Dr Shafer
Chernoff :
shows the Astra Zeneca graph : the data was collected by Julianna Barr, Dr Shafer was Principal Investigator. At that time he was an assistant professor at Stanford. When he did the graph, he was a fellow of Dr Stanski (sp). A fellow is a student , it was a fellowship in pharmacology in anesthesia.
Chernoff If the data is not correct, graph and modelling can not be correct ? Yes, they can't be correct.
Chernoff wants to talk abut other studies Dr Shafer did :
propofol pharmacokinetics on children : was not PI. Did all of the analysis and the modelling
propofol and 2 other drugs : was Pi for the propofol study. Did human studies fo this paper
inhalation vs IV anesthesia : this paper fictitious debate, dr White chose Dr white as a fictional participant of the debate, because dr White is prominently associated with propofol
2 book chapers that he wrote : shows that Dr Shafer worked with DR White abOut intravenous anesthesia. Participated in the study at the request of dr White; Dr Shafer considers the books books are high quality books, but not authoritative; Athoritative woud be an original study. Dr White wrote the chapter on propofol.
Dr Shafer has known Dr White for 30 years., in 2009 dr Shafer nominated dr White for a award
Chernoff : when you were asked about White's alledged statement you said were disappointed : Dr Shafer : I was dispointed .
Chernoff : You know this trial is on TV ? Shown on an international level ? Objection sustained.
Chernoff : yoou said 1st pass effect was a first year student thing. Did you read Dr White's letter to Mr Flanagan ? . You know that Dr White wrote that it is speculated that Mr Jackson added a mixture of propofol and lidocaine to a fuit juice. Dr Shafer agrees , obection by walgren, overruled.
Chernoff : Do you know the circumstances of the letter , Mr Flanagan had to have it in 2 days, because he was threatened of contempt ? Objection, sustained
Sidebar
Chernoff : do you know that propofol was found in Mjs Stomach ? Yes
Chernoff : do you know the number : concentration 1.83
Chernoff, subsequently you sent the piglets study, informed Mr walgren that there was no human study ? Yes. Dr Shafer called dr Glen, on the suggestion of Dr White, Dr White also contacted Dr Glen.
Chernoff : then you contacted dr Sepulvedra, Mr walgren didnt ask you to do that : Dr Shafer agrees
Chernoff : do you know that the defense paid for a study on beagles , that Paul White did the study ? No I heard that Paul had ruled out bio availability.
Chernoff : who paid for the Chile Study ? :the study took 2 months, Dr Shafer paid 600 $, the students were volunteers. Dr Shafer sent the study to dr White, dr Glen, and presented during an international conference,
Chernoff : despite the fact that a 1st year student would know that ? Yes.
Chernoff : you worked a lot more on this than Dr White, you litteraly swallowed 20ml propofol yourself ? yes
Chernoff : you know that Dr White wuldn't say that MJ swallowed propofol? No I didn't know, that and I still don't know what Dr White is going to say.
Shows the 40 mg lorazepam graph
Chernoff : what dose this show ? It shows that repaeted boluses of lorazepam can produce the concentration on autopsy. Shows 10 IV injecetions evry 30 m, from midnight to 5am.
Chernoff : did you read the statement by security ? Yes
Chernoff : the first shot was at midnight , MJ was still at rehearsal : dr Shafer : yes. Offers to do another simualtion.
Chernoff : second shot at 12 30, MJ was in a blue escalade on his way back from rehearsals
Chernoff : third shot was a 1 am, MJ was almost home.
Chernoff : in the graph you originally had another line : one for responsive to painful stimulus, and another one for not responsive to painful stimulus.
Chernoff : lorazepam is not analgesic (pain killer), it's a sedative. If a patient is not responsive to painful stimulus, he's asleep. Dr Shafer agrees
Chernoff : by the 5th shot, patient has exceeded painful stimulus. Based on this simuation, MJ would be asleep from 2 30 to 11 00. Dr Shafer : No he's been exposed to benzos for 80 nights, makes it almost impssible to predict Mjs reactions to lorazepam.
Chernoff : how de you know MJ had benzos for 80 nights ? Based on pharmacy records, and CM interview. There was no medical records. Chernoff doesnt let him check Cms interview. An ampule was found, showed that what CM said was not possible.
Chernoff : the fact that the benzo were bought doesn't mean they were used.
Chernoff : in you report you say that CM did not give MJ 2X2 mg , the information suggests a higher dose, possibly 40mg. Dr Shafer : yes I stand by that statement. I took off the responsive to spainful stimuus line, for simplicity. Chernoff implies that Dr Shafer thinks the jurors are fools.
Chernoff : you did not simulate oral lorazepam ? No
Chernoff : what happens if you swallow atablet ? The tablet into the stomach, half a pill is absord in 22 mn, then goes to the liver, subject to first pass, biovailability is 92% then, goes to the blood stream, distribute into body tissues, aong others the brain, 25% of the metablite goes to the bile, a part of the metabolite goes back to the stomach.
Chernoff : metabolite for oral lorazepam is also glucoronide, the process is the same as IV lorazepam. Dr Shafer : yes
Shows the grah with the 2 X2 mg injection, shows a graph with both lorazepam graphs in one graph. (the 2X2mg and The 40mg)
Chernoff : you said that MJ couldn't have swallowed lorazepam in his last 4 hours, based on the 22 min of one tablet. Dr Shafer says yes, and adds details that i didn't understand, sorry.
Chernoff Are there oral versions of midazolam? : not that I recall
Shows the simulation 25mg over 1 mn propofol injection , shows another simulation that he did for Dr White, 25 mg over 5mn, then another one 25mg in one shot, all at once. The all at once one was used for the prosecution examination.
The induction dose in anesthsia is given over 2 mn , because it's less painful for the patient , for sedation the dose is given over 3 to 5 mn. Dr Shafer calculated these times, because there is a delay between the time the drug gets into the system and the drug's effect. He was concerned that phyicians would continue to run the drug until they saw the effect. 3 to 5 mn is the right rate.
What's the danger of a rapid infusion ? : apnea.
What was Mjs brain concentration of propofol : needs to look at the coroner's report. No measurement in the coroners report.
Recess until monday 8 45