A stained glass window depicting global medical-science history in Meiling Hall. Credit: Daniel Bush | Campus Photo Editor
In a Sept. 22 White House press conference, President Donald J. Trump warned against pregnant women using acetaminophen, linking it to potential autism development in unborn children.
“Effective immediately, the FDA will be notifying physicians that the use of a—well, let’s see how we say that—acetaminophen—is that okay?—which is basically commonly known as Tylenol during pregnancy can be associated with a very increased rate of autism,” Trump said during the press conference, which was also attended by Health Secretary Robert F. Kennedy, Jr.
He recommended limited medication use except in unavoidable circumstances.
Trump said taking Tylenol is not good.
“For this reason, they are strongly recommending that women limit Tylenol use during pregnancy unless medically necessary,” Trump said.
Medical experts have since negated the claims made by the president linking acetaminophen use and autism development, citing a lack of scientific backing.
Various national medical associations released statements following the conference, reaffirming the safety of acetaminophen use during pregnancy.
Kristin Casper, a clinical professor and division chair of pharmacy, education and innovation at the Ohio State College of Pharmacy, said that many medical and pharmacy organizations have come out with statements affirming the use of acetaminophen during pregnancy.
“The American College of Obstetricians and Gynecology, The American Academy of Pediatrics, and, from a pharmacy perspective, the American Pharmacist Association—they’ve all issued statements that have affirmed the safety and benefits of acetaminophen use during pregnancy,” Casper said.
Christopher Hanks, medical director for the Center of Autism Services and Transition (CAST) and a professor of internal medicine and pediatrics at the Wexner Medical Center, agreed that there is insufficient evidence to suggest acetaminophen use as a cause of autism development.
“There have been studies over the past number of decades finding a potential link between autism and acetaminophen use during pregnancy. All of these data are correlation data, and it’s important to understand that correlation doesn’t determine causation,” Hanks said. “The current evidence, in my opinion, does not support a causal association between maternal acetaminophen use during pregnancy and increased risk of autism.”
Hanks also stresses the importance of acknowledging alternative factors that could contribute to a child’s development in addition to medications taken during pregnancy. Hank said that an example of a factor that could play into a potential risk in a child’s development could be an infection or chronic pain.
“The people that report acetaminophen use during pregnancy have higher prevalence of a lot of different things,” Hanks said. “There’s higher prevalence of a number of health conditions, higher smoking rates, higher rates of neurodevelopmental disabilities, lower socioeconomic status. There’s many other factors here.”
When issuing blanket statements regarding the effects of medication on neurological development, it is dangerous to ignore potential confounding factors, Hanks said.
A potential danger of this conflation is increased fear in expecting mothers.
“When women are pregnant, they are often very worried that something they do is going to have a negative effect on their child. To make such strong statements as were made without good evidence to support it is adding a lot of fear without adding solutions or benefits,” Hanks said.
In the press conference, the president said, “when you go from [1 autism case in] 20,000 to [1 autism case in] 10,000 and then you go to [1 autism case in] 12, you know there’s something artificial—they’re taking something. And by the way, I think I can say that there are certain groups of people that don’t take vaccines and don’t take any pills that have no autism. Does that tell you something?”
Though it is a fact that the number of identified autism cases has risen in the past several decades, Hanks attributes this to more strict diagnostic measures as opposed to medication usage.
“There have been absolutely massive increases of diagnoses in autism over the past two decades. There are multiple reasons for that,” Hanks said.
One reason is the change in diagnostic criteria. Pediatricians have also developed more purposeful screening tools to identify early manifestations of autism, Hanks said.
“You would be hard pressed to find a pediatrician that doesn’t screen for autism on a regular basis now, but 20 years ago that would not have been the case,” Hanks said. “It’s a combination of a lot more awareness, changes in diagnostic criteria, and much more purposeful looking for it. That is the largest driver of the increase in diagnoses.”
The tendency to assign culpability for autism development is reflective of a larger trend, Hanks said.
“I think the challenge here is historically there has been a lot of blaming in the approach to autism,” Hanks said.
He compares this recent wave in “pointing fingers” to the 1940s and 1950s, when “refrigerator mothers,” or mothers who were emotionally distant towards their children, were blamed for autism development in their offspring.
“Unfortunately, I think the current approach is taking a similar approach of blaming or pointing fingers at something without real strong evidence to support it, and potentially causing both physical and emotional harm to the mothers who have to make difficult decisions with this information,” Hanks said. “It’s harmful to the mothers, it’s harmful to the autistic populations who want to be recognized and understood and it’s harmful to trust in our medical society.”
This can cultivate a culture of fear, he explained, that causes harm towards the public understanding of autism.
“We’re essentially fearmongering around autism and providing only a negative view of a neurodevelopmental condition that has been present in our society for centuries or longer. Many autistic people have had very significant contributions to our society as well,” Hanks said. “In my mind, I think we need to move the conversation towards how we as a society can better support this population and less on creating only negative views of this population as what is sometimes described as a burden or disability on society which I think is the wrong method to take.”
Medical information is highly sensitive and can cause damage if shared improperly or without vital context, he said.
“The amount of data and knowledge in science out there is so massive that nobody can know everything so people rely on government, news, experts and a lot of different people to make decisions about their lives,” Hanks said. “I think we have to be very careful with how we share information and unfortunately when it’s shared in a way that creates such a divisive conversation I think it really undermines the opportunity for meaningful discourse.”
To combat misinformation, Hanks recommends that concerned Americans ask healthcare professionals any questions they might have.
“I do think, personally, that it is completely okay to engage in the conversation about acetaminophen and the potential link to increased rates of autism,” Hanks said. “That’s very different than the way it was conveyed [in the Sept. 22 press conference], but I don’t think there’s anything wrong with asking these questions.”
Casper agreed with Hanks, emphasizing the importance of asking medical professionals about concerns patients may face.
“Those conversations with the physician and pharmacist are key,” Casper said. “We really encourage our pharmacy students to encourage their patients to talk to their pharmacists. If they have questions, that’s really the best way to go: to talk to their pharmacist or to talk to their physician depending on what that question is.”
As Americans navigate their personalized healthcare plans, they should consult medical professionals with any questions or concerns, Hanks said.
“I hope people—regardless of what they hear—if they have questions, reach out to their healthcare providers or others they know in the medical community to ask these questions and explore them,” Hanks said. “If they’re worried about whether a choice they’re making may have a potential negative impact on their health or their child’s health or whatever it may be, then exploring that with their healthcare provider is the right way to go.”
