When science gets tangled with money and politics, certainty is the first casualty. Just ask the cigarette-smoking doctors of the 1940s, or perhaps the Tylenol debaters of today.

On Monday morning, President Donald Trump stood at a podium and confidently made a claim that set the world buzzing: Tylenol, the everyday painkiller that’s earned pride of place in bathroom cabinets and first aid kits for generations, could cause autism in an unborn child if taken during pregnancy. The ingredient believed to be at the root of the problem is acetaminophen, the pain-and-fever-reliever we usually find in the form of Panado, Calpol or Grandpa tablets here in South Africa. President Trump went on to say that the Food and Drug Administration was beginning the process of updating safety labels for acetaminophen, citing research that supposedly links prenatal use to autism and ADHD.

It may sound like a breakthrough, but the science behind the claim looks shaky at best. The FDA’s own guidance remains cautious, advising doctors to “exercise their best judgement” rather than imposing a ban. That hesitation is deliberate, since acetaminophen is still the only over-the-counter drug approved for treating fevers during pregnancy. While the potential risks of Tylenol remain hotly debated, the danger of high fevers in expectant mothers is well established and far less ambiguous.

Just days after Trump’s Tylenol claim, news broke that one of the papers cited by the president as irrevocable proof of the link between acetaminophen and autism was authored by Dr. Andrea Baccarelli of Harvard’s T.H. Chan School of Public Health – the same Dr. Baccarelli that various media outlets reported as being paid at least $150,000 in 2023 to serve as an expert witness in lawsuits against Tylenol’s former manufacturer. These lawsuits were ultimately dismissed by a federal judge for lack of reliable scientific evidence, despite Dr. Baccarelli’s paid-for testimony. 

The whole messy situation raises a thorny question: when medical research is wrapped up in politics, litigation, and big paychecks, whose conclusions can we trust? It’s a modern problem with a familiar echo. To hear it, you only have to roll back the clock to a time when doctors weren’t warning patients about risk, but actively selling it.

When doctors lit up

In the 1930s and 40s, lung cancer cases were spiking worldwide, but no one was sure why. Certainly nobody suspected the cause could be the cigarettes that were everywhere – tucked into soldiers’ rations, clutched between movie stars’ fingers, even passed around hospital waiting rooms. Doctors smoked them. Patients smoked them. Sure, some smokers complained about symptoms like throat irritation and mouth sores, but science hadn’t yet drawn a clear line between smoking and cancer. Tobacco companies seized the opportunity to turn uncertainty into a marketing edge.

Their strategy was simple: if you want credibility, borrow a white coat.

American Tobacco led the charge in 1930 with Lucky Strike. Picking up the trend around throat irritation, its headline bragged: “20,679 physicians say Luckies are less irritating”.  That oddly precise number didn’t come from lab work or clinical trials, either. It came from cartons of free cigarettes mailed to doctors along with a leading question: aren’t Luckies easier on the throat? Many doctors responded positively to this biased, leading question (probably while puffing on their free cigarettes), and Lucky Strike ads used their answers to imply their cigarettes must be medically superior.

Other companies soon rushed to copy the tactic. In 1937, Philip Morris ran a Saturday Evening Post spread claiming doctors had conducted a study proving throat irritation cleared “completely and definitely” when smokers switched to their brand. What the ad conveniently left out was that Philip Morris had funded the study in the first place.

More doctors smoke Camels

By the 1940s, the game had gone pro. R.J. Reynolds, maker of Camel cigarettes, went so far as to establish a Medical Relations Division dedicated to courting physicians and publishing studies. In 1946, they launched what would become one of the most infamous cigarette ad campaigns of the century: “More doctors smoke Camels than any other cigarette”.

How did they arrive at that conclusion? By handing out cartons of Camels to doctors and then asking them which brand they smoked. Unsurprisingly, a doctor given a month’s supply of free Camels was smoking Camels.

But it worked. For nearly a decade, ads featured kindly physicians puffing away, assuring readers that Camels soothed throats, steadied nerves, and got medical approval. Smoking was framed as not just harmless, but practically good for you. 

A frank statement and a crumbling facade

By the early 1950s, though, the tide was turning. Independent studies (as in, the kind not paid for by tobacco companies) were stacking up and showing that smoking wasn’t soothing throats or nerves; in fact, it was killing people at pace. Lung cancer rates were rising too sharply to ignore. The industry, desperate to keep its customers calm, tried a new tactic, which was to admit just enough doubt to delay the reckoning.

In 1954, America’s leading cigarette companies took out full-page ads in more than 400 newspapers under the banner “A Frank Statement to Cigarette Smokers”. They acknowledged that some research was “alarming”, but insisted the science wasn’t conclusive. To demonstrate good faith, they announced the creation of the Tobacco Industry Research Committee. Its purpose, they said, was to fund independent studies and get to the bottom of the controversy.

I’ll leave it to you to decide if there can be such a thing as an independent study paid for by the company whose products are being studied.

Of course, the committee wasn’t designed to resolve the question – it was designed to perpetuate it. By keeping the science “unsettled,” the companies bought themselves another decade of profit. But the white coat strategy was finished. Doctors, once reliable pro-tobacco spokesmen, were fast becoming whistleblowers. By 1964, the US Surgeon General’s landmark report made it official that smoking caused lung cancer, laryngeal cancer, and chronic bronchitis.

And just like that, the image of the cigarette-smoking doctor went up in smoke.

The Harvard connection

This brings us back to Tylenol. Dr. Andrea Baccarelli, the Harvard researcher whose work is now being cited by Trump and federal health officials, is no paid actor in a Camel ad. But his dual role – both as a scientist conducting studies and as a well-compensated expert witness for plaintiffs in lawsuits – draws uncomfortable parallels to the past. Just as tobacco executives once used selective surveys and industry-funded research to prop up their claims, today’s political figures are leaning on research that has its own tangled financial interests.

To be clear, acetaminophen is not cigarettes. The evidence against smoking is overwhelming and settled, while the evidence on Tylenol and autism is disputed and, by most accounts, inconclusive. But the strategy feels familiar: spotlight research that aligns with your message, downplay the conflicts of interest, and present the conclusion with absolute certainty.

Back in the 1930s, a free carton of Camels could buy a doctor’s loyalty. In 2025, the public should use history as a warning and question not just what the science says, but who’s paying to say it.

The cost of confusion

The danger isn’t only in the pill or the smoke – it’s in the erosion of trust. When credibility is bought, the public loses confidence in the institutions meant to guide them. Cigarette companies learned this the hard way when lawsuits, regulation, and science finally caught up to them. But when the message gets massaged by marketing, litigation, or politics, the truth has a way of being the last thing to arrive.

And like those early cigarette ads, the consequences of who we choose to believe could linger for generations.

About the author: Dominique Olivier

Dominique Olivier is the founder of human.writer, where she uses her love of storytelling and ideation to help brands solve problems.

She is a weekly columnist in Ghost Mail and collaborates with The Finance Ghost on Ghost Mail Weekender, a Sunday publication designed to help you be more interesting. She now also writes a regular column for Daily Maverick.

Dominique can be reached on LinkedIn here.