Endre “Andrew” CzeizelBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5509 (Published 19 October 2015) Cite this as: BMJ 2015;351:h5509
Life in Hungary was bleak in 1959 when Endre Czeizel, at the age of 24, began his career as a doctor and medical researcher at Budapest’s National Institute of Hygiene. Czeizel, like millions of others at the time, was working behind the so called iron curtain, the political boundary between democratic western Europe and the Soviet controlled communist countries of eastern Europe. Just three years earlier the Soviet army had crushed an uprising of Hungarians seeking independence and freedom. Thousands of Hungarians were wounded and killed. After defeat, hundreds were executed and thousands imprisoned.
By the early 1960s Czeizel, who had trained in gynaecology and obstetrics, had become fascinated with the emerging specialism of medical genetics. Isolated from the West, Czeizel was hungry for information. He had a good command of the English language and monitored, as best as he could, international research into medical genetics.
He persevered over the next three decades and was able to overcome huge difficulties not faced by medical geneticists in the West. On Christmas Eve 1992 he was rewarded with the publication of his most influential study in the New England Journal of Medicine. The landmark paper confirmed that the risk of neural tube birth defects can be reduced if mothers take folic acid during the periconceptional period—that is, shortly before conception and during early pregnancy.1
Pierpaolo Mastroiacovo, director of the International Clearinghouse for Birth Defects Surveillance and Research in Rome, says of Czeizel: “He will be remembered in the history of medicine for showing with a randomised controlled trial the efficacy of periconceptional vitamin supplementation in reducing the risk of neural tube defects. He also produced other outstanding research evaluating the role of medications and diseases during pregnancy that either increase or decrease the risk of birth defects.”
Czeizel was born on 3 April 1935 in Budapest. He wanted to be a professional football player. His father, a painter and decorator, discouraged him, urging him instead to choose a career that would be prestigious and last a lifetime. Czeizel chose medicine, earning his medical degree in 1959 and joining the National Institute of Hygiene as a research fellow.
In 1965 Czeizel completed a doctorate with a thesis entitled “Investigations into the pathogenesis of fetal abnormalities.” In the same year, when he was 30 years old, Czeizel was allowed to travel to western Europe for the first time, to visit with researchers in Denmark. He returned home to the National Institute of Hygiene inspired by the experience—and also determined to become a member of the international community of medical geneticists.
Before his visit to Denmark, he had used the name E Czeizel for a paper published in the Lancet in 1963.2 In his next paper, “Effects of Influenza on Pregnancy,” published in 1967,3 he adopted the first name Andrew—the anglicized version of Endre. In 1972 the first of his many letters and papers published in The BMJ was signed “A Czeizel.”4 Most of the more than 500 papers he authored during his life appeared under the name Andrew E Czeizel.
Over the years Czeizel would make occasional trips to the West, including World Health Organization fellowships to London and Edinburgh. Years later he told the Lancet that he had had the good fortune to meet British geneticist Cedric Oswald Carter in London.5 Czeizel said Carter “became my most influential teacher.”
Unlike many eastern European researchers who defected during the cold war years, Czeizel remained based in Budapest before the iron curtain crumbled in 1989—and after. Despite the isolation and difficulties, he gained the respect of colleagues in the West.
“I think Andrew was the nearest thing to a great man, although he was not easy to get close to,” says Bernadette Modell, an emeritus professor of community genetics at University College London, who collaborated regularly with Czeizel during the 1980s and 1990s. “This could have been partly because of the amount of prejudice he encountered in the years before 1990, when he was a rare participant from the Soviet bloc in meetings in the West. He did not talk about this, but it was very obvious—and painful. Naturally he faced many practical limitations in his work—for example, in access to laboratory and diagnostic technology—because of his situation.”
In 1970 Czeizel established the Hungarian Congenital Abnormality Registry.6 In 1973 he became head of the newly established Laboratory of Human Genetics, serving until 1988 when he was named director of the National Institute of Health’s newly established Department of Human Genetics and Teratology. In 1980 he established the Hungarian Case-Control Surveillance of Congenital Abnormalities, and the Budapest Monitoring System of Self-poisoned Pregnant Women.
Modell says that Czeizel “applied his imagination to use all available resources to help to improve birth outcomes for Hungary’s population, and at the same time build up an impressive body of epidemiological research.”
In 1984 Czeizel was named director of Hungary’s WHO Collaborating Centre for the Community Control of Hereditary Diseases, serving until 1998 and coauthoring numerous WHO genetics reports, including several with Modell.
Anver Kuliev, director of the WHO genetics programme from 1980 to 1985, whose current positions include director of research at the Reproductive Genetics Institute in Chicago, describes Czeizel as one of the most active WHO genetics experts and a key contributor to the development of “qualitative family planning.” Kuliev adds that Czeizel’s Hungarian Congenital Abnormality Registry was at the time “one of the world’s best in this area.” The registry and Czeizel’s other long term projects on the epidemiology of birth defects were subsequently used “as a standard for the development of monitoring systems for birth defects in many countries,” says Kuliev.
Czeizel was the author of nearly two dozen books, several available in English, including The Right to be Born Healthy: The Ethical Problems of Human Genetics in Hungary. He was well known in Hungary and had his own TV series in which he moderated shows on various health topics, including family planning, genetic issues, and prevention of diseases.
In 2000 Czeizel was one of three researchers awarded the Joseph P Kennedy Jr Foundation’s international award for scientific achievement for the discovery that folic acid could prevent neural tube defects.7 But his award was rescinded in 2002 after Czeizel was found guilty in a Hungarian court on four counts of being an accessory in a transatlantic infant adoption scheme and given an 18 month suspended prison sentence.8 9 Czeizel submitted an impassioned rapid response to The BMJ’s news article, stating his innocence and vowing to appeal the conviction.10 In 2004 a Hungarian court dismissed three of the charges against Czeizel and reduced the fourth count to a violation of Hungary’s adoption code.11 Czeizel again responded to The BMJ news article.12
Czeizel once said his worst habit was his inability to “differentiate between work and relaxation.”5 Mastroiacovo says of the final months of Czeizel’s life: “Andrew knew he was going to die within a few months. But he lived as always, without ever leaving his boundless devotion to work.”
Czeizel leaves three sons, two daughters, and five grandchildren.
Cite this as: BMJ 2015;351:h5509
Medical geneticist who showed risk of neural tube defects can be reduced if pregnant women take folic acid
Endre “Andrew” Czeizel (b 1935; q Semmelweis University, Budapest, 1959), died from leukaemia after a long illness on 10 August 2015.