I am familiar enough with the numbers that I am not necessarily surprised, but I still find it emotionally hard to grok that more than one in five would-be paracetamol suicide victims would be dissuaded by having to pop the pills out of a blister pack first.

- Metamizole has a tendency to kill some percentage of native Brits and their descendants. Yet globally it's one of the most popular painkillers, it's even OTC in countries with sufficiently low numbers of British and related people. (Has anyone ever done research to try and figure out why Brits are on the order of 1000x-10000x more sensitive to that side effect?)

That's why it's recommended to combine a half dose of ibuprofen and a half dose of paracetamol at the same time. (Plus some vitamin C)

Together they have higher pain killung effects than each alone, and the side effects are reduced as they affect different body parts. And the vitamin C reduces the damage to the stomach lining.

Adding to this, its the margin between a therapeutic dose and a harmful dose is most relevant. That margin for aspirin is wide, the same effective vs toxic margin for paracematol is shockingly narrow. Furthermore, the "aspirin is rough on your stomach whereas Tylenol is gentle" turns out to be McNeil Marketing puffery.

"Any medicine can be poison" is kinda missing the point.

There is a rich and varied multidimensional field of danger, from aspects like the safety-margin between regular/dangerous dose levels, the chronology of how it can spike or accumulate, whether there's feedback in advance of damage, etc.

Yeah, I can poison myself drinking clean water, but it's hard.

You can overdose on water and oxygen too. What’s your point?

> but due to drug marketing, acetaminophen is touted as the "safe" pain reliever.

Paracetamol's patents have expired long ago and there's not much profit to be made out of it (nowadays it's mostly not being made in the West, but imported from China, unlike profitable medicine).

The reason why it's still used it's that it's much better than the alternatives, despite the risks (it's only risky if you don't respect the doses by the way).

Sure but it’s pretty easy overdose on paracetamol.

Since it’s a mild and really common painkiller, sometimes seen as not dangerous, someone uneducated about it who is really suffering could easily take 3 or 4 times the dose.

Unlike a lot of drugs, you are not going to have a lot of immediate side effects if you overdose on paracetamol. You’ll just horribly die some days after,

I think there are a few possible factors:

- different packages of the same medication have different doses per pill. So you might read one package that says to take two pills, then later you buy a different package of the same painkiller that says one pill, but you're lazy, and don't read the label for this, and assume it is the same as last time, so you end up doubling the dose.

- For ibuprofen, the label often says if one dose isn't sufficient, then you can take another pill (with a maximum number in 24 hours). People may assume this is the case for Tylenol as well, but I don't think it is.

- people may read the size of the dose, but skip over the warning about the maximum you can take in a 24 hour period.

- The directions are in small hard to read text, which makes all of the above points worse.

Not that any of those are a good excuse not to read the label, but, well, people make bad decisions all the time.

I choose to believe that all of the movies and TV shows showing Americans pouring a handful of pills out of a bottle into their hands and throwing them in their mouths (then chewing them!!!) are 100% accurate to life rather than cinematic shorthand

Recently had a prescription error with my two month old baby. The doctor prescribed 7 times as much iron supplement as they intended (confusing labelling - so while I'm annoyed, I can see how it happened). This went on for a month until we uncovered the error.

We had blood test done (on the doctor's recommendation), and luckily there is no sign of any damage, but prescription errors do happen (even if they are rare) and it's much easier with liquids (you probably wouldn't give 8 pills to a baby, but 8ml doesn't seem so bad).

Liquid Panadol flavors were totally useless with my son. He would spit it out or upset himself so much he'd throw it up.

We ended up crushing and diluting tablets in milk, which he would drink (you waste a lot of milk to hit the right factor).

As someone in the US, I've only used liquid tylenol for my kids when they were infants and pills were a choking hazard.

Otherwise, it's much easier to get them to take a pill than drink a liquid.

> as in Europe the default

There's no “as in Europe”, every European country is different. In France the default is also liquid form, but the pipette is graduated is kilograms of baby weight, which limit the errors you can make (you know your kid doesn't weight 15kg when his weight is around 8).

> Which is much harder to dose correctly when the kid spits or drools it out.

Never met a non autistic child who would spit or drool out calpol. I'd take the stuff myself as an adult it tastes brilliant.

> Total culture shock for me, as in Europe the default for children is rectal ingestion (which is probably a culture shock as well for Americans)

Huh are you talking about new born babies or something? I've been to a few different EU countries and you can buy liquid stuff for kids in the chemists. (Spain, france, germany, italy) source me as a child getting the stuff when I was sick abroad and the local doc sold my parents basically some off brand calpol.