Medicine Isn’t a Monument. It’s a River.

Medicine is flow

Created by Christopher Caffrey, ACNP, PMHNP, Functional Medicine-trained

September 24th 2025

Key Takeaways:

1. Medicine Must Evolve

Medical knowledge is not fixed—it's constantly changing as new evidence emerges. What was once accepted as truth may later be proven incomplete or even harmful.

2. “Safe” Doesn’t Mean Risk-Free

The term “safe” in medicine often means “low risk under certain conditions,” not “zero risk.” Every drug or treatment carries potential side effects.

3. Human Studies Are Complex

Studying humans is messy. Correlation doesn't always mean causation, and unpredictable variables make science an ongoing process—not a final verdict.

4. History Teaches Us to Stay Open-Minded

Ideas like handwashing and bacteria-caused ulcers were once rejected. These examples remind us to stay curious and humble in the face of new science.

5. Questions Are the Heart of Good Medicine

Doubt isn't dangerous—it's necessary. Asking questions, exploring new data, and practicing transparency help protect patients and improve care.

Imagine if medicine were a statue—fixed in stone, unmoving, untouched by time. We'd still be bloodletting people (the medical practice that killed George Washington), smoking cigarettes in hospitals, and shunning the idea that tiny bacteria could cause massive ulcers.

But medicine isn’t a fixed like a statue. It’s a river.

It flows. It evolves. And the moment we stop letting it change, we’re no longer practicing medicine—we’re practicing dogma.

🔄 What Was "Safe" Then May Not Be "Safe" Now

Let’s start with the word "safe." The definition is "free from harm or risk." But here’s the truth—nothing in medicine is 100% "safe" or risk free. We are actually using the word "safe" incorrectly when it comes to medicine.

Every intervention carries some level of risk or harm. Even drinking too much water can kill you. So when we label something “safe,” what we really mean is: the benefits likely outweigh the risks, and the side effects are rare or mild.

But there’s a catch.

What we believe is safe (or low risk) often depends on the data available at the time. And if the data isn’t complete, or the studies are poorly designed, or long-term effects haven’t been measured yet—we might get it wrong. Not because scientists, researchers are evil or incompetent, but because humans are complicated, science is hard, and time reveals what short-term studies can’t.

🧪 Correlation vs. Causation: The Devil in the Data

You’ve heard the phrase: “Correlation doesn’t equal causation.” Just because two things happen at the same time doesn’t mean one caused the other.

It’s like noticing that more people drown when more ice cream is sold—and assuming ice cream is the killer. In truth, both happen in the summer, when swimming increases.

The same confusion happens in medicine all the time.

Take, for instance, Tylenol (acetaminophen) during pregnancy. For decades, it’s been the go-to for pain and fever. Labeled “safe.” But emerging data now links prenatal Tylenol exposure to possible developmental issues in children.

Does that prove Tylenol causes those issues? No. It suggests correlation. Maybe moms who took more Tylenol were sicker. Maybe they had more inflammation, which also affects fetal development.

But the point is: this data raises a question. And questions are not enemies of science. They’re the foundation of it.

🧬 Humans Are Not Lab Rats

Let’s be brutally honest: humans are a mess to study as we are highly complex organisms with complex organisms living within us; which have their own complex cascade events. We don’t live in isolated petri dishes. We have emotions, hormones, past traumas, food sensitivities, social environments, and unique DNA.

One drug might work miracles in Patient A and cause a disaster in Patient B.

And unlike studying plants or mice, we can’t ethically lock people in a lab for 20 years to isolate every variable. We rely on observational studies, clinical trials, and a whole lot of statistical guesswork. It’s not perfect. But it’s the best we’ve got.

That means medicine must always be open to change. Because as better data arrives, the river flows forward.

🦠 From Heresy to Hero: The Story of H. pylori

Back in the 1980s, an Australian physician named Dr. Barry Marshall had a crazy idea: maybe ulcers weren’t caused by stress, spicy food, or excess acid—but by a bacteria called Helicobacter pylori.

He was laughed at. Mocked. Flat-out rejected by the medical establishment. It was him versus the entire medical establishment.

So what did he do?

He drank the bacteria.

Within days, he developed gastritis. Then ulcers. He proved his point: H. pylori was the true culprit behind most stomach ulcers. Today, treating ulcers with antibiotics is standard care. But it took years for the system to catch up.

And that’s not an isolated story.

🧼 Wash Your Hands, Save a Life

In the 1800s, Dr. Ignaz Semmelweis noticed that women giving birth in hospitals were dying at much higher rates than those giving birth at home. The culprit? Doctors were going straight from autopsies to delivering babies—without washing their hands.

Semmelweis insisted on handwashing with chlorinated lime. Death rates plummeted.

