“Before the vaccine was developed, the diagnosis of polio required 24 or more hours of paralysis. After the vaccine release, the diagnosis changed to at least 60 days of paralysis. As you can imagine, cases of polio dropped significantly.”
The Myth That Polio Went Away Because They Changed the Diagnostic Criteria
In 1952, there were 21,000 cases of paralytic polio in the United States.
But were there really?
Didn’t they change the way they diagnosed polio a few years later, right after the first polio vaccines came out, making it less likely that folks would be diagnosed with polio?
The original diagnostic criteria for polio came from the World Health Organization and included:
“Signs and symptoms of nonparalytic poliomyelitis with the addition of partial or complete paralysis of one or more muscle groups, detected on two examinations at least 24 hours apart.”
It changed in 1955 to include residual paralysis 10 to 20 days after onset of illness and again 50 to 70 days after onset.
“In the past children’s paralysis was often not correctly diagnosed as polio. Stool samples need to be analyzed to be able to distinguish paralytic symptoms from Guillain-Barré Syndrome, transverse myelitis, or traumatic neuritis.”
Polio – Data Quality and Measurement
But you coulld’t just use stool samples, as many kids might have recently had non-paralytic polio, and could test positive for polio (false positive test), but have another reason to have paralysis.
“Isolation of poliovirus is helpful but not necessary to confirm a case of paralytic poliomyelitis, and isolation of poliovirus itself does not confirm diagnosis.”
Alexander et al. on Vaccine Policy Changes and Epidemiology of Poliomyelitis in the United States
Since polio causes residual paralysis, the new diagnostic criteria helped to make sure that kids were diagnosed correctly.
Did We Overestimate the Number of Kids with Polio?
Some folks think that since we changed the criteria, we overestimated the number of kids with polio in the years before the vaccine came out.
Most of this idea seems to come from a panel discussion in 1960 by critics of the original polio vaccine, The Present Status of Polio Vaccines, including two, Dr. Herald R. Cox and Dr. Herman Kleinman, who were working on a competing live-virus vaccine.
None in the group were arguing against vaccines, or even really, that the Salk polio vaccine didn’t work at all though. They just didn’t think that it was effective as some folks thought.
“I’ve talked long enough. The only other thing I can say is that the live poliovirus vaccine is coming. It takes time. The one thing I am sure of in this life is that the truth always wins out.”
Dr. Herald R. Cox on The Present Status of Polio Vaccines
Dr. Cox did talk a lot about the oral polio vaccine. He talked about successful trials in Minneapolis, Nicaragua, Finland, West Germany, France, Spain, Canada, Japan, and Costa Rica, etc.
When anti-vaccine folks cherry pick quotes from The Present Status of Polio Vaccines discussion panel, they seem to leave out all of the stuff about how well the oral polio vaccine works.
“Since nothing is available, there seems to be no alternative but to push the use of it. I don’t think we should do so in ignorance, nor too complacently, believing that as long as we have something partially effective there is no need to have something better.”
Dr. Bernard Greenberg on The Present Status of Polio Vaccines
And of course, they did, fairly soon, switch to something better – the Sabin live-virus oral polio vaccine.
Interestingly, using the idea that we changed the diagnostic criteria to make polio go away in an argument about vaccines is known as the Greenberg Gambit.
It tells you something about anti-vaccine arguments, that these folks are misinterpreting something someone said about vaccines almost 60 years ago.
In pushing the idea that polio hasn’t been eliminated, but rather just redefined, they also miss that:
But isn’t polio still around and just renamed as transverse myelitis, Guillain-Barré syndrome (GBS), and aseptic meningitis?
Let’s do the math.
Using the adjusted numbers in the The Present Status of Polio Vaccines discussion, there were at about 6,000 cases of paralytic polio in the United States in 1959.
While 3,000 to 6,000 people in the United States develop Guillain-Barré syndrome each year, the risk increases with age, and it is rare in young kids. Remember, paralytic polio mostly affected younger children, typically those under age 5 years.
“Transverse myelitis can affect people of any age, gender, or race. It does not appear to be genetic or run in families. A peak in incidence rates (the number of new cases per year) appears to occur between 10 and 19 years and 30 and 39 years.”
