JACKSON V AEGLIVE June 20th
Dr. Charles Czeisler Czeisler
Dr. Dr. Charles Czeisler Sleep Mediine! "ar#ard Medial Sh$$l %lainti&&s E'pert (itness
(Hearing prior to jury entering)
(ant t$ )a*e +$ur appearanes, Judge: (ant -es. G$$d )$rnin! +$ur h$n$r h$n $r.. /rian %anish &$r %lainti&&s. Mr. Panish: -es. Mr. Mr. Kosko: G$$d )$rnin! +$ur h$n$r. Mihael K$s*$&& &$r %lainti&&s.
/$ +le &$r %lainti&&s. Mr. !oyle: Ke#in /$+le Ms. "ahan: Kathr+n Cahan &$r the De&endants. Mr. Putna#: Mar#in %utna) &$r the De&endants.
Ms. $te%%ins: Jessia Steins Steins &$r the De&endants.
Judge: S$)e$d+ 1anted t$ tal* t$ )e,
-es! +$ur h$n$r. (e (e 1ere ust handed han ded a de)$nstrati#e and a dis 1ith p$1erp$int Ms. "ahan: -es! *ind $& slides $n it that 1e thin* are $in t$ e pr$le)ati &$r puttin p uttin in $ur li#e $nneti$n. And l$$*ed at the)! and I elie#e %lainti&&s3 $unsel th$uht it 1as ad#isale t$ address the) 1ith +$ur h$n$r e&$re the 1itness ta*es the stand and the ur+ is r$uht in. a$u t, Judge: O*a+. (hih 1itness are 1e tal*in a$ut, Mr. Panish: Dr. Czeisler. Judge: O*a+. Dr. Czeisler. Mr. Putna#: Dr. Czeisler. Judge: "e3s an e'pert4 riht, Mr. Mr. Kosko: "e3s a sleep e'pert! +es. Judge: And he has a slide presentati$n,
(ell! there are su))ar+ slides. (e (e an i#e the) t$ +$ur h$n$r. h $n$r. And the+3re ust Mr. Mr. Kosko: (ell! $in t$ 55 1e thin* the+3ll help )$#e the testi)$n+ al$n. (h+ d$n3t +$u i#e the) t$ the ler*, Mr. Panish: All riht. (h+ (ell! is there s$)e reas$n 1h+ it 1asn3t i#en t$ the de&ense earlier, Judge: (ell! -es. /eause it3s a de)$nstrati#e! and ude3s $rder 1as &$r an+ de)$nstrati#e Mr. Panish: -es. e'hiit! t$ sh$1 it t$ the) e&$re the 1itness! s$ 1e3re $)pl+in 1ith that. C$ntrar+ t$ +esterda+! +esterda+! Ms. Steins didn3t sh$1 us the de)$nstrati#e e&$re she used it. (e (e &$ll$1ed the $rder and a#e itt$ the). O*a+. Is it an issue $& needin ti)e t$ re#ie1 it! $r are there $eti$ns! $r +$u ust d$n3t Judge: O*a+. *n$1 +et, (ell! I3) l$$*in at the) n$1! and I ha#e $eti$ns t$ the). 6he &irst 55 1e an Ms. "ahan: (ell! l$$* at the %$1erp$int! 1hih 1as! I thin*! ust printed &$r +$u! a nu)er nu )er $& these 55 I thin* she has t1$ per pae. Mr. Mr. Panish: I thin* 1e sh$uld identi&+ it 1ith the nu)er s$ 1e an *n$1 1hat 1e3re tal*in
a$ut spei&iall+. + the rain.7 Ms. "ahan: 6he &irst $ne I ha#e sa+s! 7Sleep! the eha#i$ral state enerated + Mr. Panish: O*a+. Ms. "ahan: I d$n3t *n$1 1hat nu)er +$u 1ant t$ i#e the). Judge: 6he+3re painated at the $tt$)! 7pae 8.7 Ms. "ahan: %ae 8 has 55
-$ur h$n$r )a+ ha#e t1$ $n a pae! and Ms. Cahan has $ne. 6he &irst Mr. Mr. Kosko: E'use )e. -$ur $ne is laeled! 7Sleep!7 and an d it3s a su))ar+ slide $& 1hat sleep is. $ in t$ la+ the &$undati$n &$r this $ne in his testi)$n+! that3s O*a+. O*a+. It Ms. "ahan: I& he3s $in d$esn3t see) t$ e 55 it d$esn3t see) t$ e ited t$ an+thin!ut i& he3s $in $ in t$ testi&+ ased $n his e'periene! that3s &ine. 6hat3s n$t s$)ethin he testi&ied t$ at his d ep$siti$n! ut I thin* it3s pr$al+ &air a*r$und. Judge: O*a+. It see)s t$ e a*r$und! +$u an aree $n! it see)s. Ms. "ahan: 6hat3s &ine. Judge: Desripti$n $& i$l$ial needs $& sleep. Ms. "ahan: 6he &$ll$1in t1$! pitures $& diara)s $& the rain! I thin*! are &ine. 6he &$ll$1in $ne that sa+s 7(a*e!7 7(a*e!7 and then sa+s 7stae 9:;!7 that3s n$t s$)ethin that 1as addressed at all at his dep$siti$n. I d$n3t *n$1 *n$ 1 1hat the+ plan $n usin this &$r. &$r. Judge: (hat is that, Ms. "ahan: I d$n3t reall+ *n$1.
d urin sleep. (hat 1e3re $in t$ e sh$1in! Mr. Mr. Kosko: 6h$se are sh$1in the rain 1a#es durin +$ur h$n$r! is 55 this is all in $nneti$n 1ith his testi)$n+ that he has i#en! and his $pini$ns he has i#en at his dep$siti$n a$ut 1hat sleep depri#ati$n )eans! and h$1 55 and this is a*r$und &$r sh$1in 1hat happens 1hen +$u3re a1a*e4 1hat happens 1hen +$u3re asleep4 1hat the staes $& sleep are! and 1h+ pr$p$&$l inter&erers 1ith sleep! 1hih is the 1h$le thrust 55 that3s 1h+ he3s here! t$ tal* a$ut a$ ut 1hat the e&&ets $& pr$p$&$l is $n natural sleep. 6he &at that the+ didn3t as* the riht
-eah.. Mr. Mr. Kosko: -eah d $ 1ith pr$p$&$l! $r is this ust sh$1in 1a#es durin sleep Judge: D$es this ha#e an+thin t$ d$ $r 55 -es. It3s sh$1in 1a#es durin n$r)al sleep! and then he is $in t$ disuss 1hat Mr. Mr. Kosko: -es. the di&&erent parts $& the 1a#es are4 1hat the+ )ean in ter)s $& eha#i$r! 1h+ 1e need th$se parts. And then he3s $in t$ sa+ 55 Judge: I thin* +$u3re l$$*in at a di&&erent 55
sa + 1hat pr$p$&$l d$es t$ that. And then he3s $in t$ sa+ sa + Mr. Mr. Kosko: And then he3s $in t$ sa+ 55 Mr. Panish: "$ld $n a se$nd. I d$n3t thin* +$u3re $n the sa)e slide. Judge: "$ld $n. I3) l$$*in at this =indiatin>. Ms. "ahan: 6his $ne =indiatin>.
$n e 1ith the rain 1a#es! $r the $ne 1ith the Mr. Mr. Kosko: -$ur h$n$r! are +$u l$$*in at the $ne 7Sleep+ rain7, Judge: 6his $ne ust sa+s! 7(a*e.7
-es. 6hat3s ust sh$1in the rain 1a#es in the 1a*e state! a1a*ened state! and the Mr. Mr. Kosko: -es. rain 1a#es in the di&&erent staes $& sleep. sleep. And 1hat is $in t$ e sh$1n is 55 I )ean! he an desrie it! ut it s$unds *ind $& sill+ &$r hi) t$ desrie it 1hen he an sh$1 it! h$1 pr$p$&$l inter&eres 1ith the staes $& sleep. It sa+s under the 7Opini$ns!7 1e had n$. ?@ 7Dr. Murra+3s nihtl+ ad)inistrati$n $& pr$p$&$l t$ anesthetize MJ ad#ersel+ a&&eted his ailit+ t$ per&$r) and his ailit+ t$ learn his danes in rehearsals.7 and this is $in t$ supp$rt that. O*a+. I d$n3t thin* there d$esn3t see) t$ e a dispute as t$ 1hether it a&&ets it $r n$t. I Judge: O*a+. thin* the dispute has t$ d$ 1ith this partiular desripti$n 55 Ms. "ahan: Biht. And! +$ur h$n$r 55 Judge: 55 $& 55 55 the issue is that there 1as n$ testi)$n+ 1hats$ 55 I a#e Dr. Czeisler the &l$$r t$ tell )e e#er+thin a$ut his $pini$ns at his dep$siti$n. "e $&&ered n$ testi)$n+ 1hats$e#er a$ut the di&&erent staes $& sleep. "e did $&&er an $pini$n that Dr. C$nrad Murra+3s nihtl+ ad)inistrati$n $& pr$p$&$l t$ anesthetize Mr. Ja*s$n ad#ersel+ a&&eted his ailit+ t$ per&$r) and learn his danes in rehearsals durin that inter#al! ut he said n$thin a$ut h$1 pr$p$&$l a&&ets the rain! h$1 pr$p$&$l a&&ets sleep. 6hat 1as atuall+ 1hat 1h at Dr. /r$1n testi&ied a$ut! and I understand the+3#e eleted n$t t$ all hi). /ut that d$esn3t )ean the+ an ha#e Dr. Dr. Czeisler $)e in and sa+ thins he3s he3 s ne#er testi&ied a$ut.
n$. $. ?! he said that Dr. Dr. Murra+3s nihtl+ ad)inistrati$n $& Mr. Mr. Kosko: "e said it. "e said at n pr$p$&$l t$ MJ a&&eted it. And then he sa+s later $n! $ne $& the $ther $pini$ns 55 1hih is als$ related t$ this 55 and he als$ said in 55 in &at! he spei&iall+ said! 7pr$p$&$l ad#ersel+ a&&ets B.E.M. sleep.7 and h$1 an 55 &irst $& all! there 1as a i rep$rt that he a#e t$ +$u! and +$u ust 55 this is +$ur s+n$psis $& his rep$rt that +$u3re allin his $pini$ns. Judge: S$ a rep$rt 1as pr$#ided, Mr. Mr. Kosko: a #er+ #$lu)in$us rep$rt. Judge: O*a+. All riht. 6his has 55
-$ur h$n$r! I3) s$rr+. s$rr+. I thin* the 1itness is in the $urtr$$). Is that O*a+, The clerk: -$ur Judge: Ma+e he sh$uld step $ut. Mr. Panish: "e an step $ut. Judge: -es. -$u an step $ut. (&r. "'eisler eited the courtroo#)
h is rep$rt. It3s reall+ their s+n$psis $& his $pini$ns. Mr. Mr. Kosko: I an i#e +$ur h$n$r a $p+ $& his (ell! 1hat d$es the rep$rt $n sleep in spae ha#e t$ d$ 1ith this, I uess I3) u)pin the Judge: (ell! un! ut 55 -$ur h$n$r! +$u ha#e the 55 als$! the rep$rt 1as attahed t$ his dep$siti$n! 1hih is Mr. !oyle: -$ur l$ded 1ith +$ur h$n$r. Judge: O*a+.
le ar! the rep$rt is 90 paes. pa es. 6he &indins relatin t$ Mr. Mr. Ms. "ahan: And! +$ur h$n$r! t$ e lear! Ja*s$n! there3s t1$ seti$ns@ seti$n starts $n pae 2! 2 ! and it sa+s! 7preli)inar+ &indin reardin Mr. Mihael Ja*s$n74 and seti$n ! 1hih starts $n pae 2! sa+s! 7preli)inar+ $pini$ns.7 and there3s n$ disussi$n in there 1hats$e#er $& the e&&ets $& pr$p$&$l $n $ne3s ailit+ t$ sleep! 1hat it d$es t$ the rain 1a#es. Si)pl+ n$t a suet that 1as tee3d up + the rep$rt as it relates t$ Mr. Ja*s$n $r an+thin addressed 1ith hi) at the dep$siti$n. Mr. Panish: It is. (e 55
(e ust read that4 that the nihtl+ ad)inistrati$n ad )inistrati$n $& pr$p$&$l a&&eted 55 Mr. Mr. Kosko: (e O*a+. Ms. Cahan! i& that3s in the dep$siti$n! h$1 is that n$t s$)ethin that he $pined t$ Judge: O*a+.
in the dep$siti$n, pe$p le Ms. "ahan: /eause he said the asis &$r that $pini$n is@ 7Generall+ spea*in! 1hen pe$ple aren3t ettin en$uh sleep! it a&&ets their ailit+ t$ en$de e'perienes int$ )e)$ries and uild $n their )e)$ries.7 Judge: O*a+. Ms. "ahan: N$thin a$ut pr$p$&$l a&&etin that! n$thin a$ut the staes $& sleep! n$ne $& that detail. 6hat is 1hat Dr. /r$1n did! and I uess the+ eleted n$t t$ all hi). /ut this is n$t s$)ethin Dr. Dr. Czeisler 1as testi&+in t$ $r addressed addressed in his rep$rt 1ith respet t$ Mr. Mr. Ja*s$n. S$ the+3re ta*in an $pini$n and i#in it a Ne1 &$undati$n &$un dati$n that 1asn3t disussed at his dep$siti$n.
(ell! the+ an r$ss5e'a)ine hi)! i& that3s the ase. /ut 1e ha#e the $pini$ns! $p ini$ns! all Mr. Mr. Kosko: (ell! the $pini$ns! and this is all a*r$und t$ the $pini$ns. Let the) 55 O*a+. S$unds li*e he has the $pini$n! it ust d$esn3t ha#e the 55 Judge: O*a+. Ms. "ahan: /rand5ne1 &$undati$n. Judge: In the dep$siti$n! )uh $& the &$undati$n! 1asn3t that e'pl$red durin the dep$siti$n, Ms. "ahan: I as*ed hi) the &$undati$n! and 55 Judge: O*a+. And 1hat did he sa+, Ms. "ahan: 6he &$undati$n! he said! 1as 1athin the 6his Is It #ide$! he th$uht! and readin thr$uh testi)$n+ 1here it said Mr. Ja*s$n 1as sl$1 55 I elie#e it 1as Mr. %a+ne $r Mr. Ortea! he 1as a little it sl$1 t$ pi* up the dane )$#es. Judge: And n$1 he3s $in t$ sa+ s$)ethin else. And s$ +$u an i)peah hi) t$ the &at that he ne#er )enti$ned it in his dep$siti$n4 riht, Ms. "ahan: -es! +$ur h$n$r! ut the la1 is 55
the + didn3t sa+ s$)ethin Mr. Mr. Kosko: +es. As e#er+ $ther 1itness has een i)peahed 1hen the+ In their dep$siti$n. And Mr. Mr. %hillips! 1h$ didn3t sa+ an+thin at all a ll in his dep$siti$n and suddenl+ had re&reshed )e)$r+ 1as i)peahed! li*e! ?0 ti)es. "e an3t e pre#ented &r$) testi&+in 1hen he has the sa)e $pini$n. All 1e3re d$in is the &$undati$n 55 Ms. "ahan: And! +$ur h$n$r! I as*ed the &$undati$n &$r his $pini$n at his dep$siti$n! and it 1as s$)ethin entirel+ di&&erent. Apparentl+! Apparentl+! n$1 the+ 1ant hi) t$ tal* a$ut 1hat Dr. /r$1n 1as tal*in a$ut. /ut the pr$le) is! this is n$t the appr$priate 1itness. 6his is n$t n$r)al
i)peah)ent. 6his is an e'pert. And under the rules! the purp$se &$r an e 'pert dep$siti$n is t$ a#$id un&air surprise at trial. "e3s a sleep e'pert. "e3s een d$in this &$r ;0 +ears. I3#e studied up $n it! ut I3) n$t at his le#el! and it3s n$t &air t$ )e t$ ha#e a rand5ne1 &$undati$n &$r an $pini$n rand&athered in &$r the &irst ti)e 1hen he ta*es the stand. -$ur h$n$r! he a#e an $pini$n. nder n der the ase la1 he a#e his $pini$ns in Mr. Panish: -$ur dep$siti$n. "e3s n$t i#in a ne1 $pini$n. 6hat3s as lear as da+. Jude@ I3) $in t$ den+ +$ur +$u r )$ti$n. I d$n3t *n$1 e'atl+ e'a tl+ 1hat +$ur )$ti$n 1as. It started $&& 1ith the slide sh$1! ut it3s *ind $& turned int$! an I e'lude his $pini$ns alt$ether. And )+ understandin 55 i& that3s +$ur )$ti$n! that3s denied. h$ n$r.. I3) n$t see*in t$ e'lude e' lude the $pini$ns he Ms. "ahan: And that3s n$t )+ )$ti$n! +$ur h$n$r $&&ered at the dep$siti$n. I had a
Mr. Mr. Panish: /ut it3s illustrati#e $& the $pini$ns that he a#e at his dep$siti$n. Judge: O*a+. Mr. Panish: It3s a de)$nstrati#e e'hiit t$ illustrate the $pini$ns + the e'pert. And pursuant t$ +$ur rule! it 1as t$ e +$ur rule! the+ re
dep$ siti$n, Judge: /ut it 1asn3t presented at the dep$siti$n, Ms. "ahan: 6hat3s as$lutel+ riht! +$ur h$n$r. Mr. Mr. Kosko: 6his didn3t e'ist at the dep$siti$n. Mr. Mr. Panish: 6he e'hiit 1asn3t presented. "e a#e his $pini$n. And he an stand up there and 1rite it $n a $ard. I )ean! 1hat3s the di&&erene, Judge: "e $uld! +es. Mr. Panish: S$ 1hat3s the di&&erene, Ms. "ahan: S$ his $pini$n! +$ur h$n$r! is ne1! and that3s the pr$le). (hat he said in his dep$siti$n 1as la* $& sleep )a+ ha#e ha #e aused pr$le)s &$r Mr. Ja*s$n in learnin dane )$#es 1hile he 1as a1a*e. "e didn3t sa+! sa+! 7Ad)inistrati$n $& pr$p$&$l auses pr$le)s in pe$ple 1h$ 1h $ are a1a*e.7 6hat is n$t s$)ethin e#en Dr. /r$1n testi&ied testi&ied t$! and Dr. /r$1n 1as presented as the e'pert $n pr$p$&$l! and 1hat pr$p$&$l d$es t$ the $d+ and the rain.
(ell! that3s atuall+ n$t
e'pert. "e3s an anesthesi$l$ist. And eause the anesthesia is n$1 part $& the ase! and it see)ed t$ e $neded + the $ther side! there 1as n$ need t$ rin Dr. /r$1n in. 6his is the sleep e'pert! and he is $in t$ in &at sa+ he didn3t et sleep. And he3s $in t$ 55 that3s e'atl+ 1hat he3s $in t$ sa+. "e3s $in t$ sa+ the reas$n he didn3t et sleep is eause the pr$p$&$l 1as n$t i#in hi) sleep. It 1as i#in hi) the illusi$n $& sleep and that he didn3t et sleep! and that3s e'atl+ 1hat he3s $in t$ sa+. Judge: Beread the $pini$n that +$u read earlier, Ms. "ahan: 7 Based upon the findings summarized above, and the other materials that I reviewed in connection with my evaluation of this matter and relevant scientific information, it is my medical and scientific opinion o pinion that Dr. Conrad Murray's nightly administration of propofol to anesthetize Mr. ac!son adversely affected his ability to perform and his ability to learn dances in rehearsals that occurred during that interval. 7 And 1hen 1e as*ed hi) a$ut that in his dep$siti$n! he said that3s eause he 1asn3t sleepin! n$t eause he h e 1as 55 s$)ethin 1ith 55 the pr$p$&$l a&&eted hi). Mr. Panish: 6hat3s the sa)e thin.
(ell! this is 1hat I3) $in t$ d$. D$ +$u ha#e $eti$ns t$ all this $ther asi Judge: All riht. (ell! &$undati$n $nernin sleep, Ms. "ahan: I d$n3t *n$1 55 Judge: It see)s t$ )e i& he disussed that in the dep$siti$n! this sh$uldn3t e a pr$le). At least e#er+thin up t$ the last pae.
ne1! ut I didn3t reall+ ha#e an issue 1ith it. 6he Ms. "ahan: 6he $ne that 1e ha#e 55 that3s all ne1! $nes 1e ha#e a real pr$le) 1ith is 7Sleep #ersus pr$p$&$l anesthesia7 55 Judge: O*a+. Ms. "ahan: 55 as 1ell as the last $ne 55 Judge: O*a+. Ms. "ahan: 55 that &$ll$1s it! and the separate de)$nstrati#e. /eause these appear t$ e ased $n Dr. Murra+3s p$lie inter#ie1! 1hih is n$t in e#idene. And as +$ur h$n$r *n$1s 1ell! an e'pert an &$r) $pini$ns ased $n hearsa+ ut an3t rand&ather in spei&i in&$r)ati$n that3s hearsa+ thr$uh their testi)$n+. testi)$n+. S$ it3s this $ne =indiatin>! and I d$n3t *n$1 i& the+ pr$#ided +$u 1ith 55 Judge: 6his is 1hat I3) $in t$ d$@ I3) $in t$ stri*e the last pae. 6he rest $& it is all &$undati$nal he testi&ied t$ 1ith his e'pertise. -$u -$u an use that. I d$n3t thin* there is an+thin an +thin
pre#entin hi) &r$) $in t$ the $ard and 1ritin n$tes as t$ 1hat his testi)$n+ testi)$n+ is. Mr. Mr. Kosko: D$ 1e ha#e a $ard, Ms. "ahan: S$! +$ur h$n$r! ust s$ the re$rd is lear 55 eause s$)e $& us ha#e $ne slide per pae! and the $ther ha#e t1$ slides per pae 55 Judge: -es. Ms. "ahan: 55 1hat +$u3re e'ludin at this ti)e is the slide headed! 7Sleep #ersus pr$p$&$l anesthesia7, Judge: -es.
6uesda+! June 29rd7, 29 rd7, Ms. "ahan: And the $ne that has the headin $& 7M$nda+! June 22nd! and 6uesda+! Judge: Biht. Ms. "ahan: And 1e 1$uld ta*e 55 d$ +$u ha#e a C$p+ $& this e'hiit 9?58, I3) happ+ t$ hand up )ine. Judge: N$. And in &at! I3) $in t$ )a*e sure this ets t$ the &ile s$ it3s lear 55 Mr. Putna#: 6han* +$u! +$ur h$n$r. Judge: 55 1hat 1e3re all tal*in a$ut. Mr. Panish: Are 1e all read+,
-$ur h$n$r! 9?58 appears t$ e a ti)eline $& the ad)inistrati$n $& the pr$p$&$l and Ms. "ahan: -$ur $ther drus ased $n June 2?th $r June 2;th. Mr. Mr. Kosko: I3) $in t$ as* 55 Ms. "ahan: %lease let )e &inish. Mr. Mr. Kosko: I ap$l$ize.
Dr. Murra+3s p$lie inter#ie1. And! aain! that3s ased $n hearsa+ and Ms. "ahan: /ased $n Dr. that3s n$t appr$priate. Mr. Mr. Kosko: I3) $in t$ use it as a h+p$thetial. Ms. "ahan: It3s still n$t appr$priate.
Mr. Mr. Kosko: I3) $in t$ sa+! 7D$ +$u ha#e an understandin!7 sa)e
-$ur h$n$r! I )ean! 1e3d e happ+ happ + t$ ha#e the entire p$lie inter#ie1 $)e int$ Ms. "ahan: -$ur e#idene. I& that3s 1hat the+ 1ant t$ d$ at this ti)e! 1e d$n3t ha#e an+ $eti$n. /ut as it stands riht n$1! that ust turnin it int$ a "+p$thetial 1ith that le#el $& detail $n the hart 1ith preise ti)es is n$t &i'in the hearsa+ pr$le)! it3s ust ust snea*in ar$und it. Judge: O*a+. See i& it 55
-$u 1ant t$ stipulate t$ the ad)issiilit+ $& the p$lie inter#ie1, Ms. "ahan: -$u Mr. Mr. Kosko: N$t at this ti)e. Mr. Panish: N$t the 1h$le thin! n$. Mr. Mr. Kosko: I3ll stipulate t$ the ad)issi$n $& th$se 55 Judge: I3) $in t$ stri*e it! ut i& he ets up here! and he dra1s $ne...
(ell! I3ll $et at that ti)e! then! +$ur h$n$r. Ms. "ahan: (ell! Mr. Panish: All riht. Are 1e read+ t$ $, I assu)e 1e3re n$t ta*in a rea*, Judge: N$. Mr. Panish: All riht. Hair en$uh.
(the jury enters the courtroo#)
&irect ea#ination %y Michael Kosko:
. -$u -$u ha#e en$uh le r$$), A. 6hat3s 1hat I3) tr+in t$ &iure $ut. . G$$d )$rnin! d$t$r. A. G$$d )$rnin.
. D$t$r! 1here d$ +$u li#e at the urrent ti)e, A. I li#e in the /$st$n area in Massahusetts. . And 1here are +$u &r$) $riinall+, A. I re1 up in Chia$. . (here in Chia$, A. On the s$uth side $& Chia$. . And did +$u $ thr$uh +$ur asi sh$$lin in Chia$, A. -es. -es. I did asi sh$$lin in Chia$. (ent t$ rade sh$$l in Chia$ and then 1ent t$ hih sh$$l in $ne $& the suurs $& Chia$. . And then a&ter hih sh$$l! did +$u $ t$ $llee, A. I did. . (here did +$u $, A. I 1ent t$ "ar#ard C$llee in Ca)ride! Massahusetts. . And did +$u ha#e sh$larships, A. I had an h$n$rar+ h$n$ rar+ &resh)an sh$larship. . An h$n$rar+ &resh)an sh$larship, A. -es. -es. And as I re$llet! there 1as a J$hn "ar#ard sh$larship. . -$u3re $in t$ ha#e t$ *eep +$ur #$ie up. 6he a$ustis in here are 55 A. I3ll $ a little l$ser t$ the )ir$ph$ne. . 6hat3s reat. A. I3) 1$nderin i& 55
Judge: t #oves. *o. +ike this, %ack and orth (indicating).
The -itness: kay.
