Tylenol isn't so safe, but at least it works? | Hacker News Reader

Tylenol isn't so safe, but at least it works?

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36 pointspaulpauper38 comments

https://en.wikipedia.org/wiki/American_Council_on_Science_an...

Yeah, it struck me as a FUD factory, and lo' its a FUD factory.

Thank you for the link.

That's odd, why would a pro-industry group be down on Tylenol? Do they take funding from the Sackler family?

Looking at the discussion in the comment section, and how this author responded, this could be a piece advocating for the opioid manufactures.

or just laying the groundwork to get the FDA to consider new, patented, non-opioid OTC painkillers.

Reminder regarding the source: https://mediabiasfactcheck.com/american-council-on-science-a...

Please read the *entire* report.

It did strike me as being advocacy, but why would a pro-business group be down on Tylenol? Are they getting money from Purdue/Sackler?

cough Advil cough Motrin cough

Just because its an industry front doesn't mean it treats (take money from) all companies equally.

And the fact it calls Tylenol out rather than its generic name acetaminophen just adds to this.

Also acetaminophen is widely available in generic form. Maybe a new equivalent OTC painkiller is about to hit the market?

The article is over 4 years old.

Oh, of course, acetaminophen/paracetamol is a generic, so it makes sense the pharma industry would prefer to push consumers to pain killers that are still under patent, like orphenadrine citrate, or just straight up opioids.

That would only work if there was an OTC drug that fit that bill.

Which isn't to say no one is working on one and just spreading FUD to lay groundwork for it.

Doing so four years early would be kinda silly, though, since people would presumably have forgotten what they read four years ago. I can't recall anything specific I read four years ago. And no such drug meeting that description has come out.

It's a stretch, yes. I could speculate six ways to Sunday, just as a thought experiment. I'm mostly getting my ideas from reading books like Merchants of Doubt.

Highly factual reporting that's not very biased? Because that's what your link says.

Emphasis on bias. Though factual, the words used by the website are heavily loaded and clearly serve a purpose.

I’ve had migraines my entire adult life. Over the years I tried a number of prescription drugs with limited success. Tylenol is the only thing I have tried that works. It is night and day. Before Tylenol I lived in fear of early migraine signs and now I don’t. It may not work for many but it works for me.

If you haven't seen a Neurologist in the last 18 months, there have been HUGE advancements in prescription drugs for migraines. Prior to 2019 drugs for epilepsy were given off label. Now there are monthly injections (you give them to yourself at home) that are specifically for migraines and target the CGRP:

https://en.wikipedia.org/wiki/Calcitonin_gene-related_peptid...

Note: I only vaguely understand the science, talk to a neurologist.

"The estimated lethal dose of the drug is 10 grams in one day, which is not terribly different from the maximum daily dose."

This is hyperlinked to a page which doesn't say anything close to that. It says the LD50 is 338 mg/kg in mice and 1944 mg/kg in rats. Even if we make the most wild leap and go with 338 mg/kg, the mean human weight is 62kg and so the mean LD50 is 20.956 grams. Extra strength tylenol is 500mg/pill. I think most people can manage to not accidentally take 42 pills, and most people already know that taking the whole bottle is one way to die. So to me it's not really that dangerous at all. Also, I've taken acetaminophen to get rid of a headache about once a week for at least 20 years and it's success rate is sitting at a cool 100% (no exaggeration) in getting rid of the headache completely, and never taking longer than 15 mins. When I don't take or don't have access to it, it usually develops into a bad migrane that lasts many hours before going away on its own. So yeah, at least it works.

I take Tylenol rarely, but when I do it works pretty well. I usually break the pill in half to get a smaller dose.

If I was in a chronic pain situation I'd probably want something different, but as it is I don't have any complaints. I assume the efficacy varies from person to person, but in my case I'm glad it's available.

Anecdotal, but my subjective experience and that of my family, is that acetaminophen is worthless for pain management. Given that is poses an active risk to liver function, I can't justify its use at all. It's far too dangerous to be legal over the counter.

