 43 a 1ittla sitticutt to te:l vhsre yoa ace a:id you can 94 oy the saua a•gaentai broncLi and there ia a lot of zk:ll i:1Jo:vld ua+lny :otl In3Lcuseai.. ] Y:,4 haJ nia reasoa to dciubc the skili of Oc. bsrift? A :i'v. Q ur da ia they we r e ai. neqhiivs. rUaz reana bs dldn't ase any:a.n~; SU.piciou.:, a: :.3.t tbroauh the •c3ps$ ian•t t:,a,. true: A Naan,; to *e that tav s.O:nta: o;*ninjL that ps 664 vere neqjt,•+e. Q An.i Loan ne took a eriop.:y in the t49ion of tntr nWule, oo:a:nrci wi:n waahinq:, and I think it sdyz A• took br4:bir,qi. A11 tnoa• •srt •YSainsd by tne irstho:ogy tlc;rart.en: at Ler.os liill? A I am not suce what be msana by the noduls. One uentence be *ays it'a aeyative and tbea h• saya be takss a diopzyr can'L be Asgativ• and Aavs a nc-4ule at the •asM tiak. Ut tAt tsasu• that wa+ taken vas nsqative patboloyiCal:y or tbtouqh t,• •teroscope. Q Bis 9a.1 would 60 to oet as close to the aodul• a,: ~ m V OD I+ ~ N V •lrYi.:.IS ?. i.3Wib. CS1i 6 JOAi1XE N. bOUSTVN. CSA
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1 • 2 3 4 S i 7 8 ! 10 11 12 13 14 S 15 16 17 la 19 20 21 22 23 24 2S • Iti11a - direiit SS11 Oi6.45e 304cn42. Q Did you discuss 'r4th article. at your OspositionT A I be:levs I dia, ysu. Q Co abead. Teli tAe jury a litt1• about the artio2es. A ia the Gsbbart article tosy MY• 17 PaLisnta that havo v.ii-diPlerentiat.d eevroeridocrine wrcinocav. T'ASf uae .n . inttrsatiaq iera. Tosy Call tbe• peripherai vn,d1tterentist.d asall eoll carainosAs, vhicR souade conto;.:ny, and poiAt oyt tbe close assoziat:on betvsor, t6is tuaar anJ vhtt peop:• tl'piciliy taink o= ae saall ce:l unJii[erfntittrd. M:Ian you rrs3 the papsr they cake at c;ear taey arc tslktng abwt Lva saa• tuvor but oas dtttecen; terataoloq?e in tbetr avciej oi 17 pati.nts to.y Aave 17 btatort.a ard all vere .wokers. Mc'%"P.ylrn'j stuSy is aor• coqplic.tej, it ls aatudy ot both typical catciAOad 404 vell-diffsrrntiated neuroendocrint CirClnonJLt. They eave 1?4 oaae& tnere. Q Sorry to intel ruDt. Myen ros say typica'l oaroinoid tu,ooru, are you setstring to the tu.oc that you •tetcheJ out or. Plsint:it's ishtbit i0M A Y.a. Q Tais is AaL a tAsor that Cipollone? cas oonsidsrad tor Mr4. PHYLLIS T. 1uEd13, C.ZR a JOAIiIc M. 1NOS?OZi, CoR
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• 1 2 3 4 s 6 7 a Nills - Ccosr ss43 TAst ls ri9bt. On, ot tb• patiept• Aad saail ceii neNr00Adoctl0e Gtcifloma# and in two caseA r• Motefl't absolutely surs, and that pstiOnt is atill a:iv*. eut tnsr• is a bias in the study esaliaq vith the :act tbat at the tiea the atOdy Was Cooduct.d, tbe patieAto with sssail coil oatcinaus were not qsttinq surgical tsjecttoaa. We vete only luuking at sasactad ssct/vne that na4 largo •pou9h ti.swfs tor ud to •tudy a lot ot the tuaurK, and thete v.re patients that vees cosinf to otit hosr:tal ai: tAd tiao who vet• getting tboit sa.l1 ctal aatclnolras .liasnojed by psycboloyy and by the tAinkiny at th• ttoe, va:ch was that they shouidn't have a aurqical rsssctioz. We n.ver qo: anyaort tia3u• in tt,e sdt9ical ~ patholoyf aroa to atudy the caaea. Q Out aevertASia i, o: tbt 323 that You lookosJ at, onr wa~. -bMall csiA carcinooa, ataye one, and 15 oecs stag• on• atYpicai carcinoidj. Isn't that tly&t? A True. But that dooun't aliow you to sake a distinc:ion adwt the relative trsqusociss because of the tact tuas i.4 .any of the stage oci* saall cells csts not 9ettlng rsaezted. Q i aa sot aakinq aAy asaraptioa6. !p• articl• -- .any •saaplos of purpottad a.all coil dittorsntiatod aacoino+sa probably t.pr.s.nt atypical oacciaoids 7 A That var a oonca a ra caised at that tiw# and Ln m J N O r lQ7L:.IS T. i,eMIS, CiA 4 .10AUE N. N0DS:'0:/, CSa
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• 1 s 3 4 S 6 7 e 9 10 K.lir - Gcou: 5502 A Tho+e are the word4 be waea. Q Do yuo aqree with tbat? ~l I aa ao: +cuc• bow he is ccin9 the vor4 •peciP4etal.• It ls not tho way I vou/d ose the voc0. It be is uainy tae vord to •ean tascly close to the pleacs aurfa-Ze, tbe exterAal aeryloe ot tae luAq, it la v.&cnan a short diutanoe oi it but there are sany pleura cuctaueu. Taere are tbe great tioasre that qaoB batveen the upper anJ loaer lobe sad you can bay• a tYJsor cauee to the traearv suclace anJ sttll have a tuaor losated in the cen:ec ot tRo lu:K. We taIKQJ adou the pariyNeral cent.c terminuioqy is reslly dlflicult to tullov. 4 1lit bQ saad :ocated petiyberally nut oentra:ly? A Ha Ub6J •p.ripaerally.• I dun't aqr.*cr vicb the vosj the •ay you det:ne it an;1 Iwa: trying to ea;astn what I think be seanL. 0 He ta/ted at.oat the c:ozeness to the nieurs. Pive Mii:iseter:c aviir tros tae pleura? A It iu ispc,ctsnt tu reseaLer that a•pecicea In viiicrh the 1un9 vir caIlapeeJ, and the lcnq !s like a larqe spoaoe, a4d a tully intlated lung vculd be tbts btq, aAd wben yos let tbe air out, tt is tbst biy. tindiaatinq.) ftvion3iy, he bai a apeCiaen rcroved, and the air 1& gone fr0a Lt and •vA&ytOing 1• COAt[a0tod down# so Elve •3iYi.:.I9 T. L1S1:6t C8R 4 J01V=N3: M. OOUSY'OJS, CSR
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1 2 3 4 S 6 /lills - Cms SsiO tact tKey .Mta`t.sis• rapidly? A Mar•iss ar be i.volvsd# ub.. aar9ios aco i.volved you oowllY got a cooutr.4o* at tbat 49469 0 !b• marties veion't i.volv.d in t+usor lA 1tc.. Ctp01104046 oasot A thrr were Lavolved vitb dl/sylaia. Q iUt tbot. ws 80 twwr tbo9o? A Tb.r• vas so twor vo aar, but obvlously lt sbt got a r.currooc• at teat ar.a, tboro bad to Ir. tu,ror tb.ro tbat W• didn't s.o. p lb.ro bad to 1t.t A Yos. Tbat's vaac fav ria• to tbo coavcsouc.. rtw tuaor yots lrsphatic cbanaois a&4 lt's a discontinou3 spr.ad and your tsAasco ot s*oioq a sall locci sH qiv.n ssctioAj 16 "t biyb. Q You talJcod roatotday. Dc. Mll:r. •bout ~ovs cwr~i a ia3: ywu d.scr tb.d by tbo toro i typical oa4oac tat tuAwr. DO yrriJ raassbsc tbatt A T..ors othoi pooyl• rav" d.sori"47 Q Yos. A Yoi. Q You ottod ap acti.to, sovotal •rtiolos about that partioulas type of tdrrarT A Tbat'a aorroot. Q AeW as. *1 tsos• •ctivlos was !r • pstboloqist warsd PaYLi.I• !• WWZil Mw • JOJ1Nwi S. SOiNOltiiii• CSR
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i I I 1 I 4 S I Mllls • Cr*a $sil •ilsabett Nonwell. to that tcu.? A tbat's oorcoct. 0 Zn Eaot, sae ooined tbst tot• back t• 1ft0 •r •f3t didn't ake? A Yos, she did. Q llna You have oqsatN •typioal •rdoaris• twwori with atypfoal aarolooid, da..a't Yost A laot's riqht. I oquate taoso, •ot evorybody doos* sut to ay thinkinq on tMose gasts, •nd I•vo yiven this topic a lot oI tOouqht, th.ro are nerrruendocrioe o.ccinoaas and they lielon9 to the oateqocy ot ldny oancr:s, that's ca2lod •o4toendoor lne c.talnowy out there are aoae A !'rat's tidht, Mut that's • eecy wteoc 'otnt lu en. discropasay. 0 Oootor, Yw woold aqroe, worldn't rou, tLat tbece are a lot ot sases o! •tyolsal s.raasl• tlat ars desocib.d in the literotec• sihero there ls either so asokia9 history or the osioRlat btstotles ace soaolo to be eood? A I'd say that•* tree tor these tr.ors a.d tor other lonq eta*r peOple that dOa't show that vlov. Q Inoludinq Or. MaDOVell? A lhat'a tcre. Mos otbecs aa rall. Q Like Ot, iaqsne Ma=k? A lAat's [ieet. 0 wAo's s4 •spert sn t4is Case tor the p:aistitt? M?'VLI• !. S.Mtic CpM a 10m M. MtlOMc CfM
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1 1 t 5 6 7 Ntlls - Ctoss $593 Y've rtii.d tt out as beinq sdsissib:• on dir.ct, OuL 1t yosi want Lo puraud tt 0A 610368 tb•t'i • deCision you bave to •sko. KR# t0t..Ls Tast'o grossly a:sl0.din9 itborvise, to the Court. Masc is lt probative Oi! Kae sta&mot, it isn't wOV.e Yoo don't vaAt to csil bi. au an es?ett and you want the 9eport to qet in throagh athQ: pl.7ple. 114. [»LwI I's nut 9oto9 to s=90o vlt2! yoY. Tct:i COuR~~ Y'A Qu1 ng to d.ny the ro,dtiost tb.: 110 be 1n3ttuCte,d anJ tbw yufation is vbstAsc ot not you va4t to ?u«ue it vn arouA. . H+. Fr1R4i,GIP'1 Okoy. (T:ie fol:ov,n-j taic.s i.,sco in tbo pro.onae of the Ca:3,5 S-l:iiA`! :NJ1: 0= BY NR, 8IRR71330Ci 0 Aoator, lurtb.r on in this tOport You'il •ee soso hiyaliybtiaj i think at the bottos ot the pa0.. K5. NAI.TP.U# Arr Yu.t vitbdtOVinq tAOt lOst question? /1K, iIRRO3C: ?be •nsvot oas *ivon. NS. 11A:.TrRSt I Oolteve YOY GYt t4. YitAtas •tt. Kit. 6IR1t1NS: I' l l wit/1dt01/ the qYtstloA. 0 tUTLL I S T. LtaI 8, Cat i JCiA.Nlf2'N. Wi6:'0N. C!R
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1 2 3 4 9 6 7 8 Mai16 - Ccooa 5589 l.nqt,ly. I'J t ike tu ohk You • ooupie rif yue+tioue abo4t that repurt. ;w Yau reSe.croc teadircj that? A X.o. 9 I've t,iqnllSht4J a Couple ot aectiona WnICL I'a 9oiny to aak y4u atx.ut. Pirst one osiaq oa the tc?, pre-oparative d,.apoala, re:.ir ront oaliSnant carcinoid tusaoc, r1yt+; An:eraodia:r brun;;+iug. 8tatuu niAe ar.J one-yalt nontua attac rtq:At ui)ptr lobe losectozy tor .aliQnant caccinoid. ;cuia oUt swil c:arcinu_%1*. Tbat's aprcr-opQra:.ive tsi aytlv3iv7 A Tnat':. rir4t. 0 Ww, doYr, Lr. tha no:d do.cr lbaag tho cas., do,;tur, i • 24 25 L;iinic I've 9ut at hlh.h:is1kceJ on Youi4c, on 6/23/81, tight usliact inotuay d:J noc .ao•r any uode4 :nvolvtd vith toa:.: a:kJ_a r:gA: up,)er Zoaa lobeotooy vaa 40110 tor bAat tu:ntJ o4t to tw aaa:ignanta bat lt+cal.sed, psripr.erol caccinoio tu.tr.r. Du you aqreo arith that? A ^ai.at':& what ttit tiord% .ay. Q Do yom agc.e vAca it? A ao, I doa't. Q At tbe fwttoa oii tbe pa9o A I thinL Jr. stiaLfei raJu at Clear be no lon8sc vL.W.3 tb i s tusoc tha t wa)'. PlIYLLIS T. LLbf:S, CSA i JOA1t: S 1!. 1GYJ'.~'.^,I:. CSR
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• 4 5 6 7 25 Mills • Ctoas 3Si8 Q CervixT Q MoW, do4tor, typical caroinaid's •ot aasociated vitt, saokinq, is it? A Melt, osrtainly tbere is Ao t.ason to suspect that ssokiny pcotecta you trom qettt4q typical carcinoid tumor. Q i don't tbinx I•eted that. I tAiAr my asestiou wass It'a aot asirociated vith typical carclAOld of tbe lung, ia it? A it's not qenerally acct yted as being ansociateJ. I certainly sa+e aeen auvero4s typiaa: cacciooids of the iun,, in non-zouksci, often in yoanQ people. Q tto.+, doctor, do you ceiseut,.t moon t aaked yoa at youi d.position wbsther Yoai tAoi9ht anybody olse workinq in thv aces of nQ:rroenduarlne t.uaorm •ight have a dttierenc experience with tsgard to ssoklnq and tts r.latioAahij t4 atyyica: caccinofd at>a you anawert3, you didn't thinR so A I aai4 1 waun't avar• of anYane else's study ai~ tAsL tiaQ. Q Hivf you seen the data of Dc. tionld ln this ca4* or taa data troJO or. Yeld4an in this caso on their atypica: carcinoid cases? A J1ce you talkin9 about tbe saolcieq data? Q Yea. A Yes, I have seen tbat. tIHYLLta ?. LIN:S, CSR a J0"'.f8 M. W'.lST:7N, C±F.
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1 3 4 5 5 7 5 ! • Caoss $SiS Q H* "de a dia0u:i: at oat Cell -- sawll ceii ceccinoaa, oat cei1 :y;ts? A ?J.1:tlv rwt. Q Yud'va lookeJ at tuuse stidesz A Viot' ia cc+r t occ. 0 And yuuc sia•d,aqno=..a is osall oell caraiAons inttrr.odiiitr tyre? A Ayorra, I don't aaice tha: d:rtin:tion on ey teports. It'a a auht:y tha: ;,athuloqlctw use amon;g tboa:.sive:, an dorc:t'it,iny tueya soita:rr anJ it bas no cllnicai valuv, a Scs: tiso:e are +pe,,ftrucis th4t tncluc3e intermediate !n thiu yhile ran2e oL nalrOetljo::ran0 tiur4ta, aten'c thMret " A That'+ riO3t. V A i.QpiCattr cate5ary, inte:ntrsiace? A It's no: yo suc:il aaeimtate cate,l,iy ai ya: t of cbs aPQctrua. Ms dittscent ye4p:a hay ditterent drCinition4 tur va+s: an intmra4jiate ceil i,: as oppo.eJ to an oat ceia. 0 yaj rtcalt at. Mli:U, that at tbV ttrb of the surqety in 13E2, • urin* iiRiyle waj taxeh? A I bolaeve thstoa Correat. I'a Aut sate tihetLet It WsA iazediat.ly prior to tl.e wucqery. I eelisve it waa. 0 Let'4 take t 1o,k at lt. Cwyf of tbe rtp:vrt ovet bec• on this eids from Ths C.roina:d Tueor aaa Secotonin Aeaostch Laborat:ary, rur:.:.iS s. LEMI S, Ct1t 6 JXXns K. rWsZON, CSR
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1 2 3 4 S 6 7 3 N:lig - Cro:L 5537 the presen:t a:atN::oloyy io conaaotent witb th• •orittt d1a,nob:J oL saii9r1ai1c caccino.d tuMur. 1: tnat wiNt tbo Aotu saya? A Tt1ac'a what It ssy6. aore+er. I tbink in• otiginai aialr.oziu vaj really ntazoondoarint carolnora3 and aoliynont caicinuJd tjwu: wau jus.t ono of two otNer t.s:r.a tta; vsa ae::tionQd ln parto4ueses. 0 Zt wa: u;~e;: +ynanyocwa.y, ion't that your umicrscaadar.2? A :aat':: tra:.lcaily the way I voulti virv that. Q T:3,:; i: a irttot-ubzetvaL.lity that we ta1A.d aba4t taiu sir niny. A GJ aila:w. 13 14 0 KQra tA,.aa ait:• pa::.alog.at louklnq at the yarao siida 7and r.a42n,1 a ditferan= dia;ino:-A«e t.n't that wtwt tbat le"? :t'u not actuai:y a torsalfsed •Yao;,:• ot that but it'A 0 1r, .7 ls 19 20 21 22 23 24 as ;.:,r : ut a work;ni •aaui•l• oL tbat. ;; Na bave a ?tactlca: •Yanl.~2• taat bappQnz in patbo:a2Y :a5oratoti#.: ta:a day? A :bat'i rl9ut. I at,ouid po:r+t out thete ate torril ictudtr: r.jaiding the tntat•oustrva5:lity of ir.oll c*11 aarcano2a4 and the agc.oaant ia quitt oi9be in the san2e of !0 p1u: Pttcfnt. Q It's oertain;y not biss On subtya.a0 t& It? A ASoiA, that's adistinction that baA no clinical .a:uc. !-+ tU:.LIS T. LLK:S. C3It 4 JOJWiC !M. M4JS'1"J!:. CSR
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1 • _ 3 4 S 6 7 0 ! 10 11 13 14 ~ 15 16 17 1s 19 20 21 22 23 24 2S Milla - Cross SS66 olsarett• smokinq oausinq lonq cancer? A i'• reiyinq on .pidtaioloqio studies that Z'• •var• ot. I'• not an epide.ioloqiat, i'• aot an •xpart in tbat ar.a# but the great body ot tnovledqe that doctorr ar• awaie of rogatding srokiny causin2 cancet is in larqe pact ep1dsioloyic. Q Kave you .ver qone back and read the studies or do yoj rea3 su.ymact.s7 A I bava read auaaarif s and i've also read -- we taikQJ atr44t thic at sy d.pas3tion one day and yow asked as it I read soae of tnM=s studies and I said I badn't and subse4ueatly I wat ars:i obtaioid tbta, so I bave tead aaw o: th.m subj.4u.nt to tbat. 0 You havcr b.ers doing yoar bcrdtwurk? A So have your yes. Q :',r yo:ny tcu r.ter you, doctnr, to the 190:. 8arqeon Gens:a1'a rs;•ort. gave y:w tcrok.d it tbat, are you taailiar wit:. tr,at docu.+sentt A Z've looked at that in pact, yes. Q Mere you aware that sa those stedies, retrospect;v• and prospactiv., eyidealoioqic atudia -- you know tboas wocd: nov that you have toad the studie.? A I Icoor tAose wordr, yra. 0 And all tboze stvdies, s.tcospeotivo and pros?eativ., ~ m ~ ao t.A ~ ~ ~ ~ tbTYL:.IS T. LEiiISi, CSR 4 JOUi:=. K. YOJSTON, CSR
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1 2 3 S 6 7 Hilla - CCO36 5371 Q Ta• GtlbaardLT A Tnat wa: pjbllsbeJ in au:trac:t loto oarltor than tbat anJ I thini: ve ta:kod abatt jt at oy d*poeition. Q Yoi bave 404e t.luctanct in •cc.pting taaoarca tbat'c na: peer revAevQd, bavon't yoo satd tbat btt'ora? A Taa;. v&4 an abatrac•.. It ltad tc be rtvlaed to sake it a -- Q But you have 3.sn that artlc:e in Choit, bav+n't you7 A Yov, I kavo. Q AraS tha t' a uj th• pa:tioioQy aepartsant and by tt,e onco;ovy dvj~jrt:aent oi Vanderbiit Univaraity? A :':fibt'4 r:96,tit. Q Pta:ub~y au:ae tiva:ty hctveen totc but yaa vc.jld accipt var:Ject,,:t a~~ a C.~~ta~:e r~dtca: acctooi2 A I don't ltnar what yaJ ioan by rivalty. I conatdar taV: t*pJtaLio. Q In bakAelball? A ae've baJ a vacy bad t.aa lately. Q Torra lan't mu:.o ot a rivalry tben. A N:O . 0 I vant to reter to that actWl• in CA.3t# vbtci, lx •n;:tled, •Atypical Carcinaid ot tAe Guny, a Distinct Cllaical tatpoiogic incity.• wbat aoaa tbac tacv aQan to ya4, a distlnct clinical patboloqic •nL.tyt PtlYL:.iB !. L1'dI3e CSR i .70A::l1L° N. •,*3E:'OK, CBR
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Rill& - Crosa SS83 0 1 2 3 4 S 6 7 8 3 10 11 aAilicaetera ln a re.:ectsrj specisan ks not anytAlng clo:r to ono t.sat. i:~ tJ:: of atr. Q Fivo allalmster lV a=ltth vf an lAch? A wYit a cenc,lscter. Rouqhiy titta of an invh. 0 weil-c1tc~.:irtwJ ttra vDite y.2lrrr sub Dloura sasu. In yojr oxhorience at loo'sin9 at speci:sns and you fouru3 less tban ttn percent of the smaii oell turw:.: prosonz:, aQ vail circiwtscribed Etta vA3tR yellow autases? A A; an orQttr of •aarfituJe. Again talking about trylnj to qQ: s a.nd,• 03 w:Jat pfrcentsQa of raiail cell can..ar predent ata;~Q cna lej;.oni, I taid t.n percent in t4e psoc. Latct info:"t.Aon -- vorc recer~= iafur"ttcrn ieuqqtits on ttc arder of 30 ptrc:cnt. Nell, in that ranje, yea, I vould Nay ,t; but cbst iu tea.:uuYa3o. We have to kt ep in olnd va are ta.tinq a~'r.?NL a Cv~r, tumur. :si1, tventy, tt,irtr pQrc4nt of a common tua4r 1:4 a lut of turso:. Q I suked you ac your deposittna vwether leav t,sn ten parcent of saall cells pr.z.ntsd ai aircwwccrlbs3 v.l l•ci rcuaser lbe;3, veI l ma:.es, aetid you s9read? A Taat is reasonavla, yez. 0 m aov, r• talked about tb• trosen sec:lon rast.tciay and that Aad not bsQ3 done by Or* lfroanda bst Dr. Joachla? A Yas. Q That va+c done at soao point doctnq or alter aurqerr b;it taYL:.IS T. LMt S. CiR & JaWU n. WJJ37"Ja, CSR
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Illlls - Ccoa SM= I oa~o~c• a• v~ii. yes. s q foridA't you a3r.o vltb as that there •c., te tact, sor• 3 4 •typloal oatslmoid described le tksir lttoraturs vb.r• you "n't t.il vbat the a.otin9 Oistori.s ar• tLan those vAot• i YoV Na? t A I vauid tsrdasm4t.ily aor.e vit• that vitboot gola9 7 tbrodtb tYa •umb.rs, yos* ' I p t1e wnt tbrouqa tbe n"w.rs at your d*positt.a, didn t f ..? . 10 A ve dta. 11 o ..ite.r o4e ot m. enjoyed tbat? 12 A L.t'• rot do It •qain. 13 0 alt ciybt. - 14 aoctor, vosld yoo •yrot t0at wail oall tarciAOlu it 1S the fastest treviny and oost iilignant tYpt of lonq aanc.r? 1f A In y.nsral I vouid agree witb that, yos. I think I 17 alluded to that resterdaY. It you take tAes as a 9rospO ls 1! tAat's tru.. 0 as.# ssall ooll oarolsooss oocoir 1• •tAor 'loess ta to• 30 body tban besldes tlN lun9. Isn't tbat truiT 21 a lrat'• trro. 22 Q To11 have an tOtertlt ts tbat, dM't twp 23 a tes. I M0 24 q it Mtota 1• Uo Ittdaty? 2s A T.s. •ss"a :. s.ris, css • 11awm K. .ooNM. Css
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0 I 2 3 4 5 6 7 27 lk Mill. - Crost 5586 f t's a d:atin.-t son t:mt patii4lsrq [at• aak• asting the+ssolvsa. .C1-n@ 0: thevi •jOJt tQ Pi:::i tUaL Gn to C:inician and iithe[L dOiI' L. J t3it yo4' 11 ag: ee tritu au, Dru. Ioacb/e an:: Rutterdaa tnjug`:L it vo;. atypicai cacciauict, Dt. Snyder tbouqh6 sDali ca_1 ca:c:iti:ww4. Isn't taat true? -h Yej. I vouid agc.e ve're talktny about nuancea not zeoctrtim of ne.iroe:~~Jaca. LlretyLody aqree_ tt•o a cai.;lnoaa that t,aa n.ucoeaJuc: ine Leatureo. Q 16 uo.: :urortaat •njjy : tor tLe:a to rrakr tac naret A I c-r+c rOa;iJn they t`a9e the diotincticin i;. •t tua; t:s:+ t',ere tis:4 aacn a lrw*enJcrua dittecence in the toca - con,::de:ed oppropriato tor tae tumor tYpo3. we rnow tnvrc i: very litt.e diLtere:ice iu tl.e tcoataant toc t1:e tus6.3s, sj it'a a di,:ttncLaon t:#i: hiJ rore apparent ioj~ortanca :hata i: doe:, nQ•r. Q Atta: that hosi,ttalisatXon ln Nai, tOtre vsa anothcr bo3;+itali,citton ia June ot 1932? A T.~Aat'a ci9nt, tisat va:: to ceWove the reae:nJer ot he: crQ:,t lung. Q Tne decieloa was •ada to yo abea3 and tw4+• tt? A Taat's torreCt. Q l•ve eandod to you Or. f.tachAon'y operativt r.port troo sun~ 7, 29020 Zt's Eairly :e:1qitsy. In tact, it's very P9twLIS T. LBMiS, CbR a JOvit:s 11. 93JS:JN. CS;t
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1 3 4 S 6 7 8 10 11 13 13 14 ~ 1S 2G 17 18 19 20 21 22 23 24 as 0 llills - Ccors S565 of tbooe clearly o036tred in •on-oMokora. p You published that data, aian't youT A Ut. 2 Isn't it true, Dr. Hi:ls, that no anissi •sWriaQnt ipvoivinq tobacco saoKe inba:atioA has ovar nrodsctd •- •triK* that. isn't it tcue test no anlmal espsciNnt involv:nq totascco asolce inhalation has •ver shown s4all cell carCino+`a? A i don't oPe:.ticalty icncw the answer to that aue..cion. Q !!lCiVit you haven't teiQ the stud1@o? A 7ooce ase tbouoanJa of stud;es an eapersMe4:a1 studI+r.: on usinQ •ub.-tanca+c touad In sDoicf and Wucin9 cancer, but I'a not awace perrwnally of a stody that relateu to asoice inaaZation causing saali CC1: CanCer. we a+d taikecl abwt aI l the pcublema that a:q :t exist tryinti to oake a study like that• but I'a not aware o4C16 one. Q Yoa Aaven't cead the studioa tbouqh, how can you talk abaut the problena? Can you? A wetl. I've reac! •o" of the latocwtlor on problrj:- that have occuriod in trying to indsac• lonp atacocs in aaias:v. i didn't rely on that intoraation to sake ay opinion in tyiis eass. it's •ot an area of partioular study ot •ins. Q Are You relying on opideatolooy for your opinion, pBYLLIS T. LCKIS, CaR S JOASNe no p'ilOtiZ014 Cu
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liills • Cross 5557 1 2 3 4 3 i 7 ! ! 10 11 A Z•a sur* they were different becaUst tbey vece taken tror a dil:Vtent •icrosiccpr. Q Did you tell the jury Ltnos N1l1 ose: a ditta ent staia, basic stain tor slideo, they v" a ditterant staia than yo4 •sed at tbe Oniversity •t Ylcoiaia? Isn't that ttes? A 1 did o.atioa rebterday Wben we talRed about how the ssotions wore staioed tbat tYpically we us• •ither b.rato:ylin •oain stain rbiob Is vbat we nse er •e{watosllin, satiton aer3 phyloYln• •tsia, sbicb is vbat they vstd. Q 1 tnenK yvu say bava alin.ro4 that oot you dsdr't •ay they uasJ that pacticu:ar stain, did Yout A I asant to rskQ taat ciear. Q Out ycw d13n•t te;i tboo that atkd taat 9ives •n orango app.arancs to certain typea ot tia8ue, d4swan't It? A Y.3. Y. 6, it tundasenta3ly stains the cytop:arr. sitAec yink oc or+rn y• juaZ •a •o;:Jn stain dof3. 0 Tu.y'te dittectnt? A Yoa, but it's a sWbtla dittsteaoe •4d AoL one tAac vowid affect your tntMCpretatioa. 0 tsot your int.rpretatkon? A I don't tbtnk It roYid attoct awy.a.'a l.t.rpretatic,n. Q 'tbat's your opinion? A 2v*rytbtn9 i'• sayinp AMr• is mr espert opinion. 0-i tbink yos d.aaribed so.a broaabisi etttbeiiss, said ot. dvrsscs observed opiteolial atyplat lDY:.LiB T. Litt;t, CSK i J;JAMIt: N. d70S:vH, CSR
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1 2 3 4 5 G 7 9 g la i l 12 13 14 91 1S 2t; 13 19 20 21 22 23 24 f • ai11L - Crosr 5592 MSC. I*R1'ilRlps Y3uc poror, he testilisd ln bta depo.:it iori he d:sn't rely on sxpsrt repWtsc. M2. 01RRIDGR:.i Sappoct ceport. KS, s+1ALTEt1Ss !ia rslied on tbi wtdlc4: iecord. Yuu don't cali It a Kedical rteord, we do. It it'o qlvsn to the .foct o: ao ;sa r t of the medi cal record, vhether it' n odziau:bie t'or leqal yu:posso, medical recor• 0: not, it we* pnrt vi tbe record that that doctor celieJ upon. It rai inciudaJ in oi. Sttcbien'e sedicai. IiR. =PRrdR1Fe He iaid be didn't rely or. •edica: rspuctj In t.i:; dopocitione ih any case, I icnw the only way to solve tais iy lave 144, Welter4 adti•tae t5e vitnee4, •e Ar. E.1sll Aaa done, taat aa aa bc: to ratec to the repnrt qtvep tc: tu+e dUJ3, :srnei =ira, aont to budJ, Lorner •ttor K:s. Clpollunc':u dtata rauc be can cete:, it be riue to vyal. Ds. 8ticnien r.ay oa.e seid In scedical reco:ou. . wR:.TCRC-s It vas sent to thia dactoc •a yart c.t Jr. SticAisn'i sodicel res4:Jr:, it'4 part of the an:ire recor3 as revisved aud rtllsJ wi-ron. TUS t'.OURTc i'a not 9ofng to give ht: the: inetructioa. I think !t tAs queotion •ltaits ahut Oc. Stlcuien'a vievs ars ancd they're ooAtalneJ In the Subzequent roport, I don't thlnk it's appsoariat• tor aa to bar him tron retsr:iny to tt. ~ ~ V OD I.+ •BYLLIS T. LC412S, CSR • JOAN:i N. E1OUS'T.7:Qe CSA
