ARTICLE

Shining A Light On Tetanus

THE CASE OF THE RUSTY NAIL AND THE ANTI-FERTILITY VACCINE.

Editor’s note: This article is part of a series telling the stories and policies behind CDC-recommended vaccines. Each disease will be covered in an individual article, with separate articles for combination shots.

  • Rusty nails do not cause tetanus. A specific bacterium in a deep wound, without oxygen, produces a toxin that causes the illness, whatever the injury.
  • People cannot “just get a tetanus shot” to stop tetanus infection in wounds. First, in the U.S. and many countries it’s impossible to be vaccinated for tetanus alone: It does not exist outside a combo shot. Second, getting a vaccine at the time of an injury will not stop a tetanus infection. Providers are trained that medical wound care provides an opportunity to get people vaccinated in line with CDC recommendations. In other words, the tetanus shot people get when they’re wounded is targeted at future infections, not the present wound.
  • The WHO has been accused by multiple countries over multiple decades of masking a depopulation, anti-fertility vaccine in campaigns advertised to stop babies from getting tetanus.

Imagine a time when a person could be suddenly struck with a horribly painful and disfiguring illness, without warning or knowing the cause. And with no cure, they will likely die. Tetanus infections, left unchecked, are gruesome and deadly. The infected person experiences uncontrollable seizures of muscle that make them rigid and distort their face into what looks like a very sick and pained grin. The muscles of the face tense so much the mouth cannot be moved, thus the common name “lockjaw.”

Naturally, humans instinctually want to avoid pain and suffering. Humans are also quite clever and seek solutions that are as easy as possible to use. You may have heard of “one-ill-one-pill” answers to disease — in other words, pharmaceutical drugs. Another approach that the modern medical establishment uses is to create something unnatural and manmade in an attempt to outsmart nature. That something is called vaccines, and the tetanus vaccine is one of the first used on humans.

The tetanus vaccine has been associated with some of the most controversial vaccines ever created, appearing in combination shots with diphtheria and pertussis (like DPT), as well as anti-fertility vaccines created by the World Health Organization (WHO). How did it end up on our vaccine schedules? What do we know about its history, safety, and effectiveness? Let’s start from the beginning…

WHAT IS TETANUS?

What we call “tetanus” is the illness caused by toxic by-products of bacterial reproduction. This toxin is only produced under very specific circumstances when spores (packets of bacterial DNA) get activated for reproduction.

There’s no lab test for tetanus.[i] Tetanus diagnosis is associated with rigidity, spasms, tightening of the jaw (“lockjaw”), sweating, and soaring fevers that have been documented up to 112o F.

“The diagnosis of tetanus is based on the clinical signs and symptoms only. Laboratory diagnosis is not useful as the C. tetani bacteria usually cannot be recovered from the wound of an individual who has tetanus, and conversely, can be isolated from the skin of an individual who does not have tetanus.”—Immunize.org[ii]

There’s no cure for tetanus, nor any lifelong immunity from either natural infection or a vaccine. A person who recovers from tetanus infection can get tetanus again.[iii]

So how can a vaccine stop tetanus if the body’s immune system does not keep a memory of the infection? Public health professionals argue this is why we need boosters, to keep the antibody circulating unnaturally in our bodies. The consensus among medical professionals is that the unnatural circulation of tetanus antitoxin is a person’s only way to prevent tetanus.

Tetanus is unique on the vaccine schedules because it is the only disease that is considered infectious, but not contagious. In other words, it doesn’t pass from person to person. It is acquired environmentally. Therefore, the tetanus vaccine will never eliminate tetanus as a disease, nor does herd immunity apply.

HOW DO PEOPLE GET TETANUS?

“People get tetanus by stepping on a rusty nail” is one of the most oft-repeated myths of disease in our culture. But do rusty nails cause tetanus? What about the plastic end of a drill hitting you in the head in an auto shop? What about a gash from a car accident? What about dental work or simply being born?

Does every deep wound have the potential to harbor a tetanus infection? In short, yes. Does any wound or opening through the skin, regardless of size, have that potential? Yes.

