Same here, two children (2.5yo and 3wo), both exposed to Paracetamol in what I now hope were low enough concentrations. I'm very concerned, to say the least.
Aspirin is a much safer drug to give to kids, despite the bad press it has received. You only need to look at the actual data to be convinced that it should be prescribed over Paracetamol any day.
> The presence of salicylates in the blood or urine of Reye's syndrome patients has not been demonstrated, and no animal model of Reye's syndrome has been developed where aspirin causes the disease. It is clear from epidemiological data that the incidence of Reye's syndrome was decreasing well before warning labels were placed on aspirin products. Reye's syndrome disappeared from countries where aspirin was not used in children as well as from countries which continued to use aspirin in children.
This link with Reyes syndrom is about as valid as good old snake oil to treat ailments. Bad science was not invented just last year.
While uncommon, Aspirin can cause Reye syndrome in children, which can lead to death or cause permanent disability.
Paracetamol does not cause such harmful effects if used as directed. It definitely should be used as a first-line treatment (if needed) in case of fever or pain.
This article essentially argues that Paracetamol should be used sparingly, if necessary. Calpol (suspension of paracetamol for children) is used indiscriminately in the UK, with some parents seemingly attempting to use it as a chemical cosh when their children are in a bad mood - it does also appear to alter moods.
Oh, of course let's conduct a trial where we give aspirin to children and see what happens! I gather you'll be volunteering your own children? How nice of you!
> Furthermore, in Western regions the prevalence of male reproductive and urogenital disorders has increased. These disorders include cryptorchidism, hypospadias and testicular germ cell cancer, together with early puberty, decreased sperm counts, levels of sex hormones and decreased fertility12,13. Data support the contribution of environmental exposure during fetal life, including exposure to pharmaceuticals, to these increases in rates of neurological, urogenital and reproductive disorders13,14.
How much of the current sexual identity revolution is long-suppressed true identity, and how much is that we have poisoned an entire generation with untested pharmaceuticals, endocrine disruptors, and environmental toxins starting in-vitro and continuing through their entire childhood?
Aside from prickly, politicized discussions about gender and identity... it might not be a bad thing altogether to reduce our fertility. We're exhausting the resources of the planet enough as it is.
I don't know if you're really out of date, but the current crisis is that populations in the developed world are about to collapse, and nothing good is going to come of it.
But there are 5 billion people in the developing world about to become middle class... you having fewer kids is going to accomplish nothing. We're already going to have to engineer our way through this.
We’re projected to stabilise off at about 10 billion I believe. Which while a huge number, is not unsustained exponential growth.
As countries get richer and women gain better access to education and improved rights, the countries seem to go through an inflection point where suddenly no one wants to have children and the birth rate falls below replacement (2.0, two children to replace two parents)
For us as a species to survive we need to try and stabilise that at 2.0 + some small safety margin (to make up for infertility, people who really don’t want children, or physically can’t).
While we’re bound to one planet (which it looks like is going to be for awhile, “sending people to Mars” is very different from “sizeable % of the total human population living on Mars”) it’s preferable for that stable population point to be as small as possible.
10 billion is a lot, but it looks stable at least. If we bring our replacement rate down more to peak the total population earlier, we have this weird problem where the replacement rate is well below 2.0, so no one is having children, and we suddenly have to convince people to start having more.
It feels like everything else in life; the birthrate would keep yo-yo-ing above and below replacement rate, and we really don’t want it above while it’s so cramped here and we’re messing up fundamental environmental systems that we rely on.
Like everything else these days it seems like it kind of comes back to “well, if you want to do something, first we’ve got to deal with climate instability”. /shrug
> 10 billion is a lot, but it looks stable at least.
The relevant metric is 10 billion at what level of consumption?
Hong Kong style? Maybe. Western developed country style with detached homes with garages, 2 cars, 10k+ (16k+ km) miles of driving, and flying to destinations? I would guess not.
You're welcome to snip your own gonads if you'd like. Surreptitiously sterilizing entire generations of people without their consent is a bit more morally fraught.
Tylenol (paracetamol) is also the leading cause of acute liver failure in the United States and Canada [1]. The toxic dose is very close to the active dose, far more so than pretty much any other OTC drug you run into. It's also even more toxic when combined with alcohol.
[edit] > "It is the most common cause of liver injury. Period. Full stop," said Dr. Michael Rieder, a pediatric clinical pharmacologist at Western University in London, Ont.
There is little to no evidence that Tylenol works as a pain reliever - its analgesic effects are comparable to placebo. There's lots of evidence that it doesn't work, and there's no accepted or plausible mechanism of action.
It doesn't work. It is the leading cause of liver failure in western societies. And yet the "common knowledge" of its utility surpasses those facts among doctors and pharmacists.
They keep prescribing it and adding it to other medicines, but there's no good medical reasons to do so.
That's a lot of bold claims in one post. Have you uany studies to back up the claim that it doesn't work, it's the leadong cause of liver failure in western societies, or that there's no good reason to add it to other medicines?
There is a massive body of evidence showing that it's far more effective than placebo. There are even recent tentative evidence that show it increases risk taking behaviours and reduce emotional response to various stimulus.
You can find the studies with scihub. Tylenol doesn't seem to work for fever or anti inflammatory purposes either. It's great at hurting and killing people, though, in overdose and chronic use scenarios.
Keep in mind it’s not trivial to run pain studies at all. Placebos have a strong effect in most trials and unless you get into the moderate to severe pain category, patients subjective experience can dominate.
Small changes to a trial can completely blow it up. Same with antidepressants or anything where the trial outcome is a subjective measure by the patient.
