Translation in the Court by F. Edward Yazbak, MD, FAAP (Part 3 of 3)

Translation in the Court

As discussed earlier, Eric Fombonne MD and Stephen A. Bustin PhD were effective expert witnesses for the respondent in the Cedillo case [Theresa Cedillo and Michael Cedillo, as parents and natural guardians of Michelle Cedillo v. Secretary of Health and Human Services - No. 98-916V].

While Dr. Bustin criticized the laboratory testing and results, Dr. Fombonne directly influenced the plaintiff’s case by discussing the vaccine-injured girl herself.

He may have been the respondent’s MVP. 

Dr. Fombonne first testified in Washington DC on June 18, 2007 (Day 6).
[ftp://autism.uscfc.uscourts.gov/autism/cedillo/transcripts/day06-cor.pdf]

DOJ Attorney Lynn Ricciardella started questioning Dr. Fombonne about his education and credentials (p. 1241) by asking:
Q. Doctor, you received a Baccalaureate in science with distinction from the Academy of Paris
A. Yes. In 1971. Yes
Special Master Hastings: Dr. Fombonne, can we ask you to do the best you can to speak up a little louder so the folks can hear you?
The witness: Yes I know. I know.
Ms. Ricciardella: He has a soft voice.
Special Master Hastings: You have a nice, soft voice.
The witness: No, No.
Special Master Hastings: You just need to speak up as best you can.
The witness: I know it is a problem.
Special Master Hastings: And maybe perhaps going a bit slower would make it easier to understand as well.
The witness: Okay. Okay.

The record does show that Ms. Ricciardella asked and the witness confirmed that he received a “Baccalaureate in science with distinction” in 1971. 

It is reasonable to suggest that most people who heard the exchange understood that in 1971, the witness obtained the French equivalent of a Bachelor of Science degree, a BSc degree in science, with flying colors.

In his 59 page CV updated January 21, 2007, Dr.  Fombonne listed the following under Education and Training:

1971: Baccalauréat C (Sciences), Mention Bien (Académie de Paris)

It is not clear why Attorney Ricciardella decided to call the degree a “Baccalaureate in Sciences” instead of simply reading what was listed on the expert’s CV.   

While it might have seemed that the witness obtained the French equivalent of a BSc degree in science with flying colors, the fact is, the nomenclature is different. The term “Baccalaureat” or “Bac” is used in France to describe the examinations and diploma at the end of the last year of high school. It is a requirement to enter university and it is not unusual for French doctors to list their “Baccalaureat” with their medical education. The reference to “Sciences” now shortened to S, simply means that during the last year of “lycee” or high school, the graduate took advanced science courses instead of other focused subjects.

In France, the term “Baccalaureate” is rarely used instead of “Baccalaureat” in schools with a large number of foreign students. To confuse things even more, in Belgium and Canada, “Baccalaureat” is used interchangeably with “Bachelor Degree” at the university level. 

In the USA, where the Cedillo hearings were held, a “baccalaureate” is only defined as the degree of bachelor conferred by universities and colleges.
[http://www.merriam-webster.com/dictionary/baccalaureate]

French students will usually finish pre-school by age 6, elementary school by age 11, middle school by age 15 and high school by age 18. 
[http://www.consulfrance-boston.org/spip.php?article887]

Dr. Fombonne was 17 years old in 1971
[http://en.wikipedia.org/wiki/Eric_Fombonne]

The French “Baccalaureat” that he obtained that year was not a university degree and it was not equivalent to a Bachelor of Science degree (BSc) that requires four years of hard work in any university in Washington DC or the 50 states. 

Grading in the French educational system is different from ours. The “pass mark” is 10 out of 20 and it is unlikely for a high school student to score a perfect 20. French school exams including the “Bac” are usually very difficult and are consistently more rigidly graded than ours. A “mention assez bien” (translated “almost good”) is probably equivalent to “Honors” in our system and is awarded for a mark between 12 and 13.99. A mark between 14 and 15.99 will earn a “mention bien” (good) that is equivalent to “High Honors” over here and a mark of 16 or higher will merit a “mention très bien”, translated “very good”, but in fact comparable to our “Highest Honors”. The term “Distinction” is not used as a grade in any French exam including the “Baccalaureat” but a French student may feel that it is a “distinction” to obtain a “Mention Bien”.

Now three years later, I am at a loss to know why the attorney for the respondent thought it was necessary to inform three Special Masters, a court full of people and all of us listening by phone that her expert witness, a university Professor, had graduated from high school with a grade between 14 and 15.99 out of 20.

