MMR-autism scare: the truth is out at last

‘To conclude that Colten’s condition was the result of his MMR vaccine, an objective observer would have to emulate Lewis Carroll’s White Queen and be able to believe six impossible (or, at least, highly improbable) things before breakfast. The families of children with autistic spectrum disorders have waited in vain for adequate evidence to support the autism-MMR hypothesis. Although I have the deepest sympathy for families like Colten’s, struggling emotionally and financially to find answers about ASD’s [Autistic Spectrum Disorders] causes, and reliable therapies to treat ASD’s symptoms, I must decide Colten’s case on the evidence before me. That evidence does not establish an adequate factual basis from which to conclude that Colten’s condition was caused by his vaccines.’

Denise K Vowell, 12 February 2009
Special Master, US Court of Federal Claims
Petitioners: Kathryn and Joseph Snyder (parents of Colten)
Respondent: Secretary of Health and Human Services

‘I feel a deep sympathy and admiration for the Cedillo family. And I have no doubt that the families of countless other autistic children, families that cope every day with the tremendous challenges of caring for autistic children, are similarly deserving of sympathy and admiration. However, I must decide this case not on sentiment, but by analysing the evidence. Congress designed the [vaccine injury compensation] programme to compensate only families of those individuals whose injuries or deaths can be linked causally… to a listed vaccination. In this case the evidence advanced by the petitioners has fallen far short of demonstrating such a link.’

George L Hastings, 12 February 2009
Special Master, US Court of Federal Claims
Petitioners: Theresa and Michael Cedillo (parents of Michelle)
Respondent: Secretary of Health and Human Services

‘The Hazlehursts’ experience as parents of an autistic child, as described during the evidentiary hearing in this case, has been a very difficult one. The undersigned is moved as a person and as a parent by the Hazlehursts’ account and again extends to the Hazlehursts very sincere sympathy for the challenges they face with Yates. The undersigned’s charge, however, does not permit decision-making on the basis of sentiment but rather requires a careful legal analysis of the evidence.

‘The parties have submitted a wealth of evidence and have presented the testimony of a number of experts who have extensive clinical and research experience in the particular areas of interest in this case. Having carefully and fully considered the evidence, the undersigned concludes that the combination of the thimerosal-containing vaccines and the MMR vaccine are not causal factors in the development of autism. The weight of the presented evidence that is scientifically reliable and methodologically sound does not support petitioners’ claim. Petitioners have failed to establish entitlement to compensation under the Vaccine Act.’

Patricia E Campbell-Smith, 12 February 2009
Special Master, US Court of Federal Claims
Petitioners: Rolf and Angela Hazlehurst (parents of William Yates)
Respondent: Secretary of Health and Human Services

In 2007 federal judges were appointed as ‘special masters’ in three test cases selected from the families of more than 5,000 children claiming compensation on the grounds that a combination of vaccines containing the mercury-based preservative thimerosal in the first year of life and the measles, mumps and rubella (MMR) vaccine after 12 months, caused them to develop autism and related health problems.

The first case in the ‘Omnibus Autism Proceedings’ – that of Michelle Cedillo – was heard by George L Hastings in Washington, DC in June 2007; the second – that of William Yates Hazlehurst – by Patricia E Campbell-Smith in Charlotte, North Carolina in October 2007; the third – that of Colten Snyder – by Denise K Vowell in Orlando, Florida in November 2007. On 12 February, in simultaneously published judgments, all three judges rejected claims that vaccines caused autism in these children (1).

The special masters’ concluding summaries, quoted above, are sympathetic, judicious and categorical. The full judgments, amounting to nearly 700 pages of text, are of exceptional interest to anybody concerned to establish the truth in this long-running controversy.

A tribute to American justice

Andrew Wakefield, the former Royal Free Hospital researcher who launched the MMR-autism scare more than a decade ago, and is now based in a private autism treatment clinic in Texas, told a local TV station last week that he believes that this issue ‘can’t be resolved in the courts of law’ (2). In general, I am inclined to agree with Dr Wakefield that law courts are not the best places in which to deal with matters of controversy in science. Yet, on the particular issues at stake in the ‘Omnibus Autism Proceedings’, the legal forum offers some advantages.

