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SEXUAL DISORDERS (JP FEDOROFF, SECTION EDITOR)
Pornography, Sex Crime, and Paraphilia
William A. Fisher &Taylor Kohut &
Lisha A. Di Gioacchino &Paul Fedoroff
#Springer Science+Business Media New York 2013
Abstract The current paper reviews research findings
concerning the association of pornography with sexual vio-
lence and paraphilic interests. Little clarity concerning the
causal impact of pornography on sexual aggression or child-
oriented sexual behavior has been achieved in the scientific
literature. Laboratory experimentation demonstrates that vi-
olent pornography may contribute to antiwoman aggression,
but the artificiality and constraints of the experimental set-
ting severely limit generalization of these findings to real-
world situations, and observational studies in natural set-
tings consistently find no association or an inverse associa-
tion of pornography with sexual aggression. In addition,
although pedophiles often use child pornography, the causal
impact of child pornography on child sexual offending is not
conclusive. The current analysis considers the confluence of
predisposing factors and pornography use as issues requir-
ing clinical judgment in the reduction of sexual aggression
and management of paraphilic interest in children.
Keywords Pornography .Paraphilia .Sexual assault .
Sexual aggression .Pedophilia .Child-oriented sexual
behavior .Psychiatry
Introduction
Researchers and clinicians have struggled to understand the
impact of pornography on sexual behavior for over a century
[1,2,3•]. Unfortunately, little clarity has been achieved in the
scientific literature, and definitive guidance is lacking for the
clinical judgments that are required to understand and manage
sexually aggressive behavior and paraphilic interests in the
context of pornography use. The current paper reviews relevant
research findings concerning the association of pornography
with sexual violence and paraphilic interests. A concluding
section concerns the confluence of predisposing factors and
pornography use as issues requiring clinical judgment in the
reduction of sexual aggression and management of paraphilias.
Definition, Prevalence, and Potential Impact
of Pornography
An operational definition of pornography has been elusive.
For example, in a 2012 review of 42 published studies of
Internet pornography use, Short and colleagues [4] found that
no two studies had employed the same definition of pornog-
raphy. It is clear that sexually explicit materials may vary in
content (e.g., consensual, demeaning, or violent), media (e.g.,
text, audio, video), quality (e.g., low or high definition), and
capacity to elicit sexual arousal, positive affect, and negative
affect, on average, or for any particular user [5–7].
Guided by the assumption that the content of sexually
explicit media may be a critical influence on the conditioning
of arousal to specific sexual activities [8–11] and on the acqui-
sition and incentivizing of scripts for specific patterns of sexual
behavior [10–15], a number of researchers have focused on
differentiating sexually explicit materials on the basis of their
content. To this end, studies in the 1980s and 1990s attempted
to map out the comparative prevalence of consensual non-
violent compared to apparently violent sexually explicit mate-
rials. Scott and Cuvelier [16,17], for example, reported a
miniscule amount of sexual violence in sexual magazines,
Garcia and Milano [18] reported that 80 % of XXX videos
This article is part of the Topical Collection on Sexual Disorders
W. A. Fisher (*)
Department of Psychology and Department of Obstetrics and
Gynaecology, Social Science Centre 7428, University of Western
Ontario, London, Ontario, Canada N6A 5C2
e-mail: fisher@uwo.ca
T. Kohut
Department of Psychology, University of Western Ontario,
London, Ontario, Canada N6A 5C2
L. A. Di Gioacchino
University of Ottawa, Ottawa, Canada
P. Fedoroff
Royal Ottawa Health Care Centre and University of Ottawa,
Ottawa, Canada
Curr Psychiatry Rep (2013) 15:362
DOI 10.1007/s11920-013-0362-7
sampled portrayed no sexual violence at all, and Bogaert [19]
found that violent pornography was the least common prefer-
ence among males in a free choice situation. More recently,
Barron and Kimmel [20] have reported that 24.8 %, 26.9 %,
and 42.1 % of sex themed magazines, videos, and Internet
Usenet newsgroups sampled, respectively, contained depictions
of sexual violence, and that 65.4 %, 49 %, and 42.4 % of
violent instances in these media involved female perpetrators.
