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ritastrakosha

Acetaminophen Use for Fever in Children Associated with Autism Spectrum Disorder

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There is this interesting study from Stephen Schultz and Georgianna Gould "Acetaminophen Use for Fever in Children Associated with Autism Spectrum Disorder", published in 2016:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044872/

Conclusion of the study:

"In summary, we have presented evidence for the association of acetaminophen use with ASD. Our theory of how this may occur can be explained in the following illustration. Suppose a susceptible young boy has a fever due to a viral infection or after the MMR vaccination. His parents give him acetaminophen which increases endocannabinoid stimulation in his brain making him feel better and bringing down his fever. But the increased activation of the endocannabinoid system also decreases immune system function which prolongs the illness and leads to even more acetaminophen use. Eventually, the boy recovers but his endocannabinoid system has been dysregulated to a lower level to compensate for the prolonged over-activation. Now the neurons in his brain are not getting the proper guidance for their growth through CB1 receptors and further suffer from increased inflammation due to lack of CB2 regulation in immune system cells. The boy develops ASD. When the boy gets a fever, his parents again give him acetaminophen but it no longer works well since his endocannabinoid tone is at a low level, and his parents switch to ibuprofen. Also, when he gets a fever, the increased anandamide levels briefly increase endocannabinoid tone and improve his sociability. After the fever, the endocannabinoid tone again drops back to low levels and his sociability decreases again. His condition, however, may be reversible with new cannabinoid medications to increase endocannabinoid system activation and allow his brain to slowly recover. Research needs to be conducted to see if PEA, cannabidiol, or other cannabinoids will be effective treatments for ASD."

Acetaminophen has also been associated with increased risk for food allergies, asthma.

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The fact that they even mention the MMR vaccine is a big red flag.

It doesn't get better when you read the actual report

"fewer children with ASD vs. non-ASD children use acetaminophen as a “first choice” compared to “never use”"

Read that through a few times.

Yep, they say that fewer autistic kids use acetaminophen and then the conclude that acetaminophen may be a cause of autism.

They go on to say 

"We found significantly more children with ASD vs. non- ASD children change to the use of ibuprofen when acetaminophen is not effective at reducing fever (p = 0.033) and theorize this change in use is due to endocannabinoid system dysfunction. ".

I have a different hypothesis.

Parents of kids with ASD are frazzled.

If their child- who is already hard to deal with- gets a fever and is thus even more  challenging, they are more likely to try another  drug than the less frazzled parents of kids without ASD.

 

To follow that they say "We also found that children with ASD vs. non-ASD children are significantly more likely to show an increase in sociability when they have a fever (p = 0.037) 

Well, just for a start, how objective is a measure of "an increase in sociability"?

But even more tellingly- what they are saying is that kids who are - as a baseline- not very sociable are more likely to become more sociable than kids who were sociable to start with.

 

I'm not sure that a journal called "autism open access" is an entirely unbiased source.

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1 hour ago, Strange said:

For those outside the US, acetaminophen = paracetamol.

Oh thats just wonderful isn’t it.

In my search for data on vaccines (especially MMR) in the last year or so I spoke to quite a few mothers of autistic children between the ages of 8 and 15. All of them went through a 180 degree shift from initial anger and lobbying against vaccines to getting the knowledge and lobbying against the anti-vaccine movement. The psychological mechanisms of this conspiracy theory are equally astonishing as they are dangerous. 

Edited by koti

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2 minutes ago, koti said:

Oh thats just wonderful isn’t it. 

Roughly as wonderful as the inability to spell  "colour", and equally irrelevant.

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30 minutes ago, John Cuthber said:

Roughly as wonderful as the inability to spell  "colour", and equally irrelevant.

I don’t get it.

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4 minutes ago, John Cuthber said:

This

For those outside the US, acetaminophen = paracetamol.

isn't wonderful.

I get that. And I get that you get that its sarcasm. I don’t get the inability to spell „colour” part. 

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Ask an American how to spell it.

It's a comment on the fact that they just like to get my language wrong. :)

Edited by John Cuthber

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On 2/21/2018 at 10:28 PM, John Cuthber said:

The fact that they even mention the MMR vaccine is a big red flag.

It doesn't get better when you read the actual report

"fewer children with ASD vs. non-ASD children use acetaminophen as a “first choice” compared to “never use”"

Read that through a few times.

