Over the last two days, I haven’t spotted a single journalist at the Pilliod trial. Something very odd is going on: First, the no technology rule in the courtroom on the day of Opening Statements. Next, some “courtroom manager” showed up to be sure that people weren’t using technology (even in the hallways outside the courtroom), but didn’t return to court after a journalist found him suspicious. Key journalists have weirdly switched to new projects…
This suspicious lack of journalistic coverage seems eerily like it may originate from the “Whack-a-mole” and “Let Nothing Go” playbook in which Monsanto works to control media and scientific messaging. What is wrong with these people? Toxic poison, county fair games, and disturbing clowns wandering the halls in everyday clothes are a beyond creepy combination.
About the clowns – Bayer has discreet spies with common appearances lurking in the courthouse, keeping an eye on jurors and everyone else. I wonder where one goes to hire a spy and who is given the prestigious job of selecting the spy. It must be entertaining deciding what would most blend in at these various courthouse venues. I’ve seen everything from middle-aged women to homeless looking men.
If Roundup is perfectly safe, why go to these extremes? Bayer’s behavior is like when my daughter says she didn’t eat the gluten-free Oreos but has chocolate all over her face.
I began this GG journey because I was mad that poison in our food makes me and my family sick, and that very few brave academic souls were willing to speak out about the obvious connection between Roundup and chronic, debilitating illness. Fast forward a year, and I am now witnessing so much more crooked behavior than I could have imagined – spies, evil strategies to protect billions of dollars, lies, global government collusion. It’s all so very much worse than my outside perspective could have conceived.
For Investors
The Pilliod trial is not going to go Bayer’s way, so short sell away if there is any more money to be made in this already pummeled stock. This particular trial has allowed a bit more information into evidence on the ways that Monsanto manipulated science and knowingly ghost-wrote research. The jury is extremely attentive – several are WIDE EYED attentive. I’m sure that they too wonder why Bayer would possibly acquire Monsanto when it was extraordinarily riddled with liability. The evidence is just SO overwhelmingly bad for Monsanto.
Once again, the current Roundup cases only deal with NHL – we haven’t gotten to all of the other cancers and health conditions that will eventually land in court. I think bankruptcy is on the table. And Bayer’s largest investor, Blackrock, which owns not only stock but also the bonds that financed the acquisition, is getting concerned.
There has been whisper that the cases may be appealed all the way to the Supreme Court. While Trump’s recent appointees have undoubtedly given the Court a conservative tilt, Democrats as well have helped enable the proliferation of GMO’s for their AgChem donors. I’m not sure which party’s appointees will be worse for dealing with Roundup litigation.
Trial
Dr. “Hottie Chadi” Nabhan is back to testify – it turns out that he read my GG coverage from Johnson, which makes me turn a million shades of red given my undisguised enthusiasm when I wrote about him last. I don’t think this adoration is a new scenario for Nabhan – I’m not sure there is a single woman (or potentially man) in the courtroom who isn’t in agreement with my assessment. Women of all ages in the gallery are more alert and engaged during his testimony than in others. (Well, except for the testimonies of Roundup Toxicologist Donna Farmer and Monsanto’s Dr. Daniel Goldstein – their depositions are like watching a horror movie with a ranking of 92% on Rotten Tomatoes.)
Back to Hottie Chadi, we ladies in the gallery have a good chuckle in noticing that even the normally emotionless courtroom recorder is smiling and twirling her locks. We are soon scolded by the clerk for being too loud: “Excuse me, court is STILL IN SESSION.” Great. Now I feel like a middle schooler, chatting with girlfriends in class while we doodle hearts on our Trapper Keepers.
I wonder how much it matters for the expert witnesses to also be super smart if they’ve also got this raw, general appeal going?
