Vaccination, Ignorance, Prejudice & Greed

by Barbara Loe Fisher

Setting up the Unlocking Autism & NVIC exhibit at Netroots Nation the morning of July 17, 2008

It has been a challenging week for families living with the reality of autism and for those educating Americans about the need to institute vaccine safety and informed consent protections in public health programs. It was a week when individual extremists from the political right and the left revealed their capacity for ignorance and prejudice, even as many enlightened Americans demonstrated their capacity for understanding, concern and compassion. It was a week that ended with a revelation that the American Academy of Pediatrics, Every Child by Two and the pediatrician leading a national effort to eliminate exemptions to vaccination, Paul Offit, M.D., are all taking big money from big Pharma.

Several months ago when Unlocking Autism (UA) President Shelley Reynolds called me and asked if NVIC would join UA in mounting a major exhibit at the Netroots Nation progressive blogger conference in Austin, TX July 17-19, I knew it would be an opportunity to reach out to several thousand Americans blogging on important social and political issues. We worked hard to create a professional exhibit (the largest in the Exhibit Hall) that would include representatives from SAFEMINDS, TACA, and Age of Autism contributing information and helping to staff the booth.

The theme of our exhibit was "Vaccine Safety: What's Choice Got To Do With It?" and the buttons and t-shirts we wore said "Vaccines: Our Children. Our Choice. Our Vote" while the facts listed on the 16 foot high tower exhibit included "Vaccine Market: $21 Billion" and "Toxic Vaccine Ingredients" and "One-Size-Fits-All Vaccine Policies" and "No Vaccine Risk Research" and "Autism: 1 in 150 children; 1 in 94 boys; $3.2M per child" and "Giving Mercury to Children on Purpose Is Stupid." We were ready to answer questions from the more than 2,000 bloggers showing up to listen to Howard Dean, Nancy Pelosi, Al Gore and other speakers talk about issues important to Democrats as well as the nation.

While we were finishing setting up our exhibit on the morning of July 17, Shelley and I, along with Rebecca Estepp (TACA), Theresa Wrangham (SAFEMINDS), Kevin Barry, Paul Arthur (NVIC) and my son, Chris, started networking with other exhibitors. (Later we would be joined by Mark Blaxill from Age of Autism and attorney Jim Moody). The booth directly across from us was Media Matters.

As the bloggers came into the Exhibit Hall and walked by our booth, we handed out vaccine information. Suddenly, a middle-aged woman with a scowl on her face appeared and screamed "baby killer" at Becky but refused to engage in a conversation. Later we were told that several complaints had been lodged with the convention organizers (to which the organizers responded that Netroots Nation welcomed open dialogue on such an important health issue).

A few hours later we learned about the obscene tirade that conservative shock jock Michael Savage had let loose on children with autism and asthma. We had a conversation with our new blogger friends at the Media Matters booth, who were quite familiar with his rants.

By the end of the day, Media Matters, had set their blogger sights on Savage. Their quick action played a major role in galvanizing both the autism community and enlightened Americans from both sides of the political spectrum disgusted by the cruelty of mindless prejudice against children and families suffering with autism and asthma through no fault of their own. Big advertisers like Aflac, Radio Shack and Sears pulled their ads from Savage's nationally syndicated radio show. Radio stations in Virginia, Ohio, Mississippi and elsewhere canceled the show.

During the Netroots Nation convention, we were approached by many bloggers who either had a child with autism in their own family or knew a family living with autism. Pregnant women stopped by our exhibit to learn more about mercury in influenza vaccines. Others stopped by to describe vaccine reactions they or a loved one had suffered in the past. Several longtime NVIC members came up to greet us, grateful that we were there. My son, Chris, brought his camera and filmed my interviews with several bloggers and exhibitors expressing their opinions on topics such as vaccine mandates
and diabetes and vaccination

On the last day of the convention, we put our brochures on the luncheon tables. During the final hour, the scowling woman reappeared to hurl one last hateful insult at us. This time she targeted my son, who has come so far in the 28 years since the neurological reaction to his fourth DPT shot that left him with multiple learning disabilities and ADD. She called Chris a "traitor" and shouted "where are your double blind studies?" and then, as he tried to bring me over to speak with her, she ran away shouting "I didn't think so!" before a conversation could take place.

