Details of the Complaint
(51 Pages)
I. Mr. Terrazas misled the Court by false statement of fact
A. Mr. Terrazas misled the Court – and even his own witnesses - about amphotericin B
a. He apparently made up the part about viruses, herpes viruses, and oncogenic retroviruses. It is not found in the scientific literature such as Physicians Desk Reference, (PDR)[1], Martindale,[2] or the manufacturer’s literature.
b. Amphotericin B has activity ONLY against various fungi. This is stated clearly in the PDR (see footnotes 1 & 2 below) and every other textbook and source of information.
c. That the Court was successfully misled, in spite of factual information provided by the Defense, is obvious since these very words were included as fact in Judge Ruth Astle’s Decision where she wrote: (Decision, P. 2)
“(a) AMPHOTERICIN B (trade name Fungizone) is a polyene
macrolide anti- fungal, antibiotic derived form [sic] Streptomyces
nodosus, a soil actinomycete, with activity against lipid-enveloped
viruses, including herpes viruses, several oncogenic retroviruses …”
www.treatmentchoice.org/decision.html
20 Amphotericin B is pharmaceutical plutonium. A
21 more descriptive term for the drug, used by medical students
22 everywhere, is Ampho-Toxin-B.
“We have four patients in this case, each one having to do with the Amphotericin-B prescribed in the capsule form…”
This is misleading. Amphotericin B was prescribed for only one patient - LTS. (See charts of patients)
C. Because of the friction between LTS’ parents over custody and treatment, the father tried to get a court order to enjoin his ex-wife from using amphotericin B. Mr. Terrazas claimed in his speech at the November Hearing on Reconsideration that “a superior court judge in Contra Costa signed an order ordering the mother to cease and desist” giving LTS the amphotericin B. (TR Vol.27 p.35)
1. The court order presented as evidence was unsigned and undated.
2. LTS’ father was vague about the procedure and said: “You know, we had some differences about stuff. So the attorneys were passing these things back and forth.” (TR Vol. 1, p.76)
3. Mr. Terrazas never presented the Court with a copy of a signed and dated court order. There is no such paper in evidence.
4. The purpose of the “order” was for the non-custodial father to force the custodial mother to stop giving amphotericin B to LTS. It was not about Dr. Sinaiko. It was about a disagreement between divorcing parents.
5. There is no reason to believe that such a court order was ever made, or was ever more than an idle threat and a piece of paper anybody could have produced.
1. Dr. Sinaiko was not the prescribing physician of Ritalin for LTS, and Mr. Terrazas knew that Dr. Sinaiko had nothing to do with the start or stop of that drug. (LTS’ chart)
2. Mr. Terrazas continued to say this in spite of evidence and testimony of both parents (TR Vol. 15, p.73; TR Vol. 1, p.85) that Dr. Sinaiko was not involved in LTS’ Ritalin usage, but that Dr. Vreeland herself had discontinued it (she neglected to note this in her records).
3. And yet, Mr. Terrazas ignored this testimony in favor of his own original fictional claims.
2 ... a recess had to be called
3 during the proceedings because he [SINAIKO] became“belligerent”,(his own
4 attorney’s words,) when he was asked if he was a clinical
5 ecologist.
1. A search of the transcript on CD reveals that the word “belligerent” does not appear in the transcript anywhere, by any spelling, neither in Dr. Sinaiko’s “own attorney’s words” nor in anybody else’s.
This is a dramatic scene – except that it exists only in Mr. Terrazas’ own mind. Below is the transcript wherein Mr. Terrazas asked Dr. Sinaiko if he was a clinical ecologist. Please note that no recess was called.
What the record says:
(TR Vol. 26, p. 157-158)
23 Q. [TERRAZAS] Okay. Are you a clinical ecologist?
24 A. [SINAIKO] I don't label myself to be a
25 clinical ecologist. I don't advertise myself as a
26 clinical ecologist. Does that answer your
27 question?
28 Q. Do you consider yourself a clinical
157
1 ecologist?
2 A. Can you define that term for me.
3 Q. What is your understanding of the
4 term "clinical ecologist"?
5 A. I don't know what it means. I've
6 heard four definitions in this courtroom, mostly
7 from your witnesses.
8 Q. So is it your response and your
9 answer that do you not consider yourself a
10 clinical ecologist?
11 A. I don't advertise myself as a
12 clinical ecologist. But according to the
13 definitions that some of your witnesses have
14 given, for instance, Abba Terr, clinical ecologist
15 is anyone who believes there's a condition of
16 multiple chemical sensitivity. Sure. I must be
17 then if that's the definition.
18 Q. Do you take offense when someone
19 calls you a clinical ecologist?
20 A. It depends who it is and what they
21 mean.
2. Finally, at the bottom of TR Vol. 26, p.159, Dr. Sinaiko himself asks for a short break, which he had done periodically during his long 2-day testimony. The record certainly does not bear out Mr. Terrazas’ obviously false characterization of his behavior.
1. There is only an issue of permission to charge subjects for treatment when they actually are subjects in an experimental study.
2. The IRB protocols did not exist until 1994. In 1992, EPD was simply a treatment option. It was not “experimentation” and no “investigational drug” was involved.
3. It is a treatment in use in England and other countries for the past 30 years and all research indicated it was far superior and safer than the usual American allergy shots. (See Appendix A of this document) Doctors using this treatment were trained in it, either in England by Dr. McEwen, or by Dr. Shrader in the U.S. “Experimentation” was not involved.
II. Mr. Terrazas misled the Court by concealing material information
1. Mr. Terrazas produced expert witnesses who opined that the intake information in LTS’ chart was inadequate (these experts never saw the New Patient Form questionnaire).
2. At the very END of the 26-day trial, it was discovered that this multi-page form, which had always been in LTS original chart, had never been copied by the MBC staff. (BOR, Footnote 104; TR Vol.26, p.35) It had not been included in the materials shown to the experts. www.treatmentchoice.org/FIRSTHALF.htm#N_104_
3. When it was discovered that this form was missing (TR Vol.26, p.35), Mr. Terrazas insinuated that Dr. Sinaiko had deliberately withheld this portion of the chart. (TR Vol.26, p.42) This is ridiculous since Dr. Sinaiko would certainly have wanted this information in the record.
4. Even though the New Patient Form questionnaire had been found at the very end of the trial, Mr. Terrazas managed to keep it out of evidence by misleading Dr. Sinaiko that it would be “taken care of” during the break (TR Vol.26, p.35).
5. Mr. Terrazas again wrote in his Closing Brief that “Although she [the mother] testified that she filled out a lengthy questionnaire either immediately preceding or during her first office visit with respondent [Dr. Sinaiko] it is not found in Exhibit 7, the medical records for the patient …” (PCB p. 105)
6. This form was only accepted into evidence and included as part of LTS’ medical chart by special request at the Reconsideration hearing in November.
7. Also withheld from the experts was Dr. Sinaiko’s communications with LTS’ father, and the copy of LTS’ psychological evaluation and report cards provided by the father at Dr. Sinaiko’s request. This information was in evidence, but not with the medical chart. It was far off in State Exhibit 71 and was shown to nobody during the trial except LTS’ father himself, and Dr. Sinaiko on the last day. (BOR, Footnote 104) www.treatmentchoice.org/FIRSTHALF.htm#N_104_
8. It is believed that the experts never saw Exhibit 71. It is known that they never saw the mother’s intake questionnaire (the New Patient Form mentioned above). The experts had to assume that there was no intake questionnaire, that he had not spoken with the father, and that he had not requested or received the psychological evaluation. These assumptions were mentioned in their written opinions as reasons to call Dr. Sinaiko’s examination of LTS inadequate. (available upon request)
III. Mr. Terrazas intentionally misquoted scientific materials
www.treatmentchoice.org/FIRSTHALF.htm#IVB
1. Mr. Terrazas claims (PCB, p.75) that this Mysteclin combination was withdrawn “because of the failure to demonstrate safety and efficacy.”
2. However, the 1984 PDR itself (BOR, Appendix B-13) has a boxed paragraph informing readers that the reason for the withdrawal of Mysteclin is because a National Academy of Sciences panel decided it is “ineffective as a fixed combination … although suppression of growth of monilia may be accomplished …. It is preferable, in the Panel’s opinion, to prescribe antifungal drugs when clinically indicated, rather than to use them indiscriminately as ‘prophylaxis’ …”
3. Not a single word about any SAFETY problem with oral amphotericin B in Mysteclin or alone was to be found in this or any PDR – or in fact, in any literature whatsoever except that produced by Mr. Terrazas and his “experts.”
4. As a matter of fact, the same PDR section further comments, “Given orally, amphotericin B is extremely well tolerated and is virtually nontoxic in prophylactic doses.” Capsules of Mysteclin contained 50 mg amphotericin B.
5. Martindale, The Extra Pharmacopoeia, 30th edition, 1993, (BOR, Appendix B-12) says “Amphotericin is also used orally as 10-mg lozenges or as a suspension containing 100 mg per mL … Doses of 100 to 200 mg are given four times daily by mouth as tablets or suspension to suppress intestinal Candida.”
