Tylenol to get health warnings on cap in U.S.

Johnson & Johnson says its U.S. bottles of Extra Strength Tylenol will bear a new warning label on the cap to alert users to potentially fatal risks of taking too much of the pain reliever. (Johnson & Johnson/Associated Press)

Bottles of Tylenol sold in the U.S. will come with warning labels on the cap to alert people that the popular painkiller contains acetaminophen that can damage the liver when taken in excess.

Acetaminophen is a medicinal ingredient in more than 470 products, according to Health Canada's online database.

It's also found in more than 600 common over-the-counter and prescription products in the U.S., including brands like Nyquil cold formula, Excedrin pain tablets and Sudafed sinus pills.

The label change is prompted by the concern that people may not realize the risk of overdosing if they take more than one of these products at the same time, or even same day.

The new cap message will read: "Contains acetaminophen" and "Always read the label."

"At this time, the cap text messaging is being introduced on Tylenol bottles sold in the US market based upon a number of factors that are specific to the U.S. market, including the prevalence of simultaneous usage of multiple acetaminophen products by a significant portion of the U.S. adult population," Shelley Kohut, director of communications and public relations at Johnson & Johnson said in an email to CBC News.

"Our commitment is to continue to assess and evaluate the needs of Canadian consumers and to provide information and educate, as appropriate, to support the continued safe and effective use of our products."

Kohut said Tylenol meets Health Canada's 2009 labelling standard for acetaminophen.

The U.S. move comes as Johnson & Johnson faces more than 85 personal injury lawsuits in U.S. federal court that blame Tylenol for liver injuries and deaths. The U.S. Food and Drug Administration is also planning to curtail the use of some acetaminophen products.

Dr. David Juurlink, a drug safety researcher at Sunnybrook Health Sciences Centre in Toronto, said the U.S. change is sensible.

"Almost everyone has this in their medicine cabinet," Juurlink said in an interview. "It's a drug that if taken to excess can cause severe and sometimes fatal liver injury and I'm not sure how widely known that is."

In 2012, Dr. Rod Lim and his team at London Health Sciences Centre reported a case of the 22-day-old boy that they successfully treated in the emergency department at a community hospital after an accidental overdose of acetaminophen.

Identifying all products that contain acetaminophen is useful so parents don't mistakenly give more than one product containing the drug to their child at the same time, Lim said.

"People remember what they take for a single dose. They say, 'I take two tablets,'" Lim said. "The problem is they're used to taking it every four hours but they'll exceed the maximum daily dose within 16 hours. So it's confusing for consumers to think of what they can take and how often and not realize that they can't take it continuously for that day."

For example, taking two, 500-milligram tablets or capsules of acetaminophen every four hours from 8 a.m. to midnight for example adds up to five grams. The maximum dose for a day is 4 grams.

Acetaminophen overdoses occur when the liver is unable to detoxify high doses of the drug and liver failure results. If an overdose occurs, people can do well if they get to a hospital early, Juurlink said.

But Juurlink also fears that the warning changes might also spur deliberate overdoses, which he speculates make up the majority of severe liver injuries from Tylenol that come to medical attention.

In Canada, Tylenol's manufacturer, McNeil Consumer Healthcare, a division of Johnson & Johnson, recently introduced a website to give consumers information on the safe and responsible use of over-the-counter medicines, including products containing acetaminophen.

Gerry Harrington is director of public affairs for Consumer Health Products Canada, which represents manufacturers, marketers, and distributors of consumer health products including over-the-counter medications.

"There are significant differences between the Canadian and American experience with acetaminophen overdose, including a higher fatality rate and a greater incidence of narcotic combination products in the U.S.," Harrington said in an email. "For these reasons, I think it's too early to say whether such an initiative would be appropriate in Canada."

A spokeswoman for Health Canada said the department is aware of the labelling changes in the U.S. and is evaluating them as part of its continual surveillance of acetaminophen products.

Bottles of Extra Strength Tylenol in the U.S. will have the new label starting in October.

With files from The Associated Press, CBC's Amina Zafar and Jill English

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Soft-drink makers accused of using 'Big Tobacco playbook'

Recent studies that cast doubt on the benefits of diet soda and suggest consuming pop can lead to aggression in children come at a time when major soft-drink manufacturers are waging a controversial marketing battle to put a healthy spin on sugar-sweetened beverages.

One of the most proactive is Coca-Cola, which produced ads earlier this year that tout how easy it is to work off the calories in a serving of Coke. A version that aired in the United Kingdom was banned in July by authorities who said it misled consumers.

