Translation in the Court
As discussed earlier,
Eric Fombonne MD and Stephen A. Bustin PhD were effective expert
the respondent in the Cedillo case [Theresa
Cedillo and Michael Cedillo, as parents and natural guardians of
Cedillo v. Secretary of Health and Human Services - No. 98-916V].
While Dr. Bustin
criticized the laboratory testing and results, Dr. Fombonne directly
the plaintiff’s case by discussing the vaccine-injured girl herself.
He may have been the
Dr. Fombonne first
testified in Washington DC on June 18, 2007 (Day 6).
DOJ Attorney Lynn Ricciardella
started questioning Dr. Fombonne about his education and credentials
Q. Doctor, you
received a Baccalaureate in science with distinction from the Academy
A. Yes. In 1971. Yes
Hastings: Dr. Fombonne, can we ask you to do the best you can to speak
little louder so the folks can hear you?
The witness: Yes I
know. I know.
Ms. Ricciardella: He
has a soft voice.
Hastings: You have a nice, soft voice.
The witness: No, No.
Hastings: You just need to speak up as best you can.
The witness: I know
it is a problem.
Hastings: And maybe perhaps going a bit slower would make it easier to
understand as well.
The witness: Okay.
The record does show
that Ms. Ricciardella asked and the witness confirmed that he
“Baccalaureate in science with distinction” in 1971.
It is reasonable to suggest
that most people
who heard the exchange understood that in 1971, the witness obtained
equivalent of a Bachelor of Science degree, a BSc degree in science,
In his 59 page CV
updated January 21, 2007, Dr. Fombonne
listed the following under Education and Training:
1971: Baccalauréat C (Sciences), Mention Bien
(Académie de Paris)
It is not clear why Attorney
decided to call the degree a “Baccalaureate in Sciences” instead of
reading what was listed on the expert’s CV.
While it might have seemed
that the witness
obtained the French equivalent of a BSc degree in science with flying
the fact is, the nomenclature is different. The term “Baccalaureat” or
used in France
to describe the examinations and diploma at the end of the last year
of high school. It is a requirement
to enter university and it is not unusual for French doctors to list
“Baccalaureat” with their medical education. The reference to
shortened to S, simply means that during the last year of “lycee” or
school, the graduate took advanced science courses instead of other
the term “Baccalaureate” is rarely
used instead of “Baccalaureat” in schools with a large number of
students. To confuse things even more, in Belgium
“Baccalaureat” is used interchangeably with “Bachelor Degree” at the
where the Cedillo hearings were held, a “baccalaureate” is only
defined as the degree of bachelor conferred by
universities and colleges.
students will usually finish pre-school by
age 6, elementary school by age 11, middle school by age 15 and high
Dr. Fombonne was 17
years old in 1971
“Baccalaureat” that he obtained that year was not a university degree
was not equivalent to a Bachelor of Science degree (BSc) that requires
years of hard work in any university in Washington DC or the 50 states.
Grading in the French
educational system is
different from ours. The “pass mark” is 10 out of 20 and it is
unlikely for a high school student to score a perfect 20. French school
including the “Bac” are usually very difficult and are consistently
rigidly graded than ours. A “mention assez bien”
(translated “almost good”) is probably equivalent to “Honors”
in our system and is awarded for a mark between 12 and 13.99. A mark
and 15.99 will earn a “mention bien”
(good) that is
equivalent to “High Honors” over here and a mark of 16 or higher will
merit a “mention très bien”, translated
“very good”, but in fact comparable
to our “Highest Honors”. The term “Distinction” is not used as a grade
French exam including the “Baccalaureat” but a French student may feel that it is a “distinction” to
obtain a “Mention Bien”.
Now three years later, I am at
a loss to know why the attorney for the
respondent thought it was necessary to inform three Special
court full of people and all of us listening by phone that her expert
a university Professor, had graduated from high school with a grade
and 15.99 out of 20.
then asked the
witness about his medical education at the University of Paris
(p. 1241) and he answered “Right. I went to medical school from 1971 to
1978”. Special Master Vowell then
interrupted to tell the witness that he was talking into the court
microphone and that he should also be talking into the flat microphone
transmitting to the whole room.