1. Dr. Terr said the study results were “all over the map.” He did not discuss or name a single study, but simply gave his opinion that diet does not work for ADHD. (TR Vol.4, p.48)
2. Dr. Schultz said he had never reviewed or read any studies about the Feingold diet (TR Vol.7, p.21) though he told LTS’ father to take him off it.
3. Dr. Levin said that the Feingold diet was “broadly dismissed as irrelevant” by his group. Dr. Levin did not recall or discuss a single study on any side of the issue.
4. Dr. Miraglia did not name or discuss a single study, but assured the Court that any studies that supported the diet were badly done. (TR Vol.10 p.32-33)
5. Dr. Diller said that a famous “Dr. Winter” did an “important review” of the Feingold diet. This famous review does not appear in a MedLine search and has not been found. The only other source he named was the 1982 NIH Conference – but he neglected to mention that NIH had concluded that more research was needed and that meanwhile the NIH “…recognizes that initiation of a trial of dietary treatment or continuation of a diet in patients whose families and physicians perceive benefits, may be warranted.”
http://text.nlm.nih.gov/nih/cdc/www/32txt.html
6. Mr. Terrazas claimed (PCB p.86-7) that Dr. Diller was “very knowledgeable” about all the studies including the “disconfirming studies” cited in Dr. Diller’s expert report.
a. Dr. Diller never discussed any of these studies in testimony or his expert report – it is not known from the evidence if he was knowledgeable.
7. Dr. Diller, according to Mr. Terrazas, charitably admitted there were “two peer reviewed studies which provide some very limited support, i.e.; a small number of children under the age of 5, where it appeared that diet could play a small role in behavior.” (PCB, p.87) Although these studies were not named in any testimony or by any State expert, Mr. Terrazas provided them himself, but inaccurately.
a. Mr. Terrazas asserted that the first study was called “Behavioral Responses to Artificial Food Colors,” by James M. Swanson, SCIENCE, Vol. 207, 28 March 1980
i. This is not correct. Mr. Terrazas has “renamed” this study.
ii. The appropriate name for it is: Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test,, J.Swanson, M.Kinsbourne, Science magazine, March 28, 1980, Vol. 207. pp.1485-7
iii. This double blind challenge study showed that 85% of the hyperactive children showed deterioration on a learning test after being challenged with mixed food dyes following a short elimination diet.
iv.
Most of the children in this study were not under age 5.
b. Mr. Terrazas asserted that the second study was called “Synthetic food coloring and behavior: A dose response effect in a double-blind, placebo-controlled, repeated-measures study,” by Katherine S. and Kenneth J. Rowe, The Journal of Pediatrics, November 1994.
i. Mr. Terrazas claimed that Dr. Diller referred to this study as “the Australian Rowe and Rowe study.” (PCB, pg.87) This is not accurate. Dr. Diller did not name the study at all. Dr. Diller did not name this (or any) study. He just said there was a study in Australia. (TR Vol. 11, p.38)
ii. This study showed 75% success with a liberal “Stage 2” Feingold-type diet in 200 children, and a positive dose-dependent effect of double blind challenge with Tartrazine (Yellow #5).
iii. While it is true, as Dr. Diller said, that this was a group whose parents thought the diet might work, they comprised 25% of the entire group of 800 children evaluated for ADHD by the hospital clinic during that time.
iv. Based on testimony that only 50% of children evaluated for ADHD actually do get that diagnosis, (TR Vol. 9, p.17) then the 200 parents who thought diet might work were 50% of the entire ADHD cohort of 400.
a. 200 is not a small group.
b. 75% of 200 is not a small percent.
c. 37.5%+ of the entire 400 is not a small percent.
d. Most of the children were not under 5 years old.
8. Yet Mr. Terrazas brazenly claimed that these 2 studies prove that a maximum of 5% of children with ADHD would respond to diet – and further, they had to be under 5 years old. (PCB, p.87)
9. Since both these studies – and several more – were in State’s exhibits, where he could have and should have read them, this misinformation can only be considered malicious.
1. Dr. Swanson's study, Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test (Exhibit 20), showed that 85% of children who were diagnosed as hyperactive were impaired by a challenge with mixed food dyes. The results of this study clearly indicate a connection between diet and hyperactivity. Dr. Swanson would not have published this study if he had not believed his own results. Obviously, Mr. Terrazas and Dr. Levin had not actually read the research, or were lying. www.diet-studies.com/adhd.html#Swanson
2. Dr. Hagerman’s studies were about the connection of recurrent ear infections in early childhood and later hyperactivity, according to her published work (An Association Between Recurrent Otitis Media in Infancy and Later Hyperactivity,Clin Pediatr (Phila) 1987 May;26(5):253-7). Her work did not extend to other possible causes or treatment of hyperactivity. To claim that Dr. Hagerman's research, which is unrelated to the connection between diet and ADHD, invalidates Dr. Sinaiko's work is disingenuous. He had mentioned her study with a footnote in his review of the literature on ADHD in relation to chronic ear infections, not in relation to diet.
www.diet-studies.com/ear.html#Hagerman87
H. Mr. Terrazas misled the Court by calling EPD a “fraud” and an “experimental” treatment. (PCB, pp.18-24 and elsewhere). He goes into great detail about IRB requirements for “human experimentation” and accuses Dr. Sinaiko of not filling out all the paperwork required for such “experimentation.” (PCB pp.38-46 and elsewhere). However, it must be understood that the data-collecting national IRB-supervised study did not exist in the years in question. It did not begin until 1994 – but the two EPD patients involved in this case were given EPD years before …. At which time EPD was simply another patient treatment option -- and indeed considered by many a safer allergy treatment than classical allergy shots. It was not an experimental treatment. In fact, it was already the only allergy treatment considered safe enough to be given outside a hospital in Britain. It is ridiculous to hold a doctor responsible for the paperwork required by an IRB that would not yet exist for several years ! However, Mr. Terrazas successfully did just that – and misled the Court by relentlessly stressing the IRB requirements that were not met, while ignoring the “calendar” issues.
I. Mr. Terrazas insisted frequently that candida infection of the GI tract cannot cause skin rash or the other symptoms suffered by JH. He produced expert witnesses who agreed with him.
1. He quoted one of them, Dr. Zlotlow (PCB p.181-2) as saying “There is no information from a Medline search that such an etiology has ever been demonstrated for this disease [seborrheic dermatitis or rash].”
a. In a few minutes on MedLine, a 1990 study was found that concluded that candida albicans infection originating from the gastrointestinal tract plays a major role in diaper dermatitis.[3] Diaper dermatitis is a rash. There were 70 other studies in the search results of “rash” and “candida.”
b. It is incredible that none of these “experts” were willing to accept the fact that a classical allergy skin-prick test showed that JH was ALLERGIC to this organism. Allergies also cause rash.
2. Dr. Zlotlow also claimed to be unable to find any information on EPD in MedLine. Perhaps he needs a lesson in the use of MedLine before continuing as a professional “expert.”
Mr. Terrazas’ Closing Brief quotes the witnesses verbatim in great detail – enough to make one wonder whether he has a miraculous memory, or had access to the transcript itself long before it was acknowledged to have been printed. Unfortunately, although he appeared to quote verbatim testimony, much of what he said was skewed and simply wrong, making the witnesses for the Defense look stupid, ignorant, malicious, and devious. Because this was done at a time when neither the Judge nor the Defense had access to the official transcript of the trial, no rebuttals were possible, and Mr. Terrazas was free to invent details to suit himself.
Following are only a few of the hundreds of possible examples of the “surgery” performed by Mr. Terrazas on the testimony:
A. Example: Although the enzyme used in EPD did not require FDA supervision or listing, and was not even a drug according to the State’s own FDA witness, Mr. Terrazas frequently called it an “unapproved drug.” See TR Vol. 3, p.59 where the FDA witness says that Beta Glucuronidase is labeled as a dietary supplement. Then see TR Vol. 3, p.62 where he says that using a food product (here discussing compounding of a banana) for use in allergy treatment by a doctor for his patient would not be subject to the IND (investigational new drug) requirements. In other words, he says that such a compounded material for use by an allergist would not need FDA approval. (see line 13)
- What happened (TR Vol. 20, p.172-179) is that Mr. Terrazas confused her by discussing doctors and students in the same breath, and asking what would happen to a student who initiated human experimentation improperly. She did say he would be “talked to” and repeatedly said that it would depend on the situation, and that it would be looked into. She never said that he would not be disciplined – but that it depended on the situation, and that it would be part of the learning experience. Remember, she was asked about a STUDENT, not a seasoned clinician.
- This is not true. According to the testimony of Dr. Blackwell, (TR Vol. 16, p.101) he sent Dr. Sinaiko patients who had previously had an insufficient workup, who had not been treated adequately by the local doctors, who appeared to be difficult cases, or who had a question of a possible psychogenic v. organic issue. He called Dr. Sinaiko his “last resort.” Mr. Terrazas asked him why he did not consult an allergy specialist in Oakland. He answered “I did in fact use an allergic [sic] specialist in Oakland.” (TR Vol. 16, p.114) He added that he used both that specialist and Dr. Sinaiko. Nowhere was he “unable to articulate” anything.
