Did Big Pharma’s lust for profits lead to the deaths of my sister and many other kids?
When I was five in 1965, my nine-year-old sister became ill, as kids frequently do. Most get better. Sharon didn’t.
I went on to spend much of the subsequent five-plus decades wondering why. Sharon went on to an eternal resting site in Arlington National Cemetery.
For most of my life, I could only speculate on the cause of my sister’s death. Dad thought it had to do with some pesticides-sprayed fruit she could have eaten. Mom collected newspaper clippings on various diseases and conditions, including Reye’s syndrome, a rapidly progressive disorder that causes swelling of many organs, particularly the brain and liver.
Public records showed the cause of Sharon’s death to be “probable encephalitis,” an inflammation of the brain. But what caused that swelling?
Notes Mom took of what happened during Sharon’s illness lent some clues. On Feb. 24, 1965, Sharon complained of a headache and had a slight temperature. Under the family doctor’s recommendation, Mom gave her baby aspirin, which our physician also authorized for me and siblings Kathy and Patrick when we had fevers during those years. That was the common recommendation then, but not now. Most parents back then didn’t question doing that. Why should they? The advice came from medical professionals, right?
The next day, Sharon’s temperature rose to 102 degrees so Mom took her to see the physician. The Tampa, Fla., doctor told Mom to give Sharon adult aspirin, going beyond what most physicians recommended even back then.
The following day, Sharon’s temperature regressed to 99 degrees. But another day later, it rose again to 101 before declining to 99.
On Sunday, Feb. 28, Sharon’s temperature remained down, but she complained of a stomach ache and vomited several times a few hours later. On Monday morning, she threw up twice more, so Mom took her to the doctor. He said Sharon had acidosis and was dehydrated. He suggested she take a solution of water, baking soda, sugar, and lemon every 20 minutes, as well as a suppository to control vomiting. He also advised taking milk.
Between feedings, Sharon seemed drowsy. Mom called the doctor that evening, who said to let her sleep and call Tuesday morning. Around 5 a.m., Sharon awoke and started to scream like she was having a nightmare. She would not answer Mom or Dad or let anyone touch her. They called an ambulance, and Sharon screamed all the way in the ambulance and during the exam in the emergency room, according to the notes. They gave her a sedative and admitted her.
The doctors could find little wrong, even doing a spinal tap to check for a brain hemorrhage.
On Wednesday, Sharon experienced trouble breathing and continued to vomit. Doctors considered doing a tracheotomy but held off. On Thursday, March 4, Sharon shook with tremors, and doctors proceeded with the tracheotomy around 1 p.m. Her breathing improved, but Mom noticed afterwards she had a convulsion and her mouth twitched. Doctors asked Mom and Dad to leave the room.
Around 4 p.m. — eight days after Sharon first complained of a headache and two days after being hospitalized — doctors told my parents she was dead.
Years later, Mom told me that a public health study was conducted on Sharon, but she was only told the results were inconclusive. She suspected Reye’s syndrome, though I could tell she didn’t want to do so. The symptoms were there — vomiting, headaches, drowsiness, nightmares, screaming, sensitivity to touch, confusion to the point of not recognizing family members.
But confronting the horror of giving your child something on doctor’s orders, and that turning out to be what caused your kid’s death, was almost too much to consider. Yet, that was what likely occurred to not just Sharon, but to hundreds, perhaps thousands, of other kids.
