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Out of all the scary moments for the future of health and well-being in the United States, the nation’s president standing up and telling pregnant women to “tough it out” and forgo Tylenol during pregnancy because he believes that the drug causes autism was one of the scariest. “Don’t take Tylenol,” Donald Trump said in a White House briefing. “Don’t take it. Fight like hell not to take it.” He also announced that the Food and Drug Administration would be telling doctors to warn women about alleged autism risks tied to acetaminophen, the active ingredient in Tylenol, and questioned the standard childhood vaccination schedule, arguing that it was “too much liquid” to be injecting into infants.
Much of this seems to be coming from Health Secretary Robert F. Kennedy Jr., whose department will also be conducting research into the root causes of autism—an effort that will spend millions of taxpayer dollars not just on legitimate areas of inquiry like environmental and genetic factors, but on those that have been extensively researched and repeatedly debunked, like vaccines.
There is no real evidence tying Tylenol in pregnancy to autism in children. One major study found a small correlation between Tylenol use and autism, but it also found that the correlation disappeared when genetics were taken into account. And acetaminophen is the one painkiller approved for use during pregnancy. Telling women not to use it means not only telling women to suffer, but encouraging them to suffer through conditions, like fever, that we know for sure can be damaging or even deadly for the fetus and the pregnant woman.
Major medical groups have overwhelmingly pushed back on Trump’s claims about Tylenol and pregnancy. But the damage has been done—and this administration seems intent on continuing to steamroll over medical advice and norms that have saved millions of lives. Yes, the administration has made a small carve-out for Tylenol use in the case of severe fever. But the vast majority of Americans are not watching White House press briefings or digging into the details. What they hear are the top lines. And here, the top line is “Don’t use Tylenol if you’re pregnant.” This is what many women will internalize, and they will behave accordingly. I report on these issues, and I can see how even I might question whether to take Tylenol during a pregnancy—not because I think the president is correct, but because “Better safe than sorry” dictates so many of the choices pregnant women make, and what if?
The problem with that, though, is not just that women will have to “tough it out” and suffer unnecessarily, although that’s not nothing. It’s that, as American College of Obstetricians and Gynecologists President Steven J. Fleischman said in a statement, “the conditions people use acetaminophen to treat during pregnancy are far more dangerous than any theoretical risks and can create severe morbidity and mortality for the pregnant person and the fetus.”
In the name of preventing autism, pregnant women may rely on the president’s advice and do serious damage to themselves or their babies.
Even if you are someone who pays a bit more attention and has a more sophisticated understanding of medical science than the president—someone who, say, realizes that vaccination schedules are about more than putting “too much liquid” into babies—pregnancy is a fraught time in which women are encouraged to be maximally cautious. It can feel as if everything is off limits, and the stakes are high: If there’s even a small risk of hurting your baby, why would you do it? But there are tiny risks in a long list of things. A glass of wine might consign your child to a lifetime of fetal alcohol syndrome. Taking the wrong kind of medicine might damage their brain. Tuna could give them mercury poisoning. Too much coffee and they’ll be stunted. A turkey sandwich could cause a miscarriage. And don’t even think about the things you can’t control, like air pollution.
Pregnant women are, in other words, primed to be exceedingly cautious, then to blame themselves if something goes wrong. Economist and writer Emily Oster has created an entire cottage industry of books and an online community dedicated to examining the research behind common medical advice and breaking down the actual odds of a particular act having a particular outcome. She has let an entire generation of pregnant women know that it’s OK to have a second cup of coffee or a sip of wine, and her books are must-reads for anyone who wants a break from the pregnancy fearmongering. And feminists have increasingly pushed back on the treatment of pregnant women as mere vessels for babies, incubators whose desires, lives, and pain need not be taken into account. For the past few years, it has felt as if, finally, pregnant women are beginning to be treated as people whose needs also matter, independent of the fetus.
This administration is going in the opposite direction: Based on little more than association and amateur theorizing, the White House is guilting and terrifying women during an exceptionally vulnerable time. It is perhaps not a coincidence that this bad medical advice, which may even make pregnancy more dangerous, comes from the same “pro-life” president who appointed judges who took abortion rights from American women by overturning Roe v. Wade—a decision that has led to horrifying mistreatment of pregnant patients and several totally preventable deaths. It turns out that applying ideology instead of science-based medicine to the complexities of pregnancy and the human body results in a lot of suffering, including death. This latest Tylenol advice seems like a continuation down this unscientific and deeply misogynistic path.
Doctors, liberals, and even some Republicans are pushing back on this new broadside against vaccines and common medications like Tylenol. Unfortunately, though, we seem headed toward a scenario in which not only are vaccines politically polarized, but so is autism. Conservatives like Trump and political chameleons like RFK Jr. are the ones who have stigmatized vaccines, much to the detriment of Americans’ health. And they’re now doing the same to autism, talking about it as though it’s the worst possible outcome for a child; the broader right seems to be fixating on autism almost as much as is RFK Jr., for whom the condition has been a decadeslong obsession. Liberals have to respond to this dismantling of public health and this scaremongering about autistic people. But they also run the risk of overcorrecting and losing our credibility by arguing that trying to find autism’s cause (or causes) and either prevent or treat it is ableist.