That may well be true, but that doesn't mean it's especially dangerous. The number of people injured by a paracetamol overdose is tiny compared to the number of people who take it. Other drugs are significantly more dangerous when you consider per patient injuries.
This is compounded by the fact that paracetamol overdose with alcohol is a common way for people to attempt suicide - all those who are discovered and rescued will end up with acute liver damage. Doctors (in the UK) usually recommend that people who have damaged their liver in this way avoid drinking alcohol for about a decade afterwards.
Unless it is overwhelmingly damaged, the liver is the most resilient part of the human body and is the only organ that can regrow. It's that important.
If I recall correctly, liver damage is often because of the liver's ability to regrow. Small bits of damage to liver cells cause the liver to grow massive amounts of scar tissue which ultimately leads to failure of liver functions.
I had mild minor liver damage due to an illness when I was a teen and my doctor told me not to drink alcohol for year (which I didn't). Forty years later I still cannot drink alcohol beyond a small taste or I get headaches and nausea. I think it is for life.
I can't say that I agree there. It sounds like they can't metabolize it well. As someone who's been abstinent for large portions of my life (never been drunk either), it's still not difficult to drink a single serving, and I normally won't suffer for it.
I’m not sure if I agree with any of the claims in the article you linked.
> Each year, about 4,500 hospitalizations in Canada occur due to acetaminophen overdose, and about 16 per cent of these are accidental, Health Canada says.
So this affects only a tiny minority. It’s absurd that the tens of millions of people who use acetaminophen without an issue need to have their access to the drug restricted because of these 700 people.
To be absolutely clear, the maximum recommended dose is 4000mg over 24 hours. That’s eight extra strength pills. According to your article, the people who still accidentally overdose apparently take two pills every 2-3 hours and then forget how many they took. No wonder the vast majority avoid this fate, we simply take one pill instead.
It annoys me to no end when some folks trying to win the Darwin Award make medical professionals change guidelines in a misguided attempt to “protect” us. No, we don’t need that protection. Just keep it available while educating people about concerns around pregnancy and lower doses for younger children.
Everyone involved with writing, editing or contributing to this nothing burger of an article should be ashamed of themselves.
> To be absolutely clear, the maximum recommended dose is 4000mg over 24 hours. That’s eight extra strength pills.
It's also included as a secondary ingredient in a lot of other medicines, which makes it easy to take more than you thought. Additionally, other common drugs (like alcohol) use the same metabolic pathways, so they can dramatically lower the safe limit for acetaminophen.
When you look at the rate of death and serious injury due to overdose, acetaminophen comes out very badly. The only medicines that kill more are opioids.
A more charitable interpretation of the overdose on acetaminophen is that people are bad at handling pain and we should help with that. And also when in a flu-like state, people (me included) have trouble keeping up with their dosage.
One other thing is that many compound otc drugs (marketed as 'get through this' for ) also have acetaminophen...
I'll also say that being pregnant is the medical wild card. You shouldn't do, eat, take, catch anything. It doesn't help discriminating between the level of risks you're taking when anything you do is forbidden.
Having such a risky drug at hand mechanically increases the risk of overdose and we should strive to find better alternatives, I think. It doesn't have to be more control, since it won't help you at home and will just make suffering people more miserable, but tech could help here, with delivery or packaging for example. 700 dead people isn't nothing. And putting a 'Darwin Awards' tag on them feels the same as 'pilot blaming' in aviation: not likely to increase safety.
> To be absolutely clear, the maximum recommended dose is 4000mg over 24 hours. That’s eight extra strength pills.
In Spain you can get 1000mg paracetamol pills OTC, so that's 4 of them. It's not that unusual doctors prescripting "one every 8 hours" for acute cases. People are probably not aware that hitting themselves with that dosage could probably hurt them in the long term: next time, you self medicate again.
The problem is education won't reach everyone, and the broad, easy availability of the drug gives people the incorrect feeling that it is much safer than it actually is. ("If they let you just buy it, how dangerous can it possibly be?")
Any drug where the toxic dose is that close to the suggested dose is going to be dicey when we let people buy it OTC. Notice I'm not saying we should prevent it from being OTC -- as someone who is not a doctor I have no clue on that. Just saying that I don't think it's fair to categorize people who take took much Tylenol without realizing the potential deadliness Darwin Award candidates.
* I'm also going to make an edit to say, you suggest education, but isn't that exactly what this article is doing? If you want people to take warnings seriously, the warnings need to be serious.
> access to the drug restricted because of these 700 people.
Less, "In about 6% of hospitalizations for overdose, patients develop liver injuries"
Different US study
"In many instances, individuals are using alcohol, hypnotics, or illicit drugs in combination, undoubtedly clouding judgment and often delaying hospitalization. More than 60% of unintentional cases in our study used a narcotic combination, such as hydrocodone and acetaminophen (Vicodin and others). Excessive use (up to 40 or more tablets per day) appears to occur over weeks prior to onset of liver injury, suggesting addiction to the narcotic component and the development of tolerance to the narcotic and to the acetaminophen"
> some folks trying to win the Darwin Award
It's good you acknowledged intelligence in inherited. It's good to want to increase the general IQ. But I don't agree killing people is a solution. Other than ethics, a lot of people killed in the Darwin Award already had children, which have lower IQ's (per Darwin) and now no parent/parents, which often means they actually breed more. A lot of average/low IQ people are also quite nice. They won't cure cancer but they often are good to have in the community.
And when I tried the cold water extraction of codeine/paracetamol, even with low level university chemistry it was all a bit dodgy. It wouldn't have been impossible I made a mistake from the guide on Erowid - https://pubmed.ncbi.nlm.nih.gov/31081395/
Paracetamol was "hyped" as much as the others NSAIDs (and similars) are daemonized for rare and/or high-dosage side effects (I'm sure fear of litigation plays a part)
The medical gate-keeping/lobbying for keeping anything effective prescription-only is strong. (Of course the other side is that people will not read the leaflet and take some stuff willy-nilly)
As even the article says, having a fever is also dangerous in pregnancy.