Colleague: Reye ‘sat on this for ten years’
The first known scientific report on a condition that could have been Reye’s was believed to be written by British neurologist W. Russell Brain. He published a report in 1929 in The Lancet — a British medical journal — describing brain swelling and fatty liver tissue in six children who died. Brain described the condition as “acute meningo-encephalomyelitis.” 1
Other physicians reported similar occurrences in medical journals under different titles between 1954 and 1961. Reports in 1954 and 1955 were related to chickenpox and hypoglycemia. 2
In 1961, Harvard neurologist Gilles Lyon headed a report in Oxford University journal Brain that called attention to infants and children who acquired fevers, experienced convulsions, and fell into comas. Some patients were retrospectively found to be affected with Reye’s. 3
Lyon and his team “identified Reye syndrome before [Douglas] Reye did but gave it a broader clinical description that was not retained by the neurology readers of the time,” wrote Harvard neurologist Allan H. Ropper. 4
Drug maker Bayer began its mass marketing of aspirin in 1899. As more physicians advised parents to give their children the drug to control fever, U.S. retail sales of aspirin increased from $81 million in 1960 to $107 million in 1970. That trend continued despite an increasing number of medical researchers linking aspirin to children’s deaths. Edward A. Mortimer Jr., a pediatrician at Western Reserve University in Ohio, and others proposed in 1962 that salicylates, a major ingredient in aspirin, caused hypoglycemia in four infants who died after contracting chicken pox. 5
While Douglas Reye, the Australian pathologist credited with discovering the syndrome, observed cases starting in 1951 at the Royal Alexandra Hospital for Children, he did not publish findings in The Lancet until 1963. Colleague Jim Baral told journalist and medical doctor Lawrence Altman that he and chief resident Graeme Morgan had to push Reye to write about it.
“Dr. Reye sat on this for ten years,” said Baral, who began training at the Sydney hospital in 1961. 6
In more than half of the 21 cases reported by Reye, Baral, and Morgan in 1963, children had taken aspirin. That information was not included in the medical journal because they did not realize that link until later, Baral said. 7
Another 1963 report led by U.S. physician George Johnson detailed a flu outbreak of 16 children in North Carolina who died after developing neurological problems similar to those described by Reye. Some gave credit to Johnson by naming the disorder Reye-Johnson syndrome, though most leave him off. 8
In 1964 and 1965, reports in medical journals raised the possibility of a link between salicylates and Reye’s. H.L. Utian and other South African doctors wrote in The Lancet about 14 cases between 1955 and 1964 of mostly infants who acquired hypoglycemia, metabolic acidosis, and an “extensive fatty change” of the liver. The illness usually began with an upper-respiratory tract infection and proceeded to convulsions, coma, and death. The doctors suggested salicylate intoxication as a possible cause. 9
Then in 1965, H.M. Giles further explored in The Lancet the link between Reye’s and salicylates, suggesting victims’ enzyme system might be hypersensitive to that substance. In 1968, Canadian doctor M.G. Norman published a study of 21 cases at The Hospital for Sick Children in Toronto between 1954 and 1966. The cases were similar to the ones in other parts of the world, starting with respiratory infections, and proceeding to vomiting, convulsions, and death. 10
“These children usually were hyperventilating, suggesting salicylate intoxication and prompting an estimation of blood salicylates,” Norman wrote. “As death approached, respirations became irregular and finally failed…. Nine children were delirious.” 11
Soon after five-year-old Tiffini Freudenberger died of Reye’s, parents John and Terri founded the Ohio-based National Reye’s Syndrome Foundation in 1974. The group became a clearinghouse for devastated parents dealing with similar tragedies that established chapters across the country. Increased media attention and public education pressured medical groups and government agencies to pursue further studies and issue warnings.
As the number of reported Reye’s cases increased, studies examined the link with aspirin. In 1976, the U.S. Food and Drug Administration issued a “preliminary warning” not to use aspirin to treat symptoms of the syndrome. Then in 1980, the U.S. Centers for Disease Control and Prevention started to warn parents and physicians to use caution in giving aspirin to kids. 12
That year, the number of new Reye’s cases reported nationwide by the CDC peaked at 555, though the figure was “believed to be a fraction of those that did occur,” reported Altman. Many incidences went unreported or misdiagnosed, such as Sharon’s, whose cause of death officially remains as merely “probable encephalitis.” The percentage of victims dying in 1965 was believed to be around 80 percent, though that was hard to ascertain since reporting of the syndrome was so inconsistent. 13
The CDC did not keep continuous records on the disorder until 1977. By 1986, some 42 percent of the total known cases of Reye’s in the U.S. had resulted in deaths, while about one-third of the others suffered serious brain damage, according to a UPI report. Only a few victims of Reyes were older than twenty. 14
Following 1980, the number of incidences “declined sharply after the association of Reye’s syndrome with aspirin was reported,” noted CDC researchers in a 1999 study in The New England Journal of Medicine. That study put the percentage of those who had died after being diagnosed between 1981 and 1997 at 31 percent. By 1994, the number of new cases was two or fewer. Most of those with the disease “appeared to have taken aspirin,” the CDC stated in a media release. 15
Did aspirin companies’ legal threats delay discovering link?
