National Vaccine Information Center

January 5, 2007

Barbara Loe Fisher
204 Mill St., Suite B1
Vienna, Virginia 22180

Arthur Allen, Author
W.W. Norton & Co., Inc.
500 Fifth Avenue
New York, New York 10110

Dear Arthur:

First, congratulations on the publishing of your book, Vaccine: The Controversial Story of Medicine's Greatest Lifesaver. It is a formidable book and reflects years of hard work.

I appreciated receiving a complimentary copy of the book on Dec. 29, 2006. However, I am very disappointed you did not allow me to read Chapter Seven for factual errors prior to printing.

In 1998, you wrote your first article about vaccination which was published in The New Republic. In it, you state:

"Fisher's oldest son, now 20, suffered a seizure and became learning disabled after his fourth DPT shot in 1979. 'The afternoon after the shot I went up to his room, and he was sitting in his little chair, staring straight ahead,' she says in an interview. 'I held him, and he pitched forward, with his eyes rolling around in his head. Later that night he had terrible diarrhea and then he slept and I couldn't wake him. He's never been the same."

You get the year wrong (it was 1980, not 1979) but you do accurately state it was my son's fourth DPT shot; come reasonably close to describing some of the neurological symptoms I witnessed Chris suffering within four hours of his vaccination; and his vaccine injury is acknowledged.

In January 2001 I was asked by the Institute of Medicine ((IOM) to make a statement to the Immunization Safety Review Committee. This public statement is posted on the homepage of NVIC's website (www.nvic.org). Following are excerpts in which I describe the acute neurological symptoms my son suffered within hours of his fourth DPT shot:

"In 1980, my son, Chris, was a healthy, cheerful, exceptionally bright two and a half year old child. A lively, contented baby who loved to be around people, he had begun saying words at seven months and speaking in full sentences at age two. At two and a half, he could identify the upper and lower case alphabet and numbers up to 20 and was beginning to identify words in the books we read together. He had memorized the deck of cards and created an interactive naming game he would play. One doctor told me he was cognitively gifted.
After his third DPT shot at seven months of age, there was a hard, red, hot lump that stayed at the site of the injection for several weeks. When I called my pediatrician's office, the nurse told me it was "a bad lot of DPT vaccine" but not to worry. My response was to ask "Should I bring him down for another one?" because I thought she meant the shot might not have been strong enough and I wanted my baby protected.
The day of his fourth DPT and OPV shots, Chris was healthy except for slight diarrhea that was left over from a 48 hour bout with the stomach flu he had at the beach three weeks earlier. The nurse giving him the shots said he didn't have a fever and that a little diarrhea didn't matter.
When we got home, Chris seemed quieter than usual. Several hours later I walked into his bedroom to find him sitting in a rocking chair staring straight ahead as if he couldn't see me standing in the doorway. His face was white and his lips slightly blue, and when I called out his name, his eyes rolled back in his head, his head fell to his shoulder and it was like he had suddenly fallen asleep sitting up. I tried, but could not wake him. When I picked him up, he was like a dead weight and I carried him to his bed, where he stayed without moving for more than six hours, through dinnertime, until I called my Mom, who told me to immediately try to wake him, which I finally did with great difficulty. But he didn't know where he was, could not speak coherently and couldn't walk. I had to carry him to the bathroom and he fell asleep again in my arms and then slept for 12 more hours.
This was 1980. I had been given no information by my doctor about how to recognize a vaccine reaction.
In the following days and weeks, Chris deteriorated physically, mentally and emotionally. He no longer knew his alphabet or numbers and would not look at the books we had once read together every day. He had no interest in his beloved deck of cards and had lost the ability to concentrate for more than a few seconds at a time. My once happy-go-lucky little boy was now listless and emotionally fragile, crying at the slightest frustration as if his heart would break.
Physically, the deterioration was just as profound. He had constant diarrhea that looked like attic foam insulation, became emaciated, stopped growing and was plagued with respiratory and ear infections for the first time in his life. Sometimes I would catch him staring and drooling slightly from one corner of his mouth. My Mom used the term "spaced out" to describe him. The pediatrician told me it was just a stage he was going through and not to worry about it. But after eight months of deterioration, I decided to take Chris to another pediatrician, who took one look at him and told me he might have either cystic fibrosis or celiac disease. All diagnostic tests came back negative. None of the doctors knew what was wrong with my son, who had become an entirely different child physically, mentally and emotionally."
In April 2001, you interviewed me for a Q&A feature published in the May 6, 2001 New York Times Magazine. Following is the text for that article in which you include an abbreviated but accurate description of the acute neurological reactions I witnessed within hours of my son's fourth DPT shot (underlined):
The New York Times Magazine, May 6, 2001
QUESTIONS FOR BARBARA LOE FISHER
by Arthur Allen
A Shot in the Dark
The president of the National Vaccine Information Center argues that we don't know nearly enough about a procedure that almost all American kids undergo.

