From The New York Times, I'm Michael Barbaro.
This is The Daily.
During an extraordinary televised news conference on Monday night, President Trump repeatedly gave out unproven medical advice that linked autism to Tylenol and childhood vaccines.
Today my colleague, Azeem Qureshi, on what exactly Trump claimed, what decades of scientific research actually tells us and the confusion that the president has now created.
It's Tuesday, September 23rd.
Azeen, thank you for making time for us.
After a very long day, we're reaching you at 9 p.m.
I'm happy to be here.
Thanks for having me.
I think it's hard to overstate just how unusual, and at times literally jaw-dropping, this news conference that we're going to be talking about today was to watch.
And I watched it alongside you.
Yeah, I mean, I want to say that I've never seen anything like it.
The president was acting like he was a doctor, but much of what he was saying was totally untethered from what we know from medicine.
And it was potentially dangerous, according to a lot of the doctors who watched it.
So it was truly remarkable.
Well, I wonder if you can start by just describing the context for this news conference.
So I think for me this goes back to April, when the CDC announced its latest data on the prevalence of autism among kids in the United States.
And they found basically that the numbers had continued a really long running trend of increasing, that now one in 31 kids in the United States have an autism diagnosis.
And that number is five times higher than what the CDC found when it first started collecting this data in just 2000.
So this is obviously news that is, especially to our new health secretary, RFK Jr, who has spent much of his career focused on autism and even connecting autism repeatedly over his career to vaccines.
And months into his tenure he holds this big press conference where he says that autism is an epidemic and it is entirely preventable.
And it is his job now, as the health secretary of the United States, to find out what is causing it to increase.
And he promises that he will come to the American public with answers to that question by September.
Somewhat arbitrarily by September.
Yeah, which everyone who has been studying autism for decades was incredibly skeptical of this and pretty worried, because this has been a question that people have been studying their entire careers.
And the idea that he could whip something together in five months was a little concerning.
Right.
But here we were on Monday, as promised by the end of September, and we get a news conference and Kennedy is there.
But right away, it's pretty clear that President Trump is going to be dominating this news conference.
Yes.
Thank you very much.
So I've been waiting for this meeting for 20 years, actually.
President Trump is the first speaker at the conference.
He kind of kicks things off and he immediately starts riffing pretty wildly.
I always had very strong feelings about autism and how it happened.
Right.
And I just want to flag at several key moments in Trump's speech here.
He says things that are not grounded in science.
In fact, that science contradicts.
And so we're going to fact check what he said in a lot of detail after we talk about what it is.
Yeah.
So he starts off the press conference.
The meteoric rise in autism is among the most alarming public health developments in history.
There's never been anything like this.
He says that, you know, this is a horrible, horrible crisis.
And pretty quickly he gets to what he thinks is behind this rise.
Effective immediately, the FDA will be notifying physicians that the use of Well, let's see how we say that.
Acetaminophen.
Acetaminophen.
Is that okay?
Which is acetaminophen, the active ingredient in the very common household painkiller, Tylenol.
So taking Tylenol is not good.
I'll say it.
It's not good.
And he starts to establish what he says is a clear link between Tylenol and its use in pregnancy and autism in children.
And he says repeatedly that... But with Tylenol, don't take it.
Don't take it.
Pregnant women should not take this drug.
Don't take Tylenol.
He says, you know, don't take it.
Fight like hell not to take it.
Tough it out.
There may be a point where you have to and that you'll...
You have to work out with yourself, so don't take Tylenol.
He's really giving explicit, very black and white warnings to pregnant women to stay away from the only painkiller really recommended for use in pregnancy.
That's the way I feel.
I've been very strong on this subject for a long time.
You know, life is common sense, too.
And he's also saying, you know, I'm not a doctor.
And there's a lot of common sense in this.
This is how I feel.
The people behind me, RFK Marty Makary, might disagree with this because they're waiting for the studies.
But I'd like to be a little bit more, a little speedier in the process of a recommendation, because there's no harm in going further.
But he's saying, listen to me, I'm the president.
Here's my medical advice to you.
And it's so important to me to take...
See the doctor four times or five times for a vaccine.
And then he starts talking about vaccines, too.
Just break it up.
Break it up.
Because it's too much liquid.
Too many different.
He says that you know, the childhood immunization schedule is loading up kids with too many vaccines.
It's like 80 different vaccines and beyond vaccines.
And 80...
Too many different things going into babies at too big a number.
So let those be taken separately.
