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Andrew Wakefield and the death of the MMR debacle

27 Jun

On Day 8 of the testimony in the Autism Omnibus, Stephen Bustin – the leading world expert on PCR put a stake through the heart of the MMR debacle when he revealed that the testing done in Professor O’Leary’s lab on behalf of Andrew Wakefield and others was flawed due to uncontrolled contamination in O’Leary’s lab:

What I immediately observed was that they had forgotten to do the RT step…….If you detect a target that is apparently measles virus in the absence of an RT step by definition it can’t be measles virus because it has to be DNA. It’s a very simple concept. At least it is to me. It’s not to everyone else……[b]ecause measles virus doesn’t exist as a DNA molecule in nature, they cannot be detecting measles virus….

On day 10, the head was finally chopped off the corpse of this hypothesis. Day 10 featured the testimony of Nick Chadwick, a scientist who was a graduate students of Andrew Wakefield’s when Wakefield was being paid to find fault with the MMR. Here is the two killing sections of Chadwick’s testimony:

Q Okay. Did you personally test the gut biopsy samples for measles RNA?
A Yes.

Q What tests did you perform?
A A PCR test, a polymerase chain reaction.

Q What results did you receive from the gut biopsy materials for measles RNA?
A They were all negative.

Q They were always negative?
A Yes. There were a few cases of false positive results, which I used a method to see whether they were real positive results or false positive, and in every case they turned out to be false positive results. Essentially all the samples tested were negative.

…….

Q So you personally tested while you were in Dr. Wakefield’s lab gut biopsy material, CSF and PBMCs?
A Yes, that’s right.

Q And all the results were either negative, or if they were positive it always turned out that they were false positives?
A Yes, that’s correct.

Q Did you inform Dr. Wakefield of the negative results?
A Yes. Yes.

Same source material, same equipment, same lab. The only difference was in the results. The difference came about because Chadwick did it properly. Wakefield didn’t. But even after Chadwick _told_ Wakefield about the negative results and the false positives Wakefield had engineered, Wakefield carried on.

MMR as a hypothesis is dead. The initial results were errors. No replication has been done and published in reputable journals. Decent science has shown the exact nature of Wakefields ‘error’ and Chadwick has testified that Wakefield knew about the error.

MMR uptake dropped over 10% in 10 years in the UK. Lots of people were hospitalised, people in the UK and Ireland died.

Autism Omnibus: Vera Byers the, uh, expert

16 Jun

The Omnibus case needs to establish (at this time) two issuses: causation to Michelle Cedillo in particular and also general causation in that thiomersal and MMR in combination cause Michelle’s autism. So far the expert witnesses for the Plaintiffs have been less than stellar but on Day 4 you could almost hear the sound of a barrel bottom being scraped.

The establishment of witnesses as ‘expert’ is vital to each sides case. They have to establish to the Special Masters (which by the way is a great title – do they have long flowing robes and carry light sabres?) that _their_ experts are indeed that – experts. Bear that in mind as you read the rest of this.

The cross examination of Vera Byers was an exercise in the destruction of a persons expert credibility. No wonder the Petitoners team decided against putting Geier, Bradstreet, Haley et al on the stand. It would’ve been a massacre.

Q: You’re not certified in allergy and immunology, are you?
A: I’m board eligible. I have not taken the test.

Q: Is board eligible a phrase that’s recognized by the organization that certifies allergists and immunologists?
A: Yes, it is…

Q: You’ll see on your screen a letter from the American Board of Allergy and Immunology referencing your status with that organization. They note that the board neither recognizes, uses nor defines the term board eligible.
A Okay.
Q: So you’ve been essentially representing that that is a qualification that you have in terms of rendering an opinion about immunology?
A: Yes, I have.

Q: You mention in your resume that you’re the medical director of the four doctor team responsible for filing the Biologics License Application for Enbrel?
A: That is not exactly correct. I was a consultant medical director. There were I think either four or five physician members of the team.
Q: So that part is perhaps a misstatement on your curriculum vitae?

[NB: Here’s the wording of Byers CV: _1998 – 2000: Immunex Corp: Medical director on the team responsible for filing the BLA for for Enbrel in methotrexate resistant rheumatoid arthritis, and as initial therapy for rheumatoid arthritis._ The section this is in is entitled: Consulting Medical Director. Misleading and ambiguous in the extreme.]

Q: If we were to check the files at FDA to see whether your name appears at all on any of the documents submitted by Immunex for Enbrel, would your name appear?
A: I’m sorry. I don’t know.
Q: We checked at FDA. Your name doesn’t appear on any of the documents submitted by Immunex on the Biologics License Application

Q: You talked this morning about Nottingham University.
A: Yes.
Q: On your CV you say that you’re still a member of the faculty there. Is that true?
A: No. I think I dropped off.
Q: So your CV is inaccurate? You are not still on the faculty of Nottingham University?
A: That’s correct. It sounds like it’s an old CV.

[NB: This detail is also on Byers CV on her website]

Q: Your CV also lists you as a faculty member at University of California-San Francisco. Are you still a member of that faculty?
A: To my knowledge I am, unless this hearing has kicked me off.
Q: We checked with University of California-San 3 Francisco. What was your faculty role at University of California?
A: I’m on the adjunct series.
Q: What did you do there?
A: I did research in poison oak and ivy dermatitis, went on rounds with the docs.
Q: How long ago was that?
A: Let me see. Through from about 1974 through about 1981, and then I went back again in 1984 and was there episodically probably through about two years ago.
……
Q: Okay. About a decade ago for the dermatitis? About a decade ago for the dermatitis?
A: About, yes.
Q: Any other involvement at UCSF, at University of California-San Francisco?
A: Well, I use their library and I go to their parties…..

Amazing. Apparently affiliation with a major university can be claimed by using the library and going to parties.

Q: They in their response indicated that your participation was I believe at best gave very occasional lectures.
A: Oh, no. That’s not true. I don’t know why they said that. Maybe they just don’t know. Who did it come from? Oh, Bruce Wintroub? See, Bruce Wintroub is the head of dermatology, right? This was in biostatistics.
Q: You worked there in biostatistics?
A: No. I took the courses in biostatistics.
Q: You took courses?
A: Yes.

Seems mini-Geier isn’t the only person who likes to claim institutional affiliation from being a student.