However, are there circumstances that will make a tetanus infection more or less likely? Again, a resounding yes. The risk of getting tetanus changes with geography and behavior, as well as individual circumstances like toxic load and immune system health. Tetanus spores tend to be found in hot, damp climates with soil rich in organic matter.[iv] In some areas, tetanus is rare or unknown, like parts of the Rocky Mountains in the U.S.[v] Infections tend to happen in conditions that are unsanitary or risky. People who use injectable drugs are at high risk for tetanus. Babies born in unsanitary conditions are susceptible to tetanus through unhygienic umbilical cord cutting practices.

Until the second half of the 1800s, the cause of tetanus was unknown. Even among medical practitioners who started to get a picture, there was uncertainty. Tetanus was associated with wounds, but also considered “idiopathic” (of unknown origin) if a wound was not found.

The bacteria known as Clostridium tetani produces toxins when it is in an environment without oxygenGenerally, this is not a problem because it is surrounded by oxygen all the time when it is out in the world. Spores of the bacteria are found in the intestines of animals and in the soil from animal droppings. Dig in your garden and you’ve probably encountered the spores, especially if you live in a rural setting. The bacteria itself does not cause an infection simply by exposure — it is the precise combination of lack of oxygen and the temperature of living creatures that causes the bacteria to start producing a toxin.

The bacterium C. tetani reproduces with spores, which are little packages of DNA ready for germination under the right conditions. People and animals encounter these spores in soil and in the air. The spores are extremely hardy and can withstand a wide range of temperatures, biding time until they are activated for reproduction, which happens under certain conditions and only under those conditions.

It is not the wound itself, nor the thing that caused the wound, that creates the illness. Your entire body could be coated in tetanus spores and you could still be free from tetanus infection. C. tetani bacterium are “obligate anaerobes,” meaning they will only reproduce in an environment without oxygen. The temperature range of 35-37 degrees Celsius (normal human body temperature) is the optimal temperature for reproduction, though it can reproduce to a lesser degree outside of that range. When the spores start reproducing to create new C. tetani, the process produces substances that are poisonous to humans and animals. The most dangerous is called “tetanospasmin,” which is the cause of what we know as tetanus. Tetanospasmin is a neurotoxin, meaning it is a poison to the nervous system.

In a nutshell, when we say “tetanus,” we are referring to an illness caused by the presence of a bacteria that has gone into survival mode, and the bacteria’s survival mechanisms can kill the host.

So where does the rusty nail story come from? The general assumption is that the story came from the recognition that rich, fertile soils are also places where things like automobiles and farm equipment will rust. (Rust happens naturally when certain metals are exposed to oxygen and water over time.) The tetanus-causing bacteria lives in the intestines of animals, so you can easily see the association with farmed or pastured land. It’s found in soil and manure and even dust. Rust doesn’t cause tetanus, but the two can occur in the same environment. When the U.S. was founded, it was largely agrarian, and the rusty nail story was embedded in the consciousness of Americans well before the tetanus vaccine was created in 1924. In fact, a search of newspapers back through the 1800s will turn up articles repeatedly linking tetanus to being scraped or punctured with a rusty nail.

TETANUS VACCINE MOVED FROM MILITARY TO PUBLIC HEALTH USE

A German nurse during WWI described tetanus this way: “[I]n the earth, which bears this bacillus, it is the smallest, most cruel and most malicious weapon of this war.”[i] World War I was fought “on richly manured fields in Belgium and Northern France,” with the newer combat technology of explosives. The explosions would cause shrapnel that could bury itself deep within a soldier, along with whatever dirt and debris were around.[ii]  The combination of deep wounds and fertile soil made the possibility of tetanus infections soar.

The tetanus shot was a military asset to keep soldiers from dying from tetanus infections, to keep numbers strong. It was used as an alternative to the antitoxin serum, which unfortunately caused many soldiers to have “serum sickness” or die outright.

In the late 1800s, the treatment for tetanus was “serum,” otherwise known as “antitoxin,” which was blood from other humans or animals with the disease used to create an injectable solution of antibodies.[iii] This is known as passive immunity, because the sick person is given antibodies, instead of the body making them itself. This treatment was eagerly embraced, even when it was known to cause illness or death.