Though assemblies set up to evaluate claims of vaccine-autism links, by the Medical Research Council in the UK, or the Institute of Medicine in the USA, have sought to involve parents and other lay interests, the terms of discussion have generally been set by scientists and medical authorities. By contrast, the expert witnesses in the vaccine courts are obliged to present their evidence to judges who have no particular scientific expertise: the standard is that of the intelligent, objective, observer.

Parents who attribute their children’s autism to vaccines often claim that they – and the scientists and doctors who support their conviction – have been denied a public hearing. The vaccine courts allowed their voices, and those of their legal representatives and supportive experts, to be heard and to be interrogated. The scientific issues, though complex, can be resolved in these cases into a basic question that can be decided by a competent judge: does the evidence support the claim that this vaccine (or combination of vaccines) caused autism in this child? It is also worth recalling the precedent of the exemplary judgment made in relation to claims against the whooping cough (pertussis) vaccine in England more than 20 years ago (3).

In each of the three test cases, the special masters heard statements from lawyers for the petitioners (the children’s families) and from those representing the respondent (the US health department). They heard evidence from the parents and from expert witnesses called by the parents and those called by the health authorities; witnesses were subjected to cross examination by rival lawyers. The special masters reviewed documents submitted by both sides, including scientific papers and medical reports relating to the three children. They carefully and conscientiously evaluated the evidence and, by a process documented in detail in the judgments, came to their conclusions. By contrast with the proceedings currently underway at the General Medical Council in London, the US vaccine courts offer a process that is transparent, democratic and scrupulously fair and efficient, a tribute to the superiority of the American legal system (4).

A number of aspects of the vaccine court’s judgments merit further discussion. The first is the most important, but also the most familiar – the scientific issue of whether vaccines cause autism. The second is the questions raised by the court about the quality of the scientific and medical advice received by the petitioners, and, implicitly, by parents of autistic children more widely who identify with the anti-vaccine and associated biomedical treatment campaigns. The court also raised serious concerns about the activities of three key figures in this controversy – Andrew Wakefield (who did not appear in person but whose work was extensively discussed), the paediatric gastroenterologist Arthur Krigsman and the general practitioner Jeffrey Bradstreet. Both Krigsman and Bradstreet are close collaborators with Wakefield and both appeared in these test cases as expert witnesses and consulting physicians. Both are prominent figures in the Defeat Autism Now! network of practitioners who provide ‘unorthodox biomedical interventions’ for children with autism.

‘Bad science’

‘Doctor Fombonne summed up the body of scientific research into ASD’s [autistic spectrum disorders] causes and the petitioners’ TCV-MMR vaccine hypothesis, saying the possibility that some children are genetically predisposed to abnormal reactions to TCVs [thimerosal-containing vaccines] and the MMR vaccine so as to cause autism was less likely than the possibility of the earth being the center of the solar system. His statement is an exaggeration of the evidence (or lack thereof), but is a concise and pithy expression of the general scientific disapproval of petitioners’ theories.’ (5)

‘Sadly, the petitioners in this litigation have been the victims of bad science, conducted to support litigation rather than to advance medical and scientific understanding of ASD’. (6)

We need not dwell here on the scientific basis of claims that autism may be caused by mercury or MMR vaccines: for a comprehensive review see my new book and Paul Offit’s account (7). Let us simply present the conclusions drawn by special master Denise Vowell in the Colten Snyder case (which are similar to those in the other cases). ‘After careful consideration of all of the evidence’, Vowell found that ‘it was abundantly clear that petitioners’ theories of causation were speculative and unpersuasive’ (8). In particular, petitioners:

a) ‘could not reliably demonstrate the presence of measles virus in Colten’s central nervous system’ (this was ‘because of pervasive quality control problems at a now-defunct laboratory’ – of which more below);

b) ‘failed to establish that measles virus can cause autism or that it did so in Colten’;

c) ‘failed to demonstrate that amount of ethylmercury in TCVs [thimerosal-containing vaccines] causes immune system suppression or dysregulation’;

d) ‘failed to show that Colten’s immune system was dysregulated’.

Vowell also dismissed the concept of ‘autistic enterocolitis’, an inflammatory bowel condition that provides a hypothetical link between MMR and autism, as ‘speculative and unsupported by the weight of evidence’ (9).