Q: Now, in the last decade, about the last decade, you’ve only seen patients in consultation for litigation purposes, correct?
A: They’re not specifically for litigation purposes,…..
…..
Q:Do you recall testifying in a case in February of this year, a vaccine case?
A: Probably. Was that you?
Q: Yes, it was.
A: Hello.
Q: Welcome back. Now, do you recall what your answer was about whether you treated patients or whether you saw them in consultation for litigation purposes at that time?
A: I’m sorry. I don’t.
Q: Would it refresh your recollection then to know that you testified at that time that for approximately the last 10 years you had only seen 16 patients for litigation consultation purposes?

Ouch.

On media, neurodiversity and science

29 May

Opinions vary as to why I, and many of my online friends believe what we do. The answers cannot be easily encapsulated but an indication is given by the source of the two links I’ve just linked to.

The first group believe autism is not just a disability, that it is both more and less than that and that whatever the aetiology of ‘it’ is, it is likely to not have a single cause and further, if it does or if it doesn’t, the fact that people are autistic is a state of being (a property of their personhood) that is deserving of respect and tolerance. After all, if we can tolerate difference between sexes enough to think of a toilet seat that raises or lowers as a natural aspect of functional life then we really should be able to make the minor adjustments necessary to accommodate the needs and requirements of autistic people.

The second group believe in the scientific method. They believe that in matters of science, that the rules of science should be applied.

There is some major overlap between the position of these two groups. There are a number of bloggers on the Autism Hub and an even larger number of readers of blogs on the Autism Hub who are bloggers on Science Blogs and/or readers of Science Blogs’. A number of bloggers who have autistic children are scientists of various disciplines.

It is worth noting however that these two groups are not synonymous. I know of a few people who believe in the basic essence of neurodiversity who also think vaccines damaged them or their children. This is because they know that even if vaccines did do damage, they or their kids are still deserving of respect. Conversely, I expect there are a few science bloggers who would not agree with the standpoint of neurodiversity and would ferociously chase a cure.

But these people are the exception. By and large these are two groups who share a mutual opinion that the only way to progress our knowledge of the science of autism is to use the scientific method. Science is now, thankfully, beginning to catch on to the idea that the best way to get knowledge that may help autistic people is to listen to autistic people.

At MIT Amanda Baggs has been working with the science team there in ways that will result in positive and scientifically valid ways of helping autistic (and other) people.

Estée also gave a presentation at MIT (the second talk was fuller than this one) and she also noted Michelle Dawson’s ongoing role at the University of Montreal.

This is all good progress. It’s exciting to watch these things develop and to see the possibilities that might spring forth from these alliances and how they might benefit my daughter and autistic people generally.

I believe in the scientific method. I believe science has done more than anything else to take us closer to understanding the universe within us and around us. I believe that the naturally occurring alliance that is being forged between autistic people, their allies and science is absolutely the correct way to go. Neither side is seeking to change or alter the other but to understand each other and benefit from the union.

If I want to see an example of how _not_ to do things, I need look no further than (you guessed it) the mercury militia/malicia. These are people who have taken the polar opposite view. They eye science with distrust. They refuse to accept that the results of studies that disagree with their stance can be correct to the extent that they threaten those scientists with violence, or they ignore science and instead disagree with the wording of press releases about science. In fact, this is Lenny Schafer’s view (from a past SAR):

Myself and other autism activists believe there is enough evidence to support a causative relationship between mercury and autism in a court of law, in front of a jury, where standards of evidence are different than that of the narrow focus of scientific findings. And if you can convince a jury, you can convince the public.

Make no mistake, by ‘different’ Schafer (correctly) means looser, way, way looser. He does not want scientific standards to come to play in determining the vaccine/autism connection. The reason why is absurdly obvious.

The scientist and author Michael Crichton once gave a speech about environmental issues that may as well have applied to the autism/vaccine issue:

…Proponents are pressing their views with more PR than scientific data. Indeed, we have allowed the whole issue to be politicized—red vs blue, Republican vs Democrat. This is in my view absurd. Data aren’t political. Data are data. Politics leads you in the direction of a belief. Data, if you follow them, lead you to truth.

On the EoH group where Lenny Schafer is kingpin, there is currently something of a growing schism between Lenny, John Best (e.g. the more hardcore loony element) who believe that Aspergers Syndrome is not a disability and is not part of the spectrum and hence is not autism and a lot of other people who quite obviously have AS kids and are disagreeing very strongly with Lenny’s extremeism. As part of that debate, Lenny made the following statement:

I would like to think of what we do here is public debate, not “fighting”.

This illustrates perfectly the kind of denialism that exists amongst Lenny and his members. The Yahoo EoH group is a closed access list. You can only access the group if you join up and are accepted as a member, which is what I did back in 2005. Yet Lenny really believes that this closed access list is public debate. He _has_ to believe this as he is a firm believer (as we have seen) of political and legal definitions of autism and autism aetiology. In his world view, you need to _manage_ the PR. You need to nudge it in the right direction, much as Lenny’s colleagues from the NAA did when they lied about Paul Shattuck as they disagreed with his results.

By contrast, the Autism Hub bloggers operate openly. Their opinions are challengeable directly on their blogs. Good science is challengeable. It can be challenged by using the scientific method. There is no ‘management’ of information going on here. No one flip-flops between crucial elements of their beliefs and hopes no one notices (such as Brad Handley has done).

The interviews I have done (and am doing now) have been to periodicals that concern science or touch on the science of autism from a parents perspective. I noted with no small amusement this morning that ‘the other side’ are resorting to interviewing each other – Erik Nansteils Autism Media site carries an interview of David Kirby interviewing Katie Wright. I bet that’s an in-depth and truth revealing interview.

I believe that promoting connections between autistic people and science is the absolute best way to get good science regarding autism. I hope to do my bit in making the web work _for_ the promotion of these connections. I hope that our growing community never gets sucked into the tarpit of closed access lists that crow about the achievement of ‘converting’ celebrities and media persons. This is why I set up the Autism Hub and the Autism Parents Forum. So that we can grow as a community and come closer together. I hope to do more of this in the future. I want my email contact list to be full of the names of autistic people, scientists, responsible authors such as Arthur Allen and Brian Deer and parents that, like me, want to benefit from this growing relationship. I couldn’t care less if I never get Lou Diamond Phillips or Don Imus’ email address.