This type of treatment is still used today for diseases that need a fast response when there is no known cure. Most recently, in the early days of COVID, some doctors and researchers successfully treated COVID this way, with serum referred to as “convalescent plasma.”[iv]

As often happens, soldiers were the first population to widely use this new medical solution. Soldiers were given an antitoxin (an antibody that is capable of neutralizing a specific toxin), which would be administered before active duty or in the event of a known infection. Immediately or soon after administration, many soldiers developed “serum sickness,” which reportedly killed many. Those deaths are widely considered justified because it is believed that hundreds of thousands of deaths by tetanus were prevented by administering the serum.[v] It is also acknowledged that surgical techniques of deep wound debridement and cleaning also played a role, so some attribute the drop in disease to the sanitary techniques rather than the risky antitoxin or the vaccine.[vi]

Like influenza, the tetanus vaccine was a military technology that was designed to help keep American forces strong. The first tetanus vaccine was created in 1924, but it was widely known to cause more injury and death than the disease it was meant to treat. The U.S. military identified a way to make the shot safer and a new vaccine was ready for use in WWII.

Interestingly, many tetanus cases in the early 1900s happened due to the dangers of the new fireworks and pop guns that were marketed to children.[vii] Similar to the problem soldiers faced with explosions on the battlefield, children playing war games were also exposed to explosions and injuries that would cause bacteria spores to go deeply into wounds. This was so common at the time that one Connecticut paper described the “annual epidemics of Fourth of July tetanus,” in 1904.

Also like influenza vaccines, after WWII, the medical technology moved from the battlefield to American neighborhoods and cities in the name of public health. The tetanus shot was one of the first vaccines developed for human use. It was one of the few recommended to children by private medical associations before the CDC’s Advisory Committee on Immunization Practices (ACIP) took over nation-wide recommendations in 1964.

WHY ARE WE TOLD TO GET A TETANUS SHOT WHEN WE’RE WOUNDED?

When someone experiences a deep wound, so many people—doctors and lay people alike—are quick to say, “Get a tetanus shot.” You may have heard this said to you, or perhaps you’ve even said this to someone.

You may be surprised to learn that neither the CDC, nor the WHO recommend a tetanus shot or a combination shot like DT or DTaP as a treatment for potential or known tetanus infection.[i] Getting a tetanus shot has nothing to do with treating that particular wound. In fact, doctors have understood for a long time that a vaccine is not used to treat an infection that has already occurred. In 1959, Drs. Donald Ross and J.J. Kraut co-authored a paper for “California Medicine” that noted, “To be effective, the course of toxoid inoculations must have been completed at least 30 days before the occurrence of the wound. Toxoid given at the time of injury to a patient who has not had a toxoid series of inoculations is without value. In no such circumstances can toxoid be a substitute for antitoxin.”[ii]

Standard treatment of a wound where tetanus is a possibility hasn’t changed in a century: The wound must be thoroughly and deeply cleaned, an injection of a serum to give the sick person antibodies can be given, and antibiotics are usually prescribed. The WHO recommends benzodiazepine drugs to reduce muscle spasms. In a nonmedical setting, some use homeopathic remedies like ledum and nux vomica or high doses of vitamin C to quell infection.[iii]

No matter whether people take medical or traditional approaches, the bottom line with staving off tetanus infections is always to get potential spores out of the wound as quickly and thoroughly as possible. This is why people will watch how much a wound bleeds as an indicator of the danger level for tetanus infection. Cleaning and “debriding” the wound —flushing and scraping out any foreign matter or dead skin — is essential for the best chance of stopping the spores from reproducing, releasing toxin, and attacking the nervous system.

From the 2017 WHO position paper on tetanus:

From CDC’s information for clinicians regarding tetanus:

From the CDC’s Manual for the surveillance of vaccine-preventable disease:

These snippets of guidance from the WHO and CDC show us it’s simply routine practice to attempt to get someone up to date with the vaccine recommendations for children and adults when they see a medical provider for wound care.

And don’t forget: In the U.S. and many other places, you cannot get a tetanus shot on its own. You will be getting a booster of tetanus and diphtheria, and maybe pertussis as well, even if the provider only refers to it as a tetanus shot.

TETANUS VACCINE SAFETY DATA

It’s very difficult to discuss the safety of the tetanus vaccine alone because the shot was quickly combined with other vaccinations and at this point is largely unavailable on its own. (The safety information of the tetanus combination shots will be explored in an upcoming article in this series.)