Q: Many people consider vaccination one of the great medical successes of the 20th century. Do you disagree with that assessment? Certainly with the implementation of mass-vaccination policies in the last 40 years we've seen a decline in infectious diseases of childhood. However, we have at the same time seen a doubling of asthma and learning disabilities. A tripling of diabetes. Autism is affecting one in 500 children. We need to look at whether an intervention used with every child is perhaps contributing to the background rate of chronic disease or disability.

Q: The F.D.A. says that in most of the cases, there's no way to prove a connection between a vaccine and the adverse reaction that's attributed to it. How much of a case can be made? Less than 10 percent of all doctors report serious health problems following vaccination, and the F.D.A. doesn't have the money or staff to investigate the ones that are reported. So we don't really know. It's scientifically and ethically irresponsible to write off most of these injuries as "coincidental" to vaccination when the government has funded very little research into biological mechanisms of vaccine injury and death.

Q: Take autism. It seems to be on the rise, and there's a theory that the measles-mumps-rubella vaccine can trigger it. But several recent studies show that reports of autism are rising in areas where M.M.R. vaccination rates remain steady. Isn't this proof that vaccines are not to blame? We have never felt the M.M.R. was the only vaccine implicated in autism. The larger question is whether there is a group of genetically or biologically susceptible children who not handling the ever-increasing number of vaccines. If you have biologically susceptible children and give them three vaccines, that may not trigger dysfunction. But if you give them 37 doses of 11 different vaccines, including M.M.R., you could be creating a larger and larger group of genetically susceptible children, tipping them into neuroimmune dysfunction.

Q: You're not a doctor, but you are an established expert on this topic. And you have three children. Did you have them vaccinated? How did you make that decision? In 1980, my healthy, precocious 2 1/2-year-old son suffered a convulsion, went into shock and lost consciousness for six hours a few hours after his fourth DPT shot. He was left with minimal brain damage that took the form of learning disabilities and attention deficit disorder. In 1982, I joined with other parents of vaccine-injured children and founded the National Vaccine Information Center with the goal of preventing vaccine injuries and deaths through public education and safety reforms. I got my second and third children all their vaccines with the exception of whole-cell pertussis -- because it had hurt my oldest son. At age 4, my younger son developed a pseudo-tumor of the brain after getting two other vaccines. Thankfully there was no permanent damage. In 1993, he and my 5-year-old daughter both got whooping cough. She had a particularly bad case; she coughed until she was blue in the face. It was terrifying. After these experiences, I don't underestimate the effects of infectious diseases or vaccine reactions on young children.

Q: But in recent years outbreaks of just those infectious diseases have been attributed to pockets of unvaccinated children - including those who were not vaccinated on principle. Does it worry you that your message of personal choice might be contributing to the spread of these diseases? Many of those outbreaks are not solely in unvaccinated children. You're seeing organisms that are becoming resistant to the vaccines no matter how high the vaccination rate is. It's not just the less than 1/2 of 1 percent who choose not to vaccinate who are causing outbreaks.

Q: Still, isn't discouraging vaccination more harmful than the occasional bad reaction? The vaccine-safety and informed-consent movement has never been about telling parents not to vaccinate. We're pro-education and pro-informed consent, not antivaccine. There is a difference. It is immoral to write off an unknown number of children as expendable in the name of the greater good to justify public health policy.
On May 10, 2002, I spoke at the Defeat Autism Now (DAN) Conference in Boston, a speech which was taped and is publicly available. During the speech, I played a tape for the audience of a live debate I had on the Today Show in 1997 with Neal Halsey, M.D. in which I described my son's vaccine reaction as a convulsion, collapse/shock and state of unconsciousness. Following is an excerpt from the 2002 DAN speech in which I describe my son's acute neurological symptoms and subsequent health deterioration and regression after his fourth DPT shot:
"As you heard on the tape, I am the mother of a son, my first-born, who was left with minimal brain damage after he suffered a convulsion, collapse-shock and state of unconsciousness within four hours of his fourth DPT and OPV shots at age two and a half. The daughter of a nurse and a medical writer at a teaching hospital before I became a mother 24 years ago, I thought I was an especially well educated woman when it came to science and medicine.

