Donald Trump (1:55)

Too many different things are going into that baby at too big. The size of this thing, when you look at it, it's like 80 different vaccines.

Jonathan Cohn (2:07)

There was a lot to unpack it all to talk about it all. We have with us today, Ashish Jha, physician, dean at the school of public health at Brown University. Somebody who is not just. Doesn't just possess a vast trove of medical knowledge, but sort of exudes common sense reasonableness, which is really what I think we need in this moment. Ashish, thanks for joining us here at the Bulwark.

Ashish Jha (2:33)

Hey, thanks for having me here. I'm excited to chat with you.

Jonathan Cohn (2:35)

So before we get into that, because I want to go through a lot of the claims that were made and talk about the science behind them and, and, you know, candidly and get a realistic view. But before we get to all of that, you watched this yesterday, this press conference that President Trump gave, and what did you. What did, what did you think?

Ashish Jha (2:53)

I thought it was awful. I thought it was possibly the worst public health conference coming out of the White House I have ever seen it made. It was worse than the bleach presser from the pandemic times.

Donald Trump (3:07)

And then I see the disinfectant where it knocks it out in a minute, one minute. And is there a way we can do something like that by injection, inside or, or almost a cleaning?

Ashish Jha (3:22)

The President said a whole lot of things, including gave very, very direct medical advice that were, my view, largely not true. But what he also did, in my view, it's hard to see it any other way, is he blamed millions of women for their children developing autism and made it much, much harder for pregnant women moving forward to be able to manage their pregnancies by telling them they can't take Tylenol. Like, this is not how we do this in this country. We should not have the President making these proclamations. I'm happy to get into the evidence and science and data behind all of this, but it was terrible. And I cannot imagine if you're a pregnant woman who saw that and went to bed last night, what you must be thinking about how you're going to manage the rest of your pregnancy. So I was very upset about it. Then, of course, he went off, as you said, on these tangents, about, about vaccines, again, without any basis for things. There is a reason why medical advice comes from medical experts and why we try to shield presidents and political appointees from having to give medical advice. And we saw that on full display yesterday.

Jonathan Cohn (4:32)

That was what sort of struck me was. I mean, I was trying to even think of a time when I'd seen that for, I mean, you know, you see a major medical announcement to see, you expect maybe to see the head of this FDA or the cdc, depending on what the issue is. You know, occasionally a president will get up to say something. But, I mean, this was so unusual, I guess, except, of course, I immediately. I'm sure you did, too. I flashback to 2020, when we had the bleach moments, and the president just Getting up there and just sort of riffing.

Donald Trump (5:02)

Supposing we hit the body with a tremendous. Whether it's ultraviolet or just very powerful light. And I think you said that has him in check, but you're going to test it.

Jonathan Cohn (5:13)

He made a couple statements. Here's just one of them he made about Tylenol. He said, I just want to say, like it is, don't take Tylenol, don't take it. Fight like hell not to take it.

Donald Trump (5:25)

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

Jonathan Cohn (5:34)

The premise for this, what he was saying, was that we've now, we now have research linking Tylenol to autism and let's put aside Trump and being Trump and all that. I'm sure lots of people hear that and are like, wait a minute, what's going on here? I took Tylenol, or I might want to take. What's the status of the science here? What does the science actually tell us about acetaminophen and autism?

Ashish Jha (6:02)

Yeah, great. So let's get down to the data. This is a question that's been kind of active on people's minds for a long time. We've looked at a lot of different things that pregnant women take during pregnancy, and it's linked to autism because we're trying to understand what causes autism and to what extent medicines. There are things we know, for instance, we know, actually it's a kind of random side point, but we know that, like, for instance, the dad's age is a huge predictor of autism. Older men tend to have much higher rates and there's a little bit of evidence about older age for women, too. On Tylenol. There's been a lot of, like, small studies, not super well done studies that have been suggestive and. And so a lot of us have been curious about this issue and, and wondered to what extent this might contribute. There were, in my mind, the best study to date got published in JAMA, one of the premier medical journals, last year, 2024, from Sweden, Swedish study.

Jonathan Cohn (6:56)

Right. I've heard a lot about you.

