11 ms·

What's Tylenol Doing to Our Minds?

218 points by BruceM 13y ago

DanBC 13y ago
It is pleasing to see error bars on a graph in a mainstream publication. It's very nice to have them saying that the study was small and there are more questions to be asked. It's good that they mentioned the severe toxicity of paracetamol in overdose. It does kill many people, and it's not a pleasant death. It also accounts for many organ transplants. It would have been nice if they'd said that, taken carefully and with no over dose, paracetamol is a very safe and very effective medication. It's very cheap. (At least here in the UK, I found it bafflingly expensive in the US.) Cultural note: In the UK most medication is dispensed in blister packs. You can buy paracetamol off the shelf but you can only get limited quantities. Most shops will only sell you 16 tablets (at 500 g each) or 32 if you buy it from a person. You can get 100 if you see a pharmacist and persuade them you need them, but that'll be a struggle in most places. You can get large amounts if you have a prescription. 16 tablets at 500 g each would cost around £0.20 (for budget pills). Blister packs was an effective suicide control measure, reducing the number of pills taken and the number of overdoses attempted. Reduced quantities of pills sold had an initial success in reducing suicide rates, but number have since risen. Pills in the homes of old people are especially dangerous. This is because they're not locked away, and young children visiting sometimes take the pills. And also because suicide rates among old people are depressingly high.
- _delirium 13y ago
  > I found it bafflingly expensive in the US. Brand-name Tylenol is relatively expensive, but generic acetaminophen/paracetamol is dirt cheap in the US. Here are 200 tablets of 500 mg each for $4.00, i.e. $0.02 per tablet: http://www.walmart.com/ip/Equate-Extra-Strength-Value-Pack-Acetaminophen-Non-Aspirin/10324477 http://www.walmart.com/ip/Equate-Extra-Strength-Value-Pack-A...
  - andrewcooke 13y ago
    you can buy paracetamol in packs of 200? jeez. isn't this one of the main killers, though overdoses (many accidental)? i'm pretty sure size for otc sale is regulated in other countries. paracetamol is nasty stuff - dying from it is not pleasant, and it's surprisingly easy to do.
    - _delirium 13y ago
      I believe there isn't currently any mechanism for the U.S. FDA to restrict number of pills sold of OTC medication, only the contents of each individual pill and the dosage instructions. The assumption is that OTC means purchase itself is unregulated, so you can order a truck-load if you really want to stock up. The only cases I'm aware of where purchase numbers are limited for OTC drugs is when separate laws targeting drug precursors impact them, which is why you can't buy large numbers of pseudoephedrine tablets at once (they can be used to manufacture meth). The FDA does seem to be reducing the maximum dosage of each tablet, though: from 2014 the maximum will be 325mg, so the 500mg tablets linked above will be phased out. But that change seems aimed at reducing accidental liver damage from excessive "normal" use, rather than aimed at reducing suicides from deliberate overdoses.
      - ajays 13y ago
        I believe there isn't currently any mechanism for the U.S. FDA to restrict number of pills sold of OTC medication There are exceptions (but I'm not sure if they're from the Law Enforcement side, or the FDA). For example, you can't buy Sudafed (whose active ingredient, pseudoephederine(?), is used to make meth) without severe restrictions: not more than a pack a day, need a valid ID, etc.
        rm999 13y ago
        Potassium is another (more bizarre) example. http://answers.yahoo.com/question/index?qid=20101219083208AAP8SQM http://answers.yahoo.com/question/index?qid=20101219083208AA...
- joosters 13y ago
  It's expensive in the UK too if you buy a brand name painkiller. It's depressing that they can still sell them when the identical generic medication is next to them on the shelf and is 1/10 of the price.
  - kintamanimatt 13y ago
    > It's depressing that they can still sell them You may feel better about this if you take some Tylenol ;-) I don't see how there's anything wrong with selling brand-name drugs next to generics. In fact people that believe brand name drugs are more effective will have a better response to the more expensive drug because of the placebo effect. If anything, they're getting a better response to the same dose of the same drug than the rest of us plebs that know better than to pay a multiple of the cost of the generic.
    - TheLegace 13y ago
      In some very extreme/rare cases it does matter. Something like ADHD medication can make a difference. One of the most difficult months I've had has been a month where I tried the generic and the side effects were way worse than the brand name at same dosage.
      - logn 13y ago
        In generics they can change the inactive ingredients and obviously they don't always use the same equipment or facilities to produce it. Some people have allergies to inactive ingredients which may explain the different side effects. But in my mind the generics are just as good as name brand, albeit sometimes different. I guess I'd be just as likely to react poorly to the inactive ingredients in the name brand and might find a generic better in some cases.
        haldujai 13y ago
        Actually that's not true. Generics (at least in Canada but probably true elsewhere as well) only have to give between 85%-120% of the dose of the brand name drug, this is despite having the same official dosage as printed on the label. The difference comes from preparation, pill coatings, and inactive ingredients.
- gambiting 13y ago
  To be honest, I find the UK law to be absolutely stupid in this regard. I needed to buy 10 packs of paracetamol, and at local morrisons I was told I couldn't, maximum was 2 packs(16 tablets each). So I bought two packs, went out of the store, came back in, bought another two, repeated the process 5x and got my ten packs. The whole law is just an annoyance, nothing else. If I wanted to kill myself with paracetamol I could easily get even a 1000 tablets, would just need to drive around a few supermarkets but this law would not stop me from doing it.
  - Osmium 13y ago
    > The whole law is just an annoyance, nothing else. This is not true. It's about preventing impulsive suicides, not premeditated ones. If a depressed person is having an episode and all they have in their house is 16 pills, then it removes the opportunity: maybe by the time they've make it to the shops and buy more, the moment will have passed, and a life would be saved. It's been shown time and time again that you can reduce absolute suicide rates by removing opportunities like this. If I remember correctly, there was something similar involving gas ovens, though I can't find the reference now. Guns, bridges, etc. are all similar too. When it comes down to it, if someone's determined enough to kill themselves, they will, but the truth is most people aren't and doing things like only selling small quantities of pills really can prevent suicides.