In contrast to findings for relatively low levels of antiwoman
violence in sexually explicit materials, Bridges and colleagues
[21] reported that fully 88 % of a sample of popular adult sexual
videos portrayed physical aggression. According to Bridges
and colleagues, the perpetrators were mostly male, the targets
were “overwhelmingly female,”and the victims “often showed
pleasure or responded neutrally to the aggression”([21],
p. 1065). Prevalence estimates for pornographic content thus
vary dramatically, presumably as a function of definitional dif-
ferences, sampling differences, and actual differences detected.
Since the mid-1990s, extraordinary and unfettered access
to sexually explicit material on the Internet has further
contributed to imprecision in estimates concerning the prev-
alence of different types of sexually explicit materials, since
the Internet is a limitless and ever-changing universe from
which to sample. What is exceedingly clear, however, is that
the Internet affords unlimited access to any type of sexually
explicit material to which individuals’pro-social, neutral, or
anti-social inclinations may incline, without age, cost, or
other barriers impeding access, and Internet pornography
is exceedingly commonly consumed by males and to a
lesser extent by females today [10,22].
According to Fisher and Barak [10], there is a conceptual
and empirical rationale for concern about possible effects of
sexually explicit materials currently available on the Internet:
One view, based upon relevant theory and research [19,
23–31], suggests that antisocial personality character-
istics will encourage some individuals to seek out anti-
social sexually explicit materials from among those
available on the Internet. The “goodness of fit”[31]of
antisocial personality characteristics with antisocial sex-
ual content will, it is speculated, promote a tremendous
depth of involvement in antisocial sexual stimuli. Indi-
viduals may lose awareness of the constraints of reality
regarding enactment of antisocial sexual behavior and
uniquely strong negative effects of antisocial sexual
content on the Internet may be seen among those pre-
disposed to access such material.
A related view, also based upon relevant theory and
research [19,23,27,29–33], suggests that normal range
individuals will ordinarily choose sexually explicit In-
ternet materials which are not antisocial in nature. The
“poorness of fit”of normal range personality
characteristics with antisocial sexual content will, in
fact, provoke avoidance of antisocial sexual stimuli,
termination of contact with such stimuli if encountered,
and rejection of the antisocial sexual messages of such
stimuli. According to this analysis, most individuals
have a lifetime learning history and set of expectancies
about acceptable and unacceptable sexual behavior that
is sufficient to deter them from accessing or acting on
antisocial sexual content on the Internet (Fisher &
Barak, [10], p. 312; see also [34,35]).
Experimental Research Concerning Pornography
and Aggression Against Women
A substantial body of experimental research concerning effects
of sexually explicit materials that portray and endorse violence
against women was conducted during the 1980s. Initial re-
search exposed undergraduate men to stimuli portraying sexual
assault or consensual sex, and showed that exposure to sexually
violent materials led to increases in men’s fantasies about rape
[36], beliefs that women would enjoy being raped [37], and
acceptance of violence against women [38]. Experimental lab-
oratory based research assessing the impact of sexually violent
media on men’s behavioral aggression against women [39–42]
indicated that men who had been angered by a woman and who
had seen sexually violent materials engaged in heightened
aggression against female targets.
Despite this evidence, it should be emphasized that other
experimental research has failed to replicate key findings in
this literature, including the impact of sexually violent materi-
als on behavioral aggression against women [43–45].
Furthermore, critiques concerning the artificiality, constraints,
and limited generalizability of these laboratory findings to
real-world situations have been frequent and have raised im-
portant questions concerning the validity, reliability, and gen-
eralizability of the experimental research (see, for example,
[3•,7,43,46,47]).
Observational Studies of Pornography and Aggression
Against Women
As an alternative to laboratory based experimental approaches,
researchers have examined the association of availability and
use of sexually explicit materials with antiwoman attitudes and
antiwoman acts in natural settings. One such approach has
been to compare convicted sex criminals’and controls’history
of use of sexually explicit materials of various kinds. A sub-
stantial number of studies have found similar or lesser use of
sexually explicit materials among sex criminals compared to
controls (see, for example, [48–53]). One study, by Marshall
[54], reported evidence of more extensive use of sexually
362, Page 2 of 8 Curr Psychiatry Rep (2013) 15:362
explicit materials among sex criminals than among controls,
but interestingly, there was no correlation between type of sex
offense and type of sexually explicit material used.