Transverse Myelitis Fact Sheet
Similarly, transverse myelitis is uncommon in younger children, and there are even fewer cases, about 1,400 a year.
What about aseptic meningitis? That doesn’t usually cause paralysis.
So do the math.
You aren’t going to find that many kids (remember, the incidence was 5-7 per 1,000) under age 5 years who really have “polio,” but instead, because of a worldwide conspiracy about vaccines, are getting diagnosed with transverse myelitis, Guillain-Barré syndrome (GBS), or aseptic meningitis instead.
Anyway, kids with acute flaccid paralysis are thoroughly tested to make sure they don’t have polio. And both transverse myelitis and Guillain-Barré syndrome have different signs and symptoms from paralytic polio. Unlike polio, which as asymmetric muscle atrophy, the atrophy in transverse myelitis and Guillain-Barré syndrome is symmetrical. Also, unlike those other conditions that cause AFP, with polio, nerve conduction velocity tests and electromyography testing will be abnormal. Plus, polio typically starts with a fever. The other conditions don’t. So while these conditions might all be included in a differential diagnosis for someone with AFP, they are not usually that hard to distinguish.
“Each case of AFP should be followed by a diagnosis to find its cause. Within 14 days of the onset of AFP two stool samples should be collected 24 to 48 hours apart and need to be sent to a GPEI accredited laboratory to be tested for the poliovirus.”
Polio – Data Quality and Measurement
But why be so strict on following up on every case of AFP?
It’s very simple.
If you miss a case of polio, then it could lead to many more cases of polio. And that would tmake it very hard to eradicate polio in an area.
If anything, until the establishment of the Global Polio Eradication Initiative (GPEI) in 1988, it is thought that cases of polio and paralytic polio were greatly underestimated in many parts of the world!
And now polio is almost eradicated.
“DR. SABIN: Let us agree, at least, that things are not being brushed aside. Let us say that we might disagree on the extent to which certain things have received study. But I hope that Dr. Bodian realizes that nobody is brushing things aside. I would not have taken the trouble of spending several months studying viremia with different strains in chimpanzees and human volunteers, and viremia produced by certain low temperature mutants to correlate it with their invasive capacity, if I were merely brushing it aside.”
Live Polio Vaccines – Papers Presented and Discussions Held at the First International Conference on Live Poliovirus Vaccines
If they redefined how paralytic polio was diagnosed in 1955 as part of a conspiracy to make it look like the polio vaccines were working, then why did the number of cases continue to drop into the 1960s?
Shouldn’t they have just dropped in 1955 and then stayed at the same lower level?
And why don’t any of the folks with other conditions that cause paralysis, like transverse myelitis and Guillain-Barré syndrome (GBS) ever have polio virus in their system when they are tested?
Also, if the renaming theory explains why the polio vaccine didn’t work, then why do anti-vaccine folks also need to push misinformation about DDT and polio?
What to Know About Polio Myths and Conspiracies
The near eradication of polio from the world is one of the big success stories of the modern era, just as those who push the idea that has all been faked is a snapshot of society at one of our low points.
“Well, here are the numbers. And the numbers change every year. I think in 2012, there were 185 million doses of flu doses manufactured in this country. And I think fewer than 10 million were thimerosal-free. Over 90 percent had huge, huge doses of mercury.”
An interview with Robert Kennedy Jr. on vaccines
Huge, huge doses of mercury?
Although it was never actually linked to any significant side effects, as a “precautionary measure,” the AAP recommended that thimerosal (mercury) be removed from childhood vaccines in 1999.
Thimerosal was removed from the hepatitis B, DTaP, and Hib vaccines, the only routinely used, non-flu vaccines that ever had thimerosal, in 2001. It is important to note that thimerosal-free versions of the DTaP and Hib vaccines were already available in the late 1990s though.
By January 2003, remaining stocks of vaccines with thimerosal expired.
Also in 2003, thimerosal-free flu vaccines became available, including thimerosal-free flu shots and FluMist, the nasal spray flu vaccine.
Is he right about the number of thimerosal-free flu vaccines in 2012?
