One thing every single member of the general public needs to get drilled into them: Medical science is NOT intuitive. You cannot just read the mechanism of action of a drug and infer a dozen things from it. A drug's mechanism of action, its indication (when it ought to be used) and its adverse effects CANNOT simply be inferred logically from each other. Biology is orders of magnitude more complex than SE/CS or any other field for that matter.
I presume majority of readers here have SE/CS background. Dudes! the artifacts and systems in SE/CS have the following two properties:
1. They are human artifacts. We know exactly how they are build. The theory is all publicly accessible in principle.
2. They are layered logically on top of each other. Machine code, assembly, C, Java ... so on. Firmware, OS, drivers, apps .. etc. Clean layering.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there.
Be very very careful when you import thinking habits for daily life , or other fields of expertise, into medicine.
"This video is just for informational purposes. Consult your health care provider for your particular situation" ...is not just a legal precaution. It is a sound life advice. Nothing in life is more crucial to leave it to the experts as health/medical inference and decision making.
While I don’t disagree, the problem I often have with medical professionals is that they tend to be arrogant and unable to take in new information to adapt and evolve their frameworks.
I was married to a doctor, helped them study for board exams, etc and was surrounded by other doctors within our social circle. What most people don’t realize, and most doctors themselves refuse to acknowledge, is how limited by specialization their knowledge can be and how the education of most doctors stops after med school and residency. Nutrition, for example, is barely covered at all.
Yes, there are continuing education requirements and countless journals but most doctors do the bare minimum and don’t keep up. I’d even argue that most physician knowledge tends to be updated more often through drug and instrumentation reps promoting their products by taking them out to dinner and entering them into referral programs, etc.
I wouldn't label that arrogance. In my experience outside the USA, my GP has been unaware of new research / advice / guidelines published by the MoH. They generally respond to new info from reputable sources when you print it out and bring it to them.
I would expect specialists to be subscribed to journals and reading the latest articles in their field. When I saw a specialist at UCSF this was definitely the case; while my GP still has gaps where their current knowledge on a specific subject is from their time at med school.
An equivalence would be a front-end engineer being naive to the happenings on the Linux kernel mailing list. They could likely understand what's going on if they took the time to read it, but that is not their focus.
The fact that there are advertisements for cancer medications make me think a hell of a lot of specialists don’t keep up. It’s one thing to advertise to consumers about a new medication for their chronic condition and they might not have seen their doctor in 3 years. It’s another entirely to have cancer patients need to ask about the new hotness.
Yeah I can't with the "biology is orders of magnitude more complex than SE/CS or any other field for that matter" and then thinking he can explain to the techies how technology works. Just put the pills in the bag bro. Oh wait, we need to go to a pharmacist for that.
The med students I've known have been some of the most insufferable people I've met.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there.
I'm a doctor as well and I think your statement here is too broad. Plenty of specialists such as cardiologists, orthopedic surgeons, radiologists, etc are able to reason things from first principles. The issue is that many non-doctors may not know several key details about these systems that would let you reason through them. And even many doctors well versed in one specialty would be unable to reason about another specialty since they may not know in detail several key pieces of information from that other speciality.
I'm a doctor who used to be an engineer. Deriving things from first principles in medicine is a lie we doctors tell ourselves.the truth is this.we have some really good understanding of syne things at molecular levels that we then correlates to things that happen clinically at a macro level, that correlation is very very handwavy. But we teach it as if we know for sure. We don't.
The few things that we think we have a somwhat good correlation for, we often test on our exams, but even for most of those things, it's some handwavy link
I recall being an engineering classes, armed with just calculus and linear algebra and newton laws, I could attack just about every problem from first principles from my entire undergrad. Every. I didn't have to take into consideration real life presentation of the problem. First principles were enough to get me nearly there
Medicine is fundamentally not that way. Yes we learn the biology, but if you reason solely from biology, you will quickly end up in the wrong places. to become a doctor, I had to learn that hard way that yeah a disease doesn't just present this way just because the underlying physics and biology suggests it should. You separately have to learn how the disease presents, then try to tie it back to our extensive but still very very limited understanding of the possible biology.
I have problems with doctors that don't acknowledge how tenous that link is and despite how much we know, we still know so so little. We are far more useful than what we know.
I understand to biology majors, the few things that seem to follow physiologically from moelculqr biology dupes us into thinking medicine currebtly derives from first pricinples. But it doesnt.
This seems like a classic "rationalism vs empiricism" issue, and it was interesting for me to learn that Galen (famous / influential ancient Roman physician) wrote a lot about that.
We’d all wish it’d be so, doctor. Sometimes it’s as clean as biological systems - touch something somewhere, a different seemingly completely unrelated thing elsewhere breaks.
Even in the dawn of the era, where accumulated complexity was a while lot lower, we have tales of 500-mile emails and “magic/more magic” switch ;-)
Inferring things in a legacy codebase old enough to drink can be quite a challenge. And the way I get it, you folks are dealing with a multimillenia-old mess of layering violations - so no surprise first principles are tricky.
I don't know how you MDs/DOs do it. You give a dude medication knowing that it has a small chance to turn his stomach into goo because it will stop his brain arteries from popping like a stress ball in a hydraulic press. Sometimes without knowing how the medication does either thing.
It seems both true that 1. intuitive-sounding explanations about medicine can be extremely misleading for laypeople and 2. reasoning about mechanisms of action, supplemented with empirical science, is important and useful in medical science.
I'm not sure saying to not try to reason at all about mechanisms of actions is a good idea. If someone knows Tylenol is metabolized into chemicals that are toxic to liver, that is simple enough to understand and reason about
One of the greatest Silicon Valley tropes is when boring software guys get rich, lose the plot, and start reinventing physics from first principles because they think the universe is like computer science.
The solace of made-up physics is there for every mediocre dude, from Uber founder Travis Kalanick down to any random guy who made $10M as the CTO of a third-rate video conferencing app and immediately broke up with his girlfriend.
Oddly specific. The interactions and variables in biology and physics create way more permutations than many (perhaps all?) people can wrap their heads around but that doesn't mean the possibility of reasoning from first principles doesn't exist. There are very well defined pathways in both medicine and physics. The ones we haven't discovered are most likely much more complex and may contain recursive loops that make tradeoffs inevitable. Or not. The rapid improvement in pattern recognition and processing leads me to believe we are in for a wild time over the next 10 years with a ton of breakthroughs in both physics and medicine.
Yes, that's another issue - CS/IT seems to be unique that sharing knowledge and openly discussing problems is the norm, in other professions you can get finger wagging and some general "advice"
> But if acetaminophen is safer, then why don’t official sources tell you that?
Guess it depends on country. Here in Norway official sources[1][2] do say acetaminophen (paracetamol here) should be the default for treating fever and pain in kids, adults, pregnant women and elderly, and have for some time. Ibuprofen they say should be used with caution.
I feel like this is one of those things where Europe and the US are very different, culturally speaking - I've lived in the Netherlands, Germany and now Sweden, and the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.
Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
And I'm not saying painkillers should always be avoided. If I have insomnia-induced headaches in the morning and a long day ahead with many social interactions, then I know that headaches will make me a grumpy asshole, so I'll obviously will take a painkiller for everyone's sake. And sometimes I can only fall asleep if I take a painkiller to get rid of the headache first, so I need it to break the vicious cycle. I'm not saying people should "walk it off" here, just to focus on trying to figure out the actual cause first before medicating the symptom way. That's also healthier in the long run, no?
You're forgetting that when you're sick and hurt yourself in the US you very likely still have to go to work. Doing some quick research, roughly 25% of the US workers don't have any sick time whatsoever, so you gotta take some painkillers and get back to work. If you need to take time off to go to the doctor, you're no longer getting paid, so...a lot of people don't do that and instead hide the pain with painkillers.
I had my gallbladder out on a Wednesday and went back to work on the Monday. Nothing stronger than acetaminophen and ibuprofen. Laparoscopy is amazing.
It was a desk job and my team was great. I didn't even think twice.
Well for one thing, in America, you gotta get back to work.
Work a manual labor job or one where you're on your feet all day and sprained your ankle? Would you rather miss a week of pay (or worse lose your job) or take some pain killers and work through it?
Yeah I think this is the biggest difference. Here in Sweden if I get a headache that's bad enough I'll just take a sick day and there's not really much social stigma about that kind of behaviour unless it becomes a pattern that you don't seek medical help for.
I work in an office, but Swedish law protects blue- and white-collared jobs the same in this regard.
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.
That's a pretty apt explanation for why pain probably evolved via natural selection, but you can't therefore conclude that all or even most pain is a genuinely actionable warning sign.
Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain. I don't think it's a hubristic affront to biology to feel a bit of soreness, note it, then take the painkillers.
>Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain
which is far from harmless given how many people use them as a replacement for treating underlying symptoms and changing their life. Case study my dad. Kept taking ibuprofen to get rid of 'harmless' headaches and back pain because he was 'too busy', few years later he couldn't ignore it any more, turns out he had completely messed up disc in his cervical spine from years of physical stress, bad posture, no treatment or exercise etc.
just look at the sheer amount of back pain diagnoses. About a third of Americans report back pain at any given time, IIRC 10-15% of the population go to the doctor any given year for back pain. There's likely millions, if not tens of millions preventable cases if you replaced the liberal use of OTC drugs with actually solving the lifestyle problems.
It's not clear to me that a large portion of people are using them as a replacement for treating underlying symptoms. I suspect in a large portion of cases, treating the underlying symptoms is difficult and/or costly, and thus the choice is merely whether to treat the pain or not.
>but you can't therefore conclude that all or even most pain is a genuinely actionable warning sign.
I didn't read their comment that way at all. It seems they're critiquing the default action that many people take, which is "pain = pop an aleve/tylenol/advil/etc. and get back to it."
I've taken so much Advil/Ibuprofen in my life it would be impossible to count at this point.
I always got headaches when I was younger and it didn't really stop until I went to college at a higher altitude. When I go back to my hometown, after a couple of days they come back. Some headaches will go away on their own with water or rest, but others that seem to go from one side of my forehead all the way down the same side of my neck seem to only go away with medicine.
I used to have to take Advil what seemed like every other day to get them to go away. Tylenol never seemed to help at all. Aleve actually works better than anything for me.
Since none of them are actual migraines, most advice was the standard: drink more water, get enough sleep, are you stressed at work, etc.
I won't move back to my hometown because of it and it hasn't been as much of a problem. My grandmother said that I had a distant cousin who would get sick whenever he came to our hometown from Chicago as well. Said that his doctor thought it might have to do with the swampy air around the area. Pee Dee region of South Carolina, where Francis "Swamp Fox" Marion operated during the Revolutionary War.
Long-winding tangential anecdote (which is why I'm replying to myself in a separate comment), but I have pretty extreme example of this: I managed to avoid nearly all suffering after getting a tonsillectomy in my mid-thirties, while using almost no painkillers.
My ENT surgeons warned that me "I'd hate him for about a month, then I'd love him for never having to deal with [serious medical condition that justified the removal of tonsils] again". He prescribed all kinds of stuff to alleviate the expected suffering, and advised me to try to take the weakest options I was comfortable with, because the heavier ones might have some unpleasant side effects. It's the only time in my life I've been prescribed painkillers at all, actually (this was in Sweden, btw).
I got codeine/paracetamol as a coughing suppressor and mild painkiller, a couple of heavier painkillers for if it got worse (I forgot the name but some kind of heavy-duty variation of diclophenac that you can only get with a prescription), and some kind of nasty solution to gargle with that supposedly would numb my throat if it got really bad. I've been told this is nothing compared to what you can expect in the US.
Then in the evening after the surgery, when I was trying to eat a soup with my mom, I realized soup didn't hurt as much as drinking plain tap water. And then I thought: isn't it odd that drinking plain water feels like a thousand paper-cuts in the open wound in my throat, but whenever the coughing made the wounds open and bleed, the blood doesn't hurt at all? Blood is mostly water, so what is the difference? Could it be the salt? Is this similar to why drinking demineralized water is bad for you? What's the opposite of demineralized water? Oral rehydration solution. Ok, trivial to make, let's try that. I'll drink it luke-warm to be close to body temperature too.
Turns out that that works. Oral rehydration solution is almost painless to drink after a tonsillectomy. I know this is anecdata, but sample size three: I've since shared this information with two friends who got a tonsillectomy, and they've been extremely grateful for this tip.
It even seemed to speed up my recovery, probably due to a lack of irritation triggering inflammation. I was eating solid food within days. DAYS. My mom, a retired family physician herself, couldn't believe her eyes.
I ended up only needing the codeine/paracemtal in the evening to suppress coughing in my sleep, and brought back all the other pain-killers without opening them.
The plain water hurts because it's causing cells to swell or even burst as water rushes into them to equalize the osmotic pressure. Adding a little bit of salt to that helps remove that pressure because the environment inside and outside of the cells are both equally salt.
Well, not so much rediscovered it as reasoned that that might be the cause of the pain and then confirmed it. The shocking part is that no doctor advises to use this after a tonsillectomy (or other kind of mouth or throat procedure).
My dad (also a doctor) called it a typical case of "the nurse's wisdom": the kind of quality of life interventions that typiqally get discovered by nurses and passed down orally, but never make it to official medical journals.
I wasn't sure how old the story or where the OP is. But yes it was pulled from human usage in most countries. I don't fully understand why, although I suspect it is primarily because ibuprofen is effective enough
AIUI one of the many quirks of the US health insurance system is that a lot of people have only minimal cover which doesn't include things like physiotherapy and rehabilitation treatment. That means that they often can't treat a painful condition at source so their only option is to mask the pain with painkillers.
It's worse than that - there is also no job protection. Hurt yourself and miss a few days of work and you are possibly unemployed on top of injured. And then you lose your health insurance, so you can no longer get/afford any treatment.
I'm convinced it's designed this way on purpose. Can't have people relaxing, ever. Must extract every ounce of productivity and blood while they're alive.
It’s not perfect, but the US isn’t a perfect union either. Healthcare is usually more of working class concern, or for the working age but unemployed, which is not a small risk …
But let’s at least admit where some protections exist.
Yes, it's the combined outcome of both of those "features." Many Americans don't have access to healthcare and/or can't afford it even if they have access, AND they are not allowed to stop work to take care of their bodies, it's just a steady stream of painkillers to keep you numb and working until you retire or die.
This is so absurd to me. The expression "prevention is better than cure" isn't just folk wisdom, in just about any country with nationalized healthcare the studies also confirm that this costs less money. The only exception I ever heard was a Dutch study in the 2000s suggesting that people growing older due to smoking less was going to increase healthcare costs, because people were getting older putting pressure on the pension system, but let's not peer further into that can of worms.
So by all accounts it should be cheaper for for-profit insurance companies too, unless they have ways to externalize the costs onto the rest of society. Which I guess is more circumstantial evidence for how messed up the system must be.
> unless they have ways to externalize the costs onto the rest of society
UNH stock has been tanked all year, until the govt announced that they would raise Medicare advantage reimbursement rates. The insurance companies have an incentive to pursue volume instead of cutting costs for programs that the government is subsidizing. For everyone else, they just raise the prices which is a much more complicated issue.
Nationalized healthcare systems can reap the longterm savings from preventive care. I have had 4 different for profit insurance companies over the last 5 years because of job changes, my employer switching insurance providers and retirement. Such frequent changing of health insurance providers means that there is no guarantee that any insurance company will reap the benefit of providing me with better preventative care than required by law.
This is talking about ibuprofen and acetaminophen, not prescription drugs. Also controlling inflamation and swelling is a very important part of an injury recovery plan; it's not all about Americans complaining about pain.
If pain is a signal, then it's often a car alarm that won't shut up. Even if someone is actually trying to steal the car, I only need to be told once.
Sometimes I get headaches. I don't know why. Maybe there's a cause. I do try things to fix the underlying problem. But it's not instant. While I wait for it, why should I continue to be in pain when the pain medicine is pretty much risk free if I'm not reckless with it?
It's strange that you'll take a painkiller for the sake of others, so you don't bother them by being grumpy, but you wouldn't do the same for yourself. Surely you also don't enjoy being a grumpy asshole even when you're alone.
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
Pain is also suffering, and there is no virtue in suffering needlessly.
Even more importantly, there's also chronic pain, which can severely affect quality of file permanently and is essentially an illness all of its own. Research supports the concept of "pain memory", where chronic pain develops as the result of leaving the pain from a temporary condition untreated.
None of this is in disagreement with my argument and comes across as actively ignoring the part where I explain that I am not advocating to "walk it off".
The discussion started in the context of taking painkillers regularly for things like "inconvenient head-aches" without pausing to investigate what causes those headaches. It should be clear from the context that I am not talking about something like people struggling with migraines. I know they try to figure out not to have them in the first place, and if they do have them deserve all the pain relief they can get. I've had migraines myself growing up.
Nobody is saying that people who suffer from chronic pain shouldn't have a relief from their suffering. But as another comment pointed out: the US seems to have a big issue with untreated conditions in general than other countries.Not in the sense of not treating the pain, but in the sense of not treating the conditions leading to pain. You don't even have paid sick leave apparently. Tackle issues like that and there will be fewer chronic pain sufferers to begin with.
We're in violent agreement. My point is, I guess, that the "European way" of foregoing painkillers can be taken too far. And that's actually something that does happen - it's easy to get from from "pain is a warning signal you shouldn't ignore" to "pain shouldn't be suppressed if it's bearable", especially when you hear about dangerous side effects of painkillers. There are definitely people in Europe who think like that, even doctors.
Since we're talking about acetaminophen and ibuprofen, in France you're liable to end up with a medicine cabinet full of acetaminophen, because almost anytime you go to the doctor with any type of pain, they add it to the prescription.
Interesting, in the US they often do that too but I’ve personally never filled it because insurance doesn’t cover over the counter medications. So I’d have to pay cash for it.
You can sometimes get a prescription for a different form or different dosage than what's available OTC. These are most commonly administered in hospitals (and insurance will cover it there), when you're at home it's usually equal or cheaper to just buy the OTC version.
I don't do it in France only because I don't need it. It won't cost me anything otherwise.
(It is worthwhile to note, because Americans don't realize this, but not all medicines that a doctor prescribes for you is free, although the overwhelming majority will be.)
> insurance doesn’t cover over the counter medications
It depends on the insurance. I have pretty crap insurance and didn't expect them to cover a prescription for Omeprazole (aka Prilosec) since it's available OTC, but to my surprise they did.
> Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
Heat hot enough to kill diseases will have killed you long before. Fevers are really a pretty small temperature rise.
It does appear that fevers are an adaptive defense, but FWIW there's been basically no evidence that not taking medicine to bring down a fever will improve outcomes in practice. OTOH, evidence also shows that typical fevers won't themselves hurt you either, so they don't necessarily have to be treated.
Current medical guidance in kids and (non-pregnant) adults is to treat discomfort, usually the associated muscle aches, body chills, etc, but in general we shouldn't encourage people to suffer for no benefit. The fever isn't cleaning you out.
> In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
Most Americans aren’t allowed to take naps at work or leave for some low-stimuli environment while on the clock. If they take time off to do those things, they aren’t getting paid. So why do Americans take more painkillers? Because they can’t afford to not do so.
So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare.
Naps are fine depending on the white collar work, how much is asynchronous, etc. Reasonable accommodations are usually possible as long as it’s not shift work.
Painkillers are an interesting question since we have direct to consumer ads (uncommon globally as it turns out) and for clearly some reasons, we get sicker than other nations independent of how capable medicine is.
Sicker is doing some work, and I think the US has such a diversity of health cultures and outcomes, you almost need to do it by zip code, but that’s another topic.
>So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare
Alternative universe where WW2-era employer provided healthcare didn’t emerge, would you wager we would be there now?
> Naps are fine depending on the white collar work, how much is asynchronous, etc. Reasonable accommodations are usually possible as long as it’s not shift work.
Yeah, and it’s The people who are on their feet for a 12 hour shift who probably need it most.
Perdue Pharma/The Sacklers went on a huge campaign in the 90s convincing doctors and the general public that pain was bad and worth stopping at any cost and even though they were pushing opioids, I can imagine this also increased the cultural tendency to use NSAIDs as well.
I agree that Purdue Pharma was probably the most significant factor, maybe enhanced by the relative ease of granular lobbying of private doctors as compared to the challenges it may face in universal healthcare systems. However, I do suspect that the limited rights of most US workers to take sick leave served as one more cultural advantage in favour of Purdue's campaign.
In many countries if a doctor believes you're too sick to work you have a right to take leave until you recover, without risking your job and without expending limited "sick days". In those circumstances the doctor will of course prescribe something for your pain, but as a patient you have no incentive to insist the painkiller is strong enough to allow you to continue working.
Right, Purdue Pharma—the sleasebag Sacklers—were unethically pushing OxyContin (oxycodone) but the unethical tactics that Merck adopted in marketing its NSAID Vioxx seems to have been forgotten. Vioxx was withdrawn from the market and Merck paid out billions in law suits.
If you've time watch this YouTube video on Merck and the Vioxx scam (if you weren't aware of the facts you'd think you were in Palermo/Mafia territory): https://m.youtube.com/watch?v=K0GrFnOpJoU
Weren't the Perdue Pharma products sold in combination with Acetaminophen?
My assumption was this was always required to get regulatory approval to make abuse have harsher side effects. Liver toxicity of acetaminophen is pretty bad compared opioid abuse from what I understand
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.
This is vastly overstating the rationality of the human body. It's no more rational than the human mind, which is often quite irrational. Your body isn't the product of medical school, nor intelligent design, but rather random natural selection, which is decent but demonstrably far from perfect.
Sure, but how good are you at judging if a human mind is irrational or not without engaging in conversation with it? Why not extend that logic to your body.
I fail to see where anything I said implied that I disagree with that sentiment.
Also, you were arguing we should not listen to pain when it's acting irrational, as in unreasonable. Then you switch to "all minds being irrational", as in actually not rational. That's not the same thing.
I have no interest in playing this silly analogy game. You can't have a "conversation" with your body any more than you can have a conversation with your pet cat. Hey cat, we're trying to save your damn life, so stop resisting the veterinarians and the pills!