In contrast to findings among samples of sex criminals,
observational research involving non-criminals has reported
evidence for weak associations between use of both violent
and non-violent sexually explicit materials and attitudes
supporting violence against women [55]. However, it is
difficult to know what to make of such findings as very
similar research has failed to find that self-chosen exposure
to pornography is related to negative or traditional attitudes
toward women [56–60] and has even found that use of
sexually explicit materials is associated with more positive
attitudes toward women and with gender egalitarianism
[60–62].
Another approach to assessing the association of sexually
explicit materials with antiwoman attitudes and antiwoman
acts has been to study situations in which liberalization of the
law has permitted relatively unrestricted access to sexually
explicit materials of many different kinds. Research con-
ducted by Kutchinsky [63]inDenmark,Sweden,West
Germany and the U.S.A. showed that from the mid-1960s to
the mid-1980s, as the amount of sexually explicit materials of
many kinds became increasingly available in these countries,
reported cases of rape did not increase more than the number
of reported incidents of non-sexually violent crimes.
Evidence of an inverse relationship between accessibility of
sexually explicit materials and antiwoman acts has also been
reported in a number of independent studies. For example,
Ferguson and Hartley [47] examined the relationship of the
number of sexually explicit movie releases and sexual assault
victimization rates in the United States from 1988 through
2005. Findings showed a sharp increase in the number of
sexually explicit movie releases across this time accompanied
by a sharp decrease in rates of sexual assault victimization. In
similar fashion, Diamond and Uchiyama [64] have reported
that increased availability of sexually explicit materials in
Japan, to any age group, was accompanied by declines in rates
of reported rape involving both adult and youth perpetrators
(see also Abramson and Hayashi [65] for similar observations).
Studies in Croatia and Shanghai have also shown decreases in
reported rape as pornography became increasingly avail-
able [66,67]. In addition, Diamond and colleagues [68•]
have found that, during a prolonged interval in the
Czech Republic during which possession of child pornogra-
phy was not illegal, a significant reduction in child sexual
abuse was reported.
Research reported by Fisher and Barak [10]isofparticular
relevance in the current context of essentially unlimited access
to Internet sexually explicit materials, with the accompanying
possibility of self-selection of sexual stimulus materials to
reinforce individual predispositions, including anti-social and
anti-woman predispositions. These investigators plotted US
rates of reported sexual assault over the years of exponential
increases in Internet access to every form of sexually explicit
material, more or less at the individual user’s discretion. As
canbeseeninFig.1, enormous increases in access to Internet
sexually explicit materials of all types have been accompanied
by declines in the rate of reported sexual assault across the
years 1995-2011 (Fisher & Barak, [10], updated data added).
Preliminary Conclusions Regarding Pornography
and Sexual Aggression
Experimental findings concerning the impact of sexually
violent materials on antiwoman attitudes and antiwoman
acts demonstrate negative effects of such materials, but they
may be artifacts of contrived experimental settings, their
generalizablility has been questioned, and there are impor-
tant failures to replicate these findings. Observational stud-
ies of sexual offenders and non-offenders have offered little
support for a pornography—aggression link, and observa-
tional studies in the general population appear to show no
effect of increased availability of diverse sexually explicit
materials on rates of sexual assault or even lessened sex
crime in the context of liberalized access to sexually explicit
materials. A recent overview of the research in this domain
has concluded:
Evidence for a causal relationship between exposure
to pornography and sexual aggression is slim and may
have been exaggerated by politicians, pressure groups,
and some social scientists…The debate has focused on
violent pornography but evidence of any negative
effects is inconsistent and violent pornography is com-
paratively rare in the real world. Victimization rates
for rape in the US demonstrate an inverse relationship
between pornography consumption and rape rates. It is
concluded that it is time to discard the hypothesis that
pornography contributes to increased sexual assault.
(Ferguson and Hartley, [47], page 323.)
While we would not go as far as Ferguson and Hartley, it
does seem to us that in the context of very widespread and
unfettered access to essentially all types of sexually explicit
materials, rates of sex crime, indexed in a variety of ways,
have not increased and may have decreased. These findings
have relevance for understanding aggregate effects of sexu-
ally explicit materials on population level behavior and
relevance for the creation of evidence-based public policy
in this domain. What these findings cannot disclose, however,
is whether, “hidden”within aggregate data showing, overall,
no effects, or a suppressive effect, of sexually explicit materi-
als on sex crime, some individuals may be uniquely vulnera-
ble to effects of sexually explicit media.
