Wakefield’s article linking MMR vaccine and autism was fraudulent

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c7452 (Published 6 January 2011)
Cite this as: BMJ 2011;342:c7452

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I would like to further point out to Richard Bartley [1] that Prof Walker-Smith's research in this field pre-dates even the non-specific findings of Mary Coleman of 1975 that Bartley cites from Brian Deer's website, with a publication in the Lancet in 1972 [2].

In his autobiography Walker-Smith is very clear about the relationship between his earlier and later work [3]:

"When all this began, I did not know much about autism, although serendipitously I had studied a group of children with autism at RAHC [Royal Alexandra Hospital for Children], Sydney as I mentioned earlier. I had undertaken a study to determine whether a group of autistic children with bowel problems had coeliac disease. At that time in the late sixties and early seventies, many autistic children had been reported to have bowel problems and anecdotally there had been reports of benefit from a gluten-free diet. This study was published in 1972. My study of seven autistic children with bowel problems had used diagnostic small intestinal biopsy. It had excluded coeliac disease, but in a letter to the Lancet, we reported the finding of low levels of alpha-one-antitrypsin in the blood of these children. This low level was later found in other patients to be due to a leak of this protein from the gut. This occurs in disorders where there is a general protein loss, as I had studied years earlier at Prince Alfred. They included patients with inflammatory bowel disorders. Looking back on this work it now seems I was biopsying the wrong part of the gut. I should have biopsied the colon rather than the small intestine, as we were to do twenty three years later. Since I left Sydney in 1972, I had had no further contact with autistic children until 1995."

[1] Richard Bartley,'Re: Wakefield’s article linking MMR vaccine and autism was fraudulent' 13 March 2013 http://www.bmj.com/content/342/bmj.c7452/rr/635894

[2] John Walker-Smith , Judith Andrews 'Alpha-1-antitrypsin, autism, and coeliac disease', Lancet 2:7782 1972 Oct 21 p. 883-4

[3] John Walker-Smith, 'Enduring Memories' 2nd Edition, The Memoir Club 2012, p. 211-2

Competing interests: Autistic son

John Stone, UK Editor

AgeofAutism.com, London N22

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Perhaps I can assist Richard Bartley [1]. The principal sense in which Wakefield's 1998 Lancet paper linked "MMR vaccine with autism" is that it reported parental concerns that the onset of neurological and GI symptoms had commenced following MMR vaccination, but the paper made no claim to have proved a causal relationship [2].

The claim that there was mis-reporting of data took a substantial blow when the senior author Prof John Walker-Smith was fully exonerated in a High Court hearing last year before Mr Justice Mitting [3]. The issue of whether there was over-interpretation of the biopsies has also been earlier dismissed on these pages by both the histo-pathologist co-authors of the paper Susan E Davies [4] and Amar Dhillon [5], neither of whom was on trial.

Earlier papers which have not been retracted detected measles virus in some patients with gut pathology although these were not exclusively autism cases [6,7,8]. Even the Hornig paper [8] which tended to dismiss the issue acknowledged:

"Our results differ with reports noting MV RNA in ileal biopsies of 75% of ASD vs. 6% of control children...Discrepancies are unlikely to represent differences in experimental technique because similar primer and probe sequences, cycling conditions and instruments were employed in this and earlier reports; furthermore, one of the three laboratories participating in this study performed the assays described in earlier reports. Other factors to consider include differences in patient age, sex, origin (Europe vs. North America), GI disease, recency of MMR vaccine administration at time of biopsy, and methods for confirming neuropsychiatric status in cases and controls."

A notable flaw with paper by Honda et al [9] was that it failed to take account either of the failing vaccination rates prior to the removal of MMR from the schedule, or the fact that it was replaced by multiple vaccinations in close proximity (rather than temporally split as Wakefield recommended). This issue was scarcely resolved by co-author Sir Michael Rutter when quizzed about it in Private Eye in 2005 [10]:

"One of the co-authors of the Honda paper was Professor Sir Michael Rutter, of the Institute of Psychiatry, who had prepared a draft report for GlaxoSmithKline, one of the defendant drug companies in the UK litigation but who was not retained by them. He told the Eye that as he was not an immunlogist he could not comment on the suggestion that giving three separate vaccines a short time apart was the same as administering the MMR triple vaccine. But he added that although it was unfortunate there was little relevant material published on any possible interference between vaccine components, immunologists whom he had consulted doubted that this was a significant issue."

