The "therapeutic ratio" of a drug compares the amount required to
produce harmful effects with the amount required to provide benefit. The therapeutic
ratio of acetaminophen, the active ingredient in Tylenol, is about 2:1 -and
even lower if your liver has been compromised by hepatitis or alcohol. An Extra-Strength
Tylenol contains 500 milligrams of acetaminophen. The recommended daily maximum
is eight pills -4,000 mg, or four grams. A person taking twice that much can
incur severe liver damage -and people in pain sometimes lose perspective and
gulp a handful. "Seven to eight grams a day for three or four days can
be fatal," according to William M. Lee, MD, of the University of Texas
Southwestern Medical Center.
The active ingredient in Tylenol, acetaminophen, had been known to have anti-fever
and anti-pain effects since the end of the 19th century, but no drug company
saw fit to manufacture it until McNeil Consumer Healthcare began marketing Tylenol
Elixir for Children in 1955 as a safer alternative to aspirin.
Johnson & Johnson acquired McNeil in 1959. In the 1960s J&J pushed
Tylenol forcefully after aspirin was associated by an Australian pediatrician
named Reye (pronounced "Rye") with a very rare, potentially fatal
condition involving the liver and ultimately the brain of infants and children
who, Reye found, had been treated with aspirin in response to upper respiratory
Acetaminophen is not as benign as Tylenol's slogan, "Nothing's
safer," alleged (and aspirin may not be as dangerous as the pharmaco-medical
establishment now alleges). Acetaminophen poisoning has become the leading cause
of acute liver failure (ALF) in the U.S. Some of the cases are suicide attempts,
some are unintentional.
Many consumers don't realize they're overdosing on acetaminophen because they
don't know it's an ingredient in hundreds of over-the-counter drugs -Nyquil,
DayQuil, Theraflu, Excedrin, Coricidin D, Triaminic, Dristan, Midol, Pamprin,
etc.- and prescription painkillers, including Vicodin and Percocet, the two
most widely used.
For those with liver damage from hepatitis and/or heavy alcohol a smaller amount
of acetaminophen than the recommended "therapeutic" dose can lead
to acute failure. In May Dr. Lee presented data at a conference showing that
one in eight cases of acute liver failure attributed to hepatitis B also involves
acetaminophen poisoning. Lee summarized: "If you are sick with acute viral
hepatitis and taking acetaminophen, you are more likely to go into acute liver
failure... even if you take therapeutic doses." Given acetaminophen's known
effects on the liver, Lee commented, "I am surprised that it's still on
the market." He elaborated to a Reuters reporter: "I don't think that
any drug with this amount of (use) and length of time on the market will ever
be taken off the market, but there should be labeling change." Lee noted
that the FDA doesn't require that over-the-counter medicines containing acetaminophen
so state on the front of the package -although it's been four years since an
FDA advisory committee recommended that the agency impose such a requirement.
Last November a paper in Hepatology described a study led by Anne Larsen of
the University of Washington Medical Center analyzing data gathered at 22 U.S.
liver-transplant centers on 662 patients suffering acute failure. Forty-two
percent of the cases had been caused by acetaminophen. "The annual percentage
of acetaminophen-related ALF rose during the study from 28% in 1998 to 51% in
2003," according to Larsen et al. "Median dose ingested was 24 g (equivalent
to 48 extra-strength tablets). Unintentional overdoses accounted for 131 (48%)
cases, intentional (suicide attempts) 122 (44%), and 22 (8%) were of unknown
intent. In the unintentional group, 38% took two or more acetaminophen preparations
simultaneously, and 63% used narcotic-containing compounds. Eighty-one percent
of unintentional patients reported taking acetaminophen and/or other analgesics
for acute or chronic pain syndromes."
The National Institutes of Health tracks acute liver failure cases. Last year
there were approximately 2,000 such cases, resulting in about 500 deaths, according
to Dr. Lee. Acetaminophen overdose is the leading cause for calls to Poison
Control Centers (more than 100,000/year); it accounts for some 60,000 emergency
room visits annually. Johnson & Johnson is putting out a blame-the-victim
line, i.e., it's your fault for not using as directed, or drinking alcohol,
or inadvertently taking in combination with other drugs that contain acetaminophen.
"If you're not going to read the label, then don't buy our products,"
says a J&J spokesperson in the current ad campaign. This may be a pre-emptive
strike aimed at jurors who, in the days to come, will be weighing how much to
award the families of Tylenol victims. (For years Johnson and Johnson has been
manipulating the supine FDA to stall and soften any warnings that might put
a dent in Tylenol sales.)