If you have a point to make, then make it literally, not metaphorically.
I'm sincerely sorry for you if you are suggesting that you are completely unable to communicate with your pet cat or observe its behavior and reason about why it makes sense just because it lacks language. I assume you don't actually have that problem but that is what your comment literally implies.
I made my point and you're ignoring it: you imply that all pain is unreasonable because the body is "irrational". By that logic, you are saying that my earlier example of a sprained ankle hurting when I lean on it means my body is "unreasonable" for signalling that I should not lean on a healing sprained ankle. Quite frankly I think anyone ignoring that and harming themselves more in the process is an idiot.
The example of a cat hissing at the veterinarian because it cannot distinguish the situation from a real threat does not mean that cat's never hiss at real threats. If you cannot even be bothered to tell the difference and blame your cat on every occasion, you're being more irrational than the cat.
Especially if a new one, pain is undoubtedly a 'warning signal from the body' which is a succinct metaphor we all understand and has a clear meaning. If you don't know why or from whence the pain, check it out. It may be one of those things or perhaps not.
The previous commenter appears to argue that you need to diagnose every headache, which sounds absurd to me.
Occasionally I have a headache. Not frequently, and I don't necessarily know why. These things just happen. I take a painkiller, and problem solved. I've been seen by doctors over the years for physicals or other reasons, and there's no indication of any underlying medical condition. An occasional headache is not an indicator of something more serious, and the painkiller is not "masking" a larger problem.
The same goes for random muscle aches. They're infrequent, but they can happen, for whatever reason, and there's no reason to panic or to suffer when you can just make them go away.
I don't think I'm unusual here. As far as I've heard, random, infrequent headaches or other aches are extremely common.
Moreover, there are pains that we know the cause: for example, I experience a bump or a cut. My body continues to annoy me with pain unnecessarily. Yes, I'm healing, I'm well aware of that. I just need my body to STFU with the pain and stop reminding me of it.
Unless you have migraines, that headache is caused by something and you'll be much better taking an anti-allergic, or a sinus cleaner, or whatever else actually solves the underlying issue or make the specific symptom go away.
The same goes for muscle aches. There is also specific medicine for them. And you are probably better with an anti-inflammatory for a bump. (It's not normal for cuts to hurt for a long time.)
> you'll be much better taking an anti-allergic, or a sinus cleaner, or whatever else actually solves the underlying issue or make the specific symptom go away.
You can't even say what I should take. X or Y or... whatever else? That's not helpful at all.
> Neither is a car, but I still take it to get checked out when a warning light is on.
I can't believe I need to say this, but cars did not evolve by natural selection. Cars are intelligently designed (by humans, not by God) to show a warning light when there is a problem you should get checked out. So cars are actually rational in that respect.
> I can't believe I need to say this, but cars did not evolve by natural selection.
You didn't need to say that because that's not relevant. The issue was about signal to noise. The logical stance is to assume signal is signal, until you know otherwise.
> The issue was about signal to noise. The logical stance is to assume signal is signal, until you know otherwise.
I know otherwise. I have a lifetime of experience—lifetimes of experience, counting the experiences of other people—to know that pain is often just noise.
Pain is ancient. It predates rationality by millions of years, perhaps billions. The dumbest animal experiences pain. It's not a finely tuned system with documented diagnositic codes.
Might just be an artifact of the broken healthcare system. Painkillers are cheap and over the-counter. Going to a doctor is not.
Additionally, in EU you can just take a sick day to rest and recover pretty much any time you need it. In the US you have limited “sick days”. E.g I now only have 6 “sick days” per year.. (and I’m fortunate to work in tech, I just WFH when I’m under the weather. But people who are less well off need to suck it up and go to work).
Like I just mentioned in another comment, they're also a way to get you back to work ASAP. Just about everyone NOT working a comfy white collar office job needs to be working in order to make money. Time off is less income, people can't afford that so they do what they need to do to get back to work.
Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
>Like I just mentioned in another comment, they're also a way to get you back to work ASAP. Just about everyone NOT working a comfy white collar office job needs to be working in order to make money. Time off is less income, people can't afford that so they do what they need to do to get back to work.
>Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
The office workers will just pop the same damn pills and show up too. Office workers are more likely to show up when in pain specifically because their job doesn't aggravate it. Most people don't have a lavish BigCo sick time policy and even if they do why burn sick time just to be in the same pain and pop the same pills at home. Most people will just have to work harder to make up for being out anyway. It makes sense to just be in pain at the office.
Yup exactly, that's what I was getting at. In the US you can't afford to _not_ work. Not to mention that if you do have actual longer-term health concerns, you also need to pay for the actual treatment, and your insurance depends on your employer. The entire system is really quite flawed.
Here in EU, in order to take official sick days, i would have visit doctor to get confirmation document. Which means that for simple cases i would rather take unofficial sick days (sometimes provided by employer, like in US) or just leave.
Yeah but getting that confirmation document is low effort. And at least in Belgium the doctor visit would cost just like $25 (from memory, haven't lived there for quite some time).
Apologies, I could have clarified that (then again my comment already was a wall of text).
The body does not absorb water passively but actively, and it's been known for a very long time that water with a bit of salt and sugar is absorbed faster. This has been crucial in reducing (especially child) mortality due to acute fluid loss from diarrhea due to, say, cholera[0]. (I personally find amazing that Robert K. Crane figured out the mechanism behind it in the sixties already[1])
Now, "proper" ORS, according to the WHO, is the following:
However, that is in the context of oral rehydration therapy:
glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine; sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea (and vomiting); citrate corrects the acidosis that occurs as a result of diarrhoea and dehydration.
So you can usually get away with not having the potassium and trisodium if the reason for dehydration is neither diarrhoea or vomiting.
This translates to a simple home recipe of:
1 liter (or 4.25 cups) of water
1/2 a teaspoon of salt (3 gr)
2 table spoons of sugar (30 gr) OR 1 table spoon of glucose (15 gr)
The reason for doubling the amount of sugar is that the active absorption of water relies on glucose, while regular sugar is made out of sucrose. Sucrose breaks down into equal parts fructose and glucose (both have identical chemical formulas but a different arrangement of the atoms).
Yup - in the UK, paracetamol is usually recommended for general pain relief before Ibuprofen. Additionally, Ibuprofen and NSAIDs have a lot of interactions which can make them unsafe - SSRIs or blood thinners for example.
The Norwegian pages I linked to states you should be careful with Ibuprofen and anti-depressants. I did a quick search and these[1][2] articles came up, suggesting increased risk of brain hemorrhaging and 10x increased gastrointestinal adverse effects due to the combination.
aspirin is an NSAID, taking it modifies the prostaglandine levels (through its COX inhibition) and this influences the mucosa of your stomach. ibuprofen can still have the same side effects, because its belonging to the same class of drugs.
I once got it to make a small difference for pain - but I was in the hospital (surgery recovery) where the doctors were giving me more than the daily maximum.
This might sound like woo, but sometimes I'll find a quiet place and just sit there and focus on the pain. I try to really understand the sensation that's being registered as pain by trying to notice all the properties of it (is it throbbing, burning, etc...).
Occasionally I'll find that the more I try to identify specific features of the sensation, the harder it gets to do so and the pain sensation fades away.
I do that too. But at least if you are a meditator on my level, there are limits. I sometimes get migraines and focusing on the pain while you are shivering, sweating and close to throwing up at the same time just doesn’t work for me.
Ibuprofen is better are reducing fever and managing headaches.
Paracetamol is the safer version Phenacetin. You used to be able to buy aspirin, phenacetin and caffeine..but phenacetin with withdrawn. APC when it was marketed was very popular but soon you were told to never give children aspirin for a fever so we used Paracetamol. Then Phenacetin was withdrawn and paracetamol became part of APC (like Alka selzta XS , or just the popular caffeine paracetamol combos)
Paracetamol came in as safer but similar, yet no where near effective. It captured bith the market feeling of its pros and cons. So we interpreted it as safer than alternatives (especially aspirin for children due to Reye syndrome). But also dangerous which might be why OPs view was that ibuprofen is safer.
The NNT (number of people you'd need to take it) to be headache free after 2 hours is about 12-20 for paracetamol. But only 7-10 for ibuprofen.
It's quite surprising that paracetamol became the defacto analgesic given it performs so poorly but it was historical inertia. And plenty of people argue that if we were to start over we would not make paracetamol OTC.
Here is a summary of COCHRANE evidence on Paracetamol "widely used and ineffective"[0].
It's a paradox no?
Paracetamol is only the presumed only active metabolite, and that is why paracetamol rapidly replaced phenacetin.
There is a quirk though, phenacetin actually delivers paracetamol to your brain and spine (where it primarily reduces pain) faster than an oral dose of paracetamol.
Similarly IV paracetamol is far more effective that oral paracetamol.
Phenacetin was also considered mildly addictive, and induced a gentle euphoria and then sedation.(We still see sedation after paracetamol in children and the elderly).
But general use we don't see these effects in paracetamol, why did phenacetin do this more effectively? Probably the higher peak levels around nerve endings.
These effects are both wanting of an explanation of phenacetin is just paracetamol and directly analegisic.
I guess it tracks with personal experience. I find Paracetamol is OK for fevers/generic cold symptoms but absolutely useless for a headache, Ibuprofen is the only thing that shifts them.
Well it's the only thing that shifts them now I'm in a country where I can't buy soluble aspirin and codeine OTC.
"I took it and it didn't work so it's a fake placebo drug" - wow, your scientific method is flawless, have you considered a career at the US Department of Health?
I have a counter-study with size n=1: I did all my recovery from tonsilectomy on paracetamol and definitely noticed it working. That was however on the maximum safe dose.
(one of the major problems with paracetamol is that the effective dose is only a few multiples away from the dose which starts to cause liver damage! It is by a long way the most dangerous OTC drug)
You're partially right compared to placebo only about 5% of people are painfree over the effect of a placebo when taking paracetamol.
Paracetamol got it's start as replacing the more effective but much more dangerous and withdrawn drug Phenacetin.
Why don't people notice that it's such a small benefit over nothing? Well because placebo effect is quite good for pain and pain is usually transitory anywhere..if you have a tension headache you're probably going to aim to relax. Turn away from the screen or even have some caffeine and those are more effective than paracetamol!
Where did you pull this 5% from? There are gazillions of studies showing higher or lower efficacies for different kinds of pain. Along with the inaccuracies about Phenacetin (whose MOA is metabolising into paracetamol).
You will indeed find various figures for various pain types all are far worse than ibuprofen.
Here is an example from the Cochrane library
> For the IHS preferred outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour.
A NNT of 22 means that in absolute terms 1/22 people met the positive endpoint criteria more than placebo. This figure is usually quoted as 20% for placebo and 25% for paracetamol giving NNT of 20.
"pain free" is a long way from the pain is manageable. Pain is an understudied subject, where we have too little knowledge. Just using the word manageable is an indication of this.
That's very true, but the metric is applied to all medications you compare against that's what's important. You also just get a baseline idea of what's good by guessing what you'd accept.
Episodic tension type headache tested with ibuprofen Vs placebo NNT is 14. (Btw that's not great itself) But it's better than paracetamols often quoted figure 20.
Here's why I say it's not great. Why don't you guess some reasonable NNTs for say moderate depression treated with SSRIs, or no relapse in schizophrenia treated with an antipsychotic.
Now guess the NNT for a statin to prevent a first heart attack.
SSRI for moderate depression about 10, antipsychotics to prevent schizophrenia relapse over 2 years NNT= 3 (excellent )Statin to prevent a first heart attack 200! (This one always shocks me). Statins have a clear role of course.
They do in NZ. Paracetamol is promoted as the safest, most well studied pain relief for short and chronic conditions. In Australia however they have just started limiting how many you can buy at a time for some reason while ibuprofen covers the chemist shelves without any such controls despite the risks.
IIRC it's because Paracetamol has low threshold for overdose, and is often blended in with other cold and flu medicines in Aus so it is easy to exceed daily dose if you are say, taking some conbination of paracetamol + Sudafed (paracetamol+decongestant) + drinking a Lemsip (lemony vitamin powder with more paracetamol).
It is only packet size restricted in supermarkets, you can still buy bulk packs from chemists.
That is interesting. In the UK they're both available pretty much everywhere, and they're some of the cheapest drug prices I've seen anywhere in the world... ~20p for 16 tablets or something.
I take both. 500-1000mg acetaminophen, 200-400mg ibuprofen. Usually helps for headaches which I get frequently. I only take them for the worst headaches though, so probably once every couple of weeks on average.
Yeah if I need to I take both also. In addition I be sure to have a caffeinated drink also as caffeine has been shown to both speed the absorption and boost the efficacy (5-10%) of paracetemol over a multi hour period. https://pubmed.ncbi.nlm.nih.gov/17442681/
For inflammatory pain (most headaches, most pain from injuries), ibuprofen absolutely works better. For migraines, neither works at all on its own -- though ibuprofen plus caffeine (I generally drink tea) does a little. For overexertion aches and cramps, or fevers, I think either is generally fine.
>For inflammatory pain (most headaches, most pain from injuries), ibuprofen absolutely works better.
Unfortunately, for me ibuprofen doesn't seme to help at all with any of these. Like I understand that my pain are often inflammatory based, and i try ibuprofen, but the pain doesn't dull at all even if I take 800mg etc...
I take 1000mg acetaminophen and boom my pain is vastly reduced...
There seems to be some percentage of people that acetaminophen seems to do very little for. Ibuprofen has a much more pronounced effect, to the point that I take it at half it's recommended dosage.
perhaps it's got to do with packaging sizes. i think an acetominophen od is much worse. most of these countries regulate package size for these drugs, yes? US does not
Neither paracetamol nor ibuprofen work by blocking pain. Depending on the type of pain and your physiology it can range from really effective to not at all.
I only take paracetamol, it works better than both ibuprofen and opioids for me. I know other people who have the exact opposite experience. There’s no absolute here.
Same here. Paracetamol also gives me pretty strong stomach aches whereas ibuprofen rarely has a gastric effect and when it does it's mild at best. I've been told by many people that the opposite should be true but oh well.
I wish they dipyrone was sold here, but alas I can only get it when I travel abroad.
With medicine both can be true, the response depends on so many factors in your body. Same way that for some people, particularly those with ADHD, taking stimulants can make them sleepy.
Many years ago I had 4 surgical procedures done around my nose/throat at the same time - straightening a deviated septum, turbinectomy, enlarging the openings into my sinuses and removing my tonsils. This meant I couldn't breath through my nose for about a month - and breathing through your mouth when you've just had tonsils removed is quite painful.
Soluble paracetamol literally turned the pain off like a switch - of course I was limited as to how much I could take, which I was careful to stick to but I was almost in tears waiting for the time to come where I could take more paracetamol.
So in some situations paracetamol can be an extremely effective painkiller.
Yes, I had a herniated disc and had severe nerve pain. While waiting for a time when I could get surgery to fix it acetaminophen reduced the pain even more than opioids! ibuprofen and an oral steroid like methylprednisolone did nothing...
Acetaminophen is like a wonder drug for me while ibuprofen doesn't seem to ever do anything for me.
What is the difference between the two? I treated them as synonym.
I did not said it cures the root issue, frankly I dont care that much. I am taking it so that the pain stops and I can function normally.
Paracetamol does not stop pain/hurt. It is like taking nothing and just waiting. It may help with fewer or some such, but I am not taking Ibuprofen for fewer.
Really lovely article. In paramedicine we usually treat 10g of acetaminophen in a 24-hour window as a potentially fatal overdose. That's also why the law in Australia was changed to require acetaminophen to come in blister packs (harder to get each pill out) of no more than 16. At 500 mg, that only gets you up to 8 g if you eat the whole thing, which is still hopefully non-fatal.
I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
I randomly bought NAC just to try it. I dont know about the chemical interactions, but going out with collegues at that time taught me that it's basically impossible to get drunk. Usually a pint of beer is enough to make le feel at least a little dizzy, but when taking NAC, it was all like drinking water
If you all think NAC is great, wait till you try liposomal glutathione (glutathione is one of the things NAC is a precursor for, one of the general take-out-the-trash compounds for your cells). Of all the supplements I’ve tried, it has probably the most immediately noticeable positive effect (maybe because you take it by leaving it under your tongue to be absorbed sublingually for a bit before swallowing). Generally leaves me feeling great, even if I was kind of dragging and tired beforehand.
When I go out drinking with my pharmacist buddy, we take NAC before going out. He swears it makes hangovers less likely. I can't say I've noticed that particular effect, but I do seem to sleep a bit better on those nights.
> Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.
I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.
My anecdotal experience is that NAC makes me much more tolerant to alcohol. As in, I can drink a lot more without feeling the effects. Since I don't get the same buzz, I care less about reaching for a beer.
How is nac (acetylcysteine) delivered there? I can buy dissolvable tablets here in Europe but from what I see that’s less helpful for mucous, things like mucomyst require inhalation, which isn’t in otc products I know of.
In the Philippines it's available as an effervescent tablet to be dissolved in water. They still tend to work better than the western remedies (guaifenesin etc) even in this form IME.
Usually here in Canada it's available in capsule form which I find less effective.
Same here actually, I find it slightly helpful but the effect’s useful time is limited. I’ve wondered if I could capture the gas released while bubbling and inhale that…
The dissolvable tablets completely fix a runny nose for me. Much better than any nose spray, which tend to irritate the nose and lead to chronic runny nose if taken for too long.
I've heard it suggested that acetaminophen just come with a small dose of NAC alongside it to make it safer. I guess this would require a lot of regulatory work to approve, but given that 500 people a year OD, it seems like a thing we should at least consider.
Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.
Certain esters have been found to be much safer (in mice, at least):
> The glutathione hepatic values in mice obtained by intraperitoneal injection of the ester are superimposable on controls and the oral LD50 was found to be greater than 2000 mg kg^-1 and the intraperitoneal LD50 was 1900 mg kg^-1 ...
and more general analogs apparently can also be designed to not produce NAPQI:
> Thus, in 2020, N-sulpharyl-APAP prodrugs 39–40
(Fig. 11) were developed. [...] They are not hepatotoxic because they do not generate toxic metabolite NAPQI, even in concentrations equal to a toxic dose of APAP (600 mg kg^−1 in mice).
I am blessed with living in one of the most polluted areas in the world (PM2.5 going into thousands of µg/m³ in winter; summers are not much better due to dense chemical smog). Can you say more about how you're using it to combat that? Thanks!
What does ingesting 10g of acetaminophen even look like? I've got to imagine the fatal dose is far, far, far lower with chronic usage. Finding out that people are ingesting grams is profoundly disturbing.
Extra strength tylenol is 500mg a tablet, so 20 pills. Think most of the accidental ODs are due to people not realizing its included in other cold meds, and also being loopy from whatever illness they're trying to manage, and so end up forgetting when they last took the meds.
Its also a pretty popular choice for people trying to kill themselves, though, so I suspect a non-trival chunk of ODs in the statistics given in the article were intentional.
I have taken 4-5g in a day while suffering from intense pain before.
There is a limit to the amount of opioids they will prescribe you, even if you are in mind shattering pain. For instance while attempting to get your dental insurance to actually cover a treatment you may find yourself between risking organ damage or risking $5000+ in ER visit bills only to have them refuse to give you anything but Tramadol.
> I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
Having a condition that actually warrants strong opioids and not being able to get them at any price is definitely not an improvement.
The problem is fundamentally that we want to pretend doctors can always distinguish two people describing the same symptoms when one person actually has them and the other is trying to get drugs. The often can't, so you can either make it hard for people to get pain medications even if they need them, or you can make it easy for people to get them even if they don't. And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
> And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
Could not agree more. Depriving people with legitimate pain of opioids is IMHO legitimate torture. It's a bit of a variance on the trolley problem in that the doctor/government isn't causing the pain, but their inaction is prolonging it.
Brother (or sister), you were simply not trying hard enough. I live in a very clean, safe, expensively-policed county, and even I know where to buy fentanyl for much lower cost than a hospital. I would happily turn to that than take 20(!!!) advils in s single day.
Let's review the policy options in light of your suggestion:
1) We make it hard to lawfully acquire pain medications. You pay $$$ to see a doctor and you pay it even if they refuse you. If they do, you then have to pay $$ to get them from Stringer Bell, or start there to begin with if you didn't have $$$, and hope they're not cut with drain cleaner or unevenly mixed so that some days you get 100% corn starch and other days you get a fentanyl overdose.
2) We make it easy. Anyone can get them from Walmart. The people who need them pay the same $ they do for a bottle of Advil/Tylenol instead of paying $$ to murderers or $$$ to waste scarce medical resources that could have saved someone else's life. The bottle from Walmart always has a consistent amount of the drug in it and neither the dental patients nor the addicts get a surprise fentanyl overdose.
Whenever people here mention to my critique of US healthcare how its now mostly solved problem now, its 'good' to see the other side and reality. It certainly doesn't seem solved unless you have a million or two just laying around on the account, while mortgages and kids tuitions are paid. And I can easily imagine a long term condition or 10 which, if unlucky in terms of treatment cost coverage can wipe out that sum in a decade or two, for a single person.
Seriously, how can you guys consider this acceptable. I am not of faith but doesn't bible teach to be kind to your fellow men above all? One would expect more adherence to such basic moral rules in such conservative christian society.
I don’t know a single person in my life who thinks US healthcare is good, so that’s weird. And many my peers a have good jobs with good health insurance. Everyone I know has at least one bad story about insurance, if you’ve ever had more than really basic checkups.
The problem with the US system is that it doesn't know what it's trying to be.
If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.
If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.
The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.
It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.
Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.
I think you're trying to apply ideology where it doesn't belong. Nobody on earth would advocate for such extensive spending to facilitate agreement on financing. It's extremely, extremely inefficient. (But it does produce jobs, which makes politicians super horny.)
The market also won't assist us, as we can't exactly compete future treatment costs against unknown illnesses.
Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence. Any remaining options would highlight deficiencies in the existing system.
A schumpeterian system, if you must slap an ideology on it.
> Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
Emergency rooms operate by triage. If you're having a heart attack, you're going in right now. If your shoulder has been bothering you for six months, you might have to come back multiple days in a row and spend the whole day waiting before there is a slow enough day that you can be seen. There is then an obvious incentive to go pay a private physician to be seen immediately instead. Free clinics are similar: There are no appointments, it's first come first served, and then most people prefer to pay $100 to schedule an appointment rather than wasting an entire day waiting in a queue, but you still have that option for people with no money.
Emergency rooms are also a natural monopoly because in an actual emergency the primary consideration is which one is closest, which doesn't make for a competitive market. So it makes sense to have the government do that. Whereas non-emergency care (which is the large majority of medical expenses) would allow people to compare prices or make cost trade offs against distance or convenience etc., if we would actually expose people to pricing. For example by requiring price transparency and then having insurance pay the second-lowest price for that service within 100 miles of your location, but then letting you choose where you actually want to go and make up any difference yourself, or choose the lowest cost option instead of the second lowest and then put the difference in your HSA.
> A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence.
It's not clear how a government option that doesn't have taxpayer subsidies would do this any better than a private non-profit. There are many existing non-profit healthcare providers and they don't have meaningfully lower costs than for-profit ones.
The general problem is that "non-profits" and government-operated services still have money flowing through them and "profit" can be extracted in all manner of ways other than paying dividends to shareholders. The officers can just pay themselves high salaries, or whoever is in charge of the budget can take bribes/kickbacks to shovel money in the direction of the contractors or unions paying them off.
Meanwhile the nature of "profit" in a competitive market is largely misunderstood because of accounting differences. If a non-profit wants to buy an MRI machine, they have to take out a loan, and then pay back the loan with interest which they account for as an expense. A for-profit company might get the money to buy it by selling shares to investors, and then paying dividends to the shareholders instead of paying interest on a loan, which goes on the books as "profit" instead of interest expense. But you couldn't just replace them with a non-profit and then lower prices by the amount of "profit" they were making because then they also wouldn't have had private investment and you're back to needing the loan and paying the same money as interest to the bank.
The thing that requires providers to be efficient is competition, because then the ones wasting money or taking bribes have to cover the amount wasted/embezzled by charging more to customers and then the customers don't choose them because they have higher prices. But that's the thing the existing regulatory system goes out of its way to thwart.
Taking too much acetaminophen is bad for you but 10g is 20 extra strength pills and that much isn't likely at all to kill you but damage your organs is quite possible. Reading this might make someone in a bad place think that much will do the job and it won't. Tylenol poisoning's most likely outcome is permanent organ damage and pain, don't try it.
I've been prescribed slightly more than 5g per day (2 x 650mg tablets every 6 hours) for pain after an operation jointly with ibuprofen, which is scarily close to the limits.
The .nl indicates the netherlands. Many people in the netherlands vent/joke about how the doctors here only ever tell you to take paracetamol and come back in two weeks if it's still a problem (recursive solution).
However the last time I went to my GP she scoffed at me taking the maximum and suggested I take literally double the maximum recommended dose 4-5 times a day which totaled I think 2.5x the daily maximum on the package. I am very much a "believer" in science and reasonable medical authority but this experience sowed the seeds of doubt, because from what I have always heard, that can actually kill you or cause permanent liver issues. I was also taking diclofenac simultaenously, and when I told her how many mg, she asked "where can you even buy such small doses, that's what I would give a small child" =/
My understanding is double the max dose of paracetamol is the LD50. Seems crazy for your GP to advocate for that. Published recommended dose is assuming average weight, so maybe if you're a very large person, the advice makes some sense, but wow.
They are common in France, but not in such packages: There are restrictions that prevent you from buying more than than 8g/day (theoretically at least, I don't believe they are strictly applied in practice).
They are widely sold at 1000 mg (1g) tablets in Europe, but in many countries they require doctor's prescription. There are also purchase limits to the number of pills you can buy at once.
As an American this is such a weird question to me. I purchase my ibuprofen and benadryl in bottles of anywhere from 400 to 1000 pills every few years.
Apparently a common source of problems is taking two different medications without realizing they both contain acetaminophen.
Suppose your arthritis is acting up, so you start taking Tylenol 8hr Arthritis Pain[1]. That's 2 tablets every 8 hours. They're extended-release with 650mg per tablet. A total of 3900 mg in 24 hours.
A few days later you get the flu, so you decide to add what seems like a completely different medication: Theraflu Flu Relief Max Strength[2]. It has a cough suppressant and an antihistamine. But each caplet also contains 500 mg of acetaminophen. It says to take 2 caplets every 6 hours, so you take 8 of them in 24 hours[3]. That's another 4000 mg.
Between the two, you're at 7900 mg.
Then you wake up in the morning and take both medications, but 30 minutes later you've forgotten you took them. You're not thinking straight because you're sick. So you accidentally take a second dose. That additional 2300 mg brings your total to 10200 mg.
[3] You weren't supposed to take 8 of them, though. If you'd read the label very carefully, you'd have seen it also says not to exceed 6 in a 24-hour period.
My personal rule is to only purchase over-the-counter meds with a single active ingredient. I'd rather separately take an antihistamine, expectorant and painkiller than a concoction where I have to read the whole label and do math while sick to separate the doses and timings.
There are some that are very hard to find as a single ingredient. Recently I was purchasing a medication for back pain, I had a choice as to which other ingredient I wanted, but I didn't have the choice of none. I picked the combined ingredient I don't like to take, because I wouldn't be adding it on top.
I did toss on the other option, stand alone, at one point so I could get some sleep.
It left the medication I was more comfortable taking as an add-on option if things got bad enough. (This particular medication has much lower risk of overdose, so if I got stupid and took it again there would be no significant additional risk.)
It's ironic, but taking the combined medication with a known higher risk of its own was better than taking the lower risk medication.
One was controlled, higher risk, taken at specific times, while the other was taken in addition, on demand, as required.
Specifically this is one reason they’ll sell you cocodemol or Vicodin but not codeine or hydrocodone directly — if you take enough to get a codeine high, you’ll have taken a toxic amount of paracetamol/acetaminophen, so they assume you won’t.
I didn't until I had a bulging lower back disc pressing on my sciatic nerve. My leg felt like it was constantly on fire no matter what position I put myself in. In the past I've torn my ACL and had surgery to reconstruct and that pain was like stubbing my toe compared to the back pain. I understood how people become addicted to pain meds after my back situation.
Totally get it, I too only understood it "theoretically" till I had a (fairly minor!) dental operation.
... Suddenly I'm maintaining a continuous note of when I'm taking which medicine to avoid crossing safe limits (which I anyway was crossing most days).
I was only told to take 2 paracetamols a day (bullshit dose, I'd be waking up from the pain even with more pain meds).
"Diclofenac for rare use" - well, if nothing else is touching the pain, is it an emergency?
Eventually after forever I was able to transition to Ibuprofen + paracetamol. And I already have a health condition which is heavy on my kidneys... pain management can be absolutely crazy.
Pain management can be crazy but in your case it sounds like they simply didn't prescribe the appropriate medication presumably due to the anti opiate hysteria that has taken hold.
While that's quite possibly true, I forgot to mention that I'm not in the US but India. I was conscious the whole time, with only local anesthesia. Also the dentist in question is actually our "family" dentist, and he's a pretty knowledgeable/skillful guy (easily more knowledgeable than many GPs on health matters of the body).
Fun fact, you can totally get them to pause the procedure without saying a word. All you have to do is end up in a lot of pain, have your heart rate skyrocket like anything, and get everyone in the OT very concerned ;)
I had severe nerve pain due to a herniated disc. While awaiting a surgery, I was prescribed an opioid (Tramadol) but it didn't seem to help much at all. Acetaminophen actually worked better than the opioid for me...
This can easily happen over the course of 24 hours if you're in "fuck me I'll do anything to make it stop" levels of pain. I've taken more than 20 ibuprofens in a day a few times in my life, which, while not medically advised, did not kill me. I actually had no idea acetaminophen was so dangerous.
Just in case, ibuprophen does not work well for pain relief [at lest for some kind of pain]. Paracetamol [acetaminophen] usually is much better against pain.
And paracetamol + ibuprophen can help with strong pain for which neither paracetamol or ibuprophen work at normal doses.
Not really. Both address different sources of pain, and do so using different processes.
Ibuprofen is a Nonsteroidal Anti-inflammatory Drug (NSAID) that reduces pain and inflammation, while acetaminophen does not. (Acetaminophen is believed to act mainly in the brain rather than at the site of injury).
Ibuprofen- Fundamentally, if the pain is caused by inflammation, reducing the immune systems response to it can reduce pain, but if the pain is more acute it won't make a dent.
With acetaminophen, taking more isn't a solution in most cases, you need another method to reduce the pain further if it doesn't achieve its goal.
(That's why it's combined with things like codeine, which affects the brain in a different way for an additive effect)
> you need another method to reduce the pain further
I don’t know about “most cases” but often you don’t want to reduce the pain _further_, you want to reduce the pain _again_. (Having an alternative definitely helps in the meantime.)
Buy a pack of 20x500mg (just checked, common size in Germany), take 2-3 every half hour for a while.
Sure, that's extreme. But if you're unaware of the risks, you feel sick, and you believe it's helping you.
I mean, people aren't killing themselves in masses with it, but it happens every now and then. Easily imaginable that one in a few million people will have enough tendency to take more pills and is unaware of the overdose danger.
You can still buy 100 packs, they are just behind the counter at chemists. TBH it's a rather stupid restriction - do they think people only ever own 1 packet of paracetamol at a time? In my household we have at least half a dozen, including a 100-pack from Oz and a 500-pack from America.
Oh right - that's probably what we did, buy a big pack from behind the counter.
I don't think you can even do that in the UK.
Yeah we usually have a few packs hanging around, and I get the 'it seems stupid' thing, but sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life. I dunno, I hope that's shown in the evidence anyway. Otherwise it's just pointless like the whole pseudoephedrine song and dance, which has inconvenienced anyone looking for a decongestant while doing sweet FA to the availability of meth.
> Oh right - that's probably what we did, buy a big pack from behind the counter.
No, when you visited they were still on the shelf. They only put them behind the counter in 2025.
> sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life
I'm philosophically not for making suicide harder. If someone wants to die, that's their right. And practically, while you might be able to show a stat-sig decrease in paracetamol poisoning, I'd expect the suicides to largely just move to other methods.
The point is that many don't really want to. Those that actually want to can buy two boxes from two shops or ask the pharmacist for the big pack from behind the counter.
This just adds a tiny amount of friction to impulsive attempts, which may be a classic cry for help or just someone in the depths of some sort of mental health episode. Such folks may think better of it the next day and a very small amount of inconvenience will put them off. I think suicide is serious enough that you should probably mean it, and societally saying 'think twice about this' is a good thing.
On the idea that it just shift deaths, as your sibling poster points out (from the UK) -
"in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
So it looks like this tiny, tiny barrier does actually deter people. And that definitely points to them not really being sold on it in any rational way.
I just don't buy the paternalism. People have free will, if they want to do something they would regret later, it's still their right.
That quote doesn't say what you think it means. It's not talking at all about whether suicides shifted to other methods; it only says that there was a secular decline in poisonings (-32%) and suicides in general (-10%) during the study, so they have to also discount some of the raw 48% drop in paracetamol as being part of that broader trend and not due to the treatment. They come to the 43% number only with a generous assumption that had the law not gone into effect, there would have been an increasing trend in deaths from paracetamol poisoning, which seems wrong to me. The more obvious way to derive the prior would be to look at non-paracetamol poisonings and expect the same trend, in which case the effect might be something like -24%.
Anyhow, it's still perfectly possible that the people who were deterred from paracetamol poisoning committed suicide some other way; the data in that paper says nothing about it.
> People have free will, if they want to do something they would regret later, it's still their right.
Then this minor frictional measure is the very least of your worries. For a start, any given pharmacy has an entire pharmacopoea of compounds that people are kept away from for their own good. Not to mention liquor licensing rules making landlords cut folks off at a bar if visibly drunk etc. And guard rails to stop people climbing to high places. And ... preventing people from doing stupid shit in the moment is everywhere in our societies.
There are a heck of a lot of things I'd put higher up my list of concerns than "may have to visit two shops if wanting to kill myself"
Paraphrasing from [0], after September 1998 when the restriction was introduced, "The annual number of deaths from paracetamol poisoning decreased by 21% [...] the number from salicylates decreased by 48% [...] Liver transplant rates after paracetamol poisoning decreased by 66% [...] The rate of non-fatal self poisoning with paracetamol in any form decreased by 11%"
See also [1]: "in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
Yes, and you can still die in a car crash if you're wearing your seatbelt, and wearing a helmet on your motorcycle won't save you from a head-on with a truck, and you can still drown in a pool with a lifeguard, and you can still die in a burning building with smoke detectors.
Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0]
No. Ethanol and tylenol compete for CYP2E1 that produces toxic NAPQI, so no, acute alcohol intoxication has a protective effect at least where it comes to tylenol toxicity.
Alcohol and Acetominophen/paracetamol should not be mixed.
When alcohol enters the picture, it increases the activity of CYP2E1, so the body produces more of the NAPQI toxin. Alcohol also decreases glutathione production, the body’s natural defense mechanism, meaning NAPQI is more likely to build up in the liver in dangerous concentrations.
There is a danger in chronic abuse resulting in upregulation. Mixing the two at once is no problem for the liver, which is also why patient information leaflets for paracetamol do not contain a warning to avoid alcohol, only about chronic alcohol abuse.
Your crappy source is vague in what consumption pattern constitutes a risk and actually cites a better source that supports the idea that acute alcohol consumption reduces paracetamol toxicity. https://www.biorxiv.org/content/10.1101/2020.07.07.191916v1....
That's a mathematical model, but this relationship between the two is what I was taught in medical school and it is still supported by the science. There's plenty of other sources, I just picked that one because your article cites it. Just search for "paracetamol ethanol" on Google Scholar.
I lived with an ICU nurse for years and one of the things he emphasized was the risk of acetaminophen overdose. He's more than once treated the liver failure (and death) from it and by his words, it's one of the worse ways to go.
The positive of it is it got me in the habit of logging whenever I take it, either in a note on my phone or just a sheet of paper I place on my dresser under the bottle. This helps make sure I stay under the 3-4g/d limit.
Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis.
Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.
In my wilderness first responder class they emphasized taking a cocktail of ibuprofen and acetaminophen - both are effective pain relievers, each with different dangerous side effects.
The benefits stack, the side effects don't.
So if you are going to be loading up on higher doses of pain relief, take half acetaminophen and half ibuprofen.
P.S. like someone mentioned in a comment below happened to them, be careful with NSAIDs over the long term. Until recently I took them daily for better part of 3 years. I was recently diagnosed with chronic kidney disease. Can't definitively say causation, but they definitely contributed. They're fine for short term use but can really f$%# you up with long term, daily use.
It is absolutely valid to warn about long term use, and NSAIDs in particular (I was lucky and had a gastroscopy before they'd done any serious damage, but they found significant erosion of my stomach lining due to NSAIDs), but acetaminophen/paracetamol isn't an NSAID (ibuprofen and aspirin, for example, are)
In mozambique i was committed to the hospital with my liver failing after spending two weeks taking acetaminophen daily because everyone at work got sick and someone had to keep the business up (it was a bank, our IT department was very specific and only 6 people knew that job and everyone got extremely hill).
After two weeks, i finally went to the hospital and I couldn't leave; spent the next two weeks fighting for my life and at some point I was told I was not going to make it.
All due a simple over the counter medicine... crazy. This was 2016.
To this day I still get extremely tired if I take it, so I have to choose it carefully when to take it.
It often happens when people take the max dose of straight paracetamol, and then also take another drug that has paracetamol in it without knowing that (e.g. a codeine/paracetamol or ibuprofen/paracetamol combination).
People who are in a lot of pain and don’t know the risks.
Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.
To be fair, the "real" limit depends on how lucky you are with your body's makeup. The safe limit is below that limit.
I know people with permanent pain due to medical conditions who have been given a doctor's approval to exceed the limits printed on the packaging (after having previously been monitored). You can exceed the limit on the packaging by one or two pills.
A bit more is often not deadly, but it's very easy to take more than a bit. When I had a messed up mouth for several days, I took the maximum doses and set timers to help me regulate the dosage throughout the day, but I sure wished I could've taken more at that time.
Okay that's right, if you just keep upping the dose because you're still in pain it might be easy to just slam a few every 4 hours
From personal experience if i have a headache I'll take 1000 mg all at once; it either works right away or it doesnt and I stop bothering until I've had a good nights rest...
Imagine if that rest will do nothing for that headache and its there morning day and night. Or some injury-related pain which simply can't be downtuned. Plus when old, half of the body aches, all old injuries and general deterioration.
I had only very brief experiences with longer intense pain but it made my mind into pudding and desperate knot of how-to-stop-this-at-all-costs. Normal life is not possible and sanity is not granted.
Yah...I've been there for 6 months now with a constant headache. The first month or so, I was taking 3.5g/day consistently. At hour 4.5 - 5, it would wear off. If it wasn't for my tracking, I probably would have ODed.
If you take 2 on average every 4 hours, you're at 12. If you're feverish or otherwise feeling ill enough and sleep deprived enough, forgetting when you took them last is easy. Personally I write down the time I took the last one.
You are running a high fever or have a massive headache, so know you are going to max out at 4g/day. At that point, it's kind of hard to keep track of the clock.
"My head is pounding. Shit...did I take this at 3PM or 5PM? I know I took it and then fell asleep, but I can't remember when. It is now 9PM, can I take more or not?"
My mother in law did this. There are a lot of ignorant and uneducated people out there. They think "take this for pain" = "take more for more pain", popping one an hour not really understanding how insanely dangerous it is since acetaminophen has such a subtle effect until it's too late.
It's in all kinds of medicine. People take some pills and then add a cough syrup, not noticing that the syrup also contains it as an active ingredient.
Something I'm surprised this article didn't mention is that sometimes the anti-inflammatory is the point. If you have swelling along with the pain then ibuprofen or any other NSAID is going to be much more effective. That would be the main reason to go with ibuprofen in my opinion. But again if you take medical advice from an internet comment you're already doing it wrong.
> if I needed a painkiller, I’d try to take ibuprofen rather than acetaminophen. My logic was that if eight grams of acetaminophen could kill my liver, then one gram was probably still hard on it.
This article is explicitly considering usage as painkiller.
You can’t use Tylenol as an anti-inflammatory so it’s meaningless to compare them for that distinction usage.
If you need a painkiller it's worth considering the source of pain you are trying to kill. This is an article with a chart considering 11 different situations you might be in and which pill is better for each. A 12th line for "there is also some swelling in the part of you that hurts" would make sense to me.
The right tool for the right job. When it comes to medication, in the right dosage.
I'm aware of acetaminophen's down sides, and yet recently I was taking it combined with 2 other medications at the time.
Why? Because all three medications are recommended for dealing with the issue I had. (Alone and in combination)
The moment it wasn't helping further? Done.
There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
All medications are potentially toxic, your body wants to dispose of them. In appropriate dosages they will benefit you, but more isn't inherently better.
Even water can kill you in sufficient quantity.
We do the same with diet; where someone declares one ingredient in a meal healthier than another; it isn't. A single ingredient isn't better or worse for you in a meal. Your diet however can be good or bad; over time that matters.
I agree with your overall sentiment. But allow me some objections:
> There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
But it is. The faster I go, the earlier I arrive at a destination. The more I eat, the later I'll be hungry again. The more I pay, the more I can buy. The more I smile, the more people smile back. It's all-pervasive in life, and "more is better for many things" is just obviously true. Not for all things and there are limits of course.
> More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
A higher dose gets broken down slower, as in, the threshold below which the effect is reduced is reached later. Not a reason to damage your kidneys and better take smaller doses more often, but it's not fully accurate to say there is a limit and anything above has zero effect.
I had a herniated disc and severe nerve pain. I took 16 ibuprofen a day, 4 200mg pills every 6 hours, it did nothing that I could tell. I also used a methylprednisolone dose pack, also didn't seem to help. I also tried prescribed opioid (tramadol), didn't seem to help much.
Acetaminophen worked far, far better than all these. It worked so well, but i wanted to be careful to limit myself to 3000mg a day, so I took 1 500mg pill every 4 hours for a few days while awaiting surgery. It's the only thing that got me through it. Even a epidural lumbar steroid injection didn't help...
Yeah can confirm. I try to keep it low but then pain lingers for days and cumulatively over the days most probably I took as much as I should have taken in stating few days already.
No, moving definitely works. I can almost predict when my sciatica pain will be coming - usually when I work long hours sitting and don't do enough movement. I struggle to be more active than just going to the gym. I think we - those who suffer from herniated disc and sciatica, need to move much more than those who don't.
I grew up with the understanding that acetaminophen was the safe choice for fever or aches, and ibuprofen what the more potent compound for inflammation and severe pain. I recall casual anecdotes that "my doctor said 1.5x or 2x ibuprofen dose is ok when warranted" to address major incursions.
I've never once thought about taking more than the recommended dosage of acetaminophen, largely because I had no expectation that it would provide additional benefit..
In reality, I try to consume 1/2 doses of anything or nothing at all, unless it's a serious medical treatment being administered by a professional.
> largely because I had no expectation that it would provide additional benefit..
An interesting thing with ibuprofen is that at the regular dose of 400mg it inhibits pain but if you take 1600mg it doesn't inhibit much more pain than the 400mg dose, but the inflammatory effect does increase significantly. A lot of people don't know that and take too much thinking it scales linearly.
I think most overdoses happen as a result of someone trying to hurt themselves, but I’ve also previously been in sufficient pain (always dental) that I’m counting the minutes down to when I can take more painkillers, so it’s easy to see how you could take double the expected dosage.
If your doctor recommends to take a specific dose, take the specific dose. Don't half it. Taking half of stuff can also cause further damage. Like with antibiotics, where it can lead to bacteria becoming resistant.
So don't be the "smarter" person. Do as your doctor says and if you have doubts, consult another doctor before just doing what you think is safe, but actually isn't.
Yes that's correct, but in doing so remember that only person that cares most about you and your health is YOU - doctor cares about you for 10-15min, then next patient is waiting, and the level of doctor's care is inversely proportional to the level of burnout.
