Thanks for your balanced approach! 5+ years ago, I had a concussion from a car accident. Early on, doctors suggested using Tylenol instead of ibuprofen for pain to reduce risk of brain bleeds. A few months later I mentioned to the family medicine doctor I was still using Tylenol and he was very concerned and checked my blood levels. That was the first I was made aware of risks of regular Tylenol usage. It's probably not great for a healing brain, either.
That’s about the highest compliment I could ever receive. Thank you for sharing it. Lots of things are safe short term that aren’t safe long-term and safe is always a relative word! The craziest thing about all of this is that people are fighting back against a recommendation that says don’t take it unless you need it. That should be the standard for all medications! Tylenol can cause anemia and liver dysfunction, even at normal doses when taken for extended periods I hope that you recovered well!
I think it was liver function he was most concerned with. I suspect my usage wasn't enough to cause severe problems, anyway. I did recover well, my biggest issue post concussion was blurry vision and light sensitivity. It took awhile and lots of vision therapy but my vision seems better after all the therapy. I'm definitely more light tolerant (no sunglasses) than my previous baseline.
So glad you are on the up and up. Something that most people with concussions are surprised to learn is that there are therapies that actually help! Thank you so much for chiming in here. Appreciate having you as a critical thinker here asking questions!
Thank you so much! It was hard to achieve the right balance, but I hope it was understandable and doesn’t try to make the point that I know anything other than there are real questions that should be asked and why are we fighting asking them?!
It sounds like good studies to continue to perform, and I hope dollars are made available — lots of federal grant dollars, including NIH grants, were halted earlier this year.
My take is that the sibling correlation study refutes the Harvard literature review pretty well. I also think that the particular spokespeople were poorly chosen — the President was unable to pronounce acetaminophen, and obviously the Secretary’s position on autism causes has been extremely controversial (and his book on the subject was horrible and incredibly misleading at best).
I agree that less medicine is better (I hardly take Tylenol or anything else because of course there are trade offs). But saying that stopping it doesn’t have a cost, as the President did, is obviously wrong and misguided.
So, let’s get the money flowing again for these studies, get reputable people to make announcements on what the science says and where the gaps are, and help everyone get a little healthier!
While I don't at all disagree with anything the President said (he basically said, don't take stuff unless you really need it - which is literally the most reasonable statement imaginable), anytime he says ANYTHING we know that 40% of people are going to argue the opposite, so leaning into Marty and Jay may have been a better tactic to be heard -although they are probably on the media's naughty list too so ???
I found the pronunciation thing to be endlessly fascinating. So it happens bc we all say brand names behind closed doors (literally this is how most ppl talk bc they are shorter/catchier/better known) but for legal reasons you have to use the actual drug name for stuff like this. Someone should have made sure he saw what he was supposed to read before hand - that was sloppy. BUT what was super interesting to me was the number of healthcare professionals dogging on him for not pronouncing it correctly (super telling).
I spend a lot of time preaching to patients about how it's fine to speak up and not know everything and advocate for what is right... and seeing so many of my colleagues making really tasteless comments about someone saying a drug name wrong proved that there are more elitist arrogant jerks practicing medicine than I thought. I have zero tolerance for that behavior and lost respect for a lot of 'professionals'
That said, again, totally agree that Marty and Jay do a great job at the podium and should have done more talking, but at the same time hard to argue with 'don't take chemicals if you don't need them bc there always unknown unknowns.'
I'll talk through study nuance in a separate comment, but mostly it's all small potatoes that can be argued and refuted forever, but the truth is none of the right studies have been done. So the right call is exactly as you noted above... GET THE MONEY FLOWING (it's being spent anyway)!
I will stop and listen, and try to understand, the science/medical talk every time. The political talk I tune out quickly, and from both sides. Thank you for the science talk and for not trying to tell me to feel one way or the other about what it says.
Yay! That's exactly what I like too! Both sides have been guilty of pushing an agenda of course. But science isn't (or shouldn't be) partisan. People already don't trust public health. We need more straight talk and less screeching. I don't know what the outcome of all of this will be, but I DO know that there are good reasons to be cautious and support actual well-designed studies. Thankfully, (and this is my bias) I think Marty and Jay are well suited to the task.