Bad scientists

‘Respondents’ experts were far more qualified, better supported by the weight of scientific research and authority, and simply more persuasive on nearly every point in contention.’ (10)

The gulf in relevant expertise and experience between the rival expert witnesses is a recurring theme in the vaccine court judgments. The special masters exposed several instances of ‘resume padding’ among the parents’ experts and of illegitimate claims to academic status and authorship of published papers. They noted that one of these experts had become a professional expert witness after retiring from clinical practice 17 years ago. By contrast, the experts challenging vaccine-autism links were highly qualified and highly experienced in the relevant disciplines.

While noting their concerns about the parents’ experts’ CVs, the special masters emphasised that their judgment was not merely based on the experts’ academic authority, but also on their performances in court. All three commented that whereas they found the respondent’s witnesses in general to be knowledgeable, well-informed and credible, the parents’ experts tended to be ineffectual and unpersuasive. Special master Patricia Campbell-Smith, who presided in the Hazlehurst case, emphasised that the respondent’s witnesses were more persuasive because their evidence was ‘well supported by medical literature and significant clinical experience’ (11). She observed that they were ‘careful in matters of degree’, that they offered ‘specific, detailed criticisms’ of rival evidence ‘explaining carefully’ why they considered it was not reliable. By contrast, petitioners’ witnesses were ‘not as disciplined… where differences mattered’. When it came to the interpretation of scientific papers, they gave ‘greater weight to speculative conclusions’ than even the authors of these papers, they used ‘carefully selected sentences’ taken out of context and relied on ‘scientifically flawed and unreliable articles’.

Take, for example, the contrast between Jean Ronel-Corbier, a paediatric neurologist who treats autistic children, but has no record of academic publications or professional distinction, and Diane Griffin, a virologist with a long record of publication and an international reputation. Both, like most of the expert witnesses, appeared in all three cases. Vowell found Ronel-Corbier to be ‘earnest and sincere’ but considered that his opinions were ‘heavily laced with generalities, speculation and beliefs largely unsupported by evidence’ (12). Hastings agreed that he was ‘sincere but not reliable’; he appeared ‘unfamiliar with the medical literature’ and was ‘willing to give opinions on causation on very scant evidence’ (13). Vowell found that Griffin was, ‘despite her inexperience’ in court, a ‘model witness’ whose testimony was ‘careful, reasoned and responsive’ (14). She offered ‘appropriately qualified opinions’ and as a result was ‘compelling and completely convincing’. Campbell-Smith considered Griffin ‘highly credible and knowledgeable’.

The gulf in academic and professional standards between the rival experts in these cases is not the result of the petitioners’ difficulty in persuading high quality scientists and doctors to testify on their behalf. It reflects the fact that the bad science of the vaccine-autism campaign is not supported by reputable scientists and doctors in the relevant disciplines. It is a great misfortune that, over the past decade, thousands of parents of autistic children, on both sides of the Atlantic, have come under the influence of the plausible purveyors of the junk science of the vaccine-autism campaign (15). The great value of the Omnibus Autism Proceedings has been in exposing the work of these shady practitioners to the scrutiny of serious scientists.

‘Fraud’

‘Doctor [Robert] Rust used the term “scientific fraud” in describing the information upon which the MMR theory of causation is based. While noting that scientists are very careful about using that term, he testified that there was “abundant” evidence of scientific fraud in the body of evidence developed to support the MMR-autism hypothesis.’ (16)

The vaccine court judgments devote a great deal of attention to the claims made by Dr Wakefield, in collaboration with the Dublin pathologist John O’Leary and others, to have identified measles virus in specimens (gut biopsies, blood and cerebrospinal fluid) taken from autistic children. Given the status of these claims as the sole scientific evidence supporting the MMR-autism link and their influence on parents pursuing compensation claims, this emphasis is appropriate. The special masters unanimously rejected this evidence. Vowell noted that the O’Leary lab ‘had several of the hallmarks of unreliability’, notably that ‘it was established, primarily, if not solely, for the purpose of supporting the claimants in the UK MMR litigation’. Furthermore, ‘its results were not reproducible by independent investigators, and its quality control problems were so pervasive that they suggested gross negligence, if not outright scientific fraud’. She concluded that the evidence that the results of this lab were unreliable was ‘overwhelming’ (17).

