January 26, 2023

Does the world’s most common pain relief drug do more than just reduce pain? Recent headlines would have you believe that it also reduces your perception of risk, resulting in more risk-taking behaviors. We think it’s time to take a closer look at the details before deciding to ditch the Tylenol.

Recently media outlets were whipped into a frenzy by the release of a study on acetaminophen and risk-taking the results were often discussed in the context of the pandemic raising fears about people taking acetaminophen for covid symptoms and then engaging in risky behaviors like not wearing masks or social distancing by now many of you know to exercise caution

At a flashy headline and a few of you have requested that we cover this one in particular so we made it the topic of this week’s healthcare triage first to the research published in july the paper describes three separate experiments in all three participants were randomly assigned to receive either a placebo or the maximum single dosage of acetaminophen for

An adult 1000 milligrams risk taking was then measured later using the balloon analog risk task this task is a commonly used computerized measure of risk taking where participants pump up virtual balloons gaining imaginary monetary rewards with each pump they keep whatever rewards they gain if the balloon doesn’t pop but lose all rewards gained in a trial if

They pump too much and the balloon explodes in the first experiment participants given acetaminophen pumped the balloon a median of almost 39 times compared with a median of about 33 times for the placebo group thus earning themselves a reputation for being a bit risky in support of this reputation the number of balloons they burst landed at a median of about

10 whereas the placebo group burst a median of about 8.5 the researchers then measured the participants perception of risks and benefits via a questionnaire finding no difference between the groups in the second experiment results were similar to the first in that the acetaminophen group had a higher median of pumps than the placebo group but the difference

Between groups and the number of exploding balloons was not significantly different this time in contrast to the first experiment risk but not benefit perception was significantly reduced in the acetaminophen group though a direct comparison with the first experiment isn’t possible because a different measure was used and finally the third experiment this time

Participants completed other risk in decision making tests before completing the balloon task the authors don’t explain this edition simply reporting that they have not yet analyzed those data and will report them separately from this study the drug was also prepared differently than in the first two studies and different software was used to administer the

Balloon task both of these changes were left similarly unexplained so that seems weird but it is what it is in complete contrast to the first two studies experiment 3 indicated no significant difference between groups and risk taking as measured by number of pumps or number of balloons exploded despite this the authors began the paper’s discussion by stating

That acetaminophen increased risk taking across three separate studies while they did compile data from the three experiments and then analyze it which resulted in a statistically significant relationship between acetaminophen and risk we’re not sure that we’re down with that kind of data handling especially given the differences between the three experiments

Several media pieces are proclaiming that acetaminophen’s effect on risk taking is due to its reduction of risk perception given that the first experiment found no differences in risk perception that it wasn’t even examined in the third experiment and then in the second experiment they changed the way risk perception was measured this is a major overstep at best

There’s also the subject pool all university students at a mean age of about 19 years this means they all possessed a not yet fully developed prefrontal cortex this matters because the prefrontal cortex is part of the brain thought to play a large role in risk-taking behaviors and it doesn’t fully mature in humans until about the age of 25 and since this part

Of the brain is still stitching itself together the way it interacts with any drug could be markedly different than that of an adult which just means we should be cautious about generalizing this data to the entire population though some studies have been conducted to establish the validity of the balloon analog risk task it still isn’t entirely clear this task

Generalizes to risk taking in the real world in a similar vein we also don’t know how clinically significant these statistically significant results are that’s okay by the way just means we can’t draw major conclusions right now and there are other issues with this study detailed in a september blog post by a researcher not affiliated with the work and we’ll

Link to that blog in the description but some of the issues include pre-registration and statistical issues like slightly suspicious p-values and not accounting for multiple tests we’re not here to say the findings are totally bogus but just to provide some pushback against media headlines like the most common pain relief drug in the world induces risky behavior

Do better media hey you enjoyed this episode you might enjoy this previous episode on executive orders and the non-existent plan for replacing the affordable care act we’d like it if you’d like and subscribe down below and if you go on over to patreon.com healthcaretriage where you can help support the show even though on a global pandemic i’d like to especially

Thank our research associates james glasgow joe sevitz josh kister and michael chin and of course our surgeon admiral sam

Transcribed from video
Acetaminophen, Risk-Taking, and Covid-19 By Healthcare Triage