Is this not the case for OTC drugs? Specifically, the two mentioned in the article. I rarely take either of them, but if my doctor tells me to take 1 ibuprofen every 6 hours or so, if I halve that am I actually doing more damage?
In general, taking a lower dose than recommended can cause problems, but aside from antibiotics, the problems are probably going to be from insufficiently treating the underlying condition, rather than the medication itself. Most OTC drugs give a single recommended dosage for all adults, so some people will necessarily get a lower "effective" dose than others (eg. a 200 lb man compared to a 90 lb woman).
> Specifically, the two mentioned in the article. [...] but if my doctor tells me to take 1 ibuprofen every 6 hours or so, if I halve that am I actually doing more damage?
With the caveat that I'm not a doctor, you should be fine: the only effect of acetaminophen is pain suppression, so if the pain is tolerable, then you should be fine. Ibuprofen has some anti-inflammatory effects that could be important here, but realistically, if the anti-inflammatory effects are the primary reason for the prescription, then your doctor is more likely to prescribe naproxen or celecoxib.
But if this ever comes up for you again, probably the best solution would be to tell your doctor/pharmacist "I have a high pain tolerance, would it be okay if I take less?", since in my experience, medical practitioners are generally pretty happy to hear when you want to take less drugs.
Scattered throughout this discussion are a number of comments concerning the potential damage to the stomach lining from ibuprofen, naproxen and aspirin. This is an important consideration when choosing a painkiller. According to a recent Washington Post article by Trisha Pasricha, MD, "You should avoid taking nonsteroidal anti-inflammatory drugs, or NSAIDs — such as ibuprofen, naproxen and aspirin — whenever possible. If you do need to take them, use the smallest dose for the shortest time feasible."
Dr. Pasricha adds: "I don’t get too concerned if my patients take one or two doses every now and then. But through regular use, such as several times a month or more, NSAIDs are well-known to increase intestinal permeability. In other words, NSAIDs can damage the lining of our guts. That’s because NSAIDs reduce the blood flow in the tiny vessels feeding our guts and disrupt the intestinal cells forming a barrier between the outside world and your insides. This has been proven over and over again through decades of research."
Conclusion: Acetaminophen is generally safer than ibuprofen, naproxen and aspirin.
Anecdotal, but this is what got me to finally see a doctor about purpose-made migraine abortives. I was taking huge doses of naproxen multiple times a week, until I started to get terrible heartburn with every dose.
My father, who is otherwise in very good health for a ~60 year old, has severely reduced kidney function from taking an ibuprofen+antihistamine most days of his early life to deal with allergies.
I'll second the claim that no doctor at any point in his life had told him the risks of doing that, and many encouraged the use of ibuprofen over any other alternative (including the alternative of not using OTC painkillers every single day).
If there's one thing I'm hopeful for regarding all this AI hype, it's that some day we might actually get the Expert Systems we were promised decades ago. Then, finally, we can stop expecting human doctors to know everything. There's just so much going on inside our bodies and it's unrealistic.
I had a relative with a different story in the same theme. It sucks and I want to see this technology do something truly beneficial for a change....
The expert system relies on training data, and most of the medical data on the internet is either outdated or outright wrong. AI is not going to solve what the existence of Google hasn't solved already.
It's a very strange cultural thing too, Australians (and I presume other Commonwealth countries) default to paracetamol (acetaminophen) before ibuprofen
Paracetemol has always been seen as first thing you'd take for pain relief, and you'd "step up" ibuprofen as an escalation, but that might more to do with marketing of Panadol (paracetemol) vs Nurofen (ibuprofen).
We'd look on at the US where you were taking Advil like candy in confusion.
One great thing you learn as a parent, you can alternate acetaminophen and ibuprofen. Both of them are recommended every four hours, but you can stagger one by two hours to maintain consistency of pain-relief taking ibuprofen then paracetemol two hours later
In the article it is mentioned but it is worth stressing that N-acetylcysteine is a trivially available antidote for paracetamol overdose (and you may have it at home without knowing, Fluimucil, Mucomyst, NAC or alike).
Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric. AFAIK liver failure because of paracetamol in Europe is very rare. So here there could be cultural issues at play (medical culture of what is prescribed, and the fact that Europeans in general take lower dosages of everything).
EDIT: trick, if you very rarely take paracetamol and other pain medications, the next time try to take just 250mg. It works for most people, no need to take 750 or even 1 gram of paracetamol. 500 works for almost everybody, 250 for many folks.
> Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric.
This is not my experience. After moving to Germany from the UK, I feel like people take and expect Ibuprofen far more often than Paracetamol. It seems like the first port of call for colds and general headaches, with Paracetamol being treated with some suspicion, despite it being far more effective in my experience for certain things (I've taken a lot of Ibuprofen and other NSAIDs in my time so am quite familiar with how they affect me).
Didn't expect that, my feeling was that the situation in most continental Europe was like in Italy and the UK, and even more in France! (I believe they have the record of use), in such places paracetamol is very strong.
This is some of the most useful information I've received in a while. Like the author, the low overdose threshold of acetaminophen made me avoid it, even though I always take low doses anyway and ibuprofen gives me acid reflux almost every time.
Still take it with a huge grain of salt. Even official advice usually has severe limitations due to its broadness or straight politics, so medical analysis from random blogs truely isn't the best.
Acetoaminophen also has issues for people with weaker stomachs (I can attest), and will come with additional medication to cover these effects as needed. The whole "Is it safe yes/no" table has many asterixes and might be outright false depending on the how you look at it.
Never take anything that written on the medications with a grain of salt. Disregard everything that you have read online. The medicine instructions are your single source of truth
Both ibuprofen and naproxen sodium are NSAIDs and are bad for your kidneys especially in long term. I had kidney failure due to what was eventually diagnosed as an autoimmune disease but they first thing the ER doctor will ask is if you have been taking NSAIDs. My nephrologists told be its still safe to take acetaminophen at the proper dose.
None of us are your doctors but Naproxen has well-known gastric issues up to ulcers and stomach bleeding which is why it's advised to be taken with food and why it's also often prescribed with a PPI or H2 Antagonist. Cox-2 selectives such as Celecoxib greatly reduce this risk but seem to be associated with some small cardiovascular risk (admittedly this is a feature of all NSAIDs though less so in Naproxen apparently).
Cardiovascular risk increase is not a feature of aspirin, the original NSAID. Aspirin lessens cardiovascular risk which is why we give it to patients in the initial stages of a heart attack: It decreases the likelihood of further clotting.
Some believe naproxen sodium is worse for you because it lasts longer. Longer duration for reduced mucous membrane coverage in your stomach and intestine. Longer duration for reduced blood flow to your kidneys.
I would definitely have a chat with a doctor about it.
I had to use naproxen for some time as most effective way to control inflammation. Actually the only way, ibuprofen had some effect only in horse dozes. After visiting doctor, analyses, checking available sources was able to eliminate the reason of inflammation. Apparently it was a well known problem/solution. So far so good. Not sure about the long lasting effects of naproxen use.
Whenever its prescribed here, its paired with some sort of intestine protection medicine to stop it burning holes in your stomach/intenstines
Ibuprofen is much safer, so long as you eat with it.
Paracetamol is also safer, so long as you don't OD.
BUT! so long as you stay below 4 grams a day, you'll be safe. (yes yes, in some situations you can take double, but unless you are under supervision, thats asking for liver pain.)
In the US, Aleve is the name-brand pill for naproxen, available in grocery stores next to everything else. I have a bottle of 160 gelcaps. Each pill is 220mg naproxen sodium or in parentheses 200 mg of naproxen. The advertised effect is 12 hours / all day, getting anywhere near 4g would only happen in a suicidal "swallow bottle of pills" situation.
GP meant 4g is the safe limit to paracetamol (hence "liver pain"). About 8 typical doses over 24 hours. It's little known amongst the general population, who have the occasional extreme of people taking double doses every few hours
That combo is naproxen/esomeprazole. The brand name is Vimovo, but they don't have a patent, so you can get it as a generic. To work, though, it has to be taken 30 minutes before food.
Max dose combination (IBU/APAP FDC) can be useful as a substitute in emergency therapeutic situations compared to opiates. Not recommended ordinarily because of liver, kidney, and stomach impairment.[0]
Taking ibuprofen with questionable stomach condition may want to consider taking a famotidine adjuvant or duexis [1] or acetaminophen instead.
Overdose treatment of acetaminophen poisoning is the stinky N-acetylcysteine (NAC), so that maybe worth stocking whenever Tylenol is kept in a house with kids. Overdose of ibuprofen is palliative, requiring IV fluids and dialysis.
Both of these pills are really dangerous for dogs.
Ibuprofen damages the kidneys -- and that damage is often permanent. The little filtering devices inside the kidneys don't grow back once they're destroyed. A dog who survives the poisoning can end up with lifelong kidney disease, which means special diets, more frequent vet visits, and a shorter life than she should have had.
(I watched this happen to my own dog after a house sitter stepped on her paw and gave her ibuprofen to "help." My dog lived, but she needed a special diet for the rest of her life.)
Acetaminophen wrecks the liver, and it also can damage red blood cells so they can't carry oxygen properly. A poisoned dog may get lethargic, vomit, start to breathe heavily... This is especially dangerous for older dogs, or any dog whose red blood cells are already compromised, by conditions like IMHA.
I've known people who've overdosed on Tylenol and died. I'm not saying that ibuprofen won't give you acid reflux and won't damage your kidneys, but due to <reason> I tend to take a lot of ibuprofen and also for <reason> take another medication that constricts my arteries and for <reason> get a lot of blood/urine work done... and my kidney function is good and despite everything I'm generally healthy. So I would say, like many things, what medicines you take probably depend on your specific body and situation. Regardless, you won't die accidentally from an acute ibuprofen overdose. You just might die from taking tylenol if you don't realize your liver is already damaged for other reasons. So there you go!
My mom fell (88 yo) X-rayed, nothing broken but ignored her history of ulcerative colitis (tough to do, given the colostomy bag she’s worn for 50 years). Sent her home with Motrin. Ended up in the hospital for two weeks with bleeding ulcers.
Unless you’re in Rhabdo. If you’re in so much muscle pain and your kidneys are working overtime to clear broken down tissue and you then hit them with too much ibuprofen, then you can go into kidney failure and die accidentally.
Only twice have I ever used Acetaminophen close to the max daily limit, and those were both when I was experiencing a raging tooth infection. I'd pop 2x500 mg paracetamol 4 times a day, which helped just enough to get through the day. The tooth infections were so severe that the dentist had to put anesthesia directly into the root / nerve, multiple times - felt like a lightning strike each time. One of these times I'd put the pain level at a 9 out of 10. I'm just going to assume that 10 out of 10 pain is when you basically consider ending it all, purely in the heat of the moment.
Having gout, I've also had some pretty severe bouts where the pain level has been in the 8/10 range. Unfortunately nether paracet or ibuprofen worked.
In any case, when I see regular people eating these painkillers as candy, I'm starting to wonder what pain levels they are experiencing. I'm generally very cautious of using this stuff.
Pain is weird. It's extremely subjective, not only between people but also within your own body. Paraphrasing something Paul Rozin mentioned in a paper on so-called benign masochism: people can learn to enjoy eating the most extremely spicy food, but even those people will still scream out in pain you rub the ghost pepper they're eating in their eyes. Pain sensation is therefore localized and contextual.
So we should not be too quick to dismiss the pain of others.
As far as 10/10 pain goes, I've heard cluster headaches can get so bad it has driven people to suicide during an episode.
Acetaminophen (paracetamol) is the drug of first choice for addressing pain and fever, in India at least. To the extent that it's regularly abused, and I know people who have been hospitalized because of abuse.
Even then, doctors are usually disapproving of ibuprofen (or some combination of it with paracetamol) unless paracetamol is contraindicated for some reason, and I had always wondered why.
I did listen to this 99% Invisible story about the use of NSAIDs in India once[1]
What you describe in an interesting contrast to the situation in The Netherlands.
Here, virtually no one is prescribing ibuprofen _without_ also prescribing a baseline of paracetamol.
Acetaminophen has a quirky effect if you’re on a CGM. It makes your interstitial glucose read higher than your blood glucose.
Context: I’m t1 diabetic.
I was recovering from an injury, and I switched from ibuprofen to acetaminophen. But the whole time I was on it, my sensor glucose was reading 50-60 mg/dl higher than my blood glucose. This is really bad on a closed loop system as my pump kept trying to lower my blood sugar, but it was pushing me into hypoglycemia (50 mg/dl).
Turns out this is a common effect, but a relatively new discovery that no one told me about.
I went from introvert only-child to married with kids. As they hit daycare, I was perpetually riddled with disease for about 15 months. I still had to take care of the kids though, so I was liberally taking Ibuprofen. At some point, I started to get horrible heartburn. I tried all kinds of dietary restrictions until I realized it was probably the Ibuprofen. Now, if I take even one pill, the heartburn comes back. I switched to Acetaminophen and found it was much more effective at reducing fever with no apparent side effects.
Yeah our son became eligible for creche just when covid came. All at home but we couldn't take full time care for him forever so eventually he started going in (they can start at 6 months here in Switzerland if you are lucky and get the spot, we did it gradually since 9 months). Then daughter came and same cycle.
Needless to say we had covid at least 12 times at this point, all with positive tests so no mistake there. Plus few other questionable cases without tests. Some were brutal, like first and second one, that was before vaccines, and then a recent one when we seem to have lost most of immunity. Back then I lost taste for few weeks completely and smell didn't fully come back till 6 months after (sniffing bottle of vodka did smell like forest air, even later my perfume smelled rotten). Weird times, eating nice looking gunk and trying to imagine how it tasted before.
I don't think I had flu that many times over my whole life, hate that shit with fiery passion and having small kids in creche/school is just a 24/7 virus importing service. None of our peers had it as bad as we did, no idea why the 'luck'.
One weird analgesic/antipyretic is metamizole/dipyrone[1]. It's banned in the US and some of Western Europe (and prescription-only in other countries). Yet it's by far the most used medication here in Brazil and I have actually never heard of adverse effects, except some allergies
I created this open-source application (https://alexcpn-faers-signal-detection.hf.space/) to analyse the FDA FAERS data set a few weeks back, just to do some good work and use Claude Code completely. I got roasted on Reddit for attempting this. But this is meant for specialists to use, as most platforms that analyse this data charge a lot from what I read.
FDA FAERS is the official dataset for reporting Adverse events from taking a drug. FDA adverse event reports about 2 million cases and 4,067 unique drugs
I agree the results are not easy for non medical professionals to interpret correctly. For example DEATH is very strong with Parecetemol and so is DEPENDECE. The latter because from AI it is a confounding factor. Acetaminophen/parecetemol is frequently co-formulated with opioids (like Hydrocodone or Codeine). The "Dependence" signal is likely attributed to the opioid, not the Acetaminophen itself...
I had intestinal bleeding after double ibuprofen dosage over several weeks for back pain. Definitely watch out for any prolonged and heavy use of NSAIDs.
I’ve alternated these for fever, especially for kids, especially when it’s high and hard to control. That way you keep below the daily limit of each and don’t overdose on either.
Have gotten into a habit of keeping a note of which med when on the fridge.
Cool, throughout this entire read I was thinking "I'm gonna save this, it reads a lot like dynomight". And then at the end it turns out it was dynomight all along. I guess I should read headers more carefully.
Unfortunately, both of these medicines have substantially adverse effects on me. Ibuprofen destroys my stomach, often affecting me for days after a single dose. Acetaminophen leaves my stomach fine, but has subtle, but noticeably negative affects on my cognition and general energy levels. Both are often ineffective for bouts of significant pain, which is frequent for me.
To mitigate this, I supplement with NAC (N-Acetyl-L-Cysteine) anytime I'm forced to take acetaminophen. I will also sometimes take Betaine Anhydrous.
I do the same for ibuprofen, but sans betaine and instead take aloe, probiotics (bacillus subtilis/coagulans, Mastic Gum and experiment with other things.
For acute pain, neither does anything. And though I'll get attacked for this here, I find a stout dose of quality, lab tested Kratom (red strain) to be far more effective than both acetaminophen and ibuprofen combined. However, for regular pain, this is not a good plan, as the withdrawals can exceed the nature of the problem itself.
I sure do wish we'd get over the anti opiate [1] craze someday, or at least discover and make available an effective alternative.
1. Aside from constipation and obvious risks of dependency (or abuse), opiates have none of the deleterious effects of ibuprofen or acetaminophen, and the constipation is easily mitigated, and a bit of agmatine sulfate for saying adios when the pain subsides.
I always use acetaminophen as ibuprofen doesn't seem to do anything for me...
I have personally never found a use for ibuprofen that ever made any noticeable impact for me. I have tried it for headaches, fever, muscle pain, nerve pain, etc. It never made a noticeable improvement for any of these while acetaminophen works amazingly for all these. Acetaminophen even works better for me for pain than an opioid like Tramadol...
Ibuprofen works for me about the same as acetaminophen but it tears my stomach up. If I use it for more than a two or three days at labeled usage rates, I’ll feel like I have an ulcer.
The article mentions this but it’s my answer to “how are laymen supposed to know?” In my case it’s painfully obvious to use ibuprofen with caution
My US doctors almost never recommended Ibuprofen over Acetaminophen for mild pain. In fact, I don't remember them ever recommending Ibuprofen for anything while I hear about Tylenol pretty often.
I've had doctors prescribing short runs of opioids (2 weeks for surgery recovery) but they always said "try Tylenol first and if the pain is too much you can fill the prescription". I liked having the option but never really used it up to this point.
Interesting! In the UK the common wisdom is paracetamol is the safest. Ibuprofen is available but not the first choice. Aspirin is considered bad.
I wish people would stop saying "drinking" to mean alcohol consumption. I genuinely thought it meant after drinking any fluid until I read the description and realised it meant alcohol. I also don't like how alcohol is singled out as a "special" drug. What about other drugs? Is alcohol special in this regard?
At least in the US, its hard to find single-purpose over the counter medicines. Most "cold" remedies now also include acetaminophen. So that makes it easier to OD on acetaminophen if you take some by itself and then don't realize that your cough syrup also includes it. I think this (bundling acetaminophen) should be banned for safety reasons.
I thought this was partly intentional to discourage DXM tripping. Same reason the only opioid they seem to give anyone now is the shitty hydrocodone/acetaminophen mix.
For migraines, I take two CVS Migraine about every week to ten days. It's a cocktail of acetaminophen, aspirin and caffeine which tallies to 500 mg of acetaminophen, well under then 4g limit. It's good for four hours but you can only take two per day.
I didn't know about this acetaminophen risk. So I'll be looking for alternatives. Ibuprofen is for inflammation and not headaches. Naproxen is a candidate.
Ibuprofen is very well supported as a treatment for migraines. Not necessarily headaches generally, but definitely migraines.
But there are multiple classes of abort drugs now that a doctor might be able to prescribe you, like triptans and CGRP inhibitors, that work much better than either NSAIDs or acetaminophen.
High dose aspirin (1000mg) + caffeine worked much better for me for migraines than paracetamol/ibuprofen/naproxen which did nothing. There're some studies supporting this too...
Why don't we package Acetaminophen with NAC? The reason I can think of is it will be delivered earlier than it normally is in cases of overdose. That would mean there will be less NAC in your system than at the peak dosage when the body starts using the pathway that needs it. But every little bit must help, no?
Interesting, I've always preferenced ibuprofen because I was concerned with long-term liver effects from acetaminophen as a casual drinker and someone who is a bit overweight (both things negatively impact the liver). I think one thing that's hard to understand as someone with no medical background is the long-term impacts of medications, it sounds like once it's processed there's no long-term negative impact for acetaminophen, where-as alcohol does have long-term negative impacts on the liver even after processing. Also, there's not enough information placed on the label or known how important not being dehydrated is to having good outcomes with ibuprofen. Obviously dehydration is bad, but it's also very commonplace.
"since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen." [1]
But yet in some countries pediatricians will libreally prescribe it to toddlers
Also
from [2] "In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution."
One of the problems is that if you give it to kids with chicken pox it can cause complications. There was also some hints early in the pandemic that ibuprofen had a similar effect on covid-19. However as you link to, the data doesn't really support that view anymore.
After severe cramps once when I had to use a lot of ibuprofen (dental surgery / wisdom tooth) I now only use ibuprofen with a stomach protector to avoid stomach cramps, H. Pylori, and reflux.
Acetaminophen is part of ECA stack weight loss formula, while article says not OK with fasting. Either way, more safe solutions are known these days.
I keep reading about this lately but what doesn't make sense then is how few deaths/injuries there are relative to how much acetaminophen is consumed. If tens of millions take it every day, that's billions of doses a year of acetaminophen. Why don't we see MORE injuries/deaths?
"Acetaminophen toxicity is the second most common reason for liver transplantation worldwide and the most common cause of acute liver failure in the United States. Responsible for 56,000 emergency department visits and 2600 hospitalizations, acetaminophen poisoning causes 500 deaths annually in the United States."
56,000 emergency room visits is the key here, because "the mortality associated with acetaminophen overdose is low if recognized and treated within the first 8 hours after an acute ingestion."
So I guess it depends on if you think 56,000 is low or not.
For all accidental acute poisonings leading to hospitalizations from OTC drugs amongst adults and adolescents, the top culprits are:
1. Acetaminophen: Dangers noted in article, and stats given in my parent comment
2. NSAIDs: "NSAIDs are ingested commonly in overdose, however severe toxicity is rare"
3. Salicylates "Severe salicylate poisoning follows ingestion of greater than 500 mg/kg". For an adult weighing 150lbs that is 68kg, which means severe poisoning requires 34g of aspirin, which at 325mg per pill is 104 pills total. Hardly easy to do this accidentally.
[1] "Acute poisoning: understanding 90% of cases in a nutshell", S L Greene, P I Dargan, A L Jones, Postgrad Med J 2005;81:204–216
Considering its ubiquitous and regular consumption in general population, doesn't alcohol shift the balance in favour of ibuprofen?
Also, possible blood clotting or stomach issues sound scary, but Aspirin has similar (opposite) issues. Pharmacists regularly push its combinations with Acetominophen (which has, of course, synergetic bonuses, but is not the reason) under multitude of brands with a hefty premium when people ask for either one. So in many situations you need to consider the added risks from Aspirin too.
