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March 24, 2005

Dr. William Cheshire not nominated for Nobel Prize, either

Left2Right bags its first scalp! (link fixed)

Last night David Velleman unleashed the power of Google to learn the AWFUL truth about Dr. William Cheshire, the Mayo Clinic neurologist and bioethicist who claims that Terri Schiavo is minimally conscious.

Maybe it was more of a Brazilian bikini waxing than an actual scalping. Non-lethal, non-racist, but long overdue. In any case, The Times' latest Cheshire story is noticeably smoother than yesterday's attempt.

So, what is so horrifying about Dr. Cheshire? It's not so much that he performs diagnostic seances:

"Although Terri did not demonstrate during our 90-minute visit compelling evidence of verbalization, conscious awareness or volitional behavior," he wrote, "yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her." [NYT]

Nor that he's the best-kept secret of bioethics and neuroscience:

Mr. Bush called Dr. Cheshire a "renowned neurologist," but he is not widely known in the neurology or bioethics fields. Asked about him, Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, replied, "Who?"
Dr. Ronald Cranford, a neurologist and medical ethicist at the University of Minnesota Medical School who has examined Ms. Schiavo on behalf of the Florida courts and declared her to be irredeemably brain-damaged, said, "I have no idea who this Cheshire is," and added: "He has to be bogus, a pro-life fanatic. You'll not find any credible neurologist or neurosurgeon to get involved at this point and say she's not vegetative."

No, the really scary thing about Dr. William Cheshire is something the MSM still won't talk about...

The awful truth is that for all his preoccupation with human brains, human embryos, and the gushing human blood of Christ, William P. Cheshire is not himself human. His ruse might have continued indefinitely if David Velleman hadn't discovered: Exit Ramp, a poem so execrable it could only have been written by a Vogon.

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Comments

"The long disorienting climb
To suicide’s elusive crest
Has ended at no peak sublime,
But in the depths of wickedness.

No shadows tip topography
On slopes of medical demise,
But rather flawed theology
Leads to unsavory compromise."

Eee-ow, I may have to revise what I just wrote about Paul Reiser...

So that's where Vince the Troll is getting it from!

In fact, I would suspect Paula Nancy Millstone Jennings of Essex has finally been given a run for her money in the "worst poetry in the universe" category.

Ha! I nominate myself for the Nobel Peace Prize in Douglas Adams references. And on a blog called "Majikthise," no less. How's that for ego?

This is the very "Mayo Clinic" guy I was referring to in my rant about credentials in the Nobel nominee thread. I'm glad that the New York Times is all over Dr. Cheshire, but I bet you'll still hear other news outlets reciting his "compelling" findings. Oh, and he's affiliated with the Mayo Clinic, did we mention that?

As I keep chewing on this, I'm afraid that there's just no way to fully discredit these people. Point out to a winger that this fellow does not have the expertise to diagnose Mrs. Schiavo, and more do the point, didn't, you know, actually diagnose. I suspect you'll hear something about how we're trying to destroy his reputation because we can't refute his findings. This is creationism, anti-choice, and "judicial activism" all rolled up into one disgusting Talibornagain ball.

There is no better witness against Cheshire than himself. Here is Cheshire's letter on the matter:

http://www.miami.edu/ethics2/schiavo/
032305%20Cheshire%20affidavit.pdf

Atrios quotes a letter to the editor from Florida Congressman Dave Weldon:

Did the editors interview registered nurse Carla Iyer, who personally treated Terri for a year and a half?

She said in a sworn court affidavit that Terri "was alert and oriented. Terri spoke on a regular basis saying things like 'mommy' and 'help me" and 'hi' when I came into her room."

What exactly is going on here? Is Weldon just flat-out lying? Was Nurse Iyer lying? Or was she just mistaken?

Okay, I found more about Nurse Iyer's claims here:

From [Judge] Greer's decision:

The remaining affidavits deal exclusively with events which allegedly occurred in the 1995-1997 time frame. The court feels constrained to discuss them. They are incredible to say the least. Ms. Iyer details what amounts to a 15-month cover-up which would include the staff of Palm Garden of Lago Convalescent Center, the Guardian of the Person, the Guardian ad Litem, the medical professionals, the police and, believe it or not, Mr. and Mrs. Schindler. Her affidavit clearly states that she would "call them (Mr. and Mrs. Schindler) anyway because I thought they should know about their daughter." The affidavit of Ms. Law speaks of Terri responding on a constant basis. Neither in the testimony nor in the medical records is there support for these affidavits as they purport to detail activities and responses of Terri Schiavo. It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had she contacted them as her affidavit alleges.

