Does Tylenol cause autism?

Donald Trump and RFK Jr. seem convinced that it does. But our friends at Science Vs say the data is far more complicated. Guest: Meryl Horn, senior producer at Science Vs For show transcripts, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unxtranscripts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unexplainable⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ And please email us! ⁠⁠⁠⁠[email protected]⁠⁠⁠⁠ We read every email. Support Unexplainable (and get ad-free episodes) by becoming a Vox Member today: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/members⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Thank you! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

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• 1:29Noam Hassenfeld?

  It's unexplainable. I'm Noam Hassenfeld, and by this point, you've probably heard about Trump's Tylenol thoughts.

• 1:36Speaker 03

  Don't take Tylenol. Don't take it if you just can't, I mean, it's, fight like hell not to take it.

• 1:45Noam Hassenfeld?

  Trump and other officials like RFK Jr., they seem convinced that Tylenol causes autism, that it's responsible for the increase in autism diagnoses we've seen over the past couple decades. But when you actually look at the science, it's a lot more complicated. And when I was reading and listening to all kinds of things on this supposed connection here, I listened to this great episode of Science Versus. And it was so good that I just wanted to share it with you. I love the way they approached the question with an open mind. And they do a great job of getting into the nitty gritty of the data. Not just whether Tylenol causes autism, but what specific data has led so many people to actually think it does?

• 2:27Noam Hassenfeld?

  And why that data isn't necessarily what it seems. Okay, here's Science Versus and Merrill Horn.

• 2:37Speaker 04

  This is Merrill. And today we're diving into this question of whether there's a link between acetaminophen and autism. With me is senior producer Rose Remmler. Hey, Rose. Hey, Merrill. So yeah, you may remember that we worked on this whole autism episode a few months ago, right? Yeah. And we covered what causes autism, why it looks like it's gotten more common in the past few decades. And while I was working on that, I talked to a scientist who looked at Tylenol or acetaminophen. So it was kind of perfect because when I saw all of this was hitting the news, I was like, oh, now I can call that guy back up. You had this in your back pocket just waiting to go. Yeah. It was all set to go. So yeah, this is Brian Lee, professor of epidemiology at Drexel University.

• 3:20Speaker 05

  Hello. Hey, Merrill. How are you? It's been a very hectic last few days.

• 3:26Speaker 04

  I bet. Yeah, he's getting kind of swarmed. And I wanted him to help me understand where this idea came from in the first place. This idea that acetaminophen could affect a fetus? Like, if we were going to build the case against acetaminophen according to science, where would the story start? And apparently, these concerns have been floating around for a while.

• 3:49Speaker 05

  Over a decade ago, the first sort of research came out about acetaminophen during pregnancy and neurodevelopmental disorders. And that idea isn't crazy because it's been previously linked with other sort of disorders. For example, specific birth defects, possible sex hormone issues.

• 4:11Speaker 04

  Really?

• 4:11Speaker 05

  Yes.

• 4:14Speaker 04

  Huh. So this was surprising to me, like sex hormone issues?

• 4:19Speaker 06

  So Tylenol or acetaminophen, we already know it can affect the fetus.

• 4:23Speaker 04

  Well, there had been research on it, for sure.

• 4:26Speaker 06

  Okay.

• 4:26Speaker 04

  Suggesting that there might be some risks here, which was, it was surprising to me because I've been pregnant and doctors will always tell you that Tylenol and other stuff with acetaminophen in it is the safe one to take. You're not supposed to take Ibuprofen because that's thought to mess up blood flow to the fetus and has been linked to congenital birth defects. Acetaminophen is thought to be like the safer of the two.

• 4:50Speaker 06

  I didn't know that. So like if, if you're pregnant and you feel flu-y or you have some pain, you're supposed to take Tylenol, not one of the other ones?

• 4:57Speaker 04

  Yeah, that's, that's why it's so common. It's like the one that for so long has thought to be relatively safe.

• 5:03Speaker 06

  But then, but even though they have these suspicions from these other conditions?

• 5:06Speaker 04

  Well, there, yeah, there had been these kind of like trickling out of like concerns, like Brian said, that it might be messing with sex hormones, kind of acting as an endocrine disruptor.

• 5:17Speaker 06

  That's so random.

• 5:19Speaker 04

  Yeah. No, at first I was like, what? But apparently back 15 years ago, some researchers pointed out that some painkillers sort of look like a type of endocrine disruptor that I'm sure you've heard of, phthalates.

• 5:34Speaker 06

  Sure. They're an element in plastics that are thought to be an endocrine disruptor.