Ideally, I'd like to have an optimized strategies of using all three of the aforementioned substances for common situations. Like, is rotating ibuprofen/acetominophen during the day safer than consuming just one?
I'll admit I find ibuprofen to be a bit of a wonder drug. When I have a cold or flu, ibuprofen by itself is the most impactful medicine I take. The anti-inflammatory effects make my whole body better, including my sinuses (my sinuses are a disaster normally anyway, though). I do avoid taking it otherwise because my headache doctor says it causes rebound headaches, though.
But if I need to go out somewhere and am not feeling well? 2 advil and I'm good to go. The only medicine I've found more effective for that is (real) sudafed, but if I take that after like 10am I won't sleep that night.
Why are COX-2 drugs like Celebrex still prescription only ? Seems like it would theoretically be a lot safer to offer a medium low dose of it over the counter vs other NSAIDs
That being said I weirdly find Naproxen the most effective of all of these. Everyone is different though
"Why are COX-2 drugs like Celebrex still prescription only ?"
Why? Because Celebrex (celecoxib) is a dangerous drug which can cause irreparable harm (heart attacks and related) if taken for long periods. In fact, its sister drug Vioxx (rofecoxib) was banned and Merck had to pay billions in damages. There's more here: https://news.ycombinator.com/item?id=47835635#47862704
Whilst Celebrex is safer than Vioxx it still has the same side effects profile as the latter.
I'd also recommended you watch the YouTube video in the link on Vioxx, it demonstrates the dangers of COX-2 drugs shouldn't be underestimated.
This American Life had a good 2013 episode on the tricky dosing of acetaminophen [1]. It's also worth saying that capsaicin is used for pain relief[2]! Especially for things like muscle and joint pain.
It is a damn shame bordering conspiracy that metamizole (https://en.wikipedia.org/wiki/Metamizole, known as Analgin in eastern Europe and the Balkans, apparently also India) is not more widely available in the west. It's literally a wonder drug, the only non-narcotic (hence non-addictive) that actually relieves serious pain (including post-op) pain in my experience.
Since I've had a fair share of it in my life so far (more than 1kg of it so far, in total), and I investigated the disparaging studies and they are definitely not convincing at all; more recent ones somewhat absolve it (check the Wikipedia page).
I've never had any side effects from it, and I don't know anyone who did, unlike for any other painkiller (diclofenac, ketoprofen, ibuprofen, acetaminophen / paracetamol).
It is a medicine where I'm almost 100% sure the studies against it are intentional sabotage by pharma companies, and the vigor and persistence this is done with is really telling (lots of doctors and pharmacists in my extended family, including in regulatory bodies). The campaign against it never ends.
Metamizole is an amazing drug, I'm always grateful that I work and live in an area where it is available.
But it is not a miracle drug. Metamizole-induced agranulocytosis absolutely exists, and the insidious thing is that you don't know in advance if you will get it or not. You're trading common but avoidable side effects (ibuprofen, APAP/paracetamol) for rare but unavoidable ones (metamizole).
I've seen patients with severe side effects of all three classes of non-opioid painkillers (severe GI bleeds from ibuprofen-induced ulcers; acute liver failure from APAP overdose; metamizole-induced neutropenic fever). None of them seemed very pleasant. But if I had to choose, I'd still use APAP first line because it's the only one where you can avoid the severe side effect with certainty, by simply staying under the recommended maximum intake.
The article is not signed, we don't even know if the person writing it has any sort of medical background, take it with a grain of salt, the about page lists people and none of them has a medical background
Anectdotally, I had a headache, and the woman I was seeing in the UK said get the paracetamol unless it was killer, then get the Nurofen (ibuprofen) if I needed the heavy-duty medicine.
Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.
Mischkowski wondered whether painkillers might be making it harder to experience empathy
And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy.
For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.
Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes).
The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.
What? Read the article fully; it has to do with "negative empathy" different from "positive empathy".
Dominik Mischkowski is a Pain Researcher at Ohio University who has been studying this for a while. The word "suspects" here is statistical research-speak meaning there is a correlation (w.r.t. positive empathy) but more studies are warranted (w.r.t. negative empathy). That is all.
Reminds me when I was on a business trip in California and bought some Acetaminophen thinking "I'm in the USA - this has to be the hard stuff, right?", only to discover it was just paracetamol.
The article doesn't touch on it, but from what I've read NSAIDs like ibuprofen also slow healing. I have also read, but am unsure how reliable this is, that they can harm the remodeling process during healing and lead to chronic pain.
That said, I've found great relief at times taking a moderately large dose of ibuprofen for several days to break what seems to be a cycle of persistent inflammation. YMMV I guess.
To the author, my guy, you are clearly not an endocrinologist stop pretending you are, and trust the people that study these things for a living.
Not only you can't take more than 4 grams of paracetamol per day, you must not take it for more than 3 days straight, it says so on the leaflet.
Biochemistry and medicine are hard and complex, all the quacks out there that preach snake oil treatments went down the path of thinking their domain specific knowledge in random domains somehow transfers to medicine it does not.
Is this comment in the wrong place? The article is literally about how the medical establishment gives good advice on acetaminophen and ibuprofen, but it's not getting through to people.
He gets there after exposing a bunch of "research" he did himself and after admitting he was using ibuprofen for a long time because he "thought" it was safer.
In my personal experience, paracetamol hardly does anything when it comes to alleviating fever symptoms. Like I'm not sure whether I'd be able to distinguish it from placebo. I always default to ibuprofen and the difference it makes is like night and day. I only take it like a handful of times a year and usually no more than 1000mg a day so I'm hoping I'll be fine.
Acetaminophen and Ibuprofen are taken for different things and can be taken together as well, it's not a versus...
Ibuprofen is mostly for inflammation and Acetaminophen for fever and pain. Now there's overlap in that both work on headaches and some other kinds of pain but the main use case for each is different.
about once a month since my childhood i get an awful, slowly ramping headache that makes it unable for me to think or function.
it seems to happen more when i'm overweight, making me think it's blood pressure (BP) related, but then doing the valsalva maneuvre, which spikes BP, doesn't cause any problems at all.
i've tried acetaminophen, even 1.2g of it, to no avail. it doesn't help.
i've also tried every other remedy, such as curcumin, fire/ice locally, hot and cold showers, neck massages, working out muscles that may be involved in it, everything. nothing helps.
except for ibuprofen. 400-600mg kills it every time.
at least for me, there seems to be a definite difference, as ibuprofen can anecdotally help in some situations that acetaminophen can't. i wonder what exactly it can / can't treat and why.
To me it's obvious that acetaminophen and ibuprofen do not target the same kind of problems. I am not a woman, but my wife says acetaminophen does not work on menstrual pain for instance.
I take acetaminophen for fever, and those kind of full-body diffuse ill-feeling.
I once read that if acetaminophen were introduced today it 100% would require a prescription because of how dangerous an overdose is.
Unrelated, but it feels like an oversight that this article said nothing about how both acetaminophen and ibuprofen reduce fevers. They aren't used solely for reducing pain.
I kind of doubt that, to be honest, given how much more effective and less directly damaging it is during normal use compared to NSAIDs.
I find it interesting that people take these as fever reduction mechanisms. Fevers are a defence mechanism, not just an inconvenience. Maybe it makes more sense in places without decent workers' rights (like having a limited amount of sick days you need to manage), but it feels weird for me to actively harm your body's defence mechanisms unless you're in "you should see a doctor" territory already.
Well, I mean, drats. I too always assumed Ibuprofen was safer than Acetaminophen; not the least because of massively oversimplificatic "reduced inflammation - GOOD!" 'Logic'. I'm 47 now and have probably preferred ibuprofen for last 27 or so.
Plus caffeine, for those who don't drink coffee. Quite standard combo for people suffering from migraine. I stick to 500mg+200mg and I find it suspicious adverts for painkillers somehow always show 2 pills while dosage recommend in leaflet is just one.
I feel like this article leaves out the latest research pointing to acetaminophen having a negative effect on fertility, hindering embrionic development and potentially also also follicular development in baby girls. It's a trade-off for sure, but if you're trying to have a baby, you may want to swing back to ibuprofen.
If acetaminophen was invented today it would almost certainly be available by prescription only because of the safety concerns. There are far more benign medications that are Rx only.
For those wondering why it's acetaminophen and paracetamol, the name difference is because they both took different random letters from an even longer name.
Honestly this article is mixing a lot of different factors
> Acetaminophen has a scarily narrow therapeutic window. The instructions on the package say it's okay to take up to four grams per day. If you take eight grams, your liver could fail and you could die.
Gee I don't know, I think this is a wide enough window to not miss it. That difference is 8 500mg pills
> that for most people in most circumstances, acetaminophen is safer than ibuprofen, provided you use it as directed. I think most doctors agree with this.
Could be but I think a lot of doctors underestimate the dangers of paracetamol as well
All of the factors the author mentions about IBP are true. But it's all about the details. Safer? Safer in which condition?
"Dehydrated" ok take a glass of water. Active bleeding? Most NSAIDs interfere with that, and no you won't become a hemophiliac by taking one Ibuprofen
An as a conclusion, I find it "funny" that nobody considers how healty/safe it is to take paracetamol and have mild analgesia (translation - you're still in pain) and taking ibp and having better analgesia
No, even if morphine were metabolically safer (I don't know), its addictive potential would outweigh the potential safety benefit.
On the other hand, if in the early 2000s you were to share those concerns with certain doctors, they would propose a more effective and non addictive alternative to morphine instead. Only the first part of what they would tell you was true.
Depends what you’re taking it for. Generally people take NSAIDs for muscle and dental pain, or anything that’s obviously inflammation, and paracetamol for anything else, particularly headaches, and is a common adjunct treatment if you have a cold or flu.
"Good for fever"? Only ignorant consumers would attempt to counteract the body's very own defenses against infection and disease.
A fever is not dangerous within normal parameters, except for being dangerous to the virus and bacteria that threaten the body. Your body runs a fever because it engages in a battle to the death with these microbes.
If you defeat the body's own defenses by lowering the fever, for example if you are a nervous mother who hates her baby's fussing, or if you're hospitalized and the nurses are laser-focused on "number go down" treatments, then you can expect to be ravaged by the contagion for much longer than expected.
The priorities have drifted. In the middle of night I don't care about getting healthy, I need to get rid of fever, so I can fall asleep and able to got to work/school in the morning. And somehow there is never right time to be sick and everyone just want to supress syndromes here and now.
Someone with a basic understanding of evolution and biology understands that evolution will take any free lunch it can get.
The vast majority of the time medicine can only ever help with (acute) symptoms and rarely the underlying cause unless it is something like vaccines or antibiotics.
Medicine has side effects because if there was a free lunch to be obtained from medicine, the human body would have synthesized the medicine directly. Hence medicine is always about making tradeoffs.
When it comes to general health, there is always a causal chain of cause -> primary symptom -> secondary symptom -> tertiary symptom -> ... and a lot of medicine tends to work on the secondary or tertiary symptom.
Pain evolved to be an accurate indicator of damage to encourage you to stop ruining your body and not a punishment.
I am forever astounded by the self-satisfaction of programmers as they talk about domains unfamiliar to them.
Just imagine someone trying to lecture a network engineer about how really async bugs should really never be different than bugs you see single-threaded if you use a semaphore. I mean, that's why we have semaphores!
Anyway, the temperatures attained during fevers are at best bacteriostatic (read not helpful in actually treating an infection that would lead you to seek medical care). If you've got evidence-based arguments, happy to counter them. Just please don't evoke 'evolution' to explain your bias-du-jour.
Evolution didn't create the personal computer or build a skyscraper. We're firmly in uncharted territory wrt things our bodies were evolved to deal with. As a great example, human temperature has been going down over time—evolution tells us that must mean we're all more susceptible to getting sick!!! https://med.stanford.edu/news/all-news/2020/01/human-body-te...
This is a good argument, but it has a flaw here, which is that a systemic fever during illness may still be an evolutionarily beneficial adaption on average if there are a some situations where it can be the difference between life and death, e.g. bacterial pneumonia or sepsis, but that doesn't mean it's equally useful for all types of illness.
I did a fevered research dive last time I had the flu and came to the conclusion that there wasn't really any good evidence that fever is helpful for flu, and I should have few compunctions about suppressing it. (And that most of the situations where fever is really valuable for are ones where in the modern world you should go to a hospital and in the case of a bacterial infection be given antibiotics)
For non-habitual pain relief, combinations outperform either in isolation. Studies show a significant effect, and anecdotally for me it's often the difference between dampening and outright curing a headache. Combo pills are widely available in most countries (branded as Advil Dual Action and Motrin Dual Action in the US), but they're pretty new so consumer awareness isn't yet super high.
and my own editorializing -- this is not just a problem for little kids. As various articles explain, if you've had flu-like symptoms (from whatever cause) you should be wary of aspirin. Will one standard dosage kill you? Unlikely. But if you've got better options, particularly pre-loading NAC before Tylenol, why not consider them first?
Without resorting to research or statistical inference engines, based only on the average knowledge explained by my colleague OP, I will say that paracetamol is also toxic in continuous doses (people with chronic pain who resort to the medication for daily use) and has drug interactions with other agents (such as alcohol).
Aspirin and Ibropufen are great but really do have a risk of ulcers. As for the thrombo-prophylactic issue, it is very poorly explained and I completely disagree. My readings to date have shown that both have a very slight rebound effect on the formation of thrombi and the main problem is the release of thrombi that have already formed, prior to the use of the medication.
Frankly, very few people should be taking either of these drugs. Sometimes I forget how often people pop these things, it's really crazy. Consider just having a headache and dealing with it.
This is pretty misguided.A casual mistake like forgetting your cough syrup has acetaminophen can easily cause an overdose and then you fucking die. That’s not the risk profile you want for “most people in most circumstances”.
500mg from a capsule and 500 from cough syrup 4 times a day is still fine. With a 100% safety margin still.
If you’re taking more meds than that without clinical supervision Id say something is wrong in the system or your medicine practices.
Where I’m from it’s common to walk to the nearest pharmacy and get meds when needed. Even over the counter stuff like paracetamols. And talking to the pharmacist. They’ll ask what you’re already taking and tell you what else to get.
8g is not an insignificant amount. That's 16 500mg pills. You really need to mess up to take 16 pills and not realise you're doing something wrong. If a patient is not lucid than we have bigger issues.
And from what I see in pharmacies, you would rarely see a "cough syrup" called just like that if it contains paracetamol. It would usually be marketed as a flu-relief all-around symptom relief.
You don't want either of these; what you want is naproxen.
It works similarly, but stays a lot longer (half life is cited as being anywhere from 12 to 17 hours).
Acetaminophen and ibuprofen are just for temporary problems, like a headache that would go away on its own in a couple of hours.
They are uneconomic and inconvenient if you have something more persistent to keep at bay. Four ibuprofens or one naproxen? No brainer.
The main disadvantage of naproxen is that it's not approved for kids. So there is no naproxen syrup for infants or anything of the sort. Thus, you still need acetaminophen for that.
As pointed out in the article, naproxen is an NSAID like Ibuprofen, though slightly more COX1 selective. It likely has a somewhat lower risk of serious renal and cardiovascular events, but higher risk of GI bleeds. There are some studies that show little to no increase cardiovascular risk, but most do show some or even comparable to ibuprofen.
Convenience vs ibuprofen is a thing given the longer half life, but it still generally comes with similar risks. If you are taking anything for more than just an occasional headache, definitely discuss with a doctor, COX2 selectives like celecoxib may be a better risk profile and even more convenient.
(COX1 and COX2 selectivity loosely separate which systems get the brunt of the side effects)
I weirdly always found Naproxen much more effective than ibuprofen but also find Celebrex great which seems to further confuse the whole COX 1 vs 2 situation
Recently, I've had to take Celebrex (celecoxib) for a back injury and I've been taking it longer than is normally recommended—and that truly worries me (I've determined I have to come off it ASAP).
Where I am (Australia), most doctor's prescriptions that have to be taken long-term are issued as the first script plus five repeats. Not so with Celebrex, a script can only be dispensed three times (3 x pk of 30 200mg capsules — one per day, for 90 days max) and scripts can only be dispensed every 21 days. Reason: Celebrex is only recommended for short-term use because it's considered a dangerous drug with possible irreversible side effects if taken for too long.
This was not news to me even before taking Celebrex, way back in the 1990s I was prescribed its sister drug called Vioxx (rofecoxib) for back pain and it was much more effective than Celebrex (at least it was for me).
Anyway, sometime around 2000 I read an article in the journal Science about a significant statistical increase in deaths by heart attack, stroke etc. by those talking rofecoxib. At the time I said to myself it won't be long before Vioxx is banned. It took another three to four years for that to happen as Merck Pharmaceuticals fought the decision every inch of the way. It's worth reading the Wiki about this (when it's between a drug company and millions of dollars profit patients come off second best):
What's relevant here is that the related drug Celebrex survived because its side effects—whilst manifestly similar—aren't quite as bad as Vioxx. In short, Celebrex's COX-2 selectivity versus other less selective NSAIDs like aspirin (which target both COX-1 and COX-2) was deemed sufficiently beneficial despite its potential serious side effects.
Note: I'm not offering medical advice here and you should always take that from your medical practitioner. I mention this because only several days ago I had a discussion with two younger doctors who'd never heard of Vioxx let alone the Vioxx/Celebrex controversy.
You may be interested in this YouTube video on Vioxx. Unfortunately it's over hyped and designed to alarm but it's essentially factually correct: https://m.youtube.com/watch?v=K0GrFnOpJoU
The higher risk of GI bleeds is could be somewhat balanced by not having to take as many.
There are also slow release forms of naproxen. (Which make sense given its long action: lets people fade in the next one while the previous dose slowly fades out). That could also help make it easier on the GI tract.
> The higher risk of GI bleeds is somewhat balanced by not having to take as many!
Unless I am missing something, the data really doesn't back that up. naproxen is much more longer lasting and has a higher chance of causing ulcers. Hence why its not over the counter in the UK and is prescribed with omeprazole to reduce the risk of issues.
I'm reading about this in more detail. Indeed, it's not the contact between the medication and the digestive tract that is the problem, but simply its presence in the blood stream. By inhibiting those certain enzymes, it reduces the production of prostaglandings, causes problems for the lining.
Naproxen will be around longer due to its long half-life, so it creates more opportunity for this problem.
Doc here.
One thing every single member of the general public needs to get drilled into them: Medical science is NOT intuitive. You cannot just read the mechanism of action of a drug and infer a dozen things from it. A drug's mechanism of action, its indication (when it ought to be used) and its adverse effects CANNOT simply be inferred logically from each other. Biology is orders of magnitude more complex than SE/CS or any other field for that matter.
I presume majority of readers here have SE/CS background. Dudes! the artifacts and systems in SE/CS have the following two properties:
1. They are human artifacts. We know exactly how they are build. The theory is all publicly accessible in principle.
2. They are layered logically on top of each other. Machine code, assembly, C, Java ... so on. Firmware, OS, drivers, apps .. etc. Clean layering.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there. Be very very careful when you import thinking habits for daily life , or other fields of expertise, into medicine.
"This video is just for informational purposes. Consult your health care provider for your particular situation" ...is not just a legal precaution. It is a sound life advice. Nothing in life is more crucial to leave it to the experts as health/medical inference and decision making.
While I don’t disagree, the problem I often have with medical professionals is that they tend to be arrogant and unable to take in new information to adapt and evolve their frameworks.
I was married to a doctor, helped them study for board exams, etc and was surrounded by other doctors within our social circle. What most people don’t realize, and most doctors themselves refuse to acknowledge, is how limited by specialization their knowledge can be and how the education of most doctors stops after med school and residency. Nutrition, for example, is barely covered at all.
Yes, there are continuing education requirements and countless journals but most doctors do the bare minimum and don’t keep up. I’d even argue that most physician knowledge tends to be updated more often through drug and instrumentation reps promoting their products by taking them out to dinner and entering them into referral programs, etc.
I wouldn't label that arrogance. In my experience outside the USA, my GP has been unaware of new research / advice / guidelines published by the MoH. They generally respond to new info from reputable sources when you print it out and bring it to them.
I would expect specialists to be subscribed to journals and reading the latest articles in their field. When I saw a specialist at UCSF this was definitely the case; while my GP still has gaps where their current knowledge on a specific subject is from their time at med school.
An equivalence would be a front-end engineer being naive to the happenings on the Linux kernel mailing list. They could likely understand what's going on if they took the time to read it, but that is not their focus.
The fact that there are advertisements for cancer medications make me think a hell of a lot of specialists don’t keep up. It’s one thing to advertise to consumers about a new medication for their chronic condition and they might not have seen their doctor in 3 years. It’s another entirely to have cancer patients need to ask about the new hotness.
they tend to be arrogant
Yeah I can't with the "biology is orders of magnitude more complex than SE/CS or any other field for that matter" and then thinking he can explain to the techies how technology works. Just put the pills in the bag bro. Oh wait, we need to go to a pharmacist for that.
The med students I've known have been some of the most insufferable people I've met.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there.
I'm a doctor as well and I think your statement here is too broad. Plenty of specialists such as cardiologists, orthopedic surgeons, radiologists, etc are able to reason things from first principles. The issue is that many non-doctors may not know several key details about these systems that would let you reason through them. And even many doctors well versed in one specialty would be unable to reason about another specialty since they may not know in detail several key pieces of information from that other speciality.
I'm a doctor who used to be an engineer. Deriving things from first principles in medicine is a lie we doctors tell ourselves.the truth is this.we have some really good understanding of syne things at molecular levels that we then correlates to things that happen clinically at a macro level, that correlation is very very handwavy. But we teach it as if we know for sure. We don't. The few things that we think we have a somwhat good correlation for, we often test on our exams, but even for most of those things, it's some handwavy link
I recall being an engineering classes, armed with just calculus and linear algebra and newton laws, I could attack just about every problem from first principles from my entire undergrad. Every. I didn't have to take into consideration real life presentation of the problem. First principles were enough to get me nearly there
Medicine is fundamentally not that way. Yes we learn the biology, but if you reason solely from biology, you will quickly end up in the wrong places. to become a doctor, I had to learn that hard way that yeah a disease doesn't just present this way just because the underlying physics and biology suggests it should. You separately have to learn how the disease presents, then try to tie it back to our extensive but still very very limited understanding of the possible biology.