Direct Testimony of Dr. Chadi Nabhan
I don’t wonder for long – Plaintiff Attorney Mike Miller launches into his direct examination by walking through Nabhan’s more than impressive CV. Miller reviews his lists of awards and published research in oncology, with a particular emphasis on NHL. After years of medical practice, Nabhan decided to work improving our crippled healthcare system by better understanding the intersection of cost and treatment. As part of that career transition, he worked for 2.5 years at Cardinal Health, and recently moved to a new position at a smaller company, Aptitude Health.
Miller moves to admit Dr. Nabhan as an expert in the diagnosis, treatment, and prognosis of NHL. In a surprising move, Monsanto attorney Tarek Ismail opts to question Nabhan further before he is admitted as an expert. It quickly becomes apparent that Ismail is going to try to paint Nabhan as a corporate sell-out before he offers medical testimony to the jury. Ismail points out Nabhan’s work at Cardinal Health and Aptitude Health, specifically citing Nabhan’s interactions with client pharmaceutical companies. Nabhan clarifies that the clients are both drug companies and oncologists.
Ismail continues to work to impeach Nabhan by way of his current employment, describing how Aptitude Health “helps write medical articles and provide content for drug companies.” Nabhan replies, “And for oncologists, again.”
Ismail skirts delicately on the border of objections, making specific word choices that ring similar to those that we have heard in criticism of Monsanto. He is shrewdly painting parallels between Aptitude’s and Monsanto’s corporate strategy. Ismail claims that Aptitude provides a KOL – or “Key Opinion Leader” – network of experts to speak on behalf of drug companies. Ismail is no dummy. Using opinion leaders, albeit CORRUPT opinion leaders, is right out of Monsanto’s play book.
Hottie Chadi is peeved and wants to explain the true role of Aptitude’s KOLs. In his man-of-mystery accent, he states: “If you want me to explain what I do, I’m more than happy to, but you just have to give me an opportunity.” He explains that the KOLs work with him to better understand what is happening with EU and US investigators, so that he can better consider patient outcomes and pharma treatments.
After some animated verbal sparring, Miller finally objects that Ismail’s line of questioning sounds more like a cross-examination than a questioning on qualification. Ismail tells Nabhan that they can “continue [their] conversation this afternoon.” Nabhan replies, in a deep voice that resonates well through the courtroom, “Looking forward to it.”
GG SIDEBAR: I want to restate that I am not anti-corporation, but rather anti-anything that kills people. It’s really not fair to paint someone as corrupt because they shifted corporate in career course.
As Miller begins his Direct, he asks Nabhan about his compensation for the case, which is $550/hour. Nabhan notes wryly, “I hope that everyone in this courtroom is being paid as well.” Audible giggles and smiles arise from the jury, particularly from the female jurors. And, of course, from our middle-school fan club in the gallery.
Miller walks through the history of Nabhan’s involvement in the trial, and discusses how Nabhan arrived at his conclusion on the carcinogenic risk of Roundup. I hear something that I very rarely hear out of the mouth of a doctor: “It’s common sense.” It is “common sense” that pesticide exposure could lead to cancer. Of course, Dr. Nabhan also substantiates his opinion on Roundup and glyphosate carcinogenicity with a thorough review of research. But yes, IT IS COMMON SENSE!
To clarify, herbicides fall under the general category of pesticides, so we see them used interchangeably in these studies.
Hallelujah, another new study! Truly, for those of us on our third round of trials, it is a joyous, giddy moment to see a new study favoring our side. On April 19th, the Journal of the American Medical Association (JAMA), which we learn is second in reputation only to the New England Journal of Medicine, published a study about what the prognosis for cancer treatment is if a patient had previously used pesticides. The study names glyphosate specifically. Nabhan explains: “The entire premise of this paper is pesticides cause non-Hodgkin’s lymphoma. Let us try to ask the question: What is the prognosis of a patient who has pesticides-induced NHL versus not? And this paper actually focused specifically on diffuse large B-cell lymphoma.”