Media and politics or science? When it comes to understanding the science of autism, which will yield better results? Bear this in mind as you consider your choice – science is amoral. You cannot hide, distort or disfigure scientific achievement forever. If something is scientifically accurate, its truth is self evident. No matter how many politicians you have in your pocket, no matter how many media contacts you have, gravity will always be a force of attraction. The power of repulsion belongs to those who would deny that.

Geiers, Jim Adams – oh and some science

22 May

As I alluded to in my last post, there’s been a glut of publications regarding autism and thiomersal/mercury of late.

First (as they reached me) was Jim Adams latest nothing paper. Do’C has the full story but the salient points to take home about this study is that:

There’s plenty of other silliness in this paper, including citations of Geier and Geier, and a tiny sample size that produced data that I think most people would look at and ask, “so what?”. But the bottom line is this – is the authors’ conclusion supported by the data?….Neither mercury body burden nor excretion was demonstrated to be related to mercury levels in teeth, autistic children were not demonstrated to be “poor mercury excretors”, and high usage of oral antibiotics was not demonstrated to impair mercury excretion in humans.

An interesting side note – this paper was published in a journal that recently published the latest Geier twaddle. Seems like the editor likes a bit of woo. As Do’C uncovered from the editor of this journal:

“According to the literature there is a relationship between vaccines and autism.”

Which is weird as numerous literature reviews have shown the exact opposite. Either the editor is a very credulous sort or…well, no, he’s just a bloody idiot.

Now we turn to a study called ‘Lack of association between Rh status, Rh immune globulin in pregnancy and autism‘.

This study looked at:

whether mothers of children with autism are more likely to be Rh negative (Rh-) or to have received RhIg preserved with thimerosal, which is 49.6% ethyl mercury

So – do kids with autism come from a population who’s mothers had received RhIg? Thats what this study asked. The answer was:

Rh- status is no higher in mothers of children with autism than in the general population, exposure to antepartum RhIg, preserved with thimerosal is no higher for children with autism and pregnancies are no more likely to be Rh incompatible. This was also true for autism subgroups defined by behavioral phenotype, gender, IQ, regressive onset, head circumference, dysmorphology, birth status, essential, or complex phenotype

Of course, this answer didn’t suit SafeMinds Mark Blaxill. He released his usual pontificating crapola:

The study was funded by Johnson & Johnson, the largest manufacturer of RhIg products and the defendant in several lawsuits alleging a link between autism and mercury in RhIg. In an earlier 2005 poster presentation, the study authors acknowledged that the research was “supported by Johnson & Johnson Pharmaceutical Research,” but the University of Missouri press release omits mention of this conflict of interest.

Last I heard Marky, scientists don’t write press releases. Marketing depts do. As you yourself admit, when the poster version of this paper was presented, the *authors* (as oppose to the marketing dept) *did* acknowledge their funding. So, whats your point? That Missouri University Marketing dept. screwed up? Talk about a strawman.

And lets top beating around the bush here. If defendants in lawsuits can’t fund science, then why is it OK for prosecutors to fund science? If you want to go down the ‘conflict of interest’ route than that means Geier, Adams and a whole host of others who have already profited to the tune of several thousand pounds and who stand to profit even more should be equally discounted.

The press release headline falsely claims that the “Study Finds No Link Between Autism and Thimerosal in Vaccines.” The study is about Rh immune globulin, and immune globulins are not vaccines. “The headline deceives the public,” noted Mark Blaxill, director of SafeMinds. “It says an autism-mercury in vaccines link has been disproved when the research did not do so.”

Once again Marky – try and assimilate the difference between a press release and the actual paper. The paper’s abstract doesn’t mention the word vaccine until the very last sentence – and then only to point out thiomersal is also in vaccines. None of Blaxill’s point address _science_ at all. They try and make a strawman out of a press release. A press release the scientists who wrote this _paper_ no doubt had no control over whatsoever.

Blaxill then goes on to say that SafeMinds found numerous errors with the poster presentation but neglects to state what they were. Guess we should just trust them.

And if we want further verification of the non-link between the Rhogam issue then we should look no further than ‘Rh and ABO Maternal-Fetal Incompatibility and Risk of Autism‘ published in 2006 (Zandi et al) which states:

Moreover, some have speculated that RhD immune globulin injections may itself increase autism risk due to increased prenatal
exposure to thimerosal [Blaxill et al., 2004], an ethyl mercury containing vaccine preservative used in some formulations. The current findings do not support the hypothesis that the risk of autism is increased due to existing potential complications of maternal-fetal incompatibility with or without prophylaxis, nor do they appear to be consistent with the suggestion that the use of prophylaxis itself may increase risk.

Of course, SafeMinds don’t mention this as it clearly demonstrates the quackery that Blaxill wallows in.

And by the by, isn’t it incredible that for a group of people who are now claiming it never was _just_ about the thiomersal (See Brad Handley’s amazing feat of flip-flopping for details) they are certainly clinging on like grim death to that fallacy?

And hey – what about all those ‘other things’ (usually in vaccines) that ’cause autism’? Well, another recent study looked at just how well the practice of provoking reactions using a chelator (DMSA in this case) actually worked. ‘24-hour provoked urine excretion test for heavy metals in children with autism and typically developing controls, a pilot study.‘ looked at:

…Seventeen children with autism and five typically developing children were enrolled in a pilot study to test for chelatable body burden of Arsenic (As), Cadmium (Cd), Lead (Pb), and Mercury (Hg)

And the results?

Fifteen autistic children and four typically developing children completed the study. Three autistic subjects excreted one metal in greater quantity during the provoked excretion than baseline. Two of these were very close to the limit of detection. In the third case, the provoked excretion of mercury was between the upper limit of normal and lower limit of the potentially toxic reference range.

In other words – none of the kids, autistic or otherwise had clear progression into the toxic range of body burden of any metal. Three autistic kids had slightly higher results when DMSA was used to provoke than when it wasn’t. However, again, none was high enough to get into the toxic range. And as for the third autistic child, the team did one more thing:

Fish was removed from this child’s diet for greater than one month, and the provoked excretion test repeated. The repeat excretion of mercury was within the normal range.

Hilarious. The conclusion:

In the absence a proven novel mode of heavy metal toxicity, the proportion of autistic participants in this study whose DMSA provoked excretion results demonstrate an excess chelatable body burden of As, Cd, Pb, or Hg is zero.

Zero. None. Nada. Zip. Bugger all.

Lets hope that this pilot study is expanded upon and replicated.