. O*a+. And did +$u raduate &r$) "ar#ard C$llee, A. -es! I did. . N$1 +$u3re li*e a tal* sh$1 h$st. A. 6here +$u $. It3s a little t$$ sh$rt! $ther1ise. . And +$u raduated &r$) "ar#ard, A. -es. -es. I raduated &r$) "ar#ard C$llee in 8F;. . And +$u raduated 1ith h$n$rs, A. -es! -es! I did. Mana Cu) Laude. . Mana Cu) Laude, And &$ll$1in +$ur raduati$n &r$) "ar#ard! 1hat did +$u d$, Did +$u $ntinue +$ur eduati$n, A. -es! I did. . (here did +$u $, A. Stan&$rd Medial Sh$$l. . Stan&$rd. 6hat3s riht up the r$ad here. A. -es! -es! it is. . And +$u 1ent t$ )edial sh$$l. Did +$u raduate &r$) )edial sh$$l, A. -es! I did. . Get a deree in )ediine, A. -es. I $t an M.D. . And then a&ter +$u raduated &r$) )edial sh$$l! did +$u $ntinue +$ur eduati$n, A. -es. -es. (ell! (ell! I atuall+ 55 s$ it 1as a $nurrent pr$ra) I 1as in alled )edial sientist trainin pr$ra)! 1hih is an M.D. and %h.D. %r$ra). And I reei#ed a %h.D. in the neur$ neu r$ and i$eha#i$ral sienes! and then I reei#ed )+ M.D.
. S$ +$u $t t1$ derees@ an M.D. deree 55 that3s a D$t$r $& Mediine, A. 6hat is $rret. . And a %h.D. Deree! 1hih is a55 A. D$t$r $& $ & %hil$s$ph+. . 55 D$t$r $& %hil$s$ph+, And the D$t$r $& %hil$s$ph+ deree 1as in 1hat &ield, A. Neur$ and i$eha#i$ral sienes. . Neur$ and i$eha#i$ral sienes. 7neur$!7 d$es that ha#e t$ d$ 1ith the rain, A. -es. . And the $ther part 1as, A. /i$eha#i$ral sienes. . /i$eha#i$ral sienes, (hat are i$eha#i$ral sienes, A. 6hat is the siene related t$ h$1 i$l$+! i$l$+! in this ase! the neur$sienes! $r the rain! a&&ets $ur eha#i$r eha# i$r.. . And s$ that 1as +$ur %h.D.! in that &ield, A. -es. . And then a&ter +$u 55 +$u $)pleted that pr$ra)! 1as that in 88, A. -es. -es. I $)pleted the pr$ra) in 88. . And then did +$u ta*e a p$siti$n as a Seni$r Hell$1, A. -es! I did. . And 1here 1as that p$siti$n as a Seni$r Hell$1, A. 6hat 1as at "ar#ard uni#ersit+ at the J$hn H. Kenned+ Sh$$l $& G$#ern)ent. 6he )edial sh$$l. It 1as a $int pr$ra). . -$u -$u *n$1! &$r s$)e reas$n! the )ir$ph$ne is s$undin a little )u&&led t$ )e.
Mr. Kosko: does it sound that -ay to the jury/ t sounds a little #uled to all o us. don0t kno- -hat -e can do.
. Ma+e i& +$u put it a* in the 55 A. O*a+. I3ll tr+ puttin it a* in. . I *n$1 part $& the pr$le) is! it3s n$t tall en$uh. A. "$1 a$ut this, D$es that 1$r*, . 6hat3s a little etter. A. Is that etter, 6here. G$$d. . O*a+. G$$d. S$ 1e ha#e +$u at the J$hn H. Kenned+ sh$$l $& $#ern)ent as a Seni$r Hell$1. Hell$1. And is that a&&iliated 1ith "ar#ard, A. -es. -es. 6hat3s the 55 at "ar#ard ni#ersit+! ni#ersit+! and there3s a pr$ra) et1een e t1een the "ar#ard Medial Sh$$l 55 the Kenned+ Sh$$l $& G$#ern)ent! and the "ar#ard Sh$$l $& %uli "ealth and pr$ra) in health p$li+. p$li+. . In health p$li+, And then did +$u $ntinue and e$)e a pr$&ess$r at "ar#ard, A. -es. . Di&&erent staes@ Assistant Assistant pr$&ess$r! da5da5da! and then +$u &inall+ ea)e a pr$&ess$r at "ar#ard, A. -es! that3s aurate. . And that 1as in 8. In 200;! I see in +$ur resu)e that there3s s$)ethin alled a /aldin$ pr$&ess$r $& sleep )ediine. Hirst $& all! 1hat is is this p$siti$n! a /aldin$ pr$&ess$r, Is that a Chair in this area, A. -es. -es. S$ that3s a pr$&ess$rship. As a pr$&ess$r $& )ediine! the )edial sh$$l! 1hen it reei#es a Gi&t &r$) a D$n$r! D$n$r! it s$)eti)es estalishes a li&eti)e li&eti)e p$siti$n in a partiular &ield! in a partiular disipline. And 1e 1ere &$rtunate t$ reei#e d$nati$ns that estalished the &irst three pr$&ess$rships in sleep )ediine in the 1$rld in 200; in the "ar#ard )edial sh$$l in the di#isi$n $& sleep )ediine. And I 1as na)ed + the Dean $& the )edial sh$$l t$ e the inu)ent $& $ne $& th$se end$1ed end $1ed pr$&ess$rships. . And d$ +$u still h$ld that p$siti$n,
A. I d$. . N$1! the 55 durin the $urse $& +$ur areer! 1hen 1as it that +$u reall+ started t$ stud+ sleep )ediine, A. (hen I 1as an underraduate 1hen I &irst ean t$ l$$* at $ne $& the *e+ &at$rs that reulates it! 1hih is the ti)in $& $ur end$en$us iradian rh+th). . O*a+! sir. sir. End$en$us iradian rh+th). A. 6he internal l$* in the rain. . (hat is it, A. 6he internal l$* in the rain that $ntr$ls the ti)in $& 1hen 1e sleep and 1a*e! and the ti)in $& the release $& h$r)$nes. 6hat3s 1h+ 1e sleep at niht and 1e are a1a*e durin the da+. . S$ that i$l$ial l$* is s$)ethin that3s tha t3s alled the iradian rh+th), A. 6hat3s riht. 6he i$l$ial l$* dri#es the iradian rh+th)s. . And +$u started stud+in that 1hen +$u ea)e 55 1hen +$u 1ere an underrad, A. 6hat3s riht. . Did +$u $ntinue +$ur stud+ $& that thr$uh the #ari$us )edial sh$$l:%h.D. pr$ra)! et etera, A. -es. -es. I ean 1$r*in $n the dail+ +le $& $rtis$l as a dail+ pr$et! &$r 1hih I reei#ed a Su))a Cu) Laude e#aluati$n. And then I did )+ d$t$ral dissertati$n at Stan&$rd $n the iradian rh+th)s $& $d+ te)perature! the ther)al reulati$ns! the ti)in! aain! $& the release $& $rtis$l! and als$ $ther h$r)$nes. . O*a+. And 55 A. And the ti)in $& sleep and 1a*e. . And alth$uh +$u are a )edial d$t$r! d$ +$u treat patients, A. N$! I d$ n$t. . And +$u3re n$t in the pratie $& )ediine,
A. I d$n3t pratie )ediine. . N$1! in )$#in thr$uh +$ur urriulu) #itae! I see that there are the 1$rds 55 7iradian7 sh$1s up a l$t. And that3s 1hat +$u desried as the $d + l$*. "$1 d$es the $d+ $d + l$* a&&et sleep, A. It reulates the ti)in $& 1hen 1e sleep and 1a*e. It reulates the ti)in $& 1hen 1e are e#en sleepin! and it reulates the ailit+ t$ )aintain the $ns$lidati$n $& sleepin at niht. S$ this internal l$*! ir$niall+! ir$niall+! sends $ut the str$nest dri#e &$r 1a*in near the end $& $ur 1a*in da+ in the e#enin. It pr$#ides us a se$nd 1ind that all$1s us t$ sta+ a1a*e &$r 1hat is a )arath$n in the ani)al *ind$)! 1hih is 8 h$urs. S$)e pe$ple push it &urther! ut )$st ani)als ta*e little atnaps e#er+ &e1 )inutes. -$u -$u 1al* +$ur d$! and as s$$n as +$u et a*! +$ur d$ $es t$ sleep! and +$u $ t$ 1$r*. /ut 1e ha#e this )arath$n $& 1a*e&ulness! and the 1a+ the hu)an rain is ale t$ ahie#e that and 1e dis$#ered this in )+ la$rat$r+ 55 is that 1e is that in the late e#enin! it sends $ut this dri#e! s$rt $& a&ter the lunh! a&ter lunhti)e! the dri#e &r$) the internal l$* t$ sta+ a1a*e e$)es str$ner and str$ner. N$1! N$1! s$)eti)es thr$uh liht e'p$sure! 1e push that e#en e# en later and later! eause liht is the p$1er&ul s+nhr$nizer $& +$ur internal l$*. It sends a )essae t$ the internal l$*! this is da+ti)e! +$u sh$uld e a1a*e4 and dar*ness sends an$ther )essae t$ the internal l$* that tha t this is nihtti)e! and it is the ti)e t$ sleep. . N$1! d$es that ause pr$le)s &$r pe$ple 1$r*in 1h$ are 1$r*in pe$ple! 1h$ ha#e niht $s! &$r e'a)ple, A. It d$es. (hen edis$n )ade it p$ssile &$r us t$ ha#e arti&iial liht! suh as 1e ha#e here in the $urtr$$)! 1e an n$1 &lip $n and $&& a S1ith! 1hih is 55 sends a p$1er&ul sinal t$ the rain! shi&tin $ur iradian rh+th)s. And i& 1e turn $n that s1ith and ha#e liht e'p$sure at niht! that sends a $n&usin sinal t$ the rain. It suppresses the release $& the natural h$r)$ne )elat$nin that n$r)all+ all$1s us t$ &ailitate sleep at niht and atuall+ shi&ts the iradian rh+th)! )a*in it harder &$r us t$ $ t$ sleep at the ti)e 1e 1ant. . N$1! in additi$n t$ pe$ple 1h$ 1$r* the niht shi&t 1h$ an e a&&eted + this! is this s$)ethin that a&&ets! &$r e'a)ple! sp$rts tea)s, A. -es! it d$es. . And ha#e +$u! durin the $urse $& +$ur areer! had $asi$n t$ $nsult &$r sp$rts tea)s 1h$se pla+ers are $thered + this hane in iradian rh+th)s, A. -es. -es. 6he &irst sp$rts tea) that as*ed )e t$ 1$r* 1ith the) 1as the p$rtland traillazers! 1hih is a pr$&essi$nal as*etall tea). And the+ had ust l$st a series $& a)es in 1hih the+ had tra#eled t$ the east $ast! and $ntated )e and as*ed i& I $uld help the) deal 1ith that tra#el shedule.
. And ha#e +$u dealt 1ith $ther sp$rts tea)s t$ deal 1ith that pr$le) $& the shi&tin $& ti)e z$nes! and the li*e, Ms. "ahan: %jection, your honor. 1elevance. Judge: verruled.
A. -es! -es! I ha#e. I3#e helped the Minnes$ta 6i)er1$l#es and the /$st$n Celtis! 1$r*in 1ith d$ ri#ers. And als$ ha#e d$ne s$)e 1$r* 1ith the /ruins! and n$1 e)ar*in 1ith 1$r*in 1ith the Bed S$'. . -$u -$u ha#e n$t said a l$t $& #er+ p$pular thins in this $urtr$$) s$ &ar. &ar. A. It is 55 I didn3t sa+ the la*ers! &$r e'a)ple. . N$t +et. And I d$n3t 1ant t$ 55 I3#e een as*ed t$ as* this
. Is that a $))$n e'periene &$r these r$ups, A. 6hat 1$uld e a $))$n e'periene. . "a#e +$u $nsulted &$r an+ a n+ )usial r$ups 1ith reard t$ their pr$le)s in dealin 1ith sleep issues, A. -es! I ha#e. . (hat r$ups ha#e +$u $nsulted &$r, A. (ell! (ell! )$st n$tal+ n $tal+!! the B$llin St$nes! and their lead siner. . And! + the 1a+! 1a+! ha#e +$u atuall+ a tuall+ 55 and I *n$1 +$u ha#e per)issi$n t$ sa+ this! ut 55 eause 55 ut d$ +$u atuall+ 55 +$u 1$r*ed 1ith Sha
A. -es. -es. (e (e trained the astr$nauts in h$1 t$ set up the re$rdins! and instru)ent the). (e (e re$rded the sleep $& senat$r $hn lenn 1hen he 1as in spae! and a Nu)er $& $ther astr$nauts $n #ari$us )issi$ns. It 1as *ind $& $$l 1athin the data $)e d$1n &r$) spae and an d see EAG re$rdins! and see the di&&erent staes $& sleep the+ 1ere in 1hile the+ 1ere in spae. . N$1! in additi$n t$ +$ur $nsultin! teahin! +$u3re enaed in $n$in researh! I ta*e it4 is that riht, A. 6hat3s riht. . And d$ +$u et rants! as the head $& the sleep pr$ra) at "ar#ard! &r$) #ari$us instituti$ns reardin 55 1h$ are stud+in sleep, A. -es. -es. (e (e 55 the 1a+ it usuall+ 1$r*s is that! as in#estiat$r! as a researh sientist! I 1$uld su)it a pr$p$sal! pr$p$sed researh rant t$ the $#ern)ent. And it ta*es t$ 82 )$nths &$r it t$ e re#ie1ed. And then i& 1e3re lu*+ en$uh t$ e seleted a)$n the rant pr$p$sals that 1ere su)itted! 1e 1$uld e a1arded t$ arr+ $ut the researh pr$p$sed. . And ha#e +$u een in#$l#ed in $n$in $n $in researh, A. I3#e een $ntinu$usl+ supp$rted thr$uh the rant pr$ra) &$r a$ut 2? +ears. . D$t$r! 1hat is the institute $& )ediine, A. 6he institute $& )ediine is an $ranizati$n that 1as estalished 55 . Spea* a little sl$1er! please. A. 6he Institute $& Mediine is an $ranizati$n that 1as estalished + the $#ern)ent! ut it3s a separate! independent $ranizati$n! t$ pr$#ide p$li+ ad#ie ad #ie t$ the nited States $#ern)ent and t$ $thers $n )atters $& health $& the nati$n. n ati$n. . Are +$u a55 1hat3s in#$l#ed in ettin app$inted t$ the Institute $& Mediine, A. 6here is a seleti$n pr$ess. . "$1 )an+ appliants are there, Or h$1 )an+ ph+siians are there, A. 6here are a$ut 00!000 ph+siians in the nited States. . "$1 )an+ et app$inted eah +ear, A. ?.
. And are +$u a )e)er $& the Institute $& Mediine, A. -es. -es. I 1as eleted t$ the institute $& )ediine. . In 1hat &ield d$ +$u ad#ise the $#ern)ent thr$uh the Institute $& Mediine, (hat is +$ur &ield $& speialt+ there, A. 6he 1a+ it 1$r*s at the institute $& )ediine! +$u3re n$t di#ided int$ speial &ields $& speialt+! speialt+! ut I 1as ad)itted as a Me)er and ha#e ser#ed $n #ari$us panels in the institute $& )ediine a$ut speial issues that ha#e 55 are a )atter $& 55 1here p$liies are ein de#el$ped. de# el$ped. . O*a+. N$1! is the 55 durin the $urse $& all $& this 1$r* that +$u d$! teahin! and researhin and e#er+thin! ha#e +$u als$ had an $pp$rtunit+ t$ 55 1ell! l$$*in at 55 t$ e a )e)er $& #ari$us s$ieties! pr$&essi$nal s$ieties! in the &ield $& )ediine, A. -es! I ha#e. . And are +$u 55 ha#e +$u held $&&ie in )an+ $& these pr$&essi$nal s$ieties, A. I ha#e ser#ed as the president $& the sleep researh s$iet+! and I3#e een a )e)er $& the sleep researh s$iet+. s$iet+. . 6he sleep researh s$iet+, A. 6he sleep researh s$iet+ and the A)erian Aade)+ $& Sleep Mediine &$r )an+ +ears. I ha#e ser#ed as a )e)er $& the $ard $& the Nati$nal Sleep H$undati$n! and I a) n$1 Chair)an5elet $& the Nati$nal Sleep H$undati$n $ard $& diret$rs. And I ha#e ser#ed $n a nu)er $& di&&erent panels. I3) a Me)er $& the A)erian Aade)+ &$r the Ad#ane)ent $& Siene and S$iet+ &$r 55 . At the Institute $& Mediine! 1hat *inds $& panels d$ +$u ser#e $n, A. I ser#ed $n panels e#aluatin e# aluatin 55 $ne 1as a panel $n the $#ern)ent that 55 the ar)+ had uilt a tan* that pe$ple $uld $u ld sur#i#e in &$r F2 h$urs! ut the+ the + had n$ plae &$r the) t$ sleep in this partiular tan*. And the+ as*ed )e t$ ser#e $n a panel e#aluatin h$1 this 1$uld e depl$+ed! and 1hat *ind $& issues and hazards 1$uld e ass$iated 1ith this. And there 1as a panel $n 1$r*l$ad transiti$n. I als$ ser#ed $n! &$r the S C$nress! the $&&ie $& tehn$l$+ assess)ent! a panel $n ha#in t$ d$ 1ith shi&t 1$r* in $ur s$iet+. s$iet+. I testi&ied e&$re $nress $n 55 &$r the panel e#aluatin shi&t 1$r* pr$duti#it+ and health in $ur s$iet+. s$iet+. I d$n3t ha#e a $p+ $& )+ CV in &r$nt $& )e. . 6hat3s O*a+.
A. Vari$us Vari$us $ther panels I3#e ser#ed $n. . I thin* 1e et the piture. In additi$n t$ that! sir! and t$ all $& that 1$r* +$u3re d$in and $nsultin! and 1ith the #ari$us $ranizati$ns and ser#in $n panels! ha#e +$u als$ pulished artiles in learned $urnals in the &ield $& sleep, A. -es! I ha#e. . And d$ +$u ha#e $#er 820 $riinal rep$rts in peer5re#ie1ed $urnals, A. -es! I d$. . And 7peer5re#ie1ed $urnals!7 ust s$ 1e an understand 1hat the+ are! are the + 55 1ell! these are $urnals that d$t$rs and $ther sientists pulish in4 is that $rret, A. 6hat3s $rret. S$ 55 . "$1 d$ +$u et int$ a peer5re#ie1ed $urnal, (hat has t$ e d$ne t$ et an artile pulished, A. A 1ritten rep$rt is a &indin that 55 n$t a Be#ie1 $& the literature. It )eans +$u ha#e d$ne $riinal researh t+piall+ supp$rted + + $ne $& th$se rants I desried. -$u -$u d$ researh &$r &$ur $r &i#e +ears4 +$u $)e up 1ith a &indin! and +$u rep$rt the results $& the researh. /eause i& +$u d$n3t rep$rt the results $& the researh! then n$ $ne *n$1s 1hat +$u3#e spent the &unds $n &r$) the $#ern)ent t$ d$ this ati#it+. S$ 1hat I al1a+s li*e t$ tell the students is! i& +$u d$n3t pulish it! n$ $ne 1ill *n$1 that it happened. S$ it is an $liati$n t$ pulish the results $& the researh that the puli has supp$rted. . And then 55 A. -$u su)it the results! and then a panel the edit$r $& the $urnal in#ites pe$ple 1h$ are e'perts in that &ield t$ e#aluate 1hat +$u3#e +$u3# e su)itted t$ &ind $ut i& it3s een 55 i& it has ha s een ri$r$usl+ arried $ut and )erits puliati$n in the sienti&i literature. . And these panel $& e'perts! are the+ alled ad h$ $))ittees, A. 6he+ 1$uld e alled peer re#ie1ers. . And are +$u $n the edit$rial $ard $& an+ an + $urnal, A. I3) $n the edit$rial $ard $& the $urnal $& sleep. /elie#e it $r n$t! there is a $urnal. . 6here is a J$urnal $& Sleep. D$es it put +$u t$ sleep,
A. It sh$uldn3t. 6he artiles are atuall+ #er+ e'itin. . And in additi$n 55 and s$ +$u desried t$ us 1hat the $riinal rep$rts are. In additi$n t$ that! ha#e +$u d$ne re#ie1 artiles, A. -es! I3#e 55 . And 1hat3s the di&&erene et1een 55 +$u said the $riinal rep$rt! +$u desried 1hat that is. "a#e +$u d$ne )$re than F? re#ie1 artiles, A. -es. -es. S$ re#ie1 artiles a rtiles is 1here +$u tr+ t$ s+nthesize. S$ there are )an+ rep$rts@ 6his auses this4 this d$es this. I& 1e shi&t the iradian s+ste) 1ith liht $r 55 n$1! +$u ha#e t$ tr+ t$ s+nthesize th$se t1$ t$ether. And the re#ie1 artiles are 1ritten t+piall+ &$r pe$ple 1h$ 55 s$ the r$up $& sientists 1h$ are deepl+ in#$l#ed in $ne partiular area 1ill e readin eah $ther3s $riinal rep$rts all the ti)e. /ut then there )a+ e s$)e$ne slihtl+ $utside the area 1h$ still 1ants t$ understand 1hat that 55 1hat3s $in $n. And s$ +$u 1ill 1rite a re#ie1 artile! 1hih s+nthesizes the 1$r* that3s een arried $ut! let3s sa+! in the past ? $r 80 +ears! and puts it t$ether either &$r $ther sientists $r liniians. . And that3s 1hat a re#ie1 artile is, A. 6hat3s a re5 55 . -$u re#ie1 literature, A. E'atl+. . And + the 1a+! in these peer5re#ie1ed $urnals! 1hat r$le! i& an+! d$es )edial ethis pla+ pla + in the puliati$n in a peer5re#ie1ed $urnal, A. (ell! (ell! &irst $& all! there is the ethis $& h$1 +$u $ndut the researh. S$ e#er+ 55 . 6hat3s $ne part. A. E#er+ $ne in a (hile +$u 1ill read a$ut a Sientist 1h$ has &uded data $r )ade up stu&& t$ et it pulished! $r it )iht n$t et pulished. And then it 1ill ha#e t$ e 1ithdra1n &r$) the literature! and there is then &$re#er attahed t$ that artile a state)ent that 76his has een resinded $r 1ithdra1n eause $& the
A. -eah. -eah. -$u3re -$u3re n$t $in t$ et an$ther rant 55 . And are there ethis in#$l#ed! als$! in h$1 +$u use hu)an suets, A. -es. -es. 6here are ethis 55 e#er+ hu)an e'peri)ent 1e d$! 1e ha#e t$ $ e&$re an ethis panel. (e present 1hat 1e pr$p$se t$ d$! and then a panel! 1hih inludes researh d$t$rs in #ari$us areas! linial ph+siians 1h$ understand 1hat the ris*s )iht e in#$l#ed in 1hat $ur pr$edure is $in t$ e atte)pted! and then pe$ple &r$) the eneral puli 1h$ 55 an ethiist! and s$)eti)es ler+! ler+! and s$ $n! 1h$ sit $n a panel. pan el. And the+ sa+! is this a reas$nale thin, D$es the ris* $& the indi#iduals 1h$ are $in t$ e part $& this researh )erit 55 ased $n 1hat $ne )iht learn &r$) the researh! is the ris* 1$rth it! and are +$u pa+in the pe$ple pe$ ple a reas$nale a)$unt! ut n$t an e'essi#e a)$unt that 1$uld $ere the) e$n$)iall+ t$ partiipate, . And it3s als$ 55 O*a+. And the+ als$ ha#e t$ e ad#ised $& the ris*s! I ta*e it, A. -es. -es. 6he+ ha#e a $nsent &$r) that 55 . Let )e as* +$u an$ther an $ther
Ms. "ahan: 0ll just o%ject at this point, your honor. This -as the su%ject o a #otion to eclude as it relates to &r. "'eisler. "'eisler. Judge: s he going to oer any opinions on this/ !ecause i he is 22 Mr. Kosko: 0# going to go %ack to this later. He #ay. Judge: 3ell 22 Mr. Kosko: t0s so#ething 0ll go %ack to later. Mr. Panish: t0s not su%ject to the #otion, your honor. Mr. !oyle: This is so#ething dierent, your honor. Mr. Kosko: *ot having to do -ith &r. Murray and 456 +ive. Has nothing to do -ith that.
Mr. !oyle: Has to do -ith pu%lishing journals ethics. Mr. Kosko: This only has to do -ith pu%lishing journals ethics at this point so -e can understand -hat the i#port is o a pu%lication 7 -hat it #eans to %e ethical in a pu%lication, and -hat -ould %e considered unethical in a pu%lication. Judge: kay. Ms. "ahan: 4nd, your honor 22 Mr. Kosko: $o -e kno- -hat to rely upon, and the jury has to decide i a pu%lication is ethical or 22 Ms. "ahan: 8our honor, that is outside the scope o the opinions that he0s %een allo-ed to oer, so -e0d ask or a side%ar i -e pursue this issue. Mr. Kosko: 8ou kno- -hat/ don0t -ant to interrupt this. -ant to keep going. $o -ill ta%le that or no-, and 22 so -e can #ove on. Judge: 4ll right.
. I3#e $ne thr$uh a L$t $& +$ur redentials! sir! and I *n$1 I $uld $ $n &$r )an+ )$re h$urs $n this! ut ha#e +$u als$ $nsulted &$r #ari$us industries in the &ield $& sleep )ediine, A. -es! I ha#e. . And ha#e +$u 55 1hat *inds $& industries ha#e +$u $nsulted &$r, A. 6+piall+ 6+piall+!! industries that in#$l#e r$und5the5l$* $perati$ns. S$ the &irst $ne I ea)e in#$l#ed in 1as $utside $& Salt La*e Cit+. Cit+. Sand+! tah. It 1as a he)ial )inin $perati$n that har#ested )aterial &r$) the reat Salt La*e! put it int$ e#ap$rati$n p$nds. . (e (e d$n3t ha#e h a#e t$ *n$1 the details. A. /ut the+ 1$r*ed ar$und the l$* 55 . Just the industr+. A. 55 and the+ needed help 1ith the 1$r*ers 1h$ 1ere ha#in pr$le)s sleepin in the da+ti)e 1hen the+ 1$r*ed at niht! and ha#in pr$le)s sta+in a1a*e at niht 1hen the+ needed t$ e sheduled t$ 1$r* at niht. And s$ I spent )$re than a deade tra#elin 55 eause 1e had p$siti#e results 1hen 1e 55 . 6$$ )uh in&$r)ati$n.
