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Wednesday, July 1, 2009

Tylenol and risk perception

There was a point in time where the fear came from the the threat of cyanide salted into the Tylenol. Now the FDA has issued warnings regarding what is perceived as a serious health threat from the acetaminophen itself. Liver failure is serious business but it is not clear just how many people this affects and to what degree patients need to assume responsibility for being aware of what they are consuming.

Published data comes from registries and there is always a problem with under reporting. Even so, given the number of doses taken, the risk of liver failure appears to be rather small. What is the absolute risk to patients who take acetaminophen? How does this risk compare to the risk they take driving to the pharmacy to purchase their drugs or the risk in taking a bath?

The focus should be on education but the message conveyed to the public is that of dangerous drugs. All interventions cary some risk. I am concerned about the pattern of scrutiny regarding the use of agents available for pain relief. Chronic pain is a major problem with significant impact on quality of life in an aging population. Are we moving toward a world where the certainty of pain is accepted because of small risks of treatment?

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