testified that he attended a meeting during which dr. cotter orally reported that his testing reached results similar to those reported by uhlmann.: 56 however, he also acknowledged that this lab never published sequencing data, which is in line with the fact that the uhlmann paper does not mention the sequencing process.: 57 retired pediatric neurologist marcel kinsbourne testified that michelle was developing normally until december 20, 1995, when she was vaccinated with the mmr vaccine, and that the fever and rash she experienced shortly thereafter was caused by this vaccine. he also testified that michelle had regressive autism, and that "since michelle has experienced both chronic gastrointestinal problems and the chronic neurologic disorder known as autism, the most reasonable conclusion is that a single causative agent--i.e., the vaccine-strain measles virus--is the cause of both chronic conditions.": 86 opposing arguments one of the key lines of evidence presented by the cedillo family was that michelle was developmentally normal before she received the mmr vaccine. this, they claimed, was evident from videos taken of her when she was 6 to 8 months old. however, eric fombonne testified that michelle "... displayed early signs of autism clearly visibly on family video taken prior to her receiving the mmr vaccine." thimerosal, a preservative formerly used in vaccines. the plaintiffs claimed that vaccines containing this preservative could cause immune system dysregulation based on a number of in vitro studies, an argument which was refuted by some of the government's witnesses. jeffrey brent, the past president of the american academy of clinical toxicology, was invited to testify about the potential role of thimerosal-containing vaccines in triggering michelle's autism. he stated that "there was not a single study indicating that any form of mercury could cause serious neurological symptoms in the dosages that were used in vaccines" and criticized aposhian's use of in vitro studies and his equating them to what happens in the actual animal, arguing that "the exposure to a cell in a petri dish was far more likely to cause damage than an equivalent dosage in a living system." with regard to specific in vitro studies, brent argued that the goth study was flawed because it tested thimerosal on mouse cells, not human cells; because these cells were exposed not to ethylmercury, as the human body would be after receiving a thimerosal-containing vaccine since thimerosal is quickly metabolized to ethylmercury, but to thimerosal itself, and because the cells were exposed to far higher concentrations of thimerosal than could ever occur as a result of the administration of thimerosal-containing vaccines. brent highlighted similar problems with the agrawal study, noting that the cells in that study, like those in the goth study, were exposed to thimerosal, not ethylmercury, and to much higher doses than found in vaccines.: 26 he also examined the bradstreet and geier study and the holmes study, noting that "much better studies from other investigators could not replicate the results of either the holmes study or the bradstreet/geier study," citing two other peer-reviewed papers which had concluded that hair mercury levels were not significantly different between study participants with autism and controls,: 2354 as well as a study which had concluded that children with autism had no chelatable heavy-metal body burden whatsoever.: 2360 brent also pointed out that, like another of bradstreet's studies, the bradstreet-geier study had been published in a non-indexed journal, the journal of american physicians and surgeons, which he described as "very much of a fringe journal with lots of alternative agendas, and it's not even indexed by the national library of medicine.": 2360 brent concluded by testifying that thimerosal could not have degraded michelle's immune system to the extent that when she was vaccinated with mmr nine months later, it caused brain damage, saying "that couldn't possibly be the case." in the second set of the proceedings, which pertained to thimerosal alone (as opposed to thimerosal working in conjunction with mmr), brent testified, with regard to jordan king and one other child with autism who also served as a test case in this trial, that there was "absolutely no reason to chelate them for any mercury-related reason." many of the plaintiff's experts also relied on the reported detection of measles virus rna in michelle's intestinal tissue. this claim was based on results from o'leary's unigenetics lab, and was examined by stephen bustin, a world-renowned expert on polymerase chain reaction who has authored a number of scientific papers on the subject, as well as a book entitled a-z of quantitative pcr. he pointed out that this is based on results from the o'leary lab, and concluded, based on a 2002 paper by uhlmann that described their pcr methodology, that this lab contained a lot of contaminating dna, and that the assays were actually detecting this dna rather than the rna which makes up the measles virus. bustin pointed out that, among other things, o'leary's unigenetics lab which published this study neglected to use controls, and also did not discuss contamination. for this reason, bustin concluded that it was a "scientific certainty" that none of the children's samples analyzed by the unigenetics lab actually contained the measles virus. in addition, bustin and bertus rima both testified that cotter was unable to replicate the unigenetics lab's results, in contrast to kennedy's claim that they were able to replicate these results.: 56 a bar graph of michelle's t cell enumerations, left, the lower limits of the normal range of those parameters, center, and the upper limit, right. while byers had argued that michelle's immune system was dysregulated, christine mccusker demonstrated that when compared to values determined by other researchers for children of michelle's age, her parameters were within the normal ranges.: 2 byers' testimony was countered by that of christine mccusker, who testified that "dr. byers had compared the results from several of the tests on michelle to a set of "normal" values for such tests. the normal values utilized by dr. byers, however, were for adults, not children" and that "when she herself instead compared michelle's results to an age-adjusted set of normal values, michelle's results fell within the normal ranges,": 36 with mccusker noting in her expert report that the only marker of th2 cell activity that was assessed in