What's the True Cost of an Unsafe Pain Killer? 150? 33,000? 78,000? Or Billions?

ProPublica published an article about how easy it is to overdose with acetaminophen, best known under the brand name Tylenol. If you take just 25% more, only 2 extra pills a day over a few days, you can cause liver damage. Higher overdoses can cause liver failure and death.

Accidental overdoses killed 1,567 people between 2001 and 2010, or about 150 people a year. In a given year, double that many die, but the other cases are either intentional or the intent is unclear.

Furthermore:

Acetaminophen overdose sends as many as 78,000 Americans to the emergency room annually and results in 33,000 hospitalizations a year, federal data shows. Acetaminophen is also the nation’s leading cause of acute liver failure, according to data from an ongoing study funded by the National Institutes for Health.

In addition:

In 2010, only 15 deaths were reported for the entire class of pain relievers, both prescription and over-the-counter, that includes ibuprofen, data from the CDC shows. 

And finally:

The London-based Lancet declared in a 1975 editorial that if [acetaminophen] “were discovered today it would not be approved” by British regulators. “It would certainly never be freely available without prescription. 

One major problem is that many drugs contain acetaminophen (such as Nyquil), so it becomes extremely easy for people with a pounding headache and a bad cold or the flu to overdose when they take Nyquil and Tylenol at the same time.

This allows us to draw three conclusions. 1) Anything containing acetaminophen (including Tylenol and Nyquil) should be more tightly controlled, probably prescription-only. 2) The warnings on Tylenol and Nyquil should be much more explicit and obvious: even a small overdose can send you to the hospital, especially in combination with alcohol. And 3) if you can tolerate safer pain relievers, you should use those preferentially.

Fine. The FDA should tell these drug companies to stop pretending their product is absolutely safe. Case closed.

But then I came to the comments at the end of the article. The first commenter said, basically, "Only 150 dead people? So what!" Other commenters chimed in with stuff like, "More people die from can opener accidents." Would they think that if their daughter just died because they just tried to soothe her suffering with a spoonful of medicine? Or she was forced to undergo months of waiting for a liver transplant?

The trolls intentionally obscure the real point of the article: 78,000 emergency room visits and 33,000 hospitalizations annually. If the average emergency room visit costs $1,283, that's $100,000,000. If the average hospital stay costs $15,734, that's another $519,000,000. Many victims of acetaminophen poisoning will suffer permanent liver damage, and some will require liver transplants, which means they'll spend their entire lives taking anti-rejection drugs. If the average liver transplant costs half a million dollars and the antirejection drugs cost $12,000 a year, acetaminophen poisoning will directly cost billions of dollars annually.

And then there are the indirect costs: some victims will suffer other debilitating medical problems as a result of liver failure, which will prevent them from working, or will require expensive special care. Some of these people will wind up on welfare and Medicaid. Parents and spouses will miss work to care of them.

The real cost of lax regulation of Tylenol is not just 150 dead people a year. It's billions and billions of dollars in medical costs, plus millions of hours of lost productivity, plus an incalculable amount of human suffering.

So, who are these guys who troll the web, who minimize other people's pain and defend the profits of giant corporations who market dangerous products? Are they paid shills? Rabid libertarians who think companies should be able to make money any way they can, and let everyone else clean up the mess while they laugh all the way to the bank? Conservatives who hate it when people sue corporations? Why do they leap to these companies' defense and obscure these drugs' true costs to society?

Don't they get that dangerous products hurt everyone, even conservatives and Republicans?  Republicans like Antonio Benedi, for example. Benedi was once an assistant to president George H. W. Bush. He took some Tylenol, as per the label, and it almost killed him. He had to get a liver transplant. He sued Tylenol's manufacturer and a jury awarded him $8.5 million.

I don't think people should sue companies at the drop of a hat. But these companies are selling a product that has been known to be dangerous for decades. They've tried to make it safer and have failed. They've even produced an antidote for acetaminophen poisoning. So they know exactly how dangerous it is. Yet they're using their economic and political clout to prevent the FDA from enacting additional safety measures. All the while still telling parents that Children's Tylenol is completely safe (when used as directed).


Medicine is supposed to make us better. Not poison and kill us.