Of course, it would be introducing a straw man to pretend that anyone was suggesting that MMR was the sole cause of either autism or GI problems, but it is noteworthy that the United States Health and Human Services Health Resouces and Sevices A Administration told Sharyl Attkisson of CBS News[11]:

"The government has never compensated, nor has it ever been ordered to compensate, any case based on a determination that autism was actually caused by vaccines. We have compensated cases in which children exhibited an encephalopathy, or general brain disease. Encephalopathy may be accompanied by a medical progression of an array of symptoms including autistic behavior, autism, or seizures."

While it is gratifying to learn from Richard Bartley of the association between autism and bowel disease it does not follow that vaccines could not have been implicated in the pathology of children of that period. For example, the first measles vaccine was licensed in 1963 in the US and the first rubella vaccine in 1969-70. Of course, we have many more cases of autism now.

[1] Richard Bartley,'Re: Wakefield’s article linking MMR vaccine and autism was fraudulent' 13 March 2013 http://www.bmj.com/content/342/bmj.c7452/rr/635894

[2] Wakefield et al 'Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive development disorder' Lancet Vol 351, 28 February 1998 p. 637-41

[3] Judgment of Mr Justice Mitting (Appeal of Professor John Walker-Smith against the General Medical Council March 2012 http://www.bailii.org/cgi-bin/markup.cgi?doc=/ew/cases/EWHC/Admin/2012/5...

[4] Susan E Davies, 'Caution in assessing histopathologic opinions', 30 April 2010, http://www.bmj.com/rapid-response/2011/11/02/caution-assessing-histopath...

[5] Amar P Dhillon, 'Re: Pathaology results solve "new bowel disease" riddle', http://www.bmj.com/rapid-response/2011/11/17/re-pathology-reports-solve-...

[6] Uhlmann et al, 'Potential viral pathogenic mechanism for new variant inflammatory bowel disease' Mol Path2002;55:84-90 doi:10.1136/mp.55.2.84 , http://mp.bmj.com/content/55/2/84.long

[7] Martin et al, 'Detection of measles virus in children with ileo-colonic lymphoid nodular hyperplasia, enterocolitis and developmental disorder' Molecular Psychiatry (2002) 7, S47-S48. doi:10.1038/sj.mp.4001179

[8] Hornig et al. 'Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study' http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0003140

[9] Honda H, Shimizu Y, Rutter M (2005). "No effect of MMR withdrawal on the incidence of autism: a total population study". J Child Psychol Psychiatry 46 (6): 572–9

[10] John Stone, 'Sir Michael Rutter interviewed in Private Eye: not a full explanation' http://www.bmj.com/rapid-response/2011/10/30/sir-michael-rutter-intervie...

[11] Sharyl Attkisson, 'Vaccines, Autism and Brain Damage: What's in a Name?' CBS News http://www.cbsnews.com/8301-31727_162-20016356-10391695.html

Competing interests: Autistic son

John Stone, UK Editor

AgeofAutism.com, London N22

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Bowel problems do seem to be a feature in children and adults with autism and in this respect the MMR debate is a sideshow.

In 1974 Dr Mary Coleman, an American paediatric neurologist, conducted a study of autistic children, using neuro-typical children as controls. She identified the presence of constipation or diarrhoea in 19 of the autistic patients but only 5 of the control children (1).

What is significant is that none of the children in the autistic or neuro-typical group had been administered the MMR vaccine as it had not been licensed in the US at that time. Nevertheless she identified that there may be a higher prevalence of bowel disorders in people with autism.

However, just to put the MMR issue to bed once again - as noted by Bandolier - a study in Yokohama in the early 1990’s showed that the incidence of autism continued to rise after MMR vaccine was discontinued. The incidence of autism was higher in children born after 1992 who were not vaccinated with MMR than in children born before 1992 who were vaccinated (2).

