Navigating Ethical Issues in Brain Injury Forensics: The CRED Approach

Join Dr. Richard Batson and Dr. Joshua Goldenberg in an insightful exploration of ethical considerations in brain injury forensics. Our episode delves into the CRED approach—Causation, Research, Ethics, and Due Diligence—providing a behind-the-scenes view of its crucial role in legal proceedings. Uncover the challenges faced by expert witnesses and the delicate balance between persuasive litigation and impartial scientific explanation. Dr. Batson and Dr. Goldenberg shed light on the importance of current, peer-reviewed knowledge in forming credible opinions, addressing issues like 'lag time bias.' This conversation aims to pave the way for more objective and scientifically grounded legal practices, offering essential insights at the intersection of law and medical science.

Learn more at https://braininjuryresearchsolutions.com/ or email us directly at info@braininjuryresearchsolutions.com

The information provided on the Brain Injury Research Solutions podcast is for
general informational and educational purposes only and is not medical, legal, or
other professional advice. You should not rely on the information provided in the
Brain Injury Research Solutions podcast as a substitute for professional medical
advice, diagnosis, or treatment from a licensed healthcare provider who is
familiar with your individual situation or as a substitute for legal advice from an
attorney.

Chapters

• 2:00 Ethics in Brain Injury Forensics
• 15:08 Highlighting Differences in Forensic Work
• 21:45 Principles and Qualifications for Healthcare Witnesses
• 36:12 Ethical Considerations in Expert Witness Testimony
• 43:36 Research in Forensic Expert Testimony
• 55:12 Lag Time Bias in Research Understanding

Transcript

Introducer, Other
00:02
Welcome to the Brain Injury Forensics Podcast presented by Brain Injury Research Solutions, a forensic services and contract research organization. Join Drs Richard Batson and Joshua Goldenberg as they interview nationally and internationally renowned experts and dive into the latest developments in brain injury forensics, applied medical research, state-of-the-art forensic methodologies, gold standard advanced neuroimaging and numerous brain injury related medical topics. 

Dr. Goldenberg, Co-host
00:37
This is just a reminder before we start that while we are doctors and have advanced training in forensic medical science and forensic epidemiology, and we will be discussing topics that involve medicine and the law, the information in this podcast is not medical, legal or other professional advice, and this podcast is provided for informational and educational purposes only. You should not rely on anything you hear as a substitute for medical care by a physician or other qualified medical professional or legal advice from a licensed attorney. Always consult with your physician or other qualified medical professional for medical advice and an attorney for legal advice. Hello, Dr Batson, how are you doing today, sir? 

Dr. Batson, Co-host
01:24
Good afternoon, dr Goldenberg. I'm doing well. How about you? 

Dr. Goldenberg, Co-host
01:27
I'm doing great. I'm psyched to go into our next installment of CRED. I think I've really enjoyed our conversation so far as we march through those different letters of causation, research, ethics and due diligence. Right, did I get those right? 

Dr. Batson, Co-host
01:45
You wrote the paper or you helped write the paper. 

Dr. Goldenberg, Co-host
01:47
You wrote the paper. 

Dr. Batson, Co-host
01:49
I hope you got it right. 

Dr. Goldenberg, Co-host
01:50
I made minor edits and somehow you were kind enough to add me. 

Dr. Batson, Co-host
01:57
Well, not quite true. As mentioned last time, it's a product of ongoing work collaboratively over the last six years. And then many, many conversations contemplating the state of affairs in personal injury forensics Indeed. 

Dr. Goldenberg, Co-host
02:14
Indeed indeed. So let's jump in. We had, I think, a really good conversation about causation. We had Dr. Michael Freeman on as well to talk about that. We had a really fun, although unbiased, conversation about the R and research, and today we were going to dive into the ethics part of it. Maybe set the stage, because I think you've really been instrumental, at least for me, in highlighting and underlining how important that is in what we do. Maybe, if you can kind of maybe set the stage. But also, what brought this about? Because my understanding is it was your experience reading through a lot of these IMEs that really underlined this for you. 

Dr. Batson, Co-host
02:53
Yeah, I think you know, in going through hundreds of independent medical reports, for those that might not be in the litigation setting are reports that are written by retained experts and sometimes retained by defense and sometimes retained by the plaintiff attorney for the claimant. Nevertheless, part of what we're doing here in our podcast is looking at the current status of forensic work in personal injury litigation and looking at a critique of that work from the standpoint of a quality assessment. And one of the things that we're doing just in review is we've written a paper that'll be premiered fairly soon called the CRED approach, which is basically establishing expert witness credibility and personal injury litigation through this approach and, as you mentioned, the acronym stands for Causation, methodology, research, ethics and Due Diligence, and we've finished a podcast on causation with Michael Freeman. I interviewed you last week or a couple of weeks ago on research, and now we're talking about ethics, and so when we think about ethics in personal injury litigation, there's not a whole lot of guidance for the vast majority of experts, and so traditionally, as we mentioned, there's no formal forensic training outside of perhaps psychiatry and psychology, and so those two particular fields are the most developed by far in the forensic space and of course they're dealing with both criminal as well as civil questions of damages that have occurred, and so there are guidelines from the American Psychological Association. There's also guidelines from the American Academy of Psychiatry and the law which pertain to those respective disciplines. 

04:51
Of course, as we argue in the paper, it's a good thing to review guidelines in general that support an ethical framework for forensic practice, even if you're not in one of those disciplines, meaning if you're in neurology or you're in endocrinology or some other area. And of course our focus is brain injury medicine, and we do have psychology in brain injury medicine, neuropsychology in particular, and also psychiatry and neuropsychiatry. But for the vast majority, josh, there's no guidance, there's no training, and so you can come into this area as a so-called expert and give opinions, and you've never been through any type of formal forensic training. And so we do have guidelines that we can look at, and so we've recommended that, regardless of your specialty or your discipline, that you become familiar with the guidelines that pertain to psychiatry as well as psychology. And then there are the guidelines from the American Medical Association that pertain more broadly to expert witness work, and those are not linked to any particular discipline or specialty per se, and so in our paper we've focused on the American Medical Association guidelines as well as the American Psychological Association guidelines and those guidelines the American Medical Association guidelines are fairly short. 

06:18
The APA or American Psychological Association guidelines are a bit more extensive, and the other one that we mentioned was the American Academy of Psychiatry and the Law, and those are probably the most extensive guidelines. But a lot of that has to do with areas that are very specific to psychiatry and might not be more broadly applicable. But there are elements of the AAPL, the American Academy of Psychiatry and the Law guidelines that would pertain to other areas and that cross over with the AMA and the APA guidelines. But I think today we can focus more on the AMA and the APA, since that's been the focus of our paper. Does that? 

