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Strategic Plan Question 3: What Caused This To Happen and Can This Be Prevented?

Respondent 1

Matthew J. Carey

b. What are the remaining gaps in the subject area covered by this chapter?
The IACC should weigh heavily the harm done to the autism community by the vaccine causation debate. It is very clear that vaccines are not a primary cause of autism and that they are not responsible for the large increase in autism prevalence in the last 20 years. Two recent studies (one by the Hertz-Picciotto group and one by the Bearman group) show that there are isolated pockets of high prevalence in California. Obviously these point to some other cause than a universal environmental exposure like vaccines.

Respondent 2

K. MacDonald

a. What has been learned about the issues covered in this chapter in the past year?
What has been learned is that this committee seems intent on doing everything possible to avoid studying the most obvious possible environmental triggers: our children's aggressive childhood vaccine schedule and drugs used during delivery.

b. What are the remaining gaps in the subject area covered by this chapter?
A study of fully vaccinated children vs. never vaccinated children should be done to compare health outcomes. I feel this is especially important, given the recent primate research that indicates a problem with the vaccine schedule. By removing the vaccine research that had been previously voted for and approved, the IACC committee shattered the thin thread of remaining trust that the public had left that this committee might actually be interested in helping our children. The majority of evidence appears to favor a possible genetic predisposition with an environmental trigger. It would be nice if research dollars went to answering the important safety questions surrounding our vaccine program that should have been addressed several decades ago. If this research is left out of the final proposal, nothing else you do will matter. It will be obvious to parents that you don't have the guts to ask the tough questions, so you will never come up with meaningful answers. Confidence in our vaccine program will be destroyed.

Respondent 3

b. What are the remaining gaps in the subject area covered by this chapter?
As much research as possible should be conducted on the environmental factors that are contributing to this epidemic. We know there is a genetic link. What we do not know enough about is what environmental triggers are causing the unprecedented increase in the number of people being diagnosed with ASD.

Respondent 4

John Best

a. What has been learned about the issues covered in this chapter in the past year?
The apolopoprotein E (ApoE4) gene is passed from parents to children. That's the only genetics you need to be aware of. Of course, you are too dishonest to share this information with the public. You can't fool all of us by making up [profane language redacted] theories about genetic factors because some of us know the truth so the best thing for you to do would be to stop making up inane studies that we see right through which make you look ridiculous.

Respondent 5

Gail Elbek
Child Health Advocates

a. What has been learned about the issues covered in this chapter in the past year?
"Deletions and duplications of genetic material not found in parents, chromosomal changes, rare mutations in genes...could be due to environmental exposures...." Environmental exposure = endocrine disruptor exposure. Endocrine disruptor exposure = Soy.

b. What are the remaining gaps in the subject area covered by this chapter?
Remaining IACC gaps: Soy phytoestrogens are National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), National Toxicology Program (NTP), and National Institute of Mental Health (NIMH) confirmed endocrine disruptors (ED) thus soy consumption is a risk factor for development of ASD and multiple brain and body illnesses again not addressed in this ASD chapter. "...it is also important to design studies that assess environmental exposure during most relevant exposure windows: pregnancy and early development." Environmental exposure = ED exposure. Soy is an ED increasingly consumed during pregnancy and early development (without U.S. Food and Drug Administration (FDA) WARNING labels that urgently deserves the IACC's immediate attention. Soy ED are repeatedly published study proven to cause rare genetic mutations, chromosomal abnormalities and sub-microscopic deletions, gene duplications, due to interactions between genes and ED toxicity. ED such as soy, consumed even in minimal levels are known to especially cause fetal, infant and child abnormal hormonal silencing or activation stated to cause adverse developmental biological and behavioral effects. ED abnormally influence the entire hormonal system, influencing gene expression as especially vulnerable during developmental exposure. ED are known to be transgenerational or pass to the next generation even without soy ED exposure. It is urgently necessary that the IACC investigate soy ED causation of irreversible adverse neurological effects as repeatedly scientifically established and demand mandatory WARNING labels on soy ED products during developmental exposure. Soy is found in a few vaccines...injected ED, another remaining IACC gap.

Respondent 6

Eileen Nicole Simon
conradsimon.org This link exits the Interagency Autism Coordinating Committee Web site

a. What has been learned about the issues covered in this chapter in the past year?
1.) Trying to associate genetic deletions and duplications with synaptic connectivity has not been productive. Effects on brain-systems development (especially auditory to temporal- and frontal-lobe language areas) would be a simpler starting point. 2.) The brain is not discussed in epidemiological investigations, despite decades of relevant evidence of the auditory system being especially susceptible to damage from many causes. 3.) More animal studies should be designed to determine how two or more factors can in combination compromise vulnerable brain systems.

b. What are the remaining gaps in the subject area covered by this chapter?
The effects on the brain of trauma and asphyxia at birth must be considered as causes of autism. Experiments with monkeys done more than 50 years ago demonstrated that clamping the umbilical cord and preventing the first breath caused ischemic damage within the brain stem, which was most severe in the midbrain auditory nuclei (the inferior colliculi) (Windle, 1969). Children learn to speak through hearing. On my website I have cited 12 cases in which the ability to comprehend speech was lost following injury of the inferior colliculi. See references 72-83 at http://conradsimon.org/SpeechComprehensionLoss.html This link exits the Interagency Autism Coordinating Committee Web site. Reference Windle, W.F. (1969). Brain damage by asphyxia at birth. Scientific American, 221(4) 76-84.