But, like most new mothers, I had no idea that vaccines carried any risk whatsoever. I'm not sure why I assumed vaccines were risk free, when I certainly knew that drugs and surgery entailed risks. Perhaps it had to do with the fact that vaccines are supposed to keep well people well. The concept of risk associated with a prevention is quite different from the concept of risk associated with a cure. At any rate, I believed vaccines were 100 percent safe and effective until my son, Chris, became a vaccine reaction statistic.

I am relating my experience because it is typical of the experiences we hear from parents every day, who describe how their once healthy children became chronically ill following vaccination. Whether the vaccine reaction results in minimal brain damage, as was the case with my son, or more severe and profound brain damage, as is the case with those children who have been awarded nearly two billion dollars in compensation under the National Childhood Vaccine Injury Act of 1986, there is a pattern and common experience that emerges. And that pattern and commonality of experience, reinforced over and over again with almost every vaccine reaction report, has contributed in no small way to why the vaccine safety issue will not go away, despite the concerted efforts by industry, government and medical organizations to convince the public that, when acute and chronic health problems follow vaccination, it is always just a coincidence.

Today's college educated, internet-saavy health care consumer, who becomes a parent and whose child gets sick and regresses after vaccination, has the opportunity that I did not have as a young mother in the 1980's to more quickly obtain information and then communicate with other parents who have shared the same experience. Like the biotechnology revolution, the mass communications revolution has created a global network that shines a bright light on commonality of experience and gives immediacy and relevancy to it. That will continue to be true, even if government, industry and science continue to minimize the significance of that common experience.

In 1980, my son, Chris, was a healthy, exceptionally bright two and a half year old child. A lively, contented baby, he had begun saying words at seven months and speaking in full sentences at age two. By two and a half, he could identify the upper and lower case alphabet and numbers up to 20. One doctor told me he was cognitively gifted.

After his third DPT shot at seven months of age, there was a hard, red, hot lump that stayed at the site of the injection for several weeks. When I called my pediatrician's office, the nurse told me it was "a bad lot of DPT vaccine" but not to worry. My response was to ask "Should I bring him down for another one?" because I thought she meant the shot might not have been strong enough and I wanted my baby protected.

The day of his fourth DPT and OPV shots, Chris was healthy except for slight diarrhea that was left over from a 48 hour bout with the stomach flu he had at the beach three weeks earlier. The nurse giving him the shots said he didn't have a fever and that a little diarrhea didn't matter.

When we got home, Chris seemed quieter than usual. Several hours later I walked into his bedroom to find him sitting in a rocking chair staring straight ahead as if he couldn't see me standing in the doorway. His face was white and his lips slightly blue, and when I called out his name, his eyes rolled back in his head, his head fell to his shoulder and it was like he had suddenly fallen asleep sitting up. I tried, but could not wake him. When I picked him up, he was like a dead weight and I carried him to his bed, where he stayed without moving for more than six hours, through dinnertime, until I called my Mom, who told me to immediately try to wake him, which I finally did with great difficulty. But he didn't know where he was, could not speak coherently and couldn't walk. I had to carry him to the bathroom and he fell asleep again in my arms and then slept for 12 more hours.