I have problems with doctors that don't acknowledge how tenous that link is and despite how much we know, we still know so so little. We are far more useful than what we know.
I understand to biology majors, the few things that seem to follow physiologically from moelculqr biology dupes us into thinking medicine currebtly derives from first pricinples. But it doesnt.
This seems like a classic "rationalism vs empiricism" issue, and it was interesting for me to learn that Galen (famous / influential ancient Roman physician) wrote a lot about that.
0: https://plato.stanford.edu/archives/win2021/entries/galen/#M...
> Clean layering.
We’d all wish it’d be so, doctor. Sometimes it’s as clean as biological systems - touch something somewhere, a different seemingly completely unrelated thing elsewhere breaks.
Even in the dawn of the era, where accumulated complexity was a while lot lower, we have tales of 500-mile emails and “magic/more magic” switch ;-)
Inferring things in a legacy codebase old enough to drink can be quite a challenge. And the way I get it, you folks are dealing with a multimillenia-old mess of layering violations - so no surprise first principles are tricky.
Good analogy except a human is several orders in magnitude more complex than that
I don't know how you MDs/DOs do it. You give a dude medication knowing that it has a small chance to turn his stomach into goo because it will stop his brain arteries from popping like a stress ball in a hydraulic press. Sometimes without knowing how the medication does either thing.
It seems both true that 1. intuitive-sounding explanations about medicine can be extremely misleading for laypeople and 2. reasoning about mechanisms of action, supplemented with empirical science, is important and useful in medical science.
I'm not sure saying to not try to reason at all about mechanisms of actions is a good idea. If someone knows Tylenol is metabolized into chemicals that are toxic to liver, that is simple enough to understand and reason about
One of the greatest Silicon Valley tropes is when boring software guys get rich, lose the plot, and start reinventing physics from first principles because they think the universe is like computer science.
The solace of made-up physics is there for every mediocre dude, from Uber founder Travis Kalanick down to any random guy who made $10M as the CTO of a third-rate video conferencing app and immediately broke up with his girlfriend.
Oddly specific. The interactions and variables in biology and physics create way more permutations than many (perhaps all?) people can wrap their heads around but that doesn't mean the possibility of reasoning from first principles doesn't exist. There are very well defined pathways in both medicine and physics. The ones we haven't discovered are most likely much more complex and may contain recursive loops that make tradeoffs inevitable. Or not. The rapid improvement in pattern recognition and processing leads me to believe we are in for a wild time over the next 10 years with a ton of breakthroughs in both physics and medicine.
"Billionaires Want You To Know They Could Have Done Physics" - Angela Collier (actually has a Physics PhD)
https://www.youtube.com/watch?v=GmJI6qIqURA
I dont know if that tracks. Medicine is a science after all.
Was the article flat out wrong or at least misleading in any way that might lead people to make poor decisions regarding which drug to take?
Yes, that's another issue - CS/IT seems to be unique that sharing knowledge and openly discussing problems is the norm, in other professions you can get finger wagging and some general "advice"
> But if acetaminophen is safer, then why don’t official sources tell you that?
Guess it depends on country. Here in Norway official sources[1][2] do say acetaminophen (paracetamol here) should be the default for treating fever and pain in kids, adults, pregnant women and elderly, and have for some time. Ibuprofen they say should be used with caution.
[1]: https://www.dmp.no/nyheter/behov-for-smertestillende-slik-ve...
[2]: https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2...
I feel like this is one of those things where Europe and the US are very different, culturally speaking - I've lived in the Netherlands, Germany and now Sweden, and the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.
Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
And I'm not saying painkillers should always be avoided. If I have insomnia-induced headaches in the morning and a long day ahead with many social interactions, then I know that headaches will make me a grumpy asshole, so I'll obviously will take a painkiller for everyone's sake. And sometimes I can only fall asleep if I take a painkiller to get rid of the headache first, so I need it to break the vicious cycle. I'm not saying people should "walk it off" here, just to focus on trying to figure out the actual cause first before medicating the symptom way. That's also healthier in the long run, no?
You're forgetting that when you're sick and hurt yourself in the US you very likely still have to go to work. Doing some quick research, roughly 25% of the US workers don't have any sick time whatsoever, so you gotta take some painkillers and get back to work. If you need to take time off to go to the doctor, you're no longer getting paid, so...a lot of people don't do that and instead hide the pain with painkillers.
I had my gallbladder out on a Wednesday and went back to work on the Monday. Nothing stronger than acetaminophen and ibuprofen. Laparoscopy is amazing.
It was a desk job and my team was great. I didn't even think twice.
Reckon you've just summed up the US health care system to a tee.
Harder, faster, stronger, smarter
Well for one thing, in America, you gotta get back to work.
Work a manual labor job or one where you're on your feet all day and sprained your ankle? Would you rather miss a week of pay (or worse lose your job) or take some pain killers and work through it?
Yeah I think this is the biggest difference. Here in Sweden if I get a headache that's bad enough I'll just take a sick day and there's not really much social stigma about that kind of behaviour unless it becomes a pattern that you don't seek medical help for.
I work in an office, but Swedish law protects blue- and white-collared jobs the same in this regard.
FWIW I'm in the US and it's the same. If I have a headache I call in a sick day.
This is going to vary more between blue/white collar workers than same fields in different countries.
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.
That's a pretty apt explanation for why pain probably evolved via natural selection, but you can't therefore conclude that all or even most pain is a genuinely actionable warning sign.
Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain. I don't think it's a hubristic affront to biology to feel a bit of soreness, note it, then take the painkillers.
>Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain
which is far from harmless given how many people use them as a replacement for treating underlying symptoms and changing their life. Case study my dad. Kept taking ibuprofen to get rid of 'harmless' headaches and back pain because he was 'too busy', few years later he couldn't ignore it any more, turns out he had completely messed up disc in his cervical spine from years of physical stress, bad posture, no treatment or exercise etc.
just look at the sheer amount of back pain diagnoses. About a third of Americans report back pain at any given time, IIRC 10-15% of the population go to the doctor any given year for back pain. There's likely millions, if not tens of millions preventable cases if you replaced the liberal use of OTC drugs with actually solving the lifestyle problems.
It's not clear to me that a large portion of people are using them as a replacement for treating underlying symptoms. I suspect in a large portion of cases, treating the underlying symptoms is difficult and/or costly, and thus the choice is merely whether to treat the pain or not.
Hopefully no kidney issues too :\
>but you can't therefore conclude that all or even most pain is a genuinely actionable warning sign.
I didn't read their comment that way at all. It seems they're critiquing the default action that many people take, which is "pain = pop an aleve/tylenol/advil/etc. and get back to it."
I've taken so much Advil/Ibuprofen in my life it would be impossible to count at this point.
I always got headaches when I was younger and it didn't really stop until I went to college at a higher altitude. When I go back to my hometown, after a couple of days they come back. Some headaches will go away on their own with water or rest, but others that seem to go from one side of my forehead all the way down the same side of my neck seem to only go away with medicine.
I used to have to take Advil what seemed like every other day to get them to go away. Tylenol never seemed to help at all. Aleve actually works better than anything for me.
You're incredibly lucky that Advil/Ibuprofen has any affect on your headaches.
Imagine getting them every other day and no OTC has any affect. This is me until I went to a neurologist.
Botox + Triptans can usually stop mine ~98% of the time.
Man, I am sorry.
Thank you
Have you tried to have this diagnosed?
I have. Never really got anywhere.
Since none of them are actual migraines, most advice was the standard: drink more water, get enough sleep, are you stressed at work, etc.
I won't move back to my hometown because of it and it hasn't been as much of a problem. My grandmother said that I had a distant cousin who would get sick whenever he came to our hometown from Chicago as well. Said that his doctor thought it might have to do with the swampy air around the area. Pee Dee region of South Carolina, where Francis "Swamp Fox" Marion operated during the Revolutionary War.
> That's also healthier in the long run, no?
Long-winding tangential anecdote (which is why I'm replying to myself in a separate comment), but I have pretty extreme example of this: I managed to avoid nearly all suffering after getting a tonsillectomy in my mid-thirties, while using almost no painkillers.
My ENT surgeons warned that me "I'd hate him for about a month, then I'd love him for never having to deal with [serious medical condition that justified the removal of tonsils] again". He prescribed all kinds of stuff to alleviate the expected suffering, and advised me to try to take the weakest options I was comfortable with, because the heavier ones might have some unpleasant side effects. It's the only time in my life I've been prescribed painkillers at all, actually (this was in Sweden, btw).
I got codeine/paracetamol as a coughing suppressor and mild painkiller, a couple of heavier painkillers for if it got worse (I forgot the name but some kind of heavy-duty variation of diclophenac that you can only get with a prescription), and some kind of nasty solution to gargle with that supposedly would numb my throat if it got really bad. I've been told this is nothing compared to what you can expect in the US.
Then in the evening after the surgery, when I was trying to eat a soup with my mom, I realized soup didn't hurt as much as drinking plain tap water. And then I thought: isn't it odd that drinking plain water feels like a thousand paper-cuts in the open wound in my throat, but whenever the coughing made the wounds open and bleed, the blood doesn't hurt at all? Blood is mostly water, so what is the difference? Could it be the salt? Is this similar to why drinking demineralized water is bad for you? What's the opposite of demineralized water? Oral rehydration solution. Ok, trivial to make, let's try that. I'll drink it luke-warm to be close to body temperature too.
Turns out that that works. Oral rehydration solution is almost painless to drink after a tonsillectomy. I know this is anecdata, but sample size three: I've since shared this information with two friends who got a tonsillectomy, and they've been extremely grateful for this tip.
It even seemed to speed up my recovery, probably due to a lack of irritation triggering inflammation. I was eating solid food within days. DAYS. My mom, a retired family physician herself, couldn't believe her eyes.
I ended up only needing the codeine/paracemtal in the evening to suppress coughing in my sleep, and brought back all the other pain-killers without opening them.
You rediscovered normal saline!
The plain water hurts because it's causing cells to swell or even burst as water rushes into them to equalize the osmotic pressure. Adding a little bit of salt to that helps remove that pressure because the environment inside and outside of the cells are both equally salt.
Well, not so much rediscovered it as reasoned that that might be the cause of the pain and then confirmed it. The shocking part is that no doctor advises to use this after a tonsillectomy (or other kind of mouth or throat procedure).
My dad (also a doctor) called it a typical case of "the nurse's wisdom": the kind of quality of life interventions that typiqally get discovered by nurses and passed down orally, but never make it to official medical journals.
Maybe you took carprofen?
As the more potent diclophenac? Might have been what was prescribed, I genuinely can't recall. I do know I didn't take it though ;)
I don't think carprofen has been sold for human use in ages! Still available as a veterinary medicine though.
I wasn't sure how old the story or where the OP is. But yes it was pulled from human usage in most countries. I don't fully understand why, although I suspect it is primarily because ibuprofen is effective enough
AIUI one of the many quirks of the US health insurance system is that a lot of people have only minimal cover which doesn't include things like physiotherapy and rehabilitation treatment. That means that they often can't treat a painful condition at source so their only option is to mask the pain with painkillers.
It's worse than that - there is also no job protection. Hurt yourself and miss a few days of work and you are possibly unemployed on top of injured. And then you lose your health insurance, so you can no longer get/afford any treatment.
I'm convinced it's designed this way on purpose. Can't have people relaxing, ever. Must extract every ounce of productivity and blood while they're alive.
> there is also no job protection
https://www.dol.gov/general/topic/benefits-leave/fmla
https://www.dol.gov/general/topic/health-plans/cobra
It’s not perfect, but the US isn’t a perfect union either. Healthcare is usually more of working class concern, or for the working age but unemployed, which is not a small risk …
But let’s at least admit where some protections exist.
Yes, it's the combined outcome of both of those "features." Many Americans don't have access to healthcare and/or can't afford it even if they have access, AND they are not allowed to stop work to take care of their bodies, it's just a steady stream of painkillers to keep you numb and working until you retire or die.
This is so absurd to me. The expression "prevention is better than cure" isn't just folk wisdom, in just about any country with nationalized healthcare the studies also confirm that this costs less money. The only exception I ever heard was a Dutch study in the 2000s suggesting that people growing older due to smoking less was going to increase healthcare costs, because people were getting older putting pressure on the pension system, but let's not peer further into that can of worms.
So by all accounts it should be cheaper for for-profit insurance companies too, unless they have ways to externalize the costs onto the rest of society. Which I guess is more circumstantial evidence for how messed up the system must be.
> unless they have ways to externalize the costs onto the rest of society
UNH stock has been tanked all year, until the govt announced that they would raise Medicare advantage reimbursement rates. The insurance companies have an incentive to pursue volume instead of cutting costs for programs that the government is subsidizing. For everyone else, they just raise the prices which is a much more complicated issue.
Nationalized healthcare systems can reap the longterm savings from preventive care. I have had 4 different for profit insurance companies over the last 5 years because of job changes, my employer switching insurance providers and retirement. Such frequent changing of health insurance providers means that there is no guarantee that any insurance company will reap the benefit of providing me with better preventative care than required by law.
[dead]
This is talking about ibuprofen and acetaminophen, not prescription drugs. Also controlling inflamation and swelling is a very important part of an injury recovery plan; it's not all about Americans complaining about pain.
If pain is a signal, then it's often a car alarm that won't shut up. Even if someone is actually trying to steal the car, I only need to be told once.
Sometimes I get headaches. I don't know why. Maybe there's a cause. I do try things to fix the underlying problem. But it's not instant. While I wait for it, why should I continue to be in pain when the pain medicine is pretty much risk free if I'm not reckless with it?
It's strange that you'll take a painkiller for the sake of others, so you don't bother them by being grumpy, but you wouldn't do the same for yourself. Surely you also don't enjoy being a grumpy asshole even when you're alone.
I feel better avoiding the causes of making me grumpy, I end up feeling less tired at the end of the day.
Of course, but once it happens, why not do what you can to mitigate it?
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
Pain is also suffering, and there is no virtue in suffering needlessly.
Even more importantly, there's also chronic pain, which can severely affect quality of file permanently and is essentially an illness all of its own. Research supports the concept of "pain memory", where chronic pain develops as the result of leaving the pain from a temporary condition untreated.
None of this is in disagreement with my argument and comes across as actively ignoring the part where I explain that I am not advocating to "walk it off".
The discussion started in the context of taking painkillers regularly for things like "inconvenient head-aches" without pausing to investigate what causes those headaches. It should be clear from the context that I am not talking about something like people struggling with migraines. I know they try to figure out not to have them in the first place, and if they do have them deserve all the pain relief they can get. I've had migraines myself growing up.
Nobody is saying that people who suffer from chronic pain shouldn't have a relief from their suffering. But as another comment pointed out: the US seems to have a big issue with untreated conditions in general than other countries.Not in the sense of not treating the pain, but in the sense of not treating the conditions leading to pain. You don't even have paid sick leave apparently. Tackle issues like that and there will be fewer chronic pain sufferers to begin with.
We're in violent agreement. My point is, I guess, that the "European way" of foregoing painkillers can be taken too far. And that's actually something that does happen - it's easy to get from from "pain is a warning signal you shouldn't ignore" to "pain shouldn't be suppressed if it's bearable", especially when you hear about dangerous side effects of painkillers. There are definitely people in Europe who think like that, even doctors.
Since we're talking about acetaminophen and ibuprofen, in France you're liable to end up with a medicine cabinet full of acetaminophen, because almost anytime you go to the doctor with any type of pain, they add it to the prescription.
Interesting, in the US they often do that too but I’ve personally never filled it because insurance doesn’t cover over the counter medications. So I’d have to pay cash for it.
You can sometimes get a prescription for a different form or different dosage than what's available OTC. These are most commonly administered in hospitals (and insurance will cover it there), when you're at home it's usually equal or cheaper to just buy the OTC version.
I don't do it in France only because I don't need it. It won't cost me anything otherwise.
(It is worthwhile to note, because Americans don't realize this, but not all medicines that a doctor prescribes for you is free, although the overwhelming majority will be.)
> insurance doesn’t cover over the counter medications
It depends on the insurance. I have pretty crap insurance and didn't expect them to cover a prescription for Omeprazole (aka Prilosec) since it's available OTC, but to my surprise they did.
Does acetaminophen require a prescription in France?
No but you can get it for free with a prescription.
>Pain a warning signal from the body
Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
There are exceptions to both rules, but many people forget which part is the exception and which part is the rule.
> Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
Heat hot enough to kill diseases will have killed you long before. Fevers are really a pretty small temperature rise.
It does appear that fevers are an adaptive defense, but FWIW there's been basically no evidence that not taking medicine to bring down a fever will improve outcomes in practice. OTOH, evidence also shows that typical fevers won't themselves hurt you either, so they don't necessarily have to be treated.
Current medical guidance in kids and (non-pregnant) adults is to treat discomfort, usually the associated muscle aches, body chills, etc, but in general we shouldn't encourage people to suffer for no benefit. The fever isn't cleaning you out.
It is a cultural difference.
> In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
Most Americans aren’t allowed to take naps at work or leave for some low-stimuli environment while on the clock. If they take time off to do those things, they aren’t getting paid. So why do Americans take more painkillers? Because they can’t afford to not do so.
So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare.
Naps are fine depending on the white collar work, how much is asynchronous, etc. Reasonable accommodations are usually possible as long as it’s not shift work.
Painkillers are an interesting question since we have direct to consumer ads (uncommon globally as it turns out) and for clearly some reasons, we get sicker than other nations independent of how capable medicine is.
https://www.health.harvard.edu/blog/harvard-health-ad-watch-...
https://www.commonwealthfund.org/publications/issue-briefs/2...
Sicker is doing some work, and I think the US has such a diversity of health cultures and outcomes, you almost need to do it by zip code, but that’s another topic.
>So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare
Alternative universe where WW2-era employer provided healthcare didn’t emerge, would you wager we would be there now?
> Naps are fine depending on the white collar work, how much is asynchronous, etc. Reasonable accommodations are usually possible as long as it’s not shift work.
Yeah, and it’s The people who are on their feet for a 12 hour shift who probably need it most.
Perdue Pharma/The Sacklers went on a huge campaign in the 90s convincing doctors and the general public that pain was bad and worth stopping at any cost and even though they were pushing opioids, I can imagine this also increased the cultural tendency to use NSAIDs as well.
I agree that Purdue Pharma was probably the most significant factor, maybe enhanced by the relative ease of granular lobbying of private doctors as compared to the challenges it may face in universal healthcare systems. However, I do suspect that the limited rights of most US workers to take sick leave served as one more cultural advantage in favour of Purdue's campaign.
In many countries if a doctor believes you're too sick to work you have a right to take leave until you recover, without risking your job and without expending limited "sick days". In those circumstances the doctor will of course prescribe something for your pain, but as a patient you have no incentive to insist the painkiller is strong enough to allow you to continue working.
Right, Purdue Pharma—the sleasebag Sacklers—were unethically pushing OxyContin (oxycodone) but the unethical tactics that Merck adopted in marketing its NSAID Vioxx seems to have been forgotten. Vioxx was withdrawn from the market and Merck paid out billions in law suits.
As I've mentioned elsewhere, the Vioxx scandal is every bit as big as the Purdue one. Check this Wiki (lawsuits): https://en.wikipedia.org/wiki/Rofecoxib
If you've time watch this YouTube video on Merck and the Vioxx scam (if you weren't aware of the facts you'd think you were in Palermo/Mafia territory): https://m.youtube.com/watch?v=K0GrFnOpJoU
Weren't the Perdue Pharma products sold in combination with Acetaminophen?
My assumption was this was always required to get regulatory approval to make abuse have harsher side effects. Liver toxicity of acetaminophen is pretty bad compared opioid abuse from what I understand
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.
This is vastly overstating the rationality of the human body. It's no more rational than the human mind, which is often quite irrational. Your body isn't the product of medical school, nor intelligent design, but rather random natural selection, which is decent but demonstrably far from perfect.
Sure, but how good are you at judging if a human mind is irrational or not without engaging in conversation with it? Why not extend that logic to your body.
All human minds are irrational, including mine. And yours.
I fail to see where anything I said implied that I disagree with that sentiment.
Also, you were arguing we should not listen to pain when it's acting irrational, as in unreasonable. Then you switch to "all minds being irrational", as in actually not rational. That's not the same thing.
I have no interest in playing this silly analogy game. You can't have a "conversation" with your body any more than you can have a conversation with your pet cat. Hey cat, we're trying to save your damn life, so stop resisting the veterinarians and the pills!
If you have a point to make, then make it literally, not metaphorically.
I'm sincerely sorry for you if you are suggesting that you are completely unable to communicate with your pet cat or observe its behavior and reason about why it makes sense just because it lacks language. I assume you don't actually have that problem but that is what your comment literally implies.
I made my point and you're ignoring it: you imply that all pain is unreasonable because the body is "irrational". By that logic, you are saying that my earlier example of a sprained ankle hurting when I lean on it means my body is "unreasonable" for signalling that I should not lean on a healing sprained ankle. Quite frankly I think anyone ignoring that and harming themselves more in the process is an idiot.
The example of a cat hissing at the veterinarian because it cannot distinguish the situation from a real threat does not mean that cat's never hiss at real threats. If you cannot even be bothered to tell the difference and blame your cat on every occasion, you're being more irrational than the cat.
Especially if a new one, pain is undoubtedly a 'warning signal from the body' which is a succinct metaphor we all understand and has a clear meaning. If you don't know why or from whence the pain, check it out. It may be one of those things or perhaps not.
The previous commenter appears to argue that you need to diagnose every headache, which sounds absurd to me.
Occasionally I have a headache. Not frequently, and I don't necessarily know why. These things just happen. I take a painkiller, and problem solved. I've been seen by doctors over the years for physicals or other reasons, and there's no indication of any underlying medical condition. An occasional headache is not an indicator of something more serious, and the painkiller is not "masking" a larger problem.
