Vaccines & Autism A Deadly Manufactroversy

[Guest guest]

http://www.skeptic.com/eskeptic/09-06-03#feature

Vaccines & Autism

A Deadly Manufactroversy

by Harriet Hall, MD, " The SkepDoc "

During a question and answer session after a talk I recently gave, I was asked

for my opinion about the vaccine/autism controversy. That was easy: my opinion

is that there is no controversy. The evidence is in. The scientific community

has reached a clear consensus that vaccines don't cause autism. There is no

controversy.

There is, however, a manufactroversy — a manufactured controversy — created by

junk science, dishonest researchers, professional misconduct, outright fraud,

lies, misrepresentations, irresponsible reporting, unfortunate media publicity,

poor judgment, celebrities who think they are wiser than the whole of medical

science, and a few maverick doctors who ought to know better. Thousands of

parents have been frightened into rejecting or delaying immunizations for their

children. The immunization rate has dropped, resulting in the return of endemic

measles in the U.K. and various outbreaks of vaccine-preventable diseases in the

U.S. children have died. Herd immunity has been lost. The public health

consequences are serious and are likely to get worse before they get better — a

load of unscientific nonsense has put us all at risk.

The story is appalling. It involves high drama, charismatic personalities,

conspiracy theories, accusations, intimidation, and even death threats. It would

make a good movie. It does make a good book: Dr. Offit has explained what

happened in Autism's False Prophets: Bad Science, Risky Medicine, and the Search

for a Cure.1 I can't tell the whole story here, but I'll try to cover the

highlights as I understand them. I'll include some new revelations that were not

available to Offit when his book went to press. As I see it, there were 3 main

stages to this fiasco:

the MMR scare,

the mercury/thimerosal scare, and

the vaccines-in-general scare.

The MMR Scare

In 1998 a British doctor named Wakefield published an article in the

respected medical journal The Lancet2. He did intestinal biopsies via

colonoscopy on 12 children with intestinal symptoms and developmental disorders,

10 of whom were autistic, and found a pattern of intestinal inflammation. The

parents of 8 of the autistic children thought they had developed their autistic

symptoms right after they got the MMR vaccine. The published paper stated

clearly: " We did not prove an association between measles, mumps, and rubella

vaccine and the syndrome described. Virological studies are underway that may

help to resolve this issue. "

" Falsehood flies,

and the truth comes limping after. "

— Swift

Despite this disclaimer, Wakefield immediately held a press conference to say

the MMR vaccine probably caused autism and to recommend stopping MMR injections.

Instead, he recommended giving the 3 individual components separately at

intervals of a year or more. The media exploded with warnings like " Ban

Three-in-One Jab, Urge Doctors. " The components were not available as individual

vaccines, so people simply stopped immunizing. The immunization rate in the U.K.

dropped from 93% to 75% (and to 50% in the London area). Confirmed cases of

measles in England and Wales rose from 56 in 1998 to 1348 in 2008; two children

died. In one small hospital in Ireland, 100 children were admitted for pneumonia

and brain swelling caused by measles and three of them died. So, 14 years after

measles had been declared under control in the U.K. it was declared endemic

again in 2008.

Wakefield's data was later discredited (more about that later) but even if it

had been right, it wouldn't have been good science. To show that intestinal

inflammation is linked to autism, you would have to compare the rate in autistic

children to the rate in non-autistic children. Wakefield used no controls. To

implicate the MMR vaccine, you would have to show that the rate of autism was

greater in children who got the vaccine and verify that autism developed after

the shot. Wakefield made no attempt to do that.

His thinking was fanciful and full of assumptions. He hypothesized that measles

virus damaged the intestinal wall, that the bowel then leaked some unidentified

protein, and that said protein went to the brain and somehow caused autism.

There was no good rationale for separating and delaying the components, because

if measles was the culprit, wouldn't one expect it to cause the same harm when

given individually? As one of his critics pointed out: " Single vaccines, spaced

a year apart, clearly expose children to greater risk of infection, as well as

additional distress and expense, and no evidence had been produced upon which to

adopt such a policy. "

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This is a special issue on medical controversies including: the vaccine-autism

myth; the trouble with psychiatry; animals and medicine, and a Harriet Hall

article on reading medical research with a skeptical eye. ORDER the back issue

Wakefield had been involved in questionable research before. He published a

study in 1993 where he allegedly found measles RNA in intestinal biopsies from

patients with Crohn's disease (an inflammatory bowel disease)3. He claimed that

natural measles infections and measles vaccines were the cause of that disease.