After walking through the JAMA study, we break for lunch. Before we are set free, Judge Smith reminds everyone that only water is permitted in the courtroom, not coffee. All eyes, including Smith’s, fall on Pedram Esfandiary, whose luscious hair is nicely tied up in a Hollywood-trending blue scrunchie today. Pedram looks disappointed, because he is actually merely drinking tea, which in my self-interested opinion should get a pass. Brent Wisner loudly expresses pleasure to be validated in his warnings to young, hipster Pedram to just go with water: “I TOLD YOU!”
After lunch, my new gallery buddie Jerry kindly gives me his last stick of Big Red. Hopefully, it isn’t because my breath could use help. Yup, the Wrigley family of gums still tastes SO much better than my “Simply Gum” organic chew that sports the same appealing look as my childhood hamster Dusty’s kibble.
Miller and Nabhan run through several issues at a steady clip:
- One can’t tell the cause of a patient’s NHL merely by looking at the cell under a microscope. There is no biologic marker to indicate cause. Instead, the clinician must consider a patient’s history and potential risk factors.
- The body has both T-Cell and B-Cell lymphocytes. B-Cells are involved in both Pilliod cases of NHL under the subtype DLBCL.
- B-Cells are made in the bone marrow. Nabhan states that the B-cell lymphoma also: “Starts in the bone marrow.” Unfortunately, Judge Smith ruled that Nabhan could not pull in Dr. Sawyer’s testimony to refresh the jury’s memory that glyphosate is disgustingly stored in our bone marrow after exposure and absorption. Quite a bummer, because that’s a key biological point in connecting the glyphosate to B-cell damage.
- Research Statistical Insignificance does not equate to Clinical Insignificance. “I can cite in oncology many times where the statistical significance was proven wrong.”
Miller shows Nabhan the EPA 2016 and 2017 OPP Reports on the carcinogenic potential of glyphosate, which Nabhan states he has not reviewed in a long time. Miller presses ahead, and turns Nabhan’s attention to the conclusion of the report, and asks Nabhan to interpret the statement: “Due to study limitations and contradictory results across studies of at least equal quality, a conclusion regarding the association between glyphosate exposure and risk of NHL cannot be determined based on the available data.” Nabahn translates that they don’t know if it does or doesn’t have an association, and so they left it undetermined.
What Miller doesn’t make clear to anyone, however, is that this statement only applies to the epidemiology section of the report. The ever-revolting grand conclusion of the EPA’s OPP report is far from undecided: “The strongest support is for ‘not likely to be carcinogenic to humans.’” Jerks.
Ismail objects in the middle of the EPA discussion, pointing out that the witness hasn’t reviewed the document, among other objections. Nabhan softly and honestly agrees: “I don’t remember — yes, this is a while back.” He’s been on this case since 2016. I am certain that Ismail will clarify the EPA conclusions on the cross. The regulatory agencies and AHS study are all they have left upon which to cling.
Miller spends time walking Nabhan through our familiar epidemiological studies. Nabhan concurs with everything that has been said in previous testimonies.
DIFFERENTIAL DIAGNOSIS
Winning Wisner erects another expensive dry-erase board exhibit on an easel near Hottie Chadi. As per usual, Wisner has to quickly swap out the witness’s permanent marker for a dry erase marker. I’m thinking that they should just change all of their markers to dry erase so that Wisner doesn’t have to stressfully correct the expensive pen situation with such frequency.
On the exhibit, there is a lengthy list of potential contributors to Al Pilliod’s NHL. Nabhan articulately and confidently discusses each factor, and the vibe is that of sincerity and thoughtfulness. Good looks or not, this doctor is the one that you would like to see handling your severe NHL case.
Al Pilliod – A Few of the Factors Discussed:
Age: People get sick as they get older. It is true of any disease and not specific to Al’s NHL. After he discusses the natural progression to geriatric disease, Nabhan humorously clarifies: “And by the definition of older, just in general, when we talk lymphoma or cancer, it’s 60 to 65. So apologies to anybody who is 60 or 65 in this courtroom.”