Canadian obesity expert Yoni Freedhoff says the emphasis on health is "deceptive" and signals a last, desperate attempt to legitimize an industry that is increasingly viewed as a health risk.

"I do think that the writing is on the wall," says the founder of Ottawa's Bariatric Medical Institute and an authority on weight issues. "I don't think there's anything more clear-cut as not good for people, in my mind, than sugar-sweetened beverages. There's nothing nutritionally beneficial about them.

"I think that this really is the Big Tobacco playbook that [soft-drink producers are] playing from."

A controversial New York City department of health ad that was part of a campaign to limit the size of sodas that could be served in restaurants and other facilities. (Reuters)

Freedhoff is referring to an influential paper published in 2009 called The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Written by two obesity researchers — Yale University's Kelly Brownell and Kenneth Warner from the University of Michigan — the paper says that after studies began linking smoking to lung cancer in the 1950s, the cigarette industry stressed the importance of the public's health and promised a number of "good-faith changes."

What followed, say Brownell and Warner, was a prolonged marketing "playbook" that emphasized personal responsibility, paid scientists to deliver dubious research and criticized any science that suggested harms associated with smoking, among other tactics.

David Moran, director of sustainability at Coca-Cola Canada, calls the comparison "unfair and not accurate."

"There's no way that you can consume tobacco in any way that's healthy," says Moran. "But with our products, you can consume them in a healthy, active lifestyle."

Making connections with good health

For a number of years, medical experts have cited soft drinks as one of the leading causes of obesity, diabetes and heart disease.

In June, a study from Purdue University in Indiana suggested that despite their low calories and sugar content, diet soft drinks can still contribute to weight gain and diabetes.

Meanwhile, a U.S. study of preschoolers released on Aug. 16 reported that consuming several servings of pop a day is associated with behaviour problems such as aggression.

At the same time, soft drink manufacturers have in recent years introduced products that advertise nutritional benefits.

In the mid-2000s, Coca-Cola brought out Diet Coke Plus, which the company described as "Diet Coke with Vitamins and Minerals." In 2009, the Dr Pepper Snapple Group introduced a line of 7Up flavours said to contain antioxidants.

In 2008, however, the U.S. Food and Drug Administration ruled that Diet Coke Plus made improper nutritional claims; the drink has since been discontinued in the U.S.

In July, the Dr Pepper Snapple Group agreed to stop fortifying its 7Up drinks with vitamins and claiming they contain antioxidants, after a California consumer filed a federal class action lawsuit.

According to the complaint, the packaging of 7Up varieties such as regular and diet Cherry Antioxidant and Mixed Berry Antioxidant suggested the antioxidant came from fruit, when in fact there is no fruit content in 7Up.

Fighting obesity

Coke's Moran says the marketing approach is slightly different in Canada, because Health Canada has strong restrictions on touting the nutritional value of soft drinks.

Even so, beverage makers have taken a pro-active stance in the fight against obesity. Earlier this year, Coca-Cola Canada launched a campaign called "Coming Together," which aims to raise awareness of ways to reduce weight gain.

Not everyone liked N.Y. Mayor Michael Bloomberg's campaign to limit soft-drink sizes, including a judge who quashed the city law earlier this year. (Kathy Willens / Associated Press)

The company also renewed a partnership with ParticipAction, the national not-for-profit that promotes physical activity.

"Our focus has been a lot on calorie awareness," says Moran, who emphasizes that Coca-Cola also produces lower-calorie products, such as diet drinks and flavoured waters.

Part of the "Coming Together" campaign is an ad called "The Calorie Dictionary," which suggests some simple ways a person could work off the 160 calories in a 13.5-ounce bottle of Coke, including five minutes of skateboarding (45 calories), yelling (13 calories) or demolition work (39 calories).

Freedhoff says the ad is "purposely deceptive," saying it's unclear in the commercial that a person would have to complete a combination of these activities — not just one of them — to work off the serving of Coke.

He adds that diet is much more important than exercise in determining weight gain.

But not everyone is opposed to the ad campaign.

"Healthy living is the issue here, and so calorie-counting is a part of that, and certainly if you start drinking the Big Gulps, your toll is going to go up very quickly," says Michael Mulvey, a marketing professor at the University of Ottawa.

"At least [Coke is] initiating a dialogue — they're showing a partial solution to the problem. In a way, it is offering some balance to the other array of ads that they have that say this is a pause that refreshes or this is a treat or this is a bonding experience."

