It's a far piece from the horse-and-buggies of Lancaster County, Pa.,
to the cars and freeways of Cook County, Ill.

But thousands of children cared for by Homefirst Health Services in
metropolitan Chicago have at least two things in common with thousands
of Amish children in rural Lancaster: They have never been vaccinated.
And they don't have autism.

"We have a fairly large practice. We have about 30,000 or 35,000
children that we've taken care of over the years, and I don't think we
have a single case of autism in children delivered by us who never
received vaccines," said Dr. Mayer Eisenstein, Homefirst's medical
director who founded the practice in 1973. Homefirst doctors have
delivered more than 15,000 babies at home, and thousands of them have
never been vaccinated.

The few autistic children Homefirst sees were vaccinated before their
families became patients, Eisenstein said. "I can think of two or
three autistic children who we've delivered their mother's next baby,
and we aren't really totally taking care of that child -- they have
special care needs. But they bring the younger children to us. I don't
have a single case that I can think of that wasn't vaccinated."

The autism rate in Illinois public schools is 38 per 10,000, according
to state Education Department data; the Centers for Disease Control
and Prevention puts the national rate of autism spectrum disorders at
1 in 166 -- 60 per 10,000.

"We do have enough of a sample," Eisenstein said. "The numbers are too
large to not see it. We would absolutely know. We're all family
doctors. If I have a child with autism come in, there's no
communication. It's frightening. You can't touch them. It's not
something that anyone would miss."

No one knows what causes autism, but federal health authorities say it
isn't childhood immunizations. Some parents and a small minority of
doctors and scientists, however, assert vaccines are responsible.

This column has been looking for autism in never-vaccinated U.S.
children in an effort to shed light on the issue. We went to Chicago
to meet with Eisenstein at the suggestion of a reader, and we also
visited Homefirst's office in northwest suburban Rolling Meadows.
Homefirst has four other offices in the Chicago area and a total of
six doctors.

Eisenstein stresses his observations are not scientific. "The trouble
is this is just anecdotal in a sense, because what if every autistic
child goes somewhere else and (their family) never calls us or they
moved out of state?"

In practice, that's unlikely to account for the pronounced absence of
autism, says Eisenstein, who also has a bachelor's degree in
statistics, a master's degree in public health and a law degree.

Homefirst follows state immunization mandates, but Illinois allows
religious exemptions if parents object based either on tenets of their
faith or specific personal religious views. Homefirst does not exclude
or discourage such families. Eisenstein, in fact, is author of the
book "Don't Vaccinate Before You Educate!" and is critical of the
CDC's vaccination policy in the 1990s, when several new immunizations
were added to the schedule, including Hepatitis B as early as the day
of birth. Several of the vaccines -- HepB included -- contained a
mercury-based preservative that has since been phased out of most
childhood vaccines in the United States.

Medical practices with Homefirst's approach to immunizations are rare.
"Because of that, we tend to attract families that have questions
about that issue," said Dr. Paul Schattauer, who has been with
Homefirst for 20 years and treats "at least" 100 children a week.

Schattauer seconded Eisenstein's observations. "All I know is in my
practice I don't see autism. There is no striking 1-in-166," he said.

Earlier this year we reported the same phenomenon in the mostly
unvaccinated Amish. CDC Director Dr. Julie Gerberding told us the
Amish "have genetic connectivity that would make them different from
populations that are in other sectors of the United States."
Gerberding said, however, studies "could and should be done" in more
representative unvaccinated groups -- if they could be found and their
autism rate documented.

Chicago is America's prototypical "City of Big Shoulders," to quote
Carl Sandburg, and Homefirst's mostly middle-class families seem
fairly representative. A substantial number are conservative
Christians who home-school their children. They are mostly white, but
the Homefirst practice also includes black and Hispanic families and
non-home-schooling Jews, Catholics and Muslims.

They tend to be better educated, follow healthier diets and breast-
feed their children much longer than the norm -- half of Homefirst's
mothers are still breast-feeding at two years. Also, because Homefirst
relies less on prescription drugs including antibiotics as a first
line of treatment, these children have less exposure to other
medicines, not just vaccines.