Others tried to replicate his findings and couldn't. No one else could find

measles RNA in Crohn's patients; they determined that Crohn's patients were no

more likely to have had measles than other patients, and people who had had MMR

vaccines were no more likely to develop Crohn's. Wakefield had to admit he was

wrong, and in 1998 he published another paper entitled " Measles RNA Is Not

Detected in Inflammatory Bowel Disease. " 4 In a related incident, at a national

meeting he stated that Crohn's patients had higher levels of measles antibody in

their blood. An audience member said that was not true — he knew because he was

the one who had personally done the blood tests Wakefield was referring to.

Wakefield was forced to back down.

In 2002, Wakefield published another paper showing that measles RNA had been

detected in intestinal biopsies of patients with bowel disease and developmental

disorders.5 The tests were done at Unigenetics lab. Actually, Wakefield's own

lab had looked for measles RNA in the patients in the 1998 study. His research

assistant, Chadwick, later testified that he had been present in the

operating room when intestinal biopsies and spinal fluid samples were obtained

and had personally tested all the samples for RNA with a polymerase chain

reaction (PCR) test. The results were all negative, and he testified that

Wakefield knew the results were negative when he submitted his paper to The

Lancet. Chadwick had asked that his name be taken off the paper. So the

statement in the paper that " virologic studies were underway " was misleading.

Virologic studies had already been done in Wakefield's own lab and were

negative. Wakefield was dissatisfied with those results and went to Unigenetics

hoping for a different answer.

Soon Wakefield's credibility started to dissolve. The Lancet retracted his

paper. Horton, editor of The Lancet, described the original paper as

" fatally flawed " and apologized for publishing it. Of Wakefield's 12 co-authors,

10 issued a retraction:

We wish to make it clear that in this paper no causal link was established

between (the) vaccine and autism, as the data were insufficient. However the

possibility of such a link was raised, and consequent events have had major

implications for public health. In view of this, we consider now is the

appropriate time that we should together formally retract the interpretation

placed upon these findings in the paper, according to precedent.

Attempts to replicate Wakefield's study all failed. Other studies showed that

the detection of measles virus was no greater in autistics, that the rate of

intestinal disease was no greater in autistics, that there was no correlation

between MMR and autism onset, and that there was no correlation between MMR and

autism, period.

In 2001 the Royal Free Hospital asked Wakefield to resign. In 2003, Deer

began an extensive investigation6 leading to an exposé in the The Sunday Times

and on British television. In 2005 the General Medical Council (the British

equivalent of state medical licensing boards in the U.S.) charged Wakefield with

several counts of professional misconduct.

One disturbing revelation followed another. They discovered that two years

before his study was published, Wakefield had been approached by a lawyer

representing several families with autistic children. The lawyer specifically

hired Wakefield to do research to find justification for a class action suit

against MMR manufacturers. The children of the lawyer's clients were referred to

Wakefield for the study, and 11 of his 12 subjects were eventually litigants.

Wakefield failed to disclose this conflict of interest. He also failed to

disclose how the subjects were recruited for his study.

Wakefield was paid a total of nearly half a million pounds plus expenses by the

lawyer. The payments were billed through a company of Wakefield's wife. He never

declared his source of funding until it was revealed by Deer. Originally

he had denied being paid at all. Even after he admitted it, he lied about the

amount he was paid. Before the study was published, Wakefield had filed patents

for his own separate measles vaccine, as well as other autism-related products.

He failed to disclose this significant conflict of interest. Human research must

be approved by the hospital's ethics committee. Wakefield's study was not

approved. When confronted, Wakefield first claimed that it was approved, then

claimed he didn't need approval. Wakefield bought blood samples for his research

from children (as young as 4) attending his son's birthday party. He callously

joked in public about them crying, fainting and vomiting. He paid the kids £5

each.

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The General Medical Council accused him of ordering invasive and potentially

harmful studies (colonoscopies and spinal taps) without proper approval and

contrary to the children's clinical interests, when these diagnostic tests were

not indicated by the children's symptoms or medical history. One child suffered

multiple bowel perforations during the colonoscopy. Several had problems with

the anesthetic. Children were subjected to sedation for other non-indicated

tests like MRIs. Deer was able to access the medical records of

Wakefield's subjects. He found that several of them had evidence of autistic

symptoms documented in their medical records before they got the MMR vaccine.

