Professional medical associations such as the American Medical Association (AMA), American Hospital Association (AHA), and American College of Physicians (ACP) have historically been viewed as more than just policy-makers; they are recognized as guardians of medical ethics, champions of science, and pillars of public confidence. Nevertheless, in pivotal moments, these organizations frequently choose to remain silent—a tactic that is anything but neutral and carries significant consequences.

In recent cases, like the FDA’s updated acetaminophen labeling in September 2025, a split in responses was observed. The FDA suggested a potential yet unclear connection between the prenatal consumption of acetaminophen and neurodevelopmental disorders such as autism and ADHD, while the World Health Organization found no definitive evidence of a causal link. Simultaneously, the American College of Obstetricians and Gynecologists endorsed the use of acetaminophen at the minimal effective dosage during pregnancy. This resulted in confusion for both patients and clinicians due to conflicting messages, with the leadership of medical organizations noticeably absent.

Medical leadership typically rationalizes its silence as diplomacy, taking place in private discussions to avoid alienating government entities vital for financial reimbursement. There is also a concern about upsetting politically diverse membership, and the bureaucracy within organizations often produces lagged reactions. However, these justifications are insufficient in times of crisis, where silence translates to complicity, undermining public trust, allowing misinformation to proliferate, and leaving both clinicians and patients—particularly the most vulnerable—distressed and unprotected.

To preserve their credibility and uphold their ethical duties, medical organizations need to regain their proactive voice. This can be achieved through:

1. **Coordinated statements:** Unified responses from various associations strengthen impact and minimize confusion.
2. **Transparent reasoning:** Clarifying the reasoning behind silence to ensure members do not feel overlooked.
3. **Elevating frontline voices:** Involving practicing clinicians in advocacy efforts to counteract bureaucratic delays.
4. **Direct community engagement:** Actively involving both policymakers and the public to address misinformation and restore trust.

Neutrality should symbolize nonpartisan advocacy anchored in ethical obligations, rather than detachment. Positively, the AMA has recently enacted policies to fight health misinformation, and collaborative advocacy initiatives are on the rise. While these are encouraging strides, silence cannot dominate. The credibility of medicine relies on clinical excellence and the bravery to advocate for evidence-based practices, which is essential both professionally and ethically.

Marilyn Uzdavines is a law professor. Vijay Rajput is an internal medicine physician.