I was asked to keep quiet on this one. I won’t.
STUDY: Bottema-Beutel K, Autism 2026
STUDY TYPE: Editorial
FUNDING: The editorial is unfunded, and the author discloses her other funding sources (research grants and educational talks).
Background
Robert F Kennedy, Jr (RFK, Jr) has called for a “massive testing and research effort” to identify environmental causes of the “autism epidemic,” but the community of patients, families, and clinicians haven’t aligned with his directives. In this editorial, the director of an autism program at Boston College explains the controversy.
The Critique
The federal guidance on autism contradicts evidence. It also promotes ableist assumptions — that autism is an outcome so undesirable it justifies risky initiatives. Dr. Bottema-Beutel gives examples:
- Vaccines. The CDC website reads “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism.” But the largest study finds no link to autism, and the only research suggesting a link was retracted. The author fabricated evidence and had over $43 million in financial incentives to do so.
- Acetaminophen (Tylenol). The White House has warned that acetaminophen can cause autism when taken in pregnancy, but that link disappears after controlling for confounders (like the fact that women with more illness are likely to take acetaminophen). If we accept that level of evidence, most things cause disease.
- Leucovorin (folinic acid, Wellcovorin). This B-vitamin was promoted as an autism breakthrough, but the 3-4 trials are small and flawed. The largest of them was recently retracted for statistical errors. Later, the FDA declined it, approving leucovorin instead for a rare disorder (cerebral folate deficiency).
- Promoting risky treatments. In the past, the FDA honored reports from the public about harmful side effects from unproven therapies: chelation, chlorine dioxide, bleach cures, raw camel milk. The current FDA has quietly removed those warnings from their website.
The effects are palpable. In the 3 months after the September 2025 White House briefing, acetaminophen prescriptions among pregnant emergency patients fell 10% and leucovorin prescriptions in children rose 71%.
Some Middle Ground
I agree with Dr. Bottema-Beutel’s take on the evidence, and will add a little nuance to leucovorin.
RJF, Jr’s Make America Health Again (MAHA) has brought needed attention to non-pharmacologic therapies like leucovorin. While this B-vitamin may not deserve FDA-approval, it has possible benefits for verbal communication, language, and attention. 75% of autistic children have auto-antibodies at the folate receptor that make it hard to get folate into the brain. The problem is less severe than in cerebral folate deficiency, and the leucovorin-response less dramatic.
The right move is not approval, but funding for a large trial.
A Personal Note
I have some MAHA sympathies, enough that the Dept of Health recently invited me to speak at a conference, but there was a catch. If I criticized the administration publicly before the talk, it would be cancelled.
This blog is not a criticism. It’s in the spirit of a MAHA tenet: Transparency.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- What is the pro- and con- you see in federal positions on autism?
- Have you been censored by the government, by the pharmaceutical industry, or by gatekeepers who are funded by those entities?