The intestinal biopsies were originally reported as normal by hospital

pathologists. They were reviewed, re-interpreted, and reported as abnormal in

Wakefield's paper.

All the reports of measles RNA in intestinal biopsies came from one lab,

Unigenetics. Other labs tried to replicate their results and failed. An

investigation revealed that:

Unigenetics found measles RNA with a test that should only detect DNA.

They failed to use proper controls.

The lab was contaminated with DNA from an adjoining Plasmid Room.

Duplicate samples that disagreed were reported as positive.

Positive controls were occasionally negative and negative ones positive.

The lab was never accredited.

It refused to take part in a quality control program.

When tested by an outside investigator, it failed to identify which coded

samples contained measles virus.

The investigator said " I do not believe that there is any measles virus in any

of the cases they have looked at. "

The lab is no longer in business.

So both Wakefield and his study have been completely discredited. He moved to

the U.S. and is now working in an autism clinic. He has many followers who still

believe he was right.

The Mercury/Thimerosal Scare

In 1998, U.S. legislation mandated measuring mercury in foods and drugs. The

data came in slowly, and by 1999 the FDA had learned that infants could get as

much as 187.5 mcg of mercury from the thimerosal in all their vaccines. They

were concerned because mercury is toxic. Mercury poisoning caused the Minamata

disaster in Japan; however, that was methylmercury and the mercury in vaccines

was ethylmercury. The amount of mercury in vaccines was within recommended

guidelines. EPA guidelines for permissible mercury exposure were based on

methylmercury and were conservative — they were keyed to protect the most

vulnerable patients, fetuses. There were no EPA guidelines for ethylmercury, but

it was considered to be far less dangerous because it is eliminated more rapidly

from the body.

Two mothers of autistic children published their own " research " saying that the

symptoms of autism were identical to those of mercury poisoning.7 I don't agree.

You can look up the descriptions of mercury poisoning and autism and draw your

own conclusions. I don't see how anyone could confuse the two — their

presentations are entirely different, with only a few symptoms that could be

interpreted as similar.

Thimerosal is a preservative that allows vaccines to be sold in multi-dose

vials. It contains ethylmercury. It was tested and found to be safe before it

was added to vaccines. Animal studies showed no adverse effects. In 1929 in

Indiana it was tested as a treatment in a meningitis outbreak — adults injected

with 2 million mcg (10,000 times the total amount in all children's vaccines)

didn't develop symptoms of mercury poisoning.

A study from the Seychelles showed that children getting high doses of

methylmercury from fish did not develop neurologic symptoms. A study of children

in the Faroes who were exposed in utero to whale meat highly contaminated with

methylmercury showed subtle neurologic abnormalities (not autism), but a causal

connection was not clear because the fish there were also contaminated with

PCBs. The World Health Organization concluded:

The theoretical risk from exposure to thimerosal has to be balanced against the

known high risk of having no preservative in vaccines. Therefore, WHO, UNICEF,

the European Agency for Evaluation of Medicinal Products (EMEA), and other key

agencies continue to recommend the use of vaccines containing this preservative

because of the proven benefit of vaccines in preventing death and disease and

the lack of data indicating harm.

In 1999 the U.S. removed thimerosal from vaccines. Why? The decision was not

based on evidence but on one person's opinion. Neal Halsey railroaded the

committee and threatened to hold his own press conference if they didn't do what

he wanted. He meant well. His passion convinced the other committee members to

invoke the precautionary principle — essentially bending over backwards to

prevent any possible harm from a high total body burden of mercury from a

combination of diet, environmental and vaccine sources. He didn't even consider

autism: he was only concerned about possible subtle neurologic damage.

They announced their decision in words guaranteed to confuse the public and

create suspicion: " current levels of thimerosal will not hurt children, but

reducing those levels will make safe vaccines even safer. " A 2007 editorial8 in

The New England Journal of Medicine stated:

Although the precautionary principle assumes that there is no harm in exercising

caution, the alarm caused by the removal of thimerosal from vaccines has been

quite harmful. For instance, after the July 1999 announcement by the CDC and

AAP, about 10 percent of hospitals suspended use of the hepatitis B vaccine for

all newborns, regardless of their level of risk. [because a thimerosal-free

hepatitis B vaccine was not available.] One 3-month-old child born to a Michigan

mother infected with hepatitis B virus died of overwhelming infection.