I am a big believer in looking to the research and it seems in this case that the link to autism hasn't been fully established yet. So, in my view, the president getting up and scaring people about it is just as bad as those who are popping Tylenol just for spite. Trouble is, no one seems to want to do the research. Instead, they just dig in their heels and look for "evidence" that they are right.
Thank you for providing a scientifically based explanation that is measured and non-political. We really need this information now more than ever. I'd love to see more studies in the future that can actually prove or disprove the link as well as what other environmental factors may be at play.
By the way, I was one of those who didn't take ANYTHING when I was pregnant because I wasn't sure how it would affect my daughter. ;-)
I love this comment so much. Lot of people were annoyed that he said too many things… My take when I was watching it was that the doctors were willing to wait until the science is for the moment at least… Settled and he wanted to at least say look I’m not an expert, but if Harvard is saying, and my staff is saying that there are risks involved, I don’t wanna wait three months and let people potentially hurt their babies by taking medical treatment that they could’ve actually avoided and would have had they known that it was a possibility. I guess to me it felt like informed consent, and transparency more than saying things before you should. Especially because it came from him as a policy maker and not from like the FDA commissioner.
Bring on the studies! All I want are well designed, well powered studies. Everyone is spending my tax dollars anyway, please spend it in a way that you can statistically answer the question we need answered!
I was too young to have that much humility. I definitely took medicines with both of my kids and if I had to do it over again, I would have been way more careful!
😋I always give the benefit of the doubt it’s a blessing and a curse. Ironically, I don’t remember what the exact quote he gave about the bleach was but a few months after that happened we literally started using this antiseptic treatment in our patients noses to essentially disinfect Covid from the nasal area. It worked and became protocol for all inpatient admissions. it always made me laugh because I thought well... I guess he was onto something but not bleach, sir that’s not gonna work 😂
Great points all around. The only way to misunderstand/fail at "science" is to determine that it's settled, we can't question existing positions, and more data is bad.
This is the only sane opinion ironically. If there are questions that need to be answered, and you’re already spending a bazillion of my tax dollars please for the love of God spend them answering the question in a reasonable and statistically defensible way. Thank you, all of America.
Yes, the conversion of paracetamol to napqi and the consequent liver toxicity at high doses is standard pharmacology.
However, the hypothesis that Tylenol consumption at therapeutic doses leads to autism is implausible on its face. Every human cell produces glutathione. The production of NAPQI occurs in the liver from a group of CYPs, and at therapeutic doses, hepatocyte glutathione is barely depleted at all (ie models suggest that intracellular glutathione falls from 6 mM to 5.5 mM). Even at supratherapeutic doses of Tylenol like 5 grams in a day, hepatic glutathione is estimated to reach a minimum concentration of 4.5 mM about 5 hours after a dose, before recovering.
For the APAP->NAPQI->autism hypothesis to make sense mechanistically, you would need NAPQI levels in the developing brain tissue to be high enough to permanently alter the tissues. Since the brain tissue does not produce appreciable levels of CYPs, the NAPQI would therefore need to be produced in the maternal or fetal liver, escape the liver without inactivation by hepatic glutathione, distribute to the general circulation, travel to the brain tissue, and overwhelm the glutathione present in those tissues.
This mechanism of mom taking therapeutic doses of Tylenol leading to the child developing autism just makes no sense from a pharmacokinetic standpoint.
Thank you for your context here, although i think that there are a few issues unaddressed still - I think you would need NAPQI to be high enough in developing brain tissue OR you would need anemia/lower O2 to developing brain tissue which is also plausible in heavy use given APAP affects on RBC OR the most likely plausible issue of APAP lowering glutathione then adding high doses (high according to calculations based on EPA UL data) of ethylmercury and aluminum. When you crunch the numbers of giving multiple shots of those in combo with 3 days of APAP around the clock fighting post-vaccination fever/irritability...etc. there is definitely plausibility for neurotoxic harms- based on synergy (this is well-established in the literature mercury+lead for example is exponentially worse than either alone...etc)
Thanks for your balanced approach! 5+ years ago, I had a concussion from a car accident. Early on, doctors suggested using Tylenol instead of ibuprofen for pain to reduce risk of brain bleeds. A few months later I mentioned to the family medicine doctor I was still using Tylenol and he was very concerned and checked my blood levels. That was the first I was made aware of risks of regular Tylenol usage. It's probably not great for a healing brain, either.
