A Boston researcher says the soaring number of children being diagnosed with
autism is probably due to a change in the way doctors classify the mysterious
brain disorder and is not - as others have suggested - linked to a common
childhood vaccine or any environmental factors.
The study to be released today by Boston University Medical School Dr.
Hershel Jick is likely to fuel an already heated debate over the cause of
autism, which can severely limit children's language skills, rob them of their
ability to relate to others and prompt odd or violent behavior.
Kids who behaved like this years ago were called kids who didn't communicate
well, or they were socially inept, said Jick, whose study rules out the common
mumps/measles/rubella vaccine as a culprit.
Frankly, Jick added, It's also a huge stretch to think there's something
in the environment that would produce somewhere from a four- to 10-fold increase
in autism.
But Mark Blaxill, a Cambridge parent who watched in agony as his healthy
toddler slowly stopped speaking, retreated into her own world and was diagnosed
as autistic before her third birthday, doesn't buy Jick's conclusion.
The data is screaming out that it must be an environmental factor, Blaxill
said.
Today, his daughter, Michaela, is in a second-grade class for special needs
students, but still struggles.
She is a wonderful child and we are doing better than many families,
Blaxill said, but it's debilitating and exhausting.
Blaxill is among a growing group of parents and researchers who believe a
mercury preservative in some childhood vaccines - mercury is not in the
mumps/measles vaccine - may trigger autism. They also suspect household
chemicals may play a role.
Only 12 of the approximately 80,000 chemicals on the market have gone
through testing for neurotoxicity, for potential injury to a fetus or small
child, said Dr. Martha Herbert, a pediatric neurologist at Massachusetts
General Hospital who believes autism may be linked to environmental and genetic
factors.
The main thing is we don't know the effect (of chemicals), she said.
Nobody ever looked.
-- > DO SOMETHING ABOUT AUTISM NOW < --
SUBSCRIBE. . . !
. . .Read, then Forward the Schafer Autism Report.
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry,
Calambrone, Pisa, Italy. gabriele.masi@inpe.unipi.it
BACKGROUND: Only sparse and short-term data are available on pharmacologic
treatments in very young children with pervasive developmental disorders (PDD).
The purpose of this 3-year naturalistic study (March 1999-April 2002) is to
describe the clinical outcome of a consecutive sample of preschool children with
PDD treated with risperidone monotherapy.
METHOD: The sample consisted of 45 boys and 8 girls aged 3.6 to 6.6 years
(mean +/- SD age = 4.6 +/- 0.7 years) with a DSM-IV diagnosis of autistic
disorder or PDD, not otherwise specified.
Outcome measures included the Children's Psychiatric Rating Scale (CPRS),
Clinical Global Impressions-Improvement scale (CGI-I), Children's Global
Assessment Scale (CGAS), and a checklist for risperidone side effects.
RESULTS: Patients received risperidone for a period ranging from 1 to 32
months (7.9 +/- 6.8 months).
Twenty-five patients (47.2%) continued to receive risperidone after the study
was completed, while 28 (52.8%) discontinued due to side effects (22.6% [N =
12]), parents' choice (18.9% [N = 10]), lack of efficacy (5.7% [N = 3]), and
decision of the treating psychiatrist (5.7% [N = 3]).
The optimal dose was 0.55 +/- 0.2 mg/ day.
Significant improvement at the last observation was found in CPRS (p <
.0001) and CGAS (p < .0001) scores.
On the basis of both an improvement of 25% in CPRS score and a score of 1 or
2 on the CGI-I, 46.8% (N = 22) of subjects were considered responders.
Behavioral disorders and affect dysregulation were more sensitive to
treatment than was interpersonal functioning.
Responders received higher doses of medication for a longer period and had a
greater weight gain than did nonresponders.
Increased prolactin levels without clinical signs (65% [24 of 37]) and
increased appetite (15% [8 of 531) were the most frequent side effects.
CONCLUSION: These findings suggest that low-dose risperidone may positively
affect the clinical outcome in young children with PDD not only in the
short-term, but also in the long-term period.
