Last year, President Donald Trump told pregnant women not to take Tylenol as he promoted unproven ties between the fever reducer and autism and touted an old generic drug as a treatment for the developmental condition.
For nearly three months after that, new research found, Tylenol orders for pregnant women showing up in emergency rooms dropped and prescriptions of the generic drug for children rose. This happened despite sharp criticism of the president's
message from doctor groups saying that the drug, leucovorin, shouldn’t be broadly used for autism and Tylenol is safe during pregnancy.
“It just shows that in our country right now, health care has been politicized in a way that political messages are driving and impacting care — and not always for good,” said Dr. Susan Sirota, a pediatrician in Highland Park, Illinois, who wasn’t involved with the research.
Doctors, who published their work Thursday in The Lancet, looked at changes in drug ordering or prescribing compared with projected trends, or what might have happened if things had continued on the same path as before the White House briefing.
They found that orders for Tylenol – also known by the generic names acetaminophen and paracetamol – were 10% lower than predicted for pregnant emergency department patients aged 15 to 44. And outpatient prescriptions of leucovorin for children aged 5 to 17 were 71% higher than expected during the same study period, late September to early December.
Researchers observed no similar shifts in comparable medications, suggesting the changes were directly tied to the briefing.
The research had limitations. For example, it didn’t capture all Tylenol use by pregnant women because most people buy the painkiller over the counter outside of a hospital setting.
Still, it reflected how an unconventional news conference by a political leader could change not just patient behavior but prescribing as well, said co-author Dr. Michael Barnett.
In past administrations, "there are lots of layers of approval and expert consensus" before officials make big announcements about medical topics, said Barnett, who is with Brown University School of Public Health.
Pregnant women generally take Tylenol for pain or fever. Untreated fevers in pregnancy, particularly in the first trimester, increase the risk for miscarriages, preterm birth and other problems, according to the Society for Maternal-Fetal Medicine. Some studies have raised the possibility that taking Tylenol in pregnancy might be associated with a risk of autism, but many others haven’t found a connection.
Leucovorin is a derivative of folic acid used for, among other things, reducing the toxic side effects of certain chemotherapy drugs and treating a rare blood disorder. It has also been studied for a neurological condition known as cerebral folate deficiency and for a subset of autistic children, according to the American Academy of Pediatrics.
The pediatrics group doesn’t recommend routine use of the drug for autistic children. Early, small-scale studies have explored its use, “and some findings suggest potential benefit in carefully selected cases,” the group said.
But evidence remains limited, the pediatrician group said. And in late January, the European Journal of Pediatrics retracted a study evaluating leucovorin as an autism treatment.
Still, after the federal announcement about the drug, Sirota said some families in her practice asked about getting it for their autistic children. She educated them about the evidence, told them about the potential for side effects and didn't prescribe it. Potential side effects include irritability, nausea and vomiting and skin issues like dermatitis.
Sirota said it has been hard to deal with the repercussions of government pronouncements like the ones on autism.
“It feels like a pattern with our government, right? They keep building on these houses of cards that just fall down,” she said. “This politicizing of medicine just in general, and moving away from science, has been so challenging."
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