The spread of misinformation — and the way fear can burn through a landscape — was forefront in Tor-Arne Hegvik’s mind when, in October 2020, he opened up his web browser and found a new autism paper in JAMA Pediatrics. Hegvik is a gynecologist and researcher at the University of Bergen in Norway, and the study, co-led by biostatistician Anny Xiang of Kaiser Permanente Southern California (KPSC), made what appeared to be an improbable claim: The epidural analgesia given during labor is associated with increased chances of having a child with autism.
Hegvik had never wondered whether epidurals could contribute to autism, and he didn’t think anyone else had seriously considered it either. He assumed the association detailed in the paper was due to confounders — unaccounted-for factors that skew a result. Plus, he had clinical duties to attend to and patients to see. He tried to put it out of his mind.
But the paper continued to plague him. It reminded him of Andrew Wakefield’s infamous fraudulent statement that vaccines cause autism: Though the link was easy to disprove, it was exceedingly difficult to quash in the public consciousness. The epidural paper was not exactly that — Hegvik could see it was honest science — but the potential for harm felt similar. The decision to get an epidural requires clear, straightforward information. The Xiang paper, he worried, would muddy the waters. He couldn’t turn away. So he emailed some of his colleagues and asked: Would anyone be interested in trying to refute this?