PMID: 14628979 [PubMed - in process]
* * *
Improvement in Behaviour And Attention In An Autistic Patient Treated With
Ziprasidone
Vourc'h P, Martin I, Bonnet-Brilhault F, Marouillat S, Barthelemy C, Pierre
Muh J, Andres C. Genetique de la deficience mentale et de l'autisme, INSERM
U316, Faculte de Medecine, Tours, France.
SUMMARY: Autistic disorder is a severe neurodevelopmental disorder most
probably caused by a complex interaction of genetic factors.
Several genomewide scans identified multipoint LOD score peaks in region
7q32.
In this region, UBE2H encodes an E2 enzyme of the ubiquitin-dependent
proteolytic system.
Mutations in another member of this system, the UBE3A gene, cause Angelman
syndrome.
The participation of E2 (ubiquitin-conjugating enzymes) or E3 (ubiquitin
ligases) enzymes in neural development recently emerged.
Given its physical location and function, we examined UBE2H as a candidate
for involvement in autistic disorder.
We confirmed by reverse transcription-polymerase chain reaction that the
UBE2H gene was expressed in the rat and the human central nervous system.
The rat UBE2H and human UBE2H deduced amino acid sequences are identical.
We screened the seven exons of the UBE2H gene in autistic patients using
single-strand conformation analysis.
We observed a silent A-->G transition at position 336.
A case-control association study was performed using this A/G polymorphism.
A significant association was found between the G allele and a subgroup of
autistic patients with developmental quotient higher than 30 (P=0.004).
Although further studies are required, these results suggest that the UBE2H
gene could be one of the 7q-susceptibility loci for autistic disorder.
Over the past two weeks, California's new chief executive has made abundantly
apparent the kind of governor he means to be.
During his abbreviated gubernatorial campaign in late summer, Arnold
Schwarzenegger ran as something of a Rorschach test.
Voters could choose from among a number of Arnolds: the enviro, the tightwad,
the Kennedy-by-marriage, the Friedmanite-by-inclination, the compassionate
centrist.
By scrupulously avoiding print journalists and limiting his debate
appearances to a measly one, Schwarzenegger never had to clarify exactly which
Arnold would be calling the shots in the statehouse. Now we know.
It's Conan the Barbarian, in one of his less reflective moods.
Schwarzenegger's plan for dealing with the state's budget crisis is to put
before the voters in next year's March primary a $15 billion bond measure to
cover the shortfall in this year's budget.
But not the entire shortfall.
Rather than float a $17 billion bond or a $19 billion bond, he's designated
$1.9 billion for cuts in this year's budget, with an additional $1.9 billion in
next year's.
The proposed cuts come largely from just two areas of the state's
responsibilities: transportation, and programs that serve the disabled, the
poor and their children.
For starters, Schwarzenegger wants to cut off enrollment come January in the
state's Healthy Families Program, which provides health care to 700,000
low-income children whose parents have no health coverage at work.
(California has more than 6 million residents without health
insurance.) Californians who heard Schwarzenegger on this subject during the
campaign's one debate may be a bit surprised by this decision.
When the subject was raised, Schwarzenegger criticized then-Gov.
Gray Davis for doing too little to expand the program.
The government, he said, has not done a good job in reaching out and finding
the people and letting them know to sign up.
If I become governor, I would immediately go out there and get it so everyone
knows about it and everyone signs up because we must insure our families, the
low-income families, especially the children. That wasn't just misdirection; it
was misdirection on steroids.
As of January, if the legislature approves this cutback, children in need of
glasses, eligible for the program but not yet enrolled, will have their names
added to a waiting list.
If they can't see so well, they may not notice the hundred thousand or so
other names on the list.
And that may not be the unkindest cut.
Schwarzenegger is also proposing to take $282 million from programs to help
the developmentally disabled -- Californians suffering from autism, mental
retardation, cerebral palsy and the like.
In 1969 wild-eyed radical governor Ronald Reagan signed the Lanterman Act,
creating an entitlement for the developmentally disabled in the state.
Schwarzenegger now proposes cutbacks in programs that California offers the
626,000 of its citizens with mental or physical impairments affecting their
ability to learn and speak: music and art therapy, camping, horseback riding.
He also proposes to suspend the Lanterman Act, in order to freeze enrollment
in developmental disability programs come January.
The new applicants may experience some long waits, because the disabilities
of the current enrollees are not curable and their need for therapy is often
lifelong.