The events of the past week reinforce the fact that ignorance and hate does not belong to any one political party or ideology. The extremists on the right and the left meet at a dangerous intersection which threatens freedom and diminishes the value of individual life.

And when doctors and organizations denying vaccine risks persuade naive public figures to demonize others for making independent vaccine choices, it contributes to an ugly climate of fear and divisiveness. When it turns out those same doctors and organizations get big money from drug companies selling vaccines, the public has no reason to trust what they say or tell us to do.

Vaccination is a subject that elicits emotional responses from both those promoting forced use of multiple vaccines and those defending the human right to informed consent to vaccination. It involves a personal examination of what we know, fear, believe and value because what we choose to do can profoundly affect the health and lives of those we love the most.

Many of the conversations taking place in private and public forums about vaccination are civil and, hopefully, most Americans will turn away from those letting fear, prejudice or greed define who they are. In any case, we should never let someone else define who we are or dictate what we can or cannot do when it comes to protecting the health of our children.


"What Michael Savage said was foolish, mean-spirited, and hurtful," said J. Jioni Palmer, spokesman for Media Matters. "It's unfortunate he would use his radio program to make fun of and belittle these kids. Instead of ridicule and cheap shots, the children suffering from autism and asthma and their families need support and compassion." During the July 16 edition of his show, Savage claimed that autism is "[a] fraud, a racket.... I'll tell you what autism is. In 99 percent of the cases, it's a brat who hasn't been told to cut the act out. That's what autism is. What do you mean they scream and they're silent? They don't have a father around to tell them, 'Don't act like a moron. You'll get nowhere in life. Stop acting like a putz. Straighten up. Act like a man. Don't sit there crying and screaming, idiot.' Savage also stated: "[W]hy was there an asthma epidemic amongst minority children? Because I'll tell you why: The children got extra welfare if they were disabled, and they got extra help in school. It was a money racket. Everyone went in and was told [fake cough], "When the nurse looks at you, you go [fake cough], "I don't know, the dust got me." "See, everyone had asthma from the minority community." - Media Matters (July 18, 2008)

"Conservative radio talk show jock Michael Savage used his nationally syndicated show Monday to defend his controversial remarks on autism, even as outraged parents protested outside the Manhattan offices of his broadcaster, calling for his firing. "My comments about autism were meant to boldly awaken parents and children to the medical community's attempt to label too many children or adults as 'autistic,' Savage wrote on his Web site and read on his broadcast Monday. "Many children are being victimized by being diagnosed with an "illness" which may not exist in all cases. .....Let the truly autistic be treated. Let the falsely diagnosed be free.".....His controversial remarks drove several dozen parents and advocates Monday to protest outside WOR-710 in Manhattan. "That isn't just freedom of speech, it is hateful speech when you say 99 percent of children with autism are brats," said Evelyn Ain, whose 8-year-old son has been diagnosed with autism and who organized the demonstration. "I'll tell you, I wish I had a brat." - Carol Polsky, Newsday (June 21, 2008),0,1239587.story

Eventually her brother-in-law arranged a series of phone calls between Peet and his own mentor, Paul Offit, M.D., who is chief of infectious diseases at the Children's Hospital of Philadelphia, a co-inventor of the rotavirus vaccine, and a board member of Every Child by Two, a pro-vaccine organization co-founded in 1991 by former first lady Rosalynn Carter. "Once we had spoken, I was shocked at the amount of misinformation floating around, particularly in Hollywood," says Peet, who quickly boned up on the hot-button controversies surrounding the topic, including the unproven link between certain vaccines and autism; the safety of preservatives like mercury-based thimerosal; and the fear that the relatively high number of shots kids receive today can overwhelm young immune systems. Her conclusion? Well, not only is Frankie up-to-date on her vaccines (with no staggering), but her mom will soon appear in public-service announcements for Every Child by Two. "I buy 99 percent organic food for Frankie, and I don't like to give her medicine or put sunscreen on her," says Peet. "But now that I've done my research, vaccines do not concern me." What does concern her is the growing number of unvaccinated children who are benefiting from the "shield" created by the inoculated-we are protected from viruses only if everyone, or most everyone, is immunized: "Frankly, I feel that parents who don't vaccinate their children are parasites." - Jennifer Tung, Cookie Magazine (July 12, 2008)