Attorney Ricciardella then asked the witness about his medical education at the University of Paris (p. 1241) and he answered “Right. I went to medical school from 1971 to 1978”.  Special Master Vowell then interrupted to tell the witness that he was talking into the court reporter microphone and that he should also be talking into the flat microphone that was transmitting to the whole room.

The witness agreed and Ms. Ricciardella jested “We’re high tech here”.

She then asked again: “So you have a medical degree, Doctor, is that correct? And the witness answered: “Yes, that is correct.”

Q. And you have a Master’s certificate in Biostatistics Methods in Human Physiology, is that correct?

A. Yes

Q. Following medical school, where did you do your residency?

A. I did my residency in psychiatry at the University of Paris from 1977 to 1982, I think. Yes.

The witness had stated that he “went to medical school from 1971 to 1978” and the question was about a residency “following medical school.” Ms. Ricciardella did not ask and the expert did not explain why psychiatric training in 1977 and 1978 prior to graduation was included with training “following medical school”.   

On page 6 of his CV, the expert listed his psychiatric training in Paris as follows:

1977/10-1978/09: Intern in the Department of Adult Psychiatry of CHU Cochin-Port-Royal, Paris 14.
1978/10-1979/03: Intern Adult Psychiatry Department, Service Dr. Bertrand, Hôpital Ste-Anne, Paris
1979/04-1979/09: Intern Adult Psychiatry Department, Service Dr. Segal, Centre Hospitalier Spécialisé Les Murets, La Queue-en-Brie (94).
1979/10-1980/09: Intern Child Psychiatry Department, Service Dr. Jeanneau, Centre Hospitalier Spécialisé Charcot, St Cyr l'Ecole (78).
1980/10-1981/03: Intern Adult Psychiatry Department, Service Pr. Martin, Hôpital L'Eau Vive, `Soizy-sur-Seine (91).

No one is questioning Dr. Fombonne’s training in psychiatry but it is clear from his CV that it consisted of “internships” between October 1977 and March 1981.

Ms. Ricciardella should have referred to them as such and then asked Dr. Fombonne to elaborate and explain how in France, a year of internship may indeed be equivalent to a year of residency in the United States, which is true. She should not have referred to his residency in psychiatry at the University of Paris because, as per his own listing, the word “residency” is not mentioned in his Paris training.  

Finally, according to page 2 of his CV, the witness was serving in the French Army in Guadeloupe, West Indies from April 1981 to March 1982. He was not a resident in psychiatry at the University of Paris. He was 4,000 miles away.  

Now we get to the question posed by Ms.  Ricciardella: “And you have a Master’s certificate in Biostatistics Methods in Human Physiology, is that correct?” to which the witness answered: “Yes, it is correct”. 

On page 1 of the same CV, this particular achievement is listed as follows:

1976-1977 Master Degree ½ Certificate in Biostatistic Methods (Professor D. Schwartz, U.E.R. Kremlin-Bicêtre, Paris XI, Mention Bien)

 1976-1977 Master Degree ½ Certificate in Human Physiology (Professor Bargeton, U.E.R. René Descartes, Paris V).

It is not clear why Attorney Ricciardella added the half certificate in Biostatistics Methods from the Eleventh arrondissement to the half certificate in Human Physiology in the Fifth arrondissement to make a whole “Master’s certificate in Biostatistics Methods in Human Physiology” when the word physiology is not mentioned in the first degree and the word biostatistics is absent from the second.

For those who may be interested, a Paris arrondissement is a city district or a neighborhood. To go from the lovely 5^th on the Rive Gauche to the 11^th, one must cross the Seine and …the fourth arrondissement.

In 1976-1977, Dr. Fombonne was in his fourth cycle in medical school, the DCEM4, a grueling mix of academic and clinical training at the University of Paris.

It would be safe to say that most physicians and medical students would be in awe learning that during that very busy and crucial period, any human could do much more than fulfill the requirements of the program let alone get a “Master’s Degree in Biostatistics” as we know it and … start his psychiatric training.   

The “Certificat de Phisiologie”, a Physiology Certificate, from the University of Paris V that Dr. Fombonne indeed obtained in 1977 indicates that he satisfactorily completed an approved course in physiology.

In the United States, a Master Degree in Biostatistics from a university is usually awarded to students with a Bachelor Degree who satisfactorily complete 32 credit hours of work and study. [http://www.universities.com/edu/Masters_degrees_in_Biostatistics.html]

There is no available information concerning the specific ½ certificate in “Biostatistics Methods” that Dr. Fombonne obtained.

