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Even at Advised Doses, Tylenol May Harm Liver

Rating

4 Star

Even at Advised Doses, Tylenol May Harm Liver

Our Review Summary

This is an article that reports on a recent research study that suggests that the recommended maximum dose of Tylenol may be sufficient to cause problems in the liver. It would have been helpful for the article to point out that patients should be aware of the acetaminophen content of all medication (prescription and over-the-counter) to be sure that they are not exceeding dosage recommendations. This article raises safety concerns about acetameninphen use. However, the article could have been more clear that the increases in liver enzymes reported are only markers for possible liver damage and that none of the study subjects actually sustained liver damage in the course of the study. In its discussion of liver damage, the article failed to mention N-acetylcysteine which can be used to counteract the liver damage that may result from acetaminophen.

This article could have done a better job of putting the potential problems associated with acetaminophen use in perspective by including some context about other problems associated wth the use of other pain relieving medication. The alternatives (aspirin or other NSAIDs) are not “safe” either. People may move away from acetaminophen to other analgesics based on their reading of this article. Reporting about acetaminophen without the context of the alternatives and their associated problems is an issue.

The story did emphasize the important message that it is not prudent to take more acetaminophen than needed or recommended.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

There is no mention of the costs for acetaminophen. But since the focus of the story is on harms of the drug, not on promoting its use, cost is less of an issue.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

There were no benefits in this study; the study volunteers were healthy volunteers.

The implied message is that acetaminophen may not in fact be safe. Although that may be the case, the alternatives (aspirin or other NSAIDs) are not “safe” either. People may move away from acetaminophen to other analgesics based on their reading of this article. Reporting about acetaminophen without the context of the alternatives and their associated problems is an issue.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The absolute values for increased liver enzyme levels are presented as a composite value for those taking acetaminophen alone or in combination with other drugs. The article should have included some explanation about what an increase in liver enzymes means. And the story didn’t mention anything about N-Acetylcysteine or NAC that can be used to counteract the liver toxicity observed.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The article mentioned that the news came from a study published in the Journal of the American Medical Association (July 6, 2006), and explained that the information came from healthy individuals who were either given placebo, extra strength tylenol or prescription pain relievers that contain a comparable amount of acetaminophen. The story did not reflect on the possible limitations of the study having a relatively small sample size.

Does the story commit disease-mongering?

Satisfactory

This article raises safety concerns about acetameninphen use. However, the article could have been more clear that the increases in liver enzymes reported are only markers for possible liver damage and that none of the study subjects actually sustained liver damage in the course of the study.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

A spokesperson from the pharmaceutical company which had been developing an acetaminophen and opioid combination medication (also the company that funded the study) was quoted. McNeil, the makers of Tylenol, as well a clinician not involved in the research were also quoted.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story didn’t discuss alternatives to acetaminophen. The alternatives (aspirin or other NSAIDs) are not “safe” either. People may move away from acetaminophen to other analgesics based on their reading of this article. Reporting about acetaminophen without the context of the alternatives and their associated problems is an issue. It also would have been useful to include information about N-Acetylcysteine or NAC, the apparent antidote to the liver toxicity noted in the study.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The article mentions that acetaminophen is available over-the-counter; it also mentioned the restriction in England on how many acetaminophen tablets can be sold at one time.

Does the story establish the true novelty of the approach?

Satisfactory

The article accurately reported that acetaminophen is a widely used, over-the-counter medication.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This article does not appear to be based solely or largely on a news release.

Total Score: 7 of 9 Satisfactory

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