In recent years, public communications by high-level government officials have been shown to influence medication use in ways that sometimes bypass the standard scientific and regulatory review process. A recent analysis published in The Lancet highlights how a White House briefing in September 2025 affected the prescribing patterns of paracetamol (acetaminophen) and leucovorin across the United States.
Normally, any changes in federal prescribing guidelines involve careful review by the US Food and Drug Administration (FDA). These processes include input from FDA scientists, external stakeholders, and public commentary. However, on September 22, 2025, a White House briefing included statements from the US President and the FDA Commissioner concerning paracetamol and leucovorin in ways that were outside this standard process. The briefing highlighted potential risks of prenatal paracetamol use related to neurodevelopmental disorders, including autism spectrum disorder, while presenting leucovorin as a promising therapy for children affected by autism.
Following the briefing, it became important to understand whether this high-profile messaging influenced clinical practice. To assess the impact, researchers used data from Cosmos, a large-scale electronic health record database created by Epic. This dataset includes over 294 million patient records from more than 1,600 hospitals and 37,000 clinics across the United States, as well as patients from Canada, Lebanon, and Saudi Arabia. For the purpose of this study, only U.S. data were included to capture the population most exposed to federal messaging.
The study focused on two main groups. First, pregnant individuals aged 15 to 44 years, examining emergency department paracetamol orders and using opioid and Lactated Ringer’s solution orders as control comparators. Second, children aged 5 to 17 years, analyzing new outpatient prescriptions of leucovorin. The study included several comparators such as aripiprazole, risperidone, and folic acid preparations. Due to insufficient data, levoleucovorin was excluded.
To evaluate changes, the researchers applied an interrupted time series analysis. They used a Poisson regression model based on weekly prescription and order counts during the pre-briefing period from June 30 to September 21, 2025. This model was adjusted for time trends and demographic factors and used to project expected prescription counts for the post-briefing period from September 22 to December 7, 2025. The primary metric was the observed-to-expected ratio (OER), with 95 percent confidence intervals calculated using the Delta method.
The results showed a noticeable decline in paracetamol orders for pregnant individuals. During the post-briefing period, emergency department orders decreased by 10 percent compared with expected levels, representing an absolute reduction of 22.5 orders per 1,000 visits. The decline was most pronounced during the third week following the briefing, reaching a 20 percent reduction. In contrast, no significant changes were observed for non-pregnant individuals or for the control medications, indicating that the shift was specific to the population targeted by the messaging.
Conversely, the briefing coincided with a significant increase in outpatient leucovorin prescriptions for children aged 5 to 17 years. New prescriptions rose by 71 percent during the study period, with the greatest surge occurring in the second week after the briefing, when prescriptions more than doubled compared with expected levels. Minor increases were also observed for aripiprazole and risperidone, which could reflect searches for alternative treatments, particularly as a leucovorin shortage occurred in November 2025. Folic acid prescriptions remained largely unchanged.
These results demonstrate the influence that high-profile public statements can have on prescribing behavior. Although causation cannot be definitively established, the patterns are consistent with immediate changes in clinical decision-making and possibly patient demand following federal messaging. This effect echoes observations made during the COVID-19 pandemic, where public promotion of specific treatments led to notable changes in prescription and public interest, even in the absence of new evidence.
The findings have several implications for public health. Reductions in paracetamol use during pregnancy could increase the risk of untreated fevers, which are known risk factors for adverse neurological outcomes. However, recent evidence suggests no clear association between prenatal paracetamol use and increased risk of autism, attention-deficit hyperactivity disorder, or intellectual disability. Similarly, a surge in leucovorin prescriptions outside the context of rare cerebral folate deficiency could lead to false expectations among families and exposure to unnecessary side effects.
Several limitations of the study must be considered. The analysis did not account for seasonal variations, such as the natural increase in paracetamol use during cold and flu season. The Cosmos database, while comprehensive, may not fully represent the entire U.S. population. Additionally, the leucovorin analysis was not restricted to children with autism, potentially underestimating the effect among the intended population. Despite these limitations, the database captures a substantial portion of U.S. patients and reflects general prescriber patterns.
This study underscores the broader point that public authorities have the power to drive immediate changes in healthcare practices. Even without presenting new scientific data, messaging from high-level officials can shift prescribing behavior, highlighting the importance of evidence-based communication in healthcare. It also emphasizes the need for clinicians and patients to critically evaluate new information and consult trusted sources before making changes to treatment.
The observed trends highlight the delicate balance between public messaging, scientific evidence, and clinical practice. Regulatory agencies such as the FDA play a vital role in ensuring that any changes to medication use are based on rigorous review. While the briefing may have prompted rapid changes in prescribing, subsequent updates from professional organizations and additional research are essential to provide accurate guidance for safe medication use.
In conclusion, the White House briefing of September 22, 2025, appears to have produced immediate and measurable effects on the prescribing of paracetamol and leucovorin. Pregnant individuals were less likely to receive paracetamol in emergency departments, and children were more likely to receive leucovorin in outpatient settings. These findings highlight the influence of public authority figures on clinical behavior and underline the need for careful, evidence-based communication regarding medication safety and efficacy.
This blog is for informational purposes only and should not be considered medical advice. Readers should consult licensed healthcare professionals before making decisions about medication use for themselves or their children. The information presented is based on published studies and public reports as of March 2026.
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