This was 1980. I had been given no information by my doctor about how to recognize a vaccine reaction.
In the following days and weeks, Chris deteriorated. He no longer knew his alphabet or numbers and would not look at the books we had once read together every day. He couldn't concentrate for more than a few seconds at a time. My once happy-go-lucky little boy was now listless and emotionally fragile, crying at the slightest frustration.
Physically, the deterioration was just as profound. He had constant diarrhea, stopped growing and was plagued with respiratory and ear infections for the first time in his life. The pediatrician told me it was just a stage he was going through and not to worry about it. After eight months of deterioration, diagnostic testing cystic fibrosis, celiac disease and other conditions all came back negative. None of the doctors knew what was wrong with my son, who had become an entirely different child physically, mentally and emotionally.
It would be another year before I saw the TV documentary "DPT: Vaccine Roulette," began research into the medical literature and found clinical descriptions of pertussis vaccine reactions in the pages of Pediatrics, the New England Journal of Medicine, The Lancet, and British Medical Journal which exactly matched the pertussis vaccine reaction symptoms I had seen my son suffer within four hours of his fourth DPT shot."
Another detailed description of the neurological and systemic vaccine reaction symptoms I witnessed Chris suffer after his fourth DPT shot is also contained in the October 2004 issue of Mothering Magazine in a feature article I wrote, which was available on newsstands and is also publicly posted on our website.
On page 253 of your book, you (1) incorrectly describe the symptoms my son suffered after vaccination; (2) incorrectly attribute those factually incorrect descriptions to me; (3) imply I cannot identify a DPT vaccine reaction and (4) suggest to the reader that my son is not vaccine injured:

"In 1980, on the afternoon after his third DTP shot, as Fisher has recounted in many interviews and speeches since then, she walked into Chris's room to find her son staring vacantly into space. She picked him up, talked to him, took him to the bathroom, but Chris remained foggy for the better part of the next 24 hours. Fisher would come to believe that the shot had overwhelmed his immune system, although the symptoms she described were typical of the shocklike state that occasionally occurs after DTP and which safety studies indicate rarely has long term repercussions."

Following are the factual errors in your description of my son's vaccine reaction, which you magnify by incorrectly attributing them to me:

1. It was not my son's third DPT shot, which he received at seven months, but his fourth DPT, which he received at age two and a half years old. (You also incorrectly stated that Kathi Williams' son reacted after his second DPT shot, which he received at four months, rather than his fourth DPT shot, which he received at 18 months. You also incorrectly stated that her son was treated with homeopathy by Catherine Coulter, which he was not. It was my son who received care from Mrs. Coulter.)

2. The reader of your book does not understand that staring vacantly" lacks the fact that my son's face was white and his lips blue and that I witnessed his eyes rolling back in his head and his head falling to his shoulder in a collapse; "picked him up" lacks the fact that he felt like a dead weight in my arms; "talked to him" did not occur until I woke him up with great difficulty after six hours of unresponsiveness and he mumbled incoherently and could not sit up or walk unassisted; and "remained foggy for the better part of the next 24 hours" was how you characterized the nearly 18 hour state of unconsciousness that was interrupted briefly when I awakened him after six hours.

Quoting again from my 2001 IOM presentation, which is a matter of public record:

"If I had not walked into my child's room when I did, I would not have witnessed the post-pertussis vaccine convulsion, collapse shock and six hour state of unconsciousness which, not counting the few minutes I was able to rouse my son to a state of semi-consciousness, was actually an 18 hour state of altered consciousness. If Chris had been a four month old baby and not a precocious two and a half year old, the regression he underwent following vaccination may not have been so immediately and dramatically apparent. How many mothers are not in a child's presence to witness a serious vaccine reaction, which could easily occur in the middle of the night? And how many infants are regressing after vaccine reactions but are never diagnosed until long after the damage has occurred, thereby preventing even a temporal relationship between vaccination and neuro-immune dysfunction from being recognized?"