• 5:38Speaker 04

  Exactly. Yeah. And so they tried testing whether painkillers, including acetaminophen, acted like phthalates when they put them on cells in a dish. And they found that, yeah, they kind of did.

• 5:53Speaker 06

  Oh, interesting.

• 5:54Speaker 04

  And we think phthalates might mess up hormones like testosterone in the body. And so researchers started looking into this and some of them did find that people who took acetaminophen during pregnancy were more likely to have a son with undescended testicles when they were born.

• 6:12Speaker 06

  Huh, okay.

• 6:13Speaker 04

  Yeah, so some researchers were finding these things, not in every study, but there were these hints that something might be going on here. And that was the backdrop for this new wave of studies looking at the brain. Because we know that hormones can affect brain development. So if something's messing with the hormones, maybe it could also change how the brain is developing in the fetus. Okay, that makes sense. And then studies start coming, looking at whether pregnant people who took acetaminophen were more likely to have a kid with autism. So like, you know, some of them would get thousands of pregnant moms and ask them some questions.

• 6:52Speaker 05

  They collected data on whether a mom used acetaminophen. Did you take Tylenol? Yes, no, that kind of a thing. And then they followed the baby after it was born to see if the baby developed autism.

• 7:08Speaker 04

  Mm-hmm. That's useful for our purposes. Yeah, exactly. Like, they followed these kids and then checked whether they're autistic. And these studies, they were finding stuff, but it was a little weird. Like, one of these studies found that it upped the chance for autism, but only when the autism was accompanied by hyperactivity symptoms. Another study found that boys were more likely to be autistic with this exposure to acetaminophen in the womb, but not girls. Huh. Okay. Kind of confusing. Yeah, like, none of these studies was like a slam dunk on its own. But at the same time,

• 7:52Speaker 04

  dozens of other studies were also coming out, looking at other stuff, especially ADHD, and finding that rates of ADHD were up in these kids exposed to acetaminophen in the womb. Oh, okay. And yeah, in some cases, it looked like the link was strongest for mothers who took acetaminophen pretty often, like in all three trimesters. So there's like a dose-response element as well. That's what it looked like. And in 2021, this all comes to a head. A paper comes out from a bunch of researchers who'd been studying this, called a consensus statement.

• 8:30Speaker 04

  They issued a quote, "call for precautionary action," unquote, and basically suggested that people should pump the brakes on these pills, minimize the amount of acetaminophen that they take during pregnancy. Here's Brian.

• 8:45Speaker 05

  And then to top it off, they published in a nature journal, which is one of the most highly regarded scientific journals out there.

• 8:54Speaker 04

  And so this statement really made scientists pay attention.

• 8:57Speaker 05

  Up until that point, most people just kind of treated it like, oh, you know, like, a new study pops up every day. You aren't really sure what to believe or not. But when consensus statement came out, it gave it like a stamp of authority.

• 9:10Speaker 06

  Yeah, I would feel that way about a consensus statement in in nature.

• 9:14Speaker 04

  Yeah.

• 9:14Speaker 06

  Or a nature offshoot. Yeah.

• 9:16Speaker 04

  And some parents even started suing the companies that make meds with acetaminophen in them, saying that they should have warning labels on them about these risks. But as all of this was happening, a lot of scientists were like, wait a second.

• 9:31Speaker 05

  When you use a phrase like consensus statement, it implies a sort of every single expert in the room believes X, Y, and Z. Like nine out of 10 dentists recommend Colgate or something of that sort. So it implies a sort of authoritative weight to the evidence.

• 9:50Speaker 04

  And implying that this was the consensus seemed to piss a lot of scientists off. Some of them wrote responses to that consensus statement, saying that it was way too soon to come out so hard against acetaminophen, saying that the evidence they cited was, quote, "weak in consistence and to a large extent, methodologically inadequate," unquote.

• 10:12Speaker 06

  So they're saying the studies are crap?

• 10:13Speaker 04

  Well, basically, yeah. That's the sciencey way of saying, what? This, that, you know, this is not enough. And so a lot of scientists were really skeptical of this and didn't buy this story. Scientists like Brian. Does taking Tylenol actually increase, when you're pregnant, increase the chance that your kid will have autism?

• 10:32Speaker 05

  The answer right now points towards no.

• 10:39Speaker 04

  Oh, really?

• 10:40Speaker 05

  Yeah. So that's the short of it.

• 10:43Speaker 04

  Wow. Up next, the long of it. We'll hear the other side of the story and tell you whether or not you can have your damn Tylenol after the break.

