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    •  That's an understatement (17+ / 0-)

      Wow, this could be a huge problem. The liver transplant list is already thousands of names long (my brother-in-law has been on it for years).

      •  Depending upon how this mistake happened: (7+ / 0-)

        This level of mistake, if caused by clear lack of oversight or severe negligence (how could this not be caught before it went out the door?) could result in criminal charges.

        However, the record in the last 30 years is terribly depressing regarding holding corporations accountable for dangerous acts.

        Blessed are the peacemakers, the poor, the meek and the sick: The "party of Jesus" wouldn't invite him to their convention - fearing his "platform."

        by 4CasandChlo on Thu Jun 20, 2013 at 09:39:13 PM PDT

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        •  I'd bet my next pension check (4+ / 0-)

          that this will boil down to plain corporate greed, the virtual "ownership" of the FDA by Big Pharma, and the knowledge they'll never be prosecuted or held accountable for any harm they've done.

          Worse than simply using the wrong drug is the continual abuse of the FDA by Big Pharma pushing new drugs onto the market which are virtually untested and any studies that show the dangers of the drug get hushed up by the drug companies.  They know their hoardes of lawyers will hold lawsuits at bay and charging exhorbitant prices will fatten their wallets nicely.

          Corporate crime needs to be as vigorously prosecuted and land the guilty in prison as crime by people.

          There already is class warfare in America. Unfortunately, the rich are winning.

          by Puddytat on Fri Jun 21, 2013 at 12:17:36 AM PDT

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        •  Mistakes like this (4+ / 0-)

          had happened for years at the Novartis plant in Lincoln, Nebraska. The FDA finally shut them down and, last I heard, they weren't back up after a year. I believe they were mixing up some form of stomach medicine with Excedrin.
          I suspect it's greed: hiring as cheaply as possible people who don't give a rat fart about what they're making.

          You..ought to be out raising hell. This is the fighting age. Put on your fighting clothes. -Mother Jones

          by northsylvania on Fri Jun 21, 2013 at 01:09:49 AM PDT

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          •  More importantly (6+ / 0-)

            hiring as cheaply as possible often means hiring people who are only marginally literate, and cannot read labels or calculate quantities, so they have no way of realizing that the barrels of powder their boss told them to dump into the hopper aren't the right stuff.

          •  re: people who don't give a rat fart about what... (6+ / 0-)

              The problem is, you get fired for asking questions, just like I did in a shop that made tiny parts for airliners. I ran a very large screw machine and did my best to run it well. One day there was something wrong. I did not know what it was because I'm not an engineer. But I did know, from making 1200 of them every day the very same way, that something was wrong. They just didn't look right.
                 Told the supervisor. He didn't see it. Keep on running the machine, no time to shut down. An hour later the parts are visibly marked, I can point to where one of the tools is not installed right but am unable to fix it myself. Supervisor says he doesn't see what's wrong. Keep running.
                 After arguing with quality control all morning, the President of the company happens to come striding downstairs and through the shop. I politely get his attention, explain that I'm sorry I can't tell him what's wrong, but something is and no one will believe me. He tells supervisor to talk to QC and me and deal with it. By this time the visible line on my stainless steel parts is digging in and I am pointing out to them which tool it is that needs to be removed etc., but no one is listening. Fine. Finished the day.
                 Come in the next day, there's a meeting upstairs I have to go to, in which I am fired for making 900 bad parts and annoying everybody and also for spending too much time with the machine down.

            I've nearly gotten fired for speaking up about problems at almost every job I've run into, because I am a speak-up kind of person. I have been able to speak up only because mine is the secondary income in our household. Lots of people are doing things they would rather not and are not at liberty to speak about anything.

            So yes, it's greed- let us remember to blame the people who do not pay what a person's time is worth. I think that a CEO should forfeit all his benefits and such if he is not actually physically capable of showing up on the production line to substitute for someone who is out sick. (Plus it's a travesty that some amount of paid sick time is not the law all over.)

            •  Got to recommend that. (3+ / 0-)
              I think that a CEO should forfeit all his benefits and such if he is not actually physically capable of showing up on the production line to substitute for someone who is out sick. (Plus it's a travesty that some amount of paid sick time is not the law all over.)
              Reminds me of working in a nursing home when the flu was going around and not being able to take more than a day off. If yours is the main income, you don't have the luxury to stay home. However your presence is a life threat.
              My apologies for slanging workers in general, but when pay is minimal and the work is hard and unforgiving, the people who do care often leave or are fired, and those who are left don't and aren't.

              You..ought to be out raising hell. This is the fighting age. Put on your fighting clothes. -Mother Jones

              by northsylvania on Fri Jun 21, 2013 at 08:27:10 AM PDT

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    •  Literally. (18+ / 0-)

      Anyone who has taken the tiny 81 mg aspirins should be given pause by the size of the mislabeled 500 mg acetaminophen.

      The GOP can't win on ideas. They can only win by lying, cheating, and stealing. So they do.

      by psnyder on Thu Jun 20, 2013 at 07:48:03 PM PDT

      [ Parent ]

      •  The size may be the same (6+ / 0-)

        Hopefully the lack of coating will clue them in.

