Damn. That explains so much!

OK, I'll bite.

First Salzi with chocolate versus butter, and now this post about chocolate killing.

HOW was the LD50 determined? By scaling up from animal studies or observation on humans?

And isn't the LD50 the point at which half die? So half of us after eating five kilos would simply be burping and asking for milk?

Not to mention the potato.

OK, I won't.

But 11 pounds of chocolate? What's the maximum your average chocoholic can get through in one sitting?

Now, is 5kg the LD50 of, say, milk chocolate? Or do we need to divide by the percent cacao?

The dose makes the poison. I'll continue to ingest chocolate at a therapeutic level, thankyouverymuch.

My first time!

What %age of cocoa are we talking. Surely 5kg of milk chocolate would leave you with more issues from the sugar and fat.

Michael@7 -- perhaps not, in the short run. A lot depends on the size of the individual, for example. Is that LD50 of 5kg for a 50 kg person, or a 150 kg person? Or some theoretical intermediate size that we probably don't see very often?

The chocolate we're talking about is pure baking chocolate.

MIchael @ 7:

Surely 5kg of milk chocolate would leave you with more issues from the sugar and fat.

@5: Just so-- I spent the last three years building up an immunity to iocaine powder.

LD50? Really? I can't believe that. That's astonishing. Are you sure?

And, uh, can someone tell me what "LD" stands for? Wait, lethal dose? Okay, so, what does LD50 mean?

Isn't the LD50 for water something like ten kilos? So, chocolate is nearly twice as poisonous as water.

I'll never drink water again.

Yep, dosage makes the poison. A while back one of my dogs managed to climb up on a bookcase and grab a part of a chocolate bar. This is a small dog, a terrier weighing about 21 pounds. When I found the wrapper on the floor, I did some quick googling and calculating, and figured, based on his size, the percentage of cocoa in the bar, and the fact that he'd only eaten part of it, that he'd gotten about half of the minimum toxic dose. I kept watch on him for a couple of hours just to make sure, and he settled down and took a nap; the opposite of the normal symptoms of toxicity. Needless to say I've been a lot more careful of where I put my chocolate since.

Bruce @ 10

Michael @7 said "milk chocolate", not "chocolate milk" (whose LD50 is undoubtedly a lot higher, unless you burst first).

skzb @12: LD50 is the dosage which will kill 50% of those ingesting it. As Tom Whitmore noted, there is some important information missing here.

David @ 16: Thanks.

By the way, here's a link to the Guittard website showing their 10-pound blocks:
Chocolate blocks

You don't get a terrifically good sense of scale from that, but my parents used to buy the 5-block cases back when my mom was toying with the idea of starting up a candy store (she never did, but she put together a terrific collection of nifty metal molds, which she used occasionally) and if memory serves me right the dimensions are something like one foot by two feet by two inches -- that's a hell of a lot of chocolate to ingest all at once. (And unsweetened, yet! Presumably a 67% semi-sweet would have an LD50 proportionately larger.)

Hope the link above doesn't get me gnomed....

(Guittard is good stuff, btw. I like their chocolate better than Ghirardelli's.)

John Rynne @ 15:

Oh, dear, I do get dyslexic when I'm tired. Time to go to sleep before the gods, er, dogs get up and want to go out.

Regarding your comment, "It strikes me, too, that the defining moment (if you can speak of two centuries as a 'moment') that made Western European civilization what it is, was the simultaneous discovery/dissemination of tea, coffee, chocolate, and clockwork on the continent," I would recommend _The Empire of Tea_, by Alan MacFarlane and Iris MacFarlane, which posits this very notion, at least with regards to tea. I found it an interesting afternoon's reading.

The LD50 for theobromine for humans is about 1 gram per kilogram body weight.

This whole discussion makes me see Death By Chocolate in a whole 'nuther light.

The gnomes want all the chocolate. All Of The Chocolate.

In my youth, there was a series of televised debates in which teams of comedians spoke for and against various topics, with the late great Campbell McComas moderating.

A moment that has stuck in my memory: a speaker for the proposition "That Too Much Science Is Bad For You" - I think was either Jean Kittson or Wendy Harmer - saying, with splendid exasperation, "Of course too much Science is bad for you. That is what 'too much' means."

I note that the pattern of that "defining moment" list is a whole lotta stimulants... and accurate timekeeping. ("I'm late, I'm late! For a very important date!")

I'd say it should probably include white sugar as well -- addictive enough that wars have been fought over it.

Pendrift #21: The question is whether that LD50 for "baker's chocolate" is calculated only for the theobromine, or includes the caffeine as well.

My bet is that someone tested dosages of actual (content-calibrated) chocolate for appropriate (chocolate-"tolerant") rodents, then scaled to human levels. Such scaling is not linear, but the appropriate curves are well-known to toxicologists.

And yes, swallowing five kilos of anything at a sitting is going to be a major challenge to the human body.

Pre-eighteenth-century, say, people drank beer, wine, and cider all day long. By the nineteenth century, people drank tea and coffee all day long. I've heard it suggested that the Industrial Revolution is the result of entire societies switching from depressants to stimulants simultaneously.

Gosh, how can you leave out *tobacco*?

In my RSS reader, this post gets truncated after "It is with great regret that I inform you". My initial thought, before clicking through, was "Oh no! Some poor dog or cat got into some chocolate!" Glad to be proven wrong.

Ahem, some bibliography:

http://www.amazon.com/Sweetness-Power-Place-Modern-History/dp/0140092331

Ok, that's all. I could go on. :)

Mintz makes the pretty intense argument that the moment English factor workers decided to stir sugar into their tea, the world changed.

