that our expert testified that she did not know what whether the outcome would have been any different had treatment been instituted earlier for this cancer that's not what she testified to was that she didn't know how you know would have responded and i submit that's not the same thing it's not the same things whether she would have survived response to treatment can mean with the it had to get chemo in more cycles when they have had to otherwise and our survival dr pfister was unshakable she said that tina was a significant chance of survival that if this was a stage two cancer she lost a twenty six to twenty nine percent chance of surviv last chance and if they're the track we're currently believe and as the defense argued that dr pfister when she was talking about a response was talking about outcomes and i would submit to holton we don't have to know it of responses that matter of fact when the supreme court decided holton they did so recognizing that nobody can know what the response to treatment is and for that very reason the supreme court said we're going to allow recovery for a last chance of survival because doctors don't know and can't know in advance who's going to survive or who isn't so they treat everybody even those that don't have better than fifty fifty chance of survival in the course says asked not to impose any further birds because if you adopt what the defense is suggesting here it's going to make it almost impossible to prove causation in a failure to diagnose cancer will would have done without this what about this  all comers all women the cervical cancer all different cell marcelle small cells moderately differentiated whatever and it has determined that all of those women if given proper treatment have similar outcomes and once you have that these other things go to the way i submit this case is no different than the mark them where the plaintiff's expert in that case said i can't tell you if the growth other side to cross examine and try to show that there's you know holes in it and then it goes to the weight of that that testimony and the jury should decide you can't have the court fister talked about you know there was another issue that the defense raised about what the treatment would have been and there's no dispute on what i would venture a human therapy radiation maybe surgery and the issue is not what the trigger would have been the think might be the likely causes for the likely diagnosis you do you pass and you progressively rule in or rule out things until you come to what the most likely diagnosis yes and that's how she right get her in you know a stage of cancer exactly what they specifically approved of that method of an expert making opinion of making a differential diagnosis you want to rule out every possible thing you go through and that's what she did i want to also touch on this this gap in causation cases i call that the defense relies heavily on and there's three principal ones and sooner if there's this gap there the centers that are isn't good enough but in this case where we know she had cancer we know she was a candidate for treatment we know the treatment would have been given candidate for under those circumstances sooner is better isn't good enough in i will erica you ever read about getting confused the patient had a cyst in her brain and the claim was you should have done a c t that would have diagnosed assessed and a drain would have been put in to relieve the pressure and let the standard care expert said i think a c t would have shown this condition out evidence that has shipping down but no evidence of what it has was shown and no evidence that the patient was even a candidate for treatment under those circus i'm sorry i'm sorry under those circumstances sooner is better isn't insufficient as a matter of law to show that the alleged deviation from the standard to care resulted in a decreased chance of survival due to a delay in starting the treatment because they only thought pock in general term about if i was aging system did not and that those statistics to this to your patients case and the after did not testify quote as to what course of treatment for this patient would have been and how she might have done would have had a better outcome had the tumour been removed when it was smaller because the expert explain precisely how a lumpectomy followed by chemotherapy would be more effective if the tumor were small out there about this patient why she's watching tied into these general statistics and then then we can cross examine then get out and it was kind of a reverse process we on and she said yes these these two greet these are these are important because because she said cancers grow differently in different people and you can't predict how fast or slow a cancer will was presented in the trial is the five of it is the it's in there's a stake and right below it saying these rates are based on outcome to large numbers of people who had the disease but they cannot predict what will happen in any particular person's case many other factors may affect a person's outlook such as their general health and how well the cancer has dons in treatment well this is a last chance of recovery isn't it yes ok she never got the recover his recovery but the chance to recovers and that really the issue here is the chance to recover but how do you determine the chance to recover for any particular individual don't we have to  the jury is something more than just a table that says she might react the way that people in these numbers her chances might be chance what these what these numbers show more like more be more likely than not  well they didn't present evidence to show more probably true than they just presented these figures and and that's where the court all of the decisions of them are so far as i said not enough we need to look a little bit more you have to take out the whole vegetable law you have to take out of the reproductive system we don't we have nothing to know what what might have been possible that could have been done should have been done to these numbers by by not by lack of intervention is really most states they do have to show something something more than just throw up some numbers especially when the numbers themselves the authors of the number said don't don't really take these too seriously because the name not apply you talk to your doctor find out why how you're individuals this situation applies and that if history now is this is general information  specific individual information  to this patient she talked about her chance of survival not even as in walking similar population they mention a disclaimer in this either the five or the american cancer society