A. S$rr+. . Just 1ant t$ *n$1 1hat the industries are at this p$int. A. E#er+thin &r$) the eletri p$1er enerati$n utilities! nulear p$1er plants! )anu&aturin tires! )anu&aturin paper! dealin 1ith p$lie &$res. I3#e 1$r*ed 1ith p$lie)en! &ire&ihters! &ederal air )arshals. . Air tra&&i $ntr$llers! $r n$t, H.A.A., A. I3#e een
. And are +$u ein paid &$r +$ur ti)e, A. -es. . And appr$'i)atel+ h$1 )uh per h$ur are +$u ein paid, A. ?0. . H$r h$1 l$n ha#e +$u een harin that, A. I thin* a$ut 80 +ears. . 80 +ears. And at ?0 an h$ur! an +$u please p lease *eep +$ur ans1ers sh$rt, A. -es. . 6han* +$u. And 1hat did +$u re#ie1 in preparati$n &$r 55 1ell!
. N$1! +$u see it $n +$ur sreen 55 A. I d$. . 55 and I3) $in t$ as* a s* +$u i& 55 ust the t$p sa+s! 7/eha#i$ral state enerated ener ated + the rain t$ &ul&ill asi i$l$ial needs haraterized hara terized +.7 And 1hat is 55 &irst $& all! I 1ant t$ as* +$u! it said! 7eha#i$ral state7, A. 6hat3s $rret. . And is that asiall+ 1hat it s$unds li*e, A. It is 1hat it s$unds li*e. S$ sleep is )+steri$us t$ a l$t $& pe$ple! ut 1hen 1e stud+ it sienti&iall+! 1e tr+ t$ rea* it d$1n and understand 1hat3s in#$l#ed 1ith sleep. Sleep is atuall+ 55 a l$t $& pe$ple thin* it3s li*e turnin an appliane $&&! s$rt $& turnin the $d+ $d + $&&! ut sleep is a #er+ ati#e pr$ess. . (e3re (e3re $in t$ et int$ it a little it )$re! ut 55 A. /ut it3s haraterized +! and it &ul&ills asi i$l$ial needs. It3s i)p$rtant t$ re$nize it3s enerated atuall+ + the rain! n$t a passi#e resp$nse! and it &ul&ills asi i$l$ial needs and is haraterized +@ redued ati#it+. S$ +$u an tell i& s$)e$ne is runnin ar$un d! the+3re n$t sleepin. I))$ile p$sture. 6+piall+ 6+piall+ +$ur e+es are l$sed! alth$uh it is p$ssile t$ sleep 1ith +$ur e+es $pen. It3s readil+ re#ersile. S$ i& s$)e$ne is asleep! +$u an 1a*e the) up 1ith s$)e sti)ulati$n. 6here3s a reduti$n in sensiti#it+ t$ e'ternal sti)uli! ut it is n$t a $)plete l$ss $& sensiti#it+. sensiti#it+. S$! &$r e'a)ple! the )$ther $& a ne1$rn! i& she hears h ears the hild 1hi)per! she 1ill 55 e#en i& she is asleep! e#en i& she is deepl+ asleep! she 1ill e ale t$ et up and attend t$ the hild. And a re#ersile l$ss $& $nsi$us a1areness that is readil+ re#ersile.
. (h+ d$ +$u ha#e this thin 1here it sa+s! 7re#ersile7 and 7readil+ re#ersile7, (h+ d$ +$u sa+ that, (hat3s 55 A. /eause +$u an ta*e a Sleepin pers$n and ar$use the)! 1a*e the) up
Mr. Mr. K$s*$&&@ Can +$u sh$1 us slide 2! please, . 6hat sa+s! 7n$r)al 1a*e&ulness.7 And 1hat are th$se little 55 I see there3s l$ts $& little tennis alls. A. 6he tennis alls are r$ups $& ells 55 . O*a+. A. 55 sientists all nulei! and it3s a Cluster $& ells that t+piall+ ha#e a spei&i $. And there are a 1h$le set $& ell lusters 55
. I3) $in t$ interrupt +$u a Se$nd. S$ there are these the se little lusters $& rain ells and this is the part $& the rain that 1e use t$ thin* =indiatin>4 O*a+, S$ this is the part p art that3s neessar+ &$r $nsi$us a1areness and alled the ereral $rte'. And a L$t $& the h$use*eepin in#$l#ed in the rain is d$ne in this $ther $ ther area S$ this area $& the rain! rain! &$r e'a)ple =indiatin>! alane! is in the ereellu). . -$u -$u said alane is in the ereellu), eree llu), A. -es. -es. S$! an+1a+! these lusters that are in the h+p$thala)us! and s$)e in 1hat3s alled the rain ste) here =indiatin>! the+ send $ut )essaes that help supp$rt 1a*e&ulness $& these these areas $& the rain that are resp$nsile &$r thin*in and $nsi$us a1areness.
. N$1! +$u 1ant t$ sh$1 the ne't slide, A. -es! I 1$uld. Mr. Kosko: kay. "ould you go to the net slide, please/
A. And this is a luster $& ells =indiatin> 55 the &unti$n $& 1hih 1as dis$#ered + $ne $& )+ $lleaues at "ar#ard 55 and this r$up $& ells atuall+ ati#el+ turn $&& all $& these $ther lusters and helps t$ pr$)$te sleep. S$ 1hen this area 55 1hen the ells in this area $& the rain &ire $r inite! the+ send a sinal t$ turn $&& these $ther areas. And s$ 55 the anal$+ that3s een used t$ understand this is *ind $& a see5sa1 $r a &lip5&l$p s1ith. S$ +$u d$n3t 1ant t$ e hal&1a+ a1a*e and hal&1a+ asleep. 6hat 1$uld e ad. -$u -$u 1ant t$ e either a1a*e $r asleep. And s$ the 1a+ this area $& the 55 the 1a+ 1a + this area $& the rain 1$r*s! is that it sends $ut a sinal that helps t$ )a*e sure that all these areas are n$t 55 s$ that 1e d$n3t ha#e s$)e $n&usi$n that part $& the area is sa+in! 7/e a1a*e!7 and part $& the rain is sa+in! 7/e asleep.7
. S$ that3s 55 n$1! $in $n! this )a*es it l$$* li*e 55 1hen +$u l$$* at this slide! it )a*es it l$$* li*e asiall+ n$thin is $in $n 1hen +$u sleep. And I3) $in t$ as* +$u i& that3s true. And I alread+ *n$1 the ans1er. ans1er. A. It3s n$t true. . O*a+. A. It3s n$t true. . Is there stu&& $in $n 1hile 1e3re asleep, A. As$lutel+. As$lutel+. 6here3s a l$t $in $n 1hen 1e3re asleep! and it in#$l#es the repair and )aintenane $& the neur$ns in the rain that supp$rt 1a*e&ulness. . And I *n$1 that there3s a Slide n$1 1hih sh$1s the staes $& sleep. A. -es. . And are there di&&erent staes $& sleep, A. 6here are di&&erent staes $& sleep. Mr. Kosko: kay. 4nd sho- slide no. =, please.
A. s$ a L$t $& pe$ple pe$p le thin* $& sleep as +$u3re either asleep $r $ r a1a*e. /ut! atuall+! there are t1$ )a$r di&&erent *inds $& sleep! and $ne *ind $& sleep is alled rapid e+e )$#e)ent sleep. . -$u -$u ha#e t$ $ sl$1l+ $n this part! eause &$r )$st $& us! this is reall+ rand5ne1. A. O*a+. . And 1e3re n$t "ar#ard raduate students. A. I understand. S$ there are di&&erent t+pes $& sleep. 6here are t1$ )a$r ate$ries@ $ne is 1hat3s alled rapid e+e )$#e)ent sleep! 1here 1h ere +$ur e+es are dartin a* and &$rth in their s$*ets 1hile +$ur asleep. . O*a+. I3) ust $in t$ interrupt +$u. S$ the &irst )a$r di#isi$n is 1hat is alled rapid e+e )$#e)ent sleep. Is that are#iated, A. B.E.M. sleep. . B.E.M. sleep, And in B.E.M. sleep! are +$u sa+in that the e+es )$#e a* and an d &$rth inside
underneath the e+elids, A. 6he+ d$. . "$1
. D$es $ne $& th$se s
. I 1ant t$ understand the t$p $ne! 71a*e&ul state.7 1hat +$u3re asiall+ sa+in is di&&erent ells are &irin $&& at di&&erent ti)es in +$ur rain 1hen +$u3re a1a*e, A. E'atl+. And +$u d$n3t re$rd )uh $& a Sinal eause thins are happenin all $#er the plae! and the+3re n$t pr$duin 55 the+3re n$t in s+n 1ith eah $ther. . 6hat3s 1h+ +$u3re n$t seein i $lts! eause there3s l$ts $& little $lts, A. Biht. And the+ anel eah $ther $ut. . 6he ne't $ne d$1n 55 A. I ust 1ant t$ sa+ that in rapid e+e )$#e)ent sleep! the $ne that3s d$1n here the rain 1a#e
re$rdin l$$*s al)$st the sa)e as up here he re . -es! it d$es. A. S$ $riinall+ 1hen E.E.G. re$rdins 1ere &irst )ade! the sientists th$uht the+ 1ere a1a*e here. 6he+ l$$*ed asleep! ut the+ 1ere a1a*e! eause the+ didn3t realize the+ 1ere asleep. . And 1hat is an E.E.G., A. An E.E.G. is a rain 1a#e re$rdin 1here +$u put eletr$des! and +$u3re )easurin illi$ns $& $lts $& p$tential eletrial hanes in the salp. . S$ +$u3re )easurin eletrial 1a#es, A. -eah. -eah. S$ 1hen +$u send 55 . And the na)e $& it is alled, A. 6he tehnial na)e 55 . Sl$1 d$1n. Is an eletr$enephal$ra), A. 6hat3s $rret. . O*a+. And that3s an E.E.G. And are these dra1ins that 1e3re seein the pr$dut $& E.E.G.S, A. It is. And s$ 1hen s$)e$ne has an epilepti seizure 55 . -es. A. 55 +$u )iht see a i 1a#e $n the salp! eause all the ells are &irin at $ne eause the+3re ha#in a seizure. . I see. A. S$ in rapid e+e )$#e)ent sleep! the rain l$$*s li*e it3s a1a*e. And ulti)atel+! ulti)atel+! 1hen it 1as dis$#ered that sleepin 55 &irst $& all! parad$'iall+! eause pe$ple 1ere pr$&$undl+ asleep! ut the rain 1a#es l$$*ed li*e the+ 1ere a1a*e. . E#er+ n$1 and then! then ! I $ li*e this =indiatin>. I3) n$t tellin +$u n$t t$ sa+ an+thin! ust )$#e it al$n. A. O*a+. -$u -$u did sa+ +$u 1anted )e t$ spea*
. -es. A. S$ here 1hen +$u e$)e dr$1s+! +$u ein t$ see s$)e inrease in the size $& the th e rain 1a#es. And 1hen +$u et int$ stae 8 sleep! n$1 n$ 1 +$u see s$)e #er+ s)all $sillati$ns here that 1ere n$t present either in rapid e+e )$#e)ent sleep $r in 1a*e&ulness. . And 1hen 55 A. And then these ein t$ 55 n$1! this is 1hat3s alled a sleep spindle! 1hih is an$ther $ranized set $& rain 1a#es. And i& 1e e'panded this re$rdin $ut! +$u 1$uld see that a L$t 1as $in $n there. And then 1e see 1hat are these i 1a#es here! 1hih are alled alled *5 $)ple'es. And the+ represent s+nhr$nized &irin $& s$)e $& the ells in the $rte'. . O*a+. N$1! N$1! 1e3re $in t$ ha#e t$ $ $#er this $ne $n e little it at a ti)e and sl$1l+. sl$1l+. Hirst! +$u sa1 the dr$1s+ state. S$ n$1! in a n$r)al pers$n $in t$ sleep! h$1 l$n d$es it n$r)all+ ta*e t$ $ &r$) dr$1s+ t$ 55 1hat is that stae, I an3t read it. A. 6his is stae 8. 6he na)es $& the staes are
. 6he ne't $ne! at stae 2! is that $ne 1here it see)s li*e it3s $sillatin! $in u p and d$1n 55 A. Biht. . 55 )uh )$re #i$lentl+. And +$u said this is s$)ethin! and I didn3t et 1hat 1as $in $n in the rain durin that $sillatin 55 A. S$ n$1 +$u ha#e s+nhr$nized &irin. . 7S+nhr$nized7 )eans 1hat, At the sa)e ti)e,
A. At the sa)e ti)e. . O*a+. A. S$ that )eans a l$t $& the ells in the rain are &irin at the sa)e ti)e! and there 55 it3s as i& the $ndut$r $& the $rhestra is sa+in! 7O*a+! n$1.7 s$ n$1 it3s ein enerated internall+! internall+! n$t in resp$nse t$ e'ternal sti)uli! ut ein enerated internall+. And then 1hen +$u et 55 . I 1ant t$ sta+ $n that stae &$r $ne se$nd. A. -eah. . S$ +$u sa+ all these ells are s$rt $& urstin at the sa)e ti)e, A. -es. -es. O& a partiular lass $& ells. . Certain lass. And that3s 1hile +$u3re asleep, A. -es. 6hat 55 . /ut d$es that happen 1hile +$u3re a1a*e, A. N$. . I& it happened 1hile +$u3re a1a*e! 1hat 1$uld happen t$ +$ur eha#i$r, A. (ell 55 . -$u3d e asleep, A. -eah. -$u3d e asleep! +es. . 6hat 1$uld )ean +$u3re asleep, A. Biht. . S$ that the 1a#es 55 the ells are all urstin at the sa)e ti)e. And then the ne't $ne! +$u said! is, A. Is 55 +$u ha#e a series $& these eletrial p$tential $sillati$ns that an e re$rded at the sur&ae $& the salp that sh$1 that there is reurrent s+nhr$n$us &irin. And this is ta*in plae three $r &$ur +les per se$nd. 6hat )eans! +$u *n$1! +$u an see that the 1a#es are sl$1in d$1n. S$ +$u ha#e t$ 82! 9 t$ F! 82 t$ 8;. N$1 a "al& +le per se$nd! )eanin it ta*es $ne
se$nd! I )iht ha#e t1$ $& $ & these 1a#es t$ t1$ +les per se$nd. se$nd . And these are delta 1a#es =indiatin>! and +$u an see the) #er+ pr$)inentl+ here in this re$rdin. . And then the last $ne is the 55 1hat +$u alled the B.E.M. sleep, A. Biht. . Bapid e+e )$#e)ent sleep, A. E'atl+.
. N$1! 1e3#e tal*ed a$ut 55 +$u3#e tal*ed a$ut these staes. Is there an+ eneral 55 &irst $& all! is there an+ eneral peri$d $& ti)e that3s $nsidered a n$r)al niht3s sleep! let3s sa+, A. 6he a#erae pers$n 55 Ms. "ahan: %jection. >ague. Judge: verruled.
A. 6he a#erae pers$n sh$uld $tain a$ut F t$ h$urs $& $ & sleep at niht. . And is there s$)e s$rt $& a 55 is this pattern 8 thr$uh ;! are the+ 55 is that the $rder in 1hih these staes $ur, A. -es! -es! t+piall+. t+pial l+. . S$ that 55 and h$1 )uh 55 1ell! $ne $ther thin I didn3t as* +$u. -$u -$u tal*ed a$ut rapid e+e e +e )$#e)ent sleep at the end! ut is there als$ a part $& this 1here there is sl$1 e+e )$#e)ent! a part $& 55 A. -es. -es. 6hat t+piall+ ta*es plae in stae 8 sleep. . O*a+. S$ 55 A. In this transiti$nal state. . 55 is there an understandin as t$ a$ut the lenth $& ti)e eah $& these staes ha#e! $r d$es it #ar+ dra)atiall+, A. (e (e $ thr$uh 1hat is alled alled a sleep +le! 1hih enerall+ ta*es a$ut an h$ur and a "al&! $r a little l$ner! t1$ h$urs. And durin a Sleep +le! +$u $ thr$uh a pr$ressi$n 1here +$u3re $in t$ stae 8! 2! 9! ;! and then +$u $ int$ rapid e+e )$#e)ent sleep! and +$u ha#e a L$t $&
rapid e+e )$#e)ent sleep. And then +$u $ a* and start $in thr$uh these staes aain int$ the deep! sl$1 1a#e sleep. And that $urs thr$uh$ut the niht. S$ sleep has an arhiteture t$ it. -$u -$u see! all $& the 55 )$st $& the $ther ells in the $d+! s*in ells! and $ur l$$d ells and )$st $& the)! 1e $nl+ *eep $ur l$$d ells! &$r e'a)ple! &$r three t$ si' 1ee*s! and then 1e )a*e ne1 $nes. /ut the rain ells 1e *eep &$r $ur entire en tire li&eti)e. S$ there has t$ e a peri$d $& ti)e! ust li*e s$)eti)es +$u3ll et a )essae &r$) the an* $r 1hate#er sa+in the $)puter s+ste) is $in $&&line &$r )aintenane. And the rain has t$ $ $&&line s$ that 1e an )aintain th$se ells that 1e are $in t$ *eep &$r li&e! eause 1e d$n3t )a*e ne1 $nes. . S$ durin that 55 A. Durin that peri$d $& $&&line! repair and )aintenane is the thin 1e all sleep. . S$ 1hile 1e3re asleep! there are thins $in $n in $ur rains, A. Biht. L$ts $& thins $in $n in ter)s $& repair. Means! in essene! replae)ent $& ener+ st$res and 55 eause 1e dissipate $ur ener+ durin 1a*e&ulness. 6he rain uses 20 perent $& the lu$se 1e 55 . 20 perent. (hen +$u sa+ sa +! 7the lu$se!7 is that the ener+ that 1e use, A. 6he ener+ that 1e use. . 6he rain uses 20 perent, A. -es. -es. And $ne $& the )$st hih de)ands! ati$ns! a ti$ns! is the &irin $& these neur$ns that happen 1hen 1e thin*. . And! n$1! n$1! +$u tal*ed a$ut the *ind $& repair that $es $n 1hen 1e sleep. And ust i#e )e a $uple $& sentenes $n that. (hat *ind $& repair, A. (ell! (ell! $ne $& the thins 55 e#er+ e#er + ti)e 1e all $& $ur e'perienes e' perienes 1e ha#e in the da+ti)e! 1hen that happens! the 1a+ the rain en$des that )e)$r+ is )a*in an$ther $nneti$n 1ith n$t neur$ns. S$ 1e )a*e all these ne1 $nneti$ns durin the da+ that re&let all 1e ha#e e'periened durin the da+ti)e. At niht! $ne $& the thins is that 1e prune $ut a l$t $& th$se that are n$t i)p$rtant! and 1e $ns$lidate $n s$lidate th$se )e)$ries 1hih are. And that pr$ess is happenin durin the! in partiular! the sl$1 1a#e sleep and the n$n5B.E.M. sleep. . N$1! 1hat happens durin B.E.M. sleep 1hen +$u ha#e that rapid e+e )$#e)ent, And I thin* 55 + the 1a+! 1e )a+ ha#e a slide that an help us! slide that +$u3#e prepared.
The -itness: "an -e go to the net slide/
. Oh! atuall+! d$es this sh$1 atuall+ re$rdins $& the rain 1a#es, A. -es. -es. 6his sh$1s the re$rdin $& n$t ust the rain 1a#es! ut als$ the e+e )$#e)ents! and s$)e )usle t$ne =indiatin>. And here +$u an see the rain rain 1a#es at the transiti$n &r$) 1a*e&ulness t$ sleep =indiatin>. 6his is the sleep ha)er that 1e used =indiatin>. And these are the eletr$des that are re$rdin the rain 1a#e ati#ities and e+e )$#e)ents =indiatin>. S$ +$u an see 55 and these are 90 se$nds $& re$rdin. And +$u an see! as this partiular astr$naut eins t$ &all asleep! +$u an see his e+es r$llin ar$und in their s$*ets! and these are the sl$1in r$llin )$#e)ents that are happenin. Ne't slide.
. 6hat3s stae 8. And that slide $ntains an $#erla+ t$ it as 1ell, A. -es! -es! it d$es. And n$1 +$u an see the transiti$n t$ stae 2 sleep =indiatin>. -$u -$u an see $ne $& th$se s+nhr$n$us &irin! $ne $& th$se *5$)ple'es here =indiatin>. N$1! the sl$1 e+e )$#e)ents are $ne! and 1e3re atuall+ pi*in up rain 1a#e re$rdins $& the eletr$de riht $#er the te)ple. And this represents stae 2 =indiatin>. S$ n$1 the pers$n is de&initi#el+ asleep. And then the ne't slide! +$u 1ill see staes 9:; sleep! an d 55 ein ea)ed d$1n &r$) spae. And +$u see the $sillati$n here in the rain 1a#e ati#it+. ati#it+. S$ sleep has an arhiteture t$ it. As the rain is $in thr$uh this repair pr$ess e#er+ niht! that arhiteture is ritial as 1e $ &r$) eause B.E.M. sleep! 1hih is in the ne't side 55
. -eah. -eah. Let3s see the B.E.M. sleep. A. 55 is as di&&erent a state $& $nsi$usness et1een rapid e+e )$#e)ent sleep and n$n5rapid e+e )$#e)ent sleep as the di&&erene et1een 1a*e&ulness and sleep. . O*a+. Just $ $#er that $ne )$re ti)e. Are +$u sa+in that the rapid e+e )$#e)ent sleep is as di&&erent &r$) the rest $& it as ein a1a*e is di&&erent &r$) sleep, A. -es. . And h$1 is it di&&erent &r$) 55 A. 6here are three )a$r states $& $nsi$usness 55
Judge: 4sk you, don0t talk over each other, %ecause our court reporter is having a hard ti#e, and the rest o us are having a hard ti#e 22 Mr. Kosko: apologi'e, your honor. t0s #y ault.
A. S$ there are three staes $& $nsi$usness@ $ne is 1a*e&ulness4 the $ther is n$n B. E.M. sleep!
and the third is the rapid e+e )$#e)ent sleep. S$ in rapid e+e e +e )$#e)ent sleep! +$u see the rain 1a#es are l$$*in li*e the pers$n 55 the+3re #er+ si)ilar as t$ 1hat 55 i& the pers$n 1ere a1a*e. And n$1 +$u see the e+es are dartin ar$und in their s$*ets. I& the pers$n 1ere 1athin a tennis )ath! +$u 1$uld see the e+es $in a* and &$rth and a* and &$rth! and it is atuall+ in realti)e. S$ it is n$t sped up! as )an+ pe$ple thin*. And there are s$)e $nditi$ns in 1hih there is an area $& the rain that paral+zes the )usles 1hile 1e3re in rapid e+e e +e )$#e)ent sleep 55
. %aral+zes 1hat )usles, A. 6he )usles that 1e 1$uld $rdinaril+ the s*eletal )usles that 1e 1$uld use t$ 1al* and an d t$ run and t$ )$#e $ur ar)s. And i& that area is da)aed! then pe$ple 1ill atuall+ at $ut their drea)s. And s$ a at 1ill e hasin )ie in their rapid e+e e +e )$#e)ent sleep! and s$ $n. . S$ in this rapid e+e )$#e)ent )$# e)ent sleep! is the rain re#ie1in the e#ents $& the da+, A. In the rapid e+e )$#e)ent sleep! the rain is atuall+ interatin! s$ a l$t $& the )e)$ries that 1ere st$red in the deep! sl$1 1a#e sleep 55 . O*a+. S$ that3s 55 A. 55 and then the rapid e+e )$#e)ent sleep! 1e3re interatin the )e)$ries. . O*a+. Keep 55 I3) s$rr+. I interrupted +$u. A. In the rapid e+e )$#e)ent sleep! 1e3re interatin the )e)$ries that 1e had st$red 1ith sl$1 1a#e sleep 1ith all the $ther )e)$ries 1e had ha d learned pre#i$usl+. S$ 1e ha#e the ne1 da+3s da +3s )e)$ries $)e in and are $ns$lidated! and 1e laid the) d$1n in sl$1 1a#e sleep! and all these ne1 )e)$ries $)e in! and 1e ha#e t$ interate the) 1ith 1hat 1e alread+ ne1. And that see)s t$ happen durin rapid e+e e +e )$#e)ent sleep. 6hat3s 1here 1e interate all this in&$r)ati$n 1e ust learned t$da+ 1ith all $ur pre#i$us li&e e'perienes. And 1e! atuall+! als$! durin rapid e+e )$#e)ent sleep! 1e are ale t$ atuall+ )a*e sense $& thins that )iht ha#e een 55 that 1e )iht n$t ha#e re$nized durin the da+ti)e. H$r e'a)ple 55 . Can I interrupt +$u, A. -es. As$lutel+. As$lute l+. . I 1ant +$u 55 i#e an e'a)ple. Supp$se there3s a as*etall pla+er 1h$ durin the da+ is pratiin &$ul sh$ts 55 A. -es.