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• 14:30Speaker 04

  Welcome back. This is Meryl. So far, we've gone through a lot of the evidence against acetaminophen, the ingredient in medicines like Tylenol. Lots of studies seem to find that taking it while you're pregnant does increase the chance that your kid will be autistic or have ADHD. Are you ready for the rest of the science, Rose Rimmler? Yes. Are you ready? Yes, I'm ready. All right, so here's where Brian Lee, our epidemiologist hero, comes in gallantly with a shiny new approach to looking at this question. His paper came out just last year.

• 15:04Speaker 05

  We had a study funded by NIH before everything went to hell. And we were like, hey, we could actually look at this.

• 15:13Speaker 04

  And so Brian teams up with some Swedish researchers because he's actually really into IKEA.

• 15:21Speaker 04

  I don't think that's why. Yeah, you got me. I think it's because the Scandinavians keep really good records, public health records. Yeah, it's because they have an amazing database.

• 15:32Speaker 05

  Sweden having its lovely, universal healthcare system means that you can track everyone. They don't just disappear in the system. They're there, they're tracked. Everyone has access to this, right?

• 15:45Speaker 04

  So yeah, they got data from a ton of kids, almost two and a half million of them. Basically, every kid who was born there over a 24 year period. And they also had data from the moms, details about their medical care, like the medicines that they took during pregnancy. And so now Brian's team looked to see, were the kids exposed to acetaminophen in utero more likely to be autistic? And right off the bat, they found that, yes, they were.

• 16:15Speaker 06

  Oh.

• 16:15Speaker 04

  So they found that the kids who were exposed to acetaminophen had a 20 to 30% higher chance of being autistic.

• 16:23Speaker 06

  Oh. That's not what I was expecting you were about to tell me.

• 16:28Speaker 04

  Right. Oh, but, but actually, Brian's team was sort of relieved when they found this.

• 16:34Speaker 05

  This shows that we're not in crazy land. For example, that somehow our data are not flawed. We're not flawed. Everything is working as anticipated.

• 16:44Speaker 04

  And that's because the effects that Brian was seeing in his data was in the same ballpark as what other groups had found. But here is where Brian and his team took a different path. They wanted to see if other factors might be muddling up the data here, making it look like it's the acetaminophen to blame, when really it's something else entirely.

• 17:05Speaker 06

  Yeah, okay. So Brian is trying to think of, are there other factors that might come into play here? And trying to like, do some science to sort of suss those out, basically?

• 17:16Speaker 04

  Yeah. And so to try to do that sussing out, he starts checking like, okay, what if some of the other factors that we know are linked to autism could be contributing to that effect that he saw, that 20 to 30% increased chance? Because like we talked about in our earlier episode on autism, we know that the age of the mom can affect the chance of whether her kid will be autistic. Like, older moms are more likely to have autistic kids. Or if the mom has some other health condition or got sick during pregnancy, that might increase the chance for autism, too.

• 17:51Speaker 06

  And so those factors have been known for a while and are generally pretty well accepted.

• 17:55Speaker 04

  Yeah, yeah, exactly. And so Brian's team took another look at the data. And when they started accounting for some of that stuff, like how old the moms were, the effect of acetaminophen got smaller. It went from increasing the chance of having autistic kid by 20 or 30% down to 5%.

• 18:15Speaker 05

  When it's down to like a 5% increase in risk, you start to actually wonder whether or not it's real or not.

• 18:22Speaker 04

  Could it be like moms who are older are more likely to take Tylenol because they're like have more aches and pains or something like that? And we know that's separately associated with autism, that kind of a thing?

• 18:32Speaker 05

  Yeah, exactly. Or a mom being sicker, right? Like you don't just take Tylenol for funsies.

• 18:42Speaker 06

  So the other studies weren't adjusting for stuff like age of the parent,

• 18:49Speaker 06

  you know, other health conditions, stuff like that?

• 18:51Speaker 04

  Yeah, basically, they weren't all doing the same type of adjustments.

• 18:54Speaker 06

  Okay.

• 18:55Speaker 04

  So that's, that's one thing. And then there's another massive factor that contributes to whether someone's autistic. Their genes.

• 19:04Speaker 06

  Oh, yeah.

• 19:05Speaker 04

  Yeah, they think that this is like the number one thing that determines whether someone's autistic. It's like 70 to 90% of it. So Brian's team wanted to know, could that be part of the story too? And that's sort of tricky to sort out. Like ideally, you'd look at identical twins, right? And expose one to acetaminophen in the womb and then see if there's like a difference in autism rates.

• 19:28Speaker 06

  I guess. I don't know how you would do that.

