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XMRV: False Positive in chronic fatigue syndrome

4 Oct

Xenotropic murine leukemia virus-related virus (XMRV) has been suggested as linked to chronic fatigue syndrome and autism. This has been rather controversial in both cases.

Before we get to the “false positive” report, Science published one of the papers on XMRV and chronic fatigue syndrome

Murine leukemia viruses (MLV), including xenotropic-MLV-related virus (XMRV), have been controversially linked to chronic fatigue syndrome (CFS). To explore this issue in greater depth, we compiled coded replicate samples of blood from 15 subjects previously reported to be XMRV/MLV-positive (14 with CFS) and from 15 healthy donors previously determined to be negative for the viruses. These samples were distributed in a blinded fashion to nine laboratories which performed assays designed to detect XMRV/MLV nucleic acid, virus replication, and antibody. Only two laboratories reported evidence of XMRV/MLVs; however, replicate sample results showed disagreement and reactivity was similar among CFS subjects and negative controls. These results indicate that current assays do not reproducibly detect XMRV/MLV in blood samples and that blood donor screening is not warranted.

Reminds me of the Hornig study trying to find measles RNA in autistic children’s intestinal tissues. Multiple laboratories. No link found.

But, what of the older studies claiming a link? Well, Science also has a short article from some of the authors in an earlier paper. They reexamined samples from their study and found that their samples were contaminated with XMRV plasmid DNA:

Failure to Confirm XMRV/MLVs in the Blood of Patients with Chronic Fatigue Syndrome: A Multi-Laboratory Study.

In our 23 October 2009 Report, “Detection of an infectious retrovirus, XMRV, in blood cells of patients with chronic fatigue syndrome,” two of the coauthors, Silverman and Das Gupta, analyzed DNA samples from chronic fatigue syndrome (CFS) patients and healthy controls. A reexamination by Silverman and Das Gupta of the samples they used shows that some of the CFS peripheral blood mononuclear cell (PBMC) DNA preparations are contaminated with XMRV plasmid DNA.”

Again, this is very reminiscent. In testimony for the Omnibus Autism Proceeding, Stephen Bustin discussed contamination (and other) problems with the laboratory searching for measles virus in the samples provided by Andrew Wakefield’s group.

Science ran another article, False Positive, on the XMRV/chronic fatigue story:

For the past 2 years, a controversy has roiled around the purported link between a mouse retrovirus, XMRV, and chronic fatigue syndrome (CFS), a baffling, debilitating disease with no known origin. An October 2009 paper in Science found XMRV in the blood of two-thirds of the CFS patients examined, but more than a dozen labs have failed to replicate it to date. Millions of dollars have gone into clarifying the question, which has had far-reaching consequences for people with CFS and, if the virus lurked in the blood supply, the public at large. A nine-lab study published online this week by Science found that none of the labs could reproducibly detect XMRV or relatives of the virus in blood samples distributed under a blinded code. Science is also running a partial retraction of the original paper, as a contributing lab found that it in fact had a contamination.

More discussion can be found at the blog A Photon in the Darkness as Mikovits XMRV Study “Partial Retraction” and at ERV as XMRV and chronic fatigue syndrome: For your enjoyment– A magic trick.

Other studies have already looked closely and found no evidence of a link: PCR and serology find no association between xenotropic murine leukemia virus-related virus (XMRV) and autism. The current articles in Science do not directly address autism, but they show the serious difficulties involved with studying XMRV and help us to understand how these potential links were made in the first place.

Combating Autism Reauthorization Act signed by President Obama

3 Oct

The commitment to autism research by the people of the United States will continue at a high level. The Combating Autism Act has been reauthorized following the passage of the Combating Autism Reauthorization Act by the legislature and President Obama’s signing it into law.

From the White House Blog, this post by Micahel Strautmanis:

Every single day, I am proud and awed to be working for our President. But, some days simply take the cake. Just a few short months ago, I had a couple of those days. On April 1st, President Obama issued the first ever Presidential Proclamation to mark World Autism Awareness Day. Later that month, I had another special moment when Valerie Jarrett and Health and Human Services Secretary Kathleen Sebelius announced that the President and his administration fully supported reauthorization of the Combating Autism Act (CAA). As a father of a child on the autism spectrum, these were extraordinarily meaningful moments to me.

