Paracetamol use during pregnancy – a call for precautionary action(nature.com)
nature.com
Paracetamol use during pregnancy – a call for precautionary action
https://www.nature.com/articles/s41574-021-00553-7
162 comments
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.
> 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.
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.
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.
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.
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.
> 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.
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.
> 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.
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.
I don't see why I shouldn't run out into a lightning storm when lightning strikes on people are so rare.
Consider that maybe the restriction is why overdoses are so are.
Consider that maybe the restriction is why overdoses are so are.
"It is the most common cause of liver injury.."
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.
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.
> 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?
Really? I thought it was advised to not drink alcohol for life if you had liver damage. I thought the damage was permanent, no?
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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.
> beyond a small taste or I get headaches and nausea
Alcohol is a poison. If you didn't deliberately build up a tolerance to it your reaction is normal.
Alcohol is a poison. If you didn't deliberately build up a tolerance to it your reaction is normal.
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.
> been abstinent
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.
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.
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.
You're thinking of cirrhosis, which is usually the result of continuously injuring the liver over a long period of time.
Saying the damage is caused by regrowth is silly as without it the liver would have failed at the first injury.
Saying the damage is caused by regrowth is silly as without it the liver would have failed at the first injury.
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).
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).
> The toxic dose is very close to the active dose
Not “active dose”, recommended daily limit.
Not “active dose”, recommended daily limit.
Both! You have to take way more times the active dose of Naproxen to die as compared to Tylenol.
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.
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.
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.
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.
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.
if tylenol was a newly created drug, there is no chance it would have so few restrictions on its usage.
Imaging trying to get alcohol past regulators.
[deleted]
I disagree. Acetaminophen use is incredibly widespread yet few end up in liver failure.
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.
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.
https://www.acsh.org/news/2017/09/18/tylenol-isnt-so-safe-le...
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.
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.
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.
> Tylenol doesn't seem to work for fever
What? Not sure what alternate universe we're talking about, but paracetamol definitely works on fever in this one.
What? Not sure what alternate universe we're talking about, but paracetamol definitely works on fever in this one.
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.
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?
You might be mistaking it with other substances.
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.
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.
I would not be so sure. Regulatory agencies have recently approved AD treatment without any sort of evidence. In 2021.
True, but not quite relevant. That is a prescription drug which does/will therefore have quite a few more restrictions than over the counter Tylenol
It's relevant in the sense that you can't trust the FDA for anything scientific anymore. It's been hacked.
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?).
[1]: https://www.embryotox.de/arzneimittel/details/paracetamol/
[1]: https://www.embryotox.de/arzneimittel/details/paracetamol/
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.
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.
Paracetamol is the therapy of choice for pain and fever during pregnancy. Doctors, pharmacists, etc all recommend it in Germany. Ibuprofen is more problematic.
I expect that there will be a lot of contending articles and sources, considering the amount of money made from paracetamol globally.
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.
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.
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.
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.
[1]: https://www.embryotox.de/arzneimittel/details/ibuprofen/
[1]: https://www.embryotox.de/arzneimittel/details/ibuprofen/
Ibuprofen, and other NSAIDs, are not without their problems.
Increased risks of heart attack and stroke, hypertension, kidney damage.
Increased risks of heart attack and stroke, hypertension, kidney damage.
Surprise. Heart attack, stroke, hypertension, kidney damage are also risk factors of NOT taking NSAIDs for the reasons people commonly take NSAIDs for.
No, the best we can do is not take any pain relievers and suffer through the pain.
When you say “we”, I assume that means you’re a woman who has given birth without painkillers?
Or a child of such woman? Or... The society as a whole has an interest in keeping itself healthy. We should look for the solution together.
I think they were remarking that saying "we should suffer trough the pain" is very cheap to do if you're not a woman who knows the pain herself.
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?
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?
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.
My wife did. She stuck it out through a pretty painful episiotomy as well.
This is something everybody should read who only knows the pain killer obsessed US healthcare system:
https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
Pain by itself is not a problem. Fever might be. Especially during pregnancy.
Pain, especially chronic pain, can lead to stress which has a litany of effects on your body.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546756/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546756/
True. But
Painkillers are only for treating acute pain.
Chronic pain is fixed by treating underlaying cause (unless you don't have access to health services).
