Full opinion text
Order ANNE C. CONWAY, District Judge. This cause comes before the Court for consideration of AstraZeneca’s Motion for Summary Judgment (Doc. 13), to which Plaintiff Haller has responded in opposition (Doc. 15). Oral argument on the motion was held on January 13, 2009. Upon carefully considering the legal memoranda, exhibits, deposition testimony, relevant case law, and the oral argument, the Court determines that AstraZeneca’s motion is due to be GRANTED. I. BACKGROUND Seroquel, a prescription drug manufactured and sold by AstraZeneca Pharmaceuticals, was first approved for use in the United States by the Food and Drug Administration (FDA) in 1997. The drug, known chemically as quetiapine fumarate, is still on the market today as one of a number of medications known as second-generation, or “atypical,” antipsychotics. Although initially indicated to treat the “manifestations of psychotic disorders,” including schizophrenia, Seroquel has since been approved for various uses in patients suffering from bipolar disorder. Several years ago, people who had been prescribed Seroquel by their doctors began filing lawsuits against AstraZeneca, primarily alleging that they had developed diabetes and other related disorders as a result of their ingestion of the drug. In July 2006, the Judicial Panel on Multidistrict Litigation transferred ninety-two actions involving alleged injuries resulting from the use of Seroquel to this Court for consolidated and coordinated pretrial proceedings. Since that time, this consolidated action has grown to include the personal injury claims of several thousand people from across the nation, including the plaintiff in the present case, David Haller. David Haller is a 47-year-old resident of Largo, Florida. Born in Pennsylvania, he was adopted at six months old, and remained in his adoptive parents’ household until he was twenty-two. Haller had a troubled childhood; he only completed formal education through the third grade due to behavioral problems, and spent much of his teens in and out of juvenile detention centers and psychiatric hospitals. Haller moved to Florida in 1983, and was formally diagnosed with bipolar disorder by a department of corrections psychiatrist in 1987. Beginning shortly after his arrival in Florida, and continuing through 2002, Haller accumulated a lengthy criminal record, leading to incarceration on numerous occasions, and involuntary commission to psychiatric hospitals on at least seven separate occasions. Haller’s non-psychiatric health history indicates that he suffers from several chronic conditions, including gastroesophageal reflux disease, high cholesterol and high blood pressure, and has experienced significant weight fluctuations throughout much of his adult life. In addition, Haller has a history of alcohol abuse, has smoked at least a half a pack of cigarettes a day since he was twelve years old, and does not exercise. Haller was first prescribed Seroquel in October 2002 by Nurse Practitioner Dee Burke at Directions for Mental Health in Clearwater, Florida. Haller has remained on varying doses of the drug since that time, and was still taking the drug as recently as July 2008. Haller was diagnosed with diabetes and placed on medication in August 2004, when he was admitted to the hospital for abdominal pain. In February 2006, however, Haller’s diabetes medication was discontinued, and, according to his present primary care physician, he has not had any diabetic symptoms since she began treating him in July 2005. Haller initiated this lawsuit against AstraZeneca in October 2006, asserting claims for strict product liability, negligence, fraud and civil conspiracy. AstraZeneca now seeks summary judgment as to each of Haller’s claims. It is this motion to which the Court now turns. II. SUMMARY JUDGMENT STANDARD On a motion for summary judgment, the movant bears the initial burden of showing that no genuine issue of material fact remains for trial. Celotex v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986); see also Zivojinovich v. Barrier, 525 F.3d 1059, 1066 (11th Cir.2008). To avoid summary judgment, the opposing party must come forward with specific facts in dispute that are material and of a substantial nature. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). Conclusory allegations, evidence that is not significantly probative, and personal opinions will not suffice to defeat a motion for summary judgment. Johnson v. Fleet Fin., Inc., 4 F.3d 946, 949 (11th Cir.1993). Though the opposing party must present specific evidence showing a question of material fact, the Court must draw all reasonable factual inferences in favor of the opposing party. Anderson v. Liberty Lobby, 477 U.S. 242, 249-50, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). III. ANALYSIS The overarching issue raised by AstraZeneca’s summary judgment motion is whether Haller can carry his burden of establishing medical causation. Indeed, because establishing medical causation is critical to each of Haller’s claims, AstraZeneca is entitled to judgment as a matter of law as to all claims set forth in the complaint if Haller fails to establish a genuine issue of material fact with regard to whether his ingestion of Seroquel caused him to develop diabetes. In order to establish medical causation in a toxic tort case such as this one, a plaintiff must show both that exposure to the alleged toxic substance can cause a particular disease (general causation), and that exposure to the alleged toxic substance was a cause of his or her individual injury (specific causation). See Mary Sue Henefin, et al., Reference Guide on Epidemiology, in REFERENCE MANUAL ON SCIENTIFIC EVIDENCE 444 (Federal Judicial Center, 2d ed. 2000); see also McClain v. Metabolife Int’l, Inc., 401 F.3d 1233, 1237 (11th Cir.2005) (“Plaintiffs must prove the toxicity of the ephedrine/caffeine combination and that it had a toxic effect on them.... ”). Thus, in this action, Haller must show both that Seroquel can generally cause diabetes and that Seroquel was a specific cause of his diabetes. Having carefully reviewed the record in this case, however, the Court finds that even assuming there is a triable issue with regard to general causation, Haller has failed to come forward with evidence establishing a genuine issue of material fact as to whether Seroquel was the specific cause of his injury. A. Admissibility of Expert Testimony on Specific Causation At the outset, the Court notes that in federal court, expert opinions must meet the admissibility guidelines announced by the United States Supreme Court in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 592-93, 113 S.Ct. 2786, 125 L.Ed.2d 469 (1993). In Daubert, the Supreme Court set forth a non-exhaustive list of relevant factors to consider in determining whether the methodology employed by an expert is reliable. Id. at 593-94, 113 S.Ct. 2786. The factors include whether the methods can be tested or have been subject to peer review, the potential rate of error, and whether the methods are generally accepted. Id. Applying these principles in Tuscaloosa v. Harcros Chemicals, Inc., 158 F.3d 548, 562 (11th Cir. 1998), the Eleventh Circuit held that expert testimony may be admitted if three requirements are met. First, the expert must be qualified to testify competently regarding the matter he or she intends to address. Id. Second, the methodology used must be reliable as determined by the Daubert inquiry. Id. Third, the testimony must assist the trier of fact through the application of expertise to understand the evidence or determine a fact in issue. Id. This final requirement entails an evaluation of whether the testimony is relevant, i.e., it “has a justified scientific relationship to the pertinent facts.” McDowell v. Brown, 392 F.3d 1283, 1299 (11th Cir. 2004). Two experts have offered specific causation testimony in Haller’s case: Dr. Brian Tulloch, an endocrinologist, and Dr. I. Jack Abramson, a psychiatrist. After extensively reviewing their testimony, however, the Court determines that neither expert’s specific causation testimony is admissible under Daubert, as the following discussion demonstrates. 1. Dr. Brian Tulloch As will be discussed in detail, Dr. Tulloch employed a flawed methodology in arriving at his opinions. Further, on the merits, the causation opinions he reached are speculative and unreliable. In order to fully appreciate the deficiencies in Dr. Tulloch’s methodology, one must understand what those opinions are, how he reached them, and how they have evolved over the course of this lawsuit. Accordingly, a considerable amount of history is necessary. Dr. Tulloch’s Expert Report In his expert report, Dr. Tulloch noted the following medical history for Haller: hypertension, gastroesophageal reflux disease, psychogenic vomiting, chronic obstructive pulmonary disease, cirrhosis, hyperlipidemia, obesity, substance abuse (including alcohol and cocaine), and heavy cigarette use (up to 40 cigarettes per day). Additionally, Dr. Tulloch’s report noted that Haller’s “psychiatric history includes references to bipolar disorder in 1987, [mjixed personality disorder noted in 1996, [sjchizoaffective disorder, bipolar type, depression, suicide attempts and post traumatic stress disorder.” This is extremely significant; as will be discussed in greater detail, many of the things Dr. Tulloch listed are causative factors for diabetes. The heart of Dr. Tulloch’s report, at least as far as specific causation is concerned, consists of the following two paragraphs: In reviewing the relationship between [Haller’s] weight and the onset of abnormal blood sugars there is good evidence of weight gain from 230 lbs in January 2001 to May 2004 when the weight was recorded as 251 lbs[,] an increase of 21 lbs, and he then was diagnosed with diabetes mellitus. Soon after the initiation of Metformin and presumably an appropriate diet, however, his weight was reduced to 218 lbs by February 2005, and thenceforth the weight remained fairly stable while sugars remained under excellent control. The main detectable relationship between Seroquel and abnormal glucose physiology therefore seems to be following a 21 lb weight gain when clearly abnormal sugars are registered. Based on reasonable medical probability the excess weight gain experienced following the administration of the atypical anti-psychotic drug Seroquel was a cause of [Haller’s] developing diabetes. However[,] soon after the diagnosis of diabetes was established the weight returned to his previous level and his sugars stabilized with evidence of good glucose control measured with HbAlc values essentially in the normal range. Dr. Tulloch’s Deposition On October 15, 2008, Dr. Tulloch was deposed about his specific causation opinions regarding Haller. At the outset, Dr. Tulloch admitted that before rendering his opinions in the case, he did not physically examine Haller, he did not speak with him, he did not review all of the medical records he was provided regarding Haller, he did not read the depositions of any of Haller’s treating physicians, and he did not read Haller’s deposition. Dr. Tulloch conceded that by not reviewing all of the medical records and any of the treating physicians’ depositions, he might possibly miss explanations for Haller’s weight gain and diabetes other than his use of Seroquel. Dr. Tulloch also admitted that he had not comprehensively reviewed the medical literature on Seroquel. In fact, he read only a “small portion” of the literature on Seroquel and diabetes. Similarly, he read only a “small portion” of the literature on Seroquel and weight gain, and much of that was “summarizing.” At the time of his deposition, Dr. Tulloch knew of no scientific evidence to support the conclusion that Seroquel directly affected Haller’s pancreas or the cells of his pancreas, i.e., that it directly caused diabetes. He gave the same answer to the question regarding persons in general. Dr. Tulloch admitted that his report appeared to be incorrect regarding the date on which Haller began using Seroquel. The correct date was October of 2002, rather than February of that year. Dr. Tulloch further admitted that he did not know what dose of Seroquel Haller was taking during 2002 and the first five months of 2003. Consequently, he conceded that his opinions concerning Haller’s weight from the time he commenced taking Seroquel until May 2003 could not relate to the dose of Seroquel Haller was taking. Based on information presented to Dr. Tulloch at his deposition, it appeared that Haller was still taking Seroquel as of July 2008. Dr. Tulloch admitted that Haller’s psychiatrist had elected to keep him on Seroquel despite the fact that Haller was diagnoses with diabetes. The excess weight gain Dr. Tulloch believed resulted from the Seroquel was 21 pounds. Dr. Tulloch believed this weight was gained during the period January 2001 to May 2004. However, Dr. Tulloch admitted that the 21 pound weight gain was based on a beginning weight that was recorded nearly two years before Haller began taking Seroquel. Dr. Tulloch admitted he did not know how much Haller weighed when he started taking Seroquel. He admitted it was possible Haller might have weighed 251 pounds when he began taking the drug. Dr. Tulloch further admitted that the beginning number (230 pounds) for his weight gain calculation was not a reliable indicator of what Haller weighed just before he began taking Seroquel. Dr. Tulloch conceded that it was speculative to say how much weight Haller gained when he was on Seroquel. He specifically admitted that he didn’t know how much weight Haller gained in the first year he was on the drug. Dr. Tulloch agreed with the opinion expressed by Dr. Wirshing, another of Plaintiffs’ experts, to the effect that persons who gained weight on Seroquel gained about 9 pounds during the first couple of months of treatment, then reached a plateau. Other causes of Haller’s weight gain were his sedentary lifestyle and his psychosis. Dr. Tulloch could not rule out those factors as the sole cause of Haller’s weight gain when he was on Seroquel. Dr. Tulloch did not try to rule out alternative causes for Haller’s weight gain because he did not feel he needed or had to do that. Dr. Tulloch agreed that the complications from diabetes that he described in his report could have been solely caused by pre-existing obesity, years of smoking, metabolic syndrome, and uncontrolled hypertension that preceded Haller’s ingestion of Seroquel. Dr. Tulloch further agreed with the statement that “it would be scientifically and medically impossible ... to look at a complication and say that it came from the diabetes as opposed to it came from the hypertension or the metabolic syndrome or the smoking or the obesity[.]” Referring to the two most common causes of death in diabetics — stroke and heart attack — Dr. Tulloch also agreed that he “wouldn’t be able to look at a given individual and say his death was due to the effect of the diabetes or the effect of ... 20 years of smoking cigarettes or his obesity[.]” With specific reference to the coronary artery disease and myocardial infarction Haller presented after his diagnosis of diabetes, Dr. Tulloch could not rule out that those things were solely caused by Haller’s smoking, preexisting obesity, hypertension and metabolic syndrome. Dr. Tulloch repeatedly proclaimed that the Seroquel usage was the proverbial “straw that broke the camel’s back,” i.e., that it was an “additive” or “contributing” factor. In other words, he said, Seroquel was “one of the list,” “probably a contributing factor,” and “one of the contributing factors.” Dr. Tulloch made crystal clear at his deposition that the sole basis for his opinion that Seroquel caused the development of diabetes in Haller was the temporal relationship between Haller’s taking Seroquel and his subsequent weight gain, and the weight gain’s temporal relationship with the development of diabetes. Dr. Tulloeh made equally clear that Haller would have developed diabetes at some point even if he had never taken Seroquel. His opinion was that Seroquel somehow accelerated the development of diabetes because of the weight gain. He had not attempted to quantify the acceleration, but based his conclusions on the “correlation” between the weight gain and the appearance of abnormal blood sugar. Although Dr. Tulloch’s report does not note this fact, Haller is 5'6" tall. In January of 2001, at age 40, less than two years before he began taking Seroquel, he weighed 230 pounds. This gave him a body mass index of 37.1, which qualified him as morbidly obese. Medical records discussed at Dr. Tulloch’s deposition established that Haller gained 58 to 60 pounds during the period January 1997 to January 2001. Dr. Tulloch’s opinion was that Haller gained that weight by “taking in more calories than he burned.” Dr. Tulloeh added: “Some people eat more when they’re depressed, some people eat more when they’re in particular sets of circumstances.” Medical records further established that Haller gained 80 pounds during the 16-year period ending January 2001; he increased from 150 pounds to 230 pounds. Dr. Tulloeh admitted that because he did not interview Haller, take a medical history from him, or have him fill out a questionnaire, he couldn’t “have any specificity” about what caused his weight gain during that time period. Dr. Tulloeh further conceded that before Haller took Seroquel, he had a much bigger weight gain than he ever had the entire time he was on Seroquel. Given these weight gains, Dr. Tulloeh agreed that more probably than not, he would expect such a person to continue to gain weight whether or not they took Seroquel. However, Dr. Tulloch conceded that Haller lost weight for the first year and a half he was on Seroquel. He agreed that Haller lost 20 pounds in the first year he was on Seroquel and 23 pounds during the second year. In an effort to explain this “pattern” of weight loss, Dr. Tulloeh speculated that once Haller was diagnosed with diabetes, he became serious about his situation and reduced his caloric intake. He also suggested that the drug Metformin, prescribed for Haller for his diabetes, might explain the weight loss. Dr. Tulloeh further agreed that Haller lost 51 pounds in 2005 while he was taking Seroquel, despite the fact that his dosage increased. Dr. Tulloch also conceded that this history did not support a dose-response relationship between Seroquel and weight gain. Dr. Tulloch was then confronted with the fact that Haller’s weight “popped back up to 245” in August 2006. When asked if he attributed that particular weight gain to Seroquel, Dr. Tulloch opined that the drug was a “contributing factor” or “one of the potential confounding factors,” whereas in the instances where Haller lost weight while on Seroquel “other factors were dominant.” Dr. Tulloch posited other contributing factors for the weight gain in 2006: hypokinesis (inactivity) and excess caloric intake. When asked to quantify how much of the weight gain was attributable to Seroquel and how much to the other factors, Dr. Tulloch admitted he could not do so. He further conceded that as to any of the weight gains by any of the plaintiffs in the cases in which he was testifying, he could not say how much of the weight gain was due to Seroquel and how much was due to diet, lack of exercise and other factors. Ultimately, Dr. Tulloch conceded that in every year since Haller began taking Seroquel, he had “a major weight loss.” Dr. Tulloch also agreed that as of April 2008, Haller weighed the same as he did two years before he began taking Seroquel. When asked, “So weight gain while he was on Seroquel did not cause [Haller] to have diabetes, correct?”, Dr. Tulloch replied, “Okay. I’ll buy that.” Dr. Tulloch agreed that Haller had hypertension before he began taking Seroquel, that his hypertension had at times been uncontrolled, and that hypertension can cause diabetes. Even though scientists have quantified the risk of developing diabetes in persons who are hypertense, Dr. Tulloch did not attempt to quantify the contribution of hypertension to Haller’s diabetes. Nevertheless, Dr. Tulloch claimed he was able to rule out, to a reasonable degree of medical probability, hypertension as the sole cause of Haller’s diabetes “[b]ecause he had so many other factors.” Dr. Tulloch was aware that Haller was a long-time alcohol abuser. He conceded that alcoholic pancreatitis is a cause of diabetes. He also agreed there was “a lot of evidence” that Haller had a sedentary lifestyle and that sedentary lifestyle is a contributing cause of diabetes. Scientists have quantified the risk of diabetes in people who have a sedentary lifestyle, but Dr. Tulloch had not attempted to quantify that factor as a contributing cause of Haller’s diabetes. Dr. Tulloch further admitted that he knew Haller was taking Depakote and Lithium contemporaneously with Seroquel, and that Depakote is associated with weight gain. Dr. Tulloch did not determine what contribution Depakote or Lithium made to Haller’s weight. He characterized them as “one of the components on the saddle of the camel,” but didn’t flunk one could ascribe accurate numbers to that component with reasonable medical probability. In other words, he couldn’t determine the number of pounds attributable to Depakote and Lithium. Dr. Tulloch agreed with the statement that “as a medical and scientific matter, [he couldn’t] blame weight gain on ... Seroquel when an equal amount of weight loss occurred while the patient was on Seroquel.” He further conceded that before Haller had diabetes during the time period in 2003 when he was on Seroquel, he lost 20 pounds. He also agreed that “a weight loss during the first year that a person like ... Haller was on Seroquel is not the pattern [he] would expect to see if Seroquel caused weight gain.” Dr. Tulloch admitted that Haller’s weight decreased after he was diagnosed with diabetes. Dr. Tulloch made no effort to ascertain what was occurring in Haller’s life after he started taking Seroquel that would affect his weight. When asked to describe the pattern of weight gain Seroquel causes, Dr. Tulloch stated he didn’t have any pattern in mind. Dr. Tulloch also could not say how much weight he would expect Seroquel to cause someone to gain. He even noted that some patients on atypicals such as Seroquel do not gain weight at all. Motion Practice Following Dr. Tulloch’s Deposition On November 3, 2008, after Dr. Tulloch was deposed, AstraZeneca filed a Motion to Exclude the Specific-Causation Testimony of Plaintiffs’ Case-Specific Causation Witnesses. Therein, AstraZeneca argued that the testimony of Plaintiffs’ expert medical causation witnesses, including Dr. Tulloch, must be excluded on Daubert grounds. The first ground AstraZeneca raised for exclusion was that Dr. Tulloch and the other experts had based their causation opinions on the “mere temporal relationship” between Plaintiffs’ use of Seroquel and their alleged injuries. AstraZeneca noted that “the Eleventh Circuit has held that admissible expert causation testimony cannot be based merely on ‘temporal relationship.’ ” AstraZeneca raised the following other arguments for exclusion: (1) “all of Plaintiffs’ case-specific experts failed to consider and then rule out each Plaintiffs pre-existing obesity, substantial overweight, and many other risk factors and alternative causes for their alleged diabetes injuries”; (2) “none of Plaintiffs’ case-specific witnesses even tried quantitatively to assess the relative contribution of each Plaintiffs many other pre-existing risk factors for diabetes”; (3) “none of Plaintiffs’ case-specific experts even offers an opinion that meets Florida’s ‘more likely than not standard of causation’ including its ‘but for’ test”; and (4) “all five of Plaintiffs’ specific-causation witnesses compound the errors in their scientific and unreliable causation opinions by relying on little more than cursory review of insufficient medical facts about Plaintiffs — including misleading summary charts of cherry-picked data prepared by Plaintiffs’ counsel and spoonfed to these putative experts, which is impermissible.” On the same day it filed the- Daubert motion, AstraZeneca filed a summary judgment motion directed at -Haller’s claims. The company raised causation as its very first argument, stating: [A]ll of Plaintiffs claims fail for lack of proof on the essential element of causation — including both general and specific “medical causation.” Plaintiffs’ expert testimony on medical causation should be excluded, as explained in AstraZeneca’s Daubert motions incorporated by reference. Indeed, the specific-causation testimony of Plaintiffs two case-specific experts, Drs. Tulloch and Abramson, is clearly inadmissible under Daubert. Without expert evidence of . both general and specific medical causation, all of Plaintiffs claims fail. See Allison v. McGhan Med. Corp., 184 F.3d 1300, 1322 (11th Cir.1999). Even apart from admissibility under Daubert, Plaintiff has no evidence that meets Florida’s “ ‘more likely than not’ standard of causation,” including its “but for” test. Gooding v. University Hosp. Bldg., Inc., 445 So.2d 1015, 1018 (Fla.1984); Colville v. Pharmacia & Upjohn Co., 565 F.Supp.2d 1314, 1322 (N.D.Fla.2008). Dr. Tulloch’s Declaration In the face of these criticisms, on November 21, 2008, Dr. Tulloch prepared a 12-page declaration addressing his causation opinions regarding the four Plaintiffs — including Haller — about which he had been asked to serve as an expert. This declaration was filed in opposition to AstraZeneca’s specific causation Daubert motion. In his declaration, Dr. Tulloch noted that his expert report- stated he reserved the right to supplement his opinions because document production was ongoing. Dr. Tulloch further stated that at and after his depositions, he was provided “additional medical records which reflect additional data involving Plaintiffs’ weights and blood sugars prior to and during their use of Seroquel and diagnosis of diabetes.” Accordingly, Dr. Tulloch stated, his declaration was “supplement[ing]” and “clarifying]” his opinions based on “new records and data.” In his declaration, Dr. Tulloch reiterated that Haller’s weight was not recorded when he started taking Seroquel in October of 2002. Dr. Tulloch further noted weights of 226 pounds on March 13, 2003, 247 pounds on June 23, 2003, and a peak of 251 pounds in May of 2004. Dr. Tulloch thus stated that Haller gained at least 25 pounds since the first weight was recorded on Seroquel. Dr. Tulloch admitted in his declaration that Haller’s weight “fluctuated.” He further noted that Haller began losing weight in the months following May of 2004. Dr. Tulloch commented on the fact that in June of 2004, Haller had to be hospitalized for elevated blood sugars and “suspected pancreatitis, another condition associated with Seroquel use and which Mr. Haller’s treating physician Dr. Sreenath questioned as being drug induced.” Dr. Tulloch noted that Haller lost weight during and after this hospitalization. Dr. Tulloch stated that Haller was diagnosed with uncontrolled diabetes on August 6, 2004, when he weighed 225 pounds. Dr. Tulloch noted that the 25-pound weight gain while Haller was on Seroquel was more than 10% of Haller’s body weight and “increases his risk of diabetes.” Continuing, Dr. Tulloch stated: “As with many other drug exposure-disease relationships, the exact mechanism is not always known, yet the causal association is accepted in the medical and scientific communities. It is my opinion that is the case here and that but for the exposure to Seroquel, Mr. Haller would not have developed diabetes in August 2004.” Dr. Tulloch also discussed the issue of multiple risk factors, quantification of each risk factor in each individual plaintiff, and AstraZeneca’s criticisms of his “straw/camel” analogy. Dr. Tulloch asserted that “it is impossible to attribute a percentage of risk for each risk factor in a given individual” (as opposed to a population). He stated that risk factors may “interact synergistically in different ways in different patients.” Acknowledging that “each of these patients had other risk factors for diabetes,” he opined that “their risk profiles were relatively stable prior to the addition of Seroquel as a new risk factor for diabetes.[ ]” Further, noted Dr. Tulloch, these patients “did not develop diabetes despite having other risk factors for diabetes until after exposure to Seroquel.” Hence, opined Dr. Tulloch, “but for exposure to Seroquel, these individuals would not have developed diabetes when they did.” As for his methods, Dr. Tulloch asserted that he reached his opinions “using methodology consistent with the methods used by clinicians in clinical practice when evaluating a referred patient’s history and clinical course and when asked to give second opinions and consultations to other physicians based on the patient’s records and diagnostic testing.” Dr. Tulloch stated that his “methodology with regard to each opinion was the same: [he] reviewed medical histories and the notes of physical examinations performed by other physicians; [he] gathered and scrutinized clinical data, including weight recordings and results of laboratory tests; [he] reviewed and analyzed existing peer-reviewed published literature and the manufacturer’s own clinical trials, all supporting the view that Seroquel can cause diabetes; and [he] considered the role other risk factors might have played in the development of diabetes in each individual’s case.” “Ultimately,” Dr. Tulloch concluded that, “but for ingestion of Seroquel, ... David Haller would not have developed diabetes at the time of [his] respective diagnoses].” Although in his deposition he made