Among the many claims made in the Tylenol-autism controversy, one phrase stands out: President Trump’s suggestion that pregnant women should “tough it out” rather than take acetaminophen for fever. This short line achieved what entire press releases and TV interviews from health agencies could not: it set the frame of the debate. It was quoted, replayed, condemned and remembered. Apart from resembling something straight out of Margaret Atwood’s Handmaid’s Tale, the episode illustrates how populist rhetoric can fill the knowledge gap with emotional clarity (but with empty calories, rather than nutrients), while institutional counterarguments widened the gap with cautious lists of risks and statistics.

That phrase did more than grab headlines. It mapped onto long histories of how women’s pain has been dismissed by the medical establishment, literally for millennia. It showed how institutions once again chose a communication style that left the public without a compelling alternative narrative. In short, the medical establishment, had nothing comparable as a riposte that hit hard in the same way.

Why “tough it out” resonated

The phrase worked on multiple levels:

·       Simplicity: three words easy to remember and repeat. We expect the slogan to appear on bumper stickers, baseball caps and t-shirts very soon.

·       Moral framing: It implied that endurance was a virtue, that the “good mother” proves her toughness.

·       Identity: It aligned with broader populist appeals to self-reliance and suspicion of experts.

From a communication perspective, “tough it out” closed the knowledge gap. It gave audiences a ready answer: medication is suspect; strength lies in doing without. That answer was wrong and dangerous, but it was legible and resonant.

The Institutional Reply

By contrast, the rebuttals were factually correct but narratively weak:

·       ACOG: Warned of the risks of untreated fever, including miscarriage and birth defects.

·       MHRA: Reiterated that paracetamol remains the safest painkiller in pregnancy.

·       FDA: Balanced acknowledgement of associations with reminders that no causal link has been established.

These statements were true, but the read like technical memos. They did not challenge the moral clarity of “tough it out”. They presented risks and processes but not a counter-narrative that resonated emotionally.

The Gendered Knowledge Gap

The phrase also hit home because it echoed a longer pattern: the dismissal of women’s pain in medicine. From the millennia-old label of “hysteria” to modern accounts of women waiting longer for pain relief or being misdiagnosed by healthcare providers, there is a gendered knowledge gap in healthcare. Women are often told, directly or indirectly, to endure rather than to be treated. Trump’s phrase replayed this script. For many, it sounded familiar, not novel. Yet the institutional responses did not address this resonance. They listed clinical risks but did not name the history of dismissal or acknowledgement why the phrase stung so badly. By failing to engage with the emotional and cultural context, institutions left the gap wide open.

As we have stated in other articles, communicators can choose to narrow or widen the gap. In this controversy, institutions chose language that widened it. They could have framed their message differently:

·       Clarity first: “Fevers in pregnancy must be treated, untreated fever is dangerous.”

·       Empathy second: “We understand the fear and confusion but your health and your baby’s health depend on care, not toughing it out.”

·       Counter-narrative: “Really toughing it out means getting treatment for your fever. Protect yourself and protect your child.”

Such choices would have closed the gap with both fact and feeling. Instead, institutions left the moral framing uncontested.

Why the gap matters

The stakes are not solely rhetorical. There are real risks to untreated fever in pregnancy: miscarriage, birth defects or pre-term birth. When women internalise messages like “tough it out”, they may avoid safe treatments and endanger themselves and their babies. The knowledge gap here is not abstract. It has material consequences for health outcomes.

Lessons from “tough it out”

1.       Populist rhetoric thrives on moral clarity: It narrows the gap by giving people a simple moral frame.

2.       Cold institutional caution widens the gap: Lists of risks without story or empathy do not resonate.

3.       Gendered histories matter: Communication that ignores the lived experience of dismissal fails to connect with its audience.

4.       Narratives must be countered with narratives: Facts alone cannot dislodge a sticky phrase. Only a counter-story, courage as care, protection through treatment, can do so.

The “tough it out” remark is a case study in how communication shapes health controversies. Populist rhetoric closed the knowledge gap falsely but powerfully, with three short words that carried moral weight. Institutional replies widened the gap with accurate but inaccessible lists of risks. And in failing to address the gendered resonance of the phrase, they missed the chance to connect with their audience. The knowledge gap here was not inevitable. It was widened by choice. If institutions want to prevent dangerous phrases from defining public debate, they must learn to pair truth with clarity, empathy and narrative strength.

Thank you for reading,

Mark Gibson, Leeds, United Kingdom

Nur Ferrante Morales, Bonilla de la Sierra, Spain

September 2025