Respondent 7

a. What has been learned about the issues covered in this chapter in the past year?
Concerning risk factors for autism, a very important Danish study was published this spring (Atladóttir, et al., 2010). This involved more than 10,000 ASD cases and concluded that maternal viral infection during the first trimester significantly increased the risk for ASD in the offspring. This is the largest epidemiological study of its kind, and reinforces prior work indicating the risk for maternal infection during early pregnancy. Fortunately, a mouse model of this risk factor already exists. The offspring of pregnant mice given a viral respiratory infection, or given a molecule to activate the maternal immune system, display behavioral abnormalities consistent with those seen in autism (enhanced anxiety and neophobia, and deficits in social interaction, prepulse inhibition, and vocalizations) as well as a neuropathology characteristic of autism (deficit in Purkinje's cells). As this maternal-infection risk factor is also shared with schizophrenia, it is not surprising that this mouse model also displays some features of schizophrenia, such as enlarged ventricles. Given that this model displays face and construct validity, funds should be provided to test potential treatments and to explore the underlying molecular mechanisms by which maternal immune activation alters fetal brain development. The interaction of this environmental risk factor with genetic susceptibility factors should also be examined. Reference Atladottir, H.O., Thorsen, P., Ostergaard, L., Schendel, D.E., Lemcke, S., Abdallah, M., & Parner, E.T. (2010). Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders. Journal of Autism and Developmental Disorders, doi: 10.1007/s10803-010-1006-y.

Respondent 8

a. What has been learned about the issues covered in this chapter in the past year?
I don't know if this needs to be added but I was thinking about the opportunity to use stem-cell research to greater understand autism. On March 9, 2009, President Obama issued Executive Order 13505, entitled "Removing Barriers to Responsible Research Involving Human Stem Cells."

Respondent 10

Andrea Payne

b. What are the remaining gaps in the subject area covered by this chapter?
Parents need to be encouraged to stand on purpose, not principal. While the causes are definitely important, and if prevention is possible then it is also imperative - parents need to focus on learning and meeting their child's needs not latching on to a platform or a suspected link. Regardless of WHY this happened, it DID. WHAT MATTERS is what you do with it.

Respondent 11

G. A. Elbek

b. What are the remaining gaps in the subject area covered by this chapter?
The U.S. Food and Drug Administration (FDA) confirms that soy products are chemically 1.) estrogenic endocrine disruptors, 2.) poisonous plant, and 3.) contains: toxic phytic acid, essential enzyme inhibitors, and multiple heavy metals. Each and all of these are repeatedly pathologically PROVEN as neurotoxic with greatest risk of the occurrence of brain and body toxicity during fetal, infant and child developmental soy poisonous chemical exposure. Several hundred scientific studies repeatedly confirm that these exact adverse soy phytotoxic effects are proven to damage multiple developmental brain cell systems known to cause: autism, mental retardation, cerebral palsy, seizures, attention deficit hyperactivity disorder (ADHD) and more.

Respondent 12

b. What are the remaining gaps in the subject area covered by this chapter?
The question of whether acetaminophen is what is triggering autism and not the vaccines themselves still needs to be answered. Acetaminophen is often used to relieve symptoms of fever and pain in the perivaccination period. Recent studies have shown that acetaminophen use during vaccination blunts the immune response from the vaccine. In addition, several years worth of data point to an association between allergic disorders and acetaminophen. Since acetaminophen use has increased substantially amongst pregnant women and very young children since the 1980's when aspirin was found to be linked to Reye's syndrome, this is a question that is deserving of an answer.

Respondent 14

Kim

a. What has been learned about the issues covered in this chapter in the past year?
Many parents of autistic children hide their autistic features and may have been misdiagnosed as having borderline or other types of disorders, when really they are suffering from not being able to fit in...they are sort of between Asperger's and autism caught in limbo and not very well understood, but these types of parents if you look closely, often have autistic children.

