Reply to is RKFJr's "Tylenol(TM) causes autism" just a shakedown for extortion money from the company?

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Reply to "is RKFJr's "Tylenol(TM) causes autism" just a shakedown for extortion money from the company? "

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]I don’t know why all of you are getting worked up over this. You’re free to ingest as much Tylenol as you wish while pregnant. 
It’s still legal.[/quote]

At what point do these recommendations affect what insurance companies will cover or doctors' liability for compliant or non-compliant advice?[/quote]

lol DCUM freaking out that Tylenol won’t be covered by insurance. Chefs kiss. [/quote]

It's not about insurance coverage. It's about misleading information -- deliberately wrong information.

Tylenol is safe in pregnancy. The other options OTC are not, especially past the 30 week time. And untreated fever in pregnancy really IS connected to autism.[/quote]

And what will end up happening after this is women leaving fever untreated or thinking "I heard Tylenol is bad, I will take Ibuprofen instead." 
[/quote]

The risk is premature closure of the PDA [i]in utero[/i], leading to fetal death.

[b]Tylenol is safe in pregnancy.[/b][/quote]

How do you know?[/quote]

Because a giant study of 2.5 million children which controlled for genetic and familial factors found that any correlation with autism disappeared once those confounding factors were controlled for. In other words, the correlation found in some studies is related to confounds - genetics of who is more likely to take tylenol due to other predisposing factors. [/quote]

That’d be a totally satisfactory response if there weren’t studies pointing in the other direction, but there are. Why don’t you credit those?[/quote]

Because those studies do not control for confounding factors. They are lower quality studies. [/quote]

They claim they do. One is literally called “Use of Negative Control Exposure Analysis to Evaluate Confounding: An Example of Acetaminophen Exposure and Attention-Deficit/Hyperactivity Disorder in Nurses' Health Study II.”

Can you explain what how they are of lower quality? Or is it just that you’re heard smart people you trust say they’re of lower quality?[/quote]

Okay, let's take a look at this one. What is its GRADE scoring ?[/quote]

I’m not sure. Do you know that it has one? I wouldn’t assume that you can just pop a study in a database and get its GRADE score; I’m pretty sure that kind of assessment is almost like a study unto itself (i.e., a person who is knowledgeable in the field looks at the study and its supporting materials and analyses design). If you’ve got that, I’m interested to see[/quote]

I just want to be clear, no shame here -- you were unaware of the standardized GRADE scoring to compare the quality of evidence from studies, but were criticizing people for doing exactly that? Or was that someone else?

I can talk someone through how to do this, but I would like to know to whom I am talking. It does seem there's been a lot of people throwing around critiques that are not justified, and I think lack of understanding of how research works may well explain it.

This is exactly why claiming you have been "doing your own research" isn't necessarily a meaningful statement. [/quote]

No I actually am familiar with it. I just don’t think it’s as simple as you suppose that you can grab a study and then say “lemme get the GRADE score”. I also am aware that there are a variety of methodologies that are employed to rigorously analyze what a study does and does not show precisely been and has not been established through studies. I mean, the Cochrane reviews are a thing precisely because evaluating evidence is more than just getting a GRADE score. You seem to presuppose that’s all it takes, I think because you read some article about how the Sweden study was superior to the other ones. The reality is that it is entirely possible for one robust study to miss a real signal captured by a broader body of work. I was legitimately asking if you had actually had the GRADE scores that you’re hanging your opinion on, and it’s pretty clear that you don’t. That’s fine; you’re probably just someone who follows this news from afar, and that’s your right. But for families like mine where autism is a huge part of our life, it’s unhelpful to have laymen mansplain that a hypothesis that has support in the scientific literature is objectively wrong based on some article you read from others in your tribe. [/quote]

Nope, I write such reviews.

So if you understand how the GRADE system works, what's the score for the Swedish article?[/quote]

I find that incredibly hard to believe. If you actually were sophisticated enough that you wrote Cochrane reviews for a living, you’d understand that GRADE involves making value-laden and context-dependent judgments, such as making an assessment of the importance of various potential outcomes. Two groups of evaluators could weigh the same outcomes differently depending on their policy perspectives. I guess you can LARP on the internet as an author of Cochrane reviews if you want, but it is simply not the case that there is a singular canonical GRADE score for Ahlqvist et al. (or for that matter any study).

Beyond that, there are forms of study weakness that GRADE just won’t capture. In the Ahlqvist study, for example, just 7.5% of moms reported acetaminophen usage. Many other studies report that the share of expectant mothers who take acetaminophen is way, way higher—like 50%. Is that weakness fatal? Maybe not. But is it serious enough that a legitimate academic could conclude that Ahlqvist warrants serious corroboration before acceptance? You bet.

Look, I’m not saying that acetaminophen is the cause (or even a cause) of autism. I am certainly not suggesting that, if it is a cause, that causal connection exists outside of an unusually vulnerable subset of expectant moms and their babies. But I am saying that there is evidence on both sides of the ledger. When elites like you start “debunking” stuff just because you hate the people who postulate the rival theory, it stigmatizes legitimate science to the detriment of families like mine. [/quote]

But you can't even right out a cogent thought process on GRADE scoring -- a minimal standard, but one that allows for more reliable comparisons -- for the Swedish study, because, why? It would work against your point? You say you are familiar with it, but you are assessing studies and throwing around complaints but can't even be bothered to do the work you know would make it an accurate assessment?

Smells like a fish, flaps like a fish, is a fish.[/quote]

First of all, it’s spelled “write.”[/quote]

Sure. Speech to write.

[quote]Second, I’m not sure what you found short of cogent, but I think the problem is that you actually do not really know what GRADE is. I suspect you learned about it to backfill your confidence in the Sweden study; [/quote]

Alas, no.

[quote]after all, your latest critique that I should “do the work” to make a GRADE assessment appears to implicitly concede that you were off base to suggest that every study has an off-the-shelf GRADE study associated with it. [/quote]

No. This all started with you (or another PP, and then you didn't identify yourself as a different poster, but whatever)  writing the following:

[quote]That’d be a totally satisfactory response if there weren’t studies pointing in the other direction, but there are. Why don’t you credit those?[/quote]

[quote]Can you explain what how they are of lower quality? Or is it just that you’re heard smart people you trust say they’re of lower quality?[/quote]

There are standardized ways of assessing the quality of evidence and of studies. GRADE didn't come out of nowhere, you know. There was no magic wand and *poof!* now this is what we care about.

All it does is codify in a structured way what people have been doing, as scientists and researchers doing peer reviews of each other's work, for so many decades and decades. Anyone asking "how do you know it's any better?" in this context either is being disingenuous or just doesn't know how things work. I don't know which you are. It doesn't really matter.

The general instructions are here:

https://cgf.cochrane.org/sites/cgf.cochrane.org/files/uploads/uploads/how_to_grade.pdf

Of course, you could find a slightly different listing or verbiage and then say aha! You said THAT was the one, but there is another! And I'd call you a dork, and ask again if you could do the work. Because it doesn't seem like it. [/quote]

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