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Part One: Tylenol and Autism
Earlier this year, the Secretary of Health and Human Services promised to pinpoint the cause of autism by September. This week, he fulfilled that promise with remarkable timing. Surprisingly, the culprit has been revealed as Tylenol (acetaminophen). Previous research has indicated a slight correlation between the use of acetaminophen by mothers during pregnancy and neurodevelopmental disorders. This has been discussed previously on Naked Capitalism and in other articles. A recent study exploring this relationship was featured in Nature on September 22, following announcements from the president and RFK Jr.
The pain reliever acetaminophen, or paracetamol, is one of the most commonly used medications during pregnancy, with approximately half of all pregnant women worldwide relying on it. US president Donald Trump stated that he believes this medicine is “a very significant factor” in autism. Both Washington Post and Politico reported that an announcement from the Trump administration would raise concerns regarding the link between autism and acetaminophen use during pregnancy, though specifics were not yet disclosed. (lightly edited)
However, not all experts agree:
“There is no conclusive evidence linking paracetamol (acetaminophen) use in mothers to autism. The observed associations are minimal,” says James Cusack, chief executive of Autistica, a UK charity focused on autism research and advocacy. “At the heart of the matter is the human tendency to seek simple solutions to complex issues.” (emphasis added)
This topic has been widely discussed in recent days, and it is essential to note that leading studies align with James Cusack’s perspective. A prominent investigation published in JAMA in April 2024 examined acetaminophen use during pregnancy and the risk of autism, ADHD, and intellectual disability (open access):
Question. Does the use of acetaminophen during pregnancy increase the likelihood of neurodevelopmental disorders in children?
Findings. In this population-based study, analyses without sibling controls indicated marginally elevated risks for autism and attention-deficit/hyperactivity disorder (ADHD) linked to acetaminophen use. However, sibling paired analyses found no evidence of increased risk for autism (hazard ratio 0.98), ADHD (hazard ratio 0.98), or intellectual disability (hazard ratio 1.01) relative to the use of acetaminophen.
Meaning. Acetaminophen use during pregnancy did not correlate with the risk of autism, ADHD, or intellectual disability in sibling control analyses, suggesting that other observed associations might be due to confounding variables.
The study’s design and extensive sample size mitigate concerns regarding power and variability across studies. Conducted in Sweden, a nation with a rational and nearly universal healthcare system, it reduces the likelihood of biases impacting outcomes unlike in the United States:
Objective. To examine associations between acetaminophen usage in pregnancy and the risk of autism, ADHD, and intellectual disability in children.
Design, Setting, and Participants. This nationwide cohort study utilized sibling control analysis and included a population sample of 2,480,797 children born between 1995 and 2019 in Sweden (185,909 of whom were exposed during pregnancy), followed up to December 31, 2021.
Exposure. Acetaminophen usage during pregnancy was documented through antenatal and prescription records.
Conclusions and Relevance. No link between acetaminophen use during pregnancy and autism, ADHD, or intellectual disability emerged from sibling control analysis, indicating previous associations might be due to familial confounding.
The findings are straightforward, and readers interested in the specifics can review the data themselves. The study is well-structured. The minor correlations observed between acetaminophen use and neurodivergent outcomes may hold statistical significance, but their clinical importance is exceedingly small.
More critically, an overarching issue surrounding the use of acetaminophen exists. It is highly toxic, especially among over-the-counter drugs. According to the National Library of Medicine’s StatPearls:
Acetaminophen is one of the most commonly used pain relievers and antipyretics. Though generally safe at therapeutic doses, overdose can cause severe liver damage. Acetaminophen toxicity is a leading cause of liver transplants globally and the most prevalent cause of liver failure in the United States. Annually, over 56,000 emergency visits and 2,600 hospitalizations occur due to acetaminophen poisoning, resulting in 500 fatalities each year in the United States, with about half of these cases being unintentional.
Even healthcare professionals have frequently misinterpreted dosing guidelines. A poignant story highlights this risk: a man once attempted suicide by consuming several bottles of a cold medication containing acetaminophen. Although he survived the initial ordeal, he succumbed to acute liver failure two days later. It serves as a caution: acetaminophen should always be taken under medical supervision, and its use should be limited to clear indications.