Dr. Goldenberg, Co-host
06:58
sound good. 

06:59
Yeah, I think that sounds good and I want to jump into the specifics in a little bit, but I had some big picture questions I wanted to chat with you about first. 

07:10
I think one is the thought that and I think I can't recall I think maybe we had talked about this on a previous podcast or maybe just you and I Chatted about this in general this idea that you know, testifying, being an expert witness, I mean it really is a subspecialty, like there's all these additional aspects that are relevant and come come to the floor and I think the APA, the American psychology Association, they, or psychological Association, they, have a better sense of that. I believe forensic psychology is, is a standalone specialty. These are the guidelines, the ethics guidelines specific to them, and I think they're a lot more developed. But so I guess at first I'd like to get your thoughts on, you know, testimony forensics as a specialty within medicine, psychology, etc. And then kind of also why? What are we talking when we say ethics in Testimony, like what is that? What does that mean? Why is that important? Why would that be different than you know, your standard professional ethics guidelines? 

Dr. Batson, Co-host
08:14
Absolutely yeah, so you know. Coming back to the, the idea of sub-specialization, currently there's there's not a subspecialty within psychology per se that's recognized for forensic work, although Psychologists involved in forensic work, you know, may refer to themselves that way. And so, if you look at the, there's a, there's a group within the, the Neuropsychological group, so there's a, there's a group called the American Academy of clinical neuropsychology and then within that group, there's a group called the forensic neuropsychology special interest group and they, they had a big push I forget when it was. It was I don't want to, I don't, I don't get the date wrong, may have been 218 or so, but they had there was a push to be formally recognized by the American Board of clinical neuropsychology, abcn, as a subspecialty and then develop curriculum and guidelines, and that was rejected at the time. And it was rejected because they felt, like you know, there was broad enough training in general neuropsychology to be able to move and move within the forensic arena and give testimony, but but so it never was formally turned into a subspecialty. 

09:26
That I'm aware of and I may be wrong, I may not be up to date in 2023, and if there's a listener that knows more about this particular area. Just just email us or contact us by the website and let us know If there's anything inaccurate. But to the best of my knowledge it never formally was established as a, as a subspecialty, although there's efforts, there's greater efforts within the fields of of psychology to Develop that and of course in any other area you almost don't see it at all like there's no, I haven't heard of a Forensic neurology group, for example, even though a lot of neurologists are involved in brain injury litigation. For example, physical medicine and rehabilitation physicians are often involved in brain injury litigation. I don't that, I'm not aware of any Forensics training or or clinical practice Excuse me, forensic guidelines For that group either. And then of course other disciplines that are involved or maybe and evolve frequently Neuro optometry, neuro etology, neuro endocrinology and so on. 

10:27
And there's no, there's no space so far for specialty forensic training, and Probably just because there's not enough of a of a demand maybe, but the primary disciplines, classically that you see in the brain injury medicine space, were actually Neuro psychology and neurology. So you would hope that neurology would have some sort of some sort of training, but I'm not aware of anything in terms of, you know, formal groups like the forensic nurse, neuro psychology special interest group that they actually have within Within the field of psychology. So that's the framework I want to give you. Yeah, and then I think your second question, you know, was whether whether it should be a sub, a subspecialty, and, and I would, I would say yes, but there's different ways to go about, you know, getting training, education and knowledge. 

11:16
But I think, at some point, if there, if a discipline is involved enough Inside of personal injury litigation or other types of litigation, or in criminal Criminal cases and so forth, that that, yes, it would be prudent that that discipline develops formal forensic training Guidelines, etc. Including ethical guidelines but also practice guidelines. Which is how do you go about doing a forensic assessment? What is, what's a high quality of forensic assessment? You know the APA actually has, has produced a forensic checklist. Oh and so yeah. 

11:55
So it's actually, they've published that, and so a psychologist that's doing forensic work can go on and look at a checklist and make sure that they've gone through all of the things that should be part and parcel of a comprehensive and high quality forensic assessment like that. 

Dr. Goldenberg, Co-host
12:12
That's good. 

Dr. Batson, Co-host
12:12
Yeah, yeah, and so I think you could have that within any discipline, ideally, yeah, and then it would set the bar for other people to come in and that would kind of clean up the industry, so to speak, so that you you know, if you're not, if you're not up to snuff, then you're not gonna, you're gonna be called out for it. You might still be allowed to testify, but it's not gonna look very good. 

Dr. Goldenberg, Co-host
12:32
Right, and that was something that was underlined, I think, I think, in the and we'll link to all these documents in the show notes but in the APA, the American Psychology Association Document, that as guidelines these aren't standards. 

12:45
So you know, in the medical realm, in the psychology realm, you're held to Sort of minimal competence standards, like a minimally competent doctor or psychologists would do XYZ, whereas guidelines, they were saying you should think more about this as optimal approaches, so you wouldn't be liable per se if you weren't at this optimal level. 

13:05
But it guides practice, it guides this forensics work and I think that does set the bar and, like you said, it wouldn't stop you from practicing but it wouldn't look very good and it would give you something to aspire to as far as, as far as the approach, and and I do want to jump into like I think the nitty-gritty of this will make more sense to listeners, but also just to underline the fact, to that I think it's necessary to, in that there are different Conflicts at play, there's different incentive structures at play, there's it's a different animal than just clinical work. And so I do think that having ethical guidelines for forensics specifically, more than just our Normal ethical guidelines for practices is indeed important, because you have very unique Situations that arise in an adversarial relationship most certainly, and you know the kind of technical term is adversarial Allegiance, which means you're wanting to please or Give results according to the, the retaining parties preference, and that's a big problem. 

Dr. Batson, Co-host
14:09
And so avoiding adversarial allegiance is a key. You know, ethical at ethical challenge for some inside of the forensic setting, and so the guidelines help to try to mitigate that by giving a, as you said, an optimal, an optimal format For for engaging in forensic work. You know, my argument would be look, if you can't compel an expert to follow the guidelines because they're they're not standard of care but rather ideal practice, then it's actually the attorneys themselves, on direct and cross examination, that need to be the ones that repeatedly review Ethical guidelines with testifying experts, so that they can compare and contrast which experts are following it and which aren't that's a good idea. 

14:59
Because it's not gonna. 

15:00
You know, one expert is doing a much better job Following ethical guidelines or they're much more thorough in their forensic practice. 

15:08
A jury is not always. 

