health and wellness
What parents need to know about Tylenol, autism and the difference between finding a link and finding a cause in scientific research
The article discusses the ongoing debate regarding the potential link between prenatal acetaminophen (Tylenol) use and autism. While some studies show weak associations, establishing causation remains challenging. Factors like dosage response and sibling outcome comparisons are critical for understanding this complex issue, highlighting the need for more thorough research and consulting healthcare professionals.
What parents need to know about Tylenol, autism and the difference between finding a link and finding a cause in scientific research
Claims from the Trump White House about links between use of the painkiller acetaminophen – often sold under the brand name Tylenol in the U.S. – during pregnancy and development of autism have set off a deluge of responses across the medical, scientific and public health communities.
As a father of a child with level 2 autism – meaning autism that requires substantial support – and a statistician who works with such tools as those used in the association studies cited by the White House, I find it useful to think about the nuances of association versus causation in observational studies. I hope that this explanation is helpful to parents and expecting parents who, like me, are deeply invested in the well-being of their children.
Association is not causation, but …
Most people have heard this before, but it bears repeating: Association does not imply causation.
An often-cited example is that there is a very strong association between ice cream sales and incidents of shark attacks. Of course, it goes without saying that shark attacks aren’t caused by ice cream sales. Rather, in the summertime, hot weather drives more appetite for ice cream and beach time. The increased number of people at the beach does, in turn, cause the likelihood of shark attacks to increase.
Yet pointing this out on its own is neither intellectually satisfying nor emotionally appeasing when it comes to real-life medical concerns, since an association does suggest potential for a causal relationship.
In other words, some associations do end up being convincingly causal. In fact, some of the most consequential discoveries of the past century in public health, like the links between smoking and lung cancer or the human papillomavirus (HPV) and cervical cancer, started out as findings of very strong association.
So when it comes to the issue of prenatal acetaminophen use and autism development, it is important to consider how strong the association found is, as well as the extent to which such an association could be considered causal.
Establishing causal association
So how do scientists determine if an observed association is actually causal?
The gold standard for doing so is conducting what are called randomized, controlled experiments. In these studies, participants are randomly assigned to receive treatment or not, and the environment where they are observed is controlled so that the only external element that differs among participants is whether they received treatment or not.
In doing this, researchers reasonably ensure that any difference in the outcomes of the participants can be directly attributed as being caused by whether they received the treatment. That is, any association between treatment and outcome can be considered causal.
Yet oftentimes, conducting such an experiment is impossible, unethical or both. For instance, it would be highly difficult to gather a cohort of pregnant women for an experiment and extremely unethical to randomly assign half of them to take acetaminophen, or any other medication for no particular reason, and the other half not to.
So when experiments are simply infeasible, an alternative is to make some reasonable assumptions on how observational data would behave if the association was causal and then see if the data aligns with these causal assumptions. This can very broadly be referred to as observational causal inference.
Parsing what the studies mean
So how does this apply to the current controversy over the potential for acetaminophen use during pregnancy to affect the fetus in a way that could result in a condition like autism?
Researchers who try to understand causal roles and links between one variable and potential health outcomes do so by considering: 1) the size and consistency of the association across multiple attempts to estimate it, and 2) the extent to which such association has been established under observational causal inference frameworks.
As early as 1987, researchers have been working to measure possible associations between acetaminophen use during pregnancy and autism. A number of these studies, including multiple large systematic reviews, have found evidence of such associations.
For instance, a 2025 review of 46 studies that examined association between acetaminophen use and an array of neurodevelopmental disorders, including autism, identified papers with five positive associations between acetaminophen and autism.
In one of those studies, which examined 73,881 births, the researchers found that children who were exposed to acetaminophen prenatally were 20% more likely to develop borderline or clinical autism spectrum conditions. Another examined 2.48 million births and reported an estimated association of only 5%.