    - DanBC 13y ago
      Strongly agree with your post. About gas ovens: There's less carbon monoxide in modern gas delivery. (http://io9.com/5959303/why-have-people-stopped-committing-suicide-with-gas http://io9.com/5959303/why-have-people-stopped-committing-su...)
      - Osmium 13y ago
        Thanks! That was the one I was thinking of. >The switch from coal gas to natural gas also had one unexpected effect. During the ‘50s and ‘60s, about half of the suicides in Britain were by coal gas. By the ‘70s, when the transition to natural gas was complete, the number of gas suicides had dropped to zero and the overall suicide rate was down a third. Even the suicidal appreciate convenience. If it's too much trouble, as Dorothy Parker said, "You might as well live." Also, regarding my above post (which I can't edit now), I didn't mean to imply that "just" 16 pills was even remotely safe because I'm sure it's not (I'm not a doctor) but the general point stands...
- cmelbye 13y ago
  Bafflingly expensive? It's dirt cheap, and readily available for a few bucks in pill bottles with 100+ pills from any drug store.
- mtdewcmu 13y ago
  The UK must accept a much greater level of paternalism in health care than in the US.
- graywh 13y ago
  > It is pleasing to see error bars on a graph in a mainstream publication. Those are "dynamite plots", a favorite of scientists, but the statisticians I know prefer to use boxplots or dotplots instead.
Shenglong 13y ago
I'm not all that familiar with social tests like this. Is n=120 generally considered to be a large enough sample size to make any claims at all?
- carbocation 13y ago
  It always depends on the effect size.
  - icegreentea 13y ago
    Another important question is always, 'if this effect is true does this generalize to the overall population'. While I haven't read the paper, I bet that the test population were composed almost completely of undergrad students. So much of social science experiments are based on testing done on student. And there isn't anything wrong with that per se, but we must always be careful when trying to infer results, and drawing conclusions on the greater population, or human kind as a whole.
    - carbocation 13y ago
      External validity is an interesting but quite different question. There are any number of other interesting but distinct features of clinical trials that we could talk about.
    - tedks 13y ago
      For some things (socialization, substance use patterns, etc.), you'd expect different results on college students than on other populations, so you'd need to run additional experiments to determine if being a college undergrad moderates whatever effect you study. For other things, like perception, drug effects, etc., it seems less likely that this is actually a problem, because there's no reason to believe the neural pathways that acetaminophen operates over are different between any two humans.
- pekk 13y ago
  n=120 pales utterly beside the observation that it is totally unclear what they are actually manipulating or measuring. The design is completely hapless. If you really need to detect effects that are so small they are meaningless for almost any practical purpose, then you might need thousands of people in the study.
joosters 13y ago
Possibly a dumb question, by why is it called acetaminophen in some places and paracetamol in others? Neither of them are a brand name AFAIK.
- Rinum 13y ago
  Its chemical name is para-acetylaminophenol. That's what the names acetaminophen and paracetamol are derived from. para-ACETylAMINOPHENol PARa-ACETylAMinophenOL
  - spicyj 13y ago
    para-aceTYLaminophENOL
- icegreentea 13y ago
  The full chemical name (but not the IUPAC name) is N-acetyl-para-aminophenol. Acetaminophen and paracetamol are just various shortenings of the name. Likely whatever is popular in a location just comes down to whatever dominant drug manufacturer chose to call it in their public facing material.
pygy_ 13y ago
Among other things, paracetamol activates the cannabis receptors. http://www.ncbi.nlm.nih.gov/pubmed/17227290 http://www.ncbi.nlm.nih.gov/pubmed/17227290
Breakthrough 13y ago
Always great to see studies looking at the mental implications of non-psychoactive drugs. I suppose it's common to overlook the implications of a drug on the central nervous system with respect to consciousness, when the drug in question never causes any subjective/noticeable change. I suppose it's all too intuitive, though. Even slight, unnoticeable changes in consciousness - to the point that even you don't notice - may in-fact be detectable on paper. I hope this leads to more research into the mental changes for other drugs classified as "non-psychoactive" (who doesn't love more data? :). Anyways, to end off by inserting some colloquialism into my thoughts here... Trippy study, mannnnn.
- freshfruit 13y ago
  > Always great to see studies looking at the mental implications of non-psychoactive drugs. ... also great to read about the mental implications of priming. I'll be more punitive/forgiving depending on the unrelated thought I had minutes earlier...
- raverbashing 13y ago
  > Always great to see studies looking at the mental implications of non-psychoactive drugs. Well, it kind of fits the definition (except psychoactive drugs have their primary effect in the brain)
- npsimons 13y ago
  As someone with a family history of mental illness, I try to keep a close eye on my mental state, and it's surprising how much can affect it. Apart from drugs that shouldn't be affecting mental states, even different types of food and how much exercise I get can have noticeable impacts. Those EFA fish oil pills? Not just good for your heart . . .
  - freshfruit 13y ago
    I think you're promoting a healthy degree of self-awareness. A noteworthy risk however is that you'll make false connections -- ie. garlic is good for fight off HIV.
tosseraccount 13y ago
Just legalize opiods. Do you really need a Doctor when you stub your toe?
- carbocation 13y ago
  If you take opioids for the pain from stubbing your toe, you should re-evaluate what is important to you.
  - tosseraccount 13y ago
    Like getting by for 24 hours until I can put shoes on? I need the government to tell me I can't ease things for a day?
    - harrisonpowers 13y ago
      You might look into buying comfortable shoes.
    - Camillo 13y ago
      Clearly you do.
      - tosseraccount 13y ago
        In Soviet Obamerica, authority question YOU !!
  - tsotha 13y ago
    Perhaps. But should the government be doing that evaluation for you ahead of time?
- derleth 13y ago
  If you need opioids for the pain from a stubbed toe, you have a serious problem with something (mental, physical, or both) and need more help than an OTC opioid can give.
gte910h 13y ago
EXTREMELY small study. Just push for a larger study on this http://www.academia.edu/2057894/The_common_pain_of_surrealism_and_death_Acetaminophen_reduces_compensatory_affirmation_following_meaning_threats http://www.academia.edu/2057894/The_common_pain_of_surrealis... 121 people Search for "We recruited"
- simonster 13y ago
