Trump, Tylenol, and 2000 Years of Bad Advice
On Monday, September 22, President Trump, flanked by Health Secretary Robert F. Kennedy Jr., stated that pregnant women should not take Tylenol because fetal exposure to acetaminophen causes autism. Like the link between childhood vaccines and autism touted by Trump and Kennedy, this claim has no basis in fact. Scientists and physicians, including Steven J. Fleischman, M.D., president of the American College of Obstetricians and Gynecologists, immediately weighed in. They protested that there is no evidence of a causal link between Tylenol use in pregnancy and autism. Further, high fevers in early pregnancy, which are commonly treated with acetaminophen, can harm the developing fetus. Any kind of ban on – or even a strong warning against – the use of Tylenol during pregnancy will do more harm than good.
While it’s important to correct the misinformation about Tylenol use during pregnancy, it’s even more important to expose and counter two assumptions underlying Trump’s remarks, both of which have deep and tenacious roots. The first assumption is that anything that goes wrong with a pregnancy must be the fault of the pregnant person. Since antiquity, medical and popular opinion has held that miscarriage, stillbirth, and disability are caused by things the pregnant person does or fails to do. These beliefs have persisted into the twenty-first century, and they are now used as the basis for prosecutions of pregnant women for miscarriage. The second assumption is that motherhood necessarily involves suffering and sacrifice. Pregnant people must follow a strict, medically prescribed regimen of diet and activity, even if this regimen is onerous or even harmful to the pregnant person. For centuries, these twin assumptions have dominated medical advice for pregnant people.
Two thousand years ago, the Roman physician Soranus (fl. 1st/2nd century CE) asserted that pregnant women needed to follow a carefully prescribed diet, as well as a regimen of baths, massages, and exercise. Only if they followed his advice would they produce healthy, able-bodied babies. If a baby was born with a “misshapen” body and an “ignoble” soul, the mother must have done something wrong during pregnancy. As Anna Bonnell-Freidin writes, “Soranus clearly wants to frighten his audience into following his rules. In essence, he seems to say, you’ll regret it if you don’t listen to me!”
This message had staying power. Over a millenia later, in the fifteenth century, the physician Michele Savonarola (c. 1385-1468) wrote a book on pregnancy dedicated to the women of Ferrara, in what is today northern Italy. “If you desire to have a beautiful child, of good complexion and gifted by nature,” he wrote, you had to follow his extensive recommendations on appropriate food and drink.[1] By implication, failure to follow his advice would result in a child who was unattractive, unhealthy, and unintelligent. Savonarola admonished pregnant women that any “gluttony” on their part would harm their fetuses. Gluttony could mean eating and drinking too much or eating the wrong foods simply because they were tasty. Like Soranus, Savonarola urged women to suppress their desires and sacrifice their comfort for the sake of their fetuses.
More than five hundred years after Savonarola, American physicians were still offering similar advice. In the first half of the twentieth century, the President of the American Public Health Association, Dr. William Augustus Evans (1865-1948), published a syndicated advice column in the Chicago Daily Tribune called “How To Keep Well.” Evans answered readers’ queries on a wide range of health issues, including pregnancy. In 1928, he published a summary of a letter from a “Mrs. E.” detailing her two pregnancies. Mrs. E’s first baby was born with Down syndrome and died soon after birth. She was told by a nurse that the reason her first son was disabled was because she had refused to follow her doctor’s directions: “Her doctor told her what to eat and what not. She disobeyed him. She liked to eat, and she ate what she liked when she wanted.” Like a repentant sinner, Mrs. E. confessed to her doctor. When she became pregnant for the second time, she followed his strict orders: “Once he put her on a diet consisting of buttermilk only and kept her in bed for four or five days.” Poor Mrs. E. “thought she could not stand it,” but this time around, she resolved to “tough it out” (in the words of President Trump a century later). The result was a healthy baby boy with “a perfect body, and a perfect brain and stomach.”[2]
The moral of this story was clear: the selfish, self-indulgent mother who prioritized her own comfort during pregnancy irreparably damaged her fetus. Sacrifice and self-abnegation were essential qualities of a good mother and a healthy baby. Whenever an infant is weak, sickly, or disabled, the fault must lie with the mother. The job of a conscientious physician like Mrs. E’s was to protect the fetus from its mother.
In none of these cases, spread throughout nearly two thousand years, is there any sense that a pregnant person might know – instinctively or through experience – what was best for the health of their fetus. As I have argued in Policing Pregnant Bodies, women have been seen historically as “irrational, unstable, and emotional,” and as “poor caretakers of fetuses.” (101) They need the guidance of (male) medical authorities who are assumed to be so intellectual and rational that they must know better. Neither is there any sense that miscarriage, stillbirth or disability might have causes entirely outside the control of the pregnant person. Trump’s remarks set up an all-too-familiar opposition between “good” mothers who would “fight like hell” to avoid Tylenol and instead “tough it out” through pain and fever, and “bad” mothers who would thoughtlessly or selfishly risk the health of their babies for their own personal comfort.
Amid rising maternal and infant mortality rates, President Trump’s manufactured controversy over Tylenol distracts attention from the real causes of harm to maternal and fetal health – poverty, racism, exposure to environmental hazards, and lack of access to healthy food, clean water, safe neighborhoods, and high-quality medical care, all of which are scientifically proven to seriously affect pregnant people and fetuses. After two thousand years, it’s time to stop blaming and shaming mothers.
Notes
- Martin Marafioti, “The Prescriptive Potency of Food in Michele Savonarola’s De Regimine Pregnantium.” In Christiana Purdy Moudarres (ed.), Table Talk: Perspectives on Food in Medieval Italian Literature (Cambridge Scholars Publishing, 2010), p. 28. ↑
- W. A. Evans, “How to Keep Well: A Plea for Better Maternity Care,” Chicago Daily Tribune, Nov 11, 1928,pg. 12. ↑
Featured image caption: Tylenol rapid release pills. (Courtesy Wikimedia)
Kathleen Crowther is an associate professor in the Department of the History of Science at the University of Oklahoma. Her research interests include science, medicine, gender and religion in the early modern period. Her first book was Adam and Eve in the Protestant Reformation (Cambridge University Press, 2010). One of her current projects is an examination of anatomical studies of reproduction, including the anatomy of the male and female reproductive organs and of fetal development, in the sixteenth and seventeenth centuries.
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