Is Autism a Disability or a Difference ? BY Judy Endow


“So many ideas in the larger autism community often become a debate. As an autistic this black-or-white, choose-your-side sort of thinking is very neurologically friendly to me. I like clear choices. But I also believe we are often unwittingly duped into believing we need to choose a side only because the idea is presented as a dichotomous choice.

“Is autism a disability or a difference?”is one of these questions posed as a dichotomous choice in the autism community. The way the question is posed gives the impression that there is one correct answer.

When Autism is a “Difference”

Many autistic adults would like if autism were recognized as a difference rather than a disability. Many in this group are the walking, talking autistics. We can go out in public by ourselves. Some of us are parents. We are your friends, neighbors and co-workers. We might seem to be a bit odd, but we can fit in enough to at least be allowed a place in the world at large.

Even so, being out and about in the community poses significant challenges. The sensory overload and neurological processing differences dictated by our brain along with ever present challenges with communication and conventional social understanding are such significant differences, even though we can accommodate for them, we are usually exhausted from doing so by the end of the day.

It seems to me that when we are able to be out and about in our communities unassisted by a hired person we are often expected to look and act like typical people regardless of the challenges imposed by the neurological difference of our autism. Because we appear to be like others, our difficulties and needs are thought to be our own personal problems. Even though we have an Autism Spectrum Disorder diagnosis that by definition means we have significant difficulties in many areas of life, others often look at us and ascribe negative intentionality and character flaws to us.

When Autism is a “Disability”

For some of us, the way our autism plays out in our body means we are faced with numerous obstacles to overcome every day of our lives. We may need communication devices, occupational therapy equipment and to employ personal care workers. For those of us whose autism presents challenges with these kinds of needs – we understand the disability aspect of our autism.

We often need a hired person to accompany us when we go out into the community or to support us so that we can communicate. In fact, we may require 24/7 support staff. And for some, our autism plays out in our body in such a way that people can see it as we approach! For us, people can see we need help. Rarely do others look at us and attribute our difficulties to laziness, lack of motivation, self-centeredness or any other negative character trait.

But because our autism is so visibly noticed along with the significant support we often need, people make other sorts of assumptions about us. Our needs are so obvious that people do not always consider that we also have strengths and abilities along with likes and dislikes. Often we are placed in menial jobs as adults (if we are even deemed capable of working) and our support staff is switched around as if people are interchangeable and relationships do not matter to us. We are not often seen as people who have preferences, desires, abilities, skills and talents as the time and energy of others are focused on the meeting deficits and needs imposed by our disability.

Negative Outcome of Choosing Disability OR Difference

As an autistic person when I am asked to choose one – either “disability” or “difference” – I feel like I am being asked, in essence, which part of me I would like to ignore. When I choose “disability” it means my talents, strengths, abilities and preferences are ignored. When I choose “difference” my very real difficulties and needs are not only ignored, but I am often blamed for what others consider my stubbornness in hanging on to negative “character flaws.”

Might We Incorporate Both Disability AND Difference?

What if we all chose both disability and difference? Would we then be totally ignored or totally supported? There it is again – another dichotomous choice posed as if it were a real choice!

In the meantime, please know when you ponder whether autism is a disability or difference this is a false choice sort of deal. It serves nobody well and has poor outcomes. And yet we somehow feel that we need to choose between disability or difference.

Why is that?”

Written by Judy Endow.

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Chalk Word Lines of Separation by Judy Endow


“Sneaky words, said with a smile,
While holding a piece of chalk,
To draw the dividing line,
Made by words,
Sounding alright on the surface,
But laden with,
Less Than
Not US
And sometimes Not Quite Human

We are the people you call

  • Special
  • Low Functioning
  • High Functioning

You say we are in need of a

  • Peer Buddy
  • Peer Pal
  • Good Friend from Mrs. Jones Program

We are the

  • Inclusion Student
  • The community service hours other kids need

We sit

  • At the Peer Buddies lunch table
  • The Special Ed table in the Inclusion Room
  • On the Special Ed bench waiting for our short bus

During the school day you will find us in the

  • Inclusion Room (when it is our turn because they can only take one of us at a time)
  • Cognitively Delayed Room
  • Behavior Room
  • Emotionally Disturbed Room
  • EBD Room (Emotionally Behaviorally Disturbed)
  • Special Ed Room
  • Special Needs Room

We are so doggone “special” that after school we attend

  • Special Olympics
  • Special Arts
  • Special Night at the YMCA
  • Special Needs Social Group

Where every participant is just as special
And those who are not special are our helpers

 When we grow up we live in

  • Special Housing
  • Some of us in Section 8 rentals
  • Some in group homes
  • Some in county care facilities
  • Some of us are so special that there isn’t even a special enough place for us so we stay living with our parents.
  • Some of us are not quite special enough to get on a housing list and yet cannot maintain on our own so we stay living with our parents.

