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A press conference on autism earlier this week was pitched as a medical breakthrough. President Trump and Health and Human Services Secretary Robert F. Kennedy, Jr., had big news to share. It turned out to be a major story all right. But not as Trump and Kennedy expected. Trump’s bluster about Tylenol causing autism and his boasts to women to not take Tylenol while pregnant—“But if you can’t tough it out, if you can’t do it, that’s what you’re going to have to do”—and his insistence that doctors are pumping a “vat of 80 different vaccines” into children like “they’re pumping into a horse,” provided comedians and their audiences fodder for ridicule and laughter all week long.
What’s not funny is that Trump and Kennedy were broadcasting unfounded claims about links between Tylenol and autism and the drug leucovorin as a treatment for it. Scientists who study autism and fact checkers sprang to action to correct the falsehoods and misinformation. Even researchers and universities whose papers were cherry-picked by Trump and Kennedy to support their views gave interviews or issued statements to distance themselves from the politicians and set the record straight on their science.
The FDA’s decision to label leucovorin for the treatment of autism in children was called “irresponsible” by Lawrence Scahill, a professor of pediatrics at Emory University who specializes in the design and conduct of clinical trials in children with autism, in the pages of Science magazine. The drug is commonly used to address side effects of chemotherapy. Medical ethicist Arthur Caplan of New York University didn’t hold back, writing in STAT: “The announcement on autism was the saddest display of a lack of evidence, rumors, recycled old myths, lousy advice, outright lies, and dangerous recommendations by anyone in authority in the world claiming to know anything about science that I have ever witnessed.”
Missing from the news, I thought, is the impact that Trump’s and Kennedy’s falsehoods and conspiracies (“the potential link between autism and vaccines has been actively suppressed,” Kennedy said) will have on local doctors, especially pediatricians, and on the families they treat. After all, pediatricians are the ones who give childhood vaccines, the ones who face parents whose fears and hopes may have been stoked by Trump and Kennedy.
Fortunately for us, Rahul Parikh, a pediatrician in Walnut Creek, California, a suburb of San Francisco, is glad to share his thoughts about Trump and Kennedy and his experiences with patients. Parikh is also a writer whose personal articles on health and the medical industry have appeared in a bunch of places including the Los Angeles Times, Salon, and MIT Technology Review. I’ve known Parikh for more than 15 years and have been the editor of his Nautilus articles like “Why Reading Your Doctor’s Notes Can be Painful.” He was as candid as ever in our conversation.
I wanted to talk to you, Rahul, because, as far as I can tell, Trump and Kennedy have pediatricians like you in their sights when Trump says, and I quote, “they pump so much stuff into those beautiful little babies. It’s a disgrace.” How did their press conference on autism affect you?
When I first heard a clip of him saying we’re going to talk about autism tomorrow, the cause of autism, the cure of autism, I knew we were in trouble. I thought, “Oh, boy, here we go again.” The next day I got a request from a parent of an autistic child for a prescription for leucovorin, and so did my colleague. So, it’s a real challenge for us to respond because the news and information move so fast. It requires us to get organized, get our thoughts together, to figure out how to best respond. But we are rolling up our collective sleeves to do the right thing for our patients and families.
And what about personally?
I mean, my emotional response has been a deep level of frustration, disappointment, and recognition that this is where we are right now. It’s also resolve to push back and protect kids. You don’t want people to believe debunked information, misinformation, and disinformation. Which describes what Trump and Kennedy said. You want what’s best for your patient and their family and our community. And so, when something comes at you like a bowling ball and rams all that down, you get frustrated and disappointed. You know it’s going to require a lot of energy and effort to find ways to respond to questions and requests that don’t need to happen. You don’t want to be spending your time talking to patients about this. Instead of consuming time to discuss fake news, you want to be talking to them about real issues and risks and to offer prevention and guidance against those.
Tell me more about this “bowling ball” coming at you.
I’ve written about RFK, Jr., in the past, especially in the early 2000s when he gained notoriety with his now retracted Rolling Stone article linking vaccines and autism. What he typically does is use a form of rhetoric where he spits a bunch of facts at people, a bunch of claims in rapid fire, and each of those claims would, in and of itself, require time to rebut. So, he does it so quickly. And Trump does the same thing. You’re just overwhelmed by it. You don’t have time to think critically, or ask questions, and then he moves on. It’s called “Gish gallop.” It’s basically spitting a bunch of falsehoods, misleading information, and even outright lies at people. I first read about the term in a Los Angeles Times column by Robin Abcarian. She explains the phrase was coined by Eugenie Scott, founder of the National Center for Science Education.
So, what happens when the Gish gallop approach is used, the patient brings those to you. I spend about 15 minutes or so with each patient in the exam room. That’s the time I usually get to make an impression and impact their decisions, to build trust and confidence. But for the rest of the day, they’re taking in information and stimulus and getting knowledge everywhere else, including making decisions based on medical issues like vaccines. Health decisions are really made in the time that we’re not with the patient and the parent. They’re made in the information you consume, the conversations you have, the choices you make about what to eat. Whether you wear a helmet or not on a bike. Whether you hear Gish gallop and decide, “I’m not going to not vaccinate my child.”
As doctors, we’re left at a disadvantage. We’re not going to use that same rhetorical technique to come back at parents and overwhelm them. We’re going to be more compassionate, because we want to build trust with them. And that’s fundamentally the mismatch that we’re dealing with.
I basically said to the parent, I know this is hard, and given the news, I can imagine you have lots of questions.
So, how will you deal with Kennedy in charge of the nation’s health agencies?