> Of course the other side is that people will not read the leaflet and take some stuff willy-nilly)
In the UK, for basically any medicine you buy OTC in a pharmacy/drug store, the store assistant will ask you if you're taking any other medication, and will tell you the dosage to take (by reading the packet). It's not fool proof by any means but it does mean that people get _some_ advice.
Just anecdotal data, but in both my roles as an academic hospitalist and community hospitalist in the US (inpatient internal medicine doc, ie the person that cares for people admitted with acetaminophen overdose if not sent directly to the ICU), I have only seen two cases of intentional acetaminophen overdose (both survived, amazingly) and have heard of an accidental overdose only once (my colleague admitted them; older man taking 8-9 grams/day for about a month because he thought he was doing the right thing by avoiding opiates for hip pain).
Compare that to the three alcoholic cirrhotics I am currently caring for (which is a fairly common number where I work), and I personally don’t think acetaminophen is a very big deal for most people.
Also, we (hospitalists in the US) certainly see far more bad outcomes from OTC NSAID use contributing to GI bleeds and heart trouble (I’d say I care for a couple/month on average).
Therapeutic index for Tylenol is 2. That's already much better than NSAIDs, which are often already very toxic at usual dosage (400mg ibuprofen) in diabetics, senior citizens, children, etc. The big difference is that with acute liver damage you are feeling very sick and die quickly, while with kidney failure you feel normal and die very slowly. So, what's worse?
Additionally, it's no wonder that it's a paediatrician speaking, because many Tylenol intoxications are actually intentional in children (suicide). It's one of the most common suicide plan in teenagers.
This is extremely concerning since the two obvious alternatives, aspirin and ibuprofen, are already considered unsafe during pregnancy.
Without a decent alternative, the best we can probably do is to limit the dose and duration of use. This policy is probably the best for any medication during pregnancy and childhood.
There is nimesulide, which seems to be all nice, but comes with 1 in a 100000 chance to destroy your liver with 1-2 doses if you are born without some (yet unknown) enzymes.
Really? At what size of an effect of increased risk of ADHD, obesity, etc. do we say that a non-tangible amount of pain should be endured?
IMO the biggest benefit of studies like this is to discourage pointless use of OTC painkillers. These painkillers are pretty weak anyway so if you old have mild discomfort or find that your pain isn't responding to the drug this is yet another reason to not just 'pop an asprin' (or ibuprofen, Tylenol, etc.) at the slightest bit of discomfort or even taking it regularly without good reason. I have seen even young people just get in the habit of taking ibuprofen, Benadryl, etc. multiple times a week or even daily which just seems excessive.
On the other hand, we are reaching the point where everything is a compromise. If you are pregnant AND working I am going to take a gamble and guess that OTC pain meds are pretty much par for the course.
This attitude of "don't do anything unsafe" often has adverse effects on physical health ("what if too much exercice affected the baby ?") and overall mental health.
Depression leading to miscarriage is also a possible outcome.
Honestly this can all be traced back to the fact that women and pregnancy is understudied in medicine. We wouldn’t be forcing people to go 9 months with a significantly reduced quality of life if studying female reproductive health was more prioritized.
I completely disagree. Pregnancy, child rearing and care have been extensively studied. At a certain point, the fledgling life within takes precedence over discomfort of the mother.
I do not think it is about the form. I believe it is about whether we can make others sacrifice for the common good. And this discussion involves us all.
Sure, but it’s also very damning to discussion. What if you are 45. As a woman, you’ve already had all the kids that you are likely to have. If you already used painkillers in the 2000s, you are now forever “unqualified” to speak despite your regrets.
And on the other end, people who haven’t given birth yet are disqualified for speaking about thing they might actually do. How can one make up their mind, and drum up community support without talking about the issue?
Ibuprofen is considered safe in the first half of the pregnancy, significant risks start only after week 28 [1]. It's also considered safe when nursing.
Surprise. Heart attack, stroke, hypertension, kidney damage are also risk factors of NOT taking NSAIDs for the reasons people commonly take NSAIDs for.
I don't know whether this is a truly serious paper or can be filed under "Spurious Correlations"[0] - paracetamol is widely enough used that links to the mentioned "issues" could be tenuous at best.
It is possible that lifestyle and other factors lead to both the negative outcomes in the article, and by general pain and fever that require paracetamol. The animal studies, if verified, may be more concerning.
> I don't know whether this is a truly serious paper or can be filed under "Spurious Correlations"[0]
I don't understand what leads you to believe that a paper that can be filed under "spurious correlation" could be automatically discarded as not being serious.
One of the purposes of scientific articles is to report interesting findings to peers, which serve as food for thought. By definition, the state of the art of any field is perpetually in a "work in progress" stage, and researchers feed off each other's work to progress.
This paper reports an observation. Like all similar papers, now the community is free to look into it and bring some clarity to the topic. This is how progress is achieved.
I think the issue comes when results are reported and consumers try to use those results to determine which behaviors are risky. We all try to stay on top of "the latest science" but are results like this really actionable by consumers?
> I think the issue comes when results are reported and consumers try to use those results to determine which behaviors are risky.
Well, consumers are doing it completely wrong if they're looking up to papers as established and definite references regarding scientific findings.
Papers do not define reality, at most they only describe the author's perception of reality give their circumstances and current understanding, and reflecting the current state of the art. Thus observations might be off, but still interesting enough to spark further work to build up knowledge and clarify misconceptions.