The art of 'health-haloing'

Claire Tsai, a marketing expert at the Rotman School of Management, concedes that some of the anti-soft drink rhetoric nowadays compares it to cigarettes, but she says there is a critical distinction between the two products.

"The biggest difference between soft drinks and tobacco is that tobacco is linked with lung cancer, a fatal disease, while obesity is linked with other fatal diseases, but it's not the only thing that causes those fatal diseases," she says.

"So it's unlikely that we'll see a class-action lawsuit in the context of soft drinks."

Mulvey adds that "with tobacco, a lot of [the criticism] has been motivated by secondary smoke and all the people that didn't have the choice" in consuming it.

Freedhoff says Coke, like many food and beverage manufacturers, is simply engaging in "health-haloing," a marketing practice in which companies create associations between their products and healthy living.

"These are incredibly savvy marketers, incredibly savvy sales people," says Freedhoff.

"Not having these ads would be better than having them, but [they] are a lesser evil than further vilification of soft drinks by the public and by public health officials."

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Persistent wounds 'a big issue' in Canada

Persistent wounds including diabetic foot ulcers and bedsores can lead to severe complications and are widespread in Canada, but some can be prevented, according to a new report.

The Canadian Institute for Health Information (CIHI) report released Thursday looks at certain wounds that don't heal well.

Reduced blood flow is one of the reasons people with diabetes are more prone to foot ulcers (Lucy Nicholson/Reuters)

"We found that compromised wounds were a big issue," Kathleen Morris, CIHI's director of health system analysis in Toronto, said in an interview.

"It's an important aspect of health care because it's very painful and very distressing for patients, and it sometimes leads to significant health consequences."

Morris said compromised wounds don't heal well, perhaps because of a skin infection or chronic condition such as diabetes that can make healing more difficult. Another category is pressure ulcers or bed sores that are more likely in people with restricted mobility, for example, if they're in a wheelchair or confined to a bed.

No health-care sector was immune. Nationally, "compromised wounds" were reported in :

• Almost four per cent of acute patients in hospital — the only sector for which data was available from all Canadian hospitals. In 2011-2012, more than 117,000 people in acute care had compromised wounds.
• Almost seven per cent of home-care clients.
• Almost 10 per cent of long-term-care clients.
• Almost 30 per cent of hospital-based continuing care clients in some provinces. The hospitals treat people with chronic conditions such as those with diabetes of peripheral vascular disease.

To prevent compromised wounds, the report's authors suggest:

• Turning bedridden patients frequently to prevent pressure ulcers.
• Having people with diabetes undergo regular foot checkups.
• Reducing surgical site infections.

People with diabetes are more likely to have wounds that don't heal properly because of their reduced foot blood flow and sensation. That's why it's important to inspect the skin regularly, to identify any cuts or blisters promptly to a health-care team, Morris suggested. Keeping the feet in good condition by wearing well-fitting shoes with closed toes can also help.

Dr. Ron Linden, medical director of the Judy Dan Research & Treatment Centre in Toronto, uses hyperbaric medicine to try to treat diabetic ulcers.

Canada spends $1.5 billion a year on diabetic amputations, Linden said.

"The earlier you start treating these wounds, the easier it is to treat them. If the patients come late, where the wounds are already necrotic or the wounds are gangrenous, there's no other alternative than amputation," Linden said.

The object is to recognize that the wounds will occur and to treat them as soon as possible, he said.

Mary Anne Kecskemethy has Type 2 diabetes. She's had one foot amputated and came to Linden's clinic today to check how lesions on her remaining foot are healing.

"It's black," she said, her voice breaking on learning the bad news that her big toe became bruised without her realizing it. "Any kind of damage to my foot creates more problems."

Laura Teague is a registered nurse and nurse practitioner for the wound care program at St. Michael's Hospital in Toronto, where she focuses on pressure ulcers.

"We have a program that identifies risk of pressure ulcer, and when patients are identified as high risk we put certain measures in place," Teague said. "One of those measures is putting the patient on an appropriate patient redistribution mattress and we also put a turning schedule into place for patients."

Since many factors influence the onset and severity of pressure ulcers, Teague said not all of the wounds are preventable.

With files from CBC's Kim Bruhuber and Jill English

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Tanning beds now off limits for P.E.I. minors

As of Sept. 1, Prince Edward Island joins the rest of the Maritimes in banning tanning beds for minors.

The new regulations mean anyone under the age of 18 will no longer be permitted to use tanning beds on the Island. Users will now have to present a government ID before slipping into a tanning bed.

