Paracetamol, Autism, & the Psychology of Mistrust
A single claim was enough to rattle millions of expectant mothers. When Donald Trump and Robert F. Kennedy Jr. suggested that paracetamol taken in pregnancy might cause autism, one of the most trusted medicines in antenatal care was transformed overnight into a source of anxiety. The reassurance from doctors and regulators was immediate and consistent: paracetamol, when used as directed, remains one of the safest medicines available in pregnancy.
Yet this controversy is not really about the drug. It is about how fear reshapes perception, how mistrust feeds on psychology, how history and identity keep it alive, and how autism is repeatedly misused as a political scarecrow.
Fear explains why suspicion takes root so quickly. Humans are not built to think in probabilities; we rely on shortcuts when faced with uncertainty. Psychologists describe the affect heuristic, where risk is judged by how frightening something feels rather than by its statistical likelihood. If the thought of autism evokes anxiety, the perceived risk rises sharply, even if the evidence does not support it. The availability heuristic amplifies this effect. A vivid story about a neighbour’s child who developed autism after a pregnancy illness will weigh far more heavily than population data showing millions of safe outcomes.
Once fear takes hold, familiar errors take over. Post hoc reasoning persuades us that if autism appears after a medicine was taken, the medicine must be to blame. Omission bias leads parents to believe that the harm caused by an action is worse than the harm caused by inaction, so choosing not to treat a fever may feel safer, even though the untreated illness is objectively riskier. Confirmation bias ensures that once mistrust of medicine is established, every reassurance becomes further proof of collusion. These are not quirks of a few contrarians. They are the ordinary mental shortcuts of human psychology, and they explain why mistrust is so resilient.
History gives mistrust its story. Scandals such as thalidomide in the 1960s, the withdrawal of Vioxx in the 2000s, and the opioid epidemic in the United States left deep scars. In Britain, the contaminated blood scandal eroded faith in institutions. In France, suspicion around the hepatitis B vaccine lingered for years. In parts of South Asia and Africa, distrust of polio vaccination campaigns was amplified by rumours of foreign interference. Each episode confirmed the suspicion that medicines are pushed for profit or political gain rather than patient safety. Even in countries with publicly funded health systems, the shadow of these scandals falls long.
Identity ensures the story sticks. For many, rejecting mainstream medicine is not just a matter of doubt, but a matter of belonging. Mistrust becomes a badge of independence, a declaration of purity or defiance. This is identity-protective thinking: people interpret evidence not on its merits but on whether it threatens or reinforces group identity. In such a climate, twenty studies showing paracetamol is safe are not twenty reassurances. There are twenty pieces of evidence that the establishment is colluding. Demands for impossible proof, such as lifelong placebo-controlled trials of common medicines, are not genuine requests for science but rhetorical traps. When such evidence does not exist, its absence is presented as confirmation of a conspiracy. Fear explains why the seed of doubt germinates. History makes the soil fertile. Identity ensures the plant of mistrust grows tall and hard to uproot.
Social media magnifies these dynamics. A short video claiming paracetamol damages foetal brains can reach millions before health authorities have even drafted a statement. False claims spread faster than facts because they are simple, emotive, and novel. Algorithms reward outrage and certainty, not nuance and caveats. And because American politics dominates global feeds, its quarrels quickly become everyone’s concern. A line delivered at a rally in Florida unsettles mothers in Manchester or Melbourne the same day.
Amid all this, the autistic community bears the heaviest burden. Autism is repeatedly invoked as the spectre parents should fear, the worst possible outcome of a medical decision. Each time it is framed as a tragedy, autistic people are diminished, their lives implied to be lesser. Parents are left with misplaced guilt, believing that a tablet for pain relief or a vaccine could have caused their child’s neurology. The harm is twofold. First, autistic people themselves are stigmatised, reduced to symbols of catastrophe. Second, public attention is diverted away from where it is most needed: building educational systems, workplaces, and healthcare services that support autistic individuals to thrive. When autism is framed only as a preventable tragedy, societies spend more energy searching for a cause than investing in inclusion.
The instinct of health systems is to respond to mistrust with more data. But facts without trust are blunt tools. Rebuilding trust requires changing the way the conversation unfolds. It begins with common ground. Everyone, whether supportive of medicine or sceptical of it, wants healthy children and safe pregnancies. Starting from this shared desire reframes the clinician as an ally rather than an adversary. Compare two conversations. One begins, “You are wrong, the data show paracetamol is safe.” The other begins, “I understand why you are worried. Every parent wants to protect their child. Let me explain what we know.” Only the second has a chance of building trust.
Explaining science as a process rather than a verdict is equally essential. People who distrust authority are more interested in how we know than what we say. Explaining that hypotheses are tested, results challenged, and mistakes corrected helps the public understand why guidance sometimes changes. A revision in advice is not evidence of corruption; it is evidence of integrity. Transparency builds credibility.
It is also better to pre-bunk than to only debunk. By warning people about common pitfalls, such as post hoc reasoning, before they encounter them, clinicians can inoculate them against misinformation. A simple explanation that correlation does not imply causation, given early and often, equips people to resist more elaborate false claims when they appear.
Trust also depends on the messenger. People are more likely to believe their midwife, pharmacist, or GP than a distant regulator. Hospitals and health networks should equip these front-line clinicians with clear scripts, simple infographics, and accessible FAQs to use in antenatal clinics and pharmacies. A clear explanation from a trusted face is far more persuasive than a faceless press release.
Most importantly, autism itself must not be weaponised. Health systems should actively reject the narrative that autism is a catastrophe. This means involving autistic voices in public conversations, highlighting both strengths and challenges, and presenting autism as part of human diversity. When parents see autistic adults living full lives, contributing and thriving, the fear that fuels misinformation loses its force. Protecting trust in science and protecting autistic dignity are not separate projects; they are the same fight.
Expectant mothers should be reassured: paracetamol, when taken as directed, is safe in pregnancy. But the paracetamol scare reveals something larger. Fear creates the space for mistrust. Psychology explains how it grows. History provides its story. Identity and social media give it power. And autism is too often the collateral damage. Paracetamol is safe. Autism is part of human diversity. The real threat lies in a culture that insists on treating one as poison and the other as tragedy. Changing that story is not optional. It is a responsibility shared by health systems, clinicians, and communities that value both science and human dignity.
