Seven Common Misconceptions About Tylenol and Other OTC Drugs

Each year Americans buy about 5 billion over-the-counter (OTC) drugs in the hopes of treating routine medical problems. Many believe OTC drugs do not pose the same risks as prescription drugs and are completely safe to use, as they are so readily available.

Unfortunately, the ease with which OTC drugs can be obtained presents a false sense of security. As with all drugs, OTC drugs are simply covering up symptoms and are not addressing the underlying cause of the symptoms. Further, even though they’re available without a prescription, they are still drugs, and many contain powerful ingredients. Take a look at the following misconceptions that are floating around to get an idea of the potential risks of relying on OTC drugs, and check out my nutrition plan to learn how to prevent many of the illnesses that drive you to use these drugs in the first place.

Myth 1: OTC Drugs are Safer Than Prescription Drugs

Over-the-counter drugs can have serious side effects and can even result in death if taken incorrectly. Some 56,000 people end up in the emergency room each year from misuse of acetaminophen, the main ingredient in Tylenol, alone. As with prescription drugs, OTC drugs can interact with foods, other medications, and existing medical conditions and cause some major problems.

Myth 2: It Takes a Whole Bottle to Overdose

It’s possible to overdose without even knowing you took too much. For instance, according to government estimates about 100 people die each year after unintentionally taking too much acetaminophen (an overdose of the drug, which includes Tylenol, can poison the liver).

One of the biggest problems is that many OTC medicines sold for different uses have the same active ingredient. So someone who takes a cold remedy along with a headache remedy or prescription pain reliever may be inadvertently receiving three or four times the safe level. You should avoid taking multiple drugs with the same active ingredient at the same time.

Along with acetaminophen, another group of OTC drugs to watch out for are painkillers called NSAIDs (nonsteroidal anti-inflammatory drugs), which include aspirin, ibuprofen, naproxen and ketoprofen. Overdosing on these widely available drugs can cause stomach bleeding and kidney problems.

Myth 3: Any Potential Drug Interactions Will be Listed on the Label

While OTC drug labels will include some of the potentially harmful interactions on the label, you cannot rely on them to cover every one (and many people do not take the time to read the label anyway). Certain foods, drugs, herbs, vitamins and your own existing medical conditions could potentially create a harmful reaction. The best way to find out about these potential interactions would be to talk to a doctor or pharmacist, but since many OTC drugs are sold in grocery stores, convenient stores--even gas stations--there isn’t always a knowledgeable person available to answer your questions.

There are many interactions that can occur and many are unexpected. For instance, if you have high blood pressure you could have an adverse reaction if you take a nasal decongestant.

Myth 4: OTC Drugs are Cheaper Than Prescription Drugs

OTC medications are not always cheap. You may find that what you think is a simple OTC remedy is costing you more than some prescription drugs, and many cost more than the nutritional interventions you could take to address the underlying problems.

Myth 5: OTC Drugs Have Fewer Side Effects Than Prescription Drugs

All drugs carry the risk of side effects. Whether they’re prescribed by a doctor or bought over-the-counter does not make a difference in this risk.

Myth 6: It’s Safe to Use OTC Drugs With Vitamins or Other Nutritional Supplements

This is a major issue, as most don’t realize that vitamins and herbs can interact with medications just as medications can interact with each other. Interactions could cause unexpected side effects, could alter the effectiveness of the drug or vitamin making them more or less powerful, or could even worsen the condition you are trying to treat.

Myth 7: I Only Need to Look at the Active Ingredient on the Label

Inactive ingredients, which are labeled “inactive” by the FDA because they presumably have no effect on the body, can indeed be problematic. Many OTC medications contain additives that may surprise you, such as artificial dyes, caffeine and sweeteners like aspartame. You will want to be sure to read the inactive ingredients on the label along with the active ingredient section to be sure you are aware of exactly what you are consuming.

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Painkillers Increase Risk of Miscarriage

Dextromethorphan, the major ingredient in most OTC cough medicines, has been shown to cause birth defects and fetal death in chicken embryos exposed to concentrations relative to those typically taken by humans. Researchers found that dextromethorphan causes defects so early in the development of the embryo that in many cases the woman wouldn't even know she is pregnant. Reserachers feel that a single dose is capable of causing a birth defect and that, ultimately, it could be the cause for a woman to have a miscarriage.

