Document 4aLw5p5pmjBRxwwMqDy0qV7Oe

1 1 IN THE CIRCUIT COURT DF THE TWENTIETH JUDICIAL CIRCUIT E ST. CLAIR CDUNTY, ILLINOIS 3 4 FRANCES E. KENNER t ET A L ., } 5 Plaintiffs, } 6 vs. 7 MONSANTO CONPANY, D Case No-.80-L-97 1 8 Defendant. D 9 10 11 REPORT OF PROCEEDINGS IE February 14, 1986 13 14 Before the HONORABLE RICHARD P. GOLDENHERSH, CIRCUIT JUDGE 15 16 APPEARANCES: 17 NR. REX CARR and NR. JEROME SEIGFREID, Attorneys at IB Law,-on Behalf of the Plaintiffs; and 19 NR. KENNETH HEINEMAN and MR, JOSEPH 'NASSIF, Attorneys E0 at Law, on behalf of the Defendant, Monsanto Company. El EE S3 Kathleen Watson Brunsmann, RPR, CSR E4 Official Court Reporter 2 1 BE IT RENENBERED AND CERTIFIED, that heretofore an e ta-wit: Friday, February 14, 19BB the matter as hereinbeFore 3 set Forth came Dn For hearing beForB the HonarablB Richard 4 P. Boldenhersh, Circuit Judge, in and For the Twentieth 5 Judicial Circuit, and the Following was had of record, to6 wit: 7 8 3 CDefendant Ndnsanta's Exhibit 1704 was marked 2.0 For identification by the court reporter.!) 11 12 13 THE COURT: Good aFternoon. Okay. 14 NR. HEINENAN: Your Honar, yesterday we had marked 15 Dependant's Exhibit 1704, as Dr. Suskind had pointed out the IB First two pages oF it were missing. 17 THE COURT: Right. IB NR. HEINENAN: We now have the document with thB 13 First two pages included and w e 've had it remarked as 20 Defendant's Exhibit 1704. 21 THE COURT: Fine. Good. 22 23 24 3 1 OR. RAYMOND SUSKIND, 2 3 having previously been sworn, testified further 4 as follows: 5 6 FURTHER DIRECT EXAMINATION 7 BY MR. HEINEMAN: 8 Q I 'd like to ask the witness, Dr. Suskind, are 9 those two pages that are now attached to 1704 the pages that 10 you felt were missing yesterday? 11 A Yes, they are. 12 Q All right. Thank you. 13 MR. HEINEMAN: At this time, your Honor, w e 'd move 14 the admission of Defendant's Exhibit 1704. 15 MR. CARR: No objection, your Honor. IB THE COURT: Fine. It's admitted without 17 objection. IB Q CBy Mr. Heineman) Dr. Suskind, directing your 13 attention again to the Suskind/Hertzberg Morbidity Study 20 that we were discussing yesterday afternoon. With respect 21 to the decisions as to whether or not the people who were 22 examined were exposed or not exposed, who made those 23 decisions and on what basis? 24 A Well, we made the decisions on the basis of the 4 .1 work history, the detailed work history, which were taken by 2 the interviewer, and then after the study was completed, 3 reviewed by myself and colleagues who were attempting to 4 determine accurately or as accurately as passible from that 5 information who was clearly exposed and who was clearly not 6 exposed to the 2,4,5-T process. 7 Q Were there any situations where an amount of 8 Judgment was involved because of what was represented by the 3 person being examined, the interviewer? 10 A Yes, there was. A judgment had to be made and it 11 had to be made by persons whD knew something about thB plant 12 where 2,4,5-T was made, where Tricholarophenol was made over 13 the years, what kind of hauling was done fram one part af 14 the plant to another where the 2,4,5-T was actually 15 produced, then put into bags, all of that would indicate IB exposure. 17 f course, there were the maintenance people who 18 recognized that this was a study of persons who were exposed 13 to 2,4,5-T and if at any time the maintenance people, 20 machinists, pipe fitters, were in any of the buildings for 21 any length of time they told us about it. From those pieces 22 of information, which appears in the first several pages of 23 the work history interview, wb WBrs able to make a Judgment 24 as to whether they were clearly exposed or not exposed at 5 1 all. 2 Q Now, in terms oF thB people uiho uerB invited but 3 did not participate, did you have an impression that thosB 4 people who did not participate did nut do so because they 5 were too sick to get there? B A No, I don't believe so. I think that if there was 7 a bias, and we always look For passible biases, it was in 8 Favor oF thB people who were more heavily -- or the people 8 who were exposed, and people who had chloracne. 10 AFter the study was completed we went back and 11 looked at the records as we had them oF the invitees. We 12 knew iF they were classiFied as exposed with chloracne, 13 exposed without chloracne, and not exposed, intimately 14 exposed. 15 We Found that, First oF all, those who came to IB participate were several years older than those who did not 17 come to participte. We also Found that there was a higher 18 percentage oF exposed among the participants than exposed 19 among those who didn't participate, As a matter oF Fact, I 20 think iF I recall correctly it was about BO to 40, 21 1 Then, oF course, we had to look at who had 22 chloracne among the participants and among the non23 participants according to thB record, and we Found, and we 24 Found that about -- thers was a much higher percentage oF G 1 persons who had a record of chloracne among the participants 2 than among the non-participants. 3 Q So -4 A So I would assume that these paoplB had 5 experienced illness as a result of their BithBr exposure or 6 having chloracne and other symptoms, and there was a higher 7 percentage of thosB among thB participants than therB wBrB a among the non-participants, From the records. 3 Q Dr. Suskind, toward thB end of the day yesterday I 10 believe you told us that there was a -- after the interview 11 had taken place that there was a history taken by thB 12 physician as well; is that right, sir? 13 A Yes, there was. 14 Q Would you tell us why an additional history was 15 taken by the physician? IB A Well, although the interviewer was trained .to do 17 both work history and other kinds of history interviewing, IB as well as medical history interviewing, it was obvious that 13 the well trained physician was much bBtter qualified tD take 20 a medical history. So with respect to medical history we 21 asked the physicians to take their own history as w b II, 22 followed by an examination, which they performed. 23 We felt anybody whose beBn to a physician knows 24 that a capable physician takes a history. Sometimes it's 7 . 1 done by the nurse, but more often than not it's done by the 2 doctor, him or herself. And uie fBlt that thosB physicians 3 who were doing thB examination should also take a medical 4 history. 5 We depended on thB results of those histories for 6 determining what some of the history of health problems 7 were. B All right, sir. Now, in connection with what was 9 done with the data and the information developed as a result 10 of the study, what disposition did you make of that data? 11 You mentioned yesterday about computerizing it, 12 coding it and putting it on the computer, but in terms of 13 any disposition of the information, what did you do with 14 that? 15 A You're talking about analysis or where the 16 information went? 17 Where it went. IB A Okay. From the very beginning we told the 19 participants that we would provide the results of our 20 examination to their physicians, and we provided them with a 21 statement which could be signed by them requesting such 22 information be sent to their doctors. About 90 to 95 23 percent of the persons who participated in thB study 24 requested that we send that information to the physicians. ."S' 1 This was an epidemeologic study. But we Felt that s although there was a doctor/patient confidential 3 relationship, that that could be maintained by our sending 4 the information to their doctor. 5 However, Monsanto did not get that information. 6 The records of these participants were not sent to Monsanto./ 7 Q Sir, did you prepare any letters for the 8 furnishing of the information to the physicians? 3 A Yes, we did. 10 Okay. 11 12 CDefendant Monsanto's Exhibits 1705, 1705, 1707 13 were marked for identification by the court 14 reporter.) 15 16 Q CBy Mr. HeinemanD Dr. Suskind, let me. hand you 17 what's been marked as Defendant's Exhibits 1705, 1705, and 18 1707. I wonder if you'd take each of them, and one at a 13 time, tell the Court and Jury what those documents are, and 20 use the exhibit numbers as you do so, would you please, sir. 21 A Exhibit Number 1705 is a letter from me addressed 22 to the Monsanto employees, thanking them for their 23 participation, and it's dated August 27, 1373, thanking the 24 employee for his or her participation in our medical survey 9 1 of active and Former employees at Nitro, West Virginia plant 2 conducted in 1979. 3 And also it reads, "As you requested at the time 4 oF your examination, we have SBnt a copy oF tha results oF 5 your medical examination to your personal physician. We 6 urge you to review the results oF this examination with your 7 physician. Please remember that participation in our B medical survey should not be regarded as a substitute For a 9 periodic medical examination by your personal physician." 10 This went out to all the participants. 11 Then we sent a letter to Monsanto employees 12 individually, also on August 27, 1979, thanking them For 13 their participation in the medical survey, and we added "We 14 would like to send a copy oF the results oF your medical 15 examination to your physician. However, at the timB of thB 16 examination we did not receive a signed medical release Form 17 authorizing us to do so." IB And Further, "IF you would like us to send a copy 19 oF the results oF your medical examination to your 20 physician, please Fill in the enclosed Authorization to 21 Release Medical InFormation Form, and return it to us at the 22 address indicated on the Form. Wb urgB you to review thB 23 results oF this examination with your physician. Please 24 remember that participation in our medical survey should not 10 1 be regarded as a substitute for periodic medical examination s- by your personal physician." 3 This was sent to people uiho did not participate, 4 the non-participants. I'm sorry. This was sent to the 5 people who participated, but did not request that we send B their examination results. 7 THE COURT: Doctor, what's the number on that 8 exhibit, please? 9 THE WITNESS: Sorry? A' 10 THE COURT : The one you just read, what's the 11 number on that one? 12 THE WITNESS: The number is 170B. 13 THE COURT: Thank you. 14 THE WITNESS: And the third exhibit is 1707, a 15 letter dated August 27, 1979 from me again, addressed to thB IB physicians -- the physician who was designated by the 17 individual participant to receive a copy of the information 18 contained in the report, the medical information and 19 laboratory and test information contained in the report. 20 It reads, "In June, 1979, a medical survey of 21 active and former employees of the Monsanto Industrial 22 Chemical Company in Nitro, West Uirginia, was conducted by 23 the University of Cincinnati Department of Environmental 24 Health," This is to the doctor. ''The participants whose 11 1 medical records accompany this letter have requested that 2 you be notified of thB results of their medical examination. 3 Most of the reports are sslF-explanatory. HowBVBr, the 4 Following comments may be of assistance in analyzing some oF 5 the laboratory inFormation. 6 Plasma lipid levels, reported separately From the 7 Metpath laboratory inFormation, were perFormed by the Lipid 8 Research Project group oF the University oF Cincinnati, and 9 are compared to age and sex-speciFic normal values as 10 indicated." 11 We had two diFFerent laboratories doing our blood 12 chemistries. One was the Metpath that did most oF the blood 13 chemistries, and the other was the Lipid Research Project 14 laboratory at the University oF Cincinnati. We so indicated 15 this. 16 ''Where disagreement occurs between the Metpath and 17 the L.R.P. lipid determinations, we have chosen 18 preFerentially the' L.R.P. data as the standard to 19 diFFerentiate normal From abnormal." 20 Wb then go on tD indicate that ''Pulmonary Function 21 studies were pBrFormed with a Uitalograph spirometBr. FUC 22 and FEU1 are reported as percent oF predicted valuB For the 23 participant's age, sex, race, and body habitus. 24 IF you have any questions regarding these reports, . 12 1 please call me," and the telephone number is listed. 2 And then uie provided a sheet with the name d F the 3 participant and the results of thB physical examination, if 4 therB were any abnormal -- if there were ay abnormal 5 Findings on the physical examination. Abnormal Findings oF 6 the biochemical tests, chest x-ray, pulmonary Function test, 7 electrocardiogram, the skin biopsy and/or Scraping was so a done, and we included in his the Full copies oF the lab 9 results oF the pulmonary Function tests. io MR. ..HEINEMAN-: Your Honor, at this time we'd oFFer li into evidence DeFBndant's Exhibits 1705, 06 and 07. 12 MR. CARR: No abjection, your Honor. 13 THE COURT: They're admitted without abjection. 14 CBy M r . HeinsmanJ Now, Dr. Suskind, what eFFort 15 was made to communicate the results oF this examination to 16 the plant workers, to the people who had participated in the 17 study? IB A Well, what we actually did was in 1982 when we had 19 much oF the data analyzed and put together a draFt oF thB 20 analysis of the data, w b thought it would bB very 21 appropriate to present this inFormation to thB workers 22 themselves. So that in 1982 we paid a visit to Nitro and a 23 meeting oF the workers, the participants, as well as those 24 who did not participate, was assembled and I presented this 13 1 information in slide form to all of the people uiho uierB 2 assembled there. This included, as I indicated, the 3 participants, some of the non-participants, thB union 4 officials, members of the plant medical department, and 5 administration. 6 Now, at this meeting did you provide individual 7 health statistics or data or was it the general -- B A Wb presented, as we did in thB first draft, uie 9 presented collective information. This was an epidemeologic 10 study. Epidemeologic studies are not concerned with 11 individual records. They're concerned with collective 12 information, haw the health of the exposed collectively 13 compares with the unexposed collectively. How the -- among 14 the exposed and the not exposed, how the health of the elder 15 age group, 50 and older, compare with the group under 50 IB years old, for all of the parameters of the examination, 17 physical examination findings, history findings, laboratory 18 findings, pulmonary findings. All of the tests that we did. 19 We presented this to the workers. 20 What overall did you find with respect to the 21 chloracne status as between the exposed and the unexposed 22 group? 23 A Wall, as thB publication indicates wb found that 24 when you compared the exposed to the unexposed group BE 14 1 percent of the exposed developed chloracnB at sonfs time, not s all of them still had it, but 86 percent had a history of 3 and presently had chloracne. That is the combined group. 4 With respect -5 A And -- B I'm sorry. With respect to the unexposed group 7 how many had chloracne? 8 A We didn't Find anybody with chloracne in the 3 unexposed group. 10 Q Now I wonder if you would let me -- let me hand 11 you, Dr. Suskind, what's been markBd as PlaintiFF's Exhibit IE 1467. Would you identify that. Well, it's in evidence. 13 That is your published paper, the Suskind/HertzbBrg 14 Morbidity Study, is it not, sir? 15 A This is the paper which Dr. Hertzberg and I wrotB IB on the Human Health Effects of, 2,4,5 and its Toxic 17 Contaminants, which is -- which was published in the Journal IB of the American Medical Association on May 11, 1334. 13 Q I wander, sir, if you'd be so kind as to give us E0 the principle findings of your study. El A Well, the principle findings werB thesB, that w b EE found that 86 percent, as I indicated, of those people who S3 were exposed developed chloracne, and nans of the people who S4 were not exposed had chloracne at any time. 15 1 We also Found that among those people who had 2 chloacne, there was an increased Frequency, especially -- 3 there was an increased Frequency oF thoss whosB chloracne 4 persisted oF actinic elastosis, which is a problem 5 involving the deterioration d F the elastic Fibers of the 6 skin. Sc that in those people who still had chloracne, and 7 it was 52.7 percent oF the people who were exposed still had 8 chloracne when we examined them. In that group thBrB was an 9 increased Frequency oF actinic elastosis, sensitivity oF the 10 elastic tissue to sunlight. Those were the two major 11 Findings which were rather prominent. 12 Ule also Found that there was an increased 13 Frequency among the exposed oF a history oF upper 14 gastrointestinal ulcer, as whBn you compared the exposed to 15 the unexposed. 16 Ule also Found that among those who still had 17 chloracne there was a greater Frequency oF abnormal levels 18 oF high density lipoprotein, which is a lipid in the 19 blood. Although there was no difference whatsoever in the 20 mean values oF any lipid, triglyceride, lipoproteins, 21 cholesterol, and the mean values when you compared thB 22 unexposed to the exposed, or whBn you compared thB various 23 chloracnB groups, those who had a history of chlaracns only, 24 those who still had chloracne, or those who never had 16 1 chloracne, there was no difference in the mean. But if you s just looked at the abnormal frequency of high density 3 lipoproteins, you found that there was a greater frequency 4 among the people that still had chloracne. 5 lie also found that for -- among the exposed therB 6 was a greater frequency of abnormal pulmonary function 7 levels, that is breathing tBst measurements. They w b c b B abnormal among those who still smoked and were exposed as 9 compared to those mho still smoked and were not exposed. 10 In that instance it's kind of difficult to separate the 11 exposure factor from the smoking factor because tue do know IS that smoking and number of pack years, number of packs per 13 year over a -- '-over' the lifetime has a great influence on 14 pulmonary function. It's the most influence on pulmonary 15 function. 16 Now -- 17 A Those were the positive findings. The first two, 18 I think, are rather conclusive. ThB others that we found 19. were really -- can only be called suggestive. They were SO suggestive long term health effects. SI Q Why do you believe that the pulmonary function SS results were only suggestive? S3 A Well, as I indicated it's very difficult to S4 determine -- separate the smoking factor from the exposure 17 1 factor. 2 The ather aspect of it which I think is important 3 here that when we compared the exposed who smoked to the non 4 exposed who smoked, there were no obvious differences in 5 their clinical findings. Clinical, not th laboratory test 6 findings, not the pulmonary function findings. But there 7 was no difference if you looked at them as a group in their B clinical findings and there was no difference in their X-ray 9 findings. They had the same types of X-rays and you 10 couldn't distinguish quantitatively or qualitatively the 11 differences between the smokers who were exposed and the 12 smokers who were not exposed. 13 0 Which group had the greater history of smoking, is 14 that what the pack years means? 15 A Well, I think from the standpoint of pack yBars, 16 the present smokers, up to 1979, those who still smoked, the 17 present smokers who were exposed had a larger number of pack IB years, and then the still smokers who were not exposed, and 19 there was a 19 pack year difference between the smokers BO exposed and the smokers not exposed. 21 It was an older group and they smoked for a longer 22 period of time. So I think that one has ta look at that, 23 and that's why anybody qualified in the problems of 24 pulmonary-disease in relation to smokers would admit that it 18 1 was very difficult to separate the smoking aspect from thB E exposure aspect mostly because of that factor, that the 3 exposed smoked a greater number of pack years. 4 That's why we said, and we say it in thB paper, 5 that these are suggestive long term effects, but certainly 6 not clear cut conclusive effects. 7 Q You also mentioned that the ulcer history was a B suggestion of association, did you not, sir? 9 A Yes, we did. 10 Q And I thought I understood you to emphasize thB 11 word ''history" in discussing ulcers. Did you do that as IE well? 13 A Yes. Here again -- 14 MR. CARR: Your Honor, I would likB to approach 15 the bench. IB THE COURT: Yes, you may. 17 18 , CThe following proceedings were had at the 19 bench out of the hearing of the jury:) SO El MR. CARR: Counsel csrtainly knows why I 'm here. EE That was about as blatant and suggestive and leading a S3 question as can possibly bB asked. I have not objected and E4 I don't object in areas whre Counsel knows it's routine in 18 1 suggesting routinB articles. But he also knows that I s object to leading questions uiherB it gets into this kind of 3 area. And I do object to it. 4 THE COURT: I think that was leading. I don't 5 think there's any question about that. So I'm ordering you 6 to rephrase it. 7 While you're up here -- 8 MR. CARR: He doesn't nBBd ta rsphase it, your 3 Honor, the witness had already answered it. 10 THE COURT: Okay. 11 MR. CARR: I'm just pointing it out so I don't IE have to make a Further abjection. 13 THE COURT: While you're up here a couple of 14 little areas. 0ns of the Jurors is not Feeling well. Wb '11 15 break in an hour and take a short break and then cons back. 16 MR. CARR: Break an hour after ue started? 17 MR. HEINEMAN: What time did we start? 18 THE COURT: 1:5 or so. At :5 we'll take a 19 short break. SO El CThe Following proceedings were had in the EE presence and hearing oF the jury:} S3 24 Q CBy Mr. HBinBmanD Doctor, would you explain your 20 1 Findings with respect to ulcers to us, please. 2 A The raw data showed that there was a Four Fold 3 difference between the exposed group and the not exposed in 4 the frequency of history of -- information provided by thB 5 participant, history of upper gastrointestinal ulcer. 6 This was essentially not an ulcer study, but we 7 wanted to Find out whether or not this was actually so. So a we went back and really looked at all of the possible 3 information that we could get to verify, to verify this 10 ulcer information. What we found essentially was that there 11 were ulcers which had occurred before sxposurB was possible. 12 And there were certain number of ulcers, and this was in the 13 plant medical record, these occurred before 1948. 14 There was also in the plant record and we got it 15 from the participants themselves, a number of persons with IS ulcer symptoms who were told that this was due to the largB 17 amount of aspirin they were taking. We know that aspirin, 18 high doses of aspirin, can cause bleeding of the lining of 19 the stomach. 20 We also were told by the participant and verified 21 in the plant mBdical record that some of thB people who had 22 developed ulcers had developed them when they were taking 23 cortical steroids, cortical steroids. 24 Even if you took those out, that group out, and 21 1 you still remained with about a two and a half to three fold 2 difference in ulcer frequency between the exposed and the 3 not exposed. If you age adjusted -- not age adjusted, but 4 smoking adjusted, it still came out with a statistically 5 significant difference. 