The slow nature of moving from studies to public warnings was hampered by more than mere medical professional caution. The aspirin lobby employed legal threats, outright payments, and more to minimize and hide the findings of Reye and other medical researchers. The relationship between certain physicians and drug companies has long been close, with many doctors being paid to speak at drug-makers’ conferences and consult for them on the side.
The CDC’s public warnings in 1980 had an immediate impact, with new Reye’s cases declining almost in half to below 300 in 1981. Ralph Nader’s Public Citizens Health Research Group and the American Public Health Association pushed the feds to do more, filing a lawsuit against the FDA in 1982 to require warning labels on aspirin bottles. The action was initially dismissed in federal court, but an appeals court returned the case to the lower court in 1984. 16
In January 1982, before the Nader lawsuit was filed, representatives from Schering-Plough, which made the orange-flavored St. Joseph’s Aspirin for Children, threatened the executive director of the American Academy of Pediatrics with a lawsuit.
The academy’s crime? Publishing a small item in its newsletter about a suspected aspirin-Reye’s link. Children’s aspirin sales alone were about $50 million annually in the U.S. in the early 1980s. 17
M. Harry Jennison, then the academy’s executive director, succumbed to pressure and pulled the item. But in the next month’s newsletter, he included an academy committee’s recommendation that warning labels be required on aspirin bottles.
Schering-Plough then sent out a letter to pediatricians, saying that there was “no valid scientific data” linking aspirin and Reye’s. “Therefore, you should feel confident in continuing to recommend aspirin for the reduction of fever in children,” they wrote. 18
By June 1982, U.S. Health and Human Services Secretary Richard S. Schweiker publicly called for warnings on aspirin bottles. Lobbyists for the International Aspirin Foundation helped convince an official with the Reagan Administration’s Office of Management and Budget to torpedo the proposal. The so-called Committee on the Care of Children, which included physicians and was mostly financed by the aspirin industry, threatened a lawsuit over the warnings. By November, Schweiker retracted his comments and called for additional studies.
Meanwhile, the pediatric academy’s executive board overruled an internal committee that supported warning labels and issued a statement calling for more research. Mortimer, co-author of the 1962 ground-breaking study, resigned in protest from the AAP committee. So did committee chairman Vincent Fulginiti, head of the University of Arizona pediatrics department. The AAP and government agencies were succumbing to aspirin industry pressure, Mortimer publicly charged.
“A signal is being sent to cool it,” Mortimer said. He added that there was not enough proof to say for sure that aspirin caused Reye’s, but there was enough “to justify a warning. I’m 90 percent to 95 percent [certain] of this.” 19
In 1983, aspirin lobbyists successfully stopped almost 500,000 FDA pamphlets on the issue from going to supermarkets. A new version of the pamphlet was created, changing some answers to reflect the aspirin foundation’s positions. Later that year, the Committee on the Care of Children sent a letter to broadcasters demanding equal time if stations ran the FDA’s public service announcements on Reye’s. The letter cited the “Fairness Doctrine of Federal Law.” 20
The committee then issued its own statement claiming, “No medication has been proven to cause Reye’s.” Even an HHS official denounced that campaign as misleading. 21
When the CDC in early 1985 issued preliminary results of a study that showed children with the flu or chicken pox were 12 to 25 times more likely to develop Reye’s when given aspirin than were sick children who did not take the drug, aspirin lobbyists could do little but whine. HHS Secretary Margaret Heckler soon asked aspirin manufacturers to place warning labels on bottles voluntarily, but aspirin foundation suppliers waited for months. Their label only suggested parents consult a doctor, so the FDA issued a stronger requirement in 1986.