Fines will be issued for businesses that don't follow the law, starting at $1,000 for the first offence.

Health Minister Doug Currie said P.E.I. has one of highest rates of melanoma in Canada and he hopes the legislation will curb those figures.

Dr. Richard Langley, president of the Canadian Dermatology Association of Canada, said despite the new regulations, more work needs to be done to cut skin cancer rates.

"The tanning bed is one component of practicing healthy skin behaviour in the prevention story. Avoiding them altogether even in the older population is important in preventing skin cancer, but it is only one component of it. You know avoiding mid-day sun between the hours of 10 and three, wearing sunscreen, seeking shade, avoiding sun burn, these are all important," he said.

The Canadian Paediatric Society has said 25 per cent of Canadians aged 13 to 19 have used a tanning salon.

with files from the Canadian Press

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Soft-drink makers accused of using 'Big Tobacco playbook'

Recent studies that cast doubt on the benefits of diet soda and suggest consuming pop can lead to aggression in children come at a time when major soft-drink manufacturers are waging a controversial marketing battle to put a healthy spin on sugar-sweetened beverages.

One of the most proactive is Coca-Cola, which produced ads earlier this year that tout how easy it is to work off the calories in a serving of Coke. A version that aired in the United Kingdom was banned in July by authorities who said it misled consumers.

Canadian obesity expert Yoni Freedhoff says the emphasis on health is "deceptive" and signals a last, desperate attempt to legitimize an industry that is increasingly viewed as a health risk.

"I do think that the writing is on the wall," says the founder of Ottawa's Bariatric Medical Institute and an authority on weight issues. "I don't think there's anything more clear-cut as not good for people, in my mind, than sugar-sweetened beverages. There's nothing nutritionally beneficial about them.

"I think that this really is the Big Tobacco playbook that [soft-drink producers are] playing from."

A controversial New York City department of health ad that was part of a campaign to limit the size of sodas that could be served in restaurants and other facilities. (Reuters)

Freedhoff is referring to an influential paper published in 2009 called The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Written by two obesity researchers — Yale University's Kelly Brownell and Kenneth Warner from the University of Michigan — the paper says that after studies began linking smoking to lung cancer in the 1950s, the cigarette industry stressed the importance of the public's health and promised a number of "good-faith changes."

What followed, say Brownell and Warner, was a prolonged marketing "playbook" that emphasized personal responsibility, paid scientists to deliver dubious research and criticized any science that suggested harms associated with smoking, among other tactics.

David Moran, director of sustainability at Coca-Cola Canada, calls the comparison "unfair and not accurate."

"There's no way that you can consume tobacco in any way that's healthy," says Moran. "But with our products, you can consume them in a healthy, active lifestyle."

Making connections with good health

For a number of years, medical experts have cited soft drinks as one of the leading causes of obesity, diabetes and heart disease.

In June, a study from Purdue University in Indiana suggested that despite their low calories and sugar content, diet soft drinks can still contribute to weight gain and diabetes.

Meanwhile, a U.S. study of preschoolers released on Aug. 16 reported that consuming several servings of pop a day is associated with behaviour problems such as aggression.

At the same time, soft drink manufacturers have in recent years introduced products that advertise nutritional benefits.

In the mid-2000s, Coca-Cola brought out Diet Coke Plus, which the company described as "Diet Coke with Vitamins and Minerals." In 2009, the Dr Pepper Snapple Group introduced a line of 7Up flavours said to contain antioxidants.

In 2008, however, the U.S. Food and Drug Administration ruled that Diet Coke Plus made improper nutritional claims; the drink has since been discontinued in the U.S.

In July, the Dr Pepper Snapple Group agreed to stop fortifying its 7Up drinks with vitamins and claiming they contain antioxidants, after a California consumer filed a federal class action lawsuit.

According to the complaint, the packaging of 7Up varieties such as regular and diet Cherry Antioxidant and Mixed Berry Antioxidant suggested the antioxidant came from fruit, when in fact there is no fruit content in 7Up.

Fighting obesity

Coke's Moran says the marketing approach is slightly different in Canada, because Health Canada has strong restrictions on touting the nutritional value of soft drinks.

Even so, beverage makers have taken a pro-active stance in the fight against obesity. Earlier this year, Coca-Cola Canada launched a campaign called "Coming Together," which aims to raise awareness of ways to reduce weight gain.

Not everyone liked N.Y. Mayor Michael Bloomberg's campaign to limit soft-drink sizes, including a judge who quashed the city law earlier this year. (Kathy Willens / Associated Press)

The company also renewed a partnership with ParticipAction, the national not-for-profit that promotes physical activity.