The witness agreed
and Ms. Ricciardella jested “We’re high tech here”.
She then asked again:
“So you have a medical degree, Doctor, is that correct? And the witness
answered: “Yes, that is correct.”
Q. And you have a
Master’s certificate in Biostatistics Methods in Human Physiology, is
Q. Following medical
school, where did you do your residency?
A. I did my residency
in psychiatry at the University of Paris from 1977 to 1982, I think.
The witness had
stated that he “went to medical school from 1971 to 1978” and the
about a residency “following medical
school.” Ms. Ricciardella did not ask and the expert did not explain
training in 1977 and 1978 prior to graduation was included with
training “following medical school”.
On page 6 of his CV, the
expert listed his psychiatric training in Paris
Intern in the
Department of Adult
Psychiatry of CHU Cochin-Port-Royal, Paris
Service Dr. Bertrand, Hôpital Ste-Anne, Paris
Service Dr. Segal, Centre Hospitalier Spécialisé Les
Murets, La Queue-en-Brie
Service Dr. Jeanneau, Centre Hospitalier Spécialisé
Charcot, St Cyr l'Ecole
Service Pr. Martin, Hôpital L'Eau Vive, `Soizy-sur-Seine (91).
No one is questioning
Dr. Fombonne’s training in psychiatry but it is clear from his
CV that it consisted of “internships”
between October 1977 and March 1981.
should have referred to them as such and then asked Dr. Fombonne to
and explain how in France, a year of internship may indeed be
equivalent to a
year of residency in the United States, which is true. She should not
referred to his residency in
psychiatry at the University of Paris because, as per his
own listing, the word
“residency” is not mentioned in his Paris
Finally, according to
page 2 of his CV, the witness was serving in the French Army in
Guadeloupe, West Indies from April 1981 to March 1982. He was not a resident in psychiatry at the University of Paris. He was
4,000 miles away.
Now we get to the
question posed by Ms. Ricciardella: “And
you have a Master’s certificate in Biostatistics Methods in Human
is that correct?” to which the witness answered: “Yes, it is correct”.
On page 1 of the same
CV, this particular achievement is listed as follows:
1976-1977 Master Degree
½ Certificate in
Biostatistic Methods (Professor D. Schwartz, U.E.R.
Kremlin-Bicêtre, Paris XI,
1976-1977 Master Degree
½ Certificate in
Human Physiology (Professor Bargeton, U.E.R. René Descartes,
It is not clear
Attorney Ricciardella added the half certificate in Biostatistics
Methods from the Eleventh arrondissement to the half
certificate in Human Physiology in
the Fifth arrondissement to make a whole “Master’s
certificate in Biostatistics Methods in Human Physiology” when the
physiology is not mentioned in the first degree and the word
absent from the second.
For those who may be
interested, a Paris
arrondissement is a city district or a neighborhood. To go from the
on the Rive Gauche to the 11th,
one must cross the Seine and …the fourth
In 1976-1977, Dr.
Fombonne was in his fourth cycle in medical school, the DCEM4, a
of academic and clinical training at the University of Paris.
It would be safe to
say that most physicians and medical students would be in awe learning
during that very busy and crucial period, any human could do much more
fulfill the requirements of the program let alone get a “Master’s
Degree in Biostatistics” as we know it and … start his
The “Certificat de
Phisiologie”, a Physiology Certificate, from the University of Paris V
that Dr. Fombonne indeed obtained in 1977 indicates that he
completed an approved course in physiology.
In the United States,
a Master Degree in Biostatistics from a university is usually awarded
students with a Bachelor Degree who satisfactorily complete 32 credit
work and study. [http://www.universities.com/edu/Masters_degrees_in_Biostatistics.html]
There is no available
information concerning the specific ½ certificate in
that Dr. Fombonne obtained.
