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Jack Sisson's Life Ethics Blog
We must find new ways through many ethical issues, especially regarding bioethics, medical ethics, and criminal justice. Jack Sisson's 'Life Ethics' blog focuses on numerous areas of concern, including the philosophical and ethical dilemmas surrounding stem-cell research, abortion, medical research, and health care.
Wednesday, February 13, 2013
The most common pain killer ... is a killer
Take a close look through your medicine cabinet. First look for all the obvious Tylenol medications – Tylenol, Tylenol PM, Tylenol Cough and Cold, acetaminophen (the generic name for Tylenol), etc. Next, look for any prescription pain medications you may have such as Lortab or Hydrocodone/APAP – the APAP means Tylenol has been added. Check cold medications – Nyquil, Alka-Seltzer Plus, St. Joseph Aspirin Free and Zicam, etc. Any drug that has APAP, cet, or acetam as part of the name probably contains Tylenol. Notice how many of your medications contain acetaminophen/Tylenol.
This hunt is not just an academic exercise. Tylenol is the No. 1 reason for liver failure in America today – not because people are knowingly taking an overdose, but because they are being unwittingly exposed to acetaminophen from a variety of sources over a long period of time. The Tylenol people have done a great job of slipping their product into a myriad of commonly used drugs.
Instead of Lortab or other combination pain killers, I routinely give my patients plain Codeine after surgery, but until I specifically asked for it, my local pharmacy had no common prescription narcotic painkiller without Tylenol. Generally, pain medicine given post-op contains Tylenol.
Tylenol is marketed for two purposes – pain relief and as an anti-pyretic, i.e. it lowers fever. It is very effective in these regards, but with increased exposure, side effects are starting to emerge. In addition to liver failure – where the science is quite well worked out – Tylenol probably is bad for the brain and the kidneys.
Nearly ten years ago, an article was published in the journal Neurology looking at the risk of Alzheimer’s in people taking anti-inflammatories. Inflammation is what you see in arthritis tissues – redness, swelling, pain and increased warmth. Anti-inflammatories include drugs such as Motrin, Advil, Naprosyn, Celebrex, Diclofenac, Mobic etc., and these do more than Tylenol – which is just a pain reliever. Anti-inflammatories block a chemical pathway to inflammation and by this effect, secondarily relieve pain.
It was found in the Neurology study that if you take an anti-inflammatory medication for two years, you decrease your risk of Alzheimer’s by about 50 percent as compared to those people who took nothing. This makes sense with what we know about Alzheimer’s being partly an inflammation of the brain.
In the main section of the paper, the data also showed that people who took Tylenol for two years almost doubled their risk of developing Alzheimer’s.
Interestingly, this finding – buried as it was deep in the body of the study – was not reported in the news release, nor mentioned in the abstract summary of the article (increased Christmas bonuses to the Tylenol PR people!), so most physicians have not heard of this troubling information.
The mechanism for this brain injury is not yet proven, but is thought to involve Tylenol’s interaction with the NMDA receptor in brain cells. The NMDA receptor regulates calcium channels that lead to excitation of nerve cells, and this so called “excitotoxicity” is probably one of the final common pathways for the development of Alzheimer’s.
Lending further credence to this concern, recently there have been reports of acute memory loss in patients with only ten days exposure to Tylenol. When this Tylenol induced memory loss happened recently to a neurologist, the doctor then began noticing the problem in his patients and now is bringing this to the attention of the medical establishment. Fortunately, these acute memory losses have been reversible once the Tylenol has been removed.
Tylenol in the presence of alcohol poses a double whammy to the liver which may prove fatal. Alcohol consumption decreases glutathione in the liver – a potent detoxifying agent for Tylenol. Combining alcohol with Tylenol can prove fatal even though the amount of Tylenol ingested is within the recommended dose limits. This is magnified if the patient has been fasting, which further depletes glutathione. Since 10 percent of Americans are heavy drinkers, and since the difference between the safe range and the unsafe range for Tylenol is relatively small, this makes the population very much at risk for adverse effects. Fasting – which may be involuntary after, say, surgery, also makes the liver more vulnerable to these effects. So having too much to drink, forgetting to eat or vomiting, followed by some Tylenol for hangover is the “perfect storm” of toxic cocktail to the liver. There are numerous cases of acute liver toxicity and death from exactly this scenario.
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