Notably, the American Pediatric Society did not require any safety testing beyond observations of use of the shot on military personnel before recommending the tetanus shot for children.

“Even in the absence of well-planned clinical trials, the widespread use of a vaccine in military populations often offered de facto evidence of safety and efficacy. For example, the military experienced such high rates of safety and presumed efficacy with their tetanus vaccine that, in the absence of formal clinical trials, in 1944, the American Pediatric Association recommended the routine use of the vaccine in the general population.”[i]

Tetanospasmin is one of the most lethal poisons we know.[ii] The lethal dose for a 154-pound human is estimated to be just 175 nanograms (1.75 x 10-7 grams).[iii] Is there a way to give humans one of the most lethal neurotoxins in a way that still has enough oomph to generate an immune response that will not overwhelm the body causing injury or death? Some doctors have argued the tetanus vaccine is useless because the dosage needed must be so low and spaced out to prevent vaccine reactions that it is ineffective.[iv]

Dr. Robert Mendelsohn,[v] popularly known as “The People’s Doctor,” addressed tetanus vaccine safety concerns in his nationally syndicated column in 1985. In response to a question from a worried parent, he aired his concerns about the vaccine’s lack of a controlled trial, and his clinical observations and questions about its efficacy and safety. His views were published at a time when many parents were pushing for public awareness of the dangers of the DPT combination shot, and one year before the National Childhood Vaccination Act (“1986 Act”) was passed by Congress giving legal immunity for injury or death to vaccine manufacturers. He encouraged his readers to use his questions and professional observations as a jumping-off point for discussion with family and doctors. This was a time in our country’s history when free speech was protected and controversial opinions were understood to draw readership, because Americans will always seek truth and justice.

Sadly, in less than 30 years, we’ve moved from national publication of Mendelsohn’s views to labeling those who question public health policy as dangerous, with active and pointed censorship by the White House in our modern digital town squares.

VACCINES IN PREGNANT WOMEN TO PREVENT NEONATAL TETANUS

The CDC recommends pregnant women get a tetanus shot to protect infants from being born with tetanus. The recommendation follows guidance from the American Public Health Association from the beginning of the 20thcentury.[i]

Tetanus data wasn’t tracked by the CDC until the late 1940s. In 1957, an internal CDC report noted that incidences of tetanus in the U.S. were not changing, and cases generally occurred among drug users, after accidents, and in newborns in southern states.

Of course, CDC scientists wanted to bring down the rates of tetanus overall. Since tetanus cases were observed in newborns, even those born in hospitals, it was concluded that efforts needed to be made to vaccinate infants and pregnant mothers.

Does this make sense? One source, the Louisiana Department of Public Health, reported that only two cases of neonatal tetanus have been found in the U.S. since 1989.[i] And it’s well understood in the medical community that the vast majority of infant deaths from tetanus occur in low-resource countries. Data from organizations that monitor disease, such as the CDC, the WHO, and international nonprofits, tell us that neonatal tetanus happens when birth conditions are unsanitary. Does it make more sense to give pregnant women injections or to create more sanitary conditions? Which would have fewer side effects or less potential for complications?

How do we know the tetanus vaccine is safe for pregnant women? The WHO claims, “There is no evidence of adverse pregnancy outcomes or risk to the fetus from the vaccination during pregnancy with TTCVs” (tetanus toxoid containing vaccines).[ii] Does it track that a vaccine that has been used in the general population since at least the 1950s would show no evidence at all of adverse outcomes, especially when used in a population that is arguably one of the most vulnerable?

The package insert from Boostrix, a Tdap vaccine that is approved and recommended for use in pregnant women,[iii]includes required safety information for pregnancy use.[iv] The safety study done for the trial used a “non-U.S. formulation,” and it’s noted that the U.S. formulation contains more aluminum. Regardless, this data was acceptable for recommendation in the U.S. Do you think mothers are aware they could be receiving a vaccine with more aluminum and a different formulation than was studied? Shouldn’t they be? Do you think health practitioners are giving this information to pregnant women before recommending and trying to get consent for Tdap in pregnancy?

THE WHO AND UNICEF HAVE BEEN ACCUSED BY MULTIPLE COUNTRIES OF USING TETANUS VACCINE CAMPAIGNS AS SECRET ANTI-FERTILITY INITIATIVES.