So the nurse is a nutcase. Or maybe she just has an over-active imagination and/or poor memory.

my question is...who is carla iyer?

a woman named carla iyer has been showing up on tv and elsewhere telling her tall tale of having been a nurse who cared for terri shiavo for a year and a half, during which time terri was able to talk and eat and for all i know, dance.

so who is carla iyer? there is no record of her on the florida medical license lookup (which covers all types of medical licenses including nurses) http://ww2.doh.state.fl.us/irm00praes/praslist.asp or on the cna lookup http://ww2.doh.state.fl.us/cnanet/cnalist.aspx

now i know many women change last names when they marry or divorce, so maybe she was licensed under a different name.

but i'm suspicious. where has she been all these years? and why is she showing up now? and what exactly was her capacity in regards to terri shiavo? and is she getting paid for her current advocacy on behalf of the schindlers?


The NY Times reported that Cheshire did not examine TS, which of course gives him plausible deniability in a professional sense, while allowing him to maintain his position, which really rests on religigious grounds.

It's as disgusting as the rest of them.

Link under "First scalp" is foo'd.

Well, Vogon or Scottish, although "Exit Ramp" pales in execrableness(?) next to "The Tay Bridge Disaster" (by William Topaz McGonagall).

"...I must now conclude my lay,
By telling the world fearlessly, without the least dismay,
That your central girders would not have given way,
At least many sensible men do say,
Had they been supported on each side with buttresses,
At least many sensible man confesses..."

Apologies to any Scotspersons about.

Yikes! And I thought my poetry was bad.

re: who is carla iyer?

Looks like this might have been the same M.O. that the Swift Boat Liars used...

now i know many women change last names when they marry or divorce, so maybe she was licensed under a different name.

I don't know about nurses, but I know that doctors always keep the name they graduated from med school with in professional circles, so Howard Dean's wife is Mrs. Dean to her neighbors but Dr. Steinberg to her patients and medical colleagues.

Carla Sauer Iyers is obviously a nut, but what else is new. She claims her notes would be deleted the next time she came on shift. I've worked in health care in 4 states, (although never in Florida, but I think it's safe to assume Florida documents in much the same way as other states do). In order for her assertion to hold water, every other health care provider would have to re-write their notes to exclude hers. In my experience, each patient is charted on each shift, even if it's just a note saying something like "patient is resting comfortably."
It's very common to have several days worth of notes on 1 piece of paper. Because this is so obviously impossible, it makes me doubt everything else she says.

Incidently, anyone feeding pudding, jell-o, etc to someone like Ms. Schiavo should be fired. Just because she swallows her saliva doesn't mean she can swallow anything else. Some people have asked why she can't be fed/hydrated orally. I've never worked with Ms. Schiavo, but I have worked with lots of people with swallowing problems. It's virtually impossible she would be able to take in enough orally to sustain her life, and she would almost invariably aspirate, and the average person (although a nurse should know about this) wouldn't even notice. It's a common problem,"silent" aspiration. Is aspiration pneumonia in combination with dehydration a better way to go?

The Mayo Clinic, which enjoys a favorable reputation, has disavowed Dr. Cheshire's quackery. In a press release dated March 23, 2005, the Mayo clinic notes that:

1) Dr. Cheshire "observed" but did not examine Terri Shiavo.

2) The "the standard of care" requires "the performance of a comprehensive neurological examination."

3) "The Mayo Clinic Departments of Neurology do not have opinions regarding the diagnosis of Terri Schiavo because they have not performed" an examination pursuant to the appropriate standard of care.

The Mayo Clinic plainly implies that Dr. Cheshire's failure to comport with the appropriate standard of care renders his opinion of little or no weight.

Hackery and quackery. What else does the right have to offer?

Marc

Here's the link for the Mayo Clinic press release: http://www.mayoclinic.org/news2005-jax/2724.html

Mary Ann,

"Incidently, anyone feeding pudding, jell-o, etc to someone like Ms. Schiavo should be fired. Just because she swallows her saliva doesn't mean she can swallow anything else."