. 55 &r$) the &ree5thr$1 line. And he d$es it &$r t1$ h$urs durin the da +! and he3s $in! li*e! 0 perent &r$) the &ree5thr$1 line. (hat happens t$ the rain durin that peri$d $& ti)e 55 A. 6he area $& the rain 55 . 55 at niht 1hen he3s sleepin, A. 6he area $& the rain that he is usin t$ thr$1 that as*etall! that niht! that 55 let3s sa+ he3s riht5handed. 6he area $& the riht 55 that $ntr$ls the )$#e)ent $& the riht hand! the area $n the le&t side $& the rain that $ntr$ls the riht hand )$#e)ent! 1ill ha#e )uh deeper sl$1 1a#e sleep l$all+ riht in that spei&i area On O n the $ther hand! i& +$ur ar) 1ere in a Slin! then the area that $ntr$ls that area $& the ar) has )uh less sl$1 1a#e sleep! eause there3s )uh less t$ re$rd 1hat happened. Si)ilarl+ S i)ilarl+!! i& +$u learn a Set Se t $& n$tes $n a pian$ $r 1hate#er! i& +$u3re d$in 55 learnin h$1 t$ $perate a isa1! 1hate#er! that niht +$u3ll ha#e )uh deeper sl$1 1a#e sleep in the area $& $ & the rain that $ntr$ls the )$#e)ent $& that part $& +$ur $d+! as +$u are learnin that. And then +$u 1ill atuall+ d$ the tas* )uh etter the ne't da+ 1hen +$u a1a*en. S$! &$r e'a)ple! studies that ha#e een d$ne in ani)als. 6here are spei&i ells in the rain! i& an ani)al is in a )aze! these are alled 7plae ells.7 -$u -$u an tell 1hat plae in the )aze the ani)al is standin + 1hih ell is &irin. Kind $& $$l. And s$ the ani)al &iures $ut the+3re all dead ends in the )aze! ut i& it &$ll$1s a ertain path! it ets e ts a %iee $& heese in the end. 6hen 1hen the ani)al is sleepin! a)azinl+ en$uh! the+ an l$$* at 1here the ani)al is standin durin sleep! and +$u an see that the ani)al is re)e)erin the path $#er and $#er aain! hundreds $& ti)es! rehearsin the path 1here it ets the heese. And 1hen the ani)al is a1a*e! it an run thr$uh that )aze )uh )$re
Mr. Mr. K$s*$&&@ )a+ 1e ha#e h a#e the ne't ne' t slide, . O*a+. 6his slide 55 1hat d$es this slide sh$1! sh$1! d$t$r =indiatin>, A. 6his is sh$1in the ne't le#el $& arhiteture. I3#e sh$1n +$u $n $ther slides! there are di&&erent spei&i staes. /ut the arhiteture $& sleep is suh that +$u atuall+ $ thr$uh these staes in a #er+ #e r+ $rderl+ )anner. . (hat is the 7(7 &$r, A. 7(7 is 1a*e4 7B7 is &$r rapid e+e e +e )$#e)ent sleep4 stae 84 stae 24 stae 9! and stae ;. And then the desinati$n &$r sl$1 1a#e ati#it+! and this +$u need a $)puter t$ d$ the anal+sis! and it interates all $& th$se i 1a#es! th$se s+nhr$n$us &irin! and sa+s h$1 )uh ener+ is present. S$ 1hen +$u ha#e a l$t $& th$se deep sl$1 1a#es at the einnin $& the niht! and
+$u3re in stae ; sleep! that 1$uld 1$ uld e a hih ener+! deep sl$1 1a#e sleep $ns$lidatin a l$t $& )e)$r+. . (hat are th$se red areas $n the upper 55 A. 6hese are illustratin 1hether the indi#idual is in rapid e+e )$#e)ent sleep. 6his is that di&&erent state $& $nsi$usness I 1as tal*in a$ut. (e (e spend a$ut 2? perent $& the niht in rapid e+e )$#e)ent sleep! ut it3s n$t all at $ne. And ritial t$ the $ranizati$n $& sleep! it has t$ $ur in these e#er+ h$ur and a "al& t$ t1$ h$urs.
. S$ that3s the +le, A. 6hat3s the +le. . (ell! O*a+ O*a +. Mr. Kosko: 4nd the net slide, please/ kay. 3hy does the %rain need sleep/
A. 6he rain needs sleep in $rder t$ &ul&ill a Series $& asi i$l$ial needs. As I )enti$ned! 1e *eep $ur rain ells &$r li&e. And s$ 1e need t$ repair and )aintain th$se $nneti$ns t$ deide 1hih $nneti$ns are i)p$rtant! and shed the $nes! prune the $nes $n es that are less i)p$rtant! eause 1e d$n3t ha#e en$uh r$$) in $ur s*ull t$ )a*e eah $ne $& the $nne ti$ns ta*e spae! n$r d$ 1e ha#e en$uh ener+. ener+. (e (e $ns$lidate )e)$r+ durin sleep4 1e interate dail+ learnin 1ith pri$r e'perienes! and 1e re&ill the &uel tan* $& all these ner#e ells + rest$rin the ener+ en er+ st$res $& the ells re
Mr. Kosko: 4nd the net slide, please. : -hy does 22 -e talked a%out -hy the %rain needs sleep to restore the cells. 3hy does the %ody need sleep/
A. 6his is s$)ethin $nl+ dis$#ered at 55 in the past p ast 8? +ears. S$ in the einnin 1e &elt sleep 1as ust &$r the rain! ut it turns $ut 55 and it3s pi$neerin 1$r* dis$#ered + a 1$)an at the ni#ersit+ $& Chia$ 1h$ dis$#ered that the $d+ needs sleep! t$$. And 1e d$n3t )eta$lize lu$se. I& 1e eat s$)ethin! 1e ha#e a Glass $& s$da $r 1hate#er! in $rder t$ )eta$lize suar 1e ha#e t$ use lu$se $r suar t$ )eta$lize 55 . -$u3re -$u3re usin 55 7)eta$lize!7 +$u )ean $n#ert that suar t$ ener+, A. -es. . And s$ in $rder t$ $n#ert the suar int$ ener+! 1hat has t$ happen,
A. (e (e ha#e t$ release ertain h$r)$nes! partiularl+ the h$r)$ne insulin + the panreas! pa nreas! and the release that pre#ents us &r$) ettin diaetes re
(lunch %reak)
&irect ea#ination %y Mr. Kosko:
. (hen 1e le&t! d$t$r! 1e 1ere tal*in a$ut 1h+ the $d+ needs sleep! and the *inds $& thins that an happen i& the $d+ d$esn3t et en$uh sleep4 is that $rret, A. 6hat3s $rret. I& a pers$n is $nl+ sleepin &$ur $r &i#e! si' h$urs a niht! an inade
dishe#eled! the+3re unale t$ )aintain their $d+ $ d+ te)perature! s$ their ther)$reulat$r+ s+ste) ets $&& *ilter. And 1hen the+3re depri#ed $& all sleep! the+ die in an a#erae $& a$ut three 1ee*s. And i& the+3re seleti#el+ depri#ed $& rapid e+e )$#e)ent sleep! the + last a little l$ner4 ut + a$ut &i#e 1ee*s! the+ die. S$ it is sleep turns $ut t$ e neessar+ &$r li&e. . O*a+. S$ &irst! +$u used a 1$rd there! 1hih is the 7ther)$reulat$r+ s+ste).7 1hat is the ther)$reulat$r+ s+ste), A. 6hat3s the s+ste) in the $d+ that helps us t$ )aintain $ur $d+ te)perature. S$ 1e3re )a))als are n$t li*e $ld s$ alled $ld5l$$ded ani)als! li*e a &r$! 1hih 1hate#er the te)perature it is in the $utside 1$rld! that3s the te)perature $& the ani)al. (e ha#e a ther)$reulat$r+ s+ste) that *eeps $ur $d+ te)perature at a$ut a$ ut as e#er+$ne *n$1s! a$ut . derees! and it h$lds h$ lds it stead+ there. 6here is atuall+ a dail+ +le! +le! s$ it3s l$1er at niht and hiher durin the da+ti)e. /ut the $d+ $d+ de&ends the te)perature t$ e at 1hate#er set p$int is appr$priate &$r that ti)e $& da+. . And 1hat happens i& an indi#idual is t$tall+ depri#ed $& sleep! t$ the ther)$reulat$r+ s+ste), A. 6he ani)al eins t$ n$ l$ner e ale t$ )aintain the appr$priate te)perature! and the $d+ te)perature atuall+ dereases. . N$1 and that3s n$1! +$u als$ ha#e in +$ur slide that there ha#e een studies 1hih sh$1 sh$1 1hat happens 1hen the BEM sleep! the rapid e+e )$#e)ent sleep! is pr$hiited, A. -es. -es. S$ S$ . And 1hat happens 1hat happens i& +$u ust eli)inate the rapid e+e )$#e)ent sleep ut the rest $& the sleep +le re)ains intat,
A. I& +$u eli)inate ust the rapid e+e )$#e)ent )$# e)ent sleep! the ani)als 1ill als$ die. It ta*es a little l$ner. It ta*es $n a#erae a$ut &i#e 1ee*s instead $& a$ut three 1ee*s. /ut e#en i& the+3re all$1ed t$ $ int$ all the $ther staes $& sleep ut n$t rapid e+e e +e )$#e)ent sleep! the+ an3t sur#i#e 1ith$ut that stae $& sleep! s$ it3s neessar+ &$r li&e. . N$1! d$es sleep als$ it s$rt $& )a*es sense aid in per&$r)ane, (hen there is a 1hen a pers$n is depri#ed $& sleep! d$es that a&&et per&$r)ane, per&$r)ane, A. -es! -es! it d$es. In &at! in these in these in indi#iduals 1h$ are depri#ed dep ri#ed $& sleep! it a&&ets their $niti#e &unti$n and their ailit+ t$ $ns$lidate )e)$r+. Man+ $& the thins that 1e tal*ed a$ut in ter)s $& the &unti$ns $& sleep are i)paired i& the pers$n d$esn3t et the sleep that the+ need.
. And $niti#e I3) s$rr+. A. And $niti#e per&$r)anes! and s$ $n. One $& the thins I didn3t )enti$n in this slide is that i& ani)als are depri#ed $& sleep and the+ are! let3s sa+! l$se t$ the three51ee* )ar*! and the+3re sh$1in all the sins! the+3re sra1n+! the+3re dishe#eled! the+3re l$sin 1eiht! their $d+ te)perature is n$t ale t$ sta+ at the n$r)al te)perature and then i& at the last )$)ent )$ )ent the+ atuall+ all$1 the ani)als t$ sleep aain $& $urse! s$)eti)es! the+ d$n3t st$p the e'peri)ent s$$n en$uh and the+ still die. /ut in th$se 1h$ d$ n$t die! 1ithin $ne t$ three da+s! the+ ha#e $)pletel+ re$#ered. And s$ the lettin the) sleep! aain! an resue the) s$ that the+ an re#erse the deteri$rati$n that the+3#e een su&&erin thr$uh t$tal sleep depri#ati$n. . N$1! +$u ha#e a slide that sh$1s s$)e $& the areas in 1hih sleep depri#ati$n a&&ets per&$r)ane. Ne't slide! please, A. -es. (hen +$u3re depri#ed $& sleep! let3s sa+ i& +$u pull an all5nihter and +$u3re a1a*e &$r )$re than 2; h$urs. I))ediatel+ 1e an ein t$ detet hanes in per&$r)ane. S$ $ne $& the &irst thins that hanes is +$ur reati$n ti)e. And s$ 1hat 1$uld n$r)all+ ta*e +$u! let3s sa+! sa+! a
d$n3t resp$nd appr$priatel+ t$ +$ur en#ir$n)ent. O#i$usl+! sleep depri#ati$n inreases the ris* $& &allin asleep4 and alth$uh that )a+ see) $#i$us! )$st pe$ple thin* 1hen the+3re eause there are a )illi$n dr$1s+ dri#in rashes e#er+ +ear. A$ut 2?0!000 pe$ple a da+ n$ d $&& and &all asleep at the 1heel! and the+3re surprised + it eause the+ d$n3t realize rea lize that 1hen +$u et tired en$uh! the rain )a+ seize $ntr$l and +$u )a+ in#$luntaril+ )a*e the transiti$n &r$) 1a*e&ulness t$ sleep. And an$ther thin that happens is pe$ple e$)e e$ )e &ast and sl$pp+. S$ the+ 1ill atuall+ instead $& n$r)all+ pe$ple 1ill sl$1 d$1n t$ )aintain their aura+ aura+ i& a tas* tas* ets )$re di&&iult4 ut a sleep5depri#ed pers$n 1ill ust 1ant t$ et it $#er 1ith And speed thr$uh it.
. I 1anted t$ as* +$u a$ut the sl$pp+. ($uld ($uld a pers$n 1h$ is sleep depri#ed 1h$ is n$r)all+ a rather &astidi$us pers$n pers$n 1$uld the+ s$)eti)es ha#e s$)e sl$pp+ eha#i$r! &$r &$r e'a)ple! in their pers$nal e&&ets $r their edr$$)s $r the li*e, li*e,
A. -es! -es! de&initel+! de&initel+! eause 1hen a pers$n is e'hausted! the+ d$n3t tend t$ tend t$ the sa)e issues! the+ 1ill +$u *n$1! it3s it3s interestin. As I )enti$ned in the last slide! e#en the rats e$)e dishe#eled 1hen the+3re depri#ed $& sleep. 6he+ st$p r$$)in the)sel#es appr$priatel+! appr$priatel+! and s$ $n. . And the ne't slide! slide! please. I thin* it sh$1s $ne $& the thins +$u 1ere ust +$u 1ere tal*in a$ut! the ad#erse A. /+ the 1a+! e#en i& +$u lean s$)e$d+ up and ha#e the)! +$u *n$1! put $n their )a*eup and d$ e#er+thin else! the a#erae pers$n an re$nize i& s$)e$d+ has een sleep depri#ed $r n$t ust 1ith a in t1$ $r three se$nds se$nds + a ph$t$raph $& the)! e#en i& the+3#e ta*en a sh$1er and leaned up and s$ $n! eause 1e an tell ust &r$) the appearane! ust + l$$*in at s$)e$ne. . N$1! N$1! the +$u ha#en3t tried that $n )e +et! +et! ha#e +$u, A. N$ $))ent. . Is there an ad#erse e&&et $& sleep de&iien+ $n )$$d, A. -es. -es. -$u -$u *n$1! 1e all re$nize in little *ids i& the+ the + ha#en3t $tten en$uh sleep! )$thers 1ill $&ten sa+! +$u *n$1! that the+3re irritale! 7J$hnn+ hasn3t slept 1ell last niht!7 and that3s 1h+ the+3re r+in. (hat 1e d$n3t realize is that this pr$pert+ $& sleep l$ss $ntinues e#en int$ adulth$$d! and s$ pe$ple e$)e inreasinl+ #$latile in ter)s $& their e)$ti$n. 6he+ )a+ &l+ $&& the handle! the+ )a+ )a+ e$)e the+ ha#e di&&iult+ &$usin &$usin and sustainin their attenti$n. I& the+3re presented 1ith the sa)e i& the+3re presented 1ith the sa)e! let3s sa+! sa+! disturin i)ae! rain sans ha#e een d$ne t$ sh$1 that the e)$ti$nal part $& the rain! 1hih has a tehnial na)e alled an eni)a =ph$neti> =ph$n eti> that little luster $& rain ells 1ill reat 1ith ten ti)es the
resp$nse i& +$u d$ rain i)ain $n s$)e$d+ 1h$ is sleep depri#ed than s$)e$ne 1h$ is 1ell rested. And this is 1h+ I tr+ t$ tell the pr$&essi$nal sp$rts pla+er i& +$u ha#en3t $tten +$ur sleep! then i& the re&eree alls +$u &$r a &$ul! 1hate#er! 1hate# er! at as*etall! then +$u )a+ et a tehnial &$ul and e thr$1n $ut $& the a)e eause +$u )a+ n$t e ale t$ h$ld +$ur e)$ti$ns in he* and n$t hallene the re&eree. re&eree. %e$ple als$ als$ interestinl+ en$uh! the+ 1hen it $es $n hr$niall+! hr$niall+! the+ are at ris* $& urn $ut! depressi$n! and e#en suiidal ideati$n. And all th$se! +$u *n$1! an lead t$ depressed )$$d! 1hih is *ind $& parad$'ial eause at the einnin einnin 1hen +$u3re &irst sleep depri#ed! s$)e pe$ple! +$u *n$1! a&ter the+3#e sta+ed up all niht! the+ s$)eti)es &eel a &eelin $& euph$ria! and the+ e$)e e$)e s$rt $& slap5happ+ and punh+ punh +! as s$)e pe$ple all a ll it! 7I 1as up all niht! I3) a little punh+.7 the+3ll i#e an inappr$priate resp$nses. E#entuall+ 1hen it3s hr$ni it leads t$ a depressed )$$d. %e$ple ha#e )$re )$re $d+ $)plaints! their suseptiilit+ suseptiilit+ the+ are )$re sensiti#e t$ pain 1hen the+ are sleep depri#ed! the+ tend t$ e'periene e' periene )$re s+)pt$)s $& an'iet+ and e#en paran$ia and distured th$uht.
. And then the ne't slide! please. D$es this this sh$1 e'plain 1hat 1e3re seein in this slide. Hirst $& all! 1hat *ind $& an i)ae is this, A. 6his is this is an i)ae i)ae $& a rain san4 and in this partiular there are all s$rts $& di&&erent t+pes $& rain sans. 6his partiular rain san is l$$*in at the utilizati$n $& lu$se in the rain! 1hih is the )ain ener+ s$ure $& the rain. And in this slide! +$u an see in the areas that are a re illustrated in lue! the lu$se is n$t ein used #er+ e&&eti#el+. e&&eti#el+. And this is a $)paris$n $& a rested rain 1ith a rain that has n$t $tten en$uh sleep! that has een a1a*e all niht. 6his is 1$r* that 1as d$ne at the (alter Beed ar)+ h$spital! )+ $lleaues there. And +$u an see that the areas that are ettin that are ettin ettin that are turnin turnin lue! 1hih is t$ sa+ that the+3re n$t utilizin lu$se #er+ 1ell! the+3re n$t utilizin the ener+ s$ure a nd the &uel 1ell! th$se are the pre&r$ntal $rte'! the area I said 1as ehind the &$rehead resp$nsile &$r ud)ent and $ntr$l. S$ th$se areas! it3s *ind $& li*e! +$u *n$1! *n$1! in the in the n$rtheast! i& the ar enine is $ld! it3s n$t $in t$ 1$r* #er+ 1ell. 1ell. It d$esn3t happen here in LA! ut s$ that3s $in st$ne st$ne $ld. 6he interi$r parietal $rte'! 1hih is the area $& the rain that interates sens$r+ in&$r)ati$n $)in &r$) the e+es and ears and t$uh! is als$ n$t utilizin ener+ #er+ 1ell. And then in a #er+ i)p$rtant part $& the rain! the thala)us! 1hih rela+s sens$r+ in&$r)ati$n &r$) the in&$r)ati$n that 1e3re ettin &r$) $ur senses t$ the area area $& the rain that $ntr$ls $ntr$ls )$#e)ent is #er+ seri$usl+ deraded 1hen 1e ha#e een a1a*e all niht.
. O*a+. S$ n$1 I 1ant t$ $ thr$uh a $uple $& th$se seti$ns 1ith +$u t$ ust see 1hat it )eans in pratial ter)s. 6he area 1a+ $#er $n $ n the riht! 1hih +$u sa+ sa + is the pre&r$ntal $rte'! that $ntr$ls ud)ent and $ntr$l, A. -es.
. And d$es the lue! the #er+ dar* lue )ean it3s n$t A. -es! an+thin that3s . n$t ettin &uel $r urnin &uel, A. An+thin An+thin that3s lue is n$t urnin &uel as 1ell as it sh$uld e. S$ +$u an see and that3s used as a an indiati$n that that area $& the rain is i)paired. i)paired. . And h$1 d$es that $n#ert t$ the the &unti$n $& that area, In $ther 1$rds! h$1 1$uld h$1 1$uld that )ani&est itsel&, A. S$ that 1$uld )ean and 1e thin* that these *inds $& rain i)ae supp$rt the e'peri)ental results that ud)ent is i)paired 1hen pe$ple are sleep depri#ed. S$ that has een $ser#ed e'peri)entall+! e'peri)entall+! and it is $nsistent 1ith the rain i)ain studies. . N$1! is there s$)ethin alled 7e'euti#e &unti$nin7 1hih tal*s a$ut a pers$n3s a ilities t$ $ranize thins, A. -es! -es! that is it is the pre&r$ntal $rte' that is ritial &$r e'euti#e &unti$n. . ($uld ($uld that e i)paired in a pers$n 1h$ is sleep depri#ed, A. -es! -es! de&initel d e&initel+ +. . (hat is e'euti#e &unti$n, A. S$ e'euti#e &unti$n is h$1 1e )a*e the deisi$ns as t$ 1hat 1e3re $in t$ d$ as a hu)an ein! h$1 1e resp$nd 1hen 1e ha#e t$ deide 1hether s$)ethin is appr$priate $r inappr$priate! riht $r 1r$n! 1r$n! 1hether 1e ha#e t$ )anae a situati$n. And the ailit+ t$ d$ that is $in t$ e deraded. . -$u3re -$u3re sh$1in a rain here. "$1 )uh h$1 )uh la* $& sleep did the pers$n in this san ha#e, A. Just $ne niht. . Just $ne niht. n iht. O*a+. N$1! N$1! the in&eri$r parietal $rte'! 1hat D$es that d$, A. 6hat3s an area $& the rain that is resp$nsile &$r interatin in&$r)ati$n &r$) all all $& $ur di&&erent senses. S$ the sense $& t$uh4 the sense $& taste4 the sense $& s)ell4 the sense $& hearin4 and! $& $urse! the sense $& #isi$n. All $& these di&& di&&erent erent senses! that in&$r)ati$n is interated in that area $& the rain! 1hih is als$ i)paired! s$ $ur ailit+ t$ ta*e in 1hat3s 1ha t3s $in $n in $ur
e'ternal en#ir$n)ent is $in t$ e i)paired. . And that A. S$! &$r e'a)ple I3) s$rr+ t$ interrupt +$u. . I 1as interruptin +$u all )$rnin. A. S$! &$r e'a)ple! i& +$u present $n a $)puter sreen i)aes t$ si)ulate a pers$n ein ale t$ see $ets in their #isual &ield! and t$ re$nize the)! and t$ resp$nd t$ the)! the+ 1ill )a*e ten ti)es as )an+ )ista*es a&ter ein up all a ll niht and )issin i)aes in the #isual &ield as 1hen the+3re 1hen the+3#e slept. And! $& $urse! that3s #er+ i)p$rtant &$r )an+ $upati$ns. . And $ipital, A. 6he $ipital $rte' is 1here 1e interate in&$r)ati$n in&$r)ati$n $n #isi$n $)in in &r$) the &r$) the &r$) the $pti ner#es and the the &r$) the e+eall! asiall+. asiall+. . O*a+. And s$ that3s i)paired s$)e1hat &r$) A. -es. . a niht3s sleep l$st, And that #er+! #er+! #er+ dar* lue seti$n in the enter 1hih sa+s 7thala)us rela+s sens$r+ in&$r)ati$n!7 1hat is aain! the thala)us, A. Be)e)er! that 1as in the enter $& the rain! and it 1as at$p the rain ste). And that is ritial &$r rela+in sens$r+ in&$r)ati$n t$ the )$t$r $rte'. S$ 1e3#e n$1 interated all $& $ur senses! and n$1 1e3re $in t$ send the )essaes up t$ the t$ the thin*in part $& the rain 1here 1e reulate $ur )$#e)ents! and s$ that3s $in t$ e ritial &$r! +$u *n$1! seein 1here the step is and then )$#in t$1ard it and n$t &allin d$1n. . N$1 +$u ha#e an$ther slide 1hih 1hih sh$1s 1hat happens t$ the #isual #isual disri)inati$n 1hen in 1ith reard t$ sleep, A. -es! ne't slide. . Ne't slide! please. A. S$ this is this is a$ut learnin. S$ this )$rnin I tal*ed a$ut the i)pat $& sleep l$ss $n learnin! and this the e'peri)ent e'p eri)ent that is illustrated here 1hih 1as $nduted + )+ ) + $lleaue %r$&ess$r Sti*$ld at the "ar#ard )edial sh$$l! pulished in the $urnal $& nature neur$siene a$ut 89 +ears a$! 1as a pi$neerin e'peri)ent in 1hih he sh$1ed the i)p$rtane $& sleep t$ learnin. S$ in this e'peri)ent! $n da+ zer$ and I3) s$rr+ it d$esn3t sh$1 1hat the a'es are $n the h$riz$ntal a'is4 ut that3s da+ 0! 8! 2! 9! ;! and a 1ee* later $n da+
F. . S$ that3s se#en da+s as sh$1n + that 0 thr$uh F, A. E'atl+. . And the A. And $n the #ertial a'is is i)pr$#e)ent in the speed at 1hih the+3re d$in a #isual disri)inati$n tas*. . (hat3s that, A. S$ the #isual disri)inati$n disri)inati$n tas* is a tas* that the+ ha#e t$ the+ ha#e t$ re$nize di&&erent letters $n a sreen! $r learn h$1 t$ d$ a tas*. And in this partiular ase! the+ 1ere trained in the tas*! +$u *n$1! identi&+ the e3s that are $n their side! $r s$)e un usual tas*. 6he+3re trained in the tas* $n da+ 0! and then the+ et n$ &urther trainin &$r the &$ll$1in 1ee*. And 1hat pr$&ess$r Sti*$ld $ser#ed 1as that a&ter sleepin $ne niht! the+ sp$ntane$usl+ et etter $n the test in a 1a+ that d$es n$t $ur i& he trains the) )$re durin the sa)e da+. In &at! he did e'peri)ents and he sh$1ed that i& +$u trained the) in the )$rnin and test the) in the e#enin and the+ didn3t sleep in the inter#al! the+ d$n3t et etter. /ut i& the+ sleep riht a&ter1ards! the+ et etter4 and then i& the+ sleep the ne't niht! the+ et etter4 and eah suse
A. Biht! e'atl+. e'atl+. . S$ i& the the$r+ h$lds true! then! the+ 1$uld *eep ettin ettin etter 1ith a $$d niht3s sleep up thr$uh da+ ;, A. -es. . (ith$ut e#en pratiin, A. (ith$ut e#en pratiin.