"The vaccine industry gives millions to the Academy of Pediatrics for conferences, grants, medical education classes and even helped build their headquarters. The totals are kept secret, but public documents reveal bits and pieces.....Every Child By Two, a group that promotes early immunization for all children, admits the group takes money from the vaccine industry, too - but wouldn't tell us how much. A spokesman told CBS News: "There are simply no conflicts to be unearthed." But guess who's listed as the group's treasurers? Officials from Wyeth and a paid advisor to big pharmaceutical clients..... Offit was not willing to be interviewed on this subject but like others in this CBS News investigation, he has strong industry ties. In fact, he's a vaccine industry insider. Offit holds in a $1.5 million dollar research chair at Children's Hospital, funded by Merck. He holds the patent on an anti-diarrhea vaccine he developed with Merck, Rotateq, which has prevented thousands of hospitalizations. And future royalties for the vaccine were just sold for $182 million cash. Dr. Offit's share of vaccine profits? Unknown." - Sharyl Attkisson, CBS-TV News (July 25, 2008)

Vaccine Facts & Choice: Drawing the Lines

by Barbara Loe Fisher

As the battle lines are being drawn between those who want to force all children to use 69 doses of 16 vaccines and those who are defending the right of parents to exercise voluntary, informed consent to vaccination, it is coming down to a matter of whose message do you trust. Should government health officials, pediatricians and vaccine manufacturers, who have been denying vaccine risks for three decades, be trusted to be defacto lawmakers and force vaccination on everyone or should Americans be allowed to become informed about vaccination and legally make voluntary vaccine choices?

Tonight, July 17, Louise Kao Habakus will be speaking about "Vaccination: Building a Case for Education and Choice" at the Atlantis Ballroom, Tom's River Holiday Inn in Tom's River, NJ at The mother of two children, Louise is standing up for the right to know and the freedom to decide. The presentation is free but to reserve a seat, send e-mail to

As more parents report that their young girls are suffering disabling reactions to GARDASIL (see a video clip of the WUSA-TV coverage), doctors determined to coverup HPV vaccine risks are giving out inaccurate information (see video clip of a FOX News story ) while public health officials defending vaccine safety write books and parents want more information and choices.

All Americans deserve the right to be fully informed about the risks associated with any pharmaceutical products or medical procedure and be allowed to make a voluntary decision about taking that risk with their own life or the life of their child. The right to informed consent to medical risk taking is a human right.


"Christina Bell says 2 weeks after her 12 year old daughter Brittany was injected with the HPV vaccine, "she was walking through my house and collapsed. She told me, she couldn't feel her leg." Today, this once athletic girl has a hard time getting around and often loses her balance. Jessica Vega of Nevada got the shot at school and became temporarily paralyzed. Jamie Venice of Florida passed out and had a seizure after her Gardasil shot. "I don't think this should have been fast-tracked by the FDA," says Barbara Loe Fisher with the National Vaccine Information Center. She says Merck, the manufacturer of the drug managed to get Gardasil approved and to market, after studying the side-effects in just 12- hundred girls. What was their incentive? "It certainly is money because the bottom line for their stock holders is a profit," she says. She claims Merck has taken in an estimated 1.5 billion dollars world-wide from Gardasil sales, all for a vaccine she says may do more harm than good. She says doctors share in the blame. "I think pediatricians need to pay more attention to the patient that's sitting in front of them, rather than thinking they need to implement government policy or promote a new vaccine that a drug company rep has come in and promoted to them."The debate over the HPV vaccine rages on in Virginia after it became the first state in the country to mandate the vaccine for sixth grade girls, albeit with an opt-out provision. Those requirements have been delayed for at least one year to allow more time to study the vaccine's effects on young girls." - Nancy Yamada, WUSA-TV9 (July 7, 2008)

"It remains to be seen whether the new book will answer all queries. "You are going to continue to see parents doing their own research and coming up with a lot of questions," said Barbara Loe Fisher, a frequent critic of vaccines and co-founder of the National Vaccine Information Center, a nonprofit, parent-led organization that seeks to change the mass vaccination process to allow more opt-out flexibility regarding immunizations. She said she looks forward to reading the book but wonders if it will address the issue now being raised about the effect on children's health of recent expansion in the recommended vaccine schedule. "I've seen the number of vaccines double and the number of doses triple," Fisher said. "No matter what is published in that book, it is still an outstanding question until health authorities give us the answer as to why so many highly vaccinated children are so sick." - Susan J. Landers, American Medical News (July 7, 2008)

