The Way Forward: Finding Truth at the Intersection

published June 19, 2025

The Center’s Approach to Complex Scientific Questions

This article is Part V 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.

Acetaminophen sits at a critical intersection of maternal and child health. For decades, clinicians have called it the first-line option for fever or pain in pregnancy. Yet since 2013, observational studies linking prenatal use to autism or ADHD sparked headlines and lawsuits. The timeline that followed captures the complexity: a 2021 precautionary consensus statement in Nature Reviews Endocrinology, an April 2024 Swedish sibling-control study of 2.5 million births finding no causal link, an August 2024 federal ruling dismissing mass-tort claims for insufficient scientific evidence, and a February 2025 biomarker study suggesting a possible ADHD signal in a small cohort. Meanwhile, regulatory bodies continue to advise judicious use—because untreated fever during pregnancy remains a proven risk. As we conclude our exploration of this issue, we examine how scientific, legal, and economic perspectives must converge to find truth [1][2][3][4][5].

Beyond Siloed Thinking: The Power of the Intersection

Science alone, law alone, or economics alone tells only part of the story. Epidemiologists quantify relative risks, courts apply evidentiary standards, and economists measure downstream effects of uncertainty. History shows that when these streams run in parallel rather than in confluence—consider glyphosate, talc, or vaping controversies—communication gaps widen, trust erodes, and costly missteps follow.

The Center for Truth in Science deliberately operates at the nexus where these disciplines meet. Our framework overlays:

Biomedical data – from observational cohorts to sibling-control studies to biomarker analyses
Litigation trends – examining how evidence standards vary across jurisdictions
Economic modeling – tracing how scientific uncertainty ripples through healthcare systems

This integrated approach helps policymakers balance competing considerations: untreated maternal fever versus theoretical developmental risks; premature warning labels versus consumer confidence; defensive medicine versus equitable access. By bringing diverse experts into a single analytic workflow, we reduce the blind spots that inevitably develop when disciplines operate in isolation.

Systematic Review: The Antidote to Cherry-Picking

Scientific questions rarely have simple answers—especially in pregnancy research, where randomized trials face ethical limitations and observational studies must navigate complex confounding factors.

Systematic reviews provide a structured methodology to gather and critically appraise all relevant evidence. Following PRISMA guidelines, review teams search multiple databases, apply independent dual screening, and rate certainty using tools such as GRADE. This approach prevents selective citation—the very shortcoming that led Judge Denise Cote to describe the plaintiffs’ experts as “results-driven” in her ruling on the acetaminophen litigation [1].

Recent data illustrate why rigorous synthesis matters:

The Swedish sibling cohort of 2.5 million births found no association with autism or ADHD once familial factors were controlled [2].
Meanwhile, a Memphis biomarker study reported a three-fold ADHD signal, but only in a small sample of female children [3].

Without a protocol-driven review process, advocates on either side can cherry-pick studies that support predetermined conclusions. A transparent, comprehensive synthesis can clarify whether such differences stem from methodological variations, confounding influences, exposure misclassification, or simple chance.

CTS’s commitment to systematic reviews represents an investment in scientific clarity—one that can potentially save billions in unnecessary litigation, defensive medicine, and misdirected research funding.

Evidence-Based Decision Making: From Research to Practice

Better synthesis is valuable only if it informs real-world decisions. The acetaminophen case demonstrates the need for clearer pathways from evidence to action:

For Regulators: Agencies need transparent thresholds for label changes that balance concerns about drug exposure against the documented dangers of untreated maternal fever. The FDA currently judges the evidence linking acetaminophen to neurodevelopmental disorders as “limited and inconclusive,” but welcomes robust meta-analysis to inform future guidance [4].

For Courts: Scientific gatekeeping varies dramatically across jurisdictions. A clear evidence hierarchy could help judges nationwide apply Daubert standards consistently, reducing “jurisdiction shopping” and aligning state verdicts with scientific consensus rather than geographic accident [1].

For Healthcare Providers: Clinicians need clear, accessible materials to explain absolute versus relative risk to expectant parents. When a pregnant woman with a 102°F fever asks whether acetaminophen is safe, the answer must balance multiple considerations with numerical context, not just repeat alarming headlines.

For Journalists: Science reporting that amplifies preliminary results without appropriate caveats can create unwarranted panic. Media guidelines for communicating uncertainty could help prevent the premature transformation of hypotheses into headlines.

The Center’s Path Forward: Advancing Knowledge Through Integration

The Center for Truth in Science is uniquely positioned to address scientific controversies like the acetaminophen question. Our upcoming work includes:

A comprehensive systematic review assessing the totality of evidence linking prenatal acetaminophen exposure to neurodevelopmental outcomes
Economic analysis quantifying the costs of scientific uncertainty across healthcare, legal, and commercial domains
Stakeholder roundtables bringing together researchers, clinicians, patient advocates, industry representatives, and legal experts

By maintaining independence from litigation interests, pharmaceutical funding, and advocacy pressures, we can produce analysis that serves only the pursuit of truth—not predetermined outcomes.

In Plain English

When science delivers mixed messages about a medication taken by millions of pregnant women, everyone suffers from the uncertainty. Some large studies comparing siblings find no link between prenatal acetaminophen and childhood brain development issues. Other smaller studies measuring drug levels in umbilical cord blood still raise questions. Courts have thrown out expert testimony that ignored genetic factors, but lawsuits continue because absolute certainty remains elusive. The Center for Truth in Science examines all aspects—scientific evidence, legal standards, and economic impact—to help society navigate toward clearer answers [1][2][3][4][5].

Myth vs. Reality

Myth: “Systematic reviews just compile what we already know.”
Reality: High-quality reviews rank evidence strength, expose biases, and often overturn first impressions by revealing patterns invisible in individual studies [1][2].
Myth: “If courts dismiss plaintiffs’ experts, the science must be settled.”
Reality: Legal admissibility tests methodological rigor, not absolute truth; ongoing research conducted with appropriate controls can still advance our understanding [1][2][3].
Myth: “Small biomarker studies provide the strongest proof of harm.”
Reality: Exploratory biomarker signals require confirmation; large sibling-comparison cohorts of millions control for key confounders and currently show no association [2][3].
Myth: “We should choose between economic concerns and health protection.”
Reality: Sound science serves both goals simultaneously—preventing unnecessary costs while identifying real hazards that demand action [2][4][5].

Key Takeaway

Finding truth in complex scientific controversies demands an integrated approach that respects rigorous methodology, legal fairness, and economic realities—precisely the perspective that the Center for Truth in Science brings to the acetaminophen debate and similar challenges at the intersection of science, justice, and the economy.