Yesterday, Trump and RFK Jr had a press conference which some are characterizing as the absolutely worst firehose of medical misinformation coming from the White House in American history. I think that is fair. This was the presser we knew was coming, and many of us were dreading. It was worse than I anticipated.

I suspect much of this stems from RFKs previous promise that in six months he would find the cause of autism so that we can start eliminating these exposures – six months is September. This was an absurd claim given that there has been and continues to be extensive international research into autism for decades, and absolutely no reason to suspect any major breakthrough in those six months. Those of us following RFK’s career knew what he meant – he believes he already knows the causes, that they are environmental (hence “exposures”) and include vaccines.

So Kennedy had to gin up some big autism announcement this month, and there is always plenty of preliminary or inconclusive research going on that you can cherry pick to support some preexisting narrative. It was basically leaked that his target was going to be an alleged link between Tylenol (acetaminophen) use in pregnancy and autism. This gave us an opportunity to pre-debunk this claim, which many did. Just read my linked article in SBM to review the evidence – bottom line, there is no established cause and effect and two really good reasons to doubt one exists: lack of a dose response curve, and when you control for genetics, any association vanishes.

But Trump had a different take:

The president on Monday repeatedly issued strong warnings that flew in the face of the recommendations of leading medical groups: “Don’t take Tylenol. Don’t take it. Fight like hell not to take it.” He urged pregnant women to “tough it out” when in pain, except in rare instances, such as a dangerously high fever.

He also said he saw no downside to not taking it. But Trump, as he acknowledged, is not a doctor, which is why he shouldn’t be giving medical advice from the White House lectern. There are potential downsides to not treating pain or fever in a pregnancy. Such decisions are always a matter of risk vs benefit, but not-experts tend to see only risk, and fail to consider the risk of not treating. Standard medical practice is already to use Tylenol (and any other drug) during pregnancy only when needed, in minimal dose and for the shortest duration. But it is important to treat pain and fever, which can present risks to the pregnancy as well. It’s a balance, which takes medical knowledge and clinical judgement (neither of which Trump or RFK have).

They also wanted to use the news conferenced to announce a newly FDA approved treatment for autism – leucovorin. Taken in isolation, this is just weird – why would the president and HHS secretary make such an announcement? Obviously this is just propaganda, trying to create this impression that they are doing something about autism, even though neither of them or their policies have anything to do with this. Leucovorin may be a legitimate treatment, but only for a small subset of those with autism who have a folate metabolism disorder. It’s really a treatment for cerebral folate deficiency, one of the manifestations of which may be autism.

But more concerning – the FDA just gave approval for leucovorin for CFD without any new evidence. There was no new study, just a review of prior studies. The evidence is generally considered to be preliminary. All of this makes the timing – right before RFKs big September deadline – highly suspicious. Others have also noted that Dr. Oz, who was standing with Trump and RFK, holds a position in a company that produces leucovorin, but this can be a coincidence.

It’s pretty obvious what is going on here. RFK needed something to announce in September regarding autism, so he or his flunkies scraped the literature for anything they can present as an identified exposure risk and a possible treatment. Nothing else really explains the timing of these two announcements, especially given that the exposure (while more research is always nice) is largely debunked, and the treatment is narrow and preliminary.

But all of this is likely not the worst of it. Trump, apparently, decided to have one of his off-script rambling riff sessions – and his target, to the horror of the medical community, was vaccines. He said, “This is based on what I feel,” and “They pump so much stuff into those beautiful little babies, it’s a disgrace.” He went on to repeat anti-vaccine talking points, specifically that the MMR vaccine is not safe and that it should be split up into individual shots, that children get too may vaccines too quickly and they should be spaced out, and again suggested a link between vaccines and autism.

All of this is debunked nonsense. This is a pattern with Trump and a reason for extreme concern – he feels he can substitute his gut feelings for the consensus opinion of experts. His advice, if followed, is dangerous. There are good reasons why the vaccine schedule is what it is (again, it is the optimal evidence-based balance of risk vs benefit). Delaying vaccines leaves children susceptible to infectious disease for longer. There is currently no substitute for the MMR in the US, and no evidence for any increased risk of the combined vaccine. His advice, given with the bully pulpit of the presidency, is dangerous pseudoscience.