It's like the parable about the blind men and an elephant[¹]. We might have an academic paper describing a novel species of trees that have a strong correlation with snakes, and consumers would be using that paper to justify shooting at treetops just to be sure they aren't attacked by a snake.
It's published in nature, you can be sure it's pretty serious.
That doesn't mean it 100% establishes a causal relationship. Generally science is more nuanced and it's best not to negate its findings with the 'correlation is not causation' trope.
That is something I guess everyone learns in their first year at university, you can assume peer reviewed scientific work is created by people who got the memo.
My initial reaction was similar: “everyone uses Tylenol, if there was something really that bad about it, we would have seen it more”. But then someone pointed out that we have much more ADHD today than in the past and that does coincide with the more casual use of Tylenol starting in the 70s and 80s, so maybe we really are seeing the bad effects of Tylenol use during pregnancy after all.
Okay, but as it says in the article most normal pharmacies don’t sell it, they said look for larger ones near train stations. I did look for it many times. And Japanese people are certainly not in the business of regularly taking Tylenol etc.
Before I started visiting, I was told that TABASCO was the key to surviving Japan because it goes with everything; fish eyes, ink sacks, sea urchin guts, etc... 20-years later I realize how delicious nearly everything is on its own. (I still don't recommend any of the aforementioned, especially while wearing a white shirt)
I admit that navigating a Japanese pharmacy can be complicated as a non-native, but I can tell you that I for a fact have two boxes of the following behind me:
If you were hunting for paracetamol during the pandemic, it could be that it was all sold out because it has been recommended as the medicine to counter COVID-19 symptoms and if there is anything I trust people in Japan to do it is to be able to stock up on things at a time of emergencies.
Thankful that the authors have found a way to thread the needle and have just said “we use women and men to mean cisgender women and cisgender men” so they can just deal with it once. I’m sure someone will complain though.
Considering the ongoing experiment with novel mRNA technology, it's interesting, if confirmed, that we're learning after decades on the market that this drug so well-known and massively used could have some unforeseen side effects during pregnancy.
Well, fortunately Hacker News doesn't employ the same "fact checking" service as Facebook or YouTube.
There was a very important article on what to do if pulled over by an unmarked police car in the UK. FB's fact checker marked it as "false" because it didn't apply to the US.
That sounds reasonable to me. Except perhaps in the most unusual extreme circumstances, treating a British police officer with everything up to shear and utter contempt is likely to lead to nothing more than a stern talking to.
While I'm sure we only hear the worst of the American police force, I'm still not confident that anything but absolute and total cooperation is a safe approach.
It came about as a result of people with fake police lights committing assaults. The advice in the UK is to carry on driving and pull up in the nearest possible public place, like a petrol station.
Do I understand you correctly that the occurrence of false positives is more damaging than the distribution of misinformation?
It's easy to say it's all black or all white, as a matter of fact we live in a world that's different shades of grey. It turns out that social media is the perfect vector to spread misinformation and it's costing lives today. Where do you draw the line?
Yeah Arthur C. Clarke (of 2001: A Space Oddessey fame, among other monumenal science fiction works) famously had polio, but later (28 years later!) experienced partial paralysis in his 40s. He ended up mostly in a wheelchair for the rest of his life. Prior to that he had no signficant health complications. You could call it "long polio".
The point you make is unrelated to mRNA technology or Covid vaccines - it can happen, has happened (thalidomide, pandemrix, etc.) and will happen again.
I don't see why we this discussion has to be so politically charged. Life as an adult is all about taking risks, and most of the time a risk-less alternative does not exist.
To go back to your example: To make Covid vaccines more risky than say, alcohol, (or another common drug), a lot has to happen. Can it happen? Yes. How likely is it? Very unlikely.
Still people take great risks every day: Drinking alcohol, driving a car, eating unhealthy, taking pain killers, etc.
It's so funny that people think that Aspirin is a super dangerous drug that we should avoid giving kids based on some obscure bullshit reason, while Paracetamol has this "safe" image coming out of nowhere, despite all evidence and the trail of deaths it keeps leaving behind.
If nowhere is the marketing department for Tylenol.
It was created in 1877, before the FDA was in place with such rigorous testing requirements for drugs. It’s safe image has been marketed since then and now represents enough money for the Johnson & Johnson company that they lobby against restrictions on its use.
98% of all acetaminophen sales are not Tylenol but rather generic acetaminophen. J&J would be wasting their time considering they have drugs that provide 100x the revenue.
Every drug has risks - what matters is the relative risks, and the potential gains.
Reye's syndrome affects fewer than one in a million children a year — Wikipedia. However I do presume that number would go up significantly if more children were given aspirin?
Accidental overdoses of Paracetamol affect about 20 per million people. Calculation: (a) The current population of Canada is 38 million, (b) 700 accidental overdoses per year in Canada: https://news.ycombinator.com/item?id=28735280
You are comparing the incidence of Reyes after the primary cause (aspirin use in children) was stopped, to the current incidence for paracetamol prior to any intervention?
That's interesting. Basically it says that the causation is inverse for ADHD: e.g. parents with ADHD are more likely to take acetaminophen long term and then pass ADHD to the child genetically, which shows up as a correlation between acetaminophen use during pregnancy and ADHD in the child in an epidemiological study. If you control for it the correlation disappears. However, I don't see how liver damage could lead to paracetamol use.
As a counterpoint, embryotox says that the studies linking paracetamol to genital defects show only weak correlations and are of questionable quality [1]. The links to ADHS etc are apparently even more tenuous -- one study apparently even found a correlation between ADHS and paracetamol use by the father during pregnancy (how would that work?).
embryotox is the website of the top German research hospital and the ministry summarizing the state of knowledge on pregnancy/nursing risks of medication. It's as close to an objective source as I've come across on this topic.
