What are those safer, equally effective alternatives? Ibuprofen causes gastric ulcers, Diclofenac does too, Aspirin is an anticoagulant, and Metamizole can cause agranulocytosis. Also, the maximum recommended daily dose for Acetaminophen is somewhere around 3500 mg, which is seven extra strength Tylenol - hardly what I'd call a narrow therapeutic index.

Conversely: everything should be available over the counter. If someone wants to kill themselves by destroying their liver with acetaminophen, that's their business.

If everything were available over the counter, the presumption of safety would disappear, and we wouldn't have a problem.

As it is, we have a two tier system. Consumers are trained that OTC drugs are so safe they barely have to glance at the instructions. APAP is vastly more dangerous than its peers on the OTC shelf, and consumers are placed at risk.