The same goes for random muscle aches. They're infrequent, but they can happen, for whatever reason, and there's no reason to panic or to suffer when you can just make them go away.
I don't think I'm unusual here. As far as I've heard, random, infrequent headaches or other aches are extremely common.
Moreover, there are pains that we know the cause: for example, I experience a bump or a cut. My body continues to annoy me with pain unnecessarily. Yes, I'm healing, I'm well aware of that. I just need my body to STFU with the pain and stop reminding me of it.
Unless you have migraines, that headache is caused by something and you'll be much better taking an anti-allergic, or a sinus cleaner, or whatever else actually solves the underlying issue or make the specific symptom go away.
The same goes for muscle aches. There is also specific medicine for them. And you are probably better with an anti-inflammatory for a bump. (It's not normal for cuts to hurt for a long time.)
> that headache is caused by something
Thanks for the diagnosis, Dr. Internet Rando.
> you'll be much better taking an anti-allergic, or a sinus cleaner, or whatever else actually solves the underlying issue or make the specific symptom go away.
You can't even say what I should take. X or Y or... whatever else? That's not helpful at all.
If you don't know what causes a random headache, that's a good reason to ask a doctor.
> If you don't know what causes a random headache
Maybe HN commenters.
Thank you, I share this sentiment but couldn’t quite put it into words. Sometimes it isn’t that deep.
Yup. Try to treat the source of the pain. Of course. But dont act morally superior because you don't need acetaminophen.
> It's no more rational than the human mind
Neither is a car, but I still take it to get checked out when a warning light is on.
> Neither is a car, but I still take it to get checked out when a warning light is on.
I can't believe I need to say this, but cars did not evolve by natural selection. Cars are intelligently designed (by humans, not by God) to show a warning light when there is a problem you should get checked out. So cars are actually rational in that respect.
Hacker News comments never fail to depress me.
> I can't believe I need to say this, but cars did not evolve by natural selection.
You didn't need to say that because that's not relevant. The issue was about signal to noise. The logical stance is to assume signal is signal, until you know otherwise.
> Hacker News comments never fail to depress me.
That's also a signal.
> The issue was about signal to noise. The logical stance is to assume signal is signal, until you know otherwise.
I know otherwise. I have a lifetime of experience—lifetimes of experience, counting the experiences of other people—to know that pain is often just noise.
Pain is ancient. It predates rationality by millions of years, perhaps billions. The dumbest animal experiences pain. It's not a finely tuned system with documented diagnositic codes.
> the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.
Americans' relationship with painkillers is absolutely unhinged.
Might just be an artifact of the broken healthcare system. Painkillers are cheap and over the-counter. Going to a doctor is not.
Additionally, in EU you can just take a sick day to rest and recover pretty much any time you need it. In the US you have limited “sick days”. E.g I now only have 6 “sick days” per year.. (and I’m fortunate to work in tech, I just WFH when I’m under the weather. But people who are less well off need to suck it up and go to work).
Like I just mentioned in another comment, they're also a way to get you back to work ASAP. Just about everyone NOT working a comfy white collar office job needs to be working in order to make money. Time off is less income, people can't afford that so they do what they need to do to get back to work.
Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
>Like I just mentioned in another comment, they're also a way to get you back to work ASAP. Just about everyone NOT working a comfy white collar office job needs to be working in order to make money. Time off is less income, people can't afford that so they do what they need to do to get back to work. >Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
The office workers will just pop the same damn pills and show up too. Office workers are more likely to show up when in pain specifically because their job doesn't aggravate it. Most people don't have a lavish BigCo sick time policy and even if they do why burn sick time just to be in the same pain and pop the same pills at home. Most people will just have to work harder to make up for being out anyway. It makes sense to just be in pain at the office.
Yup exactly, that's what I was getting at. In the US you can't afford to _not_ work. Not to mention that if you do have actual longer-term health concerns, you also need to pay for the actual treatment, and your insurance depends on your employer. The entire system is really quite flawed.
Here in EU, in order to take official sick days, i would have visit doctor to get confirmation document. Which means that for simple cases i would rather take unofficial sick days (sometimes provided by employer, like in US) or just leave.
Yeah but getting that confirmation document is low effort. And at least in Belgium the doctor visit would cost just like $25 (from memory, haven't lived there for quite some time).
Im in Ireland and I have 6 sick days... More and I take unpaid leave which I can probably claim from welfare.
Well, yeah, but they do help. I had a bad case of bronchitis recently and the only way I was able to get to sleep was taking OTC ibuprofen.
> home-made oral rehydration solution
water?
EDIT: I see it's a thing. Salt, water and sugar.
Apologies, I could have clarified that (then again my comment already was a wall of text).
The body does not absorb water passively but actively, and it's been known for a very long time that water with a bit of salt and sugar is absorbed faster. This has been crucial in reducing (especially child) mortality due to acute fluid loss from diarrhea due to, say, cholera[0]. (I personally find amazing that Robert K. Crane figured out the mechanism behind it in the sixties already[1])
Now, "proper" ORS, according to the WHO, is the following:
However, that is in the context of oral rehydration therapy:glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine; sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea (and vomiting); citrate corrects the acidosis that occurs as a result of diarrhoea and dehydration.
So you can usually get away with not having the potassium and trisodium if the reason for dehydration is neither diarrhoea or vomiting.
This translates to a simple home recipe of:
The reason for doubling the amount of sugar is that the active absorption of water relies on glucose, while regular sugar is made out of sucrose. Sucrose breaks down into equal parts fructose and glucose (both have identical chemical formulas but a different arrangement of the atoms).[0] https://en.wikipedia.org/wiki/Oral_rehydration_therapy
[1] https://en.wikipedia.org/wiki/Sodium-glucose_transport_prote...
[2] https://www.who.int/publications/i/item/WHO-FCH-CAH-06.1 page 12 of the linked on that page (labeled as page 3)
Thank you, would upvote twice if I could, I learnt something new and potentially very useful here :-) *bookmarking*
Or any other solution with electrolytes (Gatorade, DripDrop) etc
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Yup - in the UK, paracetamol is usually recommended for general pain relief before Ibuprofen. Additionally, Ibuprofen and NSAIDs have a lot of interactions which can make them unsafe - SSRIs or blood thinners for example.
Ibuprofen interacts with SSRIs? Anecdotally I've never had any problems with my Escitalopram and the Wikipedia page doesn't mention any interactions
The Norwegian pages I linked to states you should be careful with Ibuprofen and anti-depressants. I did a quick search and these[1][2] articles came up, suggesting increased risk of brain hemorrhaging and 10x increased gastrointestinal adverse effects due to the combination.
[1]: https://www.cam.ac.uk/research/discussion/antidepressants-an...
[2]: https://pmc.ncbi.nlm.nih.gov/articles/PMC1884970/
Where does Aspirin fit into this? I only use paracetemol and ibuprofen. The one time I tried asprin I got a stomach pain.
aspirin is an NSAID, taking it modifies the prostaglandine levels (through its COX inhibition) and this influences the mucosa of your stomach. ibuprofen can still have the same side effects, because its belonging to the same class of drugs.
Here in my body, it tells me acetaminophen does absolutely nothing for pain where as ibuprofen does. I wouldn't take ibuprofen for fever
I once got it to make a small difference for pain - but I was in the hospital (surgery recovery) where the doctors were giving me more than the daily maximum.
This might sound like woo, but sometimes I'll find a quiet place and just sit there and focus on the pain. I try to really understand the sensation that's being registered as pain by trying to notice all the properties of it (is it throbbing, burning, etc...).
Occasionally I'll find that the more I try to identify specific features of the sensation, the harder it gets to do so and the pain sensation fades away.
I do that too. But at least if you are a meditator on my level, there are limits. I sometimes get migraines and focusing on the pain while you are shivering, sweating and close to throwing up at the same time just doesn’t work for me.
It’s the same in the UK - paracetamol is the default. Ibuprofen is better for reducing swelling, inflammation etc.
Ibuprofen is better are reducing fever and managing headaches.
Paracetamol is the safer version Phenacetin. You used to be able to buy aspirin, phenacetin and caffeine..but phenacetin with withdrawn. APC when it was marketed was very popular but soon you were told to never give children aspirin for a fever so we used Paracetamol. Then Phenacetin was withdrawn and paracetamol became part of APC (like Alka selzta XS , or just the popular caffeine paracetamol combos)
Paracetamol came in as safer but similar, yet no where near effective. It captured bith the market feeling of its pros and cons. So we interpreted it as safer than alternatives (especially aspirin for children due to Reye syndrome). But also dangerous which might be why OPs view was that ibuprofen is safer.
The NNT (number of people you'd need to take it) to be headache free after 2 hours is about 12-20 for paracetamol. But only 7-10 for ibuprofen.
It's quite surprising that paracetamol became the defacto analgesic given it performs so poorly but it was historical inertia. And plenty of people argue that if we were to start over we would not make paracetamol OTC.
Wiki for phenacetin says it's mechanism of action is being metabolized into paracetamol. IDK about your "nowhere as effective".
It was withdrawn for sometimes being metabolized into another, toxic and carcenogenic, molecule.
Here is a summary of COCHRANE evidence on Paracetamol "widely used and ineffective"[0].
It's a paradox no?
Paracetamol is only the presumed only active metabolite, and that is why paracetamol rapidly replaced phenacetin.
There is a quirk though, phenacetin actually delivers paracetamol to your brain and spine (where it primarily reduces pain) faster than an oral dose of paracetamol.
Similarly IV paracetamol is far more effective that oral paracetamol.
Phenacetin was also considered mildly addictive, and induced a gentle euphoria and then sedation.(We still see sedation after paracetamol in children and the elderly). But general use we don't see these effects in paracetamol, why did phenacetin do this more effectively? Probably the higher peak levels around nerve endings.
These effects are both wanting of an explanation of phenacetin is just paracetamol and directly analegisic.
[0] https://web.archive.org/web/20240721144157/http://www.eviden...
Interesting.
I guess it tracks with personal experience. I find Paracetamol is OK for fevers/generic cold symptoms but absolutely useless for a headache, Ibuprofen is the only thing that shifts them.
Well it's the only thing that shifts them now I'm in a country where I can't buy soluble aspirin and codeine OTC.
I end up using paracetamol often for pain because it's what's to hand.
What annoys me is that so many people have your experience and are effectively gaslit about the fact it seems to often perform so poorly.
Reminder: don't take medical advice from someone who can't write correctly.
Very interesting though that the original article makes no comment on efficacy. It's all about metabolic safety which is not contentious.
Have you seen my doctor's handwriting?
Same in Portugal.
In Western Europe too.
> but it does absolutely nothing with actual pain. It is placebo at best.
This is simply false.
you responded to the wrong comment. I assume this want mean for https://news.ycombinator.com/item?id=47860061
It is not false. It does nothing. Head hurts, you take paracetamol ... head still hurts. The belly hurts, you take paracetamol ... nothing change.
When I took ibuprofen it did actually made an actual real change.
"I took it and it didn't work so it's a fake placebo drug" - wow, your scientific method is flawless, have you considered a career at the US Department of Health?
Guideline #1 for comments-
Be kind. Don't be snarky. Converse curiously; don't cross-examine. Edit out swipes.
That might be a good fit considering who's in charge today.
Maybe you had an inflammation-induced pain. That would explain why ibuprofen helped, and paracetamol did not.
I have a counter-study with size n=1: I did all my recovery from tonsilectomy on paracetamol and definitely noticed it working. That was however on the maximum safe dose.
(one of the major problems with paracetamol is that the effective dose is only a few multiples away from the dose which starts to cause liver damage! It is by a long way the most dangerous OTC drug)
You're partially right compared to placebo only about 5% of people are painfree over the effect of a placebo when taking paracetamol.
Paracetamol got it's start as replacing the more effective but much more dangerous and withdrawn drug Phenacetin.
Why don't people notice that it's such a small benefit over nothing? Well because placebo effect is quite good for pain and pain is usually transitory anywhere..if you have a tension headache you're probably going to aim to relax. Turn away from the screen or even have some caffeine and those are more effective than paracetamol!
Where did you pull this 5% from? There are gazillions of studies showing higher or lower efficacies for different kinds of pain. Along with the inaccuracies about Phenacetin (whose MOA is metabolising into paracetamol).
You will indeed find various figures for various pain types all are far worse than ibuprofen.
Here is an example from the Cochrane library
> For the IHS preferred outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour.
A NNT of 22 means that in absolute terms 1/22 people met the positive endpoint criteria more than placebo. This figure is usually quoted as 20% for placebo and 25% for paracetamol giving NNT of 20.
The NNT of 22 gives 1/22= 4.5%.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
"pain free" is a long way from the pain is manageable. Pain is an understudied subject, where we have too little knowledge. Just using the word manageable is an indication of this.
That's very true, but the metric is applied to all medications you compare against that's what's important. You also just get a baseline idea of what's good by guessing what you'd accept.
Episodic tension type headache tested with ibuprofen Vs placebo NNT is 14. (Btw that's not great itself) But it's better than paracetamols often quoted figure 20.
Here's why I say it's not great. Why don't you guess some reasonable NNTs for say moderate depression treated with SSRIs, or no relapse in schizophrenia treated with an antipsychotic. Now guess the NNT for a statin to prevent a first heart attack.
SSRI for moderate depression about 10, antipsychotics to prevent schizophrenia relapse over 2 years NNT= 3 (excellent )Statin to prevent a first heart attack 200! (This one always shocks me). Statins have a clear role of course.
[0] https://thennt.com/nnt/ibuprofen-treatment-episodic-tension-...
American in Norway, it's always amusing when I buy some Ibux at the pharmacy, and get questioned about it and steered towards Paracet instead.
They do in NZ. Paracetamol is promoted as the safest, most well studied pain relief for short and chronic conditions. In Australia however they have just started limiting how many you can buy at a time for some reason while ibuprofen covers the chemist shelves without any such controls despite the risks.
IIRC it's because Paracetamol has low threshold for overdose, and is often blended in with other cold and flu medicines in Aus so it is easy to exceed daily dose if you are say, taking some conbination of paracetamol + Sudafed (paracetamol+decongestant) + drinking a Lemsip (lemony vitamin powder with more paracetamol).
It is only packet size restricted in supermarkets, you can still buy bulk packs from chemists.
Chemist warehouse has big signs up saying you'll be limited to buying a pack of 24 in Melbourne.
In Ireland you can buy acetaminophen in stores, gas stations etc.
For ibuprofen you need to go to a pharmacy.
I couldn't get over this after moving here from the UK where you can pick up a pack for 10p in a supermarket.
Yeah, I lived in the UK before and it's a bit mad.
You can't buy antihistamines either, only in pharmacies and they are quite expensive. I remember you could get them in Tesco or Asda for like £2.
That is interesting. In the UK they're both available pretty much everywhere, and they're some of the cheapest drug prices I've seen anywhere in the world... ~20p for 16 tablets or something.
I would say 16 tablets would be closer to 6, or even 8 euro here.
Really? I get headaches semi-frequently and my first line of defense is ibuprofen, I use acetaminophen sporadically as a last resort
I take both. 500-1000mg acetaminophen, 200-400mg ibuprofen. Usually helps for headaches which I get frequently. I only take them for the worst headaches though, so probably once every couple of weeks on average.
Yeah if I need to I take both also. In addition I be sure to have a caffeinated drink also as caffeine has been shown to both speed the absorption and boost the efficacy (5-10%) of paracetemol over a multi hour period. https://pubmed.ncbi.nlm.nih.gov/17442681/
Why? Does ibuprofen work better? It's bad for your stomach walls.
For inflammatory pain (most headaches, most pain from injuries), ibuprofen absolutely works better. For migraines, neither works at all on its own -- though ibuprofen plus caffeine (I generally drink tea) does a little. For overexertion aches and cramps, or fevers, I think either is generally fine.
>For inflammatory pain (most headaches, most pain from injuries), ibuprofen absolutely works better.
Unfortunately, for me ibuprofen doesn't seme to help at all with any of these. Like I understand that my pain are often inflammatory based, and i try ibuprofen, but the pain doesn't dull at all even if I take 800mg etc...
I take 1000mg acetaminophen and boom my pain is vastly reduced...
> Does ibuprofen work better?
In my experience it works far better at managing headaches/migraines.
There seems to be some percentage of people that acetaminophen seems to do very little for. Ibuprofen has a much more pronounced effect, to the point that I take it at half it's recommended dosage.
Same in France
perhaps it's got to do with packaging sizes. i think an acetominophen od is much worse. most of these countries regulate package size for these drugs, yes? US does not
The only issue with treating pain with paracetamol is that it does not work at all against the pain.
It works against fewer or maybe mild inflammation and what not ... but it does absolutely nothing with actual pain. It is placebo at best.
> but it does absolutely nothing with actual pain
Neither paracetamol nor ibuprofen work by blocking pain. Depending on the type of pain and your physiology it can range from really effective to not at all.
I only take paracetamol, it works better than both ibuprofen and opioids for me. I know other people who have the exact opposite experience. There’s no absolute here.
Yeah paracetamol does absolutely nothing to me with pain. I thought its mainly fever medicine.
Same here. Paracetamol also gives me pretty strong stomach aches whereas ibuprofen rarely has a gastric effect and when it does it's mild at best. I've been told by many people that the opposite should be true but oh well.
I wish they dipyrone was sold here, but alas I can only get it when I travel abroad.
With medicine both can be true, the response depends on so many factors in your body. Same way that for some people, particularly those with ADHD, taking stimulants can make them sleepy.
Yeah, for me paracetamol is worse in everything - fever, pain, etc.
For mild stuff I use ibuprofen, if it gets worse, diclofenac works every time.
Many years ago I had 4 surgical procedures done around my nose/throat at the same time - straightening a deviated septum, turbinectomy, enlarging the openings into my sinuses and removing my tonsils. This meant I couldn't breath through my nose for about a month - and breathing through your mouth when you've just had tonsils removed is quite painful.
Soluble paracetamol literally turned the pain off like a switch - of course I was limited as to how much I could take, which I was careful to stick to but I was almost in tears waiting for the time to come where I could take more paracetamol.
So in some situations paracetamol can be an extremely effective painkiller.
Yes, I had a herniated disc and had severe nerve pain. While waiting for a time when I could get surgery to fix it acetaminophen reduced the pain even more than opioids! ibuprofen and an oral steroid like methylprednisolone did nothing...
Acetaminophen is like a wonder drug for me while ibuprofen doesn't seem to ever do anything for me.
Your statements are factually incorrect.
Double blind placebo controlled trials have shown that acetaminophen/paracetamol is superior to a placebo at controlling pain.
It may not work for you, I don't know. But it absolutely does work in general!
What is actual pain?
When it hurts. Like, when your head hurts for example.
And if it stops the hurt - does it stop the actual pain?
Yes, but the thing causing the pain may still be there
What is the difference between the two? I treated them as synonym.
I did not said it cures the root issue, frankly I dont care that much. I am taking it so that the pain stops and I can function normally.
Paracetamol does not stop pain/hurt. It is like taking nothing and just waiting. It may help with fewer or some such, but I am not taking Ibuprofen for fewer.
Really lovely article. In paramedicine we usually treat 10g of acetaminophen in a 24-hour window as a potentially fatal overdose. That's also why the law in Australia was changed to require acetaminophen to come in blister packs (harder to get each pill out) of no more than 16. At 500 mg, that only gets you up to 8 g if you eat the whole thing, which is still hopefully non-fatal.
I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
I randomly bought NAC just to try it. I dont know about the chemical interactions, but going out with collegues at that time taught me that it's basically impossible to get drunk. Usually a pint of beer is enough to make le feel at least a little dizzy, but when taking NAC, it was all like drinking water
If you all think NAC is great, wait till you try liposomal glutathione (glutathione is one of the things NAC is a precursor for, one of the general take-out-the-trash compounds for your cells). Of all the supplements I’ve tried, it has probably the most immediately noticeable positive effect (maybe because you take it by leaving it under your tongue to be absorbed sublingually for a bit before swallowing). Generally leaves me feeling great, even if I was kind of dragging and tired beforehand.
NAC taken before consuming alcohol has a positive effect apparently, but taken afterwards it's detrimental as mentioned here: https://en.wikipedia.org/wiki/Acetylcysteine
Vaccine Ordering https://xkcd.com/2422/
Took me a while, because i pronounce "Pfizer" as "pfee-tseh-r" in my head
That's the original pronunciation
Not sure why this is voted down, it's true.
On mice.
Just a note: “research about the safety of taking NAC every day for the long term is limited.” cf. a concerning 2019 animal study regarding higher risks of cancer https://doi.org/10.1172/jci.insight.127647 also discussed at https://www.science.org/content/blog-post/n-acetyl-cysteine-...
Same! I thought I was going crazy but the effect is clear and reproducible. My hangovers are also less bad.
When I go out drinking with my pharmacist buddy, we take NAC before going out. He swears it makes hangovers less likely. I can't say I've noticed that particular effect, but I do seem to sleep a bit better on those nights.
Here in Singapore NAC is sold to make muckus more liquid to alleviate coughs.
Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
> Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.
I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.
You'll find a detailed description oft potential effects and uses here: https://en.wikipedia.org/wiki/Acetylcysteine (aka NAC)
My anecdotal experience is that NAC makes me much more tolerant to alcohol. As in, I can drink a lot more without feeling the effects. Since I don't get the same buzz, I care less about reaching for a beer.
How is nac (acetylcysteine) delivered there? I can buy dissolvable tablets here in Europe but from what I see that’s less helpful for mucous, things like mucomyst require inhalation, which isn’t in otc products I know of.
In the Philippines it's available as an effervescent tablet to be dissolved in water. They still tend to work better than the western remedies (guaifenesin etc) even in this form IME.
Usually here in Canada it's available in capsule form which I find less effective.
Same here actually, I find it slightly helpful but the effect’s useful time is limited. I’ve wondered if I could capture the gas released while bubbling and inhale that…
Dissolvable tablets & powders are still useful for getting rid of mucus. Maybe inhaling is better, but anecdotally the tablets seem to work.
The dissolvable tablets completely fix a runny nose for me. Much better than any nose spray, which tend to irritate the nose and lead to chronic runny nose if taken for too long.