Today, President Obama signed into law the reauthorization of the CAA. I was once again reminded of the honor that it is to be working for a President who gets it — he knows that persons on the autism spectrum are at the heart of this issue.

I find the reauthorization and the entire process quite interesting. There wasn’t the testimony involved in the first Combating Autism Act. While there was certainly a push to get the reauthorization passed, there was a lack support from many organizations, from parent-led groups pushing vaccine causation to self-advocate groups. There doesn’t appear to be much, if any, discussion on vaccines. The CAA in 2006 even had some senators mention vaccines in the congressional record while discussing the passing of the act.

And this is something that intrigues me. I’ve always worried that the CAA was passed, at least in part, based on the perception that perhaps vaccines had a role in autism prevalence. Perhaps some legislative guilt at play. I worried that in 2011, with so much more known about the fact that MMR and thimerosal did not cause an autism epidemic, that congress might let autism research drop to a lower priority. The CAA had to stand on what was accomplished and what the prospects looked like for future research. In many ways, that’s a tough sell. Research doesn’t happen overnight. Even in 5 years. But, congress and the president are supporting the effort into the future. In these economic times, and in an election year, this was not a trivial accomplishment.

The Interagency Autism Coordinating Committee (IACC) will continue into the future. Congress is authorized to appropriate funds into the future.

Childhood mortality and vaccines

2 Oct

One of the ideas that gets presented as fact all too often on the internet is “the United States is the most vaccinated country in the world and has one of the worst childhood mortality rates”. There are variations of this, of course. Unfortunately, this notion gets put forth by autism-parents and even autism-parent organizations.

This sticks in my mind since a rather blatant attempt at misinformation from Generation Rescue in the form of a pseudo-paper “special report”: AUTISM AND VACCINES AROUND THE WORLD: Vaccine Schedules, Autism Rates, and Under 5 Mortality. I wrote about the many failings of that document at the time.

One major failing in the childhood mortality comparisons is that the U.S. measures infant mortality (which is a big piece of under 5 mortality) differently than other countries. As Bernadine Healy (a source highly respected by groups such as Generation Rescue) wrote:

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that “First, it’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless.

But why bring this up again? The reason is simple: I found a very interesting source of data and in reviewing it, I found information on vaccines and on childhood mortality: the Google Public Data Explorer. The Wold Bank dataset includes childhood and infant mortality figures.

What does the childhood mortality rate look like as a function of time for the United States? Not surprising (to most) it has been dropping over the past 30 years. In fact, from 1989 to 2009 the rate dropped from 12.1 per 1,000 to 7.8 per 1,000. (click to enlarge):

Why pick 1989 onward? This is the period when the vaccine schedule in the U.S. increased dramatically. If the idea that vaccines are somehow linked to worse childhood mortality we would expect this trend to be increasing, not decreasing.

Here is a good example of why we can’t say that correlation means causation. Consider childhood mortality for a country. Consider CO2 emissions for a country. Guess what, there is a big trend towards lower childhood mortality with higher CO2 emissions. (click to enlarge)

The “effect” (quotes mean it isn’t real) is huge. Note that the graph is a log-log plot. Countries with high CO2 emissions have 20 times, or more, lower childhood mortality. If we were in the “correlation equals causation” camp, we would decide that CO2 prevents childhood mortality. We could take this another step into the ridiculous and say, “Since CO2 emissions will coincide with higher atmospheric mercury due to coal burning and other sources, mercury must prevent childhood deaths”.

So keep that lesson in humility in mind as we play armchair epidemiologist and look further into the World Bank data. What is correlated with childhood mortality that might make sense? Being from a country in sub-Saharan Africa is correlated with high infant mortality rate. Low income countries have high infant mortality rates. Having a skilled person to attend the birth is correlated with low infant mortality rates.

Vaccines? What about them? They only have data for measles vaccine uptake. Again, not surprisingly, childhood mortality is lower for countries with higher measles vaccine uptake (click to enlarge)

I chose 2003 for the year for this comparison. That year has data as well for the fraction of births attended by skilled health staff. The datapoints are color coded with this to show that this is a big correlate. The more births have a skilled health worker in attendance, the more kids live. Could be a proxy for some hidden variable, but it makes some level of sense that having a health worker would reduce infant mortality. It also makes sense that countries with access to healthcare in general would have lower infant mortality.

