It’s been a busy week for news that may be causing confusion or concern among your patients, including stories about Tylenol and autism, vaccine recommendations, and vaccine coverage. 

We know misinformation is a major concern for physicians, because you care about your patients’ health and well-being, but you’re also troubled about how trust in science and medicine seems to be eroding among some groups. We are providing you with a quick breakdown of what’s been in the news, what you need to know, and some thoughts on how to respond to your patients. 

Harms of Health Misinformation

Health misinformation is increasingly shaping public discourse, beliefs and policy actions, and it can have significant consequences, as the Canadian Medical Association noted recently.

At the same time, confusing or contradictory headlines coming from both the United States and within Canada can cause understandable uncertainty for patients and the public at large. 

Addressing Patients’ Concerns

Anytime a patient raises health misinformation, there’s an opportunity to restore trust in physicians and science. Every claim a patient brings in is a chance to respond respectfully and redirect them towards what we know to be true. 

Avoid responding with judgmental words like ​“misinformation” or ​“false” and instead focus on the validating that the patient is right to be concerned about the issue, that you as a physician take it seriously, and that you’ve taken the time to learn more about it and share what you know. 

In the current politically polarized climate, it can feel like the focus is more on who is sharing the evidence rather than the quality of the evidence itself. As physicians, try to avoid responses that could appear political. Instead stay true to your expertise, to good quality medical research, and to your commitment to your patients’ health and well-being. 

Tylenol, Pregnancy, and Autism

This week, the U.S. government publicly stated that Tylenol use during pregnancy is linked to, and can cause autism. This is not a new claim, but seems to have started with older studies of poor clinical quality, and has been given a new platform this week. 

Medical groups have reacted promptly to counter this assertion and reassure the public that acetaminophen is safe when taken appropriately. 

Key Guidance for Physicians

• The American College of Obstetricians and Gynecologists summarized the research this week. ​“In more than two decades of research on the use of acetaminophen in pregnancy, not a single reputable study has successfully concluded that the use of acetaminophen in any trimester of pregnancy causes neurodevelopmental disorders in children. In fact, the two highest-quality studies on this subject — one of which was published in JAMA last year — found no significant associations between use of acetaminophen during pregnancy and children’s risk of autism, ADHD, or intellectual disability.” 
• In Canada, the Society of Obstetricians and Gynecologists (SOGC) issued an updated statement this month after reviewing all of the most recent research, that clearly recommends ​“the use of acetaminophen as a first-line therapeutic option for fever and pain in pregnancy when medically indicated at recommended doses for the shortest duration required.” 
• SOGC notes that untreated fever poses serious risks during pregnancy, including miscarriage, organ malformations, cardiovascular complications, and even autism spectrum disorder. Untreated pain can lead to depression, anxiety and high blood pressure, which also have adverse effects on pregnancy. 
• Even the U.S. FDA’s official guidance to physicians is more cautious than the news coverage. It notes that when it comes to acetaminophen and autism, ​“a causal relationship has not been established and there are contrary studies in the scientific literature.” While it suggests clinicians should minimize acetaminophen during pregnancy for low-grade fevers, it acknowledges that it ​“is the safest over-the-counter alternative in pregnancy among all analgesics and antipyretics.” 
• Health Canada has responded too, refuting claims that using acetaminophen as directed during pregnancy causes autism. The guidance acknowledges that ​“untreated fever and pain in pregnant women can pose risks” to a fetus, and that acetaminophen ​“should be used at the lowest effective dose for the shortest duration needed.” 

Here in Manitoba, the Medical Specialty Lead for Women’s Health Dr. Vanessa Poliquin is reassuring her physician colleagues to follow the evidence and the guidance from SOGC and Health Canada. 

“Untreated fever is a serious risk during pregnancy and our approach to treating them should be guided by the evidence, which continues to say that if fever or pain control is needed, acetaminophen is the best option during pregnancy. Of course, any medication should be taken according to recommended dosing and dosing intervals.” 

With misinformation circulating rapidly only, we responded within days with a video from Dr. Joss Reimer bring an evidence-based message to Manitobans from a trustworthy source. Watch it on Instagram and share!

Vaccine Concerns and Questions

Vaccines have also been in the news causing confusion for some patients, including the U.S. reconsidering guidance on some vaccines and some provinces deciding not cover COVID vaccines for some patients. 

MMRV

• Last week, the U.S. Advisory Committee on Immunization Practices (ACIP) considered changes to guidance about vaccines for COVID, measles, mumps, rubella, and varicella. ACIP recommended against a combined MMRV shot for children under 4, instead backing an MMR shot and separate vaccine for varicella. 
• In the wake of the vote, the American Academy of Pediatrics (AAP) said the ACIP guidance promoted ​“misguided information” about childhood vaccines, adding ​“the combination MMRV vaccine should remain an option for families” at both the 1 year and 4 – 6 years of age. 
• Manitoba Public Health advises that no changes are expected in Manitoba or across Canada as a result, but your patients may be asking questions. MMRV remains the recommended vaccine in Manitoba at 12 months and 4 – 6 years, as per the provincial immunization schedule. Public Health advises that no changes are expected in Manitoba or across Canada as a result, but your patients may be asking questions. 

COVID-19

• The ACIP guidance shifted away from recommending the vaccine for most people to recommending it for some groups but ensuring it remains available to all. They backed away from a proposal to require prescriptions for the vaccine, but did reinforce the importance of ​“shared decision-making” between patients and their clinician. 
• Meanwhile, some provinces, such as Alberta and Quebec, will only pay for COVID vaccines for groups at higher risk, leaving some lower risk groups to pay out of pocket. In Manitoba, Public Health has confirmed the cost for COVID vaccines will continue to be covered this year for all eligible age groups, and that eligibility has not changed (age 6 months and up). 

Countering Viral Misinformation

Doctors Manitoba is working to counter misinformation by growing our Getting Healthy public resource. We are always looking for physicians to contribute trustworthy expert online content on health topics for Manitobans, to help them prevent disease and live a longer and healthier life. 

• Content can focus on topics like medical screenings, immunizations, eating well, moving more, reducing stress, and better sleep. 
• Our in-house writer can draft the content with your advice and direction, and you’ll get to review and approve it. 
• You will receive an honorarium for your contribution. 
• Contact us at gettinghealthy@ doc​tors​man​i​to​ba​.ca to help.