Sidney M. Wolfe, co-founder of the Public Citizens Health Research Group with Nader, said in 1987 that aspirin companies “put pressure wherever they could, and they have been responsible for the years’ delay in getting these warning labels. None of these companies has been anything but horrendous about this.” 22
Wolfe and Peter Lurie, former deputy director of the research group, explained further in a report that language finally required on labels was “essentially unaltered” from Schweiker’s original proposal in 1982. “The only major difference was that hundreds of children had died or become brain-damaged in the interim while the government and the executive board of the AAP bent over backwards for industry,” they charged. 23
Some medical researchers who examined Reye’s cases declined to use their name in speaking to a UPI reporter in 1987. “I’m already in enough trouble with the aspirin industry,” one revealed. 24
After the feds finally required labels on aspirin bottles in 1986, the misleadingly-named Committee on the Care of Children, which some charged cared about Big Pharma profits more than kids’ health, soon disbanded. Still, many didn’t realize the dangers that aspirin presented. That included the family of 13-year-old Jessica Van Dyke, the granddaughter of actor Dick Van Dyke. Jessica died in 1987 after taking aspirin while having a fever and chicken pox.
“We had no conception that Reye’s was a disease that could affect a 13-year-old,” said Roger Heller, the stepfather of Jessica. 25
The CDC authors of the 1999 study termed the reduction of Reye’s syndrome cases to almost nothing a “success…in preventing the deaths of many children.” That “success,” of course, did not include preventing the deaths of many kids like Sharon. 26
Most researchers steered clear of placing blame, while noting that other over-the-counter medications such as acetaminophen and ibuprofen didn’t seem to cause complications in Reye’s victims. Bill Sardi, a nutritional health advocate and author, didn’t mince words in a 2011 report in which he highlighted a Vitamin C depletion in some young Reye’s victims given aspirin for a fever.
“It appears modern medicine was the cause and not the cure for this deadly syndrome,” Sardi wrote. 27
Some claimed no link to aspirin
Despite the steep decline in cases after government warnings about aspirin and the belief of groups like the American Medical Association and FDA that a link between Reye’s and aspirin exists, some researchers continued to insist there was no link.
A 2002 study in Drug Safety by doctors at a Tampa, Fla., hospital near the one where Sharon died claimed that “no proof of causation” between aspirin and Reye’s was “ever established.” Their report claimed that it was “clear from epidemiological data that the incidence of Reye’s syndrome was decreasing well before warning labels were placed on aspirin products…. Reye’s syndrome was probably either a viral mutation which spontaneously disappeared, or a conglomeration of metabolic disorders that had not been recognized or described at that time.” 28
But the statement by the Florida doctors that Reye’s syndrome declined due to unexplained factors “well before” 1986 was misleading, if not wrong. New cases peaked in 1980 and declined after the government began warning the public not to give kids aspirin that very year.
It was weird that many children, including me and my other two siblings, were given aspirin for fevers before the government warnings, and we survived. Apparently, the reactions vary from child to child, perhaps depending on the dose, perhaps depending on the individual’s characteristics and sensitivity. We were not instructed to take adult aspirin when we were as young as nine, as in Sharon’s case.