But, that brings us back to the measles vaccine and infant/childhood mortality. Does the vaccine reduce infant mortality? Certainly in countries where measles is endemic. But measles vaccination isn’t the reason why childhood mortality figures are higher in, say, Chad than in the United States. And that’s why researchers try to control for other factors, like wealth and access to health care, when trying to correlate factors and diseases.

Otherwise, you end up with “mercury causes autism”. Or, using the World Bank data, “Cell phones cause low fertility rates”. Or other strange ideas.

While I think these data show pretty clearly that childhood mortality is not likely increased by vaccines, they also show the pitfalls of being an armchair epidemiologist. With the internet, data abound. One can find many correlations. Some are just random. Some are due to some unseen variable. Some are an indication of actual causation.

Do I believe that there is a reason why childhood mortality is lower in wealthy countries? Yes. Do I believe that there is a reason why childhood mortality is lower in countries with high CO2 emissions? No*. Both show correlations. What about the idea that measured autism rates went up as the exposure to thimerosal increased? Sure, there’s a correlation, just like with CO2 and childhood mortality. And, just like with childhood mortality and CO2, there are other factors at play.

*note–CO2 emissions are linked to countries with greater wealth. In that respect, yes there is a reason for the correlation. But there is no direct correlation of CO2 and childhood mortality.

Worries About Autism Link Still Hang Over Vaccines

30 Sep

A story just out from National Public Radio in the United States: Worries About Autism Link Still Hang Over Vaccines. Part of the survey on how the public views vaccines was a question on autism:

Do you believe any of the following are linked to vaccines?
1. Autism
2. Cancer
3. Diabetes
4. Heart disease

The answer: about 21% of Americans say yes to the autism/vaccine link.

The highest levels of “yes” were in those aged 35 to 64, with middle-income status, some college education and who have children.

About 1/4 said their opinions of vaccine had changed in the last 5 years, with about 60% of those responding that their opinions had changed for the worse.

Of the main reasons cited for vaccine fear, autism was the top. By far.

21.4% of respondents said they believe vaccines can cause of autism, 9.2% said they believe vaccines can be
linked to cancer, 6.9% believe they play a role in diabetes, and 5.9% cite a connection between vaccines and
heart disease.

Is this because there is actual evidence, or because of a vocal campaign to put the message of a vaccine/autism link into the public mindset? Well, since there is no convincing evidence of an autism/vaccine link (and a lot of evidence against the primary theories: mercury and MMR) I’d go with the media campaign as the reason this idea still has traction with the public.

And I’m not alone, at least in thinking that the effort of some vocal members of the autism community have had an impact. Last time such a survey came out, it was trumpeted by some of the more vocal sections of the autism-parent community, with one blogger telling his readership to take credit for an increase in belief in the vaccine/autism idea and fear of vaccines:

With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.

What was even more disturbing than those words were the conclusion of the article:

…mark my words, the results from the next survey will show that the trust continues to erode. Keep fighting, parents, America is really listening.

Yep, Keep fighting. Not to get the message out, but to erode trust in public health. The message seems to have morphed over the years. From informing the public of an idea (albeit unsupported by good data) to one of fear. As we can see from the NPR/Reuters survey, the idea that vaccines and autism are linked is still out there.

We saw a form of this idea surface recently when Michelle Bachmann recently made comments linking the HPV vaccine and mental retardation. I sent an email to the National Vaccine Information Center asking about the Bachmann claim. Here is the response I received:

Sorry to just be getting back to you but we have been inundated with emails about Michelle Bachmann.There’s no information to support her claim and now she has withdrawn it.

I chose the NVIC for this inquiry because they are an organization which I believe has rather lax standards on proof of vaccine injury. If anyone were going to support Ms. Bachmann’s claims, it would be the NVIC. The fact is that even they see this as an unsupportable comment.