Ashish Jha (6:57)

Two and a half million kids followed essentially, for the study, looked at 25 years of data and it actually found something very interesting. And it's worth taking 30 seconds to explain it because this captures the essence of the data. They initially looked at kids of moms who took Tylenol versus kids of moms who didn't and found a small effect, like a slightly higher rate of Autism. But then they did something really clever, which was the sibling study, which is they said, what if you look at a mom, same mom, and she took Tylenol for some of her pregnancies but not others, is there a difference in autism? And found no difference. To me, that is incredibly elegant. And let me explain why. Moms who take Tylenol tend to be different than moms who don't. Right. They have different partners. And so you. So the problem is, imagine a woman who has migraines, chronic migraines, which is a neurologic thing, and for that she ends up taking Tylenol. That woman might have an increased risk of her child having autism because she took Tylenol, or it might be because she has migraines, or it might be something else altogether. And it's really hard to sort this stuff out. That's the unmeasured confounding we worry about. But if you look at the same mom and she took Tylenol for some of her pregnancies but not others, now you've controlled the fact that she has migraines, you've controlled, most likely who the dad was, and you've controlled a bunch of things. And now you can look at much more clearly just the Tylenol. So that's why sibling studies methodologically are so interesting. I know it's a little nerdy, but very important. What you see in the Swedish study is when you look at the sibling study, the effect completely goes away. There's a Danish study, also pretty large, that essentially had the same effect. And then when they looked at within family effects, the effects go away. So in my view, if you look at the breadth of the data, there's a little bit of stuff that's still floating out there that is possible. But the best data to date so far suggests that it is not an association and certainly nothing that rises to the sector of HHS declaring this as a cause, let alone the president of the United States telling people not to take talent.

Jonathan Cohn (9:08)

So I actually want to put a pin in that one point because I want to come back to that in a second. But I want to ask you first, there was another study that was cited and was put out in the press materials as well, a recent study from August that Trump was citing and Trump administration officials were citing, and they said this new study, in fact, I saw someone on Fox News talking about this. This new study is better than all the other studies it looked at. It looked at the data and it found an association between Tylenol or CETAMINOPHEN and autism. Can you talk about this one study? Because it's gotten a lot of attention.

Ashish Jha (9:45)

Yeah. And people talk about it as a conglomeration of 46 studies. They took all the studies. This is a paper by Andre Baccarelli, who's at Harvard, and they took 46 studies. So let's actually talk about this. They looked at Tylenol and multiple different outcomes. Actually, there were only seven studies that looked at Tylenol and autism. So when people keep saying 46, it's not 46 on autism, it's on ADHD, it's on other neurodegenerative diseases. Those are all important issues. But we're talking about autism here. So let's say focus on autism. There are only seven studies that this paper tries to pull together. They include the Swedish study. And this is not a new study with a new research question. They're looking at all the data that's been previously published and putting it together. And as I have said, there are some older studies that are suggestive, but the best study to date is the Swedish study. And by the way, it's not just my view like that is the widespread. I mean, it was published in the premier medical journal jama. And, uh, and so the.

Donald Trump (10:51)

The.

Ashish Jha (10:52)

This is not a new study that came out in August. It's much more focused on ADHD than on autism. It only looks at seven studies. And across those seven studies, some of them find an association, some of them don't, and the best studies don't. So all it is is a rehashing of the existing medical literature. Essentially, it's saying what I just told you, which is that there are some studies out there, but the best studies suggest that there is not an association.

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Ashish Jha (12:01)

Uh.

Chris Counahan (12:01)

Oh, Ron, are you calling From a ladder.

Jonathan Cohn (12:04)

Well, I was. I wanted to ask Chris what I need to do to get my gutters ready to have leaffilter installed.

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So I didn't need to get on this ladder.

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Jonathan Cohn (12:33)

Thank goodness.

Ashish Jha (12:34)

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Jonathan Cohn (12:46)

So let me ask you about this. I mean, I was trying to think back to when my kids were born. I'm neurotic by nature, right? And I remember, you know, you're worried about everything, especially when your first child is born, because you haven't been through this before. And I can imagine somebody hearing this and even logically saying, okay, well, I get it. The science pretty strongly suggest there's no correlation. But what if there is? And why? You know, and you know, Trump is saying, you know, tough it out. You know, deal with the fever. Don't worry, but, you know, you're much better off. Why is that bad advice? Why shouldn't you tough it out? Why shouldn't we just be super cautious in that way?

Ashish Jha (13:23)