Even the International Aspirin Foundation admitted on its website in 2016 that aspirin “may be one of many possible factors” in acquiring Reye’s. But that group reiterated that “many cases currently reported are probably due to inborn errors of metabolism.” That page was no longer on the website in 2018. A 1999 report on a foundation conference noted other uses for aspirin, such as to treat heart disease and arthritis. Many aspirin foundation officials still had “nagging doubts on whether we may have lost a useful drug in children without good reason,” the report said. 29
Some general public accounts on aspirin, including in Gale Research’s Encyclopedia.com, fail to mention the link between Reye’s and the over-the-counter drug. Others, such as Wikipedia, do a better job. 30
In 1999, CDC officials insisted in a media release that the exact cause of Reye’s remained “unknown,” and the condition “may sometimes be difficult to diagnose clinically.” But they also pointed out how efforts to tell parents to not give children aspirin had a key impact in a congratulatory tone. Physician Ermias D. Belay said the “timely dissemination of preventive messages to parents and health-care providers played a critical role in raising the public’s awareness of this problem and ultimately in reducing the illness and death caused by Reye’s syndrome.” 31
Such researchers ignored why it took the government and medical establishment at least 15 years — and more if you go back to early reports in the 1950s and even the 1929 one — to warn parents about the aspirin risk. Did the efforts and intimidation by the Bayer/Schering-Plough/aspirin lobby affect researchers’ progress?
Families pursue lawsuits
In the aftermath, some lawsuits filed by parents of Reye’s victims against aspirin companies and medical providers have been successful.
In what was believed to be the first successful case filed by victims, attorneys for Gary and Judith Fox of Shell Lake, Wis., reached a $2.6 million settlement with Sterling Drug, which manufactured Bayer aspirin, in 1989, ending four years of litigation. Their daughter, Jacqueline, contracted Reye’s in 1981 as an infant after being given aspirin to treat a flu. She lived but suffered brain damage and other problems. 32
Also in 1989, a California jury sided with aspirin manufacturers, awarding no damages to the family of Larry Bunch Jr. His parents, Larry and Isabelle Bunch, filed a $50 million lawsuit in 1985, saying that their son acquired Reye’s when he was nine in 1983 after taking aspirin when he had chickenpox. Bunch also experienced brain damage. Doctors testifying for the companies said his condition was encephalitis or hepatitis, not Reye’s. 33
In 1992, the family of Sherry Fugler won a $7.8 million verdict against Sterling Drug, after a Louisiana appeals panel trimmed a $9.3 million award by a lower court. A doctor advised Fugler to take adult aspirin and an antibiotic for a fever in 1981 when she was five. She contracted Reye’s and suffered “severe permanent brain damage resulting in moderate mental retardation,” according to court documents. 34
In 2003, Chicago attorneys for the family of a boy who suffered brain damage after acquiring Reye’s in 2001 reached a $5.5 million settlement with medical providers. The boy was admitted to a hospital for a viral infection but started vomiting a few days later. He was discharged and continued to vomit at home. He was later diagnosed with Reye’s, and attorneys said the delay in treatment led to brain damage. 35
Reviving lost memories
In 2007, I took my two young kids to Van Dyck Park within a short walk of the Fairfax, Va., house where I lived for my first few years. We had moved to the Washington, D.C., area from Dallas a few years before. Preston and McKenna played tag and make-believe games with other children at the playground, mostly in harmony. At times, Preston tried to upstage others, while McKenna followed her older brother’s orders. More than four decades previously, Sharon and I likely played similar games in that very neighborhood.
From my spot under a tree, I could nearly see the house where we lived until we relocated to a Maryland suburb. Mom and Sharon cried the day they moved from that house; it had everything they wanted, including the church and school within walking distance. The Army Navy Country Club was just down the road. Relatives lived nearby. But Dad wanted a shorter commute to work. So we moved. Then when Dad got tired of shoveling snow and sought warmer weather a few years later, we pulled up stakes again, this time to Florida.
I have tried to locate the Maryland house where we lived, but the street and address changed and the old home could have been demolished to become something else. The Fairfax one hadn’t changed much. The school and towering spire of St. Leo the Great Catholic Church, where Sharon and me were baptized, blocked my view of the old homestead. I squinted harder and looked with my memory more than my eyes.
In my mind, I saw Sharon and me chasing each other in a field like this one, with Mom not far behind, trying to spot more flying birds than the other. We settled down for a picnic lunch that included cake. That was enough to quiet us, finally. Can a war or illness or cover-up or money grab be stopped, even if just temporarily, if someone is there handing out cake?
I knew that scene since Sharon memorialized it on paper in comic-strip form. The comic strip more than made me laugh; it made me wonder what the creator might have done with her life had she been given more than almost a decade on this planet.