It went on to point out:

The notion that thimerosal caused autism has given rise to a cottage industry of

charlatans offering false hope, partly in the form of mercury-chelating agents.

In August 2005, a 5-year-old autistic boy in suburban Pittsburgh died from an

arrhythmia caused by the injection of the chelating agent EDTA. Although the

notion that thimerosal causes autism has now been disproved by several excellent

epidemiologic studies, about 10,000 autistic children in the United States

receive mercury-chelating agents every year.

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A further insanity has been perpetrated by the father-and-son team of Mark and

Geier. They claimed that autistics have premature puberty and high

testosterone levels (there is no evidence that this is true). They hypothesized

that testosterone forms sheet-like complexes with mercury in the brain (there is

no evidence that this is true), preventing mercury's removal by chelation. Their

solution? They administered the drug Lupron to lower testosterone levels to

supposedly facilitate mercury excretion. The treatment amounts to chemical

castration.

Lupron is sometimes ordered by the courts to chemically castrate sex offenders,

and it is used to treat precocious puberty and certain other medical conditions.

It is not a benign drug. It can interfere with normal development and puberty

and can put children's heart and bones and their future fertility at risk. The

treatment involves painful daily injections and costs $5000 to $6000 a month.

The Geiers use 10 times the recommended dose. The company that makes Lupron does

not support its use for this purpose.

Like Wakefield, the Geiers have been accused of professional misconduct. They

built their own lab in their basement and formed their own institute to conduct

Lupron studies. Then they formed their own Institutional Review Board (IRB) to

approve studies. IRBs are required by law and must follow strict guidelines to

ensure that studies are ethical and to protect the rights of subjects. The IRB

they formed was illegal. They packed the board with friends and relatives: every

single member of this IRB was either one of the Geiers, an anti-thimerosal

activist, a Geier associate, or a lawyer suing on behalf of " vaccine-injured "

clients. One was the mother of a child who was a subject in the research. Even

worse, they let the principal investigator sit as the chair of the IRB

overseeing his own research protocols. Oh, and the IRB wasn't even registered

until 2 years after the research was done.

Mark Geier has made a career of testifying as an expert witness in autism cases.

He has not impressed the judges. Here are a few of the judge's comments:

" Seriously intellectually dishonest "

" … not reliable or grounded in scientific methodology and procedure … his

testimony is subjective belief and unsupported speculation. "

" I cannot give his opinion any credence. "

" … a professional witness in areas for which he has no training, expertise, and

experience. "

When thimerosal was removed from vaccines, there were no studies showing that it

was harmful. After its removal, study after study showed that it was not

harmful. But activist groups didn't let the new evidence interfere with their

beliefs.

Anti-vaccine groups have viciously attacked medical doctors and researchers for

simply stating what the current scientific evidence shows. They accuse them of

being shills for " Big Pharma " or covering up for government agencies, and they

call them offensive names; but they don't stop there. They threaten people who

write about the scientific evidence, and they threaten their children. Dr.

Offit, the author of Autism's False Prophets, received a direct death threat

that got the FBI involved. He had to use a bodyguard and cancel a book tour. One

threatening phone call ominously demonstrated that the caller knew Offit's

children's names, ages, and where they went to school. Another scientist who

received threats was so afraid for her children's safety that she vowed never to

write anything about autism again. One anti-vaccine activist had the bad grace

to accuse science blogger Orac of lying when he said he was mourning his

mother-in-law's death from cancer. She refused to believe he could be sorry his

mother-in-law died because he's not sorry about supporting vaccines that kill

children.

There was no thimerosal in any vaccine except the flu vaccine after 2002. The

" mercury militia " expected autism rates to drop, thereby proving the mercury

connection. Autism rates rose. Instead of relinquishing their belief, they made

implausible attempts to implicate new sources of atmospheric mercury, from

cremations of bodies with mercury amalgam fillings or from pollution wafted

across the Pacific from China.

The Vaccines-In-General Scare

If the MMR scare can be attributed to Wakefield and the mercury scare to

Neal Halsey, the next stage of hysteria is epitomized by McCarthy, actress

and anti-vaccine activist extraordinaire.

