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Trump and RFK blame acetaminophen for childhood autism. I couldn’t find a transcript yet, but the meandering press conference is recorded here. Was this on anyone’s bingo cards?
I’m confused. I vaguely knew that the Trump campaign had decided to fight autism at some point, but I always figured it was appeasement for the antivaxxers. Is there an untapped pool of Tylenol haters out there? Is this a stalking horse for a broader wave of FDA guidelines targeting the usual suspects?
Maybe there’s some sort of political smokescreen going on. We don’t appear to have started any new wars, and domestic hate for Trump looks more or less like it did since last week. If it’s a distraction, it’s not a very efficient one; I had a hard time finding reporting on it, and all the sites that bothered were also eagerly blasting his abuses of the Justice Department and the Supreme Court. That leaves the old-fashioned political motive of throwing meat to the base. Maybe Trump is just checking off campaign promises. But again, it’s so niche.
I suppose there could be some sort of personal beef. If Trump is trying to tank someone’s stock, uh, this is still a pretty weird way to do it.
That’s not even touching the medical case. The administration doesn’t appear to have provided much substance behind their claim. This will dissuade approximately no one. Enjoy your fresh CW battleground.
This was telegraphed a few weeks ago, the impression I got from Meddit at the time is that their is some inconsistent evidence for RFK's claims but that more likely than not he's wrong - however complicating matters is the fact that the medical community will instantly go blindly anti-Trump obscuring the issue.
Discussion today has seemingly forgotten the (mild) controversy in evidence and mainstream media coverage is repeating "trust the science" lies.
Sigh.
Some relevant facts: -Other analgesics have been slowly contraindicated in pregnancy over time, leaving Tylenol as the primary option. Does this mean a resulting increase in Tylenol is the cause of increased autism? Maybe not, but it is a thought and has been investigated previously.
-We don't actually really know how Tylenol works.* That makes it something of a boogie man.
*Please don't tell me this is one of the times that some important medical fact has changed since the last time I've researched it.
Isn’t Tylenol the easiest painkiller to accidentally take entirely too much of? Could pregnant women getting to dosage wrong be the cause?
Of course more likely this is a weak correlation but still.
Tylenol is weird. It absurdly safe for a drug (with the exception of someone with gross liver failure). Lots of continuous risk no matter how small for say ibuprofen, risks ramps up swiftly with pertinent comorbidity, chronic use, and high doses. Very much a "no dose is "safe"......but the benefits outweigh the risks" situation. In contrast Tylenol is usually just...safe.
Unless you have too much. Then rapidly you switch to one of the worst deaths imaginable. It goes from Safe to Dead faster than most drugs and with more sharp of a delineation. Stay on the right side of that line and you are good. Advil is more like alcohol - increasing risk that varies with the person the whole way.
This is an oversimplification but still.
For this reason dosage isn't usually a problem. But we don't know how Tylenol works, and maybe it works more like a regular drug for pregnancy and less is safer.
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We'd have to establish that there is actually a problem before looking for a cause, right? Which as I understand it we have not done. Autism is not becoming more prevalent afaict. Diagnostic criteria have repeatedly been broadened and public attention has been drawn to the issue, but that's not the same as things getting worse.
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Acetaminophen overdoses cause something like 50,000 ER visits and 500 deaths a year in the US. It's got a therapeutic index (the ratio of LD50 to ED50, i.e. how much a dose that delivers desired effects for for half of users has to be increased to be lethal for half of users) of only 10x, roughly as unsafe by that metric as ethanol and somewhat less safe than cocaine. Oh, and speaking of ethanol, you do not want to consume anything else that will tax your liver at the same time as you're taking the acetaminophen, because if you do the LD50 tanks.
It's supposedly even a bad way to kill yourself on purpose - suicidal people imagine popping a jar of pills and passing out to die right away, but instead just their livers die right away and they spend the next few days in agony while they inexorably drown in their bodies' own chemical wastes. No hyperlink for that one; I might be completely misremembering, but I don't want to read up on the details again.
So it's not impossible that scaring people away from Tylenol will do some net good.
But, as far as I know the negative effects of acetaminophen are purely via liver damage, and associations with autism exist but aren't causal - if you take a ton of Tylenol while pregnant then your kid might be up to 100% more likely to develop autism, but so will any kids who you were pregnant with without taking a ton of Tylenol; there's just some hidden cultural/genetic [edit: and/or medical - thanks to @MadMonzer for not missing the obvious] factors that correlate.
It's how Bruce Ivins, the man accused of being involved in the anthrax attacks around 9/11, killed himself.
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This.
I don't understand why it had to be hard-coupled with Autism. Tylenol is kind of ... bad? ... for people. As far as I'm aware, other general pain relievers like naproxem sodium and ibuprofen are roughly as therapeutically effective without the massive risk to your liver / accidental OD.
So, I agree with some other posters that this is "your brain on memetic reasoning ... and probably ChatGPT."
For non-pregnant people, yes. But sources not linked to the US culture war suggest NSAIDs are potentially much worse during pregnancy than Tylenol, and can cause fetal defects and maternal hemorrhage risks. US sources suggest NSAIDs increase miscarriage risk early in pregnancy too.
Learning has occurred. Thanks!
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It had to be hard-coupled with autism because RFK Jr. positioned himself as the "I'm going to solve the autism epidemic" guy, was getting raked for basically falling for Wakefield's frauds, and had to either double down and/or find something else he could point to instead.
There are still a couple pain-relief use cases for acetaminophen, though, even if it should be obsolete in general.