"Our focus has been a lot on calorie awareness," says Moran, who emphasizes that Coca-Cola also produces lower-calorie products, such as diet drinks and flavoured waters.

Part of the "Coming Together" campaign is an ad called "The Calorie Dictionary," which suggests some simple ways a person could work off the 160 calories in a 13.5-ounce bottle of Coke, including five minutes of skateboarding (45 calories), yelling (13 calories) or demolition work (39 calories).

Freedhoff says the ad is "purposely deceptive," saying it's unclear in the commercial that a person would have to complete a combination of these activities — not just one of them — to work off the serving of Coke.

He adds that diet is much more important than exercise in determining weight gain.

But not everyone is opposed to the ad campaign.

"Healthy living is the issue here, and so calorie-counting is a part of that, and certainly if you start drinking the Big Gulps, your toll is going to go up very quickly," says Michael Mulvey, a marketing professor at the University of Ottawa.

"At least [Coke is] initiating a dialogue — they're showing a partial solution to the problem. In a way, it is offering some balance to the other array of ads that they have that say this is a pause that refreshes or this is a treat or this is a bonding experience."

The art of 'health-haloing'

Claire Tsai, a marketing expert at the Rotman School of Management, concedes that some of the anti-soft drink rhetoric nowadays compares it to cigarettes, but she says there is a critical distinction between the two products.

"The biggest difference between soft drinks and tobacco is that tobacco is linked with lung cancer, a fatal disease, while obesity is linked with other fatal diseases, but it's not the only thing that causes those fatal diseases," she says.

"So it's unlikely that we'll see a class-action lawsuit in the context of soft drinks."

Mulvey adds that "with tobacco, a lot of [the criticism] has been motivated by secondary smoke and all the people that didn't have the choice" in consuming it.

Freedhoff says Coke, like many food and beverage manufacturers, is simply engaging in "health-haloing," a marketing practice in which companies create associations between their products and healthy living.

"These are incredibly savvy marketers, incredibly savvy sales people," says Freedhoff.

"Not having these ads would be better than having them, but [they] are a lesser evil than further vilification of soft drinks by the public and by public health officials."

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Persistent wounds 'a big issue' in Canada

Persistent wounds including diabetic foot ulcers and bedsores can lead to severe complications and are widespread in Canada, but some can be prevented, according to a new report.

The Canadian Institute for Health Information (CIHI) report released Thursday looks at certain wounds that don't heal well.

Reduced blood flow is one of the reasons people with diabetes are more prone to foot ulcers (Lucy Nicholson/Reuters)

"We found that compromised wounds were a big issue," Kathleen Morris, CIHI's director of health system analysis in Toronto, said in an interview.

"It's an important aspect of health care because it's very painful and very distressing for patients, and it sometimes leads to significant health consequences."

Morris said compromised wounds don't heal well, perhaps because of a skin infection or chronic condition such as diabetes that can make healing more difficult. Another category is pressure ulcers or bed sores that are more likely in people with restricted mobility, for example, if they're in a wheelchair or confined to a bed.

No health-care sector was immune. Nationally, "compromised wounds" were reported in :

• Almost four per cent of acute patients in hospital — the only sector for which data was available from all Canadian hospitals. In 2011-2012, more than 117,000 people in acute care had compromised wounds.
• Almost seven per cent of home-care clients.
• Almost 10 per cent of long-term-care clients.
• Almost 30 per cent of hospital-based continuing care clients in some provinces. The hospitals treat people with chronic conditions such as those with diabetes of peripheral vascular disease.

To prevent compromised wounds, the report's authors suggest:

• Turning bedridden patients frequently to prevent pressure ulcers.
• Having people with diabetes undergo regular foot checkups.
• Reducing surgical site infections.

People with diabetes are more likely to have wounds that don't heal properly because of their reduced foot blood flow and sensation. That's why it's important to inspect the skin regularly, to identify any cuts or blisters promptly to a health-care team, Morris suggested. Keeping the feet in good condition by wearing well-fitting shoes with closed toes can also help.

Dr. Ron Linden, medical director of the Judy Dan Research & Treatment Centre in Toronto, uses hyperbaric medicine to try to treat diabetic ulcers.

Canada spends $1.5 billion a year on diabetic amputations, Linden said.

"The earlier you start treating these wounds, the easier it is to treat them. If the patients come late, where the wounds are already necrotic or the wounds are gangrenous, there's no other alternative than amputation," Linden said.