's son Evan is autistic. At first she subscribed to the fanciful notion

that she was an Indigo mother and Evan was a Crystal child. Indigos are

" difficult " children who are alleged to possess special traits or abilities such

as telepathy, empathy, and creativity, and are said to represent the next stage

in human evolution. Many of them fit the diagnosis of

attention-deficit/hyperactivity disorder (ADHD). Crystal children represent an

even more advanced evolutionary step. They are " so sensitive, so vulnerable to

the world around them, that they go inward, disconnect as best they can from

even humans and do their best to survive in a world where they really don't yet

fit. " They are often diagnosed as autistic.

After a while McCarthy gave up on that fantasy and accepted that Evan was

autistic. She became convinced that vaccines had caused his autism. She treated

him with unproven dietary restrictions, anti-yeast treatments, and supplements,

and claims to have cured him. She thinks her " Mommy instincts " are more valid

than science. She says " My science is Evan, and he's at home. That's my

science. " She realizes that withholding vaccines will lead to the deaths of

children. As quoted by Time magazine:

I do believe sadly it's going to take some diseases coming back to realize that

we need to change and develop vaccines that are safe. If the vaccine companies

are not listening to us, it's their f___ing fault that the diseases are coming

back. They're making a product that's s___. If you give us a safe vaccine, we'll

use it. It shouldn't be polio versus autism.

She and her partner Jim Carrey have spoken out at every opportunity on talk

shows, on the Internet, and through books and public appearances. When someone

questions 's beliefs her usual tactic is to try to shout them down. She is

supported by maverick doctor Jay Gordon, who values listening to parents over

science and who supports a delayed vaccine schedule not because of any evidence

but just because he thinks it's a good idea. On one talk show, a pregnant mother

with several autistic children tried to tell Gordon that her child who had the

worst autism was the one who had not been vaccinated. He not only refused to

listen to what she was saying but tried to drown her out, loudly insisting she

mustn't vaccinate the new baby.

A member of Quackwatch's " Healthfraud " online discussion list reported sitting

next to Evan's paternal grandmother at a dinner. Grandma said Evan's symptoms of

autism were evident before he was vaccinated, and he is not doing as well as

says. Grandma is writing her own book — I look forward to its revelations.

and her cohorts claim they are not anti-vaccine, but they are certainly a

good facsimile thereof. The goalposts keep moving. First it was the MMR vaccine,

then it was thimerosal, then it was mercury from all sources, then it was other

vaccine ingredients, then it was too many vaccines, then it was giving vaccines

too early. They will not be satisfied until science can offer a 100% safe and a

100% effective vaccine proven to have no side effects of any kind even in a rare

susceptible individual. That's not going to happen in this universe.

The other vaccine ingredients that have been questioned include formaldehyde,

aluminum, ether, anti-freeze, and human aborted fetal tissue. Scientists have

explained over and over that these ingredients are either not present in

vaccines or are harmless, but activists ignore the facts and keep making the

same false claims. Formaldehyde is harmless in small amounts and is even

produced naturally in the human body. Aluminum is an adjuvant used to increase

the efficacy of vaccines, and is not harmful. Ether might be used in the

manufacturing process but is not present in the vaccines. There is no ethylene

glycol or even diethylene glycol in vaccines. (Anti-freeze is ethylene glycol.)

And to obtain enough virus to make a vaccine, the virus must be grown in tissue

cultures that were originally derived from monkey, chicken, or sometimes human

fetal cells; but there is no human or animal tissue of any kind present in the

vaccine itself. Apple trees grow in soil, but there is no soil in applesauce.

Some anti-vaccine websites perpetuate the myth that infectious diseases were

already disappearing and that the vaccines had nothing to do with it. Those

myths are easily dispelled by historical data. Vaccine critics ignore the large

body of evidence from incidents around the world where as the vaccination rate

dropped, the rate of disease rose; and when the vaccination rate rose again, the

disease rate dropped. No one can seriously deny the effectiveness of vaccines.

They are the most impressive accomplishment of modern medicine.