Six months before she died, Sharon had surprised Dad on his birthday by baking a cake from scratch. She must have really loved cake — she baked it from scratch and incorporated it into a comic. Another friend, Joan, described in a letter to Sharon meeting the Beatles in person in a D.C.-area music store during their historic 1964 U.S. tour.
“I don’t know what to do without you,” Joan wrote Sharon. “I got kissed on the cheek by Paul [McCartney] the Beatle and by John [Lennon] the Beatle the day I saw him at Clarks music store. Only little kids could see them. The four Beatles kissed me. I fainted when Paul kissed me, but John caught me.”
Sharon also must have loved the Beatles. Like many young girls, she had cards and posters of them. She must have really been sad to miss out on a chance to meet them. Getting those letters must have helped soften the blow of the long move and having to acclimate to another new school. But she wasn’t in that school long enough to really adapt.
I only took my kids to the Fairfax park that one time. That was enough. I thought it might help me process the situation, but it really didn’t.
It took me almost another decade before I could force myself to drive by the old Florida house, the last neighborhood where I lived with Sharon. Closure, which I doubt I’ll ever get in this case, didn’t drive me there. It was curiosity more than anything. After visiting cousin Barbara and her husband, Mike, I found myself in that area in 2016.
The house and yard looked smaller than I remembered. The park and church behind it seemed closer. There were no empty fields to explore, just nearby strip malls and office complexes.
I stopped in front of the old house, remembering something as I spied the carport. “I let a young kid take Sharon’s guinea pig out of its cage on that driveway under the carport,” I told the kids, pointing towards the structure. “It looked sad in the cage. We thought it might like to walk outside. But a cat got it, right in front of us.”
“I bet she was mad at you!” McKenna exclaimed.
“Yeah, she was. But not as much as you might expect.” Sharon was a saint. I can’t recall her mistreating me, only watching over me, reading to me even when I scribbled in her books, teaching me some things. She didn’t deserve to die the way she did. She deserved to live a long, happy life.
Allowing that younger boy to let her guinea pig go was the last thing I remembered about my time with Sharon there, before that dark day when my parents tearfully told us in that living room that she was gone. Fate was cruel, crazy, nonsensical. It made me think I would die by the time I turned nine. Like Sharon. Like her guinea pig.
I got out of the car and took some pictures. “How long are we going to be here?” Preston asked.
He was right. We’d been there long enough. We drove more than an hour to a happier place, Silver Springs State Park, and rode a glass-bottom boat, a tradition in those artesian springs since 1878. I know I did that at one point with Sharon, viewing gators, flamingos, turtles, fish, sunken boats, and more.
It was fun to do with the kids, to relive a bit of my childhood, to remember someone and something lost long ago. But I could only smile about the good times for so long, before I was left feeling hollow, wondering what might have been.
- W. Russell Brain and Donald Hunter, “Acute Meningo-Encephalomyelitis of Childhood: Report of Six Cases.” The Lancet, Feb. 2, 1929.
- Ivana Dvorackova, Aflatoxins and Human Health. CRC Press, 1990.
- Gilles Lyon, Philip R. Dodge, and R.D. Adams, “The Acute Encephalopathies of Obscure Origin in Infants and Children.” Brain, Dec. 1, 1961.
- Martin A. Samuels and Allan H. Ropper, Samuels and Ropper’s Neurological CPCs from the New England Journal of Medicine. Oxford University Press, 2013.
- Statistical Abstract of the United States. U.S. Department of Commerce, 1976; Edward A. Mortimer Jr. and Martha Lipson Lepow, “Varicella with Hypoglycemia Possibly Due to Salicylates.” American Journal of Diseases in Children, 1962.
- Lawrence K. Altman, “The Doctor’s World: Tale of Triumph on Every Aspirin Bottle.” The New York Times, May 11, 1999.
- G.M. Johnson, T.D. Scurletis, and N.B. Carroll, “A Study of Sixteen Fatal Cases of Encephalitis-like Disease in North Carolina Children.” North Carolina Medical Journal, October 1963.