As adults too many of us spend our days

  • In Special Programs (if our county has them)
  • At ARC (if our town has an ARC)
  • At Sheltered Workshops (if one is available)
  • In Supported Employment (if we qualify)
  • Looking for a job (on the days we are able to)
  • On the couch in our parent’s home (because other options are not available)

Because we are so deficient
In ever so many ways
Whenever we do something ordinary
like zip up our jacket, ride a horse, or answer Jeopardy questions you describe us as

  • Awesome
  • An Inspiration

I don’t understand this. If my friends and I are such awesome inspirations to the rest of you

  • Why is it that we are in two distinct groups – US and THEM?
  • Why is it that your group always holds the chalk?
  • Why do you keep using your chalk to draw lines that divide us?
  • Why do you want me on the other side of your line – away from you?
  • And why do you think this is good?”

By Judy Endow

This is just an abstract from her amazing poem, “Chalk word lines of separation”, I encourage you to read it in its entirety on her blog site at

Is the CDC guilty of a cover up? You decide.

Methodological Issues and Evidence of Malfeasance in Research Purporting to Show Thimerosal in Vaccines Is Safe
Brian Hooker,1 Janet Kern,2,3 David Geier,2 Boyd Haley,4 Lisa Sykes,5 Paul King,5 and Mark Geier2

1Simpson University, 2211 College View Drive, Redding, CA 96001, USA
2Institute of Chronic Illness, Inc., 14 Redgate Court, Silver Spring, MD 20905, USA
3University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75235, USA
4University of Kentucky, Lexington, KY 40506, USA
5CoMeD, Inc., Silver Spring, MD, USA

Received 15 February 2014; Accepted 12 May 2014; Published 4 June 2014

Academic Editor: Jyutika Mehta


“There are over 165 studies that have focused on Thimerosal, an organic-mercury (Hg) based compound, used as a preservative in many childhood vaccines, and found it to be harmful. Of these, 16 were conducted to specifically examine the effects of Thimerosal on human infants or children with reported outcomes of death; acrodynia; poisoning; allergic reaction; malformations; auto-immune reaction; Well’s syndrome; developmental delay; and neurodevelopmental disorders, including tics, speech delay, language delay, attention deficit disorder, and autism. In contrast, the United States Centers for Disease Control and Prevention states that Thimerosal is safe and there is “no relationship between [T]himerosal[-]containing vaccines and autism rates in children.” This is puzzling because, in a study conducted directly by CDC epidemiologists, a 7.6-fold increased risk of autism from exposure to Thimerosal during infancy was found. The CDC’s current stance that Thimerosal is safe and that there is no relationship between Thimerosal and autism is based on six specific published epidemiological studies coauthored and sponsored by the CDC. The purpose of this review is to examine these six publications and analyze possible reasons why their published outcomes are so different from the results of investigations by multiple independent research groups over the past 75+ years.
1. Introduction

Thimerosal is an organic-mercury (Hg) based compound, used as a preservative in many childhood vaccines, in the past and present. To date, there have been over 165 studies that focused on Thimerosal and found it to be harmful [1, 2]. (A comprehensive list of these studies is shown at Of these studies, 16 were conducted to specifically examine the effects of Thimerosal on human infants and/or children [3–18]. Within these studies, which focused on human infants and/or children, the reported outcomes following Thimerosal exposure were (1) death [3]; (2) acrodynia [4]; (3) poisoning [5]; (4) allergic reaction [6]; (5) malformations [7]; (6) autoimmune reaction [8]; (7) Well’s syndrome [9]; (8) developmental delay [10–13]; and (9) neurodevelopmental disorders, including tics, speech delay, language delay, attention deficit disorder, and autism [10, 11, 14–18].

However, the United States (US) Centers for Disease Control and Prevention (CDC) still insists that there is “no relationship between [T]himerosal[-]containing vaccines and autism rates in children” [19]. This is a puzzling conclusion because, in a study conducted directly by the CDC, epidemiologists assessed the risk for neurologic and renal impairment associated with past exposure to Thimerosal-containing vaccine (TCV) using automated data from the Vaccine Safety Datalink (VSD) and found a 7.6-fold increased risk of autism from exposure to Thimerosal during infancy [20]. The database for that study was “from four health maintenance organizations [HMOs] in Washington, Oregon, and California, containing immunization, medical visit, and demographic data on over 400,000 infants born between 1991 and 1997.” In that initial study, Verstraeten et al. [20] “categorized the cumulative ethyl-Hg exposure from [T]himerosal[-]containing vaccines after one month of life and assessed the subsequent risk of degenerative and developmental neurologic disorders and renal disorders before the age of six.” They “applied proportional hazard models adjusting for HMO, year of birth, and gender, and excluded premature babies.” The reported results showed that “the relative risk (RR) of developing a neurologic development disorder was 1.8 (95% confidence intervals [CI] 1.1–2.8) when comparing the highest exposure group at 1 month of age (cumulative dose > 25 μg) to the unexposed group.” Similarly, they “also found an elevated risk for the following disorders: autism (RR 7.6, 95% CI = 1.8–31.5), nonorganic sleep disorders (RR 5.0, 95% CI = 1.6–15.9), and speech disorders (RR 2.1, 95% CI = 1.1–4.0)” in the highest exposure group.