1. http://briandeer.com/wakefield/coleman-child.htm

2. Honda H, Shimizu Y, Rutter M (2005). "No effect of MMR withdrawal on the incidence of autism: a total population study". J Child Psychol Psychiatry 46 (6): 572–9

Competing interests: My daughter has Asperger's Syndrome

Richard Bartley, Physiotherapist

NHS, Colwyn Bay

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My Grandson is now grown up and still suffering terribly from the above syndrome, which was downgraded to 'chronic constipation' after the Royal Free Hospital was incorporated into UCL; the 'special clinic' was disbanded, with most child patients discharged back to primary care, also with 'constipation' diagnoses.

Since then, my Grandson has been prescribed only laxatives and painkillers for his bowel problems. After what happened to clinicians Professors Walker-Smith and Murch, and research scientist Dr Wakefield, following the publication of the Wakefield et al 1998 Lancet paper, no other NHS doctor has been prepared to accept and treat the 'colitis' aspect of my Grandson's original Royal Free diagnosis, and who can blame them? There are literally thousands of children in the UK alone, with the same syndrome as my Grandson, whose bowel problems are presently not being properly addressed and treated. This is prolonging their suffering.

It is time for what Dr Wakefield refers to as the 'bowel-brain bone' to be officially acknowledged by the UK medical establishment. This will have to happen eventually, particularly since Professor Walker-Smith's successful High Court appeal, completely exonerated him from all the GMC charges, and restored his medical licence. It was Professor Walker-Smith who personally compiled the Lancet twelve children's clinical histories. This is prominently stated within the 1998 Lancet paper.

Competing interests: Autistic Grandson, who was a Royal Free patient, diagnosed and treated for the bowel syndrome "Ileal-lymphoid-nodular hyperplasia, with non-specific colitis", by Professor John Walker-Smith and his excellent team.

Jenny H Allan, retired teacher

none, Scotland

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Published in PLOS ONE:

Identification of Unique Gene Expression Profile in Children with Regressive Autism Spectrum Disorder (ASD) and Ileocolitis

Walker S., Fortunato J, Krigsman A., Gonzalez L.

ABSTRACT

Gastrointestinal symptoms are common in children with autism spectrum disorder (ASD) and are often associated with mucosal inflammatory infiltrates of the small and large intestine. Although distinct histologic and immunohistochemical properties of this inflammatory infiltrate have been previously described in this ASDGI group, molecular characterization of these lesions has not been reported. In this study we utilize transcriptome profiling of gastrointestinal mucosal biopsy tissue from ASDGI children and three non-ASD control groups (Crohn's disease, ulcerative colitis, and histologically normal) in an effort to determine if there is a gene expression profile unique to the ASDGI group. Comparison of differentially expressed transcripts between the groups demonstrated that non-pathologic (normal) tissue segregated almost completely from inflamed tissue in all cases. Gene expression profiles in intestinal biopsy tissue from patients with Crohn's disease, ulcerative colitis, and ASDGI, while having significant overlap with each other, also showed distinctive features for each group. Taken together, these results demonstrate that ASDGI children have a gastrointestinal mucosal molecular profile that overlaps significantly with known inflammatory bowel disease (IBD), yet has distinctive features that further supports the presence of an ASD-associated IBD variant, or, alternatively, a prodromal phase of typical inflammatory bowel disease. Although we report qPCR confirmation of representative differentially expressed transcripts determined initially by microarray, these findings may be considered preliminary to the extent that they require further confirmation in a validation cohort.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058058

Competing interests: Autsitic son

John Stone, UK Editor

AgeofAutism.com, London N22

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It was said that parents started to refuse to vaccinate children after the Article of Wakefield in Lancet which was published in February 1998. If we search PubMed for some statistical data: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719604/ "The proportion of parents attributing their child's autism to MMR appears to have increased since August 1997." I do not like retrospective research as it is not clear, based either on memories of someone from several years ago or papers which are in their turn based on memories of parents, but anyway - there is a slight timing difference (6 months actually) and I do not really believe that parents pre-viewed Wakefield's and colleagues research results.