15:09
A jury is just not going to intuitively know that, sure, and so that that's got to be made crystal clear Through the interrogation process, through the, through the examination, direct and cross examination, so that a jury or Trier fact, other Trier fact, can identify the differences between the amount of yeah, excuse me, the the, the level of comprehensiveness, the adherence to ethics and so forth, the quality of the overall forensic work, yeah, and and because it's just not intuitive, it's complex and and it's got to be highlighted. 

15:40
So, as far as our job, you know our job, we write about it, we talk about it, but ultimately the, the burden, so to speak, is on on the litigators themselves to to highlight these differences yeah, so that the pressure of circumstance compels experts to follow ethical guidelines, knowing that if they get into the litigation environment on the other side, if those experts have followed these guidelines and they've done very comprehensive work and they've done, you know, formal causation methodology, they've done the research, you know they're applying what we call the credit approach, then they're going to be at a much higher level In terms of quality of work, and that's going to become apparent to the journey to the jury only if if the litigators themselves highlight those differences. 

Dr. Goldenberg, Co-host
16:27
I couldn't agree more. I think that's a really smart way to think about it in. You just need one One experience on cross examination where you don't meet these criteria. They're like well, isn't this your professional organization? And what do you mean? You didn't do XYZ, where you will always do XYZ, moving forward. So that's true. 

16:45
And, yeah, you know, it's just and I you know not to belabor the point because I want to get to these actual guidelines, but you know this and I know I've talked about this before, but it's just fascinating to me this role that we find ourselves in Davis as expert witnesses. 

16:58
We are meant to be these sort of like well, this is the way I think about it, anyway like quasi clinical, scientific, unbiased, impartial, you know, explainers of science and evidence to the triers of fact, to the jury, to the judge, to the bench, and yet it happens within an adversarial setup where you naturally have these adversarial Allegiances. 

17:30
I think it's the language that you use, which I like, or you, you tend in that way and it's just very awkward. And my understanding is it's very rare, but sometimes the court can set up truly impartial experts, but for the most part, like 98% of the time, you are retained by a side, and yet you are also supposed to be impartial and an explainer of things, and so it's just a very unique place to be, and I like checklists published ahead of time and registrations a priori, as we talked about before, to keep people honest in that way, right Cause then it's like, well, these are the standard things that we need to hit and this is what keeps us impartial. So, anyway, that's enough of a diatribe on my end. Shall we jump into some of these actual examples. 

Dr. Batson, Co-host
18:17
Yeah, sure can go ahead. 

Dr. Goldenberg, Co-host
18:18
Okay, awesome. So I think you did a really nice job in kind of pulling out in our credit paper and again we'll link to these the sort of salient quotations, if you will, are salient aspects of the different guidelines and then kind of highlighting, I think, what you call the core principle, underlining them. So, yeah, why don't we go through some of them, just to sort of give an example? And then, in particular, I'm curious, like how, what is the pragmatics of what this could look like from your perspective? So do you wanna kind of walk us through maybe the, you know, summarize the AMA position first, just cause that's gonna be easier. I think it's shorter. 

Dr. Batson, Co-host
18:58
Yeah, yeah, I think we're from there, for sure, for sure, yeah, and so what we did is we looked at the guidelines themselves and then we said, well, how do we distill this into core principles? And so the core principles are sort of a summation of a broader verbiage that's in the actual works of the AMA and the APA. And so the first core principle was justice. And you know the APA code of medical ethics, 9.7.1. 

19:29
Medical testimony basically says that medical evidence is critical in a variety of legal as well as administrative proceedings and, as citizens and professionals with specialized knowledge and experience, physicians have an obligation to assist in the administration of justice. Of course, this AMA guideline is designed for positions, but that could be any healthcare provider. It could be a physical therapist who does brain injury rehab, you know, for vestibular disorders. It could be an optometrist that's involved in that, you know, visual disturbance after functional visual disturbance after brain injury, ocular motor dysfunction and so on. So this is designed for physicians, but we can plug in just about any other type of provider. And so this is interesting because, you see, you know, talk to a lot of my colleagues, physicians and so forth, that are that shy away, just never want to be contacted by an attorney, and so they do everything they can in their power to avoid having to be deposed or testify. And yet here the AMA says explicitly that physicians have an obligation to assist in the administration of justice. Of course that's interesting and that's not in the Hippocratic Oath. There's nothing in the Hippocratic Oath that I'm aware of that says oh yeah, you've got to be part of the judicial system and you've got to step up and do that. But the AMA says it and so it's like you know you don't run away from if your patient is involved in litigation, you don't run away, you don't shy away from that. 

21:02
And, of course, if you're working in an area you know, specializing in an area where many of your patients are likely to be involved in litigation and that's common, for example, in physical medicine and rehabilitation, in PT work and neurology with brain injury, chiropractic, chiropractic Then you know you should know going into that field in the core training that you're gonna be, your patients are gonna be involved in litigation for your entire career. Yeah, those programs should actually have specialty training. Knowing that, I agree, and I don't know if they do at this point in time, talking to a lot of doctors that are involved with it. They didn't really have that training. But you know it could be that the younger doctors are getting that training. But so the bottom line. So the first principle is you know, physicians and other you know let's expand that to other types of healthcare providers have an obligation to assist in administration of justice, and so that really reframes it. I like that, yeah, and if you think about that going in, yeah, like to society, right. 

Dr. Goldenberg, Co-host
21:59
Like at least the way I read it is like Hippocratic Oath is very much to the individual patient, but this is like this. You have this knowledge. This is important. Justice is an important value and this you kind of owe it to society, if you will. 

Dr. Batson, Co-host
22:12
You could frame it that way. Absolutely, there's a lot of responsibilities that come from being a physician or any other healthcare provider that are implicit and explicit in the professional setting, and you know that going in, and so it's an important reminder. 

Dr. Goldenberg, Co-host
22:30
Yeah. 

Dr. Batson, Co-host
22:32
That physicians and other healthcare providers need to step up and do their part. And if they're going to do that, if they're going to be involved in a field where they have a lot of patients that are involved in litigation, then hopefully they go out and they get some additional training and they embrace that rather than run away from that. Yeah, so that's the first principle. 

Dr. Goldenberg, Co-host
22:48
Okay, that lays the groundwork pretty well as far as, like stepping up to the plate. Now let's talk about what that actually looks like. 

Dr. Batson, Co-host
22:54
Yeah, well, I think the second one, you know, the second set of core principles, are what we called accurate representation, honesty and neutrality Sorry if I lost one of my mic there for a sec. And basically it reads whenever physicians serve as witnesses, they must accurately represent their qualifications, testify honestly and not allow their testimony to be influenced by financial compensation. 

Dr. Goldenberg, Co-host
23:21
And that's where- there's a lot there. 

Dr. Batson, Co-host
23:23
There's a lot there. There's a lot. 

Dr. Goldenberg, Co-host
23:25
There's a lot there, let's unpack that. 

Dr. Batson, Co-host
23:26
Yeah, go ahead, go ahead, john. 

Dr. Goldenberg, Co-host
23:28
No, no, no, let's do it. So we've got a few things. One there's qualifications, honest testimony, and then the financial compensation and the influence of that. So, yeah, there's a lot there. Let's take that apart. So let's start maybe with they must accurately represent their qualifications. Initial thoughts on that. 

Dr. Batson, Co-host
23:47
My initial thoughts are it's not enough. I mean, and so we've talked about you know, just because you have a certain type of degree behind your name or you have a certain subspecialty doesn't mean that you have everything it takes to be an expert witness and be in the forensic setting. And we've highlighted that with you know, neurologists and things that come into the brain injury Forensic setting and they haven't published in years and they haven't or they've never published in brain injury. They're not a researcher, they're not up to date on the literature and so forth. So I think qualifications needs to be qualified, which means it's not just, it's not a synonym for credentials, right. Oftentimes we conflate those two things. 

Dr. Goldenberg, Co-host
24:32
And that's been well established in the legal space right as far as like what qualifications actually mean. Do you want to take a little bit of a side tour there? 

Dr. Batson, Co-host
24:42
I think yes and no. I think in theory, maybe I think in practice, no, oh, interesting. I mean, let me just say this there's not a. I've never seen a. I've seen neurologists in the brain injury setting that I think shouldn't be allowed to testify and the reason is they've literally never published in brain injury. They're completely. They're citing literature that's 20 years old or they don't have any grasp of the contemporary literature base and it's not really their primary population that they're dealing with clinically and they're confusing. You read their reports and they're confusing. 

25:16
They would, if they were allowed to testify. It would be confusing or misleading for the try or fact, and yet nobody's excluding them. So I think ideally, qualifications has to include and of course we're gonna come to this later in the guidelines but it has to include contemporary education, staying up to date, being thorough, being comprehensive, making sure when you look at the literature that you're not cherry picking, which we covered in our last episode on research. So I think you just have to. When we think about qualifications, it has to be expanded. But ultimately, in my understanding is the judicial system is fairly open in the sense that it's very uncommon to exclude an expert Right, and so that can be. If it's poor quality testimony or there's questions about that, that can be vetted and dealt with in the setting of litigation on cross examination. 

Dr. Goldenberg, Co-host
26:12
Gotcha and we'll do a whole session, I think, on credential issues. But I guess I was thinking specifically is it and I'm gonna butcher the actual federal rule? But where they talk about that, the training, the knowledge, experience, education, et cetera, skills, as opposed to, it's not necessarily a credential per se that's necessary for qualifications. There's other ways to attain this. The qualification, if that makes sense. 

Dr. Batson, Co-host
26:43
Yeah, I mean you're referring to rule 702 and you're referring to some of the Dahlberg criteria. So knowledge, skill, experience, training and education. But keep in mind that's really more methodological, in the sense if there's evidentiary challenges, it comes up, but those are often used heuristically when we think about experts so that who are allowed to testify, which is the idea. 

27:05
if there's somebody that has knowledge that's gonna be helpful for the trial or a fact, it doesn't necessarily matter how they got that knowledge, as long as the knowledge is viable. And so there's different. The court system or the judicial system recognizes that there's different ways that one can go about learning, and some disciplines are entirely experiential. There's no credentials, there's not a lot of credentials around it, and so there's different ways to demonstrate competency. And that's ultimately up to the judge to determine, as a gatekeeper, who can testify and who can't testify. Good, okay, but my understanding and of course we can interview some attorneys on this my understanding is it's they're gonna err on the side of caution, of not excluding testimony, and then again things can be vetted on direct and cross examination Right. 

Dr. Goldenberg, Co-host
27:53
let the trial or fact kind of decide their own how much weight they put on that. 

Dr. Batson, Co-host
27:58
Exactly. 

Dr. Goldenberg, Co-host
27:59
Okay, cool. So I think that covers qualification piece. Let's talk a little bit about testify. Honestly, I mean, on his face that sounds pretty obvious like don't lie. Do you take that in any more nuanced way, or where do you think they're going with that? 

Dr. Batson, Co-host
28:13
Yeah, I mean, I think, obviously I think they're called, they're calling out, you know, dishonest testimony in the sense that ones ones aware that they're not speaking truthfully or they're obfuscating. And does that happen sometimes? I probably, but there's probably a lot of cases where the expert believes that they're they're testifying honestly and they it's more an issue of of a lack of due diligence and and not really weighing the evidence comprehensively right. 

28:42
So I think you know, and, but again, there's probably cases of overt dishonesty. But I don't, I don't have a have a whole lot more to say on that one. 

Dr. Goldenberg, Co-host
28:50
Okay, how about this big one, though? Not allow their testimony to be influenced by financial compensation Compensation. What does that look like in practice? How do we safeguard against that? 

Dr. Batson, Co-host
29:02
Yeah, I think with financial compensation. I mean you got you got two scenarios. You've got expert witnesses that are retained by law firms and then you have treating doctors that may be fact witnesses or they may have expert opinions. So they may be, you know, have treated the patient, but they're coming in and they have a lot of expertise, so they're sort of a a treating doctor with, with expert opinions, and I think it varies state to state what. You know how, how these things are, the note, the, how these things are Classified. So again, we're not legal experts, so I'm not going to give any too much information there at risk of giving misinformation. But the bottom, the essence of it is, you know, is is the financial compensation going to bias you? 

29:41
in any way, and one of the one of the ways the system tries to Prevent that from happening is to make sure that the case outcome is not linked to the amount of compensation. So you know, a test, a testifying expert or even a treating doctor that's then paid to come in and testify because they get their time covered, has to charge a fixed fee based on a rate it's. It can't be a percentage of settlement. 

30:04
Mm-hmm and that's one way where it's like you know, otherwise doctors would be motivated. You know, if they were plaintiff retained, for example, or even if they were testifying on behalf of their patient, if they had some incentive to get higher awards, jury awards or settlements, then they would make a percentage of that compensation. So that's that's disallowed as far as I know, and nobody does it that way. So it's so that the financial compensation isn't is not, it's for a process, it's for the evaluation, it's not, it's not for an opinion, right, the opinion? The opinion has to be completely neutral, and what, what an expert's being paid for is essentially the process that they go through In order to form that opinion. 