Obesity: It isn’t a constant enough variable to be fully evaluated, because weight fluctuates. Also, the research doesn’t point to a link between obesity and NHL. GG notes that the Pilliods currently do not look obese in the slightest.
Viral Infections: HPV or genital warts are sexually-transmitted diseases…HPV by itself does not cause non-Hodgkin’s lymphoma.” The studies that Nabhan was shown during a recent deposition, that attempted to link HPV and NHL, were “beyond weak.” The other infection that Mr. Pilliod has is HSV, or Herpes Simplex Virus, which Nabhan also does not find to be a cause of NHL.
GG SIDEBAR: I feel uncomfortable on behalf of the Pilliods to have these personal health details revealed and debated so publically. It’s a necessary part of their case, but still.
Autoimmune Disease: Mr. Pilliod suffered from Ulcerative Colitis. As we learned from Weisenburger, the symptoms seemed too brief in duration to really be UC. Regardless, Nabhan says that while there is research on both sides of whether UC can cause NHL, his conclusion is that the studies more often point to the immuno-supressive drugs given to treat the UC as the real cause of the NHL, not the disease itself. Mr. Pilliod has not been taking immuno-supressive drugs.
Nabhan concludes that the evidence in Mr. Pilliod’s case supports that Roundup caused his NHL, and that if he hadn’t had pesticide exposure, Nabhan would conclude the NHL to be idiopathic.
Couples and families share the same environmental exposures, which is why my house is keeping antihistamines in high demand as everything blossoms into Springtime glory. Nabhan is shown a study Spousal Concordance for Cancer Incidence, which found that there is a statistically significant husband-wife association for NHL. After corroborating the results of the study, Nabhan once again cites the approach of using common sense. “As a clinician, I applaud an investigation like this. I think it’s great, it’s nice and so forth. But at the end of the day, it’s common sense to me.”
Alberta Pilliod’s differential is shorter and focuses primarily on her pesticide exposure and Hashimoto’s thyroid disease as potential risk factors for developing NHL. Nabhan reports that there is not a lot of evidence that Hashimoto’s causes Primary Central Nervous System Lymphoma, the type from which Mrs. Pilliod suffers.
Ismail, I am sure, has ample Hashi’s-NHL research primed to share with Nabhan on the cross. There is a large file box looming on their side of the courtroom, ominously labeled “Nabhan.” I’m glad that it doesn’t say “Glyphosate Girl.”
PROVOCATIVE SCANS
Before the trial started this morning, Monsanto argued that the Plaintiff had made Mr. PIlliod’s MRI/PET scan “provocative” by using bright red to highlight the cancerous spots on his skeleton. They argued it to be a “frightening” red color.
Now I’ve seen it all. It SHOULD be frightening either way! This body is absolutely riddled with Stage 4 systemic cancer, and no color changes that fact.
Judge Smith hung in there for the debate, and sighed. She told the Plaintiff: “You do like bright colors, don’t you? Tone the colors down a little bit. That’s a great compromise.”
Both sides began to argue at once, and Smith amusingly shouted “WHOA” and made a time out motion with her hands. She restated her order to just tone down the color.
Now, the jury gets an afternoon peek at the “provocative” scan, and the color has been removed.
In happier news, the RCHOP cancer treatment that Al Pilliod received sent his NHL into remission, and Nabhan concludes that it is unlikely to come back. Alberta Pilliod, who has lymphoma in the brain, is having success with a treatment called Revlimid. The plan is to keep taking it – the fact that she has had a positive response for four years is remarkable.
Final Notes
So much information packed into one day!
There has been a great deal of activity surrounding the Roundup trials and new glyphosate science in the news the last few days, so I will be working hard to put the stories all together this week.
Up soon, Dr. Nabhan will take the stand again for his cross examination performed by Tarek Ismail.
© 2019 Kelly Ryerson ALL RIGHTS RESERVED