3. Your statement that "Chris remained foggy for the better part of the next 24 hours" is untrue. At no time have I used the word "foggy" to describe the symptoms Chris experienced in the hours following his vaccination. For most of the 18 hours after he collapsed, he was not speaking, sitting, walking or moving. He was not conscious.
In the Institute of Medicine 1991 report on Adverse Effects of Pertussis and Rubella Vaccines, the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines on page 172 defines a "shock and unusual shock-like state with hypotonicity, hyporesponsiveness and short-lived convulsions, usual febrile" that can occur following DPT vaccination. Following is the clinical description in that 1991 report:
"Shock or shock-like state, collapse and hypotonic, hyporesponsive episodes (HHE) are terms that are used interchangeably in the literature to refer to an unusual reaction of an acute diminution in sensory awareness or loss of consciousness accompanied by pallor and muscle hypotonicity. As described, the syndrome has its onset between 1 and 12 hours after immunization. Most children are initially irritable and febrile. They then become pale, limp, and unresponsive or hyporesponsive. Respirations are shallow and cyanosis is frequently noted. The duration can be as short as a few minutes and as long as 36 hours (Cody et al, 1981; Siddiqui et al, 1989). The pathophysiology of this entity has not been well described."
In that same 1991 IOM report, on page 285 encephalopathy is defined as "a variety of conditions, affecting the brain resulting in alterations in the level of consciousness, ranging from stupor to coma. At times, febrile seizures, afebrile seizures, and epilepsy have been considered components of encephalopathy." In Dorland's Medical Dictionary (1981), encephalopathy is defined as "any degenerative brain disease."
In The Merck Manual (Fifteenth Edition), which is used as a reference book by physicians, there is a description of generalized seizures (also known as convulsions), which includes a description of absence or petit mal seizures: "Generalized seizures can be minor or major in their manifestations. Absence (petit mal) attacks are brief generalized seizures manifested by a 10 to 30 second loss of consciousness, with eye or muscle flutterings at a rate of 3/sec and with or without loss of muscle tone." Merck goes on to define akinetic seizures as "brief, generalized seizures seen in children. The child falls or pitches to the ground…" (if Chris had been standing and not sitting in a chair when his eyes rolled back in his head and his head fell to his shoulder in a shock/collapse from which I could not awaken him, he would have fallen to the ground).
In Dorland's Medical Dictionary (1980), encephalitis is defined as "inflammation of the brain" and includes the entry "postvaccinal acute encephalitis sometimes occurring after vaccination." In the 1994 Institute of Medicine report Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality, following is the definition of encephalitis: "refers to an encephalopathy caused by an inflammatory response in the brain. This is usually manifested with systemic constitutional symptoms, particularly fever and pleocytosis of the cerebrospinal fluid. However, the terms of encephalopathy and encephalitis have been used imprecisely and even interchangeably in the literature.
4. Despite the confirmation in medical books that the clinical symptoms I witnessed shortly after my son's DPT shot closely match those of convulsions (seizures), collapse/shock and brain inflammation/encephalopathy which could result in permanent brain injury, you imply to the reader in three additional paragraphs of the book that my son's brain dysfunction is not due to the DPT shot reaction he suffered.
On page 280, you suggest to the reader that my son did not have a DPT vaccine reaction "Even before their children's putative vaccine reactions, Fisher and Williams had questioned medical authority and advice. They took Lamaze classes, sought out natural remedies, made their own baby food."
In the next paragraph on that same page, you reinforce for the reader the idea that Chris was not injured by DPT vaccine: "If the medical diagnoses of the Fisher and Williams boys were somewhat open to dispute, there was no question about that of Julie-Middlehurst-Schwartz."
Based on inaccurate information you provided to the reader about my son's vaccine reaction, on page 292 you take another opportunity to persuade the reader to doubt that I can identify a DPT vaccine reaction and to doubt the truth about what happened to my son: "My doctor's son suffered an episode nearly identical, in her description, to the one that Barbara Loe Fisher described in her son Christian. But while my physician's son, like Fisher's, grew up to be somewhat learning disabled, my physician did not associate this problem with the DTP reaction. "
Since you did not describe for the reader my son's vaccine reaction accurately in the first place, there is no way for the reader to know whether your physician's son suffered post-vaccination symptoms similar to the one my son actually suffered or similar to the minimal symptoms you inaccurately described.
In the 2001 New York Times feature and in several interviews with you, I discussed genetic variability as a co-factor in adverse responses to vaccination. In my 2001 presentation to the Institute of Medicine, I forwarded the following hypothesis, which I emphasized to you may explain why some individuals, like my son and others like him, are at higher risk than others for vaccine reactions:
"The larger unanswered question is: has the increased administration of multiple vaccines in the first three years of life, when the brain and immune systems develop most rapidly, been an unrecognized co-factor in the epidemics of chronic disease and disability plaguing so many children today?
Other potential co-factors are increased exposures to pesticides, chemicals and other environmental toxins; overuse of antibiotics and other pharmaceuticals; nutritionally compromised food sources and unhealthy lifestyles. But there is a compelling argument to be made that the dramatic increase in chronic brain and immune dysfunction in children, especially the rising number of reports of regression in previously healthy children, is due to an early exposure that is being experienced by all children but which is harming an expanding minority of them.
Genetic factors alone have been suggested as a cause for autism increases, for example. But if the presence of certain genes were the sole causal factor for autism, in order to explain the huge increase in autism in the past two decades, there would have had to be a significant genetic shift in the whole population. A more likely explanation is that the presence of certain genes, together with one or more new environmental exposures which act as triggers, account for the increases in autism and other chronic diseases in childhood.
Many biological responses are at least partially under genetic control. If, for example, adverse responses to vaccination are tied to the genes responsible for predisposition to autoimmunity and immune-mediated neurological dysfunction, then it is possible that the addition of more doses of vaccines to the routine schedule in the past two decades has affected more and more children with that genetic predisposition. With each dose of vaccine or simultaneous injection of multiple vaccines, there may be a cumulative increased risk for vaccine-induced immune and brain dysfunction in genetically vulnerable children. So the pool of genetically susceptible children has not changed but the environmental triggers have increased. Therefore, when all children only were exposed to DPT and polio vaccine in the 1960's, a tiny fraction of the genetically susceptible responded adversely. But with the addition of measles, mumps, and rubella to the routine schedule in 1979, and then Hib, hepatitis B and chicken pox in the late 1980's and 1990's, far more of the genetically susceptible have been brought into the vaccine adverse responder group."