Regarding the origins of autism, many factors are involved, primarily linked to genetics within a complex interplay of genetic and environmental influences. Currently, there are 958 references to “autism” in the Online Mendelian Inheritance in Man (OMIM.org). While some may be unrelated or erroneous, substantial answers regarding autism—more accurately, answers to autism—emerge from this body of work. The environment shapes the context in which autism develops, and uncovering these answers will provide a challenging endeavor, as straightforward experiments may not yield the needed insights. In contrast to current political reductions, such a multifaceted issue lacks a single explanation.
For an interesting and impactful perspective on individuals with autism, check out Jessica Wildflower’s piece from earlier this week: They’re Going After Autistic People for a Reason.
Part Two: The Trouble with Universities
The growing tension surrounding universities has been a long time coming, and the recent criticisms against de facto institutions represent only the surface of a much larger issue. Having spent most of my career in academia, witnessing the decline of universities—particularly for someone who aspires to become a Fellow of All Souls—has been profoundly disappointing. Yet, given the pervasive influence of neoliberalism, this decline seemed inevitable.
The current administration perceives universities as strongholds for “radical leftists,” a term that has been mischaracterized. While many who believe in the seven liberal arts as foundational to human knowledge lean leftward, this does not negate the presence of diverse perspectives, including conservatives. Fraternities, sororities, business, law, medical, and engineering schools often have substantial conservative representation.
However, it is also true that the predominant interest among students tends to lean towards acquiring credentials and enjoying their time at university. Even during my own college years, few students genuinely challenged themselves with demanding courses like physical chemistry or rigorous history classes, where they were tasked with engaging deeply with extensive reading lists. Despite this, many students saw little value in such endeavors, choosing to focus on their immediate ambitions, often defined by family expectations. Today, deep reading has dwindled to mere scrolling on digital devices, further detaching them from substantive learning experiences.
In Nature, Philip G. Altbach’s lengthy commentary addresses the evolution of universities and their current challenges. He articulates several valid points: universities have become overly large, increasingly diffuse, and excessively costly. Central to these issues is “credential inflation,” a phenomenon that affects institutions across the board. Many successful professionals I encountered over the last four decades began their careers immediately after high school, illustrating that the need for advanced degrees may not be as critical as often assumed.
Credential inflation has been accompanied by rampant grade inflation, as students—and their parents—are viewed as customers rather than learners. The C-minus grade of the past has morphed into the A-minus of today, a trend ubiquitous from elite institutions like Harvard to former teachers’ colleges. Financial pressures have transformed many universities into quasi-resorts, prioritizing factors like athletics over education. The student loan crisis looms as another potential factor leading to a reckoning in higher education, reaching what some describe as the Herb Stein Limit: “If something cannot go on forever, it will stop.”
Future trajectories for these institutions remain uncertain, but significant changes are undoubtedly on the horizon, and upheaval is likely.
Part Three: A New Paradigm for Universities?
Consider the New Model Institute for Technology and Engineering (NMITE) in Hereford. An insightful article in Nature describes how NMITE is revolutionizing education, focusing more on local needs than traditional academia:
Some innovative higher-education institutions are reimagining pedagogy by prioritizing local needs over research and international student recruitment.
Here’s what NMITE aims to achieve:
As one of the few higher education institutions being developed from scratch, NMITE tackles the engineering skills gap, aiming to reshape access to education in a region with one of the lowest participation rates in England. “Our approach to learning is a departure from conventional higher education wisdom,” said Norman, who advocated for the institute’s creation and became its chair in January. “We don’t prioritize international students; we focus on enhancing the skills and intellectual capacity of British youth.”
NMITE seeks to distinguish itself from research-heavy institutions by prioritizing undergraduate teaching, industry-led initiatives, and preparing graduates for immediate employment.
Currently hosting roughly 50 staff members—most of whom reside locally—the institute offers a limited selection of specialized degrees, including integrated bachelor’s and master’s degrees in engineering, which align with the UK Engineering Council’s Chartered Engineer prerequisites and accelerate completion to three years rather than the traditional four.
Graduates will be equipped to enter the engineering profession effectively. Wendell Berry has emphasized that universities should provide a major in “homecoming,” and he is correct. As the world faces impending challenges, such a vision will become increasingly vital.
