You say acetaminophen , I say paracetamol
Let's call the whole thing off
Flashbacks
Here we go again. I’m having flashbacks to Trump’s ‘bringing the light inside the body’ and injecting disinfectants as treatments for COVID-19 in April 2020. Not that Trump is always bad, Operation Warp Speed was a great success that Trump was happy to claim credit for in his first term (and he was unfairly criticised at the time). Now, he’s certain that pregnant women should not take acetaminophen/paracetamol1 (US trade name: Tylenol) unless they can’t ‘tough it out’ ,because it is comes with a ‘very increased risk of autism’.2 This is nonsense.
The appointment of Robert F. Kennedy Jr. as the US Secretary of Health and Human Services, and huge cuts to NIH funding mean Trump 2.0 is far worse for science and health than the first iteration. Despite that, there are some good things they are doing; the removal of Direct-to-Consumer Advertising (DTCA) of prescription drugs3, and changes in the management of childhood gender dysphoria more in line with the European shift to evidence-based treatments (resisted by the Biden administration — proving that anti-science positions are strongly tied to an ideological standpoints and not confined to the ‘other side’).4
However, the effect of Trump’s second administration on health, including the effects on research funding, is clearly net negative.
A longer term flashback I’m having is back to the early to mid-2000s, when post-Andrew Wakefield’s claims, the issue of autism and vaccinations was extremely prevalent on the internet pre-social media. Robert F Kennedy Jr. was equally active then, though thankfully not in the administration, and in 2005 published an article in Rolling Stone magazine called Deadly Immunity. This pushed the idea that thiomersal, a mercury containing preservative, was linked to autism. Despite retractions by Rolling Stone because of errors made by Kennedy (such as over-estimating the amount of mercury in childhood vaccines ninety-fold), the pressure grew. Kennedy wasn't the only politician asking questions, Joe Lieberman (Democratic senator) saying in 2005:
‘If you look at the statistics about the incredible increase in autism in the 1990s, it increased 4,000 percent. And at the same time we changed the requirements for the normal vaccine dosage, including a lot of the vaccines that had thiomersal in them. You’ve got to ask yourself, isn’t there a connection between these two things?’
In 2006, John Kerry (Democratic candidate for President in 2004) gave an anecdote from a delivery driver whose child was vaccinated, whose child developed autism within days. These days there may be a view that anti-vaccine views are Republican/MAGA-coded, but historically this isn’t always the case.
Multiple studies showed no effect of thiomersal on autism, and six years after it had been removed from vaccines there was no decline in autism rates. They continued to climb. It wasn't the vaccines.
I was quite active in UK-US mailing lists and blogs at the time, trying to counter anti-vaccine material on the internet. By the late 2000s, it felt like a lot of this had retreated. Who would have guessed that RFK Jr. would end up as Secretary of Health in 2025? It’s a nightmare come true.
Added snake oil
All of that previous period is covered in great depth in Paul Offit’s excellent Autism’s False Prophets (2008), which also covers another component of the vaccine-autism wars: treatments for autism. The concern about vaccine damaged children with autism led to a new industry, cures for autism. In 2004, a father and son team (the infamous Geiers) started promoting the use of Lupron (used in prostate cancer, and precocious puberty — and these days controversially for gender dysphoria). They had no training in paediatrics. They combined this with chelation therapy to try to remove the cause of autism (the mercury), as they argued mercury was bound to testosterone making it hard to chelate the mercury.
Interestingly some of the contemporary debates about the use of puberty blockers in gender dysphoria today (such as the dangers of permanent fertility issues) were happening then in these autistic children being treated for ‘vaccine damage’. So the harms of the movement weren't just a risk of reduced vaccine uptake, but additional harms from the adverse effects of quack therapies. It is therefore no surprise to find another ‘cure’, with limited evidence, for autism promoted at Trump’s press conference.
A small tactical concern concerning public trust
The FDA notice selectively points to the studies which suggest an association with paracetamol, citing a ‘considerable body of evidence about potential risks associated with acetaminophen’ although even then they say that causality has not been proven. They also make the important point that untreated fever can harm the unborn child and warn alternative drugs like aspirin and ibuprofen have ‘well documented harms’ on the unborn child. It is at least somewhat better than Trump’s press conference.
The European Medicines Agency (EMA)’s Chief Medical Officer, Steffen Thirstrup said:
“Paracetamol remains an important option to treat pain or fever in pregnant women. Our advice is based on a rigorous assessment of the available scientific data and we have found no evidence that taking paracetamol during pregnancy causes autism in children.”
And EMA recommend that ‘When needed, paracetamol can be used during pregnancy. As with any medicine for acute treatment, it should be used at the lowest effective dose, for the shortest possible time and as infrequently as possible.’
The UK’s MHRA stated that:
There is no evidence that taking paracetamol during pregnancy causes autism in children.
Paracetamol remains the recommended pain relief option for pregnant women when used as directed.
Wes Streeting, Secretary of State for Health & Social Care in the UK, used similar language on television and X.
The problem with this ‘there is no evidence’ line is that it is not true. There is evidence, the FDA are using it. People on X are using it in a community note attached to Wes Streeting’s tweet.
I rated the community note not helpful, because it isn’t.
The point is, if you say there is no evidence then that gives people an ‘in’ to counter with studies that do show an association, even if the studies are weak, and do not change the overall balance of evidence.
Carl Heneghan and Tom Jefferson have dealt with the study in the community note above in their substack, after people started sending them links to it following a previous post (also worth reading). The study is very weak, even before they start looking at the study details they note problems such as it’s non-systematic nature, and the fact a lead author has a $150,000 conflict of interest.
Social media is currently full of people, and presumably bots, posting studies that show some sort of association between paracetamol and autism, every time someone says there is ‘no evidence’ of such a link. To some that will make those saying ‘no evidence’ look dishonest.
While many will roll their eyes and go ‘Trump', eh?’ and trust their home authorities and experts, there is no need to provide this level of certainty of ‘no evidence’.
The public can deal with uncertainty.
Things are not divided into safe/non safe, there is a balanced judgement to be made based on best possible evidence.
There is nothing to be lost in saying that after examining all current evidence, including those studies that have suggested a possible link, that the balance of evidence, and stronger studies, show that that there is no proven link. Then if someone pulls up a study, however weak, that shows a possible association, you already have it covered.
Post pandemic we have a crisis in trust in experts and authorities5, and building that trust back requires trusting that the public can deal with uncertainty and the need to make judgements.
Trump stumbled trying to say acetaminophen, which just proves that paracetamol is the better name. If only because you can tell the joke, ‘Why is there no aspirin in the jungle? Parrots ate em’ all’.
This video includes a very good short clip of Paul Offit talking about a good study that showed no association between paracetamol and autism.
This has been the subject of debate for years, and is very much a step forward in terms of drug safety in the US. Direct to Consumer advertisements push people into new drugs, which have provisional safety profiles (since it is only when a drug is used in the wider population that rarer and more long-term adverse effects can be found). There have been constant problems with such advertising.
It’s been noted that in the UK that both Labour (left wing) and the Conservatives (right wing) have the same position on paracetamol and autism. Generally, the mainstream parties in the UK don’t seem to have the same politicised stances on scientific issues, even if there are activists in their membership who do (Labour are criticised by their own side on the Cass Review for example). Reform are more ‘American brained’ and Farage has disgracefully brought up thalidomide in the context of paracetamol.