Sarah Weller (2:14)

That women are not going to do what they need to do to take care of themselves, to, you know, get rid of their pain. They can take care of themselves during a pregnancy. And I worry that autism, which is already so highly stigmatized, is going to be even more stigmatized, or that parents, you know, whose children are autistic because of genetics are going to be blamed for something they did.

Elahe Izadi (2:39)

This announcement from the White House contradicts established recommendations from major medical groups, but it's all part of the Trump administration's larger focus on autism. Dan Dimon is a White House reporter for the Post. He says Trump went even beyond the guidance of his own health experts on Monday when he attacked childhood vaccines. And when they're given, I think what.

Dan Diamond (3:01)

Took the breath away from even some Republicans I talked to was the president's attack on vaccines, that he was just up there riffing about his beliefs on how many vaccines kids should get.

Donald Trump (3:12)

And 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.

Dan Diamond (3:21)

Very bad looting, debunked theories about the connection between vaccines and autism and the fact that that was all happening in the same announcement from the White House. I don't think anyone has ever seen anything like that from the White House or a president before.

Elahe Izadi (3:40)

From the newsroom of the Washington Post, this is Post Reports.

Dan Diamond (3:44)

Eli.

Elahe Izadi (3:44)

I'm Elahe izadi. It's Tuesday, September 23rd. Today, I speak with Dan about the science behind this new guidance on Tylenol and another announcement Trump made on Monday about a possible autism treatment, a drug called leucovorin. We'll also go through where this leaves pregnant patients, children with autism, and what could come next for childhood vaccines. Well, Dan, thank you so much for joining me today.

Dan Diamond (4:19)

Thanks for having me back on Post Reports.

Elahe Izadi (4:21)

We're happy to have you here, Dan. There is all this news coming out around public health and medication and coming out of this administration. And you are the person I want to talk to about this. Let's begin with the drug that the Trump administration is now cautioning pregnant women against using early, early on in their pregnancy. And it's one that, I don't know, I feel like most people have used at least at some point in their lives. What is Tylenol?

Dan Diamond (4:50)

It is a common pain reliever. It's probably the most common drug that I use as someone who struggles with various aches and pains. My wife was pregnant this year. She used it for her discomfort because there aren't a lot of drugs you can take while pregnant. We've given it to my toddler and infant son to help relieve their fevers. It is a go to across the country. It's over the counter, it's easy to access. But it is a drug that has come in for scrutiny in the past and there have been efforts to link it to autism before that have been ineffective.

Elahe Izadi (5:20)

And Tylenol's the name brand for it, right?

Dan Diamond (5:23)

That's right. Acetaminophen is the key ingredient that is used in Tylenol and in other drugs. And we call it Tylenol in the States, but there are countries abroad that call it a different name.

Elahe Izadi (5:34)

Okay, and what exactly did the Trump administration do on Monday with regards to Tylenol?

Dan Diamond (5:41)

The Trump administration took several steps to highlight what they say is the risk of taking Tylenol while pregnant and the possible implications for autism. Specifically, federal officials issued new warnings about taking Tylenol while pregnant, but also caveated that they couldn't prove it necessarily and that this is a matter to discuss with your physician.

Elahe Izadi (6:03)

And Dan, why is Tylenol being singled out in this way? Where is this coming from?

Dan Diamond (6:09)

I think it's first worth noting that there have been studies for years trying to investigate a link between Tylenol and autism. And those studies had not found a connection. There was a major study in Sweden recently that found no link. And then a study that came out about a month ago led by researchers at Mount Sinai, some folks at Harvard, other institutions signed on, went back through prior research and said that they were able to find a connection, specifically that there was a link between Tylenol and autism and adhd. This caught fire among some of the President's base people in the Make America Healthy Again movements. Robert F. Kennedy Jr. The nation's health secretary, Laura Loomer, a well known MAGA activist, tweeted about it a few weeks ago. And then the Wall Street Journal had a story on the possibility that Tylenol would be part of a an ongoing effort by the administration to understand causes of autism. And I think all of that combined just helped this idea build steam. And in some ways it was self reinforcing. Once the theory that Tylenol was linked to autism was out there, some people in the Trump administration grew more attached to it.

Elahe Izadi (7:22)

Dan, you mentioned the study from researchers at Mount Sinai and Harvard looking at Tylenol and autism. Can you tell me a little bit more about what this study found?