We’re all struggling as doctors with him issuing information that contradicts scientific knowledge, whether it’s vaccines and vaccine schedules. Kennedy is not the master of health in the U.S. He’s the master of his own shop and his patron is Donald Trump. I’m not seeing Health and Human Services right now as an entity representative of the scientific community, the medical community. The same for the CDC or FDA. And so, you’re forced to rely on your professional societies to give you guidance. It’s more trustworthy.
To be specific, will you stop recommending Tylenol to pregnant women or children with fevers?
No, I will not. I will not change my guidance.
You mentioned a parent asked for leucovorin. What did you do?
I had to think about it before responding right away. I wanted to be empathetic. I always try to put myself in the hearts of the parents whose kids have autism, who are struggling with taking care of them every single day, not being able to send them to school because of their limitations or not being able to go to work themselves and earn a living. I see some really hard circumstances. And so, when you put yourself in their shoes, you can understand that anything that gives them hope, even if it’s not founded in a ton of science, is maybe worth a try. And that’s where it gets really difficult. It’s difficult for them and it’s difficult for you, as a doctor, who wants to do the right thing for your patient, to have to say, No, we can’t. We can’t prescribe something where the risks outweigh the benefits.
When I responded to the parent, I basically said, I know this is hard, and given the news, I can imagine you have lots of questions, and you’re doing the right thing by reaching out to me first and foremost. I said the scientific evidence for leucovorin helping autistic children wasn’t there, and the risks outweigh the benefits. What’s better is for us to have a conversation, to keep talking about the things that we know help children with autism, which is intensive therapy around different behaviors and skills. So, I didn’t give the parent the prescription. I also wanted to give my professional society, the American Academy of Pediatricians, time to issue some guidance. As of now, its position is more trials are needed to demonstrate the effectiveness of leucovorin.
Let’s get into Trump’s rhetoric. He says pediatricians like you are “pumping” vaccines into kids “like they’re pumping into a horse. You have a little child, little fragile child, and you get a vat of 80 different vaccines, I guess. 80 different blends, and they pump it in … They get fried.” Can you clear up the issue for us? How does a vaccine schedule for babies work?
I’ll start with a basic statement. Vaccines are safe and effective. There have been rigorous studies for over a century to prove that. For the most part, kids do fine after they get their vaccines. Like everything else in medicine, vaccines also have side effects. We disclose them to you before we administer any of them. But Trump is creating a picture that is just meant to scare parents. The fact is, it’s important that we give some vaccines together. We’re protecting babies as soon as possible against vaccine-preventable illness such as pertussis, pneumococcal meningitis, Haemophilus influenzae, meningitis, or other diseases that can happen at any age. That’s not a secret. It’s very public information.
Also, we do spread out vaccines on a schedule. From a clinical immunological perspective, you’re giving the body’s immune system time to develop immune memory, and to get that immune memory as close to 100 percent for a certain illness. But we don’t want to spread them out too far. Then you’re delaying the protection. It’s like I’m going to buy a car but I’m going to wait till 10,000 miles to put in the airbag. I’m going to wait another 10,000 miles to put in the anti-lock brakes. These are the common safety features that you want right up front. You would be spreading them out for no clear reason. The fact that we’ve been able to vaccinate sooner than later, with proven safety, has changed the way we practice pediatrics, has made the health of children much better. We’ve seen these childhood illnesses in many cases go away. We don’t want to slow down now.
We’re all struggling as doctors with Kennedy issuing information that contradicts scientific knowledge.
Kennedy’s infamous Rolling Stone article may have been retracted. And for 20 years the consensus of science has shown that vaccines don’t cause autism. Still, that idea is lodged in culture. Over the course of your career, have more parents been reluctant to have their kids vaccinated because they are afraid the kids would get autism?
Yes, Kennedy moved the goalposts. I have seen parents tearful about the decision not to vaccinate their child because they’re so scared that their child is going to get autism. But we haven’t made this easy on ourselves, either. There’s suspicion about institutions, and skepticism and distrust of institutions, and those include medicine and healthcare. And some are deserved. You go back to some of the stories about the Tuskegee experiments, or more recently the heavy prescriptions of opioids and deaths from them. So, when you disseminate information skeptical of vaccines, people naturally put it into those categories. Assume we are hiding or obfuscating to protect ourselves or our own interests.
And, again, that’s a challenge for me. It takes a conversation, often many conversations, to earn patients’ trust. I will tell you my attitude has changed over time. Earlier in my career, it was easy to be judgmental about parents who were either hesitant about vaccines or refused them, and then I just wouldn’t give the vaccines. I once worked in a practice that outright refused to take care of kids whose parents chose not to vaccinate them.
But I realized that’s not getting us anywhere and just building more resentment between doctors and parents. I began to really understand the struggles of being a parent. So, I would say to them, I understand where you’re coming from, and we’ll work through this together. I want to help guide you through the best information and have you learn to trust me. Share your concerns, share the information you are looking at that got you here. Curiosity and concern go a long way to earn trust. And with trust I hope you will vaccinate your child over time.
My attitude and approach changed because of my experience as a clinician, because I’m a parent, and because I also write about health and medicine and do a lot of research. I’m just more humble in my approach now. That’s better for parents and me. Can I add something else?
Yes, please.
This is all so unfortunate. Trump and Kennedy now have the bully pulpit. They can stand in front of the world and change the health of millions of kids and communities. And then just walk away. I feel bad for families who are now living with a tremendous amount of confusion. If their vaccine hesitancy now swings toward not accepting vaccines or Tylenol, that’s just a terrible outcome. But I want parents to know after Trump and Kennedy do walk away from that bully pulpit, that doctors like me and my colleagues are here for the long haul, we’re here for them. 
More from Nautilus on autism and misinformation:
Debunking Dangerous Views of Autism: This psychologist has worked with autistic people for 50 years. Here’s what she wants you to know.
Lead image: linen88 / Shutterstock