Respondent 16

Family Voices-NJ

a. What has been learned about the issues covered in this chapter in the past year?
We agree with research into genetic/epigenetic variations, environmental influences, family studies, and monitoring scientific literature on vaccines and other environmental factors (ultrasound, toxins, and pesticides as presented at the IACC).

b. What are the remaining gaps in the subject area covered by this chapter?
We agree with continued coordination with the National Vaccine Advisory Committee. At the IACC, it was mentioned that although mercury distribution is the same in children with and without autism, children with autism have genes with a heightened response to mercury. Until this controversy is resolved, fear will cause "herd immunity" to decrease which is a public health risk.

Respondent 18

Holly Masclans

a. What has been learned about the issues covered in this chapter in the past year?
Where is the vaccinated vs. never-vaccinated study???????????? I already know kids with autism have problems with eye contact and families are under stress. Everyone knows about behavioral therapy. What has been learned this year, IMO (in my opinion), nothing on your end.

b. What are the remaining gaps in the subject area covered by this chapter?
Primate studies out of the University of Pittsburgh show that after the Hepatitis B shot is given in the hospital, the monkeys lose a number of their neural reflexes including sucking. My son breastfed well until his Hepatitis B vaccine given in the hospital. He was then failure to thrive. At 3 years old he was diagnosed with autism. This can be verified in humans by simply looking at early well baby visit data. Also at the the University of Pittsburgh primates showed disruption in the amygdala after Haemophilus influenzae type b (Hib), diphtheria, pertussis, and tetanus (DPT), and measles, mumps, and rubella (MMR) vaccination. Akin to dimming of the lights in Alzheimer's patients, this is what happened to my son. He just faded away. In addition my daughter who has Asperger's after she had eight seizures after her 4-month-old shots has no fight just flight response to stress. This is controlled by the amygdala. Duplicate these studies. Are these children having microvascular strokes after vaccination? Why does the eye turn in or out, the cheek droop and the mouth turn down? Have you viewed Andrew Moulden's photographs? If not you should.

Respondent 19

a. What has been learned about the issues covered in this chapter in the past year?
We have learned that early vaccination has been shown by studies to induce specific food allergies and asthma in children (Canadian study) and that delaying vaccination by a few months was correlated to a reduced incidence of allergies and asthma. Also, there has been some research that indicates Lyme disease, certain retroviruses (xenotropic murine leukemia virus-related virus (XMRV)) and vaccine adjuvants (aluminum, mercury from thimerosal) create biological mechanisms for the regressive autism we commonly see today.

b. What are the remaining gaps in the subject area covered by this chapter?
We need to complete a vaccinated vs. non-vaccinated study of children in the United States and compare outcomes of allergies, immune system dysfunction, and neurological (including autism, speech disorder, seizures, and tics) function between the two groups. Also, a study of delaying vaccines and the incidence of allergies, asthma to replicate the findings of the Canadian study.

Respondent 20

a. What has been learned about the issues covered in this chapter in the past year?
Environmental Factors posing a risk factor for Autism include anything that would lower glutathione levels or prevent the synthesis of glutathione. This could include vitamin deficiencies, the inability to mobilize the precursors of glutathione such as cysteine and methionine, and the enzyme systems involved in this synthesis. The B vitamins may be important here as they are involved in energy metabolism. Additionally, the introduction of yeast species into the gastrointestinal (GI) tract which produce gliotoxin would tend to create a situation of lowered glutathione levels. Species known to produce gliotoxin include Candida and Aspergillus. Of 80 Candida species studied, about 50 percent were shown to produce gliotoxin. Over 90 percent of Aspergillus fumigatus have been shown to produce gliotoxin. It is likely changes in GI flora occur when an infant is given oral antibiotics whereby a gliotoxin producing yeast overcolonizes the GI tract. It is conceivable that mother-to-infant transmission of gliotoxin producing yeast occurs in utero or during childbirth. Gliotoxin may be involved in the syndrome known as pregnancy induced hypertension (PIH) as glutathione has been shown to be reduced in parturients with PIH and glutathione appears to be involved in the nitric oxide regulation of blood pressure. Hence, mothers with PIH are possibly infecting their offspring with a yeast capable of producing gliotoxin, resulting, under certain conditions as previously described in autism. The further reduction of glutathione by acetaminophen is likely the triggering factor in autism.

Respondent 21

a. What has been learned about the issues covered in this chapter in the past year?
Quit saying vaccines don't cause autism! You are misleading parents and just causing more children to be injured. Those so-called "studies" were manipulated to be in the drug companies' favor!