Dan Diamond (7:32)

The study that the Trump administration is resting its Tylenol case on is essentially a review of past studies. And these studies did not necessarily find a cause of autism linked to Tylenol, more an association which is very different than the recommendations that we might see from the federal government on other conditions. The Food and Drug Administration in their letter announcing this, said, we can't prove that Tylenol is causing this. This is an association that has been picked up. It is not causal. The possibility that some researchers have raised is it's not the Tylenol that is causing autism in these children. It's the high fevers that the women had during pregnancy, and they were taking Tylenol to treat those fevers. So more study is necessary, researchers have said. Even some of the researchers who worked on this broader effort. The idea that just a review of past studies would be enough to prompt a presidential press conference, new guidance from the Food and Drug Administration. There is nothing like this before that I've seen that measures up to this.

Elahe Izadi (8:47)

Has the maker of Tylenol said anything about this?

Dan Diamond (8:50)

Yes. They've consistently pointed to research that their drug doesn't cause autism. There's a new message on their website. They have said, quote, the facts, that over a decade of rigorous research endorsed by leading medical professionals and global health regulators confirms there is no credible evidence linking acetaminophen to autism. And then behind the scenes, they've been lobbying pretty aggressively in D.C. in the past few weeks. There's try to stave off this outcome. Obviously, that didn't work for them.

Elahe Izadi (9:20)

One thing that President Donald Trump said on Monday in this White House event is that there's no downside to doing this.

Donald Trump (9:28)

There's no downside. Don't take it. You'll be uncomfortable. It won't be as easy, maybe, but don't take it.

Elahe Izadi (9:37)

Dan, is that true? Like, what do medical experts say about that, about not taking Tylenol if you're pregnant?

Dan Diamond (9:44)

I've talked to researchers who have essentially said the opposite of what the President said about no downside. One researcher pointed out to me that high fever during pregnancy is highly correlated to neurological disorders, neural tube disorders, specifically, such as autism. So if you take away Tylenol, that means pregnant women have fewer resources to reduce their fevers. And as she said to me, so guess what will happen that could lead to more cases of autism? The American College of Obstetricians and Gynecologists called the move irresponsible. Here's a statement by that group's president, Stephen J. Fleischman. 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. So to translate that, what the head of the major group for obgyns is saying, Tylenol is safer and better than not taking Tylenol if you are a pregnant woman who really needs it.

Elahe Izadi (10:49)

Hmm. So sorry, Dan, just so I'm clear, if you are pregnant and you have a high fever or a fever or an infection or pain, is Tylenol typically the medication that doctors recommend for you to take?

Dan Diamond (11:05)

Yeah. I mean, it's been the go to. There are some other over the counter pain medications that are seen as riskier or even as total stay aways drugs like Aleve or ibuprofen, maybe if you're pregnant, you can take that with guidance from a physician and only at certain points in your pregnancy, in the first trimester or third trimester, depending on the drug and what your doctor tells you. Pregnant women are generally advised to stay away from drugs like aspirin during pregnancy because it can harm the fetus. So Tylenol has been seen as really one of the only drugs. And again, we just experienced this in my house. My wife was pregnant this year. One of the only drugs that you can take when you have fever, discomfort, various pains while pregnant.

Elahe Izadi (11:46)

And Dan, I have to say, like I know there just from people in my life, there are some underlying medical conditions that would prevent someone from taking a pain medication or fever reduction medication other than Tylenol. Like if you're on blood thinners, for instance. Like I know people in my life on blood thinners and they have to take Tylenol. Medications are not options for them. And I'm also thinking about, you know, like you said your wife, like this was an issue in your household and how difficult it already is to be pregnant and how, you know, oftentimes or sometimes you're already on edge trying to do the best you can by your own health and your child's health and then throwing this into the mix. I mean, Trump also said, you know, if you can't tough it out, you know, go for it, but it's kind of on you. Like, where did that messaging leave you hearing that?

Dan Diamond (12:39)

I think this is just going to add to confusion during pregnancy. The FDA's own letter here was mixed. If you read it, the top of the letter is a warning from the Trump appointed FDA commissioner who says there's a considerable body of evidence about potential risks associated with acetaminophen. And then the bottom of the letter says there's no causal relationship established yet. You should look at using acetaminophen because the alternatives to Tylenol have, quote, well documented adverse impacts. So it's just muddying what was already a very confusing and sometimes scary time, I think, for pregnant women and other people who have depended on Tylenol for pain relief.

Elahe Izadi (13:24)

Dan, you know, we heard at the very beginning of this episode Sarah Weller, she's pregnant. She said that she'll still occasionally use Tylenol if she feels like she needs it. But if you're listening to this and you're pregnant and you're now confused and worried. What would you recommend doing?

Dan Diamond (13:42)

Well, I'm not a doctor, so I think they should talk to one. Talk to your physician who will know the individual case and will be able to parse the medical literature far better than the president of the United States or even a Washington Post reporter.