Considering the many peer-reviewed published research studies that have shown harm from Thimerosal, including studies in which Thimerosal exposure is associated with the subsequent diagnosis of neurodevelopmental disorders (16 studies) such as autism, and the just-described evidence from the CDCs own research, which found evidence of a relationship between the level of Thimerosal exposure and the risk of a subsequent autism diagnosis, how does the CDC conclude that there is no evidence of that relationship? The foundation for the CDC’s current stance apparently is based primarily on six specific published epidemiological studies that the CDC has completed, funded, and/or cosponsored, starting in the late 1990s. These studies include (1) the Madsen et al. [21] ecological study of autism incidence versus Thimerosal exposure in Denmark, (2) the Stehr-Green et al. [22] ecological study of autism incidence versus Thimerosal exposure in Denmark, Sweden, and California, (3) the Hviid et al. [23] study of autism incidence versus Thimerosal exposure in Denmark (also ecological), (4) the Andrews et al. [24] cohort study of autism incidence and Thimerosal exposure in the United Kingdom, (5) the published Verstraeten et al. [25] CDC cohort study of autism incidence and Thimerosal exposure in the United States, and (6) the more recent Price et al. [26] case-control study of autism incidence and Thimerosal exposure in the United States. Although the CDC cites several other publications to purport the safety of Thimerosal, only these six specifically consider its putative relationship to autism.

The purpose of this review is to examine these six publications [21–26] which were “overseen” by the CDC and which claim that prenatal and early childhood vaccine-derived Thimerosal exposures are not related to the risk of a subsequent diagnosis of autism or autism spectrum disorder (ASD). This review analyzes possible reasons why their published outcomes are so different from the results of investigations by multiple independent research groups over the past 75+ years. The review begins with an examination of the Madsen et al. [21] study.
2. The Madsen et al. 2003 Study

The CDC-sponsored Madsen et al. [21] study examined whether discontinuing the use of TCVs in Denmark led to a decrease in the incidence of autism. Data were obtained from the Danish Psychiatric Central Research Register, which contains all psychiatric admissions since 1971 and all outpatient contacts in psychiatric departments in Denmark since 1995. The study authors examined the data from 1971 to 2000 and reported that rate of autism increased with the removal of Thimerosal from vaccines (starting in 1992, the year that Thimerosal-containing early childhood vaccines were phased out).

Although there are several concerns about the methodology used, the most serious concern involves diagnosis. As described in the paper, estimates of total autism cases in Denmark were only based on diagnoses occurring during inpatient visits from 1971 to 1994 and then during both inpatient and outpatient visits from 1995 to the last year of the study in 2000. Thus, the inclusion criteria are greatly expanded two years after the phaseout of Thimerosal from infant vaccines in Denmark, creating an “artificial increase” in autism prevalence. The authors conceded that “the proportion of outpatient to inpatient activities was about 4 to 6 times as many outpatients as inpatients with variations across time and age bands.” However, in an earlier publication by Madsen et al. [27], the same authors had stated regarding this same data, “in our cohort, 93.1% of the children were treated only as outpatients…” Unlike the statement in the Madsen et al. [21] study, the 2002 paper indicates that the ratio between outpatients and inpatients in the 1971–2000 dataset was 13.5 : 1, which would account for an even greater increase in cases diagnosed starting in 1995 (i.e., after the probable completion of the phaseout of TCVs that started in 1992).

In addition, the authors stated that the Danish registry which was used to count cases did not include a large Copenhagen clinic before 1993. This clinic accounted for as many as 20% of the autism cases nationwide, which would again artificially inflate the autism incidence observed in Denmark after the phaseout of TCVs was initiated in 1992. The authors do not mention this change in inclusion criteria (i.e., the addition of a new clinic in the registry) neither do they attempt to adjust their analysis in accordance with the anomaly. It was revealed, instead, in a similar paper by Stehr-Green et al. [22] where the authors state regarding the Denmark registry of autistic patients, “Prior to 1992, the data in the national register did not include cases diagnosed in one large clinic in Copenhagen (which accounts for approximately 20% of cases occurring nationwide).”

Also, the diagnosis criteria for “autism” changed within the course of the study. From 1971 to 1993, the ICD-8 standards for diagnosis (psychosis protoinfantilis 299.00 or psychosis infantilis 299.01) were used to measure autism incidence. However, from 1994 to 2000, the ICD-10 standard (infantile autism, F84.1) was used. Although the authors did not address the impact of the change in diagnostic criteria, this could result in as much as a 25-fold increase in cases as the instantaneous change in autism prevalence in Denmark, due to this change, went from a low of 1.2/10,000 to a high of 30.8/10,000 [28].

