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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Lifestyle
How to Manage Symptoms of Heart Failure
Symptoms of Heart Failure: Managing heart failure is a significant expense to the U.S. healthcare system, costing the nation approximately $40 billion in 2020 and expected to increase to approximately $142 billion a year by 2050. If you (or a loved one) are living with the condition, consider these tips to help manage it.
How to Manage Symptoms of Heart Failure
(Feature Impact) Americans are facing a growing health challenge, with 1 in 4 adults at risk of heart failure, according to the Heart Failure Society of America. Additionally, approximately 6.7 million U.S. adults who are 20 years old or older are currently living with heart failure, and that number is projected to reach 8.7 million by 2030.
Managing heart failure is a significant expense to the U.S. healthcare system, costing the nation approximately $40 billion in 2020 and expected to increase to approximately $142 billion a year by 2050.
If you (or a loved one) are living with the condition, consider these tips to help manage it.
Adhere to the Treatment and Follow-Up Plan
Ongoing outpatient care is important when managing heart failure. Understand the treatment plan provided by your healthcare team, make diet and lifestyle changes, take medications as directed and keep recommended follow-up appointments.
Pay attention to changes in symptoms and communicate with your healthcare provider if treatment does not seem to be working as expected. If their conditions are left unmanaged, patients can experience a range of heart-failure-related symptoms such as shortness of breath, fatigue, buildup of fluid and more.
Understand Challenges with Diuretic Treatment
Diuretics help the body remove excess fluid and are commonly used to treat swelling, or edema, associated with heart failure. Your provider may try different diuretics, sometimes referred to as “water pills,” to manage your heart failure symptoms. However, intravenous (IV) diuretic therapy may be required for some patients if symptoms continue.
Ask About Treatment Options Before IV Care Is Needed
For some adults, a healthcare provider may consider recommending an at-home, non-oral diuretic option prior to escalating to IV therapy.
For example, ENBUMYST™ (bumetanide nasal spray) is a prescription diuretic used in adults to treat edema associated with congestive heart failure. It’s administered as a nasal spray for short-term use to manage excess fluid with the goal of transitioning to oral diuretic therapy when appropriate.
Talk with your healthcare provider to learn more and visit enbumyst.com. Read the full Prescribing Information and Patient Information.
Photo courtesy of Shutterstock
Important Safety Information
What is ENBUMYST?
ENBUMYST is a prescription medicine used in adults to treat swelling caused by excess fluid in the body (edema) from congestive heart failure, liver disease, and kidney disease.
What is the most important information I should know about ENBUMYST?
- ENBUMYST is a diuretic that helps your body remove fluid. Losing too much fluid can cause dehydration, low blood volume, and increase the risk of blood clots. Blood abnormalities may include decreased salts (electrolytes), and increased nitrogen, glucose and uric acid. The risk of these abnormalities is higher in elderly people, those using higher doses, or those who do not get enough electrolytes by mouth.
- You should not use ENBUMYST if you have severe electrolyte loss. Tell your healthcare provider if you experience unusual thirst; dizziness or lightheadedness; weakness or tiredness; fast heart rate; dry mouth or tongue; sudden pain; redness or swelling in your joints; pain, swelling, redness, or warmth in your leg; shortness of breath or fast breathing; high blood sugar; dark urine; pale, tight, cool or clammy skin; muscle cramps; confusion.
Do not use ENBUMYST if youhave low or no urine production or are allergic to bumetanide or to any of the ingredients in ENBUMYST.
Before using ENBUMYST, tell your healthcare provider if you have low electrolytes, are on a low-salt diet, have diarrhea, diabetes, nasal problems such as a runny or stuffy nose or polyps, a history of nasal injury or surgery, are or plan to become pregnant, are or plan to breastfeed.
Tell your healthcare provider about all the medicines you take, including prescriptions, over-the-counter medicines, vitamins, and herbal supplements.
ENBUMYST may cause serious side effects, such as worsening kidney function and ringing in the ears or hearing loss.
The most common side effects of ENBUMYST include dehydration, headache, muscle cramps, dizziness, low blood pressure, nausea, and abnormal brain functioning with certain liver problems.