Let’s do the math.
Ever since thimerosal-free flu vaccines became available in 2003, the supply has increased each year.
2007-08: 112 million doses, with 10-12 million doses of thimerosal-free flu vaccine from Sanofi Pasteur, 7 million doses of thimerosal free FluMist, plus Afluria was thimerosal-free, and flu vaccines with trace thimerosal from Novartis and GSK
2008-09: 110 million doses, with 50 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine and only 25% infants and toddlers are fully vaccinated against flu
2009-10: 114 million doses, with 50 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
2010-11: 155 million doses, with 74 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
2011-12: 132 million doses, with 79 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
2012-13: 134 million doses, with 62 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine, including 13 to 14 million doses of FluMist. While 76% of infants and toddlers were vaccinated, only 50% of pregnant women got a flu shot.
2013-14: 134 million doses, with 62 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine. 13 million doses of FluMist.
2014-15: 147 million doses, with 98 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine. 14 to 15 million doses of FluMist.
2015-16: 146 million doses, with 116-118 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
2016-17: 145 million doses, with 120 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
2017-18: 155 million doses, with 130 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
So Kennedy was wildly wrong about the number of thimerosal-free flu vaccines that were available in 2012. And he is certainly wrong about the number of thimerosal-free flu vaccines that are available today.
“Over 90 percent had huge, huge doses of mercury. Not trace amounts as the industry likes to claim. Trace amounts means less than 1 microgram. They contain 25 micrograms, which is 25 times trace amount and over 100 times what EPA’s safe exposure levels are. … So today, in the last three or four years, that number has been reduced to 48 million.” Which number has been reduced to 48 million?
“I believe this year there were 150, around 150 million flu doses manufactured and 48 million of those, or a third, were loaded with mercury.”
An interview with Robert Kennedy Jr. on vaccines
What about his theory about the way the “industry” uses the term trace amounts?
There has never been a conspiracy to hide the thimerosal content of flu shots or any other vaccines. Those with trace amounts of thimerosal clearly have less than or equal to 1mcg per dose. Others were either thimerosal free or contained a standard amount of thimerosal, 25mcg.
Not surprisingly, this isn’t the first time Kennedy has tried to mislead people about vaccines.
“There is no question that meningococcal meningitis is a serious disease that can cause death and disability, but we need to ensure that the solution is not worse than the problem. There is every reason to believe that mandatory meningococcal B vaccines for every college student could kill more students than the disease they protect against. Before we relinquish our rights, pay millions and sicken students, we should do the math.”
Robert F. Kennedy, Jr.: Doing the math on meningitis vaccinations
A few years ago, Kennedy responded to a resolution that had been passed by the University of Colorado-Boulder student government about new meningococcal B vaccines.
For some reason, he devoted a good deal of time talking about the “hefty mercury load” that kids could get from Menomune, a vaccine that doesn’t cover the meningococcal B strain and which has largely been replaced by the newer Menactra (2006) and Menveo (2010) vaccines. In fact, Menomune was discontinued last year.
What to Know About Robert F Kennedy, Jr
Kennedy seems to mislead people about thimerosal and vaccines at every opportunity he can.
Many folks were surprised by the reports that Donald Trump had selected Robert Kennedy, Jr to head a committee on vaccine safety.
Or maybe it shouldn’t have been a surprise. Kennedy, an environmental lawyer, once wrote a discredited article on the dangers of mercury in vaccines, and like Trump, continues to believe that vaccines are linked to autism.
But what can we expect from a Kennedy vaccine safety committee?
Robert F Kennedy, Jr on Vaccines
Vaccines have been proven safe and necessary time and again. If this vaccine safety commission happens, most people expect Kennedy to push his conspiracy theories to even more people.
In addition to wasting a lot of time and money, Kennedy has the potential to scare parents away from getting their kids vaccinated and protected against vaccine-preventable diseases.
“The CDC is a subsidiary of the pharmaceutical industry. The agency owns more than 20 vaccine patents and purchases and sells $4.1 billion in vaccines annually.”
Robert F Kennedy, Jr
This is one of RFK, Jr statements about vaccines.