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1 2 3 4 5 6 7 t 9 10 21 12 13 14 It 1S 2: 17 10 If 20 21 2' . 23 24 25 . Nills - Ccoos $594 Q 1 will sta:a At aooin. You'1i see thsre higbliaated, dootor, ta •on a/20/61 tiqAt s.3liatinoto.f did aot sbov any nodso involvrd vitL tuaor a,ad a right apper lobe lobectomy wa3 don. !oc abat turnQd out to be a waliquant. Aat.looaiixed, peripheral aarcinoict tarar.• ia tiisc vhat it saYO A Tuoss are the vord,c that ace theia, ya. p fottod *o# the page, doatoi. 'Jl bio?sy of tois a.w saas waL raraouoly intecpceteds Oy Dt* dnydec •y ssall csll carcinxtia. Di, onrde: also r.vivsd the t/20/41 diagnosiu to saal: cel: carcinoaa, and by Drs. ioaatcs. Joacbia an9 Rostscdaa as wligaant catciaold, contitsinq the •/20/81 now is that vbat it .ayo? A Tao4s ate the vord4 tbat ace toett, t0at'b coccscc. A:3 1 auonLionsJ, tAere is satot a1 to sugqeit thst doctot -- I oan't tesesbor bis nacQ, pc, iticaien baJ tucther thoaqbts about the diaqnoxis ln tDis oaae tbat are dittecent troo tbo tbouqbts that art in this reporL. Q Lot se art you, doctor, vec• tbose torther tbouqU:b ln the s.dica: cepocts in 1942? A Tbey were ia the reaordy that I Mas Orovidcd. Tlie~ w.-ten't tn the chart la 19820 p were they la btr chart ln 1993? A no, tt wa. wr itton tA 19850 pMYLt.16 T. L!'+tIB, COA 6 .IOMINL N. 110'JS'!'0li, C8R
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1 2 3 4 S 9 7 Niils - Cros. 5559 A littl• lurtMr saya, •Atypicai carcinaldo aay bave a aioilac anata.ic distcibutton and qrosr appeaianct, althouqb n.cro.is and bes,sotaq• A tea, I see that. ar• proainent t.aturej't Q to •wusWl atYpias fla• occot La darcinold tUiorsT A t tdiat be Nana -- apr iaterpretation of that be ..onz, annsoal toru .t atrpia san koor a saroiooid tw4r., ee . •l.o said -- h* said so oaioioona in sito vhica ts a syr+onyw of s.vere dyspiaaia in his patients vath typical earclnoid. Q Ye also caid, sa4 ao aarctnw.i in sita pstisntc, duasn't be? A j*aoN nv. Q Riyht up in the pataqrayh botoro biqbiiqLted sroJe: aaali cell carcino", it sayn, ttei• is Ao Cac.inosa in situ, b4t a qr.o:, pro;>etwity tv 9*ta.tasise s.) that aarqttiS say be inrolved by lyapatlC ?.r..atinn 44 aoy the Pi.Jra. 8• d0.an't tind c.+irciau" in situ ia ssall c.li, do.$ ae' A h4. I don't agree with that sp+rcitic auot.. 4 Otay. A I do aq:f• ritb tS• tact thare !a otten IYa,-batrc prr..atios. 2 don't soN rbsr• io says that. •• Sald it 06661644 at 1,b* iosectZoqM Mtgla? p io, I didn't say tbat. io+t said tltat yostocday. A What was ths •thsr oart? Q it was sest a eontiAratton •t teat s.nt.naf about the Ln m ~ Co r Ck Ln m %J tAY:.Z.I3 T. L6i/iS. C8A & .10A.*tKi: It. N,JS::Jti, CiR
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1 2 ) 4 5 6 7 0 g 1r. I1 12 13 14 ~ is 3E; ai11u - Ccos+ 5592 lIR. tiORl'iiRlps Ysur 1lonor. Ae teatilied tn bia depozition he d:1n't tely an •xpe:t topu:tY. aR. oinaiX34s, 8appoct teport. X.",, WALTwASs !ta telied on tba radlca: t.cocd. Yuu don't cali it a redical tec,rd, we do. It it'o given to the docto: aa ;,>art of the oedical tecord, vhfL•beC it's admial:bie !or leqal pu;posta, oedical record o: noc, it oa:; part of the record tbat that doetc,r ceiieJ upon. It vas includaJ in Dr. Sttcbian'i: ersdieaS. 117. ZoRTNR1Fs We iaid be didn't rely or: aedic.: cirurtj !n t.::c dopocition. in any aase, I xncra the only way to rcolve tai« iy yave tC.:. Wc? tar.r •dvtae the vitnec4, •s Ar. f..1a11 baa done, taat aa 44 sac: to refec to the report given Lu tu+e da;i3, :.arnes tara, eent to budJ, Larnar after M:a. Ctpoi,lunc':u dtatii bit be csn cef.:, it he wi.Ate to ruat 0:. 8ctcni.n r..iy oe4e aaisJ in 4edical r.eo:cis. rtS-A. wA:.TCR;:, It vas se»t to tbia Oactoc •3 part crf ar. Stic3ien•i soJlcal ce:o:J:. It'4 pact ot the antArf recor3 a• tevievs4 •LJ et11eJ upon. !RS COuRTs I'o not Qoing to give bta tbat inatruczioa. I thipk if tbe queatton •licito rhut Dc. 3ticui.n'4 vievc ar• •nd tbey're ooptain.3 in the aubzequent t.purt, I don't think ic's a;+pro?riate tot oe to bat 4im tcoft setettin9 to it. ~ ~ V • 00 F-+ ~ N lP G PBYLLiS T. LtiiS, CSR 6 J01W:a . M. ElJilSTONr CSA
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1 2 3 4 3 6 7 8 3 lI 12 11 14 ~„ 15 1G 17 19 19 20 21 22 23 24 2S 0 rtt1i,r - C:oia 5505 0 1985. Three Yeati attec tpe titae ve've talklnQ about. lun't that truoT A Tnat'a trua. 8y the sase toic.n, tpis ls an o,Petative sacord heteo tc.qutntiY these at• •ictat.J isaediately a:te: tlse our9e:y, bstot• the 8019090 sas Aad a lot of tisa to think about th• Caae ot dtacda ttA atae WttA Ai• col i6NSuQ t. Q La; me a4K yaA, did n• sign that ttport7 A Tda, he d:d. Q D:wn taw next porapcapi), JoKttot, •SinCR ssall ce:i Carci1icsQ ol the lung is bvst tteattd by oombination cMeoo-:ac3io-tyerapy an3 eafiqnarrt carcinoid by put4snary ~ OpetatioNi, 'jYtt1lfa' dSa4nVtttc YOtiC to c:ezc up tat d:aqnu;iiO v.a in'lic.ited.• 13 that YAat t:/Q [S.'w'o[j t'Jy'.*:? A That' A v::at the recotd soya and it sbo+r:4 that obvio:a siy 4e aad so:fie ;ptrob:os& Witr the dia4nayis In tbii cayo. !it vaj concitned about the diaqno3ls. Q riua, na vert ahaJ and opttated in 19a2, and did what .u:oeon cs::a an pnwsonectoa~1? A Uac'6 ooicict. Q Tbat var sent to tha pacholo;y labP A ?bat'i Co[tacto rea. Q An3 Dc. •nyder va: again oa the osa,tninQ bench pa;balojy aabocatocy? tn tAe 04 N ~ W lfiT:.LIS T. i.BiriS, CSk a J01ltt11.*~4 lt. UW 3TA::• C6R
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1 2 3 4 s i 7 z Ntlls - Cror• 5600 stody? A We can louk tbrouqh the aiteratute. Tae s;or• ciog•:y You lovk at tbfse tumora, the s+are tbey pco4uce sve:ytb:nq. ln order to prcn9ure serotonin, you Aave to produce S hydroxy trytop.han. TUere ta a aertes of cbeaica1 re.ctiona ta.t ta4Q piace tnst start vitb aafno acid, tbon qo to S bydrosy trytophan and try?t"ine, which is sacotonin, you bave to protluca tu oake seroLonin. Q Can yov cite ar a atudy that tinai that soeii csli ca:cinoa4:: rruJuce S1i?P in the ucine anM it's swasurev at bQiny an eleva:od 1evo1? A I dcn't aave • U,Wcit:c citation of that. Yos don't neeJ tDst. It it saceo seroloatn it b.s to saks S-R':P Q Aft.c the aurqory in 1952 in Jun e, Nra. Cipollone vac diechaiy*d, vaan't shQ? A Ysb. Mg. SIRRIDZIEN Csi:u:.t as a iscoqcl. (Pauac.) 0 I've onif q2t ane copy of tbia, do.:toc, becauue it vaa retr,svsd for 6*, bat I's quing to ban.1 yau the phy`icLasl's orjec toro tcoa 1982 whsu !tr a. CipolioAe va4 in the hos0ita; and I voat you to read tsr as what It •ays on Jons 3rd where siy tin9er li. A This li rbat you were refetriny to? •On Jon• 3r3, V.lL A, dt*t.• • PtlYLL18 T. L61f 11'i, CSI! 6 J0A?lIM !1. NOUS?ON, CtR
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t 0 1 2 3 4 5 6 7 8 9 10 1' 12 13 14 20 21 22 23 24 25 Mills - Ctosd S602 btich;an asn't a sur9ical patholoyisL and I thanlt be csnta:nsa it in the repart:, that be vas bavsAy proLi.k.: Oea:iny yich tbe ailter.nt terv.r that vas •pp:i.d to thib tuacr. Me d,d sUs tt clear tnat attec toat he teit s5s naJ a saai: ceil carcinosa. a dwt hM atat.c3 ther• that abe had a t.eurtent oarcino:d taaa:,c worn be S,qnei that d:acbar9e abatt, didn't be? A Tt:st'a w:&at tno3a vord 4af, ye3. Q Ncro, thMra wa:, a blop4y o3 tht bone wrruv, waun't thero, in 19"2? 0;, yGQ rovecbet that? A Ye:. Q You toakos: •: tbc elit3el? A YQr . Q %4 tu.:ur va:: touns in the b:oE.sy, Wau tnsr e? A -Tbat'4 cortsct. Q Now, untortun+rte:y. Mru. CtyO:lvns caAs back in taz koz, itsA, In Au7vst of li¢3, and there vac an Y-ray oE us: •Woa.ns1 atsa and there waa an adcenai s.sM sasn. :s that y4uc oAderstandtny? A Taat •s correct, yss. fl And it vau aecided to do surqery? A Y~a. Q I a 9o1ny to sbov yoo, Doctoc, a re4ueit toc a consuitation s.part troa L*nos Otll Bospitat ttoa Dr. rBYL:.a T. L6JYS, CSOk & JOA.ym'3 M. YOJETO., CtR
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nills - Ctoou $564 • 1 3 4 S 6 7 13 A Tss, oh, Ys:. Q And you tlon't knov obat causss ssail ooil carcinojwet oI thoae sites, do you? A No. I think that 3uaL points out that vben you're talking about oatcino4.nesis in 9snsral, you't• talrinq ab*ut :ocatione vhsi* tuaor• orcur not so auch tuicr typo. TAere ic no rsason to think juat because clqacstt• smakin2 causss saail e.ll cancer of tbe lun9 that it would ai6o cajos, for instance, sxall oell oancer of the brsaut. Ic dofsn't cau*e any otbsr toco of bcsaat cancer taat I knov o!, tbacs iz ns •v.denao to suq9e++c that it voi2d causa tho 62411 cei. tora. Q But it's baon statirtitally •ssociatoa with sooe ut tac.:e and you sttti can'L rsaCh an opinion about caujation. Isn't that true? A I'• not 6us• I unrlerdtand the Qus:tioa. ,; It'-d baen a sta:itticallY asoociated with soma of :bfje cancO:~? !1 EupQC:ally in sits3 vh.:• n:her toca:4 of ca.,icar a~ thaL aita bave desn asuotiat.d. Q YVj'r• AOt able til iiliis a j1i.3gvent aboat Causatl0a? A No. G.t•o say I bavsn't looked in thoye areai with spscitic puspoas of tryinj to judQs t.au&atton. Q Yos oati•e looksd in a eosp:Q of oasss, Aavsn't you? A Y.s, I've looksd in the b:aJde: in pattlou:ar and soMe Ln m a oD ~ Ln N Tlitl.LI9 T. LLMIS, CZR 6 .70w=i'ti A. SO:LSi Jk, CStZ
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4 5 6 14 • K.lla - Ccoaa $549 Q Tbat'y ditt.ceot t+cou ycruts# ian't itt a tt'6 ditC.r.az aad it'a very interostang. Q It'ri int.rt:tinq becauoo it•a ditteront tto~ ; youru7 A Wai i, it'm alno 3nttreattny for otb*t r.aaous, if you look at htu patteata I belitve h• has ssokiAq hiator:eL on ten o: bii atypica: aarcinoldz. I think tbat's right. 0 1 tbink De had rroi:ing bifitory on soaovboro c1ol:.r t4 20? A Wv can pull out hls data ar4 looR at it. Are yvu taiklng about tW• atypica: on.a7 : 0.1ink it vA;. ;,;x0otLing on ths otd.r of ten. I don't have ay pa,,v: WItn aE. Q Di-i you 200k a: tLe data fro:r Dr. rQidui l? A gsu tu-"ar:: Y.re nevac 1ook.3 at etstoiogicallf a: ie;.t Z can -JOLcrrine. 8:'. Ju3t ha4 a aarQt #tti0.1 O! CQ:Q*nC:ci L4O-):G# Zvs,ic: ,,: Yti1C13 benavdJ in tb* sali9aant taa4ion anJ bous 4: Wui%;a d:da't. 30 : oan't dravr any ooaalu.;iona trocs h:4, wware:A:: with Dr. G:+uld they rers roriovea Uy a yatt,o:o91s.t anl it'a a 2ittle bit sas3er to t.ll vhat ho'` talkinif ibout. Q You'ir• not asying aa. ye:doan'• cases were never lookv9 at by a yatbolo9ist, arM you7 A Novor by oat single pstaolo9ict vhu •at down in a nnitor• iashiall to try anJ cateyorise taes• leaiono. lHYi.LIS T. L6M1S. CflR 6 JOA.M'iS It. N07STON, CSss
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1 2 3 4 S 6 7 3 tlilla - Cros,: 5632 Q bto ttcz. Capollona wa: on a control:tl dlet in Juno ot 1462, waan't o;it? A Apparantif coe va,6. At lsast It vas oraereJ taaL cbe b. N:.t O» ot1Q. 0 Nav& wArh NrY. Cipo:loae was dia;:uarg.d fcoe the bo.:pjtal, dwnat3anp v.4 tilled out called a ditcbaaga suawty ahs.c. Have you luQKad at tt.at? A I have. I don't bovr a copy wIth oa* lu tAac the 6lschatg0 susdAsty •Ltet that you Jac::oc T • 13 14 A Yo4. Io:.kaJ at, Q Kaat dar.: it aoy -- 1141 take Laat back. Let ma pa:L t:siz up i:+t tha lc+ry av tbey can Let s t, too. i'li d:;*.:t yuur •c,tvntton to the iiJdle oi tc,a pd4a tiher• i: sarj, fina. irrlnciYa: dtagao.:1a, aayv t acuc ren: cs rctnuid tuoor, t igt,: intarasd:at• b: oA:.huj. z.+ tha: vaat the di.cbarq• owwaty snsei aoya? A '1'hatli what lt aaj's. IL d1iOiA't aAK! • diiL1ACt1Oh betveen an atypical caralr.oid or typical catc:ocid. I tbintc it yos look at bov the pationt was tc.aced, even though Dc. Sticblen pat tbest vord:, on thic pl*ce of paper. Le sub.:eiuently put t4Q patient on ohomothata?y sna:i p:otocol of the trpr you vu4:d usa tor a patient 1fltI, ce:l canaec, aa I don't aqre• with tbo" wotds. Or. ldYLLIS T. 1.tt;NIS. CSK 4 JOAN:iC k. d3U3t`ON, CSR
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I 2 3 4 5 i 7 8 9 Kiila - Croaa 5570 You saw with sy oe3es bow wAen rultiple peopie loo!c at aultipie tworr., .4p.cla:ty ly vb.n it's aPooc:y urcJeratood tu&oc# you end ep wiin ditf.r.nt terrlnolog;. uauo:ly will not x.ep caios in the literature tS.it bave not treen r.•rieveJ by a aia9le patho/ogist. At 1.aat they're very ak.pticai of tpout cayei. Q Kr11, I know there i& a riva:ry betwe.n V:r9inia and Duice# out 1 auzuec You know taey have a iiatuolovy depart.ent at 3uke tsn:veruity? A Ye3, 1914 av3rt ot that. , Q Ar.d it'` yaur unJQrutaadin; that they vese the p~3t1vio'jlat:, vay looked at Dr. Feld,wn't, oaata7 ~ i tNciieva it wa3 a patholoyl4t at Duke and alaco ttto -ft:,,.,, ' Yt:ocanc A3rxtnl:tr6tioh Nosaita:, wnIrh is a p3rt ot Gjks. _ 2C 17 : Q Yoj d:3n't oentlon that papsr yestetdaf, did yoa? A W.I:, I dIdn't uao tt tu toro oy opinion. ?uat'. a vely recent p.pec. Q Yei w.ej a iosa study trov oancet this loraAA9 to tOrrVlat. yVUi opinion? A MbicL one wo tbat? 0:.:t,+:, suceky yuu have aeen tbe recent arttcle in Chect • :+a a:ypIcal casulncitl oi the .iuny? ~ 1'ou're LOaklll9 a,JiIL Lhe catotl paper? Q Ye:. A Y.4, I aara s.ea tbat. PBYLLIS T. LUIS. C8A 6 d0MN8 f/. 303ST7:2. CSR
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I 2 3 4 S 6 7 G Ki:la - atu~~ SG22 acand Qere? A No. Q Yoj uUeJ taat pnraae ia a diacu.talon of roa12 oel: catcino" and s;)camauy ce11 carclaosa and they're cbanqiny lreaueacy, rotrect? 11 Tast's corract. Q 1 lu:t van:os to dettrwlns rbat. TAE CO•URTs Nov, S thAnk we can break for lunc:., tw:1i,v &: 2s1:. A;: rioo for the jurf, yZvaae. (Lan::clQon t*c:Q44. ) 0 PIJY:.:.I.S T. LLwIv. C3R 6 JOAqiia ll. H.17S:JN, C6k
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1 2 3 4 S b 7 a 9 10 lI yitlL - Cro+ta THZ C:.EiI%: A11 r lne. cRece-is:. ) i:C CLZkK s Al1 t tsca. (Jury I+iexon:.3 Tl/E Ct)JR?, Pleaao be booto.l. l4R. SI:t.ti0y2i Thanl: you, your bnnor. 3S75 bY yR. 31 RRI J:;:: s %1. Or. Hlal:c, we cpent ocanettae talkiny about how cancer cc:la c.:i9:na:o, now tuey bsqin, anJ t tbinK yozl t.tert.d to tilic cal3 over :,ore as a parent cesl. Tpe o:i9inat cei.? A Tr.s;. d,)o:.n•z bavs to be ttli ori9inal cell !or tbe wuolo tLlu+ur. CvVi4 be jY:iL a CoI1 in the tiimvr. • ~ b4t tbeci is a yo,nt in t.l.e vhen tbtr® is a tit-at eeYi of a tuz~r? A R 15:1:. 0 Khcn dsd IIi.:. Cipu:lonR'r tuaor be9in to yro+r? A Ma ean't ekf tac i:1rt vhen ber licbt Ceii turASJ &wiiqnant. That ie aquestion rou teally Crn't ansvsr to: anf for& o: cancer. You can te:l tAat she aad a verY sapiday qrowing tuaor, and tbere are tbeot.ttce: Avdulas, vbrcb I as noL voll-v*rsed in, tbat yov can caicu:ate dackvards at a poteAtia: point in tise when her tenar •tqat bavt beqae:. 8ut tbe c.1iaLitity of thosc construotfona iL PHYLLIS T. LEiiIS. CSR i JOA.'idG M. lNJu-STJa. CSw
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1 2 3 4 S 6 7 S 9 10 11 i: 13 14 c 15 16 17 0 KI1:. - Crat# 5598 io no •v3den:r rsGo vas on a contro:1eJ ditt tor tbii levcri eithos. 0 Ar. you anr• ab4st tas:, doctor? A I'u not -- I don't have anytpinq to dispcove teat. Q t1avs you •+er Leaz,. r.: • Y.l4.A. dlet? A Taort io asoiti a tlsing, Ye4. Q wouid it auryrloo you ii qrc. Clpc+ilone vet• on a Y.ti.A. dtet, 1993 :n June, betor* tbla eaa?le vaa taiCOa? A a.3, 3t tiouidn't au:prise oe. i don't &ocall 8001114 tnat in tho recucd anJ I thinic, a+ i discuSoeu yout.rdai, an e:Qvation ot S-tt1AA or aaf c.: tbe Rataboiite:i of Se:otor.ih m,+k2lly te::6 u.: tttiat tna pa:ioat pcotu!.~ly bAS a nas:aen.iOcr tiAe CAlclnomt. Ic doe:s1't Ualp uc one d;t tn dZ':iJinj vuothOi the person bsa vrll-dilLecentiated nearoen3c,::lAe or sM3iI C611 carcinNiN. Q LeL'a y& tiAct to oy pu.c:ion. I vsnt to Myke suto Z urkier&tan3 youc reviev of the sa*J.cd; cecocd. i;p it yau: toctiadny tttac Mra. Ciyoilone va: not on • contcoLied dieL the titat week of Juno, 1902? ~ I didn't a.e taat in tba cbart. Yl yau esn show ar tbrt ai+e vau on a conLroileJ diet, I c3ldn't :ee it. Q Tae reootd talrs that, •Tb• elevste3 S-KLAA :eve2 dous •aqQejt the pou•rinllity of an atypical carcinoid whic:h ptoducey uyJroxy trytoPaan,' cbat*6 aoUctevaat.J VTa. •cs1 aasl l aawunta but doaan' l save the sasss c1sss tc •f f.ct v f roa tHYLLiS T. Lfi'd2S, CSR i JOAIiNP: M. MOJSTJ`:• CSR m
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0 1 2 3 4 3 6 7 2: 13 14 M:A1,r - Crooa $604 again. 0 8ut it w uJiJ bsve betn ot intereet vhat ber coa3ttior vab? A L'Q vahted to knov in 9ener.l terRi wbdt her cond:tlon va.;i ii aDe couiJ toiotate 9ene:al •neatheaia, cardio1oyy prc+biea.i, htstocy of a.art atteehc tbat ni9Qt Contrain.jicste +rurqery. Q I: •ay~ xu, regaiua auggeated ot pheo or rarcinotJ MtaJti410 A Th4ae are tae r:+rJ:: t.,at. ars tbete. Q ':rii:. is Q/IG, t+ro day: ly4tore the o;~eration A I tu ink tt.At i+. cor gect. on g/2Gs Q Ga thr air.aNt aperst:on tuok ?ia.;o anrl tbs •0tena: t.imui: wG:; :aaoveJ an;3 to potpotogy aeJ I bolievea you tlv:c; ts~r~ :ae tsac+r yMatar3a1? J1 Ri yI',t . Q i1n,: Dr. Rorcun'e diaqnajis vso -- iet ao look at it. 1 "vt ysndoJ you the pa:hology repsrt troa Lr. Uo:torA. Uaa di&ynoyi3 lJ -- y1iu can [fid tlit11 Rt. Metastir ;woriy ditt.rentiatec3 catcihoaa to the adcenal glond~. taii puAaoctasr yriaary. Yw s.e it: A Yei . Q ti tna: your diagnoLia os the 'i3 tYaor bau.J oa your TtiYLLI3 T. L601::, CSR ` J011UNz' M. /DUS?:?!i, CaR N
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1 2 3 4 5 6 7 s 9 10 17 3t 19 20 21 22 23 24 23 Milly - Croau 5603 9t.ict,en to yr. ldealey. Do Yoj hare tt,e record tberoT A YQ.;. I can't cead the nase at tbe bottoa. Q I don't tbink I can titete:. Dut I vill sall yvur attention to tbe tir+:t lint of tae Conzu:tstion. Saya, a S8 year oiJ rds<.n atatua post, riy:1t pne"Wnectomy tor Csrcinoid tuaor, tY that what it arafr` A That 1s w,sL• Lc say:.. In this poaltion as an be /.r not a treating ynybicaan. (~ Jlnetcua:.lUlily:iit: be{: patlants in treataenu? A Sec pai::en:s uzually the oiy:3t. betore surQary end ta:k zu the ;ucleaL dbaat coattain,iZcation:: they aiqat bave ~ regstdc:,y ,3eneral saoEthe;,l6 and this sort of tbsng. •2 Ic sV~4era f1ua the recor3 SteacbRn aske3 lte2ley for a co::iOt in tho area of 4neatheriat A Tr,nt ic uhac yau dv batvrt a pstaon; will bave su:yory. 0 Anj the lo;,cezsion of Dr. aev;ey actually reteru to it alrove, but saS?e4ted a pho;) rhtch is a phea:atcinoat? A Y.::.. A tuaar that caiti occur pr:or to -- Q 8:Ae var su::ptc: ot baviaq a pbeo -- A it vas one of tne diasnoses auqVested. Toa are taikiny aboat sn ind,vidus: that ,rav the patient at a brtet Ia:,oent in tioe, probably tbe day before sur9ery. •robab3y to:+k care of before ber, post-operattve aace, and se+er .av ner tiiYLLIS T. LESIIIi, CS2 6 JOANY.S !t. Uw]T,a, CSR
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I 2 3 4 S i 7 a 9 10 11 12 13 14 ~ ls 25 IT M111a - Crour: 5606 A Not s0a.:if Waliy. bur 2 rill take your word for it. Q Tbank you. A Don't sonLiorl tt. Q Tn.:s ra4 a conxu:tation tn the oncoioqy field afte: tata tuaor vb:: t0o0vOd? A Y.c:. I baitovo Dr. St.scnen and Dr. doriff aad Ratner bauically got tog.tber aaJ d.cided to discuzs Ktb. Cipwtionc'& caje aaJ tioo tu dQal vltb ber tuo:.i. Q 1 a12 no•t surr tnof -- tbay•ca all arounJ at that pvint t,it sevcra: ve:e? A Yvi. Q D:. Ratrne: ial.d oat a conaultatiou rep:+rte or* fiat:litC'3 ttpo:t to Dr. vtft:cbOri ali a COJictiltant sal,;, ta:rcinazinq rt9ift alrfna: reCUrrenct of a primury tuiaor tliugnt tu be ritntr oat coll or carcinoiJ. Ic6 that w:.at the r.i.ort sayL? A T0az is vhst. it aayz* ito can ta:K aduu: the vurJ4. Q Tnere are feacure.: of A!'J doaa !n tbia pari0ac anJ aho bad ayst.Qre syraptaza of bot f ia3bsa, vs+6o4Ilat ioa, otooJ prs.sur• enando: prior to recont surq.ty. Dot:; At say that? A Yaa. I Lbint; aa bei t I ean detorrin• tbis vas the firat tiae Dr. Katnor bad aen Kri. Cipolione. .0 vu. Me coneultsd on bic eauo in •d2 aad prsscrlbed Ln m J co r ~ ~ LA ab rdY:,:zS z, s,tiwIS, CSR 4 JOA;;2:L 11, llOVSrON, CsR
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1 2 3 4 S 6 Mtlls - Cross $sal A itiyat. Q AnJ yoj sbov.d u4 yMCte(day on tbs •:jd• wher• the tutior eaz located .itbin tbat apeciron? A Corcect. 0 k1d vntu that ipQv>>sOn arrweA, Oflf Of tA• patbuloQiat. i: a+.ui9ned tbe tank of doing what Is called a qrosi eiac,.ndtion, in3j)oct the turnor vlaciliy ratber tha3 us:inj a ai c: osc;0ya? A Correct. 0 AnJ tbYs re0ort inJIcatos that Dr, lernackies -- I k:&uv it is4 diific4lt to are -- but says ur. !'ernandts da+rn on the ths b;,:tou of tha qroi: •;;aaination m A tie roi.J hav• b.on tbe prosactor, the parSon vao did tbe qso::: ciisLtc:ion or tas qroas drss.ctaon of the lerion. Q bh: it it in Aali ar,d arranqeci for a pootoyra;rl, taat zcc: of tsiln4 tLat pe did? A KiytS t. 0 Gave a da.cr iption of wdat he oal lec3 tcta qrocr appeararice oL the tua*r as it arrived down in the lab? A Right. Q ti.i+. ar, ttrnaad.s atate:z la tbe roport tbatt the tusor io ..Olally and poat.riorly locited ptrtp6erallY, ls tba: what be oay::? A lbat is v,1at the report aays. Q Do yo6 aoro* with ttutT 0 pAT1.LZa T. bR3ZS, CSit 4 JO1tllili'. M. •O3d'i?0:4, CSR
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2 3 4 5 6 7 9 •. 0 1.1 i2 1: 22 23 24 tne v;6i1er une, lua,-.2if_eci Pnscuai tech.liaue. :? Rigiit. Su:t the imodiL'Lea j'4J`Lail t4cnn1:,.:a -a-a~n':. i3:-ccu thi--cdae, wa3 it, case ot Rose CxpJiione? A Ti,a t' z oor rect, yes. Q Now, I'd like to refer to -- let me azk you, cioctor, on this argyophillic staining que:.cion, didn't you say in tna:.: tape in 1987 that atypical carcinoid tur.tiors of the lung 4::: u~uaiiy weakly argyvpii:, poaicise or .:o:apioteiy negativc, L"c1a:. :i:a1i,:+ r~'~::,3.WJ.:E? 3:!'Jl1d.i fv:.3, w11C:Lea:i ::::L :+:.l3.i 1 c@:: .:ancur... arc J::i-0b~i.; to r:.::-_11 ~.1o.:1clve. ~ They Caa Ji, CnJ~1'i :~ ~ Ti3ey can Gc. '_t' a rio;: ~-najor w:jv., maka c:,t1 t'.....~1tt:Gl:lll. :) :Jt1 Yr3Il't W3ii:. ':U i+:'!G 'v:li ~iZ'~ u.'e iL? '_:o. .:L:: Ouc ;ov }'\.•llL haL C/.1 16. 011 yZd1r pLLjea.atiun }k~-.Ai:erJay yoa u it:d.clbar of (3irfcre:1L: Cu:dJrS, :;t):.ico p3i.(loll0'3;' CE'.tula, that :;urt of tning? A Ye3. Q And you showed, I think it was three slide:3 that hud been done by Dr. Soauaers. Do you remember that3 2 5- ~ . r rr. ."L,,•.'r:.: ., c:::: 0 34:,:1.~ :.,.'.: . r.. r••' q ,...