And then hepatitis B is sexually transmitted.
He talks about the hepatitis B vaccine.
There's no reason to give a baby that's almost just born hepatitis B.
You know, and says that it shouldn't be given to children until they are 12.
He goes on and on.
And, by the way, I think I can say that there are certain groups of people that don't take vaccines and don't take any pills that have no autism.
And he even says that people who don't get vaccinated don't get autism.
Right.
And he suggests that, for example, the Amish don't get vaccines and therefore don't get autism, which I went and fact-checked myself.
I know we're going to fact-check after we get to these remarks.
And neither of those statements is true.
Yeah, they are not true.
And do all those other things, little things, just spread out your visits, et cetera, et cetera.
And I want to thank everybody.
This is a very important day.
Thank you very much. aides who run the National Institutes of Health and the FDA, they give speeches of their own, much shorter, far more restrained than Trump does.
But ultimately they all cast some level of doubt on the practice of taking Tylenol during pregnancy and reaffirmed the idea that it's risky, maybe linked to autism.
So let's zoom out and talk about what we really know to be true and based on science.
And we're going to cover all of what Trump said.
But let's start with the question of Tylenol, pregnant women and autism.
Yeah, so first off, no study has shown that Tylenol use in pregnancy causes autism in children.
I want to be very clear about that.
What we have seen are some studies that have shown a positive association between Tylenol and childhood autism.
And just explain the distinction between a positive association and a cause.
Yeah.
So it's a correlation.
We can't conduct randomized controlled trials on pregnant women.
It is widely held to be unethical to do something like that.
So what researchers have to do is look at data on pregnant women, the choices that they make during their pregnancies, the experiences that they have, and look at the outcomes in their children.
These are called observational studies.
And the problem with the observational studies is that there can be lots of other things going on that might be underlying the relationships that we end up seeing in the results.
In fact, I had a really interesting conversation with an epidemiologist who was lead author on a study that RFK actually cited multiple times in this press conference, because he did find a positive correlation between Tylenol use in pregnancy and autism.
And he actually warned very explicitly against drawing any sort of causal conclusions here.
He brought up the example of rising ice cream sales and rising violent crime in the summertime.
And he said that it would be a mistake to assume that ice cream sales are causing violent crime, that actually the thing that's causing both of those things is the heat.
So it would be a mistake to assume that Tylenol use during pregnancy is actually causing autism, when there might be other underlying things at play, like what underlying health issues does the mother have?
What are her genetics?
Why is she actually taking Tylenol repeatedly over the course of her pregnancy?
Is it to treat multiple fevers?
These are the sort of questions that researchers need to be asking to actually tease apart cause and effect in these studies.
In other words, in that metaphor of ice cream sales and violence going up in the summer, Tylenol's relationship to rising autism could be akin to either the ice cream sales or the violence going up.
It may not be the real underlying cause.
It may not be the heat.
Right, exactly.
And we know that autism, ADHD, other neurodevelopmental disorders have a big genetic component.
So there have been some researchers who have attempted to account for that in these observational studies and actually do what's called a sibling matched control.
So they compare siblings born from the same mother.
And when they do that they see that the relationship, that the correlation between Tylenol use and autism actually goes away.
So that suggests that, you know, the genetics might be the heat in this scenario.
But just to be very clear, when President Trump says to America and to America's pregnant women, do not take Tylenol, that does not, based on your reporting, based on all the research that you have just described, seem at all grounded in the current science.
No, it's not.
I mean something else the president raised was this question of well, what's the downside of not taking Tylenol?
He asked that a few times during this press conference and he seemed to say there's no downside of pregnant women avoiding Tylenol.
What does the research say about that?
Yeah, I mean, he actually says to tough it out.
But the research on this is very clear.
Fevers in pregnancy come at great risk to both the mother and the fetus.
In fact, during the news conference, the American College of Obstetricians and Gynecologists announced issued a statement stressing that the organization considers acetaminophen safe.
And they said that the conditions people use acetaminophen to treat during pregnancy are far more dangerous than any theoretical risks and can create severe morbidity mortality for the pregnant person and the fetus.
Every doctor I spoke with, every medical group that was responding to this issue today, has made clear fevers are not things that should be left untreated during a pregnancy.
So In this case, do not listen to the president.
I also, Azeen, want to fact check the president's claims about vaccines.
It's been firmly established and we've talked about it a lot on the show and throughout Times journalism that there's no documented link between childhood vaccines and autism.