30:47
But of course, you know we have all sorts of explicit and implicit biases and and it's easy for there's all sorts of incentives. I mean, if someone is, you know, working Within the forensic setting and they were wanting to please the retaining party, and you know they they don't give them the result that they want, they may not get hired again, and so that's up. That's, that's critical, yeah. And so the expert has to be willing to walk away from that scenario, even if it means never working with a particular Attorney again, although my experience with attorneys has been that they're very, very respectful and if you tell them something they don't want to hear, that's not favorable for their client, they thank you for that, for being honest and that you've given a given, a better roadmap of the case, and so you know, my experience has been that that openness, transparency and honesty generally pays off. You know if you're working with With high quality, high quality attorneys. As far as I know, yeah, and it's interesting. 

Dr. Goldenberg, Co-host
31:47
You know, like I have to, I have this tendency to just go like philosophical and forget the pragmatics. But I find law fascinating, and in particular this, this Allegiance issue and yeah, I mean it's I. At first I was very put off by it, right, because I'm coming from, like, science background. It's like we, you strive so much to be impartial and then you have this environment where you literally have advocates For either side and their job is to present things in a favorable light for the client. In fact, they can be fired for, not for not doing that right and and and it, you know, it always struck me as a little bit uncomfortable. Then, like well, actually, I was talking to a buddy of mine who's a judge and I was sort of, you know, fetching, complaining about this, and it's like Well, okay, josh, like what's a better system, you know, and and I thought that was kind of a neat idea where if you have two really motivated sides working super, super hard to Present their own side, that might be a really unique way to get to the truth and that allows you as a, as a treating expert, at least one way. 

32:46
I think about it as okay, it's their job to be, you know, advocates for their side. It's your job to just present the data as you see it and to not, you know, by not linking certain explicit things like compensation to outcome. And I think the APA does a good job and kind of listing that out, like even Some of these contracts that treating providers will have with patients etc. To just make sure that explicitly it's not linked. I think that helps and if you can be conflicted out, like if your you know spouse has some relationship with you know that field or whatever it is like, you can have sort of very obvious conflicts. 

33:22
But the interesting thing to me is the more nuanced piece which you talked about, which is this sort of implicit bias and wanting to please decide. And I think you know, the more and more I think about this, the more and more I think our focus on having a priori checklist and standards Really helps here. And especially if the, if the, the attorneys are calling out the experts to follow this, then it's like look, this is, I'm going to follow this checklist, this is my professional organization or this is the credit approach and this is what we do with every case and it is what it is, you know and then let them worry about you know presenting it and whatever like they want. 

Dr. Batson, Co-host
34:03
Yeah, I agree, I agree with that. 

34:04
Yeah, I think that's as far as you can go. I mean, I think part of calling it out is just to remind experts who bother to actually review these guidelines On a regular basis, because you have to keep them in your head and you have to think about it. So it's good to good to review these periodically so that you're in alignment, but but I think the bottom line is just calling that out. So in you know, in the idea of neutrality and Trying to be free from bias and forming objective, independent opinions are Are reiterated at other points in the guidelines as well. 

34:37
Yes, yeah, so it's, it's a, it's an iterative approach. That we're where. You know, financial compensation can be connected to bias, but bias and non objectivity itself is called out separately as well, because there's other motivators. Right, it's not always financial that motivates bias. There's other other things that can motivate bias as well. 

Dr. Goldenberg, Co-host
34:55
Absolutely, and I think we're kind of learning about that more and more in different fields, and you're right that there's a lot of guidelines that are Guide rails rather that are presented here. 

Introducer, Other
35:07
If you'd like to learn more about our unique approach to brain injury forensics, email us directly at info at brain injury research solutions calm, or learn more on our website, www.braininjuryresearchsolutions.com. There you can sign up for webinars, explore featured papers and learn about the team. Enjoy the podcast. Don't forget to rate us and review us on Apple podcast to help spread the word. 

Dr. Goldenberg, Co-host
35:51
So let's, let's. I think we might have to break this up into two episodes. There's a lot to unpack here, but let's jump to the next one. I think this next one here is what I was thinking about and where I was getting with the federal rule. I've already forgotten what number it was 702. Is that right? Yeah, 702. Yeah, so this is. I think this is the more explicit reference to the training. Is that right? Is that how you look at this part? 

Dr. Batson, Co-host
36:17
Right, right. And so we're talking about core principle three now, which is appropriate, what we frame as a appropriate training, and then up to date knowledge and experience. And so it reads that physicians who testify as expert witnesses must testify only in areas which they have appropriate training and recent substantive experience and knowledge. And I think we highlighted that idea of recency, I think last week as well, but the idea that it's not enough. You know, if your core training was 30 years ago in a discipline and you're not up to date, and you're not doing continued medical education and you're not up to date on the literature and you're no longer really heavily involved in treating a specific patient population, then that wouldn't be recent and substantive experience and you should probably and knowledge, and you should probably recuse yourself from the case. 

37:12
There are experts that do not do that. I mean, we've seen that you and I have Dr Goldenberg and they continue to testify and they're just not, they're not at the level of contemporary recent substantive knowledge that really would be most helpful for the Trier fact. And so we call that out. That's important. It's important for attorneys to think about that when they're evaluating the credibility of different experts, to really look at these guidelines and say well, how recent is your knowledge, how substantive is your experience and knowledge? You know, are you a researcher? Do you do research in your field? Do you publish that kind of thing? So we see that. 

Dr. Goldenberg, Co-host
37:52
Do you see that a lot right now? Because you've a lot. 

Dr. Batson, Co-host
37:55
Yeah, I do. I see it in endocrinology. 

Dr. Goldenberg, Co-host
37:59
Yeah, okay. 

Dr. Batson, Co-host
38:00
I see that in the field where you know, because my area of research is post-traumatic hypopatuitism, so I have a lot of knowledge in that particular group of neuroendocrine conditions that happen after brain injury Very, very long dissertation on the topic, like an endocrinologist that's never ever published on brain injury or neuroendocrine dysfunction after brain injury. They might be a specialist in some other area, like diabetes, or just a general endocrinologist, and yet they come in and they hire them to say something that just isn't true. I mean, it's just not up to date with the clinical practice guidelines. They don't have any command of the research base or the literature, and yet they come in and they testify and they make a lot of white noise, right? Because? 

Dr. Goldenberg, Co-host
38:56
Do they get called out Like are you seeing the other side, like really questioning that, or they just kind of let it go and let the jury decide? 