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I 2 3 4 S 6 7 a M:l:a - CcooL 5572 A aQtor• I anwu.t that, could You 91v• se a oo}+y of the pap.r? I didn't dring one sitla se. Q Suto. A I caual:y ;cY• tlle teta dtitins:t cilnical Natso:ojSc e:t:ity w .oan tt's a•tetoacopleallY te? rodueoaaio issye that ha4 aome elinicai or tueral+.utic aiyaitieancr aZAc:1ateJ u:zts it. Q S'ou aiytlc want to relte3a ycwt cecollection, doctor, that tirnt iwraqiaph indicato4 wbat yoo w.ce say:ny y0stoclay anJ thrt l4 acyNical catcinoid !s reletroJ to u?• a var:ett (oC torris in thv litarature? ri, Ya::, : tainic r.#oryuna •gtse3, vittually •vscycon• aQre.s t:+ Lbat. ~ rj Taey ya tAro:Jqli, *aiiqtfant Oacclno:b. seti3:ia@ bron::)iol •denoJe, car:iaoid carolnooaa, Aon-Wnsyn cacctnv3a: tum~r, vQll-a~tttcentrate,l nsuc os:70jxr ing car cino4:a4 anJ Yulchitsky ceil 9rada, tW:Js 411 propoJ.0N? A Ye.. ~Q Thry eat• tha statf,aent, borever, atypicai carc:inoid ia tht pr'tecrod nasQ in theic 3odSaent? A In tbsir )udga.nt, tbat'D ttqht. Q t•a going to ctad a eoetion b.te, doQtoc, and I's euro you're coad it. In our a.ci.u tout pat.i.nta, 36 pe:ceat, Aad acvEi asok.a an,M ono was an •x-aookec. ?'Atje data alon9 vitb the . i _ ~ m J 00 r . . JdM.1:. 1f. dOUilTOt64 C+Va !lfYGt.iS T. LRrfSSo CSA i
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Mi:lc - Cto3s SS7• I 2 3 4 S i 7 a 9 1'v li lz 1) •zn our uoriaz, 36 pecceat bad never esoked an3 one patSent vaa an ex-Aaoker. Taea drta, a:oaq vith tne a.4acly ayusl occut rarce of aalei: arici L'italtL as opposed to the male predaminant .eer: in osall oell ieny caneec vou:J auqqei; ths: toDacca {iae is Aot oec*saatity 44 fii9ntia1 •tlotoSiC fac:tuc in tteiv dii.aae and other tactors szay piay a role. •lh* occupational hiatorita of our pationts did not dtsc:uza any expuumies to knorn careinoqens aAd taur, tae e.uee of tbii. Aeoplavs r.a3ins anknoYn.• is tbat vhrt it fa}:i? A t sea t:bit. I dun't ro::e:4acily aqree vttb It. Q You d.rA't agree M1CU lt? A Tr,at'g c:q:,L. Q Mi thss lu trou tUt pataoaoqy depattaent an:i tht oncotoqy divlaton at the Var:d.rpalt OnivocattY tc:iou: of aeu:ctr.e? A Tt,a:'a cotrict. Can I keep that? 25 If re're yoin3 to ta1K aLrout taas vore, i'd l ise to keep tt. i4't. 8i1cRIJ4-s What do yoo tbitfk? TiJC COJZtTs Oa yuU vaAt to take a bctai? liA. i I RRIDOE 1 Yt:. TD9 C0WN y.'Z2 take oct pr.ak •nJ rauae proxj;1tly at quart.r of 12. Ln m ~ 00 ~ 0 ~ ~ N N tb1 LLIS T. Lt;af I9. C'JR • JOA:1H2 N. l1vJ3: W:. C:R
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1 2 3 4 S 6 7 a 9 rliils - Croaa $573 Aearly •4ua1 occarcencus ln salea an1 tesaies -- yy. WA:.TU1t=s I ob3ect to the toc• of this question. I don't thtrwc be•s laid the prorer tonndation under tho role4 tor ieacuod tceati6e:. Z'r!: COVR: c 829taiaed. CxaatA. 1t. ~ Do,:tor, do you consirler tbis to bo a tellaLle autaorlty? A i:a, I vog,tln't aecva+ariiy ,ay that. i bave •ope prots:erc:; vit;, tbiu pa;&r. I've tead it. Q we'ro 9oiny to tiik awut y,uc prublers tn a isecund. ttZ. EOt:.:.I I oUJurt ta t10at atateoeat. TSiE CC1JaTt Sjrtalnec3o g.Z. :31RR1DCZI 1'l. raake a pcoftor tast vo'1: aa?#e M: ex;)Vcz viw vill reter to tnQ teliabilsty autho:ity and I or~ierve tuat a,Y:iut1eL the re4ulreeont. rS. K11'w ,LRS t Who la that? YR , staic:LrM occt:ar 4arxer. TEtr C07RTc I'll perGtt yoJ to eaanine dim on tost. MS. wA'.TCRa# Doctor ltacker Is not • yateoloyiat. ?Y:: COUNT: The vitnais ia eapert tn the tield an3 can reipnd co lts be indicated that he doesn't reeaqaise It bot I'll still perrit tt. p Let' e'o back to that, dootor* it'e on page 3730 iE you raAt to look at it. Mid+ar thronl!, that para9rapa on tde lettwtnd aide. • ~ m %J OD ~ ~ Ln N F+ tYYL~IS ?. LedIS, CSR i JOAM'.i2 M. OOuS11.1t1, CSa
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M.i11r • Ccobr 1 2 3 4 S 6 7 8 9 10 11 . 13 14 C 1S 17 la sto3 beaae!! COAvIlfc0.1 tbaL sDe bad a twll Clll CatCinofts Or oat Cell. Q : Vlnt to tnW1 v!!at he WrOle iQ the M,f cai Aoqsst 23. A Ti,out are Use .roids he osed. rep5res, Tna vaae tecurd sboda turtbar down be put the patient un MACC ch.ootberapy, which 19 a way to tceat paLienta. Q Taat irz what you pre:.:ribsd tot that az a path3lagy? A I don't actuatly glvt the drug::, but i 04 aware o: vnat druya er• uskj, and I con::uit Wita tbe cblmutAerapiat vhethor a patient oLou2c3 g*t it at Aot. Q It iz y:)ur te&timony tbat the MACC protoco: wav a vrabie vstuoJ of treating saa:l celz carctnaaa in '93? A Or.e ratu-iJ. Q asar.'t oue .t at th. Univeruity of Virgl.niat A Titey usd a variety of soctSaJd. 001; svro what protocs: we rsre ua:ny. Che'atttiorapy arugu cbange aiavat on a ,on:t,iy baj:a. 2ou vould aut •- thete Was no •vid.nce a: tba: point in ti.e that cheaotnarapy voc.:d have been the vay to tc0at a c4rav:Otfly efse4COd ot • j+atient wita a veli-dittec.ntiatod nebtoenclocctns, wouLd have ao 4linicaily obyiojj daseaae at that point in tise. Q Tou ar• not saying that cL.uotberapy vac not us.A in cases of atypical aaccinolclt 0 ~ m J 00 r TUYLLIS T. LUIS, CSR i JOA.~lNF. It. NONSPOti, C6A
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• 1 2 3 4 S 6 7 a y 23 24 25 hilli - Crosi 5609 A 8einq ui:sd sor• no.+, buc at ttast point in Lire there vas no •v3don%:e that it wav a vaiid wai• tw treat tb• patientu, wAere it waJ very ob+ioua thst yattanta vitu stasai coll cana.r nfode3 ch.mos a iut thore rere dootor: tr.atinq atyyiCOl aarciiioij with Cbe9otnerary in '33? A Yera. There vors c3 octora trying all d:itet.n: proto:,ois an tuiurc. Q Aiter thia opeiation anJ b,spitaltsativst in Auqu:t of 'fl3, therc weie n, other oj,wratioaa at :.enos Ril+ or ar,Y ot:iec bo::;)Ita: t A Cu:recce wero t.Zere? Q :aece wa:s nu patAviaqy ;::id.. !or you or anyone ts ;,ooK at Lot tost stattt:? A Carrectr o :11cce WiO no avt4p:.y tn tbii oaAs? A NQ d13Ctl:+LUJ :: yObt&rdaf. ?:fat Ai i2VrtfCt. C rOctor, you saad yeaterdsy it as noc eornon tor sutup:.y to be done irt certain heaith intt:tution: and aon-te.ching oowpataiu, r.ooavti that? A we tolteJ about tbat, ya. Yaries d.pendiny on wriotncr tt in a tsocDing hocpitai or private boapata/ aad vartes dep•nJing on bow aggros.see tbe olinician ic in seeking o4t the tanily ..absri anJ tryan9 to obtain an autopsy Eroe ,L. 0 Do you tnov vhether autopaias ar• cos<.on in caae4 viiere TdYL'..15 ?. =4Y Er CSR 6 J011K`i:. M. 87=P3t:, C3R _j
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1 2 3 4 5 5 Ma:,li - Cco6a 5610 liwaui:a ara on tile and the bealth of the perbon 14 io yjuMJClonT A Don't hav• a sFreclftc LayJrt on It. l4R. 9IRRi11=i I aa finiahsd. Tdl" COURT: Mr. Cunn? MR. COaa3 Yes, your 8onor. I think if we bcoke tur luacD, I cuaid cut do,rn sy Cross-esas:nation. TH4 C4tiRT: On Friday4 I have ajudQe4' lunc;A vh,cy dos : n't b~.•y tn tl l l une, co I wanL co aalcs use of tha c iwa. fiR. C3:3,':g Aii ri9ut. CR:15S-EtiA:'i:9A': :Q': 8: Mlt. C7:::20 • 16 17 '2 :)r . ts.l: I, M}• n3me i s U.bnd:d Coh.i and I rtpt sa;e:j: LiygatC. Kv 3:atic naije: as:, havs v.7 A Mo. ttacQ to sCac: you. 0 Ac ttlQ concai3son of your dlroct testizony tnis ••ac-ning, yuu gave aouue tef;irony about Mcs. Cipollone's saoklng up till 195C and atrs: 1966, OS 4 you Aot? A Yob, I did. 0 All ri9ht. J1nd it ia qeneraliY •qcvecl, is it noL, tthat .v.n tairly heavy asokfra vt,o stor• sncrtiing approach the non•arokiny inctdenae of lung Qancsr atter about 15 Ysar.? A Ma1l, tpst ttqur• na Imsa vritten to soos o9 th. Buzgeon Gonstat's copottac. Wt if you 9o Mct and iovt at Ln m ~ ~ ~ ~ Ln Ln 00 tgri.LZ.i T. LeffIS, CSR i ,?OAl1:a K. lrJUMe, C~.'R
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1 • 2 3 4 S 6 7 a 9 10 12 13 14 ! IS Iti 37 IS • Ilills - Cto`a SS67 tbat there vac• iroce non-smokins aooen In tbowe rtudl.a than avokiny vosen, do yoe knor that? A i did know that and I also knod that tboao stua:.: ace eaaed on cas.a ooli.ct.d during • period of tlse when tbe incidento of ssoking ta voo.n vas on a very sharp site. Q They vare eoccoct when they were doAe, certainly tDey rOf lect the literature at tMt tLm.? A Z'hat'v ri9bt, but the 1nCidonts of saok.nq tn voasn was ehanginy so tast that t4a data didn'L bave such to dc+, •scept witn vhat v.a qving on at tnat, t:oson W.%Uent in tisa. Q Do you Knov of any .or• :ocent studaes vbick :.bov anytAing d:ife:ent, epidesioloqic, prospective, r.cruQYercttv~t? • A Tns:e have been ooce recent •:udles to suggest that the incldcnt4 cibinq tc.mendouaiy in vvosn, r.s. Q i waat,'t taLkiAy about Sncidenta, I vau tatkinq a:.j:.t p:o&pactivv and r.troap+ectiva. A I don't bave •ny sptcltia intor.ation oa that. Q Ooctoc, atyYscal cacclnoAd also oacurs In otbe9 psrta tnt bsdy than tt doos An adJit/on to tA• lung? A ?hat's CorCect, rea. 0 It occurs In the iotectiao, kidney, salivacy 91and:.? A Latyns. Q stooach? h Yos, PcobaolyO of FliYLb1R T. LRC2• CSR • JOAliNS !M. YOJR'PON. C5R
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I 2 3 4 S S 7 e Niiss -ocuss yE22 s:o;? .*"+cing a;UcoacC the non-saokin9 sncidsn:c of luna cance: af tQC abOu: 13 yfars. Wau:d yo;t lil:e to ass the paye2 I will ancw you. knca it. W You so teatitisd uadvc oatir? A Riyht. And tbat vaa bausd on vDat the Sur9eon GenQral': Repoct 3aiJ, Ki,ich I vaa aware ot at tuat tiae. out vr,an I wo.^.t uac:rc and .ooAas at the studiea or, vaicb the tep4rt vao b3:•eS, yvi asc tristo ar-a soara i:av:-. In taat atateasat. ;} Or. Fti llu, you Jidn't say tbat tAat wag bausd on tar b:r9eon Genoral't raport, did yout 0 A I Wa.; ad&o%'&' a: sf thp;...itlun lf i rfa3 tbo 39tq4v:1 uene:a:'s: Reppozt .n it.: en:irezy, anJ isiaSd I badn't ait i r eaJ •u: ns r iea of tbam. ;~ Yte21, let us qa intv it. A,a ut January 7, 1W, yJa bad nat rsa:! tba cajpo&t ioi toe 5uryeon Genora:'s AdViuory CwaartteQ ot 1964 ln srs •n`.lretyl bsj you? A I:u. Cott.cL. 0 7us bad tsad p4eaayczT A Y.j, and I Lad asea tt swaarlsa4 In otbsc ariic:ey in the .ad:cal lite;atur.. L Since 1lSS, tae of tics ot the pur9awi Ceneral, nut az l1tYLLIS T. Lhi11ar CdR 6 JOdltt1eiE M. s'J1STON, C3R Ln m -J oo r ,ts Ln oh m
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I 2 3 S 6 7 6 9 14 1S 25 Nilla - croae SGlt any5ody •lsa. w4 can fil! tba aourttow wlta art.icles on tA3 top:c. Q In any event, at yosr aepo4ition vAen you wece taikinq auoYt tbe Lac:t that •voA vitu respect to tairly bMavy eaoke:c vho uta;Pjred saikipq, they apprvacbed tbe non•ruaok:ny incad+ancc o: lunq canc.r after about 15 years, you •asd that that vs,: zaoae;uor,tly sirovdj didn't yuu? A I u:.e3 rt,ise vord* at that taro. Q W::u d:d you eean qan+ra:iy aQreod: Ao Uaatcaily "ant in ouamarie.: I had tead of tne Surqeom Gei1rcd.'a Rapart, tho:,c statearea;i wece sii.ds. 0 Okay. x4*d, Dr. liiila, at yoc:r dMyosition y4u qave a_ Lia.c:a%jic, coaid yoj def ino 'aistoloqi.^•? A D:e:violrc Da:tcalty awan:. tae way cel:ra ace oryanise:3 Q Yaur hiatcioqic diaynoui:P of Kt. Capolions! A K:o. CaDoi2ont. Q 1 aaid A Ya4 aa;ci •11a . • Q I iP0Ioq i aC. Aca. Clpoltone's aasa was s.ail aeli onditferantiatts carcinmaa, and you 9ave it tbe oob type iot.ra.d.ace varaatal tiqtht? A YeY. 8e ask.d aMt to sub tyi+s it aod i said I don't noraat,y do it aaiapc a.ony wy eoll.a9uea, but it I bad to Ln m J OD r ~ W m pDYLL 15 T. LaW1 S, CSIi G Jo"ML N. axj?rW;, CSR
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• I 2 3 ~ 5 E 7 0 16 17 25 Mi::a - Ctosi $502 tuaor.: producin2 5 uydrosy tryptaaine,• vhicu La iecoton,n.' 1iM Lhst's what you vara tallciny apout yeatesdvy, r19a:7 A Zuet' y r iqa:. Q •CeLcanoid twnor4 tound in the lung ar• aoati..s in thia cateiory. A thin layer optona:o9ras of thIa 24 bouc urlne d:ci show the preaencs of a b:g1 concoaCratioA of Si3TP beiny excreteJ. Tnis vould support the above assusption tno: an etyyicei cacctnosd tunor vas pzeasnt.' lo tDat waat the ceco:@ sayc7 A ?aat's vhat to'&e record cay6, bat it•s tm?ortant to po:nt uut t:hat tui bio-cnaci`t uaed a turn atypical carcinoid tota:ly differant tcow the Say pa;h:,iogiat looking at qlass rtida;: u3.. T<<ef oaan c,c..:notd vnicb aoae not Fraduot biq:+ l.ve:z of aasotonin. That'a wbat tbeic definition ia. It dc*adn't t+lve aayt.aing to do with what the tuaor lcsva:: :iko t raroi1iA a pl.ccvbCope. Q Ooctor, doea tdls cecord aay anrtbinj abaut eosai ce:t co t c 1'1Q51, 7 A ho, at doesn't. Ax I painted out ya torday, ali aoL'ts of a*uCo*w-17oc lA• c4nvet'ii can ptodiicQt Sfrotolin, b bydcouy trrptopbaa and S-tlllul and tbst'cr eot the way we dia9noae lung cancar. Q Caa You t.ll :00 one rtudy that baa toaa:3 that a 810411 cell carcino" pcuduc.s S YTa. S byroxy trytophan, one ~ m J OD N l!1 J lBYt.LIS T. LSs/1S, CSR 6 JoANti: N. N7JS:0i:, cs3R
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. i 2 3 4 5 6 7 a 9 Nili* - croa4 suu type it, 1 wouad ca11 it an intera.diat• sab typa. S62S Q Did ysj ooc tatify at yogr dsyo,altion that toa12 cell corctnoraa bag two suu type P&tteina, the intsrotdiate tYpt •nd the 03t ce11 patt.tpl lan't that cors.ct? A TAojM are l.Qe Ms jvr swytypa pstterns. You itan ar9ue abuit sove otbe: ttra3 that bave been csod 1 ilce lyrphocyte 1 ixo, out tho::e are tao sa jor typ.j, y.3. Q 1613 between tboae two subtyi+ea, you choet lntetaodiato tar ~'.:.:. C4pallurc's tuaor. Isn't t:r.t correct? A Ayaln, ct,at'z cstrocto ackn"ted9ing that tbat'a not a tN::a i uae in r.POc ;.& 444 1uat a ter& tbat Patboto9istp uav aziaj cnoo3e+ va3. . Q h'vuid yoJ u4r the teta uat ce:i it you hsd been an oat Cl`ia pJttern? A I have dsed that teca tn tbt past. I try oot to asQ st nov bacaubo it o.anb dttier*nt teinqs to difftrenc pevplt in3 I'cJ rathei aticK vitb or.311 ce:l .ndttter.nttat.d or iM313 nllirotAi3iiCrIAe. Q You voJld treat suUtype oit oe2l tb• .aro+ way yoU trtat uubtypo interwdiato? A I vou:d ps.tsr to treat it tb&t wiy, r.y. Q Is that why you never o.ntioned tbo word iateroectlat• tn ywrr dir.::t t.rtinonyT A Tnat',c ri9ht. I convid.r that to AaY• no olinical significenc.. L- s@YL4ZS :. LtNIS, cbR i JoANNlS M. Me?or:, csf:
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I 2 3 4 S 6 7 a 3 10 Ht.l3 - Cros:: $605 rQviev of thb olidev? A Tno 4s aro Ms: the •xact vords I vould gse. I be:3evQ it la tttiC dej,c»ttlaa I LaN trom Xl'. MGZton. do iaid he ,balslcally interpriLad it L9 a Owlj cbL'a Carcinaia. Q You raad the depoaltlon of D=. Uotton? A Ye6. It was in some of the dspoelttona I read sac.iy on. Q 11ow long aftsr tbla re:ard va& that dopoaition? A non't knov the fxdcL tine p*riod. Q w4u:c] it surprt4Yt yQu li it rax thtee y.aru atttr? A NGUidn't ir4c pr iv• ao. Nt aixo degcr ,*oe3 the luaar ay above, ar.J Irv sap. Lrwt tnQ to*Qr that cona.cti of brwJ uase:o and sacav ioiouleo of Warly SitFirentiatec3 oarcia*w, t:rey 11310 avundani Mf:a:ic llgura:r, an;S thbt Lol3 ix con:l..terit with aamlignar.t tuo;.r •syeciai:y oa: cel: vb: lrtY. Q Coaid or. Aur:on navs ci:sy~no~e.i wPal: cei: carctn=s on thaL sW*:::Man7 A ie::. Coo id bavQ cco~.sn to oae tho+:e WorJ4. Q knd be didn' L. di3 hiT A Lt• aa3e • diagnoai4 o: poorly ditterontiated oaccincZl, alcnc+uVh in hiY AOte bo yays it 1• oonbisttnt with oat ce? : v:,lcii is b.aaca2 Zy a awa11 csl i eacloctins. Q You lcnotir when that tuwor vas ssat doun at said 'poebibly oa: ce11• laL.led right Yn it, do you rt+habcr the deposition? PNTLLIS T. LSWIb, C:+R i JOA3HL' M. fiJJSTOl;, C3A
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i 2 A P P E A R A N C E S: (Continved) • • 3 4 5 6 7 a 9 10 11 12 GREEIJBAUl1, RVE, SMITH, RAVIN, DAVIS i BER-STEIN, ES~S., BY s ALAII S. FZAAR, ESQ. , -ana- h'EtlSTiR & SF3EFFICLD, ESQ3., BY: DOnALD J. C4H:v, E3Ct. , JAXES !CJ+ARFrY, Es,Q. , FRANCIS DECKER, E5Q, Attorneya for Deiandant, Liqqett. II.^.04:1 & C0t4t3CRY, ESJ3., BY s RAY>•!O'a t. DROZDOi-;SP.I, ESQ., Attorneys for Detendant Pr.:liy Horrie. STRYT.Z:;Z, TA.'1S & DILL, ES;;S., IIYs 1iIL:.IA:i S. TJC1::.'R, JR., ESQ., -and- SUD01C, H;,RJY & B:1COU, CS'1S., BY: P:.RAIStI, LSQ. , RJ3SP.: 1:. NORT.',:2I P, E Sa. , PA^RICK N. SIRR103"", i:SQ. Attorney.: for Defenoants, Pailip Morria and Loriliarc3. PilYLLI3 T. LVIS, CSR 6 JOAI4UE H. CJUSTJtt, CSR
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I 2 3 4 5 6 7 a 0 10 11 12 13 14 t~.. 1S 16 17 18 13 29 21 22 23 24 25 0 Kilia - oross 5611 the iarge aec ia on .bxch that data is basej tb.t VNi11d ir:-w-lu3s the dtitlal pnyaicianu ssrie3 and United Stat.s worie,5. Yc.u aes the p.o,r:e that Wtott it did not artive at yjite that conciu:ion. In lact, tiDat they "id, the patientr vuo quit lizai;rny awintsiu • signiticant tncce.sed clzk o! iuuv .:ancoc an3 th.t thij ri6k 1s virtua:ly tD• 99160 as the siak at the point at vt,ica tAey quit se:,kiny, at 1.aat out twenty yoar" in one a:u:ly anj, in [act, uoaie ot the data auqge9ti vt,ert ucwRrr,: quit sAakinj tt,ey actuilYy continue to t.ava a sati;.:a in;:r.ateJ riyK in tAr trem4u.noy of lung CanCer satDJUj., cdrt8.ti:y it 1G no: a;;. lsrgi an 1nCreistd liak 43 pfVp;C tl:4;, kecp z0ot.1 ny. Yriu 1s.rrnaJ all that trom r.aJ;ng Or. sairaz a;L.t your depa-,.itionl Is ti1i1L' Cott9Ct? A t.:,. I rea3 it ba:su-:o at. arridgr askeJ sw it I tia.! r.aJ ttlo epido3:ologi.: stu9ie4 at cb. tiM ot ey deIM-0jition an3 tben, aa you say, t d;J ay noo.vora, wtnt cwt and coaJ t ierc. Q Yos paJ Ao trou6.* oip:ning aWut tar caurc• ot Ncs. Cipc+:lono'z lung canctr at your drp,sitton i4 1l=7i did you? A t7o. Q AnS taA't it a tact that in your deposition tn 1f07, you t*:titi.d under oath tDat -- tbic is page 344 As., ttalters -- it is 9enerallY agteed tast even tsitly bearry ssokera wb7 tRY:.:.I6 !. Uif I ~'i, Cott a .=pJ1Na.^. N. MOUMN, GSR
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1 • 2 3 4 s 6 7 9 9 10 11 12 13 14 ~ 15 16 17 10 19 20 21 22 23 24 25 • 1lilla - r*dir.ct 5634 Q Tbis would be tUlcbltdky tOre.? A te;i. Q wuu is that? A The Pa2laduyo group in Caiitornia. City ot qaiao, Q Ar• they the only people that use the tera? A Correct. Q Ace the other toraz ubeJ wore lrequontly by otwer doctot&? A Y.a, Q Mc, Sirrie9e asked you aboit the so-called typlcal or t.tie carc3nLid tuLur? t. Rig:1t. Q o4 you reaal1 it? . A Y.... 0 ia that ieoarate tcoa t'rlese tbree? A Ye:. Distinct separ.te leaion. Q Ia tais tumur one tnat bas been considered by any eYyert in tbio cade as the tunorAbat Kra. Cipo:ione bid? A r.,;, Traat diaqnosis baa not been ooruiderfd by any exrort in tb&s case. 0 Did any of Mra;. Cipo:tone's treatiny patholoqists, •: any ti.e, diaqno6o ber tuaor as a carcinord? A That diaqnouis voi oade as an inoorrect diaqno4is at the tiae of the initial frozen section. Q Ifn.n was that? PHYLL2S T. L8'rilS, CSR & JO)Lsa:: N. 90uSTON, CSn