. And 1hat3s A. E#en a 1ee* later! the+3re n$t d$in adl+! adl+! e#en th$uh the+ ha#en3t pratied it &$r a 1ee*. . S$ 1hat is that attriuted t$, A. As I )enti$ned this )$rnin! 1hen 1e are sleepin! 1e are $in thr$uh and repla+in the e#ents! and 1e3re als$ $ns$lidatin th$se )e)$ries! s$ 1e3re atuall+ pratiin 1hat 1e learned durin sleep. . And i& +$u d$n3t et sleep! is there a slide that sh$1s 1hat happened, A. -es. -es. Ne't slide. S$ i& +$u didn3t sleep that niht! then e#en i& +$u sleep! the ne't niht a&ter the s$ +$u )issed )issed a sleep a&ter da+ 0! then +$u slept a&ter da+ 8! slept slept a&ter da+ 2! ut +$u ne#er et the sleep5related i)pr$#e)ent. . S$ that sh$1s 1hen d$ +$u ha#e t$ sleep t$ start start ettin the i)pr$#e)ent, A. -$u -$u ha#e t$ sleep $n the niht a&ter learnin. . S$ i& +$u3re learnin a tas*! and +$u d$n3t et a niht3s sleep a&ter +$u learn the tas*! that 1h$le thin +$u sh$1ed us earlier a$ut a $ut i)pr$#in! i)pr$#in! i)pr$#in d$esn3t happen, A. E'atl+. . And 1hat a$ut 1hat3s sh$1n $n da+ 9 there, A. 6hat3s e#en a&ter t1$ suse
. Is sleep used as a &$r) $& t$rture s$)eti)es, A. It is. . Can +$u i#e e'a)ples $& that &r$) +$ur e'periene and a*r$und and in&$r)ati$n, A. It is $ne $& the it3s een used as a )eth$d $& t$rture &$r )an+! )an+! )an+ +ears4 and it3s it 1as e#en! un&$rtunatel+! un&$rtunatel+! used t$ t$rture pe$ple in the )iddle east in an e&&$rt t$ et the) t$ $n&ess t$ thins and un&$rtunatel+! un&$rtunatel+! it3s n$t a $$d )eth$d. -$u -$u an et pe$ple t$ $n&ess t$ thins! ut the+ )a+ n$t ha#e d$ne the)! ut the+3re s$ e'hausted and it is s$ pain&ul t$ e sleep depri#ed that it3s een &$und that pe$ple 1ill $n&ess t$ thins that the+ didn3t d$ ust t$ e ale t$ et s$)e sleep. In &at! Menahe) ein! 1h$ used t$ e 1h$ 1as t$rtured 1ith 1ith sleep depri#ati$n he 1as t$rtured 1ith )an+ di&&erent thins in the ula in the S$#iet ni$n. And he said! 1hen he 1r$te his )e)$irs! that sleep depri#ati$n 1as + &ar the 1$rst &$r) $& t$rture! 1$rse than an+ ph+sial thins the+ $uld ha#e d$ne. . S$ the pe$ple 1h$ ha#e su&&ered &r$) sleep depri#ati$n! d$ the+ l$$* &$r 1a+s t$ et sleep, A. -es. . And is there there s$)ethin alled 1hat is sleep5related an'iet+, Is there suh a thin. A. 6here is. It is! it3s part $& a t+pe $& ins$)nia. It3s related t$ pri)ar+ ins$)nia in 1hih pe$ple 1ith ps+h$ph+si$l$ial ins$)nia an atuall+ ha#e 1hat $uld e desried as an $#er5 $nern &$r l$sin sleep eause the+ d$n3t 1ant t$ su&&er su&&er the $nse
A. S$ pri)ar+ ins$)nia is there are a nu)er $& di&&erent t+pes4 ut! &$r e'a)ple! it an e ps+h$ph+si$l$ial ins$)nia! )eanin that the indi#idual t+piall+ it3s hr$ni in nature! s$ pri)ar+ ins$)nia 1$uld n$t e s$)ethin 1here! +$u *n$1! *n$1! +$u the air $nditi$ner 1as t$$ $ld $ne niht and +$u had tr$ule sleepin. -$u -$u )a+ ha#e had ins$)nia! ut +$u d$n3t ha#e pri)ar+ ins$)nia. S$ pri)ar+ ins$)nia i)plies that that it is hr$ni4 and that it has een $in $n &$r at least a )$nth! three )$nths! si' )$nths! dependin $n 1hih de&initi$n +$u 1ant t$ read. /ut it is hr$ni. . D$es 7hr$ni7 )ean that the+ the + al1a+s ha#e ins$)nia, A. N$4 ut it )eans that the+ ha#e it &$r a sustained inter#al $& ti)e. It3s n$t ust that it 1as t$$ $ld in the r$$) last niht! $r the ed 1as un$)&$rtale. . /ut +$u3re tal*in a$ut pri)ar+, A. -es. . And then +$u said there3s s$)ethin alled se$ndar+ ins$)nia, A. (ell! (ell! )a+ I &inish 1hat I 1as sa+in sa +in a$ut pri)ar+, . -es. A. I3) s$rr+. S$ 1ith the pri)ar+ ins$)nia! 1ith the ps+h$ph+si$l$ial ins$)nia! pe$ple 1ith that are $&ten h+per ar$used! e#en durin durin the da+ti)e! and the+ ha#e the+ ha#e an $#er5$nern a$ut the inailit+ t$ sleep! sleep! and the+ )a+ ha#e learned the+ )a+ ha#e ass$iati$ns 1ith the edr$$) $r 1ith sleep that are atuall+ neati#e ass$iati$ns &$r the) t$ et the sleep that the+ need. 6hen there is an$ther $nditi$n alled parad$'ial ins$)nia in 1hih the rep$rt $& $ & the ins$)nia +$u *n$1! pe$ple sa+! sa+! 7I didn3t sleep at all niht!7 ut i& +$u d$ an atual re$rdin! +$u )a+ &ind that the+ sleep sleep &i#e $r si' h$urs. S$ the $)plaint the a)$unt $& sleep that the+ thin* that the+3re ettin is less than the+3re atuall+ ettin. N$1! N$1! at least )easurin their sleep 1ith an E.E.G. Mahine ut it )a+ e that the+3re ale t$ their sens$r+ s+ste) )a+ n$t e turned $&&! and the+3re the researh is n$1 sh$1in that the+ )a+ atuall+ e )$re distured distured than it see)s. An+1a+! An+1a+! there is parad$'ial ins$)nia. 6hen there3s a phen$)en$n alled 7adust)ent sleep dis$rder.7 and that an e an ins$)nia ass$iated 1ith a spei&i stress$r $r a spei&i situati$n 1here the pers$n an3t sleep 1hen the+ are at their in5la1s! $r the+ an3t sleep 1hen the+ are at their +$u *n$1! in ass$iati$n ass$iati$n 1ith a ti)e that the+ ha#e t$ prepare &$r e'a)s i& the+3re in sh$$l! $r s$ and that3s alled adust)ent sleep sleep dis$rder. dis$rder. And then there3s ins$)nia ass$iated 1ith sleep h+iene. N$1! N$1! 7sleep h+iene7 s$unds it3s n$t a$ut rushin +$ur teeth. Sleep h+iene is li*e i& +$u ha#e an irreular sleep:1a*e shedule! $r i& +$u ha#e alertin i& +$u d$ a l$t $& alertin ati#ities e&$re edti)e! +$u3re $n a #ide$ a)e 1ith +$ur udd+ and +$u3re pla+in riht up until and then +$u 1ant t$ shut the lihts $&&.
. D$ *ids su&&er &r$) that a l$t, A. -es! the+ d$. . %la+in #ide$ a)es &$r *ids! is that a $$d thin &$r the) t$ e d$in at niht, A. N$4 and it happens a$ut a $ut 9 illi$n h$urs a 1ee* $lleti#el+ in $ur hildren. 6he industr+ $al is t$ et it up t$ 20 illi$n h$urs a 1ee* + the end $& this deade! ut that3s an$ther st$r+. st$r+. It an e a p$$r sleep en#ir$n)ent! s$ lihts $n in a edr$$). F0 perent $& parents put a 6V. 6V. In their *id3s edr$$) t$ tr+ t$ help the) t$ sleep! n$t realizin that it atuall+ inter&eres 1ith sleep and the+ 1ill spend three )$re h$urs a da+ $n rereati$nal )edia i& the+ ha#e h a#e a 6V. 6V. In the edr$$). E'essi#e a&&eine usae. Man+ pe$ple d$n3t realize that a&&eine has A. Si'5 t$ nine5h$ur hal& li&e! and the+3re s1iin d$1n these &i#e5h$ur ener+ drin*s and! +$u *n$1! an+ a&&eine ta*en a&ter lunhti)e is $in t$ a&&et +$ur ailit+ t$ sleep at niht. S$ that3s the sleep h+iene area. And then there are a $uple $& $thers. One is idi$pathi and $ne related t$ eha#i$ral ins$)nia $& hildh$$d. 6h$se are the pri)ar+ ins$)nias. . N$1! the se$ndar+ ins$)nias! 1hat are the+, A. 6he+ an e se$ndar+ related t$ a )edial $nditi$n! as I )enti$ned. %ain! &$r e'a)ple. Or i& +$u ha#e it an e the treat)ent! als$! $& a )edial $nditi$n! s$ s$ +$u )a+ ha#e asth)a and +$u ha#e t$ ta*e an inhaler. 6hat inhaler )a+ ha#e )ediati$n in it that )a*es +$ur heart rae and )a*es it di&&iult &$r +$u +$u t$ &all asleep. S$ it an e it is se$ndar+ t$ s$)ethin else. It an e se$ndar+ t$ sustane ause4 s$! +$u *n$1! *n$1! i& +$u3re ta*in $aine e&$re +$u $ t$ ed! that3s n$t $in t$ help +$u sleep. It3s $in t$ inter&ere 1ith +$ur sleep! and +$u )a+ de#el$p an ins$)nia ass$iated 1ith sustane ause. Or e#en a presripti$n dru that )a+ inter&ere 1ith +$ur sleep. And then ins$)nia an als$ e ass$iated 1ith an'iet+ $r depressi$n. -$u -$u an e#en ha#e re$und ins$)nia &r$) ha#in ta*en sleepin pills. S$ )an+ sleepin pills! $ne +$u are ta*in the) &$r a series $& nihts! then i& +$u st$p ta*in the)! n$1 +$u an3t sleep and +$ur sleep is atuall+ 1$rse than e&$re +$u start ta*in the sleepin pills. . S$ th$se are s$)e $& the se$ndar+ auses $& A. -es. . (here ins$)nia is n$t the pri)ar+ thin +$u3re dealin 1ith! ut A. 6hat3s $rret. . the result $& +$ur pain $r the result $& s$)ethin else that3s $in $n, A. 6hat3s $rret.
. O*a+. And in 200! 1ere there a 1ide rane $& $th )edial and n$n5)edial 1a+s $& treatin ins$)nia, A. -es. -es. One $& the )$st e&&eti#e 1a+s $& treatin treatin ins$)nia is $niti#e eha#i$ral therap+ . (hen +$u sa+ 7$niti#e eha#i$ral therap+!7 1hat is $niti#e eha#i$ral therap+, A. C$niti#e eha#i$ral therap+ is a therapeuti appr$ah in 1hih t+piall+ a ps+h$l$ist 1ill identi&+ the ta*e a #er+ are&ul hist$r+ &r$) the indi#idual! &ind $ut 1hat thins in the indi#idual3s en#ir$n)ent )a+ e inter&erin 1ith sleep! tr+ t$ adust th$se issues! and $es thr$uh atuall+ a s+ste)ati appr$ah! &irst $& all! t$! ir$niall+! ir$niall+! restrit sleep and s$ that that3s all and restrit the edr$$) t$ sleep. S$ +$u ta*e $ut all the the e'trane$us thins! )a*e sure that it3s dar* and
A. 6here are )ultiple di&&erent drus that )a+ e used t$ treat an 'iet+! 'iet+! inludin s$)e $& the /enz$diazepine drus that that are )$st the drus that are appr$#ed t$ treat treat ins$)nia are enz$diazepine reept$r a$nists appr$#ed + the HDA. . And are there als$ appr$#ed drus li*e A)ien and the li*e, A. -es! -es! A)ien 1$uld e a enz$diazepine reept$r a$nist. a $nist. . O*a+. Lunesta! 1e heard a$ut! that3s een )enti$ned in this ase. A. -es. . And Best$ril! is that an$ther $ne $& the drus s$)eti)es used &$r A. H$r ins$)nia. . And are all $& th$se drus! 1hether $r n$t the use $& th$se drus! is that in a$rd enerall+ 1ith the standard $& are that 1as e'istin A. I& the+3re an appr$priate d$se and the+3re i#en $rall+! $rall+! then +es. . (hat3s the &irst step in tr+in t$ treat s$)e$ne &$r a sleep dis$rder, A. 6he &irst $ne is t$ &iure $ut 1hat the dis$rder is. 6here are a$ut ? di&&erent sleep dis$rders that ha#e een ate$rized! and the+ ha#e spei&i s+)pt$)s! and s$ a d$t$r has t$ ta*e a $)plete )edial hist$r+! hist$r+! $&ten a ph+sial ph +sial e'a)! eause there are s$ )an+ sleep disturanes that are ass$iated 1ith )edial $nditi$ns. S$)eti)es an $#erniht sleep re$rdin in a la$rat$r+ li*e the sleep re$rdin re$rdin that I sh$1ed 1ith the astr$nauts s$)eti)es that is indiated &$r ertain sleep dis$rders. And s$ a are&ul hist$r+ has t$ e ta*en! a a ph+sial e'a)! $&ten a sleep l$ is used! s$ a re$rdin $& 1hen the indi#idual 1as sleepin and 1a*in. /eause )an+ ti)es an irreular shedule $& 1hen pe$ple are atte)ptin t$ sleep and 1a*e is $ne $& the ausal &at$rs &$r ins$)nia! and s$)eti)es a a little de#ie that3s 1$rn $n the 1rist that re$rds ati#it+ and an e used t$ )$nit$r sleepin and 1a*in 1a*in s$)eti)es that t+pe t+pe $& de#ie is used. And &$r eah $ne $& the dis$rders! dis$rders! there is there3s the A)erian Aade)+ $& Sleep Mediine has re$))ended uidelines uidelines &$r the dian$sis and treat)ent $&
. And is it enerall+ re$nized as a treatale $nditi$n, A. -es. . N$1! 1e3#e heard a$ut di&&erent )ediati$ns! and 1e3#e heard )enti$n the ase $& a )ediati$n alled %r$p$&$l. Is %r$p$&$l a sleep )ediati$n, A. N$4 it3s an anestheti.
. And is there a di&&erene et1een an anestheti and a sleep )ediati$n, A. -es. . And 1$uld it help &$r +$u t$ sh$1 $n a hart the A. It 1$uld! atuall+. atuall+.
. s$)e $& the di&&erenes di&&erenes et1een A. Ma+ I,
Mr. Kosko: this co#es under the heading, your honor? o ho- #any la-yers does it take to put up an easel. &o you -ant to just -ait or a second so people can get in position -here they can see/ Mr. Panish: they -ant to kno- i they can #ove over there.
A. I thin* i& 1e put it here! it 1ill e &ine. Mr. Kosko: this -ould %e 9@, %elieve. Judge: ehi%it 9@, chart. (#arked or identiication, ehi%it 9@? chart.)
A. s$ 1hat I3) d$in here is I3) $in t$ )a*e a list $)parin natural enuine sleep 1ith 1hat happens durin %r$p$&$l anesthesia. O*a+, Ms. "ahan: your honor, 0ll o%ject to lack o oundation %eing laid as to his epertise in Propool or anesthetic. Judge: $ustained. you have a oundation to lay, lay, you need to do it. Mr. Kosko: okay.
. D$t$r! as part $& +$ur trainin and e'periene! and an d +$ur researh! ha#e +$u l$$*ed int$ the 1hat happens int$ the e&&ets e&&ets $& %r$p$&$l %r$p$&$l $n sleep, A. -es. -es. It3s atuall+ a a #er+ h$t area $& in#estiati$n eause the &ield $& anesthesia is 1hih has een used &$r $#er 8?0 +ears and )$st $& the ti)e! pe$ple ha#e the anesthesi$l$ists ha#e een )$nit$rin heart rate and respirati$n. /ut e#en th$uh it is the rain that the+ are anesthetizin! the+ ha#e n$t een )$nit$rin the rain t+piall+ in the $peratin r$$)! and
there3s urrentl+ a sea hane in in the pratie $& )ediine that is related t$ tr+in tr+in t$ understand usin the sa)e *ind $& rain 1a#e re$rdins that 1e use t$ )easure sleep t$ )easure the e&&et $& the anestheti. And there ha#e een a series $& e'peri)ents e' peri)ents d$ne t$ tr+ t$ understand! espeiall+ sine )an+ anesthesi$l$ists use the 1$rd 7sleep7 1hen the+3re tal*in a$ut anesthesia! t$ understand the e'tent t$ 1hih it is si)ilar $r di&&erent &r$) sleep. And s$ it is a )atter that3s presented at $ur sienti&i )eetins )eetins in the sleep &ield! and it is $ne $& the p$std$t$ral trainees that 1$r*ed in )+ la$rat$r+ has $ne $n t$ ha#e this as a )a$r area $& researh interest! and he is n$1 a pr$&ess$r at the "ar#ard )edial sh$$l. S$ there are )an+ pe$ple 1$r*in
. I3) as*in a$ut +$ur in#$l#e)ent. Ms. "ahan: %eore do that, your honor, #ove to strike as not responsive. He didn0t testiy to his epertise in this area. Judge: 0ll allo- it. !ut you need #ore. Mr. Kosko: tell #e a%out your involve#ent in looking into the distinction %et-een sleep and anesthesia.
A. 1ell! I ha#e re#ie1ed the the sienti&i literature literature and read and listened t$ letures! read papers letures at sienti&i )eetins! read papers in the internati$nal sienti&i literature! and ha#e studied the di&&erene /et1een sleep and anesthesia. . s$ +$u3#e d$ne th$se studies, A. -es. Judge: okay. Mr. Kosko: okay. $o can you then go ahead, please, and tell us the dierence %et-een sleep and Propool anesthesia. Ms. "ahan: 0# sorry, your honor. don0t -ant to take up ti#e -ith this, %ut #ay voir dire hi# as to the etent o his revie- o the literature and eperience in this area/ Mr. Kosko: she can cross2ea#ine hi#. &id she say she -anted to strike the testi#ony/ Ms. "ahan: asked to >oir &ire hi# a%out the etent o his eperience %ecause don0t think an adeAuate oundation has %een laid as to his epertise.
Judge: go ahead. 0# going to allo- it.
A. )a+ I sit d$1n, Judge: go ahead.
>oir dire ea#ination By ms. Cahan:
Q. Dr. Dr. Czeisler, Czeisler, you've been worked in the sleep medicine field for ! years" is that ri#ht$ %. &et's see. es, es, studyin# sleep and circadian rhythms, rhythms, yes. Q. %nd about how many hours ho urs a year do you devote to your professional endeavors, if you can estimate$ %. ('ve never done it on a yearly basis, but it is it is ( would say )* hours a week. Q. +kay. %nd you work year yea r round$ %. retty much. ( occasionally take a vacation. Q. %nd when did you be#in first be#in lookin# into the scientific literature literature on anesthesia and what it does with the brain waves and circadian rhythms$ %. &et's see. ( first became interested interested in that in discussions with -mory Brown, Brown, who is the collea#ue ( mentioned. Do ( remember the year$ &et's see. ( would say he published an article in the new -n#land ournal ( think it it was in /*0*, or and he's published some some articles before before that. that. ( be#an talkin# with him about it because ('m the director of our trainin# pro#ram on sleep circadian and respiratory respiratory neurobiolo#y, neurobiolo#y, which ('ve been directin# directin# since 0!!1, and about ( want to say about ten years a#o he has to have a trainee supported supported by our trainin# pro#ram pro#ram on sleep who is #oin# to be studyin# anesthesia, and so we be#an havin# discussions about the hemolo#y between sleep and anesthesia, and why it was important to study study to do the same kind of brain wave recordin#s that are done to study sleep to study anesthesia in order to understand their similarities and differences. differences. Q. +kay. 2o you started ('m sorry. sorry. ( want to make sure ('m #ettin# this ri#ht. ou started started lookin# at the literature on Brain wave recordin#s recordin#s and anesthesia around /*0*, you said$ %. ( started talkin# with him about ten years a#o about this, followed some of the research research of some of the students. %nd then he wrote wrote % very pioneerin# article in about or a review article of the sort that ( was describin# earlier in one of in the most widely circulated circulated medical ournal in
the world, which is the new -n#land ournal of medicine. %nd he 3 he published this 3 this paper ( believe it was either in /**! or /*0*, as ( recollect, recollect, so about three or four years a#o, and was invited to be the keynote speaker at the %merican %cademy of sleep medicine meetin#s that 3 that subse4uent year. year. %nd ( listened to his keynote presentation there, read his article, attended some of his other lectures and became interested in some of those areas. areas. ( don't remember e5actly which article ( read in which year. year.
Q. But fair to say /**!6/*0* is when you started readin# the literature in this area$ %. es. es. Q. +kay. %nd of your )* hours a week of work in the last four years or so, how much of that have you devoted toward research research or reviewin# reviewin# the research research or listenin# to information about brain waves and anesthesia$ %. 7ell, 7ell, it's become it's an important area, area, and ( actually submitted a #rant proposal to the the #overnment about two years a#o on sleep and anesthesia in the perioperative period because ( was many times the perioperative period is a particularly particularly dan#erous period for people with sleep disorders because of the the combination of anesthetic that they #et and then in the recovery room, if they have sleep8disordered breathin#, breathin#, they are at increased risk of sudden death or havin# a stroke if they are not monitored. %nd so some pro#rams were be#innin# to investi#ate, and as a (9m currently the chair of the the steerin# committee of the of the sleep research research network, and we are we've been tryin# to or#anize a collaboration. %nd, as ( said, ( submitted a #rant proposal ( think a year or two a#o on screenin# of patients with with sleep disorders because of the increased susceptibility susceptibility to sudden death or 3 or adverse medical conse4uences in in the immediate period when they have had the anesthesia and the postoperative period when they're #ettin# medications for pain. 2o and, in fact, there's ust been established established a sleep and anesthesia society in the field. But your 4uestion about ( don't keep track of e5actly how many hours ( spend on one 3 for e5ample, writin# that #rant proposal or doin# 3 versus the the work that ( do on sleep and a#in# and the work that ( do on resettin# the circadian circadian system with li#ht. But if ( were were to make a #lobal let me make a #lobal it's somewhere somewhere around around five. Q. ( don't know what #lobal means, and ( don't want to cut you off. ( ust want you to answer my 4uestion as to what percenta#e of how man y hours of your )* hours a week that you spend devoted to your work since /**! or /*0* do you spend reviewin# the scientific literature about anesthesia and the effect of anesthesia on the brain$ %nd if you don't know kno w, that's okay. %. ( don't know. know. ( don't know. know. ;he literature itself itself is not that bi#. Q. +kay. %nd do you hold yourself out as an e 5pert in the effect of anesthesia on the brain$ %. ( would say yes.
Q. +kay. +kay. %nd what's the basis basis for that e5pertise, e5pertise, other than the is it is it ust the review of the e5istin# scientific literature literature that you've done since /**! and /*0*, or is there somethin# more$ %. (t would be it would be on understandin# the impact. (n particular, particular, my interest is the the relationship relationship between the hemolo#y or lack of hemolo#y between anesthesia and sleep, and so ('ve read many of the articles that have been written on that topic. Q. +kay. 2o it's ust ust readin# the articles in the field, that's the e5tent of your e5pertise correct$ as a e5pertise in the area area of anesthesia and the effect on the brain$ %. (n relationship to to its my particular interest interest is in its relationship relationship to sleep and whether or not it sub serves the same whether or not it's the same or different different than sleep. Q. 2o yes, it's ust readin# the literature in the field$ Mr. Kosko: o%ject. He ans-ered the Auestion, think. Judge: overruled. 6o ahead. Ms. "ahan: just -ant to #ake sure
%. ( don't #ive anesthesia. (f that's the $ *$
%. (t would be less than a dozen. Q. +kay. %nd you #ot a little bit ahead of me. ou said you're not an anesthesiolo#ist, ri#ht$ %. Correct. Q. ou ou don't practice medicine$ %. Correct. Q. ou ou don't have a D.-.%. &icense, you can't can' t administer or prescribe any medication$ %. ;hat's correct. Q. %nd you yourself, have you done any 3 we talked earlier about research research #rants that you applied for to do science research$ %. es" es" to do clinical research, research, yeah.
inhalant anesthetic, which don't dissipate the drive for sleep, ropofol appears to dissipate the drive for sleep. %nd b ecause of that distinction, there is a #reat deal of interest in ropofol. 2o whereas the inhalant anesthetics, since they don't e5hibit that cardinal feature, feature, they're automatically it's clear that that they are are not they are not dissipatin# the sleep drive" and since they don't do that, they're sort of off of the list of possible hemolo#ies to sleep. 2o the real interest in this area, and its connection with sleep, has been focused on ropofol Q. +kay. 2o can you estimate %. in the field. Q. =i#ht. 2o can you estimate the percenta#e of the amount of literature that there is that you've reviewed re#ardin# re#ardin# anesthesia and an d the brain that relates to ropofol specifically$ %. Can you repeat the 4uestion, please. Q. %re you able to estimate what percenta#e of the literature discussin# anesthesia's effect on the brain that you've reviewed is specific to ropofol as opposed to other anesthetics$ %. ( would say most of the literature literature that that is kept in the area of the sleep field field that ( have reviewed has been related to ropofol. Q. %nd ('ve had an opportunity opp ortunity to review your curriculum vitae, Dr. Dr. Czeisler" and the copy ( #ot was 1@ pa#es lon#. %nd ( don't do n't know if you know this off the top of your head, but ('ll represent represent to you that there's no reference reference whatsoever to ropofol or Diprivan anywhere. %nd Diprivan is the which one is the brand name and which which one is the #eneric name$ %. ropofol is the #eneric name and Diprivan is the the brand name. Q. +kay. ( didn't see any reference reference %. +ne of the brands names. Q. ( didn't see any reference in your 1@8pa#e curriculum vitae to ropofol or any of the brand names of ropofol in your publications or otherwise. (s that accurate$ %. ;hat's accurate. Ms. "ahan: okay. 8our 8our honor, honor, -ould su%#it that &r. "'eisler doesn0t have the necessary epertise to testiy to this chart that he0s intending to create. Mr. Kosko: #ay ask a Auestion, your honor/
&irect ea#ination %y Mr. Kosko:
. Dr. Dr. Czeisler! are +$u re$nized are +$u re$nized as $ne $& the sleep e'perts in the 1$rld, A. -es. -es. I 1$uld n$t n$ t run ar$und sa+in that! ut +es. . And is the
A. n$. . And ha#e +$u l$$*ed at this suet t$ see 1hat the di&&erene is, A. -es! I ha#e. . And has %r$p$&$l een the dru that is )$st $&ten used in the studies that ha#e l$$*ed at the #er+
A. -es! -es! the h$)e$stati dri#e &$r sleep. . H$r e'a)ple! i& Judge: let #e ask you a Auestion. s there any%ody -ho is an epert in this area/ n other -ords, there0s one person -ho has an epertise speciically in sleep and Propool/ r is this kind o a ne- area/
A. it is a ne1 and e'itin e)erin area in the &ield $& sleep )ediine eause eause eause $& this stud+ that 1as d$ne sh$1in that it dissipated the dri#e &$r sleep. Judge: so there are so#e people -ho have studied #ean, you study their literature, then, right/
A. that3s $rret. Judge: and ho- ar does that literature go %ack/
A. it $es a* a$ut nine $r ten +ears. I )ean! it3s n$t a hue literature. And there aren3t that )an+ studies that ha#e een d$ne durin that inter#al. Judge: so there0s %een nine or ten years o study, %ut there0s %een kind o sporadic studies over that ti#e/
A. riht. . Is the siene s$rt $& prett+ $$d! th$uh! $n reahin a $nlusi$n as t$ the di&&erenes et1een %r$p$&$l and sleep, A. -es. I )ean Judge: %eore -e go any urther, -hy don0t -e go to side%ar.
(the ollo-ing proceedings -ere held at side%ar:) Judge: let0s talk a%out it. Mr. Kosko: he0s the ore#ost epert in the -orld on sleep. There is no%ody -ho could %e %etter Aualiied to talk a%out the eect o anesthesia on sleep. t0s not that he0s going to talk as an anesthesiologist a%out ho- #uch anesthesia to use and, you kno-, kno-, the any o the lia%ility aspects o the case. He0s going to %e talking only a%out -hat happens to the hu#an %rain. His %ackground is in neuro%iology, he0s get a neurology %ackground, an #.d.
