Suggestion of autism, vaccination link earns doctor harsh criticism

By Terry Murray

HALIFAX – Dr. Walter Spitzer, the Canadian physician who could be considered the "dean" of epidemiology, has come in for harsh criticism for saying there might be a link between measles-mumps-rubella (MMR) vaccine and autism.
   He stated that contention in a letter to the editor of the Globe and Mail earlier this month in responding to the paper's news coverage of the fourth Canadian National Immunization Conference here.
   "I am embarrassed that he is an emeritus professor of epidemiology at McGill (University)," said Dr. Noni MacDonald, dean of medicine and professor of pediatrics and medicine at Dalhousie University.
   In a keynote address at the conference, she added, "I think he better go back and look at proper causality assessment before he makes that kind of a statement. I would flunk him."
   "Indiscriminately pushing for universal measles vaccination, as (Dr.) Ciro de Quadros (of the Pan American Health Organization) has done at the Canadian National Immunization Conference in Halifax, may be hasty and even irresponsible," Dr. Spitzer's letter said.
   "It is not possible to rule out the possibility that excessive rates of autism occur among children immunized with MMR. The early epidemiological findings are worrisome. The clinical and laboratory data strongly suggest the biological plausibility of a link between MMR and autistic disorders.
   "I strongly endorse immunization as a pillar of public health strategy for most diseases. But one should never surrender caution."
   Another physician at the conference here argued that there are no controlled epidemiologic studies supporting the hypothesis, but there is evidence against it.
   For example, a British study on the question showed a rise in the incidence of autism in North London began before MMR vaccine was introduced, said Dr. Robert Pless, a Canadian who is currently medical epidemiologist with the Vaccine Safety and Development Branch of the National Immunization Program at the U.S. Centres for Disease Control and Prevention.
   Dr. Spitzer seems to have joined forces with immunization opponents, speaking and testifying in the last year about the purported MMR-autism link on behalf of parent groups opposing vaccines, such as the National Vaccine Information Centre in the U.S.
   Those groups may benefit from his impressive credentials. According to his résumé on the McGill Web site, Dr. Spitzer was instrumental in helping create the two major departments of epidemiology in Canada—the Health Services Research Unit at McMaster University and the department of epidemiology and biostatistics at McGill, which he chaired from 1984 to 1993.
   He has also been involved in the Canadian Task Force on the Periodic Health Examination, and was instrumental in attempting to deflate the scare, largely confined to Britain in the mid-1990s, about thromboembolic complications of third-generation oral contraceptives.
   Most recently, he chaired a consensus conference on the use of intravenous immune globulin for Canadian Blood Services and Héma-Québec.