As we have heard during this conference, there has been a surge in the medical literature during the past few years in the area of acetaminopher overdose. The index of suspicion in the United States prior to 1973 was low, but, judging from case reports and other literature, it is now receiving appropriate concern. For example, the national study reported here, involving treatment of acetaminophen overdose with acetylcysteine, has captured 416 patients in the first 12 months; approximately 25% of these were toxic by plasma acetaminophen level measurements. Clearly, physicians are aware of the problem and are beginning to deal with it in a more appropriate manner.

As the British have shown previously, acetaminophen overdoses have correlated directly with the increased availability in the marketplace. In the United States, salicylate has a 71% share of dosage units on the market today, while acetaminophen has a 29% share. Great Britain, with a population about one-fourth that of the United States, has basically the same number of individuals using acetaminophen even though the percentages are reversed, with acetaminophen having a 75% share.

There are major economic factors involved in any comparison of salicylate and acetaminophen. While physicians are educated through peerreviewed medical literature, the public is not. Manufacturers of salicylates in this country are clearly aware of the loss of their market share, and the public has been inundated with advertisements. New products such as Bayer Nonaspirin indicate manufacturers' anxious awareness of the potential market shift in the direction already achieved in Great Britain.

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