Both of those are weak associations. For context, estimations of increased lung cancer risk from smoking in the 1950s were between 900% to 1,900%. That is, a smoker is 10 to 20 times more likely than a nonsmoker to develop lung cancer. By comparison, in the two autism studies above, a pregnant woman who takes acetaminophen is 1.05 to 1.20 times more likely than one who does not take the drug to have a child who would be later diagnosed with autism.
It’s also important to keep in mind that many factors can affect how well a study is able to estimate an association. In general, larger sample sizes provide both greater power to detect an association if one does exist, as well as improved precision over estimating the value of the association. This does not mean that studies with smaller sample sizes are not valid, only that from a statistical perspective, researchers like me place greater confidence in an association drawn from a larger sample size.
Once an association – even a small one – is established, researchers then must consider the extent to which causation can be claimed. One way to do this is through what’s called dose-response. This means looking at whether the association is higher among women who took higher doses of acetaminophen during pregnancy.
The study mentioned above that looked at 2.48 million births shows an example of dose-response. It found that pregnant women who reported taking higher doses have higher autism risk.
Another way to examine possible causality in this context is to analyze sibling outcomes, which that same paper did. Researchers looked at whether associations between acetaminophen and autism persisted within families with more than one child.
For example, in a family with two children, if the mother used acetaminophen during one pregnancy and that child was later diagnosed with autism, but she did not use it during the other pregnancy and that child was not diagnosed, then this strengthens the causal claim. Conversely, if acetaminophen was used during the pregnancy of the child who was not diagnosed with autism and not used during the pregnancy of the child who was, then that weakens the causal claim. When this was included in the analysis, the dose-response disappeared, and in fact the overall 5% increased risk mentioned before likewise disappeared. This weakens the claim of a causal relationship.
Consult your doctor
At present, there is clearly not enough evidence to establish a causal association between prenatal acetaminophen use and autism.
Yet as a parent who wonders if my daughter will ever be able to write her name, or hold a job or raise kids of her own, I understand that such explanations may not appease the fears or concerns of an expecting mother who is suffering from a fever.
Naturally, all of us want absolute certainty.
But that’s not possible when it comes to acetaminophen use, at least not at this time.
Your doctor will be able to provide you with much sounder advice than any existing study on this topic. Your OB-GYNs are very likely aware of these studies and have much better judgment as to how these results should be considered in the context of your personal medical history and needs.
Researchers, meanwhile, will continue to dig deeper into the science of this critically important issue and, hopefully, provide greater clarity in the years to come.
Mark Louie Ramos, Assistant Research Professor of Health Policy and Administration, Penn State
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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(Feature Impact) To add charm to your yard, encourage local wildlife and give you a front-row seat to nature, building a birdhouse is a simple weekend project that checks all of those boxes.
Building a Birdhouse
Seasoned DIYers and first-timers alike can follow this step-by-step guide to create a functional, welcoming birdhouse.
Step 1: Choose the Right Design
Start by deciding what type of birds you’d like to attract. Different birds prefer different house sizes and entrance types. A simple, classic birdhouse design makes the project beginner-friendly and works well for common backyard birds like wrens, chickadees and bluebirds. In general, plan for at least a 1-1 2/2-inch entrance hole, a 5-by-5-inch interior space and 2 inches or more of roof overhang.
Step 2: Gather Materials and Tools
Most DIY birdhouses can be built with basic materials and tools you may already have at home, including untreated cedar or pine wood, screws or nails, wood glue, sandpaper and exterior-safe paint as well as a measuring tape, pencil, saw and drill.
Step 3: Measure and Cut Wood
Measure and cut wood to make the front panel, back panel, two side panels, floor and roof. Then sand all edges for smooth assembly.
Step 4: Drill Holes
Using a hole-saw bit, drill the entrance hole into the front panel. Position it a few inches below the roofline to keep predators out. Next, drill 2-3 small drainage holes in the floor piece to prevent water buildup and help keep the birdhouse dry.
Step 5: Assemble the Birdhouse
Attach the side panels to the back panel using screws or nails. Add the front panel then secure the floor piece, slightly recessed, so rainwater can drain. Attach the roof last, making sure it slopes slightly to allow water to run off.