That's a great question. And by the way, pregnant women feel this all the time. Like, I know I'm. I'm not an obstetrician, but I have obstetrician friends, and they talk all the time about how pregnant women come into their office and say, okay, I'm stopping everything. I'm not taking anything. I'm not gonna do anything. And some of those is good advice. You should avoid alcohol during pregnancy. But one of the things that obstetricians tell patients is that, look, if you're worried about the health of the baby and worried about the health of the mother, uncontrolled disease is also harmful to the baby. So if you have diabetes and you don't control it because you don't want to take diabetes medicine, poorly controlled diabetes is not only bad for the mom, it's actually really bad for the baby. If you have a really high fever and you don't get that fever down, it's not about Toughing it out like that's bad for the baby. The baby is not. It's not good for the baby to have the mom have a super high fever. If a mom is having severe pain, that releases a lot of stress hormones. That's not great for the baby. And you want to get that pain under control. So every single thing is a trade off. And you want to do the trade off of what? And if you only care about the baby, forget about the mom for a second. You want to ask the question, what's good for the baby? What's harmful for the baby and the underlying disease and not treating it can be harmful. And you want to weigh that against the risks of treating it with a medicine. And all the evidence so far suggests Tylenol is exceedingly safe in pregnancy. There are these few suggestive studies we've discussed. So there is a real cost of telling moms, don't take Tylenol and tough it out, because there is real potential danger to the baby. And one other point, sometimes it's tough to rough, you know, sort of tough it out. And so moms might reach for a different medicine like ibuprofen, which is much more harmful. They're the average, worse, uncontrovertibly clear. Ibuprofen, the second or third trimester of pregnancy is that. And so you're gonna lead to a bunch of people taking that. If they are having chronic and severe pain, they may say, okay, maybe I'll take an opioid instead. That has its own complexities. So you want to think through this stuff. We do this all the time in clinical practice. You think through your advice and say, if I'm going to ask somebody not to do X, what are they going to do? None of that thoughtfulness went into what happened yesterday at the White House. It was this blanket, unfounded recommendation that will have real costs for people where.

Jonathan Cohn (15:44)

Just to take a step back on the research, what we know about autism, I mean, there was part of this. They say they want to do more research on it. I mean, I assume no more research is fine. What should that research look like? Where are we? I mean, just broadly speaking, what we.

Ashish Jha (15:56)

Know is two or three things. I mean, one is there is no question about it, that a lot of the rise in autism has been because of a broadening of the diagnostic criteria. Let me explain why that has happened. You know, we've now included Asperger's. We've included other things that we didn't use to count. So that has driven the numbers also. And I Think this is a good thing. Society is a lot more accommodating towards children with autism. Schools provide additional services for kids with autism. That's good. We should do that. I mean, we should take care of our kids. And what that does is if a kid is struggling and may have even mild symptoms, doctors are more likely to give that kid the diagnosis because they know it'll open up a whole bunch of services for that child. So there's a lot of that that has actually driven the rise. Okay. We also think there's some other things. Increasing paternal age, increasing maternal age, those have been driving it. What we need right now is better, higher quality studies on. On prenatal exposures. I think acetaminophen should be on the list of things we're studying. The data just isn't there yet. I think there are a lot of. Of environmental toxins and pollutants that may be contributing. We should be studying those things. And then obviously, we need a whole bunch of new studies on treatments beyond the one drug that was mentioned yesterday at the White House, which may be useful for a very small subset of kids. So there is a very large research agenda here. Jonathan. What I'm worried about is much of that is going to get derailed because now we're going to put all of our attention on Tylenol, and it's going to take us years to unwind. What we saw yesterday at the White.

Jonathan Cohn (17:28)

House in terms of things that have been derailed, as we were saying at the top, after President Trump was done talking about Tylenol, he started to talk more about vaccines and autism. I'll read just one quote he had. He said. He said, you know, he's worried that we load up children with vaccines. They pop so much into babies. It's a disgrace.

Donald Trump (17:48)

They pump so much stuff into those beautiful little babies. It's a disgrace. I don't see it. I don't. I think it has. I think it's very bad.

Jonathan Cohn (17:57)

He said, you know, suggested that this was. We need to ratchet back, revisit what kids are getting for vaccines, space them out more. Do we load up our kids with too many vaccines? Is there a reason to worry about the number of vaccines our kids are getting?

Ashish Jha (18:14)

Yeah. Well, whether we should worry or not should be driven by evidence and data and not some theoretical. I feel like it's too many or I feel like it's not enough. Let's talk a little bit about some basic immunology. Children are exposed to hundreds and hundreds of antigens, viruses, bacteria in. In the early weeks and months of their lives. The idea that a child's immune system can't handle four vaccines at once is just nonsense. Of course it can. That that kind of exposure of the immune system is more than capable of doing. If you look at how much, how many vaccines we give in the first year of life compared to, let's say, the big five European countries, uk, Germany, France, Italy, Spain, those are the five largest. It's about the same. Slight differences, but about the same. So this is not some American phenomenon that we're loading them up. Third is, you'd want to look at, like, what are the effects of this? Well, the effects are childhood mortality has declined substantially because from these diseases, children are living longer, healthier, better lives. And so my take is these things have been widely studied. I'm not seeing much in the way of downsides. We're seeing clear upsides. And basic immunology tells you that children can handle this. That's why I got all my kids vaccinated on schedule. I was never worried about this, and I think most parents should be worried about this.

