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 I A In general, most ¢)_ the dr_gs do cause
 2 vomltlngas a direct effect of the drug itself. '_
 3 In a clinical practice, most patients --
 4 _ost patients, if they're going %0 have vomiting from
 5 chemotherapy, do not start having vomiting with their first
 6 treatment.
 ? ..... For _ampie, yesterday while you were waiting
 8 to meet Wlth me, one of my patlents_ threw up. That was his
 9 ninth treatment. That was %he first -_ second tlme he has
 10 thrown up.
 11 The first tlme that there was vomiting.
 12 associated with that patient, was when his roon_ate threw
 13 up the flr_% day of the treatment. He had anticipator7
 _ 14 vomiting. The patient did not.
 15 Many patients develop more vomiting as time
 18 _oes on, and it's antlclpatory because it's real in %he
 17 same way that if you start kicking your dog, your dog is
 18 going to begin to start running away from you, because he
 I
 19 !kT_ows what's coming.
 20 And it is ant_clpatory, but the way to
 21 prevent anticipatory vomiting is to prevent vomltlng in the
 i
 22 i_rst place, which is, _ think, what thls hearing is all
 23 abouto
 24 Q So, are you saying then that anticipatory
 25 vomltlng is a real effect as opposed to _. inaginator7
 i
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