More dangerous than metal fragments

יום שישי י''ט בחשון תשס''ז

Tylenol (or, more accurately, acetaminophen, which is the generic name for the drug most commonly known as Tylenol) is back in the news.

The AP reports that a massive recall is underway because of possible metal fragments in pills sold under store brands by Wal-Mart, CVS, Safeway and many other major retailers.

No deaths or injuries have been reported (at least not yet) due to this contaminant. But you can't say the same about what's supposed to be in the pills -- acetaminophen, itself. The dirty little secret about acetaminophen is that thousands of people are injured or killed every year from accidentally overdosing on this over-the-counter medicine that can be found in everything from cough syrup to prescription pain killers (anything, like Percocet, that has -cet at the end, has acetaminophen in it).

The problem with acetaminophen is that, unlike aspirin for example, the amount that can seriously harm you is not all that much greater than the recommended dosage. This article says that 42% of the new cases at liver centers are due to acetaminophen overdoses. About half those cases were accidental overdoses, not suicide attempts.

Here is the conclusion of an academic article cited on the wikipedia acetaminophen article:

[Acetaminophen] is a commonly used, moderately effective analgesic and antipyretic. In overdose it causes significant morbidity and mortality. The burden to health care services is considerable, with a high financial cost and many hospital admissions. According to the Medicines Control Agency Medicines Act Leaflet (MAL 82, March 1996), which gives guidance on changing the legal classification of a medicine to the General Sale List, a criterion for inclusion on the General Sale List is: ‘where the hazard to health, the risk of misuse, ... is small and where wider sale would be a convenience to the purchaser’. It is surprising that [acetaminophen] is available on the General Sale List, as it appears to fail this criterion for an OTC medication. [Emphasis mine]

Bottom line -- there is very real public health threat here, and something needs to be done. I hope the metal fragments stories will raise people's consciousness about the real risks of this medicine.