These are not all the possible side effects of ENBUMYST. Talk to your healthcare provider for more information.
Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
US-ENBU-2600110
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Esperion
recipes
Keeping the Love of Food with Type 2 Diabetes
Living with Type 2 diabetes often means making adjustments to your daily routine, especially when it comes to food. Although adjusting to life with diabetes may take time, you don’t have to give up your favorite foods and flavors. In fact, it can be an opportunity to discover meals that support your health goals while still enjoying the foods you love.
(Feature Impact) Living with Type 2 diabetes often means making adjustments to your daily routine, especially when it comes to food. Whether you’re living with the condition or supporting someone who is, it can influence everything from meal planning to dinners out and everyday activities. Although adjusting to life with diabetes may take time, you don’t have to give up your favorite foods and flavors. In fact, it can be an opportunity to discover meals that support your health goals while still enjoying the foods you love.
That’s what professional chef and TV show host Kardea Brown did, alongside her husband Bryon Smith, who was recently diagnosed with Type 2 diabetes at age 38.
“When my husband was diagnosed with Type 2 diabetes, it didn’t mean the end of the foods we love,” Brown said. “It meant I had to get creative. I started reimagining my recipes, so they still carry that same soul, that same comfort, just with ingredients that love him back a little better.”
To remove the guesswork about how certain ingredients affect Smith’s glucose levels, the couple relies on Abbott’s FreeStyle Libre 3 Plus sensor with Libre Assist*, a feature within the accompanying Libre app**. The technology provides real-time glucose insights and can help predict how certain foods may affect his glucose^ levels before a meal.
“I open the Libre Assist feature in the app, snap a photo and instantly see how that food might affect me before I even take the first bite,” Smith said. “It even suggests healthier swaps to help lower the impact.”
Small lifestyle changes can also make a difference in diabetes management. Brown recommends:
- Building balanced meals that prioritize non-starchy vegetables, lean proteins and healthy carbs for added fiber.
- Reading labels carefully to ensure you choose ingredients with little or no added sugars.
- Boosting fiber intake with ingredients like lentils, oats, beans and whole fruits.
- Cooking smarter at home by using simple methods like grilling, baking or sauteing with healthy fats, such as olive or canola oil.
- Planning and preparing for success by shopping with a list and planning meals in advance so you always have nutritious ingredients ready to cook.
To learn more about Libre Assist and to see if you qualify for a free† sensor, visit freestylelibre.us/LibreAssist.
The views expressed in this article should not be used for medical diagnosis or treatment or as a substitute for professional medical advice. Individual symptoms, situations and circumstances may vary.
* Libre Assist is a feature within Libre app that uses generative artificial intelligence to provide information on how foods could impact your glucose levels. Generative artificial intelligence may not always be accurate, and it should not be used to make treatment decisions.
** The FreeStyle Libre systems apps are only compatible with certain mobile devices and operating systems. Please check the Support section of our website for more information about device compatibility before using the apps. Use of the FreeStyle Libre systems apps may require registration with LibreView.
^Predicted glucose impact is based on user-provided food data and may differ from actual impact, which depends on sensor readings and factors like activity, stress, medication and alcohol. For personalized advice, consult your healthcare provider.
†Offer available for people who qualify. Visit MyFreeStyle.us to see all Terms and Conditions. Certain exclusions apply. Medicare and Medicaid patients are not eligible. See MyFreeStyle.us for more information.
Important Safety Information: Product for prescription only, for Important Safety Information visit FreeStyleLibre.us.