Some people are going to take this number as a target.

Sugar (and tea) of course are old world foods.

Er, Jim, chocolatl, as the Aztecs called it, was first encountered by Europeans as a cultivated crop in its native ground of Mexico and Central America. Unless they've moved since the map on my office wall was printed, those are located in North America.

Obviously we're talking about pure cocoa product here, 100% chocolate, and ignoring the milk and sugar and assorted fats the pushers cut it with to make it palatable to kids.

So what's the standard recreational dose of cocoa solids?

A small US Hershey bar weighs about 43g, and its 11% chocolate, so about 5g. That might be a typical dose for someone not addicted yet. Here in Britain the most common chocolate is probably the 120g bar of Cadbury's Dairy Milk. That's 20-26% chocolate (different recipies for different formats) so lets say 28g of chocolate in the bar. A real cocoa junkie might eat a whole 100g bar of 70% chocolate at a sitting. 70 grams of the drug itself! And some will stretch to 80% or 90%.

So the LD50 is anything from 50 to 1000 times a normal recreational dose. Which probably makes chocolate about as safe to eat as spinach and safer than apples but not as dangerous as rhubarb and nowhere near as dangerous as potatoes ;-)

I'm not up-to-date, but a few years ago there were infinitely more documented cases of death from overdose of carrots in the UK than from overdose of cannabis. That is any at all as opposed to none.

Yes, Jim, you're not the first to connect the Enlightenment with the switch from socializing over alcohol to having the option of socializing over stimulants, especially the combination of coffee (stimulant one is inclined to linger over) and tobacco (stimulant that also aids mental clarity and acuity), combined with the growth of a middle class with sufficient leisure to sit around drinking coffee, smoking, and shooting the breeze.

I have long wondered how the heck the Romans managed to wake up enough to build an empire, without tea or coffee. Hot vinegar just doesn't cut it . . .

we had a dog among the Easter chocolate last year, like Bruce I spent some quality time calculating dog weight, theobromine dosage, etc etc.
For information, the Merck Vet manual was the best single source. There's not much one can do as a home remedy, activated charcoal is about it.

My calculations suggested the pup had a non-lethal dose. Since I already knew his usual resting heart rate (from helping #2 son with a science fair project) I could tell his HR while elevated was not extreme. This being a Sunday evening of course, since all child/dog medical emergencies always happen in ER-only hours, we just gave him plenty to drink and walked him around until he stopped jittering.

I seem to remember that the LD50 for tabasco sauce is about a liter. I think you'd WISH you were dead a lot sooner than that.

rea @ 35:

Um .... you've clearly never wandered into the kitchen just after waking and accidentally had a drink from the pitcher of photographic fixative (dilute acetic acid) in the refrigerator while intending to get the chilled water. Wakes you right up, it does.

Don't remember where I read it, but as I understand it David Harmon is on to something with the sugar comment. Chocolate and coffee, at least, were just bitter, gritty drinks consumed only by new world aboriginals until they were combined with newly plentiful white sugar in the 18th century.

Slavery and rum were also involved.

Not sure how I can work chocolate, sugar, slaves and rum into the manufacture of fine clockwork though. I suppose the clockwork did eventually make navigating off to fetch them somewhat more convenient.

So, if the LD50 of theobromine is about 1 gram per kilogram of body weight, and the theobromine content of chocolate is in the range of 2-10% depending on how dark the chocolate is (yes, Wikipedia, but it'll do as a ballpark figure), my danger point would be around 700 grams for the dark chocolate, up to 3 kg of milk chocolate. Which is quite a bit less than I'd have thought: 5 kg of chocolate is an entirely implausible amount for me to eat, whereas 700 grams is only a stupidly unreasonable one.

The calculations are based on my body weight because that's of most immediate interest to me. If you only know your weight in pounds, google is happy to convert.

jack lecou @38:

Don't remember where I read it, but as I understand it David Harmon is on to something with the sugar comment. Chocolate and coffee, at least, were just bitter, gritty drinks consumed only by new world aboriginals until they were combined with newly plentiful white sugar in the 18th century.

Wherever it was that you read that, I wouldn't be inclined to believe much of anything it says, given that coffee is an Old World plant (most likely originating in either Yemen or Ethiopia).

Besides, for many people coffee is by preference still a bitter drink consumed without sweeteners.

Hmm. Good point. Maybe it was just chocolate.

jack lecou, I think Thomas Pynchon wrote that novel already. One adventure in Mason & Dixon is going to St. Helena to watch a clock that will then be compared to a clock on the other side of the world somehow. It was some big part of the advancement of science. There is a lot of timekeeping. The slaves, rum, chocolate, and sugar are in the rest of the story.

It makes me imagine old Miami Vice episodes where smugglers would hurriedly toss keys of cocaine off their fancy boats and speed off in the darkness, under the hauntingly baroque tones of a Yamaha DX7.

Maybe there'd be an episode where Crockett would have to snort a line of "pure, un-cut dutch processed..." in order to maintain his cover, but the rest of the episode would center around his guilt and angst, and Lt. Castillo would just stare past him, shaking his head disappointedly when he saw signs of melted Hershey's Special Dark near his nostrils. He'd call Crockett in, neon blue light diluted through the glass block walls of his office, slam the door and mumble "It's bad enough I have a cop strung out on 'cao, but now you're getting the cheap stuff from the low-life street dealers." Crockett would go out on un-paid leave and brood on his boat with his alligator, finally angrily flushing brownie mix down his boat toilet while Hans Zimmer played a medley of previous leit-motifs on the Rhodes.

