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Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f403 (Published 07 February 2013) Cite this as: BMJ 2013;346:f403

Re: Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses

We should not be surprised by the results of this research, as the intervention being studied is the application of one of Dr William Haddon’s “Ten Countermeasures” (1).

Dr Haddon was a physician and engineer and is considered to be the father of modern injury epidemiology. He developed two complementary conceptual frameworks: the Haddon Matrix and Ten Countermeasures (1,2). Both these frameworks are excellent tools for generating ideas about possible new public health interventions. They can be applied to a large variety of important topics including alcohol, smoking, obesity, and guns (3,4).

Hawton and colleagues state that significant reductions in deaths due to paracetamol overdose have already been achieved by the intervention they were studying, but that there is still a need for further preventive measures (5). Perhaps the pioneering work of Haddon should be drawn upon for potential new measures.

References:
1 Haddon, W. Energy Damage and the Ten Countermeasure Strategies. Journal of Trauma 1973;13:321-31.
2 Haddon W. The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based. American Journal of Public Health 1968;58:1431-1438
3 Runyan C. Back to the future: revisiting Haddon’s conceptualization of injury epidemiology and prevention. Epidemiol Rev 2003;25:60-4.
4 Runyan C, Baker S. Bulletin World Health Organization 2009;87:402–403
5 Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W, Gunnell D, Kapur N. BMJ 2013;346:f403

Competing interests: No competing interests

10 February 2013
Michael C. Watson
Associate Professor in Public Health
Emily Clare Watson (GP Registrar, Barnsley Hospital)
University of Nottingham
Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA