NOTICE: All slip opinions and orders are subject to formalrevision and are superseded by the advance sheets and boundvolumes of the Official Reports. If you find a typographicalerror or other formal error, please notify the Reporter ofDecisions, Supreme Judicial Court, John Adams Courthouse,Pemberton Square, Suite 2500, Boston, MA 02108-1750; (617) 557-1030; [email protected]
Norfolk. September 9, 2005. - November 8, 2005.
Present: Marshall, C.J., Ireland, Spina, Cowin, & Cordy, JJ.
Homicide. Practice, Criminal, Capital case, Assistance of
counsel, New trial. Evidence, Insanity.
Indictments found and returned in the Superior Court
The case was heard by Margot Botsford, J, and a motion for a
new trial, filed on November 19, 2002, was heard by her.
Donald A. Harwood for the defendant.
Varsha Kukafka, Assistant District Attorney (Susan Corcoran,
Assistant District Attorney, with her) for the Commonwealth.
CORDY, J. On October 26, 1999, a Superior Court jury found
Richard Shuman guilty of the premeditated murder of two of his
business associates. Shuman appealed and filed a motion for a
new trial in this court on November 19, 2002, on the grounds that
newly discovered evidence cast substantial doubt on the justice
of his convictions, or alternatively, that he was denied the
effective assistance of counsel. We remanded the motion to the
Superior Court for disposition and stayed appellate proceedings.
After reviewing the affidavits and materials filed in support of
the motion and without holding an evidentiary hearing, the motion
judge, who was also the trial judge, denied the motion. The
direct appeal from Shuman's convictions and the denial of his
motion for a new trial have been consolidated in this court.
Shuman's defense at trial was lack of criminal
responsibility due to a mental illness (depression reaching
psychotic dimensions), exacerbated by other ailments and the side
effects of medications that left him unable to conform his
conduct to the requirements of the law. On appeal, he argues
that evidence regarding the connection between the prescription
medication Zoloft and a state of agitation known as akathisia,
was discovered after his trial and casts substantial doubt on the
justice of his convictions; or in the alternative, his counsel
was ineffective in failing to present evidence concerning the
connection between Zoloft and akathisia at trial. He also argues
that the motion judge erred in denying him an evidentiary hearing
before acting on his motion for a new trial. Finally, Shuman
asks the court to exercise its power under G. L. c. 278, § 33E,
to reverse his convictions and grant him another trial so that
the "critical evidence" he proffers regarding Zoloft may be heard
and weighed by a jury. After undertaking a complete review of
the trial record, we affirm the convictions, affirm the order
denying Shuman's motion for a new trial, and decline to grant
1. Background. We summarize the evidence in its light most
favorable to the Commonwealth, reserving certain details for
discussion in conjunction with the issues raised. The essential
facts are not in dispute. On the afternoon of August 5, 1997,
Shuman used a nine millimeter Beretta semiautomatic pistol to
kill Jack Badler and Howard Librot. Shuman first went to
Badler's office at Cabot Place in Stoughton. Badler called his
human resources manager, Helen Anderson, to his office door so
she might see that Shuman had a gun on his lap. He told her to
dial 911 if Shuman did not put it away. Shuman told Anderson,
"Don't worry. I won't hurt you," and put the gun away. As
Anderson was leaving, Shuman told Badler that he had ruined his
business and his life. He then shot Badler in the upper chest,
eye, neck, and thumb, and left the office, telling two nearby
employees, "Don't worry. I'm not going to shoot you two. I'm
Shuman then drove to Librot's office, also in Stoughton. He
entered the office and shot Librot in the head, neck, and chest.
With his gun in hand, Shuman left the building and drove away.
Both victims died as a result of their wounds. A few minutes
later, Shuman arrived at his parents' house and told his mother
that he had killed two people. While there, Shuman raised a gun
to his head. His mother begged him to stop. Shuman put the gun
away, and his parents drove him to the police station.
The shootings were directly linked to a worsening business
relationship between Shuman and the victims. That relationship
began when Shuman's printing business (Foremost Printers)
purchased Web Corp. from Librot in 1989. Librot and his wife
continued to run Web Corp. under Foremost's ownership. In 1991,
Foremost hired Badler to handle all of its finances and maintain
control of the company books. Badler was a friend of Librot. By
1996, after a series of poor business decisions, Foremost was
experiencing serious financial difficulties. In the face of
these financial difficulties, tensions and disputes between
Shuman, Librot, and Badler mounted. Badler and Shuman argued
frequently about Badler's control of the company books. Foremost
was unable to pay Badler for managing its books, and the company
got behind in its financial obligations to the Librots. Librot
instructed his employees not to permit Shuman on Web Corp.
property and not to assist Shuman with any printing work. On
August 1, 1997, Foremost's assets were sold. In connection with
the sale, Shuman was required to sign a document that released
Badler from any liability related to his work for Foremost.
Shuman would not sign the release. On August 5, Badler processed
the payroll for Web Corp., but not for Foremost. Badler refused
to process Foremost's payroll until Shuman signed the release.
That morning, there was a loud argument between Badler and Shuman
in Badler's office. Shuman left, but returned later in the day
with the gun, and the shootings followed.
There was also evidence that, starting in January of 1997,
friends and family began to notice changes in Shuman's
personality. He could not sleep, seemed depressed, lost weight,
and on one occasion, held a gun to his head. Dr. George Gardos,
a psychiatrist, saw Shuman on July 29, 1997, one week before the
shootings, and diagnosed a major depression but did not believe
Shuman to be a risk of harm to others. Dr. Gardos increased
Shuman's preexisting Elavil prescription, to ease depression
symptoms, and also prescribed Zoloft, a "mood elevator." After
the killings, psychiatrist and defense expert, Dr. Harold
Bursztajn of Harvard Medical School and the Massachusetts Mental
Health Center, examined Shuman. Dr. Bursztajn opined that Shuman
suffered from "a major depression, with anxiety which reached
psychotic dimensions." He also testified that Shuman's diabetes
exacerbated the depression, and that the antidepressants that had
been prescribed to Shuman shortly before the killings magnified
its symptoms. In particular, Dr. Bursztajn noted that Elavil,
combined with Zoloft, can give rise to agitation, a need to act,
and compulsive behavior that may be organized but is irrational.
He also testified that these troubling side effects can come
"right away," particularly in patients suffering from diabetes.
2. Discussion. a. Newly discovered evidence. Shuman
argues that his motion for a new trial should have been allowed
on the ground of newly discovered evidence linking Zoloft to a
state of violent urges and agitation, known as akathisia, and
proffers the following evidence to support his claim: (1) a
posttrial study, published in 2000 by Dr. David Healy, linking
Zoloft for the first time to violent urges in individuals who had
previously suffered no mental illness; (2) expert testimony given
in 2001 in civil litigation involving Pfizer, Inc., which
publicly linked Zoloft to akathisia; (3) Dr. Joseph Glenmullen's
posttrial examination of Shuman and his medical records, leading
Dr. Glenmullen to conclude that Shuman was in a drug-induced
state of akathisia when the murders occurred; and (4) an advisory
released by the United States Food and Drug Administration (FDA)
in 2004, warning of the possible side effects of Zoloft,
including akathisia and agitation, especially at the beginning of
A defendant seeking a new trial on the ground of newly
discovered evidence must establish that the evidence was unknown
to the defendant or trial counsel and not reasonably discoverable
at the time of trial. See Commonwealth v. Jones, 432 Mass. 623,
633 n.6 (2000); Commonwealth v. Pike, 431 Mass. 212, 218 (2000).
He must also establish that the evidence "casts real doubt on the
justice of the conviction." Commonwealth v. Salvati, 420 Mass.
499, 506 (1995), quoting Commonwealth v. Scanlon, 412 Mass. 664,
679-680 (1992). The evidence said to be new not only must be
material and credible, see Commonwealth v. Brown, 378 Mass. 165,
172 (1979), but also must "carry a measure of strength in support
of the defendant's position." Commonwealth v. Pike, supra,
quoting Commonwealth v. Grace, 397 Mass. 303, 305 (1986).
The decision to deny or grant a motion for a new trial based
on newly discovered evidence is committed to the sound discretion
of the motion judge. Commonwealth v. Cintron, 435 Mass. 509, 517
(2001). In deciding whether the new evidence would have been a
significant factor in the jury's deliberations, had it been
admitted at trial, we accord special deference to the action of a
motion judge who was also the trial judge. Commonwealth v.
Grace, supra at 307, citing Commonwealth v. DeChristoforo, 360
Mass. 531, 543 (1971). The judge here found that the evidence
submitted in support of Shuman's motion was not "new" and that
there was "no substantial risk the jury would have reached a
different conclusion had the evidence been admitted at trial."
Commonwealth v. Grace, supra at 306.
Our examination of the record leads us to agree that
Shuman's motion fails on two broad grounds.1 First, the evidence
does not meet the test for "newly discovered" evidence because it
was available prior to the trial. Second, the opinion of the
defense expert submitted in support of the motion is not
substantially different from the defense offered at trial.
The new evidence -- Dr. Healy's study, the expert testimony
in the Pfizer litigation, Shuman's examination by Dr. Glenmullen,
and the FDA advisory -- are new only in the sense that they had
not occurred prior to trial. The link, however, between
selective serotonin reuptake inhibitors (SSRIs), such as Zoloft,
to violence and akathisia, was known in the scientific, medical,
1 We review the judge's decision under the substantiallikelihood of a miscarriage of justice standard, as required byG. L. c. 278, § 33E. This is the standard that is applied whenthe appeal from the denial of a motion for a new trial isconsidered in conjunction with a direct appeal from a convictionof murder in the first degree. See Commonwealth v. Hill, 432Mass. 704, 710 n.14 (2000); Commonwealth v. Nieves, 429 Mass.
763, 770 (1999).
and academic communities prior to trial and was widely reported.2
2 At the time of the defendant's trial, a number of studiesthat examined the connection between violent behavior and SSRIswere available. For example, the following articles, whichdetail such studies and the effects of various kinds of SSRIs,are referenced in Dr. Glenumullen's affidavit. See, e.g., Fava,Four-Year Outcome for Cognitive Behavioral Treatment of ResidualSymptoms in Major Depression, Am. J. Psychiatry 153 (1996);Hamilton, Akathisia, Suicidality, and Fluoxetine [Prozac], J.
Clinical Psychiatry 53 (1992); Lane, SSRI-Induced Extrapyramidal[Involuntary Motor] Side-Effects and Akathisia: Implications forTreatment, J. of Psychopharmacology 12 (1998); R.E. Hales, S.C.
Yudofsky, & J.A. Talbott, Psychiatry 1398 (3d ed. 1999); A.F.
Schatzberg & C.B. Nemeroff, Psychopharmacology 939 (2d ed. 1998);Masand, Suicidal Ideation Related to Fluoxetine [Prozac]Treatment, New Eng. J. Med. 324 (1991); Dasgupta, AdditionalCases of Suicidal Ideation Associated with Fluoxetine [Prozac],Am. J. Psychiatry 147 (1990); Papp, Suicidal Preoccupation DuringFluoxetine [Prozac] Treatment, Am. J. Psychiatry 147 (1990);Mann, The Emergence of Suicidal Ideation and Behavior DuringAntidepressant Pharmacotherapy, Archives of Gen. Psychiatry 48(1991); Koizumi, Fluoxetine [Prozac] and Suicidal Ideation, J.
Am. Acad. of Child and Adolescent Psychiatry 30 (1991); King,Emergence of Self-Destructive Phenomena in Children andAdolescents During Fluoxetine [Prozac] Treatment, J. Amer. Acad.
of Child and Adolescent Psychiatry 30 (1991); Creaney,Antidepressant [Prozac and Luvox]-Induced Suicidal Ideation,Human Psychopharmacology 6 (1991); Dewan, Prozac and Suicide, J.
Fam. Prac. 33 (1991); 5-HT Blockers [SSRIs] and All That, Lancet345 (Aug. 11, 1990); Rothschild, Re-exposure to Fluoxetine[Prozac] After Serious Suicide Attempts by Three Patients: TheRole of Akathisia, J. Clinical Psychiatry 52 (1991); Ichikawa,Effect of Antidepressants on Striatal [involuntary motor system]and Accumbens [another region of the brain] ExtracellularDopamine Levels, Eur. J. Pharmacology 281 (1995); Dewey,Serotonergic Modulation of Striatal [involuntary motor system]Dopamine Measured with Positron Emission Tomography (Pet) and InVivo Microdialysis, J. Neuroscience 15 (1995); DiRocco,Sertraline [Zoloft] Induced Parkinsonism. A Case Report and InVivo Study of the Effect of Sertraline [Zoloft] on DopamineMetabolism, J. Neural Transmission 105 (1998); Wirshing,Fluoxetine [Prozac], Akathisia and Suicidality: Is There a CausalConnection?, Archives of Gen. Psychiatry 49 (1992); Teicher,Emergence of Intense Suicidal Preoccupation During Fluoxetine[Prozac] Treatment, Am. J. Psychiatry 147 (1990); Pfizer, Inc.,Safety Evaluation and Epidemiology, Suicide-Related Behavior inChildren and Adolescents in the Sertraline [Zoloft] OCD ClinicalDevelopment Program (May 23, 1996); Beasely, Fluoxetine [Prozac]and Suicide: A Meta-Analysis of Controlled Trials of Treatmentfor Depression, Brit. Med. J. 303 (1991).
Shuman claims, however, that the information available at the
time of his trial principally linked akathisia to drugs such as
Prozac, but not to the drug he was prescribed, Zoloft. As the
motion judge found, there is "no suggestion in Dr. Glenmullen's
affidavit that Zoloft is qualitatively different than other
SSRIs, such as Prozac, such that the medical and other literature
about Prozac that was published before October of 1999 would not
be understood as relevant to Zoloft."3 The proposition that
reasonable pretrial diligence would not have revealed the
connection between SSRIs such as Zoloft and violent behavior in
these circumstances is unconvincing. Moreover, although trial
counsel has filed an affidavit stating he was "unaware of the
phenomena of Zoloft poisoning and/or the now-established link
between Zoloft and violence," he did question one of his own
medical experts and the Commonwealth's expert regarding the
connection between Zoloft and "[e]nhanced aggression," and the
existence of "studies of whether or not Zoloft has contributed to
This information was also available in the legal community,
as civil litigation and criminal prosecutions concerning the linkbetween SSRIs and violence had been reported before thedefendant's trial. See, e.g., Prozac Defense Rejected by SantaClara Judge, The Recorder (Cal.) Nov. 13, 1991 (defense builtaround Prozac rejected); Brancaccio v. State, 698 So. 2d 597(Fla. Dist. Ct. App. 1997) (defendant entitled to instruction oninvoluntary intoxication by Zoloft, side effects of whichincluded aggression, difficulty sitting still, and loss ofimpulse control).
3 At trial, trial defense counsel repeatedly elicitedtestimony from the medical witnesses and the Commonwealth'sexpert that Zoloft was an SSRI.
killings."4 Additionally, in his opening statement, trial
counsel referred to Shuman as someone "in a state of depression"
who had been "crank[ed] . . . up on Zoloft" by his psychiatrist.
There was also no evidence presented in connection with the
motion for a new trial that Dr. Bursztajn, Shuman's highly
credentialed psychiatric expert at trial (and a colleague of Dr.
Glenmullen at Harvard Medical School), was unaware of the link
between SSRIs and akathisia when he examined Shuman and formed
his opinion, or that his opinion would be significantly different
today from what it was at trial. In light of the extensive
literature on the subject that existed in 1999, the judge found
that a conclusion that Dr. Bursztajn was unaware of this link
would be "very difficult to accept." She also noted that his
testimony at the trial suggested otherwise. We agree.
The new evidence proffered here is merely a broadening of
the research regarding SSRIs and violence already present in
legal and scientific circles. The mere addition of further
information to the preexisting debate does not amount to "newly
discovered evidence" for the purposes of a new trial motion:
"Undoubtedly, recent research has broadened the scientific
community's understanding [but] we have concluded that expert
4 Trial counsel also advised the judge at sidebar that heintended to question one of the medical witnesses aboutpharmaceutical company litigation alleging a connection betweenZoloft and enhanced aggression, including litigation concerningan alleged Zoloft-induced murder. The judge refused to allow it. Additionally, he elicited testimony from the Commonwealth'sexpert that the Physicians' Desk Reference contains a warning of"[e]nhanced aggression" with respect to the use of Zoloft.
testimony may not be considered newly discovered for purposes of
a new trial motion simply because recent studies may lend more
credibility to expert testimony that was or could have been
presented at trial. To hold otherwise would provide convicted
defendants with a new trial whenever they could find a credible
expert with new research results supporting claims that the
defendant made or could have made at trial." Commonwealth v.
Even if we concluded that the evidence might marginally meet
the "newness" requirement of a motion for a new trial, the
proffered testimony of Dr. Glenmullen does not differ
qualitatively from the testimony offered by Shuman's expert at
trial. Dr. Glenmullen's posttrial conclusion that Shuman
suffered from Zoloft-induced akathisia at the time of the
killings is consistent with the testimony of Dr. Bursztajn, who
testified that Elavil and Zoloft combined can make people more
irritable and can give them more energy, "so they feel they have
to do something." Dr. Bursztajn found Shuman "depressed, panicky
and delusional." Dr. John Daignault, another defense expert who
interviewed Shuman within hours of the shootings, found that
Shuman was exhibiting signs of paranoia, depression, and that he
was "[r]obotic." Shuman's delusion was that "he had to protect
his family at any cost, at any price. And the only way to do so
was to go ahead and shoot the two people that he felt had
threatened his family." These descriptions of Shuman's symptoms
are very close to Dr. Glenmullen's description of akathisia as a
state of "anxiety, tension, irritability, and impatience,"
In essence, Shuman offers the same evidence of his symptoms
simply cast under a different name, akathisia. Other than
providing a specific term for those symptoms, Dr. Glenmullen's
observations do little to change or add to the trial expert's
testimony. At best, the distinction between the two opinions is
that Dr. Glenmullen identifies Zoloft and the side effect of
akathisia as the cause of Shuman's allegedly panicked, suicidal,
and violent thoughts and actions, while Dr. Bursztajn attributed
those same thoughts and actions to overwhelming depression
exacerbated by Shuman's diabetes and side effects from the group
of medications he was taking, including Zoloft. In these
circumstances the motion judge did not abuse her discretion in
finding that this distinction was not significant enough to
create a substantial risk that the jury would have reached a
different conclusion had the evidence been admitted at trial.
See Commonwealth v. LeFave, supra at 176.
The denial of Shuman's motion either for its failure to
establish newness or for its failure to cast doubt on the justice
of the convictions, or on both grounds, did not create a
substantial likelihood of a miscarriage of justice.
b. Ineffective assistance of counsel. "In evaluating a
claim of ineffective assistance of counsel in a case of murder in
the first degree, we begin by determining whether there was a
serious failure by trial counsel." Commonwealth v. Harbin, 435
Mass. 654, 656 (2002). We have described serious failure as
"serious incompetency, inefficiency, or inattention of counsel -
- behavior falling measurably below that which might be expected
from an ordinary, fallible lawyer." Commonwealth v. Saferian,
366 Mass. 89, 96 (1974). If serious failure is found on the part
of counsel, the court then determines whether the failure
resulted in a substantial likelihood of a miscarriage of justice,
as required by G. L. c. 278, § 33E. Commonwealth v. Mitchell,
428 Mass. 852, 854 (1999). Shuman argues that he was deprived of
effective assistance of counsel because trial counsel failed
fully to investigate and raise the defense of Zoloft-induced
The record of the trial reflects a vigorous, well-prepared,
and well-presented insanity defense, with substantial expert and
medical testimony to support it. As the motion judge noted,
counsel's cross-examination of the Commonwealth's rebuttal
psychiatric witness was done "with skill, and specifically
[included] ask[ing] that witness about the possible link between
Zoloft and heightened aggression." Shuman, on the other hand,
emphasizes the affidavit of his trial counsel to the effect that:
counsel was unaware of Zoloft poisoning or the link between
Zoloft and violence, his expert did not inform him of Zoloft-
induced violence, and counsel was unaware of the impact Zoloft
Shuman's claims are unconvincing. Even if trial counsel did
not use the term "akathisia" in his questioning of the witnesses,
he did, as a part of the insanity defense, raise the link between
Zoloft and heightened aggression. The Zoloft defense that Shuman
now offers, and the insanity defense that trial counsel
presented, are very close indeed; both aver that drugs, in
combination with Shuman's preexisting depression, contributed to
his aggressive behavior. Trial counsel argued in his opening
statement that the defendant was "crank[ed] . . . up on Zoloft"
by his doctor, and was a man "in a state of depression, with his
medical condition, on Zoloft," who had been driven to the
psychotic state that resulted in his pulling the trigger. Counsel
also repeatedly argued in his closing that Shuman was affected by
a "toxic soup" of medication, and had been "jack[ed]" up on
"meds," including Zoloft. Application of the term "akathisia" to
the behavior rather than "heightened aggression" is of little
In questioning trial counsel's use of the insanity defense,
instead of the "Zoloft defense," Shuman challenges the tactical
approach of his counsel and his principal psychiatric witness.
This court gives some deference to trial counsel's tactical
decisions, see Breese v. Commonwealth, 415 Mass. 249, 251 (1993),
and unless such decisions were "manifestly unreasonable when
made," we will not find ineffectiveness. Commonwealth v. LaCava,
438 Mass. 708, 713 (2003), quoting Commonwealth v. Martin, 427
Mass. 816, 822 (1998). Shuman essentially asserts that his
insanity defense may have been more effective if it had
emphasized the alleged toxic effects of Zoloft, rather than the
effect of depression worsened by a "toxic soup" of medication.
We do not find the choice of emphasis in a defense to be
manifestly unreasonable. See Commonwealth v. Lucien, 440 Mass.
658, 670-671 (2004) ("Where the claim of ineffectiveness involves
a tactical decision of defense counsel, we inquire whether the
decision was 'manifestly unreasonable' when made").
This case is not akin to those in which we have found that
the failure to investigate an insanity defense falls below the
level of competence demanded of an "ordinary, fallible lawyer,"
where the relevant facts were known by or accessible to the
attorney. See Commonwealth v. Doucette, 391 Mass. 443, 458-459
(1984); Commonwealth v. Saferian, supra at 96. Presenting a
similar but slightly different version of an insanity defense
does not fall below the ordinary lawyer's level of competence.
Nor is this a case where defense counsel "failed to pursue
adequately . . . the only realistic defense." Commonwealth v.
Licata, 412 Mass. 654, 661 (1992). Shuman cannot claim that he
was deprived of an "otherwise available, substantial ground of
defence." Commonwealth v. Saferian, supra. Trial counsel's
effective presentation of a well-prepared insanity defense,
raising the link between Zoloft and aggression, rather than a
pure "Zoloft defense" was not a serious failure on his part, nor
is any difference between the two sufficient to create a
substantial likelihood of a miscarriage of justice.
c. Denial of motion without an evidentiary hearing. It is
within the judge's sound discretion to determine whether an
evidentiary hearing is necessary. "In exercising the discretion
to hold an evidentiary hearing, the judge must decide whether a
substantial issue necessitating a hearing has been raised. In
doing so, the judge looks not only to the seriousness of the
claim presented, but also at the adequacy of the defendant's
factual showing." Commonwealth v. Trung Chi Truong, 34 Mass.
App. Ct. 668, 674 (1993), citing Commonwealth v. Stewart, 383
Mass. 253, 257-258 (1981). Shuman argues that the motion judge
should have at least held an evidentiary hearing before deciding
the new trial motion, especially because she discounted trial
counsel's affidavit stating he was unaware of Zoloft's link to
violence. We review the judge's decision for any abuse of
discretion. Commonwealth v. Martinez, 437 Mass. 84, 96 (2002).
The judge conducted a nonevidentiary hearing, thoroughly
reviewed the extensive affidavits and materials filed by Shuman,
as well as the trial testimony, and issued comprehensive
findings. She found that the motion supported by Dr.
Glenmullen's and trial counsel's affidavits did not present a
sufficient basis for a new trial. We agree. "[E]very dispute
among experts [does not require] an evidentiary hearing."
Commonwealth v. Meggs, 30 Mass. 111, 114 (1991). It is of no
consequence that the judge discounted trial counsel's affidavit
stating he was unaware of Zoloft's link to violence. She had
ample reason to do so based on, among other things, trial
counsel's arguments and examinations at trial. A judge may
properly discount any portion of defense counsel's affidavit.
See Commonwealth v. Goodreau, 442 Mass. 341, 351 n.6 (2004);
Commonwealth v. Savage, 51 Mass. App. Ct. 500, 505 (2001).
d. Review under G. L. c. 278, § 33E. We have reviewed the
entire record as required by G. L. c. 278, § 33E. The evidence
of premeditation in the murders of Badler and Librot was strong.
There is no basis for ordering a new trial or directing the entry
of a verdict of a lesser degree of guilt. The defendant received
a fair trial, and the jury's verdicts are consistent with the
Order denying motion for a new trial affirmed.
Journal of the Egyptian Nat. Cancer Inst., Vol. 16, No. 3, Septemper: 188-194, 2004 Pleurodesis as a Palliative Treatment of Advanced Lung Cancer with Malignant Pleural Effusion ISMAIL A. MOURAD, M.D.; ABDEL RAHMAN M. ABDEL RAHMAN, M.D.; SHERIF A. AZIZ, M.D.;NAGI M. SABER, M.D. and FOUAD A. FOUAD, M.D. The Department of Surgery, NCI, Cairo University. ABSTRACT nosed exudative pleural ef
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