Goddammit, now I want a cupcake. And possibly to listen to some Duran Duran.

I guess all those restaurants that have "Death by Chocolate Cake" on their menus now have a goal to work towards.

@lorax #40:

Besides, for many people coffee is by preference still a bitter drink consumed without sweeteners.

But what if your sweetener of preference is chocolate? (Unlike my brother, who has taken his coffee black since at least 7th grade, and probably earlier.) (Sayeth she who likes her tea black and strong enough to sit up on its own.)

Ian Osmond@28

Aha - at long last an explanation for the early industrialization of the Ottoman empire.

@43--Have you read much Kage Baker? For her immortal cyborgs, chocolate is an intoxicating drug . . .

@37--yeah, I can see how hot vineger in the morning would certainly wake you up--but for me, at least, the wakeup would be followed by thoughts of self-destruction rather than world conquest.

I'm very amused; my Amazing Girlfriend and I bought a 5kg bar of 71% Callebaut last weekend... but it's not for consumption in a single sitting. It'll likely last us 12-18mo for baking.

For chocolate as a mind-altering substance, check out Kage Baker's Company series. The Company's time-traveling immortal employees are bioengineered in such a way that alcohol and conventional human drugs have very limited effect on them, but theobromine gets them high. There's a wonderful scene in The Graveyard Game where two immortals get totally stoned at Ghirardelli Square. By the end they're snorting lines of cocoa powder off the table.

Oops - I didn't see Rea's post at #48 when I posted! Count my post as a second recommendation for Kage Baker, then.

(if you can speak of two centuries as a “moment”)
uh, yeah
chocolate = post-Columbus=1492+
coffee = last siege of Vienna* = 1683

* not 1529. I checked.

Maia found, actually, that she was far more awake when she switched to decaf tea.

The caffeine was merely bringing her back to a state of wakefulness. When she cut it out, there was no crash from it's absence, and she woke up quite awake.

When I was eleven, I discovered my mother was keeping a whole enormous bar of chocolate in the pantry. Unannounced! Unbeknownst! Unguarded! So first chance I had, I nipped back there and chomped off a big square of the stuff, right from the bar.

My mouth turned inside out. It was baking chocolate, just cocoa and a little fat to hold it together, and not even semi-sweet.

I carefully rewrapped the bar and put it back, lesson learned. If a food-pilfering kid couldn't choke down an ounce, I can't imagine anyone managing to get through kilos of the stuff!

(That pantry, it was perilous. When my folks moved in 2004, Mom cleaned it out and gave me a cake mix that, on inspection, turned out to have been made in 1983. Which means it was already six years expired when she moved with it into the house in '89. Sometimes I think I should have sold it on eBay instead of throwing it away.)

Singing Wren@46 But what if your sweetener of preference is chocolate? [...] (Sayeth she who likes her tea black and strong enough to sit up on its own.)

I thought cocoa with a bit of coffee added was the gateway drug to drinking coffee with milk, and later black? Certainly was for me. (And really, if the spoon falls over, that means the coffee wasn't strong enough, unless it's falling over because it melted.)

David Goldfarb - Guittard
Yum. My standard recipe for hot chocolate is to melt Guittard bittersweet chocolate chips in the microwave with a bit of water, stir, then add milk and heat until almost boiling. Most other chocolate chips are too sweet for me, and my local market often only carries the semisweet.

skzb: LD50 = "Lethal Dose 50%" - the dose (in milligrams/Kg of body weight) of a given substance that kills 50% of the sample population exposed to it. Note that the LD50 for a given substance differs between species because we may have wildly different metabolic processes; rats are incredibly alcohol tolerant, cats and dogs are poisoned by chocolate, and so on.

Also of note is the ED50, or "Effective Dose 50%" - not used so much in pharmacology these decades, but it's the dose at which 50% of the sample population exposed to it will display signs of being effective.

And then we have the handy term Therapeutic Index; the TI of a given drug substance is the ratio between the Effective Dose and the dosage level at which harmful side effects (usually short of death :) cut in. A narrow TI -- say, 2.0 -- means that you go from "this has no effect on me" to "oh dear, I feel really ill" simply by doubling the dose. A wide TI -- say, 1000 -- means you have to take a thousand times the minimum effective dose to start feeling unwell. Chocolate is an example of a substance containing a drug (theobromine) with a relatively wide TI. Warfarin -- if you've ever known anyone being prescribed it as an anti-thrombotic agent after a TIA or stroke -- has such a narrow TI that frequent blood monitoring is required to prescribe it [relatively] safely. And so on.

Interestingly, caffeine is pretty toxic; the LD50 in humans is approximately 150-200mg/Kg of body weight, or around 50-100 shots of espresso ... however, some antibiotics suppress the liver enzyme that metabolizes the stuff, cutting the LD50 by around 80%. People have been known to die of a coffee overdose!

Charlie--

Which antibiotics?

Vicki: per wikipedia (I am so rusty that my copy of the BNF is 11 years out of date) levofloxacin is a big no-no with caffeine. However, if you're on that stuff you're probably in hospital with a life-threatening infection.

More worryingly, the SSRI anti-depressant fluvoxamine also inhibits these enzymes (heavy caffeine users may experience insomnia and irritability) -- and there are issues with smoking and fluvoxamine. (Fluvoxamine came along some years after I quit doing this stuff for a living, so I'm not even rusty in this particular area.)

Ah... 'minds me of the time:

1. Haägen-Dasz Chocolate Decadence (slice of chocolate, wedge of chocolate on top, choc icing, scoop of choc ice cream)
2. A slice or two of the family Tactical Nuclear Chocolate Cake
3. Two or more handfuls of M&Ms

Spent several hours in bed that night with my skull feeling too small for my brain, the room spinning, and not quite feeling like I wanted to throw up.

Rymenhild #50: It occurs to me that sort of thing could easily blow an agent's cover.

Charlie Stross #56: Tylenol is pretty nasty too -- IIRC, its Therapeutic Ratio is around 5 or so, and it doesn't take much alcohol to drop that below 1. (Competition for a liver pathway.)

I've been known to drink chocolate with my coffee too -- these days, mostly via Ovaltine powder, but I used to use fancy cocoa mixes. This despite the point that I don't really "get" chocolate as an addictive substance (but I do drink my coffee light and sweet. Except for some places' espresso.)

I've just remembered the two 10 pound bars of chocolate (one milk, one dark) I bought at Trader Joe's awhile back. Over the last couple of years I've eaten a couple of pounds, and then just forgotten about it (it's not exactly the best chocolate ever). So I probably have at least one lethal dose right here. Now what would Dorothy Sayers have done with that?

Bruce Cohen @ 38

That'd be stop bath, actually. It neutralizes the alkaline developer, which stops development and extends the fixer's usable life. It's not strictly necessary, some photographers prefer using a water rinse. Since the indicator dye is orange I can see drinking it by accident when sleepily finding it the fridge. Which is one reason why I wouldn't keep it in the fridge in the first place.

And speaking of caffeine, you can make photographic developer using instant coffee and washing soda. I haven't tried it (yet).

Reliable clockwork, and reliably working clocks, also allowed people to subdivide a working hour, and to make and keep appointments with a finer degree of exactitude than "sometime before noon." (The canonical hours, for those places with bells to ring them, still didn't break things down as far as into single 60-minute hours.) In a pre-clockwork world, any gathering of two or more people with the intent to transact business could only be scheduled approximately.

Charlie Stross @56: TIA, stroke, or embolism -- my wife was hospitalized for a pulmonary embolism less than a month before the deadline for turning in her dissertation. Probably a good thing that it happened when it did, and not, say, two weeks later. Anyway, she was on warfarin for some months after that.

@Bill Stewart #55:
I thought cocoa with a bit of coffee added was the gateway drug to drinking coffee with milk, and later black?

Despite my fondness for strong black tea, there's something about the taste of coffee that I just never developed a taste for, even with copious amounts of chocolate.

My joke is that I only drink coffee medicinally. The old home remedy about drinking coffee for an asthma attack? Works because one of the components in coffee (not the caffeine) acts as a bronchial dilator. It also works on non-asthmatic chest congestion, so that's when I'm most likely to have a coffee-containing beverage.

Singing Wren (65): one of the components in coffee (not the caffeine) acts as a bronchial dilator

Is that something one can get from another source? (And if so, is it safe to self-dose?) Because I can't even stand to smell* coffee, let alone actually drink any.

*the odor of brewing coffee will drive me out of the room, lest I become violently ill

@Mary Aileen #66:

It could be the theobromine, but I honestly don't remember any more. Ordinary packets of hot chocolate don't provide the same effect as a packet of hot chocolate with about a third of the water replaced with black coffee.

Perhaps hot chocolate made from a good dark chocolate (rather than milk chocolate flavor cocoa packets) would work? I would recommend a hot beverage over solid chocolate, as the steam is also helpful in loosening upper respiratory congestion.

Singing Wren (67): Thanks. I'll have to decide if it's worth burning my tongue on the hot liquid.

No, really. I can (usually) eat soup without incident, but drinking hot liquids invariably leaves me with a burned tongue. Sometimes--every few years--I decide that hot chocolate is worth it.

Mary Aileen @68: What I've found works fairly well for hot drinks is using about 3/4 the recommended amount of very hot water (or a little less) to make the drink, then making up the balance with chilled water straight from the refrigerator. This puts the overall temperature below tongue-scalding, but still pleasantly hot. I'm not sure how this would affect the vapor effects.

"Tea, Coffee, Chocolate, and Clockwork" - I'd buy that steampunk anthology in a heartbeat.

Singing Wren @67: It could be the theobromine, but I honestly don't remember any more.

Theophylline, I believe. Leastways, that was what was in the inhaler a friend of mine used when her asthma would kick up. I vaguely recall hearing somewhere that raspberry-leaf tea gives a nice theophylline kick.

Chris @69: temperature below tongue-scalding

Or, you could live at altitude. It's really hard to get water hot enough for my taste in Boulder. (I mostly don't bother with hot tea in restaurants.) At home, water at a rolling boil is what goes into my tea cup. At work, I get water out of the dispenser, and then nuke it for 30 seconds. I do occassionally scald my tongue, but I prefer that over tepid tea.

Half way though calculating how much dark chocolate I could eat it occurred to me that I did not really want to use the LD50 (one in two) value. I'm a big fan of chocolate, so I might just limit myself to a dose that kills one in thousand.

Even lightheartedly considering what sort of risk I would take in order to eat chocolate is an interesting exercise. Hmm, perhaps one in a hundred.

Chris (69)/Jacque (71): The only thing that's ever worked for me is drinking the hot chocolate* outside on a very cold day.

*hot chocolate being the only hot drink I have any interest in whatsoever

This has served to remind me that there are still a few bites left of my chocolate Easter bunny. I'm going to have to do something about that.....