The WHO has spent decades researching “birth control vaccines,” starting in the 1970s. What does that have to do with tetanus vaccines? The “tetanus toxoid,” which is the “killed” form of the neurotoxin tetanospasmin that is used in the tetanus vaccine, turns out to be a great carrier for other molecules. Many researchers working on a vaccine for cancer are linking their target to the tetanus toxoid.[i] Other researchers have linked SARS-CoV-2 to the tetanus toxoid to create a COVID vaccine.[ii]

In the case of anti-fertility, birth control vaccines, the tetanus toxoid gets bound to a portion of Human Chorionic Gonadotrophin (b-hCG pronounced “beta HCG”). HCG is made when conception occurs, triggering the body to maintain the pregnancy. (This is the hormone that’s tested with a pregnancy test). Without HCG, a pregnancy will end. When tetanus is linked to HCG and delivered in a vaccine, the body creates antibodies both to tetanus and to HCG. If the body is eliminating its own HCG, a woman can no longer carry a pregnancy.

More than one country has accused the WHO of secretly sterilizing pregnant women under the guise of neonatal tetanus campaigns in low-income (mineral rich) countries. The belief is the tetanus vaccines are laced with HCG. When the woman’s body mounts an immune response to the tetanus toxoid, it also creates antibodies to HCG, stopping or preventing pregnancy.

Birth control vaccine research was largely directed by Dr. G.P. Talwar, who was recruited by the WHO to start and lead a National Institute of Immunology in New Delhi, India. Dr. Talwar worked with the WHO and scientists at the U.S.’s NIH to begin the project, which was first presented in 1976 to the U.S. Proceedings of the National Academy of Science.[iii]

The work was so successful that Dr. Talwar was able to patent the technology for “birth control vaccines” in multiple countries, first on his own,[i] and a second patent was shared with a researcher from NIH.[ii]

It is not surprising that NIH was involved in research for a birth control vaccine when we look at history. At the same time the WHO embarked on this research, the U.S. was contemplating global population growth as a national security issue. In 1974, “U.S. National Security Study Memorandum 200, Implications of Worldwide Population Growth For U.S. Security and Overseas Interests,” better known as the “Kissinger Report,” set the stage for U.S. population control policy in the name of security. [i]  The document was a result of collaboration among the US Departments of State, Defense, and Agriculture, along with the Central Intelligence Agency (CIA), and an independent agency known as United States Agency for International Development (USAID).[ii]

Dr. Talwar continued to research birth control vaccines for the WHO through the 1990s. In 1994, in a published paper titled, “A vaccine that prevents pregnancy in women,” he boasted, “This study presents evidence of the feasibility of a vaccine for control of human fertility.”[iii] In other words, the ability to stop women from having babies using a vaccine has been scientifically possible since at least the 1990s. It hasn’t been licensed yet, but has it been used? For licensing to happen, it must be tested on humans. Although “The Atlantic” recently reported[iv] clinical trials are underway, those trials are only the most recent in a sequence of trials with different iterations of the birth control vaccine that have occurred around the globe, mostly in low-income countries, since the 1970s.[v] Some religious and political leaders believe their countries were targeted for secret trials, dressed up as neonatal tetanus campaigns.

In 1995, the Catholic Women’s League of the Philippines won a court order halting a UNICEF program where it was believed the tetanus vaccines were laced with an anti-fertility agent.[vi] Scientists also found sterilizing agents in UNICEF tetanus vaccines in Nigeria in 2004.[vii] The Pro Life Committee of Mexico had similar concerns in 1995, and claimed to find the tetanus vaccines included anti-fertility agents.[viii] Most recently the Catholic Bishops of Kenya have accused the WHO of the same. A recent documentary, “Infertility: A Diabolical Agenda,” dives deep into the known facts and unanswered questions around the accusations of human rights violations and involuntary sterility to Kenyan women of childbearing age as a result of the WHO’s neonatal tetanus campaign.[ix] The documentary features authors of a must-read 2017 paper titled “HCG Found in WHO Tetanus Vaccine in Kenya Raises Concern in the Developing World.”[x]

CONCLUSION

Tetanus, untreated, is a painful and horrible illness. Fortunately, advances in understanding of the human body and in sanitary and surgical practices leave us in a very different place than those facing tetanus before the 1900s. Given what you’ve learned in this article, next time you or a loved one gets a wound, what do you think about rushing to get a tetanus shot?