        •  It couldn't be the same size. The 81mg aspirin (15+ / 0-)

          tablets are tiny, much smaller than the standard aspirin tablet. I have never seen any acetaminophen tablet as small at any dosage level.

          •  However, 500mg is also pretty tiny and is in (6+ / 0-)

            fact smaller than one of those "81 mg" aspirin tablets.  So if the error occurred during manufacturing rather than the bottling step you could very well end up with 500mg of tylenol in a pill the same size as an 81mg aspirin.

            You have watched Faux News, now lose 2d10 SAN.

            by Throw The Bums Out on Thu Jun 20, 2013 at 08:37:52 PM PDT

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            •  I wondered how much of those things was filler. nt (4+ / 0-)

              The GOP can't win on ideas. They can only win by lying, cheating, and stealing. So they do.

              by psnyder on Thu Jun 20, 2013 at 08:42:47 PM PDT

              [ Parent ]

            •  A gram is one cubic centimeter of water (2+ / 0-)
              Recommended by:
              viral, OldDragon

              A milligram is one thousandth of a gram. So absolutely tiny.

              Most of our medication is filler.

            •  No, you cannot make 500 mg acetaminophen (6+ / 0-)

              as small as 81 mg of ASA.  Also, the basic dose of acetaminophen is the same as ASA, 650 mg. We have just gotten used to the 500 mg supersized pill and you can hardly find 325 mg of acetaminophen. 500 mg is Not tiny.

              Two huge problems with this. 81 mg ASA dose is used for two reasons:

              - Children's doses. Their dose of acetaminophen is also much smaller. A child weighing enough to get 162 mg ASA would have been getting 1000 mg - a toxic dose. If it is repeated every 4 hours as is safe for ASA, a child could have been getting 3000 to 6000 mg over 24 hours. The max dose for adults is 4000 mg in 24 hours. This has been very controlled, in the hospital computerized drug dispensing machines and the computerized Medicine Administration Records (MARs) for years.

              - Adults are prescribed 81 mg ASA for anti-coagulation when at risk for MI. Anyone who enters the EMS, by ambulance or ED, with chest pain or other symptoms of MI, the first thing they get are 4 chewable 81mg ASA. Not O2 (2nd), not NTG. It works that well. (I think they may have developed a spray too)

              Confusion on mgs and gms. One chemical (salt) is not the same in mgs or gms as another. That nomenclature is used for measurements of volume and weight. They are not the same # for both. Some of the comments are based on not understanding the difference. (Which is one of the really fun things to learn in pharmacology, and just as much fun to teach ;)

              "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

              by Ginny in CO on Thu Jun 20, 2013 at 11:53:55 PM PDT

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              •  Ok, so just how much is 500mg of pure (3+ / 0-)

                acetaminophen without any filler or other inactive ingredients?

                You have watched Faux News, now lose 2d10 SAN.

                by Throw The Bums Out on Fri Jun 21, 2013 at 12:37:04 AM PDT

                [ Parent ]

                •  Have no idea. It doesn't come that way. (2+ / 0-)
                  Recommended by:
                  Throw The Bums Out, indubitably

                  I have no way of knowing or figuring it out. The functional milligrams of acetaminophen are determined by a weight measurement - in the manufacturing process. One of the additives may be to allow the powder to flow into the capsule or mold that makes it a tablet.

                  This is why RX meds have identifying colors, letters and numbers on them. OTC common drugs are not always marked.

                  "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

                  by Ginny in CO on Fri Jun 21, 2013 at 12:57:04 AM PDT

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                  •  What I was referring to was what if the machine (2+ / 0-)

                    that adds the drug were set to "500mg acetaminophen, add fillers as necessary to get the size of an 81mg aspirin tablet" instead of "81mg aspirin, add fillers as necessary to get the size of an 81mg aspirin tablet" like it should be?  Then wouldn't you have 500mg of acetaminophen and less additives in the same size pill?

                    You have watched Faux News, now lose 2d10 SAN.

                    by Throw The Bums Out on Fri Jun 21, 2013 at 02:23:46 AM PDT

                    [ Parent ]

                    •  More likely the tabs were made (1+ / 0-)
                      Recommended by:
                      Susan from 29

                      properly. The wrong labels were put in the production line and placed on the bottles. Quality control? As often as it should be done?

                      A lot of people may not have paid attention to the different size. Off brands that sell cheaper than the name brands get picked by a lot of buyers who take whatever is cheapest because it generally doesn't make a difference.

                      It may have taken some time for the inquires to come in and perhaps a certain threshold for the issue to be addressed. Don't recall right now the date of production.

                      "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

                      by Ginny in CO on Fri Jun 21, 2013 at 02:45:02 AM PDT

                      [ Parent ]

              •  It occurred to me after thinking about that (4+ / 0-)

                answer I left out another important piece.

                Children really should not be given aspirin at all. The risk of Reyes syndrome has been known for decades and most parents are warned about this extensively. Problem is some don't have health care, others choose not to believe very good science for whatever reason.