Singing Wren @ #65: actually, it seems it is the caffeine:
http://www.ncbi.nlm.nih.gov/pubmed/3948545
http://summaries.cochrane.org/CD001112/the-effect-of-caffeine-in-people-with-asthma

David Harmon @60: After helping treat a cat which had been intentionally dosed/accidentally poisoned with paracetamol (Tylanol, acetaminophen) I wrote it up for my final-year case book. I calculated that the minimum LD for me (48 kg bodyweight) would be eight standard-strength paracetamol taken at one time (4 x standard dose). Scares me silly the number of things that contain it - cold remedies etc.- that someone could accidentally overdose far too easily: take paracetamol plus cold remedy, wake up an hour later thinking it's eight hours later, repeat... And yes, it happens (non-accidentally as well - but that's a whole other problem).

Bruce Cohen (Speaker to Managers) @14: my MIL's terrier managed to eat a 1/4 pound of dark Belgian chocolate a while back. I did the calculations and didn't like the results so I went over there and poured salt water and mustard down his throat until he up-chucked it. Of course, he then tried to eat it again... My SIL's terrier managed to get a half-bar of 85% cocoa dark chocolate a while later, but by the time I came across the evidence (uneaten but slightly chewed wrapper) it was too late to do that to any good effect - he wasn't very well, but he survived, thankfully.

At least cats don't tend to scavenge that sort of stuff. Ours will go for cereal products (bread, breakfast cereals) but not chocolate.

heckblazer @ 62:

Right. I'm a little hazy on the details, as that happened to me back in 1968, and I haven't done any darkroom work in several decades now. I was staying at a friend's apartment for a couple of days, and the stop bath was his, which is why I made the mistake. But I sure do remember the taste.

dcb #76: non-accidentally as well - but that's a whole other problem

Yeah. On a mailing list I used to run, there was some discussion about the best/worst methods of suicide. Among the "practical" methods, massive Tylenol overdose was hands-down the worst: no symptoms to speak of for 10-12 hours, by the end of which your liver is destroyed. Then two weeks of agony before you actually die....

Bruce @78

Somewhat related - a number of years ago at a reenactment site (an 1870's farm), the ladies had been making shrub, fruit vinegar drink. I wandered in afterwards, thought mine tasted strongly vinegar, so topped it up from the jug on the table that I thought was water. It was more vinegar. Ingesting half a cup or so of vinegar on a hot day is not very refreshing. I don't think I upchucked, but it was close. Stop bath would be more palatable.

I did wind up tasting a few of those chemicals, siphoning by mouth (bad habit). Mostly bad tastes. I got some of my bad habits from my father, who was a chemist and chemical engineer and later science teacher from the 1940s through about 1975. That fact that he died of liver cancer (in his 70's) is probably attributable to what used to be acceptable lab practice and levels of exposure.

Benzene and carbon tet, even methyl-ethyl-ketone, are now viewed (correctly) as quite hazardous, but used to be handled very casually.

Even simple post-lab hand washing wasn't made mandatory through my university days in the 1980s. (Nor wood and metal shop, lubricants can be nasty.)

(Wash your hands! Everything your mother told you about horrible things if you don't wash your hands is completely true!)

My partner looked up the LD50 for distilled water and says it's only slightly less toxic than chocolate -- 6.6 kilos as opposed to 5. That's about 6½ liters of water, which is certainly more than most people would drink in a day -- but for those working in the heat and sweating out electrolytes, it gets riskier.

Ulrika, #34: It might be much simpler than that. When did safe drinking water supplies become common? Once people no longer had to drink alcohol to avoid cholera and dysentery, new societal dynamics would result.

Jacque, #59: Eep! There's a reason that when I send out my Chocolate Decadence invitations, they say "bring something chocolate or fruit", and why we always provide salty snacks. The first year I had the party we had nothing but chocolate, and everybody got well and truly chocolated out after a couple of hours!

Mary Aileen, #66: You're not alone. "Mocha" to me is a synonym for "perfectly good chocolate ruined".

Matthew, #70: Ooh, so would I!

I remember doing a dessert party a few years ago... and having my friends complain of chocolate/sugar hangovers on the following Monday.

Lee @81: One thing I'm surprised isn't available at your Chocolate Decadence parties is milk. Chocolate always makes me thirsty for milk specifically (as opposed to water, fruit juice, or soda).

Instant hot chocolate, mixed with hot coffee instead of hot water. Definitely a gateway drug for a child to develop a coffee habit as an adult. And probably the only gateway drug that kids are routinely introduced to at church, during the coffee hour between service and Sunday school.

Henry Troup @ 8):

Many chemists, chemical engineers, and chemical process techs were horribly casual with really very nasty substances in the mid-20th century. When polyvinylchloride was mass produced in the 1950s, the cleanup crews were told to climb into the reactor tanks to clean them out without gloves and masks because it was good for them! There were a lot of cases of liver disease and liver cancer from the precursors and additives to the PVC left in the tanks in the next few decades.

I recently (as in, I think within 2012) read an article about fatal paracetemol (acetominophen) poisoning in people who took slightly over the safe dose for weeks at a time. Slightly meaning people using as little as 4.5 or 5 grams per day for a few weeks. (I think this was on the BBC news website.)

Things like that are another piece of why I try to avoid the stuff unless I'm at the point where I want to take the maximum reasonable dose of an NSAID every four hours, and add some amount of acetominophen every four hours, displaced by two hours. (E.g. Advil at 8 a.m., Tylenol 10, Advil noon, Tylenol 2 or 3.) Not that NSAIDs are guaranteed safe, but the risk seems significantly lower, even for someone like me who consumes very little alcohol. That's along with trying to avoid medications that pre-mix Tylenol with other things.