In 2002, the IOM Immunization Safety Review Committee published a report entitled Multiple Immunizations and Immune Dysfunction. They addressed my hypothesis with the following acknowledgement:
"The Committee was unable to address the concern that repeated exposure of a susceptible child to multiple immunizations over the developmental period may also produce atypical or non-specific immune or nervous system injury that could lead to severe disability or death (Fisher, 2001). There are no epidemiological studies that address this. Thus, the committee recognizes with some discomfort that this report addresses only part of the overall set of concerns of some of those most wary about the safety of childhood immunizations."
This important acknowledgement by the IOM of the lack of scientific knowledge about genetic factors which might predispose some individuals to adverse responses to vaccination was not mentioned in your book. Is this what you were referring to when you stated "Fisher would come to believe the shot had overwhelmed his immune system?" If you are, then you do not understand the potential biological mechanisms for vaccine injury to which I and the Institute of Medicine Committee were referring, which include atypical or non-specific immune or nervous system responses to repeated vaccination in a genetically susceptible child. This potential biological explanation for why some children could be at higher risk than others for vaccine-induced brain and immune system dysfunction, does not translate into your assertion that I believed my son's DPT shot "overwhelmed his immune system."
On page 279 of your book, you state that "Fisher began writing a muckraking book about DTP."
DPT: A Shot in the Dark, published by Harcourt Brace Jovanovich in 1985, Warner Communications in 1986, Avery in 1991 and currently, Putnam, was used as a reference when the Institute of Medicine Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines published their 1991 report on Adverse Effects of Pertussis and Rubella Vaccines. My book was part of the report's extensive bibliography (page 224) and was again used as a reference in the IOM Committee's report on Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality published in 1994.
In one instance, on page 158, the 1991 IOM report discusses hemolytic anemia and a case report from DPT: A Shot in the Dark:
"Coulter and Fisher (1985) reported on one case of hemolytic anemia in a 2.5 year old boy, which first occurred following a fourth dose of DPT vaccine. Six days after vaccination, the boy became irritable and anorectic. Fever, vomiting, and apparent jaundice and anemia developed over the next 7 days, at which point the boy was hospitalized with a diagnosis of hemolytic anemia. The boy returned to a state of health until 6 days after his fifth DPT vaccination (age not specified), when he developed the same constellation of symptoms, plus loss of consciousness. The boy was rehospitalized with a diagnosis of hemolytic anemia. No laboratory tests were reported and, again, the boy recovered."
In their summary of evidence linking hemolytic anemia to whole cell pertussis vaccine, the Committee discusses re-challenge as evidence for causation. They stated:
"Although the body of evidence concerning the possible relation between vaccination with DPT or its pertussis component and hemolytic anemia is limited to rare case reports, the case described by Coulter and Fisher (1985) is suggestive of a causal relation because hemolytic anemia was detected 6 days after a DPT immunization on two separate occasions."
On page 324, the 1991 IOM report states that in 1985, "The book DPT: A Shot in the Dark is published. Authors Harris L. Coulter and Barbara Loe Fisher (a founder of Dissatisfied Parents Together) describe numerous case histories of children reportedly injured or killed by the DPT vaccine. The book criticizes laws requiring vaccination, calls for further research on and testing of acellular pertussis vaccines, and urges additional research to identify children at particular risk of reacting to vaccines."
The Institute of Medicine, National Academy of Sciences, considered DPT: A Shot in the Dark a resource for examining clinical evidence for a causal relationship between DPT vaccine and serious adverse events. It was considered an information resource because of the extensive bibliography and meticulous documentation of DPT vaccine reaction case histories, which were checked with original sources and reviewed for accuracy by lawyers at Harcourt Brace Jovanovich, as was every sentence in DPT: A Shot in the Dark.
There are other references to me in your book which are inaccurate. For example, you state on page 422 that I have asked "public health authorities" for a clinical trial comparing 10,000 vaccinated children to 10,000 unvaccinated children:
"To the public health authorities who dismissed her all-encompassing doubts she asked for the grand experiment, an impossible experiment, really, that antivaccinists had been demanding since the nineteenth century - give vaccines to 10,000 kids and leave 10,000 kids unvaccinated, then check their health over the next 20 years."
I have never publicly called for a clinical trial that would require "10,000 unvaccinated children" to evaluate health differences between the vaccinated and unvaccinated?
I made the following statement in an article I wrote that was published in the October 2004 Mothering Magazine: "There have never been any large, prospective, long term studies comparing the long term health of highly vaccinated individuals versus those who have never been vaccinated at all. Therefore, the background rates for ADHD, learning disabilities, autism, seizure disorders, rheumatoid arthritis, and other brain and immune system dysfunction in a genetically diverse unvaccinated population remains unknown."
In presentations and interviews I have explained that there is a need for a large, prospective, case controlled clinical trial enrolling babies at birth with the largest group being those fully vaccinated according to CDC/AAP guidelines; a smaller group who receive fewer vaccines; and an even smaller group of those who remain totally unvaccinated. If the trial lasted for at least 10 to 20 years, which has been done with the large heart and cancer studies, and pathological changes in immune and brain function as well as chromosomal integrity were measured over time, preliminary information on biological and health outcome differences between the groups could be available as early as between years five and seven. Identification of genetic and other biological high risk factors for vaccine adverse responses might also be made and this would help develop screening tools to identify high risk children. The numbers of unvaccinated children which would be required to make the study scientifically valid would depend upon the study design.
Arthur, after our long conversation in April 2001 and the publishing of the factually correct profile you wrote for the May 6, 2001 New York Times Magazine, I believed we had developed a grudging mutual respect for one another even as we agreed to disagree on a subject important to us both. I anticipated your book would be critical of the vaccine safety and informed consent movement, but I never anticipated you would incorrectly state facts about my son's vaccine reaction, attribute those incorrectly stated facts to me or suggest to the reader, based on those incorrect facts, that he is not vaccine injured.
As Senator Moynihan so aptly put it and you acknowledge in your Epilogue, "Every man is entitled to his own opinions, but not to his own facts."

