The Journal of the American Medical Association carried an excellent interview with one of the authors of the large Swedish study on any association between Tylenol and autism. It gives a good sense of how real “science” and research should be done and the thought processes any researcher should be following. An important aspect of science is the “null” hypothesis–that whatever intervention or link between two events or variables that you are studying does not exist, that in fact there is no causal relationship. Life is full of millions of “events” and “variables”. The likelihood that any two are going to appear to have some relationship is very high and almost certainly false. I may have mentioned the website Spurious Correlations, which has hilarious examples, using real data, of “associations”, all of which obviously have no causal erelationship.
The JAMA study author explains that while their data showed some initial association or trend between Tylenol use and autism or neurodevelopment issues, upon closer examination of more variables, particularly genetic ones, such as sibling issues, the association disappears. The problem with a lot of research is that the researchers want to find something, they want a result to publish and get attention. Finding no link isn’t that interesting, but it is super-important in most health research involving products. You want to know if something is effective and safe. The safe part usually requires showing that the null hypothesis is accurate–there is no association. I guarantee you RFK, Jr. doesn’t understand this or care, and Trump certainly doesn’t understand, but probably does care and when he gets better advice on the research, he will reverse himself. RFK, Jr. can’t go too soon, he is doing even more damage to trust in health advice. (JAMA Article)
Slight update–here is a link to the Japanese study, just published in September, which confirms the findings of the Swedish one, using a similar rigorous methodology. (Japanese Autism Study)
There are quite a number of issues associated with acetaminophen that should be mentioned. First, even though it is OTC, the therapeutic and toxic doses and not that far apart, and up to 50% of liver failure cases are associated with intentional or accidental overdoses. This is not inherently a “safe drug.” It needs to be used cautiously by everyone, especially pregnant women. You agree?
Next, the Swedish and Japanese studies were done specifically in those countries where the acetaminophen use in pregnancy is much less, in the case of Sweden 7.5% vs 60% of pregnant women in the US (from supplemental online in the Swedish study). In other studies (Norway) use of acetaminophen for >29 days is associated with 2x ADHD. At any rate the data associated with acetaminophen and subsequent autism or related health issues are complicated by accurate recall of use, percentage use in the population of pregnant women, and frequency/duration of use. Many variables.
The DHHS MAHA report has a section on autism in the context of an increase in the unhealthy state or American children, of which autism is only one example.
The Sept 25 DHHS report (https://www.hhs.gov/press-room/autism-announcement-fact-sheet.html) specifically discusses this acetaminophen issue and states, “Chronic acetaminophen use in pregnant women, especially late in pregnancy, may cause long-term neurological effects in their children.” It also states, “Evidence does not definitively establish causality, but the consistent associations raise concern.” This report acknowledges the Swedish study, but also references https://pubmed.ncbi.nlm.nih.gov/34556849/ which recommends “precautionary use” during pregnancy.
What Trump has to say on this is on Trump, it does not reflect on the fairness and solid content of the DHHS/RFK Jr MAHA report and acetaminophen follow-up.
If you think about and put all this information together in context, then I believe the recommendation should be for women to consider using Tylenol ONLY for treatment of fever during pregnancy when the risk of untreated fever is known to cause birth defects, and consider other analgesics for pain relief. What specific content in MAHA and follow-up reports do you feel “damages trust in health advice”?
Finally, the JAMA piece is a product of the editors of this Journal, which accepts pharmaceutical advertising. And, I encourage you to read the MAHA report pages 67-8, especially, “More than half of top medical journal editors have been paid directly by drug companies, often as funding for research.” Much of the reaction to RFK Jr and MAHA represents a defense of the massive government support for the grifting enterprise of “sick care” as apposed to any discussion, new thinking, and research on human health. Note also the comments in the JAMA article that don’t find the Swedish study to be that compelling in its findings.
not sure it is accurate that the therapeutic and “toxic” doses are close together. You have to take a lot of Tylenol to have a liver issue, for example, a whole lot, and most of those few cases occur in people who are susceptible, like people who drink a lot. People obviously may take too much, as they might with a prescribed drug, but the manufacturer is hardly to blame for that. I know that those who are trying to ignore these studies claim that Americans take more but there is limited or no evidence for that and it is irrelevant as these studies did study impact across doses in a very large population.
I honestly don’t trust a thing RFK, Jr. puts out, he and his advisors are distinctly unscientific and he is pursuing the trial lawyers’ agenda. For someone who appropriately spouts off about pharma conflicts, he ignores his own equally blatant one. The MAHA report is basically a work of fiction in regard to autism. It was written by people who have conflicts just as bad or worse than any established journal editor. He should stick to promoting exercise and a healthy diet. Along the way he is doing immense damage to public health, which was already damaged by the stupid CV-19 response. He does that by calling into question established medical practices with zero evidence that they aren’t appropriate. I really don’t think Trump will keep him around long.
I think you may have mixed up the weight limits for a recommended therapeutic dose and a toxic dose. I had to look twice when first reading up on this to be sure I caught that they are different units so orders of magnitude different
I think you may have mixed up the weight limits for a recommended therapeutic dose and a toxic dose. I had to look twice when first reading up on this to be sure I caught that they are different units so orders of magnitude different