But to bring this back to the NPR survey: yes, there are concerns about vaccines in the American public. Concerns are one thing. We should all be concerned about such an important part of the public health system. Fears. That’s another thing. Unfounded fears. Discounted fears. That is yet something else. And we are at the point where unfounded fears and disproved fears are still promoted, largely by autism parents. And that is why autism parents like myself feel the need to counter the misinformation. Because these fears have consequences:

As parents fret, vaccination rates for kids have dipped. Childhood vaccination rates against measles, mumps and rubella (MMR), for instance, fell almost 3 percentage points to 90.6 percent in 2009 from the year before, according to data from private insurers.

As vaccine rates drop, the risks to us all, and infants in particular, rise. In the words of Simon Murch, colleague of Andrew Wakefield in the now-retracted Lancet study which fueled the modern fears of MMR and other vaccines:

“If this precipitates a scare and immunization rates go down,” Murch warned, “as sure as night follows day, measles will return and children will die.”

Fare Well, Lisa Jo

29 Sep

Lisa Jo Rudy, Autism guide for about.com, has entered her last post: A Farewell to the About.com Autism Site.

She puts out a number of parting insights. I quote one below:

Life is for living. Even (and perhaps especially) when your child is autistic. PLEASE get out there, have fun, enjoy life, enjoy your kids, don’t spend your life, love and treasure exclusively on therapies. Go fishing. Go swimming. Take a hike. Volunteer. Sing. Play. LIVE! And while you’re out there, look for ways to help your child with autism to join in the fun. Use your imagination, and help your child with autism to use hers. Introduce your child to his world, and to the people in his world. Help them to get to know and care about your child. It’s the community that, in the long run, will make or break your efforts to help your child succeed.

She has always had many writing projects ongoing, and will continue to write.

Combating Autism Reauthorization Act Passed by Senate and House

28 Sep

The Combating Autism Reauthorization Act has been passed by both houses of the US Legislature. President Obama is expected to sign this into law. The announcement from the Office of Autism Research Coordination is below.

Late Monday night, September 26, 2011, the Senate passed The Combating Autism Reauthorization Act (CARA) by voice vote. The bill was passed by the House of Representatives last week. The bill is now en route to the White House to be signed into law by President Obama. The reauthorization of this legislation will allow the continuation of the Interagency Autism Coordinating Committee (IACC) and several other important Federal autism programs for three years, until September 30, 2014.

The Office of Autism Research Coordination looks forward to continuing to partner with Federal agencies and private organizations to facilitate the activities of the IACC and serve the autism community

Sexual understanding and development of young people with intellectual disabilities: mothers ‘ perspectives of within-family context

28 Sep

Sexuality in others, especially family members, is just not a subject I want to consider. It’s no doubt a family culture thing. My parents have yet to have the talk about “the birds and the bees” with me, and I’m passing from middle age to that strange period in life where I’m not yet able to get discounts, but I don’t really expect to live to double my age (and isn’t that the definition of “middle” age?). Given my druthers (a word that pegs me as middle aged or older), I’d stall this intro until you, the reader, had noticeably advanced in age.

While I can put off writing about it, I have to face the fact that my kid, disabled or not, will mature. Will grow into a sexual being. How do I, a parent, address and support that?

I wish I had the answers. I wish I could put it off until some combination of school/friends/Internet/experimentation took over.

The recent paper which brought this question forward again is:

Sexual understanding and development of young people with intellectual disabilities: mothers ‘ perspectives of within-family context.

Here is the abstract:

The sexual development of young people with intellectual disabilities is a marker of their transition to adulthood and affects their sense of well being and identity. Cognitive impairments and a socially marginalized position increase dependence on their families to assist with sexual matters. In this study, the authors adopted a novel interpretive phenomenological analysis approach, asking 8 mothers to contrast their experience of supporting similarly aged siblings with and without intellectual disabilities. Acknowledgment of their nondisabled offspring’s sexuality was demanded by increasing autonomy, whereas continuing dependence of the offspring with intellectual disabilities hindered mothers who were addressing this intensely private and sensitive issue with them. The topic of sexuality brought to the forefront mothers’ fears about their offspring’s ability to cope with the challenges of adulthood

In the end, this study seems to focus on the experiences of the parents, their fears. Which is a valid subject for study. But I’m still wondering: what us the right approach for this parent to take? As with any parent, any kid, there is probably no single “right” approach. I hope that as time marches forward, some good approaches become clear.