E. Example: In reviewing the testimony of Dr. Marinkovich, (PCB, p.116-117), Mr. Terrazas says that he reviewed LTS’ chart and that “the MAST test results did not show evidence of a candida infection” and that he (Marinkovich) “does not use oral amphotericin B.”
- Dr. Sinaiko had never said or recorded that LTS had candida. The MAST[4] test showed that LTS had elevated IgG antibodies to aspergillus, cladosporium, and penicillium – all molds against which amphotericin B is active. Dr. Marinkovich (TR Vol.19, p.28) confirms this in detail from the MAST test report – detail entirely left out of Mr. Terrazas’ version. In fact, Mr. Terrazas objected multiple times and made it very difficult for this information to be put in the record, because he kept insisting that the only diagnosis was ADHD and therefore nobody could talk about these fungal allergens. Since there was “no candida” there was no fungal issue for Mr. Terrazas.
- Mr. Terrazas also neglected to say that while Dr. Marinkovich did not use amphotericin B himself, he did say he was familiar with its use orally and believed it was an appropriate medication for LTS. He simply had a different but similar nonabsorbed antifungal medication he liked to prescribe.
F. Example: Mr. Terrazas wrote (PCB, p.141) “Mrs. Jobe testified, somewhat disingenuously, that she does not know Dr. Sinaiko in a social fashion.”
- Here he is calling her a liar because her husband, Dr. Jobe, had testified that Dr. Sinaiko had been to his son’s wedding, and he had been to his house one time. It must be noted here that a woman does not normally call a one-time visit “knowing someone socially” and many doctors get invited to weddings of patients. I invited my son’s doctor to his circumcision, and I talk to him if I see him in the supermarket – but I would deny “knowing him socially.” We are not buddies. This is typical, however, of Mr. Terrazas’ manner of calling almost every one of the Defense witnesses a liar.
G. Example: Mr. Terrazas apparently could not think of a way to discredit Elyse Thalheimer (TR Vol. 26, pp.132-143) so he totally left her out of his lengthy document covering details of all other witness testimony. Although he left out anything that the other witnesses said that was favorable to Dr. Sinaiko, he at least acknowledged their existence (even Mr. Garcia had a sentence or two - see Section J) – but he left all her testimony out as though she did not exist. A former patient of State witness Dr. Terr, her child was cured of severe life-threatening food allergies by Dr. Sinaiko – and EPD. Of course Mr. Terrazas would not want the Court to be reminded of this. He believes EPD should be declared illegal.
1. When asked by Mr. Terrazas (TR Vol. 25, p.154) whether more than 90 percent of the children with ADHD who came to him had some sort of food intolerance, Dr. Sinaiko said “More than half. I'll say 70 to 90 percent.” This is not the same as “greater than 90 percent.” Again, patients who go to allergists usually suspect that they are allergic to something. It is not surprising that they are often right.
2. Dr. Sinaiko is an allergist. The children brought to him have symptoms of allergy. Their parents suspect allergy, and wish them tested for allergy. Not all the children are allergic, but it is not “incredible” that many of them are. Is it “incredible” that a high percent of patients going to see a dermatologist get diagnosed with a skin problem?
1. In the Black Binder was the Samantha Simon Letter which will be addressed in Section IX and X.
2. In the Black Binder was a note by RS claiming that Dr. Sinaiko had given him treatments “without medical necessity.” It is obvious, from his medical chart, that the treatments he received cured his ailments completely. He did, however, have outstanding medical bills of about $2,500 for the 3 years of treatments, and Dr. Sinaiko’s nurse, Trish Miles, 913-782-7211, can verify that he threatened to release his medical records to the Medical Board (at their request) unless he received a “paid in full” bill from Dr. Sinaiko. This does not qualify as a true “patient complaint.”
3. Also in the Black Binder was a note written by SL asking not to be bothered. She had moved to another state years before, and her medical chart contained a friendly note thanking Dr. Sinaiko for the good care he had taken of her. She was not a complaining patient. It is understandable, in light of her diagnosis of paranoid schizophrenia, that she would not want to be approached by anybody questioning anything about her past. This does not qualify as a “patient complaint.”
4. Also in the Black Binder was a copy of the complaint to the FDA written by the non-custodial father of the child LTS. He did not bring his son to Dr. Sinaiko; indeed he could be considered hostile to the whole idea of his son being tested for allergies. Furthermore, he solicited the bogus “child endangerment” letter from Dr. Vreeland for the purpose of making trouble for his wife. Both he and Dr. Vreeland herself acknowledged this. This is not a “patient complaint” and he is not a patient.
5. Also in the Black Binder was a group of pictures of JH. The intent was (TR Vol.27) to illustrate that JH had been a robust healthy athletic man, a rodeo rider, whom Dr. Sinaiko’s evil ministrations turned into a pitiful wreck living in the desert sand with the spiders. It was insinuated that his suicide was Dr. Sinaiko’s fault.
a. This is disingenuous and misleading. The “before” pictures were from many years before JH was ever a patient of Dr. Sinaiko. On JH’s first visit, he complained to Dr. Sinaiko that “everything’s been broken or stepped on at one time or another.” (See his medical chart)
b.Left out of the binder (and left out of Mr. Terrazas’ hypotheticals and briefs) is the information that JH got well and stayed well for years under Dr. Sinaiko’s treatment. After being gone for 3 years, however, he was ill again – much more so – possibly due to reactions to treatment he had undergone for back injury and severe osteoporosis by another doctor.
c. JH did not become this ill under Dr. Sinaiko’s treatment, but rather without it.
d.Left out of this picture by Mr. Terrazas is that JH had again begun to improve, this time with EPD treatment (1992) before he moved out of state to go back to his parents’ home (1993). (See his medical chart) Although Dr. Sinaiko referred him to a doctor who could continue his treatment, JH never went to him. Two years later (1995) he committed suicide, and a few weeks later, the Medical Board asked his parents to release his records.
e. “Doctor” Terrazas diagnoses JH as having a somatoform disorder (which makes the patient think that he is chemically sensitive), in spite of the fact that Dr. Terr, in his position as an expert for the State, actually says it is highly unlikely that JH had somatoform disorder since such patients actually enjoy their symptoms. In fact, Dr. Terr emphatically said “So, I wouldn’t think somataform [sic] disorder would be involved in this at all.” (TR Vol. 5, p.101)
J. Example: Mr. Terrazas misled the Court on the issue of drug compounding in the matter of amphotericin B.
a. When the pharmacist from Oregon, who had compounded the amphotericin B, was brought in to testify, Mr. Terrazas tried to impeach him with a long voir dire, (TR Vol. 20, p. 10-18) going to great lengths to stop him from testifying, arguing that he was not a California pharmacist and therefore could not testify, and objecting to his education, training, etc.
b. John Garcia – a pharmacist in California – testified for the Defense that he would indeed have been willing to compound amphotericin B into an oral capsule in 1993. (TR Vol. 20, pp.84-88)
i. However, Mr. Terrazas does not mention this. In his Closing Brief, Mr. Terrazas writes about the testimony of John Garcia only that Mr. Garcia had said amphotericin B was available “as a bulk drug” in 1993 and that a pharmacy is defined as where “dangerous drugs or dangerous devices … are stored…” (PCB p. 131)
ii. Mr. Terrazas continued to claim that Dr. Sinaiko had not proven that the Oregon compounding pharmacist had met all the FDA requirements of a drug manufacturing plant. It is important to note that the pharmacy was not manufacturing the pills, but simply taking the bulk powder and putting them in a gelatin capsule. This is damaging to the reputations of compounding pharmacists nationwide.
K. Example: Mr. Terrazas wrote (PCB, p.126) that Dr. Pulec – an expert witness for Defense – testified that he “considered mainstream medical specialty associations to be ‘close-minded self-serving majority groups of physicians’ who were ‘commercially self-serving’” etc.
- A thorough word-by-word electronic search of Dr. Pulec’s testimony on CD (TR Vol. 18) led to the conclusion that this statement does not have even one word of confirmation in the testimony. It is an absolute, total, fabrication.
L. Example: Dr. Philip Lee, past U.S. Asst. Secretary of Health, testified that MCS and Chronic Fatigue were diagnoses he would be willing to use, and which he considers “a perfectly acceptable practice.” (Vol. 16, p.47).
1. This was the reason Dr. Lee was invited to testify.
2. Mr. Terrazas did not mention this testimony in his Closing Brief, but rather said that Dr. Lee “has not studied variations of medical practice patterns” – although in the next paragraph, Mr. Terrazas inexplicably also reported that Dr. Lee’s work included “measuring small medical practice variations…” (PCB, p.107).