Shrimp Scampi and Cauliflower Grits
Recipe courtesy of Kardea Brown on behalf of Abbott
Prep time: 15 minutes
Cook time: 25 minutes
Servings: 4
Grits:
- 3 cups low-sodium chicken broth
- 1 cup light cream
- 1 cup stone-ground grits
- 1 cup cauliflower rice
- 2 tablespoons butter
- 1/2 cup shredded Parmesan cheese
- 1/4 teaspoon salt
- 1/4 teaspoon black pepper
Shrimp Scampi:
- 2 tablespoons butter
- 2 tablespoons olive oil
- 4 cloves garlic, minced
- 1/2 teaspoon red pepper flakes (optional)
- 1 pound large shrimp, peeled and deveined
- 1/2 cup low-sodium chicken broth
- 2 tablespoons dry white wine
- 1 lemon, juice only
- 1 teaspoon lemon zest
- salt, to taste
- pepper, to taste
- 2 tablespoons chopped parsley
- To make grits: Bring broth and cream to gentle boil; whisk in grits. Cook 10-15 minutes. Stir in cauliflower rice and cook 5-7 minutes. Add butter, cheese, salt and pepper.
- To make shrimp scampi: In pan, heat butter and oil; saute garlic and red pepper flakes, if desired, 30 seconds. Add shrimp, cook 1-2 minutes per side and remove.
- Add broth, wine, lemon juice and lemon zest; simmer 2-3 minutes. Return shrimp; toss; season with salt and pepper, to taste; and stir in parsley.
- Serve shrimp over creamy grits.
Macaroni and Cheese with Chickpea Pasta
Recipe courtesy of Kardea Brown on behalf of Abbott
Prep time: 20 minutes
Bake time: 30 minutes
Servings: 4-6
Pasta:
- 8 ounces chickpea-based, gluten-free pasta
Bechamel Sauce:
- 2 tablespoons butter
- 3 tablespoons almond flour
- 1 cup half-and-half
- 1/2 cup heavy cream
- 1/2 cup low-sodium chicken or vegetable broth
- 1 teaspoon Dijon mustard
- 1/4 teaspoon garlic powder
- 1/4 teaspoon smoked paprika
- salt, to taste
- black pepper, to taste
Cheese Blend:
- 1 cup medium cheddar cheese, shredded
- 1/2 cup Gruyere cheese, shredded
- 1/4 cup Parmesan cheese, grated
Topping:
- 1/2 cup shredded cheddar and Gruyere cheese
- 2 tablespoons almond flour (optional)
- chopped parsley
- Preheat oven to 375 F and grease baking dish.
- To make pasta: Cook pasta al dente.
- To make bechamel sauce: Melt butter and whisk in almond flour, 1-2 minutes. Slowly add half-and-half, heavy cream and broth. Stir until thickened. Season with mustard, garlic powder, smoked paprika and salt and pepper, to taste. Remove from heat.
- To make cheese blend: Mix cheddar, gruyere and Parmesan. Stir half the cheese blend into bechamel sauce until smooth. Stir in pasta.
- Layer pasta and cheese sauce in dish: half pasta, half cheese and repeat. Top with reserved cheese and almond flour, if desired.
- Cover with foil and bake 15-20 minutes. Remove foil and bake 10-15 minutes uncovered until golden.
- Rest 5 minutes, garnish with parsley and serve warm.
Red Velvet Layer Cake with Almond Flour
Recipe courtesy of Kardea Brown on behalf of Abbott
Prep time: 25 minutes
Bake time: 20 minutes
Chill time: 30-60 minutes
Servings: 12
Cake:
- 2 cups almond flour
- 1 cup whole-wheat pastry flour
- 1 tablespoon unsweetened cocoa powder
- 1 1/2 teaspoons baking powder
- 1/2 teaspoon baking soda
- 1/2 teaspoon salt
- 1 1/2 cups monk fruit-allulose blend
- 3 large eggs
- 1/2 cup plain unsweetened Greek yogurt
- 1/3 cup avocado oil
- 3/4 cup buttermilk
- 1 tablespoon distilled vinegar
- 2 teaspoons vanilla extract
- red food coloring (optional)
Whipped Cream:
- 6 ounces cream cheese, softened
- 1/3 cup powdered monk fruit
- 1 1/2 cups cold heavy whipping cream
Berry Drizzle:
- 1/2 cup no-sugar-added wild berry jam
- 1-2 tablespoons water
- 1 teaspoon lemon juice (optional)
Filling and Topping:
- 2 cups mixed berries (strawberries, blueberries, raspberries)
- Preheat oven to 350 F and grease or line three 8-inch pans.