abundantly clear that his specific causation opinion as to Haller rested on a single ground — temporality—Dr. Tulloch concluded his declaration by listing five different bases for his opinion: (1) “the temporal association of ingestion of Seroquel with the onset of diabetes”; (2) “the fact that other risk factors had not brought about the onset of diabetes prior to the introduction of Seroquel”; (3) “the presence of a biologically plausible mechanism whereby Seroquel can cause diabetes”; (4) “the demonstration in the literature of a significantly increased risk of diabetes as a result of Seroquel ingestion”; and (5) “the consistency in the clinical courses of the individuals here compared with those of patients in literature and clinical trials.” Dr. Tulloch’s Testimony at the Daubert Hearing The Court held a Daubert hearing on January 15, 2009. Dr. Tulloch testified at that hearing. On direct examination, when asked for his opinion regarding whether Haller’s “use of Seroquel was a substantial contributing cause of his development of diabetes in August of 2004,” Dr. Tulloch replied: “I believe it was a contributing factor.... [At my deposition] my simple concept was that of the final straw that breaks the camel’s back. I acknowledged all of the risk factors that this man had. And then I pointed out that he got Seroquel at a certain date. On three separate occasions after that he developed pancreatitis, which is a known complication of Seroquel. And then some months after that he developed high blood sugar, compatible with diabetes.” When questioned about the materials he reviewed in reaching his opinion, Dr. Tulloch noted that Haller had “voluminous medical and other records.” Dr. Tulloch stated he “skimmed through most of those, and then also a summary that puts all of those together”; he also stated some of the information had been put on a “flow sheet.” Dr. Tulloch noted that he relies on summaries of medical records in his regular medical practice, and remarked, “[t]hat’s the only way I survive[.]” Dr. Tulloch then reiterated his oft-used “straw/camel” analogy: “I believe that if one adds up the circumstances, the final straw arrived, that broke the camel’s back, of his blood sugar on the 6th of August in 2004.” Dr. Tulloch referred to Exhibit 19, which he described as “a serial listing of [Haller’s] weights from 1985 until 2008.” At the outset, Dr. Tulloch admitted that Haller’s weight “does oscillate.” Dr. Tulloch testified that in 2002 Haller was given Seroquel, and “from that time there’s an apparent dramatic rise in weight.” At a later point in his testimony, Dr. Tulloch reiterated: “There is a dramatic increase in body weight, which occurs from his first exposure to Seroquel in October of 2002, and that high weight is maintained until his development of diabetes in August of 2004.” During his direct examination, Dr. Tulloch noted that Haller developed pancreatitis in November of 2003, January of 2004, and July of 2004. He also admitted that Haller had a “fairly dramatic rise” in weight in 1997. Dr. Tulloch testified that prior to using Seroquel, Haller had the following risk factors for diabetes: he was psychotic; at least from the year 1997, he was overweight; he was a smoker; he had high blood pressure; he had high cholesterol; he had a sedentary lifestyle; and he was on Depakote from 1997-2000. Dr. Tulloch added that the blood pressure medications Haller was using when he developed diabetes were not the sort that precipitate diabetes or pose a dramatic risk factor for diabetes. Dr. Tulloch also noted that even though Haller had all those risk factors, he did not develop diabetes during time frame 1997-2000, nor did he after he began taking Risperdal. When Dr. Tulloch was asked, “[A]re you able to say, with a reasonable degree of medical certainty, that any of the risk factors [discussed], other than the Seroquel, was not the sole cause of his development of diabetes in August of 2004?”, he replied: “Well, yes, sir. You know, in these additive risk factor issues, that simple concept of that final straw that breaks the camel’s back is the best analogy I can use. Yes, sir.” When asked if his opinion that Seroquel caused Haller to develop diabetes in August of 2004 was based simply on the fact that he developed diabetes while on the drug, Dr. Tulloch reiterated his “final straw” analogy. Plaintiffs’ counsel then asked, “So your opinion then that Mr. Haller’s diabetes was caused by Seroquel is not based merely on the temporal relationship between his use of Seroquel and his diagnosis of diabetes?” Dr. Tulloch replied, “No, sir. We have and will discuss a number of other mechanisms by which Seroquel can cause a rise in blood sugar, damage to the pancreatitis [sic], and the development of diabetes.” When asked if he had “any opinion as to whether Seroquel was a substantial contributing cause of Mr. Haller’s development of diabetes in August of 2004,” Dr. Tulloch replied: “I have summarized for you, sir. I believe Seroquel causes weight gain, Seroquel causes a rise in glucagon, Seroquel causes insulin resistance, Seroquel is — use of Seroquel is associated with high levels of diabetes. And I think that would summarize both the outcome and some of the contributing factors.” Apparently recognizing the non-responsiveness of this answer with respect to specific (as opposed to general) causation, Plaintiffs’ counsel tried again: “So we’re absolutely clear, is it your opinion that Mr. Haller’s use of Seroquel was a substantial contributing cause of his development of diabetes in August of 2004?” Dr. Tulloch replied: “The final straw that broke the camel’s back. Yes, sir.” Wrapping up the direct examination, Plaintiffs’ counsel asked Dr. Tulloch, “Is it your opinion that ... Mr. Haller would not have developed diabetes in August of 2004, but for his use of Seroquel?” Dr. Tulloch replied, “You are pushing me hard, sir, but certainly it was the final straw that broke the camel’s back, yes, sir.” Dr. Tulloch was subjected to vigorous cross-examination. At the outset, AstraZeneca’s counsel elicited that in this case and the other three in which Dr. Tulloch was testifying, Dr. Tulloch was willing to give an opinion after reviewing only a portion of the medical records. Defense counsel then established that in most cases in which Dr. Tulloch has testified, he has been able to obtain an independent history and had the ability to examine patients. In his clinical practice, he always takes a medical history and does a physical examination. Dr. Tulloch further testified that apart from the situation where someone shows him data “casually in the hall” and he “helps” that person make a diagnosis, if a diagnosis is going to be made in his name, he must see the patient before rendering a diagnosis of diabetes. Dr. Tulloch essentially admitted he did not follow his regular method in analyzing Haller’s case; he formed his opinions without talking to Haller and obtaining a medical history. Dr. Tulloch conceded that even though Haller was prescribed Seroquel in October of 2002, Dr. Tulloch formed his opinions in this case without knowing what dose of Seroquel Haller was on until May of 2003, some eight months after he started taking Seroquel. Dr. Tulloch also admitted his prior testimony that Haller did not always take his Seroquel and that he wasn’t compliant with many of his medications. Dr. Tulloch further conceded that he had testified in deposition that he didn’t know