How would that work? If both the maternal drug use and the ADHD outcome are the result of a third familial confounding variable, then it's reasonable to expect that this third variable also leads to paternal drug use.
This would be corroborated by the fact that siblings of kids whose mothers took Paracetamol during pregnancy also experienced higher ADHD.
As always in these things, effect sizes are small, confounding variables are huge, and much much much larger socio economic factors that we as a society could actually do something about are routinely ignored.
Embryotox is a collection of pregnancy safety info for many drugs maintained by the Charite hospital in Berlin, Germany. It’s very popular locally, I’ve seen it used also in pharmacies.
Paracetamol is the therapy of choice for pain and fever during pregnancy. Doctors, pharmacists, etc all recommend it in Germany. Ibuprofen is more problematic.
How about not taking any medicine during pregnancy that's not strictly necessary, independent of study results? There's a myriad interactions going on, with just the tip of the iceberg being known. Studies might give you confidence you won't experience catastrophic outcomes (think: Contergan), but any subtle deficits in future behavior of your child and similar are probably unaccounted for. It's just 9 months of abstinence from modern comforts ffs.
Lowering fever is not only comfort. High fever for a long time can be damaging.
Women are already told to avoid everything not strictly necessary during pregnancy. Oh, but they're also supposed to keep working, commuting, handling the modern world without 'modern comfort'. This is all without saying that pregnancies can be pretty painful and a shitty experience. How about we give them a break (if they want) or, barring that, a little empathy. And try to find something to help?
Tylenol/paracetamol/acetaminophen doesn't work as an analgesic, and should be avoided, regardless of pregnancy. If your doctor prescribes it, request that they research the Cochrane reviews of Tylenol, and other studies that show efficacy no better than placebo.
I'm not sure I understand: hundred millions of people feeling (even slight) relief from their pain are victims of some placebo effect/marketing hack? It doesn't relieve pain at all and I've been dreaming it my whole life?
I was also talking about lowering fever, I suppose it doesn't work for that either?
Yeah. Lots of studies are readily available. A good starting point is Cochrane reviews of acetaminophen for pain - acute, chronic, muscular, neurological, joint, spinal, and otherwise. There's a similar amount of material showing little to no effect on reducing fever, or providing any anti inflammatory effects at all.
It's fairly conclusive evidence, please take the time to review.
Reading a Cochrane review is worthwhile. Whether cherry picking things you wanted to be assured of out of one is a good idea... well, maybe they'll do a Cochrane review eh?
For example, they've got a study on Paracetamol in treatment of the Common Cold. You might be surprised to see the headline outcome is paracetamol doesn't work. But wait, in what sense exactly doesn't it work? Well, the key observation is that people taking paracetamol still sneeze. Sure, lots of them say they feel better, but if we just count the sneezes we can see it didn't help at all...
Well, I'm guessing most readers have had a nasty cold at some point, and I leave it to you to decide whether "My headache felt better but I was still sneezing" means the cheap medicine was ineffective and you shouldn't have bothered.
Edited to add: Or, say, what one on post-surgical pain relief has to say about paracetamol:
"A single dose of paracetamol provides effective analgesia for about half of patients with acute postoperative pain, for a period of about four hours"
When a woman becomes pregnant, everyone is only seeing a fragile infant that has to be protected from the environment.
That evolution already provides the infant with some very strong protection including two blood barriers to protect the developing brain is easily overseen.
The dosis makes the poison and there are numerous examples of addicted, underfed, stressed and overworked pregnant women giving birth to healthy intelligent childs, even in dirty and polluted environments.
Drinking a beer or taking medicine is not harming the child in any way, as long as it is done in moderation.
The paracetamol problem is an old one, because people tend to take to much of it, when feeling the slightest discomofort. Combined with coffein, aspirin and or alcohol it has a huge draw on liver and kidneys.
You have to diffentiate between taking a pill once a month and eating one package per week. Both would be inside the recommended dosage, but are clearly different.
For pregnant women it is a bit more difficult than 9 month from modern comforts, so some little remedy once in a while can go a long way.
I think describing the notion of going without any, including life saving, medication as “abstinence from modern comforts” is uncharitable and unempathetic towards both the quality of life medicine can provide and the difficulties of being pregnant.
I am highly concerned with all the comments in the thread, that say, "it has only affected a tiny minority".
Life-threatening liver damage to a tiny minority likely means non-life threatening liver damage to everyone else. Just because everyone else didn't end up complaining to a doctor does not mean no harm was done.
The vulnerable elements of society are often indicators of what will happen to the normal elements, if the pressure is increased—or if the damage gets accumulated over time.
Isn't it ironic that there's a concern over this, while completely new drugs, the mRNA vaccines, already shown to have by far the highest reported serious adverse effects of any other vaccine, are blithely recommended to pregnant women by the CDC? For something encapsulated in lipid nanoparticles that almost certainly cross the placental barrier and into rapidly dividing fetal cells, causing the SARS-CoV-2 spike protein to be expressed on their surface? Such a recommendation is a gigantic crime.
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[ 2.9 ms ] story [ 247 ms ] threadI've been giving my infant paracetamol and am now having second thoughts about it.
I'm gonna go ahead and continue not giving aspirin to kids.
https://pubmed.ncbi.nlm.nih.gov/11994026/
> The presence of salicylates in the blood or urine of Reye's syndrome patients has not been demonstrated, and no animal model of Reye's syndrome has been developed where aspirin causes the disease. It is clear from epidemiological data that the incidence of Reye's syndrome was decreasing well before warning labels were placed on aspirin products. Reye's syndrome disappeared from countries where aspirin was not used in children as well as from countries which continued to use aspirin in children.