As for our case - first the doctor suspected that our son had measles after vaccination and even called vaccine producer to claim it (was refused), said "in the worst case let's suggest he had measles and hope it will be OK". 1 year later our son was diagnosed with autism. If his autism is the result of measles infection or not - we do not know, but it is clear he had a viral infection as a result of vaccination which should normally PROTECT from that infection. It still surprises me how a vaccine-producer representative can diagnose the absence of link ON THE PHONE, contradicting to diagnostics of our doctor (35 years experience) made "in vivo"... Several days after vaccination he started to have fever, rash (first - behind the ears, then on the face, then on the body, then on the extremities (I remember it well, because I called the doctor literally every 2 hours as changes were quite notable), diarrhea, vomiting (did not drink for 3 days, any liquid was thrown up, even 10 ml). All medical records before the vaccination were perfect except that he had bowel problems (frequent diarrhea). After vaccination diarrhea stopped, but then he started to have constipation. He started to walk at 12.5 months, was walking from his dad to me, laughing, pointing, knew several words (we keep records and video), when his dad came from work he crawled to greet him, pointed to animals and objects and named them, "read" books. After 2 weeks after vaccination we took him to walk in the park. He ran away from us like he does not hear, started to turn around, liked spinning objects, no eye contact.

Recently we made immune tests and found that he has an immunosuppression of 48%. Now we have a paper where it is written "prophylactic vaccination is not recommended". If we have this paper before vaccination it is less likely our son have measles.

I am not against vaccination, but against doing it to all kids without taking into the account their immune system's capacity to fight the infection.

That should not be done by simple "doctor thought", but by appropriate laboratory tests before vaccination.

The required tests should be based on proper research - not retrospective, but medical trials, taking into the account that adults immune system is different to kids, that mice passed thousands times more generations than people optimising their sensory system when people optimised their capacity to interact, so the trials on healthy mice would not give any meaningful results.

If humans are ready to have kids at 15 y.o. then humans passed about 15000 generations from their "existence", 3500 generations from the time they started to talk, 500 generations from medical interventions (whic decrease survival optimisation). Mice do not have any medical treatment and their breeding onset is 50 hdays of age. So, even if we suppose they appeared at the same time as "relatively modern" humans (i.e. 200000 years ago) - then they passed 1.46 mln generations. Compare this to 15000 it is 1.445 mln generations more. How that can be compared to people, who on the top are not oriented to survival (i.e. optimisation of their sensory skills), but on medicalisation since birth - it is even ridiculous! Not surprising a language and sensory systems are the first things which are impaired. First one was "recently acquired" and second one regressed instead of being optimised.

So, it is not relevant to compare species quickly changing generations with no medical interventions, which improve their capacities to adapt to changing environment with each generation to humans, who do not improve their survival characteristics.

The better way would be to use computer programs modelling homeostasis changes due to external interventions. That could be one of the tools. Thus, even with that tool (or especially with that tool) research results theoretically could be manipulated.

Competing interests: Mother of the son with autism. Measles infection due to vaccine were claimed by the doctor (denied by vaccine producer on the phone) 1 year before autism diagnostics.

Nika Kachler, Parent

Home, Netherlands

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I was appreciative that some readers have taken the opportunity to look at the exciting developments in Autism research most notably by such eminent institutions as the University of California 1 and Johns Hopkins. 2

Further to this there is a number of excellent Distinguished Lecturer Series presented in multimedia format.Sourced at UC Davis MIND Institute.

I have always been concerned that the British Medical Journal and others were ignoring the real contribution parents can make in an open and honest dialogue with health professionals on a range of issues associated with ASD.

Though I was grateful the BMJ drew my attention to Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report.3 I found as a parent of an ASD child information contained at statements 14 to 18 particularly relevant to my families circumstances.

Readers then might be also interested in further research undertaken by The Kennedy Krieger Institute, Center for Autism and Related Disorders, The Johns Hopkins School of Medicine, USA in conjunction with Division of Biostatisics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, USA. 4

The research presented as "Development in infants with autism spectrum disorders: a prospective study" reinforces the very real observations of parents and caregivers.

Infants were tested at 6 14 and 24 months using the Mullen Scales of Early Learning.

87 children were selected as either High Risk for ASD or low risk. High risk children were siblings of ASD children Low risk were children from families with no history of ASD.

Results

At 6 months no statistical change evident.

By 14 months the ASD group was beginning to show signifcant performance deficits in all but one area.

By 24 months the ASD group performed significamtly behind all groups including the language delayed group. (LD) Particularly in Gross and fine motor skills as well as receptive language.

Their conclusion that reinforces parental observations.

"Unusual slowing in performance occurred between 14 and 24 months of age in ASD."

