We are no closer to knowing the cause of autism. We are no closer to understanding how to decrease the incidence of autism. We are further from people trusting science, or at least understanding that not all scientific findings are equally trustworthy. We have left pregnant woman even more uncertain about how best to care for themselves and their baby during pregnancy.
Start your autism prevalence / incidence graph in 1990... a few years after the vaccine injury act of 1986 and before the explosion in the numbers of vaccines given to infants and toddlers.
[Not a doctor] The doc on Youtube channel MedCram looked at how acetaminophen metabolizes. Mostly in the liver, a bit excreted, but some into a toxic substance which is normally handled...unless there is a stressor. I will not go into the details here. Does this sound right?
A hypothesis waiting to be proven. Association is not causation. This is all another sleight of hand and diversion from the fact JFK, Jr is incompetent and purveyor of lies. Look what he is doing to the CDC. Look what they are doing to the NIH and NCI. These are the real issues.
“I am pretty convinced … there has not been a major increase in autism … What has happened is that there has been a rise in awareness of the disease and an enormous broadening of the diagnostic criteria.”
. . .
Last year, I did a deep dive into this issue. Jill Escher has written extensively about “autism denialism.” It's worth noting she does NOT believe vaccines are a cause of autism (I disagree, but that's another issue!).
Here's a quote from her 4/15/25 post, “RFK Jr. is right to say there’s an autism epidemic – Today the CDC announces autism rates have surpassed 3% of U.S. children, including 5% of boys. The health secretary may be WRONG on vaccines, but the data support his insistence on a true increase.” https://jillescher.substack.com/p/rfk-jr-is-right-to-say-theres-an
"Major media outlets have repeatedly supported the latter narrative with the refrain that the rising number of cases is mainly due to “growing awareness about the condition” and that “milder forms of autism and related conditions have been folded into the umbrella.” … But a seasoned investigator in the CDC’s autism surveillance team disagrees with this “magical koan,” as he has called such rationalizations, invoked to wave away the increase. “This is such a distortion“ says Walter Zahorodny, PhD, associate professor of psychiatry at Rutgers University, who investigates autism prevalence, and has led the CDC’s efforts in New Jersey for more than two decades.”
For a deeper dive, I would highly recommend reading Escher's very thorough, detailed discussion of the scientific data & evidence for and against a true rise in autism in her 10/30/24 article, “Getting Real About Autism’s Exponential Explosion” https://www.ncsautism.org/blog//autism-explosion-2024
Dr. Cifu (and other readers) would be well served by actually examining the evidence, instead of just uncritically parroting talking points about "increasing awareness".
Interesting how your ‘age of diagnosis’ graph stops showing the ‘age 1-6’ in ‘06-‘07. Most kids are diagnosed before 6. It would be interesting to see that line carried out to present.
Also - could diagnostic improvement really take it from 1:10,000 to 1:31 in just 35 years? If people think this, how insulting to the great docs just 25 years ago. And where are all the 70 year old autistics today?
None of this qualifies as science. Your introductory paragraph sums it up well. Statistics on the incidence of autism are questionable because the definition of the disorder has been broadened to include most children with neurological development abnormalities. I think advice to minimize medication during pregnancy is prudent but incriminating Tylenol is absurd.
I am the mother of a 21-year-old son who is autistic. I remember distinctly that my doctor told me that I could use Tylenol during all three of my pregnancies, but to use it judiciously. Of course, I wonder if there is something that I could have done to prevent this. The frustrating thing is that no one REALLY knows. I have followed Dr. Makary and Dr. Battacharya extensively since they began their positions at the FDA and NIH. I am incredibly interested in their commitment (I hope that they are still committed) to revisit studies and look into root causes that may be contributing to the increased diagnosis of autism. As they have discussed many times, addressing the gut microbiome and inflammation could be a promising approach. I fear that one day we truly may find a cause or a substantial contributing factor, and because the 'wrong team' made the discovery, 50% of us will not believe it.
My 25-year-old daughter has ADHD and dyslexia. She worked with an educational psychologist during her K-12 years, and we were told repeatedly that she is technically on the autism spectrum. I do not at all consider her to have autism when compared to my son. I believe that these numbers are overstated to increase fear. Maybe we also need to revisit what we define as autism.
Dr. Cifu, I am typiclly in awe of your keen eye for detail when reviewing studies. One of the improtant lessons I have learned from you is that the underlying data needs to pass a simple "smell test". In looking at the widely cited Ahlqvist study I am surprised that you appear to accept the underlying data as credible. You make no mention of the fact that fewer than 10% of pregnancies in this study had ANY exposure to acetominophen. It is widely reported that nearly 50% of pregnant women take acetominophen at some point in their pregnancy. The study relied on prescriptions for acetominophen (an OTC drug in Sweden) and nurse midwife reports to acquire this information. I don't believe the underlying data on acetominophen use passes the smell test.