Although you are entitled to hold the opinion that my book, DPT: A Shot in the Dark is "muckraking" and I can overlook your overstating the numbers of unvaccinated children I have suggested be included in a future clinical trial comparing the health of the vaccinated to the unvaccinated, it is wrong for you to alter the facts about the acute neurological symptoms I witnessed my son suffer within hours of his fourth DPT shot and his subsequent health deterioration that was followed by permanent brain dysfunction. I trust in the basic decency of most people and I want to believe that you have a conscience and did not deliberately alter the facts about my son's vaccine reaction and suggest to your book's reader that my son is not vaccine injured in order to discredit me and my 25 years of work to prevent vaccine injuries and deaths through public education.

At this point I am going to assume that, during the long years of work on your book, you simply forgot the facts about my son's vaccine reaction, facts which you have previously acknowledged in articles you wrote for The New Republic and New York Times Magazine. The harm which I have suffered and may suffer in the future from the mischaracterization of my son's DPT vaccine reaction in your book can be minimized by (1) correcting the factual errors in the book regarding my descriptions of my son's DPT vaccine reactions in future printings of the book; (2) notifying journalists, who have already received the book for review, of those factual errors; (3) notifying visitors to your website (www.vaccinecontroversy.com) of those factual errors; and (4) refraining from incorrectly stating the facts about my son's vaccine reaction in future statements you make verbally or in print.

Please let me know by January 15, 2007 if I am correct in assuming you did not deliberately alter the facts about my son's vaccine reaction in your book, but that it was an unfortunate mistake and you will correct it.

Very truly yours,

Barbara Loe Fisher