The marketing of Tylenol is one of the all-time triumphs in the annals
of corporate public relations. By the start of the '80s, Tylenol had
surpassed aspirin and had a 37% share of the OTC painkiller market. It generated
almost 20% of J&J's profits during the first three quarters of 1982. But
then came a national recall of all Tylenol products, occasioned by a whacko
terrorist in Chicago who laced some bottles with cyanide and killed seven people.
CEO James Burke's handling of the situation is held up in the business schools
as a model of genius p.r. It is the subject of many learned articles, theses,
"Johnson & Johnson's handing of the Tylenol crisis is clearly the
example other companies should follow if the find themselves on the brink of
losing everything," says a typically admiring text used in a Defense Department
communications course. Actually, the terrorist's attack in Chicago gave Johnson
& Johnson an opportunity to conflate safety with purity (just as the terrorists'
attack on 911 enabled the Bush Administration to conflate safety with conquest
abroad and repression at home). Johnson & Johnson reintroduced Tylenol with
great fanfare "in new triple-safety seal packaging," writes the DoD
analyst a glued box, a plastic seal over the neck of the bottle, and a foil
seal over the mouth of the bottle." The label carried a warning not to
use if the package had been tampered with -and nothing about liver damage. The
unspoken message, etched heavily into consumer consciousness, was that the synthetic
compound inside the bottle is perfectly safe as long as it's pure.
James Burke, master salesman of Tylenol, has been selling the marijuana prohibition
for decades. Bill Clinton gave Burke the Presidential medal of honor in 1996,
when he was chairman emeritus Partnership for a Drug-Free America, the private-sector
partners of the drug czar's office. The Robert Wood Johnson Foundation helped
launch and has been the major backer of another prohibitionist propaganda project
the Community Anti-Drug Coalitions of America. Less than two weeks after Prop
215 passed in November 1996, the Drug Czar convened a meeting at which prohibitionist
tacticians from the private and non-profit sectors, along with California and
federal officials, discussed steps to block its implementation. Paul Jellinek
of the Robert Wood Johnson Foundation said, according to notes taken by a government
attorney, "The other side would be salivating if they could hear [the]
prospect of feds going against the will of the people." This is an unusually
frank acknowledgment of bias, conspiracy, and projection on the part of a man
who thinks it's all a game, who doesn't understand the magnitude of the crisis.
There are some parallels between Johnson and Johnson's public relations strategy
with respect to Tylenol and the Prohibitionist ideology Burke et al have helped
to frame. A misdirection play is involved. In the case of Tylenol, they made
it seem as if safety was simply a function of sealing out adulterants In the
case of marijuana, "the crude plant" can't be defined as a medicine.
False safety measures now abound. Drug testing has replaced good goggles in
many a workplace.
Angel Raich Gets Support From Her Son
Angel Raich sent an email to her friends June 9, "My son Tad has in the
past not wanted to speak out about medical cannabis or about how it has affected
him and his life growing up. Now at the age of 20 Tad wants to speak out in
support of medical cannabis, and his mom. He asked me to send to you all. In
June 2005 Tad joined the US Army. After being away from home and after working
for the US government for almost a year and he is now stationed in Korea since
January 2006. After seeing how the government treats medical cannabis patients
for years and now seeing the way some of the higher ups treat some of the soldiers
including him. He decided to make a statement to post on my website so people
would know what it is really like growing up with a parent that using cannabis
as a medicine and how it affects the children, the truth about medical cannabis
through the eyes of a child, or when he was a child. I am proud of my son."
Angel has posted Tad's letter, which was written in April, on her
webpage along with a picture of him graduating from boot camp on Sept. 1,
To the U.S. Government:
My name is Tad, I am 20 years old. This letter is about my mother and medical
My mother first became disabled when I was 8 years old. She was confined
to a wheelchair for several years and had a difficult time just getting out
of bed. She could never make it to my basketball games or golf tournaments
and barely made it to my 6th grade graduation. I was completely devastated
-- my own mother couldn't go to any of my events because she couldn't get
out of bed. Then one day she told my younger sister and me that she started
using medical cannabis. My sister and I were in complete disbelief. We couldn't
believe what she was telling us and we were completely against it. Then after
a short while, my mom started moving around more and eventually started walking
again. She was able to make it to more of my and my sister's events. I have
seen with my own eyes over the past 9 years that cannabis is a miracle drug.
You know, you call people who attack the United States terrorists, but what
do you call yourself for attacking innocent civilians for trying to stay alive?
TERRORISTS! That's what you are. You are terrorists and I can tell you right
now that I hate terrorists. So guess what that means? You are nothing but
hypocrites. You can't call MY mother a criminal or a terrorist for using medical
cannabis to stay alive. She's not harming anyone or attacking anything. She's
fighting for her life, so how the hell is she a criminal!