That’s about the highest compliment I could ever receive. Thank you for sharing it. Lots of things are safe short term that aren’t safe long-term and safe is always a relative word! The craziest thing about all of this is that people are fighting back against a recommendation that says don’t take it unless you need it. That should be the standard for all medications! Tylenol can cause anemia and liver dysfunction, even at normal doses when taken for extended periods I hope that you recovered well!
I think it was liver function he was most concerned with. I suspect my usage wasn't enough to cause severe problems, anyway. I did recover well, my biggest issue post concussion was blurry vision and light sensitivity. It took awhile and lots of vision therapy but my vision seems better after all the therapy. I'm definitely more light tolerant (no sunglasses) than my previous baseline.
So glad you are on the up and up. Something that most people with concussions are surprised to learn is that there are therapies that actually help! Thank you so much for chiming in here. Appreciate having you as a critical thinker here asking questions!
Well written!
Thank you so much! It was hard to achieve the right balance, but I hope it was understandable and doesn’t try to make the point that I know anything other than there are real questions that should be asked and why are we fighting asking them?!
It sounds like good studies to continue to perform, and I hope dollars are made available — lots of federal grant dollars, including NIH grants, were halted earlier this year.
My take is that the sibling correlation study refutes the Harvard literature review pretty well. I also think that the particular spokespeople were poorly chosen — the President was unable to pronounce acetaminophen, and obviously the Secretary’s position on autism causes has been extremely controversial (and his book on the subject was horrible and incredibly misleading at best).
I agree that less medicine is better (I hardly take Tylenol or anything else because of course there are trade offs). But saying that stopping it doesn’t have a cost, as the President did, is obviously wrong and misguided.
So, let’s get the money flowing again for these studies, get reputable people to make announcements on what the science says and where the gaps are, and help everyone get a little healthier!
Totally agree these are good studies to be done!
While I don't at all disagree with anything the President said (he basically said, don't take stuff unless you really need it - which is literally the most reasonable statement imaginable), anytime he says ANYTHING we know that 40% of people are going to argue the opposite, so leaning into Marty and Jay may have been a better tactic to be heard -although they are probably on the media's naughty list too so ???
I found the pronunciation thing to be endlessly fascinating. So it happens bc we all say brand names behind closed doors (literally this is how most ppl talk bc they are shorter/catchier/better known) but for legal reasons you have to use the actual drug name for stuff like this. Someone should have made sure he saw what he was supposed to read before hand - that was sloppy. BUT what was super interesting to me was the number of healthcare professionals dogging on him for not pronouncing it correctly (super telling).
I spend a lot of time preaching to patients about how it's fine to speak up and not know everything and advocate for what is right... and seeing so many of my colleagues making really tasteless comments about someone saying a drug name wrong proved that there are more elitist arrogant jerks practicing medicine than I thought. I have zero tolerance for that behavior and lost respect for a lot of 'professionals'
That said, again, totally agree that Marty and Jay do a great job at the podium and should have done more talking, but at the same time hard to argue with 'don't take chemicals if you don't need them bc there always unknown unknowns.'
I'll talk through study nuance in a separate comment, but mostly it's all small potatoes that can be argued and refuted forever, but the truth is none of the right studies have been done. So the right call is exactly as you noted above... GET THE MONEY FLOWING (it's being spent anyway)!
I will stop and listen, and try to understand, the science/medical talk every time. The political talk I tune out quickly, and from both sides. Thank you for the science talk and for not trying to tell me to feel one way or the other about what it says.
Yay! That's exactly what I like too! Both sides have been guilty of pushing an agenda of course. But science isn't (or shouldn't be) partisan. People already don't trust public health. We need more straight talk and less screeching. I don't know what the outcome of all of this will be, but I DO know that there are good reasons to be cautious and support actual well-designed studies. Thankfully, (and this is my bias) I think Marty and Jay are well suited to the task.