The object is to recognize that the wounds will occur and to treat them as soon as possible, he said.

Mary Anne Kecskemethy has Type 2 diabetes. She's had one foot amputated and came to Linden's clinic today to check how lesions on her remaining foot are healing.

"It's black," she said, her voice breaking on learning the bad news that her big toe became bruised without her realizing it. "Any kind of damage to my foot creates more problems."

Laura Teague is a registered nurse and nurse practitioner for the wound care program at St. Michael's Hospital in Toronto, where she focuses on pressure ulcers.

"We have a program that identifies risk of pressure ulcer, and when patients are identified as high risk we put certain measures in place," Teague said. "One of those measures is putting the patient on an appropriate patient redistribution mattress and we also put a turning schedule into place for patients."

Since many factors influence the onset and severity of pressure ulcers, Teague said not all of the wounds are preventable.

With files from CBC's Kim Bruhuber and Jill English

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Tylenol to get health warnings on cap in U.S.

Johnson & Johnson says its U.S. bottles of Extra Strength Tylenol will bear a new warning label on the cap to alert users to potentially fatal risks of taking too much of the pain reliever. (Johnson & Johnson/Associated Press)

Bottles of Tylenol sold in the U.S. will come with warning labels on the cap to alert people that the popular painkiller contains acetaminophen that can damage the liver when taken in excess.

Acetaminophen is a medicinal ingredient in more than 470 products, according to Health Canada's online database.

It's also found in more than 600 common over-the-counter and prescription products in the U.S., including brands like Nyquil cold formula, Excedrin pain tablets and Sudafed sinus pills.

The label change is prompted by the concern that people may not realize the risk of overdosing if they take more than one of these products at the same time, or even same day.

The new cap message will read: "Contains acetaminophen" and "Always read the label."

"At this time, the cap text messaging is being introduced on Tylenol bottles sold in the US market based upon a number of factors that are specific to the U.S. market, including the prevalence of simultaneous usage of multiple acetaminophen products by a significant portion of the U.S. adult population," Shelley Kohut, director of communications and public relations at Johnson & Johnson said in an email to CBC News.

"Our commitment is to continue to assess and evaluate the needs of Canadian consumers and to provide information and educate, as appropriate, to support the continued safe and effective use of our products."

Kohut said Tylenol meets Health Canada's 2009 labelling standard for acetaminophen.

The U.S. move comes as Johnson & Johnson faces more than 85 personal injury lawsuits in U.S. federal court that blame Tylenol for liver injuries and deaths. The U.S. Food and Drug Administration is also planning to curtail the use of some acetaminophen products.

Dr. David Juurlink, a drug safety researcher at Sunnybrook Health Sciences Centre in Toronto, said the U.S. change is sensible.

"Almost everyone has this in their medicine cabinet," Juurlink said in an interview. "It's a drug that if taken to excess can cause severe and sometimes fatal liver injury and I'm not sure how widely known that is."

In 2012, Dr. Rod Lim and his team at London Health Sciences Centre reported a case of the 22-day-old boy that they successfully treated in the emergency department at a community hospital after an accidental overdose of acetaminophen.

Identifying all products that contain acetaminophen is useful so parents don't mistakenly give more than one product containing the drug to their child at the same time, Lim said.

"People remember what they take for a single dose. They say, 'I take two tablets,'" Lim said. "The problem is they're used to taking it every four hours but they'll exceed the maximum daily dose within 16 hours. So it's confusing for consumers to think of what they can take and how often and not realize that they can't take it continuously for that day."

For example, taking two, 500-milligram tablets or capsules of acetaminophen every four hours from 8 a.m. to midnight for example adds up to five grams. The maximum dose for a day is 4 grams.

Acetaminophen overdoses occur when the liver is unable to detoxify high doses of the drug and liver failure results. If an overdose occurs, people can do well if they get to a hospital early, Juurlink said.

But Juurlink also fears that the warning changes might also spur deliberate overdoses, which he speculates make up the majority of severe liver injuries from Tylenol that come to medical attention.

In Canada, Tylenol's manufacturer, McNeil Consumer Healthcare, a division of Johnson & Johnson, recently introduced a website to give consumers information on the safe and responsible use of over-the-counter medicines, including products containing acetaminophen.

Gerry Harrington is director of public affairs for Consumer Health Products Canada, which represents manufacturers, marketers, and distributors of consumer health products including over-the-counter medications.