Surprisingly, some parts of this statement are true.
The Centers for Disease Control and Prevention (CDC) does own some vaccine patents. And the CDC does buy about $4.1 billion in vaccines each year.
They don’t sell those vaccines though. They are distributed through the Vaccines for Children program to children who can’t afford vaccines.
Other Robert F Kennedy, Jr Vaccine Conspiracy Theories
What else does Kennedy believe?
While many anti-vaccine folks believe in Big Pharma conspiracies, Kennedy takes it to an extreme and believes that they have a “broad reach” and that “virtually all the institutions that are supposed to stand between a rapacious industry and vulnerable children have been compromised,” including “Congress, the regulatory agencies, FDA and CDC, the IOM, the NIH, the AAP, the science journals, the university science departments and the press.”
Kennedy has also stated, or to be more precise, misstated that:
“Pharma’s stranglehold on the journals keeps independent vaccine safety science from ever getting published. Just this month, the Swiss journal, Frontiers in Public Health, cancelled publication of the first vaccinated/unvaccinated study. The study showed that vaccinated children had less measles and rubella, but four times as many neurological disorders—including autism –and 30 times the incidence of allergies.” – The very small study had been only provisionally accepted and was rejected upon further review. It wasn’t even the first vaccinated/unvaccinated study. That would be the “Vaccination Status and Health in Children and Adolescents Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS),” which looked at “whether unvaccinated children and adolescents differ from those vaccinated in terms of health.” And not surprisingly, they do. The unvaccinated kids get more vaccine preventable diseases. So what happened to the study? Like many retracted anti-vaccine studies, they republished it in another journal.
“…there is an overt conspiracy by a small group within the CDC vaccine division. It’s explicit. You can watch it unfold if you read the Simpsonwood transcripts and the related emails…” – Kennedy wrote extensively about Simpsonwood, the 2000 Scientific Review of Vaccine Safety Datalink Information conference, in his article Deadly Immunity, which was so full of obvious errors (some described them as lies), that it was eventually retracted. In addition to the obvious errors, Kennedy “quote mined the IOM report to make it seem that it said the exact opposite of what it really said.”
“…the CDC’s best and most recent science shows that autism spectrum disorder rates in Scandinavia dropped 33 percent following the removal of thimerosal in 1993.” – the article Kennedy cites is actually about recurrence risk, how likely you are to have another child with autism and “supports the role of genetics in ASDs,” and although rates seemed to decrease after a peak, they were still the same as before thimerosal was removed
“Vaccine mercury exposures to children today are comparable to exposures in the 1990s, and, for the first time, thimerosal vaccines are being administered to pregnant women in America.” – this is perhaps Kennedy’s most ridiculous claim. I think he mostly bases it on the fact that pregnant women get flu shots, but with the availability of thimerosal free flu vaccines (70% of flu vaccine dosages available this year) and the fact that only about 40% of pregnant women get the flu vaccine during flu season, it is impossible to think that “vaccine mercury exposures to children today are comparable to exposures in the 1990s,” when the hepatitis B, DTaP, and Hib vaccines could all have thimerosal and were all given to infants multiple times.
Kennedy has compared getting vaccinated to “a holocaust” and in his mind, there is a conspiracy among the CDC, doctors, and the press that is “akin to what happened to the Catholic Church during the pedophile scandal. The institution suddenly became more important than the children it was supposed to protect. Only a few individuals were actively involved in raping children and shuffling known pedophile priests to unsuspecting dioceses.” – he apologized for the holocaust statement, but not for anything else he has ever said.