You’d think his peers would celebrate. Instead, he was visiously rejected, ridiculed and eventually committed to an insane asylum where he was beaten by the guards after an attempted escape and died from infection from his wounds.

And again, only decades later did medicine catch up and acknowledge his brilliance to hand washing. Unfortunately, dogma and ego in the medical field is especially strong and stubborn. How dare we question authority; even if it is a good question.

Never forget how Doctors hated the nurse Florence Nightingale for her asking them to wash their hands in between surgeries and opening the windows for fresh air. Medicine is not immune to the dogma, ego, power and blind spots...and it didn't simply vanish since then.

So what do these stories teach us?

They remind us that medicine is often wrong before it’s right. And that resisting new evidence doesn’t protect patients—it delays progress.

💊 PPIs: From Wonder Drug to Risk-Balancing Act

Proton Pump Inhibitors (PPIs) like omeprazole were once seen as miracle drugs for acid reflux, ulcers, and GERD. They turned off acid like a light switch. No more heartburn. No more pain.

And yes—they work!

But years later, studies began showing long-term risks: increased fractures, nutrient malabsorption (like B12 and magnesium), kidney disease, significant effect of microbiome which have a cascading effect, and even possibly dementia. Again, correlation doesn’t prove causation—but it signals we should pause and investigate. Not double down on dogma.

The answer isn’t to ban PPIs. It’s to use them mindfully. Short-term when needed. Lowest effective dose. And always paired with lifestyle change—not as a lifetime Band-Aid.

🤰 Tylenol and Pregnancy: A New Conversation

Wow, this is an emotional hot topic Acetaminophen has been the gold standard for pregnant women—"safe," easy, effective. But now, new studies are questioning its "safety," especially when used frequently or long-term.

Some data links prenatal Tylenol use to developmental issues like ADHD or autism spectrum behaviors. Is this cause-and-effect? Not definitively. But the studies are large enough and consistent enough to raise concern.

Tylenol’s reputation for being “safe” is misleading. While effective at proper doses, acetaminophen has a narrow safety margin. The LD50 (lethal dose for 50% of population) is around 70–115 mg per pound, meaning just 10–15 grams (20–30 extra-strength tablets) can be fatal for a 150-pound adult. Even lower, repeated doses can cause serious liver damage, especially with alcohol or hidden overlap in other meds. It’s actually the leading cause of acute liver failure in the U.S.

Here’s the key: asking questions and discussing risk is NOT fearmongering.

It’s responsible. Even if you do not like the person that is asking the question or presenting the evidence.

Because when new evidence emerges, the goal is not to panic. It’s to educate, so that patients and providers can make better, more informed decisions. That’s how science works. That’s how trust is built.

Fight the urge to be controlled by a narrative. Instead of thinking, "They’re taking Tylenol away from us!" (they’re not), we can shift our perspective to: "I’m glad this is being looked at more closely. Now I can be more mindful about how I use it, stay informed about potential risks, and support further research."

🧠 The Best Medicine Is Still a Question

We need to stop treating questions as threats, despite any internal discomfort it may illicit.

Good medicine doesn’t silence doubt—it welcomes it. When questions are not being asked, science stops.

Science is: “We thought this was safe. But we’re seeing patterns that raise concern. Let’s look deeper. Let’s be cautious. Let’s tell patients what we know, and what we don’t.”

Science is meant to apply to all interventions, surgeries, vaccines and medicines (including tylenol) and the moment it stops being applicable, something controlling, powerful and sinister has likely occurred.

Science isn't the enemy of uncertainty. It’s the art of managing it.

⚖️ Rethink What “Safe” Really Means

So here’s the big takeaway:

• Always ask questions with new information and

• “Safe” more accurately means no risk and we have been using the word incorrectly in medicine. The word "safe" could be used more wisely and instead replace it with "low risk," or “the benefits outweigh the risks under certain conditions.”

It means:

• Use the right dose

• For the right reason

• For the right duration

• With full awareness of potential side effects

  
  

And it means we must stay flexible—because what’s “safe” today might look different tomorrow.

🌱 Transparency Is Healing

No medication is perfect. No study is flawless. And no one—not even your doctor or the "experts"—has all the answers. But what we can have is transparency.

We can say:

• “Here’s what we know.”

• “Here’s what we’re learning.”

• “Here’s what might change.”

  
  

That honesty builds trust.

And in a world where medicine moves at the speed of light—and misinformation spreads even faster—transparency is more than good ethics. It’s good medicine.

✨ Final Thought: Science Is a Living Organism

You’re a living being. The human body is fluid, responsive, unpredictable. So why would we expect medicine to be any different?

We should want science to evolve. To get better. To admit mistakes. To correct course.

So let’s celebrate the river—not fear it.

Because in that flow, we find truth.