well here the next hose in ran marina you are ok it's kind of like that thank you in that the evidence in this case the scientific evidence is stronger then we typically see in multi day strict injury cases let me examples of that st typically in a pharmaceutical case the plaintiffs are swimming upstream against the f d a in this case the f d a has already found there is reasonable evidence of a causal association between leaving or just roll the drug in marina and intracranial hypertension which is why the f d a required their to add this as a warning on their j dell product which is the exact that medication as marina nd point of star often on the forefront ahead of the literature in the scientific consensus in this case there is been a well established relationship between intracranial hypertension and  leave her just role recognized in the peer reviewed literature for years in two thousand and five for example one of the top experts on its cradle hypertension deborah friedman wrote that there is a well established relationship between this condition and we are no just role releasing implants they are retained her as an expert and then never disclose a report from her rd the epidemiology in this case is stronger than you typically see in multi district litigation in the powder cases which survive delbert the relative risk which measures how likely a person is to get a condition this is one yes it is that you know there's this early and we have an earlier decision in two thousand seventeen on how how is that case different from this case your honor it's different in every way in that case the same as she would that the same issue of expert opinions on general causation right is so in a sense yes of we are here at the end of a daubert but the cases could not be more different you know in the in the marina one case which involved this idea of secondary perforation after the implant is is put in months or years later it causes a perforation in that case the nd circuit here when it affirmed one published opinion identified three problems with the the point of claim there one but the point those experts head no authorities that supported the existence of secondary perforation in this case no one doubts the existence of intracranial hypertension no well i think i would disagree with that of that is what the literature is recognized so far is that there is a causal association between it now what you don't have is what the district court said was required we don't have a single published study that  litigation that's ever gone anywhere or any firm or civil case that could point to a study where the purity lurcher specifically asserts the full journal causation analysis that's just not what any of the literature looks like that's why we have the experts in my view of the cases you know and i think a nd point that the that the nd circuit recognized in the marina one case was that the experts had no pre lit a geisha an expertise in the phenomenon of secondary perforation in another one of our experts dr johanson was retained by nasa to advise on cerebral spinal fluid dynamics for astronauts he even the district court recognized that he would be on the short list for anyone in the world as an expert in this issue another one of our experts dr darren he has done twelve clinical trials on leave in or just roll including being hired by a or to conduct a clinical trial we are nothing like the experts and marina one they have extensive pre litigation expertise and are frankly dr stuffy introductory johanson are two of the best in the world anywhere they've published on this issue extensively prior to litigation then the  hypertension is occurring in these women as occurred in all nine hundred of the plaintiffs here you know that's that was a very different case of essentially was unknown of the injury even exist and the experts said no relationship and no expertise here no one doubts the injury exists no one doubts the literature before him to describe this and describe this relationship you know our our relative risk here in our peer reviewed literature is three six to seven six in the something that there repeats here is there are references these five studies of oral contraceptives now none of those studies involved something with just leaving or just role in it which is how marina works and it's unknown how many of the drugs  at all and it's possible none of them did this court in the murky on us our firm excluding an expert who had done exactly that they had mixed together studies that involved different chemicals from the one issue and what the district court held here is that our experts were required not just to you know analyze and incorporate these studies of completely different drugs but that they were required to it's the conclusions that bear was drawn from them and this is you know only a part of what has gone wrong here in the truth is the district court was in a race to dismissal here we had to use discovery from the prior litigation our clients did not get any chance to offer individual proof we had to do summary judgment in reverse order you know that's well everything leading up to that was much faster but i would say it wasn't a careful analysis it was a cross examination there was nothing that would be different in a cross examination a trial than what we saw in it was that weren't there as i understand and you know it is somewhat unusual least in my view to to exclude so many different expert reports but in each one with respect to briefs the hard look standard doesn't really have any foundation in this court's precedent and what the district and this court also is reviewing on a day novo for application of a lot of facts the rd circuit has said the same on  one thing if a district court has deference towards you know the manner in which it is assessing a methodology but if it improperly applies the lot of the facts that it's a de novo review so our view is no district court should not be weighing the evidence and that's you may please the court my name is lisa vlad and i represent the bear defense for two reasons the district court did not manifestly err in exercising its gatekeeping role to exclude plaintiffs general causation experts st the experts failed all for general dr factors and sat at the experts for life on multiple slot methodologies and inappropriate sources and data of the st reason we don't think this court should be the st court ever to reverse a district court for excluding an expert that failed all for a dog or a general factors which after all the supreme court developed in a drug the court below recognized that expert testimony that strong stocker may still be admissible but here the plaintiffs face that where is that where we get to the hard looked after at that point yes the well you get to the hard rock in two ways the court said look you fail all four factors because you didn't test there's no general medical reception so it's not peer reviewed but i didn't give a deeper look and see if there's anything else but the court also gave the same sort of hard look at the other rape case came and that's from this court's decision