This link with Reyes syndrom is about as valid as good old snake oil to treat ailments. Bad science was not invented just last year.
Paracetamol does not cause such harmful effects if used as directed. It definitely should be used as a first-line treatment (if needed) in case of fever or pain.
Edit: typo
This has never been demonstrated
https://www.theguardian.com/science/2015/apr/14/paracetamol-...
https://www.theguardian.com/lifeandstyle/2019/jun/04/why-par...
How much of the current sexual identity revolution is long-suppressed true identity, and how much is that we have poisoned an entire generation with untested pharmaceuticals, endocrine disruptors, and environmental toxins starting in-vitro and continuing through their entire childhood?
But there are 5 billion people in the developing world about to become middle class... you having fewer kids is going to accomplish nothing. We're already going to have to engineer our way through this.
As countries get richer and women gain better access to education and improved rights, the countries seem to go through an inflection point where suddenly no one wants to have children and the birth rate falls below replacement (2.0, two children to replace two parents)
For us as a species to survive we need to try and stabilise that at 2.0 + some small safety margin (to make up for infertility, people who really don’t want children, or physically can’t).
While we’re bound to one planet (which it looks like is going to be for awhile, “sending people to Mars” is very different from “sizeable % of the total human population living on Mars”) it’s preferable for that stable population point to be as small as possible.
10 billion is a lot, but it looks stable at least. If we bring our replacement rate down more to peak the total population earlier, we have this weird problem where the replacement rate is well below 2.0, so no one is having children, and we suddenly have to convince people to start having more.
It feels like everything else in life; the birthrate would keep yo-yo-ing above and below replacement rate, and we really don’t want it above while it’s so cramped here and we’re messing up fundamental environmental systems that we rely on.
Like everything else these days it seems like it kind of comes back to “well, if you want to do something, first we’ve got to deal with climate instability”. /shrug
The relevant metric is 10 billion at what level of consumption?
Hong Kong style? Maybe. Western developed country style with detached homes with garages, 2 cars, 10k+ (16k+ km) miles of driving, and flying to destinations? I would guess not.
http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
[edit] > "It is the most common cause of liver injury. Period. Full stop," said Dr. Michael Rieder, a pediatric clinical pharmacologist at Western University in London, Ont.
[1] https://www.cbc.ca/news/health/acetaminophen-toxicity-health...
Without acetaminophen your only option for pain relief without going to much stronger drugs would be the NSAIDS like aspirin or ibuprofen.
While not toxic to your liver, if you take them often enough you’ll end up with GI bleeding pretty reliably.
It doesn't work. It is the leading cause of liver failure in western societies. And yet the "common knowledge" of its utility surpasses those facts among doctors and pharmacists.
They keep prescribing it and adding it to other medicines, but there's no good medical reasons to do so.
There is a massive body of evidence showing that it's far more effective than placebo. There are even recent tentative evidence that show it increases risk taking behaviours and reduce emotional response to various stimulus.
You can find the studies with scihub. Tylenol doesn't seem to work for fever or anti inflammatory purposes either. It's great at hurting and killing people, though, in overdose and chronic use scenarios.
Small changes to a trial can completely blow it up. Same with antidepressants or anything where the trial outcome is a subjective measure by the patient.
What? Not sure what alternate universe we're talking about, but paracetamol definitely works on fever in this one.
That may well be true, but that doesn't mean it's especially dangerous. The number of people injured by a paracetamol overdose is tiny compared to the number of people who take it. Other drugs are significantly more dangerous when you consider per patient injuries.
This is compounded by the fact that paracetamol overdose with alcohol is a common way for people to attempt suicide - all those who are discovered and rescued will end up with acute liver damage. Doctors (in the UK) usually recommend that people who have damaged their liver in this way avoid drinking alcohol for about a decade afterwards.
Really? I thought it was advised to not drink alcohol for life if you had liver damage. I thought the damage was permanent, no?
Saying the damage is caused by regrowth is silly as without it the liver would have failed at the first injury.
Your skin does not regrow if you chop off a large patch. It can only heal damage.
Alcohol is a poison. If you didn't deliberately build up a tolerance to it your reaction is normal.
I read this like you had a chance to build up tolerance earlier
> they can't metabolize it well
Also a possibility orthogonal to tolerance factor.
Not “active dose”, recommended daily limit.
> Each year, about 4,500 hospitalizations in Canada occur due to acetaminophen overdose, and about 16 per cent of these are accidental, Health Canada says.
So this affects only a tiny minority. It’s absurd that the tens of millions of people who use acetaminophen without an issue need to have their access to the drug restricted because of these 700 people.
To be absolutely clear, the maximum recommended dose is 4000mg over 24 hours. That’s eight extra strength pills. According to your article, the people who still accidentally overdose apparently take two pills every 2-3 hours and then forget how many they took. No wonder the vast majority avoid this fate, we simply take one pill instead.
It annoys me to no end when some folks trying to win the Darwin Award make medical professionals change guidelines in a misguided attempt to “protect” us. No, we don’t need that protection. Just keep it available while educating people about concerns around pregnancy and lower doses for younger children.
Everyone involved with writing, editing or contributing to this nothing burger of an article should be ashamed of themselves.
It's also included as a secondary ingredient in a lot of other medicines, which makes it easy to take more than you thought. Additionally, other common drugs (like alcohol) use the same metabolic pathways, so they can dramatically lower the safe limit for acetaminophen.
When you look at the rate of death and serious injury due to overdose, acetaminophen comes out very badly. The only medicines that kill more are opioids.