Schattauer, interviewed at the Rolling Meadows office, said his
caseload is too limited to draw conclusions about a possible link
between vaccines and autism. "With these numbers you'd have a hard
time proving or disproving anything," he said. "You can only get a
feeling about it.

"In no way would I be an advocate to stand up and say we need to look
at vaccines, because I don't have the science to say that," Schattauer
said. "But I don't think the science is there to say that it's not."

Schattauer said Homefirst's patients also have significantly less
childhood asthma and juvenile diabetes compared to national rates. An
office manager who has been with Homefirst for 17 years said she is
aware of only one case of severe asthma in an unvaccinated child.

"Sometimes you feel frustrated because you feel like you've got a
pretty big secret," Schattauer said. He argues for more research on
all those disorders, independent of political or business pressures.

The asthma rate among Homefirst patients is so low it was noticed by
the Blue Cross group with which Homefirst is affiliated, according to
Eisenstein.

"In the alternative-medicine network which Homefirst is part of, there
are virtually no cases of childhood asthma, in contrast to the overall
Blue Cross rate of childhood asthma which is approximately 10
percent," he said. "At first I thought it was because they
(Homefirst's children) were breast-fed, but even among the breast-fed
we've had asthma. We have virtually no asthma if you're breast-fed and
not vaccinated."

Because the diagnosis of asthma is based on emergency-room visits and
hospital admissions, Eisenstein said, Homefirst's low rate is hard to
dispute. "It's quantifiable -- the definition is not reliant on the
doctor's perception of asthma."

Several studies have found a risk of asthma from vaccination; others
have not. Studies that include never-vaccinated children generally
find little or no asthma in that group.

Earlier this year Florida pediatrician Dr. Jeff Bradstreet said there
is virtually no autism in home-schooling families who decline to
vaccinate for religious reasons -- lending credence to Eisenstein's
observations.

"It's largely non-existent," said Bradstreet, who treats children with
autism from around the country. "It's an extremely rare event."

Bradstreet has a son whose autism he attributes to a vaccine reaction
at 15 months. His daughter has been home-schooled, he describes
himself as a "Christian family physician," and he knows many of the
leaders in the home-school movement.

"There was this whole subculture of folks who went into home-schooling
so they would never have to vaccinate their kids," he said. "There's
this whole cadre who were never vaccinated for religious reasons."

In that subset, he said, "unless they were massively exposed to
mercury through lots of amalgams (mercury dental fillings in the
mother) and/or big-time fish eating, I've not had a single case."

Federal health authorities and mainstream medical groups emphatically
dismiss any link between autism and vaccines, including the mercury-
based preservative thimerosal. Last year a panel of the Institute of
Medicine, part of the National Academies, said there is no evidence of
such a link, and funding should henceforth go to "promising"
research.

Thimerosal, which is 49.6 percent ethyl mercury by weight, was phased
out of most U.S. childhood immunizations beginning in 1999, but the
CDC recommends flu shots for pregnant women and last year began
recommending them for children 6 to 23 months old. Most of those shots
contain thimerosal.

Thimerosal-preserved vaccines are currently being injected into
millions of children in developing countries around the world. "My
mandate ... is to make sure at the end of the day that 100,000,000 are
immunized ... this year, next year and for many years to come ... and
that will have to be with thimerosal-containing vaccines," said John
Clements of the World Health Organization at a June 2000 meeting
called by the CDC.

That meeting was held to review data that thimerosal might be linked
with autism and other neurological problems. But in 2004 the Institute
of Medicine panel said evidence against a link is so strong that
health authorities, "whether in the United States or other countries,
should not include autism as a potential risk" when formulating
immunization policies.

But where is the simple, straightforward study of autism in never-
vaccinated U.S. children? Based on our admittedly anecdotal and
limited reporting among the Amish, the home-schooled and now Chicago's
Homefirst, that may prove to be a significant omission