First: it doesn't interact with other pain relievers, so you can "double up" in cases of extremely strong pain, alternating doses of acetaminophen with a NSAID, taking both at full strength. My son had to do that recently for a broken arm; for the first few days of healing his only other sufficiently-effective option was a prescription for codeine (pre-combined with acetaminophen; not sure how much of that is "synergy" and how much is "we can deter opioid addicts by holding their livers hostage"), which he saved for when he needed to sleep.
Second, and more significantly in this context: it has been basically the only pain relief option that (assuming you're not allergic and don't overdose) is still thought to be safe during pregnancy! Even if you banned it for any other use case, there'd still be a strong argument to make it available for pregnant mothers, where the liver risks are the same but the next best alternative is "no pain relief" rather than "ibuprofen". NSAIDs increase risks of miscarriage when taken early in pregnancy, and risks of premature birth and birth defects when taken late. I've never dug into the research to see how much they increase risks, and of course typical lists of side effects never include probabilities, but these are the sort of qualitative risks that steer mothers and ob-gyns away from a drug regardless of the numbers.
Yeah, and it's not like we've all got formidable cognitive defenses to begin with.
Consider how "typical lists of side effects never include probabilities" gets treated as a normal, reasonable state of affairs - how can humanity be so innumerate that even teams of MDs can default to functional innumeracy without noticing? I like Mark Liberman's use of the Pirahã language (which has no words for numbers more specific than "some" or "many") as a metaphor, seeing their hand-wavy attitude toward numbers as a reflection of ours towards probability distributions ... but, damn it, the median first-world citizen educated enough to read his medication's fine print still isn't expected to be past the point of being hand-wavy about numbers! When it comes to questions like "how likely is it that the medicine you're about to swallow will make you sicker", we're not just simplifying "the Bayesian posterior looks like a lognormal with mean 1e-4 and standard deviation 1e-5" to "1 in ten thousand", we're effectively simplifying "1 in ten thousand" to "some"! We could translate it to Pirahã and back just fine!
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I wonder if we'll see an overall increase in mortality due to consumption of Protest Tylenol over a six month period.
Has that happened for literally any other protest fad?
If “trigger confidence” wasn’t enough to show up in mortality rates, this isn’t going to be any worse.
I vaguely remember a similar trend around ivermectin, which made me think of it.
That said, there was so much propaganda flying in every direction at the time that I would not stake my life on it being true.
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I hate having Tylenol in the house. It was one of the scarier parts of pregnancy and neonates. My 2 year old slurped up half a bottle while I was trying to dose the 3 month old and I called poison control crying. Couldn't sleep all night from shaking, though they told me it was below their threshold for going into the ER. An overdose is a miserable death.
That said, pregnancy sucks and you have to be able to give women something. If they can't take willow bark tea, can't have a shot of brandy, can't take anything more modern, they're going to come up with something. And that something is likely going to be dangerous.
This attitude feels odd to me - I wonder if it is a difference in national cultures around paracetamol/acetaminophen (bizzare that the pharmaceutical name and not just the trade name has a BrE/AmE difference - I think it is the only drug where this is the case). I can't imagine not having suitable paracetamol preparations for all family members (Calpol is the brand of children's paracetamol syrup in the UK, the pills for adults are all generic) on hand if needed - and adult paracetamol in Europe is the strength of "extra strong" Tylenol in the US. I keep them safe with the prescription medicines - mostly for the dog's sake. (Paracetamol and antifreeze are the dog poisons our vet is most worried about, although according to the RSPCA slug pellets are the cause of most fatal dog poisonings in the UK). One time I forgot and the 4 yo tried to chug a half-finished bottle of Calpol, although he spilt enough that there was no risk of an OD.
I know the UK licensed safe paracetamol (with an antidote incorporated into the tablets so you can't dangerously overdose) for dementia patients. It was taken off the market because the antidote caused nausea often enough to be a problem, but we now have a better antidote. It seems odd that nobody has tried again.
It might be cultural, my parents always preferred ibuprofen. But also migraines run in the family, and ibuprofen is more useful for that sort of pain.
In the US there was an infamous Chicago Tylenol Murder spree when my parents were in the 20s, which probably gave the brand a bad name.
Actually the response by the company behind Tylenol handled the murder spree so well it's taught in public relations textbooks to this day as a great example of what to do in cases like that. The aftermath was what resulted in the no-tamper foil covers becoming common, for example, and fewer powder-filled capsules. They pulled it from the market for a while, cooperated with a detailed investigation, and then returned it with the new packaging and lots of marketing and they were back up top in market share pretty quickly. I'm sure some people kept grudges, though, because they always do.
Anecdotally some people I know respond more to Tylenol than others. For several members of my family it's kinda so-so in effectiveness compared to ibuprofen.
When pregnant I got headaches at the normal-to-me frequency. With Ibuprofen I can just take one pill, small dose, and it's gone. With Tylenol I would take the recommended dose, wait four hours of suffering, and then on the second dose I could finally feel some effects. The pain was gone but I could still feel the headache waiting. Numb but still pounding? It was weird and not pleasant.
But still better than absolutely nothing, which is what is left to pregnant women now.
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Checking the history, ibuprofen was pharmacy-only in the UK until 1996 (whereas aspirin and paracetamol were on general sale). So when aspirin became contra-indicated for children because of the risk of Reye's Syndrome, a generation of kids grew up with paracetamol as the most available pain relief. The messaging from people who send public health messages (I was too young at the time to be more specific) was "ibuprofen is a stronger version of aspirin", so I assumed that it was also unsuitable for young children until I had kids of my own and bothered to check.
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If we had organ markets we would be able to track the damage in real time.
Rationalists need to fund prescription markets.
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