Curr Psychiatry Rep (2013) 15:362 Page 3 of 8, 362
A Confluence Model: Individual Predispositions
and Effects of Sexually Explicit Media
At the outset of this discussion, we suggested the plausibility
of the combined influence of individual predispositions, self-
regulated exposure to sexually explicit materials, and effects
of sexually violent materials on sexually aggressive behavior.
One version of such a conceptualization, the Confluence
Model, has been formally specified by Malamuth and col-
leagues [27,69•]. In this model, Hostile Masculinity (includ-
ing narcissism, defensiveness, hypersensitivity, hostile
distrustfulness, especially toward women, and sexual gratifi-
cation derived from controlling or dominating women) and
Impersonal Sex (including family history of abuse, delinquent
tendencies, and a non-committal and promiscuous approach
to sexual activity) are thought to interact in confluence with
sexually explicit materials to result in attitudes accepting of
violence against women and in overt violence against women
[27,69•]. According to this model, men who are at the highest
predispostional risk (in terms of Hostile Masculinity and
Impersonal Sex and their components) and who use sexually
explicit materials frequently will show a significant elevation
in attitudes supportive of sexual violence and in aggression
against women per se.
Several studies are consistent with the propositions of the
Confluence Model. Malamuth and colleagues [27,69•]have
reported research on a large sample of US college men who
were assessed in the 1980s in relation to predisposing factors,
consumption of pornography (“How often do you read any of
the following magazines?”Playboy,Penthouse,Chic,Club,
Forum,Gallery,Genesis,orHustler), and attitudes supportive
of violence against women and self-reported antiwoman sexual
aggression. Findings supported Confluence Model predictions
in that men with the most extreme levels of Hostile Masculinity
and Impersonal Sex, and the highest levels of consumption of
sexual magazines, showed relatively high levels of acceptance
of violence against women [69•] and relatively high levels of
self-reported sexual aggression [27]. Findings consistent with
the Confluence Model have also been reported by Vega and
Malamuth [70], as well as Williams and colleagues [71], who
found that the association between pornography use and devi-
ant behavior held only for participants high in psychopathy.
While the predictions made by the Confluence Model have
received support in the research literature, conceptual and
empirical criticisms remain to be resolved. First, key research
findings [27,69•] have relied on frequency of use of sexually
explicit magazines that were very generally nonviolent in
nature, with no compelling explanation offered to conceptu-
alize a linkage between nonviolent sexual imagery and atti-
tudes and behavior involving sexual violence. Second,
pornography use (that is, sexual magazine use) was found to
increase the prediction of sexual aggression against women by
a very modest 1 % when the predisposing factors at focus—
which accounted for 37 % of the variance in antiwoman
aggression—were also considered [27]. Third, differences in
attitudes supportive of violence against women among US
college males with high versus low predisposed risk were
relative in nature [69•]. Even at the highest levels of predis-
position and sexual magazine reading, participants were not in
an absolute sense supportive of violence against women, as no
reported mean level of attitudes supportive of violence against
women exceeded the scale neutral point. Finally, Confluence
Model evidence is correlational in nature, and third variable
accounts (e.g. sex drive) offer plausible alternative explana-
tions for the relationship of pornography use with antiwoman
attitudes and antiwoman acts in these studies. As Malamuth et
37.1
36.3 35.9
34.5
32.8
32.0 31.8
33.1
32.3 32.4
31.8 31.6
30.6
29.8
29.1
27.7
26.6
25
27
29
31
33
35
37
39
41
43
45
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Rates of Forcible Rape Per 100,000
Year
Fig. 1 Rates of reported sexual
assault as a function of
exponential increase in
availability of all types of
sexually explicit materials on
the Internet (after [10] with
updated data)
362, Page 4 of 8 Curr Psychiatry Rep (2013) 15:362
al. [27]havenoted,“…we cannot conclude on the basis of
these analyses that pornography use is a cause or an outcome
of sexual aggressive tendencies…” [27,p.79].