- H.L. Utian, J.M. Wagner, and M.B. W’srand, “White Liver Disease.” The Lancet, Nov. 14, 1964; “Labeling for Salicylate-Containing Drug Products.” Federal Register, Dec. 28, 1982.
- H.M. Giles, “Encephalopathy and Fatty Degeneration of the Viscera.” The Lancet, May 15, 1965; Lisa A. Degnan, “Reye’s Syndrome: A Rare But Serious Pediatric Condition.” U.S. Pharmacist, March 20, 2012.
- M.G. Norman, “Encephalopathy and Fatty Degeneration of the Viscera in Childhood: Review of Cases at The Hospital for Sick Children, Toronto (1954–1966).” Canadian Medical Association Journal, Sept. 21, 1968.
- Michael Hinds, “Warning issued on giving aspirin to children.” The New York Times, June 5, 1982; U.S. Centers for Disease Control and Prevention press release, “CDC study shows sharp decline in Reye’s Syndrome among U.S. children.” May 6, 1999.
- Altman, op. cit.; “Reye’s Syndrome: A Medical Mystery.” Science, March 28, 1980.
- Larry Doyle, “Aspirin and Deadly Reye’s Syndrome: Warnings Can Be Missed.” United Press International, May 31, 1987.
- Ermias D. Belay, Joseph S. Bresee, Robert C. Holman, Ali S. Khan, Abtin Shahriari, and Lawrence B. Schonberger. “Reye’s Syndrome in the United States from 1981 through 1997.” The New England Journal of Medicine, May 6, 1999; CDC press release, May 6, 1999.
- Peter Lurie and Sidney M. Wolfe, “Aspirin and Reye Syndrome.” Paradigms for Change: A Public Health Textbook for Medical, Dental, Pharmacy, and Nursing Students, Public Citizen Health Research Group.
- Doyle, op. cit.; Hinds, op. cit.; Lurie, op. cit.
- Doyle, “Aspirin-Reye’s Chronology : Threat of Suits Delayed Warning Process.” UPI, May 31, 1987.
- “Administration says pressure was not responsible for aspirin warning delay.” The Associated Press, Nov. 19, 1982.
- Marlene Cimons, “New Study Strongly Links Aspirin, Reye’s Syndrome.” Los Angeles Times, Jan. 9, 1985.
- Doyle, op. cit.
- Lurie and Wolfe, op. cit.
- Doyle, op. cit.
- “Aspirin Labels to Warn About Reye Syndrome.” The Associated Press, March 8, 1986; Doyle, op. cit.
- Belay, op. cit.
- Bill Sardi, “Why Reye’s syndrome prevailed from 1950–1980 and then suddenly disappeared.” Knowledge of Health, Sept. 18, 2011.
- James Orlowski, Usama Hanhan, Mariano Fiallos, “Is aspirin a cause of Reye’s syndrome? A case against.” Drug Safety, 2002.
- “Aspirin and Reye syndrome.” International Aspirin Foundation, 2016; “Lessons from the 15th Scientific Foundation Scientific Meeting,” International Aspirin Foundation, Oct. 26, 1999.
- Greg Ling, “Aspirin.” How Products Are Made, Encyclopedia.com. 1996; “Aspirin.” Wikipedia, April 2018.
- CDC news release, May 6, 1999.
- Patrick Jasperse, “Bayer agrees to pay $2.6 million in Reye’s case.” The Milwaukee Journal, Aug. 12, 1989.
- “Jury scuttles $50 million aspirin suit.” United Press International, Aug. 4, 1989.
- Sharkey v. Sterling Drug, Court of Appeal of Louisiana, First Circuit. Leagle, April 23, 1992. ; “Girl Stricken With Reye’s Gets $7.8 Million Award.” Orlando Sentinel, April 27, 1992.
- “$5.5 Million Settlement for Child who Suffered Brain Damage as a Result of Medical Negligence.” Rapoport Law Offices news release, Oct. 13, 2003.