Combating Autism Reauthorization Act Stalled in Senate

22 Sep

The Combating Autism Reauthorization Act recently passed in the U.S. House of Representatives. The next steps are approval in the Senate and, should that happen, signing by the President. Mr. Obama has indicated that he will sign. The senate, however, is a different story.

Disability Scoop discusses this in Senate Republicans Move To Derail Autism Act.

Just hours before, however, a clash on the Senate floor revealed fresh opposition in Congress to the measure. When the bill’s sponsor, Sen. Robert Menendez, D-N.J., called for his colleagues to give unanimous consent to the autism legislation, a group of Republican senators objected.

“All of us who object support autism research… but it makes absolutely no sense for us from where we sit to try to play scientist and physician,” said Sen. Jim DeMint, R-S.C.

It’s politics, so I don’t expect the short sound-bytes to be logical. The CARA doesn’t make legislature “play scientist and physician”. It does set up an infrastructure to plan for the research priorities, using researchers and stakeholders for input.

Another paragraph from Disability Scoop:

In addition to opposing condition-specific legislation, DeMint, who was joined by Sen. Tom Coburn, R-Okla., in speaking against the bill, said the measure was not necessary in order to continue current research programs which are funded under other appropriations bills.

Again, let’s consider what actually happens. The Combating Autism Act, and the re-authorization, don’t appropriate funds. They authorize the appropriations. Simply put, they are a plan for what will be authorized. But the Act doesn’t commit congress to make the appropriations. Consider it a statement of intent. A promise.

The Washington Times has a story: Standoff threatens autism research funding. This includes a statement by Senator Tom Coburn:

“What we are opposed to is tying the hands of the researchers and the directors at National Institutes of Health and telling them what they should do and how they should do it.”

I find this odd on two counts. Again, the Act does not tie the hands of people at NIH other than in the formation of the IACC to create a strategic plan and advise the Secretary of Health and Human Services.

As to telling the NIH what to do, what areas to focus upon. Well, there’s the National Cancer Institute, the National Eye Institute, the National Heart Lung and Blood Institute…you get the idea. The NIH has already created specific focus areas. The Combating Autism Act is not out of place in the way the NIH is run by congress.

The Times quotes Rep. Michael F. Doyle:

Mr. Doyle said he spoke with two senators who had concerns about the bill and that he “did not have an indication that there was an effort to block this thing permanently.”

If accurate, this places the current stall in the category of “politics”.

Law Firm Faces Legal Action Over Handling Of MMR Vaccine Case

21 Sep

This story is in the U.K. version of the Huffington Post. The article, Law Firm Faces Legal Action Over Handling Of MMR Vaccine Case, brings the question of MMR litigation back up, but in a different way. First, the families are claiming that encephalitis, not autism, was the claimed injury. Second, they are suing the law firm that handled the case, not the vaccine manufacturers.

Three families who claim their children suffered a potentially fatal illness from the mumps, measles and rubella (MMR) vaccine are suing a law firm they say grouped them with a now discredited case over a link between the jab and autism.

A case was brought against the manufacturers of the MMR jab – Smithkline Beecham, Smith Kline & French Laboratories and Sanofi Pasteur MDF – in 2007, over claims that the jab caused autism in children. However three families who say the vaccine caused encephalitis in their children, not autism, believe they were unable to claim compensation because of the way the case was dealt with.

Note that the Huffington Post has the dates wrong in the section quoted above. The case was brought in the late 1990’s and abandoned in 2003 when lack of evidence resulted in a loss of public funds to support the investigation further.

The BMJ also covers the story, noting that in 2002 the then chairman of the UK’s Committee on Safety of Medicines, Alasdair Breckenridge, said: “There is sound evidence that mumps vaccine containing the Urabe stran of virus is associated with a risk of meningitis and [has} no proven additional benefits. The risk to children of a potentially serious neurological complication makes its use unacceptable.”

Since the focus here at Left Brain/Right Brain is primarily autism, and the Wakefield case has been discussed (and discussed, and discussed), I expect that most readers know the basic story. But, indulge me for a moment while I give a short history.

