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As a firm believer in the past work of Michel Odent to lead the way to gentler birthing practices worldwide, I began reading "Exclusive Interview with Michel Odent: The Autism Epidemic" in Midwifery Today E-News 9:11 with excitement and deep interest. As the mother of two boys diagnosed with autistic spectrum disorders, my interest and excitement quickly turned to disbelief and then to outrage. I am appalled that Dr. Odent would suggest that we "study autism as an impaired capacity to love." Obviously Dr. Odent has not spent much time around children with autism. Autistic children DO NOT have an impaired capacity to love. Children with autism have an inability to effectively communicate their needs, wants and desires. That inability to communicate effectively is a far cry from an impaired capacity to love.

Autism does not have one single cause. Research is being done and more is being discovered every day. I am deeply disturbed by the apparent attempt of Dr. Odent to discredit the truly valid studies and unbiased research that demonstrate an association between vaccines and autism. The primal health research database to which readers are directed by Dr. Odent in the interview contain nothing but abstracts of studies that, in the areas of autism and vaccination, are completely out-of-date.

In this interview Dr. Odent makes reference to a study published in the New England Journal of Medicine (NEJM) (347 [19]: 1474–75) regarding Autism and MMR vaccination. Much updated information is available regarding this particular study done in Denmark. The original study was flawed for reasons too numerous to list. I would encourage Dr. Odent to look at the study in the Fall 2004 Journal of American Physicians and Surgeons 9(3), which revisits and refutes the one published in NEJM. There IS an association between autism and the MMR vaccination.

Dr. Odent also cites a study published in 2003 by JAMA (290[13]: 1763–66), to continue to make his point that no association exists between thimerosal-containing vaccine and autism. Dr. Odent is not clear and does not inform us that this study was specifically looking at only the DTP vaccine and not the MMR.

The JAMA study is flawed for numerous reasons. First, and probably the most important to note, is an apparent conflict of interest. Michael Stellfeld, MD—one of the authors—is affiliated with the Statens Serum Institut Medical Department, the maker of the vaccine being studied. Second, the study authors were not certain who received thimerosal-containing vaccines. They "considered" vaccines administered before 1992 to contain thimerosal and those administered after to be thimerosal-free. This is not sound methodology, especially because not until 1992 were the last batch of thimerosal-containing vaccines released and administered. That potentially means that the vaccines administered that were "considered" thimerosal-free may have contained thimerosal well into 1994.

In addition, from 1991 to 1994 the authors only included those children hospitalized (inpatient) and diagnosed with autism; yet in 1995 they included both inpatient and outpatient diagnosis of autism. As most children are diagnosed on an outpatient basis, the number of children used in the study between the years of 1991 to 1994 would be inaccurate and far below the actual number of children diagnosed with autism during those years. One also should consider that the study period concluded prior to when many of the youngest children in the study would have reached the age of three. Many children are not diagnosed until age three or later.

Comparing children in the US to children in Denmark is useless. The vaccination schedules are different and although at age three months children in both countries would have received the same amount of thimerosal according to the JAMA study; children in the US receive many more vaccines than in Denmark. When looking at the DTP vaccine in particular; children in Denmark received the vaccine at five weeks, nine weeks, and then not again until 10 months. In the US, children receive the DTP vaccine at two months, four months, six months, and then again at one year of age. The comparison is unreliable at best and dangerous at worst.

Last, I would also like to point out that the authors admit at the end of the study that the methodology and follow-up may be a "weakness," yet they continue to say that this is more likely to be a problem in an incidence study versus a risk factor study.

Dr. Odent points out that the data suggest that significant risk factors occur before the age at which children receive the MMR vaccine. The significant risk factors would include medication and environmental toxins and pollutant exposure both in utero and during the first year of life, and all the vaccines children receive prior to the MMR vaccine one year of age.

Also of note: the time frame during which China saw an explosion of autism was when the US removed thimerosal from vaccines, AND took much of the thimerosal-containing vaccine supply off shelves in the US and shipped it to other countries, one of which was China.