Of course their is a variety of hypotheses that can be generated from this information and I make no claim as to what this conclusion may mean . I just suggest that parents were faithfully describing a very real event in their ASD child's development.

regards

Further readings for those interested in all matters pertaining to ASD. I have referenced internet links as this is perhaps the easiest for parents and caregivers.

1. Distinguished Lecturer Series http://www.ucdmc.ucdavis.edu/mindinstitute/videos/video_dls.html#dls11

2. Johns Hopkins Neuroimmunopathology Laboratory research on autism http://www.neuro.jhmi.edu/neuroimmunopath/autism.htm

3. Buie et al Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report http://pediatrics.aappublications.org/cgi/content/full/125/Supplement_1/... 4.Landall,Garrett-Mayer Development in infants with autism spectrum disorders: a prospective study

http://onlinelibrary.wiley.com/doi/10.1111/j.1469- 7610.2006.01531.x/abstract

Competing interests: Father of ASD son.My children are fully immunised on time and schedule.I have never made a claim between vaccination and my son's ASD.

John R Smith, Special Education

Parent

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New unorthodox approach to treat inflammatory bowel disease in autism gets approval from the FDA

I read a remarkable report published recently in The Scientist (Vol 25, Issue 2, Page 42)that shows how effective treatment of gut inflammation can reverse the most severe symptoms in autistic individuals. What is perhaps even more remarkable is that this new highly unorthodox treatment now has the stump of approval from the FDA. Why unorthodox? Because it involves feeding autistic patients with live ova of the nematode Trichuris suis, pig whipworm !

The idea for this came from Stewart Johnson (father of a child with autism) who discovered the work of researchers at the University of Iowa who had previously successfully treated patients with Crohn's disease and ulcerative colitis with Trichuris suis ova (TSO) [1-2]. Both Chron's and ulcerative colitis are autoimmune disorders in which the immune system attacks the intestinal walls. Stewart's hypothesis was that parasitic worm infection would modulate his son's immune system and calm the gut inflammation that was causing his disruptive behaviors. He came to this conclusion after reviewing the landmark study by Vargas et al. [3] which showed extensive glial activation and neuroinflammation in the brain of patients with autism. This led Stewart to conclude that indeed, there was a gut-brain connection in autism and that by fixing the gut problem the latter would be fixed as well.

He proposed this treatment to Dr. Eric Hollander from the Montefiore Medical Center University Hospital of the Albert Einstein College of Medicine.

After obtaining permission to administer the treatment from the US Food and Drug Administration (FDA) under "compassionate use" rules, Stewart and Hollander initiated the treatment.

Within 10 weeks of treatment (with 2,500 eggs given every two weeks), the boy's symptoms did no just improve. They vanished. He stopped smashing his head against walls and gouging at his eyes. His psychotic behaviours stopped and the family was finally allowed to have a normal life.

The big question is: what is the mechanism by which TSO modulates the immune system to calm down autoimmune attacks and inflammation in autism ? It was initially assumed that intestinal worms could activate a Th2-type response and as a consequence, suppress the Th1 response, which is usually implicated in autoimmune diseases. However, this hypothesis was later dismissed in favour of more recent research which showed that the mechanism involves direct modulation of regulatory T-cells (T-reg) by the worms. T-reg cells function to suppress activation of the immune system thereby preventing it from attacking the body's own tissues. Research indicates that intestinal worms can induce T-reg cells initially in the gut and that this changes the inflammatory setting which finally results in less inflammation in the brain.

This is good news! Even better is that the FDA finally started thinking outside of the box!

References:

1. R.W. Summers et al., "Trichuris suis therapy in Crohn's disease," Gut, 54:87-90, 2005. 2. R.W. Summers et al., "Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial," Gastroenterology, 128:825-832, 2005. 3. D.L. Vargas et al., "Neuroglial activation and neuroinflammation in the brain of patients with autism," Annal Neurol, 57:67-81, 2005.

Competing interests: None declared

Lucija Tomljenovic, Postdoctoral Fellow

University of British Columbia

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11 February 2011

In common with Dr Yazbak, I have no intention of dissecting Brian Deer's article in this rapid response. Instead I too wish to state the grateful thanks of all my family members to those two wonderful Royal Free clinicians, Professors Walker Smith and Murch. They were kind compassionate and very professional, and my Grandson's condition and behaviour improved greatly as a result of their diagnosis and care. My daughter was fully informed and consulted at every stage, including all diagnostic procedures.