Another disconcerting methodological issue was that the 2001 data, which showed a strong downward trend in autism rates in at least two of the three age groups (continuing from 1999 through 2001), was not included in the final publication. This was apparent because when the paper was initially submitted for publication, it included the 2001 data. After the paper was rejected for publication by the Journal of the American Medical Association (JAMA) and the Lancet, it was submitted to the journal Pediatrics again including the 2001 data. As stated by one of the peer-reviewers of the Pediatrics submission, “The drop of incidence shown for the most recent years is perhaps the most dramatic feature of the figure, and is seen in the oldest age group as well as the youngest. The authors do not discuss whether incomplete ascertainment in the youngest children or delay in recording of data in the most recent years might play a role in this decline, or the possibility that this decrease might have come about through elimination of [T]himerosal” (January 23, 2003, communication between Dr. Poul Thorsen, Aarhus University, and Dr. Coleen Boyle, CDC scientist). In response to this criticism, the authors removed the 2001 incidence numbers. The authors’ decision to withhold these data resembles scientific malfeasance, especially when coupled with the previously discussed problematic methods for counting autism cases. If the scientists believed that downward trend between 1999 and 2001 was caused by some phenomenon unrelated to the phaseout of the TCVs, these scientists should have included those data and then explained the trend within the discussion of the data.

If the 2001 data had been included in the final publication, the results would have been consistent with a more recent CDC study [29] where a decreasing trend of autism prevalence in Denmark after the removal of Thimerosal in 1992 was reported. Instead of large increases in autism prevalence after 1992, the recent Danish study revealed that the autism spectrum disorder prevalence in Denmark fell steadily from a high of 1.5% in 1994-95 (when children receiving Thimerosal-free formulations were too young to receive an autism diagnosis and, because of the known offset in diagnosis, most of those being diagnosed had been born 4 to 8 years earlier [from 1985 to 1990]) to a low of 1.0% in 2002–2004 (more than 10 years after the phasein of the use of Thimerosal-free vaccine formulations was started in 1992).
3. The Stehr-Green et al. 2003 Study

The CDC’s Stehr-Green et al. [22] study compared the prevalence/incidence of autism in California, Sweden, and Denmark with average exposures to TCVs. Graph-based ecologic analyses were used to examine population data from the state of California (national immunization coverage surveys and counts of children diagnosed with autism-like disorders seeking special education services in California); Sweden (national inpatient data on autism cases, national vaccination coverage levels, and information on use of all vaccines and vaccine-specific amounts of Thimerosal); and Denmark (national registry of inpatient/outpatient-diagnosed autism cases, national vaccination coverage levels, and information on use of all vaccines and vaccine-specific amounts of Thimerosal).

The study followed and appeared to be conducted in response to California study data [30], which was presented to the Institute of Medicine’s Immunization Safety Review Committee. The California data showed that increased uptake of Thimerosal-containing vaccines in California during the 1990s correlated with a corresponding increase in autism diagnoses. In the Stehr-Green et al. [22] study, the researchers stated that the reliability of the autism prevalence data, citing that the California data included autism spectrum disorder diagnoses such as pervasive development disorder (PDD), could account for the increase. However, in a published response to this paper, Blaxill and Stehr-Green [31] stated that the California prevalence rates were reported based solely on autism cases.

In the Stehr-Green paper, the Sweden autism prevalence data showed an increase in autism rates from 5- 6 cases per 100,000 in 1980–82 to a peak of 9.2 cases per 100,000 in 1993. In Sweden, TCVs were phased out starting in 1987. Denmark’s autism prevalence data was identical to that reported in the Madsen et al. [21] study critiqued previously. For Denmark, the authors reported an astounding 20-fold increase in autism prevalence between 1990 and 1999, despite the phaseout of TCVs that started in 1992.

In addition, the data from Sweden were based on inpatient (hospital) visits only. This limitation (counting a small fraction of the total number of cases) likely accounted for the erratic swings in the annual numbers of autism cases reported in that country. Also, the Thimerosal exposure level based on the Swedish vaccination schedule during this time period was much less (a nominal maximum of 75 μg of Hg by two years of age) than that possible in California (and the United States as a whole) where developing children nominally received up to 237.5 μg of Hg by 18 months of age through the standard immunization schedule. In conclusion, the Stehr-Green et al. study was problematic in its attempt to combine ecological data from three different countries that, relative to each other, demonstrated different vaccination policies and widely different Thimerosal exposure levels.
4. The Hviid et al. (2003) Study

The Hviid et al. [23] population-based cohort study, widely cited by the CDC, compared rates of autism prevalence among individuals who received Thimerosal-free vaccines to those receiving TCVs. The authors report that there was no evidence of increased autism prevalence with Thimerosal exposure.

The study authors stated that the mean age of autism diagnosis within their population was 4.7 years with a standard deviation of 1.7 years. However, cases and controls as young as 1 year of age were included within the analysis. Accordingly, controls that were less than the mean age of diagnosis minus two standard deviations (1.3 years) from that age had a 97.5% probability of actually being individuals who will later develop autism and are therefore possibly misclassified. Similarly, in this study, the mean age for an ASD diagnosis was 6.0 years with a standard deviation of 1.9 years. Thus, the study methodology is questionable because it appears to have underascertained the number of cases diagnosed with autism and ASD.