“I want to apologize to all whom I offended by my use of the word to describe the autism epidemic. I employed the term during an impromptu speech as I struggled to find an expression to convey the catastrophic tragedy of autism, which has now destroyed the lives of over 20 million children and shattered their families.” – of course, his “apology” was just as offensive to many people
“First of all, vaccines are not subject to the safety rigors undergone by other pharmaceuticals in the FDA approval process. There are no large scale, double-blind, placebo-controlled studies.” – there actually are…
“…in the one 1930 human study of thimerosal that predated its use in vaccines, all the subjects injected with thimerosal died.” – all of the subjects had meningococcal meningitis, a now vaccine-preventable disease that is life-threatening even today
“Verstraeten’s original analysis of those datasets found that thimerosal exposures increased autism risk by 760%. The CDC now knew the cause of the autism epidemic.” – it didn’t, although this is a common anti-vaccine conspiracy that involves the CDC hiding data about thimerosal, vaccines, and autism
Ironically, Kennedy is the nephew of President John F Kennedy, who signed the Vaccination Assistance Act in 1962 (Section 317 of the Public Health Service Act). President Kennedy’s vaccine law started as a three year program to help get kids vaccinated against polio, diphtheria, tetanus, and pertussis, and has been continuously reauthorized ever since.
What Happened to Kennedy’s Vaccination Safety Committee
Kennedy never did get appointed to head Trump’s vaccine safety commission.
“In both of those two meetings he asked me if vaccines weren’t a bad thing because he was considering a commission to look into ill-effects of vaccines,” Gates recalled, noting that Robert Kennedy Jr. had been urging Trump to launch such an effort. Gates said he told Trump, “that’s a dead end, that would be a bad thing, don’t do that.”
In fact, Trump never even created a vaccine safety commission, perhaps because he got some good advice from Bill Gates.
What to Know About Robert F Kennedy, Jr’s Vaccination Safety Committee
Plans for a Vaccine Safety Commission, which would help Robert F Kennedy, Jr gain a bigger audience for his ideas about thimerosal and autism, seem to be on hold.
More on Robert F Kennedy, Jr’s Vaccination Safety Committee
One anti-vaccine group did test and find thimerosal in a vaccine, but it was a flu vaccine that said it contained thimerosal. How much did they find? The amount that was supposed to be in the vaccine… If they were really reporting about some kind of conspiracy, you would have thought they would have tested one of the thimerosal free flu vaccines that are available.
What about the idea that “some information regarding additives and residuals is considered to be a trade secret and thus confidential?”
The chapter in the book Vaccines where that quote comes from also states that because of FDA regulations “the use of, and quantity of, additives and residuals should be disclosed on the vaccine label.”
Specifically, vaccines labels must include:
the preservative used and its concentration
known sensitizing substances
the type and calculated amounts of antibiotics added during manufacture
the source of the product when a factor in safe administration
the identity of each organism used in manufacture, and, where, applicable, the production medium and method of inactivation
So what are the trade secrets?
“It is important to recognize that FDA-approval of all new vaccines involves not only assessment of the antigens and final contents, but the entire process of synthesis. Each and every component introduced and used in the manufacture is scrutinized. While there are a wide array of excipients required to either manufacture, package or deliver effective immunity, each of these is part of this approval process.”
Vaccinophobia and Vaccine Controversies of the 21st Century
They are likely very specific details about the production process. In other words, how exactly they put all of the ingredients together to actually make the vaccine.
There is no secret about what’s in your child’s vaccines. No hidden ingredients either.
What about warnings over contaminates in vaccines?
When they rarely occur, contaminated vaccines are discovered and removed. Keep in mind that vaccines are very safe from contamination and the only issue with any recent incidents is that they are used by the anti-vaccine movement to further scare parents who are on the fence about vaccines.
What to Know About Hidden Ingredients in Vaccines
There are no secret or hidden ingredients in vaccines.
There is plenty of evidence that the standard immunization schedule is safe and effective.
What about the alternative vaccine schedules that some folks push?
Is there any evidence that is safe to delay or skip any of your child’s vaccines?
Alternative Vaccine Schedules
Many people think of Dr. Bob Sears when they think of alternative vaccine schedules.
He created both:
Dr Bob’s Selective Vaccine Schedule
Dr Bob’s Alternative Vaccine Schedule
He didn’t invent the idea of the alternative vaccine schedule though.
Well before Dr. Bob appeared on the scene, Dr. Jay Gordon had been on Good Morning America with Cindy Crawford to discuss vaccines and how she had decided to delay vaccinating her baby.
Where did she get the idea?
After the segment, Dr. Jay stated:
“They edited the segment to make me sound like a vaccination proponent. We also have to understand the impact of a person as well-known as Cindy Crawford delaying vaccines for over six months.”