But Trump insisted on suggesting that there was.
He specifically targeted, as you mentioned earlier, the hepatitis B vaccines and the MMR vaccines.
Both are extremely common vaccines given to newborns.
Yeah.
So there has been no data connecting the MMR vaccine, the vaccine against measles, mumps and rubella, or connecting the hepatitis B vaccine to autism in children.
And, you know, we have three decades of studies that have shown this.
And yet today we heard the president of the United States casting doubt on vaccines yet again.
Right.
I mean, given everything you just walked through, the number of times that the president issued forceful and specific medical advice that contradicts what medical groups have said, what existing scientific research says, in some cases, the outright misinformation he put forward.
What should our understanding be of why he would do this?
I think this question feeds into a lot of pet narratives that Trump is focused on all the time.
You know his anti-establishment thinking.
You know the experts knew this and they were hiding this from you.
That you know, the pharmaceutical companies have actually been profiting off of your family's pain, and I'm going to be the one to be the truth teller in this situation.
I think what's really important is to look at what Trump and his health advisors, on that stage today, actually didn't say, which is what we do know about the causes behind the rise in autism.
And those answers don't feed the sort of anti-establishment narrative that Trump is seizing on here.
Those answers have a lot more to do with how autism has been defined and diagnosed over the last several decades.
We'll be right back.
So Azeen, right before the break you mentioned that a big, well-understood cause of autism's rise is how it's been diagnosed.
So just explain that and why that was not something mentioned in Monday's news conference.
Yeah.
So over the last several decades, what we actually consider to be autism has broadened a lot.
Autism used to only refer to young children who had really severe impairments, people with severe language delays or who couldn't speak or who often had intellectual disabilities and couldn't live or function really independently.
But over time we have broadened the diagnosis of autism to include people with much less severe impairments.
And we've folded other diagnoses, including something called Asperger's, under one umbrella that we now refer to as autism spectrum disorder.
So it's a spectrum from, on the one end, people who really have these profound disabilities to, on the other end, people who maybe have some social and communication challenges but might be even highly intelligent.
You know, Elon Musk is always brought up as an example of someone who has spoken about having an Asperger's diagnosis.
And just how much is this broader diagnosis, this bigger spectrum of autism, seen as accounting for the growth in autism in the US, this meteoric rise, as Trump puts it?
It is a lot of the rise, but it is not the whole thing.
The CDC has actually published data showing that, while the number of diagnoses of kids with profound autism — so those are the kids with the most severe impairments — that those diagnoses have increased a little bit over the last couple decades.
The increase in diagnosis among kids who are quote unquote higher functioning is actually increasing a lot more quickly.
So that seems to be very clearly a big driver in the increased diagnoses that we're seeing in this country.
However, every researcher I've spoken to has said that that is not the only thing that is going on here.
We've identified now hundreds of genes that are associated with autism.
We know that those genes interact with each other.
We also know that they interact in some way with the environment.
And, in terms of what environmental factors could be doing, that we have some evidence of things that are definitely playing a role.
Air pollution is one.
We know certain toxic chemicals interact with genes and contribute to a rise in autism.
A very clear other factor is people having children later in life, which we know is happening more and more as people delay having kids.
So all of those things are linked, but there's still a lot we don't know.
And scientists are always going to be the first to say that it's very, very possible that there are other risks out there in the environment that we don't know about yet.
But if we do know that this expanded diagnosis of autism is a pretty big factor in the rise in autism?
I know you mentioned other potential factors, but this one seems kind of indisputable.
Why wouldn't the health secretary or the president focus on that in this news conference?
Yeah, I mean RFK has actually been pretty dismissive of the role of diagnosis and increasing incidence of autism in the US before.
I mean, we talked about this earlier, but it is not an answer.
That has a shadowy pharmaceutical company behind it.
It is not an answer that has experts concealing things from the public.
It's a lot more boring and procedural, frankly.
What I hear you basically saying is that People like President Trump, people like R.K.
Jr. prefer the silver bullet theory, the somebody did you wrong theory.
And a broader diagnosis by the medical community of autism over the past 25 years doesn't fit into that.
I want to return now to Monday's news conference and what happens next.
Now that the president is putting so much weight on Tylenol, despite any evidence of causality when it comes to autism, the president and those around him started to outline a series of actions that would seem to flow from that alleged link.
And so I want you to walk us through what comes now.
So, coming out of today's press conference, they announced four actions that they were gonna take to address autism in the United States.