3. Mr. Terrazas, in an effort to discredit Dr. Lee, also claimed that he “was totally unfamiliar with the allegations against respondent” (PCB, p.107) and in his oral report at the reconsideration hearing, Mr. Terrazas said “With all due respect to Dr. Lee here, when he testified in this case, I asked him specifically, "Have you reviewed the medical records of the four patients in question here?" And he said he had not. So, again, I have no reason to question his capacity for truthfulness. Like the judge said, however, I do have reason to question his capacity for relevant testimony regarding the issues in this case.” (TR Vol.27, p.28)
4. Mr. Terrazas was successful in thus misleading the Court about all the Defense witnesses, because Judge Astle’s decision reported no details but only that “The experts who testified on behalf of the respondent concerning such medical diagnoses as Multiple Chemical Sensitivity, Environmental Illness, Chronic Fatigue Syndrome and Candida Hypersensitivity . . . were of questionable credibility . . “ (Decision, parag. 79) www.treatmentchoice.org/decision.html
1. Actually, what Dr. Lee said was the exact opposite.
a. First, he testified that the “gold standard” – NOT the “standard of practice” – consists of the controlled clinical trials.
b. Second, he testified that the percent of medicine that actually IS based on the “gold standard” and considered “evidence based” is only 15 to 30 percent depending on who is judging it. The rest – 70-85% of the practice of medicine (the “standard of practice”) is NOT evidence-based. (TR Vol.16, p.24)
V. Mr. Terrazas misled the Court by producing inappropriate experts
a. Dr. Sinaiko was not diagnosing ADHD. He was diagnosing allergy.
b. Allergists do not do mental status tests or any of the other behavioral assessments described by Dr. Tepper. Allergists do allergy tests.
1. When this conflict was objected to, Mr. Terrazas said “this does not apply to the office of the attorney general” [TR Vol 4, pg. 124]. Really? If not so, then who would it apply to?
2. By using an expert (Dr. Abba Terr) who is paid by insurance companies to discredit the same type of patient that Dr. Sinaiko sometimes treats – those suffering chemical spills or chemical exposure resulting in hyper-sensitivity to environmental chemicals – Mr. Terrazas selected a witness who is not only obviously biased, but who has a financial conflict of interest.
“Since respondent performed no tests or other examinations to confirm that the patient’s gastrointestinal tract was normal and intact before prescribing this potentially lethal medication, such that the absorption would be negligible, … this conduct is an extreme departure from the prevailing standard of practice.” (PCB, p.167)
1. What they DID clearly establish was that they knew nothing about it and were not qualified to make any such judgment.
- Dr. Terr: TR Vol.4, p. 39
6 Q. Do you know whether California licensed and
7 practicing allergists commonly use EPD in their practice?
8 A. It's hard to say, because I haven't
9 surveyed allergists specifically for this reason. ... The
13 amount of allergen and amount of enzyme is so small, so
14 incredibly small, that it's really almost unacceptable
15 that it could have any physiological effect at all.
Note: That reasoning sounds a lot like those opposed to the Germ Theory not so long ago.
- Dr. Terr: TR Vol. 4, p. 38
27 It [EPD] was devised by Mr. McEwen in England
28 because he had done some tests in animals some years ago
Notes:
(1) This is Dr. McEwen, not Mr. McEwen.
(2) He has done much more than a few “tests on animals.” Those early studies on animals were done 30 years ago. This is not current information, and is misleading. See Appendix A – Research on EPD
- Dr. Schultz: TR Vol.7
The words “E.P.D.”, “EPD”, “Enzyme”, “Potentiated”, or “Desensitization” do not occur anywhere in his testimony. He did not say a word about it in his testimony. But Mr. Terrazas claims that this non-existent testimony about EPD is credible, and that it shows EPD is bad.
- Dr. Zlotlow: TR Vol. 13, p.25
21 Q. Okay. Now, at the time that you prepared
22 this document[5], did you know what EPD meant or stood for?
23 A. No.
24 Q. So did you at the time that you prepared
25 this report try to do anything to educate yourself as to
26 what EPD meant?
27 A. Well, I searched the pharmaceutical
28 databases. I used what I had available at work, which is
1 Martindales PDR and Drug Ex. It's on our computer
2 system. And then I did a Medline search from my commuter
3 at home, and I couldn't find the initials EPD as coming
4 up with an article.
Notes:
1. Why was he looking in a drug index? This is not a drug, but a course of treatment.
2. Somebody should give Dr. Zlotlow a lesson in how to find information. If he had done even the most rudimentary MedLine search, he would have found information to educate himself.
- Using the words “EPD” and “allergy” together elicits 5 studies on EPD.
- Doing a MedLine search of E.P.D. brings up another 2 studies.
- Doing a MedLine search of “Enzyme Potentiated Desensitization” today brings up 15 appropriate studies out of 16 items. Presumably he did not bother to do this.
3. Even if he had found the studies in MedLine, the full text of the studies are not in MedLine – how does reading a few abstracts make somebody into an “expert??”
4. See abstracts of studies on EPD at Appendix A.
VI. Mr. Terrazas misled the Court by misquoting and misreading
from the medical charts of patients
"In addition to the results of the child's 'IgG Food & Mold MAST' [6] testing, ordered by respondent during the initial office visit, being completely normal, it is an inappropriate test for minor patients with a diagnosis of ADHD with no clinical signs of allergic diathesis (persistent rhinitis, conjunctivitis, or asthma).”
There are several parts to this accusation, all of them based on misquoting and misreading from the medical charts and/or testimony:
1. "… being completely normal…” The results of the MAST test were not “completely normal.” On the contrary, they showed unusually high exposure to three kinds of mold (Aspergillus, cladosporium, Penicillium) as well as possible allergy to milk and egg. (BOR Appendix C-2, p.3)
2. “…it is an inappropriate test…” Mr. Terrazas claims that this allergy test itself is inappropriate because it tests for elevated IgG instead of IgE. This single laboratory processed 50,000 such tests per month in 1993 (TR Vol. 19, p.16). Obviously other allergists agreed with Dr. Sinaiko that this is a useful test, even if it is not a favorite of Dr. Terr. Medical literature and testimony (TR Vol. 19, pp.4-122) is in evidence indicating the use of IgG testing and immune complexes in immunology, as well as information on the test itself (TR Vol. 15, pp.8-54) Mr. Terrazas ignored it all.
3. “…with no clinical signs of allergic diathesis …” Mr. Terrazas assumes that the boy LTS had no “allergic diathesis” which he defines narrowly as rhinitis, conjunctivitis or asthma. This ignores the family history of allergy to bee venom, allergy to animals, and the child’s history of eczema.
4. “…for minor patients with a diagnosis of ADHD …” Mr. Terrazas seems to think that there is something unique about a child with ADHD in that he must not be tested for allergies unless he has a runny nose, red eyes, or asthma. Apparently, it is not permissible to test this sort of child just because a mother asks to have him tested, or if he has some other allergic symptoms such as eczema -- which Dr. Vreeland had previously diagnosed in this boy as a chronic condition requiring chronic use of a cortisone cream and being careful about soap and detergent. (See medical chart)
1. Mr. Terrazas says that JH was treated with Nystatin nose spray for “presumed increased candida colonization of the intestinal tract” (Suppl.Accusation p.39) Although Dr. Sinaiko explained to him that the nose spray was part of the treatment for his severe sinus infection, (TR Vol. 26 p.70) Mr. Terrazas kept the original wording. (PCB p.175)
2. Dr. Sinaiko explained that he did not “add Candida immunotherapy” or do testing on October 7, but simply planned – scheduled – allergy testing of Candida, which was done on Oct. 22. (TR Vol.26, p.76) Although Mr. Terrazas changed “immunotherapy” to “testing” he still got it completely wrong, saying that “Candida testing was added” on the October 7 date (PCB p.176)
3. Dr. Sinaiko asked him to include the explanation from the chart that Dr. Felix Kolb had prescribed swimming in a warm unchlorinated pool for the handicapped, as part of his back therapy. Dr. Sinaiko believed that is where JH acquired the parasite he had treated him for. (TR Vol.26, p.87) Mr. Terrazas neglected to include this requested information.
4. Dr. Sinaiko requested that the history of SL in a letter he had written to Dr. Jessop asking for her consult on the case be included because the bare list of symptoms was a “gross oversimplification of a very complicated history.” (TR Vol.26 p.88) Mr. Terrazas ignored the request.
5. Mr. Terrazas did say that he was “just trying to correct what we had in front of the other witnesses.” (TR Vol.26, p.88) He was here admitting that he had the wrong information in front of all the witnesses for 6 weeks.
If the ethics of a Prosecutor require that he search for the truth, then he should not have left out as many items as he did (see below).
Chart of JH: www.treatmentchoice.org/working.htm#JH
Chart of SL: www.treatmentchoice.org/working.htm#SL
Chart of RS: www.treatmentchoice.org/working.htm#RS
a. 102 items were left out of the history of RS including most of his symptoms, making one wonder why he was being treated at all. His improvement upon treatment was also left out. His comment that the Nystatin was “never of benefit” was faithfully reported by Mr. Terrazas, but the fact that every time he was off it for a while his symptoms returned was ignored.
b. 116 items were left out of the history of JH including 2 years when he was doing very well, followed by 3 years when he did not come for any treatment, had a back injury and developed severe osteoporosis, coming back as a sick man – Mr. Terrazas would have us believe that Dr. Sinaiko caused JH’s subsequent illness
c. 90 items were left out of the history of SL including several appointments in which she said she was improving, and an entire year during which the Zovirax (acyclovir) lead to dramatic recovery. Of course Mr. Terrazas had to leave this out – it would have interfered with his charge that the Zovirax should not have been prescribed!!