A course in “Methodologie statistique” presently given in Paris started October 5, 2010 and will end January 28, 2011 with a break for Christmas from December 18, 2010 to January 3, 2011. The course consists of a weekly formal lecture of 90 minutes in addition to 2 hours a week of “Travaux Dirigés”, essentially a period of practice and statistical exercises.
[http://cesam.vjf.inserm.fr/index.php3?page=methodoc]

On June 25, 2007 his second day on the stand, the witness’ testified mostly about epidemiology and biostatistics.
[ftp://autism.uscfc.uscourts.gov/autism/cedillo/transcripts/day11-cor.pdf]

He discussed several epidemiological studies including two of his own, one from the U.K. and one from Canada. The reports of both studies were published in PEDIATRICS in 2001 and 2006 respectively.

In “No Evidence for A New Variant of Measles-Mumps-Rubella-Induced Autism” [Pediatrics 2001;108;e58] Fombonne and Chakrabarti reported that:
“No evidence was found to support a distinct syndrome of MMR-induced autism or of “autistic enterocolitis.”

Discussing that particular study in their highly esteemed evidence-based Cochrane MMR Review, Demichelli, Jefferson et al opined that “The numbers and possible impact of biases in this study is so high that interpretation of the results is impossible.” [Demicheli V, Jefferson T, Rivetti A, Price D. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004407. Review]

In “Pervasive developmental disorders in Montreal , Quebec , Canada : prevalence and links with immunizations” Fombonne et al (Pediatrics. 2006 Jul;118(1):e139-50) concluded that: “…The findings ruled out an association between pervasive developmental disorder and either high levels of ethylmercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose measles-mumps-rubella vaccinations.” 

It is likely that many at the hearing were impressed by the witness’ knowledgeable presentation and the dazzling statistics that he quoted with great ease and clarity. It is also likely that no one realized that in this study, which only included 180 children from one English school district in Montreal and centered on their PDD diagnosis and vaccination history, not one of the five authors ever reviewed a single chart in order to at least confirm the diagnosis. According to the authors “Children with a diagnosis of PDD were identified by school personnel and given a study code to preserve the anonymity of the data. Children’s diagnoses were not verified by direct assessments …”

In a letter to the editor of PEDIATRICS, David Ayoub MD objected to the data and conclusions related to the Thimerosal in vaccines in the school district the authors investigated. In a letter I sent to the editor, I took issue with the authors’ claim that in that same school district, “pervasive developmental disorder rates significantly increased when measles-mumps-rubella vaccination uptake rates significantly decreased.”

Quoting three official Montreal incidence studies, I showed conclusively that the MMR vaccination rates in Montreal had actually increased during the study period along with the cases of ASD. The authors had used MMR vaccination rates from Quebec City and its surrounding, 160 miles away from Montreal.
[http://www.jabs.org.uk/pages/yazbak-2cities.asp]

Dr. Fombonne refused to answer our letters and the editor never published them.  

Listening by phone to the testimony in the Cedillo case, I wondered how many at the hearing knew that in 2001, Dr. Fombonne had questioned the very existence of an epidemic of autism spectrum disorders.

In “Is There an Epidemic of Autism?” also published in PEDIATRICS, the expert had asserted: “… To date, the epidemiologic evidence for a secular increase in the incidence of PDDs is both meager and negative… [PEDIATRICS Vol. 107 No. 2 February 2001, pp. 411-412]

According to a CDC study, 6.7 out of 1,000 eight year old U. S. children were on the autism spectrum in 2000, when Dr. Fombonne was writing his paper.
[http://www.cdc.gov/media/pressrel/2007/r070208.htm]

The Merriam-Webster Dictionary defines an epidemic as an excessively prevalent condition. Many would agree that a prevalence of 1 in 149 is excessive.  

After listening to days of testimony from both sides in the Cedillo case, the Special Masters decided that the respondent’s experts were more believable and that their testimony was more convincing.  

I certainly respect the Special Masters’ right to their opinion but after listening to many experts from both sides and reading several transcripts, I must respectfully disagree with their final decision.

In the previous pages, I reviewed some of the testimony of the likely leading expert for the respondent. There is every indication that the special treatment he received influenced the hearing and its outcome.

In any case and as I keep repeating, the Special Masters’ decision does not mean that Michelle Cedillo was not vaccine-injured.

Her parents, who have been with her all along and who have witnessed and documented what happened to her, are sure that she was.

I believe them and I agree with them.

F. Edward Yazbak, MD, FAAP
Falmouth, Massachusetts