AUTISM
UPDATE An alternative view of autismits epidemiology, causes and treatmentwas presented at Autism 2001: Place For New Medical Discoveries in Quebec City. The conference, under the honourary chairmanship of Dr. Victor Goldbloom, a pediatrician and former Quebec government minister, was organized by Autisme Québec et Chaudière-Appalaches in collaboration with Autisme et troubles envahissants du développement Montréal (ATEDM), two non-profit autism education and advocacy groups. Sponsors were the Quebec Ministry of Health and Social Services, and the Ministry of Research, Science and Techology, the Quebec Office of the Handicapped and Heritage Canada. Medical Post staff writer Susannah Benady files these reports.By Susannah Benady May 8, 2001 http://www.medicalpost.com
QUEBEC CITY Speakers at the conference here maintained statistics show a
demonstrable link between an "explosion" in autism
cases and introduction of the measles-mumps-rubella vaccine, even though California
researchers contend the start of the upward swing predates the MMR vaccine.
Physicians monitoring autism said
the explosion could not be explained away by better diagnosis. The fact that the start of
the increase did not coincide exactly with the date of introduction of the MMR did not
exonerate the vaccine, they said.
The number of children with autism
and related developmental disorders has been rising at an alarming rate in many countries,
including the U.K., the U.S. and Canada, said Dr. Bernard Rimland, director of the Autism Research Institute in San Diego, Calif.
The U.K. reports a rate of one in 250 and the most recent figures from
the U.S. Centres for Disease Control and Prevention show a rate as high as one in 150 for
boys in the U.S.
California, which maintains the world's most systematic database on autism and other developmental disabilities, reports an
almost 10-fold increase in the prevalence of autism
over a 20-year period, said Dr. Rimland.
The number of autism cases being
diagnosed in California since the introduction of the fouth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV) tripled, to almost 2,000 cases in 1999
from 633 cases in 1994.
There has been no corresponding increase in mental retardation, epilepsy
or cerebral palsy, Dr. Rimland said.
He criticized a recent paper in the Journal of the American Medical
Association by physicians from the California department of health services concluding
that the increase in autism predated the MMR vaccine.
He offered a contrary interpretation as he presented a graph summarizing the California
figures and statistics from a study done in North London (see page 21).
The graph shows a jump in the California figures starting in 1977. The
MMR vaccine was not introduced until 1979. Similarly, the increase in North London began a
decade later, according to the graph, with numbers rising from 1984. The vaccine was not
introduced there until 1987.
However, Dr. Rimland said the graph shows the children's year of birth,
not year of diagnosis, so the increase would inevitably have to predate the introduction
of the vaccine.
Also, he said the JAMA authors had not taken into account that when the
vaccine was introduced it was given to older children as well as those under age two.
Additionally, said Dr. Rimland, the authors did not account for the fact
that the number ofvaccines being given to children generally doubled between 1980 and
1999.
"This fact alone could be making them more susceptible to the MMR
trigger," he said.
Dr. Ed Yazbak, a Boston pediatric infectious disease specialist and
former professor at Brown University, now conducting independent studies into autism, dismissed any suggestion that the increase in the
statistics could be due to changes in the way the disorder is diagnosed.
"It is the same individuals making the diagnosis according to the
DSM-IV, which has very clear and strict criteria, as it was seven years ago when that
standard was introduced," he said.
"If it was to do with methods of diagnosis, we should have seen the
huge increase in 1994, not now."