1. LTS had several side effects of Ritalin including stomach ache, jitteriness, and unexplained bloody noses from “falls at school.” Dr. Sinaiko appropriately called Dr. Vreeland to report this (LTS chart 6/1/93).
a. However, Mr. Terrazas decided to diagnose LTS with “ataxia” [inability to coordinate voluntary muscle movements; unsteady movements and staggering gait, according to Dictionary.com]
b. While “dyskinesia” [An impairment in the ability to control movements, characterized by spasmodic or repetitive motions or lack of coordination, according to Dictionary.com] is a listed side effect of Ritalin in the PDR, “ataxia” is not listed there.
c. Mr. Terrazas apparently made this differential diagnosis himself. He then accused Dr. Sinaiko of negligence for not performing a neurological workup on LTS’ “new” disorder.
i. Dr. Sinaiko is not a neurologist.
ii. Dr. Sinaiko was not the prescribing physician for Ritalin, and fulfilled his responsibilities by informing Dr. Vreeland of the side effects that the boy was experiencing on Ritalin, the drug that she had prescribed.
2. In the case of JH, Mr. Terrazas decided that candida could not cause JH’s allergy symptoms. He said that Dr. Sinaiko was excessively prescribing oral antifungal medication as long-term treatment. He insisted that “candida cannot cause symptoms” and claimed that “candidiasis” or “candida hypersensitivity” does not exist, ignoring the research studies and medical textbook chapters on the subject [Exhibits A-68, I, & others].
a. JH was a man who tested allergic to all sorts of molds including candida. Whenever he had to take antibiotics or steroids (prescribed by a specialist for his back injury and severe osteoporosis), or flagyl (for a documented parasite) he would have a massive fungal overgrowth, severe oral thrush, etc.
b. JH was tested by the classic skin-prick method and was allergic to molds, including candida. Therefore, Mr. Terrazas’ argument that “usual numbers” of candida in the gut cannot cause symptoms (PCB p.183) is akin to stating that the “usual amount” of peanut butter cannot hurt anyone – without allowing that it can kill a person allergic to peanuts.
c. The long-term treatment for JH was intended to keep the internal “normal” fungal contents as low as possible, and other measures were used to avoid external fungi and food containing mold; avoidance is standard treatment for anyone allergic to something. Of course it was long-term treatment -- allergies are a long-term condition. Nystatin, however, can safely be used for the long term because it is not absorbed from the gut. Mr. Terrazas was aware of this, and he was aware of the safety of long term use of Nystatin (Exhibit M) and the fact that hundreds of studies in the medical and research literature relate candida to allergic conditions (Exhibit A-68A)
d. Mr. Terrazas reported in his description of the patient’s treatment, that on November 21, 1988 Dr. Sinaiko had “ordered a MAST test” for patient JH for “increased fungal sensitivity.” (PCB, p.176) A thorough search of JH’s medical chart reveals that a MAST test was never ordered for him at any time. Mr. Terrazas does not approve of the MAST[7] test, so he apparently just invented the episode in order to object to it. JH, back in 1986, was tested with the classical skin-prick allergy tests and was allergic to molds. Apparently, since Mr. Terrazas could not object to a skin prick test, he changed the record to suit himself.
3. In the case of SL, Mr. Terrazas was so out of line that it is hard to know where to start.
a. Mr. Terrazas said that her “only significant physical finding was a slightly enlarged thyroid and rhinitis.” (PCB p.204) He leaves out fever, mouth sores, sore throat, and a long list of other symptoms, many of which were certainly just as “physical.” Mr. Terrazas does not have the medical training to decide which findings were “significant.”
b. From the Reconsideration Hearing transcript: “That sick building syndrome is very similar to the diagnosis of the little female patient in the accusation filed against Dr. Sinaiko.” (TR Vol.27 p. 46) “little female patient?” This apparently indicates SL, the ONLY female patient. Who says she was “little?” Who diagnosed her with “Sick Building Syndrome?” (not Dr. Sinaiko)
i. LS was 29 years old when first seeing Dr. Sinaiko. She presented with abdominal pain, herpes-type mouth sores, muscle pain, fever and fatigue. Laboratory data indicated past infection with Epstein-Barr virus, and a thyroid disorder. Dr. Sinaiko referred her also to a psychiatrist, who diagnosed her with situational depression.
ii. Mr. Terrazas apparently considers himself qualified to re-diagnose her as having “negative” Epstein-Barr titers and “Sick Building Syndrome.”
iii. Mr. Terrazas then concludes that one cannot have chronic fatigue with “negative” Epstein-Barr, and “Sick Building Syndrome” does not exist, so therefore Dr. Sinaiko was negligent. But please remember that this is a DOCTOR TERRAZAS diagnosis, not a Dr. Sinaiko diagnosis. Dr. Sinaiko has many years of medical training and 3 decades of treating patients, with no patient complaints against him. “Doctor” Terrazas’ medical training is unknown.
c. In his closing brief, Mr. Terrazas changed his own original “diagnosis” and wrote that Dr. Sinaiko had actually diagnosed SL with Multiple Chemical Sensitivity, and not Chronic Fatigue. This again is not true according to her medical chart. Although Mr. Terrazas has claimed throughout the documents that all of these are equally “nonexistent diseases,” he used this “change of diagnosis” to deny the relevancy of Dr. Jessop’s expert testimony for the Defense, since her area of expertise is Chronic Fatigue Syndrome rather than Multiple Chemical Sensitivity. (PCB p.210)
d. Dr. Sinaiko had consulted with a top researcher on chronic fatigue, who recommended Zovirax, which looked like a promising drug at that time. Besides Epstein-Barre titers showing previous exposure, the herpes-like sores on her mouth would convince most physicians today to prescribe an antiviral medication, and Zovirax (approved for genital herpes and commonly used off-label for oral herpes virus sores) is commonly used for it.
e. LS got better with the combined treatment for thyroid dysfunction, depression, and the antiviral medication. Her response to Zovirax was in fact extremely dramatic; she was soon without pain or sores, was able to exercise in the gym and was preparing to re-enter the work force. (see medical chart) This was not reported in the Terrazas version of LS’ history.
f. Mr. Terrazas quoted Dr. Terr’s opinion that Dr. Sinaiko’s “use of provocation neutralization testing is a departure from the standard of care.” (PCB 204) Whether it is or is not a departure – the fact is that Dr. Sinaiko did not use this treatment.
4. In the case of RS, Mr. Terrazas derided both the EPD protocol which calls for pre-treatment with antifungal medication and a later (unrelated) lab report indicating an infection for which antifungal medication was indicated. He still insisted that all prescription of antifungal medication was not appropriate. Also, while he never did actually say that allergic fungal sinusitis “did not exist,” Mr. Terrazas claimed that treatment of it with the systemic antifungal medication Diflucan was excessive.
a. Dr. Sinaiko did have lab proof of fungal infection but, according to Mr. Terrazas, was still wrong for treating patient RS.
b. RS suffered from allergic fungal sinusitis, (see his medical chart) and was treated repeatedly with a combination of prednisone and Diflucan – this is correct treatment, but he relapsed and treatment had to be repeated until EPD took care of the problem permanently.
i. However, Mr. Terrazas claimed that the use of Diflucan for 30 day periods was “excessive” in spite of the fact that this is the exact recommendatiion in the PDR – and indeed, the PDR warns against prescribing it for too short a time because of likely relapse.
ii. The PDR says: “An inadequate period of treatment may lead to recurrence of active infection.” Although symptoms may go away after a few days, it further says that “treatment should be continued for at least 2 weeks to decrease the likelihood of relapse.” (PDR 1992, p.1950)
iii. Further, the PDR says that “treatment of infections other than vaginal candidiasis should be based on the infecting organism and the patient’s response to therapy.”
iv. This is a systemic well-absorbed antifungal medication, which is why it was useful for fungal sinusitis, as opposed to Nystatin which is not absorbed and therefore more useful for the pretreatment of the GI tract itself during preparation for EPD.
5. Per Mr. Terrazas, if there was no lab test showing “excessive” candida (SL, JH), then Dr. Sinaiko was “treating an unproven condition”; but if there WAS a lab test showing “a proven condition,” (RS) Dr. Sinaiko still should not have prescribed antifungals. It appears that, per Mr. Terrazas, it is never appropriate to prescribe antifungal medication. Please note, Mr. Terrazas is not a doctor, and none of the experts called by him had any expertise in treating any fungal conditions.