  In Study 2 there we 236 subjects, which AFAIK is a pretty big sample size for these kinds of experiments. There error bars on the graph are still somewhat large, so there was a lot of variability, but assuming there is no bias in what data the experimenters chose to include, combining both studies, p < .02*.01 = .002. Furthermore, as the article notes, there was a prior study that also showed cognitive effects of Tylenol. While these effects could be spurious due to publication or selection bias or deliberate manipulation, it's not all that plausible that they happened by chance.
  - carbocation 13y ago
    Just multiplying the P-values from different studies is invalid. You can intuit this by imagining 10000 studies, each of which had a P-value of 0.99. Seeing 10000 negative studies and no positive studies, you'd be convinced that there was no real effect, intuitively. But multiplying 0.99 10000 times yields a P-value of 2.2 x 10^(-44), a result of impressive significance. To combine studies, many people use inverse variance weighted meta-analysis, e.g., https://en.wikipedia.org/wiki/Inverse-variance_weighting https://en.wikipedia.org/wiki/Inverse-variance_weighting
    - simonster 13y ago
      You're right. There is a mathematical explanation for this in addition to the intuitive one you provide: If the null hypothesis is true, the p-value of each test is uniformly distributed between 0 and 1, but the product of p-values will not be uniformly distributed between 0 and 1, so it is not a p-value. To combine p-values, what we really want is the CDF of the product of p1 and p2 in the distribution formed by the product of uniform random variables. Mathematica can compute this; the general formula is (p1p2)(1-log(p1p2)), and for the two p-values in question this yields p = 0.0019 (which is close to what I said initially, but only because I made a calculation error; .02*.01 = 0.0002). Thanks for pointing out the mistake in my reasoning! I learned something.
lutusp 13y ago
Some obvious responses occur to a skeptical reader of science: 1. This study has precisely no meaning until it has been replicated, preferably with a larger set of experimental subjects. 2. Science is not one study making ten claims, it is ten studies making one claim. This study falls into the former category. 3. The study describes, it doesn't try to explain. Science requires a testable explanation, one that can be generalized and potentially falsified by independent laboratories. If the study had offered a possible, testable explanation, it would have crossed the threshold of science. 4. It's important to say that psychological studies are virtually never replicated. One reason is that the original studies tend to maker nebulous claims that are difficult to quantify (like this study does). Another is that psychological studies tend not to be accompanied by the original study data, to a greater extent than studies in scientific disciplines. A third reason is that psychological journals tend to reject replication papers, especially those that don't confirm the original study's findings.
- carbocation 13y ago
  I was going to write in disagreement with your point #3, but then I went back and re-read the Atlantic article. In that context, I can see why you would write that. However, I think it needs this context, so to others who were going to knee-jerk react to point #3, re-read the article first. The study is not impressive. Most studies aren't, and exploratory, early-stage studies rarely can be. It's OK that early studies of a phenomenon are not impressive, but the tests do seem to be extremely narrow. The claims should be equally reserved and narrow. I certainly wouldn't start invoking morality, judgment, or other abstractions of the human psyche (as did the author of this article) from such a small and contrived set of experiments.
  - lutusp 13y ago
    > The study is not impressive. Most studies aren't, and exploratory, early-stage studies rarely can be. Yes, but a longitudinal examination of psychology publications shows that, compared to mainstream science, psychology studies are rarely anything but "early-stage studies". Almost none of them is ever successfully replicated, nor is an effort made to replicate them, compared to other fields. > I certainly wouldn't start invoking morality, judgment, or other abstractions of the human psyche (as did the author of this article) from such a small and contrived set of experiments. I of course agree, but then it's a psychology study, where such hand-waving claims are commonplace.
tokenadult 13y ago
As usual in threads on topics like this, you can rely on HN participant carbocation's comments for some thoughtful perspective on the original article. As the submitted article notes, responding to the press releases by the study authors, "This all raises more questions than it answers. This study was small. The headlines are grandiose. The way people pass moral judgements is not necessarily indicative of their level of existential anxiety." Indeed. This is an intriguing issue to study, and well worth some further studies by other investigators to see if the results will be replicated in other study populations, but the author of the submitted article was correct to have a headline with an open-ended question rather than a definitive statement about Tylenol. On my part, because I take different over-the-counter pain relief medications when I need any of those, I'm curious if this result would be replicated for aspirin or for ibuprofen. That the pain of stubbing a toe and the pain of rejection in love might have some of the same brain mechanisms is suggested by our use of the word "pain" for both phenomena. But that requires further study. (I'm sure there are many studies already on that issue, but I'm not deeply familiar with the research literature on that topic.) That pain (of either kind) might motivate action and thus dulling pain might reduce motivation for some actions is also plausible, and also has surely been investigated before, but perhaps there are still some very basic facts about that issue yet to be discovered. As so often happens after a new study is published, the most firm conclusion is "further research is needed."
- rcthompson 13y ago
  Tylenol has a different mechanism than most other over-the-counter pain relievers. Most other OTC pain relievers are "non-steroidal anti-inflammatory drugs" (NSAIDs), which means that they actually reduce inflammation at the site of injury instead of just reducing the amount of pain that your brain feels (though they do that too). But I still wouldn't be surprised if they had similar emotional effects.
  - redwood 13y ago
    Good point. It's hard to see the experience of specific pain as ever existing within a vacuum of human experience. It's interesting to compare ourselves: a population of pill poppers at the slightest twinge, to those in other parts of the world who simply don't. Perhaps it affords us some extra (or different) mental space in an intangible way.
elchief 13y ago
Why do people take Tylenol, when aspirin/asa is safer and likely even good for you?
- DanBC 13y ago
  Aspirin is not safer. Aspirin is not "good for you" apart from narrow groups of people taking very small doses of aspirin. Aspirin can be harmful to the stomach lining; aspirin can be fatal to people under 12; aspirin has a number of risky side effects; aspirin can be very dangerous for some people with under-lying conditions.