how much weight Haller gained in the first year he was on Seroquel, and that it was speculative to say how much weight Haller gained while on the medication. However, Dr. Tulloch countered that the information “has been summarized very nicely in Exhibit 19.” AstraZeneca’s counsel established that Dr. Tulloch did not review any of Haller’s treating physicians’ depositions. More to the point, she elicited that Dr. Tulloch formed his opinions without knowing that Haller’s treating physician testified in 2008 that Haller was not diabetic. In fact, Dr. Tulloch admitted that he was learning that information for the first time at the Daubert hearing. Dr. Tulloch also conceded that Haller is still taking Seroquel and Haller’s sugars are currently “absolutely well controlled” while he’s on Seroquel. As for his testimony on direct regarding Haller’s prior episodes of pancreatitis, Dr. Tulloch admitted that he testified in deposition that there is not enough scientific evidence to conclude that Seroquel is a cause of pancreatitis, that his expert report was wrong to say it was causal, and that all he could say was that there was an association based on case reports. Dr. Tulloch agreed that an association is not causation, “[u]nless it’s been shown to be a mechanistic way ... in an experimental setting with animals or in a clinical setting[.]” Dr. Tulloch reiterated that to a reasonable degree of medical probability, Haller would have developed diabetes whether or not he ever took Seroquel. This is because Haller had many other risk factors for diabetes: obesity, hypertension, smoking, sedentary lifestyle and psychosis. In fact, Dr. Tulloch made clear that all of the plaintiffs about which he was expressing causation opinions would have gotten diabetes at some point in time, even if they had never taken Seroquel. Dr. Tulloch posited that this might not have happened until age 105, but he admitted that they could have gotten diabetes at age 25 if they made bad lifestyle choices, became pregnant, or were exposed to certain medications, including some antipsychotics and blood pressure medicines. On the other hand, he indicated, if they made really good lifestyle choices, they might live to 105. Although Dr. Tulloch was extremely reluctant to agree that it was “speculative” to say when these plaintiffs — including Haller — would get diabetes, he gave an answer that effectively conceded the point. Invoking his “straw/camel” analogy, Dr. Tulloch stated, “I don’t know what speculative means. I leave the analogy, sometimes at 25, if everything is bad, sometimes at 105, if the guardian angel is kind, and somewhere in between the straws stack up hard.... I’m avoiding the word ‘speculative,’ because I don’t know what it means legally.” Defense counsel then examined Dr. Tulloch about the declaration he submitted after AstraZeneca filed its summary judgment and Daubert motions. Specifically, counsel brought up the statement in Dr. Tulloch’s declaration that Haller would not have developed diabetes in August of 2004 absent ingestion of Seroquel. Dr. Tulloch responded, “Without that being the final straw, yes, ma’am.” Regarding Dr. Tulloch’s theory that Haller’s Seroquel use accelerated the onset of his diabetes, Dr. Tulloch admitted he had not attempted to quantify the acceleration of Haller’s diabetes, because he can’t. In that regard, Dr. Tulloch stated, “You are trying very hard to get me to quantify a lot of things, ma'am, and I wouldn’t, because I couldn’t, because it’s not good science. That’s correct.” Dr. Tulloch was then asked, “And you could not say how much [of] Mr. Haller’s development of diabetes was accelerated, right? ... [BJecause it would be speculative?” He responded, “The final straw, yeah. The final straw that breaks the camel’s back. That’s the date it happened. That’s what happened to his weight. There are the other mechanisms. But that’s it. Those are the facts.” Pressing the point, AstraZeneca’s attorney asked, “You couldn’t say without ... taking Seroquel ... whether he would have gotten diabetes on August 1 of 2004, or August 1 of 2003, or August 1 of 2005, right?” Dr. Tulloch replied: Ma’am, you’re trying to paint me into a corner that I don’t think there is good data for. What I have said was that this man developed it under the circumstances. Now you’re taking that came[l]’s back that’s broken and saying, Tulloch, pull off one straw at a time and tell me when the diabetes would have gone away. That’s not good science. What I can say is that those circumstances resulted in him having a blood sugar that was compatible with diabetes and with a hemoglobin A1C that showed the sugars had been way off for a good period of time. Now, ask me to take away Seroquel, well, it would still have happened, but it may not have happened until many years later, ma’am. Q: Without taking Seroquel, if he’s not taking Seroquel, you can’t say whether he would have gotten diabetes in August of 2003, August of 2004, or August of 2005, right? A: No. You’re trying to make me speculate, and I don’t know what the legal issue of speculation is, so I’m trying to avoid that. He developed diabetes, we saw it. And the factors were there; weight gain, Seroquel and all the things that Seroquel does to the body. Now you’re saying, Tulloch, take away that straw, and I’m reluctant to commit myself, because you’re understanding my problem. Q: I’m saying you can’t. You can’t say whether — if he’s not taking Seroquel, whether he would have developed diabetes in August of 2003 or August of 200k or August of 2005. You can’t say, right, because of all the lifestyle choices? A: Ma’am, but the facts are the facts. He had a medication, which by epidemiological data causes weight gain, diabetes, and by a chemical data, causes pancreatitis and hypothalamic change and all the rest of it. Q: You can’t say? A: Okay. You need me to say yes, I’ll say yes. But do you understand the circumstances? I don’t want to speculate the facts where he got diabetes. And he gained a lot of weight with that medication. Defense counsel then queried Dr. Tulloch regarding paragraph 21 of his declaration. Dr. Tulloch agreed that the declaration listed five different things as bases for his causation opinions: (1) temporal association; (2) other risk factors had not brought about the onset of diabetes; (3) mechanism; (4) literature; and (5) consistency. However, AstraZeneca’s counsel pointed out that in his deposition, Dr. Tulloch admitted that the only basis for his opinion that Seroquel caused the development of diabetes was its temporal relationship with weight gain, and the weight gain’s temporal relationship with diabetes. Dr. Tulloch agreed that the mentally ill have increased levels of diabetes. He acknowledged that when Haller gained weight in the 2002-2003 time period, he was taking the following other drugs besides Seroquel: Depakote, Lithium and Risperdal. He further agreed that with all these medications, there is a temporal relationship between the drug and weight gain; nevertheless, Dr. Tulloch maintained that Haller’s biggest weight change began when he started taking Seroquel. Dr. Tulloch also noted that the other medications were exposed to him before “this massive weight gain.” Regarding the “string of things” Dr. Tulloch brought up on direct examination “about mechanism, about glucagon, about insulin physiology,” AstraZeneca’s attorney pointed out to Dr. Tulloch that in his deposition, which took place “just a month or so” before he filed his declaration, Dr. Tulloch admitted that he knew of no scientific evidence that would allow him to conclude that Seroquel directly affects the pancreas, or the cells of the pancreas, or has any other direct effect on people. Dr. Tulloch conceded that he had given that testimony, but reiterated that he had promised if he received new data, he would share it. In that regard, he stated: “And then in the airplane last night, I came over and I found three amylases which [were] dramatically in excess of normal,” so he added pancreatitis to the list. He asserted that at the time of his deposition, he had not noticed that data. When asked the follow-up question, “In fact, that’s because you didn’t do a thorough review of [Haller’s] medical records before his [sic] deposition?”, Dr. Tulloch replied, “Our time is limited, ma'am, that’s correct.” Addressing mechanism, Dr. Tulloch testified that “the most probable mechanism” by which Haller got diabetes was “weight gain.” AstraZeneca’s attorney then asked, “With all this other mechanism stuff, for Mr. Haller you testified it was weight gain, right?” Dr. Tulloch answered, “Again, I go back to that additive issue. Seroquel causes weight gain, but Seroquel causes all the other issues as well. We have shown it in animals. We’ve hypothesized it to be there in humans. And as the data becomes stronger, so my opinion on the other mechanisms also become[s] stronger.” Defense counsel then addressed the issue of Haller’s weight fluctuations. She pointed out that in his deposition, Dr. Tulloch testified that he attributed an “excess weight gain” of 21 pounds to Seroquel. Dr. Tulloch conceded, however, that before Haller began taking Seroquel, he had a period of weight gain in which he gained 80 pounds; 60 pounds of that was during the four-year period from January of 1997 to January of 2001. Dr. Tulloch then volunteered, “I think if you go back to '94, you could make the weight gain even more.” Dr. Tulloch acknowledged that this was a “big weight gain.” Additionally, he conceded that he testified in his deposition that such a weight gain was not normal. Dr. Tulloch admitted that he didn’t have any information regarding how Haller gained all that weight before he began taking Seroquel. Dr. Tulloch agreed that Haller was mentally ill and that sometimes people eat more when they’re depressed. When asked if he had agreed in deposition that Haller’s “sedentary lifestyle and underlying psychoses were causes of his weight gain,” Dr. Tulloch answered, “Contributing factors, yes, ma’am.” Defense counsel then forced Dr. Tulloch to concede that he had used the word “causes” in his deposition, not “contributing factors.” When asked, “And there are many reasons that you know that account for Mr. Haller’s weight gain, right?”, Dr. Tulloch stated, “Yes, ma’am. And Seroquel was the final straw that broke the camel’s back.” AstraZeneca’s attorney then returned to the subject of Dr. Tulloch’s methodology. She established that in Dr. Tulloch’s own clinical practice, when a patient presents with weight gain, Dr. Tulloch asks them what they eat, what their diet is, whether they exercise, what calories they take in, what calories they burn, and what medications they are taking, in order to determine why they gained the weight. Defense counsel then asked, Q. You didn’t do that with Mr. Haller? A: I didn’t see Mr. Haller. Q: You didn’t follow your own method to figure out what the cause of Mr. Haller’s weight gain was, did you? A: I didn’t have access to him, ma’am. Q: You didn’t even take — send him a questionnaire, right? A: No, ma’am. Q: You didn’t have — because you didn’t take a medical history from Mr. Haller, or even send him a questionnaire to fill out, or even read his deposition, right, you didn’t have any specificity about what was causing the weight gain he experienced before he took Seroquel, or while he was on Seroquel? A: Other than the access to his chart. That’s correct, ma’am. Defense counsel then asked Dr. Tulloch whether it was fair to say he had not ruled out alternative causes for Haller’s weight gain. Dr. Tulloch replied, “Again, association with a medication that’s been associated with weight gain in a whole lot of settings was one of the options. If your question is, did I have access to what else might have caused the weight gain, you’re correct, ma’am, I did not have access to this man.” Counsel then pointed out that in his deposition, Dr. Tulloch agreed that he “did not rule out the alternative causes for [the plaintiffs’] weight gain, because [he] didn’t feel that [he] needed to or had to.” Dr. Tulloch reiterated that he “didn’t have access to [these plaintiffs].” Continuing this line of questioning, AstraZeneca’s counsel asked: Q: You cannot say how much of Mr. Haller’s weight gain was due to Seroquel, and how much was due to diet, and how much was due to his lack of exercise or other factors, correct? A: Yes, ma’am. Q: For example, you can’t say whether Seroquel caused him to gain zero, one, two, twenty. You can’t say, right? A: Ma’am, no. I think one has to point to Reference 19, and to show that from the time that he had access to Seroquel, and if one just eyeballs those numbers, then weight went, within the next few months, from 180 to 245. * * * Q: You cannot say how much of his weight gain was due to Seroquel and how much was due to all these other factors, like diet, exercise, and psychosis, and so on, correct? A: Yes, ma’am. But if Seroquel was the only variable that was added to everything else that had been stable, then one would have to assume that Seroquel was responsible for a fairly major part of that. * * * Q: [In your deposition] you were asked, “As to any of the weight gains by any of the plaintiffs in these cases, you cannot say how much of the weigh[t] was due to Seroquel and how much was due to diet, and how much was due to lack of exercise or other factors. Correct?” And your answer was: “That’s correct.” Right? A: That’s correct again. Ma’am, you read my deposition. On the subject of alternative causes, AstraZeneca’s attorney raised the point that Haller’s weight fluctuations appeared to correlate to his alternating periods of incarceration and release. On that point, Dr. Tulloeh agreed that Haller got out of prison in September of 2002, something Dr. Tulloeh conceded was “a huge change in his life circumstances.” Haller started taking Seroquel the very next month. Dr. Tulloeh admitted that in prison, food is controlled and that when Haller got out, he could eat what he wanted. Counsel then inquired: Q: You can’t quantify the amount of weight gain Mr. Haller had after he started taking Seroquel, upon his release from prison, that would be due to change in diet from prison food to cooking on his own, right? A: No, ma’am. Without asking him. And even there, if he was on a medication that stimulated his appetite, he may not have been aware that he was eating because of the effect of the medication. And we have shown that there is mechanisms [sic] by which these medications stimulate appetite. ❖ * * Q: [B]efore forming your opinions, did you ever look back at his weight to see if in fact he actually had a pattern of losing weight while he was in prison and gaining it back when he got out? A: Ma’am, I did acknowledge when we were last together that he had in fact had oscillations in his weight. And we are looking at another one. The reason why I believe Seroquel