The Four Horseman of the Woo-pocalypse join President Trump to spread autism pseudoscience and quackery

Regular readers of my not-so-secret other blog probably wonder why I haven’t written about the thing that everyone knows about, you know, the thing that happened late in the afternoon a couple of days ago. Yes, I am referring to President Trump and HHS Secretary Robert F. Kennedy Jr.‘s press conference on autism. It turns out that the timing was bad for my not-so-super-secret other blog, as my posting day is Monday, and, worse, the timing of this press conference on autism was…bad. I couldn’t watch it live. On the other hand, maybe that wasn’t so bad. Taking all the lies, quackery, scientific misinformation, and, yes, antivax pseudoscience being proclaimed to the nation by the President himself and the very highest-ranking members of the federal public health, medical, and biomedical research establishment would have been bad for my hypertension, I was thus able to watch it in small doses, thus saving my health. The other problem I faced was that I wanted to resurrect this blog with a post about this press conference, only to find that there is a technical issue with WordPress that has made accessing the back end to actually publish a new post very challenging. I won’t go into the details, but to be able to truly resurrect this blog, I need to spend some time dealing with technical support, so that I can access the back end without having to do various contortions.

Maybe I should just move to Substack, like everyone else, but that’s another issue. (Feel free to comment about it, if WordPress lets you. I promise to get this old hulk of a blog working again soon, as the workarounds to get this posted were pretty kludgy.)

Be that as it may, let’s discuss what drove me to work to resurrect this blog. You know what I’m talking about, I’m sure. I’m referring to President Donald Trump and HHS Secretary Robert F. Kennedy, Jr.’s press conference to announce their findings thus far investigating the “cause” of autism. Let’s just say that it was even worse than I feared that it would be, a veritable firehosing Gish gallop of autism pseudoscience, anecdotes, and, yes, antivax disinformation that presented bogus “findings” that acetaminophen use during pregnancy is linked with autism as fact and proposed using leucovorin (more on that later) to prevent and treat autism, complete with the government saying that Medicaid would pay for it.

The Four Horsemen of the Woo-pocalypse and Dear Leader

Watching this press conference led me to label our current federal health leadership as the Four Horsemen of the Woo-pocalypse. The Horsemen include, of course, HHS Secretary RFK Jr., NIH Director Jay Bhattacharya, FDA Commissioner Marty Makary, and CMS Commissioner Mehmet Oz. No, seriously. Look at them. They are truly the Four Horsemen that herald the end of US leadership in biomedical research, public health, and medical advancements in favor of bad science, pseudoscience, quackery, and, yes, antivax nonsense. Why do I add the bit about antivax quackery? Simple. Leading up to the press conference, news reports indicated that this press event would be primarily about the administration’s nonsense “conclusion” that taking acetaminophen (most famous trade name Tylenol) during pregnancy is associated with an increased risk of autism and autism spectrum disorders (ASDs). At the time, I thought that this was probably strategic, that RFK Jr. knew that if the first promised finding of his autism initiative that he announced in May, in which he promised to find announce the first findings about the cause of autism in September, concluded it was vaccines, the predictions of people like me (who repeatedly said that he’ll conclude it’s vaccines) would be validated. As I’ve said ever since I heard that the first autism report this month would blame Tylenol during pregnancy for autism, I knew that the next report would blame vaccines.

For your edification, in case you want to subject yourself to it too, here’s the full press conference:

Before I discuss the administration’s “finding” that Tylenol use during pregnancy increases the risk of autism and that the use of leucovorin can be used to decrease the risk and to treat autism, let me just say very clearly that this was an antivax press conference run by the President. Don’t believe me? Listen to President Trump, who started out by pointing out that he had first been indoctrinated in the “vaccines cause autism” cause by RFK Jr. when he met with him in his office in Trump Tower 20 years ago.

