Great Britain and most of Europe. Acetaminophen toxicity accounts for approximately 50% of all cases of ALF in the United States and carries a 30% mortality. 1 More than 100,000 calls to Poison Control Centers, 56,000 emergency room visits, 2,600 hospitalizations and nearly 500 deaths are attributed to acetaminophen in this country annually. 2 The incidence of acetaminophen-related ALF exceeds by at least three-fold that due to all other idiosyncratic drug reactions combined. 3 Nevertheless, acetaminophen has been a highly successful product. Off patent long ago, it is found in more than 300 products with sales in the billions of dollars annually. A combined preparation consisting of acetaminophen together with a narcotic is the top selling generic drug in the United States, with 109 million prescriptions written in 2006. 4 The Public Policy Committee of the American Association for the Study of Liver Diseases (AASLD) began a year ago to look into what might be done to address this unfavorable health issue. I was asked by the Committee to write this commentary as a brief overview of acetaminophen toxicity and to discuss possible ways to bring about harm reduction by beginning to partner with regulatory agencies to alter the way acetaminophen is marketed and sold in the United States.