!ackground, he0s the -orld0s authority on sleep, he0s got a chair at Harvard to do nothing %ut study sleep. just don0t see the issue. t is a ne- and e#erging ield, as your honor %rought out? and there0s not that #uch there? %ut -hen you hear the studies, the studies say -hat 7 -hat the acts are, and it0s not su%tle. Ms. "ahan: your honor, honor, you asked right %eore -e ca#e to side%ar i there -as i there -ere any eperts in this area o -hat anesthesia does to the %rain. There is, and the ore#ost epert on it is &r. !ro-n. 4nd -e have studies that &r. "'eisler indicated he0s relying on, and they0re -ritten %y &r. !ro-n. 4nd i they -anted to have &r. !ro-n co#e testiy Judge: he cited &r. !ro-n. Ms. "ahan: yes. He0s the epert a%out that. 4nd he just said this is a%out -hat anesthesia does to the %rain. That0s &r. !ro-n. That0s his epertise. they -ant to have hi# say that sleep deprivation causes various eects, -hich they0ve had hi# do, -e think that0s air? %ut there0s no %asis that he has epertise in the ield o the neuroche#ical reactions that Propool causes on the %rain other than revie- the literature, and any physician could have done that. Judge: &r. !ro-n, does he have any opinions a%out its eect on sleep, though/ Mr. Panish: no. Ms. "ahan: the eect o Propool on sleep/ Judge: that0s -hat -e0re dealing -ith is the sleep and the Propool. Ms. "ahan: one o the studies that &r. "'eisler indicated he0s relying on and produced to us in response to our docu#ent reAuest is called Bgeneral anesthesia sleep and co#a.B it0s a study %y &r. !ro-n, it0s *e- 5ngland journal o #edicine. think that #ay %e the study he0s reerring to. t has a CD
Ms. "ahan: -e don0t have an issue -ith hi# doing the let2hand side o the chart, %ut the right2hand side he didn0t even get the grant that he applied or in this area. Mr. Panish: -hat does that #ean/ 8our honor, -e don0t need the -orld0s reno-ned epert Judge: no, %ut you need an epert. Mr. Panish: right. 4nd they can0t sho- 7 this guy is clearly Aualiied. 4. +ot o eperts in their ield revie- scientiic literature and rely on it. That0s allo-ed %y the evidence code @D<.<
Judge: %ut that0s the single thing that he applied or that connected the sleep and the Propool. Mr. Panish: no, it0s not. That0s not his testi#ony. 4nd i -e need to take it outside the presence o the jury in a =DC hearing, -e should %e allo-ed to lay the urther oundation, %ecause it0s not just that that Aualiies hi# to do it. 3rite a grant -e haven0t even gone into -hat0s involved in -riting a grant, revie- o scientiic literature and all the other actors. That hasn0t co#e in. The act -hether or not a grant -as granted has no %earing on -hether he0s Aualiied or not. $o no- are -e going to call in -hoever is in the ederal govern#ent and get into -hy they gave it to this person and that person/ t has nothing to do as to -hether he0s Aualiied as an epert. That0s totally i##aterial, unless they can %ring the surgeon general to say -e didn0t give it to hi# %ecause -e didn0t kno- i he -as Aualiied.
Ms. "ahan: the surgeon general has nothing to do -ith it. Mr. Panish: a lot o your Auestions don0t have anything to do -ith a proper >oir &ire. Those -eren0t appropriate Auestions as to his Aualiications. Those -eren0t appropriate >oir &ire Auestions, -hich he didn0t o%ject to, -hich -ould have. Mr. Kosko: %y the -ay, your honor, he doesn0t have to %e an epert in anesthesia to talk a%out the eect o anesthesia on sleep any #ore than he0d have to %e an orthopedist to say -hat pain caused, or a psychiatrist to say ho- that intereres -ith sleep. He kno-s hoanesthesia intereres -ith sleep. That0s -hat he0s %eing called to talk a%out, and there0s no one %etter Aualiied in the -orld. 5#ory !ro-n, -ho do kno-, and -ho have enor#ous
respect or, or, is an anesthesiologist, not a sleep epert. $o -hat they0re sort o they0re sort o saying is -e %ring in 5#ory !ro-n to do the anesthesia side o the chart and this person to do the other side o the chart/ They -ould have the sa#e argu#ents a%out 5#ory !ro-n and sleep. Ms. "ahan: t-o issues, your honor. &r. !ro-n is a retained epert or the#. He -as -ithin hours o testiying -hen they pulled hi#. They can %ring hi# %ack, -e -ouldn0t o%ject to that. They0re still in their case. they -ant to have the right epert testiy to this issue, -e0re not o%jecting to the testi#ony co#ing in.
Judge: did !ro-n conduct any tests -ith sleep/ Mr. Panish: no. Ms. "ahan: -hat !ro-n !ro-n has pioneered doing is he does he
Mr. Kosko: no, he didn0t. Ms. "ahan: he studies 5.5.6.0s. ne o the things that he0s doing is -orking on getting so#ething patented to look at the 5.5.6.0s during anesthesia, look at the %rain activity during anesthesia %ecause he thinks that that is a %etter #easure o ho- so#eone is reacting to anesthesia, ho- deep they are.
Ms. $te%%ins: not to do -ith sleep. Judge: she0s not inished. Ms. "ahan: he is so#e%ody -ho studies the eect o anesthesia on the %rain -aves, -hich is eactly -hat that right2hand side o the chart has %een pitched as doing. 4nd, your honor, -hat0s also i#portant here Judge: -ho is going to testiy a%out the relationship %et-een anesthesia and sleep/ t doesn0t sound like !ro-n necessarily has it. 0# not sure this -itness has it. Mr. Kosko: he has it. He kno-s -hat sleep -aves look like. He has the literature -hich sho-s -hat anesthesia -aves look like. He0s going to sho- that they are entirely dierent, and that0s -hat and he0s a neurologist, he has a %ackground in neurology, neurology, in #edicine. He is this -orld sleep epert. don0t get it. $uppose he -as just Joe $ch#oe neurologist o the street, and -e say, Bhave you researched this topic/B Byes.B Band could you sho- #e -hat this 7 -hat this %rain -ave says/B -e could do that. Mr. Panish: right.
Judge: not in #y court. Mr. Kosko: -e have the -orldFs chie 7 the %iggest sleep epert in the -orld, and their sole criticis# is he0s not the top Propool anesthesia epert epert in the -orld. Judge: is there so#e%ody -ho is an epert in %oth areas/ there0s not, then Ms. "ahan: your honor, this is &r. !ro-n0s study that says Bgeneral anesthesia, sleep and co#a.B and the irst i#age sho-s all the phases o sleep and -hat anesthesia does to the %rain -aves versus -hat sleep does to the %rain -aves. 4nd he0s the guy on this. 4nd don0t -ant to lose the act here that -e also have an o%jection to the act that none o this -as testiied to at his deposition, it -as not an opinion at his deposition, it -as not %rought out, every single slide -as ne-, al#ost all o your %ackground -as ne-, and allo-ed it consistent -ith 8our honor0s rulings this #orning. Judge: so i !ro-n co#es in to testiy Ms. "ahan: he0s the guy. Mr. Kosko: he can0t talk a%out the sleep. Judge: they0re saying they have no Mr. Kosko: that0s not his epertise. Mr. Panish: he doesn0t kno- that. Judge: sounds like he does. Mr. Panish: that doesn0t sho- that. Mr. Kosko: he can co#e in and say the %rain -aves sho- that it0s dierent, %ut this epert can say -hat that dierence #eans ro# the point o vie- o sleep, and so he can depend on the #edical literature. This epert can depend on the #edical literature, -hich is -ell esta%lished, -hich they concede is authoritative, it sounds like, to say this is -hat the %rain -ave looks like in Propool. 4nd then -e can ask hi#, Bno-, -hat does that #ean as a sleep scientist in ter#s o -hether or not the person is getting sleep/B and -e did say it -as one o our opinions that -e -ere going to talk a%out Propool.
Judge: -here is that opinion/
Mr. Mr. Kosko: nu#%er @ E, think it is. 3hy did they say -e didn0t say it -hen -e said it/ Mr. Panish: can rely on #edical literature. There0s nothing -rong -ith that. The *e5ngland journal and all these are recogni'ed authoritative treatises. Judge: 0# not saying he can0t. Mr. Panish: -hy do -e have to %ring the nu#%er <, according to the#, person in the -orld/ 3hat is the standard, that no- you need the nu#%er < person in the -orld/ The standard is is he Aualiied in his %ackground %ased on his training and eperience, things he0s revie-ed, to give those opinions/ That0s the only issue that should %e assessed. 4nd he doesn0t need to %e the -orld reno-ned epert on the su%ject. Mr. Kosko: in his report, he talks a%out the Propool in his report. Ms. "ahan: he0s pu%lished
Judge: okay. okay. 3hat is this this -as this this epert -as deposed right/ 3hat -ere his opinions/ Ms. "ahan: as re#e#%er it, he said, a#ong other things, that sleep is not the sa#e thing as anesthesia? that the eect o anesthesia on the %rain is not to create the sa#e kind o restul sleep, the restorative unction o sleep that eists -ith real sleep. 4. +ot o people get conused %y that. nduction o Propool and #aintenance o Propool #ight leave one eeling rereshed, %ut it0s not a co#para%le su%stitute or sleep. That0s the right2hand side o the chart. Judge: that0s -hat you0re trying to elicit out o the sa#e -itness. Mr. Panish: it0s not the sa#e -itness. Judge: -hat 0# saying is the opinions that this person rendered are the sa#e ones you0re trying to elicit ro# this -itness. Mr. Panish: no. Judge: okay. 3hat is it that he0s going to say/ 0# asking Mr. Kosko.
Mr. Kosko: -e0re trying to elicit ro# this -itness that %ased on the literature, the %rain -aves that are elicited in a Propool2induced co#a -ill have a, not the sa#e as sleep? and %, are going to have an eect on %ehavior, and the %ehavior is going to %e the sa#e as a sleep2deprived person. That0s -hat so his his opinion is that it0s the that 7 the %rain -ave is easy %ecause that, he could get ro# any-here. He could get it ro# the internet.
Mr. !oyle: your honor, this is ro# &r. !ro-n0s opinions? and i you look, these are the su##ary that he -rote o his opinions. kay/ *ot one o these is sleep. 4nd 0ll read the# into the record. &r. !ro-n0s su##ary o opinions. t -as ehi%it to !ro-n0s deposition on =GEG<. ne, Propool -e got this ro# ro# other people, so that0s -hy -e haven0t called !ro-n yet. !ut one, Propool and its uses and standard #edical practice. T-o, training reAuired to saely ad#inister Propool and sedation. Three, use o Propool to treat sleep pro%le#s. our, &r. Murray0s training to ad#inister Propool. ive, &r. Murray0s #anage#ent o Mr. Jackson during ad#inistration o Propool and other sedation? and ;, &r. Murray0s #anage#ent o Mr. Jackson during the e#ergency situation. 3hat -e0re asking or here here is sleep it0s the eect on sleep. Mr. Panish: -hich is not one o his areas. Ms. "ahan: your honor, his opinion a%out the use o Propool to treat sleep pro%le#s that they just read, that enco#passed the testi#ony that just reerenced a%out -hat sleep does or the %rain versus -hat Propool does or the %rain, and the lack o co#para%le eect on the %rain in ter#s o restoring so#eone and actually giving the# the %eneits that real sleep gives. 4nd contrary to -hat they0re saying no-, this is the chart that they0re going to have hi# -rite up ver%ati#. That0s not Mr. Kosko: no. That0s oundational. Ms. "ahan: it0s testiying to -hat anesthesia is and ho- it -orks. The clerk: your honor, can they go on a %reak/ Judge: can0t talk a%out that right no-. 0# reading this. kay. This side is not talking a%out ho- Propool and sleep deprivation ho- Propool aects the %ehavior. %ehavior. Mr. Kosko: that0s right. That0s preparatory to that discussion. This is the oundation. Mr. !oyle: no 15M sleep. That0s -hat he0s an epert on. That0s the -hole point. Mr. Kosko: he0s an epert on 15M sleep, and this is non215M sleep is a%nor#al. $o he0s going to take these, and then he is going to talk a%out ho- that aects %ehavior, ho- the lack o 15M sleep and non215M sleep and sleep in general aects %ehavior. He0s %een talking a%out that all along. He0s %een talking a%out ho- it happens in ani#als, and he0s
going to talk a%out ho- it happens in people, and ho- it happened to Michael Jackson. Mr. !oyle: as a sleep epert, he says ho- do things aect sleep/ Pain, -hatever. ne, Propool doesn0t allo- 15M sleep, and that0s he0s the sleep guy, guy, and so he can say Propool doesn0t allo- 15M sleep, and then he can talk a%out -hat that #eans -ithout 15M sleep, -hich is -hat he0s %een saying all day. Mr. Kosko: it0s not an anesthesia Auestion. t0s a sleep Auestion. Judge: ho- does it aect the %ehavior/ The disheveled and all that stu like Mr. Mr. Kosko: everything that -e see happening to Michael Jackson is consistent -ith %eing caused %y sleep deprivation ro# the Propool, assu#ing that he had %een given it every night. 3hat he0s going to say is that there is nothing that anesthesia is nothing %ecause o that loss o 15M sleep, and non215M sleep, he -as not getting he -as like the rats -ho took a long ti#e to die. 4nd here here is and there0s proo. There0s a lot o proo all through through this record o -hat -hat his %ehavior -as, ho- he ho- he 7 he -as late, hoho- he had the ther#al loss o ther#al regulation. Judge: -earing the heavy %lankets. Mr. Kosko: -earing the heavy %lankets, his conusion, his ina%ility to re#e#%er steps. 1e#e#%er ho- he testiied that the 15M sleep is -hat allo-s one to re#e#%er to consolidate and re#e#%er, re#e#%er, and it0s just it0s perect. t0s an eAuisite Ms. $te%%ins: not eactly Judge: and &r. !ro-n, is he going to %e a%le to say that, though. Mr. !oyle: have his deposition right here. Bdo you hold yoursel out as an epert in sleep/B Bno.B that0s Ms. "ahan: your honor, can just look at the chart part. $o the drug2induced co#a part, don0t think that0s a%out ho- Propool -orks on the %rain, don0t think he has oundation or that. &oesn0t ulill needs, don0t kno- -hat that #eans. Proound unresponsiveness is a%out ho- the anesthetic eect o Propool? Propool? again, inappropriate. *o consciousness at all, inappropriate. &e%ata%le -hether he can say
Judge: let #e say this. 8ou0ll %e a%le to elicit those opinions on the condition that you %ring !ro-n in. 8ou have to %ring !ro-n in to testiy to that. 8ou can ask hi#, B4ssu#e that there is this literature that says this. 4re you a-are o this literature/B assu#e that0s the acts, and then opinions a%out the %ehavior.
Mr. Panish: -hich issues are -e talking a%out no-/ Mr. Mr. Kosko: in other -ords, let #e just say this drug2induced co#a, this stu is any tet%ook o #edicine has this. This is not cutting edge. *one o this is cutting edge. The only thing that -e0re depending on the studies or is the 15M sleep. Judge: the literature that says that Propool does not give the sleep, that nor#al sleep. Mr. Kosko: -hy can0t he depend on an authoritative article or that/ t0s an article that relates to his opinion. sn0t that standard kno- in "onnecticut Mr. Mr. !oyle: -ait a #inute. There is no article he0s the sleep epert. He says, okay, here0s -hat %rain -aves look like on Propool? and he says, okay, 0# the sleep epert, that is not 15M sleep %rain -aves. He0s the one guy in the -orld, the %est guy in the -orld to do that. Ms. "ahan: your honor, don0t kno- -hy they0re avoiding calling &r. !ro-n. t see#s like this -ould %e very easy to deal -ith i they -ere to call hi#. !ut to the etent that that counsel is going to try to have hi# #ake the inerential leap %et-een Propool and all the things that -ere seen in Mr. Jackson, they0re going to run into another huge pro%le# there. 4nd don0t kno- i this is the ti#e to discuss it, %ut the only evidence in the record and the only evidence he0s relying on or that is &r. Murray0s police state#ent, -hich is not in evidence and is hearsay as o no-. 1ight no-, the only thing that sho-s that Michael Jackson had Propool in his syste# in 4pril, #ay, June CDD9 is the coroner0s reports that sho-s he had it in his syste# the day he died. *o-, he0s talking a%out long2ter# eects o #ultiple nights o Propool ad#inistration. The only person -ho says that is -hat &r. Murray tells the police -here he says, B0ve %een giving it to hi# nightly or t-o #onths.B so i this is supposed to lay a oundation or no- inally late in the day applying this to Michael Jackson, -ho hasn0t %een #entioned yet today, think they0re going to have a %ig hearsay pro%le# there, as -ell. Mr. Panish: -hy can0t he rely on hearsay. "an #ake a suggestion -e let the jury go or no-/ 3e0re going to -ant to #ake an etensive oer o proo i -e have an issue on this, and #ay%e a urther =DC to lay the oundation. Judge: sure. 3hy don0t -e go out there.
(<@2#inute recess taken.)
(the ollo-ing proceedings -ere heard in open court, outside the presence o the jury:)
Judge: let0s talk a%out this. Mr. Panish: -ell, your honor, -hat -ould like to do is Auestion hi# and lay a =DC oundation right no- under @D<(a) or these opinions that he0s going to give. can do it very Auickly. Judge: one o the issues -as -hether he0s giving a ne- opinion no-. Mr. Panish: -ell, that0s dierent than the o%jection right no-. Judge: true. Mr. Panish: okay. $o -hich one do -e -ant to address irst/ Judge: the one -e originally Mr. Panish: okay. &octor, -e0ve heard a%out your Aualiications, your epertise. n your ield, do you regularly rely on #edical literature/
A. +es! as$lutel+. as$lutel+. Mr. Panish: -hy do you do that/
A. as I said this )$rnin! that3s the 1a+ 1e $n#e+ the results $& $ur )edial researh t$ all $& the $ther $th sientists and liniians liniians in the area. N$ $ne pers$n pers$n an d$ all $& the di&&erent di&&erent Mr. Panish: in this case, do you have epertise in the area o sleep/
A. +es. Mr. Panish: have you revie-ed literature, scientiic, relia%le, #edical literature in the area o Propool/
A. +es! I ha#e. Mr. Mr. Panish: have you are you a#iliar -ith the eects o Propool on sleep/
A. +es! I a). Mr. Mr. Panish: the literature that you have revie-ed, revie-ed, is that is that #edically recogni'ed as authoritative/
A. +es! it is. Mr. Panish: can you give us a list o the journals in -hich these articles that you0ve relied on are pu%lished/
A. +es! I an. Mr. Panish: go ahead, please.
A. 1ell! I 1$uld need t$ l$$* at )+ $)puter. Mr. Panish: you need your %ag/
A. )+ $)puter. $)puter. Mr. Panish: okay.
A. )a+ I, Judge: yes, you #ay step do-n.
A. d$ +$u 1ant )e t$ start ans1erin the
A. s$ $ne $& the $urnals is alled 7anesthesi$l$+.7 7anesthesi$l$+.7 there are se#eral artiles in that $urnal. An$ther artile $n in the $n this t$pi als$ in 7anesthesi$l$+.7 7anesthesi$l$+.7 there ha#e een a nu)er $& the) pulished in 7anesthesi$l$+!7 the ne1 Enland $urnal $& )ediine! in the $ urnal sleep! in the annual re#ie1 $& neur$siene. Mr. Panish: okay. 4nd the journal o sleep, did you #ention that earlier today/
A. +es. Mr. Panish: are all those journals so ar recogni'ed as authoritative in the #edical
A. +es. Mr. Mr. Panish: you0ve got to let #e inish. in the #edical co##unity/
A. +es. Mr. Panish: are those the type o journals and pu%lications that are co##only relied upon
%y #edical physicians and PH&.0s that do research/
A. +es. Mr. Panish: -hy do you rely on literature to do research in your part o your research/
A. eause I rel+ $n peer5re#ie1ed p eer5re#ie1ed literature 1here $ther sientists ha#e are&ull+ re#ie1ed the )eth$ds + 1hih th$se that researh has een $nduted! and it has passed the peer5re#ie1 pr$ess and een seleted &$r puliati$n in a reputale sienti&i $urnal. And then $ne re#ie1s the )eth$ds that 1ere used eause the )eth$ds are artiulated in the artile suh that the reader a reader #ersed in the art an )a*e an $pini$n as t$ 1hether $r n$t the+ h$ld redene in the partiular ite) ein rep$rted.
Mr. Panish: have you revie-ed all o the literature that you0re a-are o on this su%ject that eists in the #edical ield/
A. I ha#e d$ne )+ est! +es. Mr. Panish: are there articles and pu%lications that are peer2revie-ed, #any that are not pu%lished %y &r. &r. !ro-n/
A. +es! there are a nu)er nu )er $& artiles that are n$t pulished + Dr. /r$1n in this area. Mr. Mr. Panish: Panis h: no-, sir Judge: did -e talk a%out &r. !ro-n earlier/ #ean in our cha#%ers, -e did, %ut Mr. Panish: -hat, in ront o the jury, you0re talking a%out/ Judge: yes. Have -e done that yet/ Mr. Panish: think he did #ention it %riely.
A. I t$ld he 1as $ne $& )+ p$std$t$ral &ell$1s. Mr. Mr. Panish: yeah, he did say that. !ecause he -as asking hi# like got t-o o the# co#ing, one ro# #y side, one ro# their side co#ing on #e. +et #e inish up #y ea#ination. *o-, sir, the opinions, irst o all.
A. )a+ I sa+ $ne thin, An$ther $ne is the $urnal the pr$eedins $& the nati$nal aade )+ $& sienes. Mr. Panish: is that recogni'ed as authoritative/
A. +es. Mr. Panish: is it co##on or physicians, PH&.Fs, that are -orking as epert -itnesses to rely on pu%lications o others in giving their opinions/
A. +es. Mr. Panish: the area -hich you have %een Auestioned a%out, and there0s an o%jection on the eects o Propool and sleep, is that an area in -hich you are an epert in the sleep area/
A. +es. Mr. Panish: is that -hat you0ve done 9 plus years o -ork in/
A. in the &ield $& sleep )ediine in eneral! +es. Mr. Panish: and are you Aualiied to revie- #edical journal articles and interpret the# as it relates to your ield in sleep/
A. +es. 6hese auth$rs 1ritin these artiles ha#e used the sa)e tehni
A. it3s the sa)e t+pe $& )eth$d$l$+ that I sh$1ed +$u 1ith the astr$nauts. S$ it in#$l#es d$in the E.E.G. Be$rdins and the re$rdins $& the di&&erent staes $& sleep t$ &ind $ut 1hat happens 1hen +$u are ein anesthetized! and then there ha#e een studies in ani)als l$$*in at re$und ins$)nia e'use )e re$und sleep a&ter %r$p$&$l ad)inistrati$n! &$r e'a)ple. Mr. Panish: and have you used the sa#e #ethodology in co#ing to your opinions in this case/
A. +es. Mr. Panish: 15M sleep. 4re you Aualiied to testiy -hat is 15M sleep/
A. +es. Mr. Panish: and -hat is non215M sleep/
A. +es.
Mr. Panish: and the conseAuences o having 15M sleep or not having 15M sleep/
A. +es! I a). Mr. Panish: and have you %een studying that or #any, #any years/ Judge: since #y doctor ea#s, yes. Mr. Panish: that0s all have or the oundation on the 15M and non215M. Judge: let0s take one thing at a ti#e. &id you -ant to Auestion hi# on anything/ have a co##ent, %ut -as thinking that suppose he could testiy to the opinions that he -as going to give a%out the eect o Propool on sleep %ased on the research that he0s done in that particular research piece on %y !ro-n, %ut it0s really really up to the jury to deter#ine -hether or not that thing that he0s relied on is relia%le, correct/ 4nd -hether it truly supports his opinion. t pro%a%ly -ould %e %etter i they %rought in !ro-n to prove that act? %ut i they don0t, then the jury #ay say, -ell, that0s a act that hasn0t %een adeAuately proved, or isn0t relia%le, relia%le, or and then disregard it, and as a result, disregard his opinion. #ean Mr. Panish: %eore she #akes her argu#ent can say one thing so she can address it/ Ms. "ahan: sure. Mr. Panish: that0s -hat evidence code II< is or? that they are entitled to cross2ea#ine hi# on the contents o the periodic journal or the literature that he has revie-ed to try to esta%lish that it0s not relia%le or not so#ething that0s co##only relied upon. t doesn0t go to the oundational %asis o the opinion, it goes to the -eight on -hich it should %e given %y the trier o act. $orry. didn0t #ean to cut
Judge: guess -hat 0# saying is i the jury inds that that research is unrelia%le or shouldn0t have %een relied on, they #ay disregard his entire opinion. Mr. Panish: that0s -hat you0re going to instruct hi#, that the eperts0 opinion is only as good as the acts upon -hich it0s %ased, and you decide that yoursel %ased upon the evidence, acts, testi#ony, epertise, et cetera. Ms. "ahan: your honor, #ay%e it -ould %e %est to ecuse the -itness at this point. have an argu#ent %ased on the case la- to #ake a%out this. Mr. Panish: all right. 3ell, do you -ant to Auestion hi# irst/
Ms. "ahan: not at this ti#e. Judge: okay. 3ould you step do-n, please, leave the courtroo#/ $orry to distur% you.
A. I3) s$rr+. (the -itness let the courtroo#.) Ms. "ahan: don0t kno- -hat Mr. Panish -as reerring to -ith respect to II< %ecause that0s a%out rereshing #e#ory. #e#ory. don0t think that0s applica%le here. !ut the actually think your honor0s solution -hich you proposed in cha#%ers o having &r. !ro-n actually co#e in and support this testi#ony is the right solution, and that0s %ecause the case la- is clear that eperts can0t rely on non2testiying eperts0 opinions or talk a%out the data in inad#issi%le reports. Just %ecause it0s pu%lished in the *e- 5ngland journal o #edicine doesn0t #ean he gets to talk a%out it. have a couple o cases on that, 3hitield v. 1oth,
Judge: that0s -hat -as suggesting, -hy you can ask an epert, Bassu#e so and so, &r. &r. !ro-n co#es in and testiies that.B no- you have opinions and you can render those opinions. looked that up, too. did so#e research on #y o-n, and that0s another -ay that an epert can testiy, is they can either listen to another epert testiy in the courtroo# or the Auestioner can ask a hypothetical?B assu#ing this other person co#es in and testiies to this opinion or this act, -hat are your opinions %ased on that/B no-, that -ould #ean that his opinions -ould %e conditionally ad#itted today.