I just experienced this firsthand with my father, who is in the hospital after a heart attack (he's doing fine now, so no worries). He could not eat anything at all until they conducted a swallow test to make sure that he could swallow soft solids and liquids properly. It is extremely dangerous to try and feed someone that is not capable of properly swallowing their food.

Dr. Cheshire is a graduate of the West Virginia University school of Medicine.

His father is William Cheshire, formerly editor of the conservative newspaper, the Charleston (WV) Daily Mail.

In the early 1970's Cheshire Sr. moved to Raliegh North Carolina to work at WRAL-TV where he wrote nightly commentaries for the news broadcast. In this position he replaced the former commentator, Jesse Helms.

this passage from Cheshires report was particularly patronizing, chauvanistic and unprofessional:

I could not withhold life-sustaining nutrition and hydration from this beautiful lady....

people who are concerned should write to the Mayo Clinic in all three of its branches (google it) to let them know that having people like Cheshire hanging around makes the Mayo unacceptable for our health care.

Thank you for posting the link to "Exit Ramp". Giving access to a work in it's entirety and seeing the author's comments is much better than isolated quotes.
Providing the link to the Mayo release was also helpful. I believe it would have been more accurate to say "a complete exam", for observing a patient is part of an exam, and if the question at hand is, "Is there any evidence to throw the diagnosis of PVS in doubt" simple observation may be all that is necessary. For example (with hyperbole), I can tell a person is not dead if I see the person breathing and talking to another person. A psychiatrist can tell if a person is depressed without laying a finger on them.
I could not link to the miami.edu site, I assume/presume it was the document Dr. Cheshire presented to the State upon his review of the history and observing Mrs. Schiavo. Reading it is indeed very helpful. He states in his prelude that he does consider it possible in some instances to withdraw artificial nutrition from patients with PVS (which would cause him to catch flack from "hard core right to lifers"). He also discusses issues about the diagnosis in question, how the diagnosis of MCS was not established at the time of the original proceedings, medical literature revealing that the diagnosis of PVS can be mistaken, and agreement with critics of the Schindlers that some movement which appears voluntary may well not be and only false reason for hope.
Art Caplan, PhD, does not know you or me either. In searching "Medline" for years 1985 through present Dr. Caplan did have an impressive list of 187 publications. These were essentially all in the area of medical ethics, including co-authorship on panel reports and non-medical forums. Dr. Cranford has to his credit 46 publishings located in the same manner, primarily in matters of end-of-life from both "medical" and "bioethics" perspectives. Dr. Cheshire has 28 references listed, only 2 of which are related to medical ethics, the rest being clinical neurology ranging from letters that report an individual case to reviews in major journals.
I agree that some of the "expert" medical testimony quoted by the Schindlers is suspect. But then at the time of the proceedings in 1998 Mr. Schiavo and Attorney Felos had some of the best witnesses money could hire, which did not seem to be the case for the Schindlers.
Dr. Cheshire does appear to be guilty of Christian faith, and if that is considered de novo evidence of incompetence, then so be it, but that includes a long list of people.

Mike,

I believe it would have been more accurate to say "a complete exam", for observing a patient is part of an exam, and if the question at hand is, "Is there any evidence to throw the diagnosis of PVS in doubt" simple observation may be all that is necessary. For example (with hyperbole), I can tell a person is not dead if I see the person breathing and talking to another person. A psychiatrist can tell if a person is depressed without laying a finger on them.

1. Quibble: You have misunderstood what a 'clinical examination' means to an MD. A clinical examination encompasses a mental state examination. A psychiatrist, when he diagnoses depression in a patient, does so by conducting an examination. The fact that this portion of the exam does not require the laying on of hands does not make it any less an examination - psychiatrists and neurologists are constantly examining your mind when they speak to you, by observing not just the content of your responses, but the form of your speech, the pattern of your thought processes, your mannerisms, etc.

2. You are completely correct to say that a simple observation may suffice to rule out a diagnosis - for example, if I walked into TS's room and she sat up and started speaking to me, that would be pretty conclusive evidence that, whatever she had, it was not PVS.