Gardasil Controversy: Are the HPV Vaccine's Side Effects a Legitimate Concern?

produced by Ben Evansky
Fox News
July 11, 2008


HPV Vaccine Victims Pile Up: $1.5B for Merck

by Barbara Loe Fisher

While Merck has pulled in $1.5B from sales of GARDASIL vaccine worldwide, there are continuing reports that girls are being crippled and dying after getting the HPV vaccine fast tracked and licensed by the FDA in 2006. Although the roll-out of GARDASIL with an unparalleled multi-million dollar mass media advertising blitz has created a profitable market for the drug company that took huge losses from Vioxx injury/death lawsuits, the persistent reports of Guillain Barre Syndrome (GBS) paralysis, arthritis, seizures and sudden loss of consciousness within 24 hours of vaccination continue to haunt the marketing campaign.

Last week Judicial Watch issued a report on more than 8,000 GARDASIL reaction reports to the federal Vaccine Adverse Event Reporting System (VAERS) obtained under the Freedom of Information Act (FOIA). A search of the VAERS database , which includes reaction reports through April 30, 2008 released to the public by the FDA, reveals nearly 6,700 reports of injury and death after GARDASIL. Two GARDASIL vaccine injury claims recently were filed in the federal Vaccine Injury Compensation Program under the National Childhood Vaccine Injury Act of 1986.

Exactly two years ago, NVIC sounded the first public warning about GARDASIL risks pointing out that Merck had not adequately proven the vaccine was safe and effective to give to girls under age 16. NVIC pointed out that pre- licensure trials were flawed because they used an aluminum containing placebo that may have masked the true reactivity of GARDASIL, which also contains 225 mcg of aluminum. Like mercury, aluminum can cause inflammation in the body and kill brain cells.

The fact that Merck had only studied the vaccine in fewer than 1200 girls under age 16 and followed them up for less than two years before licensure did not seem to bother doctors working for the CDC's Advisory Committee on Immunization Practices (ACIP), who saluted Merck smartly and promptly recommended that all 11 year old girls entering sixth grade get three doses.

By the end of 2006, Merck had marshaled its well- paid lobbying forces bolstered by a flashy television advertising campaign in an unprecedented effort to persuade legislators in every state to turn CDC recommendations into law and pass HPV vaccine mandates. Texas Governor Rick Perry went so far as to issue an Executive Order mandating the vaccine for all sixth grade girls.

GARDASIL had only been on the market for a few months and nobody, including Merck, knew the full range of side effects when GARDASIL was given to millions of girls entering puberty. Nevertheless, the pressure was on young girls, their parents and state legislators to trust blindly that the vaccine had no real risks.

In early 2007, NVIC again warned the public that there were significant risks associated with GARDASIL , especially when it was combined with other vaccines. NVIC warned that there was evidence that giving GARDASIL during active HPV infection may increase the risk for cervical cancer while girls were not being tested for active HPV infection before getting vaccinated. NVIC also advised that girls should not drive home after getting the shot because of the risk for sudden loss of consciousness after leaving the doctor's office.

In March 2007, the CDC admitted that there was no scientific evidence that GARDASIL can be safely co- administered with other vaccines (like TDaP, meningococcal, varicella, MMR, influenza). Even so, without a second thought, the CDC urged doctors to assume safety and go ahead and give GARDASIL simultaneously with other vaccines.

By end of May 2007 almost every state had rejected proposed mandates for GARDASIL vaccine and there were more than 2,000 GARDASIL adverse events reported to VAERS. In August 2007, NVIC released a comprehensive analysis of GARDASIL reaction reports to VAERS and a critique of the CDC's universal use recommendation. In a letter, NVIC asked the CDC to warn doctors that the simultaneous administration of Menactra with GARDASIL increases the risk for GBS and other serious adverse event reports.

The CDC chose to blow off NVIC's report and do nothing.

Two years after licensure, it is clear that GARDASIL has plenty of risks for young girls. Among the more than 130 GARDASIL reaction reports that have been filed with NVIC's 26-year old Vaccine Reaction Registry is one that was posted by a mother, who witnessed what happened to her daughter on the International Memorial for Vaccine Victims.