And talking of chelation studies, Diva has some hot gossip regarding the fate of the NIMH chealtion study:

Dr. Swedo was running a chelation study at the NIMH until recently. The word, coming from a reliable source, is that the study has been shut down. This is good news, because it was a horrible study with horrible ethical problems and no legitimate scientific underpinnings. The study still appears on the clinicaltrials.gov page, but the link to the NIMH page is dead. So maybe the study rests in peace, too.

Last, but far from least, a fascinating theoretical study called ‘The Autism Epidemic: Fact or Artifact?’ has looked at the epidemic wankfest:

Using a prediction analysis, we calculate how broadening diagnostic criteria, younger age at diagnosis, and improved efficiency of case ascertainment could produce temporal trends in the incidence and prevalence of AD.

and what did they come up with?

Time trend studies report an increase as large as 11.0-fold over a 13-year period for AD. Conservative changes in the three methodological factors produced increases in the frequency of AD ranging from 2.1- to 28.8-fold

Interesting stuff. Hardly conclusive, but certainly food for thought. I can’t help but note that it comes from researchers at Columbia University. I wonder what that other CU employee Mady ‘they chewed through my skull’ Horning thinks about this study?

DAN! Doctors – The ‘other’ list

12 May

The eagle eyed amongst you will have noticed a new main menu entry at the top of this page between ‘wiki’ and ‘contact’ called DAN! Doctors.

This page contains a (worryingly long) list of some of the people with the loose honorific of ‘DAN! Doctor’ who are on the official ARI list. However, unlike the ARI list, this list will tell you the ‘other’ side of the happy-clappy hero’s of DAN! It contains notes on prosecutions, license suspensions, criminal acts and current investigations.

I can take absolutely no credit for the compilation of this list. It was handed to me by someone who wishes to remain anonymous.

This is a static page at the moment. In the near future, this page will move to its own domain and website and be driven by a database backend as it grows (as I’m sadly sure it will) however I wanted to get this up as quickly as possible.

The bottom line is that over 10% of DAN! docs (that have been looked at so far) have been in trouble. Trouble ranges from killing a patient, to paedophilia, to gross negligence to tax evasion. If you know a parent considering a DAN! doctor then make sure they read this list first. At the very least, even if they do decide to go ahead, they can avoid the bad guys.

Jenny McCarthy – Autism mum

5 May

As surely as day follows night, more and more loony ideas about autism and what it is will come along. Bad mothering, secretin, vaccines, TV…..and now…well…..

Jenny McCarthy is a US celebrity who has an autistic child. She also has a website that discusses her, uh, interesting stance on autism.

The day I found out I was an adult Indigo will stay with me forever. I was walking hand in hand with my son down a Los Angeles street when this women approached me and said, “You’re an Indigo and your son is a Crystal.” I immediately replied, “Yes!” and the woman smiled at me and walked away. I stood there for a moment, because I had no idea what the heck an Indigo and Crystal was, but I seemed so sure of it when I had blurted out “Yes!” After doing some of my own research on the word Indigo, I realized not only was I an early Indigo but my son was in fact a Crystal child.

A what? She’s an ‘Indigo’ and her son is a ‘Crystal child’???? what exactly are these things?

The Indigo child concept was first publicized in 1999 by the book The Indigo Children: The New Kids Have Arrived, written by the husband-and-wife team of Lee Carroll and Jan Tober. Carroll insists that the concept was obtained via conversations with a spiritual entity known as Kryon.

Wikipedia

The Crystal Children began to appear on the planet from about 2000, although some date them slightly earlier. These are extremely powerful children, whose main purpose is to take us to the next level in our evolution, and reveal to us our inner power and divinity. They function as a group consciousness rather than as individuals, and they live by the” Law of One” or Unity Consciousness. They are a powerful force for love and peace on the planet……The terms “Indigo” and “Crystal” were given to these two generations because they most accurately describe their aura colours and energy patterns. Indigo children have a lot of indigo blue in their auras. This is the colour of the “third eye chakra”, which is the energy center inside the head located between the two eyebrows. This chakra regulates clairvoyance, or the ability to see energy, visions, and spirits. Many of the Indigo children are clairvoyant

Starchild

Okaaaay.

And – of course – She’s anti-vaccine – what wingnut isn’t?

So why am I discussing Jenny McCarthy? It seems she’ll soon be doing a show on autism (she has a soon-to-be-released book to flog). I am sincerely hoping that people examine very carefully the sort of utter kook she is when this show airs (if it does) and consider her message – whatever it may be – in terms of the source beliefs that have inspired it.

Generation Rescue II – This Time It’s Vague

3 May

As already blogged by Steve and Orac, Generation Rescue have undergone a change in both website and message.

Up until this week and for the last two years, Brad Handley – GR Head Honcho has promoted a message quite unequivocal:

“Autism is treatable. It’s reversible. It’s nothing more than mercury poisoning,” said JB Handley, founder of Generation Rescue.

In fact, giving a reason for the redesign of the site on Orac’s blog, Brad said:

From my perspective, our website and its message have always been broader than “its ONLY mercury”…

Huh. Weird. Maybe its just me but I detect a teensy-weensy inconsistency between those two statements. Lets switch to the video!!:

And for the non-video-blessed amongst us, what Brad said was:

We immediately realised…and I think this is something that is a big surprise to people….um, that autism is a misdiagnosis for mercury poisoning.

Riiight. So let me see if I can summarise the position. When there is no science to have an informed debate about mercury, and when there’s lots of scary sounding stuff like ‘the Amish aren’t vaccinated and have no autism’ or ‘CDDS proves the epidemic’ floating around then the situation is:

“Autism is treatable. It’s reversible. It’s nothing more than mercury poisoning”.

Now that there’s no science to establish a causative link between mercury and autism, plenty of epidemiology to refute it and now that the first piece of science on the Amish has shown that actually they do vaccinate and that the penny has finally dropped, even for David Kirby, regarding CDDS’ inability to support the epidemic, what is the Generation Rescue position now? Lets see shall we?:

Our children are experiencing epidemics of ADD/ADHD, Asperger’s, PDD-NOS, and Autism. We believe these neurological disorders (“NDs”) are environmental illnesses caused by an overload of heavy metals, live viruses, and bacteria.

Wow. So we’re now no longer talking about just autism. We’re now talking about ‘neurological disorders’, including ADD/ADHD which is not even classed as being on the spectrum. That is quite some turnabout.