In addition, rather than counting persons within the cohort, the authors counted “person-years of follow up.” With this technique, each age group (one-year-olds, two-year-olds, etc.) was considered equally, despite the fact that younger age groups were much less likely to receive an autism diagnosis. This again contributed to the undercounting of the cases with a diagnosis of autism and ASD and biased the study towards the null hypothesis (that there is no statistically significant Thimerosal exposure effect on the outcomes observed).
5. The Andrews et al. (2004) Study

The Andrews et al. [24] study was a retrospective cohort study completed using records from a database in the United Kingdom, where autism prevalence rates were compared for children receiving Thimerosal-containing DTaP and DT vaccines. In the Andrews et al. [24] study, Cox’s proportional-hazards ratios were used to evaluate periods of followup in the cohort examined by the investigators using the records in the general practitioner research database (GPRD), a database that was known to have a significant level of errors. These investigators reported that increased organic-Hg exposure from TCVs was associated with a significantly reduced risk for diagnosed general developmental disorders and for unspecified developmental delay (although there was a significantly higher risk for diagnosed tics).

Considering that there are several studies conducted by independent investigators that have found that exposure to Thimerosal is a risk factor for neurodevelopmental delay and disorders [10, 11, 16], the reduced rate of neurodevelopmental delay and disorders with Thimerosal exposure found in the Andrews et al. [24] study suggests possible methodological issues.

This result may have occurred, in part, because other studies examined cohorts with significantly different childhood vaccine schedules and with different diagnostic criteria for outcomes. This difference may also exist because these other studies that found Thimerosal to be a risk factor for neurodevelopmental delay and disorders employed different epidemiological methods, especially with respect to the issue of follow-up period for individuals in the cohorts examined. The method used to measure follow-up period for individuals is a critical issue in all studies examining the relationship between exposures and the subsequent risk of a neurodevelopmental disorder diagnosis, especially in those instances where the postexposure periods for all of the participants in the study are essentially the same. This is because the risk of an individual being diagnosed with a neurodevelopmental disorder is not uniform throughout his/her lifetime. As observed in the present study, the initial mean age for any neurodevelopmental disorder diagnosis was 2.62 years old, and the standard deviation of mean age of the initial diagnosis of neurodevelopmental disorder was 1.58 years old. These findings are highly problematic because (1) any follow-up method that fails to consider the lag time between birth and age of initial neurodevelopmental disorder diagnosis will likely not be able to observe the true relationship between exposure and the subsequent risk of a neurodevelopmental disorder diagnosis and (2) statistically, the mean and standard deviation age of diagnosis as reported lead to the nonsensical result that a significant portion (2.5%) of the children in this study were diagosed with a neurodevelopmental disorder more than six months before they were born (i.e., the mean age minus two standard deviations, 2.62 − [2 × 1.58] = −0.54 years of age).

Another issue with this study is that the authors used a nontransparent, multivariate regression technique to analyze vaccine uptake and autism prevalence data. The study included one dependent variable (autism) and multiple independent variables, including two independent variables (Thimerosal exposure levels and year of birth) that were “correlated” with each other, since Thimerosal exposures increased with time. Thus, the researchers did not report a statistical analysis of the effect of Thimerosal exposure on autism incidence, despite the fact that the authors stated that no such effect was observed. Moreover, the methods used in this study can create a problem in regression known as “multicolinearity.” In this case, since the time variable and the vaccine exposure variable are correlated, they actually compete to explain the outcome effect. Inclusion of the time variable reduces the significance of the exposure variable. Yet, the authors did not explain why they included a time variable that competes with the exposure variable. Unfortunately, the authors of this study never released the raw data so that a valid single-variable analysis could be conducted to ascertain the probability of an association between Thimerosal exposure and the risk of autism.

It is also important to note that the UK Thimerosal exposure (a maximum of 75 μg of Hg by 4 months of age) was not comparable to that in the United States (a maximum of 75 μg of Hg by 2 months of age and 187.5 μg of Hg by 6 months of age). Thus, this study should not be extrapolated to the probability of an autism-Thimerosal association based on the US vaccination schedule.
6. The Verstraeten et al. (2003) Study

The CDC’s published Verstraeten et al. [25] study consists of a cohort analysis of a subset of records from the medical records databases for several of the HMOs whose records were maintained in a central data repository, the Vaccine Safety Datalink (VSD). This study was conducted in at least five separate phases. In the final phase (i.e., the results reported in the publication), the authors stated that there was no relationship between Thimerosal exposure in vaccines and autism incidence. However, no data are reported in the published study to support this conclusion.

Results from the first phase of the study released in an internal presentation abstract by Verstraeten et al. [20] (mentioned earlier) using records from four (4) HMOs showed that infants who were exposed to greater than 25 μg of Hg in vaccines and immunoglobulins at the age of one month were 7.6 times more likely to have an autism diagnosis than those not exposed to any vaccine-derived organic Hg. Within the same abstract, Verstraeten reports that the risk for any neurodevelopmental disorder was 1.8, the risk for speech disorder was 2.1, and the risk for nonorganic sleep disorder was 5.0. All relative risks were statistically significant.

In the second phase of the study, a different approach was taken: exposure was compared at 3 months of age, rather than one month. Results of this phase showed that children exposed to the maximum amount of organic Hg in infant vaccines (62.5 μg) were 2.48 times more likely to have autism diagnosis compared to those exposed to less than 37.5 μg of Hg in vaccines. These results were also statistically significant. No assessment against a “no exposure” control was apparently completed in this study phase.