• 19:30Speaker 04

  Yeah, exactly. You can't do that. But there is another way to get at this. They could look at siblings in their data.

• 19:38Speaker 05

  What if we did this within the same family unit? So basically, kids born to the same mom, but during one pregnancy, the mom used acetaminophen and the other pregnancy, the mom did it. Right, so then you control at least partially for genetics.

• 19:57Speaker 04

  Yeah, that's great. So Brian's team looked in their giant Swedish database and gathered thousands of cases like this. They crunched the numbers and here's what they found.

• 20:08Speaker 05

  Everything flatlined in terms of risk. You know, what was already a very minimal increase in risk just flatlined to absolutely no difference in risk for a child who is exposed.

• 20:22Speaker 04

  No increased chance of autism.

• 20:24Speaker 05

  No increased risk for autism, for ADHD, for intellectual disability. It was just a pure flatline.

• 20:32Speaker 04

  Hmm. Yeah, so what this means is that within a family, whether or not the mom took acetaminophen, the chance that her kid was autistic was the same.

• 20:42Speaker 06

  So can you put this all together for me? Like, what's going on here exactly?

• 20:47Speaker 04

  Okay, yes. So the more I learned about this, the more I realized that there could be a completely different explanation for why acetaminophen and autism might seem like they're linked. Because like, if you imagine, like, say you're a mom of an autistic kid, that means that you're also more likely to be on the autism spectrum yourself, right? You probably have some of these autism genes too. And being on the spectrum, having some autistic traits, that's actually been linked to having more pain when you're pregnant. It's also been linked to having migraines. Yeah.

• 21:24Speaker 06

  Oh.

• 21:25Speaker 04

  And so like, we have these reasons why people on the spectrum might be more likely to take acetaminophen. So maybe that's why it's looking like it's the medicine causing the autism. But we have a way of explaining all of this without blaming the acetaminophen at all.

• 21:41Speaker 06

  So, all right, so this is like a classic, sort of red herring science story.

• 21:46Speaker 04

  Yeah.

• 21:46Speaker 06

  So like, it looked like it was this one thing, but it's actually that one thing is associated with this other thing that it was sort of covering up.

• 21:54Speaker 04

  Mm-hmm. Yeah, that could really be what's going on here. I mean, it would be like, if you looked at your chance of playing outdoor pickleball, that might go up along with how likely you are to have had ice cream recently. But really, both of these things are just linked because it's warmer outside.

• 22:18Speaker 06

  Uh-huh.

• 22:20Speaker 06

  Yeah, exactly. Exactly. That's what I mean.

• 22:22Speaker 04

  Yeah.

• 22:22Speaker 06

  It's like, they're not directly influencing the other. It's just like, they're both responding to the same third variable.

• 22:28Speaker 04

  Yes, there's a third variable. Exactly.

• 22:31Speaker 06

  Okay, classic.

• 22:31Speaker 04

  That's what it seems like to me. But there is still like, a back and forth here, a bit of a nerd fight. Like, other researchers saying, "Brian's study isn't perfect either." And there are still reviews coming out that say there is a link between acetaminophen and stuff like autism. So I asked Brian about these studies. I guess like, normally I would trust a meta-analysis, looking at a bunch of studies over, like, a couple of studies here and there, saying something else. Like, why should I trust your study more than this meta-analysis?

• 23:07Speaker 05

  So, one of the fun things with the meta-analysis is that it's a garbage-in, garbage-out kind of a thing. You can feed it garbage, but your meta-analysis is not going to turn this garbage into something beautiful. You can repeat the wrong thing many times in completely different samples, and get the same wrong results in every single sample.

• 23:34Speaker 04

  And yeah, it's not like he's saying that these are all terrible scientists. But more that these reviews are mostly looking at studies that didn't have that genetic stuff. Like, they couldn't look at siblings. They just didn't have that data. And so they couldn't do what Brian's team did. But Brian's study, it's not the only one that, that did do that kind of like sibling analysis. And so like, there was one that just came out a couple of weeks ago, from Japan, that did the same thing, and it backed up Brian's study.

• 24:08Speaker 06

  Okay, so given all that, what do you make of all this? Like... If you were pregnant right now, would you take Tylenol?

• 24:18Speaker 04

  Well, for the autism question, I do find studies like Brian's to be the most convincing. Like, I don't think there's a clear link here. And even to go back to those other concerns around Tylenol, like that idea that it might be a hormone disruptor.

• 24:34Speaker 06

  Oh, the undescended testicles.