The first thing that they do is RFK says that the FDA is gonna be initiating the process to put a new label on acetaminophen.
So presumably this will be something like a warning label on Tylenol to warn patients that there is this possibility of a link.
The FDA also sent a letter to doctors across the US today about the possible link between acetaminophen use during pregnancy and autism.
Really interestingly, they were far more measured in this letter than the president's remarks.
The letter says really explicitly that, you know, a causal relationship has not been established.
And they say that the matter is an ongoing area of scientific debate.
But nevertheless they still urge doctors to warn patients that there is the possibility of this link and that they shouldn't take Tylenol except in the case of high fevers.
Right.
Very different than the president saying, do not take Tylenol when you're pregnant.
Yes, very different.
And then the third thing that they did was that the FDA announced that it was going to be approving a new treatment for autism.
It is this drug called Leucovorin.
It is a B vitamin-based drug and it has shown in very small studies so we're talking about just dozens of participants in each that it could have some positive benefits for children with autism.
So improving communication, things like that.
But this is very unusual for them to be pushing through an approval like this, you know, with so little data to back it.
And what do you make of that?
That this drug has only been tested in dozens of people and yet now the government wants to approve it for use as a treatment for autism and is talking about it and endorsing it on such a giant platform?
Yeah, I mean, I think it is absolutely projecting to people that this is possibly going to lead to a cure.
And the scientists who are actually researching leucovorin as a possible treatment.
They are the first to say, like our findings are really early days.
You know they are promising, but this is not something that should be at the level of the federal government pushing through a drug approval at the FDA.
And the last thing is that they announced that They had determined the recipients of 50 million of new federal grants that would be used to study the causes of autism.
And again, it's this mixed bag.
There are absolutely legitimate researchers who have received this funding who are going to be looking into the genetics and the interplay with the environment.
But RFK also made clear that they're also going to be looking again despite the many, many studies that have failed to show a link at the possibility that vaccines play a role in development of autism.
I mean, how should we think about what happened on Monday.
On the one hand, the White House is giving people with autism something.
They're elevating autism in a way perhaps no administration has ever done before.
But the way especially Trump did, that seems to absolutely test and, in a few cases, absolutely exceed the bounds of what we think of as responsible public health.
And just to put a point on that, our colleague christina jewett got an email from the head of medical ethics at nyu's medical school pretty prestigious medical school here in new york and after watching this news conference, this is what he wrote to her quote the announcement on autism was the saddest display of a lack of evidence rumors, Recycling old myths, outright lies and dangerous advice I have ever witnessed by anyone in authority in the world claiming to know anything about science.
So how should we think about that, stacked up against what?
Maybe what the Trump administration thinks is providing an answer to families with autism?
I mean, I have spoken to many autistic people, many families of autistic people, in the process of doing this reporting, and the autistic community is not a monolith.
There are people who are viewing what RFK is doing and from beginning to end see it as harmful.
But then I've spoken with the parents of kids with the most severe impairments and they have really made clear that They're so torn about RFK and this moment for autism in this country.
They absolutely appreciate that he is spotlighting autism, that he's throwing research money to find out the causes, that he is talking about their experience.
But they really, really struggle with and are really worried about the fact that that comes with recycling these theories about autism that have been just proven to be false, that it comes with a lot more fear-mongering directed towards pregnant women, so that you know, if they do have a child with autism, that they somehow think that it was something they did during pregnancy, that it was their fault, that you know they didn't tough it out.
They see RFK and Trump doing that and they kind of don't know what to do with it.
They appreciate the focus and they really struggle with what the consequences of what that focus might be.
Well seen.
Thank you very much.
We appreciate it.
Thanks, Michael.
We'll be right back.
Here's what else you need to know today.
On Monday, ABC said that the late night host, Jimmy Kimmel, would return to its airwaves beginning tonight.
Despite the fierce outcry from conservatives over his comments about the assassination of Charlie Kirk.
The reversal came after Hollywood unions and hundreds of actors and directors condemned ABC's decision as a betrayal of free speech.
But at least one major owner of ABC stations, the Sinclair Broadcast Group, said that it would not run Kimmel's show and would instead replace it with news.
Today's episode was produced by Alex Stern, Nina Feldman and Rob Zipko, with help from Alexandra Lee Young.
It was edited by Liz O'Balin and Michael Benoit, and was engineered by Alyssa Moxley.
That's it for The Daily.
I'm Michael Barbaro.
See you tomorrow.