                Aspirin is unique in the pain and fever meds. It was derived from white willow bark which naturalists still use. Not sure if that has been linked to Reyes or not.

                "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

                by Ginny in CO on Fri Jun 21, 2013 at 02:55:46 AM PDT

                [ Parent ]

                •  No aspirin is not unique in that regard (2+ / 0-)
                  Recommended by:
                  indubitably, Ginny in CO

                  Most of our medications are simply refined and concentrated neuropathic preparations.

                  •  True, but in developing other products (0+ / 0-)

                    such as the other NSAIDS, they have not been able to duplicate some of the unique properties - the anticoagulation piece especially. Which is true of most pharmaceuticals. As one head of a medical school pharmacy program put it, if a drug doesn't have side effects, it doesn't work anyway.

                    Interesting history about the anticoagulation property. In the 50's a mid west GP noted that his tonsillectomy patients who received aspirin for the pain bled more than those who were given other analgesics. He wrote this up in an article published by Case Western Reserve medical journal. Not just what he observed, but the implications for it. He suggested that this could be useful in the exploding emergence of cardiac disease. (This was when the founder of Prevention Magazine was getting major push back from medicine and the feds for suggesting that red meat and dairy products were the cause of the problem and that people who had heart attacks should not be sedentary during recovery. Some may remember he died on Dick Cavett's show back when the talk shows  were all done live.)

                    The concept was not picked up by anyone, the GP was aging and died without pursuing it further.

                    I have a hard time thinking about this. Realizing that countless millions, including my father in law, died much too young because no one saw the importance of an observation by a GP.

                    "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

                    by Ginny in CO on Fri Jun 21, 2013 at 11:46:10 AM PDT

                    [ Parent ]

            •  Most of the size of tablets (3+ / 0-)

              is predicated on what are called excipients, or inert filler. An 81mg medication might be exactly the size as a 500 mg med depending on the intended usage. Usually size is based on getting a size that is easy to handle but not too big to swallow. Note that meds that come in varying doses are usually the exact same size. Warfarin, for example comes in dosages from 1 mg to 10 mg and every tab is the same but for color and markings.

              If you look at veterinary meds, for example, when they are not just human meds sold for pets (often oral antibiotics for pets are just pediatric meds sold for pets at a huge markup -- which is why you give your dog bubblegum flavored antibiotic) are often smaller at the same dosage to make it easier to administer to a cat, for example.

              What I find odd, is that an 81mg aspirin, generally sold as prophylaxis for cardiac patients (in addition to pain relief, aspirin is an anti-platelet coagulator, slightly helping to prevent the formation of blood clots which can lead to heart attacks or the worsening of existing clots), would be sold as a general NSAID (non-steroidal anti-inflamatory) for pain. Generally the aspirin dosage for pain relief is 325 mg. In addition, such 81 mg aspirins for cardiac patients should be chewable since they should be taken at the onset of chest pain to prevent increased clotting and enterically coated medications are designed to dissolve in the duodenum rather than the stomach, which delays absorption for as much as 20+ minutes, making them useless for cardiac pain.

              What this manufacturer seems to be doing is selling an NSAID formulation as a cardiac med, thus trying to cover both uses with the same product.

              •  I disagree with your assumption about 81 mg (2+ / 0-)
                Recommended by:
                white blitz, VClib

                aspirin usage.

                These are taken as a daily preventative medicine by heart patients not just when someone is experiencing chest pain.

                •  Prophylaxis means preventative (0+ / 0-)

                  I said what I meant: They are taken as prophylaxis and at the onset of chest pain. As a paramedic, I administer this on a pretty much daily basis.

                  Yes, most patients at risk for a heart attack or another heart attack take 81mg ASA daily. That's prophylaxis. They ALSO take up to 324 mg at the onset of chest pain to prevent or delay further clot formation.

                  An 81 mg enterically-coated ASA dosage is actually contra-indicated for sudden onset chest pain and should not be tried. To market their med like this actually seems like a bad thing, possibly leading to people taking it for chest pain and not getting the benefit soon enough.

                  That's pretty much what I said, above.

          •  Most of all pills is filler. 500 mg is a tiny (6+ / 0-)

            amount, physically, but a big dose!

            "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

            by YucatanMan on Thu Jun 20, 2013 at 09:37:05 PM PDT

            [ Parent ]

          •  The aspirin (1+ / 0-)
            Recommended by:
            erush1345

            at this dose are almost exclusive used as daily doses to protect against heart attack and stroke.  They'd be ineffective as a pain-killer, and therefore the people endangered by the switch are unlikely to take several in one day as they might if their headache wasn't going away.  One acetaminophen per day won't help prevent blood clots like the aspirin, but shouldn't cause many cases of liver damage.

    •  . (3+ / 0-)
      Gob: “I've made a huge mistake.”

      Code Monkey like freedom / Code Monkey like peace and justice too
      Code Monkey very nerdy man / With big warm fuzzy bleeding heart
      Code Monkey like you!

      Formerly known as Jyrinx.

      by Code Monkey on Fri Jun 21, 2013 at 06:35:42 AM PDT

      [ Parent ]

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