Painkillers are only for treating acute pain.
Chronic pain is fixed by treating underlaying cause (unless you don't have access to health services).
That assumes the underlaying cause is known… and fixable.
Totally wrong.
--a random MDThis is a great argument for why women should not work for a year or more after pregnancy.
Probably just not take anything that can alter body functions in a significant manner.
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.
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.
9 months without any medication
Yes, it’s quite reasonable considering the end result.
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.
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.
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.
CBD?
Wow! I have two young children, and we’ve been cautious about using paracetamol. But this really changes the perspective for me.
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.
Why do you use the word "exposed"? You seem to be overreacting.
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.
Ok... I looked at the data and when people stopped giving aspirin to children, prevalence of Reye syndrome dropped by 90%.
I'm gonna go ahead and continue not giving aspirin to kids.
I'm gonna go ahead and continue not giving aspirin to kids.
You know the saying that correlation is not causation ?
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.
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.
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.
Edit: typo
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
> Aspirin can cause Reye syndrome in children
This has never been demonstrated
This has never been demonstrated
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.
https://www.theguardian.com/science/2015/apr/14/paracetamol-...
https://www.theguardian.com/lifeandstyle/2019/jun/04/why-par...
https://www.theguardian.com/science/2015/apr/14/paracetamol-...
https://www.theguardian.com/lifeandstyle/2019/jun/04/why-par...
Absolutely not.
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.
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.
Everything in life involves trade offs. And every decision in life involves unknown unknowns.
The only option is to keep collecting and evaluating data over and over and make decisions with the best available information.
The only option is to keep collecting and evaluating data over and over and make decisions with the best available information.
aka acetaminophen (popularly aka Tylenol in the United States).
When I moved to Canada it took me 6 months to realize that paracetamol was available nowhere because acetaminophen was how it was called here.
Same in Japan apparently
http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
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.
[0]: https://www.tylervigen.com/spurious-correlations
[0]: https://www.tylervigen.com/spurious-correlations
> 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 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.
[1] https://en.wikipedia.org/wiki/Blind_men_and_an_elephant
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
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.
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.
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.
> It's published in nature, you can be sure it's pretty serious
Haha. No. (MD with 15y experience in clinical research)
Haha. No. (MD with 15y experience in clinical research)
Paracetamol is widely used so any attempts to investigate its safety aren't 'truly serious'? This is really strange, closed minded thinking.
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.
Related discussion: https://news.ycombinator.com/item?id=28735314
Interesting comment from gwern on a discussion over on reddit:
https://www.reddit.com/r/slatestarcodex/comments/q01gwl/comm...
https://www.reddit.com/r/slatestarcodex/comments/q01gwl/comm...
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.
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.
We also don't know what unforeseen side effects of an infection with Covid we'll discover in the coming years.
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".
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.
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.
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.
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.
In this case, it's best compared to covid19 itself since not taking the vaccine will almost certainly result in getting covid.
That risk isn't so great, also not long-term. There's already a lot of evidence and indication for that.
That risk isn't so great, also not long-term. There's already a lot of evidence and indication for that.
There is also a lot of evidence that the vaccines are safe and effective.
ekianjo(1)
pillefitz(4)
[deleted]
I found it very frustrating you cannot buy paracetamol in Japan. I wonder if the know something we don’t…
It's sold under the name アセトアミノフェン (acetaminophen) in Japan.
http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
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)
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.
wrong on all counts.
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.bufferin.net/
It's heavily advertised and available in every drug store in Japan (you don't even need to go to pharmacies!).
Pretty sure bufferin is aspirin, not paracetamol.
Some versions contain Aspirin, other contain Paracetamol like this one: https://www.bufferin.net/products/premiumdx.htm
and they all use the same brand name
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:
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://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.
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.
> "safe" image coming out of nowhere.
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.
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.
How is Reye's syndrome a bullshit obscure reason?
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
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?
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.
I see only one complaint in this thread, and that is your comment.
It’s not a complaint. Much better than the alternatives:
https://twitter.com/iaindale/status/1441504448266833920?s=21
https://twitter.com/iaindale/status/1441504448266833920?s=21
Rather fitting considering the subject of the article.
> 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?
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.
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
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.
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.
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.
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.
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.
gremloni(1)
[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...