And look at this! Now, we’re talking about a _combination_ of causative agents: heavy metals (not just mercury any more), live viruses and bacteria.

Incredible. Makes you feel almost sorry for poor old mercury don’t it? Last week it was the Terror of the High Seas. Now it doesn’t even make it as a distinct causative agent.

The ‘live viruses’ is in there to placate the Wakefield Worshipers who think the MMR also (or in combination with mercury) caused autism. The ‘bacteria’ mention is I’m guessing a nod to the Martha Herbert theory of mold causing autism – a theory that was described thusly last time Martha took it to court:

Dr. Herbert’s publications indicate that she is an outspoken advocate of increased attention to the possibility of environmental influences. Even she, however, despite that acknowledged perspective, speaks in her published work of possibilities and potentialities, rather than of the ‘reasonable degree of medical certainty’ to which she offers to testify under oath in this case. Neither Dr. Herbert’s publications, nor any others cited, identify mold exposure as even a suspected, still less a known or proven, trigger of autism

Going back to MMR and taking a brief side journey for a minute, here’s the latest update from the Autism Omnibus proceedings. When last we left it, Petitioners had put forward one family as a ‘test case’ to see if the whole Omnibus proceeding had enough merit to proceed. There were supposed to be three. Awhile ago, the court told Petitioners to hurry up and identify the other two. They couldn’t. Respondents replied with:

The Court ordered the PSC to find two cases (similar enough to the first) to present the same basic theory of causation…..the essence of its (PSC’s) response is that it does not know of any case presenting the same causation issues as are implicated in Cedillo.

Ouch. How long has this been dragging on? Five years or something? And out of the 4,700 cases in the Omnibus no other case can be found to match the first one put forward. The only people who must be enjoying this are the lawyers.

Anyway, back to Generation Rescue.

Of particular note is the much vaunted, never seen ‘California-Oregon Unvaccinated Children Survey’ of described thusly by GR:

no studies have ever been done to compare neurological disorder (“ND”) rates of unvaccinated children to vaccinated children. We commissioned a national market research firm to survey more than 17,000 children in California and Oregon.

National market research firm eh? How very scientific. Researching popular chewing gum, researching autism causation. Yep, they’re the same. Souds very much like a a ‘convenience sample’ where people are called up. Here’s a friend of Brad’s describing what a convenience sample is and is not:

So. Not data according to David Kirby. Bummer.

Generation Rescue have also revamped their ‘Testimonials’ section. This is the section I looked at I August of last year and reached a (very) rough figure of a 5% success rate for the kids talked about on the GR site where ‘success’ is losing the diagnosis:

Out of these 59 success stories, just 3 describe their child as having been reclassified as no longer meeting a diagnosis of ASD. That’s a ‘recovery’ rate of 5%. Interestingly, one of these cases states they did not use chelation at all. That puts the Generation Rescue chelation success rate at a little over 3%.

Now, Generation Rescue have 76 ‘success stories’ (except they’re not called that any more, now they’re ‘testimonials’). Of that number, 6 claim full recovery with total loss of diagnosis. That’s a percentage of 7.8%. A heady leap of over 2%. Woo-hoo.

I was drawn to some of the newer testimonials, particularly the 6 year old ones as Meg only recently turned 7. One of them, about a girl called Liz was fascinating.

Our daughter Liz was diagnosed with low functioning autism at age three. We blamed the DTP vaccine which she had a bad reaction to. She would have very long lasting meltdowns, she would smear faeces, she would exhibit self injurious behaviour, she did not talk at all, she avoided eye contact and her only activity was that involving toys that spun. She walked on her tip toes and the doctor said she had a low IQ (below 70). We were told by mainstream medicine that she was ‘unreachable’.

Today Liz is six and after following biomedical interventions (and some other things) Liz will talk – on Christmas morning this year I went to wake her up and she said ‘good morning’ to me. She no longer smears faeces and is 99% toilet trained, she can write notes to people and knows all the letters of the alphabet and can count up to 40 unprompted. She can use a computer mouse unaided and has numerous favourite websites. The self injurious behaviour is vastly lessened, as are the meltdowns. Her eye contact is now perfect and overall her sensory issues seem 99% under control. She can drink out of a normal cup and use a knife, fork and spoon to eat whilst sitting at the table.

In so many ways, this is a different child.

Why was I drawn to this little girl so much?

Because it’s Megan’s story. I assumed a false name – Mr Clarence House – and emailed it to the Generation Rescue site. ‘Clarence’ received an email saying it was going to be on the new site which I was very happy about.

All of it is true except the name. The biomedical treatments I was talking about were multi vitamins, fish oil and a steroid inhlaer for her asthma. The ‘other things’ were love, acceptance, patience and education.

Why do this? To prove a point. You can make anyone’s story fit your own beliefs if you twist it hard enough.

Don’t worry, if it disappears I took a loving screenshot.

Brad Handley has tried to shift his goalposts as his first guess wasn’t working out. As evidenced above, he has latched on to items that are equally silly. As evidenced above he is incapable of seeing autism. He only sees mercury. As evidenced above, improvement is not limited – or even related to – detoxification of heavy metals.

Lisa Sykes and Paul King: CoMed with a silent ‘y’

17 Apr

One of the more extreme quackery groups formed post-EoH is CoMed (the ‘y’ is silent) which is run by the Rev Lisa Sykes and Dr Paul King recently emailed a large group of people with a PDF Press Release that tried to make the case that autistic children were proven to be clinically mercury poisoned.

How did they reach this earth shattering conclusion? By stating that two papers and one methodology backed them up. Have a read of the document – its a fascinating example of how the militia attempt to ‘spin’ the reality of the situation and try to make things sounds like a given. Note the silent switch about halfway through from talking about ‘mercury’ in general to talking about ‘vaccines’ in particular.

Anyway, Sykes and King were good enough to note only post this press release on EoH but also to tell the group exactly who they had emailed – a motely crew, ranging from fellow whacko’s like David Ayoub to Governer Arnie “I’ll be back” Schwarzenegger, plus a host of journalists, lawyers etc.

So, I thought I’d better put these poor people straight and consequently sent them a letter. This is what I sent them:

Dear Madams and Sirs,

Firstly, please accept my apologies for the unsolicited email. I hope it is not intrusive.

I wanted to write to you as you were the recipients of a recent email/PDF press release from the group ComEd regarding their belief that ‘Autistic Children Clinically Proven Mercury Poisoning’. I wanted to offer an alternative to this erroneous belief. I will cite any references I make and I promise to keep this brief.