But the criticism of Chesire, of course, is that he made no such observation. And failing to make any observation that would lend credence to a diagnosis other than PVS, he brain-farted his way to a "sense of the presence of a living human being who seems at some level to be aware".

This was preposterous.

I agree that some of the "expert" medical testimony quoted by the Schindlers is suspect. But then at the time of the proceedings in 1998 Mr. Schiavo and Attorney Felos had some of the best witnesses money could hire, which did not seem to be the case for the Schindlers.

This may be true. But it is no fault of Michael's. And I take it even further: of the 8 neurologists who examined TS, that only a charlatan not fit for the MD degree, leave alone the title neurologist, was willing to say she was not in PVS and could actually be "rehabilitated" is an indication that they would have been hard-pressed to find any genuine expert who'd have mouthed their talking points, for whatever amount of money. Even a hired gun needs at least strands of evidence that he may spin. When there is none at all...

Dr. Cheshire does appear to be guilty of Christian faith, and if that is considered de novo evidence of incompetence, then so be it,

It is not. And you are smart enough to know that no serious liberal argument has ever suggested any such thing. Chesire's mistake here was his trying to prostitute his profession into the service of his religion - not that he has a religion.

To AR,

Perhaps you are a physician like myself, but are looking at things from a different perspective. A "clinical exam" certainly does mean something specific to an MD. A cardiologist means one thing by saying "a complete (cardiac) exam", which is different from saying "a complete (neurological) exam". A cardiologist could tell by looking at a patient whether he/she is cyanotic or not, has edema or not, has labored breathing, clubbing of the fingers, perhaps even JVD and the pulse. The cardiologist may check the blood pressure or rely on the value written by a respected nurse. While there may be many things the cardiologist does not know after a mere 5 minutes looking at a patient and the recorded blood pressure, if the question is, "Is this patient in acute cardiopulmonary distress" an answer could be given.

The diagnosis of PVS is made by observing a patient for a prolonged period of time to see whether evidence of consciousness is totally lacking. "Evidence of discriminative perception, purposeful actions and communicative acts is incompatible with the diagnosis of the VS. Thus a smile in response to the arrival of a friend or relative, an attempt to reach out for an object or the appropriate use of language would all indicate the presence of a ‘functioning mind’ and the recovery of awareness, although such recovery is sometimes very limited." (From "The Vegetative State: guidance on diagnosis and management: A report of a working party of the Royal College of Physicians", Clinical Medicine, Vol.3 (3) May/June 2003 pp 249-254.) If you read Dr. Cheshire's report you will see that he states his conclusions were, "Based on my review of extensive medical records documenting Terri's care over the years, on my personal observations of Terri, and on my observations of Terri's responses in the many hours of videotape taken in 2002..." He goes on to describe the observations he made ("brain-farting" was not listed) that give him cause to doubt the diagnosis of PVS.
I think I would trust his "sense of being in the presence of a living human being" over the reports that Attorney Felos gives of being able to hear a person in PVS "shouting" to be released and his ability to cause a commercial jet crash by "willing" the autopilot to shut off in the cockpit. (See his book: Litigation as Spiritual Practice).

The fact that Michael had the best experts he could get was not his fault (unless one thinks using money that was to be used for Terri's rehab for the lawyer fees was inappropriate). I was simply pointing out that of the 5 expert opinions in the original trial the two that the Schindlers had were not people I would stake my life on.

Mike: "Dr. Cheshire does appear to be guilty of Christian faith, and if that is considered de novo evidence of incompetence, then so be it,"
AR: "It is not. And you are smart enough to know that no serious liberal argument has ever suggested any such thing."

Whether a "serious liberal argument has ever suggested any such thing" or not, I don't know. But I do know this little blurb was in the first post of this thread, "The awful truth is that for all his preoccupation with human brains, human embryos, and the gushing human blood of Christ, William P. Cheshire is not himself human." What does it mean to be preoccupied with "the gushing human blood of Christ" other than a less than polite way of saying he is a Christian?

"Prostituting his profession into the service of religion-not that he has a religion." What does that mean?

Concerning who knows who, perhaps it is Dr. Caplan after all who is not up on his research.
Dr. Cheshire is the lead author in this paper:
Cheshire WP Jr. Pellegrino ED. Bevington LK. Mitchell CB. Jones NL. FitzGerald KT. Koop CE. Kilner JF.; Stem cell research: why medicine should reject human cloning. Mayo Clinic Proceedings. 78(8):1010-8, 2003 Aug.