One other thing is that many compound otc drugs (marketed as 'get through this' for ) also have acetaminophen...
I'll also say that being pregnant is the medical wild card. You shouldn't do, eat, take, catch anything. It doesn't help discriminating between the level of risks you're taking when anything you do is forbidden.
Having such a risky drug at hand mechanically increases the risk of overdose and we should strive to find better alternatives, I think. It doesn't have to be more control, since it won't help you at home and will just make suffering people more miserable, but tech could help here, with delivery or packaging for example. 700 dead people isn't nothing. And putting a 'Darwin Awards' tag on them feels the same as 'pilot blaming' in aviation: not likely to increase safety.
In Spain you can get 1000mg paracetamol pills OTC, so that's 4 of them. It's not that unusual doctors prescripting "one every 8 hours" for acute cases. People are probably not aware that hitting themselves with that dosage could probably hurt them in the long term: next time, you self medicate again.
Any drug where the toxic dose is that close to the suggested dose is going to be dicey when we let people buy it OTC. Notice I'm not saying we should prevent it from being OTC -- as someone who is not a doctor I have no clue on that. Just saying that I don't think it's fair to categorize people who take took much Tylenol without realizing the potential deadliness Darwin Award candidates.
* I'm also going to make an edit to say, you suggest education, but isn't that exactly what this article is doing? If you want people to take warnings seriously, the warnings need to be serious.
Less, "In about 6% of hospitalizations for overdose, patients develop liver injuries"
Different US study
"In many instances, individuals are using alcohol, hypnotics, or illicit drugs in combination, undoubtedly clouding judgment and often delaying hospitalization. More than 60% of unintentional cases in our study used a narcotic combination, such as hydrocodone and acetaminophen (Vicodin and others). Excessive use (up to 40 or more tablets per day) appears to occur over weeks prior to onset of liver injury, suggesting addiction to the narcotic component and the development of tolerance to the narcotic and to the acetaminophen"
> some folks trying to win the Darwin Award
It's good you acknowledged intelligence in inherited. It's good to want to increase the general IQ. But I don't agree killing people is a solution. Other than ethics, a lot of people killed in the Darwin Award already had children, which have lower IQ's (per Darwin) and now no parent/parents, which often means they actually breed more. A lot of average/low IQ people are also quite nice. They won't cure cancer but they often are good to have in the community.
And when I tried the cold water extraction of codeine/paracetamol, even with low level university chemistry it was all a bit dodgy. It wouldn't have been impossible I made a mistake from the guide on Erowid - https://pubmed.ncbi.nlm.nih.gov/31081395/
Consider that maybe the restriction is why overdoses are so are.
The medical gate-keeping/lobbying for keeping anything effective prescription-only is strong. (Of course the other side is that people will not read the leaflet and take some stuff willy-nilly)
As even the article says, having a fever is also dangerous in pregnancy.
In the UK, for basically any medicine you buy OTC in a pharmacy/drug store, the store assistant will ask you if you're taking any other medication, and will tell you the dosage to take (by reading the packet). It's not fool proof by any means but it does mean that people get _some_ advice.
Compare that to the three alcoholic cirrhotics I am currently caring for (which is a fairly common number where I work), and I personally don’t think acetaminophen is a very big deal for most people.
Also, we (hospitalists in the US) certainly see far more bad outcomes from OTC NSAID use contributing to GI bleeds and heart trouble (I’d say I care for a couple/month on average).
Additionally, it's no wonder that it's a paediatrician speaking, because many Tylenol intoxications are actually intentional in children (suicide). It's one of the most common suicide plan in teenagers.
Without a decent alternative, the best we can probably do is to limit the dose and duration of use. This policy is probably the best for any medication during pregnancy and childhood.
IMO the biggest benefit of studies like this is to discourage pointless use of OTC painkillers. These painkillers are pretty weak anyway so if you old have mild discomfort or find that your pain isn't responding to the drug this is yet another reason to not just 'pop an asprin' (or ibuprofen, Tylenol, etc.) at the slightest bit of discomfort or even taking it regularly without good reason. I have seen even young people just get in the habit of taking ibuprofen, Benadryl, etc. multiple times a week or even daily which just seems excessive.
On the other hand, we are reaching the point where everything is a compromise. If you are pregnant AND working I am going to take a gamble and guess that OTC pain meds are pretty much par for the course.
Depression leading to miscarriage is also a possible outcome.
And on the other end, people who haven’t given birth yet are disqualified for speaking about thing they might actually do. How can one make up their mind, and drum up community support without talking about the issue?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546756/
Painkillers are only for treating acute pain.
Chronic pain is fixed by treating underlaying cause (unless you don't have access to health services).
https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
[1]: https://www.embryotox.de/arzneimittel/details/ibuprofen/
Increased risks of heart attack and stroke, hypertension, kidney damage.
[0]: https://www.tylervigen.com/spurious-correlations
I don't understand what leads you to believe that a paper that can be filed under "spurious correlation" could be automatically discarded as not being serious.
One of the purposes of scientific articles is to report interesting findings to peers, which serve as food for thought. By definition, the state of the art of any field is perpetually in a "work in progress" stage, and researchers feed off each other's work to progress.
This paper reports an observation. Like all similar papers, now the community is free to look into it and bring some clarity to the topic. This is how progress is achieved.
Well, consumers are doing it completely wrong if they're looking up to papers as established and definite references regarding scientific findings.
Papers do not define reality, at most they only describe the author's perception of reality give their circumstances and current understanding, and reflecting the current state of the art. Thus observations might be off, but still interesting enough to spark further work to build up knowledge and clarify misconceptions.