I want to thank the man who brought this issue to the forefront of American politics along with me and uh we actually met in my office. Is it like 20 years ago, Bobby? It’s probably 20 years ago in New York. I was a developer, as you probably heard, and I always had very strong feelings about autism and how it happened and where it came from. And he and I don’t know the word got out, and I wouldn’t say that people were very understanding of where we were, but it’s turning out that we understood a lot more than a lot of people who studied it. We think—and I say we think because I don’t think they were really letting the public know what they knew. Thanks as well to the director of the National Institute of Health, Dr. Jay Bhattacharya, FDA Commissioner Dr. Marty Makary. These are great people. Administrator of the Centers for Medicine and Medicaid Services, Dr. Mehmet Oz, and acting assistant secretary of HHS, Dr. Dorothy Frink. So, thank you all. Thank you, Darothy, very much. The meteoric rise in autism is among the most alarming public health developments in history. There’s never been anything like this. Just a few decades ago, one in 10,000 children had autism. So that’s not a long time. And I’ve always heard, you know, they say a few, but I think it’s a lot less time than that. It used to be one in 20,000, then one in 10,000, and I would say that’s probably 18 years ago, and now it’s 1 in 31, but in some areas it’s much worse than that.

Of course, as I’ve written more times than I can remember, there is a huge difference between the number of diagnoses of a condition and the true prevalence of a condition. Whenever I discuss how the increased prevalence of autism diagnoses can be explained by changes in the diagnostic criteria, increased awareness and screening, increased acceptance, and increased access to services over the last three-plus decades, I like to point to other examples of conditions and diseases whose apparent prevalence has increased enormously just due to screening, even without any broadening of diagnostic criteria. Given that this whole press conference, as you will see, was a tsunami of bullshit, a veritable Gish Gallop of some antivax greatest hits to spice up the quackery of claiming that Tylenol use during pregnancy I’m not going to explain in depth, other than to refer you to a couple of my previous posts on the issue and remind you that there is no “autism epidemic,” as claimed over and over again by everyone who spoke at this presser.

In fact, President Trump’s introduction was so bad that the satirical site McSweeney’s just couldn’t, if you know what I mean. So instead the just published his remarks verbatim. It’s also amusing to note that apparently President Trump has trouble pronouncing the word acetaminophen. Again, there was so much Gish gallop and long-debunked nonsense in this presser, but, again, make no mistake. This was a profoundly antivax event. Let’s just look at some of the antivax nonsense that Trump himself parroted:

TRUMP: And by the way, I think I can say that there are certain groups of people that don’t take vaccines and don’t take any pills that have no autism. That have no autism. Does that tell you something? That’s currently—

RFK JR.: There are some studies that suggest that, yeah, with the Amish, for example.

TRUMP: The Amish, yeah, virtually. I heard none. See, Bobby wants to be very careful with what he says, and he should, but I’m not so careful with what I say. But you have certain groups. The Amish, as an example, they have essentially no autism.

Ack! The claim that there is no autism among the Amish because the Amish don’t vaccinate! Holy hell, that’s an oldie! I was coming across debunkings of it 20 years ago, which would be right about the time that RFK Jr. supposedly met with Trump in his office for the first time. Moreover, we knew nearly 20 years ago that most Amish do vaccinate (one survey said 84%), which makes the claim pretty much nonense.

At another point, Trump said:

The other thing that I can tell you that I’ll say that they will maybe say at a little bit later date. But I think when you go for the shot, you do it over a five-time period. Take it over five times or four times. But you take it in smaller doses. And you spread it out over a period of years. And they pump so much stuff into those beautiful little babies. It’s a disgrace. I don’t see it. I don’t, I think it has, I think it’s very bad. They’re pumping, it looks like they’re pumping into a horse. You have a little child, a little fragile child, and you get a vat of eighty different vaccines, I guess. Eighty different blends, and they pump it in.

For those of you who might be surprised by this kind of talk, let me just remind you that Trump said pretty much the same thing in 2012, calling it a “monster shot” that caused autism:

They go in and they get this monster shot. I mean, have you ever seen the size of it? It’s like they’re pumping in–you know, it’s terrible, the amount. And they pump this in to this little body, and then all of a sudden the child is different a month later, and I strongly believe that’s it. They should have vaccinations, but do them separately and over an extended period of time, not all at one time.

Here was Trump in 2007:

When I was growing up, autism wasn’t really a factor,” Trump said. “And now all of a sudden, it’s an epidemic. Everybody has their theory. My theory, and I study it because I have young children, my theory is the shots. We’ve giving these massive injections at one time, and I really think it does something to the children.