Step 6: Paint the Exterior
If you plan to paint your birdhouse, stick to neutral, nature-inspired colors. Light browns, soft greens or white help regulate temperature and blend into the environment.
Step 7: Mount Your Birdhouse
Once dry, place your birdhouse in a quiet, sheltered spot away from heavy foot traffic. Mount or hang it 5-10 feet off the ground, facing away from prevailing winds.
Visit eLivingtoday.com for more DIY project inspiration.
Photo courtesy of Shutterstock
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Study Links Agent Orange Exposure to Higher Risk of Rare Melanoma
A study revealed that U.S. veterans exposed to Agent Orange are at increased risk of developing acral melanoma, a rare skin cancer located in areas not typically exposed to sunlight. With higher odds of diagnosis and poorer prognosis, early detection in veterans is vital for effective treatment and improved outcomes.
(Feature Impact) A new study found U.S. veterans exposed to Agent Orange face a higher risk of developing a rare and often overlooked form of melanoma that appears on the hands and feet, and under the nails.
Researchers reported in “JAMA Dermatology” that veterans with documented exposure to the herbicide had significantly higher odds of developing acral melanoma, a subtype of skin cancer that forms on the palms, soles and nail beds.
Unlike most melanomas, which are associated with ultraviolet radiation, acral melanoma develops in areas not typically exposed to the sun. It can resemble a bruise under a toenail or a dark patch on the bottom of a foot – locations that are easily missed and not commonly associated with skin cancer.
Because of its unusual appearance and location, acral melanoma is often diagnosed at later stages, when treatment is more difficult and survival rates are lower.
The researchers analyzed 20 years of Veterans Health Administration data, comparing more than 1,200 veterans diagnosed with acral melanoma with more than 5,000 veterans without melanoma. Veterans exposed to Agent Orange had about 30% higher odds of developing the disease.
The findings suggest Agent Orange may be an underrecognized risk factor for acral melanoma, particularly for veterans who may not view themselves as at risk for skin cancer because of limited sun exposure or darker skin tones.
“Identifying exposures that may increase risk can help inform earlier recognition and, ultimately, earlier diagnosis when treatment is most effective,” said Marc Hurlbert, chief executive officer of the Melanoma Research Alliance and a principal investigator on the study.
Senior author Dr. Rebecca I. Hartman of Brigham and Women’s Hospital said acral melanoma behaves differently from other melanomas and often responds less well to current therapies.
“Acral melanoma has a poorer prognosis than the more common cutaneous melanoma because it is often diagnosed at later stages,” Hartman said. “Identifying risk factors is critical to improving detection and outcomes.”
Agent Orange was used extensively during the Vietnam War and exposure has been linked to several cancers and chronic illnesses. These findings add to evidence the herbicide may also affect the skin in ways not reflected in traditional melanoma awareness efforts.
Acral melanoma has also been associated with sex, race and ethnicity, and prior skin lesions. Researchers said the study supports treating the disease as distinct from sun-driven melanomas that dominate public education campaigns.
For veterans, the research highlights the importance of examining less visible areas of the body, including the bottoms of the feet, between the toes and under the nails. Changes in nail color, dark streaks or unexplained spots on the palms or soles should be evaluated by a health care provider, especially for those with known Agent Orange exposure.
Researchers said the findings could help guide future screening strategies for higher-risk populations and encourage further study of why acral melanoma differs biologically from other skin cancers.
Find more information at curemelanoma.org.
Photo courtesy of Shutterstock
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Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.
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Progress, Not Perfection: How Healthy Habits Can Stack Up One Step at a Time
The article emphasizes that achieving better health relies on progress, not perfection. It advocates for realistic goals and highlights tools like My Life Check for personalized health assessments. Small, manageable changes in diet, exercise, sleep, and stress management can significantly impact overall well-being, making healthy habits more attainable and sustainable.
Progress, Not Perfection: How Healthy Habits Can Stack Up One Step at a Time
(Feature Impact) Despite the best of intentions, it’s common for plans to build healthier habits to fall flat. Often, the culprit isn’t a lack of motivation or discipline; rather, it’s unrealistic expectations.