Respondent 22

Aimee Doyle

a. What has been learned about the issues covered in this chapter in the past year?
I know that there is increasing interest in the role of environmental factors in autism, and I think this is a good thing. It seems very clear that even though there is a genetic predisposition (not that we've been successful in identifying those genes). Of the two, environmental exposure seems an easier thing to identify and treat, so I don't understand why more research isn't focused on this.

b. What are the remaining gaps in the subject area covered by this chapter?
I want to see research on vaccines and autism. My son developed seizures almost immediately after his first DPT (diptheria, pertussis, tetanus) vaccine; he lost language and skills and eye contact and sociability with his first MMR (measles, mumps, rubella) vaccine; he developed repetitive behaviors and vocal tics with his second MMR vaccine. That was when his diagnosis of "speech delay" became a diagnosis of "autism." Why is it so difficult to believe that some children might be especially susceptible to the viruses, toxins, and adjuvants in vaccines? After all, children can be sensitive to particular drugs. I would also like to see some safety studies on multiple vaccines given at the same time. Multiple drugs can interact in negative ways; why is it so difficult to believe that multiple vaccines could do damage in concert? As far as I know, even though vaccines may be tested for safety individually, they are never tested for safety in the context where a number are given at once.

Respondent 23

Age of Autism

b. What are the remaining gaps in the subject area covered by this chapter?
Very little in what the IACC says offers any explanation of what things in the environment may be contributing to the epidemic of autism now plaguing our children. As far as I can see, the IACC has found out little in the last four years to advance our knowledge of autism. Limited genetic studies costing millions of dollars mean nothing to parents struggling with a disabled child. Vague references to "toxicants" and "environmental factors" tell us nothing. There isn't one thing the IACC can tell a mother about to give birth to a son how she can prevent her baby from becoming the 1 in 70 boys with autism. I watched Thomas Insel testifying before Senator Harkin's committee last August. http://www.ageofautism.com/2009/08/the-really-big-lie-about-autism-thomas-insel-testifies.html This link exits the Interagency Autism Coordinating Committee Web site. Nothing was said about prevention. The cause was still unknown. Nothing was said about recovering children. Insel didn't refer to autism as "a national health emergency" or even as "a crisis." The IACC seems to have little concern about the reports of countless thousands of parents that their children were normally progressing until they received certain vaccines. It also seems that the IACC is unmotivated when it comes to further vaccine research. This past spring Insel gave a talk on autism at National Institutes of Health (NIH) where he said "We...also need to be thinking about how we prepare the nation for a million people who may need significant amounts of services as they are no longer cared for by their parents or as their parents are no longer around." It is my fear that no one will do anything to address autism as a health care emergency until the the sheer numbers of young autistic adults in need of services simply bankrupt social services. Maybe then people will focus on finding the cause and stop the waste.

Respondent 24

Ray Gallup

b. What are the remaining gaps in the subject area covered by this chapter?
The autoimmune/gastro link and vaccine link to the ASD epidemic.

Respondent 25

Maria Durci

a. What has been learned about the issues covered in this chapter in the past year?
HIB vaccine primate study that showed poor latch-on reflex following vaccination. High levels of testosterone in children with ASD.

b. What are the remaining gaps in the subject area covered by this chapter?
I am glad to see the plans for research into vaccines and autism. Where is the study of prevalence of autism in vaccinated vs. non-vaccinated populations? Additionally, further explore the neurological impact of early vaccination on infants to expand the primate studies that showed poor latch-on reflex in monkeys following the HIB vaccine. This reported impact was remarkably familiar to me as a parent. Replication of vaccine studies already completed. Review effects of prophylactic and long-term or multiple exposures to antibiotics on infants and young children. Do these exposures through our food sources, medical use and other environmental exposures cause some of the bowel disease and dysfunction we see in children with ASD. Review impact on growth and development of children from hormones in the food and water supply. Thorough examination of a large population with and without ASD to provide comparative data on bowel health (gut flora, bowel biopsy, evidence of viruses, parasites and bacteria), blood levels (toxins, metals, nutrients, hormones) and urinalysis for (metals, bacteria, yeast and fungus, toxins).

Respondent 27

a. What has been learned about the issues covered in this chapter in the past year?
not so much

b. What are the remaining gaps in the subject area covered by this chapter?
too much emphasis to genetics

Respondent 28

J. Fenech

a. What has been learned about the issues covered in this chapter in the past year?
The environment includes immunizations. I want the monkey study replicated. And you should too.

Respondent 30

Lisa H. Randall
Immunization Action Coalition

a. What has been learned about the issues covered in this chapter in the past year?
Since the last revision of the Strategic Plan, scientists have made great strides in recognizing the complexity and breadth of genetic variation that underpins the development of autistic features, and much data has been amassed on the potential contribution of environmental exposures. We applaud the advances that have been made on both fronts and emphasize that the IACC's decision to prioritize scientifically promising lines of etiological research, rather than the biologically implausible idea of a connection between autism and vaccines, has maximized the progress achieved during this period. We encourage the IACC to continue to follow where the science leads, particularly with regard to new Objective E, which, without careful oversight, may encourage the mining of data for subgroup correlations that could prove artifactual. Clarifying the causes of autism will not only benefit affected individuals and families but also reduce the public's lingering fears about life-saving vaccines.