References

[i] https://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html

[ii] https://www.immunize.org/catg.d/p4220.pdf

[iii] https://www.who.int/news-room/fact-sheets/detail/tetanus#:~:text=Tetanus%20can%20be%20prevented%20through,and%20can%20be%20infected%20again.

[iv] https://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/EpiManual/TetanusManual.pdf

[v] https://www.msdvetmanual.com/generalized-conditions/clostridial-diseases/tetanus-in-animals

[vi] https://sci-hub.st/10.1136/medhum-2011-010157

[vii] https://sci-hub.st/10.1136/medhum-2011-010157

[viii] https://www.nature.com/articles/d42859-020-00009-4

[ix] https://www.medrxiv.org/content/10.1101/2020.08.12.20169359v1?

[x] https://americanhistory.si.edu/collections/object-groups/antibody-initiative/battling-tetanus

[xi] https://mh.bmj.com/content/38/2/78

[xii] https://americanhistory.si.edu/blog/patriots-got-tetanus

[xiii] https://www.who.int/publications-detail-redirect/WHO-WER9206

[xiv] https://pubmed.ncbi.nlm.nih.gov/13651954/

[xv] https://pubmed.ncbi.nlm.nih.gov/18425960/

[xvi] https://link.springer.com/article/10.1057/palgrave.jphp.3200064

[xvii] https://en.wikipedia.org/wiki/Median_lethal_dose

[xviii] https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html

[xix] https://thepeoplesdoctor.net/drm-archive/tetanus-vaccine-contains-dangers/

[xx] https://llli.org/dr-robert-s-mendelsohn-the-peoples-doctor/

[xxi] https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.47.12.1493,https://archive.org/details/controlofcommunie8amer/page/184/mode/2up?q=%22tetanus+neonatorum%22 (page 183).

[xxii] https://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/EpiManual/TetanusManual.pdf

[xxiii] https://www.who.int/publications/i/item/WHO-WER9206

[xxiv] https://www.fda.gov/media/162210/download

[xxv] https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Boostrix/pdf/BOOSTRIX.PDF

Errata: The initial publication of this article mistakenly stated the U.S. formulation of Boostrix had more aluminum. We apologize for the misunderstanding and have updated the article. SHF welcomes and appreciates feedback from readers when something doesn’t look right. The integrity of the information is paramount.

[xxvi] https://www.frontiersin.org/articles/10.3389/fimmu.2020.00927/full

[xxvii] https://www.news-medical.net/news/20210214/Vaccine-candidate-containing-tetanus-toxoid-potentially-protective-against-SARS-CoV-2.aspx

[xxviii] https://www.pnas.org/doi/epdf/10.1073/pnas.73.1.218

[xxix] https://www.freepatentsonline.com/4780312.pdf

[xxx] https://www.freepatentsonline.com/5733553.pdf

[xxxi] https://pdf.usaid.gov/pdf_docs/Pcaab500.pdf

[xxxii] https://sci-hub.se/10.1073/pnas.91.18.8532

[xxxiii] https://www.theatlantic.com/science/archive/2023/05/birth-control-vaccine-efficacy-contraceptive-gaps/673927/

[xxxiv] https://www.semanticscholar.org/paper/Anti%E2%80%90hCG-Vaccines-are-in-Clinical-Trials-Talwar-Singh/4f03872a59a2ed625cf63b7f8c369a9824c5595d, https://pubmed.ncbi.nlm.nih.gov/2453766/,

[xxxv] https://www.ucanews.com/story-archive/?post_name=/1995/03/20/court-stops-use-of-antitetanus-vaccine-in-immunization-drive&post_id=46985

[xxxvi] https://www.lifesitenews.com/news/unicef-nigerian-polio-vaccine-contaminated-with-sterilizing-agents-scientist-finds/

[xxxvii] https://pubmed.ncbi.nlm.nih.gov/12346214/

[xxxviii] https://infertilitymovie.org/a-diabolical-agenda/

[xxxix] https://www.scirp.org/pdf/OALibJ_2018011811381800.pdf

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