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I Z 3 4 5 a 7 0 r Nills - Ctosb $595 A Ylap. ~ Lat as give you a ccoy of it so you can took at it. Tiast NIOpLy v.a dlaynosucd by Dr. SaipA SnyJcr, iwajl cQ:l carcinocaa3, oat ce.i tyye, occu:rin9 in bronviua. 14 tbat tiy:)L7 A Tt,at' L cot ceat. 0 tiow* looklny a: tboje sa.ae slids=, it's yosc diaynoLis ot a"1: ceii car:,•inooa, snters.Jlate call tyyQ, voutJ l+e yc.ir yptcltac d:rr=lno:la, vou:3n'c ttt A A3 I ment4oneJ be:sie, that's aaiipar d:t:inCLson. It 0 043 DJ C.tnl.:al value. Ic'r juit a d:atin:tion :n• pscaa:o~;;.t awciny in :ookiny a: tho tuwars. Q it's t dijirnctiun yoj s`s+cr w. s patboiog:zt? A tas:'s ttght, bacaUse I tu.J yuu, I don'; pa4a on tbat tu clioician... it'a juat a da&tinction islLnolv~isL~ oskt aoong tbeaselVee. Q s:ic he useJ a siw,:itic suntype yere, you lnow vrls: be wa.. talring avoatT A Yea, I knw vhat De waa ta:king aWut. Q There lz a nott on the aottosa of that and yoa talkad aboa: it yest.rd.y, I'st qain;, t3 r.ad it. ?bis tuaoc vaa a3so cxaaaine:l in consuitation by D:. Ioachiv an:! Rottsrrlam vho bels.vt tbat tYs present blopzy is •ntiroly atrilar to the twaoc diaa4osec3 In lftl, In tnis case 0B-a1, v4tch was the nwutbet tco. 1lt1. They teei tbat laYL:.r~ T. LEKiS, GRa 4 J4J~ta9 N, MSTON', CSR
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1 3 4 S 6 a 2S 0 M:11s - Cceas S526 A tupsct to !t cotnyenaated for by tiet, siqht. 0 Doctor, tber• was quite a discussion yestecday at dilfereat junctutts about Dt. Sheldon toarets. You conaidoc his a wt11-tesptcted patholoQi:,t. don't you? A 1 tAinic be is • well known pati,oloyist. I have never abaced •tsy otber cass with his otbtt than Xrtr. Cipollono'& caat to aot bov We vou;d eoaipate our dia980osy on the aa:as. No is certainly well tnown. Q aat YoJ have no teason to bt:ieve that be io not a vsll-renpeccs,! patt,ologiot, do you? A I have no ccason to have an upinson one way crt tbe :ituSC 0:1 his •xpst'Ll:+o. ; Are you a.vare be Is a prota:taor of patbololy at Co:;rz!;0i4 Univrrsity Kedical iic14o0:? A Yea. 9a alsL belonys to the sase so:iety I bsac-ng ;U, Atcc-ur lucdy Stout 8octt-y. 0 Tell tnQ jury vuat the Actiwt lstJy titolt Su:istf ir. A A society of au:qica2 poLboSo9ista devot+3 -- v:to..t aatst[a aca devoted pr;sat3ly to the study of ana:uoica, pstboloqy. Initialiy it was a very small society who eon~~:.;e3 of people r:to were e6110ayu63 of Dt. Stout and be a43 a ptlS:et dOCtot In the Onlted st4tes. •ubaequsncly LOt society enlatqsj to lAciodt, I bs:ieve, not close to 2,000 fBYLLI• T. LsriiS, CaR i JOI`%rz M. ROUS:0::", CSR
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0 1 2 3 4 C 7 0 9 2^ 12 13 1G Kllia - Cro:.s $597 Da ysu have a copY ot tbot an front of yau? R Ye~. C Taert wo4 a tirti3in, of S-i:ydrusyarNloleacetic acid, which wa ca:ie3 S-UII.A au an abLReviation7 A Ye.:. Q OL a nncoal 1eve1 ot 2004? A 25,4, Q 25.< vaea the nor:ml ta.qa ia 1,5 to ten. I:i tuat vhat the rVcUtJ oaJz? A Tnat' a valt tat c tcurd &aya. And 00101: [t!.?4+t3 on tsli/ point eHplSAbllv toe fact ti,a: tilerc ra:: co-Icarr, aWwL tbe tacL tbat the yatient va:n't orn a eon:ru4leJ d:et at the tiao this stuGy vad 4onc aa] d.etdry lacturi. c3fn lnttue:lce twf leYt: of S•U:A%. Q lz :t yo4c laatiacony hece tha: tb.zo aeJicat redordd aay that 63,6 vas Aot vn a Cort::c:Jed daet? A Taare is eviaence :n the record. Aod I don't have tae &;pa:afic c;teraon vWh so, but I bellove Dr. Sc3ciuien ralJrd tior QUe3:iNn of bilnV conceeneJ •bC`4: Uil?etnst that 1/a;: a v.aid •tevation because o: the tact that the patieNt sigh: have 4een on or she •iqht bave beeA •a:inq 90036 or taKing aeJacationb that incoclert vith that level. Q Are you aure that oaan't ip 1981, doctor, when tbe levei vaa 1 S. S? A I don't •p.cYticaliy lKa1S. It sipht have wen. Tuere ~ ~ ~ OD ~ ~ Ln ~ Ln lt3YLLIS ?. L!i'W1S. CSA i JOANHE N. Y-W3TGl:, CSR
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0 • 1 2 3 4 S 6 Kil;cc - redirect $6» Q Any other tYpe4 of vndifiorontiated carcinosN in the luny other tban thQ large and aoall cel17 A Qo, tba:e are tbe cwjor sub typvs. Q My ucaer teraj usod Eor atali eoll neurotndoc;ine caccinoaw? A Tue term3 we 3avr covecoe tbere. baoil ceii nouroen4ocr:ne AntorscJiat• eell earcloo". 6.~ali eL-11 ocucoen.JuLC ine c.atcinoaw ar• a11 synonyaouiu. a A Otaet tstrm:: sucA a:: perlpnet.t: azsll c*:: circiDo:4.:. Sasstiaos that i:: aae:i alone and ac+setirea u6ed with a aoc:ifying roieag)iing carcinoid ttinor, aiao atypical anduicrine tuaorc. 0 Anycain,3 •:::e? A I tbink tboce ate too ssJor onot that bave been uied bere. Q Kre itrriega use.J tt,e ters tuicbitsieY two? A Ta:. ftat ls tbo t.ra one particuiac 9roup use: an.i u:.e tuicAitaxy two to tetar to atypical oarcinoid. u::e a typuC1: ca: cInolci? A Correct. ~? What about salig;saipt c:aicinoidt A Ye:, ar.utis*c terio that wa: ussoc3. Q Kuat 3the: terz:' bavo oatn Y3O4? Liec'u uz do sorae tera&3 fot vtll-dift.centiatod nesrovndvct ano caroinwa. I tb:nk !!r. sic: iege pr st.rce-J tu t!lYLLIS T. LLttIS. CXR 4 J0AI+irJL M. 1lJJ3T.3H, C»+R
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0 0 1 2 3 4 5 6 7 C 25 A Ysj. Q bjt it k:4:: nu c:in:cal ,cignitLcAnct? N2. bIRF1OuCI Oliject:on. Lrsdinv. TUC CD'JHT: SuM:a,nt+i. Jtllla - redirect S632 sut, in addition, bec.use we locur aa yatholoQizts su intenaely on tiasue wt sakM otber diatinctiona e,4onq ouraMlvea that don't bave ellnical i"rtance arld that we oake, in part, as a t.a;ning •xercisr tot residents. It is a sort ot -- w5at I oosnt when I said a oental 9an& or aental oxercice that we iAvolve oarsolva in to bely ua unJerztand the tvaora am,ng ou:oaivoa but tbey don't have c:inical iaplicationc, so the djstinction between tDe two doej not hav• any citn:cal value. ,? So 3our doccora: oc ao;.e rejearchery will aiatinjqlsh aoal: c:el:a cScn:a into sud tyl+ai, ot rntecaediate anJ oat? 0 It a du4:o: u,;ej s3ie te:s intsra*diatf "all ecr:: can;:bc, i:: he ra`u:r:ng t:+ te:e aanQ tbini aa a smili ce:i nouroMnJ.icrine? A Yoa. Q If ne u:csb oat cr:l Ai be 1s refnrring to asail crii ae~rotnjocrin~. WAat •ooat undllterentistod catcinooa, 16 that tna saao as the sua:1 coll ntoroen,ivccine carcinoma? A Aa long a: i: is aut vhot i: ca: ifd iarqa coll undiff.renttatod carcano", y.u. PHYLLIS ?. :.E'dIS• C3R l Jo1'..ti.',," IC. t131J."+:o1:, CSR
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1 2 3 4 S 6 7 a Nillc - r.diroct S63S A That was In 'S1 whon 6he ba3 eec initiai lung r.asction In Aug4st ot 't1. Q Anu ttiat ray the vory as~ali troa.n ooction that wac done during tu• surqsry on a v.cy iittl• piece of the tusor. ItR. SlltRiOCOLc 0bj*ctiQA. Leadinq. TuC COVR:s Su:tainod. A Thit vaa done on the froseA soctioa tiaouo and we ta:ksd about y.aterday how tAio as an intr.-op.rative ooaru:t and divissorwl diag~~o~it. 0 w:,at t l 3:js vaj i t dune on? A U:.uo11y s:rsll but nut aA larqe ai taQ ti:juo tGat vsa avaiiavle onao they rea,ove3 the ontico lobe of the iung. • 0 And tilis aiaQnu:t:: ber., tn• sveond va:l-dtlLorenciatwJ neuroer,dscrina carcinoxi vai asde on the lung after it va: resovsd In '61? tI.Fc. EIRRIDGG: OSjectson. Loadinfl. T8"" COJR:: Su3tsin*d. Q iihen vac tye diaynoala we:i-ditt.ront:attd o*jra.nJocrine eareinass sade? A TAO diagno,:io n.urosndoorine carcinowas vas suao by Dr. 6opaass at the tiit he saw the section& on the initiai tcoson &.terial In Auquit of 'il. Q ithen vas the diagnos:s of snall cell cancer wde ucing any of tbese for.z, be It s.all ot1a, interaediate oat csi: or unditfsrs4tiat.d oatcin;,a.a? PHYLLIS ?. LF'.t11S. C3R k lOA:T.;i, M, llJUS? Jh, CSR
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1 2 • 3 4 S 6 7 8 9 10 12 13 14 io 5625 AlT9 2 li0 01i 2 C3 3 1 0 N (t3arcU 26, 1980.) ?tiL CLCRt:: All r i io. (Jury prs:ent. ) tHE COJRa: Pleaze be aeated. l1r. Cohn? MR. C'J7::: Tl:ark You. 3 T A C E Y S. K I L L S, rejuat' ti:c stan:7, prtviouioly avirn, an4 te.:tllieJ iurther •:: tollorss CRO:ir-CSA.`tltiP:PIOa CJ:T1aiJL-:) Dl' H+t. C02ti;:4i ? I taink wimi vt broke L%Pc :ancG, you haJ said tba: tUo iucadenc:e ot squazouu ctcll crrcinoAS waa 9oirsV down, a431i coi2 yoin~ up, •Ad tbr Jata vojidn't ttytid still? A Ye.. Sc,ua varlatiori An th• artic:es, but tbat trrnd rs. ds:.cc ibed in aoae ;aapero. 0 And yo,t acceated tbat? A My own porsc:na: •:cper ienco tencla to cet:.ct taat, ye.:. Q AACS ycru wer• boocd-cert itied in vaat yar, Ooctot 7 A Ia 1961. Q '#1. W since that tise, ac we disceaz.*d 3asit befQre 1uacb, you bave kept uy the data and cthanqed your eiev: aw • rUYvwl.^s ?. L11WLi, CSR 4 JOA/i::P. M. BOJS'P,:ie C.''+R
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K11ln - Qrois S620 1{ A Ansl I don't aiKe the tets atypiaa: earclnoad eecau:e I :A:a2va11ns, at laively llAkz theas tumors to csnow we tait.d about ysut.raay. ~fiiulc !t ras taloe and oisleading in 1902 your aresc:O? ;t9ra that rras been u;ied bofote tor tbed* +1Ca:ly we Lty• 1t 1k can# to continue u::1t1t; I.X _ 1"c-04-s ot tboia belor• Na uyed just brCeN'.O it SakOD iL •asirc to uaderstand wbac'a yoinq on. - --,ftt .1 acknarledge tAat I had problew:i witrh tnn t~roa, ao diS other4, or. Coa:d's teto lo the One I uJe~ . ye.~ta'i3ay, t~,e we::-,3ifterentiat.d aouroendvcrine . CA ~ C 1 A~i1f 3. W_Y~WHe ilsa, tewtlftlr4 that tAt=e'a bfen a cbanye in MW Miy'~.~t'J ai* trfateJ. In Ot1Ze[ wacdu, p0A1ae are alitc:: rore Viil:ily Ifoil to oiWtste 0n iYali cell Garci0o3"4f COrrict? A ?.tist'n riqist, be.:au#• tae data haA shorrn tbat the vnes with lioitMJ stago dt+:.*aes do so wc3a bQttor. Q An3 yoj bave also chinged yc+ur vlewa about tAe surviva: tiasa ot aslali ae11 c.rcinosaas, correct? A ?hat'a eorteet. Egp.c:ally tor tho orsea tr+ at.a our9ically. Q And tsn't it a ta:t that you bav0 /1at.ratned a change in ' eateinoaas, you beiiev it's the tre;luen:y of airall 001.6 •$YLLI6 ?. LEYLst CriA 6 JOAiNL' !1. 110'36?ON. CSR
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1 0 2 3 4 s 6 7 8 ! 10 11 12 13 14 ~ 13 16 17 1+1 19 20 21 22 23 24 25 0 Malir - rfd4twt 5637 neuroendocrine caccinoma• becaus• I think the pcoblta with the teta •atypieal c.rc&noict• is that ic wronQly aasociates tbis lesion with typical carcinoids that you Aava Gbarn on the left over tbere outaido ot tne spsctrua. Tbe tec` to4 closely •+sociate3 the wotd •catclnoid• vitb tbate neurotn3ocrine circinwa and tor that reason I doo't likc the tera. Q Let's take a iook at w:,at the de[endants' pathology eYqert~6 in tbi:: ca::e that Mr. Sirrid9a aeked You about u:e. iiaat aLjut Yictor Gould, vnicla tera dors oQ u6c tor tui,U ty;,e uf can-;:ec ? A He u6ea tha term •woil-dtfterentisteJ neuroenducr,no carcinoaz.• Tha:'s not tl,Q typr of cancer that Mra. Cipollone baa but it',& cne term bo use:. toc that group of turtorl. Q -',1ay doo~n't Dr. 3uu1d u;.e tnQ term •acypica: eace:n~i.i.• lyu. SIrR:O3Si OSSe%;tion, your Nonar. Thij ir; cloariy improa ar queationiui. bte docun't know what Dr. Gou:d doeu. T:14 COUR: a Koli. M3. tiA:.TCi:Ss I'll rephrose it. TEiE C:1CRTe Queation wittidcavn. Q Doesti Dc. Gou:d ipd,cate in ar,y ot Ws publlcation: or papers he soad why he dot;A't liice the tecrino:oSy •atyp:cai carcinoid•7 teYLLIS T. LtaI5o CiR a JOJL4..qZ M. 1107S?ON, CSR
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. 1 2 3 4 S 6 24 25 Nilsa - redice.:t 5639 He's publiabe3 tbat as one of bio attillattons. Q Kaat ls tbe Council tar Touacoo Re+:earcb, do you know? A My qnJerstanding 13 ttsat it's basically • tunc)ing age4cy tnat providei •onef toc reaearcb. Q And have yov read Dc. 8omeru' expert report in this caaae? A Yos, I 4avo. Q llnd be ia a asabet of tbe Arcbac Purdy ttout iaciet}' wita you? A Yec, he ic. n Do yuu kn:ar of any otber ota:iet of ttle Artuur Pu:dy Stout Sr,rtety that share:: ar. Shcldon somtis' opinion in tht:+ ceoe rilat it t1a:1 niit been proJen ttIel' ciqstetto sa#oK:ny ceuooz lung cancer? KA. SZFcRit)W:i I orrject to tbet unlebs the du:tor knuv,; al: the oea.yer~, oL tne •vc:tety. Tyz 1/I TNZOSS: I can tei i you ab:wL bow nany I kn~.r. TAC COaRTs I'll wrait it. Overruled. Q You can a.now.:. A No, I do not. I do not knav auy of the other ireo5e::: oi the "ciety who hoiJ Dr. S.rmers' view that It das not poen ptoven tbat saoRing cau:ea lung eancer. Q How about Dr. Goiald, is he • tc iend ot Dr. Somer:z? A Yea. Dc. Could trained with Dr. Sosasca and i'v• scon P©Yi.:.IS T. LL`1i15, C3R 4 J OAN34 N. s0U ST.7:: t CS i2
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f 1 2 3 4 5 6 Mill• - redir,ect 5640 them to9ethar at .eetin9o and It's my unAerstandinq that they've .aintained a triencl3btp. 0 Are you aware Dt. Victor Oould bai teceivad funding and grantw froo tb• Council for Tobacao Res.arcbt MR. BIRRIDGdi I object. Are you testifying to tbat? This is way outside tb• scope of my crorc.-eYaAination, your !lonor. I let it go for avnil• to taiK abouC tae undsrstanding of tAis, but this io clearly outoide tho scoLw. Tzi• is cross-axaa:aation for Dt. 8oe.Aera or Dr. Guuld when they coaie and teKtify. It'a clearly iaprop.r. T:3R COJRT: ?hi:z ritncss bas been aste3 abojt b:s view3 of theae various •sperts and I tbank it'a aypco?riate to aik hix waether pQ's aware of any po,.sible bias. I'll i+etmit It. Q Are you awsre Or. aosid has received tunding fcom tho Coun.:il tor Tobacco Re;aarca? A Y.a, I aa. Q Do you Icnoa+ what Or. ciould's opjn:ons arM roqardany tobacco and boaltb? A Yey* fIft has -- 11R. A:.tArj.tY: Ob3.ction, your 6,nor, aw nOcu swr• art we going to allor tbis ritn.as to anticipate the d.f.ns• and ebaracC.rtsa witness' testimony that bac nQt YMt PHY:.LIS T. LEiiI5, CSR 4 JO&N:il: K. 8.7L.4?7:l, CvR
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0 1 2 3 4 5 6 7 S 13 i1 Ktlls - acosa $613 adviaory coaJ.ittacs, baa isausd =si,acLa •vsry yeatt t• tbat corrcct? A Cot:evt. Q Yocc hovs not read tbose rsportd •ithsc as of the tis+Q of youc daposition vai takew oad yuu? A Uo, hoc d:d t tbina I needed to not 44 I think I neoJ to WW. Q R1(;-It. Y,au *atd ttist thoss cepurt9 aro a crucaiacy of the aed:ca: irte:d:vcs as the Surqaon Gsnecal *sva itI corract7 A Cc aM chQ adi:svey pand: sets it. ~ T.'!3L vLitO:t "- r. u::ual:y %ccitos Lh+r rapoct. Q RQ dssaa't vr ite tc hl+aaslt? A t aa aure ha approvsa it brdt doa4n't hava the tima ta: a1: taa d,.ta-gacascin-1 reyuir.d. Q It c.j~rsjsr;L, LhaL statf'+c lntecptotiation oi cat baJf of ko3icai lic.catuta wu1ca •Ytata at ttiat pactacu;ar putnt ir1 tiors cocroct? Jt I vos:d agrMo to it, yss. t? A.-4 you aro nore :nterssted in cass .ateriel an•i or,%:nal sooresi than readlA9 solrsDody •lss'a coapitation of vhat th* litsratnrt sayo$ isn•t that cdtr*ct! A I ao intsc.&te:3 tn seadlnQ vl,at the litaratur• sayz a.2 va:i. ln.rf is suciL a buqs o.dy of lttaratucs daaiing vit;, saokinq acound 1981 ca4csr I Can't keep ttack oor oan tgYLLiS !. LlKib, CsR i JOArZRG M. 11.?V8Z'Ja, G1A
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yllls - ccosa 5617 0 1 2 3 4 3 E 7 dea tb?• Nov. t wa. undec the idYro3:ctcrn you vece piviny YoQc oh:nton a:: to ca:ise of desta, not r.aJrn9 ti M oedical tocord.+? A bPt :1 e «•• Q wsa that yo4c opinioll of the oauoo of death? A My opinis,, is that sDe had saw11 coll unditEer.ntiateJ or sasal; cti i neuCOOndacr ine canrtt, l&Jw, GoAO pf,P:• 630 that terv bYnonolii.itlsly 1/1tL oa~ ct11 cansar an3 that's why I ui.d tha word oat cc:: cane*r tbo[u. ::ave w:.en I was be 1ny dopo,otd, Mr. Ei c cad-li and I apint aour4 tstk:ny about all those ttia+ atul I 6.rILioaeJ at one point I msy slip up a.~J aue oat call anJ e.utotn~i~:ttnv cancer synvnua4u•r1y and I try noc to do that, bat a lot ot pcjyie dv do that. I say have dona tbat yeattrJay. Q Yw toid tLi:: )uly y.st.rday t4at you -- In your opintar% tLo oauao of liri:. Cipollcrne'a drath was seca.tottc owll celi unditCsrentiateJ oat c.11 aarcinooa, •v.n tbouqh at your depcrzition yov ba1 subtyptd it 1nt.r4adlat• aad bas nevor aubty"d It oat ct:1. Irn't ttiat cott.c:t? A Sba:'• eorr.ct, but as 1 aaid, oat o.li and mrall cell anditi.r.ntlattd are as.d srnonoO,uiilY by a 1ot of pe3p:.Q and taat'a the reason I 2.nynd tbaa together at that point. Q Zt's not b.cause it wou.3 tbtn bt coAsistent witb the teYC.Lts r. 1.arrIS, CdR 4 Jo,«i:it N. roudZ0t;, caR m Ln
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1 2 9 3 4 S i 7 a ! 10 11 12 21 14 ~ 15 16 17 10 19 20 21 22 23 24 25 Mill` - crooo $630 therapf. A Corcect, I aQr.e with it. I don't aee the patients in tbe role of a coun&elor t.gardin9 wbether they abould hav• therapy. I see tbcir phyaiclane and oounnel t;hesa regarding whether their patient shouid have thera;rf. 0 Niaa Nalter* sta:d. Z ai&une you uan tbat -- the quejtion -- wLetber yoj ar• an er? .ct, ia the sedical e.nae# not the lesai oeAse, and you aaid yes. Do yoj oake a diatfnction between an expert in the wodica: aen3e an3 the legal aen:yu? KS. K1iLTCR3c Oi,jQction. I vas oek:ng the da:tin.:tion for the cecocd. I w.s objecz4ny to the io:a of tho queottoa that tbey wuuldn't •sk taiy witnebib abojt a legal -- TciE COURTs Su:tainoJ. KIt. CO:iN: tie anware.i the yueation. :8E C4JRi $ I knov. KR. 4,09111 Sor r y. Your Monos, I as tiniahed. THE COtTItT c AnyOo`!y el at? KR. bORTN?RZPc Mu queatton.+. TJC CoURTi aed,c.ct. xs. NA:,TBasc Yea, Judge* PRYLLIS T. Lr'..~':S. CSR 4 JOAaI;:: Il. JiOJSTX-i. CFiR
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0 I 2 3 4 S 6 7 8 9 1? Kilis - crosa SC16 Q Hva, Or. Ms:is, 2u it not a fact tnat ye.terday ia yuur oirect te:tiMwny, tuia i: at payer S60a -- MS, btA:.TSRS i :.lna, pieaaet tUt. COtI':s llst soou 62 1 f tnJ tt. Soc ty, vtong paye. 5421P 1'+a sor ry, Ms, Wa1 terx. q3. 1JIt;.TCRS : What 1ine7 liR. CJUri: Lan• 140 ~ You vere a.:ke3 tLta questioae •1u>a what vas the caur~e of i,or doatn," refarrin$ to Krs. Ctpu;lonv7 Your answet ws4:s •tc we~ a vlclely metaatatic saali c.ll undifccralitlbtol oat cs:: c,trc:inoot, suall eell nauroeni:,4c ine ca:clna:rw. • ~ Wn:r tlitt Yo4r an;~v4r? A I Dc:savr i» pert I va4 rea:lin9 tioA what va* s.id in t11t aCtua: t'lpJtt" tha'%; wa.i tile.l. 0 Yuu vere uot thea •xptl3ilLng yoilt A'R:1 of;niOn, wert y.7u' A dt:3, sy o}inion la that it's a aawit cell unJiffer.ntiates carcinoa.a, vhtcn ia vlttually the saac 04 wbat we're taikiaq aliout. 1te're fus,t bavind a little es:aantic c.pe:oire here r.qardiny the vot,s. Q ttell, esov iet m •how you the traaoetip:, Or. N;:la. 1 only have on• coyy. A That' i al l r iqa:.. p 11o., the aue;tlon ras: •And wbat waa tAe oause of 4er P1dYL:.I S'1'. LMI S• CaR a JOAl1~:r. M. /J"'JS?t7:1. CSR
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1 • 0 15 0 Milis - redirtcl• 5649 opinion one ray or the other? MR. •LtAKLtYi That's perfectly all ti9t:t. MR. COt1st6 You just don't identity the Yattioioqisc. tte can't characterise -- the jury is hearing a conclusion rith avthinq else berind it. Til"hp COURTo Isn't that a 9orx3 laitb baLia tor tbia? AT,. COU!:: lio. I'a saying the lnty doemn't bear tAe aasid iut it, underetand? Be says it'a a-• that by?uLheticai queation ls vould you tiad it hard to beliera a pa:holo.jiot .+as yays be doe4n' z knoi? O/ei l, that pa:.lmic,yta: iy noc here to bay. TH5 CUU:Ts Wo'il dQ it that oay. Oo it vitboit re:eren.:e to thib parcicuiac vitne33, p.rs?ective vatuea;p. flu. NA1..TCR.;r Caa i aot it he's aware there iu no opinior, ans thar+ ask the hypot5eticai? TdE CJ:: 7% ku. :': s let yuj a.~,k t t!ot any p.1tAOlogi:.L vho 1181 no orfnion. KS. WALT»A:,: Vi:a f. TTI:: COUR:r witLout tdentifyin9 bta. it5. ti1LL.TEF.3a 8vr attiout a p.ttoo:oQ;sc of atatuteo berauas that vr.at's re're deaiin,, vito? ThE COUR:i Yes. (The tollo.iny takes place in the pre.anc• oi t:tie 2 3 4 S 6 7 6 3nry.! m ~j EO ~ 10b Ln %o oh pifY:.i.Iwo T. LCWi.rr. C: A JOAaNG N. NJJSTUw, CZIR