This all may make for some interesting table talk between Arnold and his
family-by-marriage.
Eunice Kennedy Shriver, his mother-in-law, is, of course, the founder of the
Special Olympics, a privately funded foundation that offers sports activities to
the developmentally disabled.
Schwarzenegger himself has been a spokesman for the Special Olympics.
Just last month, he proclaimed that he envision[ed] a world where people
with intellectual disabilities are fully accepted, and where every person has
the opportunity to succeed. That world, apparently, will not include California
so long as Schwarzenegger calls the shots.
Today the first anti-Arnold demonstration of his tenure as governor is
scheduled to be held at the state capitol.
The marchers will be advocates for the developmentally disabled, who
doubtless never imagined that it would be a Kennedy in-law who laid waste to the
most humane program Ronald Reagan ever created.
Schwarzenegger has told the state's Democratic-controlled legislature that he
wants these cuts enacted during its current special session, and he's prodding
the legislators to place his bond measure and a state spending cap on the March
ballot.
(The constitutional deadline for doing that is Friday.) The spending cap
would mandate that any increase in revenue that would come, for instance, as the
state recovers from the dot-com bust, be directed toward tax cuts and a reserve
fund.
Further increases for, say, school spending would be off the table.
The spending cap would also grant the governor the right to terminate any
program he saw fit if the state was running a deficit; the legislature could
overturn such a decision only by a two-thirds vote of each house.
The people elected a governor, protested Democratic state Senate leader
John Burton, not a czar. Or a Conan.
* *
Brief commentary: The indefinite nature of the Governor's politics is indeed
worrisome. However, it is too early to start demonizing his leadership as
hopeless. My guess is that he is still getting his feet wet about California
politics and is still much of an unknown factor -- things can still go either
way.
Much depends on whether the disability community can become energized and
organized enough to defend its interests by developing grass roots support. I
believe we would find the public sympathetic and supportive of resisting the
proposed cut-back in services if we can get our voices heard.
The governor said that if elected he would not raise taxes. The exception
being he might do so for emergency situations. If things are so bad that we have
to starve the poor and abandon the disabled, then we have such an emergency at
hand. Our job is to sell the idea to the public, the media and the legislature,
that for the poor and disabled, such a tax increase is humane and warranted.
We can also start organizing a grass roots ballot initiative to save, and
fully fund, the Lanterman Act via a tax increase, if we cannot get satisfaction
from the Governor and the legislature.
I believe this is not only entirely do-able, it is a good alternative to
catastrophic defeat. Those of us in California cannot afford to wait for the
Governor to make up his mind. - Lenny Schafer
* * *
PUBLIC HEALTH
Reaction of Sen. Patrick Leahy to the Administration's Retreat from Mercury
Reductions
U.S. Newswire -- Several news organizations Wednesday reported that the Bush
Administration is on the verge of approving a proposal to reverse an earlier
EPA/Clinton Administration December 2000 decision to regulate mercury emissions
under Section 112 of the Clean Air Act.
The 2000 decision launched the writing of new requirements for utilities to
meet Maximum Achievable Control Technology (MACT) standards that would have
reduced mercury emissions by 90 percent. Utilities would have had until December
of 2007 to meet these standards. The Bush Administration proposal, reported
today in the Washington Post and the New York Times, reverses the 2000 decision
by arguing that mercury pollution should not be regulated under Section 112
because, the Administration now says, there are no confirmed health effects of
mercury pollution. Instead of requiring utilities to adopt mercury controls at
individual power plants, the Administration's draft proposal would allow
utilities to trade the right to emit mercury into the air.
Sen. Patrick Leahy (D-Vt.) for many years has been Congress's leader in
pushing for mercury reductions and led a coalition of senators that successfully
pushed EPA in 2000 to begin writing the mercury regulations for power plants. On
Wednesday Leahy released the following statement about the Administration's
impending reversal of the mercury rules for power plants: Once again the Bush
Administration is catering to industry wishes, letting big polluters off the
hook at the expense of the public's health. Never before have the big polluters
had this kind of clout in any previous White House, and they are cashing in, big
time.