Interesting that it is included at high doses in prescription painkillers - no medical function, just a rather deadly deterrent to anyone seeking opiates.

It was interesting when I studied abroad that it is not OTC, at least in Germany. (In Germany it's known as paracetamol.)

Lower dosage paracetamol is OTC in pharmacies here in Germany (I think the limit is 10g per pack).

And this is why anecdotal evidence aren't worth much.

So when making medical decisions you should... not consider empirical evidence? n=1 is good enough when n is the only subject in question.

My n=1 experience with "tylenol" is that, even carefully prescribed, the use of acetaminophen can cause very severe problems when combined with pre-existing conditions and other medications.

No one told me that shit until I was in the ER 4 times.

Knowing how toxic it is, how potentially harmful the drug interactions can be, and how little evidence exists for its efficacy as a generic painkiller, I have no qualms saying that acetaminophen should be a highly regulated drug - Available to anyone who needs it per a doctors order certainly, but removed from all "consumer" products.

It depends on the types and intensity of the pain. Annoying/sleep-interrupting pains: yes, severe pains: no. For moderately-severe pain, either use acetaminophen + ibuprofen + famotidine if you know the source for certain, or go to the ER. Actual, short-term severe pain requires a prescription medication such as an opiate.

I read this article and could immediately relate. Too much anger by the media is directed at drug companies, such as opioids manufactures. They ignore the other scam that is the OTC pain medicine racket, which I think is worse. OTC drugs are not that effective and can be as dangerous as abused prescription drugs, such as kidney or liver toxicity.

Too much anger by the media is directed at drug companies, such as opioids manufactures. They ignore the other scam that is the OTC pain medicine racket

Why not both?

Why do sleight of hand to distract attention away from opioids manufacturers?

I was prescribed colace to address constipation, but I was curious about the mechanism and timing of its effect, so I took a glance at the research. It was worse than this Tylenol business. It seems to be pure placebo, but it's by far the dominant remedy.

It's not though. Colace is primarily an emollient laxative i.e. it acts by softening stools and is not necessarily as active as the other kinds of laxatives in inducing bowel movements. As such you shouldn't expect it to provide a quick relief and it roughly takes at least half a day to a couple days depending on your diet and internal constitution to see results. It's possibly that delay that made you consider it a placebo perhaps.

Miralax and fiber supplementation is what many elderly people use.

Magnesium citrate if that doesn't work.

never took the stuff. I won’t take an aspirin either, but Tylenol is hard on the body.

https://www.theatlantic.com/national/archive/2013/09/150-ame...

Despite what the article says, alternating Tylenol and another fever reducer definitely works well, and reduces the chance of overdosing on either due to a mistimed dose.

(Source: Personal experience, numerous doctors’ advice over the years.)

Yes you can overdose on Tylenol, but considering how widespread it’s use is, there are only 2800 cases of liver failure in the US each year and a fraction of those are due to Tylenol. That out hundreds of millions of users.

So people should be careful and follow the label, but to suggest it’s too toxic to be on the market is silly. You could say the same thing about GI bleeds with NSAIDS and the harm done. Should we just have not OTC options for pain at all?

And it looks like this blog post cherry picked a few studies. And pain studies are notoriously hard to do. Placebo effects are very high for pain.

> Should we just have not OTC options for pain at all?

We should not pretend they're harmless.

And we should probably make opioids more available (albeit still regulated): If the pain is bad enough that you'd risk your liver, you need something stronger than Tylenol!

And we should educate people better about how to use these things safely and sparingly. Some people use them like candy, which isn't safe and isn't effective. (There seems to be some evidence, admittedly of poor quality, that using pain relievers more frequently leads to less effectiveness. This is just one reason why treatment of chronic pain is so difficult.)

Who pretends they are harmless? Every medicine with Tylenol in it has big warnings. Pretty common knowledge.

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