5 ms·

Prenatal acetaminophen increases autism and ADHD risk 20%

30 points by mleonhard 5y ago

sebmellen 5y ago
A close family member is a well-known member of the pharmaceutical industry. This family member has told me on probably 10 occasions that if acetaminophen and many common NSAIDs were sent through an FDA clinical trial today, they would stand absolutely no chance of passing. Is this true? If so, does anyone else know why this is?
- ksenzee 5y ago
  Mainly because of liver toxicity. You can damage your liver to the point of needing a transplant with 4000 mg of acetaminophen in a day. There's an offhand mention of it here: https://blogs.sciencemag.org/pipeline/archives/2017/10/31/watch-your-covalent-drugs-carefully#comment-286272 https://blogs.sciencemag.org/pipeline/archives/2017/10/31/wa...
  - sebmellen 5y ago
    The number of people I know who've "attempted suicide" by swallowing a whole bottle of Tylenol is pretty high.
  - toomuchtodo 5y ago
    Eric Engstrom of DirectX fame died from this fairly recently. https://news.ycombinator.com/item?id=25423712 https://news.ycombinator.com/item?id=25423712
  - ddoolin 5y ago
    4000mg is also the maximum daily dose listed on the label, which is pretty crazy to think about. I would, as a regular consumer, absolutely think it's safe to take that much if I felt it was warranted absent any long term warnings (which there are none on the labels). After taking even _less_ than that for a few days, you can start to show overdose symptoms.
    - treeman79 5y ago
      Fun fact. Use the same dose man at days in a row and you’ll trigger rebound headaches. Which often are much more painful then original issue. Leading to yet more usage.
- krrrh 5y ago
  It’s interesting that your family member is German. When my wife and I lived there it was quite an adjustment from $10 500 ct bottles of ibuprofen to €1 per dose blister packs of 12 that always came with a stern question from the pharmacist, “have you taken this before?” It seemed like a human rights violation at the time to charge so much for something that is a monthly ritual for women of child-bearing years, but as I’ve paid attention over the years I’ve started to think that they might be on to something.
  - thyrsus 5y ago
    This article says nothing about the safety of ibuprofen, which has different (generally safer) toxicity than acetaminophen/paracetamol.
    - krrrh 5y ago
      Yeah I was responding to the comment about NSAIDS in general not being approvable by today’s FDA.
  - sebmellen 5y ago
    Yes! I always find it hilarious to pay so much for allergy tablets or other things of that nature when I'm in Germany. Part of it, I think, is an effort to avoid having tons of pills laying around all the time. To think... There must be thousands of lethal doses of all sorts of medications strewn throughout my neighborhood (in the US). That's a scary thought. Germany is probably a bit different. Also, apologies — I edited my comment for brevity so the information about my family member's nationality no longer appears.
  - brnt 5y ago
    Here in the Netherlands I've never seen or heard of an MD prescribe ibuprofen, always paracetamol. I understand that the risk of kidney damage with ibuprofen is higher than liver damage with paracetamol, but that may be incorrect. I'd be curious to learn if there are reasons to favour one over the other.
    - 5y ago
- JMTQp8lwXL 5y ago
  Slightly tangential, but I would be curious to hear examples of other pharmaceuticals that wouldn't be permitted today, and more broadly, how many "legacy" products wouldn't be approved? And if we have information saying it's unsafe: why is it still on shelves? It seems approval should be mutable, not an immutable characteristic. Perhaps periodic re-approval should be mandatory, for example.
  - jjeaff 5y ago
    There are plenty of FDA approved medicines that get yanked after more severe side effects are found. Seems very unlikely Tylenol would be hard to get approval for today. You can overdose on almost anything. Tylenol is still one of the safer options out there when taken within guidelines.
- pkaye 5y ago
  It might due to something called the therapeutic index. Its the ratio of the effective dose to lethal dose. For some drugs its pretty narrow and requires careful monitoring. https://en.wikipedia.org/wiki/Therapeutic_index https://en.wikipedia.org/wiki/Therapeutic_index
efields 5y ago
The adhd numbers don’t seem that far off from average: https://www.cdc.gov/ncbddd/adhd/data.html https://www.cdc.gov/ncbddd/adhd/data.html
brundolf 5y ago
I'm convinced that something happened to 80s/90s babies; it's like an entire generation got ADHD. It could be cable TV or the internet, it could just be that people are more open and aware about mental health now, or... it could be acetaminophen > Concerns about paracetamol's [(acetaminophen's)] safety delayed its widespread acceptance until the 1970s, but in the 1980s paracetamol sales exceeded those of aspirin in many countries, including the United Kingdom. This was accompanied by the commercial demise of phenacetin, blamed as the cause of analgesic nephropathy and hematological toxicity. [0] [0] https://en.wikipedia.org/wiki/Paracetamol https://en.wikipedia.org/wiki/Paracetamol
- firecall 5y ago
  I think the criteria for a clincal diagnosis wasnt accepted until the 1970s. Also, Therapists are influenced by trends as much as anyone else, and are motivated to diganose something so they continue to get paid... (not wishing to sound cynical, but to a hammer, everything looks like a nail!) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/
- strikelaserclaw 5y ago
  Keep in mind that society has become much more cognitive for even average people. I think ADHD diagnosis will keep increasing as people find it difficult to keep up.