The Administration claims this reversal will give power plants more
flexibility to reduce mercury pollution faster, but it really gives them the
flexibility to ignore the dangerous health effects of mercury and the new
technologies now available to control it. Downwind states like Vermont will
continue to get reap more mercury pollution for decades to come while corporate
polluters soak up more profits. We know who the biggest polluters are when it
comes to mercury emissions, and the Administration is preparing to let every one
of them off the hook.
This makes it a triple whammy that the Administration has delivered this
fall to the Northeast. First it let these same big polluters out of the
enforcement cases. Then it promised them big new subsidies in the energy bill.
And now it is letting them buy their way out of cutting back on mercury
pollution their smokestacks pump into the air that drifts over Vermont and the
Northeast.
Administrator Leavitt promised a kinder and gentler EPA two months ago when
the Senate confirmed him. That's not what we're seeing in his first major
decision. We know that mercury is harmful, especially to children. We have the
technology to control mercury pollution. I call on Administrator Leavitt to
reconsider this rollback.
AP - President Bush on Wednesday signed legislation giving the government the
ability to require drug companies to test medicines to ensure that dosages are
appropriate for children.
Now, only a fourth of the drugs on the market are tested and properly labeled
for safe use in children. Because children and adults react to drugs
differently, calculating the amount of medicine children should take based on
what is appropriate for adults can lead to either overmedication or
under-medication.
The bill is aimed at eliminating that guesswork for doctors.
In 1988, the Food and Drug Administration issued the pediatric rule to give
itself the authority to require tests on adult drugs that are prescribed more
often for children. Last year, a federal court ruled that it was up to Congress
to give the FDA the authority it needed.
The new law ensures the FDA can require testing of medicine dosages for
children, even when drug companies lack the financial incentives to voluntarily
do so. It also expands on 1997 legislation that extended the length of the
patent rights of pharmaceutical companies that volunteer to conduct pediatric
studies to develop labeling standards for children.
The law applies to all medications, such as vaccines, whose intended use for
children is the same as that for adults.
Copyright 2003 Associated Press. All rights reserved.
Channel Five is facing demands to pull the plug on a hard-hitting drama
favourable to the disputed view that the MMR jab may be linked to autism.
A former colleague of the scientist at the centre of the row claims the
programme will endanger children's lives by fostering doubts about the triple
vaccine against measles, mumps and rubella.
But Juliet Stevenson, who stars in the film, yesterday called for the
government to stop patronising the parents whose concerns she portrays.
Hear the Silence, to be broadcast on December 15, is a rare foray by Five
into original drama. In her first major role on British television in five
years, Stevenson plays a mother who is sent into emotional turmoil by the
illness of her son and the dismissive attitude of the many doctors to whom she
is referred.
It shows her delight at discovering Andrew Wakefield, the scientist whose
1998 research at the Royal Free hospital in north London prompted the MMR row.
Dr Wakefield is played sympathetically by Hugh Bonneville; the chief medical
officer, Sir Kenneth Calman, and Dr Wakefield's bosses at the Royal Free, who
eventually blocked his research, are the bogeymen of the piece.
To satisfy television regulators, Five will follow it with a discussion
programme, hosted by newscaster Kirsty Young. Dan Chambers, the channel's
director of programmes, said at a screening to journalists in London yesterday
that the subject was enormously controversial.
Stevenson, who opted for single vaccines for her two-year-old son Gabriel,
said she was astonished at how Dr Wakefield appears to have been ostracised by
the medial establishment, and hoped the drama would provoke an enlightened
discussion about the issue.
She said: I would like a calm and informed debate to come out of it. There
is a sort of hysteria coming from the government at the moment, and you just
can't go on telling frightened people that they are wrong. You have to
understand what the fear is. At the moment, people are just being told, 'Shut up
and don't worry, have the MMR'. It's very patronising.
But senior figures at the Royal Free are concerned that the film could lead
to a dangerous drop in immunisation levels, which are already low in some parts
of the country.
One of the doctors who has worked with Dr Wakefield wrote to Jane Lighting,
Five's chief executive, asking her not to transmit it.
The doctor, a co-author of the original Lancet paper that provoked the
controversy, says in the letter that the film is undeniably good drama, but it
unacceptably and dangerously blurs the border between truth and fiction.