In previous articles, I have given an account of the ‘devastating’ testimony of the British molecular biologist Stephen Bustin, given in the Cedillo hearings in June 2007, concerning the O’Leary lab (18). The latest judgments provide full details of Bustin’s damning critique. Here Bustin’s evidence is comprehensively corroborated by a number of authoritative experts, including virologists Diane Griffin and Bert Rima and infectious diseases specialist Brian Ward. These accounts are supplemented by evidence from other experts who attempted to replicate or validate the Wakefield/O’Leary work – Liam Cotter, Peter Simmonds, Michael Oldstone. The technical deficiencies in the O’Leary ‘Unigenetics’ lab are too numerous to detail, but here is Vowell’s summary:

‘Unigenetics had problems in RNA extraction and sample quality, poor internal controls and poor adherence by laboratory personnel to Unigenetics’ own SOP [Standard Operating Procedure], unblinded testing that permitted data manipulation, and a critical problem with contamination. Some of the data discovered during Dr Bustin’s review suggested a fraudulent manipulation of laboratory notebooks and machine settings. Other evidence generated during the UK litigation demonstrated anew that Unigenetics’ results could not be reproduced.’ (19)

British gut immunologist Tom MacDonald surveyed Wakefield’s work from the early 1990s (when he first claimed to have identified measles virus as a cause of Crohn’s disease), indicating growing concerns, not only about the quality of his research but also about his integrity as a researcher (20). It emerges from these accounts that, even before the publication of the 1998 Lancet paper that launched the MMR scare, Wakefield’s fellow researchers had already largely lost confidence in his work and were refusing to collaborate with him. By the time he left the Royal Free Hospital in December 2001, shortly before the publication of his collaboration with O’Leary, leading experts in virology and immunology on both sides of the Atlantic were highly suspicious of Wakefield’s claims. One of the ironies of the campaign against MMR is that while Wakefield’s credibility in the world of science declined steadily through the 1990s, his public reputation – skilfully managed by himself, his PR firm and compliant journalists – grew apace. The major casualties of this divergence were the parents of autistic children who were drawn into the anti-MMR litigation. The vaccine court proceedings have finally revealed to them what the scientists have known for a decade: the science linking MMR and autism is junk.

In the past I have been reluctant to endorse allegations of fraud against Wakefield (21). However, on the basis of the extensive evidence presented in the US vaccine courts – together with the recent revelations by British investigative journalist Brian Deer concerning the falsification of data in the 1998 Lancet paper, I am obliged to concede that I appear to have underestimated the extent to which Wakefield’s apparent incapacity to face up to evidence contrary to a cherished hypothesis may have led to the misrepresentation of data (22). The documents from the vaccine court reveal this to be the verdict of authorities who are in a strong position to make such a judgment.

Dr Krigsman

‘After studying the extensive evidence in this case for many months, I am convinced that the reports and advice given to the Cedillos by Dr Krigsman and some other physicians, advising the Cedillos that there is a causal connection between Michelle’s MMR vaccination and her chronic conditions have been very wrong. Unfortunately, the Cedillos have been misled by physicians who are guilty, in my view, of gross medical misjudgment.’ (23)

Arthur Krigsman is a paediatric gastroenterologist, originally from New York, now working in collaboration with Dr Wakefield at his private clinic in Texas. In December 2003 he supported Dr Wakefield in the Channel 4 debate following the screening of Hear the Silence, a docudrama presenting Dr Wakefield as the heroic champion of families with autistic children and martyr to the medical establishment. He shared a platform with Dr Wakefield at a parents’ conference in Bournemouth in 2007.

Dr Krigsman appeared as both expert witness and as ‘treating physician’ to Michelle Cedillo and Colten Snyder. The special masters found that his credentials were ‘scant’ and noted that though he claimed to be ‘assistant clinical professor’ at New York University he had never taught there. His four publications were reduced on inquiry to one. It emerged that he left New York following disciplinary action at his former hospital and was fined $5,000 on arrival in Texas for misrepresenting his registration status.

The special masters were not impressed by Dr Krigsman’s performance as an expert witness. Hastings commented that in the Cedillo case he ‘did not find Dr Krigsman to be an expert upon whom I could reasonably rely for sound opinion and judgment’ (24).

