In July 2009 the FDA finally took a stand on the long-standing “Tylenol problem.” This drug has been harming/killing a whole lot of people without those minding the drugstore saying much about it. Fortunately, they had to finally face the music: Tylenol is responsible for about half of the liver failures and a significant proportion of pharmaceutical-fatalities in the USA.

What is a bit irritating is that we have known about this problem for so long. 

While I don't wish anyone to suffer in pain for any reason, I feel we need to be more careful when we pop any pharmaceutical product, even those considered to be safe because they don't require a prescription. Oh, by the way: remember that about 100,000 people die each year from prescription drug-related problems. Most of those deaths are from drugs like ibuprofen. 

Surely Tylenol is still a good drug to take, provided we understand the risks and keep the dose under 4 grams a day. Also, it would be helpful to have at least a superficial knowledge of how we detoxify chemicals in the gut and the liver.

We need to have BMs 2-3 times a day, which is not far fetched if we eat the amounts of fibre that are recommended (38 and 24 grams for men and women under 50, and 31 and 21 grams for people over 50). Fibre feeds the friendly intestinal flora that has the same capacity to detoxify drugs and toxins that the liver has. Remember that most fibre is found in fruits and veggies; every day we would do well to consume 13 servings. Since most would roll their eyes at such a lofty goal, supplementing fibre is a good idea. My favorite one is slippery elm fibre. If you mix it with goat's whey it is ever more anti-inflammatory. While you are at it, you may want to supplement probiotics, or friendly bacteria.

Optimizing gut function also reduces inflammation throughout our body, so that any pain issue is thus better addressed. If you are still in pain consider D3 2-5K units/day and omega oils, 2-4 capsules a day. They are anti-inflammatory antioxidants. If you like herbs, boswellia, stinging nettles and cat's claw are my favourites for pain. SAMe, a metabolite of B complex, has been found to be equal to ibuprofen for pain. No wonder it became a pharmaceutical product in Europe.

Back to Tylenol:

The problem is not just Tylenol, but our culture of quick prescriptions to treat symptoms while leaving the roots of the problems unanswered. 

For these and many other obvious reasons I rejoiced in the JAMA's courage to publish the article “Promoting More Conservative Practices.” So that you rejoice with me I am extensively quoting from this article. The implications of the following statements are enormous:

• “Although medical and pharmacy curricula and journals are rich with information about drug and treatment of specific diseases, there is a paucity of education on ways to become effective lifetime prescribers. Two recent reports from the Association of American Medical colleges (AAMC) lamented the current state of pharmacology teaching and the disturbing extend of pharmaceutical industry influence at all stages of medical education. Given the well-documented prevalence of medication-related harm and inappropriate prescribing, such educational reform is necessary but no sufficient to ensure that patients are optimally treated... trainees need guiding principles to inform their thinking about pharmacotherapy to help them become more careful, cautious, evidence-based prescribers.”

• “These lessons are fundamental for teaching clinicians how to develop excellent prescribing skills, yet such fundamentals are absent or underemphasized in current medical pharmacy education... they also need to be taught a set of skills and attitudes that will help them approach claims for drugs, especially new drugs, more critically.”

• “Without a more cautious and more skeptical approach to using drugs, prescribers will lack the will and the skills to resist ubiquitous promotional messages encouraging them to reach for newer and often m ore expensive medications.”

• “Although the attitudes and behaviors recommended in our principles [see box below] should not be terribly controversial, taken together they represent a departure from current practice.”

• “From the founder of modern medicine Dr. Osler to leading pharmacology textbooks, taking a more skeptical and conservative approach to pharmacotherapy has a long and honorable history in medicine...Rather than therapeutic nihilism, the approach of these guidelines aims to better respect the limitations of knowledge and more closely align clinicians with the interests of patients.”

Many doctors reading this article are dedicated to these simple principles. While not perfect in their prescribing I would guess they strive to follow the old dictum “primum non nocere” (first do no harm) to the best of their abilities. 

Of all the recommendations in the box, I would like to emphasize the first three under “think beyond drugs.” Many doctors reading this article no doubt have had these simple principles and their desire to implement the best ways to heal patients as the driving force behind their pursuit of research highlighting nutrition, environmental issues and the Mind-Body-Spirit connection.

In my own experience, applying the references I have found in our leading medical journals have helped me avoid and/or stop 80 percent of the prescription medications commonly used for chronic ailments, a figure that Dr. Willet at Harvard Medical School has also documented. 

Gordon Schiff and William Galanter, "Promoting More Conservative Prescribing," JAMA 301 (2009):865-867....

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This article by Dr. Hugo Rodier is used with permission.