6. Mr. Terrazas’ knowledge of any fungal condition and their treatment can be illustrated best, perhaps, by his statement about amphotericin B at the Reconsideration Hearing:
27 It was approved in 1996 in an oral swish and
28 swallow or in a swish and expectorant form for a single
1 life-threatening condition, oral candidiasis flush [sic]
2 usually for severely immune compromised patients, AIDS
3 patients, leukemia patients, chemotherapy patients,
4 severe burn patients.
a. It is a swish and swallow medication – expected to be swallowed. He added the “expectorant” himself.
b. The medication is labeled for use in thrush – candidiasis of the mouth, common in babies as well as AIDS patients.
c. This is NOT a life-threatening condition. On the contrary, it is a local, minor condition.
d. No pre-testing is required to make sure that the gut is intact or anything else.
e. Studies have been done on pediatric patients, including premature infants, and in fact the same dose is used regardless of age.
f. None of the dread renal and organic reactions Mr. Terrazas has spent so much time on are even listed in the PDR. The ONLY adverse reactions listed for oral amphotericin B in the 1998 PDR (p.743) are:
i. Rash, GI symptoms, including nausea, vomiting, steatorrhea (floating stools), and diarrhea have been reported
ii. Rare occurrences of urticaria (rash), angioedema (hives), Stevens-Johnson Syndrome (a rash) and toxic epidermal necrolysis (flaking skin, e.g. dandruff) have also been reported.
7. Not only did Mr. Terrazas “diagnose” Dr. Sinaiko’s patients himself, but he then complained that these diagnoses are illegal. Whether diagnoses of MCS (Multiple Chemical Sensitivity) and CFS (Chronic Fatigue Syndrome) should be acceptable or not is a point of dissention in the medical community, but apparently Mr. Terrazas has already made the decision for everybody. He, himself, diagnosed the patients, complained that the diagnosis was illegal, credited it to the doctor and argued for punishment. Alice in Wonderland could not have done it better.
VII. Mr. Terrazas misled the Court by making inappropriate
assumptions as to the aim of therapy
1. Again and again, with various “expert” witnesses, he led them to say that allergy testing was not the appropriate way to diagnose ADHD – yet Dr. Sinaiko never claimed to be diagnosing ADHD … he was at all times diagnosing possible allergy. That the mother was hoping such an allergy may explain the boy’s problems, is not relevant. The boy either did – or did not – have any allergies, and indeed the tests pointed to several.
2. Mr. Terrazas was successful in his efforts – Judge Astle concluded in her Decision (www.treatmentchoice.org/decision.html) that allergy testing was not “a valid diagnostic test for a minor patient with a diagnosis of ADHD.”
1. He asked his expert psychiatrists if allergy treatment or antifungal treatment was in the standard of practice as “treatment for ADHD.”
2. Again, Dr. Sinaiko never claimed that using amphotericin B was for treatment of ADHD. Indeed, it was part of the diagnostic effort. (TR Vol.25, p.77) The child had shown high antibodies to cladosporium, penicillium and aspergillus – all molds against which amphotericin B is active.
VIII. Mr. Terrazas cited as authority a decision that had been
overruled or a statute that had been repealed
1. Dr. Sinaiko never was and still is not a clinical ecologist. He is Board certified as a clinical immunologist (allergist) and an internist.
2. To “prove” that clinical ecologists are bad doctors, Mr. Terrazas introduced into evidence and encouraged Dr. Terr to testify about a document that had already been withdrawn six years earlier. This was the 1985 California Medical Association (CMA) Medical Practice Opinion concerning clinical ecology. (TR Vol. 4, pp.55-58; PCB p. 5)
3. The letter documenting the change of position is dated October 11, 1995, from Lise Dyckman, at the library of the California Medical Association, to Ken Crispin regarding “CMA’s [old] policy on clinical ecology”
It reads:
“As discussed in our pleasant phone conversation earlier today, the California Medical Association has no current policy or position statement with respect to clinical ecology.
“More specifically, CMA’s medical practice opinion concerning clinical ecology was withdrawn more than two years ago, and is no longer in effect. The paper “Clinical Ecology – a Critical Appraisal” (reprinted in the Western Journal of Medicine 144:2), which details a task force hearing that reviewed the scientific evidence in April 1985, is now considered as a historical informational document only.” (emphasis added)
4. Mr. Terrazas was aware of the fact that it had been withdrawn because the letter explaining the withdrawal and the fact that this document is now only for “historical information” was in Respondent’s exhibits as Exhibit No. A51. While this exhibit is not officially in evidence, nevertheless, it was visible to him. Even without it, he should have known if the policy statement he was quoting was still valid.
5. Neither Dr. Terr nor Mr. Terrazas acknowledged in discussing this position paper that the CMA had changed their position.
IX. Mr. Terrazas inappropriately introduced into evidence
materials that had been barred from consideration by a
previous Judge
(www.treatmentchoice.org/docs/C.html)
G. Detailed annotation on the Samantha Simon Letter can be found in Appendix B. The 16-page letter itself is available on request. Its importance lies not in the (false) information it contains, but in the fraudulent impression it gave to the Court.
X. Mr. Terrazas colluded with another to deceive the Court
XI. Mr. Terrazas’ behaved inappropriately by using slander
According to the ethical duties of a Prosecutor,[8] he must, in particular, “exercise the utmost professionalism as he or she is in the position of demonstrating ideal social behavior for others to follow.” Please consider whether the behavior of this Prosecutor is what you would recommend for others to emulate.
B. Mr. Terrazas slandered Dr. Sinaiko’s patients both in his opening statement (p. 7; TR Vol.1, p.41) when he referred to them as “alienated people – many of whom are paranoid…” and in the Hearing on Reconsideration when he tried to show the movie “Bad Chemistry” so that the Panel could see the “patient population that he treats with these exotic treatments for these exotic diseases.” (TR Vol. 27, p.41)
C. Mr. Terrazas frequently called Dr. Sinaiko a “clinical ecologist,” a title he deemed applied to doctors practicing “pseudoscience” (TR Vol.1, p.38). Per Mr. Terrazas, clinical ecologists tend to use antifungal medications for a range of symptoms and to prescribe special diets.
What the record says: (TR Vol. 25, p. 152, lines 10-14)
10 Q [Terrazas] Okay. There are other locations in the records
11 where you describe yourself on these same forms as a clinical
12 immunologist. Is that a variation of the word clinical
13 ecologist?
14 A [Sinaiko] No. I'm Board certified in clinical immunology.
D. Mr. Terrazas further maligns Dr. Sinaiko by calling him “evasive when asked whether he practiced environmental medicine…” (PCB p. 151)
What the record says: (TR Vol.25, p.152, line 18- p.153, line 6)
(When Dr. Sinaiko bought the practice from the previous doctor, he used some of the old doctor’s forms, and changed letterhead and forms several times until he settled on the ones he liked)
18 Q [TERRAZAS] Here I'm specifically referring to Exhibit 25, your
19 medical records for James Hawkins, Pages 56 through 62, 64
20 through 67, 69 through 71, Dr. Sinaiko. As for patient Reed
21 Settlemeyer, 2 through 7, 9, 11, 12, 14 through 17. It was
22 just a name change?
23 A [SINAIKO] You know, if you want to say that I was using one
24 piece of paper for a while and using another piece of paper,
25 that's fine.
26 Q You like the words environmental medicine. What
27 does environmental medicine mean?
28 A It just means careful attention to the
1 environmental history and environmental events. It's
2 something that allergists are trained to pay attention to.
3 Q Not all allergists use that designation, do they?
4 A The good ones do. Designations are just
5 designations. I don't claim to be an expert on how they are
6 used.
(Mr. Terrazas’ Opening Statement begins at TR Vol. 1, pg. 36 and can be seen
also at www.treatmentchoice.org/Hear1.html )
1. Mr. Terrazas began by “defining terms” in a prejudicial manner. First, without any proof, he leapt to the conclusion that Dr. Sinaiko practices “alternative medicine.” (TR Vol. 1, pg.36) This also is untrue.
2. Mr. Terrazas then introduced his concept of “alternative medicine” with no factual basis, as follows:
"Before beginning, I believe that it is important that a working knowledge of the lexicon or the jargon of the "alternative health" approach to medicine is in order. (TR Vol.1, p.36)
. . .
"Methods that are not based on established scientific knowledge have been called many things. Their critics most often choose among unproven, unconventional, unorthodox, unscientific, non-scientific, questionable, dubious, cult, faddism, fraudulent, quack and quackery. (TR Vol.1, p.36)
. . .
"Many promoters of quackery (i.e., Dr. Sinaiko) are true believers, zealots, and devotees whose real problem is the failure to apply skepticism to the favored therapy, very much like the religious fanatic who blindly accepts the faith. Their apparent sincerity and self-confidence help persuade people to try their methods and discourage those who become disillusioned from trying to seek justice." (TR Vol. 1, p.41)
3. Mr. Terrazas defines words he claims relate to “alternative medicine” – again, with no factual basis, and in an attempt to prejudice the Court. “Quackery, Fraud, Unscientific, Non-Scientific, Cult, Faddism, Unproven” are words he claims define “alternative medicine.” He informs the Court that other words such as Unconventional, Unorthodox, Non-traditional, or Holistic are “falsely used” by proponents of “alternative medicine” thus insinuating that these would be terms used by Dr. Sinaiko.