"There are significant differences between the Canadian and American experience with acetaminophen overdose, including a higher fatality rate and a greater incidence of narcotic combination products in the U.S.," Harrington said in an email. "For these reasons, I think it's too early to say whether such an initiative would be appropriate in Canada."

A spokeswoman for Health Canada said the department is aware of the labelling changes in the U.S. and is evaluating them as part of its continual surveillance of acetaminophen products.

Bottles of Extra Strength Tylenol in the U.S. will have the new label starting in October.

With files from The Associated Press, CBC's Amina Zafar and Jill English

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Tanning beds now off limits for P.E.I. minors

As of Sept. 1, Prince Edward Island joins the rest of the Maritimes in banning tanning beds for minors.

The new regulations mean anyone under the age of 18 will no longer be permitted to use tanning beds on the Island. Users will now have to present a government ID before slipping into a tanning bed.

Fines will be issued for businesses that don't follow the law, starting at $1,000 for the first offence.

Health Minister Doug Currie said P.E.I. has one of highest rates of melanoma in Canada and he hopes the legislation will curb those figures.

Dr. Richard Langley, president of the Canadian Dermatology Association of Canada, said despite the new regulations, more work needs to be done to cut skin cancer rates.

"The tanning bed is one component of practicing healthy skin behaviour in the prevention story. Avoiding them altogether even in the older population is important in preventing skin cancer, but it is only one component of it. You know avoiding mid-day sun between the hours of 10 and three, wearing sunscreen, seeking shade, avoiding sun burn, these are all important," he said.

The Canadian Paediatric Society has said 25 per cent of Canadians aged 13 to 19 have used a tanning salon.

with files from the Canadian Press

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Crowded Thunder Bay hospital to convert lounges to patient rooms

Thunder Bay's regional hospital is planning to convert some family lounges into much needed space for patients.

The hospital was keeping patients in hallways and alcoves, but that no longer complies with the city's new fire codes.

Now, the plan is to convert seven sun rooms currently used as lounges for the families of patients, into spaces for patient beds.

Andree Robichaud, the CEO of the Regional Health Sciences Centre, said she hopes the extra space will free up the hallways which are currently crowded with beds occupied by patients whose treatment has finished.

CEO of the Regional Health Sciences Centre Andree Robichaud. (CBC)

"Is it the ideal care? No," Robichaud said. "They should be in the community in either a long-term care facility or in an assisted living facility. But we're going to provide the best care that we can."

The rooms will be renovated and equipped with the standard privacy curtains and call bells.

Most of the patients that will get the new rooms are 'alternate level of care' patients, Robichaud said, but ultimately it will be up to the doctors and nurses of each unit to decide where each patient goes.

As of Thursday the hospital said there were 59 'alternate level of care' patients and six waiting in the emergency room to be admitted to the hospital.

Robichaud said she is not sure how long they will use the sun rooms for patients because it depends on when more community space becomes available.

Currently the hospital is looking into other places within and outside the hospital as well, she added.

The conversion will also affect families who used the space as a place to gather.

"That's very inconvenient for the families and I hope that they understand that we're very tight for space and that our priority is for patient care," she said. "So we apologize for any inconvenience that we're creating for the families."

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Soft-drink makers accused of using 'Big Tobacco playbook'

Recent studies that cast doubt on the benefits of diet soda and suggest consuming pop can lead to aggression in children come at a time when major soft-drink manufacturers are waging a controversial marketing battle to put a healthy spin on sugar-sweetened beverages.

One of the most proactive is Coca-Cola, which produced ads earlier this year that tout how easy it is to work off the calories in a serving of Coke. A version that aired in the United Kingdom was banned in July by authorities who said it misled consumers.

Canadian obesity expert Yoni Freedhoff says the emphasis on health is "deceptive" and signals a last, desperate attempt to legitimize an industry that is increasingly viewed as a health risk.

"I do think that the writing is on the wall," says the founder of Ottawa's Bariatric Medical Institute and an authority on weight issues. "I don't think there's anything more clear-cut as not good for people, in my mind, than sugar-sweetened beverages. There's nothing nutritionally beneficial about them.

"I think that this really is the Big Tobacco playbook that [soft-drink producers are] playing from."

A controversial New York City department of health ad that was part of a campaign to limit the size of sodas that could be served in restaurants and other facilities. (Reuters)

Freedhoff is referring to an influential paper published in 2009 called The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Written by two obesity researchers — Yale University's Kelly Brownell and Kenneth Warner from the University of Michigan — the paper says that after studies began linking smoking to lung cancer in the 1950s, the cigarette industry stressed the importance of the public's health and promised a number of "good-faith changes."