• 24:36Speaker 04

  Exactly. What about the undescended testicles? And to go back to those, those studies on the undescended testicles are super mixed. So like, some studies will find a link there, other studies don't. And actually, the most recent review that I could find on this said that most studies don't find more undescended testicles in babies exposed to acetaminophen in utero.

• 25:00Speaker 06

  So even the thing that started this whole suspicion of acetaminophen during pregnancy off, that has actually a pawn for their investigation, not really borne out. Like, there might not actually be a link there either.

• 25:13Speaker 04

  No, yeah, exactly. And a bunch of big medical groups agree here. They say that we don't have evidence that taking acetaminophen during pregnancy causes autism or issues with the development of the fetus, like the FDA, regulators in Europe, a big group of OBGYNs. But like, yeah, just in case if I did take acetaminophen, I'd try not to take it for like, weeks at a time. Because generally, some of the studies that do find risks only find them if you take acetaminophen for like, longer periods of time.

• 25:49Speaker 06

  It also depends, I guess, on what you're taking it for. I mean, I'm not a, I'm not a, this is not medical advice, but it does make me wonder, like, if you have a high fever.

• 26:00Speaker 04

  Yep.

• 26:00Speaker 06

  That might be worse for the fetus than the like, infantisimal risk of some Tylenol on their brain development, right?

• 26:09Speaker 04

  Yes, actually, that's true too. So having a fever when you're pregnant, we know that ups the chance for lots of serious stuff, like birth defects for the kid, heart malformations, premature birth.

• 26:21Speaker 06

  Uh huh.

• 26:22Speaker 04

  And fevers also happen to be linked to a kid being autistic later.

• 26:26Speaker 06

  Oh.

• 26:28Speaker 06

  Uh huh. Okay, that's very interesting and fairly satisfying, actually.

• 26:33Speaker 04

  Yeah.

• 26:34Speaker 06

  All right.

• 26:35Speaker 04

  And by the way, we did reach out to the company that owns Tylenol and they sent us a big statement pointing to some of the science that we've talked about. And they said, quote, "We continue to believe that taking acetaminophen does not cause neurodevelopmental disorders, including autism," unquote. And for Brian's part, he really doesn't think the science supports the idea that taking a little Tylenol when you're pregnant makes the kids later become autistic or have ADHD.

• 27:01Speaker 05

  Like, taking off my epidemiologist hat and just, you know, as a person hat, like, blame is damaging, it's harmful, and it doesn't exactly help. People might be blaming themselves for like, that one random Tylenol they took when, you know, they were pregnant 10 years ago. And, you know, if we can help, you know, take away some of that guilt that's there, I think that's, that's nice, because people shouldn't be feeling guilty about these things in the past.

• 27:30Speaker 04

  Yeah, feel guilty about something else.

• 27:32Speaker 06

  Go back to feeling guilty about eating lunch meat.

• 27:35Speaker 04

  Yeah.

• 27:37Speaker 04

  All right, well, thanks, Rose.

• 27:38Speaker 06

  Thanks, Meryl.

• 27:39Speaker 04

  That's Science vs.

• 27:43Speaker 04

  All right, Rose, do you want to ask me how many citations I have in this episode?

• 27:47Speaker 06

  Oh, yeah, Meryl. How many citations do you have in this episode?

• 27:51Speaker 04

  We have 59 citations.

• 27:53Speaker 06

  Woo!

• 27:55Speaker 04

  So if you want to see all the science that went into this episode, check out the transcripts. You can find links to that, which has all these beautiful citations in the show notes. And we did reach out to the US Department of Health and Human Services about this, and a spokesperson said, quote, "Until we release the final report, any claims about its contents are nothing more than speculation," unquote. And if you want to learn more about autism, check out our other episode on this, called Autism: The Real Reason It's Going Up. And if you want to tell us what you think of this episode, or have episode ideas, reach out to us. Our Instagram is science underscore VS.

• 28:39Speaker 04

  This episode was produced by me, Merrill Horn, with help from Rose Rimmler, Michelle Deng, and Akedi Foster Keys. We're edited by Blythe Sorrell. Mix and sound design by Bumi Hadaka. Our executive producer is Wendy Zuckerman. Fact checking and consulting by Erica Ikiko Howard. Music written by Peter Leonard, Bobby Lord, So Wiley, Emma Munger, and Bumi Hadaka. Thanks to all the researchers that we spoke to for this episode and our other episode on autism. Science Versus is a Spotify Studios original. Listen for free on Spotify or wherever you get your podcasts. And if you do listen on Spotify, follow us and tap the bell for episode notifications.

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• 30:00Speaker 07

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