Dr. Batson, Co-host
39:03
Well, no, I think they call it. I mean I call it out. I mean I'll call it out and my depositions are in rebuttal reports and that kind of thing. But it's, you know, to me it's very, very unethical, right, it's absolutely an ethical violation. Because you're coming in and you're saying you're using a credential that you got. You're saying, okay, I got a credential, I'm a board certified endocrinologist and therefore that allows me to provide expert testimony in the area that I really don't work in a lot, you know, and in no research, no background in that area, no ongoing research and not really that literate around brain injury. But I'm going to testify anyway and I'm going to take some money for it. You know that's just not right. You know, to me that's not an ethical approach. If we really held them to recent substantive experience and knowledge. It also needs to be even within a medical discipline. It needs to be within treating a specific patient population in my opinion. 

40:02
And it needs to be. You know, you get. I mean, we have so much sub specialization in medicine. Now, right, we have a, we have a. You know, you have general practitioners and then they go to internal medicine and then from internal medicine they go into a specialty like like endocrinology or gastroenterology, and then within that they might focus in an area like pituitary and hypothalamus. So now they're in neuro endocrinology. 

Dr. Goldenberg, Co-host
40:26
Or they're pancreas guy, or they do cancers. 

Dr. Batson, Co-host
40:29
Well, yeah, and now they're in neuro endocrinology, and now they focus on acromegaly, or they focus on, you know, particular types of tumors, or they focus on post traumatic pituitary, and so the sub specialization gets more and more granular, because the science expands at such a rate. 

Dr. Goldenberg, Co-host
40:44
So it shouldn't be hard to find these folks, you know no, it should be hard to find them. 

Dr. Batson, Co-host
40:50
But but again, keep in mind, you know attorneys, attorneys pick witnesses according to what they want to hear, right, and so you've got motives from both sides. So if you're plaintiff, you're going to, you're going to affiliate, you're going to retain an expert that that has a history of you know giving you diagnoses and things that are favorable for your client, right. And if you're a defense expert, you're going to have, you're going to, you're not going to hire that person. And so you know you always get in litigation, they'll ask you in deposition well, how many, how many cases have you done plaintiff versus defense? As if that's some valid marker of bias. And it's absolutely not. Because certain conditions if you're a researcher, for example, in an area and you know a lot about a particular condition or set of conditions, then you're going to be, you're going to have a lot of knowledge in that area and and you're more likely to to identify cases that are positive. So there's a selection bias. 

Dr. Goldenberg, Co-host
41:51
Yeah, that's an interesting way you tune me into that. You know I was thinking I was looking in some of the forensics training. They were talking about the shaken baby syndrome and you know the controversies around that and that you have these like legitimate experts and researchers who you know their research supports it or their research doesn't support it, and so it's not like the testimony is being influenced by the compensation is. The attorneys are selecting the experts that have the published opinions that support their side, and so you're you're 100% correct. 

Dr. Batson, Co-host
42:26
That is like a selection bias issue, not so much like a compensation bias issue, which is, I think, a much more nuanced way to think about it, and I think that, yeah, strikes me as that makes a lot more sense, is closer to the truth, for for most of the time anyway, yeah, I mean one of the one of the things and you know some of the attorneys that are listening will appreciate this one of the things we we have in in in Daubert versus Merrell Dow pharmaceuticals, which is one of the landmark cases that formed the you know the Daubert criteria that everybody refers to, which was ninth, ninth, ninth circuit, I think, 1995. 

42:58
But basically, there there's a, there's a, there's a, there's a space in there where it says, you know, identify whether, whether experts are proposing to testify about things that are trying to remember how it's framed, things that naturally grow out of their research they've conducted independent of the litigation setting, or whether they've developed their opinions expressly for the purposes of testifying. And that's profound because that's one that's not talked about as much, but it's critical, yeah, because I haven't, I haven't heard that. 

Dr. Goldenberg, Co-host
43:31
Can you say that again? I know we're kind of at time, but I think this is important yeah yeah, and this is very important. 

Dr. Batson, Co-host
43:36
Yeah, whether experts, whether experts are testifying on matters that have been generated or grown out of their independent research in their routine, you know routine research, right? Independent of the litigation. Meaning, are you a researcher doing research on a particular condition or set of conditions or brain injury or something when you're not testifying, right? Are you publishing on that or you doing ongoing research, or is do you just have opinions when somebody calls you and says we need, we need you to testify? Are you? And so are your opinions being developed just for the purpose of testimony? 

44:11
Because I already have opinions, because I mean, I mentioned I'm a researcher when I do, because I work with with, particularly right now, with post traumatic growth hormone deficiency. So we have about two publications coming out to post your presentations next year, and so that's going on independent of litigation, and it doesn't matter. I mean these are, you know, this is stuff that we need to know for clinical purposes, and so that research, which will be peer reviewed very soon, we would inform my, my testimony, of course, and so my testimony would grow out of that research. But it wouldn't be the reverse, right? It's not like I'm just, I'm not, I'm not just. You know, I'm asked to do litigation only and I have no research going on, and so my opinions are exclusively formulated in the research setting. Does that make sense? 

45:02
It doesn't I mean excuse me, in the litigation setting it's correct in the litigation setting setting only, and that and that points to bias, right, like if you're only, if you're only formulating opinions in that setting only. I'm not saying they are biased, but but you want to, you want to look more deeply? Yeah, because they're. It's entirely limited to the litigation setting. 

Dr. Goldenberg, Co-host
45:24
It's. It's like in the research world and evidence in this world we say we don't say bias, we say risk of bias, because of course you never know right. So it's sort of the same idea is sure is it's a higher risk of bias. That makes sense to me and you know another. I hadn't thought about this before, davis, but your, your point is a valid one. And then I want to follow that up with a question, which is you know you also have this track record if you're a researcher. You know multiple paper publications, you know supporting a position, like you said, independently, and that kind of track record I think is is easier to see in a harder risk of bias, although we still have that selection bias issue as far as, like, picking your expert based on their opinion. 

46:01
But here's a question to follow up on that, like we're clearly coming down pretty heavy on. You know you need to be involved in research to be a good forensic expert. Is that always the case? Like, can you do? Is that true? Can you not have clinician experts? Do you really need to be involved in research to be a good, you know, forensic witness? What are your thoughts on that? 

Dr. Batson, Co-host
46:22
Well, I mean, I think I think to be a good forensic witness. I think it depends what you're testifying on. Hmm, I think you know. Take a neurosurgeon, for example. Right, if there's, if there's a clear, if there's clear anatomical damage to the brain in a brain injury you know moderate, severe, traumatic brain injury and there was neurosurgical intervention, then you know, maybe not, maybe not, maybe not, because it becomes really, really clear. You know, and let's say you know there's, there's residual damage that's identified, like you know, a large area of encephalomalacia, where, where the brain tissue has been lost and replaced with cerebral spinal fluid. So you got a hole in your brain, pretty straightforward, and then, and then it's a major, you know, and so that and that may, and it really depends on the demands of the case or like malpractice. 