It was in relation to his personal testimony as Michelle’s doctor that Hastings found Dr Krigsman to be most ‘unpersuasive’ and of ‘doubtful credibility’. He was shocked to discover that he had ‘presented an opinion concerning Michelle’s case either without examining Michelle’s medical records at all, or after badly misreading these records’ (25). He noted that Dr Krigsman had ‘diagnosed Michelle with “inflammatory bowel disease” in July of 2003, before he had even met and examined her’. Hastings further noted that ‘Dr Krigsman seems highly inclined to diagnose the presence of gastrointestinal inflammation on the basis of almost any chronic gastrointestinal symptoms’. He concluded that Dr Krigsman had advanced a ‘grossly mistaken understanding of Michelle’s gastrointestinal symptoms’ and that ‘a simple reading of Michelle’s medical records demonstrates that Dr Krigsman’s understanding was clearly wrong’ (26). Michelle endured five upper gastrointestinal endoscopies and three lower gastrointestinal endoscopies, none of which in the opinion of the respondent’s experts, revealed inflammatory bowel disease (27).

Dr Bradstreet

‘Dr Bradstreet’s opinions on causation informed his treatment of Colten, and for that reason, if for no other, they warrant consideration. It is clear that Colten’s condition materially improved between the time he began speech therapy in April 1999 and the time of the hearing. However, it is far from clear that Colten’s improvement was due to Dr Bradstreet’s treatment. It is even less clear that the treatments were designed to remove a dangerous virus from the body and the evidence that any of the treatments were capable of doing so is non-existent.’ (28)

Jeffrey Bradstreet also featured in the December 2003 Channel 4 debate, when he was variously presented as a paediatrician, a family practitioner and a professor of neuroscience. In fact, as the special masters established, he is not ‘board certified’ in any speciality and he withdrew his claim to a university appointment. He runs a private autism treatment clinic in Florida (to which Dr Wakefield was attached after his departure from the Royal Free), an evangelical Christian ministry and a commercial company supplying nutritional supplements. Vowell noted that two courts had rejected his claim to appear as an expert witness in vaccine-autism cases, because he lacked relevant expertise. Nevertheless, he was allowed to testify as an expert witness, particularly in relation to Colten Snyder whom he had been treating as a patient since 1999.

The account of Colten’s investigation and treatment by Dr Bradstreet reveals the close relationship between the promotion of the vaccine causation theory of autism and the provision of a range of alternative ‘biomedical’ treatments purporting to treat the conditions alleged to result from vaccine damage. In her discussion of conflicts of interest arising from Dr Bradstreet’s involvement in anti-vaccine litigation, Vowell also noted his ‘financial motivation’ for providing biomedical treatments (29). It emerged that Dr Bradstreet could ‘directly benefit from medical services paid for by the ministry [his non-profit evangelical foundation] for some of his 3,000 autism patients’. In addition, he directly sold to his patients the nutritional supplements he prescribed.

Dr Bradstreet’s treatment of Colten involved 160 office visits over an eight-year period, numerous laboratory tests (‘many of which were non-standard tests not approved by the FDA’), several lumbar punctures and both gastroscopy and colonoscopy. He proferred a range of diagnoses, including ‘autism, yeast overgrowth and a fungal infection’, autoimmune encephalopathy, post-vaccinial encephalopathy, allergic gastroenteritis, mercury toxicity and ‘disturbance of sulphur-bearing amino acid metabolism’ (30). Vowell observes that ‘three well-qualified experts [paediatric neurologist Max Wiznitzer, infectious diseases specialist Brian Ward and immunologist Burton Zweiman] examined Dr Bradstreet’s opinion on the nature of Colten’s illnesses, post-vaccination, and all disgreed with his autoimmune reaction/post-vaccine encephalopathy conclusion’ (31). They also dismissed the notion that he suffered from a ‘mercury efflux disorder’ or ‘autistic enterocolitis’ (32).

Dr Bradstreet treated Colten with dietary supplements, secretin, ‘numerous rounds’ of chelation therapy, immunoglobulin (in oral and injected forms), glutathione and prednisolone (a potent steroid), and he attributed improvements in his condition to these interventions. ‘In addition to challenging the scientific basis for, and reliability of, Dr Bradstreet’s opinions’, rival experts ‘pointed to inconsistencies in Dr Bradstreet’s reasons for therapies and Colten’s test results, the scientific evidence for the effectiveness of such therapies, and challenged his qualifications to offer opinions’ (33). They were ‘highly sceptical of Dr Bradstreet’s treatment rationale and its efficacy’. For example, Dr Wiznitzer, rather than attributing improvements to the effects of treatments, ‘noted that Colten’s developmental pattern was consistent with the natural history of autism, in that those with the disorder are worst at the second or beginning of the third year’ (34).