Yep, they say that fewer autistic kids use acetaminophen and then the conclude that acetaminophen may be a cause of autism.

They go on to say 

"We found significantly more children with ASD vs. non- ASD children change to the use of ibuprofen when acetaminophen is not effective at reducing fever (p = 0.033) and theorize this change in use is due to endocannabinoid system dysfunction. ".

I have a different hypothesis.

Parents of kids with ASD are frazzled.

If their child- who is already hard to deal with- gets a fever and is thus even more  challenging, they are more likely to try another  drug than the less frazzled parents of kids without ASD.

 

To follow that they say "We also found that children with ASD vs. non-ASD children are significantly more likely to show an increase in sociability when they have a fever (p = 0.037) 

Well, just for a start, how objective is a measure of "an increase in sociability"?

But even more tellingly- what they are saying is that kids who are - as a baseline- not very sociable are more likely to become more sociable than kids who were sociable to start with.

 

I'm not sure that a journal called "autism open access" is an entirely unbiased source.

Fewer older autistic kids used acetaminophen because they changed to the use of ibuprofen.  Did the parents who usually used ibuprofen as first choice change to acetaminophen at the same rate as the parents who used acetaminophen as first choice? If the answer is yes, than you would be right that it is rather the anxiety of the parents that is making them change between medications. If the answer is no, than the culprit would be acetaminophen. 

The increase of sociability is as objective as the sociability term itself is, as objective as psychiatry/psychology can get. 

 

 

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So, on balance, there isn't evidence in that paper which shows a causal relationship between acetaminophen and autism.

1 hour ago, ritastrakosha said:

 Did the parents who usually used ibuprofen as first choice change to acetaminophen at the same rate as the parents who used acetaminophen as first choice?

We don't (yet) know what causes autism, but something does- there is some "causation event".

Anything that happens after that event can not tell us anything about the event itself.

So, a study of a change in painkillers* after the condition is noticed  can't tell us what the causation event was.

A study of children who don't have the condition also can't tell us much about it.

To me, it seems that whole paper is nonsense based on a pointless study.

It gives a clear outcome- fewer kids with ASD got acetaminophen- and yet they report this as "acetaminophen causes autism"- which is clearly nonsense.

The resources they used would probably have been better  employed elsewhere.

 

 

* It's also important to recognise that the change of painkiller is an action by the parents, not the patient; so it's not directly related to any effect of the drug on the child.

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On 2/24/2018 at 12:48 PM, John Cuthber said:

Anything that happens after that event can not tell us anything about the event itself.

The causative factor can continue to effect the result (autism) if applied again. There are degrees of disease and different severity of symptoms. 

 

On 2/24/2018 at 12:48 PM, John Cuthber said:

A study of children who don't have the condition also can't tell us much about it.

 

The study uses the non-ASD children as controls. The contrast between the non-ASD and ASD children can tell something about ASD. 

 

On 2/24/2018 at 12:48 PM, John Cuthber said:

It gives a clear outcome- fewer kids with ASD got acetaminophen- and yet they report this as "acetaminophen causes autism"- which is clearly nonsense.

 

They explain their theory behind the statement. More studies can be done to clarify the causation, if there is any. 

 

On 2/24/2018 at 12:48 PM, John Cuthber said:

It's also important to recognise that the change of painkiller is an action by the parents, not the patient; so it's not directly related to any effect of the drug on the child

Parents can directly observe different effects of the drug. 

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14 hours ago, ritastrakosha said:

The study uses the non-ASD children as controls. The contrast between the non-ASD and ASD children can tell something about ASD. 

That's as may be, but that doesn't mean it tells you what causes ASD.  My autistic husband wears sunglasses more than a non-autistic person (and did so long before his autism diagnosis) because he's very sensitive to bright light, that doesn't mean wearing sunglasses caused his autism.

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On 2/24/2018 at 5:48 AM, John Cuthber said:

So, a study of a change in painkillers* after the condition is noticed  can't tell us what the causation event was.

 

That is true, for example the cause could very well be an infection that prompted acetaminophen use in the first place. That being said, finding cause relationships is a high bar for epidemiological studies. Especially for effects that differ between humans and common animal models these links may be very hard to establish even in detailed follow-up studies. As a general precaution it is therefore recommended to minimize medication, when not medically indicated.