Dr. Goldenberg, Co-host
47:15
All you probably want is the clinician right. 

Dr. Batson, Co-host
47:17
Well, we'll hold on. So let me, let's, let's, let's keep with this analogy, for not this analogy, but let's keep with this idea for a minute, right? So so, if, if that amount of damage is sufficient for the case to resolve, right, and which is okay, we're just going to, we're going to tender limits, or the settlement is reached that everybody's happy with, fine. But then the question becomes then there becomes epidemiological questions like well, based on this severity of brain injury, what's the prognosis? Well, I mean, you can give prognosis from working with many patients and you can say this is my experience and working with these types of patients, but it's not great, yes, and yeah, it's not. You're not going to be, you're not going to be bang on with prognosis, and so now, now you've got to move into population data and epidemiology. And so then, do you feel you're qualified? I mean, if you're super focused on on nurse surgery, you might also be focused on epidemiology. You might be a researcher as well. 

Dr. Goldenberg, Co-host
48:18
But if you're not, I don't. I don't believe it, davis, because I'm telling you, I teach clinicians critical evaluation of the literature and they're brilliant clinicians and they've gone through all this training program and, honestly, they you know this is not a knock on them, this is not their job, but they have a very hard time reading research papers, even now and I don't think it's fair to say, yeah, they would be masters of epidemiology to your point. Yeah, probably not. 

Dr. Batson, Co-host
48:43
And so if it really depends on the demands of the case and the legal questions being asked, so, for example, that makes a lot of sense. Well, yeah, for example, what's the risk of dementia based on the severity of brain injury? And of course we just did a white paper on concussion and dementia and that's an epi question, yeah, but then we could look at things like well, if you had an epidural hematoma, if you had a subarachnoid hemorrhage, you could look at the hemorrhage. If you had a subdural hematoma, if you had a particular type of, you know, paruncomal bleed, the extent of the bleed, the you know whether there was different types of herniation, midline shift, various other anatomical abnormalities secondary to brain injury, and then what does that look like for the risk of dementia? And then, of course you know that's an epidemiological question, but the diagnosis and it requires it requires a team to be able to look at that. 

Dr. Goldenberg, Co-host
49:33
But the diagnosis piece like that's that's the clinical side, right, that's the clinical side, yeah, yeah. 

Dr. Batson, Co-host
49:40
I mean, and that's, you know, that's clear cut. Right, that's clear cut. So, again, I think it really depends on the context and what the goal, what's needed with the case? Yeah, but ultimately, you know, I think there needs to be. That's why there's more than one expert in the case. 

Dr. Goldenberg, Co-host
49:56
Yeah. 

Dr. Batson, Co-host
49:57
Right, and so you need to be able to meet those different demands. And so if you're, if you're working the plaintiff side, the plaintiff has the burden of proof, and so it's the job of the attorney who wants to work up the case satisfactorily or optimally, to make sure that those different types of experts are on board. And to me, in many cases not all cases epidemiology, forensic epidemiology, is very, very important to be able to look at. You know it helps inform prognosis, essentially. 

Dr. Goldenberg, Co-host
50:25
Yeah, so that I like the way you're phrasing this. So essentially, just to summarize it in my head to make sure I'm tracking with you, essentially it really depends on the purpose. If we're talking about, you know, malpractice case, like what's a doctor supposed to do that they didn't do right right, or a diagnosis which you know doctors are literally experts in, that makes sense that you would want a really good experience clinician, like you know, up-to-date, well-trained clinician. But if you're talking about even prognosis might straddle the line there. But certainly causation and Freeman, you know Michael talks about this a lot which is, you know, there's a difference between diagnosis and causation and doctors are experts in diagnosis, not necessarily causation, because we don't need it in practice, right? Like you know, the root cause of how this happened is less relevant usually than make getting the diagnosis right and knowing what treatment to do and how to manage that. So, yeah, that makes sense to me. 

Dr. Batson, Co-host
51:15
Yeah, where there's, where there's questions of causation. I mean, I mean, in some cases there's not Right. You had a brain injury. Your day of CT imaging was absolutely abnormal and then your post-imaging, you know, was also abnormal and it's very clear that that was linked to the injury event. But then the sequelae that they're experiencing, the symptoms and sequelae, become a matter of debate. 

Dr. Goldenberg, Co-host
51:39
Yeah, no, that makes sense. 

Dr. Batson, Co-host
51:40
Yeah, so that's kind of how it would frame it. 

Dr. Goldenberg, Co-host
51:43
Love that, love that, love that. Okay, so question procedural question we are over a normal time allotment. Do you want to kind of finish up the AMA? We're almost done there and then we can circle back in part two to go over some of the APA stuff we haven't covered. 

Dr. Batson, Co-host
51:57
Yeah, let's finish up the AMA. What's your time frame? 

Dr. Goldenberg, Co-host
52:01
I think we should probably wrap up the episode. People don't like to listen to super, super long podcasts. In my experience, I think we've been doing pretty good around 30, 40 minutes. I think we're pushing 50 right now. So maybe we can kind of wrap this up, if doable. Otherwise, we can save it for part two. 

Dr. Batson, Co-host
52:17
Yeah, I mean, I think what we just what we just talked about was but we had talked about appropriate training and recent substantive experience, and what we're going to talk about I'm not sure that we need to spend a ton of time on it. But the next one's objectivity and independence, and to evaluate cases objectively and provide an independent opinion, and so I think this is maybe a big topic rather than a little one, because I think we should do a separate podcast, because objectivity itself is an interesting topic philosophically. 

Dr. Goldenberg, Co-host
52:51
Like it. 

Dr. Batson, Co-host
52:53
And also medically and scientifically, and so we get into a whole discussion of cognitive biases, which I know you and I are both really in informal logic. Hmm, yummy, that sounds good, and getting into that, because to be objective implies that you're not biased. Well, every human being is biased, so it's always a matter of mitigating bias. So so it you know what they should say being at evaluate cases as as objectively as humanly possible, within the constraints of being a human being who's fallible. 

53:28
I love that, right, and so so we're talking about weight of evidence, we're talking about getting as close to the truth as possible, or or the facts, or whatever, whatever it may be, yeah, but essentially we that's a big topic, that's Pandora's box, so let's let's do a podcast on objectivity. We can get into talking about cognitive biases in clinical medicine and also in forensics and see where the crossover is. And, of course, the independent opinion just means that that that's happening. That's happening in a bit of a vacuum, meaning the litigators or the attorneys, counselors, have not influenced that opinion and and other other physicians or doctors haven't influenced that opinion, with the exception that that, if you need to rely what would be reasonably relied upon in the context of clinical practice to inform your opinion is okay, meaning, if you know, if you've referred out to a different discipline and that doctor you know that's not your specialty, you can most certainly adopt that opinion and incorporate that into your overall opinion. So that doesn't mean that you're not independent. It just means you're relying upon opinions of other experts or treating physicians that are more specialized in a particular area. So then the next one is is is. 