4. At no time did Dr. Sinaiko claim to be using “alternative medicine” or attempt to describe himself as holistic, unconventional, non-traditional, or anything similar. Nor did Mr. Terrazas ever show any evidence that Dr. Sinaiko practiced “alternative medicine.” In other words, whether or not one likes “alternative medicine,” Dr. Sinaiko wasn’t doing it.
5. Every single treatment employed by Dr. Sinaiko has backing in the legitimate mainstream peer reviewed scientific literature. In some cases, he was in touch with the research scientists (e.g., Dr. Jessop) before their research was published.
6. Throughout his presentation, and in all his briefs, Mr. Terrazas used slurs and name-calling just like someone would make racial or ethnic slurs, to label and thus prejudice the Court against Dr. Sinaiko and all his witnesses: The following are some examples:
"Aggressive Loose Cannon" (AOR, p. 16)
"Akin to a religion" (AOR, p. 14)
"A 'victim'" (AOR, p. 18)
“Belligerent” (PCB, p. 151)
"Bogus" (AOR, p. 15)
"Controlling" (AOR, p. 18)
"Cult-like beliefs" (AOR, p. 14)
"Endangers the public" (AOR, p. 18)
“Evasive” (PCB, p. 151)
"Grandiose" (AOR, p. 16)
"Guilty of health care fraud" (AOR, p.17)
"Has persecutory delusions" (AOR, p. 17)
"He will 'mutate his practice into some other form of quackery'" (AOR, p. 17)
"History of defying rules" (AOR, p. 18)
"Incorrigible" (AOR, p. 15)
"Insidious" (AOR, p. 22)
"Looks for 'holistic' approaches" (AOR, p. 17)
"Manipulative" (AOR, p. 18)
"Mumbo-jumbo" theories (AOR, p. 14)
"Perpetrating a 'cruel and profitable hoax'" (AOR, p. 13)
"Petulant" (AOR, p. 19)
"Phony treatments" (AOR, p. 17)
"'Preys' on desperate people" (AOR, p. 14)
"Promotes bogus illnesses (chronic fatigue syndrome and multiple chemical
sensitivity)" (AOR, p. 17)
"Pseudoscience" (AOR, p. 14)
"Quack" (TR Vol. 1, pp. 40,41)
"Quackery" (TR Vol. 1, pp. 40, 41)
"Quack Theory" (TR Vol. 1, p. 47)
"Selling a bogus treatment" (AOR, p. 14)
"Sophist" (AOR, p. 19)
"Suffers from delusions, paranoia, grandiosity" (AOR, p.16)
"Uses 'junk science'" (AOR, p. 23)
"Uses patients as 'experimental subjects'" (AOR, p. 13)
"Voodoo medicine" (AOR, p. 14)
7. Mr. Terrazas continuously used terms such as disingenuous, and sophistry to smear the witnesses for the Defense, as an attempt to discredit them without bothering with facts. (PCB, p. 127)
8. Mr. Terrazas said, about a video tape he wanted to show during the Hearing on Reconsideration, “Dr. Sinaiko and Dr. Robert, [sic] who all the people have indicated is the evil personified with regards to the opinions that he holds, they both appear on the tape.” (TR Vol. 27, p. 44) Presumably, he meant Dr. Abba Terr, since there was no “Dr. Robert” involved in the case at all. Who are “all the people?” Who is “evil personified?” Surprisingly, nobody asked.
XII. Mr. Terrazas broke his promise to all patients that their
names would be confidential.
1. However, all their names WERE revealed in some of the transcripts, and in Mr. Terrazas’ Closing Brief, which are of public record.
2. Patient confidentiality promises by the State to all patients, including the 9 year old child, were thus breached.
XIII. Mr. Terrazas violated the ABA Code of Professional
Responsibility, EC 7-13
“Thus a prosecutor's duty of neutrality is born of two fundamental aspects of his employment, First, he is a representative of the sovereign; he must act with the impartiality required of those who govern. Second, he has the vast power of the government available to him; he must refrain from abusing that power by failing to act evenhandedly. These duties are not limited to criminal prosecutors: "A government lawyer in a civil action or administrative proceeding has the responsibility to seek justice and to develop a full and fair record, and he should not use his position or the economic power of the government to harass parties or to bring about unjust settlements or results." (Id., EC 7-14.)”
A. We have shown in these pages the lack of neutrality and impartiality of Mr. Terrazas, the Prosecutor.
B. Toward the end of his 272-page Closing Brief, he apparently got tired of even pretending to follow the rules, and flew off on a whimsical tangent with no factual support whatsoever – not even make-believe support.
1. He writes (PCB, p.247) that Dr. Sinaiko “becomes very much like a ‘pied piper’ leading the unwary and unsuspecting to the edge of the cliff where his patients, almost like dreamlike lemmings, take the ‘leap of faith’ into the abyss of ‘quack’ diagnoses and ‘faddish’ modalities that invoke the ‘holistic’, thus ‘better’ and ‘environmentally correct’ approach to healing.”
2. He writes next that the Medical Board of California must “put an end to ‘voodoo medicine’ masquerading as a ‘reasonable substitute for orthodox care’.”
3. He then goes on for several paragraphs calling clinical ecology a cult-like belief akin to a religion.
4. On p. 249, Mr. Terrazas claims that Dr. Sinaiko “views himself as a romantic ‘Irascible Renegade.’” He says “This ‘benign rouge’ self-perception was demonstrated multiple times during the administrative hearing where respondent described himself as being ‘persecuted’ because of his ‘cutting edge’ and ‘Galileo’ approach to treating allergic causes for ADHD and Candida Hypersensitivity Syndrome.”
a. Dr. Sinaiko never claimed in the Testimony or other documents that he was persecuted by others in the medical field.
b. Neither the word “cutting” nor the word “edge” even occur anywhere in the entire 2 volumes of Dr. Sinaiko’s testimony. (TR Vol.25; Vol.26)
c. Dr. Sinaiko never described himself as having a Galileo-approach to anything. Dr. Jessop – a witness for the Defense – did liken him to Galileo during her testimony, but he himself never did or would.
5. Mr. Terrazas writes next that “During the course of the administrative hearing respondent’s testimony respondent’s thought processes displayed him as an impulsive, branching, tangential, grandiose, hyperverbal person who, on many occasions, would skip points and was hard to follow.”
a. Those who have ever heard Dr. Sinaiko speak agree that he is a thorough, careful, quiet, speaker – the quintessential professor. He sometimes can be too technical for a layman audience, but for those with any background in medicine or biology he is very clear and easy to follow. He does not tell jokes and is not particularly amusing as a conference speaker, but is asked repeatedly to speak at conferences because of his great knowledge and logical presentation.
b. For reasons unknown, the Court Reporter during the first day of his testimony (TR Vol. 25) made numerous errors, some of them of fantastic proportions, making the sentences “hard to follow” indeed, and changing what he said radically.
i. A list of these errors was included as Appendix F in the Respondent’s Brief on Reconsideration.
ii. Random examples of transcription errors would be using the word “inclusions” instead of “conclusions,” (TR Vol.25, p. 31 line 4) or (worse) the alarming statement “I like most Amphotericin in the intravenous form. Let’s reassure you that this is a very safe medication when given orally.” This is a transcription error. What he actually and obviously said was “UNLIKE most Amphotericin in the intravenous form, let’s reassure you that this is a very safe medication when given orally.” (TR Vol. 25, p. 43, line 6)
6. Soon, Mr. Terrazas gets really revved up, and writes:
“Like a “rogue” general, “storming” Dr. Sinaiko had a new toy, oral “Ampho-Toxin B”, pharmacological plutonium, in his arsenal. He felt compelled on using a tactical thermonuclear device (Amphotericin B) on a “sick” patient (the non-emergency ADHD) …
“However, the real “new” weapon in his armamentarium bag of tricks was EPD. This “new” weapon was better than a “thermonuclear” device because it destroyed the “colonization” without destroying the shell of the building, much like a “Neutron” bomb. Yet, the new “Neutron” bomb wouldn’t work unless the “preparatory plutonium” (anti-fungal medication) was used to “pave the way” for the ultimate weapon, EPD…”
By Page 251, “Doctor” Terrazas is diagnosing Dr. Sinaiko, using terminology reminiscent of communications by Northington:
“Dr. Sinaiko maintains a persistent, nonbizarre delusion and paranoia of the grandiose type. He is convinced that he possesses some great, but unrecognized, talent or insight in the field of allergy and/or immunology, or that he has made some important discovery that no one else has made. This delusional state also has elements of jealousy associated with it that makes him highly confrontational to his professional “peers” and which then serves to justify the persecutory delusion which he also harbors such as being conspired against by the entire medical community and maliciously maligned, harassed or even much obstructed in the pursuit of his long-term goals of expanding the field of allergy and/or immunology medicine.”
It is important to note, here, that nowhere in the testimony or any other documents has Dr. Sinaiko claimed to discover any new treatment, or to possess any talent nobody else has. His patient treatment is always based on the science and clinical experience as well as training – just like all good doctors. He has never in any document or volume of testimony claimed he was conspired against nor has he ever appeared confrontational to his peers (indeed they lined up begging to testify on his behalf – including Dr. J. Brostoff, editor of the medical textbook Food Allergy and Intolerance, who offered to come from England at his own expense.) However. Dr. Sinaiko has, with good reason, objected to having his medical charts reviewed by doctors from unrelated specialties.