contributed was the association between his massive weight gain and the onset of Seroquel. [sic, presumably “diabetes”] Dr. Tulloeh testified he was aware that Haller was also in prison from April 1993 until January 1995, and that he lost 63 pounds during that time period. He further conceded that by January 15, 2001, “after a longer period of freedom,” Haller’s weight had gone back up to 230 pounds, and that all of this occurred before Haller began taking Seroquel. Regarding his deposition testimony that Haller had a major weight loss every year while he was on Seroquel, Dr. Tulloch agreed that he'had given that testimony; however, he stated “that’s clearly not correct, because I may not have had 2008 data. But from 2008 there was another weight spike that ■ went up to 230.” , Nevertheless, Dr. Tulloch agreed that Haller weighed 230 pounds in January of 2001, before he took Seroquel, and weighed the same in August of 2008. Additionally, Dr. Tulloch conceded that in 2005, Haller’s Seroquel dosage was increased from 400 mg to 600 mg, yet Haller lost 51 pounds that year, reducing his weight from 235 pounds to 184 pounds. Dr. Tulloch offered the following explanation: “Under the finger of somebody saying, you have diabetes, therefore, you get your act under control.” When confronted with his deposition testimony in which he admitted that Haller’s weight gain while he was on Seroquel did not cause him to have diabetes, Dr. Tulloch agreed that he had said that, but added: “I can’t say that in the current setting. I have shown you how much he gained weight when he was exposed to Seroquel, with all the other issues that were present. And we have shown that while his weight was high, with all the other medications that had been present, this man developed diabetes following a period of pancreatitis. So if [sic] that context, I might have been thinking of it in a different context. But I think we have shared the data today, and now we have a nice simple graph to show the weights in relationship to the- diagnosis.” Dr. Tulloch agreed that Haller was morbidly obese, with a BMI of 37.1, before he started- taking Seroquel. Dr. Tulloch also agreed with his prior .deposition testimony that weight gain in someone with a BMI of 37.1 does not increase the risk of developing diabetes. Additionally, before he began taking Seroquel, Haller had uncontrolled hypertension, smoked heavily for decades, had a sedentary lifestyle, and had high cholesterol or hyperlipidemia. Dr. Tulloch essentially agreed that Haller was psychotic and that a significant percentage of mentally ill patients taking Seroquel would be expected to develop diabetes because of the background incidence of diabetes in the mentally ill, even assuming no effect of Seroquel. Dr. Tulloch agreed that Haller had “many, many causes of diabetes that predated his Seroquel use.” He conceded that Haller’s obesity, hypertension, smoking, psychosis, sedentary lifestyle, and hyperlipidemia all were causes of his diabetes. He further admitted that these things can be the sole cause of diabetes in some people. AstraZeneca’s counsel next addressed the association between Seroquel and particular weight gain. Q: ... Is it your testimony today that you cannot say one way or the other whether Seroquel caused one pound or two pounds or five pounds or ten pounds or twenty pounds of weight gain in Mr. Haller, right? A: I can accept that it is difficult to quantitate. I point out that in every other patient there’s been reports of weight gain that have been summarized in some of the literature, including by Dr. Brecker. In this man, there was significant weight gain, which is about 65 pounds, when he started taking Seroquel. And as a physician, I have got to accept there might have been other factors as well. But the temporal relationship is very impressive, 65 pounds when he started Seroquel. Q: So you agree with me that you cannot say that one pound or two pound[s] or five pound[s] or ten pounds? A: Of that 65 pounds was Seroquel, yes, ma’am. I’m always open to there being — if it was 65 pounds, there might have been other factors for some of them. Concluding her examination, AstraZeneca’s counsel got Dr. Tulloch to agree that in his expert report he calculated Haller’s weight gain after he began taking Seroquel at 21 pounds, that he upped that figure to 25 pounds in his declaration, and that at the Daubert hearing, for the first time, he increased that figure to 65 pounds. Finally, she elicited that Haller stopped taking diabetes medications in 2006 and he continues to take Seroquel today. On redirect, Dr. Tulloch testified that the fact that Haller’s blood sugars are now under control does not mean he is not diabetic. Dr. Tulloch also stated he did not need to examine Haller to recognize that he satisfied the criteria for diabetes. He asserted that “in a lot of these referrals, [he] look[s] at the numbers.” He also reiterated that even though Haller gained a tremendous amount of weight before he took Seroquel, he didn’t develop diabetes while he was on other drugs that can cause weight gain. Finally, when asked if anything defense counsel brought up regarding his deposition had changed his testimony or opinions at the Daubert hearing, Dr. Tulloch replied: “[N]o, sir. [Defense counsel] and I entertained one another at great length over many evenings, and I think we shared data. Which I then — I promised her I would update. And as I had access to more and more, my opinions fine-tuned, but they’re pretty well similar.” Analysis In this particular case, there are so many Daubert problems associated with Dr. Tulloch’s opinions that it is difficult to know where to begin. The Court will first address methodology, then turn to the substance of Dr. Tulloch’s opinions. The Court accepts as a general proposition that a physician need not necessarily examine a patient, interview that patient, or speak with the patient’s treating physician(s) in order to render opinions regarding diagnosis, prognosis, course of treatment and perhaps even causation. In other words, the Court does not deem it necessarily fatal that an expert medical witness has relied on medical records alone to reach a specific causation opinion. However, Haller’s particular circumstances expose the failings of applying to this specific case what might otherwise be considered a generally acceptable methodology. The lynchpin of Dr. Tulloch’s causation opinions is that Haller had a “dramatic weight gain” after he started taking Seroquel, and that this particular weight gain constituted the straw that broke the camel’s back and led to Haller’s diabetes. However, in Haller’s particular case, there were other factors at work that could have caused Haller’s weight gain. Specifically, the month before he began taking Seroquel, Haller was released from prison, and he had a demonstrated history of weight loss while in prison and weight gain during periods of release. Additionally, Haller had a history of sometimes dramatic weight gains and losses throughout his life. These fluctuations occurred before he began taking Seroquel and have continued while he is on the drug. Given this background, simple logic and common sense dictated that Dr. Tulloch do more than merely “skim” Haller’s medical records and summaries to ascertain the cause of Haller’s alleged weight gain after he began taking Seroquel. At a minimum, he should have conducted some further inquiry concerning Haller’s diet, caloric