The truth is that novel diseases and disorders are scary, and humans have always sought explanations for them that veer solidly into the ridiculous. In past times (and still in some parts of the world), the culprit might have been identified as witchcraft, sorcery, or punishment from an angry God. When polio was surging, blame was placed on everything from cats to Italians to blueberries. One prominent doctor, who also crusaded against carbohydrates (you might call him an early MAHA adherent), claimed a correlation between sugar consumption and polio; ice cream sales dropped. We desperately and rightly want to keep bad things from happening, so we often identify what seems to be causal patterns. This is why the scientific method is so crucial: It aims to strip out what seems to be and to zero in, through repeated testing and careful control of other variables, on what actually is.
What the scientific method can’t do, though, is make moral claims about right and wrong. And that seems to be where this debate is headed. Already, many progressives are arguing against not just this administration’s profoundly unscientific advice on Tylenol and vaccines, but the very premise that autism needs a cure or prevention at all. Treating autism as a problem that needs fixing, some claim, is eugenics.
Trying to find a treatment or cure for psychological disorders like schizophrenia does not mean that people with schizophrenia lack dignity or personhood. Trying to find a cause or cure for, say, intersex conditions does not mean that people who are intersex are less worthy than those who are not. It does mean that human beings have long sought to prevent or diminish suffering, as we should. I suspect that most Americans would indeed like to prevent autism in their children if they could, and would be interested in determining the condition’s root causes—and not because they see autistic people as subhuman or in need of elimination. Progressives can fight the stigma against autism—the assumptions the public makes about autistic people, the kind of blame that gets assigned to the parents of autistic children—and press for a more open society that meets the needs of neurodivergent populations without arguing that there is no downside at all to profound autism beyond the social circumstances within which the condition exists.
Medicine is increasingly a polarized issue thanks to the right. The left shouldn’t turn research into autism into the same.
What we know about autism can help alleviate some of the stigma that the right seems intent on placing on the shoulders of mothers, and it may point to better outcomes for everyone, especially autistic people. Genetics seems to be the big driver, reinforcing the argument that autism is a normal human variation and there is no Big Pharma bogeyman at the heart of this issue. That people are having children at older ages seems to be a factor, and environmental degradation, including air pollution, may also have an effect—something it would be useful to recognize with more research, as pollution is actually a solvable problem. It’s also clear that exploding rates of autism are spurred in large part by more-expansive definitions of the condition and loosened-up diagnostic criteria. Many of the very people arguing on behalf of autistic populations would not have been diagnosed as autistic a generation ago. The criteria is now so broad that the same psychiatrist who led the diagnostic expansion now argues that although the results have been overwhelmingly positive in getting autistic people much-needed services, “we should be concerned about the increasing tendency to mislabel socially awkward behavior as autistic.”
In other words, we shouldn’t take RFK Jr.’s fearmongering at face value and adopt his seeming position that the average autistic person is highly disabled or somehow living a worse life than a neurotypical person. But we also shouldn’t assume that every autistic person is a version of Elon Musk, a socially awkward prodigy with a few charming or useful special interests.
This expanded criteria makes discussions about curing or preventing autism incredibly fraught, because the label autism spectrum disorder is now such a big tent. Autistic people have long argued that they don’t need to be cured: Their autism is not a disorder so much as an integral part of who they are. And they’re right—but given the breadth of the spectrum, they may not represent all of it. They’re right that neurodivergence is part of the human condition; human societies should create systems that enable all of us to thrive. But not all autistic people can speak out about their lives and desires; many are profoundly disabled, unable to speak, use the toilet, or ever live independently. That doesn’t make their lives any less valuable, any more than a person whose polio infection left them using a wheelchair was less valuable as a result of challenged mobility. And there is an ocean of distance between “This is a condition that causes significant suffering for some people who have it, so we should figure out what is causing it, how to treat it, and how to prevent it” and “We should get rid of autistic people.”
Liberals have long prided ourselves on holding an ideology of nuance and rejecting demagoguery. But our era of political polarization and political capture by extremists does not allow for much of that. That’s how we’ve ended up in a position of arguing about not only whether Tylenol causes autism, but whether we should even care what might. If progressives go down this route, we may wind up fomenting even deeper distrust with a public that might be skeptical of RFK Jr.’s claims about vaccines and Tylenol but will find it flat-out absurd to argue that there is no problem with 1 in 31 American children being diagnosed with autism, even if only a minority of them are living with conditions severe enough to require around-the-clock care for the rest of their lives.
This is indeed a terrifying moment for all of us who care about human health and well-being and who would like our fellow citizens to take health advice from the experts, not conspiracy-minded crackpots who have improbably stumbled their way into power. Most Americans do still vaccinate their children. Most do prefer that reputable public health entities make science-based recommendations. And that means that liberals have the upper hand here: We are the ones who want more medical research, who want a healthier society, who have a proven track record of fighting the big corporations that harm our health. The key here will be to stick to our principles and stick to the science, rather than polarizing ourselves into irrelevance in reaction to the bad actors currently in the White House.