Dennis K. Flaherty

In 1998, Dr. Andrew Wakefield, a British gastroenterologist, described a new autism phenotype called the regressive autism-enterocolitis syndrome triggered by environmental factors such as measles, mumps, and rubella (MMR) vaccination. The speculative vaccination-autism connection decreased parental confidence in public health vaccination programs and created a public health crisis in England and questions about vaccine safety in North America. After 10 years of controversy and investigation, Dr. Wakefield was found guilty of ethical, medical, and scientific misconduct in the publication of the autism paper. Additional studies showed that the data presented were fraudulent. The alleged autism-vaccine connection is, perhaps, the most damaging medical hoax of the last 100 years.

We studied 248 grain handlers and 192 city services workers (control subjects) before and after an 8-h work shift and measured total dust levels using personal samplers. We found that grain workers exposed to a mean total dust level of 3.3 +/- 7.0 mg/m3, when compared with control subjects, had (1) a higher prevalence of work-related respiratory symptoms (p less than 0.05) and significant decrements in forced-expiratory volume in one second (FEV1) and maximal flow rates after exhalation 50 and 75% of forced vital capacity (Vmax50 and Vmax75) during the work shift, and (2) significant differences (p less than 0.05) in preshift/postshift percent changes in forced vital capacity (FVC), Vmax50 and Vmax75. Adjusting for age, height, and smoking habit, grain handling still had a significant negative effect on FVC, Vmax50, and Vmax75. In grain workers, we found a significant (p less than 0.05) negative relationship between total dust levels and the percent change in FVC, Vmax50, and Vmax75 and a positive relationship between dust level and percent change in leukocyte counts. Grain workers' perception of dust level correlated with the measured dust level and the prevalence of symptoms. Occupational exposure to grain dust during a work shift has a dose-related adverse acute respiratory effect regardless of smoking habit, atopic status, or age, and it produces a dose-related leukocyte response at total dust levels below 15 mg/m3.

1. We measured the concentrations of leucocyte subpopulations, immunoglobulins and complement in six well-conditioned runners before and after a typical 8-mile (12.8 km) training run at 70-75% of VO2 max. 2. Before running all components were within the normal range. Exercise failed to produce a significant rise in neutrophils. There was also no change in immunoglobulins or complement concentrations immediately or 24 h after exercise. Lymphocyte subpopulations were also unchanged except for a progressive rise in antibody-dependent cytotoxic effector cells (K-lymphocytes). 3. These results suggest chronic exercise training has no apparent adverse effect on circulating cellular or humoral immune components in healthy subjects. An increase in K-lymphocytes may provide added host defence capacity during periods of stress, although the mechanism of increase is unexplained.

A survey of 300 grain elevator workers revealed that 77 per cent complained of eye symptoms; 64 per cent, of nasal symptoms; and 88 per cent, of one or more respiratory symptoms on exposure to airborne grain dust. Symptoms on exposure were independent of age and length of employment. Cough and wheezing on exposure were more common among smokers than nonsmokers (P less than 0.025). Nineteen per cent of the workers had had episodes of grain fever. The prevalence of chronic bronchitis was 37 per cent (42 per cent of smokers and 30 per cent of nonsmokers). Wheezes on auscultation were found in 23 per cent. Measurements of lung ventilatory function, as well as diffusing capacity, correlated significantly with age and smoking habits, but not with length of employment. Thirty-seven per cent of the workers had an abnormal mean forced expiratory flow during the middle half of the forced vital capacity (47 per cent of smokers and 13 per cent of nonsmokers), and 34 per cent had an abnormal maximal expiratory flow after exhalation of 50 per cent of the forced vital capacity (40 per cent of smokers and 13 per cent of nonsmokers), whereas only 13 per cent had an abnormal ratio of 1-sec forced expiratory volume to forced vital capacity. There was no correlation between precipitins to fungi, bacteria, grain, or grain dust antigens and acute or chronic respiratory symptoms, lung function, or grain fever. There was, however, a significant correlation between cutaneous reactivity to grain dust and wheezing on exposure (P less than 0.02). Abnormal flows at low lung volumes were more common among cutaneous reactors to common allergens. We concluded that exposure to airborne grain dust can cause acute inflammatory reaction to the exposed mucosa, and it is highly probable that grain dust contributes and, in some cases, causes chronic airway disease.