  - parasubvert 13y ago
    Thats fear mongering. Aspirin one of the safest drugs known to man, has a much longer history than Tylenol, and some scientists promote a more aggressive use of it in the populace. http://www.nytimes.com/2012/12/12/opinion/the-2000-year-old-wonder-drug.html http://www.nytimes.com/2012/12/12/opinion/the-2000-year-old-...
    - shaggyfrog 13y ago
      Aspirin (and ibuprofen) is counter-indicated for people with stomach problems like GERD. That's not fear mongering.
      - parasubvert 13y ago
        Of course not, but it's a big difference to say counter-indicated for one issue vs, leading off a post with "It is not safer". The point of this story is whether Tylenol IS safer, and that's mostly contingent on the person (and studies showing its own inherent risks).
        DanBC 13y ago
        Paracetamol is safer. You've failed to provide any sources saying otherwise.
stcredzero 13y ago
> They either watched The Simpsons or a film by surrealistic neonoir writer/director David Lynch, in which humans with rabbit heads wander an urban apartment muttering non sequiturs. They then passed judgement on people arrested in a hockey riot. Again, the people in the existential mindset imposed harsh sanctions, but the people who'd watched The Simpsons were lenient. I shoulda stuck with psychology after all! This sounds fun! Who thinks of this stuff?
- freyrs3 13y ago
  > in which humans with rabbit heads wander an urban apartment muttering non sequiturs I don't know how you could sit through this film without already being disturbed. [1] https://www.youtube.com/watch?v=5jSBVo59j9U https://www.youtube.com/watch?v=5jSBVo59j9U
noonespecial 13y ago
It should at least be noted that an awful lot of those overdoses are because narcotic painkillers are often doped with paracetamol in a misguided attempt to keep people from using them to get high.
powertower 13y ago
> The way people pass moral judgements is not necessarily indicative of their level of existential anxiety. That actually makes quite a bit of sense... These days everyone has an opinion on everything, combined with a very judgmental tone - and at the same time living extremely purposeless and egocentric lifes.
- Evbn 13y ago
  And purpose-driven zealots are not judgmental?
coolestuk 13y ago
Never mind what it is doing for your mind, in my experience, paracetamol causes pain. I've suffered from what doctors call "pain syndrome" for years. Many different parts of my body are painful at any one time. It is years since I had a pain-free day. I never accepted that I had pain syndrome, even when doped up simultaneously on codeine, paracetamol, tramadol and diclofenac. And still in pain. Finally I was moved onto morphine, but I still cannot sleep at night because of the pain. However, I think that my pain problems were exacerbated by (at the very least) paracetamol (max dose daily for 2 years). It is well known that sulphur compounds (NAC specifically) are required for the detoxification of the byproducts of paracetamol. Long term use of paracetamol will lead to sulphur depletion in many people. And it seems this depleted sulphur is compensated by the body taking sulphur from other places (joints, cartilage), thus causing further pains. Trying to get an answer from doctors and pharamacists about why taking sulphur reduces my pain more than the above concoctions of "pain-killers" got me nowhere, so the above is my explanation for why the more paracetamol I took the worse my pain problems got.
- Daniel_Newby 13y ago
  You should try drugs for neuropathic pain if you have not already: amitriptyline, gabapentin, duloxetine, and many others.
  - Evbn 13y ago
    You should maybe talk to your doctor about these drugs, before just trying them.
  - coolestuk 13y ago
    Thanks for the suggestion. Tried them all. Amitryptyline made me suicidal (turns out that is a very common side-effect, and really unwelcome for someone who is in extreme pain). Gabapentin (and pre-gabalin) had no effect, but at least did not cause mental disturbance the way that Amitryptyline and Duloxetine did. The last one they tried me on was Venlaflaxine - I didn't notice any pain reduction, but I just got insomnia from it. It's been a bad 5 to 10 years. My opinion is that "pain syndrome" was almost certainly not my problem. My pains were all skeletal/joint pains, except for pains that would suddenly appear in my left hand or right calf, even when doing nothing. Those latter two I could explain as being neuropathic, but after being in so much pain from my back, coccyx, hips and shoulder, I think my pain registration system was out of whack. And I wouldn't be surprised to discover that all the different "pain killers" I was taking were in fact contributing to further problems. Currently I am just on morphine, but must tie myself to the bed at night to stop myself turning over in my sleep. If I lie on my sides, the pain will build (even through morphine) until it wakes me up. By that stage turning on my back will not reduce the pain and I cannot get back to sleep. Taking a sulphur supplement (NAC, or MSM) seems to be as effective as morphine (neither alone or together is really satisfactory though). What has been so appalling in my case, has been the difficult of getting doctors to look at the individual problems properly in early stages (so a dearth of scans/treatments), until it got to the point where they were saying "you have pain syndrome". Most of the treatments that have had any success are those that I have insisted they do even when they have said they won't work. Some major treatments I have had to insist they don't do (cutting nerves??). I'm finally getting a scan this week on my hips, after asking for this for almost 2 years. Hopefully it will show what I expect it to show, and they can treat it with steroids.
guylhem 13y ago
I see many post mentionning how Tylenol can be lethal in overdose due to liver damage. Some studies have demonstrated liver enzymes raise significantly on a typical extra-strength dose of acetaminophen, called paracetamol in Europe. This could be indicative of low-level damage, for casual users (it's frequently prescribed for minor pain) A quick and simple hack is to take it along with N-acetylcysteine, usually given for coughing. Personally, to play it safe, when I have to take more than half a gram of paracetamol, or when I have to take it for more than 2 days in a row, I add n-acetylcysteine with it. Cheap, and without side effets at low doses. (BTW, it's used IV in the ER as the antidote for tylenol overdosing)
- gmac 13y ago
  I'm sure I remember a debate being had in the news at some point about whether this antidote should be included in all paracetamol/acetaminophen pills sold. Since this seems not to have happened, does anyone know if there's some side-effect of taking N-acetylcysteine alongside paracetamol/acetaminophen as standard? Or was it just a question of price?
zachdonovan 13y ago
Well, I for one will be taking two tylenol daily starting to day. You know, to dull the existential angst.