Post-surgery a few years ago, the narcotic prescription painkillers had tylenol mixed in, but if I just have a cough I'll take a cough suppressant that is just a cough suppressant, not an all-in-one syrup. The last time this came up,I had to go to the "children's medicine" section of the drugstore. And was then asked to prove I was over 18, in order to buy a medicine that was explicitly labeled as safe for small children.

[This comment visited us because you omitted the space after one of your commas. It's a small thing, but it cuts out a lot of spam -- Roquat Rufus, Rex Gnomi]

I'm being gnomed, I think because of mentioning other things that are sometimes mixed with paracetemol in medication.

Back when our family had a dog (small/medium beagle and pointer mix), he ate an entire bag of Nestle's semi-sweet chocolate chips. This was before chocolate was widely known to be toxic to dogs and cats. He promptly vomited it all up, barely melted (luckily that is the way dogs swallow their food, without chewing).

Lindt now offers 70%, 85%, and 90% cocoa chocolate bars. 90% is basically baking chocolate, only with a better texture.

Vicki: Not that NSAIDs are guaranteed safe, but the risk seems significantly lower,

Oh, it is. I suspect the only reason there hasn't been a movement to make Tylenol prescription-only (it certainly wouldn't have been approved OTC today) is because there are people who can't take aspirin or ibuprofen for other reasons. (Anticoagulant and kidney loader respectively, there may be other issues as well.)

Also an astounding amount of advertising (from TV to doctors' waiting rooms) in the US, evidently intended to make the original OTC brand seem so indispensable to consumers that they would fight attempts to make it prescription only. I think they know it's coming.

89
NSAIDs can have funny effects when mixed with prescription drugs. (The antidepressant I'm taking specifically mentions aspirin and ibuprofen, but not acetaminophen.)

David G., #83: Remind me about this next year. We don't drink that much milk ourselves*, and I just never thought of it -- but for a specific request, it's no trouble to make sure we have some.

* As in, I don't drink unadulterated milk at all because the taste makes me gag, and Russ doesn't drink enough to make it worth buying large quantities.

Acetaminophen is also the only common painkiller they consider consistently safe for use in pregnancy. (I have contradictory advice for postpartum-but-breastfeeding on Naproxen/Aleve, in that at least one book named it specifically to avoid, but the hospital gave it *and* my ob/gyn prescribed it. Otherwise, it's the same for nursing.) I distrust the stuff for the reasons stated, but I still used it when I had to. Of course, my idea of when I have to is fairly strict.

geekosaur #90: All the advertising in the world won't help if the FTC "offered" to make the manufacturer liable for the liver damage, or similar hardass tactics. Also, the FTC can put out ads too... probably scarier ones.

That said, I don't actually expect them to force it behind the counter, because, again, all the various pain relievers have their own tradeoffs, and there are a significant number of people who need acetaminophen for ordinary use. On the other hand, I wouldn't be surprised if the FTC eventually slapped the company for that advertising.

Geekosaur @90, David Harmon @94: that's one of the huge triggers for cognitive dissonance I experience when visiting the USA -- at least, the dense coastal cities that don't feel culturally too alien to what I'm used to; that advertising prescription-only medication is even legal!

(Here in the UK it is legal only in medical journals aimed at practitioners -- doctors and pharmacists -- and even then, it's very tightly regulated. Even the "ask your practitioner" ads would be flat-out illegal over here. And this may well be a very good thing because, if I remember correctly, we have a significantly lower rate of iatrogenic disease and death from adverse drug reactions than the US.)

Charlie Stross #95: Oh, definitely -- we used to have similar restrictions, but a few years back, the pharma companies bought their way out of them.

Vicki @86 is indeed correct. Acetaminophen, aka Paracetamol, like most drugs, is metabolized and excreted at a fairly constant rate -- we can talk about its metabolic half-life (the time taken for the blood serum level of a drug to decline by 50%). In the case of paracetamol, its half-life is 1-2 hours, so taking doses 6 hours apart should be safe (6 hours = 1 hour for absorption followed by 2.5-5 half-lives, so after 6 hours the serum concentration should have dropped to no more than 20% of the level it was at 1 hour after taking the previous dose). However: suppose you take the doses at six hour intervals. At initial dose time plus 7 hours, i.e. an hour after dose #2, your serum level will be 100-120% of what it was after dose #1. If you then take another dose, at 13 hours you may have a serum level somewhere between 100% and, in extremis, 140% of what it was an hour after dose 1. The baseline level of paracetamol in your circulation slowly builds up if you take it too frequently.

Of course, most folks don't religiously stick to six hour intervals. They maybe take the first dose of the second day a couple of hours late, by spending eight hours in bed/sleeping. That gives an extra half-life, which is enough to re-set the accumulator almost back to zero.

The problems start if you have someone who thinks "four times a day" means every four hours while they're awake, and then doesn't sleep in regularly or otherwise give their liver an extended break. It's not common, but it does appear to be a killer: the original paper seems to be paywalled, but here's a BBC news story.

Narcotic painkillers are often mixed with Tylenol/Paracetamol to make it harder to abuse them, and I gather this leads to a certain number of deaths by liver failure from people who took too much of their medicine when they were in a lot of pain. It's hard to express how completely f--ked up this seems to me. (But then, we poison dogs and kids in order to keep people from evading taxes on liquor, too.)