While I concede that birthing practices may contribute somewhat to autism, I believe that the most likely cause is vaccines. I have four children. All were born without anesthetics of any type. My boys (ages 7 and 5) were born in the hospital. I experienced wonderful labors with both in water. My oldest was "a vacuum extraction" (iatrogenic, obstetrician/gynecologist, supposed decels that were never confirmed); my younger son (CNM—learned my lesson) I birthed after about thirty minutes of beautiful pushing. Both boys had perfect Apgars. My girls (ages 3 years and 8 months) were born at home and in water. With both of my girls I was induced (thanks to my loving and compassionate midwife) with prostaglandin gel (half of recommended dose for first birth, a quarter of recommended dose for the second). Although quick (about three hours each) they were gentle, wonderful labors and births. The girls' Apgars were perfect as well. My boys had all of their vaccinations and both have been diagnosed with autism. My oldest is much milder; his vaccinations were more spread out that those of my younger son. My five year old has never had a Global Assessment of Functioning above 55: His autism is moderate to severe. Both boys had chronic ear infections and received tons of antibiotics. My three-year-old daughter had three sets of vaccines beginning at age 4 months, then 6 months, and again at 8 months. She too began with the chronic ear infections resistant to antibiotics. I said "enough is enough" and she has had no more vaccines. She is quite fine and is developmentally far beyond her age. My youngest child has had no vaccines (and won't, I might add) and is developmentally beautiful!

While that I could take up many other "issues" with this interview, the most important thing we need to remember is that only one diagnosable cause of autism is known, and that is Fragile X syndrome (a chromosome disorder). For all other children with autism, we have no sure answer. If we are to find the causes and potentially, cures, we all need to work together.

I have been in involved with the birth world for many years and am a firm believer in the education and issues that Midwifery Today brings to light. I have for many years seen a serious division among all those involved in birth. I agree that all possible causes of autism need to be explored—including the oxytocin theory. But when I finished reading this interview with Dr. Odent, I walked away feeling angry and seeing the beginning of more division in the world of autism research. I saw that because instead of saying "Here's an area (oxytocin) that should be researched along with everything else," Dr. Odent approached it from a seeming place of needing to discredit the vaccine theory in order to make oxytocin appear more relevant. It's all relevant.

— Angela Warner,
Vancouver, Washington

Response from Michel Odent:

I thank Angela Warner for her passionate comments. If she is aware of epidemiological studies of autism (in the framework of Primal Health research [1]) that are not included in our database, I would be pleased to receive the references.

I agree that some of the studies I mentioned may be considered old. For example, the huge study by C. Hultman and colleagues was published as early as 2002: We must take into account that their research protocol could not be easily replicated since it had involved all the Swedish population born between 1974 and 1993, all the Swedish children diagnosed as autistic, plus five controls for each of them. The point is that more recent studies, such as the Australian one published in 2004 and the Israeli one published in 2006 have reached the same conclusion that there are significant risk factors for autism in the perinatal period.

As for the Danish study exploring possible links between autism and MMR, I mentioned it because it involved half a million children. I might have mentioned the similar results obtained in a US study (Dales, L., S.J. Hammer, N.J. Smith. 2001. Time trends in autism and in MMR immunization coverage in California. JAMA 285(9): 1183–85) and in several British studies (such as Kaye, J.A., M. Melero-Montes, H. Jick. 2001. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ 322: 460–63), in spite of differences between countries regarding vaccination programs. For similar reasons, I mentioned the Danish study only among those exploring possible links with vaccines containing a mercury derivative.

As early as 1982, Niko Tinbergen (the Nobel Prize winner) was wondering why the medical community and many parents do not want to hear about risk factors for autism in the perinatal period. This led me to introduce the concept of "cul-de-sac epidemiology." (Odent, M. 2000. Lancet 355: 1371)

Note by the editor: "Primal Health Research" includes all studies exploring correlations between the "primal period" (from conception to the first birthday) and what will happen later on in life in terms of health and personality traits. The database can be accessed at: http://www.birthworks.org/primalhealth
(This feedback piece can be read at: http://www.midwiferytoday.com/enews/enews0913.asp#feed )