Notwithstanding such limitations, Kingston and colleagues
[72] have concluded that “…the findings are highly consistent
across experimental and nonexperimental studies and across
differing populations in showing that pornography use can be
a risk factor for sexually aggressive outcomes, principally for
men who are high on other risk factors and who use pornog-
raphy frequently.”(Kingston et al., [72], p. 216; see also Seto
et al.’s[73] review of relevant literature). In our view, the
Confluence Model remains relevant to consideration of indi-
vidual predispositions which may interact with pornography
use to influence sexual aggression and paraphilic interests,
within the significant caveats noted above.
Pornography and Paraphilia
The paraphilias are conditions characterized by persistent
unconventional and problematic sexual interests. In the
Diagnostic and Statistical Manual of Mental Disorders—
Fourth Edition, Text Revision (DSM-IV-TR) [74], para-
philias are defined as “recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors generally involving 1)
nonhuman objects, 2) the suffering or humiliation of oneself
or one’s partner, or 3) children or other non-consenting
persons that occur over a period of at least 6 months”and
which have been acted on (in the case of a paraphilia
involving a criminal act) or have caused “significant distress
or impairment in social, occupational, or other important
areas of functioning.”(p. 566). Arousal to and enactment
of sexual assault and child sexual abuse may thus be con-
ceptualized as potential indicators of paraphilia (for discus-
sions relevant to this issue see [71,75–78]), although it is
also quite possible for acts of sexual assault or child sexual
abuse to be motivated by non-paraphilic interests
Does Pornography Cause Paraphilia?
The possibility that sexually explicit materials may encourage
the acquisition and incentivization of the sexual behaviors
portrayed in such material—specifically sexually aggressive
behaviors and child-oriented sexual behaviors—has motivat-
ed considerable research, some of which has been discussed
earlier in this paper. Associations between frequent pornogra-
phy consumption and sexually aggressive behaviors, among
men at high dispositional risk for sexual aggression, have been
reported [27,69•,70]. Such findings are consistent with the
view that certain individuals may be likely to seek out violent
or paraphilic-themed pornography and that the effects of
exposure on sexual behavior will be more prominent for such
individuals, within a number of caveats articulated earlier in
this paper. It also appears that many rapists use consensual
sexually explicit materials accompanied by deviant sexual
fantasies [54] and it is possible that such practices may rein-
force motivation to engage in antisocial sexual acts and con-
dition sexual arousal to such acts.
There exists particular apprehension regarding the use of
child pornography and the development of paraphilic interest
in children. Such concern begins with the understanding that
the production of such material involves child sexual abuse
and extends to the possibility that child pornography may
contribute to the development of paraphilic child sexual inter-
ests and increased incidence of contact child sexual offending.
Aslan [79•] has discussed a number of ways in which viewing
child pornography may facilitate contact offences against chil-
dren, including imitation (in which the offender replays behav-
iors portrayed in child pornography with an actual child
victim), permission giving (in which the offender gains cour-
age and ideas from what the offender has witnessed in child
pornography), and reinforcing existing feelings (which moti-
vate the offender to want to act on their desires). In recent
years, however, it has become clear that not all child pornog-
raphy offenders are involved in hands-on sexual offending.
Meta-analytic research has found that about one in eight online
child pornography offenders (12 %) had an officially recorded
contact sexual offence with a child while approximately half
(55 %) admitted to a contact sexual offence in studies that
solicited self-report offence data [73]. As a proportion of these
individuals with a clear sexual interest in children appear to
have acted on this interest in the form of hands-on offences,
and a proportion appear not to have done so, the researchers
have speculated that personality traits and life circumstances
may be important for discriminating between online and off-
line sexual offenders. Similar conclusions have been reached
by Prentky and colleagues [80•] who studied a sample of 349
sex offenders. Of those charged with contact offences against
children, 60 % had also committed an online child pornogra-
phy offence. Furthermore, among those charged with an online
child pornography offense, the presence of non-sexual antiso-
cial behavior was found to dramatically increase the likelihood
that they had also committed a hands-on offense against chil-
dren. In fact, a 1-point increase in the Antisocial Behavior
(AB) scale was associated with a 33 % increase in the proba-
bility that an online child pornography offender had also
committed a contact offence with children [80•].