6 We say it's suggestive for several reasons, and I 7 think it should be pointed out that we didn't intend to B conduct an ulcer study, and those who have, and we consulted 9 some at the University of Cincinnati who have, told us that 10 we don't have the kind of information in our data to say 11 without any doubt that there is an increased frequency of 12 ulcer based upon the history, and even if we did have an 13 adequate history the numbers of people who were involved 14 were too small to make any Judgments. 15 With our data, not all of the persons who gave a IB history of peptic ulcer could we verify that they actually 17 did have a history of peptic ulcer. We did not have access IB to their physicians medical records -- records of the 19 physicians who made the diagnosis, at least told the patient 20 that they had a peptic ulcer, nor did we have their X-rays, 21 nor did we have thB results of endoscopy, that's a visual 22 observation of the gastrointestinal tract. 23 So that, in essense, I think it has to be said 24 wihout modesty, without criticism, although we did find a 22 1 statistical relationship, we have to look at the 2 significance of it, and whether or not we have proper data 3 to make hard and fast conclusions about it. Wb don't. So 4 that we say these are suggestive long term effects. 5 Okay. With respect to your morbidity study, did 6 you find any absences of associations that you were looking 7 for? B A Yeah. I think that the data itself demonstrates 9 that there was no evidence of any abnormal long term effects 10 which affected the cardiovascular system, no increase in 11 cardiovascular disease among the exposed as compared with 12 the not exposed. There was no increase in hepatic disease, 13 renal disease, neurologic problems, or nerve conduction 14 velocity, and you have to take the values such as they are. 15 They are non conclusive, but we found no difference bBtweBn 16 the results of our nerve conduction velocity, or 17 neurological examination between the Bxposed or thB not IB exposed. 19 Excuse me, sir. 20 A Nor did we find any evidence of persistence of 2,1 peripheral nerve problems, something that we saw earlier. 22 We saw peripheral neuritis. There was no evidence of 23 increased frequency of neuralgia or peripheral nBUritis 24 problems in the exposed as compared to the not exposed. 23 1 Q Excuse me, Dr. Suskind, can I interrupt you For 2 just a moment. 3 A Please. 4 Q What did you say about the nerve coduction Dr the 5 nerve velocity studies as being non conclusive? 6 A No. I think most people Feel that current status, 7 the current state oF nerve conduction velocity measurements 8 as such, and the equipment as such, that you cannot draw 9 hard and Fast conclusions From them. However, we Found that 10 there was no diFFerence in nerve conduction velocity 11 outcomes between the exposed and the not exposed, nor was 12 there any diFFerence in the Findings on neurological 13 examination, on neurological examination. And we Found that 14 there was no increased risk For birth deFects or 15 reproductive outcomes. 16 Now do you have an opinion, sir, as to whether or 17 not the Findings oF the Noses Study which you described 18 beFore are consistent with or inconsistent with the Findings 19 oF your morbidity study? 20 A Well, I think that iF they did a cross sectional 21 study and didn't separate the exposed and the not exposed. 22 They had separated -- they looked at or compared their 23 chloracne groups with the non chloracne groups. 24 But essentially they Found that thB only, major 24 \ 1 finding was chloracne. They Found that in thBir population e that they exposed-- that they examined rather, 5E percent 3 had at some time had chloracne. In our exposed group we 4 found that B6 percent had chloracne, and it persisted in 5 5E.7 percent. So in that sense it's consistent. 6 They did find some increased frequency in abnormal 7 G.G.P.T., which is a liver enzyme laboratory test, among thB a chloracne group as compared to the non chloracne group. U)e 9 didn't Find that to be so. 10 They Found on a kind of gross neurological 11 examination of the response to pinprick, that is you stick a 12 pin in the skin and ask the individual do you feel it, don't 13 you feel it, and so on, and they found that there was a 14 decrease ability to appreciate pinprick, pain to pinprick in 15 the chloracne group as compared to the non chloracne group. 16 It's a very crude measurement, and my only comment 17 on something like that would be did they adjust for age, 18 because the response ,to pain is often -- pain diminishes 19 with age. Areas of the body, for example the lower E0 extremities are less likely to be sensitive to that in aging El people, or who had diabetes, and you get decrease in EE sensation to the diabetes. E3 However, even with all of that, thB findings arB 4 really very similar. They're very similar to ours. They