The ComEd press release uses two studies[1,2] and a technique as the ‘mainstay’ of its certainty that autistic children are clinically proven to be mercury poisoned.

The Geier paper [1] is an attempted replication of the Nataf paper [2] and suffers from its same substantial drawbacks.

Issue one: The role of precoproporphyrin.

Nataf et al claim that the presence of elevated precoproporphyrin is a specific indicator of mercury toxicity. They do this on the basis of three studies produced by one author[3,4,5]. When these studies are read properly, if we ask the question “Does exposure to heavy metals cause a relative elevation for certain porphyrin compounds in urine?” the answer would appear to be “Yes.” However, If we ask the question “Is the presence of certain urinary porphyrin compounds a specific indicator of heavy metal toxicity?” the answer would have to be “No”[6]

The Woods papers are interesting but far from conclusive enough for the Nataf and consequently Geier papers to reply on.

Issue two: Creatinine and the subsequent UPPA technique

In their press release ComEd claim that the UPPA (urinary porphyrin profile analysis) technique is a ‘highly accurate’ method of determining toxicity. Indeed, it is the method used by the Nataf and Geier papers. In this method, the urine of children is collected and analysed for the presence of porphyrin’s. If they are elevated then QED: the children must be metal poisoned.

Except its not as simple as that. The content, volume and dilution of urine varies considerably from patient to patient. The way around this issue is to measure a secondary constant element from the urine and compare the amount of porphyrins found against the amount of this compound and express the result as a ratio. This is what Nataf, Geier and the UPPA technique does. It utilises creatinine – a constant in urine – to provide a baseline figure and thus get an accurate percentage of porphyrins.

This is a standard way of measuring compounds in urine. The only issue is found when the population in question (autistic children in this case) are known to have significantly low levels of creatinine. Obviously, this would skew the results considerably and present a false reading of elevated porphyrins.

Is there recorded instances of low creatinine in autistic kids? It seems that there might be.

“Spot urinary creatinine excretion in pervasive developmental disorders” published in Pediatrics International[7], reports low creatinine levels in PDD:

a significant decrease in urinary creatinine concentration was found in the PDD group compared to controls using a Mann–Whitney two-tailed ranks test.

Of course, this just one study. Its a good start but thats it. But maybe its interesting that the group of maverick DAN! doctors (of whom one is treating Rev Sykes of ComEd’s autistic son I believe) also find low creatinine in autistic kids[8]:

“”Creatinine is often found to be marginal in the urine of autistics, and low creatinine can skew urine analyte results to high levels. So, also take note of creatinine levels if the laboratory results include ratioing to creatinine.””

I engaged in an email exchange with Professor Richard Lathe, secondary author of the Nataf paper[2] regarding the study his group had published and I questioned him at length regarding this creatinine issue. He said:

1.There was no significant decline in urinary CRT levels in any of the autism groups, though there was a non-significant trend to a reduced level. 2. Reduced CRT, and increased porphyrin, both appear to be markers of environmental toxicity.

However, neither of these observations were reported in the published paper. Lathe described it as ‘pointless’ to publish all data. I disagreed with him citing the uncertainty over creatinine levels and he conceded:

The long and short of it is that the response of CRT to different levels of heavy metal toxicity has not been studied adequately.

Which is a troubling statement considering that his paper required CRT to be well understood and to be functioning as described in order for the science in the paper to be accurate.

Lathe also conceded that other key parts of his paper (and consequently the UPPA method) were in doubt and relied on science that had been refuted and thrown out of court when attempted to be used in private prosecution[9]

The UPPA method has been in use for some time amongst adherents to the theory that mercury poisoning (notably from vaccines) causes autism. I have found numerous emails to a private access Yahoo Group called ‘chelating2kids’ which details peoples experiences with this method. Here are just three.:

1: “A fellow listmate had her son tested twice– once over the summer which showed he had no elevated metals, and one this fall that showed he did indeed have elevated metal levels. She has sent an email to the lab asking about the differing results and has not received a response. I believe she is still trying to contact them”

2: “FWIW, my neighbor’s dad happens to be a porphyrin specialist here in Boston (believe it or not– how many of those are there??). He reviewed lots of info for me– Nataf’s paper, my son’s results that showed very elevated metals across the board– and said he would have rejected the paper for publication had he been asked to review it. He said that fecal, not urine, should be used to measure the porphyrin levels. I sent an email to the lab inquiring about this and also received no response”

3: “I just received the results of the French porphyrin test for myself and my 7 year old NT [NeuroTypical – i.e. non autistic] daughter, and the results also show severe lead and mercury toxicity. My daughters numbers are worse than my ASD son!”

In closing, I would suggest that any assurances that mercury poisoning as a causative agent of autism are even likely, let alone ‘clinically proven’ should be taken with a very large grain of salt. I would also suggest that Rev Sykes role as an anti-vaccine activist and vaccine/autism litigant[10] are taken into account when considering the validity and motives of this press release.

Thanks for listening. My motive for writing this email is that, as parent to a severely autistic seven year old girl, I am sick to death of hearing bad science and media-driven misrepresentations attempt to coerce from autistic people what they truly need – decent, peer reviewed science which lead to good educational interventions for all autistic people. Thanks again.

References

[1]PubMed
[2]PubMed
[3]PubMed
[4]PubMed
[5]PubMed
[6]NotMercury
[7]Ingenta
[8]Google Cache of DAN! site
[9]Me
[10]Neurodiversity.com

I’ve had a number of fascinating responses, but my far and away favourite response was:

thank you for your email it has made it easier to apply you to my junk filter even though the junk file is far to good for the likes of you sir.

Which I received from one David Ayoub MD. The same man I publicly challenged to a web based debate less than two weeks ago on a third party letters page and who backed down.

Update: 18th April 2007

Dr King of CoMed produced a response to my rebuttal. You can read that here. and I couldn’t resist one more frolic through the CoMedy logic,as you can read here.

Autism, Chelation and Quackery

15 Apr

Mercury Mum, Christine Heeren recently posted a video of her son receiving IV chelation on YouTube.

