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'Frustrated, worried, disappointed': Georgia doctors deal with fallout of Tylenol and autism claims
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Last month, federal health agencies made claims that acetaminophen could cause neurological conditions in babies if taken during pregnancy. Medical providers and trusted organizations say there isn't enough evidence. GPB's Sofi Gratas reports.
On top of regular appointments, doctor Dawn Mandeville of Atlanta Gynecology and Obstetrics says she takes extra time to meet with her high-risk pregnant patients every week.
“And we go through each patient to make sure we know what the high-risk issue is, to make that she has gotten the referrals and the consultations and evaluations that she needs, and then to determine a delivery plan,” Mandeville said.
Mandeville takes the extra time because every pregnancy is different and requires its own attention to detail. A mom with a chronic condition like lupus or high blood pressure faces risks during childbirth that are different than those based on age or other life experiences.
Managing any kind of pregnancy means having conversations about risk. Those conversations between her and her patients, Mandeville said, rely heavily on scientific evidence that’s available on what’s safe to do during pregnancy, and what is not.
But she said it's been harder to stay focused under what feels like a deluge of health misinformation.
“We are fighting an uphill battle to convince them to say, 'Here, these are your options,'” Mandeville said. “This is what we know, this is what we don't know. But we don't make up stuff.”
On Sept. 22, the Department of Health and Human Services announced that as part of the agency’s tackling of the “autism epidemic,” it planned to greenlight a change to the language on acetaminophen bottles that warns pregnant people of an increased risk of neurological conditions, like autism and ADHD, in babies if taken during pregnancy.
It also plans to approve health insurance coverage for a medication called leucovorin as a treatment for autism spectrum disorder. Many scientists and medical providers are highly skeptical.
The proposed actions, amplified by President Donald Trump, come as HHS explores “a potential association between acetaminophen use during pregnancy and adverse neurodevelopmental outcomes.” They also build on HHS Secretary Robert F. Kennedy Jr.’s own statements calling autism “preventable" and promises that the agency will investigate how environmental factors and vaccines might contribute.
Mandeville is choosing to follow the guidance of professional organizations such as the American College of Obstetricians and Gynecologists, who say there isn’t enough scientific evidence to prove that taking medications like Tylenol will cause autism in babies.
Her practice sent a letter to patients a few days before the statement from HHS went out, assuring those who are pregnant that acetaminophen is still a safe option for them.
“We wanted to set the record straight in terms of what we think, in terms of the science that we know, in terms the experience that we as OB-GYN clinicians have,” she said.
Mandeville’s practice is also recommending the COVID vaccine during pregnancy, despite claims by Kennedy that it’s not safe either. She said her office has been “bombarded” by requests for it.
Other providers in Georgia are taking similar measures to clarify what’s safe and accessible.
Confident in the science, but worried about repercussions
At Gwinnett Pediatrics and Adolescent Medicine, pediatrician Keyana Washington says she is sticking by science.
While the new take on acetaminophen by HHS and the FDA suggest a risk to pregnant people, Washington said it’s also opened a can of worms for parents. She’s seeing more parents worried now that if they give their child medication for pain and fever relief, it could cause or worsen autism symptoms. She tells them it will not.
She also said that the idea of a proposed treatment like leucovorin for autism symptoms is problematic.
“I have to say that I do take issue with the thought of a cure for it,” Washington said. “There are many people with autism who contribute greatly to our world and our society. And that is something that is to be celebrated and treasured."
Washington’s guidance, and the position taken at her practice, is that acetaminophen is safe for kids when needed and with correct dosing.
“We are all on board with still recommending Tylenol after a discussion with your doctor,” she said.
- RELATED: One conversation at a time, pediatricians hope to prevent the spread of infectious diseases
In a statement made last month, the American Academy of Pediatrics cited various studies that show no correlation between acetaminophen and autism, ADHD or any other intellectual disability.
“I worry about a child having a 104 fever and a parent sitting at home and not treating that,” Washington said, “when in actuality, the fever itself can cause damage.”
In addition, other medications used to treat fever and pain, such as ibuprofen and aspirin, have shown adverse side effects in kids of a certain age.
Pediatrician LaKesha Davison Reddy who also practices in metro Atlanta says she is far more likely to warn her patients of those dangers.
“Not only is Tylenol safe for kids, it's one of the few that is safe for kids,” she said.
“It really feels like a problem that doesn't exist, that is being created and causing panic,” Davison said of the HHS and FDA statements on acetaminophen.
While fever is one of the most common conditions Washington gets in her waiting room, she said what has changed is that she’s spending more time with parents talking about where they get their information. She will take telehealth appointments just so she can take a look at the websites or videos that parents are pulling advice from.
Often, the claims being made by self-proclaimed experts fall outside the evidence-based information she has built her practice around.
For the patients in Tucker and Decatur that pediatrician Davison has been seeing for over a decade, what’s at risk, she said, is a dissolution of the trust that she’s built.
“Over multiple visits across years and sometimes across generations,” Davison said. “And then when people are telling them something totally different, it can really threaten that relationship.”
More questions than answers
The studies being used to support the federal government's warnings of acetaminophen use in pregnant people suggest a correlation between taking the pain-relieving drug and having a baby born with autism.
But even a lead researcher of those findings has asked that the government hold off on making sweeping conclusions.
Anastasia Kerr-German is a developmental psychologist and an assistant professor of biological psychology and neuroscience at Mercer University in Macon. She works with newborns to school-aged kids who have a variety of neurological disorders.
Kerr-German said it’s important to remember that correlation does not equal causation.
“This is something that I teach even in our introductory courses for undergrads,” she said. “And the same goes for this type of statement. If there is not enough evidence to rule out potential confounds or other factors that could impact this outcome of having a diagnosis of autism, then we simply can't, in good practice, implement a guideline.”
In the statement issued by the Food and Drug Administration on the changes, it also notes a missing causal relationship.
Kerr-German would like to see more research, especially in how external factors, such as pathogens or material pollution, can impact the brain of a developing fetus.
“I think the positive that comes from this is now we have sort of a call to action and an obligation,” Kerr-German said.
A study large and comprehensive enough to yield trustworthy results could require the collaboration of multiple research institutions across the country. Expanding research on autism is part of the Trump administration’s promises under the Make America Healthy Again agenda.
Kerr-German and other the medical providers who spoke with GPB recognize that life can be frustrating or disappointing for people who just want to know what causes autism.
But they warn that statements blaming acetaminophen, or recommending any one treatment for autism symptoms, should not be trusted blindly.
“I'm one of those parents who's like, 'Tell me the right answer. Tell me what to do,'” Kerr German said. “I don't want any gray area. But science is evolving and self-correcting. So, we kind of exist in the gray area.”
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