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• 0 1 2 3 4 S 6 7 a Malls - redirect 5649 RY KS. YAL?£RSt 0 Doctor, would you find it tncredible tor any pa:ha:c,gist of stature in the resesrch ooaaunity tcx3aY to bav• knov oPinion regarding vhecuer or not ci9arette aaoking aauseu lung cancer? Kt. SIARIDGSt I object to tbat, It's a lea3:ng question, I ob)ect to the tort. Tti£ CCURTa Overculod. I'll perait it base,l on oir diacuu::ion at the sldo5ar. A Yea, I wouid. Q WiiY is Lbat? A It's suca a tondaaentAl iaiue anJ there is such a bugc bo3y of lcterature on thia tupic and it's an c.bvLou=iy a concept tnat p.ti:t,ologiat:: dual wita on a daily Ua:ic.. 6+aryday tboy sre the4o wtienta a4J tt'` sooEtainq that they have to cioai vith .•ery, vecy trequently. it's Da:.icslly inconceivabie to s* that soa4o3M Would not aaVe arn oyinion on t'ni:p topic that ts ex;+oaeJ to it aa such •: a patGologloc ij. X:,, wALTSRSt Me. SircidqQ, do you have the Gluuuj) of tne broncboecolry report? KR. .~iS RRIOC'rS 8 Yez. MS. MA:.TSRSs I can't locate ii. p Doctor, do you rtcall tt,ac tber• was •m* dtrcoasion with Mc. SirrieQa aho4t Dc. Seritt's broacbosaoDy report in Ln m ~ oo ~ ~ Ln %a .j UYLLIS T. L1GY13, CbR i JOAMt3 M. /jJJSTOti, CSA
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I 2 ~ 5 6 7 11 12 13 14 ~ 15 1z 17 13 19 20 21 22 23 24 2S 0 Kilta - oroso SE1t diaynoal:: in the bospitai esgocda that is soot tavorauie p1st~~:~Pit the A Ncit nut P4tticulariy. Q Oicay. In u:n.: vordo, but taere va,t no Casnqe, in yosr opinion, .a taere? A W-, thetr iy no citan9e in sy o7inion. Q T4aL tblu wa:, an intsrA.diate ssbtype? to A Kr:l, sy opini:.n i4. •s I'.v• eK?rsjjej it, •aal i. ocll tkejcoQr+JJ.:t Ane cai ctno". Now, we spent a sot c+E tima talkinr; tn deN4sition aboat wbetbo: !t waa lnt.reodiote suvty&.c: ar oat coll sabtYsps •RJ I agtes you have to r.uSI;tpe it, it'c an iniaroedSaLe. Q 8ut you to3d the jucy it wa41 asall cell -- it va:. 85,311 aa:: un;:,tLer.nttat.cJ oat eel:, didn't yOu? A WQil, in tnat •en:.e I wae o4in9 oat ee:t to oe ,tynoac:aou;: wito aaa2i call, wbica 3. waat a iot ut the people du and I tend nort to du. lroa that point t asac: an error. Q vid yQs t.:: the joty that •t ta• tisW? A bo. I told then what the diagnochs ve&,, sy dia9noat.i iu the sans aa it'a aiwsyz bt+tn. I used the term oat cQt: [oc tboa was a lot of people dv uge tAat ters synono.ou::ly. Q Out you diJn't tell t4e 3ory yoat.tdal• tbac tbert ws.: anotber subtype called later.ediste, vbaeb is wbit you Pi3YLLIS T. Li`dZi, CSA 6 JOAttx! N, 2OJS:Oti, Csib
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• • 1 2 3 4 S 6 7 15 Milli - i0dicoct S647 Aave a view -- KR, aLLAXLEY& Oeeaus• it'r beacuay. KR. CORys Yout Yonor, tbat'a tholr caaracttrisation ot -- be'e read tbe sepott. Tne point ly that jost becauee you'r• aaked ab4ut -- 2 oean, they'r• a:kYnq bilk about Cr. Rockoer, the1'r• setting up Dr. t.ord, they're settiny up their witndtser the iaass way. Ta. point ia tnat doeWt open up the tloodqstej to hava thia guy now opina about everybody elao's optnions an1 how tnat effects his credibllity. MR. B.'.SA::.BYs tie're only talkinq abvut one yuestions wbat at& thii oplnl,n47 hR. CO:iat St doe:cn't do tt, MR. IILLA.fiLEYj There is AotbinS wrong vith Riis wattcru sayin?, do you -- sbe already asksd bio vhetnec ae knei of any other pothologiet. Do yos tini it d;ft,cuit cv De1l.vr that ani patuologist today eouid not havo tAoae v1eWo? Ail that of ir okay. He can ask that queatioll, iptIe can as'r, that question any which auober of way:. Tae objectsuzi i9 to assinq tbis Yitneis to obatactoraae on the opinion: of one of ouc •spertc vho basn't teftifttd yet. TUC COJRTs Suppose it wau put in a bypotheticai? MR. 6LE11XLCYt I don't knov waot the hyputs,ftical is. TEit COJRTi Aaa"ing that a patholo91st 4as no NYLLIS T. L6WZS, C8R i 30WtNS M. YOJST91+. CSP. j
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1 2 ~ 3 4 5 6 7 0 9 10 11 1: 13 14 ~ 15 1G 17 18 19 20 21 22 23 24 2S • Miilu - rodirect 5651 attent ion to his deacr ipt ior. of vbat ho vaa able to Ne• befor e the bronc:iosaojry. If you can read it tco th. jucy and •xplain it to thew. A Be *aya, all aiddle and lovet lobe otiiicev, vnicA lii, another vord for openinqz, tad all o.owontal o?eninqu are i t e,e on the r iLht aide. Lett upper ;obe and left lover loDe bronchi anJ re3pe;:tiv* .ey:atnta1 openinq4 ae.4 are tound tre• ot anf aQ4ions. ? Was Dir. SLeicaeu aLle to i:ea into lece. Cipollone'i eeqoental broncni when be perfarmeJ this procedure? A U.o repart inJiCatv4 he vas only ab:C to aee tbo • oponings of it. 0 Do you bait any r4a~o:; to be: icvu that at.icaen s:: yK112eJ than Dr. Gertft? A tio. 0 waat ia the •iqni[:cance in this wie of only being ab:e to uea the seqaental opsn,nq: in the broncao:.copy proco3irc? A Secaulie at tde tire of the ottqinai tuaoc tn 196:, Lue tuaor vas aridinq tro. a eeqr.entai broncaua, and only the openinq, I•usaoct, eou:d have oeen •een at tba time ot the bconchoscop}•, •o that the twmor LurtDer up the aeqsencal bconchaa could pot be visibie. Q Wou:d tbey have perfotoed the bconcbocco?y if tbit were •NYLLIS T. LU2S. CSR i .iJA'.:::: !i. BJOS:JN, C" :
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. is 1 2 3 4 5 6 7 Mil:s - sedirect $643 are qoinq to be vhen tAey corae and testity. TH& COnRTe Lec'a talk about tbis for a.inute. If you're riqat, that oeans tost once the defendants' expertu tes+tify, tbat tbe plsintitf vill hav a to brinj all the;e expects back in to teLut it? M•. a:.EAtLSYe To r ebut what Dr. Gould's vie1: are? /!S KALT ERS o cit Ri . q . ltR. lt;,FAE:.EYs Your 8onor, I can't b+ lieve tai6 . TUC C1;TRit You'll Aave to for the tise bein9. Be atient with o p e. MR. O:.LIIXLCYt Dr. Gould vil: be bere a.nd teatity. He vi:i qiva his v:e13. When he hxa linisbed qivinq diL v1QVU be Will 5o cala.d by tAe p:ainti:l. ?bey wi)i tsk e whatever evitlencs tbey bavu about tGo::e viev u and crous-esaainQ bin. If be oonccsdicti birael t, tbe!'li potnt thac ouL. 19 Ae': vritten sces:hiny toat'a incvnc&tteAt # they'lI point tpat out. 2f be baj no vie•r, they vi:i poin: it uut vhon they exa:aino Dr. Coutd. TRE COtili3: 9upyo:r* che p:aintitEs' expert ba;i a teoponze to the driendsnta' eYpert? U2, s:.eAr!.EYs Ybat's Aot vbst be's wioy. T81S COUZ:Ps I don't know tbat. ItR. 11:.i'.h.'+cLCYA Be's pein,7 aaked to charscteriac Dr. G;wld's vievu. lhat's not what ae's do,nQ. Ne's not renpondinq to Dr. Gos1d'i view. You bet tbe proper vay ix Ln m ~ 00 J.A titYLLtS T. LE1:S, CbR a JOANtit il. 600lTJ="f. CSR
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I Z 3 4 S 6 14 t 25 0 Ma31r - Cro,is 5607 Ot1e10QL~1~ra~'f, dilJ thly ls the io0011d tiW4 he CCAjJ:te.3 on ha: case. My Vues:ion ia, oootort Tnsrt vas a:iia uncettaintY about vbat Hrs. CipullvnQ bacl even tben, tiva dayb sftec aurye:y7 A It JcpenJ:4 on tGe u:f %:ert+rintiea !n rt,u++e oin,l. I. tae i,a:Aoioyi.::0 nin3i, the psople tbat bda:cally saKe tim diaqno:.i4 it aeeAJ tUa: tbore raS • tselin7 toat !t .ai. •n neuroen3acrinr c4rCino,ca, and Dr. iistton *aiJ it vas con4intenc viLa *at cell. Tcm ciiuLCia:1:y se.is t4 be axvregsin2 6o&e Cc::t~~ion aLost tae tsc«i,noiost fcrr t:,iA tcmu. ~ SJt yJJ VcJ:%l •ire! VitO aC, DiCtOi, taat CZipaCOl dG.:toC Ga[! eltt 1 tl03 to YikC diagnO.a4 tOJ? A Tno; die oaLitie3 to rike diaq:sosei. T'asy don't tfy±caliy rswLe 4i4Vcto;,es on pai.ns/loyicai tissus an.! u+-u4:ty defar to the dieqnv•.iv mdo by tue patt6olo0isc. They oay d1c:agreE an.3 a::wr the s/3Jou to otpsr patt,oloqit/ts oit I 4on'L know toa Many cbeaotherapiot• qcaliEied to aske ~iLrwlO~% ~~ Q r atboic.gioti take the taboratory, the patholoqy, a:ea sak* a e:inical diaqnowia, Isn't that trus7 A Tttey take the eliniaal t.ature& and •crsvs at tbeir best 9ue,ta an3 when the patboloQiaa: matsrlal is availabls, it i: the tinai dlaqnorie. I belisve Ratser tastitied toat be t1tYLLI3 T. LW/1G, CSR 6 J*AaUe „. X403T3t+, CFR Ln
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0 1 2 3 4 S 6 7 8 9 IJ 11 , 1' 13 14 ~ 1S 15 17 13 19 ZO 21 22 23 24 25 Mil:s - re4icert S6S0 '81? A Yev. Q Anc3 tbis is tiae report of the procedure vbece ba went down tbrouq:a her aoc• ot swith wath a tabe up tbrouqb the lunqa and tried to look at the bronabuu that corstained the tuaor that Mrs. Cipollone bad? A YQ3, I recali it. IsR. C3ahI 8xcuSe .e. ?tiat was a•uaaUrY of teatioany whic:, I tninx .boulJ cua+e froo the Doctor it we have to sui.a*sc.se it. nC. WA::LRS: AtreaJy au,nMarise3 tace. lis:. CO13::: Otije.:t ion, leadtn9. TLcS COOk':: Ka1:, the witnoZ:. i• baVln9 bis atter,tion ca12eJ to ia.o pcior testitonf. It ic tor t6he jury to determine wbetaar that wno the testi.ony. I will pOr2lt it. Q A.nJ do you recal: betnj a.ke3 sovg quaoZions v:,athur or not D:. 3erift vas •5:e to see intu toe ie0sfentli of lsra. Cipol:one's bronclus ur ju4t see the segACntal oponinq37 A Yos,, I do. Q Lot se sbow Yoq the bronchorcopy report tor the 1982 twmor, vhic5 pr. iteicben pertorned the broAaboscopy tc:r, aad I vcw:d oalt rour attention to the hottw paraqrap:1 vaere he La dssctibins the proncDoaao1Y ptocedute reqardXo4 the •iddle and lorer lobe opentnqa. I woald call rout ~ m ~ OD r ~ Ln W w •tlYLLIS T. LF.WI.a, C.`'+R & JOJW:7.r+ M. 900STOti, C3R .
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I 2 0 3 4 5 6 7 8 9 10 11 12 13 14 ~ 15 16 17 18 19 20 21 22 23 24 25 0 !lills • cross 5631 A0-OIABCT QXAMItiATION oY l1S. MALT3lLi s 0 Oactor, there was a lot of discussios durin7 your cross-Qxaoination ai+oat the different taraa that ar• uoed toc the ditl.rent tyyoa of aouroondocrine oarciaosiai that ve discus,ce4 on your direct •sa.lnation. I would like to, it we oould, just put teirs on the board so we can elarity it. A Al 1 r lyht. sase of tus Q Ouctor, vhat ace soae of the torez that are usod for soali Coll? I delilvo, intecao3:at• cell vas mentioned? A Yeb. Tnat vo.a aentionoa. Q 11n3 oat Cei1? A Oat coll vaL also •oatiocie3. 0 Hhat iz the disttnction, i! aay, between laterMedisce and oat cell? A As I•entioned tbi:: .vrniny, it io a distinction that patt,oluyists wy stiake among tbeozslveip. That bas no clinical idaoctance toaL vo a:e a4are at at tbt Moawnc. 1t la a diatinction that patholoqists sake bOcauss they look very cloiely at lonq oancors. Obviously, patholoqlst4 ai• concerned about diaqaosea tb&t beve irportanco to the patlont and toat is the sajor aspect o: surgical patbolo9y• tHYLLI9 T. LCWIS, CSR & J0A,11dC M. IW:)3T0•;. CBit
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0 • 1 2 3 S 6 7 17 13 Mallo - croas 5620 related. p Aa i oaid* yod personally thtnk yoy ean eoae to some r.asonn5l• concluuionz, but y:w aaa't really prove it, anct tt is baaically a oatter of faith, anJ otber people say coae to other eonclusion6 and they can't prove it •itLsr? A axactly. BQOsrae once aSalignant call iwkei its firL: division it no longet •Yiats, at i& two ee116 and the eel: dirappeats. Q Wacn we say •tbc cull of orssin,' ve oean t4e parz:cular cell wherQ it all starts? A %C' orrect. Q tlov, yestetJay -- escuut oa -- 7r. Ki11t, at Page 5373 oS the tranzctipt, you vdte askeJ soMe ijuvation4 about tne t rsst:+en: of cance r. D;~ yo4 r.za11 that by My. Waitetc4 A No•t a,-wcifltZlly. yut I knor we talkel abjut treat;ion:. : D4 yuu reca:l I x:n:1 ut sw;io an ubjsction. I taink yc,u vsre expert in trst:twnt? A YZ+. 1 reC*ai tnat. Q t:ow, do rou tec.alt :.: yuur dtpo:.Ltion t,at yoo vQre a:kQ:+ tqLs quoation anj qa,re thia anivei at Page =01. Let be get tbe lins. Line 19; Do you eonaider rotirse;f an •Ypert in the area ot tne treatsent of lanq cancer? tUYLL1.3 T. LB+I:S. V.:R & JCGAS:.•I.r~. N. BJJr:'Ot., C: R 01
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• IN TIIE UNITED STATZS DISTRICT COJRZ' FOR THE DIS:'RICT OF NC4 JERSLY Civil Action tlu. 83-2864(SA) - - - - - - - - - - - - - - - - - - i 114IO CIPJLLONE, individually, and aa Executor of the Estate c TRA'tS:RIP:` oP of Ru3Q D. Cipilione, PRJCzc:JIH3S Piaintiff, t t Nexark, tieW Jtryel LICGCTT G1t0UP, I:JC.s a Dalaware Corpcrationj Pt1ILZP t March 18, 1983 HORZlS. Iii:;ORPJRA;ia7, a 8ETER.N0,h SI:SSIJN Virqinia Corporationf and i LO;:W' S Tt:EATR: S, I:7C. , a ::o; York Corporation, : Defendunts. : to - - - - - - - - - - - - - - 3 T' t' 0 R.r.: :1O.`::~i.A3i.E H. LuE ..'+AZOi:I:: U:~tITE0 STATIa DISTFiCi JUDGr A P P E A R A t: C£ S: BJ», LAR:::.R, GR.'%#SS, PICI:LJ, R0: La3'%il::, v'RCE';3.r.R4 4 SAJL, ECQS. , CY : HAf:I Z. rJEL:., ES;r. WaLCNT3, GOL:)t4:~:M i SPi:ZLFt, E3JS., IIY: hLA:: !:. DJ~Ii~,.IJ, ErQ. , Attorncya for the PtaiAtiEf. ARNXJ') 5 PORTBR, ES-23. , DY : PI: t^ER K. OLCPON:.EY, 63Q. , bY: TtIO!dAC C. SILFC:1, ESQ. Attorney4 for the Defendant, P:,ilip aozriz. Purauant to Section 753 Titie 23 Un.teJ Stataj CuJ:, the following tronacri?t is eemitied ts, oo aa a::curate re..ord az taken atenograpnically in the at+we-entitled proceedinqs. , F:ii':.!•;v T. L.r'•4lv, C.S.R. Official Court Rrportet - U.z:ted S:ato4 District Coirt P.O. Box 255L3, Newark, tltcv J3r:.ey 07101 piIYLLIS T. LE,i:S, CSR i ?i. HOX".Tir.'i, CSR
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• • 1 2 3 4 S 6 7 Aills - re,direct 5656 wiignant carcinoid or one ot tn• terost A Ye3. Q Nny vav -- and there vas ceferance to ao.e con:u:.ion cn the parts of the ttaating doctors as to tbe type of tw.ur sha bad az lecit back In '81, up Into Jun* of '82. itay vaa it i*"rtant for the ttoater, that iv Dr. Steichen, tu Icno• precisely what kanJ of tusor It vaa back 3n '827 A That was iaPcrtant, bocauae the thinkinS at that tiu-~ v,ju1J have been tAat saall cell carrinomas sbauld not be reje;:ted, not 3uat primarily small oeli can.:er, but all o:::ur:encs:, an:J t?,of should be treatsj vith c:+eiaothoraay and raJiation thers:-rj pr+sa:iiy. I miBGt adla, aa I rentione4 before, we eov tnriwr tbat t:+mc 3a nat tDe ca6s, but It vaa ttae pctvailiny fetiing at tbat tiae. Q Oray. You sarntionej a 1985 report vrttton by Dr. Steic:be7 ci&at be vcote in thia Caa+t. KAat dosa that rQport -- MR. SIRRIJvCz Obj.ction, adQ batr pl.a1Pe. (Tae tollorring taLe4 plaCv at 6140 dar.) ?38 CO;iRTo Le: *e bear the test of the Queotiun tacst. 1Ri. MALT:.RSt I was quing to ask what tb* gQp.)rt te:ls bia or Aelp& bto In identsfyiog or elatifyin? Dt. ~ m v 0O qa m tiiYL:.:S T. LLb':St G8R i J:J"he N. /10Q6:.3a, C3R
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1 2 0 3 4 S G 7 a 9 1C :'s 17 131 19 20 21 22 23 24 23 0 Mills - otoas $627 SC Y.ars and I can gain a ttesoniouy •xpariencs just by revieviay tbose caass !n a short psctoJ ot tine. Ob;riously, a general ptactitioner, so.ebody wuo sees patients at the rate they come tbroasb hid office dour, doesn't bave the abtlity to 9ain experience ln the short pQriod of time. Q But there are other patbolo9ists rs4o bolo tbo sarc. pocition3 a* you? A Yoj. Q vnlvcraity anJ ned:cal achool:z and teacbtns horpptta::7 A To vacying degree4 tbey have elected to go aacit tairou6h thoir fiis s an:3 thcar ca:.ea. Q Huv, at your dcpoa:itton, You teatified that ao one rea2 iy knov3 what the cell oc iQin of any tasoc taI iN tnaL cSr=Qct. Pdyc 2U, M.:. Kalttta. A T.1at• is corte:t. Wha: I ssaan !s, we don't hnov tiaat t:1o co:l -- v.,:ch celi at vaz that be:aao aa:i9nant. ? Curr+ect. I unde:stuod tbat, that va: ay oest qu.:.tion :.o tae jcry vould icnov what yov .ean by cell oraqin. I believe you alao testitied that rhile you can aake sose raaaonable assua1tions about it, yiju QouZdn't prove tt, and it ls realLy a.atte: of fate? A To soos estent, that !s oottect, Ye•r. You oan gain a aMe inaiybt, ao I ta;keJ about, by lookiny at tbo way twst;,tj are titYL:.1S T. L6•J13, CS.1t 4 JOAt:: *T--d M. B7USt4l:, CSR
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• I 2 3 4 S 6 7 M1Iii - teclirect S`65 it was a sw:l cell cancer? A Tbat's correct. Q Nov, was Dr. 8tlcbi.n'i operative record that Mr. Sirridge shoved the jury, vAs that prepared Oef ore or after tho pathology report was prepared in 1982? A That vas prepared before. Q dow do you koxr that? A I believe tn the record be aantions aDout ava4taag pathoicgy aad operative note$ are al.oct dictatad riqut a:ter the surgery, psthology, takes a couple daftr after t'A3c to 4et the f silal report. Q Le`.'s taxe a looK at the June 7, 190Z patnology reporr, o: part of lt. Wuo ic, the patloioVict on tais diaynoils tn 1982+ A Dr. kalp.,~ Snfder. Q And vha; was hia diaQno.:lc? A t1i4 diagnobf:. was aoait cell rarciefowo, oat eell tyPe. Q Is there any 6econd 9uto.;iny on this VatAoloqy rep:.c L about the type of t"or? A Nu, there is yu4t one diagnojia ots t0io report. Q Doctor, what are progre8a notea or doctor's noLes? A ?hey•re notea that physletans write in a ahart in tnc:r Wm handwriting on a daily basis reqardinq the pcesent oondition of the patient. BoAeti0.,, they ake hiatorical notes reqardin9 what happened in the paut. Thtae, as I Ln m -j 00 tA ~ ~ w PHY:.LIS T. LC'if IS, C8R b JOAliai. R. QOJ3Tuiy, CSP
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0 1 2 3 4 S 6 7 8 hiita - r*dir.ct 5659 Steicben'a •tateoents in the operative recerd in 1982 and lo the 1983 report. lbsy asked bim directly about it and ve knar It bas been clarilied. RR. aIRRIDG61 You save to stop the tcain, tfe alreadf popped It in. TbL' CJt1RTt ?4e truch vill r.c yat tcN. t1R. SIltRZmt It ia clearly inada:aatbla. Tney aro trying to qet it In again throuqh another •xp•rt bacauua they acr not ns. nR. ltA. Tac qoe:ction It could not oil a heaLs:y THP. docuuent;.T yJo va+: vitb the THZ COt1RT: i:*. !l3 willing to call tbia expert to trial. KJu,TGRS: Tney tvtsttd the trutb. fPJKTattIPi No. StRAiDM It is olearly bear•ay, inadois3ible. i• ohjectionable •nd your culiny esriler sayin9 coa+e ln ouqht to stand, and It ia clearly ba4.dl docuaceat. COUF,T: Wnrt ib the -- what ts in the NRL?ERSi Mot causatlone idave you sern it? ?: papers thef gave you7 Wils.UR9: Taere ic a I/taLeMent atwut cau`acA,on on tbe bottom, but tbat is not vbat vd are concerneJ atrouL. We are concerned he vas relyiny on the patholo9ic diaqnoris in tDia caaI. In 'il It was .a2rqnant carainoid aad then cbanye3 PeriLIS T. t.W1S, CSR i JOA.'i~ N. 87US1wJli. C"A