218 points by BruceM 13y ago

DanBC 13y ago

It is pleasing to see error bars on a graph in a mainstream publication. It's very nice to have them saying that the study was small and there are more questions to be asked. It's good that they mentioned the severe toxicity of paracetamol in overdose. It does kill many people, and it's not a pleasant death. It also accounts for many organ transplants. It would have been nice if they'd said that, taken carefully and with no over dose, paracetamol is a very safe and very effective medication. It's very cheap. (At least here in the UK, I found it bafflingly expensive in the US.) Cultural note: In the UK most medication is dispensed in blister packs. You can buy paracetamol off the shelf but you can only get limited quantities. Most shops will only sell you 16 tablets (at 500 g each) or 32 if you buy it from a person. You can get 100 if you see a pharmacist and persuade them you need them, but that'll be a struggle in most places. You can get large amounts if you have a prescription. 16 tablets at 500 g each would cost around £0.20 (for budget pills). Blister packs was an effective suicide control measure, reducing the number of pills taken and the number of overdoses attempted. Reduced quantities of pills sold had an initial success in reducing suicide rates, but number have since risen. Pills in the homes of old people are especially dangerous. This is because they're not locked away, and young children visiting sometimes take the pills. And also because suicide rates among old people are depressingly high.

_delirium 13y ago
> I found it bafflingly expensive in the US. Brand-name Tylenol is relatively expensive, but generic acetaminophen/paracetamol is dirt cheap in the US. Here are 200 tablets of 500 mg each for $4.00, i.e. $0.02 per tablet: http://www.walmart.com/ip/Equate-Extra-Strength-Value-Pack-Acetaminophen-Non-Aspirin/10324477 http://www.walmart.com/ip/Equate-Extra-Strength-Value-Pack-A...
- andrewcooke 13y ago
  you can buy paracetamol in packs of 200? jeez. isn't this one of the main killers, though overdoses (many accidental)? i'm pretty sure size for otc sale is regulated in other countries. paracetamol is nasty stuff - dying from it is not pleasant, and it's surprisingly easy to do.
  - _delirium 13y ago
    I believe there isn't currently any mechanism for the U.S. FDA to restrict number of pills sold of OTC medication, only the contents of each individual pill and the dosage instructions. The assumption is that OTC means purchase itself is unregulated, so you can order a truck-load if you really want to stock up. The only cases I'm aware of where purchase numbers are limited for OTC drugs is when separate laws targeting drug precursors impact them, which is why you can't buy large numbers of pseudoephedrine tablets at once (they can be used to manufacture meth). The FDA does seem to be reducing the maximum dosage of each tablet, though: from 2014 the maximum will be 325mg, so the 500mg tablets linked above will be phased out. But that change seems aimed at reducing accidental liver damage from excessive "normal" use, rather than aimed at reducing suicides from deliberate overdoses.
    - ajays 13y ago
      I believe there isn't currently any mechanism for the U.S. FDA to restrict number of pills sold of OTC medication There are exceptions (but I'm not sure if they're from the Law Enforcement side, or the FDA). For example, you can't buy Sudafed (whose active ingredient, pseudoephederine(?), is used to make meth) without severe restrictions: not more than a pack a day, need a valid ID, etc.
      - rm999 13y ago
        Potassium is another (more bizarre) example. http://answers.yahoo.com/question/index?qid=20101219083208AAP8SQM http://answers.yahoo.com/question/index?qid=20101219083208AA...
joosters 13y ago
It's expensive in the UK too if you buy a brand name painkiller. It's depressing that they can still sell them when the identical generic medication is next to them on the shelf and is 1/10 of the price.
- kintamanimatt 13y ago
  > It's depressing that they can still sell them You may feel better about this if you take some Tylenol ;-) I don't see how there's anything wrong with selling brand-name drugs next to generics. In fact people that believe brand name drugs are more effective will have a better response to the more expensive drug because of the placebo effect. If anything, they're getting a better response to the same dose of the same drug than the rest of us plebs that know better than to pay a multiple of the cost of the generic.
  - TheLegace 13y ago
    In some very extreme/rare cases it does matter. Something like ADHD medication can make a difference. One of the most difficult months I've had has been a month where I tried the generic and the side effects were way worse than the brand name at same dosage.
    - logn 13y ago
      In generics they can change the inactive ingredients and obviously they don't always use the same equipment or facilities to produce it. Some people have allergies to inactive ingredients which may explain the different side effects. But in my mind the generics are just as good as name brand, albeit sometimes different. I guess I'd be just as likely to react poorly to the inactive ingredients in the name brand and might find a generic better in some cases.
      - haldujai 13y ago
        Actually that's not true. Generics (at least in Canada but probably true elsewhere as well) only have to give between 85%-120% of the dose of the brand name drug, this is despite having the same official dosage as printed on the label. The difference comes from preparation, pill coatings, and inactive ingredients.
gambiting 13y ago
To be honest, I find the UK law to be absolutely stupid in this regard. I needed to buy 10 packs of paracetamol, and at local morrisons I was told I couldn't, maximum was 2 packs(16 tablets each). So I bought two packs, went out of the store, came back in, bought another two, repeated the process 5x and got my ten packs. The whole law is just an annoyance, nothing else. If I wanted to kill myself with paracetamol I could easily get even a 1000 tablets, would just need to drive around a few supermarkets but this law would not stop me from doing it.
- Osmium 13y ago
  > The whole law is just an annoyance, nothing else. This is not true. It's about preventing impulsive suicides, not premeditated ones. If a depressed person is having an episode and all they have in their house is 16 pills, then it removes the opportunity: maybe by the time they've make it to the shops and buy more, the moment will have passed, and a life would be saved. It's been shown time and time again that you can reduce absolute suicide rates by removing opportunities like this. If I remember correctly, there was something similar involving gas ovens, though I can't find the reference now. Guns, bridges, etc. are all similar too. When it comes down to it, if someone's determined enough to kill themselves, they will, but the truth is most people aren't and doing things like only selling small quantities of pills really can prevent suicides.
  - DanBC 13y ago
    Strongly agree with your post. About gas ovens: There's less carbon monoxide in modern gas delivery. (http://io9.com/5959303/why-have-people-stopped-committing-suicide-with-gas http://io9.com/5959303/why-have-people-stopped-committing-su...)
    - Osmium 13y ago
      Thanks! That was the one I was thinking of. >The switch from coal gas to natural gas also had one unexpected effect. During the ‘50s and ‘60s, about half of the suicides in Britain were by coal gas. By the ‘70s, when the transition to natural gas was complete, the number of gas suicides had dropped to zero and the overall suicide rate was down a third. Even the suicidal appreciate convenience. If it's too much trouble, as Dorothy Parker said, "You might as well live." Also, regarding my above post (which I can't edit now), I didn't mean to imply that "just" 16 pills was even remotely safe because I'm sure it's not (I'm not a doctor) but the general point stands...
cmelbye 13y ago
Bafflingly expensive? It's dirt cheap, and readily available for a few bucks in pill bottles with 100+ pills from any drug store.
mtdewcmu 13y ago
The UK must accept a much greater level of paternalism in health care than in the US.
graywh 13y ago
> It is pleasing to see error bars on a graph in a mainstream publication. Those are "dynamite plots", a favorite of scientists, but the statisticians I know prefer to use boxplots or dotplots instead.