Jonathan Cohn (19:34)

He mentioned one vaccine in particular, one I know that has come up. It came up last week in the meetings of the Advisory committee on vaccines. It's likely to come up again. Which is the vaccine for hepatitis B. We now, it's not recommended be given to newborns, I think within 24 hours of birth. Ideally there was discussion, and again, I think we could see this happen in the near future of moving that first dose back to a month, maybe even longer. Donald Trump was talking about years.

Donald Trump (20:04)

Even hepatitis B is sexually transmitted. There's no reason to give a baby that's almost just born hepatitis B. So I would say wait till the baby is 12 years old.

Jonathan Cohn (20:21)

I think people do. There's a little confusion out there. People say, why are we giving all these babies hepatitis B? Isn't that something you get from needles or sexual transmission? Why are we even doing this? Can you explain what is the rationale for giving the hep B shot right away?

Ashish Jha (20:37)

Yeah. So one of the major sources of transmission for hep B around the world, including in the United States, is maternal to child transmission. A mom might be infected and passes it on to the baby at the time of birth. What we know is if you get hep B at the time of birth, your chances of developing chronic liver disease, liver failure, liver cancer are pretty high. And so we used to see a lot of chronic liver disease and liver cancer from hep B. We have essentially eliminated them by giving babies hep B vaccines. Now we do it at birth. Bunch of the European countries do it at one month. Clinically, that's fine. Like if you wanted to wait to a month, it's fine because you're still going to be able to. You're still in that window where you can prevent a maternal child transmission because that vaccine will still have a high degree of efficacy against a maternal child transmission, even out to a month. Once you get beyond a month or two, you've lost that window. The reason we do it at birth is because it's super convenient. The baby's there. Most women have kids in the hospital. The baby's there. That's why my kids all got hep B vaccines at birth, because they were there. It was easy. You know, asking the mom to come back a month later when there's no clear advantage to waiting a month is unnecessary. And you know, we can have a conversation. But why do the Europeans do it a month from now? And as I said, I'm not going to lose sleep. If we move to a month from now, it just will mean that it'll be a little less convenient and some kids won't get it, who could get it. And that will bother me. But medically it's fine. But this is not just a sexually transmitted disease. Again, a major source of transmission is from the mom. And it's an exquisitely safe vaccine. We have given it to literally tens of millions of babies around the world. And the side effects are like pretty mild. And yeah, occasionally there's a little fever. We know that with almost any vaccine it's a no brainer. To me, the risk benefit here is very one sided.

Jonathan Cohn (22:29)

You know, watching this press conference, I was thinking back to 2020 and all the times we saw Donald Trump up there riffing on medical science. And one, one feature of those appearances was we often, there's often somebody there from NIH or FDA or cdc, somebody who might have been a political appointee, might have been a career scientist, who you got the impression was pushing back or at least trying to keep the guardrails on in some way, shape or form. You've been in that position. You worked with the White House, in the White House. You've been there. I feel like as an observer, I'm not seeing that now. I'm not seeing the FDA head, the CDC head. I'm not seeing people put their push back against him. I see a bunch of people around him who are reinforcing his sort of worst tendencies. But you've been there. What do you see?

Ashish Jha (23:15)

Yeah, I have been there. And as I was watching this, I was thinking about my own experiences. And let me tell you a little bit of what we did in the White House before the President went to the Roosevelt Room to talk about whatever medical issue. First of all, I would read all over. I would read his speeches and make edits and changes that I thought were not scientifically grounded. I would go brief him. He would ask me, Joe Biden would say, can I say this? I'd say, no, Mr. President, you can't say that. He'd be like, why not? And I'd say, that's not what the evidence. He's like, okay. And. And so there was a lot of back and forth and a lot of the work that went into what will the President say? Because our view was that the President's words have a lot of meaning and they have a lot of power, and they should be used very thoughtfully and careful, carefully. Now, every politician will sometimes riff. We know this. And, you know, did Joe Biden occasionally say something that I wish he hadn't said? Sure. And then it was my job in the. Often there. But certainly in the time that followed to just, you know, clean it up a little bit, as we all did. That was just a normal part of. Of how we do these things. What we saw yesterday, I wonder, did anybody brief him? Did anybody tell him where what he could not like? The stuff he was saying was so beyond the pale. And it was very clear. No one who followed him even made a slight effort to pull back a bit. They just sort of praised him and doubled down. That felt very alien to me. I have not seen that. I didn't see it in 2020 under President Trump. The first time. Never was something I saw under President Biden. It was super disturbing.

Jonathan Cohn (24:52)

Yeah, it was something to watch. It was something to watch. Well, Ashish, thanks so much for being here, giving us a little perspective and some common sense. And hopefully people like you have a lot of influence in the coming months and years, I guess, because I'm not sure how much we can trust what's coming out of the White House and even other health agencies these days with the Trump administration in charge. Thanks for joining us.

Ashish Jha (25:21)

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