And:

When a little baby that weighs 20 pounds and 30 pounds gets pumped with 10 and 20 shots at one time, with one injection that’s a giant injection, I personally think that has something to do with it. Now there’s a group that agrees with that and there’s a group that doesn’t agree with that.

Yes, the group that agreed with Trump were antivaxxers, and the group that didn’t agree with Trump were basically the entire scientific community, aside from a few cranks and kooks. Most importantly, President Trump has believed antivax misinformation at least since 2007, although, given that he now says he met with RFK Jr. 20 years ago, I’m guessing that he’s probably believed this stuff way longer.

But that’s not all! Before ceding the floor to the Four Horsemen, Trump dropped another drippy stinky turd of antivax nonsense on the world:

I also, and we’ve already done this, we want no mercury in the vaccine. We want no aluminum in the vaccine. The MMR, I think, should be taken separately. This is based on what I feel, the mumps, measles. And the three should be taken separately. And it seems to be that when you mix them, there could be a problem. So there’s no downside in taking them separately. In fact, they think it’s better. So let it be separate. The chickenpox is already separate. Because when that got mixed in, I guess they made it four for a while, it really was bad. So they make chickenpox. Individually, they’re okay. When you mix them, something maybe happens. So there’s no downside in doing it. It’s not like, oh, if you do it, bad things. No, it’s only good. And it may not have that much of an impact, but it may have a big impact. So let those be taken separately. And then hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. So I would say wait till the baby is twelve years old and formed, and take hepatitis B. And I think if you do those things, it’s going to be a whole different, it’s going to be a revolution in a positive sense in the country.

One can’t help but note that the MMR, being an attenuated live virus vaccine, does not contain mercury or aluminum. Thimerosal, the mercury-containing preservative that used to be in some childhood vaccines until 2001, would inactivate the virus, as would aluminum adjuvants. As for Trump’s “belief” that the MMR vaccine should be split up into its component parts, holy Andrew Wakefield! That’s the same grift that the godfather of the 21st century antivax movement, Andrew Wakefield, argued, mainly because he was working on a separate measles vaccine, which was part of his grift claiming falsely that the MMR vaccine could cause autism. As for the MMRV vaccine, as I discussed the other day at my not-so-super-secret other blog, and I’ve discussed more times than I can remember the science showing that aluminum adjuvants in vaccines are safe and do not cause all the bad things that antivaxxers claim that they cause.

Let’s move on, though.

One hugely annoying thing about the presser was that Trump and company kept everyone waiting for over 45 minutes before taking the stage. Sorry, but in this case anticipation did not make the final product more exciting, just more anticlimactic and brain-melting.
The other thing that really nauseated me about this entire press conference was the utter self-congratulatory nature of it. Starting with their leader President Trump, all Four Horsemen went on and on about how this was the greatest thing ever with respect to autism research, how the President pushed them to move fast, how this is the first time that “silos” have been broken down to tackle the problem (it’s not). At one point, old conman, showman, and quack that he is, Dr. Oz said with a straight face:

The aggressive approach and it is aggressive demanded by the president and by the secretary have already identified risk factors and opened the door for the first the first FDA recognized treatment pathway for autism. It is the first of its kind and it wouldn’t have happened without the leadership of the president and the secretary. The five-fold increased prevalence of autism over the past 25 years demands a rapid response. The average clinician researcher we spoke to many thought it would take 5 years to get this data. Parents are unwilling to wait five years. The president is unwilling to wait five years for these results. So the president and the secretary are acting today with this tri- agency move. The administration’s bold actions investing in groundbreaking research. Follow the science. They restore trust which has been lacking and they will change the trajectory for millions of American families. Mr. President, God bless you for being brave. Thank you very much.

