During the last week of September, I attended the annual meeting of the American Academy of Pediatrics in the Civic Center in Denver, Colorado. Thousands of fellow pediatricians from around the world gathered to network and to hear about the latest research from the leaders in the field. The mood of excitement and collaboration was only slightly dampened by the fact that we participants had to cross two picket lines daily to enter the halls. One consisted of large, bearded men dressed in white jumpsuits, with red stains on their crotches, with a humongous parade banner, saying “Welcome Murderers.” It was an anti-circumcision rally. The smaller but noisier crowd consisted of folks protesting puberty blockers and “men in women’s sports.” I tried to engage one of the women in this group, but, after being shouted down every time I opened my mouth to say something, I realized the fruitlessness of this endeavor.
At the two seminars I attended about autism, the air was electric with the news from Sept. 22, when: 1. Martin Makary, commissioner of the current FDA (who wrote the new policy advising against Covid boosters for healthy children and adults younger than age 65) said that acetaminophen (brand name Tylenol), taken prenatally was linked to conditions like autism and ADHD. 2. President Trump announced the cure for autism, the folate derivative folinic acid, and authorized FDA approval before any agency review.
The speakers, experienced developmental pediatricians and autism specialists Adiah Spinks-Franklin and Marilyn Augustyn, asserted that acetaminophen has never been shown to be a teratogen (cause of any birth defects). A recent metanalysis — published in the Journal of the American Medical Association, which compared the results of 5-6 studies that represented millions of children — found no relationship between ingestion of acetaminophen in pregnancy and autism in their offspring. Another study, done by the American College of Gynecologists (ACOG) found similar results. The advice that the FDA has given about acetaminophen in pregnancy is really the same that holds true for any medication: it should be used only if necessary and in only the smallest dose necessary.
This has not stopped podcasters like addiction medicine specialist (and now presumed obstetric and pediatric expert) Dr. Drew from proclaiming loudly on a recent podcast about pregnant women filmed taking Tylenol: these “ladies of the left” were “assaulting their fetuses.”
And what of the risks of NOT taking acetaminophen if needed in pregnancy? An untreated fever for someone who is pregnant is known to increase the risk of cleft palate, congenital heart disease, and neurological disorders in a newborn infant; it can double the risk of neural tube defects like spina bifida. Untreated fever and pain increase the risk of maternal hypertension dehydration, miscarriage, and underweight infants.
When I reviewed the medical literature I found something odd: Almost every study that
claimed that acetaminophen was a teratogen came from the same authors, at the same institution — the WP Lab in Durham, NC. Its website declares its present mission: To prove that acetaminophen is the cause of “90%” of the cases of autism in this country.
In one of their recent articles, and on their website the researchers of this institution seem to have pivoted: Rather than blaming pregnant people, they are now blaming pediatricians. They say that actually, acetaminophen taken in the first year of life. is the cause of autism.
They base this assertion on the dramatic rise in autism since acetaminophen has taken the place of aspirin for fever and pain control, due to concern about Reye’s syndrome, (an association, not a cause) and a number of small studies. In one study, for example, a refurbished telephone survey of parents who claimed their children developed “retrograde autism” after vaccines, but it was not the fault of the vaccines, the researchers surmised but rather the dose of Tylenol the kids received with the shot. Or the problem is that acetaminophen metabolism yields a small amount (less than 10% of total metabolites) of an hepatotoxin called N-acetyl-p- benzoquinone, which, they claim, babies have decreased ability to handle. Yet if this were a problem, babies would be developing hepatitis and liver failure (seen in acetaminophen overdose), and this isn’t happening.
What about folinic acid, also known as leucovorin? This is a derivative of the vitamin
folate. It is not dependent on the enzyme folate dehydrogenase to work in the body, so it can work to replace folate in cases where it is depleted, by the cancer chemotherapy drug, methotrexate, for example. There are a number of small studies showing that folinic acid may help children with psychiatric and neurodevelopment disorders, and specifically, may increase verbal communication, and social behavior in children on the autism spectrum, especially in children with antibodies to glutathione folate receptors (called “FRAA’s”). These antibodies are more common in autistic people and may cause forms of oxidative stress that folinic acid, through a series of biochemical reactions, can neutralize.
So folinic acid may be a promising therapy, for some patients. But measurement of FRAAs is inexact. The studies were small, had methodological problems, and used different doses and forms of folinic acid.
Autism spectrum disorder is a complex syndrome caused by hundreds of genes, environmental toxins, and epigenetic factors (genes turned on by environmental toxins or stressors.) Unfortunately, this administration has decimated funding for research into the potential causes and treatments for autism. This president has trashed the EPA and other agencies responsible for protecting women and children from known neurotoxins like those derived from the “forever chemicals” known as PFAS and from the common plastics known as phthalates. And countless programs supporting autistic people have seen funding slashed.
But that doesn’t stop the administration from choosing one culprit and a new “cure,” fueling false fears and hope for autistic people and their families. As the Society for Developmental and Behavioral Pediatrics stated recently, “Unscientific, overly simplistic, and premature assertions about causes and treatments are a distraction from the very real needs of the autism community.”
Dr. David Gottsegen is a pediatrician who focuses on the interrelationship between mind body and spirit. He lives in Belchertown.