Respondent 33

a. What has been learned about the issues covered in this chapter in the past year?
I don't know much about the advances in genetics, but I can weigh-in about now-debunked environmental factors. Obviously you know about this but I'm referring to the "research" by Andrew Wakefield and how his pseudo-logical claims have been thoroughly debunked. Three cheers for those who believe in real science! Like your organization, Autism Science Foundation, and others.

b. What are the remaining gaps in the subject area covered by this chapter?
I had never heard about twin studies strongly suggesting a genetic cause of autism and would want to know more about that in the future. Anti-vaccinators may try to twist your findings to say that yes, there are some kids who shouldn't get vaccines because for their small group, vaccines present an environmental trigger. Therefore, they say, vaccines should be avoided or delayed, and this puts their children, and others, at risk. So I think there should be a firm statement that while vaccines challenge the immune system, this does not cause autism. The risk to children from the diseases is great.

Respondent 35

Marc Rosen

b. What are the remaining gaps in the subject area covered by this chapter?
"Prevention" is a concept that is considered offensive to the autistic community, and originates from eugenics. Furthermore, inappropriate references to a linear concept of the autism spectrum need to be removed from the report. Autism is not a line.

Respondent 37

Caroline Rodgers

a. What has been learned about the issues covered in this chapter in the past year?
THIS JUST IN: Data from key government reports and peer-reviewed studies indicate that mothers who receive first trimester prenatal care and/or prenatal ultrasound are at increased risk of bearing autistic children. Here is a list of relevant reports and studies that were published toward the end of 2009, after most Strategic Plan revisions had been made, or in early 2010, after changes were finalized. SEPT 2009: Grether JK, et al. Antenatal Ultrasound and Risk of Autism Spectrum Disorders. J Autism Dev Disor. This is the first retrospective study to investigate a link between prenatal ultrasound and autism. It was hampered by missing data and questions regarding the metrics. Although the study did not report a link between ultrasound and autism, among the findings that should be followed up are why mothers of autistic children had more education than controls and why girls exposed to multiple ultrasound scans in the second trimester were at a higher risk of autism. NOV 2009: Siddique J, et al. Trends in Prenatal Ultrasound Use in the United States. Medical Care. This report, which studied ultrasound trends for the 10 years ending in 2006, found that the chances of a woman having an ultrasound during a prenatal visit nearly doubled. Groups of women who have been independently identified as being at higher risk of having autistic children, such as White women and women over the age of 35, also averaged three or more ultrasounds than other women. The same study found Hispanic women's odds of receiving an ultrasound were 20% lower than White women's, which becomes more interesting when – a month after this study was published – the CDC revealed that in both 2002 and 2006, Hispanics had the lowest autism rate. A study that was in the IACC's Summary of Advances that found that for every 10-year increase in a mother's age, her risk of having an autistic child increased 38% (Grether JK, et al. 2009 Am J Epidemiol), takes on even more importance when it is combined with data from this trends study, given the increased ultrasound exposure documented for women over age 35. DEC 2009: CDC 2006 autism prevalence report. This was published too late for the results to spur changes in the 2010 Strategic Plan. However, it revealed valuable information that could lead to understanding what is causing autism, such as: The 57% increase in autism between 2002 and 2006 indicates that whatever is causing autism increased sharply during a four-year period. Previous research on brain anomalies indicates that autism begins in the womb, which would mean that what changed between the gestational periods of 1993 to 1994 and 1997 to 1998 would be of greatest interest in isolating factors that contribute toward autism. Lower autism rates among Hispanics and Blacks than non-Hispanic Whites in both 2002 and 2006, combined with a CDC report, "Entry into Prenatal Care -- United States, 1989-1997," reveals that groups that received the highest percentage of first trimester prenatal care also had the highest rate of autistic children. In Florida, where the monitored population lived in Dade County, the ethnic group with the highest autism rate was Hispanic, which is different from the overall Hispanic rate, which was the lowest among the three top ethnic groups. Since we know that Hispanics in general are less likely to receive prenatal ultrasound scans, it would be worth comparing Dade County's Hispanic prenatal ultrasound exposure to that of Hispanics residing elsewhere. FEB 2010 Van Meter KC, et al. Geographic Distribution of Autism in California: A Retrospective Birth Cohort Analysis. Autism Res. This study identified 10 autism clusters in which highly educated women were more likely to have children diagnosed with autism than less educated women in the same areas. In six of the clusters, the ratio was as high as 4 to 1. The previously mentioned CDC "Entry into Prenatal Care" report found that high school graduates with some college were more likely to receive first trimester prenatal care than women without high school degrees – supporting the idea that some first trimester prenatal care increases the risk of having an autistic child. Since women with the most prenatal care had the most autistic children, it would be worth going back into those clusters to get detailed information regarding prenatal ultrasound exposure. MARCH 2010 McDonald ME and Paul JF. Timing of Increased Autistic Disorder Cumulative Incidence. Environ Sci & Technol. This EPA study found that the autism boom began with children born after 1987 in California, Denmark, Japan and other industrialized nations. According to the CDC's National Vital Statistics Reports, Volume 47, Number 27, Trends in the Attendant, Place and Timing of Births, and in the Use of Obstetric Interventions: United States, 1989-97, 48% of mothers who gave birth in 1989 had at least one prenatal ultrasound – a percentage that increased 35% by 1997, when 64% of mothers had at least one ultrasound. Comparing prenatal ultrasound use, starting at the beginning of the "autism boom," across different countries could yield valuable information regarding prenatal ultrasound as an autism risk factor. JULY 2010 Williams EL and Casanova MF, Potential teratogenic effects of ultrasound on corticogenesis: implications for autism. Med Hypotheses. This carefully reasoned article suggests a biological pathway for exactly how prenatal ultrasound could cause autism, as well as why it would not always cause autism. It gives weight to the hypothesis that prenatal ultrasound is causing autism.