Shenglong 13y ago

I'm not all that familiar with social tests like this. Is n=120 generally considered to be a large enough sample size to make any claims at all?

carbocation 13y ago
It always depends on the effect size.
- icegreentea 13y ago
  Another important question is always, 'if this effect is true does this generalize to the overall population'. While I haven't read the paper, I bet that the test population were composed almost completely of undergrad students. So much of social science experiments are based on testing done on student. And there isn't anything wrong with that per se, but we must always be careful when trying to infer results, and drawing conclusions on the greater population, or human kind as a whole.
  - carbocation 13y ago
    External validity is an interesting but quite different question. There are any number of other interesting but distinct features of clinical trials that we could talk about.
  - tedks 13y ago
    For some things (socialization, substance use patterns, etc.), you'd expect different results on college students than on other populations, so you'd need to run additional experiments to determine if being a college undergrad moderates whatever effect you study. For other things, like perception, drug effects, etc., it seems less likely that this is actually a problem, because there's no reason to believe the neural pathways that acetaminophen operates over are different between any two humans.
pekk 13y ago
n=120 pales utterly beside the observation that it is totally unclear what they are actually manipulating or measuring. The design is completely hapless. If you really need to detect effects that are so small they are meaningless for almost any practical purpose, then you might need thousands of people in the study.

joosters 13y ago

Possibly a dumb question, by why is it called acetaminophen in some places and paracetamol in others? Neither of them are a brand name AFAIK.

Rinum 13y ago
Its chemical name is para-acetylaminophenol. That's what the names acetaminophen and paracetamol are derived from. para-ACETylAMINOPHENol PARa-ACETylAMinophenOL
- spicyj 13y ago
  para-aceTYLaminophENOL
icegreentea 13y ago
The full chemical name (but not the IUPAC name) is N-acetyl-para-aminophenol. Acetaminophen and paracetamol are just various shortenings of the name. Likely whatever is popular in a location just comes down to whatever dominant drug manufacturer chose to call it in their public facing material.

pygy_ 13y ago

Among other things, paracetamol activates the cannabis receptors. http://www.ncbi.nlm.nih.gov/pubmed/17227290 http://www.ncbi.nlm.nih.gov/pubmed/17227290

Breakthrough 13y ago

Always great to see studies looking at the mental implications of non-psychoactive drugs. I suppose it's common to overlook the implications of a drug on the central nervous system with respect to consciousness, when the drug in question never causes any subjective/noticeable change. I suppose it's all too intuitive, though. Even slight, unnoticeable changes in consciousness - to the point that even you don't notice - may in-fact be detectable on paper. I hope this leads to more research into the mental changes for other drugs classified as "non-psychoactive" (who doesn't love more data? :). Anyways, to end off by inserting some colloquialism into my thoughts here... Trippy study, mannnnn.

freshfruit 13y ago
> Always great to see studies looking at the mental implications of non-psychoactive drugs. ... also great to read about the mental implications of priming. I'll be more punitive/forgiving depending on the unrelated thought I had minutes earlier...
raverbashing 13y ago
> Always great to see studies looking at the mental implications of non-psychoactive drugs. Well, it kind of fits the definition (except psychoactive drugs have their primary effect in the brain)
npsimons 13y ago
As someone with a family history of mental illness, I try to keep a close eye on my mental state, and it's surprising how much can affect it. Apart from drugs that shouldn't be affecting mental states, even different types of food and how much exercise I get can have noticeable impacts. Those EFA fish oil pills? Not just good for your heart . . .
- freshfruit 13y ago
  I think you're promoting a healthy degree of self-awareness. A noteworthy risk however is that you'll make false connections -- ie. garlic is good for fight off HIV.

tosseraccount 13y ago

Just legalize opiods. Do you really need a Doctor when you stub your toe?

carbocation 13y ago
If you take opioids for the pain from stubbing your toe, you should re-evaluate what is important to you.
- tosseraccount 13y ago
  Like getting by for 24 hours until I can put shoes on? I need the government to tell me I can't ease things for a day?
  - harrisonpowers 13y ago
    You might look into buying comfortable shoes.
  - Camillo 13y ago
    Clearly you do.
    - tosseraccount 13y ago
      In Soviet Obamerica, authority question YOU !!
- tsotha 13y ago
  Perhaps. But should the government be doing that evaluation for you ahead of time?
derleth 13y ago
If you need opioids for the pain from a stubbed toe, you have a serious problem with something (mental, physical, or both) and need more help than an OTC opioid can give.