I might be a bit pedantic, and I recognize it is somewhat tangential to the main point of your post, but I wanted to address the idea that pregnant women have traditionally managed childbirth well on their own. In my area (Vancouver, Canada), there’s a growing trend of women choosing to give birth at home or in natural settings like forests, often driven by the belief that childbirth is inherently safe because it’s “natural.”
While complications are rare today, that’s largely thanks to modern obstetric care. Over the past century, maternal mortality during childbirth has dropped by 99%, and infant mortality has decreased by 93%. These stats show how far medical advancements have come in making childbirth safer for both mothers and babies.
I disagree that we are 'no closer.' Any time you shine a bright light on something, it's easier to get closer.
That press conference was meant to shine a light.
I have several friends with autistic children, one low functioning, the other higher. The both were very excited that the nation was discussing things. They live with this every single and for the most part they are ignored.
Light is the best disinfectant, so they say.
Nobody said they know everything, but they want to study things now and that's a start.
Also, I have to say that is hard to believe that Vinay who is a vocal critique of obs studies let this pass right under his nose, when he is one of the people running the FDA!.
Would love to hear what he has to say about this. Call him up Adam! :)
I suspect Vinay would say doing an observational study on pregnant women is ok, because an RCT is bad. Not as bad an RCT testing whether jumping out of an airplane with and without parachute bad, but really bad.
There are recent -meta-analysis of Obs studies showing the risk For ex, One from 2021 (Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts) shows an OR of 1.19 with acetaminophen use.
BUT the important point here is that when they look at sibling control in one of the latest studies, the increased risk disappears showing the increased risk was confounded.
I have never heard of the Navigation Guide used to assess quality of evidence. They should have used Cochrane ROB and GRADE which is what Cochrane and other leading organization use. . Their so-called tool even has a scoring criteria for expert opinion , which is laughable. The GRADE tool evens starts obs studies at LOW certainty.
Dr. Cifu- I wish you had mentioned that one of the authors of the study has a conflict of interest- he testified in a case against Tylenol and received money to do so. The same data was dismissed in court, and he turned around and published it.
Start your autism prevalence / incidence graph in 1990... a few years after the vaccine injury act of 1986 and before the explosion in the numbers of vaccines given to infants and toddlers.
[Not a doctor] The doc on Youtube channel MedCram looked at how acetaminophen metabolizes. Mostly in the liver, a bit excreted, but some into a toxic substance which is normally handled...unless there is a stressor. I will not go into the details here. Does this sound right?
A hypothesis waiting to be proven. Association is not causation. This is all another sleight of hand and diversion from the fact JFK, Jr is incompetent and purveyor of lies. Look what he is doing to the CDC. Look what they are doing to the NIH and NCI. These are the real issues.
Nicely done! As an MD and father of a son with ASD -- I agree with your assessment.
“I am pretty convinced … there has not been a major increase in autism … What has happened is that there has been a rise in awareness of the disease and an enormous broadening of the diagnostic criteria.”
. . .
Last year, I did a deep dive into this issue. Jill Escher has written extensively about “autism denialism.” It's worth noting she does NOT believe vaccines are a cause of autism (I disagree, but that's another issue!).
Here's a quote from her 4/15/25 post, “RFK Jr. is right to say there’s an autism epidemic – Today the CDC announces autism rates have surpassed 3% of U.S. children, including 5% of boys. The health secretary may be WRONG on vaccines, but the data support his insistence on a true increase.” https://jillescher.substack.com/p/rfk-jr-is-right-to-say-theres-an
"Major media outlets have repeatedly supported the latter narrative with the refrain that the rising number of cases is mainly due to “growing awareness about the condition” and that “milder forms of autism and related conditions have been folded into the umbrella.” … But a seasoned investigator in the CDC’s autism surveillance team disagrees with this “magical koan,” as he has called such rationalizations, invoked to wave away the increase. “This is such a distortion“ says Walter Zahorodny, PhD, associate professor of psychiatry at Rutgers University, who investigates autism prevalence, and has led the CDC’s efforts in New Jersey for more than two decades.”
For a deeper dive, I would highly recommend reading Escher's very thorough, detailed discussion of the scientific data & evidence for and against a true rise in autism in her 10/30/24 article, “Getting Real About Autism’s Exponential Explosion” https://www.ncsautism.org/blog//autism-explosion-2024
Dr. Cifu (and other readers) would be well served by actually examining the evidence, instead of just uncritically parroting talking points about "increasing awareness".
Interesting how your ‘age of diagnosis’ graph stops showing the ‘age 1-6’ in ‘06-‘07. Most kids are diagnosed before 6. It would be interesting to see that line carried out to present.