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more effective problem solver. Kida provides examples that demonstrate how

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is to unconsciously accept false ideas. ORDER the book

Giving up the known benefits of vaccines because of a vague hypothetical

possibility of risk is a poor trade-off. We were able to eradicate smallpox, and

we ought to be able to eradicate all the diseases that are spread solely by

human-to-human contact. Once enough people have been vaccinated to eradicate the

disease, no one will ever have to be vaccinated for that disease again. Smallpox

is long gone; polio and measles are next on the list. Polio had been reduced to

only 3 countries a few years ago. Then Nigeria stopped vaccinating due to rumors

that the vaccines were an American plot to sterilize their children or give them

AIDS. The polio rate soared and the disease broke out to several other

countries, as far away as Malaysia.

When the rate of immunization reaches a certain level, the population is

protected by what we call herd immunity. It means there are not enough

susceptible people for the disease to keep spreading through a community. In

many places the herd immunity has already been lost. It is only a matter of time

before diseases break out again. One traveler from a country with polio could

reintroduce the disease into the U.S. Lowered vaccination rates endanger even

those who have been vaccinated, because the protection is not 100%. People who

are immunosuppressed, chronically ill, or too young to have been vaccinated are

also put at risk. Parents who choose to delay vaccination are prolonging their

children's period of risk. And they are endangering everyone else's public

health.

Scientists had been urged to " listen to the parents. " They did listen to the

parents and then conducted research to test the parents' hypotheses. There were

various kinds of studies in different countries by different research groups.

The results were consistent:

10 studies showed MMR doesn't cause autism

6 studies showed thimerosal doesn't cause autism

3 studies showed thimerosal doesn't cause subtle neurological problems

Now it's the parents who won't listen to the scientists.

Autistic children and their parents are being misled and victimized with

useless, untested, disproven, expensive, time-consuming, and even dangerous

treatments. Despite the evidence that mercury doesn't cause autism, children are

still being treated with IV chelation to remove mercury — at least one child has

died as a result. Along with Lupron injections for chemical castration, children

are being treated with secretin, restricted diets, supplements of all kinds,

intravenous hydrogen peroxide, DAN (Defeat Autism Now) protocols, cranial

manipulation, facilitated communication, and other nonsense. One family was

strongly urged to take out a second mortgage on their home so they could buy a

home hyperbaric oxygen chamber.

The real tragedy is that all this hoopla is diverting attention from research

into effective treatments (usually behavioral) and into the real causes of

autism (almost certainly genetic, with environmental triggers not ruled out).

An anti-anti-vaccine backlash is now afoot. Outbreaks of vaccine-preventable

diseases are being reported. Scientists are speaking out. Blogs like Respectful

Insolence and Science-Based Medicine have covered the subject in depth. The

Chicago Tribune published an exposé of the Geiers.9 Even Reader's Digest has

contradicted . They said that vaccines save lives and do not cause autism

and they stressed that the science is not on 's side. Let us hope that

sanity will prevail before too many more children die from vaccine-preventable

diseases. They are dying now. The McCarthy Body Count webpage is keeping

track of the numbers.

References

^ Offit, . 2008. Autism's False Prophets: Bad Science, Risky Medicine, and

the Search for a Cure. Columbia University Press.

^ Wakefield A.J., et al. 1998. " Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific

Colitis, and Pervasive Developmental Disorder in Children. " Lancet 351: 637:41.

^ Wakefield A.J., et al. 1993. " Evidence of Persistent Measles Virus Infection

in Crohn's Disease. " Journal of Medical Virology, 39: 345–53.

^Chadwick N., et al. 1998. " Measles Virus RNA is Not Detected in Inflammatory

Bowel Disease Using Hybrid Capture and Reverse Transcription Followed by the

Polymerase Chain Reaction. " J Med Virol., 55(4):305–11.

^ Uhlmann V., et al. 2002. " Potential Viral Pathogenic Mechanism for New Variant

Inflammatory Bowel Disease. " Mol Pathol, 55(2):84–90.

^ Details can be found on Deer's website:

http://briandeer.com/wakefield-deer.htm

^ Bernard S., et al. 2001. " Autism: A Novel Form of Mercury Poisoning. " Med

Hypotheses 56:462–71.

^ Offit, . 2007. " Thimerosal and Vaccines: A Cautionary Tale. " NEJM

357:1278-9, Sept. 27.

^ Tsouderos, Trine. 2009. " `Miracle Drug' Called Junk Science. " The Chicaco

Tribune, May 21. Available online at

http://www.chicagotribune.com/health/chi-autism-lupron-may21,0,242705.story?page\

=1