A course in
“Methodologie statistique” presently given in Paris started October 5,
2010 and will end
January 28, 2011 with a break for Christmas from December 18, 2010 to
3, 2011. The course consists of a weekly formal lecture of 90 minutes
addition to 2 hours a week of “Travaux Dirigés”, essentially a period of
practice and statistical exercises.
On June 25, 2007 his
second day on the stand, the witness’ testified mostly about
He discussed several
epidemiological studies including two of his own, one from the U.K. and
one from Canada. The reports of both studies
were published in PEDIATRICS in 2001
and 2006 respectively.
In “No Evidence for A
New Variant of
Measles-Mumps-Rubella-Induced Autism” [Pediatrics 2001;108;e58]
and Chakrabarti reported that:
“No evidence was found to support a distinct
syndrome of MMR-induced autism or of “autistic enterocolitis.”
that particular study in their
highly esteemed evidence-based Cochrane MMR Review, Demichelli,
Jefferson et al
opined that “The numbers and possible
impact of biases in this study is so high that interpretation of the
impossible.” [Demicheli V, Jefferson T, Rivetti A, Price
for measles, mumps and rubella in children. Cochrane Database Syst Rev.
Oct 19;(4):CD004407. Review]
developmental disorders in Montreal , Quebec , Canada : prevalence and
with immunizations” Fombonne et al (Pediatrics. 2006
concluded that: “…The findings ruled
out an association between pervasive developmental disorder and
high levels of ethylmercury exposure comparable with those
experienced in the United States in the 1990s or 1- or 2-dose
It is likely
many at the hearing were impressed by the witness’ knowledgeable
and the dazzling statistics that he quoted with great ease and clarity.
also likely that no one realized that in this study, which only
children from one English school district in Montreal and centered on
diagnosis and vaccination history, not one of the five authors ever
reviewed a single chart in order to at least
confirm the diagnosis. According to the authors “Children with a
PDD were identified by school personnel and given a study code to
anonymity of the data. Children’s diagnoses were not verified by direct
In a letter to the editor of PEDIATRICS, David
Ayoub MD objected to
the data and conclusions related to the Thimerosal in vaccines in the
district the authors investigated. In a letter I sent to the editor, I
issue with the authors’ claim that in that same school district,
developmental disorder rates significantly increased when
vaccination uptake rates significantly decreased.”
incidence studies, I showed conclusively that the MMR vaccination rates
in Montreal had actually increased during the study
period along with the cases of ASD. The authors had used MMR
rates from Quebec City and its
160 miles away from Montreal.
Fombonne refused to answer our letters and the
editor never published them.
Listening by phone to
the testimony in the Cedillo case, I wondered how many at the hearing
in 2001, Dr. Fombonne had questioned the very existence of an epidemic
autism spectrum disorders.
In “Is There an
Epidemic of Autism?” also published in PEDIATRICS,
the expert had asserted: “… To date, the epidemiologic evidence
a secular increase in the incidence of PDDs is both meager
Vol. 107 No. 2 February 2001, pp. 411-412]
According to a CDC
study, 6.7 out of 1,000 eight
year old U. S. children were on the autism
spectrum in 2000, when Dr. Fombonne was writing his paper.
Dictionary defines an epidemic as an excessively prevalent condition.
would agree that a prevalence of 1 in 149 is excessive.
listening to days of testimony from
both sides in the Cedillo case, the Special Masters decided that the respondent’s
experts were more believable and that their testimony was more
I certainly respect the
Special Masters’ right
to their opinion but after listening to many experts from both sides
reading several transcripts, I must respectfully disagree with their
previous pages, I reviewed some of
the testimony of the likely leading expert for the respondent. There is
indication that the special treatment he received influenced the
any case and as I keep repeating, the Special
Masters’ decision does not mean that Michelle Cedillo was not
parents, who have been with her all
along and who have witnessed and documented what happened to her, are
believe them and I agree with them.
Yazbak, MD, FAAP