b. What are the remaining gaps in the subject area covered by this chapter?
­­­­­­­­­­­­­­­­­­The current IACC Strategic Plan does not consider that first trimester care and/or prenatal ultrasound exposure is an autism risk factor. In view of emerging data that support the idea that prenatal ultrasound is causing autism, I urge the IACC to follow the lead of its Vision Statement to "accelerate and inspire research" into prenatal ultrasound. The IACC's Mission is to create a Strategic Plan that will "focus, coordinate, and accelerate high quality research and scientific discovery" and to do so with a sense of urgency and demand for excellence. In the spirit of is Vision Statement, the IACC should carry out is Mission by actively seeking answers regarding prenatal ultrasound, as evidence-based science clearly is supporting the idea that it is involved in autism. While the IACC is charged with many responsibilities regarding the autism community, in the words of the Strategic Plan, it "is critical for research to identify the methods and approaches that can be used to prevent the challenges and disabilities of ASD." The IACC assumes that finding out what is causing autism will be a drawn-out, very complicated and expensive undertaking that involves complex interactions of up to 8,000 chemicals with a multitude of gene variations. There is a serious flaw in this thinking, which is quite simply that it would take an astronomical number of coincidences to have completely different exposures in different places around the world to factors such as building materials, clothing, food, air and water quality, cleaning agents and pesticides combine with different gene pools to produce exactly the same result: steep increases in autism during the same period of time. What women in these different countries and cultures DO have in common is that virtually all of them subjected their fetuses to ultrasound exposure. That is the common denominator. The danger of thermal intrusion on fetal development has been well documented at high temperatures, which produce visible birth defects or even death, but has not been adequately explored at the lower temperatures caused by prenatal ultrasound. Einstein said, "Everything should be made as simple as possible, but not one bit simpler." In terms of prenatal ultrasound use, this may mean not eliminating it altogether but recommending against first trimester or routine scans, if they increase the risk of autism. I urge the IACC to: For every study I listed in the section, "What has been learned about the issues . . ." work with the appropriate government agency, such as the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), or U.S. Environmental Protection Agency (EPA), to get the facts regarding why first trimester prenatal care and/or ultrasound increases the risk of autism. Work with the FDA to devise a consistent, detailed way that all ultrasound operators be required to record sessions, whether for medical or "keepsake" scans, and make these data are available to autism researchers. Issue a Request For Information regarding prenatal ultrasound and autism and match qualified researchers with IACC partners and funders. Work closely with the National Children's Study and Early Autism Risk Longitudinal Investigation (EARLI) to adapt these longitudinal studies to collect all pertinent prenatal ultrasound data and make sure they are available to autism researchers. Focusing attention on the potential harmful effects of prenatal ultrasound will not help the IACC win any popularity contests. Unlike developing genetic or pharmaceutical autism interventions, or identifying environmental hazards, which all have profit potential, unplugging routine prenatal ultrasound will be very costly to ultrasound manufacturers and providers. Casting doubt upon the safety of prenatal ultrasound will also upset consumers, who so dearly want to view their babies in the womb and who want all available information regarding their development. It will take great courage on the part of the IACC to foster meaningful investigation into prenatal ultrasound and ensure that the research is neither delayed nor compromised in any respect. But to do anything less would be to let down the very individuals and families the IACC is dedicated to helping.