gte910h 13y ago

EXTREMELY small study. Just push for a larger study on this http://www.academia.edu/2057894/The_common_pain_of_surrealism_and_death_Acetaminophen_reduces_compensatory_affirmation_following_meaning_threats http://www.academia.edu/2057894/The_common_pain_of_surrealis... 121 people Search for "We recruited"

simonster 13y ago
In Study 2 there we 236 subjects, which AFAIK is a pretty big sample size for these kinds of experiments. There error bars on the graph are still somewhat large, so there was a lot of variability, but assuming there is no bias in what data the experimenters chose to include, combining both studies, p < .02*.01 = .002. Furthermore, as the article notes, there was a prior study that also showed cognitive effects of Tylenol. While these effects could be spurious due to publication or selection bias or deliberate manipulation, it's not all that plausible that they happened by chance.
- carbocation 13y ago
  Just multiplying the P-values from different studies is invalid. You can intuit this by imagining 10000 studies, each of which had a P-value of 0.99. Seeing 10000 negative studies and no positive studies, you'd be convinced that there was no real effect, intuitively. But multiplying 0.99 10000 times yields a P-value of 2.2 x 10^(-44), a result of impressive significance. To combine studies, many people use inverse variance weighted meta-analysis, e.g., https://en.wikipedia.org/wiki/Inverse-variance_weighting https://en.wikipedia.org/wiki/Inverse-variance_weighting
  - simonster 13y ago
    You're right. There is a mathematical explanation for this in addition to the intuitive one you provide: If the null hypothesis is true, the p-value of each test is uniformly distributed between 0 and 1, but the product of p-values will not be uniformly distributed between 0 and 1, so it is not a p-value. To combine p-values, what we really want is the CDF of the product of p1 and p2 in the distribution formed by the product of uniform random variables. Mathematica can compute this; the general formula is (p1p2)(1-log(p1p2)), and for the two p-values in question this yields p = 0.0019 (which is close to what I said initially, but only because I made a calculation error; .02*.01 = 0.0002). Thanks for pointing out the mistake in my reasoning! I learned something.

lutusp 13y ago

Some obvious responses occur to a skeptical reader of science: 1. This study has precisely no meaning until it has been replicated, preferably with a larger set of experimental subjects. 2. Science is not one study making ten claims, it is ten studies making one claim. This study falls into the former category. 3. The study describes, it doesn't try to explain. Science requires a testable explanation, one that can be generalized and potentially falsified by independent laboratories. If the study had offered a possible, testable explanation, it would have crossed the threshold of science. 4. It's important to say that psychological studies are virtually never replicated. One reason is that the original studies tend to maker nebulous claims that are difficult to quantify (like this study does). Another is that psychological studies tend not to be accompanied by the original study data, to a greater extent than studies in scientific disciplines. A third reason is that psychological journals tend to reject replication papers, especially those that don't confirm the original study's findings.

carbocation 13y ago
I was going to write in disagreement with your point #3, but then I went back and re-read the Atlantic article. In that context, I can see why you would write that. However, I think it needs this context, so to others who were going to knee-jerk react to point #3, re-read the article first. The study is not impressive. Most studies aren't, and exploratory, early-stage studies rarely can be. It's OK that early studies of a phenomenon are not impressive, but the tests do seem to be extremely narrow. The claims should be equally reserved and narrow. I certainly wouldn't start invoking morality, judgment, or other abstractions of the human psyche (as did the author of this article) from such a small and contrived set of experiments.
- lutusp 13y ago
  > The study is not impressive. Most studies aren't, and exploratory, early-stage studies rarely can be. Yes, but a longitudinal examination of psychology publications shows that, compared to mainstream science, psychology studies are rarely anything but "early-stage studies". Almost none of them is ever successfully replicated, nor is an effort made to replicate them, compared to other fields. > I certainly wouldn't start invoking morality, judgment, or other abstractions of the human psyche (as did the author of this article) from such a small and contrived set of experiments. I of course agree, but then it's a psychology study, where such hand-waving claims are commonplace.

tokenadult 13y ago

As usual in threads on topics like this, you can rely on HN participant carbocation's comments for some thoughtful perspective on the original article. As the submitted article notes, responding to the press releases by the study authors, "This all raises more questions than it answers. This study was small. The headlines are grandiose. The way people pass moral judgements is not necessarily indicative of their level of existential anxiety." Indeed. This is an intriguing issue to study, and well worth some further studies by other investigators to see if the results will be replicated in other study populations, but the author of the submitted article was correct to have a headline with an open-ended question rather than a definitive statement about Tylenol. On my part, because I take different over-the-counter pain relief medications when I need any of those, I'm curious if this result would be replicated for aspirin or for ibuprofen. That the pain of stubbing a toe and the pain of rejection in love might have some of the same brain mechanisms is suggested by our use of the word "pain" for both phenomena. But that requires further study. (I'm sure there are many studies already on that issue, but I'm not deeply familiar with the research literature on that topic.) That pain (of either kind) might motivate action and thus dulling pain might reduce motivation for some actions is also plausible, and also has surely been investigated before, but perhaps there are still some very basic facts about that issue yet to be discovered. As so often happens after a new study is published, the most firm conclusion is "further research is needed."

rcthompson 13y ago
Tylenol has a different mechanism than most other over-the-counter pain relievers. Most other OTC pain relievers are "non-steroidal anti-inflammatory drugs" (NSAIDs), which means that they actually reduce inflammation at the site of injury instead of just reducing the amount of pain that your brain feels (though they do that too). But I still wouldn't be surprised if they had similar emotional effects.
- redwood 13y ago
  Good point. It's hard to see the experience of specific pain as ever existing within a vacuum of human experience. It's interesting to compare ourselves: a population of pill poppers at the slightest twinge, to those in other parts of the world who simply don't. Perhaps it affords us some extra (or different) mental space in an intangible way.

elchief 13y ago

Why do people take Tylenol, when aspirin/asa is safer and likely even good for you?

