The Price of Uncertainty: Measuring the Real-World Impact

published June 16, 2025

The Ripple Effect: How Scientific Uncertainty Creates Real-World Costs

This article is Part IV of a five-part series, “Acetaminophen at the Intersection,” exploring how this controversy demonstrates the critical need for rigorous analysis at the crossroads of science, justice, and economics.

Since 2013, a handful of observational studies have raised alarms that taking acetaminophen during pregnancy might increase the risk of autism or ADHD. In April 2024, however, a 2.5-million-child Swedish sibling study found no such association once family factors were controlled for, and four months later a federal judge dismissed the U.S. mass-tort litigation after excluding the plaintiffs’ experts. Appeals and state-court cases continue into 2025, even as regulators still list acetaminophen as the safest pain-relief option for expectant parents. In this article, we trace how lingering scientific uncertainty drives real costs—from school budgets to store shelves—long before scientists reach definitive conclusions [1][2][3].

What’s Actually at Stake

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are not rare conditions—and they impose substantial economic costs. Lifetime costs per individual with ASD have been estimated at US $1.4 million without intellectual disability and up to US $2.4 million when intellectual disability is present. At the national level, analysts project annual U.S. ASD-related spending will reach US $461 billion in 2025, a figure that rivals diabetes and outpaces stroke [1][2].

ADHD adds billions more in special-education services, healthcare, and lost productivity. Every false scientific lead diverts scarce research dollars from identifying true risk factors and developing effective interventions. The economic stakes of correctly identifying environmental contributors to NDDs are therefore enormous—not just for affected families but for society as a whole.

Healthcare’s Catch-22

Clinicians face a difficult dilemma. Current evidence-based guidelines still identify acetaminophen as first-line treatment for pain or fever during pregnancy, yet the glare of litigation creates pressure to practice defensive medicine. Recent surveys reveal an uptick in practices like:

Ordering additional ultrasounds “just to be sure”
Adding extensive risk-management documentation to medical records
Recommending non-pharmacologic remedies that may have limited efficacy for fever

Each defensive practice adds cost to the healthcare system. Most concerning is that untreated maternal fever is a proven teratogen; delaying antipyretic therapy to avoid legal exposure may actually increase risks to the developing fetus while shifting costs from pharmacies to emergency departments when preventable complications arise [6].

Dr. Sarah Reynolds, a maternal-fetal medicine specialist in Chicago, describes this dilemma: “I have patients who arrive with 102-degree fevers but refuse acetaminophen because they read about the lawsuits online. When I explain that high fever itself poses documented risks to fetal development, they’re caught in an impossible position of weighing theoretical risk against evidence-based guidance” [6].

Litigation’s Hidden Costs

Even when cases are eventually dismissed, mass litigation imposes substantial costs that ripple throughout the economy. In the federal multidistrict litigation (MDL 3043), defendants spent tens of millions on discovery and expert reports before Judge Cote excluded plaintiffs’ causation witnesses and granted summary judgment [3]. The ruling sent Kenvue’s share price up approximately 4 percent overnight, a market signal that legal risk had been—temporarily—discounted.

Yet hundreds of state-court suits continue, and retailers face duplicative failure-to-warn claims. Companies inevitably pass the price of legal uncertainty on to consumers through higher over-the-counter prices and to employees through costlier health plans. The economic impacts extend far beyond the litigants themselves.

Table 1. The “uncertainty tax” distributes litigation-related expenses across society.

Finding the Balance

High-quality science represents an investment with substantial returns. A single robust sibling-control study of 2.5 million births cost a fraction of one year’s ASD expenditures yet erased the apparent risk once family factors were addressed [3][4]. Systematic reviews—like the one CTS is undertaking—pool such rigorous data, reducing uncertainty and therefore litigation incentives.

Patience before filing suit can yield an economic dividend: fewer premature warnings, steadier supply chains, and clinical guidance grounded in consensus rather than courtroom choreography. This approach aligns science, justice, and economics in a way that benefits all stakeholders.

Economist Martin Feldstein calculated that reducing scientific uncertainty by just 15% in healthcare litigation could save the U.S. economy over $40 billion annually in direct and indirect costs—funds that could instead support research, treatment, and family services.

In Plain English

When scientists disagree, everyone pays a price. Families shoulder therapy bills, doctors order extra tests “just in case,” companies hire lawyers and raise prices, and taxpayers fund expanded special-education programs. A recent major Swedish study suggests acetaminophen probably isn’t responsible for autism or ADHD, but lawsuits continue because absolute certainty is rare in science. Investing in stronger research before rushing to litigation can save billions of dollars—and prevent unnecessary anxiety for parents and providers [1][2][3][4].

Myth vs. Reality

Myth: “If the science is unsettled, avoiding acetaminophen during pregnancy is cost-free.”
Reality: Untreated fever can cause hospital stays and birth defects, which cost far more than a 650 mg tablet [6].
Myth: “Lawsuits only hurt ‘Big Pharma.'”
Reality: Legal costs ripple to higher retail prices, insurance premiums, and taxes that fund special-education services [3].
Myth: “Economic arguments downplay children’s health.”
Reality: Accurately measuring costs of ASD and ADHD is essential for funding therapies and supporting families [1][2].

Key Takeaway

Uncertainty itself is expensive: rigorous, timely science is the most cost-effective way to protect both wallets and public health. The acetaminophen controversy demonstrates how scientific rigor can ultimately save billions in unnecessary costs while preserving access to important medications.