Joe Escher (3:33)

Thanks for having me, Ari.

Ari Weitzman (3:35)

Our pleasure. So I want to just start by giving you the headline response that I received, which was this press release that came to my inbox yesterday from the Health Department of Health and Human Services, the Office of Public affairs, which said the first, the subject line was, fda responds to evidence of possible association between autism and acetaminophen or Tylenol used during pregnancy. They said the US Food and Drug Administration today initiated the process for a label change for acetaminophen, Tylenol and similar products to reflect evidence suggesting that, that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children just in general. What do you make of that? What do you make of this finding in this press release?

Joe Escher (4:24)

I think it was not founded in science, and I think that it was irresponsible, frankly, of the administration to hold a press conference really at the highest echelons of government, yet the president and the DHS secretary there, you know, to make this sort of pronouncement, which was based only on, I think, cherry picking some research and not on fully vetted science that incorporated more thorough research on the matter. So, no. Well, I think we should definitely not be cavalier about the use of medicines during pregnancy. And we're right to be cautious. We're right to exercise questions about what are the effects on the fetus and the embryo of various medications. These are important questions. We shouldn't be dismissive of that at all. But on the other hand, Tylenol and acetaminophen, they've been fairly well studied in epidemiology, and when they do find an association, it's really quite small. And the bigger and better studies find no association. So of all the things to worry about, this is probably not one to worry about. And there are other reasons to think that acetaminophen is not having an effect on autism rates. Clearly, there's no temporal associations that one would expect that would maybe be concurrent with the upward curve of autism prevalence. So acetaminophen has been around since the 50s, I believe, and it went off, it was over the counter, I think, in 1999, 1961, and it's been in use for a long time. There hasn't been this rapid increase in the use of prenatal acetaminophen in the recent decades where we see the upswing of autism. So there's no real temporal association at all. There's also no real biological plausibility. The underlying mechanisms of autism don't map to what we might see in with acetaminophen use. So there's really no reason for them to have chosen this one. I just think that they were very eager to get something on the map. They just, I feel the administration just wanted to throw some spaghetti at the wall at this point.

Ari Weitzman (6:51)

And let's actually talk a bit about the rising incidence of autism rates. That's something that, as you said, there's a difference in the usage of acetaminophen and prenatal acetaminophen and how that would map to the increase in autism. But I've also seen a lot of narratives in the media that are saying we can attribute most of, if not all of the rise in autism diagnoses to the way that we diagnose autism or ADHD or other other psychological diagnoses that we have. But in this case, just to focus on autism, I'd refer to a recent episode of Derek Thompson's wonderful podcast, his plain English podcast, where he brought on Suzanne o', Sullivan, who's a neurologist, who's written about how diagnosis can be attributed to the rise of incidence in autism. I'm just wondering how you would rebut that argument. Is it actually the case that autism as we would have defined it in the 80s has gone up and not that autism as we define it now has gone up, but that would then correspond to the entire incidence increase that we see in the diagnosis. We'll be right back after this quick break. Only Boost Mobile. Boost Mobile will give you a free year of service. Free year. When you buy a new 5G phone. New 5G phone. Enough. But I'm your hype man. When you purchase an eligible device, you get $25 off every month for 12 months with credits totaling one year of free service taxes extra for the device and service plan online only.

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Joe Escher (9:14)

Yeah, I mean, I strongly disagree with those who attribute the rapidly and very markedly dramatically increasing rates of autism to awareness and diagnostic practices. There actually is next to no hard evidence for that at all. This is purely based on speculation. There are a couple kind of cherry pick studies here and there that people might refer to to support that argument. But when you look at the breadth of the data over decades, it's really clear that there is overwhelming evidence for an increase in autism. Autism as defined by a serious neurodevelopmental disorder, not autism as defined by things that we might consider kind of awkward or quirky or kind of poor social development. And we can see that in many, many places. I mean, I could go on for half an hour about them, which you don't want to do, but I'll give you just an example from California. California has the best autism statistics of any state. We keep great data here because of our robust developmental services system that has been around really since the 60s and 70s. This system has been counting autism cases in the state. Now autism in the scope of developmental services in California is defined as a serious developmental disorder that involves three or more areas of basic lack of function, like whether that's communication or self help skills. So these people are very impaired who enter the system. There were about 3,000 such cases in the 1980s and today there are more than 220,000 such cases. Right. This is again, we're comparing apples to apples here. We're not opening up, we're not blowing up the spectrum, right. To include everybody in this particular administrative area. So yeah, 3,000 to 220,000. It's not even close. There's never been any showing that that is attributable to diagnostic shifts. In fact, when it has been studied, for example, by the UC Davis Mind Institute, they concluded that the growth cannot be explained by diagnostic factors. Now there are lots of examples like that. I can go rattle off many from not just from the US Also from other countries as well, including the uk, including Australia, Japan, et cetera. Israel is another good example. But we frankly just don't understand what's causing the increase. And I think that it's the discomfort with the lack of understanding it that leads us to kind of be in denial about it and kind of has us looking for justifications for it that aren't really there.

Ari Weitzman (12:11)

So as a person who's been involved with the research in this area for a long time, and you're talking about the findings that you know of that are convincing about the rise in this apples to apples severe profound autism diagnoses and cases going up. And as a parent of two autistic children, I think that's something that you've been invested in personally, just trying to understand what's causing this increase. Just to reiterate, what you're saying is that this increase is real. At the same time, there's a real increase in the number of cases that fit the autism diagnosis umbrella as that's expanded. But is it fair also to say that the administration is actually looking at something that is a real trend that has been generally not given a lot of focus by the scientific media or the scientific literature or just the scientific apparatus in general? And is it fair for them to be looking into questions about what could be causing this increase?

Joe Escher (13:13)

Yeah, well, this is one area where I fully agree with the administration, both President Trump and Secretary hey everybody, this.

John Law (13:22)

Is John, Executive Producer for Tangle. We hope you enjoyed this preview of our latest interview. You if you are not currently a newsletter subscriber or a premium podcast subscriber and you are enjoying this content and would like to finish it, you can go to readtangle.com and sign up for a newsletter subscription. Or you can sign up for a podcast subscription or a bundled subscription which gets you both the podcast and the newsletter and unlocks the rest of this episode as well as ad free daily podcasts, more Friday editions, Sunday editions, bonus content, interviews and so much more. Most importantly, we just want to say thank you so much for your support. We're working hard to bring you much more content and more offerings, so stay tuned. I will join you for the daily podcast on Monday. For the rest of the crew, this is John Law signing off. Have a fantastic weekend, y'.

Ari Weitzman (14:12)

All.

John Law (14:15)

Peace.

Ari Weitzman (14:19)

Our Executive Editor and founder is me, Isaac Saul and our Executive Producer is John Lawrence. Today's episode was edited and engineered by John Law. Our editorial staff is led by Managing Editor Ari Weitzman with Senior Editor Will Kbach and Associate Editors Audrey Moorhead Bailey Saul, Lindsay Knuth and Kendall White. Music for the podcast was produced by Diet75 and John Law and to learn more about Tangle and to sign up for a membership, please visit our website@readtangle.com only. Boost Mobile Boost Mobile will give you a free year of service Free year when you buy a new 5G phone new 5G phone enough, but I'm your hype man. When you purchase an eligible device, you get $25 off every month for 12 months with credits totaling one year of free service. Tax is extra for the device and 20 service plan online only.

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