Jonathan B. Wight

A column in today's New York Times argues that public policy should indeed be paternalistic with regard to product packaging. This topic has been covered extensively on this blog (here, here, here, here, and here).

Similar to the "super-sizing" soda law attempted by Mayor Bloomberg, Ezekiel J. Emanuel argues that public policy should ban the super-sizing of over-the-counter drugs associated with accidental overdoses and suicides.

Emanuel argues:

"We need to make it harder to buy pills in bottles of 50 or 100 that can be easily dumped out and swallowed. We should not be selling big bottles of Tylenol and other drugs that are typically implicated in overdoses, like prescription painkillers and Valium-type drugs, called benzodiazepines. Pills should be packaged in blister packs of 16 or 25. Anyone who wanted 50 would have to buy numerous blister packages and sit down and push out the pills one by one. Turns out you really, really have to want to commit suicide to push out 50 pills. And most people are not that committed."

There are interesting issues here that go beyond behavioral economics. People can sometimes act irrationally and not achieve the outcomes they desire. Paternalists would like to help them achieve their goals by forcing them to take an action that produces the result the person intends.

But in this case people who intend to commit suicide want to buy super-sized pill bottles, which is a rational action if that is the goal. Emanuel argues that paternalism is justified in this case because the desire to commit suicide either is transitory or it is weak. People are not committed enough to the goal to do the hard work of breaking apart blister packs. Paternalism in this case raises the time cost of self-destruction. Emanuel reports that:

"In September 1998, Britain changed the packaging for paracetamol, the active ingredient in Tylenol, to require blister packs for packages of 16 pills when sold over the counter in places like convenience stores, and for packages of 32 pills in pharmacies. The result: a study by Oxford University researchers showed that over the subsequent 11 or so years, suicide deaths from Tylenol overdoses declined by 43 percent, and a similar decline was found in accidental deaths from medication poisonings. In addition, there was a 61 percent reduction in liver transplants attributed to Tylenol toxicities."