Elahe Izadi (13:59)

After the break, we talk about this second drug, this possible new treatment for autism and the administration's bigger autism agenda. We'll be right back. Dan, you were talking about this rush to make this announcement and zero in on Tylenol in a way that feels very unprecedented. Why was there such a rush to do this and do it in this manner? What has your reporting and your colleagues reporting revealed about that?

Dan Diamond (14:39)

I think the place to start is not this week, not a few months ago, but years and years ago. President Donald Trump, then real estate developer Donald Trump got very interested in the idea that autism was linked to vaccines or that there might be other environmental causes of autism. And he's spoken about having a personal connection here, knowing people in his life whose children he has said were affected by vaccines became autistic. He connected, according to the president about two decades ago with Robert F. Kennedy, Jr. Who had become a leading anti vaccine activist and had been raising questions about why autism rates were going up in the United States. And for a long time, President Trump in his first administration, now in his second, has wanted to delve into this question, why are more kids autistic? Is there a way to control for that? Is there a way to treat that? Early this year, the president tasked his health team with coming up with answers on autism, new answers. And originally I think this was supposed to be a multi year event. They were going to start the research in September, some administration officials told me. And then Robert F. Kennedy, Jr. The nation's health secretary, said in a televised cabinet meeting, we're going to have answers in September. By September, we will know what has caused the autism epidemic and we'll be able to eliminate those exposures, which is just an astoundingly short amount of time to uncover new details about a condition that has been with us for decades. So I think there's been a rush to try and prove by September, the month that we are now in, that the Trump administration has new answers, new data on the causes and potential treatment for autism. And Tylenol just kind of came along potentially at the right time.

Elahe Izadi (16:31)

I think at this point it's actually helpful to just step back and ask you, what is autism?

Dan Diamond (16:37)

Autism is a neurodevelopmental condition, where some people have minor difficulties in understanding speech, language, communicating. Other people have more severe autism, where they can't function independently. They need help to move around the house, use the restroom. It is truly a spectrum, which is how it is referred to. And the rate of autism in American children has increased. But some of that might just be we know how to recognize it better. There has been an expansion in how to diagnose autism. But even researchers who are of the belief that autism is primarily genetic and that the rise is driven by diagnoses acknowledge that there might be environmental factors, too, that there might be something that has led to more American children being diagnosed with autism. And they have generally supported work not just by the Trump administration, but by prior administrations to research those causes.

Elahe Izadi (17:36)

Dan, I want to ask you more about this other medication, Leucovorin, that the administration announced it would take some action on as a potential autism treatment. What exactly did they say?

Dan Diamond (17:49)

They homed in on a lesser known drug called leucovorin, which is a form of vitamin B9, and it is often prescribed to cancer patients, patients who may need it to counteract the side effects of drugs that they're taking and also possibly dealing with vitamin B9 deficiency. There have been some recent studies, small studies, that show that leucovorin has real promise in helping autistic children who have language difficulties either speaking or understanding it. And our colleague Arianna Cha, one of the health reporters at the Washington Post, who's been covering the Trump effort on autism, had a great story this week on the fragile hope there. The belief and the desire that this could really help, but also the acknowledgement that we're very, very early, and the fact that the Trump administration embraced it so quickly shows how eager they were to trumpet something that is not proven.

Elahe Izadi (18:48)

Yeah. What kind of evidence does there already exist that indicates it could help?

Dan Diamond (18:53)

There have been some small studies that have shown leucovorin can boost cognition, it can improve communication. Ariana has spoken with families who swear by it and say that this drug has made all the difference. But again, these are very small studies. Scott Gottlieb, who led the Food and Drug Administration and the first Trump administration, has said this is promising, but it's way too early. We need to do bigger studies before we can decide that leucovorin is a treatment for everyone.

Elahe Izadi (19:25)

Dan, as we're talking about these medications, like, really, when we step back, this conversation on autism itself and the way it's being framed by this administration, I'm just wondering how advocates within the autism community feel about how this is all being discussed, how this is being framed, and if there's any sort of tension there in discussing autism in this way.