One unanticipated benefit of direct to consumer advertising of prescribed meds is the often unintended humor of the ads themselves. When I prescribe what we call, in my office, affectionately, pick-me-up drugs for imp*tence,(1) I tell the patient, oh by the way, the ads aren't kidding when they say to call your doctor if you go deaf or blind. How they're supposed to find the phone or hear me telling them to go to emergency is beyond me.

(1)I'm hoping to avoid adding to your amazing amount of spambots.

I once brought 60kg of chocolate back from a science fiction convention in Jersey.
(Only 5kg of it was mine - several friends were flying, but I was taking the ferry with a car, and someone I'd given a lift there was going back a different route so I had spare space.
And I didn't eat my 5kg bar in a single sitting....
Several people did buy 5kg each of white, milk, and plain. (Yes, I know white "chocolate" is technically not chocolate by some definitions.))

I am somewhat alarmed at what I am reading here about acetaminophen. My baby just got over a persistent fever, which we had been treating at four hour intervals. 3.6mg of liquid suspension. The current concentration is 160mg per 5ml of suspension, and she only weighs 18-19 pounds.

Ironically, our pediatrician prefers it to ibuprofen, since IB is "hard on the stomach"
I think I'll have to spend some time doing math to see how dangerous that dose is. *

*our situation was complicated by the fact that she was due for her quarterly checkup, and so we'd started with a 3ml dose based on her previous weight at her last check. This was ineffective at reducing her fever, but seems to represent a danger point for uncautious parents. Also worthy of note that in late 2011, the concentration for infants was changed to align with childeren. I forget which direction it went in, but there was an opporultunity for error there that they closed up. The dose per weight lines up with the non- infant ibuprofen now too, which is somewhat helpful too.

albatross 98: Narcotic painkillers are often mixed with [acetaminophen]/Paracetamol to make it harder to abuse them

That's not why. It's because opioids and acetiminophen (and NSAIDS) synergize, so that relatively small doses of opioids can be given to the same effect that large doses without the OTC combination would have.

As for poisonings, an FDA panel voted in 2009 to ban these combo drugs and put other restrictions on acetaminophen, including reducing the maximum daily dose. In a rare move, the FDA declined to do so. You can guess why.

Kimiko @101: I am not [currently] a [up to date, licensed] pharmacist. However: the 3.6ml of oral suspension you describe should contain 100mg of acetaminophen. Body weight ... around 8kg. That's equivalent to 1000mg for an 80kg adult, which is to say, two 500mg tablets. As long as you don't keep it up for several consecutive days your baby therefore ought to be okay.

Note that neonatal drug metabolism differs from adults in some significant ways, so I can't guarantee this is safe.

Ibuprofen and aspirin are contraindicated -- in the UK -- in neonates and infants under 10; rare life-threatening complications may occur. (I'm too out of date to give you an authoritative statement on this, however.)

I'd talk to your paediatrician if you've got any worries at all about the dosage. But it doesn't sound far enough out of the norm to set my alarm bells ringing loudly.

Aspirin in children: that's a no-no due to the risk of Reye's syndrome if taken by a child with a viral infection. Rare, but very serious if it happens.

There's this rare condition called Reye* Syndrome that sometimes results from aspirin ingestion in children and adolescents. The Glyraby brand of acetaminophen made a big deal out of this for a while, but then there was one (disputed) study suggesting that acetaminophen caused the problem too, and nobody much talks about Reye Syndrome any more.

*Well, Reye's, but I'm told the current thinking is to stop using the possessives for these disease/syndrome names, hence Reye Syndrome, Asperger Syndrome (not a disease), Parkinson Disease, etc.

Crossposted with dcb. dcb, remember "Baby Aspirin"? Cute little orange-flavored pills. Even without Reye syndrome..what were they thinking?!?!?

Xopher #106: And ironically, that same quarter-dose asprin is now being sold for senior citizens....

There's increasing evidence that acetaminophen may be behind the rise in childhood asthma. Some doctors are now recommending ibuprofen for children, instead.

Until we learn what's awful about that, I suppose.

Xopher Halftongue#102

albatross 98: Narcotic painkillers are often mixed with [acetaminophen]/Paracetamol to make it harder to abuse them

That's not why. It's because opioids and acetiminophen (and NSAIDS) synergize, so that relatively small doses of opioids can be given to the same effect that large doses without the OTC combination would have.

Actually, albatross is partly right.

The synergy thing is definitely true and part of standard pain relief practice. The FDA advisory committees, as Xopher says, are worried about the overdose and don't like the fixed combinations

However, the DEA does make it significantly easier to prescribe combos of opioids and acetaminophen, because of the lower abuse potential. That does affect the FDAs thinking, because it affects how the medication can really be used.

As is often the case, there's interesting and informative discussion in the transcript of the FDA advisory board meeting. FDA advisory boards, by and large, are one of the good things about the US government.

I've had morphine for pain-killing purposes

Some of the dreams while I was in intensive care were interesting, but I don't think the dreams were worth the constipation.

Thank you Charlie, that is both informative and helpful.

Just a pedantic note: Acetaminophen (or Paracetamol) is not an NSAID, although it is used like one. This medication is known to adversely affect the liver, particularly in combination with alcohol, and this can happen at seemingly "safe" doses. NSAIDs, on the other hand, use a different physiologic pathway and generally do not have adverse interactions with alcohols, but this is not something one should push. The unwanted (not side) effects of aspirin/acetylsalicylic acid would probably cause it to be not an OTC drug in today's world, even without the entire Reye's Syndrome (sorry, Xopher, learned it the old way) issue.