UPDATE: Shortly after this blog post went live, the YouTube video disappeared. Luckily I had already grabbed a copy which you can view here:

http://video.google.com/googleplayer.swf?docId=-5984127405622843714&hl=en-GB

Its a disturbing video on many levels. Heeren’s son has been undergoing chelation for seven months now and is still clearly totally autistic. During this video he is apparently writing ‘bus numbers’ down. The blog that Ms Heeren keeps (link on YouTube page) also makes it clear that her son still stims and he displays many common outward signs of autism (the scrunching up of the eyes at the start of the video reminds me of something my daughter does very much).

Heeren is subjecting her son to the Buttar protocol which should give anyone the stone cold heebie jeebies in and of itself. One patient of Buttar’s said that:

I find that Dr. Buttar talks a lot but produces little evidence.

And another said:

All the information about Dr. Buttar is still on this site but I no longer am one of his patients and I do not recommend him to any one for any reason. If you go to him for treatment BEWARE, BEWARE and read Roger Mason’s books first and go to QuackWatch.org first!

However, maybe we should take some kind of solace from the fact that Heeren’s doctor is not actually Buttar himself, only trained by Buttar. Maybe he’s a good doctor.

Heeren’s doctor is Muneer ImamMuneer Imam a shy, kind looking man wouldn’t you agree?

Well, he may well be.

In Jan 1993, the New York Office of Professional Conduct charged Muneer Imam:

…with gross negligence, gross incompetence, negligence on more than one occasion and failure to maintain adequate records.

The Hearing Committee sustained the charges of negligence on more than one occasion, incompetence on more than one occasion and failure to maintain adequate records. The Hearing Committee found Imam guilty of careless practice, lack of attention to detail and failure to appreciate the severity of patient illness

The incidents have included at least one death of a patient under the care of Imam.

The Hearing Committee (incredibly in my view) said he could probably be rehabilitated and laid out a plan of rehabilitation.

This all took place under Imam’s work at an ER. Imam no longer does ER work. I asked a medical friend about why that might be and xyr response was:

Since he no longer seems to do ER work, I imagine he settled a med mal claim for deceased patient A, and his insurer refused to write coverage for ER work and no hospital would cover him

Is this really someone any parent would want to trust with the kids life? A doctor found to be incompetent, negligent and who doesn’t pay attention to detail?

This inability to pay attention to details certainly seems to be playing out on Heeren’s video. Here is Imam’s nurse (a Vietnam vet called Nick) fitting the IV for a course of chelation.

No sterile

When I showed this to my medical friend xyr response was horrified:

WTF is this alleged nurse doing starting an IV without gloves??? What happened to sterile technique? Have they lost their minds?

and

What is this alleged nurse doing using that frigging tiny gauge needle???

It seems that the chelation protocol Buttar uses specifies a 22 gauge butterfly needle, not the tiny one seen in the video. There are good reasons why:

…..because this is the easiest to use for employees with no medical training who call themselves “chelation technicians.” The tiny needle also serves to prevent patients from killing themselves by increasing the drip rate when they’re sick of sitting around for hours. Increasing the drip through a 22 gauge butterfly needle should (in theory) burst the vein before delivering Endrate at a lethal rate. Clever stuff.

While almost everyone can start an IV with this tiny needle, it’s dangerous to use for chelation because if patients get into trouble you want a large bore needle inserted in case you need to administer drugs and fluids for treatment or god forbid, resuscitation. Starting a second IV with an appropriate size needle in a patient in circulatory collapse from shock is difficult and sometimes impossible. The daunting prospect of starting an IV in the jugular makes sane physicians do everything to avoid being in this position.

Administering a bolus of calcium gluconate to counteract hypocalcemia through this tiny needle can result in a swollen hand (when the IV infiltrates) attached to a dead patient.

So – Nick the Nurse also has incompetence issues.

At one point in this video I thought I had gone mad. Did my ears deceive me or did I really hear Nick the Nurse describe how they also chelated with vinegar and garlic? I rewound the video. Yep, he said it alright. Vinegar and Garlic. I could say ‘wow’ or ‘holy crap’ to express my incredulity after hearing that but really, no words do it justice. They are chelating this poor lad with Garlic and vinegar.

And why? What for? First test

Here is Heeren’s son’s first ever lab report (click the image to get a bigger one).

Let’s remember that these lab reports are all part of the quack culture and I suspect are frequently exaggerated to get the parent to use more of their treatments. If even these results are exaggerated then I’m dumbfounded. Everything except Aluminium and Lead are within normal ranges. And even those two are just barely in the elevated range.

It is on this basis that Heeren decided to start chelating her son using a doctor described as medically negligent and incompetent under the tender care of a ‘nurse’ who doesn’t know the protocol he is supposed to be using and who is actively putting this boy (and presumably others) in potential danger.

Oh and don’t forget the garlic and vinegar. Thanks Rashid, thanks Muneer, thanks Nick.

MMR and Autism – 2007 is the year

1 Apr

This year, the Autism Omnibus hearing in the USA will examine the idea that MMR causes autism. They will do this by taking one of the plus 4,500 cases and looking at it as a ‘test case’. The case in question is the Cedillo family, mother Theresa (just a coincidence), father Michael and daughter Michelle.

The document above by the way establishes that they want the evidence they accumulate to be open to the other families but that they do not want the identities or the evidence of their expert witnesses to be made available online. I wonder why. If I may be so egotistical, it could have something to do with the fact that several bloggers have trounced both the data and the experts and they don’t want this happening any more.

Anyway. What do we know about the Cedillo’s?

We know that Michelle’s bioposies were examined by Professor O’Leary, one time colleague of Andrew Wakefield who went on to have his own results seriously questioned and who went to say:

Professor John O’Leary, who did the tests for solicitors representing the families of autistic children, said his scientific findings “did not support the MMR/autism hypothesis”.

We also know that Michelle was seen by Arthur Krigsman, who, despite claiming to replicate Wakefield’s discredited Lancet paper has had no papers on autism, or vaccines published at all. What he has had however, are numerous close calls with licensing bodies – in one instance he had to resign in order to escape official investigations into his conduct.

And what do the Cedillo’s believe has happened to Michelle?

We just found out the left hind foot bones in Michelle’s foot are deformed. Instead of being one on top of the other, they are growing side by side. Michelle is on pain meds nearly around the clock. She limps and walks with a side to side gait instead of forward like normal. This was caused by the Crohn’s associated arthritis (confirmed independely by 2 orthopedic spec and a ped rheumatologist AND Dr. Krigsman and Dr. Wakefield), which was caused by the Crohn’s disease caused by the vaccine strain measles RNA found in her bowel tissue from the MMR. Michelle gets periodic ocular inflammation – also from the Crohn’s disease. This gives her headaches.