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On 2/28/2018 at 8:42 PM, ritastrakosha said:

More studies can be done to clarify the causation, if there is any. 

More studies, and far better ones than this hogwash.

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1 hour ago, John Cuthber said:

More studies, and far better ones than this hogwash.

I have not read that one, but there was one from a Spanish cohort that, in my memory, was not terribly conclusive, and clearly not in a clinical sense. Also the effect was not really worrisome and the authors themselves have acknowledged that it does not justify any change in medical practice. However, in my memory that study was conduct fairly typically with no huge warning signs (aside from the usual cautions and limits of these type of studies).

 

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On 2/24/2018 at 6:48 AM, John Cuthber said:

To me, it seems that whole paper is nonsense based on a pointless study.

 

Autism is so serious and epidemic that ANY thought to its cause is valuable even if only for the fact that it stimulates discussion and raises possibilities.

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18 minutes ago, coffeesippin said:

Autism is so serious and epidemic that ANY thought to its cause is valuable even if only for the fact that it stimulates discussion and raises possibilities.

I disagree completely. ANY thought?! No way. The anti-vax conspiracy has caused untold damage to the credibility of medicine in general. Some thoughts are just plain stupid and harmful.

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26 minutes ago, coffeesippin said:

Autism is so serious and epidemic that ANY thought to its cause is valuable even if only for the fact that it stimulates discussion and raises possibilities.

The whole anti-vaxxer thing stems from an erroneous study done in the UK.

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Your concern is the credibility of medicine, my concern is the life of my children. Do you care for the life of millions of children? If yes, the credibility of medicine is of minor importance. Medicine has never been an exact science, like math and physics, so every finding and practice in medicine is up for improvement, change. 

16 hours ago, StringJunky said:

The whole anti-vaxxer thing stems from an erroneous study done in the UK.

One study?? One scientist?? There are dozens of them.

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1 hour ago, ritastrakosha said:

Your concern is the credibility of medicine, my concern is the life of my children. Do you care for the life of millions of children? If yes, the credibility of medicine is of minor importance. Medicine has never been an exact science, like math and physics, so every finding and practice in medicine is up for improvement, change. 

One study?? One scientist?? There are dozens of them.

That was the one that was cited most often, that I saw when it was all the rage. If you care about your children, you'll get them vaccinated; inaction is pure negligence, unless medically advised not to do so. Those people that can't have it need protecting by those people that can have it..Immunisation is one of those things where we all have to be in it together for it to be effective in protecting each other.

Edited by StringJunky

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6 minutes ago, StringJunky said:

That was the one that was cited most often, that I saw when it was all the rage. If you care about your children, you'll get them vaccinated; inaction is pure negligence, unless medically advised not to do so. Those people that can't have it need protecting by those people that can have it..Immunisation is one of those things where we all have to be in it together for it to be effective in protecting each other.

Viruses are triggers for inflammatory diseases. Bacteria are triggers for inflammatory diseases. Heavy metals, like aluminum, are triggers for inflammatory diseases. But vaccines, which have all of these, cannot cause any problems?! Yehuda Shoenfeld is much more up to date with vaccines and immunity than Wakefield (but Wakefield was a pioneer). I recommend you read Shoenfeld. There are diseases which are not transmittable (tetanus), there are vaccines which do not impede transmission (pertussis vaccine), there are vaccinated people who spread the disease they are vaccinated against (influenza), there are diseases which are less dangerous than the diseases that vaccines exacerbate (mumps versus asthma), there are facultative vaccines, and there are children genetically susceptible to autoimmune diseases. In all these cases, it is better left to the individual to vaccinate or not. 

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1 hour ago, ritastrakosha said:

Wakefield (but Wakefield was a pioneer)

Wakefield was a fraud who was struck off for his near-criminal activities. He is personally responsible for thousands, possibly millions, of deaths. Not someone I would recommend using as any sort of reference. 

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4 minutes ago, Strange said:

Wakefield was a fraud who was struck off for his near-criminal activities. He is personally responsible for thousands, possibly millions, of deaths. Not someone I would recommend using as any sort of reference. 

He is a scientist. By your logic Einstein is responsible for the atomic bomb and Kalashnikov for wars' victims. After you discover something you decide what you use it for. He discovered very interesting things and he had minor procedural problems with his research. His colleague who cooperated in the research won the trial. 

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