Overhauling your lifestyle requires a level of commitment that isn’t always practical. Understanding your personal health needs and the challenges you need to overcome can help give you a more realistic roadmap toward better health.
Tools to Guide You
Every plan needs a starting point and there are many reputable sources that can help guide you toward a plan that addresses your personal health needs.
For example, the American Heart Association introduced My Life Check, a simple, free tool to help individuals understand their heart health and what’s driving it. Users answer simple questions about their daily habits and health factors to get a personalized Heart Health Score in minutes.
The results are private and downloadable, giving you full control of your information. The tool turns big goals into small, specific actions you can start right away. Knowing your numbers relative to your heart health (and where you are in comparison to target ranges for optimal health) can help you decide how to build a better map to get you where you want to be.
While the report is customized to each individual, no personal data is stored and answers are only used to calculate health scores and provide personalized recommendations and practical steps to improve your health, so you can use your results to focus on what matters most to you. Every small step you take, such as moving more, eating smarter, sleeping better or managing stress, can add up over time.
Finding Your Path
Once you’re armed with data and know where you stand on your heart health numbers, small steps become clearer and more manageable. That knowledge makes it easier to choose one area to focus on, such as getting more sleep, taking daily walks or adding more color to your meals.
Healthy changes don’t need to be expensive or complicated. The best habits are ones that fit real life when every action you take moves you closer to your goals.
Staying motivated and on track is also easier when you can check back in, see your progress and realize the steps you’re taking are making an impact. Checking in every few months to see how you can grow gives you the chance to celebrate your progress, learn from challenges and keep building lasting habits that feel good.
To get started with personalized tips to set your own health goals, visit heart.org/mylifecheck.
Healthy Habits for Everyday Life
Eat Smart
Choose foods that help you feel your best, one meal at a time. Add more color to your plate and focus on balance, not restriction. Simple, affordable swaps can make a real difference.
Smart Tip: Aim for an overall healthy eating pattern that includes whole foods, fruits and vegetables, lean protein, nuts, seeds and cooking in non-tropical oils such as olive and canola.
Move More
Find movement that fits your life, such as a walk, a stretch or dancing while you cook. Every bit of activity counts and it all supports your heart and mind. Move for joy, not just for results.
Smart Tip:Adults should get 150 minutes of moderate physical activity (or 75 minutes of vigorous activity) per week. Kids should aim for 60 minutes every day, including play and structured activities.
Sleep Well
Rest is a foundation of good health, not a reward. Protect your bedtime routine and give your body the recovery it deserves. Notice how good sleep makes everything else easier.
Smart Tip: Most adults need 7-9 hours of sleep each night. Children require more. Adequate sleep promotes healing, improves brain function and reduces the risk for chronic diseases.
Manage Stress
Check in with yourself regularly, both mentally and emotionally. Create simple moments to pause, breathe, laugh or step outside. Connection, kindness and calm all support a healthy heart.
Smart Tip:The first step to stress management is awareness. Step “away from yourself” for a moment. Objectively ask yourself, “Is my stress level too high?” If so, look at what might be causing that stress.
Ideas for Incremental Changes
- Dedicate 15 minutes at the beginning or end of the day to focus on self-care, whether it’s unwinding with some music, writing down your goals or reflecting on the highlights of the day.
- Aim to add an extra serving of fruits or veggies each day, such as creating a savory veggie omelet or exploring new smoothie blends that let you pack in the produce on the go.
- Give your cabinets a quick update and put the smaller plates front and center. When you use a smaller plate, you can fill it while still sticking to recommended serving sizes.
- If you’re not a fan of the gym, think about how your hobbies can play a role in your physical activity. Even gardening counts as physical activity, so get creative to get moving with an activity you truly enjoy.
- Establish a bedtime routine that allows you to ease into sleep more easily. Once you feel the impact of better-quality rest, you may find yourself more motivated to make a regular bedtime a priority.
Photos courtesy of Shutterstock
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