Tough It Out

Tough it out, ladies: “Don’t take Tylenol,” President Donald Trump told America’s pregnant women yesterday. “Don’t take it. Fight like hell not to take it.”

Instead, pregnant women should “tough it out” when they’re in pain, said Trump, touting a possible link between Tylenol use—specifically, acetaminophen—in pregnancy and autism.

Acetaminophen is frequently the only pain reliever pregnant women are allowed to take. And the link between that drug and a child in utero developing autism is rather tenuous; medical research is in no way conclusive on this, so it’s a little insane that Trump and his top health deputy Robert F. Kennedy Jr. are going public with this. (RFK Jr. and Marty Makary, Food and Drug Administration commissioner, also touted a B-vitamin-based drug called leucovorin that has showed some promise at treating autism.)

There are a few issues here. One is that we need to sort out whether autism rates have actually increased a lot because autism is on the rise or because we have gotten more expansive about what we consider autism to be.

“The constellation of traits categorized as ‘autism’ wasn’t named until Leo Kanner’s descriptions of ‘abnormal behaviour’ in the 1940s, and it would be another nearly forty years before American psychiatry provided criteria for autism diagnoses in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III),” writes Cremieux on the Cremieux Recueil Substack. “Before the DSM-III came out in 1980, autism diagnoses were usually ad hoc, based on the personal views of different clinicians and researchers about what autism is and how to diagnose it. Because autism was regarded as particularly severe prior to the DSM treatment of it and those whose condition goes unnoticed by adulthood likely aren’t severe cases, and because there was practically no incentive to diagnose until the most recent generations, that meant it was diagnosed rarely, making subsequent increases that much more exaggerated.”

And there was a clear incentive in place, passed in 1975 and altered in the early ’90s, for autism diagnoses to become much more common: “The Education for All Handicapped Children Act (known as the Individuals with Disabilities Education Act or ‘IDEA’ from 1990 onwards), [led] to the ‘Child Find’ mandate, whereby schools were required to actively identify, locate, and evaluate all children with disabilities, regardless of severity. With the Child Find mandate in place, each disabled child found led to additional funds for schools, incentivizing them to classify ever more children as having disabilities,” writes Cremieux.

It’s possible that autism is on the rise, but it’s very hard to get a real sense of the truth of this (and the magnitude), since diagnostic criteria and incentives have changed so drastically in recent decades. As for the link between acetaminophen and autism, it looks like our health officials and president are claiming a strong link when none exists. It’s certainly a worthy area of study, but irresponsible for the president and top health officials to be making such bold claims.

In a study of ~2.5M children, there was a small association between in utero Tylenol use and subsequent autism. But the association disappears entirely when you introduce sibling controls, implying it’s spurious. https://t.co/mFUJmHMRtB pic.twitter.com/OTZimYfuso

— Charles Fain Lehman (@CharlesFLehman) September 22, 2025

Thankfully, the actual guidance hasn’t really changed but acknowledged the possible link to autism. It’s just “doctors, instruct pregnant women to minimize acetaminophen usage”—which is what they had already been doing. “While an association between acetaminophen and autism has been described in many studies, a causal relationship has not been established and there are contrary studies in the scientific literature,” wrote FDA Commissioner Makary in a letter to physicians. “The association is an ongoing area of scientific debate and clinicians should be aware of the issue in their clinical decision-making, especially given that most short-term fevers in pregnant women and young children do not require medication. In the spirit of patient safety and prudent medicine, clinicians should consider minimizing the use of acetaminophen during pregnancy for routine low-grade fevers.”

This is representative of so many Trump admin moves: Make a slightly foolish proclamation that doesn’t really change all that much, everyone freaks out, outrage news cycle is generated, people overstate the importance, Overton window is changed slightly to bring an obscure theory (link between Tylenol and autism) into the mainstream, everyone moves on and is mostly fine.

Politically, this sounds plausible to me as the theory of what went down behind the scenes:

Ok. Here’s the deal: RFK Jr. overpromised an autism report with a tight deadline to his base and to Trump, who is curious about autism in a sort of hobbyist way.