It's like the parable about the blind men and an elephant[¹]. We might have an academic paper describing a novel species of trees that have a strong correlation with snakes, and consumers would be using that paper to justify shooting at treetops just to be sure they aren't attacked by a snake.
[1] https://en.wikipedia.org/wiki/Blind_men_and_an_elephant
That doesn't mean it 100% establishes a causal relationship. Generally science is more nuanced and it's best not to negate its findings with the 'correlation is not causation' trope.
That is something I guess everyone learns in their first year at university, you can assume peer reviewed scientific work is created by people who got the memo.
Haha. No. (MD with 15y experience in clinical research)
http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
https://www.bufferin.net/
It's heavily advertised and available in every drug store in Japan (you don't even need to go to pharmacies!).
https://www.tylenol.jp/products-tylenol
If you were hunting for paracetamol during the pandemic, it could be that it was all sold out because it has been recommended as the medicine to counter COVID-19 symptoms and if there is anything I trust people in Japan to do it is to be able to stock up on things at a time of emergencies.
https://twitter.com/iaindale/status/1441504448266833920?s=21
There was a very important article on what to do if pulled over by an unmarked police car in the UK. FB's fact checker marked it as "false" because it didn't apply to the US.
While I'm sure we only hear the worst of the American police force, I'm still not confident that anything but absolute and total cooperation is a safe approach.
It's easy to say it's all black or all white, as a matter of fact we live in a world that's different shades of grey. It turns out that social media is the perfect vector to spread misinformation and it's costing lives today. Where do you draw the line?
https://en.wikipedia.org/wiki/Post-polio_syndrome
We'll only find out about long-term side effects of Covid... when/if they happen. Should be interesting, to say the least.
I don't see why we this discussion has to be so politically charged. Life as an adult is all about taking risks, and most of the time a risk-less alternative does not exist.
To go back to your example: To make Covid vaccines more risky than say, alcohol, (or another common drug), a lot has to happen. Can it happen? Yes. How likely is it? Very unlikely.
Still people take great risks every day: Drinking alcohol, driving a car, eating unhealthy, taking pain killers, etc.
That risk isn't so great, also not long-term. There's already a lot of evidence and indication for that.
If nowhere is the marketing department for Tylenol.
It was created in 1877, before the FDA was in place with such rigorous testing requirements for drugs. It’s safe image has been marketed since then and now represents enough money for the Johnson & Johnson company that they lobby against restrictions on its use.
Reye's syndrome affects fewer than one in a million children a year — Wikipedia. However I do presume that number would go up significantly if more children were given aspirin?
Accidental overdoses of Paracetamol affect about 20 per million people. Calculation: (a) The current population of Canada is 38 million, (b) 700 accidental overdoses per year in Canada: https://news.ycombinator.com/item?id=28735280
https://www.reddit.com/r/slatestarcodex/comments/q01gwl/comm...
[1]: https://www.embryotox.de/arzneimittel/details/paracetamol/
This would be corroborated by the fact that siblings of kids whose mothers took Paracetamol during pregnancy also experienced higher ADHD.
As always in these things, effect sizes are small, confounding variables are huge, and much much much larger socio economic factors that we as a society could actually do something about are routinely ignored.
Paracetamol is the therapy of choice for pain and fever during pregnancy. Doctors, pharmacists, etc all recommend it in Germany. Ibuprofen is more problematic.
While undergoing one of the most intense transformations the human body is capable of.
Women are already told to avoid everything not strictly necessary during pregnancy. Oh, but they're also supposed to keep working, commuting, handling the modern world without 'modern comfort'. This is all without saying that pregnancies can be pretty painful and a shitty experience. How about we give them a break (if they want) or, barring that, a little empathy. And try to find something to help?
Tylenol is a marketing hack, not a painkiller.
I was also talking about lowering fever, I suppose it doesn't work for that either?
It's fairly conclusive evidence, please take the time to review.
For example, they've got a study on Paracetamol in treatment of the Common Cold. You might be surprised to see the headline outcome is paracetamol doesn't work. But wait, in what sense exactly doesn't it work? Well, the key observation is that people taking paracetamol still sneeze. Sure, lots of them say they feel better, but if we just count the sneezes we can see it didn't help at all...
Well, I'm guessing most readers have had a nasty cold at some point, and I leave it to you to decide whether "My headache felt better but I was still sneezing" means the cheap medicine was ineffective and you shouldn't have bothered.
Edited to add: Or, say, what one on post-surgical pain relief has to say about paracetamol:
"A single dose of paracetamol provides effective analgesia for about half of patients with acute postoperative pain, for a period of about four hours"
So that's nice.
That evolution already provides the infant with some very strong protection including two blood barriers to protect the developing brain is easily overseen.
The dosis makes the poison and there are numerous examples of addicted, underfed, stressed and overworked pregnant women giving birth to healthy intelligent childs, even in dirty and polluted environments.
Drinking a beer or taking medicine is not harming the child in any way, as long as it is done in moderation.
The paracetamol problem is an old one, because people tend to take to much of it, when feeling the slightest discomofort. Combined with coffein, aspirin and or alcohol it has a huge draw on liver and kidneys. You have to diffentiate between taking a pill once a month and eating one package per week. Both would be inside the recommended dosage, but are clearly different.
For pregnant women it is a bit more difficult than 9 month from modern comforts, so some little remedy once in a while can go a long way.
Life-threatening liver damage to a tiny minority likely means non-life threatening liver damage to everyone else. Just because everyone else didn't end up complaining to a doctor does not mean no harm was done.
The vulnerable elements of society are often indicators of what will happen to the normal elements, if the pressure is increased—or if the damage gets accumulated over time.
The only option is to keep collecting and evaluating data over and over and make decisions with the best available information.