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. 1 w 3 4 S 6 7 Kill& - Croso $590 NR. S1rR1DGx, Your 6onor, can we bave a sidebar, bri~Ily? (Tb• lollowinq tikMa place at sid.bac.) 11A. S1RAIG'Ge't : I tuink that is anotber •saaple ot aa •apert ttylng to pop in somethlnq that'a ruled inadmiszswto. r:,at'6 the atict,i.n r.Paxt br 3cst rslatreJ to. I asrkQd lsim vhat did the toport salds vbotber he aqr.cJ w:t:, it. I d:dn't atk bio vhat Dr. 9ticbiaa thou94t later in 1945, 1 taink wAas it'a going to take is a daoision by you, JuJ,3a, tnat tasr car.'t Ewppinq in tuase tbiAq:: when t3sry have bean rulfd insduiasib:s, in fl:t# he uaW in bis depoc:tioa be didn't taiy on exparts' tspirta ln bla opinion In the caza. Md it'e a ciat;Di.: •xaai;:• aY what bapyen.J in tAi• case ol •x;+act:. trfiay to 9at in tna3sai8.:ib:• sat.rlal when the Qusr•tivns d3r1't call .*oi it. I tbink 1t'& tinf tbat Ve at i*ost t6k• a yoo3 look anotnsr tust practice. TRE CWRlt txc.pt I oatb.r tbat the first qusetion diract.d to hir was to qot bis •grees.nt with or. itjcbien and -- MR. BiRR:AGts I said did as agree with that statfYent in tZ1t rtCord? ?s32 CDMRTa Oaa Dc. SticbsaA tndaad ehanqad that opinion? KR. •IRRIDOti Ya hasn't oDanysd that one bit at I fBYLf.IS T. LCVi6, Csft 6 aoxN:u It. !OJlTaa, csR
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I 2 3 4 5 G 7 a 9 13 11 12 13 14 ~. 15 16 17 14 19 20 21 22 23 24 25 • Milla - etoss $619 really thou9at t4li t,u*oi Ya:? A Tatce's no d.tttraace for all Lntont= and pgrpviiss bstwe::j ti:o tvo. It'a luat a llttl• 9ame patho:oyists pAay wben tuay Siaqno.aj siidos. So** eali inttrs.diatt cells and saa. ni tw.a caYl tb.m oat coll. Q wb.n you playtd tnat qaat at Yout dopaJition -- 11 1.ra4 a::kad to p:ay the qaot anc3 I ayratd. ,~ St WA.: lA:.ttaaJ3iLlT A Taat'a t iyiit. Q NVw. Vr. K:lis. 3vrlhg y4jr teitiOVnl you haJ! Lt:.tLtitd ;lor y,wr view:4 havs chsnqt3 over tbe yostd an you'v• qaine3 ro:c •:prrivnCr •n3 you'VQ a.aA aort dsta. 13 that cot tect: A ~ast'x. corr.cc. :t'a not wat .y vi.vL tnat Dav• cnaliqcd. I tt1ink tveryont':: vi.ws on tbao cbangt3. tumors bavt Q tiars tnaj all cGanytJ tne vay youri have? A Protsa:rly not, but I tnint asony -- vith aptcit ic t.ttr.nCe to bw thtao tu2ori sbouid be trtatt;l, I tb3n+c th.y Aave. Q nvr, a3 you've taicititd, there have boers cl,an4t= in tbv t.rain,ioyy uasJ to dtar6nose tbtb• variou* tusors, corrscc? A Yfz. i've changed aY own tacainoloqf that I usa an3 so bav. otberc. Q UZfd to oall tb.ro aLypical carolnotd an3 Aov tA*ry'tt va:l-VilferfntLatod Neutoendoctin• Carc3nOVa+T Ln m J 0O lJ1 M v PbYLLIS T. L6WIV, C3A i 3ou,A: M. rMsr04,191, CsR
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0 0 i 2 3 4 S 6 1G 17 13 Nillu - oroSs 5629 1lnaver i No, I do nut. Do Yoj recall tuat quo::tion an;i anssvstt A I recall that and we ta:l:ed about toot th1L aornin2. Ah tar •s beinQ the todividLal who detero1nez the doLayes uC the druga and bur of ten tbey ats oiven, ro, Z don't con®ider ay4tlf an •ui7ert in that araa. Sut in terms of vhich patient should receive additional tAerapy, i sn one ot the pe:+plo that gets con:.ulted to a&ke the deeiaaon. Q Bit you don't aake the dociaionT A I provido inp.it, but the clinician, pcrion trratiny the pot;ent iz obviou,:ly funda.Qntally responLable tur the care of the Pa:i.zt. ~ Q Let me ahov you you: depo.:ation borc. hya;n, it':& page 301. ?h.• qwestion I riadt Oo yoa cvnoidor yourat lf an exjrer t in tt+e area ot the trtaLaent of the lunyi tZ.7. Ms. Naiters saids I as&,u%e y4u eean tdat in tna addLcal senae, no: tho ieyal sense? And you iaid, yes. I an asyvsinQ y,u oean, vuuld I offer ay servsees to pattanti in the hospatai as a phycicaan regarding trea voent and the answer aould be, acr, i do not routinely •ee patiento with lung tuaora and eouno.: tben on t !lYLLIS T. LP.WiS, CSR & J7A.`~.A N. jiOJ.~'iT.7:, C8R
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1 2 3 4 S i 7 M:llc: - C[oSO SS21 tncreaseJ? h I do 3alieve it's incce.yin9. NY cwn ex,j>erlence •nd tiiot of a:hor . it ,u incrda-Jin9. 4 And you be:ieve taac t:re •quasouu cei4 oancer, tbe sinJ yoa i•ld was sklti 214/0, Zr diCtemilA9• Cott'en? A Ttior• in oora• •vidoage, yes, and ry ovn expo: iance ceflectu they'9• decr..slA9 soswsaat. Q Yoce deoctioeJ tnia •rs• •a one va.re tbe dats 3uzt v.l4idil't atand st111, corre:t? h 1 kncw I uueJ tbat ;ohcas• yentecday. i don't knr.v lf it wa:. In rsttrenco tci tb.t. 0 1 oon't tuinx you u4rrJ it yeit.rdiY, I taink yoo dZeJ it 1n your dspoxirion? A Tai.'s riqat. _ _ V - ---• _- -=- - - Q Lf t• a shov you yaqr 297 and wyhe yov oan •- __that W.1 i tMrca:.in yout tecollection. M:.. NA:.TEASr Itusc llnt? KR. COi3ls Mi* wa:taro, ttre ansver ststta at tbe bcrttoa ot 283 4n lius Z4, turtx over to ptye =67 and tot phra:e •d.ta juat vou;dn'= stand etl:1• is on lane e:Y. MS. NALTLA3c Are you qoipg to cead tbe vho2e tul.: quertion snd •nsver? MA. COG!4 I'o •boving it to tbe doctor tirat. Q Ooctot# aiaw• it•s .y only ao;ry, You doA't oind it I A Uay. cp m ~ OD ~ ~ Ln o+ tlIYLLID T. LRWiS, C8A & J3ANtJ6 A. MOUSM:1, CStt
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~ 1 Z 3 4 5 6 7 6 9 12 12 13 24 ~ 15 16 17 10 19 20 22 23 24 25 . Mills • redir*ct 56S7 Q In youc •xperistoce, bsve You •ver seen a sicVation vbere patholoyicts have ooaseAted opon tbe pcisary patboloqlat'i diaqnoUis In a aase? A Mo. I have not. latoolo9ists often eonfer auong thoaselv*n regarding ho+ a case aGowld be signed out, but tbey invariably pr.aent a unit*4 front in Choir final diaqno~iiv. I have never •e.n thoo dlsaqrta in a separate note like tbis. There may be carei In rbicb an obvioar diaqnoais can be madr, ar.d it ia diseusiod aboot the posaib1llty, buc this casQ has one tinal •• ons vecy eleaccut dtaqnosis by Dr. Snyder. anS then adae d.scuozton about two otber pataoloyist.z vLo disaqreo. ' 1 Aave o+rtainly been involvod In cases where Aot all of us agreed on the diaqaoiis, but we us+u,:ly •spre:s it in the linai diaQnoaic. Q Is Dr. Ioi:biR's naoe here? l1 YUa. Q Ia or the saao pateologtat that incorroctly diaqnoaed tne tunor in 1931 as a carctnoid? A MiqSt. Ora the ia:tial lrosen iertion. Q xr. fiirieve diaoussed with Yoa •sveral reports that vere writtsn Ory Dc. Mt.icb.n, on• va•r bis operat3ve report in '12, and one vas a rtport In 1983. boLL ot vbitb ha teterced at tiocs to Mrs. Cipollone's t"or as being a YJY:.LIS T. LA1IS, CSR 6 J*JU4.':r M. lOUSTOZJ, CSR
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I 2 0 3 4 S 6 7 a 9 10 11 12 13 16 Is 1S 1G 17 10 1S+ 20 21 2'' 23 24 25 • M:lls - c9dltect $630 0 Nhat vaa hia diagno.ia? A paail cell carctnooa, oat ceil typo. Q When ae c.yc •oat cell,• io that the saoe tb:s19 ac a s,rwll aell? A One ot the •fnonya:g se talkes about a tev sinoteu aqo. Q Look at the note and cead It to the jucy. A Tb:s tumor y aa also exaAIned in oon,rultatton by Dr. IoacbiW and Aotte:dan, vi,o belreve tbat the pt.sent blop;q a: •ntirely siarlar to the tuooc dia9nose4 tn 2451. Taey teQ: that ti,e prssent aocpholocy ia consistent vith the ea:liQr d:aQno/ic of na2iqnant circlnoid twxor. 0 Esp:a:n eba: a Diopiy it, hav larqe it !a anJ aoo :c c:oxpare;, to a rega:ar alJdc o: a tusor once renovo;i? - A it i4 a aaallec pisie of tta&ue, a traction of a cu3or reaovto initialiy, and 3n t,ts particu:ar cese, the :arqet tuwur vsj temov..i alter tttat. Q ic a blups•y 44 acc;urats 43 a tu:l set of illcii.. troal a tumor in rilagno4ing a tuaor? A Can bt•. But olten onov you #Afc sore of the tumjr, e:pacially tuaora toat have so:+e vatiation tn tboir app.arance, yoa c.rtatnly bave a bettec tsaqa of v.:at the overall appearance of a tusoc is, vt,ece you have dli o: the tusor to lOok at at. Q Did Kra. Cipallone•s tuaoc have vacaation in appoacancoT A Ye3. tNY:.LIo T. L1+11i3. CDR 4 JOIL-M Il. NJ:1S:-3'•i, CGR
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1 . Milis - riedtrect 5464 in '03# as •Ypr.aaed in somQtbiny In '0S. TidC COURTi I don't Itnov about speculation, dow did that docwspent asaiat you In artivlnq at your opinion? Is that all ripht? ltR. COeNa That wa4n't the Queition. TdE COURTs No objection to that? MR. CObNs «o, your donor. A it helped rrw to und.rs+tand why tbe tirat Dr. Stichiea was having prablera3 with the terminology early on In Mrs. Cipollone's diseaje. It also shors that It was his opinion that aithuugt, her initial tuoor aay have been a wQil--dilicrentiateJ n.ucoendocrine carciAOOa, by the tia+o abu doveloped ber Fi:st rocurrence, In hto aiAd, it vaa' clearly a saali cell neuro.ndoccine carcinooa type earcinoaa. It beipeJ 4s to andsrstand why be kept usinq tbs two tera:.. It ciaritied that be was convinced after the 1931 cQcurren.:• tAat her tu"c was a an.l: cali type carcit,or.a. 0 What did Dr. 3tiohl.n say abo.tt the two tomora, about th4 transition fres 1981 to '627 A !ie tboudtat perhaps tbe tuaur bad bequn a well-ditEereatiatu.i neuroendocrioe careinosa and then toraeJ ot at.anqed into a aaall ce:l neucoenslocrine earcinoma. Q Eo be thought all along that the 1931 to4-ir waa a weil-difler.ntiated or mali9nant oaccinold and that by 1902 2 3 4 s i 7 6 ' 10 11 12 13 14 ~ 1S 16 17 13 19 20 21 22 23 24 25 1dYLLIS T. LViS, CiR 4 JOAHt:Z M. YOJSTvh. CSR N
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• S 2 2 3 4 S 6 7 tl 19 K111a -, tedLt*ct Sttchien belleves that !lro. Clpollone had a ssail aell c+3rc1nomA. 5667 Q Noa, le: so juot ahow you and tbo Sury the docioi'i aote of Dc. Na:han Seriff that vaa aecond fol:covinq the not• ot Dc. Stichien. Do you tosemi,er wbo Or. seriif vao? A Tez, hQ vas the pula:.nary spscialiat. 0 He'+: coxxtnttng on Dr. Stfcbien'o note above anJ do yva rocognise Dr. Seriff's si9natate as con:cistent with tho otGe: o in the rtcorct? A YO~. Q JUlJ lchiy seani. pilaiansty, oo=rect? A Toat'a rtgat, 0 8c wao the pu:Qanary apscaailat an tb! cave7 A Ye;i, be va4. Q AnJ be state4, I nv:4 B:. 6tiic:,ion's comsWnta v:tit aaJne4.:. Bit surgery vay the proF•et course anc3 even it aaa:i celi atill b.ve c:SSutuerapy a•+ailable anJ if locaiiteJ to che»t, cbanCt uf aure, slbait small, tbough the X-ray sAor dlftuae no.iuleo. Ancd taan he qc+ta on to dtsct ibe •oae other f indiAg. that I don't tbink at• pertinont bete* t1 Z aQtle. Q Nuat is ttIe si9nificsnae Of tDvs• notOa vith r*gard tj tt,Mir f.elinys axwut the diagnolta fn tbic case and tha tBYi.LI3 ?. LttWISs C3R 4 J.7A2i'.+j3 M. H.70STJ-3, C.r+P.
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I 2 0 3 4 S 6 7 8 ~ 10 ll 11 13 14 ~ 15 16 17 16 19 20 21 22 23 24 25 • Mi»r - redireet 5660 to small ce2l. Vbat be decidod v,.s it vay amaliqnont eaccinosd that changsd to s0all cell ean:er, so vber,ever tie is referring to a catainoid, all bt !s doing is c.t.rring back to the 1981 oraginal diaqnoais ond aarrying lt tArou9y. sat it is very clear by June of '82 ho belleved it vao a wwll Coll ednc.r aad wae trsatini her for it. Tc,at is vbat that recor4 states. KR. 8IRA1D-3£i Taat is not citar. Be vas eootin3 vith tt+e yiai»tift'a lavya:b and sent them a report in M3. Thi„ ls three years after ttio faot. The recarda of Dr. Stoichen ouglt to apeaL• iZ0r thr40aivtl'. Shey l1awe been a,icaitted tn •vidtnve. We ctlpu:.t.d to 01014, Itecord: at that time arM aa they sta:~•.] an3 they shou3d speak for t4a&3elvoj. Anythiny out of taat iY taoac::al. He has •lready droppt3 It !n, and I voi thc bene: ic:acy ot lt, but to W1ng it in tbrous:: tnoi r da:uoenta i:, not -- ts inadai.jib:.• hearaay as You csn yaz. N;:. WALTCR3: Pa t L of the oaJl cal r e:ord: t:: i°.* d4ctor va3 qive» to r..iev and rely on, pact of tde sod:ce: r.corJa. Dr. 6tescr,en 9avc to us -- Kk. SIRAID.:Es be said in n.s depoaltton be did no: raly on •&pert r.ports for dopositioA tor Ais eapect opiaion. MR. ltOR?:ITAIM ba said tn regard to other •Yprrt tecorda, these at• eot •edical rfcord:. -- Ln m J OD N P B OD PBYLLIS T. LL'iiilS, CSIt s JOJt::::S M. Q.7JSTi3::, C3R
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• • 1 2 3 4 5 6 7 12 13 14 If 17 v 1" 19 20 21 22 23 24 ZS Milla - [Ocross S632 A SpeaRinq of well-diff.rentiat.J aeucoen;loccine carCinmal I have ieen about 47, 0 bo-d many have you puS:iaAed? . A There are 17 in the tirat paper, and then we can look at the record, the Choplin sadio9raphte study haa tour sore an3 four •ore in the Pciaraon. Q S3 bow many la that? A Taat is -- Q T.renty-tive? A -- twenty-ttya, corrtct. Q You dave not pubiitheJ on the sout of thv 47? A beverz: of thew are in the ab3ttact Cocro, ou: have na: been pabiibi,cJ a:a a tora:.zi artlc:e, no. - 0 So:asLiae., at take.f tiae tot ttse ptepacacioa for tLe anatyai.:, and threca as a!oy tlas between wben y3u 9e: Lni:4 data and actualiy get It in par,iicatinr,. 1+ that riy :0 A Cuc rlCt. 0 Sort of the batute of &:SenCe? A I vould agree with tt,at. 0 You Lien:ioneJ the artic:e in CAeat, aqsin in your tectiaony thia alternoon. Tbat article cited your otudie3l didn't i:? A YeE, it diS. 0 84 it wao awace of your patholo7lc crrte: ia tcrr diaqnoais ut atypicac carcinoiJJ? cn m V OD F+ 01 W m Piti':.LtS T. LG7ii:3, CrR i JOA:INi. I!. RDUST 0!J, CS k
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i 2 0 3 4 S 6 7 e 9 10 11 12 13 14 Is 15 1f. 17 lE ' Malla - orosa s626 the data bas cban9+d? A As aiy own •xperi•Acoi cbanged and otd•r p.ople'.; •X;?erieAc•s have cbanQed, I think we have readjust.d our thinking abovt the zmsll cell tumurs. Q And I think you aaid •o"thing tn anawer to a duestiora by Mr, iirrtege, as I wrote it dovn, you said yuu think -- and correct ae if I vrong -- that eheacitberapy and the uae of drugc ehanyei almost •onthly? A we11, certainly, if you look at •:?aiiuer,tal protocola tL`r• are ncd druj:: aiway& ccrasng uut an3 cbeautisrapi:ta wr,4 vocx on tho forcf ront of cbeuothetapy •t• exper insntiny with uziny ncy dr uqG a2oU;:t on a oontuly basi4. Rigc,t . 3aciding whicn ona cot the dcugs is etie4tive, o:wi3ua:y, tar.es 1on9tr ancd thoar ptotocols don't ctiangs a:s ta-at. 0 Bo, 1 taka it tbe:i, tha lorger oDo ts a; thia 3os anJ tc,a o3re exyert.nc• an3 Jota one gets, tbe Dettrr you det at it? A I think ve all get betLer wlta tsso. Mo are al: aha:iny • coamon data base. Q he a board-certiti.d patboisr9:st, you bave been at this businoic for about sev•n yats? J1 tight. sut because I aa a p3tltio!oy.Lst I oav• tho 2u:uc y of being abis to 9o back tbrough the archives and lookir,g at out deyart.ent's ooll•ction of lung can.:ors tKat go oack foc tn m -J OD r ~ Ln v A PHYI.L:S T. LtA:S, CA:t 4 JOAJW:: M. ZiJ.73T01`2, CSit
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I i •,:4 -- t*4.c(j6a $683 A I osoucca it tGey c&t.d it they were •ware ot at. Khetber tbey applied tne criteria correctly or not, I don't 2 3 4 knw. p They app:ied the criteria of the A:igonL crLteria? A Tney liated that vhich •o ba.ically the aame au a:ne, yea. Q Lot se ba:ktrac:k on th• Arigoni articte so ta• jury can underztend. T:)at was an acttclr publianed in 1972, the Joucnsl of Car:iiova4cuIsr an1 Tuoricic Sur9ocy? A Cor re.;t. Q trom a Mayu C/inic? A Yirw. S 6 7 6 9 tC 11 12 13 Q Geiier*liy reqardo, ad tua ttrut article vhicn inttoduceJ 14 a 15 0 this concept ot atypica: carcinuiJ? Q Ancl the pdopie davn in vanJcrzoilt in tahis :.:udi+ were ui:ng tnat criteria which they out:ined in their tec:o:- a:13 C1oCn:id.: OectiJA? A T.icy liated tLo3e criteraa ahd cited tAo Arigon: oFsr and dy pa~bac# but liscinV criteria anil apl+lyin2 tnc:o are n~o: aeces:arily ti,e saa*. Q 00 You knov ot den Davia lca+s tAat study? A M~. Q Werr you avare taat be ros boarJ-a.rtif:e.i in ana:xaj, A .:oc rect. 17 16 2a 1) 21 20 23 22 MJ ~r. 24 tuY:.LI$ T. LCr1: S, CSR 4 JOANaE Il. MMTJN, C3R
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0 • I 2 3 4 s 6 24 25 Milla • redire,ct S671 understandin9 this docua.nt? MR. CONN& Obj.ction. Tas coctse of 1tra. Clpollone#a disease, aa I undoratanJ it, did not assiat Dr. Mills in rrkinQ baa diagnoiis of the hystoloqic type of cancer. U• teatillstit over and over ayain anJ be did that through the atcrosscope and the other utulf 1s juat bacicyrovnJ. TJE COURTi xeil, to the estent that he'i: rQlieci ui?on i:, I'11 pera:t rt. Overruied. ~ Cu ahea+3? A In this cor.auitation that's on the atand tbere, it aaya that tasc:net ing r rqat a;3ronal rocurrence ot aPr isaty WraLr tbouqht to be sitber oat coll or carcanc:id an.i vaat Dr. Ratner vaa do,ng vaj prov:drng htstorical background taQardiny thi.s ca4e. lte te:::ifies !n h:u deposrttoA that by tbiu tiao no v44 convfnced that Mra. Crpollone had a &as21 cell earcinooa. it's just tDas., lik• Dr. btiehiep, he baJ •o.~eo confusion r.garcling what the initial tuaoc was in 19010 it's elear troA his dsposition, by 1962 be con:iadereJ tLo cancer to be a saa11 cell neurosndocrins aarcinona. Q Doetor, lot's just take a look at a few of the rococdr lroo Mrs. Cipollone'i later course of tr*ataent. AnJ I'll show you the dizcharqe awwuvey abest froq tbe Leaox Diil PHYLLIS :. LB'dlti, CSk 6 J0.'i.ati.~^. M. N9USTObi, C6R
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0 1 2 3 4 5 6 7 8 /Iills - teditect S673 neuio.ndoorine carcinor.a ot tbe any of tboL• syvo4yta. Q Do rost r.csll Nrs. CtPo1YoAe'L traatiny pbysiclan at tiuly liaaa vas Dr. Pascual? A Us. Q And he also entered tbe diaqnosiis or caus• of deatb on her death cortificate. Ia that correct? A Tnat's correcc. Q And leti y sbov you the death certificote and a3k you vtiat the cauue of her death vas? A Ktde:y aetastat:Q cell carcinoa:a. Q ifov, .rcOen lir. Cotin •ukej you on crosr.-t1caaination aWut yxir tcatiaony in this caae yei-terday, vnere you were d:scusnln,g the cau:e of Mr6. Cipollone'd death and ha nc.tocd tha t you had u/sd tna: terainoloqy, where dic3 you yot that terminaloqf irom? A I vas retQrt:ng tv tr.3L docuuent, tbt or.+e that you have on chu dcreen. Q u1;3 that ia a aynonyin for tbe terainology that you b4ve beon uzing aii along, aaulZ ccll unditferentiatwi carc:aoso? A Tbat'a videiy u3ea as a Lynooya, yes. Q Ductor, tbere's beea nuch d.scus:ion In tbiy casu, at least wicb Hr. Sirrtd9u, abuut tbe oifference Detweon ctata one cancer# ctage two can.:er, stay• tbre• cancors and so f or tb. Yov sany oanoers atart off as stage one canceraT PiiY:.LIS T. LsatS, CSR i JOA.`aE M. tl02M.`JI:. CSR
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1 2 0 3 4 S G 7 d 9 1Q 16 25 0 Miils - redicect 5681 wbile ago, tbat luap both typical QarclAoido and rell-di!lersatiatad neuroendoctln. aarclnm&a to2.tAer and find that tbo smoking patiantc ace the oneu tbat have the bi9oes: sortality rate. MS. M.'1LTERSi Na turtnec yueutiona. TitC C4URTs Anytbin9 lurthec of this wltneas? MR. SIRBIDGCI Yls, your Boaur. Ta3 COURTs Ali cig4t. Lonq or ubort? MA. SIRSUDG?e Ate we cloae to tne bcta%. THC COJR?e We are at the break unie:+o you can d4 it tn rive .inote:. MR. SIRR2ZGE: Uon't thinr, it vi+1 be five sinu:e::. :Uc COJR'F's Hw vili tar,e and : osame at f ive to tour. TJL Ci.ERRt Aii ttje. (ReCeaa tai:on. ) ?HL C:.LRi: s Al1 r ive. Wary present. ) TJ: COUR?1 Yleaoe b• our "idaf ternoo4 receaa+ seated. Rt'.ROGS EiAMZ:UITION BY MR. SIRRIDG3s p Or. Mills, I think yoc bav in,icated on severes occasions tbat you bav. seen about 47 caaes of atypical carcinQid:+? 4% N PETLLIB T. LRNtS, C3R 4 JOAH:i.S 1K. NOUSTOti, CSR
