05/03/2024
The struggle to make people aware that acetaminophen is not safe for babies and children is sometimes exciting.
On April 9, 2024, a very misguided paper was published in a VERY prestigious journal (JAMA). Misguided papers are occasionally published despite the best efforts of everyone, so that’s not surprising. In this case, however, the National Institutes of Health (NIH) touted the paper in one of their rare press releases. The NIH funds about 100000 publications per year, but produces less than 20 press releases per year (estimation based on the number of press releases they’ve produced between January and mid-April of 2024), so this was a significant decision.
The JAMA paper claims that acetaminophen does NOT cause autism during pregnancy. The New York Times and other major newspapers carried the headline of the study in when a senior author (the corresponding author) received funding from corporate lawyers working for the leading pharmaceutical company that has manufactured acetaminophen for decades.
But we know that acetaminophen causes many cases of autism at the time of birth, and it probably causes at least a few cases during pregnancy based on other studies. This new paper could be pivotal, changing our thinking. But it is not. The conclusions are not justified by the results.
In the JAMA paper, the authors made two assumptions. They assumed that acetaminophen and the MIA (maternal immune activation, a.k.a. oxidative stress) act independently of each other, that it had to be one or the other. We know based on other scientific studies that this is an invalid assumption. They also assumed that it doesn’t matter if they underestimated acetaminophen use. We know from another study in Sweden (and from other studies in high-income countries) that they probably did dramatically underestimate acetaminophen use.
In science speak: the authors did not apparently appreciate the pharmacology of acetaminophen, which caused them to treat cofactors as confounding factors, and caused them to disregard the importance of under-reporting acetaminophen use in their analysis.
What’s exciting about this (yes, exciting!) is that this gives us yet another opportunity to demonstrate that exposure of susceptible babies and children to acetaminophen really is causing autism. We have just completed the formal proof demonstrating the error.
The answer is….
IF 50% of all cases of autism are induced by acetaminophen use during pregnancy in susceptible women, and IF 90% of susceptibility factors are considered in the analysis and acetaminophen use correlates with those parameters, and IF 60% of women used acetaminophen, but only 7.5% reported using it,
THEN, the analysis shows that acetaminophen does NOT cause autism. (Science speak: HR = 0.992, p = 0.886)
Keep in mind that this is a computer simulation with PERFECT data. In other words, we know absolutely that 50% of autism is induced by acetaminophen in this artificial data set, but under conditions which are possible and even likely in the recent study published in JAMA, even with 50% of all autism induced by acetaminophen during pregnancy, the calculations used in the JAMA article show that acetaminophen is safe for use during pregnancy.
It will take us weeks to incorporate the results into a manuscript for peer review. We will try to publish the paper in JAMA, and will publish it elsewhere if JAMA declines to publish our proof of error. That could take months or even a year or longer.
Our previous conclusions, now published in several pediatric journals, still stand. Exposure of susceptible babies and children to acetaminophen still causes many if not most cases of autism.
And, to answer the big question for now: acetaminophen use during pregnancy at high levels may still be risky, but it’s not nearly as risky as giving acetaminophen to babies and small children. We set the computational analysis at 50% of all autism induced by acetaminophen during pregnancy to prove a point. There is no way that this much autism is induced during pregnancy. Most of it happens after pregnancy.
You can review the evidence for yourself by going to preventautism.org