Also - could diagnostic improvement really take it from 1:10,000 to 1:31 in just 35 years? If people think this, how insulting to the great docs just 25 years ago. And where are all the 70 year old autistics today?
None of this qualifies as science. Your introductory paragraph sums it up well. Statistics on the incidence of autism are questionable because the definition of the disorder has been broadened to include most children with neurological development abnormalities. I think advice to minimize medication during pregnancy is prudent but incriminating Tylenol is absurd.
I am the mother of a 21-year-old son who is autistic. I remember distinctly that my doctor told me that I could use Tylenol during all three of my pregnancies, but to use it judiciously. Of course, I wonder if there is something that I could have done to prevent this. The frustrating thing is that no one REALLY knows. I have followed Dr. Makary and Dr. Battacharya extensively since they began their positions at the FDA and NIH. I am incredibly interested in their commitment (I hope that they are still committed) to revisit studies and look into root causes that may be contributing to the increased diagnosis of autism. As they have discussed many times, addressing the gut microbiome and inflammation could be a promising approach. I fear that one day we truly may find a cause or a substantial contributing factor, and because the 'wrong team' made the discovery, 50% of us will not believe it.
My 25-year-old daughter has ADHD and dyslexia. She worked with an educational psychologist during her K-12 years, and we were told repeatedly that she is technically on the autism spectrum. I do not at all consider her to have autism when compared to my son. I believe that these numbers are overstated to increase fear. Maybe we also need to revisit what we define as autism.
Thanks for your comments. Hope all is well with your children.
Dr. Cifu, I am typiclly in awe of your keen eye for detail when reviewing studies. One of the improtant lessons I have learned from you is that the underlying data needs to pass a simple "smell test". In looking at the widely cited Ahlqvist study I am surprised that you appear to accept the underlying data as credible. You make no mention of the fact that fewer than 10% of pregnancies in this study had ANY exposure to acetominophen. It is widely reported that nearly 50% of pregnant women take acetominophen at some point in their pregnancy. The study relied on prescriptions for acetominophen (an OTC drug in Sweden) and nurse midwife reports to acquire this information. I don't believe the underlying data on acetominophen use passes the smell test.
I agree with you. I was limiting this by not going into the underlying data.
I might be a bit pedantic, and I recognize it is somewhat tangential to the main point of your post, but I wanted to address the idea that pregnant women have traditionally managed childbirth well on their own. In my area (Vancouver, Canada), there’s a growing trend of women choosing to give birth at home or in natural settings like forests, often driven by the belief that childbirth is inherently safe because it’s “natural.”
While complications are rare today, that’s largely thanks to modern obstetric care. Over the past century, maternal mortality during childbirth has dropped by 99%, and infant mortality has decreased by 93%. These stats show how far medical advancements have come in making childbirth safer for both mothers and babies.
The real question is what is the reason that a pregnant woman needs Tylenol?
A dehydration headache? An infection causing fever?
What if the culprit was the infection rather than the Tylenol?
I would also like to hear a take on FDA approving leucovorin.
I disagree that we are 'no closer.' Any time you shine a bright light on something, it's easier to get closer.
That press conference was meant to shine a light.
I have several friends with autistic children, one low functioning, the other higher. The both were very excited that the nation was discussing things. They live with this every single and for the most part they are ignored.
Light is the best disinfectant, so they say.
Nobody said they know everything, but they want to study things now and that's a start.
Also, I have to say that is hard to believe that Vinay who is a vocal critique of obs studies let this pass right under his nose, when he is one of the people running the FDA!.
Would love to hear what he has to say about this. Call him up Adam! :)
I suspect Vinay would say doing an observational study on pregnant women is ok, because an RCT is bad. Not as bad an RCT testing whether jumping out of an airplane with and without parachute bad, but really bad.
Makary did too. Super disappointed in him.
I didn't expect much from Makary. My guess is after the resignation jolt, Vinay is picking his battles carefully.
I did not expect him to bend the knee so easily.
Agreed!
There are recent -meta-analysis of Obs studies showing the risk For ex, One from 2021 (Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts) shows an OR of 1.19 with acetaminophen use.
BUT the important point here is that when they look at sibling control in one of the latest studies, the increased risk disappears showing the increased risk was confounded.
I have never heard of the Navigation Guide used to assess quality of evidence. They should have used Cochrane ROB and GRADE which is what Cochrane and other leading organization use. . Their so-called tool even has a scoring criteria for expert opinion , which is laughable. The GRADE tool evens starts obs studies at LOW certainty.
Dr. Cifu- I wish you had mentioned that one of the authors of the study has a conflict of interest- he testified in a case against Tylenol and received money to do so. The same data was dismissed in court, and he turned around and published it.