In the third phase of the study, in which more data stratification methods and different inclusion/exclusion criteria were applied to the analysis, the relative risk of autism for children at three months of Thimerosal exposure dropped to 1.69. At this point, evidence in an email from Verstraeten, the lead investigator, written to a colleague outside of the CDC (obtained by the authors via the US Freedom of Information Act of 1950 as amended), suggests that Verstraeten could have been receiving pressure within the CDC to apply unsound statistical methods to deny a causal relationship between Thimerosal and autism. In this email, Verstraeten states (Figure 1), “I do not wish to be the advocate of the anti-vaccine lobby and sound like being convinced that thimerosal is or was harmful, but at least I feel we should use sound scientific argumentation and not let our standards be dictated by our desire to disprove an unpleasant theory.”
Figure 1: July 14, 2000, email from Verstraeten to Philippe Grandjean regarding the risk of harm due to Thimerosal (obtained by the authors via the US Freedom of Information Act of 1950 as amended).

The fourth and fifth phase of the study used records from only two of the original HMOs and incorporated a third HMO, Harvard Pilgrim, into the analysis. Some critics of the study questioned the use of Harvard Pilgrim, as this HMO appeared to be riddled with uncertain record keeping practices, and the state of Massachusetts had been forced to take it over after it declared bankruptcy. In addition, the HMO used different diagnostic codes than the other two HMOs used in phases 2 and 3. Other criticisms include that the study used younger children, from 0 to 3 years of age, even though the average age for an autism diagnosis at the time was 4.4 years. Since half of the children receiving an autism diagnosis would be over 4.4 years of age, far greater than the maximum age in the study at 3 years, this analysis excluded more than 50% of all autism cases from this HMO. Also, the cohort from this HMO contained 7 times fewer individuals than the main cohort from the previous study (i.e., HMO B), and there was no apparent attempt to assess the power of this HMO to show any statistically significant effect.

Also of note is the lack of variability within strata among the different HMOs in the Verstraeten et al. [25] study. By design, a cohort study seeking to assess the effect of some treatment on a subsequent outcome should be designed to maximize the range of the independent “treatment” variable (Thimerosal exposure in this instance) in order to determine if there is indeed an “effect” in the dependent postexposure outcome variable (neurological disorders in this study). However, the authors knowingly stratified the analysis based on the participants’ gender, year of birth, month of birth, and clinic most often visited. This effectively reduced the variability of Thimerosal exposure within the strata to the point that it reduced the capability of the final analysis to find any but the “strongest” Thimerosal exposure-related outcome effects. The problems with such “overmatching” practices have been discussed in detail in peer-reviewed scientific literature and will be treated in greater detail in the forthcoming review of the CDC’s Price et al. [26] paper.

Another methodological concern about the Verstraeten et al. [25] study is related to the issue of the minimum follow-up period required for individuals in the cohorts examined to ensure that all the cases in the cohort will have been identified with a high degree of certainty. This issue has been mentioned as a problem in the previous studies. As mentioned earlier, the method used to determine the minimum follow-up period for individuals is a critical issue in all studies examining the relationship between exposures and the subsequent risk of a neurodevelopmental disorder diagnosis, especially in those instances where the exposures to all participants in the study are the same or essentially the same. This is the case because the risk of an individual being diagnosed with a neurodevelopmental disorder is not uniform throughout his/her lifetime. Any follow-up method that fails to consider the lag time between birth and age of initial neurodevelopmental disorder diagnosis will likely not be able to observe the true relationship between exposure and the subsequent risk of a neurodevelopmental disorder diagnosis. Verstraeten et al. [25] included children in the control group who were too young (down to “0” years of age) to receive a neurodevelopmental disorder diagnosis.

Within this study, Verstraeten et al. [25] still found significantly increased risk ratios for tics and language delay. However, the authors stated that, because these results were not consistent between the HMOs tested, these significantly increased risk ratios could not be used to make a determination of the potential adverse consequences of organic-Hg exposure from TCVs.
7. The Price et al. 2010 Study

In 2010, the CDC published another epidemiology study on Thimerosal and autism [26]. This case-control study was conducted using the records from three managed care organizations (MCOs) consisting of 256 children with an ASD diagnosis and 752 controls that were matched by birth year, gender, and MCO to the children with an ASD diagnosis. Exposure to Thimerosal in vaccines and immunoglobulin preparations was determined from electronic immunization registries, medical charts, and parent interviews. Conditional logistic regression was used to assess associations between ASD, autistic disorder (AD), and ASD with regression and exposure to ethyl-Hg during prenatal, birth-to-1-month, birth-to-7-month, and birth-to-20-month periods. Their published finding was that prenatal and infant Thimerosal exposure from TCVs and Thimerosal-containing immunoglobulin posed no statistically significant risk of autism.

As mentioned earlier, in case-control studies, the main methodological concern is the phenomenon called “overmatching.” This concern for overmatching in the Price et al. [26] study was voiced previously by DeSoto and Hitlan [32]. In their comprehensive analysis of overmatching errors specific to the Price paper, DeSoto and Hitlan [32] stated that “Matching cannot—or should not—be done in a way that artificially increases the chance that within[-] strata exposure is the same; this happens when a matching variable is a significant predictor of exposure and is called overmatching.”