This was some serious “Dear Leader” vibe going on here, for sure. For example, here’s RFK Jr.:

We expect this to be the first of many announcements over the coming years that deliver actionable information to parents on underlying cause of autism and the potential paths for prevention and reversal. Finally, autism is a complex disorder with multifactorial ideology. We are continuing to investigate a multiplicity of potential causes with no areas of taboo. One area that we are closely examining, as the president mentioned, is vaccines. Some 40 to 70% of mothers who have children with autism believe that their child was injured by a vaccine. President Trump believes that we should be listening to these mothers instead of gaslighting and marginalize them, marginalizing them like prior administrations. Some of our friends like to say that we should believe all women. Some of these same people have been silencing and demonizing these mothers for three decades because research on the potential link between autism and vaccines has been actively suppressed in the past. It will take time for an honest look at this topic by scientists. But I want to reassure the people in the autism community that we will be uncompromising and relentless in our search for answers. We will perform the studies that should have been performed 25 years ago. Whatever the answer is, we will tell you what we find. We are researching this issue to all three agencies. Jay will discuss one of our research initiatives at NIH. This model of unleashing unbiased depoliticized gold standard scientific research and academic freedom to deliver actionable information to prevent and reverse disease will be a model for the framework to deliver sim similar results from many other chronic conditions that plague Americans.

See what I mean? truth be told, RFK Jr. probably kissed Trump’s tuchas the least of the four, but where he excelled was, as one might expect, in presenting himself as a brave maverick who’s been “silenced” and whose Truth has been “suppressed,” which is what all conspiracy theorists claim. That bit about trying to imply hypocrisy when we say we should believe women about sexual assault but that we supposedly don’t believe women when they say that vaccines caused their child’s autism is another old antivax deflection. No, we do believe women when they say that they first noticed their child’s symptoms of autism after a vaccine. That’s the reason so much money and effort has been sunk into studying claimed links between vaccines and autism over the last 30 years! It’s one reason (of several) why we keep wasting money reinventing the wheel by doing the same studies over and over again to look for links between vaccines and autism and always keep coming up negative, only to be prodded to do the same types of studies yet again, because ideologues and fools like RFK Jr. refuse to believe the results, no matter how rigorous the science or how many times rigorous science comes to the same conclusion. I had to laugh out loud at the part about “depoliticized” and “gold standard” science. Anything overseen by RFK Jr. (and Donald Trump and his allies) is anything but “gold standard science.”

Quoth Dear Leader and the Four Horsemen: It’s Tylenol that causes autism!

As bad as things were in this press conference, it was really so much worse than you thin. You really can’t get a good idea without yourself watching the whole thing. Fortunately, for you, I watched it so that you don’t have to. Circling back to acetaminophen, Trump started things rolling:

And I will say there are parts of the world that don’t take Tylenol. I mean, there’s a rumor, and I don’t know if it’s so or not, that Cuba, they don’t have Tylenol, because they don’t have the money to put Tylenol. And they have virtually no autism, okay? Tell me about that one. And there are other parts of the world where they don’t have Tylenol, where they don’t have autism. That tells you a lot. And I want to say it right now. And you know, the way I look at it, don’t take it, don’t take it. There’s no downside in not taking it. So I’d like to ask Bobby to come up and say a few words. I hope I didn’t ruin his day, but that’s the way I feel. I’ve been very strong on this subject for a long time. You know, life is common sense too. And there’s a lot of common sense in this. And I wish things like this were brought up. And this group has worked so hard on it. But I’d like to be a little bit more, a little speedier in the process of a recommendation, because there’s no harm in going quicker. There’s absolutely no harm. At worst, there’s no harm.

WTF was that part about Cuba? Acetaminophen is an inexpensive and abundant drug that even low income countries can afford, which is one reason why it’s so widely recommended. As for Cuba supposedly having low rates of autism, there’s that pesky difference between diagnosis and actual prevalence. It very well might be true that Cuba has low numbers of autism diagnosis—but not “virtually no autism” diagnoses—but that would far more be likely to be as a result of less screening, less awareness, and less infrastructure to get an accurate estimate of autism prevalence rather than any true difference in prevalence compared to other countries. As for Trump, he said “don’t take Tylenol” so many times during this presser that Jimmy Kimmel made a 55 second montage of it for his show, with a laugh track:

Kimmel's show put together a montage of Trump insisting dozens of times yesterday to "DON'T TAKE TYLENOL." Complete insanity. pic.twitter.com/7GlRwc4VpX

— Aaron Rupar (@atrupar) September 24, 2025

As for the demonization of Tylenol, it’s a very old trope, as Andrea Love discussed in more detail than I have time to go into. Marty Makary leaned into that by cherry picking two studies and then dismissing a much larger and better designed study that failed to find any correlation between Tylenol use during pregnancy and autism thusly:

There’s a very large study, the Boston birth cohort with researchers that have uh from Johns Hopkins, my former institution and Boston University found quote unquote consistent associations between acetammenophen in pregnancy and autism. And the nurse’s health study with researchers from Yale, Columbia, and Harvard looking at 9,000 kids found that acetaminophen use in pregnancy was associated with neuro developmental disorders. And four weeks ago, a Mount Sinai Harvard study reviewed all the existing literature and found the overwhelming body of evidence points to an association. Sure, you’ll be able to find a study to the contrary. That’s how science works.

