Pushing Back on Tylenol Hysteria

CORRECTION: Ack. I got the key stat in this piece wrong–there were 458 acetaminophen overdose deaths per year in the United States in the 1990s, not 458 over nine years. (In fairness, I was led by an erroneous correction to this Slate article, but I should have read the source more closely.) That changes all the follow-on stats in here by one order of magnitude. I still think restrictions on quantities in acetaminophen sale, like those seen in the UK and France, look unwarranted given those numbers, but it’s obviously a closer question at 450 deaths a year than at 50. 

Following the Obama Administration’s decision not to allow Plan B sales to minors over the counter, we’ve seen a spate of articles about how various drugs sold over the counter are more dangerous than Plan B–chiefly, acetaminophen, the active ingredient in Tylenol. This has led Matt Yglesias to worry that the articles would create the sense that acetaminophen should be moved behind the counter, despite the authors’ intent to encourage OTC sales of Plan B.

It’s true, acetaminophen can kill you by acutely destroying your liver, and in dosages that are not as massive as you might expect. But deaths from acetaminophen are very rare, compared to how common acetaminophen use is. The allegedly alarming statistic is that 458 people overdosed on acetaminophen in a nine-year period, or about 50 deaths a year annually. You can compare that to 28 billion doses of acetaminophen sold every year in the United States, or one death for every 560 60 million doses sold.

That makes acetaminophen far safer than a wide variety of products available without a prescription. Cigarettes. Liquor. Firearms. Butter. Bicycles. Turkey fryers.

There were 613 deaths in 2007 just due to accidental discharges of firearms. But I think alcohol provides an the most instructive example. The CDC reports 75,000 alcohol related deaths per year as of 2005. That number may be a bit inflated–auto accidents can be categorized as “alcohol related” if any party to the accident had been consuming alcohol, whether or not alcohol contributed to the accident. But even with a significant haircut to that figure, alcohol is orders of magnitude more dangerous than Tylenol. Total consumption of ethanol is roughly 2.75 gallons per American per year, the equivalent of nearly 600 shots of 80 proof liquor. Using the CDC’s figures, that works out to 1 death per 2.4 million “doses” of alcohol, 230 25 times the death rate for acetaminophen.

But alcohol is legal, and sold without a prescription, because people like drinking and can take informed risks. If alcohol passes that test, then Tylenol certainly passes it with flying colors.

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