The truth is out

In his interview following the publication of the vaccine court judgments, Dr Wakefield appears in his Texas clinic, with a stethoscope prominently displayed on his desk. This is a familiar TV device to provide visual confirmation of the interviewee’s professional status, here used to confirm the image of Dr Wakefield as the caring, listening, doctor as he was portrayed in Hear the Silence (35). Yet in the case of Dr Wakefield, the stethoscope is curiously inappropriate. After training as a surgeon, he switched to research in (adult) gastroenterology and has never had clinical responsibility for any patients (the children in his Lancet series were under the clinical care of Drs Walker Smith and Simon Murch). He is not qualified as a physician or a paediatrician and is certainly not registered to use a stethoscope on patients, adults or children in the USA. While Dr Wakefield may believe that the stethoscope on his desk signifies his engagement in clinical practice, in fact it symbolises his duplicity.

Wakefield’s tragedy is that his incapacity to acknowledge scientific error has led to his professional disgrace. The tragedy for the parents who have followed his campaign is that they have been the last to discover the truth. At least now, thanks to the grand masters of the vaccine court and their excellent expert witnesses, the truth is out.

Dr Michael Fitzpatrick is author of the new book Defeating Autism: A Damaging Delusion, published by Routledge. (Buy this book from Amazon(UK) or Amazon(USA).)

(1) The judgments can be found here. For an earlier report on the Cedillo hearings, see The MMR-autism theory? There’s nothing in it, by Dr Michael Fitzpatrick, 4 July 2007

(2) Expert discusses court’s vaccine ruling, My Fox Houston, 13 February 2009

(3) See pp23-24 MMR and Autism: What Parents Need To Know, Michael Fitzpatrick, Routledge, 2004; and The vanishing victims

(4) The MMR scare: from foolishness to fraud?, by Dr Michael Fitzpatrick, 10 February 2009

(5) Vowell/Snyder, p209

(6) Vowell/Snyder, p 208

(7) Defeating Autism: A Damaging Delusion, Dr Michael Fitzpatrick, Routledge, 2009; Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure, Paul Offit, Columbia University Press, 2008

(8) Vowell/Snyder, p2

(9) Vowell/Snyder, p29

(10) Vowell/Snyder, p2

(11) Campbell-Smith/Hazlehurst, p19

(12) Vowell/Snyder, p19

(13) Hastings/Cedillo, p106

(14) Vowell/Snyder, p16

(15) see ‘Unorthodox biomedics’, Chapter 5 in Defeating Autism: A Damaging Delusion, Dr Michael Fitzpatrick, Routledge, 2009

(16) Vowell/Snyder, p208

(17) Vowell/Snyder, p168-9

(18) The MMR-autism theory? There’s nothing in it, by Dr Michael Fitzpatrick, 4 July 2007. See also RT-qPCR and molecular diagnostics: no evidence for measles virus in the GI tract of autistic children, Stephen A Bustin, European Pharmaceutical Review 2008; 1:11-17

(19) Vowell/Snyder, p182

(20) See Autistic enterocolitis: is it a histopathological entity?, MacDonald and Domizio, Histopathology, 50 (3), January, 2007

(21) Stop witch-hunting Wakefield, by Dr Michael Fitzpatrick, 19 June 2006

(22) The MMR scare: from foolishness to fraud?, by Dr Michael Fitzpatrick, 10 February 2009

(23) Hastings/Cedillo, p173

(24) Hastings/Cedillo, p145

(25) Hastings/Cedillo, p146

(26) Hastings/Cedillo, p149

(27) Hastings/Cedillo, p156

(28) Vowell/Snyder, p 275

(29) Vowell/Snyder, p 278

(30) Vowell/Snyder, p 232

(31) Vowell/Snyder, p 258

(32) Vowell/Snyder, p 263

(33) Vowell/Snyder, p 257

(34) Vowell/Snyder, p 256

(35) p158, MMR and Autism: What Parents Need To Know, Michael Fitzpatrick, Routledge, 2004

See also:

In your eye, Jenny McCarthy, Slate, 12 February 2009

Autism Treatment in the Evidence Gap, Neurodiversity weblog, 16 February 2009

First Three Autism Omnibus Test Cases Dismissed, Neurodiversity weblog, 12 February 2009

Omnibus: the decisions are decisive, LEFTBRAINRIGHTBRAIN, 13 February 2009

The Cedillo case and failed science?, Black Triangle