I have treated more than 200,000 patients in almost 40 years of practising medicine. Autism is a complex disorder which can present in many different ways and in a spectrum of severity. Causation is a very important consideration and, as a paediatrician, I know that parents often ask why their child has autism.
Particularly in the severe end of the autism spectrum, genetic disorders can present with autistic features; for example Angelman syndrome, Smith-Magenis syndrome, Williams syndrome and many others. However, for the majority of the children who are diagnosed with autism, no cause is found. We also know that the number of children diagnosed with autism in the developed world is increasing. There are many reasons for this, not least that we are better at diagnosing it. However, in my work I often heard the question “why is my child autistic?”
There have been many studies over many decades trying to answer this question. There has also been a number of discredited claims – such as those around MMR vaccines propagated by false prophets (of which the US health and human services secretary Robert F Kennedy Jr is one) which have led to poor health outcomes and caused considerable distress and damage. These claims have been repeatedly disproven but are continuing to be promulgated by some.
The recent comments by the US president Donald Trump regarding a possible link between paracetamol (acetaminophen, Panadol, Tylenol) usage during pregnancy and causation of autism is very worrying on many levels.
Firstly, there is no evidence of causation in any study that I have seen, and while there may be small associations, a causative effect has been disproved by the largest and most recent Swedish study and Japanese study. Secondly, there has already been significant distress caused and nothing has been done to explain what evidence has been used and what is the scientific evidence for his comments.
Paracetamol is a very important and commonly used medication in pregnancy and is classified as safe. Alternative medications are not as safe and can affect the foetus.
Medicine regulators around the world, including in the UK and our own TGA (Therapeutic Goods Administration), have concluded that paracetamol is safe for use during pregnancy based on “rigorous assessment of the best available scientific evidence”.
We should trust our regulatory framework to provide us with the best scientific evidence to make decisions about healthcare and not unscientific and poorly informed health policy.
Our regulatory agency, the TGA, is the best in the world and I am confident in their advice.
Any comments about the diagnosis, management and causative mechanisms of complex neurodevelopmental disorders have the potential to cause significant anxiety and distress. They may also lead to inappropriate health outcomes.
It is very important that concerns are dealt with by timely assessment of the scientific evidence and that we listen to the experts. The US president and health secretary have failed to do that in the past and are continuing a pattern of ad hoc actions that will not end well.
In Australia we are very lucky to have regulatory systems of the highest standards and we need to trust in them.