Although a causal relationship between use of child por-
nography and hands-on offending against children has not
been established, it is important to recognize that pornography
use has been associated with child sexual abuse recidivism. In
a study of 341 child molesters, Kingston and colleagues [81]
found that frequency of pornography use contributed to the
prediction of violent recidivism among men who were at
higher risk of reoffending but not among men deemed lower
Curr Psychiatry Rep (2013) 15:362 Page 5 of 8, 362
risk for sexual aggression. Additionally, experience with
violent pornography, as well as experience with sexual
depictions involving children, was also found to be associated
with an increased likelihood of recidivism, regardless of this
risk status.
We note that conclusion of a causal relationship of expo-
sure to child pornography and subsequent sexual abuse of
children would be premature. Research in this area is nec-
essarily constrained by the nature of correlational findings
which can be accounted for equally well by assuming that
pedophilic interest drives the use of child pornography.
Consider for example that McCarthy [82] has found that
84 % of a sample of child sexual molesters engaged in child
sexual abuse before they possessed child pornography, not
after. Moreover, pornography use more generally cannot be
considered a necessary or sufficient cause of paraphilias or
sexual offending. Sex crimes can be committed by individ-
uals with little or no exposure to pornography, and most
individuals who use pornography do not commit sexual
offences.
Does Pornography Divert Sexually Aggressive
and Paraphilic Behavior?
Claims that exposure to violent or child-oriented sexually
explicit materials provoke sexually aggressive or child-
oriented sexual behavior have encountered a contrarian “ca-
tharsis”hypothesis which has not been entirely without em-
pirical support. Specifically, observational studies discussed
earlier have shown an association between the availability of
sexually aggressive pornography (including child pornogra-
phy) and a decrease in sexual aggression [10,47,64–67]and
child sexual offences [68•]. Some researchers have hypothe-
sized that a number of users of child pornography, including
pedophiles, may employ this material as a method of
escape in which they indulge their fantasy and relieve
sexual tension without contact offending [83] although
we hasten to emphasize that any production of child
pornography with actual children itself constitutes a
child sexual offence. In support of this “catharsis”view,
Carter and colleagues [83]havereportedthatchildmolesters
may use child pornography both prior to and during an
offence, but may also use pornography to relieve the
impulse to sexually abuse a child. Similarly, an anonymous
online survey of 290 self-identified “pedosexual”males found
that 84 % of participants asserted that watching child pornog-
raphy acted as a substitute for being in contact with a child
[84]. Further, Seto and Eke [85] have also shown that not all
individuals with child pornography convictions progress to
having sexual contact with minors, which is inconsistent with
the assumption that all child pornography offenders pose a
high risk of committing offences involving child sexual abuse.
Conclusions
The findings that we have reviewed in relation to pornog-
raphy, sexual aggression, and paraphilia lead us to a number
of conclusions. First, while experimental research shows
that exposure to violent sexual images may have negative
effects, generalization of findings beyond the constraints of
artificial experimental situations is problematic. Second, and
generally contradictory to any broad implications of exper-
imental findings, observational studies consistently show
few if any population level negative effects of availability
of pornography on sexual aggression or, albeit with extremely
limited evidence, on child sexual abuse. Third, a confluence
model involving the combined effects of an array of antisocial
predispositions and pornography exposure on sexual aggres-
sion or child sexual abuse remains plausible, but supportive
data are limited and have been critiqued, and the correlational
nature of the findings do not permit us to decide whether a
causal direction of pornography effects is justified.
The management of sexually aggressive behavior and para-
philic interests remains a matter of clinical judgement in indi-
vidual situations with sensitivity shown to both predisposing
factors and sexually explicit material use. At the very least, the
evidence appears to indicate that pornography use in the con-
text of certain predisposing factors including but potentially not
limited to hostile masculinity, impersonal views concerning
sex, psychopathy, or previous hands-on sexual offenses may
warrant increased concern regarding the possibility of future
sexual aggression being directed toward women or children.
Importantly, our critical position concerning research on the
effects of pornography should not be misconstrued as advocacy
for the use of such material, and it should be emphasized that
the production and distribution of child pornography is both
criminal and harmful to children and ultimately society.
Conflict of Interest William A. Fisher declares that he has no
conflict of interest.
Taylor Kohut declares that he has no conflict of interest.
Lisha A. Di Gioacchino declares that she has no conflict of interest.
Paul Fedoroff has received payment for consulting from Janssen
and has received grants from University Medical Research Fund.
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