What followed, say Brownell and Warner, was a prolonged marketing "playbook" that emphasized personal responsibility, paid scientists to deliver dubious research and criticized any science that suggested harms associated with smoking, among other tactics.

David Moran, director of sustainability at Coca-Cola Canada, calls the comparison "unfair and not accurate."

"There's no way that you can consume tobacco in any way that's healthy," says Moran. "But with our products, you can consume them in a healthy, active lifestyle."

Making connections with good health

For a number of years, medical experts have cited soft drinks as one of the leading causes of obesity, diabetes and heart disease.

In June, a study from Purdue University in Indiana suggested that despite their low calories and sugar content, diet soft drinks can still contribute to weight gain and diabetes.

Meanwhile, a U.S. study of preschoolers released on Aug. 16 reported that consuming several servings of pop a day is associated with behaviour problems such as aggression.

At the same time, soft drink manufacturers have in recent years introduced products that advertise nutritional benefits.

In the mid-2000s, Coca-Cola brought out Diet Coke Plus, which the company described as "Diet Coke with Vitamins and Minerals." In 2009, the Dr Pepper Snapple Group introduced a line of 7Up flavours said to contain antioxidants.

In 2008, however, the U.S. Food and Drug Administration ruled that Diet Coke Plus made improper nutritional claims; the drink has since been discontinued in the U.S.

In July, the Dr Pepper Snapple Group agreed to stop fortifying its 7Up drinks with vitamins and claiming they contain antioxidants, after a California consumer filed a federal class action lawsuit.

According to the complaint, the packaging of 7Up varieties such as regular and diet Cherry Antioxidant and Mixed Berry Antioxidant suggested the antioxidant came from fruit, when in fact there is no fruit content in 7Up.

Fighting obesity

Coke's Moran says the marketing approach is slightly different in Canada, because Health Canada has strong restrictions on touting the nutritional value of soft drinks.

Even so, beverage makers have taken a pro-active stance in the fight against obesity. Earlier this year, Coca-Cola Canada launched a campaign called "Coming Together," which aims to raise awareness of ways to reduce weight gain.

Not everyone liked N.Y. Mayor Michael Bloomberg's campaign to limit soft-drink sizes, including a judge who quashed the city law earlier this year. (Kathy Willens / Associated Press)

The company also renewed a partnership with ParticipAction, the national not-for-profit that promotes physical activity.

"Our focus has been a lot on calorie awareness," says Moran, who emphasizes that Coca-Cola also produces lower-calorie products, such as diet drinks and flavoured waters.

Part of the "Coming Together" campaign is an ad called "The Calorie Dictionary," which suggests some simple ways a person could work off the 160 calories in a 13.5-ounce bottle of Coke, including five minutes of skateboarding (45 calories), yelling (13 calories) or demolition work (39 calories).

Freedhoff says the ad is "purposely deceptive," saying it's unclear in the commercial that a person would have to complete a combination of these activities — not just one of them — to work off the serving of Coke.

He adds that diet is much more important than exercise in determining weight gain.

But not everyone is opposed to the ad campaign.

"Healthy living is the issue here, and so calorie-counting is a part of that, and certainly if you start drinking the Big Gulps, your toll is going to go up very quickly," says Michael Mulvey, a marketing professor at the University of Ottawa.

"At least [Coke is] initiating a dialogue — they're showing a partial solution to the problem. In a way, it is offering some balance to the other array of ads that they have that say this is a pause that refreshes or this is a treat or this is a bonding experience."

The art of 'health-haloing'

Claire Tsai, a marketing expert at the Rotman School of Management, concedes that some of the anti-soft drink rhetoric nowadays compares it to cigarettes, but she says there is a critical distinction between the two products.

"The biggest difference between soft drinks and tobacco is that tobacco is linked with lung cancer, a fatal disease, while obesity is linked with other fatal diseases, but it's not the only thing that causes those fatal diseases," she says.

"So it's unlikely that we'll see a class-action lawsuit in the context of soft drinks."

Mulvey adds that "with tobacco, a lot of [the criticism] has been motivated by secondary smoke and all the people that didn't have the choice" in consuming it.

Freedhoff says Coke, like many food and beverage manufacturers, is simply engaging in "health-haloing," a marketing practice in which companies create associations between their products and healthy living.

"These are incredibly savvy marketers, incredibly savvy sales people," says Freedhoff.

"Not having these ads would be better than having them, but [they] are a lesser evil than further vilification of soft drinks by the public and by public health officials."

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