30 points by mleonhard 5y ago

A close family member is a well-known member of the pharmaceutical industry. This family member has told me on probably 10 occasions that if acetaminophen and many common NSAIDs were sent through an FDA clinical trial today, they would stand absolutely no chance of passing. Is this true? If so, does anyone else know why this is?

ksenzee 5y ago
Mainly because of liver toxicity. You can damage your liver to the point of needing a transplant with 4000 mg of acetaminophen in a day. There's an offhand mention of it here: https://blogs.sciencemag.org/pipeline/archives/2017/10/31/watch-your-covalent-drugs-carefully#comment-286272 https://blogs.sciencemag.org/pipeline/archives/2017/10/31/wa...
- sebmellen 5y ago
  The number of people I know who've "attempted suicide" by swallowing a whole bottle of Tylenol is pretty high.
- toomuchtodo 5y ago
  Eric Engstrom of DirectX fame died from this fairly recently. https://news.ycombinator.com/item?id=25423712 https://news.ycombinator.com/item?id=25423712
- ddoolin 5y ago
  4000mg is also the maximum daily dose listed on the label, which is pretty crazy to think about. I would, as a regular consumer, absolutely think it's safe to take that much if I felt it was warranted absent any long term warnings (which there are none on the labels). After taking even _less_ than that for a few days, you can start to show overdose symptoms.
  - treeman79 5y ago
    Fun fact. Use the same dose man at days in a row and you’ll trigger rebound headaches. Which often are much more painful then original issue. Leading to yet more usage.
krrrh 5y ago
It’s interesting that your family member is German. When my wife and I lived there it was quite an adjustment from $10 500 ct bottles of ibuprofen to €1 per dose blister packs of 12 that always came with a stern question from the pharmacist, “have you taken this before?” It seemed like a human rights violation at the time to charge so much for something that is a monthly ritual for women of child-bearing years, but as I’ve paid attention over the years I’ve started to think that they might be on to something.
- thyrsus 5y ago
  This article says nothing about the safety of ibuprofen, which has different (generally safer) toxicity than acetaminophen/paracetamol.
  - krrrh 5y ago
    Yeah I was responding to the comment about NSAIDS in general not being approvable by today’s FDA.
- sebmellen 5y ago
  Yes! I always find it hilarious to pay so much for allergy tablets or other things of that nature when I'm in Germany. Part of it, I think, is an effort to avoid having tons of pills laying around all the time. To think... There must be thousands of lethal doses of all sorts of medications strewn throughout my neighborhood (in the US). That's a scary thought. Germany is probably a bit different. Also, apologies — I edited my comment for brevity so the information about my family member's nationality no longer appears.
- brnt 5y ago
  Here in the Netherlands I've never seen or heard of an MD prescribe ibuprofen, always paracetamol. I understand that the risk of kidney damage with ibuprofen is higher than liver damage with paracetamol, but that may be incorrect. I'd be curious to learn if there are reasons to favour one over the other.
  - 5y ago
JMTQp8lwXL 5y ago
Slightly tangential, but I would be curious to hear examples of other pharmaceuticals that wouldn't be permitted today, and more broadly, how many "legacy" products wouldn't be approved? And if we have information saying it's unsafe: why is it still on shelves? It seems approval should be mutable, not an immutable characteristic. Perhaps periodic re-approval should be mandatory, for example.
- jjeaff 5y ago
  There are plenty of FDA approved medicines that get yanked after more severe side effects are found. Seems very unlikely Tylenol would be hard to get approval for today. You can overdose on almost anything. Tylenol is still one of the safer options out there when taken within guidelines.
pkaye 5y ago
It might due to something called the therapeutic index. Its the ratio of the effective dose to lethal dose. For some drugs its pretty narrow and requires careful monitoring. https://en.wikipedia.org/wiki/Therapeutic_index https://en.wikipedia.org/wiki/Therapeutic_index

efields 5y ago

The adhd numbers don’t seem that far off from average: https://www.cdc.gov/ncbddd/adhd/data.html https://www.cdc.gov/ncbddd/adhd/data.html

brundolf 5y ago

I'm convinced that something happened to 80s/90s babies; it's like an entire generation got ADHD. It could be cable TV or the internet, it could just be that people are more open and aware about mental health now, or... it could be acetaminophen > Concerns about paracetamol's [(acetaminophen's)] safety delayed its widespread acceptance until the 1970s, but in the 1980s paracetamol sales exceeded those of aspirin in many countries, including the United Kingdom. This was accompanied by the commercial demise of phenacetin, blamed as the cause of analgesic nephropathy and hematological toxicity. [0] [0] https://en.wikipedia.org/wiki/Paracetamol https://en.wikipedia.org/wiki/Paracetamol

firecall 5y ago
I think the criteria for a clincal diagnosis wasnt accepted until the 1970s. Also, Therapists are influenced by trends as much as anyone else, and are motivated to diganose something so they continue to get paid... (not wishing to sound cynical, but to a hammer, everything looks like a nail!) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/
strikelaserclaw 5y ago
Keep in mind that society has become much more cognitive for even average people. I think ADHD diagnosis will keep increasing as people find it difficult to keep up.