By Dr. W. Gifford Jones
June 25, 2002
Why would I want people to suffer pain when in the past I've criticized doctors for inadequate pain control? For years I've stressed it was inhuman allowing terminal cancer patients to die in agony. How some get insufficient amounts of painkillers. How others are denied medication for fear of addiction even though they have days or weeks to live. But suffering a little bit is the right prescription for million of other people.
Today many North Americans take acetaminophen, better known as Tylenol, to ease a variety of pains. It's been known for years that too much Tylenol can cause liver failure and death. Now, a new study shows that even taking the recommended daily dose may cause liver problems. This should be a wakeup call for millions of people who take this medication.
Dr. Neil Kaplowitz of the University of Southern California, cites a study of 145 healthy patients who took four grams of Tylenol a day, the maximum daily dose, for two weeks. 40 percent of these volunteers showed an increase of aminotransferase, a liver enzyme that indicates possible liver damage. In fact, the elevation was three times the usual point for concern.
It's easy to overdose when using Tylenol. Extra-strength Tylenol contains 500 milligrams (mg) of acetaminophen. Two of these tablets four times a day equals 4,000 mg.
the maximum dose. And any increase above this dose is flirting with danger.
Today acetaminophen causes more overdoses and overdose deaths than any other drug in the U.S. A study at the University of Texas and Washington showed that nearly half of all cases of liver failure in 662 patients from 22 liver transplant centers over a six year period were the result of acetaminophen poisoning.
It's equally worrying is that in 1998 only 28 percent of liver poisonings could be traced to this painkiller. Just five years later in 2003 this figure had escalated to 51 percent.
The Federal Drug Administration in the U.S. estimates that 56,000 emergency visits a year are due to acetaminophen poisoning.
Some of these emergency visits were due to what researchers call "therapeutic misadventures". This occurs for several reasons and often patients have no idea it's happening.
For instance, there is a North American tendency to overdo things. The reasoning that if eight tablets of Tylenol a day helps to ease the symptoms 12 tablets a day would be even more helpful. It's a bad error.
There's another unsuspecting Tylenol trap that results in double dosing. While suffering from a backache you awaken one morning with a cold. Now you reach for a cold remedy that also contains acetaminophen. Today there are over 150 non-prescription over-the-counter medicines that contain acetaminophen. And who takes the time to read the label that this painkiller is present.
Parents should remember that children's versions of acetaminophen come in a variety of formulations. For instance, by substituting infant drops for syrup or elixir the infant could be receiving three times the dose it should be.
Tylenol is a safe medication if used properly. The problem is there are too many unsafe people. It's also shocking why some people reach for Tylenol and other minor painkillers. Some patients tell me, "It lifts me up" or "It helps to relax me" or "I have a slight headache". These patients have been brain-washed by TV ads that no one should ever suffer any pain, slight as it may be.
Painkillers are metabolized by the liver and excreted by the kidneys. Researchers say that safe doses do not injure these organs. Maybe they're right, but I can't believe that even low doses are good for these organs and the fewer drugs we take the better.
During the past few years we have seen how many drugs other than Tylenol have either caused severe injury or death. Some patients were taking these medications for bone-fide medical problems. I have no problem when painkillers help to ease the suffering of those riddled with arthritic and other disabling diseases.
But compared to our ancestors who hacked their way into the forest we've become a nation of too many wimps who want total freedom from pain. It's a bad and dangerous addiction.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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