The acting was excellent, and the story was gripping. Unfortunately, the
fact that your programme is not accurate is a matter of the utmost seriousness,
and one which could lead children to die. You may seek to justify the
inaccuracies by invoking the notion of artistic licence. However, there is no
room for artistic licence when the lives of children are at risk.
The doctor, who does not want to be named but has the backing of other
colleagues of Dr Wakefield, gives 14 detailed examples of alleged inaccuracies.
The programme conflates ideas and events in a way that inappropriately
indicates Dr Wakefield to be more reasonable and thoughtful than the history
would suggest, he writes.
Dr Wakefield's colleagues have peeled away, the letter claims, because of
our increasing concerns about the scientific quality of his work. It says he
was not treated as a pariah either by the hospital or the medical school -
instead, he made himself a pariah by turning down offers to work with other
researchers if he felt they were not of the faith.
The programme-makers point out that elements have been fictionalised in order
to tell the story coherently. Stevenson's character, for instance, is based on
several different people. Adrian Bate, the producer, admitted the film was
emotionally positive towards the concerned parents, but insisted it remained
rooted in fact. It is emotionally biased, but it's not factually biased, he
said.
Tim Prager, the writer, said: What we have tried to do is to say that there
should be a freedom to think and report what you discover without fear of losing
your career, and to show that much of what has been written about the
possibility of a link between MMR and autism has been based on statistics - part
of the point was to humanise the story.
A number of senior doctors have boycotted a debate to be shown after Channel
Five's drama documentary on Andrew Wakefield, because they say it is biased and
emotive in its portrayal of the scientist behind alleged links between the MMR
vaccination and autism.
Scientists from the Department of Health and the Health Protection Agency are
understood to have turned down an invitation. Former colleagues of Dr Wakefield
at the Royal Free hospital in north London also declined to take part.
David Elliman, consultant community paediatrician at Great Ormond Street
children's hospital, said: "The film is very, very partial. It's very much this
one man against the medical establishment, who is the only man who listens to
children and to parents - paediatricians don't and GPs don't.
"However one tried, if there has been 1 hour of that, how on earth can you
redress that balance?"
Hear the Silence, starring Juliet Stevenson as the mother seeking answers to
her son's autism and Hugh Bonneville as Dr Wakefield, will be screened on
December 15.
Dr Elliman said that he initially thought it would be helpful to have a
debate to redress the balance immediately after the programme, but as he watched
a preview he came to the conclusion "that one could not have a sensible
discussion about the facts".
The programme "starts from the premise that MMR is linked to autism and the
onus is to disprove that. We know from past experience that, when you give
balance to somebody, the public goes away thinking there is a balance in the
scientific argument which is 50:50. That is not the case here."
Dr Wakefield's former colleagues, who jointly published the paper
hypothesising a link in the Lancet in 1998, all said then and still say they
believe in the safety of MMR. They have become increasingly critical of him.
The pupils in Michelle Harper's special education class have their own small
victories every day - a temper tantrum stifled, two words rhymed.
When it comes time to take the standardized tests that the federal government
uses to measure public schools, many of Ms. Harper's pupils at White Mountain
Middle School merely pick answers at random, not realizing the potentially
severe consequences for their school.
Across the country this year, thousands of schools were deemed failing
because of the test performance of special education pupils.
The results have provoked feelings of fury, helplessness and amusement in
teachers such as Ms. Harper, who say that, because of some of their pupils'
disabilities, there is no realistic way to ever meet the expectations of a new
federal law backed by the Bush administration that requires that 99 percent of
all children perform at or above grade level by 2014.
If schools fail to meet those targets, they risk being taken over by the
state or private companies; teachers can lose their jobs.
These children are going to plateau at a certain level - that is the nature
of a disability, said Ms. Harper, who teaches pupils with autism, learning
disabilities, mental retardation, Tourette's syndrome, vision and hearing
deficiencies and brain injuries. These kids are not going to grow out of it,
not going to grow up and be OK. It's sad, but that is the way it is.
Special education has been a battleground for years. Parents of special ed
pupils fought long and hard for their children to be included in mainstream
classrooms, and for the money to provide them with extra help.
Now the new law, dubbed No Child Left Behind, has focused even more attention
on special education, because of the consequences for entire schools.