Its terrible that such a young girl is in so much discomfort. But looking past that and concentrating solely on the science, we see that the Cedillo’s believe that Michelle contracted Crohn’s disease brought on by the measles element of the MMR.

So – Crohn’s _and_ autism? Searching VAERS, I find only seven cases that refer to ‘crohn’ and had the MMR vaccine. That’s pretty rare.

Even those who might be expected to support the MMR/autism hypothesis don’t. In an email to the Autism Biomedical Group on March 08, 2004, Vice President of SafeMinds Mark Blaxill stated:

epidemiological evidence (albeit from studies that have not carefully considered interaction issues), have not supported the broader proposition that “MMR causes autism.”

I will be very curious to see exactly who their experts are and what their evidence will be. If it really is, as I suspect, Andrew Wakefield, then they won’t be able to choose a worse time to invoke his ‘expertise’. Wakefield’s hearing at the GMC starts at about the same time.

Here’s a beginners guide to the MMR/autism hypothesis and what Wakefield claims to have found. The hypothesis states that the MMR vaccine, being a live vaccine, leaves bits of live Measles virus in the gut. Wakefield claimed to have found it there. This goes on to trigger autism.

No part of this hypothesis has ever been replicated and published in a decent journal. Wakefields closest colleague – Krigsman – has been unable to find a publisher for his ‘replication’ which indicates the quality of _his_ science. As reported above John O’Leary claimed to have replicated Wakefield’s work but it turned out there was a good chance his data was contaminated and he later stated none of his work showed a connection. Various epidemiological studies have also failed to find any link (as Mark Blaxill admits).

We also have two clinical science papers that demonstrate convincingly that Wakefield did indeed make a substantial error. One Paediatricsin Pediatrics was very damning:

The real-time assays based on previously published primers gave rise to a large number of positive reactions in both autism spectrum disorder and control samples.

Translation: We replicated Krigsman/Wakefield etc to their end point and there were lots of measles virus just like they said.

Almost all of the positive reactions in these assays were eliminated by evaluation of melting curves and amplicon band size.

Translation: We did the science properly just like they didn’t. When we did most, but not all of the positive reactions disappeared.

The amplicons for the remaining positive reactions were cloned and sequenced. No sample from either autism spectrum disorder or control groups was found to contain nucleic acids from any measles virus gene.

Translation: When we looked at the rest of the very small number of positives we had left we found no measles virus in any of them.

In the nested polymerase chain reaction and inhouse assays, none of the samples yielded positive results. Furthermore, there was no difference in anti-measles antibody titers between the autism and control groups

Translation: We double checked our methods and tools and there were now _no_ positive reactions at all. Further more, just for clarity – there were none in our non autistic people _or our autistic people_.

It’s going to be very, very difficult for the Cedillo’s to overcome this.

Now, closer to home (for me anyway), there are a couple of new papers that discuss what impact the MMR really _did_ have on people. Here’s some real evidence of harm.

In “Tracking mothers’ attitudes to MMR immunisation 1996–2006“, we hear the alarming statistic of how much damage Wakefield et al did to the UK MMR program:

The proportion of parents believing MMRto be a greater risk than the diseases it protects against has fallen from 24% in 2002 to 14% in 2006. The proportion of ‘hard-core rejectors’ of MMR vaccine remains stable at 6%. There has been a gradual and sustained increase in the proportion of parents across all social groups saying MMR was completely safe/slight risk rising from 60% in 2002 to a current level of 74%. There now appears to be a sustained move away from fears over MMR safety and belief in the unfounded link to autism towards a more positive perception of the vaccine.

It a relief that the authors believe there is a sustained move back towards a more rational state of mind regarding MMR but its incredible that 24% of people ever believed that MMR was more risky than the diseases it protected against.

Its no surprise then, that in the years 1997/98 – 2004/05, MMR uptake dropped by a massive 10%. Of interest, when comparing that _fall_ in MMR uptake is the epidemic rhetoric that claims autism is sweeping the UK too. Both things can’t be true. If MMR causes autism then however one paints the stats, there should’ve been a 10% fall in autism.

One group of people truly have suffered through this period. They have been the front line recipients of the bad science of Wakefield et al: parents of autistic kids.

In the new paper, “MMR: marginalised, misrepresented and rejected? Autism: a focus group study“, investigators interviewed parents of autistic kids:

Of the parents whose children received the MMR vaccine, many felt guilty that they may have caused or contributed to their child’s autism. Some parents felt frustrated by health professionals’ lack of understanding of the negative impact the MMR controversy has had on them. Some parents were anxious about subsequent MMR decision-making for their children.

This is the legacy of Andrew Wakefield. Parents who are guilt ridden and unsure who to turn to. The study conclusions state:

The controversy has had a negative impact on some parents of children with autism. This has implications for health professionals, who need to be particularly aware of the issues these parents face in future MMR decision-making for their affected child and younger siblings.

These focus group discussions produced moving and often emotional accounts of parents trying to come to terms with their child’s diagnosis of autism against a backdrop of widespread public speculation about the role of the MMR vaccine in the aetiology of autism.

As Jim Sinclair states in his essay ‘Don’t Mourn For Us’:

Some amount of grief is natural as parents adjust to the fact that an event and a relationship they’ve been looking forward to isn’t going to materialize. But this grief over a fantasized normal child needs to be separated from the parents’ perceptions of the child they do have: the autistic child who needs the support of adult caretakers and who can form very meaningful relationships with those caretakers if given the opportunity.

The parents in these focus groups (and remember these people were interviewed when the MMR conspiracy theory was still well underway) never had a chance to move past the natural adjustment period and on to acceptance. When the media and ‘scientists’ continue to express certainty despite having absolutely no evidence that MMR causes autism its hard to get past the guilt. I know. That’s how I felt as well.

Parents often spoke angrily about how the MMR controversy had impacted on their lives. Even parents who stated that their
child’s autism was entirely genetic in origin felt affected by the uncertainty about the causes of autism which were heightened
by the controversy. For example, one mother who thought her son had been born with autism nonetheless found the speculation surrounding MMR upsetting, and stated that: … it makes you feel pretty damn rotten. I feel as if at the time I did the best for my boy… I wouldn’t have put my child through anything that I think would harm him. (G1: P3)

Thanks again Andy.

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