DanBC 13y ago
Aspirin is not safer. Aspirin is not "good for you" apart from narrow groups of people taking very small doses of aspirin. Aspirin can be harmful to the stomach lining; aspirin can be fatal to people under 12; aspirin has a number of risky side effects; aspirin can be very dangerous for some people with under-lying conditions.
- parasubvert 13y ago
  Thats fear mongering. Aspirin one of the safest drugs known to man, has a much longer history than Tylenol, and some scientists promote a more aggressive use of it in the populace. http://www.nytimes.com/2012/12/12/opinion/the-2000-year-old-wonder-drug.html http://www.nytimes.com/2012/12/12/opinion/the-2000-year-old-...
  - shaggyfrog 13y ago
    Aspirin (and ibuprofen) is counter-indicated for people with stomach problems like GERD. That's not fear mongering.
    - parasubvert 13y ago
      Of course not, but it's a big difference to say counter-indicated for one issue vs, leading off a post with "It is not safer". The point of this story is whether Tylenol IS safer, and that's mostly contingent on the person (and studies showing its own inherent risks).
      - DanBC 13y ago
        Paracetamol is safer. You've failed to provide any sources saying otherwise.

stcredzero 13y ago

> They either watched The Simpsons or a film by surrealistic neonoir writer/director David Lynch, in which humans with rabbit heads wander an urban apartment muttering non sequiturs. They then passed judgement on people arrested in a hockey riot. Again, the people in the existential mindset imposed harsh sanctions, but the people who'd watched The Simpsons were lenient. I shoulda stuck with psychology after all! This sounds fun! Who thinks of this stuff?

freyrs3 13y ago
> in which humans with rabbit heads wander an urban apartment muttering non sequiturs I don't know how you could sit through this film without already being disturbed. [1] https://www.youtube.com/watch?v=5jSBVo59j9U https://www.youtube.com/watch?v=5jSBVo59j9U

noonespecial 13y ago

It should at least be noted that an awful lot of those overdoses are because narcotic painkillers are often doped with paracetamol in a misguided attempt to keep people from using them to get high.

powertower 13y ago

> The way people pass moral judgements is not necessarily indicative of their level of existential anxiety. That actually makes quite a bit of sense... These days everyone has an opinion on everything, combined with a very judgmental tone - and at the same time living extremely purposeless and egocentric lifes.

Evbn 13y ago
And purpose-driven zealots are not judgmental?

coolestuk 13y ago

Never mind what it is doing for your mind, in my experience, paracetamol causes pain. I've suffered from what doctors call "pain syndrome" for years. Many different parts of my body are painful at any one time. It is years since I had a pain-free day. I never accepted that I had pain syndrome, even when doped up simultaneously on codeine, paracetamol, tramadol and diclofenac. And still in pain. Finally I was moved onto morphine, but I still cannot sleep at night because of the pain. However, I think that my pain problems were exacerbated by (at the very least) paracetamol (max dose daily for 2 years). It is well known that sulphur compounds (NAC specifically) are required for the detoxification of the byproducts of paracetamol. Long term use of paracetamol will lead to sulphur depletion in many people. And it seems this depleted sulphur is compensated by the body taking sulphur from other places (joints, cartilage), thus causing further pains. Trying to get an answer from doctors and pharamacists about why taking sulphur reduces my pain more than the above concoctions of "pain-killers" got me nowhere, so the above is my explanation for why the more paracetamol I took the worse my pain problems got.

Daniel_Newby 13y ago
You should try drugs for neuropathic pain if you have not already: amitriptyline, gabapentin, duloxetine, and many others.
- Evbn 13y ago
  You should maybe talk to your doctor about these drugs, before just trying them.
- coolestuk 13y ago
  Thanks for the suggestion. Tried them all. Amitryptyline made me suicidal (turns out that is a very common side-effect, and really unwelcome for someone who is in extreme pain). Gabapentin (and pre-gabalin) had no effect, but at least did not cause mental disturbance the way that Amitryptyline and Duloxetine did. The last one they tried me on was Venlaflaxine - I didn't notice any pain reduction, but I just got insomnia from it. It's been a bad 5 to 10 years. My opinion is that "pain syndrome" was almost certainly not my problem. My pains were all skeletal/joint pains, except for pains that would suddenly appear in my left hand or right calf, even when doing nothing. Those latter two I could explain as being neuropathic, but after being in so much pain from my back, coccyx, hips and shoulder, I think my pain registration system was out of whack. And I wouldn't be surprised to discover that all the different "pain killers" I was taking were in fact contributing to further problems. Currently I am just on morphine, but must tie myself to the bed at night to stop myself turning over in my sleep. If I lie on my sides, the pain will build (even through morphine) until it wakes me up. By that stage turning on my back will not reduce the pain and I cannot get back to sleep. Taking a sulphur supplement (NAC, or MSM) seems to be as effective as morphine (neither alone or together is really satisfactory though). What has been so appalling in my case, has been the difficult of getting doctors to look at the individual problems properly in early stages (so a dearth of scans/treatments), until it got to the point where they were saying "you have pain syndrome". Most of the treatments that have had any success are those that I have insisted they do even when they have said they won't work. Some major treatments I have had to insist they don't do (cutting nerves??). I'm finally getting a scan this week on my hips, after asking for this for almost 2 years. Hopefully it will show what I expect it to show, and they can treat it with steroids.

guylhem 13y ago

I see many post mentionning how Tylenol can be lethal in overdose due to liver damage. Some studies have demonstrated liver enzymes raise significantly on a typical extra-strength dose of acetaminophen, called paracetamol in Europe. This could be indicative of low-level damage, for casual users (it's frequently prescribed for minor pain) A quick and simple hack is to take it along with N-acetylcysteine, usually given for coughing. Personally, to play it safe, when I have to take more than half a gram of paracetamol, or when I have to take it for more than 2 days in a row, I add n-acetylcysteine with it. Cheap, and without side effets at low doses. (BTW, it's used IV in the ER as the antidote for tylenol overdosing)

gmac 13y ago
I'm sure I remember a debate being had in the news at some point about whether this antidote should be included in all paracetamol/acetaminophen pills sold. Since this seems not to have happened, does anyone know if there's some side-effect of taking N-acetylcysteine alongside paracetamol/acetaminophen as standard? Or was it just a question of price?

zachdonovan 13y ago

Well, I for one will be taking two tylenol daily starting to day. You know, to dull the existential angst.