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I 2 0 3 4 S 6 7 8 9 10 11 12 13 14 a 15 16 17 19 19 20 21 22 23 24 25 . 1lilis - c*d1cMct Si75 tQere vas sat* discuasion abNwt a distinction between t.n peroent that you had t.stilte3 to at your depouition and approYimateiy 30 percent that you had testititj to ytstecday. Couid you just •s?lain to the )ury the basts for tbat didttaction? A Ye3. It'a due to the fact that artictea ar• continuaily app.arinq on the percentage of tb.se turvrs that pcezQat sa aocslis.d dts:easa aiid tbore bave been recent studtes, very cecent t6nat I Lacase •.rar• of in ceviroing tor tQie cese that do quote ftgur.r ac biga a.> >0 percent stafle one ::s4i: cell carcinoaa. ocaor studios, eetlter utudiv.: have reportecl lower nuabeca, numbers in tbt range of ten pticenc or even r.asli.r in aoae vecj oid study. Q So toera i&~ a range ot Jplnion as tV ri1at P.reenZag:e begin or ate diagitosQ3 au stage one? A Tha;.'i co:rect. 4 Nov. Mr. Girradge questioned you about a paper -- recent papec that appeared tn Chtot, tbe periodicai Chest aagasine anJ it vai authoce3 by a doctor -- A Orote, G-r-o-t-e. t'r not •uct bw you pconuuncQ iz. Q Do you have a copy of that f+aPec taare? A Yea. I do. Q Rov &any vell-dittacentiated neucoe:iJocrine earclnorss ~ m V OD F-+ ia 01 N W PidYL:.IS T. LlWZS, CSR 4 JOA1iNCO N. iOJSTJIi, CSIt
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i • i 2 3 4 5 6 7 a 9 13 11 42 13 14 t, 1? 2? 21 22 24 25 Mills - tedirect 5674 1 A All uf them. Q One hun~ireJ percent? A One aundceJ poccent. 0 Why la it that sooa are only alagnoaod vaen they'c• already progresasW to staQe three? A it BQNend,o on bov rapidiy the tunor gro.rs, vL.u+er ita baa a large coaponent that grotrs incide the broncbaa so tbat it proJucos ayoptwau when it'a still taitly anall or vhet:+er it'6 tarcaer o4t in the lunq, in which case it can be aucn larrer anJ haie tiee to spread oeLoro it beoo&es syaptozati:. It bas to du vitli a:w oftfn a patitnt 66044, ju3i routine roedicdt ex3oaaatson, for in:aanca. 0 K;,y are wore :aa:l ce23 cauce:a aiagno-we3 a&, advanceJ sta4e dibeaae taan other type3 of cancers? .~ Tsecause they're vorQ ra;:id2y growing turoors. Q ecw .s it that Hrr. Cipu:iuno's tumur wa3 diagna3e3 a.: a at4g@ O.'1C aisieb :e? A oaa H:t. CO:I:Is Your flnn4c, tbiz baz bten .aKeJ anj answereci ab2u:. four tira.:i. TqE COJit:i I taink it Aas. Sustaxntd. ~ Joctur, Y4u aaid tbat your taink.nV had ahahgad vity reylard to stagou oi dts+casea anrl tbe percent that aca diagno:od aa eitner sca9• one or stage three tuoor:4 anJ PHY:.LIS T. LENl3, CSR 4 JOA:j:iZ H. I3,USTON, CSR
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0 S 1 2 3 4 S 6 7 a 9 25 Mi11• • sedirect $636 A That was s+ade at the tiiw oL ber recurreace in 1Q9:. Q xas that tba biopsy? A That waz sado •- yea, I beiieve It was on the biopsy. Q Naa it also aade subu.,luent to that? A Ye6, it va4 oaJe subMluant on tbe Ct.ectton of the iuny a:: vell anu !t wac ai.a sads on tpe adcenal pass in '03. Q After 1932 did any of the doccocs tbat were treating Mrs. Cipvl.ono refer to this cancor sa anything other taar, a ar,all cr:l cancer or one of tdeze ters::t A ti.,, tnvy dtd no:. Q lund wl,a: .ras the diagnoLts on HrQ. CiNolione's daaLn certlticate? A I don't reaumLer tw exa:t vord:ng tr.tt tt vaa cao of 't:,e cynonym:: in that c4teyaty of sual: ce:Y neuroe:idocttnc catcinoLn. 0 7na: va.; in 19Ci? I. Tuat'o riQbV, 4Cto5or ot 1904. Q Do:tur• thet0 vi-s a discusuioA vitU yoil aQd Mr. Sirr:6yo abJJt tNo u:.a of ta• term •atyptcsi carcanold• verbuz Lhe use of the terra •.rell•JiLLMrentia:e! neuroenducrins carclno+4s• aad you statej that you prote: to uue L'ae terainulo9y •vell-diELarentlated nesroen3octtno caicinwa.• Cou:d you tell the jury why you preter that tar4? A Tas. I've YseJ the terc •aty;.tca: caretno:dg in the past, but I eotir pret.: tne to:a •well-ditferenziated ptiYLLI.^. T. i.Ca:3. CSA 6 JOAS:ia: M. lt'7t13S0lip Cre:
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1 2 ~ 3 4 3 6 7 8 9 30 11 12 13 14 ~ is 16 17 le • flill• - recrosr 5696 A zbey oa*1 that t.ralnoloqy and they ar• the only onfM who do. Q After our discuasloA I Aat• to brin9 up Dt. eteicb.n ont •oce tioe, but there was quita • lot of taatirrony in Youc rediroct about the views at Lonox Hili Ifoapital oo rbat !lrs. Cipo:lone had. In t.rss of the dtsaast, you were quit• confident In sayioQ everybody believed sho bad awll roll carcinosai is tuat corrtct? A Mo revi.v.J her recor,u and showed what I base tnat on, yls. Q I vould lika to spov you. Doetor, tpia la the p:eo,erativ• cepurt 1963, R.ae®ber in 1993 sb• is in to( tno adrenal proylea. ?ber• bau bean an x-ray. Ilow th.r• is goinq to be surgery? A R~y:zL. Q Oicay. You, toors i;: a proop•rativ4 dia9nosis. oefore a avcqeoa go*s so, bt bau a pr.upecative dlagnosaa. Wha: I tntr.k iu yoiny on bere, what I tbink I will do? A it is an oJucacN 9uen:., corrooz. Q Sut that is his dlaynoair going Into aur9ery? A ais pu.sa 8olay Into aur9ory. Iawdiately aaperM.dmf by tho diagnosis that i» aa3e on tne patbolugicai .at.riai atter tbe surgical procodtire. 0 Wovld you agree if Dr. Stoicb.u bad a diaqnoale in June PBY'..;.IS ?. LCW:S, CSR 4 JOmq:ic lt. !iwmN. "tt
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• 0 1 2 3 4 3 6 7 /I;lla - reaicect 5669 purpose and coocern about !t? A hgain, it docusent4 that at the tlas ot this recurrence, Or. atichlen be:ieved tRat Mcs. Cipollone had a saall ce11 neuroen0oCcins cacc:now. Ne va3 concereed about the taot that she had bad sucgical reseation for tbis twoor bbecaus• at that tiae, an we .entioned batore, surgery was not confiidere4 the approyriate way to treat a•aall cell neuroeadocrine oarcinosa. Q In r.trojpeCt, doctor, was tbere any real concern aLout or should there have been any r.al concern about operat:ng on a cs+all ceil cancer, Q MR. 8IJU1IOCCi Oojection, your bonor, torra. lLS. 11A:.:GRo: I'll repniaae it. • in retroapect, doctor, vnat wo3 tuo nst •ffect of the surgery that vaj peaforaed on Mrs. Ctpa2lone in 19a1 and again in 19823 A 3'aa nst effect waj; that slho got exact:y the lorrs of therapy that at tt,ir point ia tis» we cesoqniie at bera9 th+r uo::t oeneticial to protonging the life of a patient wita saa2i celi neuroendoccina carc:inoaa. 6be was unlucky in the sense that sbe gat a wncer at al:, but she ras tortunate that ber tuwr ra• diagnosed tortuitously wsen abe yust happened to accorpany her husband to ii phYtlcian. And sbe vaa alao toctuAate that eonfusioo about the dia9noai+s eirly on actually lad to ber having what we now know as tUYL1.IE ?. LIrW1S, CSk 6 JOu:7E m. H'J'J.iP;?Z:, C6ji
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• 0 1 a 3 4 S 6 7 1S I C 17 iI 15 20 2i 22 23 24 25 Milla - tedXrect S6S5 sOpPort yoUr oPiniona in thio case? A W0:4, znall c.ll unditte:entiated carc:noa4a or saail cell neuroend"rine •ore Itequent7Y acise in broncai as appo4ed to tho tact th.t ve:l-dtftere::iated nevrovn2occ:nr carcinozas .ore typically arise far out in the lunq perlyuery, Q Can atypacai carcanoid2 ari.e ln dconcbiT A Yos. Q Can asa2i cell concero ariye aWi• pertpbecally? A i eY. C Wujid it rat:er vbetbsz tae tumor va: in the oid-iun,~ f ie13 or in one o: t:aa wain btonchi in -tero: of the J.Jynoolo? A t:v. Q Caqsr.:Le-inauccJ con.;er apperec in any of tao otjr..:;,i? A Yej, tbey can. o 016ay" aoctur, there va6 soQe discusei3n vi::i .Yc, srrrteye atiout tne d.apute aaong the pa:noloq:ats on the bio;J::f ih 1992 aboit tiae specitic cua type or negroen:iocrane carcinoss thst tfr&. Cipul:ond hsd. Let uM tooR at toe entice potAoloqy report here. W1o vaa tb• primary patilo:oytat -- vho vaa diaqnostnQ Mra. Cipollone'a tuaur at that :taeT A Ra1Pa 9nydec. PHYLLI6 ?. LQWiS, CSR 4 JQAaR~ M. YOJS: ON, CSF
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• 1 2 3 4 5 6 12 19 19 2.) 21 22 23 24 2's Milis - recr7s:. s63a I KD. MA:.TE:RLs If you aro fanlabed Ny I tako a:ook at it? Hk. 9:RRID;.Eo 9ure. 0 Yoj indicated D:. Steicaen belleved it beQan a& a saliqnant vsrcinosd ancd pro9r..rs.J to small cell carcinjxd:.? A I tbink that was bi+: attempt to synthesisv what va<a baNpsning in bar caae. I aqree 3t vaa a wwl: c.ll carcinoaa. I tlon't aqrso tnat the initial tern vas an or39Snal aarciooid. T:le.+o tuaorii can change tbrir cell type at tno tia+r, tt iz noc a couAMan pbenwuen$ out occurc -- ~+ You dan't nel1eva it? A -- in talu aaro. Q You don't believe tney cAanyc c.l1 ty0sj do yoa3 A in tbiW particular caso. Are you taltinq abu+it taAur+c in qeaer.:? atypicai carctno:d. A In tnia pscticuiar a.se. Q Ye.+? A w4, I deliev that Mcs. Capultone'o tumor Wa:: a Lmal: ct11 tuuor risht troo tbe btart. Q would You •yrea, doctv:, tt,at tbere was aoae contuiion between the patnuloq} arsj alinical aiag4oac* at :.enox Mill? A Yea, I vcruld say tSe:a wan •ocra oor.t'u+ion •tsrl/ on P:IYS.LIS T. .LtW:S. Z'Sa 4 JJA.'iaM N. VOJST?N, C:iR
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Mill~ - r~Croy: Sia4 i patDolosy and clinicai patholoqy In '81 tbe aase 44 you 2 vare? ~ 3 A Ho. I was not. 4 Q Let as aak you a co+cple of vuestions, Ooctor. .bovt your r J category over here. Tas neuroena*criae carcinos o. 6 A Otay. 7 4 who in tbe literaturt on atypical cacctnoid, or 8 int.reediate neucoendocrine carcl4o", ccaol,l cell -- whu ha:s D 10 two aateyoriea in tLe literature -- sttike it -- who in the literature, vno publishe3 an at:icle on toie area, lioitrQ 11 tnia spQctcua to two tuaorc? Can you nsse anybo3y? 12 A Not surt 1 undec:tanJ what ycru ssean. 13 Q You are liw:ting tbis apQCtrurt to tvo tuaurs. 14 t,teli-difietentiated neuco.adocaine anJ aaall call -- a 15 M3. NhLTERSi Object to the fora. I don't tbinii it 11 i s a Q s,"~ c t r uta. i.et ua aay Clc+.:aitication. iLepbraae it. 13 You liaited this eiasbifioation that you doveioye3, 19 o: v1ev, you lis.ited it to two. 20 Call you tell ae one artic:e in the literature vutc:z 21 lin1 ts aauraeacloccine earcinaaa.: to two? 22 11 I still don't aad.ratanJ vt,at your point is. 23 Are you saYiA9 sw, articie:+ divide teese up 24 dttterently or •ome people include other sub tYpea? 25 Q Let .e try it a ditlerent waY. . J=at:L N. iNJJ5TJN. CSR tHILLZS ?. LEN:S. CSR 6
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1 2 • 3 4 S i 7 e 9 10 11 12 13 14 ie 3-3 16 17 16 19 20 21 22 23 24 2S 0 Nille - [oditoCt S611 Oeen preseat.d in tbii courtroos? 11S. KAL?ERSs Judqe, Kr. •icrWge veAt on at length about tbeoe two vitnssass io his direct esaoination. Tat CODft?& I'll peraft it. Ovsrrule.i. ~ Do you rnow wbat Dr: Gould'a opinions ars regarding to:j~acco an.! b*althT lA. aLC1.tLBYe I'd like a sidebar. (The following takrs place at rcidebar.) MR. 8:.eAR:aY: Youc rtonor, I can't btalsve Yoj'ce goiA9 to allow tUij vitneja to chatactQrize Dr. Govld's vlevz on clgarette s4oking and heaitb onder the quise tuat it's to shw vhe wer or not Or. Gvu:d is biasod. Dov can he poavi5iy be qua:lli.d to give or. Gou1d'a vlsv4? Tn• &aa iu going to te3tiFy in tbiL caie, let's wait and bsat wr,at Dr. Gojid say4. :':1E COJ2:': KS. KA:.7CttS, L.t be Qear Tue doctor the protfer. bau reviwe`i all of the tx;vrt::' report: in tb:a cas., so be knoara what Dr. Go ilJ'ao opinioni are. Dr. Gould i: the only one of the •rperto in tbia oibe wyo bss no op3n:cn regacdtn9 vbetbec ciqace:te eocrkiny aaasey lonq . NR. MORTUAIrr Titsre rasn't an opinion? MS. K11LT 6RSt Mo. At tbe depo,;ition be sald he couldn't give an opinion. !e bad no idea vbetbec eiqarectei caused any aiasaie. •liYLLIS T. LXN:S, CSR A JOAAJ::L K. iDt1STOil, CSR
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h' R}' b.S. 4raite:-, 4 s ~) r lt.) C `". . . R: , f . . } ~:.. Sirr55..1i COhn " 5GJ.C~ 5625 1 11 S MW -', ,I _ I I>> ',~.T . Ft+-0 , t.\ 5S 0 7 552.6 p._ 5; ,I~~4 5427, 5707 54?~~; 54 2, 54 3C±, 5431, 543i; S43 3, 5434, 54 3`;, 5469, 54"~G, 543"l, 5438, 5439, 5440, 5441, 5443, 5445, 5446, 5447, 5449, 5451, 545?; 5453, 545r,, 5458, 5460, 5465, 5466. 563?. it;' _ s-! -. . _ . 9 . C 0 ( i I ` `. v I --I
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• . 1 2 3 4 S 6 7 17 13 1s 23 21 22 23 24 1S Killa - Recroaa 5691 What vaa in tDe ;racentbeaQaT A Tnat ws odvionaiy baa favor it• terrr in parentheaea a.*u3 ba baJ a atypical eacctnoid and then aftar tbat ali9nattt catci0old. 0 Arypica: carcinotdt A That'a ti9ht. Q After Lht parenzneiaL. Ian't it a tact tbat based on Loat diagnw::c, Mr.c. Ca+ollone had an operationt A Tuat'st correct. Q And isn't It a tact tt,at for tbat perio3 0f tiaa Lhst wa;i tav aphropriate treatoent fsr that .iiaQno:tf of J:. 3o,-A..wrd 7 , A 7na:' z cor rQct, ye:.. Q And Sun't lt a fact tbat 63 a roys:t uf that treutment, Hrd. Cipol:ona'a 2ife wa4 p:o:onyo3? A That i.: correct, yes. 0 And If Or. Som.aera haJ dta3nossJ that tuwor aa a a&aa:l cell carerna;as, it iz oore liKaly than no;, tbe pbrase we hoard 3n th1: couctrcoir, t6at tbet• voa1d have been no operation. Isn't tAat oorcec:? A Tnat': tiqhc. Q An3 Kr4. Ciyol:cno'a li:• would not bave been pcolongra. Isn't tbat cortert? A Tt'a an •xaaWl• of a alstalca leadinj to tbe-approar:ate PIiYl.Gi3 T. LP.MiIb, CSk i JOAa1: K. !lOUSTOti, CSR
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• • I 2 3 4 S 6 7 8 25 Mill• - tedirect in the fac periphery of the lung? MR. BYRRiDGL't Objection. ip.cu;ation. Tu: COJRYa Rcrry. 5652 MR. SiAit2Du= gpeculatlon. Objection to form baaed oa apeculatioa, asking the vitneza to say vouid thry tsave done sosethiny. I taink it is ipeculative. NR. CO!1:1t It ta an area not in the Doetor's expertiLe, t!e ic n:r.r testifytnq about waen peopie perforae:i the broncroaco;+1. !te testifieJ be is not a puloonolog.st. ?aC CJURT: 30 teat i f ied tnac Ae kaoWs the caioabza ity. Rostate thv -- a o,ctu:, are you faaz2iac with the procsddrc; for do:n-s broachoacopissT A YQ4. KQ ta:ked aboit it yesterday. 0 . An:! the pur po.ae of tnv o: an:Aozaoyf ia to tcl* patho:ogitt tc lowk at? l. Corrtct* gtt t:o;::+r t:.: 0 Are You faaiiiar s•ith when bronobos:oyitr art PQitut2cJ bf ptjy:.zcAans;? A They are pscfoc:a*J when the pay:.lelan.: 4avt reason cc, bolieve toat the tuoor is iocattd to a bronchuai, ao they have a ohan::e to biopsy It tMroogn the broncboscopc. it the tuarvc is located tar eut into the lung on u-ray, such tnat tt i+ un3er the •dge of the luny, tbo:1 the PdYLLa'3 T. LVIf'+, Ci+R i JOANiIL !l. WV3T.7ti, C3R
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I 0 2 3 4 S 6 7 12 13 14 * 25 • 17 Nills - 1t.croow 5692 therapy. ~ A alatake in your opinioA, doctor? A .hat'+: corr.ct. lcR. COtfN r No furtber 9utstiona. ~ RGDYR:.rT EXAMiJ1:IO:J ©Y /iS. W1WTS1lss Q N:. Sirridge ahorea you an operative record dated Aujsjt 13, 1933M that ia tyNad v:th a si9natyre of Dr. Stichi.r•, at tie battora, ture.-paqt report. Looking at tuet ce;>att, do you have any vay ot rna+ring who t.lled that out, otbur than the uigniture, who put irt tho prr-oi,> dlsqAa:+t0 A t3o, I do nat. Q Do.:tor, let ria ju.;,c Ltiow you the ottice cec;.rda wwis): i bt•lievo yo4 ate aiready taai:iac vzta of Ar. SticAi.:: !oc tLo aawd d,ry that the o;rcrati.3n wa.: poctoraw3. L.: it taic to 6ay tAat tbe pat:1o/uqy repoct v~J:J r,uz taave Dven renJo: eJ at th.j tiacr? A Ye~, that is correct. 0 waac doe:: Stlcnien have in thMCe in :,3cr or:a nandwrit:n;~ for tbQ dia9no:ia on Auquat I9, 2903? A ee bas, r i9at adc.rw:ertosy, rh:csb wan3 ttaova i ot the ctybt adrenal 9iand and the dtagnoSe 16 oat cell, 1ook: lika tasoc. Q- Ii tttat toe Vimj a+i a&al: OOlI? A Ye5, it i&o PHYLLIS T. LLAIS. CSR i JOA2N.''. K. H778TJh, CU
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• ! 1 2 3 4 S G 7 8 9 10 Milla - rodirect $653 corr.ct or tbo •atab:iah.d procauro for getting tlvsue on those biopaloa iz to sticic a poedl.e tblouQa the cbe+:t tiali, a: I talkoj aboat yeatorday. Q That l,: b.canioe tAo tuavr would b• looat.d ntar tb• outside ot the lung' KR. SiRkIDvto Ob3tction loading. Tas CdUR7i siBtaiA.d. Q What ie: the rsaron !or it? A Because the tuoor would be too tar out troa tbe luny tor tne c e to be ony caance for it to be t oached throuq:, the u: onchos:opQ. Q Doctur, la: u3 qo oaclk to '81. lic. birt:eg• discuaa:c:9 Mitb yN:1 and sboweci yoj anJ tae 1jry, in lact, soa• portion:: ot tAt hocpital record taat dr.actitood H:a. Cipolionc's tu:Mor a:. actually beinq lc+caco3 pori7hecalty, or thaL vat tbe terwinvloyj ujoJ by one of the doctor:.? A Corr.c.t. Q Le: ac show you a radioloy,c rooort troa 19a1, 1wqu4t 8 21st, 19 1. If Yoo caD read to the iury the psrtlnont aectior.s tbat describe where tbf ridiologist noted that the twror vai locat.d. A fay:, PA, vDic4 s.ans pwat.ria or anterior, lateral vle4 of the cbost d..wnatrat• rounded cioarly-deEine3 deosity in p8YLL1S T. L3tii:3, CSR 6 JOJ1::.V.~'r M. !!7UST0:i, C6A
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1 i 2 3 4 S i 7 a 9 10 11 12 13 14 ~ 1S lE 1I 16 19 20 21 22 23 24 23 Milla - rtdir,ect 5638 l1 Tea, de bas written that be bas sisi]ar probleas vitn it be:auso it In a saligaant tuaor and aiso be tbinku -- tor that rea6un be thinks there is sose probisas rith it and luat as i mentioned batore. Q abat about Dc. Onsldon Roa:"ra, tAat was the origanal pstholoyiet vbo dragnobed the twor in 1981. vhst terainoloyf doeb he vse? R In 1981, v:ben ipe saw the case, be used the tera "nearoenjocrine carcinoxa' •rvM t.ad so;w synonyo. In parenthoaes, I thinic aal igaanl carcSnaid vai one of tAea. 0 Ktlat oboj: ths N1alntAtl'c •Ypfrt in this case, SugenQ Kark, utso 13 tit? A Ur. Kark 19 okoatboloyist at darvard, Mauaucaette:.. *6e ib an eYpert in t6s atea of palcronary patl,o2ogy, autbsreJ a teitbooic in the area of pu:aortiary pat.bolopy, aaJ the t.ra he uscj tor the.+e tuaora is p.ripberal aaall ce:l earcinoas re:•QaLiiny carcinaiJ. Q We talLed abjut Or. Victor Gould a!ew aiastei ago, un• oF tbo Oetendant..' eY;rorcc, and ve taixod aboJt Dr. Sbe:Jan 6omawc c, another oAV of thf dsferwlancs• •npert: in thish caje. vao alao Aapp.ns to be qrt. Cipollone'a patbologlstb for the on• diaqaa,:i: tn 1931. Are you aware that Di. S4eidon io..ers 1s a scientitic dicec:tor cot tbe Council for Tobacco Resesrct,? A Ye4. I'v have besa aware of that for a nuaber of yeacs. tHYLLIB T. LW1S, C3R 6 JOA4t43 1t. AOJr'TON. CSR
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S 0 i 2 3 4 s 6 7 Mills - re,direct SSG2 HR. AORx:ttTRiTs Can ve bave that outside of tha pre:.nce of the jury, YriiAi• ionor? TNs CJURT: Just a foundation Wettion. ttot as to tbe contanto. tw. xA:.reR:, Okay. (end of side bar. ) BY MS. KhL?SRSo 0 Doctor, without tellin9 u:: the content of the re?o:t that vas pr.paro3 by Dr. Steicarn, could you tell the Jud;a and th• jury vhnt the 1rWortanco of that docuaent va5 anJ tkaw yoa r.laed upon tost in the forwulation of yuur opinionz? A Dr. tteicuan vas oov1ou::1y ont of Mry. CiPol1onf'Q dain trQatinq phy:iciana, anj bia oonccption of the natursi course of 1lrc. Cipolione diasa:ie a3 rei:eet.d, in par:, in the-i.tt.r vas of value in my unc3erstandin9 bec diz+e:~:c... Tt1S COtSRT: When d.d you first ite tbQ iettar, Doct,r? T8"' MIThI:SS: Caa't raca:J the •xact date. I tNink It was in the large pa.:kaqe of sw;iicrl r.cosls that I receivad vUen I w as tirst eoiStacted about the oaas. ?NL COURTs And was It swsetbinq tbat you bad in your posaesaion at the tl.e of your dapoottion? litY MI?1+ZSSa tes. tjiYLLIS T. LZ413. C.SR 6 JOA?7:iF, M. 8JJ5TJtI0 CSF.