michelle's case, namely serum immunoglobulin e level, was entirely normal.: 5 additionally, ward's expert report stated that byers' expert report contained "many statements that appear to be entirely unsubstantiated.": 8 kinsbourne's testimony was countered by that of ward, who noted that if kinsbourne were correct and persisting measles virus were causing autism, then it ought to be detectable in the blood, since kinsbourne himself had stated that mv would travel throughout the body via the bloodstream;: 62 he also criticized kinsbourne's expert report for citing bradstreet et al.'s case series which had been published in the journal of american physicians and surgeons. with regard to this study, ward said that "the cerebrospinal antibody data from the three asd children included in this manuscript actually argue powerfully against a persistent measles infection in the brains of these children.": 6 ward also noted that krigsman had cited research conducted by vijendra k. singh of utah state university which had concluded that more than 80% of children with autism had elevated measles antibodies. however, ward stated in his expert report that "unless virtually all cases of autism are caused by measles virus (a position expressly excluded by the mrc, iom and cochrane reports), then singh's work must be in error or there must be an alternate explanation for this finding. we have recently tested anti-measles antibodies in children with asd and found no differences with control children.": 4 another point of contention was a paper by paul ashwood, which had been cited by kinsbourne in his expert report; however, as ward noted, kinsbourne had neglected to mention that ashwood's paper concluded that "the overwhelming majority of epidemiological, population studies indicate there is no established correlation between vaccinations and autism." additionally, ward noted that this paper made no mention of the potential link between mmr and autism.: 6 decision on february 12, 2009, the three special masters each ruled against the petitioners' causation claims. in his decision, george hastings noted that, unlike aposhian, jeffrey brent, who testified that there was no evidence that children with autism were uniquely susceptible to mercury exposure, was a medical doctor. hastings also described dr. brent's testimony as "persuasive.": 24 in addition, with regard to the theory that some children are genetically hypersusceptible to mercury toxicity, hastings concluded that the "petitioners have failed to demonstrate that this theory has any validity.": 26 according to hastings' decision, byers' testimony "was far outweighed by the testimony of dr. brent and respondent's other witnesses ...";: 33 he also concluded that "her insistence that it was acceptable to use adult norms to measure the immune function of infants and young children was, frankly, incredible." hastings also wrote that kennedy made the same mistake that byers made—namely, comparing the measurements of michelle's immune system to the parameters for adults,: 39–40 and that while kennedy testified that cotter's results were evidence of the unigenetics lab's testing, that "no conclusions can reasonably be drawn" regarding these results, noting that they had not yet been published.: 56 after examining kinsbourne's testimony, hastings concluded that it contained "... contradictions and inconsistencies ... concerning the appropriate time period between mmr vaccination and onset of autism symptoms,": 88 and also noted that kinsbourne had not included measles virus as a cause of autism in a chart he wrote for a textbook, but had done so in the proceedings. hastings, in his decision, noted that "all of the petitioners' causation theories depend upon the validity of certain testing that purported to find evidence of persisting measles virus in the biological materials of michelle and a number of other children with autism.": 41 however, hastings concluded that this testing was "not reliable.": 41 in his decision, he noted that the authors of the d'souza paper first performed pcr on pbmcs from children with autism, which resulted in a large proportion of apparently positive results. however, "the d'souza group ... subjected those apparently positive samples to additional testing techniques in order to determine whether the pcr testing using the uhlmann primers was truly identifying measles virus and only measles virus. ... the application of those two techniques revealed that all but nine of the samples that had initially tested positive by the pcr test using the uhlmann primers were, in fact, not measles virus." with regard to the 9 remaining samples, the d'souza paper performed sequencing on 7 of those samples. this step "demonstrated that the material, which in the pcr testing had appeared to be measles virus material, was in fact not measles virus material, but human genetic material.": 45 with regard to the michelle cedillo case in general, hastings concluded that "the evidence was overwhelmingly contrary to the petitioners' contentions." he also said that the cedillo family had been "misled by physicians who are guilty, in my view, of gross medical misjudgment." the cedillos appealed this case in march 2009, but the court upheld its dismissal thereof in august 2010. impact in response to the second rulings in 2010, safeminds stated, "the denial of reasonable compensation to families was based on inadequate vaccine safety science and poorly designed and highly controversial epidemiology." similarly, rebecca estepp of the coalition for vaccine safety said in a statement, "the deck is stacked against families in vaccine court. government attorneys defend a government program, using government-funded science, before government judges," and generation rescue's j.b. handley argued that "the courts won't concede something that will bring down the vaccination program." on the other hand, vaccine scientists praised the ruling, with paul offit stating "the autism theory had 'already had its day in science court and failed to hold up.'" additionally, autism speaks said that "the proven benefits of vaccinating a child to protect them against serious diseases far outweigh the hypothesized risk that vaccinations might cause autism. thus, we strongly encourage parents to vaccinate their children to protect them from serious childhood diseases." the department of health and human services released a statement saying that "hopefully, the determination by the special masters will help reassure parents that vaccines do not cause autism." similarly, the