Here we go again. It’s the ivermectin wars all over again, only this time the roles are reversed. It’s the right who are insisting that Tylenol is poison and the left who are insisting it’s the wonder drug of the ages, and they’ll gobble it by the pound to prove it. Worse, this time we’ve got the polarising RFK Jr in on the act.
To obsessed hammers, every nail ‘causes autism’, so it’s not surprising that RFK Jr is banging this drum. But that doesn’t mean he’s entirely wrong. Instead, as always happens where the Trump administration is concerned, everyone loses their minds and few of them seem even remotely capable of stopping, shutting up and letting their critical faculties work for even a nanosecond.
So, let’s try and peer through the hail of mutually flung poo, and figure out just what’s going on.
Firstly, what did the Trump administration actually say?
The main component of today’s announcement was the recommendation that pregnant women should limit the use of acetaminophen because of concerns about links with autism.
[Robert F Kennedy Jr…] stated the US Food and Drugs Administration (FDA) would issue a physician’s notice about the “risk of acetaminophen during pregnancy” and change the safety labels on packaging for products sold in the US like Tylenol.
Mr Kennedy said clinicians should use their “best judgement” by prescribing the lowest effective dose for the shortest amount of time.
Acetaminophen is sold in Australia and New Zealand as paracetamol, with brand names like Panadol, Panamax, Pamol, etc.
US President Donald Trump on Monday claimed that using acetaminophen or Tylenol (known in Australia as paracetamol) during pregnancy “can be associated with a very increased risk of autism”. The US Food and Drug Administration quickly followed with updated guidance, advising pregnant women to limit use of the medicine unless medically necessary – for example, in cases of high fever.
Ok, two things: first, Trump is doing no favours with his usual hyperbole. ‘Very increased risk’ is simply and unequivocally false. Secondly, though, the TGA guidence seems reasonable enough. What is the evidence?
Some have cited studies like this one, from Marsawa, et al, 2018, published in the American Journal of Epidemiology:
Acetaminophen use during pregnancy is associated with an increased risk for ADHD, ASD, and hyperactivity symptoms. These findings are concerning; however, results should be interpreted with caution given that the available evidence consists of observational studies and is susceptible to several potential sources of bias.
Note that: results should be interpreted with caution. Firstly, the study is observational: it simply correlates one thing and another, without establishing a causal link. Secondly, the effect was very small: about a two per cent increase, on an already small risk.
So, studies like this are very, very, far from a slam dunk.
More importantly, other studies suggest otherwise.
Ahlquist, et al, 2024, in the Journal of the American Medical Association, found that:
Acetaminophen use during pregnancy was not associated with children's risk of autism, ADHD, or intellectual disability in sibling control analysis. This suggests that associations observed in other models may have been attributable to familial confounding.
This was an even bigger study than Marsawa, involving 2.5 million Swedish children, which more importantly controlled for confounding factors such as parental neurodivergent diagnoses and sibling relationships.
But, how is everyone reacting? As predictably as always. Left-media are right out the gate, bellowing that paracetamol is like, the safest drug ever, and any claim of risk is as anti-science as burning witches. Case in point, the ABC:
The US Trump administration’s advice that pregnant women should limit the use of acetaminophen – also known as paracetamol – because of links to autism in children has been broadly condemned as “baseless” and causing unnecessary fear.
This is the equal and opposite reaction to many on the right, who are shrieking just as loudly that their golden idol RFK has at last nailed the cause of the ‘autism epidemic’ and them Big Pharma demons are behind it all – we knew it all along.
They’re both as stupid as each other.
Even the ABC’s trundled-out experts give their own game away.
Professor [Andrew Whitehouse], who researches autism in children, said that there is categorically no evidence that paracetamol use causes the condition.
He says some studies have suggested a “small, weak” association, but they haven’t proven a cause or link.
So, which is it? ‘Categorically no evidence’? Or a possible weak association? Those two are not the same thing.
Danielle McMullen, the president of the Australian Medical Association, is at least more measured.
“Certainly for pain or fever in pregnancy, the advice is still here that paracetamol in pregnancy is a reasonable and safe option for Australian women to use,” she said.
“It’s really important that we think about that science and critically analyse it before causing fear in families, and hence, why the medical community today is responding and saying all medicines should be used with caution during pregnancy, but paracetamol has been widely used and is still considered a safe option.”
As she says, all medicines should be used with caution during pregnancy. Which is, indeed, basically what the FDA has stated.
Finally, the Australian makes a good point: is it even worth taking paracetamol during pregnancy?
If a medicine offers only limited benefit, even a small potential risk could outweigh its value.
In 2021, my team led the world’s largest review of paracetamol for pain relief. We analysed clinical trial evidence across 44 different pain conditions to answer four key questions: What conditions does paracetamol help with? How well does it work? What doses are effective? And how safe is it?
We found moderate- to high-quality evidence that paracetamol was more effective than a placebo for just four conditions: knee and hip osteoarthritis; pain after craniotomy (brain surgery); episodic tension-type headache (not migraine), and; perineal pain shortly after childbirth.
Even in these cases, the effect was generally minimal.
Here we get the sort of sensible analysis that no one else is taking the time to turn off their reflexive reactions and think about:
While the science around a possible link to autism is conflicting – and far from settled – it shouldn’t distract us from a more immediate, evidence-based concern: paracetamol may not work very well for the kinds of pain people commonly use it for.
When using any medicine, the equation should always be about balancing benefit and risk.
And if the benefit is small, is it worth taking at all?
Oh, and the same goes for ‘natural’ remedies. It’s no stretch to say that a fair percentage of the RFK true believers will be fans of ‘natural remedies’. Well, guess what? Many of those can be just as risky as any Big Pharma product. Chamomile tea, for instance. Pennyroyal, ginseng, yohimbe... Other common remedies during pregnancy, like ginger, are indeed safe and effective.
But, as always: consult your doctor, not the legacy media, not that guy on YouTube. Not me.
And everybody calm the hell down.