in a more geodes which says a court should which means the court is required to rigorously examine the facts and the methods that the expert literature and dependently determine if the sources and the data the expert relies on is sufficient to support your conclusion and that's from the supreme court's case and joiner and also this court's decision and more geodes so the expert i mean two million women it's also a birth control device that's disproportionately prescribe to overweight women and hypertension that issue here is highly associated with overweight women of reproductive age so any expert that wants to reliably conclude that l n g or levon or jester ought to cause the disease here has to grapple with the overlapping risk factors of age gender and wa picking sources selective use of case reports and deciding stents and any one of those errors in addition to the four daubert factors would be sufficient to survive an abuse of discretion and as to the other three experts who opined on how it's biologically plausible that the miranda could cause the disease here at the court halted them because they among other things it made it their opinions were only had kopassus they misread the literature they speculated as to critical links and didn't experts methodologies were based on mere guesswork or conjecture or unsigned unscientific scientific principles which would in turn allow the jury dry and guesswork so the court recognized that obviously once you get past the point  question the court properly entered sorry judgment absence of any expert testimony as to general causation i think two principles govern that here st the other side doesn't cite any state that dispenses with the need to t hat's before you get to individual proof of specific translation nor do they dispute the presumptive notion that in complex medical cases you need expert testimony and you just clarify for me the hypertension you have to st get past a general causation that the drug is even capable and then you get to the specific cause ation as to what actually could have caused it in this individual case that the worker smoker did he have exposure to other substances that could be the plausible so here you could be arguing about you know but temporal stuff like for instance if a woman had the disease before she ever started taking the her or a that those would be arguments about specific one case so that it was good up to me not subject to any reasonable dispute that general causation the whole battle and that case is whether you can get beyond expert testimony it seems so obvious that you have to share general causation hear the bottle ok thank you i think your honor i think critically though not one state anywhere in the country follows general causation the way that the district court did here now general causation that these actual state laws the defendants never raised at all intil a reply in support of their motion for summary judgment where they attached the table with just a series of citations and no explanation here the district court did not apply general causation the way that would new york state the way that wouldn't any other state that has a general causation here the district court didn't have a bellwether didn't have particular plaintiffs who could have brought in particular evidence it has t to prove general causation in the abstract unconnected to any particular plaintiff well general in the oh it was just vision so i think that you can correct me if i'm wrong the idea of general causation we could describe it as could should but it's it's it's with the reference necessarily to specific victims or specific injured individuals and so the question is can this product is this product capable of causing the injury and issue why would you need specific plaintiffs as opposed to experts so in this particular context even more than others the way this condition is diagnosis there are differential diagnosis the way that every other cause that it's been identified for intracranial hypertension from eating polar bear livers to taking too much retinal has been identified through a differential diagnosis by a physician here we had no opportunity for that none of the plaintiffs was able to actually have an ophthalmologist who is the person who diagnosis this condition look at them diagnose them refute their record say your your cause was the lever nor just for all which is recognized in the literature as a cause for this the district courts get largely that i mean the question is why would you even do that why would you need to do that if the product cannot scientific matter cost that kind of injury well your honor i think it's part of how you prove it can cause the injury would be through a differential diagnosis and that's the problem here which is the district court on this one limited subject the district court did not allow us to even present the proof and i think in a general sense to worry us just that you didn't have that proof no we were not allowed to present that proof we have multiple clients who have their own doctors writing in their medical records that the cause of this was their marina but we were not allowed present any proof or any plaintiff whatsoever we weren't allowed to call in to the mala just to show  defense what you know that's part of the race to dismissal here which is that the district court had followed what most courts do and had done a bellwether process we would have started out with individual plaintiffs instead of abstract reports on general causation we would vet individual plaintiffs with their own honor i'm sorry you make us are there in this section at the last a look at the gears nine hundred and twenty six but i don't know if there had been new filings in the sense that without him none of them have been able to brief their state laws nor to present their doctors for you know by chance whether that number would have been a robust enough sample to make a conclusion about general causation a statistical statistically  robust interview he could have done a debate about whether the sample was physically robust enough but why not do that so your honor the truth is that this was done that is the felons will a study was looking at particular patients and comparing them to people with you know identical characteristics for them and you know redoing that with our client saying the problem with using your your litigation sample is you will never really get a defense expert who says that you have self selected by your clients that you know you cherry pick to you've put into it which is why we can't really use it as our own statistical sample for but vangelis study did exactly what your honor is asking it was a practice of up the moloch just two different practices in two different continents that looked at their own  people with it within twenty hypertension and compared them to other other women who didn't have it met the sit in characteristics and found that the bahraini users were three dollars to seven dollars times more likely than screening hypertension i see my time is up on thank you thank you both the court will reserve all decision