The evolution of medicines is a gradual process and one that is just as often reactive as it is proactive.
Because of this, whilst incredible scientific developments and new technologies can help to advance scientific development and create new medicines that become accessible through an NHS electronic prescription service, other developments emerge in response to extraordinary events.
Arguably one of the best examples of this in the world is an infamous recall caused by the murders of seven people who all had the medicine they consumed in common.
Paracetamol And Cyanide
Tylenol is a Johnson & Johnson brand of paracetamol, a common over-the-counter painkiller, which had its reputation tarnished when 12-year-old girl Mary Kellerman and six other people took an Extra-Strength version of the drug and died within days.
Quickly, investigators in the Chicago metropolitan area suspected foul play, with an almond scent and symptoms of the six initial dead that suggested the poison cyanide was the cause.
Cyanide is a highly potent poison that causes sudden life-threatening symptoms including cardiac arrest, unconsciousness, breathing difficulties and seizures. Immediate administration of an antidote can help stop its effects, and ingesting medical activated charcoal can also stop it from being absorbed as quickly.
However, in these cases, the sheer potency of the cyanide found in the Tylenol capsules was 10000 times the dose it would take to kill you, likely within minutes of ingestion from a heart attack.
This led to one of the largest medical recalls in history, as all bottles from three specific lots and any bottle sold in the Chicago area were recalled by Johnson & Johnson as a precautionary measure and part of their contribution towards the investigation.
Never Again
Whilst there were many theories of who the perpetrator was, including “the Unabomber” Ted Kaczynski, convicted extortionist James William Lewis and Roger Arnold, the only confirmed part of the Tylenol deaths was that it was a deliberate act of murder rather than the result of tainted production.
Johnson & Johnson regularly communicated with the public and were honest about their role in the investigation and how their products were bottled, batched and distributed, arguing that it was impossible for the poisonings to be the result of faulty manufacture but also refused to take risks with the general public.
Their biggest contribution, however, was in the development and popularisation of a triple-sealed, tamper-resistant packaging system for medicines, which made it exceptionally difficult for anyone to contaminate a bottle without it being noticed.
The product tampering was believed to have been done in a relatively simple way; Tylenol bottles were taken off of pharmacy shelves, opened, the capsules opened and their contents replaced with potassium cyanide salt, before putting them back on store shelves without anyone noticing.
The widespread adoption and later legal requirement of anti-tamper packaging helped to significantly reduce the risk of this type of medication tampering, and helped to ensure people that medication is safe to use.
Tylenol is one of the most popular brands of painkiller in the world, and the particular management of an event that could have destroyed the brand is now a case study of the importance of honesty and cooperation between the pharmaceutical industry and the medical profession.