Cases were matched with controls of the same age and sex, within the same HMO and essentially the same vaccination schedule, using the same vaccine manufacturers. DeSoto and Hitlan then state further, regarding the lack of variability of Thimerosal exposure in the Price study, “Across the different years, the average cumulative exposure varies from 42.3 μg to 125.46 μg; while within the birth year stratas (sic), the mean exposures do not vary by more than 15 micrograms.” In other words, the maximum level of variation in Thimerosal exposure in the cases and controls being compared was 15 μg of Hg, as compared to the “83” μg of Hg range for the average cumulative exposures in the cohort studies. Moreover, this range is much less than the range of Thimerosal exposures that could have been used to determine risk including (a) 0 to 50 μg of Hg for one-month exposures, (b) 0 to 190 μg of Hg for seven-month exposures, and (c) 0 to 300 μg of Hg for 20-month exposures. Finally, regarding the Price study, DeSoto and Hitlan [32] concluded, “this paper is flawed. Unfortunately, there is not an analytic fix for overmatching: it is [a] design flaw.”

Prenatal Thimerosal exposure for the children within the study arose from the Thimerosal-preserved inactivated-influenza vaccine given during pregnancy and the Rho immunoglobulin administered to pregnant women to prevent Rh-factor incompatibility injury to the developing child. Unlike postnatal exposure from TCVs in the recommended childhood vaccination schedule, prenatal exposures would not be overmatched in a study design that stratified the participants based on their birth year or HMO. Evidence from the background CDC report regarding the Price study showed a significant risk of regressive autism due to prenatal Thimerosal exposure levels, at exposure levels as low as 16 μg of Hg [33]. However, the risk of regressive autism due to prenatal Thimerosal exposure reported in that paper was 1.86 and yielded a value of 0.072 which was deemed as insignificant based on the authors’ “cut-off” value of . However, values between 0.05 and 0.10 are “marginally significant” and should merit further study. In addition, upon further analysis, it was found that the 2009 background report [33] to the Price et al. [26] study showed that the prenatal Thimerosal exposure model was run in six different ways and that the most reliable methods (those that factored out the postnatal Thimerosal exposure effects) found highly statistically significant relative risks of up to 8.73 ( ) for regressive ASD due to prenatal Thimerosal exposures from Thimerosal-containing influenza vaccines and Rho immunoglobulin products relative to no such prenatal Thimerosal exposures. Curiously, these more compelling results were not reported in the paper. Withholding these data from the publication and, instead, reporting a significantly lower value could appear to constitute scientific malfeasance on the part of the authors of this study.
8. Conclusion

As seen in this review, the studies upon which the CDC relies and over which it exerted some level of control report that there is no increased risk of autism from exposure to organic Hg in vaccines, and some of these studies even reported that exposure to Thimerosal appeared to decrease the risk of autism. These six studies are in sharp contrast to research conducted by independent researchers over the past 75+ years that have consistently found Thimerosal to be harmful. As mentioned in the Introduction section, many studies conducted by independent investigators have found Thimerosal to be associated with neurodevelopmental disorders. Several studies, for example, including three of the six studies covered in this review, have found Thimerosal to be a risk factor for tics [10, 17, 24, 25, 34, 35]. In addition, Thimerosal has been found to be a risk factor in speech delay, language delay, attention deficit disorder, and autism [10, 11, 15–17, 24, 25, 34].

Considering that there are many studies conducted by independent researchers which show a relationship between Thimerosal and neurodevelopmental disorders, the results of the six studies examined in this review, particularly those showing the protective effects of Thimerosal, should bring into question the validity of the methodology used in the studies. A list of the most common methodological issues with these six studies is shown in Table 1. Importantly, other than the Hviid et al. [23] study, five of the publications examined in this review were directly commissioned by the CDC, raising the possible issue of conflict of interests or research bias, since vaccine promotion is a central mission of the CDC. Conceivably, if serious neurological disorders are found to be related to Thimerosal in vaccines, such findings could possibly be viewed as damaging to the vaccine program.”
Table 1: Methodological issues most common in each of the six reviewed studies.
Conflict of Interests

All of the investigators on the present study have been involved in vaccine/biologic litigation.

Funding was provided by the nonprofit Institute of Chronic Illnesses, Inc. and CoMeD, Inc.

Copyright © 2014 Brian Hooker et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Original source


Asperger Syndrome and the need for Social Justice – Could Autism be benefiting our society?


A feature of Asperger’s syndrome that can be advantageous to society is a concern with social justice and discrimination against minority groups.

This can sometimes be strikingly developed in Asperger’s cases, often because of their characteristic impatience with conventional hypocrisy and publicly accepted double standards (not to mention the fact that they sometimes feel the victims of discrimination themselves).

Modern societies have canonized such concerns in law and public attitudes, and a number of famous campaigners for equal rights and social justice have been posthumously proposed as Asperger’s cases.

Autistics tend to be loners, who are poor at participating in group activities of the kind that exploit social justice and anti-discrimination sentiment for self-serving political and social advantage.