Contributing authors included Dr. Edmund Pellegrino (Professor Emeritus at Georgetown, recipient of 41 honorary doctorates, and practitioner of medicine and bioethics before Dr. Caplan graduated high school) and Dr. C. Everett Koop (legendary pediatric surgeon and Surgeon General in the '80's).

Mike,

With respect to the clinical examination

You said in your first post: ...if the question at hand is, "Is there any evidence to throw the diagnosis of PVS in doubt" simple observation may be all that is necessary. For example (with hyperbole), I can tell a person is not dead if I see the person breathing and talking to another person. A psychiatrist can tell if a person is depressed without laying a finger on them.

In my reply, I was trying to clear a common misperception: ‘simple observation’ is actually very much a part of a doctor’s clinical exam. Furthermore, many lay people mistakenly do not consider the psychiatrist’s mental status examination to be a ‘clinical exam,’ (since it is performed entirely with words) when you and I and every trained physician know that it is. I agree with your latest comments on the examination, noting that you are making exactly the point I did: that often a ‘simple observation’ can be sufficient to rule out (or confirm) a diagnosis.

However, Dr. Cheshire did not make any observations that allowed him to rule out PVS in TS.

He says so himself on page 6, (no 7) of his affidavit:

‘Although Terri did not demonstrate during our 90 minute visit compelling evidence of verbalization, conscious awareness, or volitional behavior, yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of things around her.’
(emphases mine)

But the diagnostic criteria for PVS, despite all the rhetoric in the press over Schiavo, is unambiguous:

1. Intermittent wakefulness manifested by the presence of sleep-wake cycles;
2. Sufficiently preserved hypothalamic and brainstem autonomic functions to permit survival with medical and nursing care;
3. Bowel and bladder incontinence;
4. Variably preserved cranial nerve (pupillary, oculocephalic, corneal, vestibulo-ocular, gag) and spinal reflexes;
5. No evidence of awareness of self or environment and an inability to interact with others;
6. No evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; and
7. No evidence of language comprehension or expression.

There is no dispute with 1-3. 4 is a source of confusion for the family: she seems to have some preserved brainstem function. 5-7 are the ones disputed by right-wingers. Of the 8 board certified neurologists who examined her, only a long-standing charlatan - well-known to many in the Florida neurological community even before the Schiavo case - felt she didn’t satisfy the criteria. The judges agreed with the 7, apparently because when they viewed the evidentiary tapes, they saw that Hammesfahr was full of it.


Whether a "serious liberal argument has ever suggested any such thing" or not, I don't know. But I do know this little blurb was in the first post of this thread, "The awful truth is that for all his preoccupation with human brains, human embryos, and the gushing human blood of Christ, William P. Cheshire is not himself human." What does it mean to be preoccupied with "the gushing human blood of Christ" other than a less than polite way of saying he is a Christian?

The statement that “William P. Cheshire is not himself human” made by a commentor above is a rhetorical device, and a very stupid one. Not only is Cheshire human(e), he is, I’m sure, an excellent neurologist. On this one issue over Schiavo, he rendered an opinion before a court and the country that was unsupported by most of the evidence. It is likely that his strong religious convictions played some role in this, and that is regrettable. THAT is what is being objected to by serious commentators, not that he has personal religious beliefs.

Concerning who knows who, perhaps it is Dr. Caplan after all who is not up on his research. Dr. Cheshire is the lead author in this paper: Cheshire WP Jr. Pellegrino ED. Bevington LK. Mitchell CB. Jones NL. FitzGerald KT. Koop CE. Kilner JF.; Stem cell research: why medicine should reject human cloning. Mayo Clinic Proceedings. 78(8):1010-8, 2003 Aug. Contributing authors included Dr. Edmund Pellegrino (Professor Emeritus at Georgetown, recipient of 41 honorary doctorates, and practitioner of medicine and bioethics before Dr. Caplan graduated high school) and Dr. C. Everett Koop (legendary pediatric surgeon and Surgeon General in the '80's).

I had not commented on this issue that you raised in your first post, but here you are indulging in a little brain-farting yourself, doctor.