Dextromethorphan suppresses cough by acting on receptors in the adult central nervous system. But in embryos, the drug appears to "knock out" the receptors, thus leading to the defects. Further study is needed, but in the meantime, the authors suggests that pregnant women or women attempting to get pregnant, be advised not to use dextromethorphan-containing cough medicine.

Pediatric Research January 1998;43:1-7

In 2000 the Food and Drug Administration (FDA) voted against making cholesterol lowering statin drugs available over the counter. Now, the question has come up again: will cholesterol drugs soon be available without a prescription?

Click on full story below to see the entire article.

Doctors are the Third leading Cause of Death

Many of you reading this have read or seen this in many places other than my Web site. This article, available on my home page, was widely circulated on the Internet and was one of the reasons why my Web site was initially popular. What you may not realize is that I am the one who made this analysis and popularized it. The original study was published by Dr. Starfield, a full professor of public health at the most prestigious hospital in the United States, Johns Hopkins. Her study never had the headline in it, but instead listed the published research documenting the various causes of deaths that doctors contributed to. I simply added them all up and compared them to cardiovascular diseases and cancer and came up with the above headline, which was widely circulated on the Internet.

Click the full story link below to read the entire article.

Doctors Are The Third Leading Cause of Death in the US, Causing 250,000 Deaths Every Year

This week's issue of the Journal of the American Medical Association (JAMA) is the best article I have ever seen written in the published literature documenting the tragedy of the traditional medical paradigm.

This information is a followup of the Institute of Medicine report which hit the papers in December of last year, but the data was hard to reference as it was not in peer-reviewed journal. Now it is published in JAMA which is the most widely circulated medical periodical in the world.

The author is Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health and she describes how the US health care system may contribute to poor health.

ALL THESE ARE DEATHS PER YEAR:

• 12,000  — unnecessary surgery 8
• 7,000  — medication errors in hospitals 9
• 20,000  — other errors in hospitals 10
• 80,000  — infections in hospitals 10
• 106,000  — non-error, negative effects of drugs 2  
• These total to 250,000 deaths per year from iatrogenic causes!!

What does the word iatrogenic mean? This term is defined as induced in a patient by a physician's activity, manner, or therapy. Used especially of a complication of treatment.

Dr. Starfield offers several warnings in interpreting these numbers:

• First, most of the data are derived from studies in hospitalized patients.
• Second, these estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.
• Third, the estimates of death due to error are lower than those in the IOM report.

If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Even if these figures are overestimated, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).

Another analysis (11) concluded that between 4% and 18% of consecutive patients experience negative effects in outpatient settings, with:

• 116 million extra physician visits
• 77 million extra prescriptions
• 17 million emergency department visits
• 8 million hospitalizations
• 3 million long-term admissions
• 199,000 additional deaths
• $77 billion in extra costs

The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care.

However, evidence from a few studies indicates that as many as 20% to 30% of patients receive inappropriate care.

An estimated 44,000 to 98,000 among them die each year as a result of medical errors.2

This might be tolerated if it resulted in better health, but does it? Of 13 countries in a recent comparison,3,4 the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. More specifically, the ranking of the US on several indicators was:

• 13th (last) for low-birth-weight percentages
• 13th for neonatal mortality and infant mortality overall 14
• 11th for postneonatal mortality
• 13th for years of potential life lost (excluding external causes)
• 11th for life expectancy at 1 year for females, 12th for males
• 10th for life expectancy at 15 years for females, 12th for males
• 10th for life expectancy at 40 years for females, 9th for males
• 7th for life expectancy at 65 years for females, 7th for males
• 3rd for life expectancy at 80 years for females, 3rd for males
• 10th for age-adjusted mortality

The poor performance of the US was recently confirmed by a World Health Organization study, which used different data and ranked the United States as 15th among 25 industrialized countries.

 There is a perception that the American public "behaves badly" by smoking, drinking, and perpetrating violence.  However the data does not support this assertion.

• The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range s from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best).
• The US ranks fifth best for alcoholic beverage consumption.
• The US has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.

These estimates of death due to error are lower than those in a recent Institutes of Medicine report, and if the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.

Even at the lower estimate of 225,000 deaths per year, this constitutes the third leading cause of death in the US, following heart disease and cancer.

Lack of technology is certainly not a contributing factor to the US's low ranking.

• Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population. 17
• Japan, however, ranks highest on health, whereas the US ranks among the lowest.
• It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the US, high use of diagnostic technology may be linked to more treatment.
• Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among the countries ranked, whereas they are very low in Japan, far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.

Journal American Medical Association Vol 284 July 26, 2000

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COMMENT: Folks, this is what they call a "Landmark Article". Only several ones like this are published every year.

One of the major reasons it is so huge as that it is published in JAMA which is the largest and one of the most respected medical journals in the entire world. I did find it most curious that the best wire service in the world, Reuter's, did not pick up this article. I have no idea why they let it slip by.

I would encourage you to bookmark this article and review it several times so you can use the statistics to counter the arguments of your friends and relatives who are so enthralled with the traditional medical paradigm. These statistics prove very clearly that the system is just not working. It is broken and is in desperate need of repair.

I was previously fond of saying that drugs are the fourth leading cause of death in this country. However, this article makes it quite clear that the more powerful number is that doctors are the third leading cause of death in this country killing nearly a quarter million people a year. The only more common causes are cancer and heart disease. This statistic is likely to be seriously underestimated as much of the coding only describes the cause of organ failure and does not address iatrogenic causes at all.

Japan seems to have benefited from recognizing that technology is wonderful, but just because you diagnose something with it, one should not be committed to undergoing treatment in the traditional paradigm. Their health statistics reflect this aspect of their philosophy as much of their treatment is not treatment at all, but loving care rendered in the home.

Care, not treatment, is the answer. Drugs, surgery and hospitals are rarely the answer to chronic health problems. Facilitating the God-given healing capacity that all of us have is the key.

Improving the diet, exercise, and lifestyle are basic. Effective interventions for the underlying emotional and spiritual wounding behind most chronic illness are also important clues to maximizing health and reducing disease.

Related Articles:

Medical Mistakes Kill 100,000 per year

US Health Care System Most Expensive in the World

Author/Article Information:

Author Affiliation: Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.

Corresponding Author and Reprints:

Barbara Starfield, MD, MPH, Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public

Health, 624 N Broadway, Room 452, Baltimore, MD 21205-1996 (e-mail: bstarfie@jhsph.edu).

REFERENCES

1. Schuster M, McGlynn E, Brook R. How good is the quality of health care in the United States? Milbank Q. 1998;76:517-563.

2. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.

3. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998.

 4. World Health Report 2000. Available at: http://www.who.int/whr/2000/en/report.htm. Accessed June 28, 2000.

5. Kunst A. Cross-national Comparisons of Socioeconomic Differences in Mortality. Rotterdam, the Netherlands: Erasmus University; 1997.

6. Law M, Wald N. Why heart disease mortality is low in France: the time lag explanation. BMJ. 1999;313:1471-1480.

7. Starfield B. Evaluating the State Children's Health Insurance Program: critical considerations. Annu Rev Public Health. 2000;21:569-585.

8. Leape L.Unecessarsary surgery. Annu Rev Public Health. 1992;13:363-383.

9. Phillips D, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998;351:643-644.

10. Lazarou J, Pomeranz B, Corey P. Incidence of adverse drug reactions in hospitalized patients. JAMA. 1998;279:1200-1205.

11. Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology and medical error. BMJ. 2000;320:774-777.

12. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality. London, England: Routledge; 1996.

13. Evans R, Roos N. What is right about the Canadian health system? Milbank Q. 1999;77:393-399.

14. Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D. Annual summary of vital statistics1998. Pediatrics. 1999;104:1229-1246.

15. Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499-511.

16. Donahoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med. 1998;158:1596-1607.

17. Anderson G, Poullier J-P. Health Spending, Access, and Outcomes: Trends in Industrialized Countries. New York, NY: The Commonwealth Fund; 1999.

18. Mold J, Stein H. The cascade effect in the clinical care of patients. N Engl J Med. 1986;314:512-514.

19. Shi L, Starfield B. Income inequality, primary care, and  health indicators. J Fam Pract. 1999;48:275-284.

Food, Not Supplements

Despite the known health benefits of folate, researchers say caution is needed in regard to folate supplements.

Folate in its true natural form can be obtained from fresh vegetables, but it can also be found in its synthetic form in supplements and processed foods. This form, called pteroylmonoglutamate (PGA), does not occur in nature and is both cheap and stable--unlike most native forms of the vitamin.