Q&A: How Acetaminophen-Autism Link Creates Concerns in Clinical Decision-Making

Following the unprecedented events leading to a potential link between acetaminophen use during pregnancy and autism spectrum disorder, health care providers and experts anticipate a lengthy time frame where they will be forced to refute this information for the benefits of their patients.

“Our society seems to have lost the ability to reasonably disagree with one another, particularly in matters where feet are dug in and there’s no chance to convert one’s views,” Mark Garofoli, PharmD, BCGP, CPE, CTTS, clinical assistant professor at the West Virginia University School of Pharmacy, told Drug Topics. “We just walked into a scenario where, for the next few decades, us health care professionals will spend an incredible amount of time and energy refuting the acetaminophen claims.”

While the events surrounding this disrupting claim have certainly led to debates and confusion, Garofoli does not believe providers will be forced to make sweeping changes in the ways they recommend clinical approaches or manage their patients. Rather, he believes news of this potential link will create further divide between patients and providers when it comes to making a shared clinical decision.

Garofoli discusses what the future will hold regarding clinical decision-making following the reported acetaminophen-autism link. | image credit: Kenishirotie / stock.adobe.com

Read through the final part of our interview with the “Pain Guy” Mark Garofoli, who touched on this news’ impact on mothers, patients with acute or chronic pain, health care providers across the country, and public health as a whole.

READ MORE: Q&A: Pain Medication Expert on Controversy Surrounding Acetaminophen-Autism Link

Drug Topics: If the Trump Administration is successful in its commitment to phase out acetaminophen, how do you believe pregnancy outcomes and pain management will evolve in the near future?

Mark Garofoli: Perhaps one of the most concerning aspects of this entire adventure [is] our pregnant mothers. Some have pointed to the realization that if a pregnant mother elects to utilize acetaminophen as appropriate, there now comes a potential ‘shame’ for ‘not sucking it up.’ As a father and husband, myself, I can attest to the incredible efforts that our mothers go through in the entire pregnancy experience, albeit not with my own body, obviously.

To think that a pregnant mother would be shamed into not treating her own incredible needs (fever, pain) is not only deeply concerning on a compassionate level, yet clinically concerning as the resultant tachycardia, hypertension, anxiety, stress—amongst other sequelae—can literally be detrimental to both the pregnant mother and child. Given the poignant response of just about all respective health care professional organizations—American College of Physicians, American Pharmacists Association, the list goes on and on—I do not anticipate many health care professionals to change their practice. Rather, the concern lies with patient perspectives within the shared decision-making process.

All medication comes with baggage (side effects) along with various dosage factors such as hepatic and renal function. When taken appropriately, acetaminophen has been deemed safe and efficacious enough to be available as an OTC medication. Let’s not lose sight of that concept. Hopefully, the current landscape doesn’t facilitate conversations on conversion to prescription-only status; particularly considering that approximately 50,000 patients a year present to the ER with acetaminophen toxicity due to taking well more than recommended doses. However, there is an appreciable difference in a patient in pain utilizing an OTC medication appropriately and someone ingesting an entirely more-than-recommended number of pills.

Drug Topics: Whether in the spaces of neurodevelopmental disorders, public health, or pain management, where do you see this recent event taking the greater health care community as the Trump Administration continues to make industry-impacting claims and recommendation updates?

Mark Garofoli: Unfortunately, further divide. Our society seems to have lost the ability to reasonably disagree with one another, particularly in matters where feet are dug in and there’s no chance to convert one’s views. We just walked into a scenario where, for the next few decades, us health care professionals will spend an incredible amount of time and energy refuting the acetaminophen claims. Sound familiar? [Do] immunizations come to mind? Just so unfortunate.

READ MORE: Q&A: Acetaminophen-Autism Link Highlights Issues of Confounding Evidence

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our free Drug Topics newsletter.