In his effort to influence the Judge to revoke Dr. Sinaiko’s license, Mr. Terrazas stresses that Dr. Sinaiko showed no “remorse” and did not admit he was wrong. He wrote, among other things:
… the real problem is the “salesman”; i.e., you can take aluminum siding away from an aluminum siding salesman, but what’s to prevent him from getting a job selling used cars.
In the present case, if respondent is merely prevented from employing specific treatment modalities, i.e.; EPD, his long term past patient diagnosis and treatment history and total lack of insight into the wrongfulness of his actions coupled with his total lack of professional medical judgment will only cause him to mutate his practice into some other form of quackery.
Mr. Terrazas lists several “quack” medical treatments he is sure that Dr. Sinaiko would begin to use, and then passes on to discuss types of punishment he recommends.
XIV. Mr. Terrazas misled the court by attempting to show “guilt by
association”
1. To help LTS’s mother implement the commonly used elimination diet to diagnose sensitivity to milk, wheat & eggs (which were suspected), Dr. Sinaiko gave the mother a standard diet sheet from Halter Steer which is a division of Cutter Laboratories in Berkeley. Dr. Randolph was one of the authors of this document. (TR Vol.26, p.174)
2. Before coming to Dr. Sinaiko, SL had been treated by Dr. Randolph.
3. Mr. Terrazas writes that “It is noteworthy that Dr. Randolph’s name appears in the medical records of two of the four patients identified in the allegations against respondent.” (PCB, p.8) Then he gives the above details. This is part of his “proof” that Dr. Sinaiko himself is a “clinical ecologist.”
1. Perhaps this is the basis for his “re-diagnosis” of all Dr. Sinaiko’s adult patients as having Multiple Chemical Sensitivity.” However, just because the symptoms “sound” similar to the layman does not mean they are right.
2. Not all people who throw up have the flu. Some have brain tumors. Some have other illnesses – including the psychological illness bulimia. This is why we need specialists. If it were so simple, we could all simply ask “Dr.” Terrazas.
1. Mr. Terrazas claims that Dr. Sinaiko lied …. That he “disingenuously represented that it was Benjamin Feingold, M.D. as his mentor who “taught” him his approach… when in truth and in fact, it was another “Clinical Ecologist”, Joseph McGovern, M.D., who was his true mentor.”
2. In recalling his takeover of Dr. McGovern’s practice, Dr. Sinaiko recalls that he was pleased that Dr. McGovern’s nurse/secretary would continue to work with him because she was efficient and good with the patients.
a. While he “inherited” some of Dr. McGovern’s patients, he was more interested in the tables, exam beds, and office setup.
b. Dr. McGovern retired and shortly thereafter died of cancer. He did not “mentor” Dr. Sinaiko.
c. Apparently, according to Terrazas, using the tables and chairs of a “clinical ecologist” makes one automatically also a clinical ecologist.
d. Those of you who wish to practice medicine without bothering with medical school, take notice: all you have to do is buy the office furniture of a doctor in the specialty you fancy.
1. This is bizarre because neither Dr. Jessop nor Dr. Sinaiko treats cancer – not by any therapies, “alternative” or otherwise.
2. Terrazas apparently believes that by simply saying the names of treatments others will recognize as discredited treatments, in the same sentence with the names of those he wishes to discredit, the deed is done.
3. Ironically, the Gerson Cancer Treatment is the subject of intensive study by the NIH because people with pancreatic cancer who try it live longer than anyone else with that type of cancer.
XV. Mr. Terrazas took advantage of the naiveté of the
Respondent and his Defense Counsel
C. In a deceitful attempt to avoid the above criticism, Mr. Terrazas wrote, “Dr. Sinaiko was taken paragraph by paragraph through the written hypothetical summaries … and with very minor corrections and changes, agreed with the factual representations.” (PCB p.149)
1. Mr. Terrazas neglects to say that he did this on the last day of testimony, (TR Vol.26, p.7 on) which means that throughout 6 weeks of testimony, the hypotheticals were used with their errors intact. They are today still incomplete and misleading.
2. Mr. Terrazas never clarified to Defense what a “hypothetical” actually is. Defense attorney Nancy Cahill had never before been in court. Because of the misleading terminology “hypothetical,” both she and Dr. Sinaiko assumed that there were no rules about what could be in or left out of a hypothetical. They did not understand that these were used as the stories of the cases, upon which experts were giving their opinions, and that therefore errors of omission (as documented in the section on misreading the patient charts) were as important as errors of commission.
3. After 26 days of testimony, Dr. Sinaiko still did not understand the use of the hypotheticals, and said “I thought hypotheticals is just a hypothetical. You can put anything on a hypothetical, can you not?” THIS is why he never objected to their incompleteness and inaccuracy.
4. Following is the first part of the review of the hypotheticals, which will clarify how very much in the dark the Defense was on this:
TR Vol. 26 p.11
16 Q. [TERRAZAS] Okay. Doctor, we -- or at least
17 I -- have used hypotheticals during the course of
18 these proceedings that have been in writing. Do
19 you recall those?
20 A. [SINAIKO] Yes.
21 Q. Okay. And you have seen those?
22 A. I have.
23 Q. Okay. I'd like to go through some
24 of them with you to see where we have agreement
25 and -- or perhaps not agreement. Can I place
26 before you a copy of what has previously been
27 marked as Hypothetical No. 1 having to do with
28 Travis Sutton?
. . .(comments re exhibit numbers) . . .
14 Q. Okay. Do you agree or disagree with
15 Paragraph No. 10?
16 A. This is a hypothetical. I don't
17 understand the question.
18 Q. Well, it was presented as a
19 hypothetical. Based on your review of your
20 medical records, Dr. Vreeland's records -- you
21 have reviewed those, have you not?
22 A. I don't understand what you're
23 asking me.
24 Q. Based on your review of the medical
25 records, is this hypothetical accurate?
26 A. I thought hypotheticals is just a
27 hypothetical. You can put anything on a
28 hypothetical, can you not?
1 Q. Doctor, I'm asking you whether or
2 not Paragraph No. 10 conforms with your
3 understanding of the accuracy of your records,
4 Dr. Vreeland's records, Dr. Schultz's records, and
5 Dr. Levin's reports.
6 THE COURT: All right. Doctor, you
7 have to answer, "I don't know," or "I can't answer
8 the question," or "Yes" or "No."
9 THE WITNESS: Thank you, Judge. I
10 can't answer the question.
By these diabolical means, Mr. Terrazas has won a political victory – he “got” the doctor – but this has nothing to do with good medicine. The real victims are the patients who will never receive the care they need from Dr. Sinaiko because he did not know how a “hypothetical” works, and because he was unequal to the task of fighting the clever dishonesty of which Mr. Terrazas is master.
[1] 1998 PDR, p. 742. “…amphotericin B, an antifungal polyene antibiotic obtained from a strain of Streptomyces nodosus. Amphotericin B is designated chemically as …. Fungizone Oral Suspension is a flavored aqueous suspension providing 100 mg amphotericin B per mL. Inactive ingredients …. Amphotericin B exhibits antifungal activity by binding to sterols in the cell membrane of susceptible fungi with a resultant change of membrane permeability allowing leakage of intracellular components … The antibiotic is without effect against bacteria, rickettsiae and viruses.” “…is poorly absorbed from the gastrointestinal tract.”
[2] Martindale 1993, p.317. “Amphotericin is a polyene antifungal antibiotic which appears to act mainly by interfering with the permeability of the cell membrane of sensitive fungi by binding to sterols, chiefly ergosterol…. It is inactive against bacteria, rickettsias, and viruses.”
[3] Relation between the intestinal flora and diaper dermatitis in infancy,
Gokalp AS, Aldirmaz C, Oguz A, Gultekin A, Bakici MZ
Trop Geogr Med 1990 Jul;42(3):238-40
[4] The MAST test is a blood test which measures levels of IgG antibodies. Although IgG is present normally, there are “normal” levels, “low” levels, and “elevated” levels just like in many normal components of the human body. Absent IgG is often found in patients who have anaphylactic reactions to allergens. Elevated levels indicate an exposure to an allergen resulting in immune complexes. While IgE antibodies are often measured in allergy testing, especially by doctors who favor skin prick testing, some patients with allergy will convert to make IgG at a rate of 100,000 times that of IgE, which can then not be detected. (TR Vol.19, p.88) IgG is considered by those familiar with its use to be the more sensitive test. Elevated IgG levels to foods are usually followed up by a diet eliminating these suspected foods to confirm the diagnosis.
[5] The document was his review of Dr. Sinaiko’s charts and materials.
[6] See Footnote #4
[7] See Footnote #4
[8] The Ethical Duties of Prosecutors, Section IV of “What Is A Prosecutor???” by California District Attorneys Association. In first section of this Complaint.
[9] EIE is Idiopathic Environmental Illness, aka Multiple Chemical Sensitivity