Comment by tialaramex | Hacker News Reader

Comment by tialaramex | Hacker News Reader

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If Paracetamol was invented today it would likely never receive an OTC (over the counter sale, meaning you can just buy it from a retail outlet the way you'd buy cough medicine or toothpaste) license in the UK. Yes, it's safe (and for a bunch of people including me, effective) at the licensed dose, but it's useless at about half that dose, and it's toxic, leading to very nasty deaths in some cases, at just about 3-4 times that effective dose.

That's a very narrow efficacy window. There are modern drugs with a narrow efficacy window but they have pharmacy only licenses or require prescription, which both mean somebody who knows what the hell they're doing sold you the drug, not the automated checkout at a supermarket. That's a vital opportunity to spot that e.g. you're taking this every single day (so it's ongoing pain, probably needs a different intervention, paracetamol is contrandicated) or you have an obvious wound, which needs medical attention not painkillers. Or sometimes very dumb things, like, hey, the actual symptoms you have described mean you're likely pregnant did you even realise that? Would you like a pregnancy test instead ?

Always surprises me as an American in the UK how hostile the UK is to paracetamol. You buy it in like 300-pill packages in the US, and I've literally never heard of anyone having a single accidental over-dose. I'm not sure I've ever heard of anyone intentionally overdosing on it, but I guess I can't rule that out since I'm aware of who 1-2 people personally have taken "a handful of pills".

The efficacy window of driving cars is pretty narrow, and represents existential risk to third parties. But as with cars, sometimes the balance favors wide availability.

The problem becomes, 8 tablets a day, minimum of 4 hours between doses is fine for a week or so, but do that for months and the liver toxicity creeps up on you.

If you feel the need for 8 tablets a day for months, go see a doctor. Your liver is probably the least of your concerns.

It doesn't make much sense to think of efficacy windows for driving, it's not a medical intervention.

Besides US traffic deaths are crazy high by UK standards.

I believe the numbers normalize a bit when you adjust for the fact that everyone drives in the U.S. and tends to be alone when driving. So it’s like accident per mile driven and you see it’s around the same. But in the UK many fewer people drive as a proportion of the population and especially those who are more dangerous (e.g. young, old, disabled, drunk) tend to opt out here due to the availability of mass transit which doesn’t work in the U.S.

The small packages available in the UK are entirely to reduce the chance of suicide.

iiuc it's really hard to OD on tylenol but really easy to end your quality of life through drug interactions with tylenol

> Always surprises me as an American in the UK how hostile the UK is to paracetamol.

This is so funny because there's a post in another subthread by someone from the UK saying the same thing about Americans being hostile toward it.

I've only been to the UK a few times, but I feel like it's a funny meme that people in the UK unhesitatingly suggest and take paracetamol for everything. I guess that's not really true, or at least has some truth to it but is an exaggeration?

I’m more referring to the fact that it’s treated like a controlled substance here and sold in limited quantities from behind the counter. It’s the same treatment the U.S. gives to Sudafed which is an input to meth as I understand it.

I'm by no means an expert in assessing OTC drug safety, but your efficacy window feels... fine... to me? I feel like it shouldn't be hard to avoid taking 3-4 times the effective dose of something? But I guess people still do it, and mess up their liver anyway.

I'm always very torn on how to best protect people from being stupid. The label on the bottle says not to use the drug for longer than a certain period. Sure, people might not read it, or might not understand the risks and ignore it. Sure, someone might be too dumb / in denial to realize they might be pregnant, and take inappropriate medication. I do really want to protect these people from themselves, but I also don't want to go to the doctor every time I have the common cold to get a prescription for one of the only things that clears up my symptoms enough so I can sleep.

You don't need a doctor. In the UK today there are pathways for Advanced versions of several non-doctor careers which get you either limited, or in some cases full blown unlimited prescribing rights. I think ordinary Advanced Midwife is just a set of common pregnancy drugs, stuff so you can keep down food, sleep properly and so on despite some of the nastier but still non-critical pregnancy side effects, but Advanced Nurse Practitioner and Advanced Pharmacist are both full blown prescribing rights.

The only thing which I think Advanced Practitioner doesn't get you is going entirely off piste, like fuck it, maybe this untried drug will fix your cough. But the person with their name on the pharmacy paperwork can sign off any ordinary stuff, far beyond just "common cold" treatments, anti-nausea, anything a doctor signs on an average day unless they're in some weird research field. The idea isn't that you'd need a GP appointment but that probably it shouldn't be with the bubblegum and cornflakes in the supermarket without even talking to a professional.

Not to mention veterinary pathways. My ex GF was volunteering at a vet practice, where they kept no track of their meds, other than "hey boss, we seek to be low on Ketamine, swing past the animal pill shop and get a load of it pls".

Also there are travel pharmacies, which will sell you prescription drugs, so long as you insist you're about to go travelling somewhere remote.

The whole pretence that dangerous drugs are controlled and kept away from people is a pretty thin veneer.

personal responsibility is more common in the UK, it is assumed that one can cross the road safely without needing traffic lights for example, or walk along a stretch of an ancient monument without needing a handrail.

I've never met anyone here who has ever had any issues associated with paracetamol abuse/overdose, and only a single person who failed to cross the road correctly.

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