Amanda's mother describes her daughter as "a beautiful, active girl that was brought down." Only 14 when she was vaccinated, Amanda "became weak, tired and sick to her stomach" but the symptoms subsided. One week after the second HPV vaccination, her legs "became very weak and she started losing feeling in her feet." She was hospitalized in the Intensive Care Unit for four days with a diagnosis of Guillain-Barre Syndrome.

Amanda's mother said "The doctors thought we were CRAZY when we mentioned that the HPV vaccine could cause this."

"Amanda is constantly sick," says her Mom. "Something has suppressed her immune system so badly she can barely function. The depression got really bad because she is experiencing a lot of pain in her knees now and can't do any sports. She was once very active and right now can barely go to school We were told me her doctors that there is nothing more that they can do and that she could use a good psychiatrist."

How many more girls like Amanda and her mother have had their futures stolen by a vaccine that is supposed to prevent a viral infection that is cleared without any residual effects by more than 90 percent of all who get it to prevent a cancer that causes less than 1 percent of all new cancer cases and cancer deaths in the U.S. every year? Did Amanda and her mother know that cervical cancer can be prevented nearly 100 percent of the time with annual pap smears and early intervention when pre-cancerous cervical lesions are diagnosed?

Or did Amanda's Mom believe Amanda would be "one less" because a pediatrician told her so?

NVIC continues to receive reports from grieving mothers and fathers who can't find doctors to treat their once-healthy daughters who are now chronically ill and disabled after being injected with GARDASIL. In almost every case, the doctors are denying the vaccine had anything to do with what happened.

The tragic denial by the medical profession of the harm vaccines can do continues decade after decade after decade. When will doctors stop being marketers of pharmaceutical products and implementers of government policy and embrace the moral imperative to "first, do no harm?"

The "its all a coincidence" defense mounted by doctors when something bad happens after vaccination is illogical, unscientific and dangerous. When will Americans get up off their knees and stop worshipping men and women in white coats who do not know what they are doing?


"Katherine Kimzey started suffering debilitating headaches, fainting spells and arthritis-like stiffness last November. Six weeks later, the 14-year-old Dallas resident became so dizzy she could barely walk. She was hospitalized and missed three weeks of school. Then, she had a seizure. For weeks, she bounced back and forth between specialists and was eventually diagnosed with epilepsy. Katherine's mother, Michelle Kimzey, now believes her daughter's symptoms were caused by a new vaccine that was supposed to protect her against cervical cancer...... The HPV vaccine has generated debate across the country and in Texas. Gov. Rick Perry issued an executive order in February 2007 requiring that all sixth-grade girls get the HPV shot. But angry parents and conservative groups fought the mandate, fearing it condoned premarital sex and took away parental rights. The Legislature defeated the order last April. The National Vaccine Information Center heralded the decision, saying that testing of the vaccine was not extensive enough in girls under 12. The nonprofit center had already started warning about the possibility of adverse reactions such as extreme fatigue, arthritis and loss of consciousness. Barbara Loe Fisher, co-founder and president of the center, said she's frustrated that the CDC has "assumed safety" for Gardasil, which has been tested only in conjunction with the vaccine for Hepatitis B. Today, girls often receive the Gardasil shot at the same time as a meningitis vaccine and another new booster that immunizes against tetanus, diphtheria and pertussis. The FDA has approved all the vaccines separately, but studies on administering them together are still ongoing. "Not only was Gardasil put on the fast track and licensed quickly," said Ms. Fisher, "but to say safety is assumed and you can give any vaccine with it is even more shocking." - Jessica Myers, Dallas Morning News (June 6, 2008) http: // news/stories/DN- vaccine_06met.ART.North.Edition1.46ef875.html