Dr. Jay has long talked about only giving infants one vaccine at a time and waiting until they are “developmentally solid” before vaccinating.
Similarly, other folks have pushed ideas about delaying and skipping vaccines before Dr. Bob, including:
Donald Miller and his User-Friendly Vaccination Schedule – no vaccines until age two years and no live vaccines and when you begin vaccinating your child, give them one at a time, every six months (first published in 2004)
Stephanie Cave – starts at 4 months and delays many vaccines
homeopaths with immunization schedules that say to wait until six months and then start giving nosodes every five days
chiropractors with immunization plans that say to get regular chiropractic adjustments instead of vaccines
Of course, Dr. Bob is the one who popularized the idea of the alternative vaccine schedule in 2007, when he published The Vaccine Book: Making the Right Decision for Your Child.
That’s when parents started to bring copies of his schedule into their pediatrician’s office, requesting to follow Dr. Bob’s schedule instead of the standard immunization schedule from the CDC.
What’s the Evidence for Alternative Vaccine Schedules?
There is no evidence that following an alternative vaccine schedule is safe for your kids.
“No alternative vaccine schedules have been evaluated and found to provide better safety or efficacy than the recommended schedule, supported by the Advisory Committee on Immunization Practices of the CDC and the Committee on Infectious Diseases of the AAP (the committee that produces the Red Book).
Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.”
American Academy of Pediatrics
What’s the first clue that these so-called alternative vaccine schedules have absolutely no evidence behind them?
They are all different!
Paul Thomas, for example, doesn’t even offer his patients the rotavirus vaccine. Dr. Bob, on the other hand, has it on his list of vaccines that “that could protect a baby from a very potentially life-threatening or very common serious illness” and is sure to give it at 2, 4, and 6 months.
How slow should you go?
Both Dr. Bob and Dr. Paul give two vaccines at a time with their schedules, but Dr. Jay and Dr. Miller say to give just one at a time.
“Would any scientist give SIX vaccines at once to a baby? Asking for trouble. One at a time makes so much more sense.”
And while some start their schedules at 2 or 4 months, others delay until 6 months or 2 years.
There is also the fact that the folks who create these schedules admit that there is no evidence for what they are doing…
“No one’s ever researched to see what happens if you delay vaccines. And do babies handle vaccines better when they’re older? This is really just a typical fear that parents have when their babies are young and small and more vulnerable. Since I don’t know one way or the other, I’m just happy to work with these parents, understand their fears and their worries, and agree to vaccinate them in a way that they feel is safer for their baby.”
Unvaccinated kids aren’t healthier – they just get more vaccine preventable diseases. Most of which are life-threatening, even in this age of modern medicine, with access to good nutrition and sanitation.
So whether you only get one or two vaccines at a time; delay until four months, six months, or two years before you get started; skip all live vaccines or just wait until your child is “developmentally solid” to give them; or go with some other non-standard, parent-selected, delayed protection vaccine schedule, the only things that you can be sure of is that there is no evidence to support your decision and that you will leave your kids unprotected and at risk for getting a vaccine-preventable disease.
“…when I give your six-week-old seven different vaccines with two dozen antigens, I am supposed to try to convince you that the adverse reactions you have heard about are just coincidences.”
Better yet though. Find a pediatrician who will listen and answer your questions about vaccines, concerns about vaccine myths and misinformation, explain that no vaccine is optional, and not just simply pander to your fears.
What to Know About the Evidence for Alternative Vaccine Schedules
There is no evidence that skipping or delaying any vaccines with an alternative vaccine schedules can keep your kids safe from vaccine preventable diseases.
More on the Evidence for Alternative Vaccine Schedules
Tragically, the pseudo-scientific arguments on many anti-vaccine websites can sometimes be persuasive, especially if you don’t understand that they are mostly the same old arguments that the anti-vaccine movement has been using for over 200 years to scare parents away from vaccinating and protecting their kids.
Sites that are considered anti-vaccine by most people and that push propaganda and myths include:
Age of Autism
Child Health Safety (The facts about vaccine safety your government wont give you)