Respondent 38

Audrey Smerbeck

a. What has been learned about the issues covered in this chapter in the past year?
I hope to hear that no money is wasted on "vaccine damage" and other such nonsense. Not only is the science debunking any link between vaccination and autism detailed and consistent, I, like many people with ASD, find the whole idea ridiculous and insulting, as it implies it would be better to risk death by communicable disease than to risk autism.

b. What are the remaining gaps in the subject area covered by this chapter?
As ASDs are heritable, it should be reasonably common for one or both parents of a child with ASD to have some expression of the ASD phenotype. Yet, I am aware of no studies that examine how the parents with ASD characteristics differ from neurotypical parents in terms of how they report on their child's behavior on a diagnostic interview or checklist (e.g., perhaps the parent doesn't realize the child's facial expressions are abnormal because the parent rarely looks at the child's face) or participate in the child's treatment (e.g., the parent may be unable to model the behavior he or she is supposed to help teach).

Respondent 40

b. What are the remaining gaps in the subject area covered by this chapter?
A study comparing children who are fully vaccinated according to the Centers for Disease Control and Prevention's (CDC's) recommended schedule with children who were never vaccinated would directly address whether vaccines are linked to ASDs. I do not understand why this study is not being undertaken.

Respondent 43

Michael Framson

a. What has been learned about the issues covered in this chapter in the past year?
For years parents have reported that their children regressed developmentally and physically after vaccination, and subsequently were given a diagnosis of autism. The Vaccine Injury Compensation Program has compensated 1,322 cases on the basis of vaccine-induced brain damage, seizure disorder, acute disseminated encephalomyelitis, and encephalopathy. Many of these cases were also diagnosed with autism after suffering the vaccine injury. Vaccine adverse events temporally related to a diagnosis of autism deserve to be investigated to the fullest extent possible. It is also concerning that influenza vaccine is now universally recommended for all pregnant women during any trimester. The event of immunization induces an immune response in the mother that can interfere with neuronal growth of the fetal brain. Prominent researchers have questioned this policy, reporting that even if a prenatal immune response occurs only one percent of the time, vaccinating an entire population of pregnant women can affect thousands of children. According to the Centers for Disease Control and Prevention (CDC), pregnant women may receive multiple flu vaccines (due to the addition of the H1N1 vaccine) which contain thimerosal and adjuvants to increase immune response. Unfortunately, clinical trials in pregnant women do not include long-term monitoring of health status or of developmental outcomes in the infants. A recent study by Hewitson (2010) in infant primates documented accelerated brain growth in those receiving the recommended vaccination schedule from 1999 compared to unvaccinated controls. The vaccinated primates also showed altered maturation of their brains' amygdalae. Both of these findings are documented to also occur in ASD. Reports of environmental toxicant exposure associated with ASD include metals and chlorinated solvents (Windham, 2006 ), environmental mercury (DeSoto & Hitlan, 2010; Palmer & Adams, 2009) organophosphates (Eskenazi, 2007) and lead (Lidsky & Schneider 2005). There is also evidence that individuals with ASD respond differently to environmental exposures and may be more vulnerable. Woods (2010) recently documented altered porphyrin profiles associated with metal exposure in 20 percent of autistic children compared to controls and gene expression in blood was correlated with mercury levels in blood of 2 to 5-year-old boys (Stamova, 2009) and lead (Tian, 2009). A recent study in prairie voles adds support to these findings; low dose ingestion of mercury or cadmium resulted in two hallmark characteristics of autism: social avoidance and greater effects on males (Curtis, 2010). These environmental agents need to be added as categories of highest priority for investigation in the Short-Term Objective B and F and Long-Term Objective C. Postmortem brain tissue should be investigated for direct and indirect indications of environmental exposures.

b. What are the remaining gaps in the subject area covered by this chapter?
Evaluate neurodevelopmental and neuroimmunological outcomes, longitudinal structural and functional imaging of the central nervous system (CNS), and tissue pathology, including gene expression and proteomic profiling, in response to the combined early infant immunization schedule (including prenatal exposure to influenza vaccine) in nonhuman primates.

Respondent 45

b. What are the remaining gaps in the subject area covered by this chapter?
We need to investigate the potential association of bisphenol A (BPA), xenotropic murine leukemia virus-related virus (XMRV) and viral gene fragments in vaccines with ASD. We should also continue to survey tissues from ASD patients and vaccines with virus microarrays. The IACC is now under acute pressure to ensure the proposed studies are very effective and provide applicable insight and results.

Respondent 47

Duke Crestfield

a. What has been learned about the issues covered in this chapter in the past year?
Looking for a 'smoking gun' genetic markers is a bust. The entire approach is fundamentally flawed, because it assumes that ASD people are damaged versions of 'normal' people.

b. What are the remaining gaps in the subject area covered by this chapter?
Look for the 'perfect storm' genetic mutations that gave neurologically typical (NT) individuals the special 'mind reading' perception, perhaps 30,000 years ago. ASD may be anything that disrupts that delicate construct.