- To make cake: In bowl, mix almond flour, pastry flour, cocoa powder, baking powder, baking soda, salt and monk fruit-allulose blend. In separate bowl, mix eggs, Greek yogurt, avocado oil, buttermilk, distilled vinegar, vanilla extract and red food coloring, if desired. Combine dry and wet ingredients until smooth. Divide evenly into pans and bake 18-22 minutes. Cool completely.
- To make whipped cream: Whip cream cheese and monk sugar until smooth. Add cream gradually and whip to medium-stiff peaks. Chill.
- To make berry drizzle: Warm berry jam with water and lemon juice, if desired, until pourable; cool slightly.
- To assemble cake: Layer cake, whipped cream, jam and berries; repeat for three layers. Top with berries and drizzle.
- Chill 30-60 minutes before slicing.
Photo courtesy of Abbott (Bryon Smith and Kardea Brown, a paid partner)
SOURCE:
Abbott
Health
When Vision Changes: 5 Ways to Navigate What Comes Next
Whether sight changes suddenly or gradually, a question often follows: “Now what?” There is no single way to adjust to vision loss, and the questions can change over time. These five starting points can help you identify what matters most now and where to find support.
(Feature Impact) A change in vision can turn ordinary routines into unfamiliar challenges. A favorite book becomes harder to read. Walking through a familiar neighborhood feels different. A family member offers help, but you may not know how to ask for what you need. Whether sight changes suddenly or gradually, a question often follows: “Now what?”
Medical care is essential, but many people encounter a Grand Canyon-sized gap between clinical care and everyday life with vision loss. Questions arise around getting around safely, continuing to do things you love, talking to family about what is changing and more. The answers take more than information; they require practical guidance, emotional support and connection with people who understand.
“The medical conversation rarely has room for what people are actually grappling with: fear, grief and the very practical question of how to keep living the lives they want,” said Johnjoe Farragher, CEO of Hadley, a nonprofit dedicated to helping adults with vision loss. “Those ‘now what?’ moments are where people need a clear place to begin.”
There is no single way to adjust to vision loss, and the questions can change over time. These five starting points can help you identify what matters most now and where to find support.
Take One Step at a Time
You don’t have to solve every challenge at once. Ask your vision care team about your diagnosis and treatment then think about what is most difficult in daily life right now. It could be reading email, moving safely through your home or using your phone. Choose one concern to address first. A small, useful change can make the next step feel more manageable.
Make Room for the Emotional Side
Vision loss may bring grief, frustration, fear or a change in how you see yourself. Those feelings don’t have to be brushed aside before you can move forward. Share those feelings with someone you trust and seek professional support if you need it. Hearing how others navigated similar changes can help you feel less alone and identify possibilities you may not have imagined.
Find a Trusted Place to Begin
Ask your vision care team about support available in your community. If you’re unsure what to ask for, start with a specific daily challenge on your mind. Offering on-demand guidance, practical tools and opportunities to connect with others living with vision loss, Hadley focuses on life with vision loss beyond the doctor’s office. Its expert-informed guidance and community members address both practical problems and the emotions that come with them, shaped by lived experience. Support is available without cost or waitlists, whether you’re living with vision loss or helping someone you love.
Define Independence on Your Terms
Independence doesn’t have to mean doing everything alone. It may mean finding a new way to do something, choosing a tool that helps or telling family and friends exactly what assistance is useful. Think about a goal that matters to you, whether it’s getting around your home with more confidence or staying involved in a favorite activity, and build from there.
Keep Doing What Matters to You
A change in sight can change how you do things without ending your connection to the people and activities you love. The right adaptations depend on your vision, your interests and your goals.
For instance, when reading gets hard, magnifiers, enlarging fonts, access to free audiobooks and learning braille can make a difference. Passionate home chefs may use tactile or high-contrast labels, well-placed lighting, consistent organization or adaptive tools and techniques to keep cooking with confidence. Assistive technology, low-vision tools and simple adaptations can make everyday routines more accessible and help people stay connected to the activities and relationships that matter most.
When a new “now what?” question comes up, HadleyHelps.org offers a trusted place to start and a path forward.
Photos courtesy of Shutterstock
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