Ms. "ahan: right. 3e0d %e ine -ith that. Judge: on the assu#ption that !ro-n is going to co#e in and give his opinion. Ms. "ahan: your honor, just to inish the point, to the etent that they are going to -ant to say, -ell, he0s not really relying on !ro-n, he0s relying on the underlying studies that pri#arily !ro-n and so#e other people -orked on, that0s not okay either under 6ri#shav. ord #otor co. 4nd that0s <<9 cal.app.d IEI, it0s a <9@< case. 4nd that stands or the principal that an epert #ay state that he or she relied on inor#ation contained in certain reports, %ut #ay not testiy to the contents o the reports. 4nd another case to the sa#e
eect is "ontinental 4ir +ines, nc., v. Mc&onnell &ouglas, C<; "al.app.d @@. That0s a <99D case -here an epert -as per#itted to testiy that he relied on certainly cost and price igures su%#itted to hi# %y his su%ordinates, %ut not per#itted to testiy a%out the contents o the report. That0s the sa#e situation here.
Mr. Panish: that0s not -hat -e0re doing. 0# very a#iliar -ith 6ri#sha- versus ord Motor co#pany. n 6ri#sha-, just like here, just like in every trial 0ve %een in, an epert can state the %ases or his opinion including scientiic or #edical literature. Then that is not hearsay. He0s not saying -hat the article he0s relying on those articles to give his opinion. That0s allo-ed. That has nothing to do -ith i he0s trying to %ack door in another epert0s opinion. 4ll eperts, i they0re Aualiied, rely on relia%le, 4uthoritati v 5treatises? and the code allo-s that. Judge: true, %ut think her point is they can0t sit up there and regurgitate those things. Mr. Panish: he0s not going to. He doesn0t have to. He can say, B#y opinion is, %ased on #y training, eperience, %ackground and revie- o #edical literature.B then they have a right to cross2ea#ine hi# on the literature. 3e can0t air#atively put it in, %ut Judge: so you0re not going to put in. Mr. Panish: -e0re not going to put the literature, %ut it0s not su%ject to so#e epert0s opinion. He0s not trying to regurgitate -hat so#eone else is saying. He0s giving his o-n opinion %ased on his training, eperience and revie- o the literature? and he0s co#petent and Aualiied to do that. t0s a co#pletely dierent situation than 6ri#sha- -here the plaintis0 epert regurgitated -hat -as in scientiic auto#otive engineering society, Michigan, -here he and other eperts -ere regurgitating -hat -as in the reports. He0s not doing that. they -ant to get into it into cross2ea#ination, they can say, Byou0re relying on this report. 3ell, that doesn0t say this and that doesn0t say that.B then they have the right to do that. !ut -e0re not trying to air#atively get in ront o the jury these reports? and -e don0t have to do that, and it had doesn0t have to %e conditionally ad#itted on so#e other guy testiying it %ecause he0s not relying on his opinions. He0s relying on relia%le, authoritative #edical treatises, -hich is allo-ed under @D< o the evidence code.
Judge: okay. $o -hat is the opinion that he0s going to %e giving/ 3hat0s Mr. Mr. Panish: okay. 3ell, 3ell, he0s going to talk a%out, nu#%er <, there0s the 15M and non215M sleep and eects o the Propool anesthetic versus regular sleep, -hich is an area in -hich he0s an epert in, and -hich he0s read articles a%out and he can testiy on.
Ms. "ahan: and, your honor, the situation here is he doesn0t have an independent opinion.
4ll he his only opinion, and he said this, is he just kno-s -hat he read in the literature or -hat he discussed -ith &r. !ro-n. don0t kno- -hy they0re resisting calling hi#. That see#s like the easiest, astest solution here. !ut he doesn0t have an independent opinion, it0s not like say he0s a cardiologist, and he0s a#iliar -ith the literature ro# authoritative treatises, and he0s rendering a diagnosis, and part o the %asis or that is -hat he0s read in his #edical tet%ooks, right/ That0s not the situation. His only %asis, he hasn0t done any independent research, he hasn0t pu%lished in the ield, he doesn0t have epertise in the ield, so all he can do is regurgitate -hat he0s read and discussed -ith &r. !ro-n? and that0s eactly -hat these case say is not appropriate. $o think the solution o having &r. !ro-n co#e testiy to support this and conditionally letting it in no- is the right one
Mr. Panish: he0s Judge: that0s -hat 0# going to do. Mr. Panish: your honor, he0s not Judge: 0# conditionally ad#itting it. He can testiy to it, %ut you0re going to have to %ring in so#e%ody else. Mr. !oyle: just to %e clear, so#eone else to say that there0s no 15M and non215M sleep -ith Propool/ !ecause that0s really the only Judge: yeah. That0s -hat &r. !ro-n said. Mr. Panish: so irst o all Judge: -ell, he testiied to a lot o other things. don0t think you0re going to need all those other things, ro# -hat -e read in cha#%ers. t sounds like the only thing that -ould %e necessary is that one opinion. Mr. Panish: irst o all, -ant to #ake clear or the record that this -itness has testiied that he has independent opinions %ased on his eperience and revie- o the #edical literature. The court is no- ruling that his opinions can %e conditionally ad#itted i -e call &r. !ro-n to give the sa#e opinion on -hich he0s relying on. 4# understanding you/
Judge: you can ask hi# a hypothetical, that portion. Mr. Panish: -hy can0t -e ask hi# directly his opinion %ased on his revie- o literature that he did/ That0s not -hat 0# not understanding. Mr. !oyle: your honor, to %e clear, he has a stack o articles that are not -ritten %y &r.
!ro-n that say there0s no 15M or non215M sleep on Propool. $o it0s kind o -ired that they0re trying to -edge everything on &r. !ro-n. *u#erous people say that little link? then he0s the sleep guy -ho says, Band -hat does that #ean in ter#s o sleep/B right/ Mr. Kosko: can say one other thing a%out it/ That is that -hat he0s relying on is the pu%lished literature, -hich sho-s the pattern o sleep under Propool. That0s really all it is. *ot any conclusions. He can dra- the conclusions. This is a cross specialty -hen it co#es to #easuring the -aves, the %rain -aves. This is a cross specialty o neurology, neurology, anesthesiology, sleep #edicine, et cetera. Judge: it does appear to %e that Mr. Kosko: so he is as Aualiied to look at those sAuiggly lines and to interpret the# or the jury as &r. &r. !ro-n is in that case. $o all he0s all -e -ant hi# or is to say -hat are the patterns that are sho-n in the literature or patients -ho are anestheti'ed -ith Propool. Ms. "ahan: and repeating the patterns that are sho-n in the literature is eactly -hat is not allo-ed here, and think your honor has ruled and it0s clear. Judge: i you -ant to %rie it 0# going to allo- hi# to testiy? %ut like said, it0s conditional to %ring in the other epert. you -ant to %rie it to #e urther, #ay%e -e -on0t need to do that, it -ill just co#e in. Mr. Mr. Panish: -e0ll do that. 4nd can also reAuest you kno-, getting &r. &r. !ro-n to is it possi%le to do it %y video conerence and play it later/ 3e ask hi# the Auestions and they cross2ea#ine hi#, so -e don0t have to #ake hi# co#e across the country/ That0s all. Ms. "ahan: your honor, this #ay %e as si#ple as playing portions o &r. !ro-n0s deposition, -hich they0re allo-ed to do. 3e can #ay%e stipulate to that. Mr. Panish: all right. 3e0ll just play the depo, then. 8ou said -e could do it, ine. don0t kno- i he -as asked those Auestions. Ms. "ahan: i he -asn0t asked those Auestions, then they do need to call hi# live, %ecause Judge: live/ Ms. "ahan: yes. Judge: is there any need to have hi# live/ Ms. "ahan: i -e can -ork it out technologically Mr. Panish: according to -hat you just said, there0s %asically three Auestions -e need to
ask &r. !ro-n, and they can cross2ea#ine hi# on those three Auestions. !ut it doesn0t #ake -e0re ine, 0# -illing to -ork it out -ith the#, do a video conerence at their oice, -e0ll put hi# on the thing, ask those three Auestions, and they can cross2ea#ine on those three Auestions. !ecause other-ise, it0s just not eicient. !ut i that0s -hat the court is reAuiring ater %rieing, ater you look at it, then so %e it? %ut don0t -ant to #ake the guy co#e here to testiy or ive #inutes. That doesn0t see# eicient. $o -ould ask or the alternative, that0s all. Judge: okay. think the alternative is reasona%le. +ook at the depo, too, %eore you Mr. Panish: right. 3e0ll look to see i it0s covered. don0t recall it %eing. Ms. "ahan took the depo, she -ould kno- %etter. &o you kno- i it0s covered in the depo/ Ms. "ahan: don0t kno- eactly -hat you0re going to elicit, %ut -e can certainly igure it out ater the act. 4nd to the etent that it -ould %e a ne- opinion ro# &r. !ro-n, then -e reserve or rights on that, as -ell, %ecause they can0t just keep adding ne- opinions -ith eperts as -e go. Mr. Panish: no. 8ou0re saying -e0re relying on his article. 3e0re not going on his opinions. 3e0re not saying he0s relying on &r. !ro-n0s opinions? -e0re not trying to get any o that in in ront o the jury. Judge: okay. 3here0s our jury/ Mr. Kosko: no- -here -ere -e/ Judge: %asically you can go ahead and do -hat you0re going to do, 0# conditionally ad#itting it or no- on the condition that -e %ring in &r. !ro-n in so#e or#. !ut 0# going to allo- to you %rie it urther i you -ant to convince #e other-ise, and #ay%e it -ill just stand the -ay it is. Mr. Putna#: and the jury -ill understand it0s presently %eing conditionally ad#itted/ Judge: 0ll tell the#. don0t kno- i they0ll understand -hat it #eans. Mr. Putna#: think it0s i#portant that -hen a person is hearing it, they understand this is %eing conditionally ad#itted. Judge: all tell the# is Mr. Panish: -hat are you going to say/ That0s all -ant to kno-. Judge: can tell the# the opinions are %eing conditionally 4d#itted, and that0s it.
Mr. Mr. Putna#: Putn a#: perect, your honor. Mr. Panish: that0s ine. (the ollo-ing proceedings -ere held in open court, in the presence o the jurors:) Judge: okay. +et0s #ove or-ard. 0# conditionally ad#itting this -itnesses0 testi#ony, so
Mr. %anish@ $n this area $nl+. Jude@ +es! $n this in this area that 1e3re $in int$ riht n$1. n$1. . D$t$r! 1hen 1e r$*e! +$u 1ere a$ut t$ dra1 a hart. ($uld ($uld +$u n$1 please dra1 the hart and as 1e $ thr$uh it! e'plain 1hat eah $& the ite)s $n the hart is! please, A. 6han* +$u. S$ this is is sh$uld I Mr. Kosko: can you hear all right/ Judge: can that #ove -ith hi#/ The clerk: yes.
A. the )ir$ph$ne is n$t
A. than* +$u #er+ )uh. S$ I3) )a*in a hart in 1hih the le&t $lu)n represents the harateristis $& enuine sleep! and the $ther $ ther $lu)n is %r$p$&$l anesthesia. S$ as I )enti$ned earlier t$da+! enuine sleep is is ati#el+ enerated Judge: can stop every%ody or just one #inute/ it0s conditionally ad#itted, is there any reason -hy -e can0t use the chart/ #ean, no- that in other -ords, it -ill #ake it easier, easier, it -ill go aster. Mr. Kosko: yes. think that Judge: 0# sorry. 3e0re changing things up as -e go along. The chart that you prepared, -e0re going to actually use it. Mr. Kosko: -e0re going to sho- it on the screen. Judge: -e0re going to sho- it on the screen so you don0t have to -rite it out. Have a seat.
A. 6han* +$u. Mr. Kosko: so there -ill %e no challenge to your artistic a%ilities today.
A. I 1as #er+ $nerned a$ut that. . e#er+thin else! ut n$t +$ur artisti ailities. A. $*a+. S$ in preparin this hart! $n the le&t side! I ha#e listed the harateristis $& enuine sleep4 and $n the riht side! %r$p$&$l % r$p$&$l anesthesia. S$ +$u an see that enuine sleep is ati#el+ enerated + the rain! 1here as %r$p$&$l anesthesia is a dru5indued $)a. I )ean! the d$t$r tells +$u 1hen +$u3re $in int$ the $perati$n that the d$t$r is $in t$ e puttin +$u t$ sleep. 6hat3s eause the+ d$n3t 1ant t$ tell +$u that the+3re puttin +$u int$ a dru5indued $)a eause that s$unds a little sar+. sar+. /ut it is n$t sleep. S$ enuine sleep &ul&ills i$l$ial needs! 1hereas %r$p$&$l anesthesia d$es n$t &ul&ill th$se i$l$ial needs. Genuine sleep is a readil+ re#ersile reduti$n in sensati$n4 and readil+ re#ersile! I e'plained earlier! )eans that i& s$)e$ne i#es +$u! +$u *n$1 sha*es +$u t$ 1a*e +$u up! $r i#es i#es +$u s$)e sti)ulus! +$u +$u 1ill 1a*e up. %r$p$&$l anesthesia! +$u are pr$&$undl+ unresp$nsi#e. 6hat3s 1h+ the+ i#e it t$ +$u4 eause Other1ise! 1hen the sure$n sure$n is $peratin $n +$u! +$u 1$uld 1a*e up and +$u 1$uld &eel and +$u 1$uld e upset. upset. S$ +$u as l$n as the %r$p$&$l is is in +$ur s+ste)! it it is +$u 1ill n$t $)e $ut +$u 1ill n$t e ale t$ e ar$used $r it is n$t readil+ re#ersile. Genuine sleep is a readil+ re#ersile l$ss $& $nsi$us a1areness. In %r$p$&$l anesthesia! there3s n$ $nsi$usness at all! and +$u ann$t e a1a*ened until the %r$p$&$l is $ut $& +$ur +$u r s+ste). And that happens )eta$lizin the dru! there is n$ HDA.5appr$#ed H DA.5appr$#ed re#ersal aent &$r %r$p$&$l4 s$ i& the %r$p$&$l is in +$ur l$$dstrea) at a ertain le#el! +$u are n$t $in t$ e $nsi$us and +$u 1ill n$t e ale t$ e a1a*ened n$ )atter +$u *n$1! *n$1! e#en i& +$u an3t reathe! &$r e'a)ple. S$ i& +$u an3t reathe and +$u ha#e sleep apnea! e#er+ ti)e +$u an3t reathe! +$ur rain 1ill 1a*e +$u up s$ that +$u start t$ reathe. -$u -$u )a+ sn$re! 1hate#er! and that essentiall+ sa#es +$ur li&e.
. Is that in enuine sleep, A. 6hat3s in enuine sleep. . O*a+. A. 6hat 1$uld 1$uld n$t happen 1ith 1ith %r$p$&$l anesthesia eause and that3s and that3s $ne $& the hazards ass$iated 1ith %r$p$&$l! is that +$ur rain the n$r)al thin that 1$uld 1$uld 1a*e up +$ur rain! 1hether it3s pain $r a *ni&e $r n$t reathin! the+ d$n3t the+3re n$t &unti$nin. In eneral sleep! +$u an e easil+ a1a*ened4 as I said! +$u an3t e a1a*ened until it3s $ne. In enuine sleep +les et1een the t1$ #er+ di&&erent eha#i$ral states! BEM sleep! the $ne ass$iated
1ith #i#id drea)in! and n$n5BEM sleep in %r$p$&$l5indued anesthesia! there is n$ BEM sleep! and the n$n5BEM sleep is an$r)al. an$ r)al. . Can +$u sa+ that aain, A. 6here is n$ rapid e+e )$#e)ent sleep! n$ne! zer$. . In %r$p$&$l, A. Biht! %r$p$&$l! +$u d$n3t ha#e an+ BEM sleep. . And d$ +$u ha#e it in enuine sleep, A. -es. . O*a+. And then 1hat a$ut the $ther t+pe $& sleep, A. 6he n$n5BEM sleep sleep is the arhiteture is an$r)al4 s$ instead $& $in thr$uh th$se th$se +les that I sh$1ed +$u! it is ust +$u3re in $ne state the entire ti)e! and 1hate#er state +$u3re in depends $n e'atl+ the $nentrati$n $& %r$p$&$l in +$ur l$$dstrea)! n$t $n an+ ph+si$l$ial pr$ess. S$ that 1h$le arhiteture $& sleep 1hih is ritial &$r the the $ns$lidati$n $& )e)$r+ and ritial &$r satis&+in satis&+in +$ur $ther i$l$ial needs &$r sleep! that is n$t that is n$t happenin! and the and the interati$n $& +$ur )e)$ries )e)$ries 1ith +$ur $ther )e)$ries! )e)$ries! that3s n$t happenin eause +$u3re n$t in rapid e+e )$#e)ent sleep. And i& the %r$p$&$l le#els et hih en$uh in +$ur l$$dstrea)! +$u3re n$ l$ner e#en e'hiitin an+ sl$1 1a#es! ut +$u ust ha#e h a#e this relati#el+ &lat E.E.G. 6hat is si)ilar t$ that 1hih $urs in pr$&$und $)a $r e#en in rain rain death. It3s ust s$rt $& and that is s$)eti)es that le#el $& anesthesia is s$)eti)es indued i& i& i& pe$ple ha#e se#ere seizures $r s$)e $ther and +$u ust need t$ st$p all rain ati#it+. In enuine sleep! +$u3re sensiti#e t$ pain. I& s$)e$d + sti*s a *ni&e in +$ur le! +$u 1ill 1ill 1a*e up and +$u 1ill e sensiti#e sensiti#e t$ the pain. In In the 1h$le purp$se $& the anesthesia is that it indues 1hat is! in the )edial area! alled analesia! 1hih )eans +$u are n$t sensiti#e t$ pain! 1hih I 1r$te $n the hart as ein insensiti#e t$ pain. p ain. S$! in su))ar+! %r$p$&$l anesthesia dissipates sleep dri#e! and that3s 1hat has )ade it $& suh reat interest in the &ield $& sleep )ediine.
. 6hat3s a ne1 th$uht &$r us4 s$ ust tell us 1hat it )eans! it dissipates the sleep dri#e. A. S$ n$r)all+ i& +$u3re +$u3re n$t sleepin! i& +$u3re n$t ettin an+ enuine sleep let3s sa+ +$u didn3t sleep last niht. 6hen +$u 1$uld sleep )uh )$re deepl+ t$da+! and +$u 1$uld sleep &$r a l$ner ti)e. S$ and that3s als$ true $& the indi#idual sleep staes. S$ i& +$u didn3t et BEM sleep +esterda+ eause s$)e$ne 1$*e +$u up e#er+ ti)e +$u 1ere $in int$ BEM sleep! then +$u 1$uld ha#e 1hat 1ha t 1e all a BEM re$und. -$u -$u 1$uld suddenl+ ha#e )uh )$re BEM sleep. -$u -$u
)iht &all diretl+ int$ BEM sleep! 1hih $rdinaril+ d$esn3t happen. suall+ +$u $ thr$uh the staes. S$ the BEM pressure uilds up! the sleep pressure uilds up 1hen 1e ha#en3t $tten en$uh sleep. . D$se that ause the desire t$ $ t$ sleep,
A. -es. . -$u d$n3t et a $$d niht3s sleep! +$u3re tired! +$u still 1ant t$ $ t$ sleep, A. Biht. I& +$u 1ere up all niht preparin &$r an e'a)inati$n $r s$)ethin . Aptl+ h$sen. A. then +$ur sleep pressure 1$uld e hiher and +$u 1$uld sleep )$re $n the &$ll$1in niht. S$ ir$niall+! ir$niall+! %r$p$&$l this 1as the &indin that I )enti$ned. A$ut nine +ears a$! it 1as dis$#ered that %r$p$&$l anesthesia! 1hen it3s s$ the+ an sleep depri#e ani)als4 ani)als4 and i& +$u sleep depri#e an ani)al! and then +$u i#e the) %r$p$&$l anesthesia! the+ d$n3t ha#e a re$und! s$ it3s s$)eti)es alled A. S$)n$l+ti aent! )eans it l+ses $r destr$+s the dri#e &$r sleep . S$ 1hat happens i& the the pers$n &irst $& all! h$1 d$es a pers$n &eel 1hen the+ the+ 1a*e up &r$) %r$p$&$l anesthesia &r$) the p$int $& #ie1 $& a sleep e'pert, A. S$ &r$) the p$int $& #ie1 $& sleep! the+ 1a*e up &eelin re&reshed eause it has dissipated their sleep need e'use )e it has dissipated dissipated their sleep sleep dri#e 1ith$ut &ul&illin their their sleep need. . D$ the+ thin* the+3#e had a $$d niht3s sleep, A. 6he+ thin* the+3#e had a $$d niht3s sleep! +es. . "a#e the+, A. N$. . "a#e the+ had an+ sleep at all, A. 6he+ ha#en3t had an+ sleep at all. . S$ it dissipates the sleep! ut +et the+ d$n3t ha#e an ure t$ sleep, A. N$. S$ that3s the that3s the that is the *e+ di&&erene di&&erene et1een %r$p$&$l anesthesia anesthesia and sleep!
is that +$u3re dissipatin the sleep dri#e. S$ enuine enu ine sleep dissipates the sleep dri#e! %r$p$&$l anesthesia dissipates the sleep dri#e. Genuine sleep &ul&ills the i$l$ial need &$r sleep! %r$p$&$l d$es n$t &ul&ill the i$l$ial need &$r sleep. S$ it is it 1$uld e li*e eatin s$)e s$rt $& ellul$se pellets instead $& dinner! and +$ur st$)ah )iht e &ull! +$u 1$uld n$ l$ner e "unr+! "unr+! ut +$u 1$uld ha#e ha# e had zer$ al$ries and it 1$uld n$t &ul&ill an+ $& nutriti$nal needs.
. 6han* +$u. 6hat3s #er+ help&ul. N$1! earlier 1e tal*ed a$ut s$)e $& the )ediati$ns that are used t$ treat ins$)nia. And an +$u tell )e! d$t$r! 1hether there are an+ I #. intra#en$us )ediati$ns that are appr$#ed &$r the treat)ent $& ins$)nia, A. 6here are n$t. . N$1! ha#e +$u re#ie1ed! as a part $& this! +$ur preparati$n p reparati$n &$r this ase! the )edial re$rds $nernin Mihael Ja*s$n, A. -es! I ha#e. . And I3) $in t$ partiularl+ all +$ur attenti$n t$ the last three )$nths $& his li&e. O*a+, And d$ +$u *n$1 i& durin that peri$d $& ti)e! he had een reei#in De)er$l, A. -es! he had. . O*a+. And 1hat a&&et d$es De)er$l ha#e $n sleep! i& an+, A. De)er$l is an $pi$id! and it inreases sleep pr$pensit+. pr$pensit+. It is n$t the sa)e as an anestheti4 s$ alth$uh it has e&&ets $n sleep and sleep staes! and dereases the a)$unt $& BEM sleep! &$r e'a)ple ut it ut the e&&et e&&et that it has is n$t s$ pr$&$und that! &$r e'a)ple! +$u an3t e a1a*ened &r$) the sleep! sleep! that that +$u d$n3t &ul&ill an+ $& the sleep need! and s$ $n. S$ 1hen e#en 1hen +$u are 1hen +$u ha#e had De)er$l! the sleep that +$u3re ettin is still ati#el+ ein enerated + the rain! it is n$t ein the sl$1 1a#es are n$t a dru5indued $)a. . And 1hat a$ut A. Ma+ I sa+ $ne )$re thin, . Sure. A. "$1e#er! i& +$u are reei#in De)er$l durin the da+ti)e da +ti)e and sleepin &$r a nu)er $& h$urs h$u rs a&ter +$u3#e reei#ed the De)er$l ineti$n! ineti$n! &r$) the sedati#e s$ De)er$l is a sedati#e! n$t anestheti! and it3s used usuall+ in $nneti$n $nne ti$n 1ith a pr$edure $& s$)e s$rt &$r treat)ent $& pain. 6hen it is $in t$ dissipate s$)e $& +$ur i$l$ial dri#e dri#e &$r sleep4 and i& +$u 1ere spendin se#en h$urs asleep a&ter a De)er$l De )er$l ineti$n durin the da+ti)e! it3s $in t$ e )$re di&&iult then &$r +$u t$ sleep at niht.
. And 1hat a$ut 1hat e&&et! i& an+! an+! d$es a pers$n 1ithdra1in &r$) De)er$l ha#e $n sleep $r ins$)nia, A. 6hat 1ill as I )enti$ned earlier! in in the se$ndar+ t+pes $& ins$)nias! there3s a 1h$le lass $& ins$)nias ass$iated 1ith dru use! De)er$l ein $ne $& th$se drus that $th inter&eres 1ith sleep 1hen +$u3re ta*in it! 1ith n$r)al n$ r)al sleep! as 1ell as ausin ins$)nia 1hen +$u st$p ta*in it. . S$ that that an that inrease ins$)nia, ins$)nia, A. -es. . And 1hat e&&et! i& an+! d$es the 1ithdra1al $& %r$p$&$l ha#e $n &unti$nin, A. On 1hat,
Ms. "ahan: o%jection? vague as to B-ithdra-al.B Judge: sustained. Mr. Kosko: 0ll -ithdra- the Auestion. kay.
. (hat a$ut i& a pers$n 1h$ has een i#en %r$p$&$l $n a repeated asis 1hat e&&et! i& an+! an+! 1$uld $ur &r$) the st$ppin the i#in $& %r$p$&$l! essati$n $& i#in $& %r$p$&$l, Ms. "ahan: o%jection, your honor. don0t think there0s any oundation. t0s a ne- area. Judge: sustained. Mr. Mr. Kosko: it relates to -hether or not the Propool and sleep it -ould aect Propool and sleep, -hich is part o his proposed opinion. 0ll go a%out it a dierent -ay. &octor, do you, %ased on your revie- o the records in this case do you have an understanding as to ho- #any nights in a ro- Michael Jackson received Propool prior to his death/
Ms. "ahan: o%jection? hearsay. Judge: %ased on so#ething he read/ Mr. Kosko: %ased on -hat he0s read, %ut the kind o inor#ation that an epert -ould nor#ally rely upon in rendering an opinion.
Ms. "ahan: your honor, this is the issue that -e discussed at the side%ar %eore. Just %ecause it0s so#ething that an epert -ould rely upon doesn0t #ean that the doctor can testiy to the speciics o -hat0s in that. they -ant to stipulate to it %eing ad#itted into evidence, -e0d %e happy to do that. Judge: -hy don0t you #ake it a hypothetical/ Mr. Kosko: okay.
. I 1ant +$u t$ assu)e! d$t$r! that Mihael Ja*s$n reei#ed %r$p$&$l &$r 0 $nseuti#e nihts in anesthesia pri$r t$ June 22nd! 200. Can +$u )a*e that assu)pti$n, A. -es. . And assu)e that it 1as ad)inistered + a ?05)illira) $lus! the usual ineti$n! &$ll$1ed + an intra#en$us drip &$r the re)ainder $& his h is sleep peri$d. Ms. "ahan: o%jection? inco#plete hypothetical. Mr. Panish: he hasn0t inished. Judge: let hi# do his hypothetical. see there #ay %e a pro%le# -ith this so#e-here, %ut #ay%e that0s not or no-. Mr. Kosko: have a very long hypothetical, too. Judge: all right. 3e0re listening to all your assu#ed acts. Ms. "ahan: #ay have a running o%jection to the hypothetical/ Mr. Panish: he hasn0t even inished the Auestion. Judge: yes. "ontinue.
. I 1ant +$u t$ assu)e assu)e that a para)edi na)ed Bihard
A. Ma+ I as* &$r a lari&iati$n, (hen +$u sa+ 7June 29rd!7 1$uld this ha#e een the niht $& the 22nd int$ the 29rd, . It 1$uld e durin the the da+ niht int$ the da+! da+! +es, A. O*a+. 6han* +$u. S$ )idaz$la) and . Midaz$la) and L$razepa) $nl+. 6hat Mihael see)ed t$ ha#e resp$nded )$re ph+si$l$iall+ t$ that4 he 1as n$t r$+ 1hen he 1$*e up4 and i& he $t up in the )iddle $& the niht! he 1$*e up #er+
$r there are $in t$ e $nse
Assu)e that Ali& San*e+ testi&ied she elie#ed that Mr. Ja*s$n 1as sl$1 at raspin h$ld $& the 1$r*! and she 1as $nerned. Assu)e that Kai Chase! the &a)il+ he& 1h$ 1$r*ed in April and June! testi&ied that at a )eetin in June et1een MJ.! Mr. %hillips and Mr. G$na1are! Dr. Murra+ and Dr. Dile$ at MJ3s h$use4 that Mihael 1as #er+ $#ered up! h e had a surial )as* $n in the h$use and la+ers $& l$thin! s1eat pants! sh$rts $#er the s1eat pants! pan ts! a t5shirt! and a s1eatshirt $#er that! and that he l$$*ed sared and &rihtened. Assu)e that at $ne p$int! his s$n had t$ help hi) upstairs4 that $n the niht $& June 8th! Ms. San*e+ and Mr. Ortea 1ere r+in t$ether eause Kenn+ sent Mihael h$)e h$ )e a&ter the $stu)e &ittin! Kenn+ t$ld her that 1hen he 1as )assain Mihael3s &eet! Mihael 1as tal*in a$ut 1as tal*in a$ut $d spea*in t$ hi)! he didn3t understand 1h+ $d $ d 1as spea*in t$ hi). Assu)e that Kenn+ and San*e+ 1ere $th r+in eause Mihael 1as n$t spea*in n$r)all+. n$r)all+. Assu)e Assu)e there3s an e5)ail! e'hiit 8! &r$) /uzee that sa+s 7%aul and %aul! rand+! rand+! I3) n$t ein a dra)a
Assu)e e'hiit 928 is an e5)ail &r$) /uzee "$udahl t$ %hillips. 7)+ la+)en3s deree tells )e he needs a shrin* t$ et hi) )entall+ prepared t$ et $nstae and a trainer t$ et hi) int$ ph+sial shape.7 and assu)e /uzee then sa+s 7I ha#e 1athed hi) deteri$rate in &r$nt $& )+ e+es $#er the last eiht 1ee*s. "e 1as ale t$ d$ )ultiple 90 spins a* in April. April. "e3d &all $n his ass i& he tried it n$1.7 assu)e e'hiit 2 is an e )ail &r$) Ortea t$ %hillips! a 7tr$ule at the &r$nt7 e5)ail! in 1hih Ortea sa+s 7)+ $nern 7 A. I3) s$rr+. Hr$) 1h$) t$ 1h$), . I3) s$rr+! sir, A. 6he last $ne 1as &r$) 1h$) t$ 1h$), Mr. Kosko: this is ro# Kenny rtega to Mr. Phillips, and it0s dated June CDth. Mr. Putna#: do -e need to -ait until the end to o%ject that this is an i#proper hypothetical, your honor/ Judge: keep going.
Mr. Mr. K$s*$&&@ this e5)ail sa+s 7I 1ill d$ 1hate#er I an t$ help 1ith the situati$n. I& +$u need )e t$ $)e t$ the h$use! ust i#e )e a all in the )$rnin. M+ $nern is that n$1 that 1e3#e r$uht the d$t$r int$ the &$ld and ha#e pla+ed the t$uh l$#e n$15$r5ne#er ard is that the artist )a+ e unale t$ rise t$ the $asi$n due t$ real e)$ti$nal stu&&. "e appeared
and &atiued this e#enin! he had a terrile ase $& the hills! h ills! 1as tre)lin! ra)lin! and $sessin. E#er+thin in )e sa+s he sh$uld e ps+h$l$iall+ e#aluated.7 and he sa+s 7I 1as t$ld + $ur h$re$rapher that durin the artist $stu)e &ittin 1ith his desiner t$niht! the+ n$tied he3d l$st )$re 1eiht.7
Assu)e e'hiit 2 is an e5)ail $n the 20th &r$) Ortea t$ %hillips. It3s at 8@20 p.). "e sa+s 7I3) h$)e a1aitin +$ur all and instruti$ns. I h$nestl+ d$n3t d $n3t thin* he is read+ &$r this ased $n the $ntinued ph+sial 1ea*enin and deepenin e)$ti$nal state. 6here are str$n sins $& paran$ia! an'iet+ and $sessi#e5li*e eha#i$r. It3s li*e there are t1$ pe$ple there4 $ne deep inside tr+in t$ h$ld $n t$ 1hat he 1as and still an e! and n$t 1antin us t$
Ms. "ahan: o%jection, your honor. t0s going to take #e a little -hile to go through all the o%jections. t0s a long Auestion. t0s an i#proper hypothetical Mr. Kosko: can -e do this in the a%sence o the jury/ Mr. Putna#: not -ith a Auestion posed. Ms. "ahan: i#proper hypothetical, inco#plete hypothetical, outside the scope o this -itness0s epertise, #isstates evidence, #isstates testi#ony, assu#es acts not in evidence, counsel -as testiying, it -as leading, an i#proper conclusion %y counsel, and -e -ould #ove to strike, your honor. Judge: -ell, assu#es acts not in evidence, so#e, perhaps, so think -e0re going to have to ecuse the jury or the night so -e can discuss this. +et #e ind out -hen you co#e %ack. 9:
(the ollo-ing proceedings -ere heard in open court, outside the presence o the jury:) Mr. Putna#: Ms. aye has %een pro#ised to us yet again or to#orro-. t -as discussed, i you recall, t-ice over the last t-o days the idea that i -e didn0t inish -ith hi#, aye -ould still go to#orro-. t has no- %een si -eeks since she -as last here. #oved everything the 3ednesday 3ednesday to the riday or the hal day %ecause they said aye -ould %e a%le to go.
Ms. "ahan: your honor, given the a#ount o %rieing that -e0ve already agreed to and -hat epect #ay %e #ore, -e pro%a%ly could use the couple days to -ork through these re#aining issues %eore the testi#ony is co#pleted. Judge: are you talking a%out this -itness/ Ms. "ahan: this -itness. Judge: okay. $o %asically, in a rounda%out -ay, you -ant to interrupt this -itness0s testi#ony to take on aye. kay. 3hat0s the deal -ith aye/ Mr. Kosko: -ell, they -ant to interrupt t-o -itnesses rather than one, -hich already has %een interrupted, and they -ant to interrupt this -itness -ho has co#e here ro# !oston to take a -itness ro# "aliornia. 4nd it see#s to #e that just ro# a kind o a airness point o vie-, it -ould %e %etter to inish this -itness and allo- hi# to go %ack ho#e rather than have hi# have to co#e cross country t-ice.
Mr. Panish: -hat date is this/ s it a ull day on the C@th/ Mr. !oyle: it is, %ecause that0s the day -e -ere going to try to get &r. inkelstein, %ut he0s out o that0s perect. Mr. Panish: understand Mr. Putna#0s issue. hate to say this, %ut sy#pathi'e -ith -hat he0s saying, %ecause it0s %een a -hile or Ms. aye. also let0s just assu#e hypothetically that Ms. aye this -itness and haven0t even discussed it -ith the#, so don0t #ay%e you should go outside. don0t -ant you to hear -hat 0# going to say. Judge: -ell, co#e %ack at 9:
A. +es. Judge: thank you. (the -itness and Mr. Panish coner sotto voce.) (the -itness let the courtroo#.) Mr. Panish: he said it0s going to %e diicult or hi# to co#e %ack. $o let0s assu#e, hypothetically, -e try to like %eg hi# to stay until Monday. Monday is a hal day. kay/ $o understand -hat Mr. Putna# is saying. kay/ 0# not disregarding that. understand that Ms. "ahan -ould have several hours, assu#e, o cross2ea#ination. Judge: okay. Mr. Panish: 0# not in any -ay trying to #ini#i'e her. assu#e Mr. Kosko is getting to-ards the end. Mr. Kosko: very close. Mr. Panish: -ould have Ms. aye here -aiting the #inute this -itness is done to take the stand, %ecause kno- Mr. Putna# #ade arrange#ents to do this, and appreciate it, and thanked hi# or that. !ut she you kno-, 0ll try to get her to co#e i he 7 kno- he pro%a%ly -ouldn0t inish in a hal a day. 8ou kno-, #ay%e you could order her to co#e on Monday. Mr. Putna#: Monday is a hal day.
Mr. Panish: right. !ut i you go on riday and Monday, #ay%e she -ould %e done. not, she can co#e on the net riday. understand 0# certainly sy#pathetic to Mr. Mr. Putna#0s position. Judge: the pro%le# is i -e go -ith your suggestion, then they have to disrupt their entire -itness presentation. Mr. Panish: -hy is that/ Judge: they just eplained to #e that they have other -itnesses that they have lined up. Mr. Panish: the#/ 3e0re still in our case. t0s our case. Judge: -eren0t you calling other -itnesses/ Mr. Putna#: it0s cross o aye. Judge: all right. Mr. Mr. Panish: 0# not trying i they had a -itness that they told us, that0s no. This is just ayeFs cross. !ut sy#pathi'e -ith Mr. Putna#. t0s %een a -hile, there0s no Auestion? and that0s -hy -as intending on this no-, -asn0t intending on an hour side%ar issue. Judge: so -hat is the necessity o Ms. aye right no-/ that0s the just %ecause they said they could. #ean 7 thought it -as so#e -itness arrange#ent issue. Mr. Putna#: not at all, your honor. They0ve told us three ti#es %eore. Judge: okay. $o they0ve told you three or our ti#es. Mr. Putna#: i they -ant to #ove it again, -e0ll #ove it again. Judge: -hat is the necessity o doing it no-/ Mr. Mr. Putna#: Putn a#: none. Judge: okay. Mr. Panish: thank you. Judge: so -hy is this an issue/ Mr. !oyle: it0s not.
Mr. Mr. Panish: thought Mr. Mr. Putna# -as #aking it an issue. 0# sorry. May%e apologi'e or sy#pathi'ing too #uch. -as trying to -as trying to -ork -ith Mr. Mr. Putna# so#eho-. Judge: thought it -as %ecause o so#e -itness Mr. Panish: 0ve told hi# one ti#e -e had Phillips -hen Ms. aye -as supposed to co#e, and -e agreed -e -ould inish her. 4nother ti#e, another -itness. $o, #ean, it0s not like -e0ve intentionally said she0s co#ing and she can0t co#e, you kno-. $o she0ll co#e net riday. +et0s don0t let any -itness go past =:DD o0clock on Thursday and, you kno-, Ms. aye %ut 0# saying i this -itness gets done early, she 7 %ecause she %locked out the day, day, she could co#e and they could get a e- hours in, unless they -ant to -ait until a ull day. 0# not trying to stall it at all. #ean, %elieve #e, -ant to get it done #ysel. -ould like to inish this -itness irst. Ms. $te%%ins: rather than have Ms. aye co#e %ack t-ice, think, given ho- long it0s taken today -ith Ms. "ahan0s cross ea#ination and the likely redirect, and the act that to#orro- aternoon is only C:D to =:DD, it0s pro%a%ly %etter to just %ring Ms. aye in net -eek. Ho-ever, -ould ask that plaintis not call an out2o2to-n epert on Thursday that can0t %e inished in a day net -eek. Mr. Panish: that sounds like a reasona%le reAuest. Ms. $te%%ins: just so -e can %e sure to have her all day.
Mr. Mr. Panish: is it really only C:D to =:DD to#orro-/ Ms. $te%%ins #entioned and knothe court so#eti#es does #otions on riday. s that happening to#orro-/ The clerk: there0s no #otions to#orro-. Mr. Panish: good. hate to %ring this up, %ut -ould ask i could leave ten #inutes early, approi#ately, %eore noon, %ecause 0ve %een ordered to appear in judge "'uleger0s depart#ent to#orro-. 4nd tried to schedule it later, and couldn0t, and they told #e have to %e there. 4nd it0s an i#portant #atter on a trial, so i could just leave at ten #inutes to noon. #ean, tried to tell hi#, and he -as not any-ay, that0s -hat they told #e have to do. tried to get it %eore court at @:D, and counsel ro# out o the state couldn0t %e there then. Judge: oh, you have an out2o2state counsel in that Mr. Panish: they0re on the other side.
Judge: yes, on the "'uleger case/ Mr. Panish: yeah. That0s -hy he #ade it later, so they could %e here. They0re ro# three states. asked to do it at @:D %ecause kno- -e -ould start later. t0s only ten #inutes, and apologi'e. Judge: so you -ant to leave at ten to
Mr. Panish: let0s talk a%out that. Judge: suppose does it #ean the -hole opinion goes out, or is it just a -eak opinion %ecause so#e o the acts haven0t %een proven/ Mr. Panish: irst o all, under the "aci, the jury is instructed on hypothetical Auestions, and they0re to, you kno-, ea#ine each act. !ut %ack to -hat Ms. "ahan has %een saying in ront o the jury. "ertain o these acts are in the police state#ent. kay/ Judge: -hich is not in evidence, %ut yes. Mr. Mr. Panish: no. Ho-ever and kno- you #ade one ruling already regarding a speciic state#ent that the deendants tried to use. Judge: right. Mr. Panish: okay. !ut other parts o the state#ent, i there are eceptions to the hearsay rule, they could %e ad#issi%le and relied upon %y an epert. $o, you kno-, it just doesn0t say one or t-o sentences, then everything is in. That0s not the ruling. $o the Auestion is, are there any state#ents contained -ithin &r. Murray0s police intervie- that -ould %e eceptions to the hearsay rule/ !ecause the o%jection %y is that -hatever &r. &r. Murray said out o court -ould %e hearsay. $o the issue then %eco#es are there any state#ents contained -ithin that that #eet the relevancy reAuire#ent irst, and that are eceptions to the hearsay rule/ 4nd %elieve that there are several state#ents %y &r. Murray that #eet recogni'a%le eceptions to the hearsay rule. 4nd Mr. Putna# has #arked, %elieve, the transcript and the tape. 0# not sure a%out the tape. &id you #ark the tape, also/ Mr. Putna#: did. Mr. Panish: o &r. Murray0s intervie-. $o there0s one layer o hearsay that has to %e Judge: -ho is going to testiy/ &id the police oicer/ Mr. Panish: yes, he did. He identiied and authenticated that the transcript truly and accurately depicts the state#ent. $o there0s one layer o hearsay that has to %e addressed or anything additional o &r. Murray. 4nd %elieve at least t-o o those state#ents that -ere #ade are recogni'a%le eceptions to the hearsay rule. Judge: -hat are the state#ents/ Mr. Mr. Kosko: the only ones the only assu#ption that are assu#ptions not %ased in evidence right no- are, in act, eceptions to the hearsay rule.
Judge: and those state#ents that are eceptions, that you -ant to pull out -hat are they/ Mr. Mr. Kosko: they0re the ones that think you pro%a%ly you picked up on it right a-ay. t0s the putting hi# on or ;D days, and -eaning hi# on the last several days ro# that. Ms. "ahan: your honor, -e tried to elicit that ro# detective Martine' and you disallo-ed it %ecause detective Martine' said he didn0t %elieve that -as credi%le. Judge: don0t think that0s the reason disallo-ed it. think just disallo-ed it altogether as hearsay. 3hat0s the eception/ Mr. Kosko: the eception is Mr. Panish: declaration against interest %y &r. Murray. Mr. Kosko: against penal interest. t -as a cri#e, and it turned out he -as convicted o the cri#e. Mr. Panish: so i you #ake an ad#ission out o court to so#ething that0s against your penal interest, that is an eception to the hearsay rule. Judge: -eaning Michael Jackson o the Propool/ Mr. Kosko: ad#inistering it ;D days straight in a ho#e setting. Judge: 0# not %uying it. Mr. !oyle: that -as the lead evidence in the cri#inal trial that convicted hi#. Judge: that doesn0t #atter. Mr. Putna#: in addition, your honor, that0s not the only %it o evidence Judge: that ca#e in through Mr. Putna#: that0s not the only hypothetical that0s not %eore the court. There -as several ehi%its he cited to. ne in particular he cited to as i it -as ad#itted, it -asn0t. Mr. Panish: -hich one/ Mr. Putna#: he indicated that those three 7 the three %eginnings o the hypothetical -ere the only things in the hypothetical that -eren0t %eore the court. Judge: that0s -hat ocused on.
Mr. Mr. Putna#: that0s -hat ocused on initially. There -ere several -e -ent to see think it0s @;<. n addition, your honor, as you kno-, or a nu#%er o these ite#s, a nu#%er o these ite#s, the reason it0s an inco#plete hypothetical Mr. Panish: actually Mr. Putna#: can inish or once/ Judge: 0# listening. 0# sorry. s that chatter distracting. Please keep it do-n. Mr. Mr. Putna#: your honor, honor, or a nu#%er o these, as you kno- 0ll give you one perect ea#ple. There -as instances -here he talks a%out the idea that Karen aye had testiied to so#ething that actually Karen aye had not testiied to %ut, rather, Kai "hase had testiied to. or ea#ple, the idea o -ho ca#e in 4pril, -ho ca#e in June. Mr. Panish: -e agree -ith that. He #ade a #istake on that. Mr. Putna#: in addition, the other things -hich occurred in that -hich #akes it inco#plete is the idea that -hile Kai "hase said he -as carried upstairs, -e then sho-ed that the person -ho supposedly carried Mr. Jackson upstairs said he never did that. Judge: that0s just a credi%ility #ean, the jury can decide -hether or not they %elieve that. That doesn0t #ake it inco#plete. Ms. "ahan: or ea#ple, Mr. $ene0s testi#ony, they reerred to the act that he said he thought he -as a hospice patient? %ut on cross, elicited ro# hi# that that -as ro# the totality o the circu#stances, the .>. Pole, the oygen tanks, the Judge: that0s okay. Mr. Panish: ehi%it @;< is in evidence as another ehi%it. t0s an e2#ail that is in evidence. Judge: the only things 0ve heard so ar that0s a pro%le# is -hat0s taken ro# &r. Murray0s testi#ony. That0s a pro%le#. ther than that, don0t think there #ay %e conlicting evidence concerning the jury can decide -hether or not they -ant to %elieve one version or the other. Ms. "ahan: the ulti#ate Auestion that -as asked, your honor, honor, %elieve and don0t have it 7 didn0t get get a chance chance to jot it do-n, do-n, %ut it -as -as a%out -hether -hether,, %ased on his his #edical #edical epertise, he %elieved there -as a reasona%le pro%a%ility that the Propool interered -ith Mr. Jackson0s sleep and a%ility to Ms. $te%%ins: caused the sy#pto#s, think.
Ms. "ahan: caused the sy#pto#s that -ere seen. 4nd don0t think he has the oundation to rule out the causes or those non2speciic sy#pto#s. 3e have other people -ho said they thought that -as a drug2related issue. t0s not 0# concerned a%out the oundation or the ulti#ate opinion, also that he0s %eing asked to give %ecause it0s not so#ething he testiied to at his deposition. Judge: let0s ind out -hat it is. 3hy don0t you proer -hat is his ans-er going to %e to that Auestion/ Mr. Kosko: he0s going to say all o these things -ere caused %ecause o MichaelFs deterioration over the si -eeks the t-o #onths, his co#plete deterioration -as caused %y the ad#inistration o Propool, and the cessation o the Propool is -hat -ill account or the act that in the last t-o days, he -as doing %etter. %etter. This is it0s a perect #atch, and he -ill say it0s a perect #atch, and there is 7 you kno-, and -hat they say is right. They have an epert, a drug addiction epert, -ho they can ask a%out this, and they can %ring in a dierent opinion, %ut -hen it co#es to sleep, think he0s Aualiied to give that opinion. Ms. "ahan: that0s a%solutely not an opinion he oered at his deposition, it -asn0t one o his nine opinions, and it0s not appropriate or hi# to %e oering this ne- su##ary opinion su##ing up all the evidence in the case that they think supports the point no- or the irst ti#e in trial. Judge: think the hypothetical is okay ecept or those acts, %ut those are crucial acts. Mr. Putna#: they are the crucial acts, your honor. They say that everything ste#s ro# ater-ards, %ecause they say he had that or ;D days and hadn0t slept? and thereore, -hen they started to -ithdra-, the ollo-ing occurred. The very thing that -e sat in cha#%ers and talked a%out, that -e talked a%out #ore than once in cha#%ers, a%out their ina%ility to use this as the %asis or an opinion, they nonetheless have used or the %asis o their hypothetical. Ms. "ahan: your honor, it #eans that their epert -itness and plaintis are vouching or everything that "onrad Murray told the police %ecause there0s no evidence in the record -hatsoever that he ever had Propool in his syste# ecept or the day that he died. Mr. Kosko: -e0re not vouching or everything "onrad Murray said, %ut he did say in his deposition that part o his %asis or his opinion -as that Murray gave hi# Propool or ;D nights. t0s on page Mr. !oyle: page =I, line Judge: let #e ask you this. the other acts are all proven
Mr. Panish: they0re transcripts. Judge: then perhaps it0s really the deense0s guess your counter attack or your i#peach#ent o the opinion is that these acts haven0t %een proven, and they have no -ay o proving it up. n other -ords, guess -hat 0# asking is does it #ake it a deective do have to thro- out the entire opinion, or is it you can co#e %ack and say, Bladies and gentle#en, there0s %een no you should disregard his opinion %ecause he hasn0t proved these three crucial acts, so disregard it.B there0s a dierence in thro-ing it out altogether versus allo-ing you to argue that it should %e thro-n out %ecause the acts underlying the opinion haven0t %een proven. Ms. "ahan: your honor, they have to have a good2aith %asis that i it0s not in evidence, so#ething this speciic, i it0s not in evidence, it0s going to co#e into evidence, and they0re ighting it co#ing into evidence, as said repeatedly. Judge: -ell, it0s not going to co#e into evidence. *one o MurrayFs state#ents have co#e in, and don0t see any eception. Ms. "ahan: so the oundation or this entire hypothetical alls co#pletely apart, and it0s o no value -hatsoever, and it0s going to conuse the jury i he0s allo-ed to oer it as a theoretical thing -ith all these details and pieces o e2#ails that they0ve heard and testi#ony they0ve heard. t0s going to %e hugely prejudicial, and it0s o no evidentiary -eight -hatsoever, so under EC, it0s co#pletely inappropriate. Mr. Putna#: there0s a reason you have an epert like this, your honor. 3e sat here and heard his credentials this #orning. They0re incredi%le, the -hole Harvard thing, *5$4 "4. could go through the list. Mr. Kosko: it0s *5$4, not *4$4. Mr. Putna#: 0# sorry i you don0t like #y accent. kay/ Mr. Panish: -e love your accent. Mr. Putna#: as you go throughout, your honor, all o that is incredi%ly i#pressive and it0s -hy it0s so prejudicial -hen you have an epert -ho opines on so#ething that has a%solutely no oundation. t0s not enough or us to get up and say those three parts, they didn0t prove that, did they/ t #akes it so prejudicial, your honor. think the only re#otely curative ele#ent that -e can do at this #o#ent is strike it and not allo- it. Judge: -ell, the instruction does say the opinion is only as good as the acts that are relied on, and it0s up to you to deter#ine -hat acts have %een proven. !ut they0re so#e o the #ost crucial acts in his opinion.
Ms. "ahan: your honor, honor, there0s no good2aith %asis it0s one thing i he -ere -ere oering, or ea#ple, all the stu he did -ith Propool, it0s conditional on &r. !ro-n co#ing and shoring it up. That0s one thing. !ut there0s no good2aith %asis. 4nd you0ve told us
Ms. "ahan has said that she -ill stipulate that the -hole police state#ent can co#e into evidence. $he said that in ront o the jury, she said that 7 Judge: you o%jected to that portion o the state#ent, and sustained it. Mr. Panish: did, to that one portion. Judge: it0s the sa#e grounds to eclude the -hole thing. t0s not as though a portion o it can co#e in and the other portion Mr. Panish: don0t necessarily agree -ith that. There -as a speciic reason on that portion, not just hearsay, there -as another reason that you gave or it %eing inad#issi%le -hen you did. 8ou took the %rieing and you #ade your ruling on that. 4nd just %ecause one speciic state#ent #ay not %e ad#issi%le doesn0t #ean the rest o it #ay %e ad#issi%le. think she0s saying
Judge: i you -ant to agree the -hole thing can co#e in, perhaps this opinion can stand? %ut don0t see it i you -ant to retract retract that and MurrayFs state#ent can co#e in a%out he -as the personal doctor or Michael Jackson, and that0s -ho he understood -as his e#ployer i you0re -illing to allo- that into evidence, then -e can let the rest rest o this in. !ut think to parse it out that -ay is unair. Mr. Panish: understand -hat you0re saying in the police state#ent. 3e0ll go %ack tonight and -e0ll, you kno-, assess the situation and igure out ho- -e -ant to ask the Auestions. Judge: okay. 0ll take argu#ent in the #orning i you -ant to co#e %ack. Ms. "ahan: thank you, your honor. Mr. Mr. Putna#: Putn a#: thank you, your honor. honor.
(proceedings adjourned to riday)