54:43
The next core principle is current science and acceptance in the relevant field, and that's basically to ensure that testimony reflects current scientific thought and standards of care that have gained acceptance among peers in the relevant field. Now, that's an interesting. There's actually a problem with that. The problem with that is that current scientific thought and standards of care have a separation, and you mentioned that. You mentioned a two and a half decade gap. 

Dr. Goldenberg, Co-host
55:12
Lag time, bias big issue. 

Dr. Batson, Co-host
55:15
Lag time bias is what we talk about. Yeah, why don't you explain lag time, because I think that's important to understand. I mean, we want to be as current as possible and, at the same time, we want to be operating within standards of care, and those are often dichotomous. Tell us about lag time bias, josh. 

Dr. Goldenberg, Co-host
55:30
Yeah that's a good point and maybe that underlines what you were saying earlier, which is sort of the need to have someone in the research world too, in other words, that they're at the cutting edge, yeah, yeah. So lag time bias is essentially this concept that research accumulates faster than clinical practice changes essentially. And you know, back in the day before we had evidence-based medicine and evidence synthesis and all this yeah, that example we talked about last time two and a half decade lag where you had solid evidence to do X but clinicians and textbooks were not changing for another 25 years. To reflect that was a pretty egregious example. Hopefully it's better these days with these updatable online textbooks like up-to-date and dynamet and stuff like that, but it still exists. Lag time bias is a thing, and I agree. 

56:21
I think what they're trying to get at at this point is you need to be up-to-date. Now there's a little bit of a nuance there, too, to put nuance on top of nuance, which is you don't want to be so cutting edge that it's not standard in the field, right, and so that's sort of. The other thing is that your presentation and correct me if I'm getting this wrong, but my understanding is like you need to present standard accepted scientific methodology, and sometimes, when you get on that cutting edge, there is a little bit of debate, right, because the evidence is currently accumulating. So it's almost like you're not on the cutting edge, but maybe you're right behind it. 

Dr. Batson, Co-host
57:01
Could be. Yeah, and I think and again, there's always going to be debate over that. You know, cutting edge is not ideal, because the cutting edge implies that it's novel and it may still need to be vetted. It may, there may need to be reproducibility as a key tenet of the scientific method, and yet there's a sweet spot in between. 

57:21
Right yeah, there's a sweet spot where the clinical practice guidelines have not changed yet, which is really those often represent. That's one marker of the standard of care is what are your CPGs in a particular field? 

Dr. Goldenberg, Co-host
57:36
And they can be 10 years old easy. 

Dr. Batson, Co-host
57:38
They can be 10 years old easily, yeah, yeah, and so you know staying, you know so, and yet you've got, you know, five, six peer reviewed publications where research has been replicated in that decade and that really does represent the best available evidence and current scientific thought. 

Dr. Goldenberg, Co-host
57:55
Right. 

Dr. Batson, Co-host
57:56
And you can know that, unless you go into the literature and you do do what we try to do and encourage others to do, which is to take a systematic review approach or a scoping review approach, to make sure that we aggregate all the literature, look at the quality and say you know, are we, are we in a position to say this is truly best, best, best practice, best available evidence, despite the clinical practice guidelines and standards of care represented by them being a little bit behind. 

Dr. Goldenberg, Co-host
58:27
Yeah, good point. Yeah, so it says sweet spot and that will be discipline specific and perhaps even intervention specific as well. 

Dr. Batson, Co-host
58:34
Absolutely, and I'm thinking we close it here. 

Dr. Goldenberg, Co-host
58:37
Love it. 

Dr. Batson, Co-host
58:38
Yeah, and the last one is about really about investigating false or misleading testimony by institutions, and so I'm not going to, we're not going to, we're not going to focus on that. That's really, you know, it's about state specialty societies, medical licensing boards and so forth. Holding witnesses accountable when there have been claims of false or misleading testimony and then actually in issuing disciplinary sanctions is appropriate, and I don't, I've never seen that happen in the forensic setting. I don't. I don't think people are out there reporting other other physicians or other witnesses for misleading testimony. I think it's sort of understood that that if there's, if there's good cross examination, that's probably going to be be handled or it might be handled through, you know, David or fry challenge. 

59:31
Right, it's gonna say yeah evidence you challenge, or it might be handled through motions and lemonade and that kind of thing, and those are all things for for litigators, that are their specialty and not ours. So that's as much as I would say about that Love it. I want to come back and I do want to talk about objectivity and cognitive biases and we I'm not going anywhere. Let's do it. Let's do it. 

Dr. Goldenberg, Co-host
59:53
You want to talk about cognitive biases, I'll be here. I love that stuff. I think that's great. 

Dr. Batson, Co-host
59:59
Yeah, that'll be 2024. 

Dr. Goldenberg, Co-host
01:00:02
Well, let's not. Yeah, I love this, let's not, let's not push it. There's a lot to unpack here. We'll definitely have a part two. So we'll come back, we'll do objectivity, some cognitive bias stuff and then maybe finish up the APA ethical guidelines, a lot of which we probably covered today. But we'll clean up fabulous. Well, thank you so much, Dr. Batson. That was super fun and we'll see you all in a couple weeks. 

Dr. Batson, Co-host
01:00:24
Dear listeners, we'll see you all in, it is January 3rd 2024.  So a Happy, Happy New Year to everybody that's listening, even if it's not anywhere near January, but that's right. 

Dr. Goldenberg, Co-host
01:00:36
Happy contemporaneous New Year's, whatever it ends up being. Okay. 

Dr. Batson, Co-host
01:00:43
Thanks again, Dr. Goldenberg, and we'll we'll see you next time. 

Dr. Goldenberg, Co-host
01:00:46
All right, take care. 

Introducer, Other
01:00:52
Thank you for listening to the Brain Injury Forensics podcast with Doctors Batson and Goldenberg, brought to you by Brain Injury Research Solutions. If you'd like to learn more about our unique approach to brain injury forensics, email us directly at info at braininjuryresearchsolutions.com, or learn more on our website, www.braininjuryresearchsolutions.com. There you can sign up for webinars, explore featured papers and learn about the team. Enjoy the podcast. Don't forget to rate us and review us on Apple Podcast to help spread the word.