Back in the mid-1990’s, some families believed that MMR caused their child’s autism. They sought both legal and medical expertise to pursue their case. The legal end was led by Richard Barr of the firm Alexander Harris. For medical expertise, they (parents and leagal team) approached Andrew Wakefield, a research gastroenterologist who had just recently implicated the measles vaccine in Crohn’s disease.

After Mr. Wakefield and his team published their first paper in The Lancet in 1998 (a paper since retracted), he became even better known for his views on MMR. Sometime after this, attorney Richard Barr was contacted by a public health insider with concerns about the MMR. Mr. Barr and Mr. Wakefield met with this “whistleblower” in secret.

The thing is, the concern was about encephalitis from the mumps component. Not autism from the measles component, as was Mr. Wakefield’s hypothesis.

The meeting between Mr. Wakefield and this gentleman became known only recently, 1998, while Mr. Wakefield faced charges before the General Medical Council. Mr. Wakefield released details of his story and threatened to disclose the name of the “whistleblower”. Mr. Wakefield later followed through on this threat.

This raises very important questions. Most notably, why didn’t the legal and scientific team working on MMR litigation follow up on the mumps/encephalitis question? The idea was known to Mr. Wakefield and Mr. Barr. The MMR litigation went forward with the theory that the measles component was causing autism, and failed.

And now some parents consider these events to be a strong enough case to sue a law firm handling their case: Alexander Harris.

The families claim the MMR vaccine brought neurological injury and are suing the law firm that brought the original litigation against the vaccine’s manufacturer.

As part of the group autism case, the families claim they were deprived of the compensation likely to come from bringing individual actions.

Mr. Wakefield’s discussion of his meeting with the “whistleblower”, together with commentary from Brian Deer, is in the video below:

While Mr. Deer focuses on how Mr. Wakefield is treating the “whistleblower”, another big question is left open by this discussion: did Mr. Wakefield act on the information he was given? Did the attorneys? The secret meeting in the train station makes a rather dramatic story, but it doesn’t really reflect well on Mr. Wakefield.

Autism Speaks Hails House Approval of Bill Renewing Combating Autism Act for Another Three Years

20 Sep

The U.S. House of Representatives have voted to approve the Combating Autism Re authorization Act (CARA). The announcement, from Autism Speaks, is below:

Autism Speaks Hails House Approval of Bill Renewing
Combating Autism Act for Another Three Years

Urges Quick Senate Action Before Sept. 30 Deadline

NEW YORK, N.Y. (September 20, 2011) – Autism Speaks, the nation’s largest autism science and advocacy organization, hailed today’s voice vote by the U.S. House of Representatives approving the Combating Autism Reauthorization Act, and urged the Senate to quickly complete congressional action on the bill and send it to President Obama.

The legislation would renew the 2006 Combating Autism Act, which expires September 30, renewing the federal government’s commitment to fund autism research and treatment for another three years. The bill would sustain federal funding at current levels, authorizing $693 million for research and treatment for autism and related disorders.

“Autism Speaks thanks Reps. Chris Smith (R-NJ) and Mike Doyle (D-PA) for their leadership in assuring a strong federal response to autism, which now affects 1 in every 110 children—including 1 in 70 boys,” said Autism Speaks co-founder Bob Wright. “Autism has been declared a public health emergency—doing nothing is not an option.”

Action on the bill moves to the Senate where the measure cleared the Health, Education, Labor and Pensions Committee on Sept. 7 by unanimous vote.President Obama has pledged to sign a bill reauthorizing the CAA this year. The CDC has determined that the incidence of autism in America has jumped to 1 in 110 children, and 1 in every 70 boys.

CARA would authorize a total of $693 million on continued biomedical and treatment research on autism and require further development of an overall strategic plan for the intensification, expansion and better coordination of federal efforts designed to help persons with autism and their families. The fight for CARA in the Senate has been led by Senators Robert Menendez (D-NJ) and Mike Enzi (R-WY).

The Combating Autism Act of 2006 was signed into law on December 19, 2006 by President George Bush following a nearly unanimous Congressional vote. The CAA made a clear statement by the U.S. government on the public health emergency posed by the growing prevalence of ASDs, and the lack of adequate research, effective treatments, and services to address this urgent and growing crisis.

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