Yes, which is why you can find studies that claim to find links between vaccines and autism but guess what? You’re supposed to look at the best studies and weight them the highest, while giving much less weight to less rigorous or smaller studies. Makary does the excact opposite, ignoring (and presumably dismissing) and weigh the weaker studies, well, a lot less. In fact, Makary totally ignored the largest study to date, a large Swedish cohort study encompassing nearly 2.5 million children born between 1995 and 2019 found no evidence of an association between prenatal acetaminophen use and elevated risk of autism spectrum disorder, concluding:

Acetaminophen use during pregnancy was not associated with children’s risk of autism, ADHD, or intellectual disability in sibling control analysis. This suggests that associations observed in other models may have been attributable to familial confounding.

The authors are referring to a handful of earlier studies that suggested a link but had inadequate controls for confounders. In brief, again, the overall scientific consensus is currently that there does not appear to be a link between acetaminophen use in early pregnancy and autism spectrum disorders. Naturally, though, Makary picked much smaller and methodologically less rigorous studies to highlight and dismissed the Swedish study as, in essence, one of those “studies to the contrary” without even mentioning it. He also cites Andrea Baccarelli , the Dean of the Harvard T.H. Chan School of Public Health, who conveniently published a review article in BMC Public Health in August that concluded that there was a link between acetaminophen use during pregnancy and autism. Given how long this post is, I’ll just let Andrea Love demolish it for me, but I will also mention, in addition to the fact that Baccarelli seems to discard and/or downplays the largest, most rigorous studies that show no association between Tylenol use and autism, that Baccarelli has been paid $150,000 to be an expert witness in Tylenol lawsuits.

Also, Dr. Oz has an interest in iHerb, a company that sells folinic acid supplements. Remember, it’s always about the grift.

Nor is there good evidence that folate use during pregnancy can prevent autism. There is very good evidence that folate deficiency can lead to neural tube defects, which is why folate supplementation has long been recommended during pregnancy. Leucovorin, also known as folinic acid, is a synthetic form of of folate that has a number of uses. Given that I am a cancer surgeon, I’m most familiar with its use in oncology to counteract the toxic effects of chemotherapy agents (e.g., methotrexate) that target folate metabolism in cancer cells. Let’s just say that the evidence that leucovorin can be used to treat or prevent autism is…weak:

But researchers not involved in the study urged caution when evaluating this and other studies on leucovorin as a possible treatment for autism. “The studies on leucovorin in autism so far have been very small, not replicated or have found inconsistent findings, and not used the same dose,” said Alycia Halladay, chief science officer of the Autism Science Foundation. Halladay said the foundation “does not consider this a treatment for autism.”

Did that ever stop quacks from using something to treat autism? You know the answer to that one.

The Four Horsemen are ushering us into the age of autism biomed quackery as federal policy

Watching this press conference, I became profoundly depressed. The worst people are in charge of HHS, public health, and biomedical research. (And I didn’t even mention the autism research “initiative” that Jay Bhattacharya trumpeted, which will no doubt disburse precious NIH money to dubious researchers who couldn’t have possibly competed successfully for it before.)

Unfortunately, all I can conclude now is that the FDA is embracing “autism biomed” quackery for autism. What’s next? Miracle Mineral Solution (MMS)? Chelation therapy? Because leucovorin for autism has only slightly more evidence for it—and I do mean slightly, given that there are tiny studies suggesting maybe something—than these other forms of biomedical quackery. Moreover, this quackery will do real harm to women, who were just urged by our President to “tough it out” and were shamed if they can’t and need to take something as innocuous as Tylenol for pain. Yes, there was, in addition to autism biomed quackery and antivax, serious misogyny here as well.

To paraphrase the words of the immortal Charles Pierce, this is your democracy now, America. Cherish it.