I am a big believer in looking to the research and it seems in this case that the link to autism hasn't been fully established yet. So, in my view, the president getting up and scaring people about it is just as bad as those who are popping Tylenol just for spite. Trouble is, no one seems to want to do the research. Instead, they just dig in their heels and look for "evidence" that they are right.
Thank you for providing a scientifically based explanation that is measured and non-political. We really need this information now more than ever. I'd love to see more studies in the future that can actually prove or disprove the link as well as what other environmental factors may be at play.
By the way, I was one of those who didn't take ANYTHING when I was pregnant because I wasn't sure how it would affect my daughter. ;-)
I love this comment so much. Lot of people were annoyed that he said too many things… My take when I was watching it was that the doctors were willing to wait until the science is for the moment at least… Settled and he wanted to at least say look I’m not an expert, but if Harvard is saying, and my staff is saying that there are risks involved, I don’t wanna wait three months and let people potentially hurt their babies by taking medical treatment that they could’ve actually avoided and would have had they known that it was a possibility. I guess to me it felt like informed consent, and transparency more than saying things before you should. Especially because it came from him as a policy maker and not from like the FDA commissioner.
Bring on the studies! All I want are well designed, well powered studies. Everyone is spending my tax dollars anyway, please spend it in a way that you can statistically answer the question we need answered!
I was too young to have that much humility. I definitely took medicines with both of my kids and if I had to do it over again, I would have been way more careful!
Okay, I'll give the benefit of the doubt on this one. However, he also told us to drink bleach to counter COVID so...
😋I always give the benefit of the doubt it’s a blessing and a curse. Ironically, I don’t remember what the exact quote he gave about the bleach was but a few months after that happened we literally started using this antiseptic treatment in our patients noses to essentially disinfect Covid from the nasal area. It worked and became protocol for all inpatient admissions. it always made me laugh because I thought well... I guess he was onto something but not bleach, sir that’s not gonna work 😂
Great points all around. The only way to misunderstand/fail at "science" is to determine that it's settled, we can't question existing positions, and more data is bad.
This is the only sane opinion ironically. If there are questions that need to be answered, and you’re already spending a bazillion of my tax dollars please for the love of God spend them answering the question in a reasonable and statistically defensible way. Thank you, all of America.
Yes, the conversion of paracetamol to napqi and the consequent liver toxicity at high doses is standard pharmacology.
However, the hypothesis that Tylenol consumption at therapeutic doses leads to autism is implausible on its face. Every human cell produces glutathione. The production of NAPQI occurs in the liver from a group of CYPs, and at therapeutic doses, hepatocyte glutathione is barely depleted at all (ie models suggest that intracellular glutathione falls from 6 mM to 5.5 mM). Even at supratherapeutic doses of Tylenol like 5 grams in a day, hepatic glutathione is estimated to reach a minimum concentration of 4.5 mM about 5 hours after a dose, before recovering.
For the APAP->NAPQI->autism hypothesis to make sense mechanistically, you would need NAPQI levels in the developing brain tissue to be high enough to permanently alter the tissues. Since the brain tissue does not produce appreciable levels of CYPs, the NAPQI would therefore need to be produced in the maternal or fetal liver, escape the liver without inactivation by hepatic glutathione, distribute to the general circulation, travel to the brain tissue, and overwhelm the glutathione present in those tissues.
This mechanism of mom taking therapeutic doses of Tylenol leading to the child developing autism just makes no sense from a pharmacokinetic standpoint.
Thank you for your context here, although i think that there are a few issues unaddressed still - I think you would need NAPQI to be high enough in developing brain tissue OR you would need anemia/lower O2 to developing brain tissue which is also plausible in heavy use given APAP affects on RBC OR the most likely plausible issue of APAP lowering glutathione then adding high doses (high according to calculations based on EPA UL data) of ethylmercury and aluminum. When you crunch the numbers of giving multiple shots of those in combo with 3 days of APAP around the clock fighting post-vaccination fever/irritability...etc. there is definitely plausibility for neurotoxic harms- based on synergy (this is well-established in the literature mercury+lead for example is exponentially worse than either alone...etc)