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0 1 2 3 4 S 6 20 21 22 23 25 Milla - tedlrect 5663 ?Uc CouRTLI Kero you Oxauinod abaut it? T:i3 NITHtGS& I doA•t spocifically recalt boinq exavined about it. TUS COJRTs But you had it there and it vaL identified to the ba3t of your cecollection? TItE MIVR3Ss You. TUC Cr)URTs All ciqut. Objectioa overruled. I411 yeriait it. ? if I can remembsr the quoRtion. Duc:or, could yc-u exp:ain to the jury how tr.e 1995 report written by Dr. St icAlen in thio cz.;o heipyrd you to unlerwtanJ the stateian:~; that Dr. Sticbien ma4e in h.e 2932 an,i 1933 recorda in th:4 caso whete he reterreJ to the tu:s~r in puct aa a s-3119nant carcincid7 MR. COtitrs Objec:t:on. Tai,: ab tbe pcob:ez we run rnto when one doctJt 1s cua;aantiny ulwn socebotly slat•'u acnta: state. Dc. E:zicnier. -- well, I objtct. Tl15 COURrt I overrule, it. MR. COiiJ; I objec: to the Coto of thc cjNtt:iL'1, n. T:i*S CO:JP.T: :t he test:[tej 116hat he re:3eJ ui~un at -- veil, in arriv:aq at his opiniors an3 :'a peroitting at for that purpv:e. ltR. CO:IUs I's not objectin5 to that. I'e oW)ectinq to the fora of tbis queocion, which to adting tbia vit4ea:: to spec:ulate on what was in some otner doctor'n m:nJ PHYLLIS T. LtWIS, C: A 4 JQAlIIiE N. YOJSTU::• CSR
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0 1 2 3 4 S 6 7 d 9 10 11 12 23 14 ~ 1S 16 17 18 19 20 21 22 23 24 25 . Niils - redirect $654 the right rld-luaq field. ?bis denoity is weil-visualis.d on the lateral s-tay. Ths istipreoslon, the following Is -- it Is bottoa liae basically -- roundea, well-defined o.ss density in the tiybt aid-lun4 field, toltovup recoootnded. Q DoCtOr, what io the, significance of tht` ae.ctiption uf the location of the tuior in this oaae? A We13, It pointd back to what I ta:ke,3 a:Mut ye+tter:3ay, ttie difficulty In ditferent tqcvinolo9ies regarding ul,at i.: a partpheral and what ia a aid-fre:d tuaor and vhAt la a cen:ra1 tuaor. ?. AnJ tnete vere -- did the doctoru disayree about tac IoCA:lon of Mt:. Cipollone's tuuar In 'O1? A Tnece va;i sose Jacaqr+eneat aboctt voere it eras. i qutas b..,Qd oainly on ub:cb set of teras the part3oular phygician Q Doe3 the location of the tutwr have any siqnitic3a.:e t4 tha diaQnosis of the tuoor In this c.se? A We:1, ao I ronttone3 yesterday, it providez aapp4:tivc evldeilce, beCiuie sWAe tYO4rs tend tv 4CCNC far oiit In the lYng, and Otber tuaot's tend to at/ie ln associati4n y itt4 t+tonctti. It Is Juct a sinor •upportin9 bit of t+idence, In no vay doed It substitute for exaaeining the twror tbrougc, a rictoaaope. p Bav does the location of the tueor In the broncbus raY:.;.I6 T. i.EK:3, CsA 4 JoAr::1C II. sovFi'PCK, CGR
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1 2 0 3 4 5 6 7 6 9 13 13 14 ~ 15 16 17 17 19 21 22 23 24 25 Mills • redirect 3661 MS. WA:.?ERSo The record is not addr.aoed to ut. Merely a letter frov tht doctor's file, to vboa it say concern. Mii. HORTtsTRIP, In respon4e to a letter frosr Mr. Nainer (pbonttic). MS. WAL?CRSs Maybe I vaun't involved in the caxo, an,) I acknowledqe it vas, but this doctor revieve0 it tn conjunction with tbQ recorda, it var: inoloclec) in the tuJ,cai r.cordse part of the doctor's medical senorC3 bQ revievod. :t wsy be hearsay, but ae reiied on it •n3 it as rea:or,obie fo: hio to reiy on the report of a trfatinq phy,:ici&A aj ve:l aj bospatai recorde. ' Tf1E COtlrtT: 8as tio te3tifIed he rolied on it? MK. biRRIDU: in bis dopoj:tion he dici not rely on expart report4 for lU. WALSERSi Ds3n't know - Mp.. CO3t:s lie haQ teatlfied forever and a alilion tiaea he ba.iea his diaqnoais on vba: hs •Qea 1n the srides. It anythiny ts ctearer than tb:s aua's teatiwnf, I don't knwr vnat It i4. Tb8 COURTs tttore I vill sttle on St, I•ould like to pesr a foundation aa to the extent and purpose for which bo used the document aAt] then I vill docid.. You dor.'t bave to te..rqu• it. PdYLLTS ?. LbNI.~'+, CSTc i JO1WN.3 lt. B.IUS?ODi. CS1:
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1 0 2 3 4 5 6 1J 11 22 13 14 ~ 15 16 17 16 19 23 21 22 23 24 25 0 Kitaa - tecroox 56,57 of ' 02, it vould bc tDe scasse dia9aoai 2 ia J1u8ust of ' 63, saoQ caso, same patient? A Dr. Bteicben ha3 th• con::ayt that Nra. Cipollone's tumor began a4 a sall9nanc earcinoid and at the ti.o of ber ficcc reo:eurcenca and focever after tbat. rat a c®ali cel: n*uroendocrino carCinooa. Q Le:'s talk about forever after tlsat, because it wes Auquut lath bv wrote pr+ opetativt diaynosis, right adrenaZ tuzur, pu4zible tA.*rochcome cytoaa, vo4eib:• atypicsi c3tCino2a a6tdzLa&il. That i: w:jet ite wr oto on Auguut 18, 1933 vaan ha vas goiny to du the adrenal au: Qory, iuR't tb4t tri4? tW. NALTEF.+s Ob)ectian. !io covered ta:t• an croaa-exa:uinat4on a3ceavy. MR. SIRRIwL'a I don't belteve s4, T:fZ COUR: c Otorru:e:l. I vt11 psca:`- z:. A :i,at iv what h:j preoporaciv• roport says.o h: I aoentioneJ that is iuusec3;ately rupor:*de,l by 44ic. poc:-opt:ativo, vr,icn ia zladi3 ce:l vatsxtouls fro:. tt,e riyn: adrensl 9:asld. 4 Iiu t as of -- lIS. WA..TCRSt Do yw bavt • Copy of cAat? MR. SIRRIDGk & You have it in your twux. !!3. NALTFUSs I don't. MR. S:RRID4Le T4ic i& the only ono I bad Wcau;e PBYL:.1C T. LtMt9. CSR 6 JO'1.yaC N. YOUSTOOi, Cyfi
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1 2 3 4 S 6 7 6 ! 0 15 Mills - redir.ct 5644 it be aaye soa.othing tbat tbis pecron baz rebdttal •vidence to do, you're darn right the vay to do it is oall his back. You doa't anticipate the defense case. lhey have been doing It for tbcee d+iyo. They take tbeir risk -- TNE CJJRTs Kaat was the purpove of Nr. iirridgQ aaking this witne::s about the qualiflcations of the dQtenca expsrtLt MR. SI&RI3GEi decauae I aat and listenod for a day u3o hiu teroinology and go over it for Four bours and use Dr. 8osaers• on the screens, vhich is juct abs:at as tac •a you can Qo. 1 nQedod to bave soao discussion of tho:v tvo bccaa;~Q Luef NrocledQd to talk aboJt tbe.9 for folr t1our s. HR. Y0ur Honor -- . KR. SIRitIDICZ1 On• otboi tDiny. Ms ba:: cas3 in hia dePoZ1tioo, i'a nat telyiny on tne dtpositton OL •YpcrL reportb. 8e's cc.m:ny in anJ tcatitYiag about what he lea:n.cJ in depo:.itAonb or vhat counLet told bii. KR. C:):::.L1 Your floncr, it was c/ear that they spent an inordinate a:wunc of tiso building their own osp.rts up tbrough Aiu vitness, that was i+ertectly c1ea;. t4ow, vaat they want to do is prevent tb:s vitne:o troa alaritYlag bis teati.ony to those very questions s: to trav eredibility ot tAese prrticUlar -- •nJ tbe objectivity of tbeae partioular vitnessov. tt?YLLIS T. LeWI6, CtA a JOl.N!!:. H. 07:lSTOn, C8R
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0 • 1 2 3 4 S 6 7 15 20 21 22 23 24 2:; 111118 - tedire;,t 5669 ap,Pcopriat• therapy for the lore af aancer tAat cAe bad. Q Would it be tair to say that Nre. Cipollone got 1985 statc ot the art treatment !or a 1941 twx,r? A Saa did, yea. Q ooccor, 1'a qoin4 to ah" you the blowup that toe detendanta sads of Dr. Ratnoc. Lbe on,:o:oqiat, consultation report on Auqu&t 23 of 1983. 1:cyv, Dr. Ratner had b*aa treating Nra. CiNollona iainco 1962. 13 that corroct? A That'.; correct. Q And ho's an exF+crt in tniw case. ir tAst cocrect? A TasC' y ccor taCt. Q AnJ dio yoa read bio doi+~)4ation? - A Ya4, I diJ. 2 Can you tail tho jury whs: Dr. Ratuec ariJ ab:pj: tbij dei.:rIPtion? A Unot Dr. itatner raiu i: ;nat it rou rea9 it -- KR. CD.I::: Oo3ect.ion. If Dr. RatnQC isu liate3 aa witno4s, Dr. Rotne: can tell ua wt:at he'a going to say. I thsnk tt.i3 ic -- I object. K,S. MAi.TER3c They Qave uatol tuia record tcv inte: that ar. itatner tbou9bt :n 1l83* tbat MrU. Cipo:ionc'i adcenai recurrence waa oat a.ell or oarcinoid an3 tb+tt'a clcarly not wt.at that seanb. SSES COUR:c Are you having ble cead ttov t1:ie P..LIS T. LE+f1S, C.BR 6 JOA.M M. UJJ.~'iTOh. CSA a
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i I a 2 3 4 S i 7 8 9 10 11 12 13 14 ~ 15 16 17 28 19 20 21 22 23 24 25 i Ni123 - rediteot $672 Xo3pital of August 1a, 1983, vbicb was after hsr adr.n.l t,ad been xtsoved. Nhat wari the tinal prtncLpal diagno.i.7 A it wa; ataatatic oat cell carcinoaa, it says of the rigi,t adrtaal 9land. Q w you recoqnise Or. Stichi.A'a aaaa on that report? A Yaj. it'a down it the bottoa. Q It'& hacd to aee. A itight, ys3. Q Bvw, vaa Kr::. Cipo::one'n treatnent transLecred tu Hev J.csay in 1934? t. Ys4, 1 Del ieve thau' a adr rect. Q Do yrr,t recai1 what bvupstal ,rtre was treated at? A 8o1y Nasse. p Ho:y t14AU iiovpital7 A Yea;, that•4 it, isa?y NaNa iiatpitsl. Q-ltnd do Yy4 recaii tAe diaqno:is that, t3.e doctora duc in;i thei t t re3ta@r.t o: tit a. C&Vol iOt4e at tIOlY Ntae Uo~~ita~? A I ceCall thom in suh4taace bu; Aot the exaet wzcds trat they u6od. Q Can you tell the fucy ttie substance of the diaqnoafs7 A ?tieit diagnozes were titber amali ct21 unSitferentrate,3 carcinoRa or the other +cyaonysx that wt talkeJ alio;ct, adt aeil oaceia"&# cho:.* tera4, not well-dlffetentiated 1itYLLtS T. L*'dIS, C3R i JOA'::45 !i. BOOSTa7, CS Q
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0 r • 1 2 3 4 5 6 7 a 9 10 11 12 13 14 is lt 17 Nilla - redirect $676 did Dr. Grote have lo toat paper? A Ae b.0 21. Q An9 how sany of thoae ver• saoksra? A seven were •r.oicers. Q Wers tbe:e fJYr non-rwokers? A Yta, four who said,tbey never soolced. 0 pov doej that dat. cwrpsce to your data and the otber literatoz• on aaoking anS weli-ditfstsntiated nturoeAdocrins corcanoww? t. It'a dift.rent trov what a+y •sperience baa been and what tne experience 4as i+eeri ot otiatr studies. 2 14 taore any rea::on toL that that you can Lin3? h wel:t wy su4yiexon :3 thaL in tbi3 study the autnoraj reviswed Waat thay called 31 cassf. KR. CJUN: Oe;eQtion, yuu: 6onor, auspicion, I tn.n4 there baaj Qot to be saa+e noie basis tor sxpsrt testioony than tl,at. TUt COJR'Ti I don't knov waotoer tbat's a f iyjce of different traM your37 ~ipa4Ci~. ?IJ3 WiTaEESs It vaa. KR. COt!::e Titiat'` what I bsicd. p Doctor, vbat'* your oDinion about vay thoae fiqure: ars A TAa autbor3 revieved 31 tuvors that toey te:t vesM in tue aategori.:: of sitber typic:ai oarcinaid. N ;s PiiYLbl8 T. Lt`.ia5. C3R & aOM::Z M. bOUSro-N, CsAI
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I 2 3 4 S i 7 I 9 10 11 12 13 14 i3 Hi:I~ - toctoaa S6~! re0icclina tb~as. Q What do you d.Eiae aa •arly oA, doctor7 A 1981* rAsn ahe had hoc iNtttai tusiar and than -- Q 2982 and in 19037 A setoce h.r surqory for ser ascoad r.aur:snc• and ve ja:ft went through 411 thoss sedioal r00ords. Q Mbat was the date •4 this one? A Tb. dat• on this s," ts 1083 and this ia what wjust t.lked abouto tb• pse-operatie• aiaqaosia. I tt,ink anotber reason Dr. sticb:sn put yrQ-oPera;:irt dla3nu4i.• Ur yusction ut r.aiaynant caccino:3 4e wantv-j to qlve tirs. c:ipulione the Lenefst oC ttao d;+uDt,. I tninK ae waa stitl concerned about the propti.ty or coa vniUc• n: opvtatiny on a sa3:: ceii earcinasea aetastaai:.. Q w you reaob.c vs taikMd thsa aoraany :n cr.o cross,-Qxaaidation a5oaz t,ha anei;.Le:.ia aonju:tat,oni A Ye:r. Q Done on i/1d': A xey. Q Doe:.a' t it tit witL thaa e/18 r.gort? A That would pars been at the tiae oi tDf saos •u:gecy, tbat'• ri9ht. p Cerr.at. liat ws 19t3, va..'t it? A lMat's ti9bt. Ife talked a0oat ta taet that the "astbssioloqiat vaa aot a ttortteq ppyaivian in this oou.. PHYj.:+IS T. LC3iv, C52 & JOAtiSCO N. D0q3TJUP L:iR
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0 1 2 3 4 5 6 Rilis - codic*ct 5645 T1iE COJR^: tvan aos"ing tbat that's t iqt,t, tuat they brought out on crosa-ts"inrtioa the qualificatia na and rtspect. ii any* this witAets botds for the otb.rs, bow doea that aot into the aont.nt of tb.:c opinion,a? MR. RDLLLs Do..aus• that goes to his •valuatiun of their crsdibility. Nov, it be finds it anJ You can auk bis, your donor, I'll aak hi• or fts. Ma:tors wiil* a• dwsn't finJ tb• testirony to be ccssibi• that any pataoloslst in today's soci.ty aoild not bav• an opinion one way or another. 8c finds it incroJibls that a patnoiogiat cojid ooncludO at taiz point In tiae that ti9arottt saoktng is not a cauje of luny cancer. ~ THt COUR: s Ars you qolng to go into that? Ms. NA:.TER3t wpil, tnar• voaidn+t be stich to go into bscao;.a a11 ht'll sai is Dt. Oould is one oi -tbe tto pscna:ugists that is ars52t to foto any ol.ioion, that': vaat ne raid at hii dapo:itios, sither way. KR. XJC:.Ls He rarttwad tbaL dtpo.itton toatiaony. He's nit dispaLing Lt. MR. a:.SAKLEYs Zbat's the way to do it, KR. 1tOLLts 1 acked a apo:ific a:Jaation. it'a not like you bavt to ttad 42 pages to tvaloat.. !'be queition is, is there ... Nr, i2oakioy dooa tbts all dvring the triai. I have n.v.r, I wish I have a oaara tor orary ti... I ntvar in ali the ti.r I tried a case •o.n anyt,biag iika r .~. PbYLLZS T. LEyilS, CSR 6 J3A+t'vE M. NOJS:ak. CSlt
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0 1 2 3 4 S 6 7 a 9 10 11 12 13 14 ~ 1S lE 17 18 19 20 21 'l 3 24 25 • Mills • cedir*ct S646 tbiQ. Touc donoc, tlaat'o not an objection, b.cauae hQ'c never i*fq it boforo. ?nts ls perfectly leq1tiarte tedirect on an isaut tbat they btooqat up, the credtbiiity of tb.ir vit4eases and b:a evaluatiop of tuat credibility. Taa• are factots t5st coms to play in tera:: of hts evalustion of the peopie, tbo jury sbould know abost it. An;l i'• sorcy I atepYed on your toes. MR. COaai Can I say ariaothtng? licst, I tuink it'i far bojona the ucvpd of the cross. There vas no yuestiVn ot cra3i5iaity. 7:iiL vitnesi: Das alroady te.,0*titie;l a: great i.nyta that pataologi:•.a lo::kinq at tha aoce t1ic34s can difter. It has nothing to do vitb crtdi5llity. • Secondly, ths plain:iff 9oem t:rat. He ba:. the burden of ptoo:. ?ne dof.nsa-:y ;+ut on evidonca to an::ver tov:. Thst doo*n•t xta» thc piaLntiff qttj a e.zance to try rt- II wno:c direci eo::e and r.butta:. Rebuctal ic to anycG~ni neW tLs: co~.~a4 up in the defense. ?a:s !a notbiny ne« that':: sar:ng up. ?Ao d4ienje uaj to an.cver tne plaincitt.-:' caas, Yoar B=1or. I think thia vho:o tGinq ab.iut ttDuttal is aisjing the putnt. The point is voiY siople m TttSN COJRli What atwut the factor that tbio vitnQ::u bis wron •xaainsd as to ola vi.vj~ of yout •Yperta anJ ha.: 1AdiCatf3 biC toliabillty? Mby aan't thaj gind out vaethtr he has an opinion as to vbcth.t the inability or faiiuct to PUY`.:.T6 T. LC•f1Se CSR 4 JOANN: n. tl'JUS:J:•, CS,i
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1 2 • 3 4 5 i 7 9 9 10 11 2? 13 14 17 23 20 21 22 23 24 25 . !ti»s - r.dirfct 5670 docuaent or -- tlS. MA'.T6R: s EIe is testifying about the depoaition that •xplains this docuaent. The detenc3ant3 took tbat d.position, Judy+ . T:,ey •saaiaa4 the doott,r at ien9th and then they prejsnied the jury with this docuvrnt as it it meant coaething eloe. :EtC CAOR:I Again, I think you havt to lay a losnJation as to vhatnet or not the toading of that dMposition in any way aaszisted hra in reoderiny hio opinion. T;i• scrc tact he rtad the deyoaition dcro.:n't swke it a3v+:Li:b:t. Mit. C01t:10c ?:if6 dicuoent. ia in •vidQrk:e. It can be Lead fro:a. I thank that'4 a;x tha: Mt. Sirridye shojid d:+; read Irom lt. :3S. at.;.TERSt He calteJ tAt vitne3c and it he meanr acr.e:hiaq o:arr chsz vha: it asana -- Mn. Cai:iij Ar. Mi1-iL is PerleCtiy capari:e of anwerZny queZt;ons. TdZ COUR:: Lay the lovnds aon. Q noctor, ia revieviny 3r. Aatnet'a deposition, did that aid you in coolnq to an opinion in this case vit4 regard to tnLa record? A It vas on• of the tactora thdt belped se dpdetstand the coursy of yrs. Cipoilona'a disaace, yes. Q Could you tell the jury bow that aided you in ~ m ~j 0o F I ~ r Co taYr.LIS T. LVWI S, C$R a JOAN!tt M. NJt2STJ[?, C."+fi
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0 0 1 2 3 • 5 6 19 20 21 22 23 24 25 qilla - tedirecC 5666 aentloned, ace nsually tntered -- usual so.e entry every tiss tAe ;rhyoiclan seea the patient. p Let 6e just show yoU an •Atty .ads bY Dr. ttiahien on June 10, 1932, follovinS Mrx. Cipollone's sutq.ty. if you could tead it !ot the jury, the coament on the siSnificance in this case. This io Dr. Sticbion's siqnature. Do you recoyrsise tuat? A Yes, 0 A ytrltr.inary tevi.r ahowa the byatoioqic feature.y to ao:.t thoja of sawli cell cancer, the type tt,at sv::a patho;3sist do s.parate into aali9nant carcino3d. 8:.veve:, va;2e ali the nLae3 esamined at opetatioa were neyd:iva-for tumo:, thoie strictly attacbed to the -- A To Lhe s;+oci.en. 0 A:e inva.3ed, in ad;ixtion the raz;l;wrrr•like tum;.r zaan now and recected with a very lary* sieroscopiaaaly safe aaryin ls only the tip OZ an icebery of infiltrative tsti:.r extending ali thu way to near the sarqin of resect:or,. in tetroa,?ect th:s patient ba,i aa oat cell tszo: anJ the aiasu in tb• right op?.er lobe vag the only vis:ote aanite.tation of a snach .ote di=fuae diseaoe. Could you just coanent on the si9ntfieance ot tnst to your opia&ona that you've )oat •xptesued? A I think it's c:ear at that cine troa that note that Dr. t8?l.i.IJ T. LINIS, CSA 4 JO)OVU.". R. BJU33`7ti, CSR
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1 2 0 3 4 5 6 7 • 9 10 11 13 14 ~ 15 16 17 lg 19 20 21 22 23 24 25 0 Milis - redirect Si79 ce9.rdin;j the nuab.cs of isstients vho have well-ditterenziat.d 4euro*ndocriae caroinooa who are ssokers? A As I i.entionad yesterday, there are studies that luop toqstner typica: carcinoids an1 atypicai caccinoiA, aot the vay 1 approach it, but tSer• ar• roae that dcr it. If you look, you ae• studiea are •vailable that the patients toat were saokers develop distant diasasec and it you look at Dr. Gould's caieu, of his five Patients toat weie smokQrar, one way a alive and well tour years later uti3 the other four haJ incurabie diaeaxe. Of htb tiv patients that wece Aoa.aokeca, louic of tt,Q;a woce al:ve an.i coop.letely well anJ only one dte3 of- disQa::e. So ju4ti to repeat, sasoicers haJ a QO percent s~artality rate, and hio aon-suokers DaJ a 20 percen: norza2Aty race. 0 Lec u:, su..r.u,: ire thrt d,ata trou that particular papflr of Dr. G,4tJ. Re had ttn yeop:e with smukin9 biatory. MA. COK::s Your Uonor, objection. Suswrisiny it tor the fourth tichr. !!S. NAwTSIt:: We bave never suar.aciaed this paper betore. TRB COURT: Ovrrrule;l. 0 And yoc said five wet• ct.okers? A Correct. PIlYLLI9 T. LbtiilS, CSR 6 JOh:atC H. U0037JN, CSR
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0 • 1 2 3 5 6 7 24 25 Ni11L - [edlcoct 5477 w.ll-ditlerentiattd aeuro*nJooripe carcinooa erid otbar n aroendocrine twaors. Nhorever thia qtoup of 31 cajes, 33 percent were dlaqnoseJ as vell•ditte[entiat4d oeurorndoc[&ne carcinosa. Yn ay •xper4ence that would be a very bigh peraentag• of n.uroendocrine cancrri that vould be we1.1-diff9rentiated neucorndocrine type. rty suvptcion -- my optaioo le tha: the authoro bave in:.ludeJ In taair atudy •xasaples of typical catclnoid taxior that sayb.i bave some very •inor degre,t+ of microecoric p.eworphicz noc cruf :iciant to put them in tbe vell-.ftfterentiated nauroinJoccint cateqory. 0 Yoa baileve t4e auttaord uyoj an a++tr inclusive 4r:wp that woulJ uavv include;i not just we:t-differentiatej . neuruanducrine ciccinoua3 but wouid have includeJ a few of tbe tuaara thaL fa:l vitnin the carc.noid cat.qoty? MR. S:RAIDi'%Id: OtbjecLiJn. TbS COJR:i Sustainecl. Q H:. Sirridqe a2ao aik.J you w4eturr you vore avart of come data cegarJtny asokiny hlatotiea tha•t w.re provided :n tt)iy case by Ot. Victor Gould, vho iz one of tao dotea3.nc:.' Du you cecail that? A Yes, 1 do. Q Sav+e you reviweJ that data? A =es, I have. P:1Yi...iS T. LEd1S, C:iR 6 JOAN:::: g. d4USTOt:, CSR
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0 I 2 3 4 5 6 7 25 bfro. 0 AnJ d,d yoa ta=k about tus case? A :lot vtry oucn, a little, yes. Mills - ceaross $690 Q Dut Dt. Stichlao staa? A U• was tb• key pi,ysician, tbat's rIpht. YW talked about the way he •yntheaised his understanctinq ot this tutwr. MR. SIRRxDGEs Thank you. MS. WALTMOs Can I s.e that? pk, COUtil A fev Ques tions. AErAOSS-EXAMINATL03 BY U. COHNt Q Dr. Klila, did you bave lunolL vith Jlj. Walter& anc: Hr. L3.i1 taday? A I had lunsh vitn br. Sde1i ard Krs. italttrs sat out Q Did they give you an idea of what your ted,cect esaaination vas qoing to be? A We talked in general tera.., yez, aboat vhat we v.re qviny to covet. Q Yuu qot aome hantj about tt, tisnt? A we:l. I don't know 1f hintd !s the proper ttrr, bs,6 vQ tallced aboot the ateas Ye were going to covet, yaa. Q Dr. Nil1s, isn't it a tact that Dr. Soxuerrr in 1931 diagnosed Mcs. Cipollone's tusar as an atypicai catcino:0? A Moll, his pcixaty diaqnocia is a nsuroandoc:rine oatcinow. 0 Okay. PHY:.LIS T. LV:S, C3A 4 JonAi:Z H. "u::rON, C.n1R
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• 0 1 a 3 4 s 4 7 Mi11a - lledicect 5693 Q And tbat's the dtasnools that you tendeted ln tbis caye, Ia that correct? A ?aat is corcect. qS. KA;.?ZR3t No further qvestiona. xR. S1RRiDGt: flo turtboc queotlons. MR. C0aRs So turthec Queetiona. THE COJRT s Doctoc, you ocay at.p dovn. TAanK yov. We ctarted 15 sinut9.: early today. 1 thinK lt *L tridsy, ve can iet the 3ucy o0 15 oinutex •octy. Ho:.be:t; of the iury# let ae reaind you wo are aizting this !lon.lsy. I oeve sa,ething on in tUe •ocninj, so p:ea4a ba here at auactec of t.n ancl wo'la ot.ct pco&wtly a: 10i~0. Esavt a vecr nice versuerid. TUC CGCRiRt 3151 ciuo. Me jusy is •xc+rceJ and the tolioving taicea p.aca ou: oE tus presence of the jury.) TiIC COJRTs llease be aested. Anytning? KR. SLBAlCLEYs Yea, a aouple of tbiny4. 7ttL :.'OJRT: All tight. Itake them short and eayy. MR. BLBAALEY: I don't know wUetbec they'11 oa shott oc eaey, but, we a1t tbougbt I beiieve that Dc. Mil:3 •iqht be tlniaUeJ sooner than thic. We bad bosn •Jviaed ~ m J 0O r pUYL:.tS T. LCWI3* CSR 4 JUA!I:;4 M. HOuSZ"JV, CS$
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2 2 3 4 S 6 7 a 9 12 Nilic - redirsft-t 5642 MR. eLSAKLt!'c What doe3 that have to do vity the adoissibilitiea of tals vitneyo' cderactertsation of what aaotbcr witneas wil: say, it he'a QvkeJ? It's aoL propQr t.J,cect esardinatlon. 1t~. MA:.TSRas Taat'e all be's going to say. TttE COURTs eas be been ideat/fteJ aL an •Ypert? MR. SZRF.2DGt:c Of courst, RS. WALTERSt They directly s:a»inoJ tbe witnr:,. abo,it Dc. Gou/d and his credentials and bov be vievsd aip. It wan: on for a5ort five otnutr. aboat the two •Yrpartu, L:4at tary vact g4tng to call. MF. CD::LLt Tney tried tu build Dr. Gould an3 Dr. Sonaacw up cncuugh th:s ritnv::s, y"r Xanor. Tauy oyene.3 tbe dooc to thir rtiolo llnr of juaitloninj. Ha. SLSt.K:.CYs YLu don't o?ea tDc door to ieproper tQ:.tliaur:y. Z'r+i i; i. aearsay, youc SoRor. He duoan't kn:r++ vbat, Jt. Gaas1j'i visua aca. • ..1. i.YN:IrJ 9uro dosJ . tiR. a:.EA,.':..CY1 Look, iP that'a true, tota wu wouldn't nae3 to Lave any yitna:.:.e::, we could bave tbc lawytro stan9 up, stiage reyreasntottons about wilst everybu3y baa to .ay. ?bat's aot the way a trial vockg. I bavr never, •vec bMard of puttinS an eapett in ti,e stand in the plaratitfa' ca a aod bavin9 the plain:3Eia' •xpert say Lhta la what the v:ev of the defsn.9antx' •xport3 PHYvLSS T. L8'wT:S, CSR 4 JOAll..:. AL. HrlJSTJt:# CiR
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r I 2 3 4 S 6 7 Nal1s - redirect 5690 p &nd tive vere aon-aookers? A Correct. Q And what was the outeaae in that paper tor the svoa.rs? A The smoktts, one was alive anJ rell four Y.ars af ter the tuwor was res*ctad. Q Wiat about the otbers? A The otaec tour vQre alive bat they Yere a31 said to be incurable diLeaae or unrejectable dlseaae. MR. COIi!vA Could I have the la4t ansv.r read ba:k, pl#aaQ? (The last answer was read back by to• r.porter.) • 16 24 25 0 ti•hat a:JJJC tne iive non-saokers? A OL tr,e tivr n:.n-sasotaia t:wr vnre alive and c:inicsity trae of diofa:a4 and ane had dieJ o: diAeaae. 0 Atter oor• aany yeari? A The onu that died of d&*eaLe, dtfd 20 .wontha atte: diaqnos:R. TAe onez •;ive an,i vejl had b.dn tollo++tJ froc: 13 .onta:G to four years. Q ib thia data ccn::iatsnt rith other literature on t::a subl*%-Vt? ItR. SiRRIDGEc Obyection. What other titerature? TflE C9JRT's Sxplain it. Q On thr subject at proynovid and outeoue !or zA(picese verdui aV11-S/ldOxQrs? A it la consiatent w:th tbe other arcicl.y I nentioned ~ m V OD F+ 01 N OD tl1Y:.:.I%'3j T. LL'1i:;i, C.°ifi 4 J.1J~~ii:S N. HOUS:J::. C5R
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I S67! - tldittGt ~dirscc 5678 ~i11L a ana otblt GstCi ouP noO ot 31 caJes. 33 any of tht payr.ra tba: pr. ,ts4 Al1~tO.nSo:r iaa [ ~QCCVa= thio Si tvsotoo asutola3occtne ~ as v.ll-sittltsntiat4d the -- 1'n looking for the .aqnos! vould ~ • vscY bi9i~ that lY tp 1f04, you cart take ay lsp+t:lnco youla D° Canc~c,, tlwt 1 aad dlts~roin• which n.uc~n,locc•na ntu[o~nd°c` lns tY~• that var• saoksr:~ ao~S :taod ioD is tba= t~ •uthar4 bavs .- IDY p?1a LilKs7C usPictoa caccinoid lQS oi typicai rttQ included in that :Dalc atudy •taap oi eiccorco~+1c dt~clr:+ •o•e vec, rinoc avo them to tbs at th• data bQ t nou arut:icLon: to Vuc. cina catlgo:y• ition. On t!n of h,i ntacosn3~c ~ sntiaLS3 o.~,tr inclu;~.~'s qt~u, uyt3 an the tlevrnth patit,~t. 6ie4a tue autt~oc~ • -31ttlclntiatlJ r u~t rl~l f Pa~lt~~ inclucieJ no. 3 v o0 bavt bav• inc;ud+t~ a ta 3 butv~ld ~ccin~ catlqoty? :c ie+* is cacc:+no;d ne hod asol:inq 3uta on ~ Eaal vitnia~ t tha~ xR. b:RRI0.::s av~tc`'iun. no.~-.aul:tci. S~StainvJ• d to be TbZ ~~~1 ou Wtro avact ot as~cel you I ijetiuec Y d Ln ts tba: data cu:~hare .e also thi~, u.[s pLO % lids ~ Stcttd't vith te:jsct tc, tsgsrdin~~ aookiny ai•toTil~ ~,.~o on! oE tao Oatsaj•n~, :a 'oendosr ia! ~ce by Dt . Viet ot G°u13. :• cail tbat? Du Y o,t t s es~ i do• data? av! you rlvi*+eJ that t.s. i havl* totY. Not liu[t of . troo the pspa::; nq and ytsttrday t+ ~ JpA.:.... . d~'TO ~ C , .... K us:aH, cS~
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1 • 2 3 4 S 6 7 a 9 •o 11 12 13 14 ~ is 1C 17 13 19 20 21 22 23 24 2S • Aills - recroih You will aqree vitb ie tAat Dt. Gould baa four cateqories, aarcinoid -- A woich be c2early aistinquivbe3 troo carcino:oi. stas Q Kel:-diff.c.ntiated neucoendocciAe cacc:in"a, taat uou+ d be tvu, interaediate saall cell voul11 ba tbreo, and waail cell enJoorine carcinoma would be tour? A Correct. A Duc vo are not tatkinq aboat full spectruo. CarcitwiJ:, ara ciearly di3t1n9u:sheJ -- Oould ciea:ly diatinquichej tbeu an uo do other3. we talk.d about tho int.raed.atQ ce11 type, vt,lcb Ae recognistv and I tbir+k in tiis article •entsoneci thcre is no clinical dilferehaQ ootvoen tuaLe tiaors anJ the small cei 2 turao:::, bit s,me peopta m+ke tae dictiacta~.n that we taAked abwt thiu marninq. Q :i,e group from Ca/iturnla, Cicy oE tlope, the be:lf:e:J group? A Yea. Q Taty call tai,6 Kulchitiky Ono# earcinvid. We havo Kulebitsxy tAreM, two. Tbere is Xicicbitaky one? A , Tney are the only p.opl• tbat uae that terainolvqy and one of tU. !.v p.op.e that uae tbe vorJ carcinosa to describa tb• typical carcinoida ta:kiny aboat on the ieft. Q. Toey uae it aaJ pobli4Atrd tt in Cances ? A we talked about it, yeo. Q MJ the ansver? ~ m ~ OD r ~ m w w lbYLL13 T. LCiIS, CSR & JOArt!4$ It. BOJi:.7ti, CaA

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