Part Four: Advancements in Huntington’s Disease Treatment
Identified in 1993 through the commendable efforts of Nancy Wexler and the Hereditary Disease Foundation, the gene responsible for Huntington’s disease (HD) has seen some promising advancements. A recent study has reported that an experimental gene therapy from uniQure slowed Huntington’s disease progression by 75% over three years:
This study’s outcomes support the potential first approval of a genetic intervention for this rare neurodegenerative condition, offering hope to individuals dealing with Huntington’s disease. An effective one-time therapy could significantly delay the loss of muscle control and cognitive abilities associated with the disease, preserving vital years of personal relationships and employment.
How is this therapy administered? Huntington’s disease is autosomal dominant, meaning that inheriting one mutant gene results in the disease. In contrast, the unaffected chromosome produces normal huntingtin protein. This gene therapy works by introducing a small RNA molecule called microRNA, which when binding to the mRNA directing mutant huntingtin production, reduces the synthesis of the harmful protein. Although this isn’t a cure, it’s a promising intervention:
The treatment utilizes a benign virus to deliver the recipe for creating a short RNA sequence—microRNA—directly into cells in the brain regions affected by HD. The microRNA targets the defective huntingtin gene, impeding the synthesis of the faulty protein. Once delivered, the virus’s genetic instructions remain within the cells, enabling continuous production of the therapeutic microRNA. The discovery of microRNAs received acclaim with a Nobel Prize last year, although relevant treatments have yet to be approved.
Administering the treatment necessitates complex surgery, where clinicians precisely place a cannula through small openings in the skull, allowing infusion into the striatum, a brain region severely affected by the disease.
While this treatment may be costly, it represents a viable investment. Although it does not cure HD, early gene therapy may significantly delay the disease’s onset. MicroRNAs were initially dismissed as “junk” RNA three decades ago but have since emerged as critical players in gene regulation and treatment innovation. Such advancements rejuvenate the potential for future therapies.
Part Five: The Debate Surrounding the Hepatitis B Vaccine
Should newborns receive the Hepatitis B vaccine? The debate is ongoing, with some dissenting voices arguing against it as HepB is primarily a sexually transmitted infection. However, HepB can also be transmitted through non-sexual routes. Evidence supporting harm from the HepB vaccine is scarce, and it has proven effective thus far. I recently heard a report on Morning Edition that highlighted vital points:
Hepatitis B attacks the liver, is incurable, and can lead to severe outcomes like cancer, cirrhosis, and death. The risk of these outcomes significantly increases for those infected as infants. Approximately 25% of children who develop chronic hepatitis B will ultimately die from their condition.
Prior to the onset of universal vaccination in 1991, around 18,000 children were infected before age ten annually. Nearly half of these infections originated from maternal transmission at birth, while the others came from various sources.
The virus is present in blood, saliva, and tears, and can survive on surfaces for up to seven days, indicating potential risks for children with wounds.
Thanks to the widespread incorporation of the HepB vaccine in the U.S., infection rates have plummeted by 99% among those aged 19 and below.
In summary: Before 1991, 18,000 children annually contracted HepB before turning ten, with approximately 4,500 expected to die from HepB-related sickness. Unless evidence emerges indicating that the HepB vaccine is harmful to young infants, there’s no valid justification to delay vaccination. This notion is quite straightforward.
Part Six: The Outlook for American Science
The meeting I was en route to when I encountered the HepB vaccine discussion was a gathering for young researchers organized by a national private biomedical agency. Attendees comprised individuals planning to pursue medical or graduate education to become professionals in the medical or scientific fields.
Most of these aspiring researchers do not come from families belonging to the Professional Managerial Class (PMC), which underpins the rationale for this gathering. In light of the current political climate, one wonders how long it can continue to foster the next generation of first-generation college students in medicine or biomedical research. My role was to engage with students interested in a scientific career pathway, preferring a PhD over an MD. I spent an hour discussing their aspirations and addressing their questions—an interaction I found far too brief!
Last year’s meeting was inspiring, but this year’s was even more impressive. However, a prevailing sense of disillusionment lingered. Perceptive and dedicated to their scientific ambitions, the participants demonstrated engagement and enthusiasm. They posed thought-provoking questions and showed determination, which could drive America to greater heights in the future. Yet whether they’ll receive opportunities that reflect their potential seems doubtful. As my late grandmother often noted, “That is a sin and a shame.”