"Gardasil has been a shot in the arm for pharmaceutical giant Merck. The company had been reeling from the withdrawal of its anti-arthritis drug Vioxx because of increased risk of heart attacks and resulting lawsuits. Now, however, Merck's new vaccine against the human papilloma virus (HPV) - aimed at combating cervical cancer - has been deployed worldwide, earning an estimated $1.5 billion in sales. But the drug is coming under increasing fire from anti-vaccine activists. Already very vocal about childhood innoculations, now they are expressing concern about the effects of Merck's drug on young girls, a primary focus of the company's big ad campaign....."This issue is not going away as more and more vaccines are brought to the market," Barbara Loe Fisher, president of the National Vaccine Information Center (NVIC) who became an activist after a serious reaction in her son to a DPT vaccine (a combined innoculation against Diptheria, Whooping Cough - pertussis - and Tetanus). Fisher, who has served on an Federal Drug Administration consumer advisory committee on vaccines, takes issue with the CDC's read of the VAERS Gardasil reports. Her organization, NVIC, has called on the CDC and FDA to warn the public that Gardasil has been associated with at least 15 cases of Guillain-Barre Syndrome (GBS), an autoimmune disorder; and it says there is an increased risk for GBS when Gardasil is co- administered with other vaccines, particularly Menactra, a meningitis vaccine....NVIC is concerned about the growing number of vaccinations required by schools and the push, in some public health quarters, to mandate more vaccines. The political fight has been taken to New York and New Jersey. New York state public health officials have endorsed state legislation that would take the CDC's recommended vaccine list for children and declare it to be mandatory, Fisher says, and she sees that as a move that should alarm parents. Vaccinations should be voluntary, Fisher says, and be made with "informed consent" by parents." - Hilary Hylton-Austin, Time/CNN (June 19, 2008),8599,1816507,00.html

"Judicial Watch, the public interest group that investigates and prosecutes government corruption, today released a report based on new documents obtained from the U.S. Food and Drug Administration (FDA) under the provisions of the Freedom of Information Act, detailing reports of adverse reactions to the vaccination for human papillomavirus (HPV), Gardasil. The adverse reactions include 10 deaths since September, 2007. (The total number of death reports is at least 18 and as many as 20.) The FDA also produced 140 "serious" reports (27 of which were categorized as "life threatening"), 10 spontaneous abortions and six cases of Guillain-Barre Syndrome - all since January 2008." - Judicial Watch (June 30, 2008)

"About a month after being vaccinated against the cervical cancer-causing HPV virus, 13- year-old Jenny Tetlock missed the lowest hurdle in gym class, the first hint of the degenerative muscle disease that, 15 months later, has left the previously healthy teenager nearly completely paralyzed....Her father, Philip Tetlock, a psychology professor at UC- Berkeley's Haas School of Business, has embarked on an odyssey to find out whether the vaccine or random coincidence is to blame..... Tetlock, though, wonders if Jenny carries genes that predisposed her to problems with the Gardasil vaccine. At age 10, Jenny developed a rare skin disease called pityriasis lichenoides that's thought to be triggered by an overactive immune system, and her grandmother died of a nervous system disease. Could it be that certain genetic tendencies make some people more likely to develop severe reactions from vaccines?....Jenny endures terrible suffering each day."..... "She must watch her capacity to control her own body gradually ebb away-and each day her hopes of ever having a normal human life recede ever further into memory. The disease is cruel beyond belief." - Deborah Kotz, US News & World Report (July 2, 2008)

"Lawyers last month filed the first two claims on behalf of girls with ailments blamed on Gardasil under a federal program to compensate victims of vaccine-caused illness, The Post has learned. Both girls got the injections at their middle schools. One is Jesalee Parsons, now 15, of Oklahoma, who began vomiting the day she got a Gardasil shot and developed pancreatitis, her claim says. "It makes me mad because they're saying how great it is, but they never mention how many people have been hurt by it," Jesalee told The Post. Healthy all her life, her family says, Jesalee has been hospitalized on and off for more than a year. She restricts her diet, takes pain pills and misses many school days. "I'm pretty sick all the time," she said. The other claim was filed for Jessica Vega of Nevada, who came down with Guillain-Barré Syndrome, an immune-system disorder, at age 14 - a week after her second Gardasil shot. Thirty others have reported the syndrome after getting the vaccine. JESSICA'S mom, Rhonda Vega, says the girl's lower legs and arms were paralyzed, but she's learned to walk again. "Protecting girls against cervical cancer is a fabulous thing, but if this is what's going to happen, they need to research it more," she said......Merck spokeswoman Kelley Dougherty said the company "actively monitors" reports of side effects. "An event report does not mean that a causal relationship between an event and vaccination has been established - just that the event occurred after vaccination," she said. - Susan Edelman and Bruce Golding, New York Post (July 6, 2008)