Respondent 50

Theresa K. Wrangham

b. What are the remaining gaps in the subject area covered by this chapter?
Again, there is a lack of citing environmental research and databases (data sharing) that exist to further IACC research goals and an overemphasis on genetic research that is already well funded privately. Vaccine research goals remain vague, though the National Vaccine Advisory Committee's (NVAC's) Task 1 Review of the Centers for Disease Control and Prevention's (CDC) Immunization Safety Office (ISO) agenda had ASD specific recommendations. IACC is charged with conducting ASD research agenda and should incorporate the ASD specific recommendations made in the NVAC June 2009 ISO Review Report.

Respondent 52

b. What are the remaining gaps in the subject area covered by this chapter?
Family history -- is there an increased history of Alzheimer's, gastrointestinal (GI), autoimmune -- can we share some insight and intervention? GI/probiotics prophylactically, etc. -- to neutralize antibiotics, inadequate food processing, etc. Many scientists believe -- the GI system is the hub of immune function for the body; that the immune system and its functionality is a big piece of what happens in autism... E. New Objectives. Vaccines have been studied and studied and nothing. Recently spoke to a woman that had lived overseas for a number of years with her family. All (parents + 2 kids) received typhoid vaccinations at the same time. She and her children were fine with the shot and disease; her adult husband became very sick (with typhoid), was hospitalized and almost died. ?? There are subpopulations with differences...

Respondent 53

Donna Young
Natural Birth Education

a. What has been learned about the issues covered in this chapter in the past year?
Etiology- Prevention by Truth in Education on Contributing Factors of Autism(s). See Article No. 67, on the Open Letter to President Obama at www.medical-truths.com This link exits the Interagency Autism Coordinating Committee Web site.

Respondent 54

Rebecca Estepp
SafeMinds

a. What has been learned about the issues covered in this chapter in the past year?
Autistic regression is established (Ozonoff 2010; Kalb 2010; Wiggins 2009). The Vaccine Injury Compensation Program has compensated 1,322 cases on the basis of vaccine-induced brain damage, seizure disorder, acute disseminated encephalomyelitis, and encephalopathy. Many of these cases were subsequently diagnosed with autism after suffering the vaccine injury. Influenza vaccination recommended during pregnancy can induce maternal immune response that interferes with fetal brain neuronal growth similar to ASD observations (Patterson 2009). An infant primate study (Hewitson 2010) documented accelerated brain growth and altered amygdala maturation (both ASD features) after vaccination. Vaccine-induced autism needs to be studied. New reports on other environmental toxicants associated with ASD indicates priority investigation for Short-term objectives B and F and Long-term objective C: mercury (Palmer 2009; DeSoto & Hitlan 2010; Lakshmi, Priya & Geetha 2010; Stamova 2009) and lead (Lakshmi, Priya & Geetha 2010; Adams 2009) exposure/retention; unique ASD vulnerability to mercury via porphyrin or gene expression profiles (Woods 2010; Stamova 2009), to lead via altered gene expression (Tian 2009), to organophosphates via PON1 gene (Gaita 2010); animal models of autism and exposure - social avoidance/male effect in prairie voles given low dose mercury or cadmium (Curtis 2010), neuroligin-deficient mutants of C. elegans hypersentitive to oxidative stress and mercury with ASD-like behavioral deficits (Mostafa 2010).

b. What are the remaining gaps in the subject area covered by this chapter?
Study prenatal/infant vaccination schedule using non-human primates evaluating neurodevelopmental and neuroimmunological outcomes, longitudinal structural and functional central nervous system (CNS) imaging and tissue pathology, including gene expression and proteomic profiling. Expand the National Children's Study (NCS) to add detailed prenatal/infant medication and vaccine (including manufacturer and lot number) histories and to oversample families who do not vaccinate or alternatively vaccinate for comparisons of total health outcomes. Develop mechanism-based biomarkers using cellular and animal models for environmental exposure assessment for high priority pollutants. Understand role of immune and metabolic differences and how they might arise from chemical or viral exposures. Create animal models based on meaningful exposures (not obscure ones like thalidomide) at real-world doses to understand genetic susceptibility, pharmacokinetics, mechanisms (including effects at the cellular level and systems level such as gastrointestinal, immune, and brain), retention and localization of body burden, and response to potential treatments. Investigate post-mortem brain tissue for direct/indirect indications of environmental exposures. Add mercury and vaccines as high priority research areas in objective B and F.

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Please note that respondent numbers are not sequential due to the fact that some respondents did not provide an answer to each question or sub-question. Some respondents indicated that they wished to have their name and/or affiliation be associated with their response, and in those cases, the information is provided at the top of the response.

Typographical and spelling errors have been corrected and abbreviations lengthened to facilitate searching the document. Every effort was made to avoid altering the meaning of the comments. Responses that referenced an individual respondent's earlier responses (e.g. "See above.") and did not contain additional information were omitted to make this working document more concise. Profane, abusive and/or threatening language, and personally identifiable information have been redacted.

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