My Grandson was properly referred to the Royal Free by his GP and his treatment was paid for by the NHS, which is 'free at the point of use' in the UK. He is still autistic and is still receiving NHS treatment for his bowel problems.

These two outstanding clinicians did not deserve the vilification, which has been their reward for doing their jobs properly and conscientiously, always putting their patients first. I was standing outside the GMC premises in July 2010 when the verdicts were announced. My delight at the total exoneration of Professor Simon Murch was tempered by my anger about Professor Walker Smith and Dr Wakefield both being 'struck off' the Medical Register.

My placard said 'Travesty of Justice'.

Competing interests: My autistic Grandson was treated for his bowel disorder at the Royal Free Hospital by Professors Walker Smith and Murch. (NOT one of the Lancet 12)

Jenny H Allan, retired

none

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In response to Catherina Becker's comment. For parents of non-MMR vaccinated children with gastrointestinal symptoms and developmental regression, I don't think the topic at hand is "whether MMR causes autism with gut problems", but whether gastrointestinal disease triggered by environmental factors lead to brain malfunction in their previously normal children. If we knew what those factors were they could be avoided, even if one of them is a particular vaccine, a combination of vaccines, or a component of vaccines, and then vulnerable children could be shielded from permanent harm.

From my perspective, the most important aspect of Wakefield's 1998 paper is that it highlighted a medical problem in the group of children with regression - one medical problem among many other medical problems that for decades doctors have ignored by attributing physical manifestations of disease to autism, which, thanks to Leo Kanner and Bruno Bettelheim was blamed until only recently on poor parenting and refrigerator mothers breast-feeding their babies their black milk. (1)

We have a group of children with autism spectrum diagnoses whose medical problems (gastrointestinal disease, sub-clinical epilepsy, severe auditory problems and more) are overlooked time and time again because the children carry a psychiatric label, and the only solution doctors have offered to date is medication with a whole raft of dangerous, mind- altering drugs to control their behaviour. (2)

If it were not for Dr Andrew Wakefield, I very much doubt that in 2010 the American Academy of Pediatrics would have even entertained the idea of gastrointestinal disease in children with autistic conditions. I believe we have him to thank for their Consensus Report: "Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs" (2010). (3) They say:

"Care providers should be aware that problem behaviour in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders".

The question is:

How much longer must we wait for it to become standard medical practice for children presenting with regression and autistic symptoms to undergo full neurological, audiological, gastrointestinal and immunological testing?

It is surely high time to stop diagnosing babies, toddlers, and small children with lifetime mental disorders without looking for the root cause. Because autistic conditions do not have one cause, but many, the only way to do that is to examine the children as individuals.

Catherina Becker says she is baffled that with Lucija Tomljenovic's scientific training she should associate herself with "the anti-vaccine circus". Thinking people have always questioned the science behind vaccination, its efficacy and its safety. (3) George Bernard Shaw was one. Unfortunately, with very little science to support it, vaccination has become a religion, and anyone who questions its efficacy and/or safety is regarded as a heretic.

The bottom line is whatever side you take, pro-vaccine, pro-some- vaccines, or anti-vaccine, we all want our children to be healthy and mentally-fit, but with 1 in 7 children with neurological disorders today, can we really say in 2011 that they are?

(1) http://www.amazon.com/Empty-Fortress-Infantile-Autism- Birth/dp/B001MSIENO/ref=sr_1_1_title_1_h?s=books&ie=UTF8&qid=1295994362&sr=1 -1

The Empty Fortress: Infantile Autism and the Birth of the Self Bruno Bettelheim (1967)

(2) http://www.medicalnewstoday.com/articles/187386.php

Children With Autism Frequently Receive Psychotropic Medications 04 May 2010

(3) http://www.pediatrics.org/cgi/content/full/125/Supplement_1/S1

Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs Pediatrics 2010;125;S1-S18

(4) http://openlibrary.org/books/OL7164739M/

The_story_of_a_great_delusion_in_a_series_of_matter-of-fact_chapters. The Story of a Great Delusion by William White - Published 1885

Competing interests: My son regressed after vaccines. He has never received the MMR.

Alex Snelgrove, Carer/Retired teacher

None

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