The government is defending the special education portion of the law, though
officials said some changes are in the works that would give more leeway to the
most seriously disabled children and their teachers.
But the Education Department does not want to let all special education
pupils and their teachers off the hook, said Ronald Tomalis, acting assistant
secretary for elementary and secondary education.
There have been low expectations for some of these children all along, he
said. And that's not because of mental abilities, but because of poor
instruction received in the early grades.
* * *
Let's Make Our Schools Accessible To Everyone
It's time to crack down on school boards that don't enforce rights of disable
children
[By Janis Jaffe-White And Reva Schafer. Thanks to Janis Jaffe-White.]
Now that the provincial election is over, perhaps we can pause and take a
closer look at the Ontario Human Rights Commission Report, The Opportunity To
Succeed: Achieving Barrier-free Education For Students With Disabilities.
The report, released by Keith Norton, chief commissioner of the Ontario Human
Rights Commission, on Oct. 27, created nary a ripple around the province. That
is a tragedy.
The report has the potential to reap major benefits for those individuals
with additional needs and has serious ramifications for those who are
responsible for accommodating the needs of those individuals.
Yet it received minimal media attention.
The Norton report was prepared and developed over two years and is based on
consultations across the province with students, parents, educators, school
boards, colleges, universities, government ministries, agencies, associations,
and other individuals and groups.
The commission received 124 written submissions and heard 50 oral submissions
presented to an Ontario Human Rights Commission panel chaired by Norton.
The Opportunity To Succeed: Achieving Barrier-free Education For Students
With Disabilities recognizes and clearly delineates the difficulties faced by
persons with additional needs within all levels of the educational system.
The report illustrates that this fact is not only well known and well
documented but that little, if anything, has been done to eradicate or
circumvent the problems.
The lack of responsiveness from the previous government led to a great loss
of human potential and hardship for not only the individuals who could not have
their needs met within the educational system but for their families, as well.
The emotional cost to the families is unforgivable; the economic cost to our
society is still undetermined.
It is obvious from the report and its recommendations that the Ontario Human
Rights Commission recognizes that many current educational practices are
discriminatory and systemic. Although the report discusses financial
considerations, greater emphasis is placed on attitudinal barriers.
The families and the individuals who have been affected by the lack of
responsiveness of boards of education and the ministry of education applaud the
commission for their excellent recommendations.
Unfortunately, many families, due to past experiences and present
circumstances, have little faith that anything will change based on this report.
The Education Act and the Ontario Human Rights Code have been ignored in the
past with no recourse being taken against the offending parties. A lack of
acceptance of responsibility and accountability has been a constant problem.
Families want to see the right thing done that is, the provision of
opportunities to lead to full citizenship for their family members with
additional needs.
That means opening doors for all individuals, educating all individuals in a
respectful manner in order that they can achieve to the best of their abilities.
The human rights commission has now got the base from which to act. To not do
so would be to be complicit in the discriminatory process itself.
It is time for the Ontario Human Rights Commission to review those complaints
that have been submitted within the last two years that continue to be
unresolved, recognize their commonality, and take action based on broader public
interest.
This action would clearly indicate to all those who have contravened the
Education Act and the human rights code that things must change and that to
ignore their legal and ethical responsibilities will lead to immediate action.
It is time for everyone involved in the process of educating individuals in
this province the Ministry of Education and Training, the Ministry of Health
and Long-Term Care, the Ministry of Community and Social Services, Integrated
Services for Children to recognize their responsibility to the children, youth
and adults of this province by: Focusing on the inherent dignity of all
individuals and demonstrating respect and acceptance of each and every
individual.
Advancing the value that differences is the norm.
Considering the best interests of the individual.
Providing equity education based on individual requirements leading to
independence and self-reliance.
Empowering the individual so that he or she can achieve active and meaningful
participation in the community and full citizenship.
DISCLAIMER: All
information, data, and material contained, presented, or provided here is for
general information purposes only and is not to be construed as reflecting the
knowledge or opinions of the publisher, and is not to be construed or intended
as providing medical or legal advice. The decision whether or not to vaccinate
is an important and complex issue and should be made by you, and you alone, in
consultation with your health care provider.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"