He had to deliver something that would satisfy them. He has insisted forever that epidemics are *only* caused by… https://t.co/i5up9oSBQ3

— Rachael Bedard (@RBMD1982) September 23, 2025

“Doctors have always approached medications in pregnancy by using it only when indicated, lowest dose, for the shortest duration,” Nathaniel DeNicola, an adviser to the American College of Obstetricians and Gynecologists, told The New York Times. “That applies to Tylenol tomorrow the same as it does today, the same as it did yesterday.”

Perhaps we will soon return to our time-honored tradition of ignoring the public health authorities and doing whatever the damn hell we please.

Follow-up: The White House said, following news coverage and outcry, that doctors may in fact get a special waiver from the new, boosted $100,000 H-1B visa fee (covered in yesterday’s Roundup). This is better than creating a physician shortage, but the Trump administration could also surely manage to do less picking of winners and losers.

Scenes from New York: “Zohran Mamdani, the Democratic nominee for mayor of New York City, said on Monday that he was withdrawing from a town hall on WABC that had been planned for this week, in protest of the decision by the station’s parent company to indefinitely suspend Jimmy Kimmel’s talk show,” reports The New York Times. Just one issue: Kimmel was reinstated. So, does that mean Mamdani no longer has an excuse?

QUICK HITS

Forget Tylenol, there are thousands of first trimester babies bathing in ozempic as we speak

— Kitten ???????? (@kitten_beloved) September 23, 2025

• “107 Days is about the advice not taken. Democrats built a cautious campaign, with policies they could pay for, on the premise that most voters didn’t want truly radical change on immigration and tariffs. They did. Biden, and then Harris, bet that the country would be repelled by at least one of Trump’s decisions or character traits,” writes David Weigel for Semafor. “It wasn’t. The result is a book that will convince on-the-fence Democrats that Harris isn’t part of their electoral future….Harris sounds trapped between the expectations of Trump’s first term, when progressives saw him as an accidental president, and the experience of his 2024 primary campaign—that the country is more conservative than Democrats thought. When Bernie Sanders urges her to ‘focus on the working class, not just abortion,’ she notes it. But she doesn’t come up with a memorable economic offer, griping at how Trump got out a viral ‘no tax on tips’ policy while she tinkered with a more comprehensive one.”
• “Walt Disney Co. said Jimmy Kimmel Live! will return to the air on Tuesday, ending a suspension imposed following controversial remarks its ABC late-night host made about the assassination of Republican activist Charlie Kirk,” reports Bloomberg. “‘We have spent the last days having thoughtful conversations with Jimmy, and after those conversations, we reached the decision to return the show on Tuesday,’ Disney said in a statement.” (Sure they have.) Not every affiliate will bring him back, though:

This just in: A @WeAreSinclair rep tells me that “beginning Tuesday night Sinclair will be preempting ‘Jimmy Kimmel Live!’ across our ABC affiliate stations and replacing it with news programming. Discussions with ABC are ongoing as we evaluate the show’s potential return.”

— Brian Stelter (@brianstelter) September 22, 2025

Even if we pretend for the sake of argument that these are comparable cases: Why would you expect libertarians to support the FCC’s indecency rules? Is there a single libertarian in America who thinks FCC v. Pacifica was rightly decided? https://t.co/APTkeQMJpm

— Jesse Walker (@notjessewalker) September 22, 2025

• I don’t relate to this. “Aesthetics” and “sensibilities” are one level of critique, sure, but I think Charlie Kirk’s widow, Erika, is doing an incredible job of communicating the tenets of the Christian faith—extraordinary, Christlike forgiveness—during the worst moments of her life. Her intense trust in the Lord has really inspired me, personally. That matters more than whether the aesthetics are off. And, remember, this is really a covert way of saying middle-America believers are low-brow compared with the high-brow, truly enlightened big-city dwellers who don’t need to rely on Big Man in Sky. I don’t like that way of looking at our fellow Americans, both because it is unkind and because it is untrue:

I’ve spent half of my adult life living in one foreign country or another and I don’t think I’ve ever felt so estranged from the surrounding culture as I am from the aesthetics and sensibilities of this movement. Not even a criticism, I just feel more at home in Greece than in… pic.twitter.com/rz6K9YYdVO

— Thomas Chatterton Williams (@thomaschattwill) September 22, 2025