Caplan is a renowned authority on biomedical ethics. I am sure he knows exactly who Koop and Pellegrino are. Cheshire is of junior standing in that paper you cite. Most people working in a field will be aware of the other heavyweights and the bright rising stars. But we won’t normally be aware of every junior worker. When papers come out from other labs in my area of research, I may not be able to identify the grad students/honor students on the byline, but I’ll know the senior authors and most established post docs. This is normal in the research world. It is not at all surprising for Caplan not to have heard of Cheshire, especially since he does not even work in bioethics – he’s a practicing neurologist with a research interest in the autonomic nervous system, I believe.

AR,

You quote point #7 of Cheshire's report to the neglect of points 1-6. In addition, when you do quote #7 you do not highlight the modifier "compelling". Elsewhere in the report he describes actions at his direct observation that could have been construed as responses to her environment, but he is careful not to over interpret those events.

You have acknowledged that Dr. Cheshire is human and you have suggested he is an excellent neurologist. These are much more flattering than the (many) rhetorical devices used previously in this thread.

As to whether his religious convictions affected his judgement, I do not know. He stated that he thought it could be permissable to withhold food and liquid from a person who is truely in PVS. Dr. Cranford elsewhere has expressed that he feels it is appropriate to withhold food and water even at times when the person is not in PVS. From a purely logistical viewpoint, if one felt it was OK to withhold food and water from Mrs. Schiavo whether she was in PVS or MCS then there would not be much reason to differentiate the two.

I readily admit a bit of rhetorical streeettcch myself in the Who knows Who bit, but I thought mine was somewhat less slanderous than what was implied in the reporting of Dr. Caplan's and Dr. Cranford's comments.

Yes, it is true that Dr. Cheshire is not principally a bioethicist (though he obviously has written on it after getting a Master's degree in the field). and yes, Dr. Caplan was well known even when he was in Minnesota (at U. of M., not Mayo) before he came to Penn. I have had the opportunity to hear him a number of times, talk with him a few times, and an occasional email. In addition to other things, he was behind the idea that trying gene therapy for a metabolic disorder in a critically ill child was inherently too coercive to allow for informed consent, and such trials should be done in older patients with less severe forms of the disease. This course led to the death of a 17 year old who had been getting along pretty well before the attempted treatment. The family successfully brought a suit against Penn, and the physician in charge of the work was disciplined and removed from much of his responsibility. In balancing the concepts of informed consent, the possibility of doing good, and the avoidance of doing harm, the scale did not tip in the right direction.

I prefer bioethics from a physician who has direct responsibility for the outcome of his life and death decisions, and if I am ever in need of a neuro consult I hope it is Dr. Cheshire and not Dr. Cranford on call.

Mike,

#7 in Cheshire's affidavit is his summary of his findings, such as they were. If you look at the Schindlers' edited footage, you'll see some behaviors that are not inconsistent with a non-PVS diagnosis. The behaviors are also, unfortunately for the Schindlers, perfectly consistent with a PVS diagnosis. When the full evidence was weighed (by the only people with access to the full evidence) it was found that PVS is the most probably diagnosis. Points 1-6 of Cheshire's affidavit are variations or repetitions of these issues. Even he finally concludes that the evidence he has is not sufficient for him to say that TS was not in PVS. But he then threw out the "presence of a living being" statement, for which he has, rightly in my view, been criticized.

Re: Caplan & the gene therapy case. That's an interesting story. I am surprised however at your reasoning: you appear to apportion at least some of the blame for that unfortunate event on Dr. Caplan (that's the way it sounds). Caplan opining that the ethics of informed consent require that the experiment could not be carried out on an infant or small child has no moral bearing on the fact that the investigator subsequently tried it out on an older kid with horrific results. I do not remember enough of the details of the case to comment in detail on the ethics involved, but I will say that whatever happened between the older kid and the team can have nothing to do with Caplan's thoughts on experimenting on infants or toddlers.

If the parents of the 17 year old won the suit, one what grounds? Was it determined that the team failed to provide information on the risks? Were they misled? These issues pertain directly to the investigating team, and the award or denial of penalties rests solely on a determination of whether the team screwed up, or didn't. Blaming Caplan because he felt experimenting on a toddler was unjustified is rather absurd.

Best.

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