My mom has tried many prescription drugs and each and every one of them made
her severely ill. Prescription medication approved by the Federal Government
can cause patients severe side effects and possibly kill them. Medical cannabis
hasn't killed anyone! I am always hearing about recalls on prescription drugs
because of the dangerous side effects, yet what deadly side effects does medical
cannabis have? NONE!!!
They say this is the "Land of the Free." How is it the land of
the free when we have you TELLING US what to do with our bodies? Last time
I checked, you don't own our bodies. I can tell you that I am going to do
whatever I want to my body because it's mine and not yours, and NO ONE OWNS
IT BUT ME!
I am going to do what I can to stand by my mom. I look at the flag and see
nothing but hypocrisy. You are waging war against innocent civilians. You
need to stay out of our private lives and let us do what we need to do to
stay healthy and alive. We American citizens have the right to use whatever
medication works to ease our pain and keep us alive. If it weren't for medical
cannabis I would have grown up without a mother. My mom is a mother who cares
for her children and her life. I don't see any harm or terrorism in that.
So take a good long look at yourself and stay away from innocent civilians.
All you are doing is causing a civil war against sick Americans, and in THAT
war I will fight to protect my mother."
Fred Gardner is the editor of O'Shaughnessy's
Journal of the California Cannabis Research Medical Group. He can be reached
Another Marijuana Myth Goes Up In Smoke
by Paul Armentano
Epidemiological data presented last May at the
International Conference of the American Thoracic Society concluding that smoking
marijuana, even long-term, is not positively associated with increased incidence
of lung-cancer, is just the latest in a long line of government claims regarding
the alleged dangers of pot to go – pardon the pun – up in smoke.
Investigators from the David Geffen School of Medicine at the University of
California assessed the possible association between cannabis use and the risk
of lung cancer in middle-aged adults (ages 18–59) living in Los Angeles.
Researchers conducted interviews with 611 subjects with lung cancer and 1,040
controls matched for age, gender, and neighborhood. Data was collected on lifetime
marijuana use, as well as subjects' use of alcohol, tobacco and other drugs,
diet, occupation, and family history of cancer. Investigators used a logistical
regression model to estimate the effect of cannabis smoking on lung cancer risk,
adjusting for age, gender, ethnicity, education, cumulative tobacco smoking,
and alcohol use.
"We did not observe a positive association of marijuana use – even
heavy long-term use – with lung cancer, controlling for tobacco smoking
and other potential cofounders," investigators concluded. Moreover, their
data further revealed that one subset of moderate lifetime users actually had
an inverse association between cannabis use and lung cancer. Much less surprising,
the NIH-funded study – the largest of its type ever conducted –
did find a 20-fold increased risk in heavy tobacco smokers.
Officials from the White House’s Drug Czar’s office had "no
comment" on the UCLA findings.
While the investigators’ failure to demonstrate a positive association
between cannabis use and cancer may seem surprising to some, the bottom line
is that scientists overseas have been studying pot’s potential anti-cancer
properties for nearly a decade. Most recently, investigators at Italy's Instuto
di Chemica Biomolecolare reported in
the May issue of the Journal of Pharmacology and Experimental Therapeutics that
compounds in marijuana inhibit cancer cell growth in animals and in culture
on a wide range of tumor cell lines, including human breast carcinoma cells,
human prostate carcinoma cells, and human colectoral carcinoma cells.
Previous studies by European researchers have shown that cannabis’ constituents
can reduce the size and halt the spread of glioma (brain tumor) cells in animals
and humans in a dose dependent manner. Separate
preclinical studies have also shown marijuana to inhibit cancer cell growth
and selectively trigger malignant cell death in skin cancer cells, leukemic
cells, and lung cancer cells, among other cancerous cell lines.
But none of these findings should come as a surprise to the US government,
which ironically, sponsored
the first experiment ever documenting pot's anti-cancer effects in 1974 at the
Medical College of Virginia. The results of that study, reported in an Aug.
18, 1974, Washington Post newspaper feature, were that marijuana's primary psychoactive
component "THC slowed the growth of lung cancers, breast cancers and a
virus-induced leukemia in laboratory mice, and prolonged their lives by as much
as 36 percent."
Shockingly, federal officials have steadfastly refused to fund any follow up
research on the subject in the following decades, and today continue to oppose
any use of cannabis – even for medical purposes in states that have authorized
its use. What’s the Fed’s rational for maintaining such a foolish
and misguided policy? Most likely, they have "no comment."
Paul Armentano [send him mail]
is the senior policy analyst for the NORML Foundation in Washington, DC.
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