Dan Diamond (19:50)

It'S mixed in the autism community based on people I've talked to, people who've spoken to my colleagues. On the one hand, there is excitement and hope that the power of the government is being pushed on this area where many parents, researchers, others have long wanted it. At the same time, autism research in the past was more carefully done, more openly discussed, and that's the kind of approach that autism leaders want to see, not something that is essentially a quick fix overnight that could backfire with misleading belief in drugs and that may or may not be linked to autism after all. And I also think there are many advocates in the autistic community who are really nervous about what this Health Secretary Robert F. Kennedy, Jr. Is doing and saying with relation to autism. He has been an advocate for more help for that community, and he's raised a number of questions about causes of autism. But he's often done it by drawing on false claims or things that have been debunked. So to have that person leading this new effort and investigation, it's hard for many people to trust what Robert F. Kennedy, Jr. Is saying when he stands behind a government podium. Secretary Kennedy, when he spoke about autistic people earlier this year, offended a lot of them, talking about how they were unable to function, unable to hold jobs, have normal lives. There are many autistic people who function in society perfectly well and say that they don't need to be fixed because there's nothing wrong with them. So there really is a spectrum when it comes to autism. Many people who live with the condition point to their ability to understand the world as something that they would never want changed. There are other people, especially parents of severely autistic children, who have desperately wanted answers and fixes, and those are the ones who are most eagerly anticipating help.

Elahe Izadi (21:54)

Dan, one thing I don't want to. I don't want to leave without talking to you about our vaccines, because that feels like it's been the focal point for many months now within this administration. And this came up in this announcement on Monday, like the president spoke at length about vaccines and on the vaccines.

Donald Trump (22:16)

It would be good. Instead of one visit where they pump the baby, load it up with stuff, you do it over a period of four times or five times.

Elahe Izadi (22:26)

When you were listening to him talk about the childhood vaccine schedule, like, what stood out to you?

Dan Diamond (22:33)

Everything. Public health. People were already on edge and nervous about this news conference because of the unproven claims about Tylenol and Leucovorin. Everyone that I've talked to has been blown away that President Trump veered into his pet theories on vaccines. And I'm including people who were in the first Trump administration, some people who are in his current administration or Republicans on Capitol Hill, they don't want the president spouting off about vaccines based on his gut because the implications are so significant. We saw in the first administration when President Trump stood at a White House podium and talked about drugs like Ivermectin as a potential coronavirus treatment. There were Americans who went out and tried to use ivermectin to treat their coronavirus to no effect or ill effect. So the president raising questions about common childhood vaccines, telling parents to start spacing out when their kids get the vaccines based solely on his own beliefs. It's mind boggling and it's something that many Americans don't agree with the president on when it comes to questioning vaccines. Even Republicans who are Trump supporters do not believe that the MMR vaccine, the mumps, measles and rubella vaccine that is commonly administered. They think that that is important, that it's life saving, that people should get it. So to have the president talk about this, it's part of a broader initiative that he's overseeing to change Americans relationship with vaccines.

Elahe Izadi (24:06)

Dan, why does it matter that the president is saying things that are out of step with what even those experts that he has appointed and have within his own administration are ready to say?

Dan Diamond (24:17)

The president is arguably the most famous person in the world, certainly in America. He has millions of dedicated followers, people who believe what he he says as the truth. And even if the CDC or fda, these acronym agencies, are saying something different, the president standing behind a podium in a widely viewed press conference that is getting aggregated, that is going to have some impact. And whether it's saying don't take Tylenol or wait on vaccines, there are Americans who are going to listen to the president and not to their doctor.

Elahe Izadi (24:48)

Dan, as you keep covering the Trump administration's approach to autism, what will you be paying attention to next?

Dan Diamond (24:56)

Well, the Trump administration's initiatives on autism aren't over. They have been working on this sweeping report by the National Institutes of Health that was originally seen as the centerpiece of their autism effort that was going to investigate dozens of different hypotheses about autism. Now everything I've heard is that that report is serious, that there are career experts weighing in on it that has gone through the normal process, not like the rush process we just saw. So I am curious what that is going to deliver. And then on vaccines, it's sort of like a mask off moment with the President where it has been known for years that he has questions about vaccines. I remember during the coronavirus pandemic talking to White House and other administration officials who said that the irony of President Trump overseeing Operation Warp Speed, overseeing this coronavirus vaccine effort, that we had the most anti vax president in history overseeing the biggest vaccine effort in history. So I think now we have Trump kind of unfiltered in his second term being able to push his deputies and speak more plainly about what he believes.

Elahe Izadi (26:06)

Dan, thanks so much for joining and explaining all this. I really appreciate it.

Dan Diamond (26:09)

Thanks for having me.

Elahe Izadi (26:15)

Dan diamond is a White House reporter for the Post. That's it for Post Reports. Thanks for listening. If you're looking for the latest updates on the big news of the day, check out our morning News briefing. The Seven. They bring you the seven stories you need to know about every Weekday morning by 7am you can listen to it wherever you listen to podcasts. Today's episode was produced by Rennie Sfornofsky with help from Lucas Trevor. It was mixed by Sam Behr and edited by Ilana Gordon. Thanks to Sabrina Mulley, Akilah Johnson and Lynn Bowie. I'm Elahei Izadi. We'll be back tomorrow with more stories from the Washington Post.

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