Modern authorities on autism have described autistics as “truth-tellers” and, thanks to their bottom-up, devil-in-the-detail style of cognition, are often the first to see that the emperor has no clothes or that the great idol has feet of clay.

Furthermore, they are also likely to be the ones to blurt out the truth, and draw attention to the inconvenient fact, irrespective of what others may think.

I do believe that autistic antagonism to lies and deception of all kinds is not only the most redeeming feature of the so-called disorder, but one which autism shares increasingly with modern societies—and very much to their benefit.” Original Article by Christopher Badcock

I have often wondered whether or not the world would be a much better, fairer place, if it were being run by people who felt a burning need for social justice… aka…Aspies.

The above abstract is from a much larger article by Christopher Badcock which makes some strikingly good points regarding the ways in which the strengths of those with Asperger’s could be put to good use within our societies.

So what do you think?

Have your say on whether or not you think the world be a better, fairer place if it were being run by Aspies in the comment section below.

Different on the Inside by Susan Golubock part 2

Artwork by Loui Jover

Artwork by Loui Jover

Remember those awkward,

Social moments,

As an adolescent,

Or pre-adolescent,

When you were trying,

To fit in,

But didn’t really know,

What was in?

Or what was expected?

So you stood there,

In conspicuous silence,

Rehearsing everything ,

You wanted to say,

Waiting for the chance,

To speak,

Then blurted out,

Some untimely statement.

Or more,

Than you really intended,

To say?

Not knowing when,

Or how to stop?

Imagine having those moments,



With family,


And strangers alike.

Your best defense,

Is to memorize small talk,

Or keep your mouth shut,

And let others talk,

About themselves.

Meanwhile you struggle,

To filter out,

The background noise,

They so easily,

Seem to ignore,

Processing about 50%,

Of what they say.

Then there’s the feeling of panic,

When the dreaded question appears,

Requiring you to suddenly shift,

From processing to productive,

Without the time you need,

To do it.

It makes you wonder,

When it’s so difficult,


So many people,

Consider socializing,

To be,

So much,


Different on the Inside by Susan Golubock

Different on the Inside. By Susan Golubock

Artwork by Tran Nguyen

Artwork by Tran Nguyen

“To look at us,

You and I appear very much the same.

Yet I have learned that we experience life,

And therefore view our experiences,

Very differently.

I have learned that I just don’t think like you,

No matter how hard I try,

And believe me I have.

My nervous system seems to be,

Configured differently.

I’ve learned to do,

What you do,

At least the mechanics of it,

But I don’t understand,

Why you do it.

I’ve memorized the words you use,

And can repeat them fluently.

Figuring out what you mean,

And why you say them,

Is the hard part.

I process words literally,


And naively,

Which often leaves me baffled,

And confused.

I thought that by pretending,

To BE you,

I would someday,

Understand you.

But I don’t.

Any more than you understand me.

There are times when I join in,

With you,

And truly enjoy,

Interacting with you,

But I rarely feel that I belong.

I can focus on you,

Or I can focus on me,

But understanding the complexity,

Of relationships,

Is very much beyond me.

There are times when I can connect,

With my feelings or yours,

But never both,

At the same time.

And some emotions not at all.

There are times when,

I really think,

I understand you,

Then you change,

And I don’t.

And even though,

I have stopped,


To BE like you,

I haven’t stopped,


To understand you.

It would mean a lot to me,

If you would try,

Just for a little while,

To understand,

What it must be like,

To be ME.”

This is an abstract from the poem “Different on the Inside” by Susan Golubock.

Stop Expecting Me To Apologize For Being Who I Am

Artwork by Jasmin Junger

Artwork by Jasmin Junger

“I am not “lazy” because I can’t function emotionally or mentally in the general work force.

I am not “weak” because I have a hard time processing emotions and am easily overwhelmed by the emotions of others.

“I am not a “recluse” because I prefer to stay at home where I feel most in control and safe.

I am not “anti-social” because I cannot handle large public gatherings and can only handle one or two friends at a time.”

I am not “stupid” because I cannot understand some math concepts and have a hard time with my handwriting and communicating verbally at times.

I am not what you want or need me to be

I am Autistic and I don’t have to apologize for that to anyone.”

These powerful words  by represent  the way many with Autism feel about the overwhelming expectations placed on them by a society that refuses to accept them for who they are and instead replaces understanding with often cruel and ignorant  judgements.

lennemi’s words have been reproduced on this blog with the full permission of the author.

They are part of a brilliant post which I urge you to find here 

I will be your compass


I look at you today,

And I know that although,

You’ve grown larger,

Your world has grown smaller,

Instead of expanding,

Yourself outwards,

You’re now shrinking,

Hunkering down,

Beneath your own skin,

So wary,

Of being bitten and torn,

By the words of others,

Hiding your scars,

As you return home to me daily,

Endlessly dazed and confused,

By the actions committed,

Against you,

The ones that make you feel stupid,

Lonely and small,

You are none of those things,


Not at all.

You are lovely,


And brave enough,

To go out into a world,

Every day,

In which you hold,

No internal compass,

No way to navigate,

The sea of another’s intent.

But I am here for you,

My darling girl,

And I will be your compass,

If you’ll let me.