[Mercury News] Last week a federal advisory panel recommended banning America’s most popular and effective prescription pain pills, including Percocet and Vicodin. Across the country howls were heard from doctors and patients suffering from everything from arthritis to toothache.

It’s no surprise that these pain relievers are considered dangerous. They contain powerful, habit-forming narcotics like oxycodone and hydrocodone. But that’s not the issue. Percocet and Vicodin also contain acetaminophen — you know, Tylenol, that “harmless” over-the-counter pain reliever we pop like candy at the least sign of a headache, sore throat or general malaise.

It turns out that Tylenol isn’t all that harmless. Overdoses kill more than 400 people each year and send 42,000 to the emergency room with acute liver failure. And so-called “combination pain killers” account for most of those overdoseIf the FDA follows the panel’s recommendation, and it usually does, will the result be another manifestation of the “nanny state”? Will sick people be unjustly deprived of an effective drug like Vicodin because some idiots don’t bother to read the directions?

A bad combination

I put that question to Dr. Scott Fishman, the chief of pain medicine at the University of California-Davis School of Medicine. He’s an advocate for pain management, so I expected he’d say the panel overreacted.

But Fishman is fine with getting rid of drugs that combine opium-based drugs with acetaminophen.

“The FDA panel is not saying the drugs in Vicodin are bad,” he said. “They are saying that tying those drugs together is wrong.”

By adding acetaminophen to narcotics, combination drugs provide better pain relief with lower levels of narcotic. They are great for short-term use, such as after surgery.

Patients who take these drugs for chronic pain, however, build up a tolerance to the narcotic. As they take more and more, they also take more acetaminophen, and are at risk of liver damage.

Instead, Fishman said, doctors should prescribe the narcotics and acetaminophen separately. More trouble, but a safer option.

A pill for everything

Whatever the FDA decides, the panel has identified a problem that I fear can’t be solved by taking a few drugs off the market.

We are a nation of pill-poppers. Stomach upset? Don’t give up those hot peppers, just reach for Pepcid AC. Got a cold? Don’t suffer. DayQuil and NyQuil will get you through. No matter what ails us, from high cholesterol to low libido, we expect relief in a pill bottle.

But do we really know what we’re taking?

Like millions of Americans, I have a bottle of Extra-Strength Tylenol in my medicine cabinet, another in the kitchen, and a little vial in my purse for emergencies. I know not to exceed the recommended daily dose of eight tablets a day. So when I saw the statistics about overdoses, I couldn’t believe how careless some people are. How hard is it to count to eight?

Then I looked in my medicine cabinet to see how much acetaminophen was lurking. A bottle of NyQuil, 500 milligrams per dose. A few individually wrapped (and impossible to open without the Jaws of Life) DayQuil capsules, 325 milligrams each. And a box of TheraFlu with whoa! 1,000 milligrams per packet.

I imagine some coughing, sneezing, fuzzy-headed person, desperate for relief, finding that packet of TheraFlu and not thinking about the Tylenol she already has taken. She squints at the directions on the label but can’t make out the fine print without a microscope. Oh, what the heck. Down the hatch.

Just thinking about that poor woman’s liver is giving me a headache. Hmm. Where’s that bottle of Tylenol?

-Patty Fisher