Note: Although I am a veterinarian and did my Master's in Toxicology, I am not offering any medication information, just general information about NSAIDs and Acetaminophen.

Tim Smith @72: Even lightheartedly considering what sort of risk I would take in order to eat chocolate is an interesting exercise. Hmm, perhaps one in a hundred.

I dunno. I lurves me some chocolate, but having experienced a non-fatal overdose, I'm pretty confident I don't want to do that again.

Lee @81: "Mocha" to me is a synonym for "perfectly good chocolate ruined".

I'm not a coffee fan, but I can pack away truly ridiculous amounts of coffee Haägen-Dazs. (Harkens back to the one time I was allowed coffee as a kid—on camping trips: equal parts coffee, milk, and sugar.)

Kimiko @101: My baby just got over a persistent fever

I was under the impression that acetaminophen was not effective in reducing fever? (I ask because I don't use the stuff, as it is entirely ineffective for me for any use.)

Acetominaphen is definitely not an NSAID; I can't take NSAIDs or aspirin without getting a ringing in the ears, a tingling in the fingertips, and a general feeling of disconnectedness. Acetominaphen does none of that to me and remains my drug of choice despite the liver toxicity stuff. I'm careful about dosing though often worried. I'd be happy to know of an alternative that might work without making me feel like I'm dying.

While I agree that attempts to make it acetominaphen prescription-only are unlikely to succeed, I've seen suggestions to require that it be sold in blister packs, rather than bottles, to make it harder for someone to accidentally shake out and gulp down an extra pill and to subliminally suggest that "dosage really matters here". I'm not sure how much good they'd do, but to me it seems be a case of "can't hurt, and I don't really see the downside" (other than increased cost, I suppose). I'd also very much like to see sales of other acetominaphen-containing products made prescription-only; lots of accidental overdoses are not from people taking too many Tylenol, but from taking a variety of medications each of which contains acetominaphen.

Melissa: If you're aware of the overdose potential and stick to the safe dose (and don't keep on with the max dose day after day after day) you should be fine. If you are feeling groggy (so might start mis-remembering number of doses) then start each day with a strip of eight tablets (assuming you're using standard dose tablets, two four times a day) and if you come to take more and you've already finished the strip, you know you took them already! - Or if you buy them loose in a larger container, decant the day's supply into a small pill box or whatever for the same double-check.

dcb: Most of the time, one dose--two at the most--will banish a headache. In that case, when I take the initial dose, I set an alarm on my phone to ring the appropriate number of hours later for the second dose.

When I am sick and using meds all day for discomfort/fever, when I take the first dose in the AM, I sit down and figure out how many hours I am likely to be awake that day, and then determine when the next three doses should be taken. Then I program my phone to remind me of each dose. I do the same thing with any medication that must be taken--cough medication, antibiotics, etc. Each medication gets an alarm of its own.

When the phone alarm goes off, I check to see what med is required and then take it.

That way I don't skip doses or think I've taken it when I haven't and don't take things too early/close together.

Before phones, I would carry a piece of paper with a column for each med and dosing times written down, and I'd cross out each time when I took the medication.

When I had pneumonia (about 18 years ago), I set an alarm for the middle of the night to get the spacing on the antibiotics right, because I was sleeping at weird times and for weird numbers of hours and couldn't reliably count on X hours awake.

I know, I'm weird.

Melissa Singer @117: That's not weird, that's organised! (Also, safe and sensible).

Xopher@106, those orange-flavored aspirin nearly killed my husband, long before he was my husband, when he was about three or four. He ate 99 of them (not counting the one he'd been given previously which demonstrated to him that the bottle in the medicine cabinet contained "candy") in one go. He had to have his stomach pumped, and to this day can barely force himself to take a pill of any kind.

(He's the only person I know who, when he got strep throat, asked the college nurse to give him penicillin INJECTIONS rather than pills....)

Cassy, that's approximately what I was referring to when I said "What were they thinking?!?!"

Melissa Singer @117: That is very well organized! I started doing much the same as a vet student (hard to overcome the training at that point), and also use some form of tracking for any patients at home, whether human or non.

CaseyB @119, I'm another one who got my stomach pumped out due to an overdose of the orange-flavored baby aspirin. I don't have a problem taking pills, but to this day, some 50 years later, can't stand anything even close to that particular flavor of orange.

Coming in late:
Many (many many) years ago, as I was standing in the tutoring office at my college, working my way thru a Chunky bar, a self-appointed savior of mankind decided to start yammering in my ear about the evils of chocolate. This was, of course, some years before the benefits of chocolate became well known.

My first thought: You don't have a girlfriend.
Second thought: and with that attitude, you ain't gonna get one.

Never said a word. Yammerer still yammering. My tutoring student walked in, I finished my Chunky, carefully licked my fingers, turned to the SASOM, and said,

Did you know oxygen is addicting?
[small pause]
The withdrawal symptoms will kill you.

And walked out. The tutoring office staff said he stood there for at least five minutes with his mouth hanging open.

it's the dose at which 50% of the sample population exposed to it will display signs of being effective.

Speaking as part of the sample population, I have shown no signs of being effective at any point in the last three years...

ajay @ 124:

I think that should be "affective"; at that dose half the population can crack a smile. At higher doses they all break out laughing.

Vicki @40

700 grams? That can't be right. We went to the Chocolate Salon last year and I'm sure my wife ate at least 700 grams of dark chocolate.

Maybe one can build up a tolerance?