Have you tried a neti pot or similar?
Same where I'm from, it's in pill / capsule form
I've heard it suggested that acetaminophen just come with a small dose of NAC alongside it to make it safer. I guess this would require a lot of regulatory work to approve, but given that 500 people a year OD, it seems like a thing we should at least consider.
Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.
Could somebody package Tylenol with a sufficient amount of NAC to de-risk it? I suspect such a formulation would not require trials?
Certain esters have been found to be much safer (in mice, at least):
> The glutathione hepatic values in mice obtained by intraperitoneal injection of the ester are superimposable on controls and the oral LD50 was found to be greater than 2000 mg kg^-1 and the intraperitoneal LD50 was 1900 mg kg^-1 ...
That's for pyroglutamic and glutamic acid esters of paracetamol: https://pubmed.ncbi.nlm.nih.gov/8799871/
and more general analogs apparently can also be designed to not produce NAPQI:
> Thus, in 2020, N-sulpharyl-APAP prodrugs 39–40 (Fig. 11) were developed. [...] They are not hepatotoxic because they do not generate toxic metabolite NAPQI, even in concentrations equal to a toxic dose of APAP (600 mg kg^−1 in mice).
https://pubs.rsc.org/zh-tw/content/articlepdf/2024/ra/d4ra00... p. 9702.
These would probably require trials, though.
See superscript 6 on the article. Apparently NAC might has side effects of its own.
One of the side effects in a study in mice was inducing lung cancer: https://doi.org/10.1172/jci.insight.127647
Ah
NAC is so amazing for us in terribly polluted areas. Also great before drinking
I am blessed with living in one of the most polluted areas in the world (PM2.5 going into thousands of µg/m³ in winter; summers are not much better due to dense chemical smog). Can you say more about how you're using it to combat that? Thanks!
Glycine + NAC even better, both precursors for Glutathione, Glycine also great for sleeping.
What does ingesting 10g of acetaminophen even look like? I've got to imagine the fatal dose is far, far, far lower with chronic usage. Finding out that people are ingesting grams is profoundly disturbing.
Extra strength tylenol is 500mg a tablet, so 20 pills. Think most of the accidental ODs are due to people not realizing its included in other cold meds, and also being loopy from whatever illness they're trying to manage, and so end up forgetting when they last took the meds.
Its also a pretty popular choice for people trying to kill themselves, though, so I suspect a non-trival chunk of ODs in the statistics given in the article were intentional.
I have taken 4-5g in a day while suffering from intense pain before.
There is a limit to the amount of opioids they will prescribe you, even if you are in mind shattering pain. For instance while attempting to get your dental insurance to actually cover a treatment you may find yourself between risking organ damage or risking $5000+ in ER visit bills only to have them refuse to give you anything but Tramadol.
It is mind boggling how statements like that are possible in the US.
I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
> I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
Having a condition that actually warrants strong opioids and not being able to get them at any price is definitely not an improvement.
The problem is fundamentally that we want to pretend doctors can always distinguish two people describing the same symptoms when one person actually has them and the other is trying to get drugs. The often can't, so you can either make it hard for people to get pain medications even if they need them, or you can make it easy for people to get them even if they don't. And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
> And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
Could not agree more. Depriving people with legitimate pain of opioids is IMHO legitimate torture. It's a bit of a variance on the trolley problem in that the doctor/government isn't causing the pain, but their inaction is prolonging it.
> and not being able to get them at any price
Brother (or sister), you were simply not trying hard enough. I live in a very clean, safe, expensively-policed county, and even I know where to buy fentanyl for much lower cost than a hospital. I would happily turn to that than take 20(!!!) advils in s single day.
Let's review the policy options in light of your suggestion:
1) We make it hard to lawfully acquire pain medications. You pay $$$ to see a doctor and you pay it even if they refuse you. If they do, you then have to pay $$ to get them from Stringer Bell, or start there to begin with if you didn't have $$$, and hope they're not cut with drain cleaner or unevenly mixed so that some days you get 100% corn starch and other days you get a fentanyl overdose.
2) We make it easy. Anyone can get them from Walmart. The people who need them pay the same $ they do for a bottle of Advil/Tylenol instead of paying $$ to murderers or $$$ to waste scarce medical resources that could have saved someone else's life. The bottle from Walmart always has a consistent amount of the drug in it and neither the dental patients nor the addicts get a surprise fentanyl overdose.
The first option is still the bad one, right?
Whenever people here mention to my critique of US healthcare how its now mostly solved problem now, its 'good' to see the other side and reality. It certainly doesn't seem solved unless you have a million or two just laying around on the account, while mortgages and kids tuitions are paid. And I can easily imagine a long term condition or 10 which, if unlucky in terms of treatment cost coverage can wipe out that sum in a decade or two, for a single person.
Seriously, how can you guys consider this acceptable. I am not of faith but doesn't bible teach to be kind to your fellow men above all? One would expect more adherence to such basic moral rules in such conservative christian society.
> Whenever people here mention to my critique of US healthcare how its now mostly solved problem now
Who says that? I don't think anyone sane can believe that US healthcare is "solved".
I don’t know a single person in my life who thinks US healthcare is good, so that’s weird. And many my peers a have good jobs with good health insurance. Everyone I know has at least one bad story about insurance, if you’ve ever had more than really basic checkups.
The problem with the US system is that it doesn't know what it's trying to be.
If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.
If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.
The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.
It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.
Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.
I think you're trying to apply ideology where it doesn't belong. Nobody on earth would advocate for such extensive spending to facilitate agreement on financing. It's extremely, extremely inefficient. (But it does produce jobs, which makes politicians super horny.)
The market also won't assist us, as we can't exactly compete future treatment costs against unknown illnesses.
Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence. Any remaining options would highlight deficiencies in the existing system.
A schumpeterian system, if you must slap an ideology on it.
> Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
Emergency rooms operate by triage. If you're having a heart attack, you're going in right now. If your shoulder has been bothering you for six months, you might have to come back multiple days in a row and spend the whole day waiting before there is a slow enough day that you can be seen. There is then an obvious incentive to go pay a private physician to be seen immediately instead. Free clinics are similar: There are no appointments, it's first come first served, and then most people prefer to pay $100 to schedule an appointment rather than wasting an entire day waiting in a queue, but you still have that option for people with no money.
Emergency rooms are also a natural monopoly because in an actual emergency the primary consideration is which one is closest, which doesn't make for a competitive market. So it makes sense to have the government do that. Whereas non-emergency care (which is the large majority of medical expenses) would allow people to compare prices or make cost trade offs against distance or convenience etc., if we would actually expose people to pricing. For example by requiring price transparency and then having insurance pay the second-lowest price for that service within 100 miles of your location, but then letting you choose where you actually want to go and make up any difference yourself, or choose the lowest cost option instead of the second lowest and then put the difference in your HSA.
> A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence.
It's not clear how a government option that doesn't have taxpayer subsidies would do this any better than a private non-profit. There are many existing non-profit healthcare providers and they don't have meaningfully lower costs than for-profit ones.
The general problem is that "non-profits" and government-operated services still have money flowing through them and "profit" can be extracted in all manner of ways other than paying dividends to shareholders. The officers can just pay themselves high salaries, or whoever is in charge of the budget can take bribes/kickbacks to shovel money in the direction of the contractors or unions paying them off.
Meanwhile the nature of "profit" in a competitive market is largely misunderstood because of accounting differences. If a non-profit wants to buy an MRI machine, they have to take out a loan, and then pay back the loan with interest which they account for as an expense. A for-profit company might get the money to buy it by selling shares to investors, and then paying dividends to the shareholders instead of paying interest on a loan, which goes on the books as "profit" instead of interest expense. But you couldn't just replace them with a non-profit and then lower prices by the amount of "profit" they were making because then they also wouldn't have had private investment and you're back to needing the loan and paying the same money as interest to the bank.
The thing that requires providers to be efficient is competition, because then the ones wasting money or taking bribes have to cover the amount wasted/embezzled by charging more to customers and then the customers don't choose them because they have higher prices. But that's the thing the existing regulatory system goes out of its way to thwart.
Taking too much acetaminophen is bad for you but 10g is 20 extra strength pills and that much isn't likely at all to kill you but damage your organs is quite possible. Reading this might make someone in a bad place think that much will do the job and it won't. Tylenol poisoning's most likely outcome is permanent organ damage and pain, don't try it.
I've been prescribed slightly more than 5g per day (2 x 650mg tablets every 6 hours) for pain after an operation jointly with ibuprofen, which is scarily close to the limits.
I managed to overdose by accident with severe dental pain. Wasn't thinking straight, took about 8g - which is even more scarily close to the limits.
I'm fairly sure that caused some liver damage. I wasn't aware of anything apart from feeling a bit weird.
At the time, I had no idea it was potentially deadly.
> What does ingesting 10g of acetaminophen even look like?
20 not-especially-large tablets
Or 10 slightly larger ones
edit: https://www.24pharma.nl/paracetamol-eg-1000mg-120-tabletten
I’ve pretty much only ever seen them sold at 500mg; are you regularly seeing them where you are sold in 1g form?
The .nl indicates the netherlands. Many people in the netherlands vent/joke about how the doctors here only ever tell you to take paracetamol and come back in two weeks if it's still a problem (recursive solution).
However the last time I went to my GP she scoffed at me taking the maximum and suggested I take literally double the maximum recommended dose 4-5 times a day which totaled I think 2.5x the daily maximum on the package. I am very much a "believer" in science and reasonable medical authority but this experience sowed the seeds of doubt, because from what I have always heard, that can actually kill you or cause permanent liver issues. I was also taking diclofenac simultaenously, and when I told her how many mg, she asked "where can you even buy such small doses, that's what I would give a small child" =/
My understanding is double the max dose of paracetamol is the LD50. Seems crazy for your GP to advocate for that. Published recommended dose is assuming average weight, so maybe if you're a very large person, the advice makes some sense, but wow.
They are common in France, but not in such packages: There are restrictions that prevent you from buying more than than 8g/day (theoretically at least, I don't believe they are strictly applied in practice).
In Europe for sure they're also sold in 1g dosing. I think the packages don't contain lots of pills, though. Definitely not US style buckets of pills.
They are widely sold at 1000 mg (1g) tablets in Europe, but in many countries they require doctor's prescription. There are also purchase limits to the number of pills you can buy at once.
The linked size is also quite common in Belgium.
As an American this is such a weird question to me. I purchase my ibuprofen and benadryl in bottles of anywhere from 400 to 1000 pills every few years.
Is this not suicidal behavior?
Apparently a common source of problems is taking two different medications without realizing they both contain acetaminophen.
Suppose your arthritis is acting up, so you start taking Tylenol 8hr Arthritis Pain[1]. That's 2 tablets every 8 hours. They're extended-release with 650mg per tablet. A total of 3900 mg in 24 hours.
A few days later you get the flu, so you decide to add what seems like a completely different medication: Theraflu Flu Relief Max Strength[2]. It has a cough suppressant and an antihistamine. But each caplet also contains 500 mg of acetaminophen. It says to take 2 caplets every 6 hours, so you take 8 of them in 24 hours[3]. That's another 4000 mg.
Between the two, you're at 7900 mg.
Then you wake up in the morning and take both medications, but 30 minutes later you've forgotten you took them. You're not thinking straight because you're sick. So you accidentally take a second dose. That additional 2300 mg brings your total to 10200 mg.
---
[1] https://www.tylenol.com/products/arthritis/tylenol-8hr-arthr...
[2] https://www.theraflu.com/products/day-night-flu-relief-max-s...
[3] You weren't supposed to take 8 of them, though. If you'd read the label very carefully, you'd have seen it also says not to exceed 6 in a 24-hour period.
My personal rule is to only purchase over-the-counter meds with a single active ingredient. I'd rather separately take an antihistamine, expectorant and painkiller than a concoction where I have to read the whole label and do math while sick to separate the doses and timings.
There are some that are very hard to find as a single ingredient. Recently I was purchasing a medication for back pain, I had a choice as to which other ingredient I wanted, but I didn't have the choice of none. I picked the combined ingredient I don't like to take, because I wouldn't be adding it on top.
I did toss on the other option, stand alone, at one point so I could get some sleep.
It left the medication I was more comfortable taking as an add-on option if things got bad enough. (This particular medication has much lower risk of overdose, so if I got stupid and took it again there would be no significant additional risk.)
It's ironic, but taking the combined medication with a known higher risk of its own was better than taking the lower risk medication.
One was controlled, higher risk, taken at specific times, while the other was taken in addition, on demand, as required.
Specifically this is one reason they’ll sell you cocodemol or Vicodin but not codeine or hydrocodone directly — if you take enough to get a codeine high, you’ll have taken a toxic amount of paracetamol/acetaminophen, so they assume you won’t.
Doin' the Lord's Work here, sir.
Also, loved your TV show back in the day. :-)
I took 2 full packs in a day once while trying to recover from severe pain. Didnt find out until later that it was supposedly a fatal dose.
Mm. Apparently i don't understand pain and the medication it drives people towards.
> Apparently i don't understand pain
I didn't until I had a bulging lower back disc pressing on my sciatic nerve. My leg felt like it was constantly on fire no matter what position I put myself in. In the past I've torn my ACL and had surgery to reconstruct and that pain was like stubbing my toe compared to the back pain. I understood how people become addicted to pain meds after my back situation.
> Apparently i don't understand pain...
Speaking as someone who is not-infrequently in significant pain, I sincerely hope that you never have to.
Totally get it, I too only understood it "theoretically" till I had a (fairly minor!) dental operation.
... Suddenly I'm maintaining a continuous note of when I'm taking which medicine to avoid crossing safe limits (which I anyway was crossing most days).
I was only told to take 2 paracetamols a day (bullshit dose, I'd be waking up from the pain even with more pain meds).
"Diclofenac for rare use" - well, if nothing else is touching the pain, is it an emergency?
Eventually after forever I was able to transition to Ibuprofen + paracetamol. And I already have a health condition which is heavy on my kidneys... pain management can be absolutely crazy.
Pain management can be crazy but in your case it sounds like they simply didn't prescribe the appropriate medication presumably due to the anti opiate hysteria that has taken hold.
While that's quite possibly true, I forgot to mention that I'm not in the US but India. I was conscious the whole time, with only local anesthesia. Also the dentist in question is actually our "family" dentist, and he's a pretty knowledgeable/skillful guy (easily more knowledgeable than many GPs on health matters of the body).
Fun fact, you can totally get them to pause the procedure without saying a word. All you have to do is end up in a lot of pain, have your heart rate skyrocket like anything, and get everyone in the OT very concerned ;)
I had severe nerve pain due to a herniated disc. While awaiting a surgery, I was prescribed an opioid (Tramadol) but it didn't seem to help much at all. Acetaminophen actually worked better than the opioid for me...
Did you suffer any liver function damage as a result?
I presume your protein intake was adequate and diverse prior to this misadventure....
Not knowingly.
This can easily happen over the course of 24 hours if you're in "fuck me I'll do anything to make it stop" levels of pain. I've taken more than 20 ibuprofens in a day a few times in my life, which, while not medically advised, did not kill me. I actually had no idea acetaminophen was so dangerous.
Just in case, ibuprophen does not work well for pain relief [at lest for some kind of pain]. Paracetamol [acetaminophen] usually is much better against pain. And paracetamol + ibuprophen can help with strong pain for which neither paracetamol or ibuprophen work at normal doses.
Not really. Both address different sources of pain, and do so using different processes.
Ibuprofen is a Nonsteroidal Anti-inflammatory Drug (NSAID) that reduces pain and inflammation, while acetaminophen does not. (Acetaminophen is believed to act mainly in the brain rather than at the site of injury).
Ibuprofen- Fundamentally, if the pain is caused by inflammation, reducing the immune systems response to it can reduce pain, but if the pain is more acute it won't make a dent.
With acetaminophen, taking more isn't a solution in most cases, you need another method to reduce the pain further if it doesn't achieve its goal.
(That's why it's combined with things like codeine, which affects the brain in a different way for an additive effect)
> you need another method to reduce the pain further
I don’t know about “most cases” but often you don’t want to reduce the pain _further_, you want to reduce the pain _again_. (Having an alternative definitely helps in the meantime.)
Only if you take them all at once.
Also dementia
Buy a pack of 20x500mg (just checked, common size in Germany), take 2-3 every half hour for a while.
Sure, that's extreme. But if you're unaware of the risks, you feel sick, and you believe it's helping you.
I mean, people aren't killing themselves in masses with it, but it happens every now and then. Easily imaginable that one in a few million people will have enough tendency to take more pills and is unaware of the overdose danger.
And think of the children!
When was this changed?
I arrived in Aus in 2021 and was amazed to be able to buy a pack of 40+, coming from the UK where the limit had been in place for some years.
You can still buy 100 packs, they are just behind the counter at chemists. TBH it's a rather stupid restriction - do they think people only ever own 1 packet of paracetamol at a time? In my household we have at least half a dozen, including a 100-pack from Oz and a 500-pack from America.
Oh right - that's probably what we did, buy a big pack from behind the counter.
I don't think you can even do that in the UK.
Yeah we usually have a few packs hanging around, and I get the 'it seems stupid' thing, but sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life. I dunno, I hope that's shown in the evidence anyway. Otherwise it's just pointless like the whole pseudoephedrine song and dance, which has inconvenienced anyone looking for a decongestant while doing sweet FA to the availability of meth.
> Oh right - that's probably what we did, buy a big pack from behind the counter.
No, when you visited they were still on the shelf. They only put them behind the counter in 2025.
> sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life
I'm philosophically not for making suicide harder. If someone wants to die, that's their right. And practically, while you might be able to show a stat-sig decrease in paracetamol poisoning, I'd expect the suicides to largely just move to other methods.
The point is that many don't really want to. Those that actually want to can buy two boxes from two shops or ask the pharmacist for the big pack from behind the counter.
This just adds a tiny amount of friction to impulsive attempts, which may be a classic cry for help or just someone in the depths of some sort of mental health episode. Such folks may think better of it the next day and a very small amount of inconvenience will put them off. I think suicide is serious enough that you should probably mean it, and societally saying 'think twice about this' is a good thing.
On the idea that it just shift deaths, as your sibling poster points out (from the UK) -
"in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
https://www.psych.ox.ac.uk/research/research-groups/csr/rese...
So it looks like this tiny, tiny barrier does actually deter people. And that definitely points to them not really being sold on it in any rational way.
I just don't buy the paternalism. People have free will, if they want to do something they would regret later, it's still their right.
That quote doesn't say what you think it means. It's not talking at all about whether suicides shifted to other methods; it only says that there was a secular decline in poisonings (-32%) and suicides in general (-10%) during the study, so they have to also discount some of the raw 48% drop in paracetamol as being part of that broader trend and not due to the treatment. They come to the 43% number only with a generous assumption that had the law not gone into effect, there would have been an increasing trend in deaths from paracetamol poisoning, which seems wrong to me. The more obvious way to derive the prior would be to look at non-paracetamol poisonings and expect the same trend, in which case the effect might be something like -24%.
Anyhow, it's still perfectly possible that the people who were deterred from paracetamol poisoning committed suicide some other way; the data in that paper says nothing about it.
> People have free will, if they want to do something they would regret later, it's still their right.
Then this minor frictional measure is the very least of your worries. For a start, any given pharmacy has an entire pharmacopoea of compounds that people are kept away from for their own good. Not to mention liquor licensing rules making landlords cut folks off at a bar if visibly drunk etc. And guard rails to stop people climbing to high places. And ... preventing people from doing stupid shit in the moment is everywhere in our societies.
There are a heck of a lot of things I'd put higher up my list of concerns than "may have to visit two shops if wanting to kill myself"
> I hope that's shown in the evidence anyway
tl;dr: Yes
Paraphrasing from [0], after September 1998 when the restriction was introduced, "The annual number of deaths from paracetamol poisoning decreased by 21% [...] the number from salicylates decreased by 48% [...] Liver transplant rates after paracetamol poisoning decreased by 66% [...] The rate of non-fatal self poisoning with paracetamol in any form decreased by 11%"
See also [1]: "in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC31616/
[1] https://www.psych.ox.ac.uk/research/research-groups/csr/rese...
Jan 2025: https://www.psa.org.au/changes-to-paracetamol-scheduling-wil...
It's the usual public health balancing act of help vs harm.
Similar rules in Europe, or at least, Portugal.
You can still die if you take your idiot-proof Aussie blister packs with alcohol. So it's more an inefficient use of cabinet space.
You can overdose on water too, they haven't banned 5-gallon jugs (yet).
Yes, and you can still die in a car crash if you're wearing your seatbelt, and wearing a helmet on your motorcycle won't save you from a head-on with a truck, and you can still drown in a pool with a lifeguard, and you can still die in a burning building with smoke detectors.
Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0]
[0]: https://pubmed.ncbi.nlm.nih.gov/440889/
No. Ethanol and tylenol compete for CYP2E1 that produces toxic NAPQI, so no, acute alcohol intoxication has a protective effect at least where it comes to tylenol toxicity.
No.
Alcohol and Acetominophen/paracetamol should not be mixed.
https://www.medicalnewstoday.com/articles/322813Sorry, crappy link. If you don't like it, it is easy to search for a better one.
There is a danger in chronic abuse resulting in upregulation. Mixing the two at once is no problem for the liver, which is also why patient information leaflets for paracetamol do not contain a warning to avoid alcohol, only about chronic alcohol abuse.
Your crappy source is vague in what consumption pattern constitutes a risk and actually cites a better source that supports the idea that acute alcohol consumption reduces paracetamol toxicity. https://www.biorxiv.org/content/10.1101/2020.07.07.191916v1....
That's a mathematical model, but this relationship between the two is what I was taught in medical school and it is still supported by the science. There's plenty of other sources, I just picked that one because your article cites it. Just search for "paracetamol ethanol" on Google Scholar.
This is correct.
s/idiot-proof/idiot-resistant/g
Also applies to most similar phrases ending in -proof. Should be eye-opening.
I lived with an ICU nurse for years and one of the things he emphasized was the risk of acetaminophen overdose. He's more than once treated the liver failure (and death) from it and by his words, it's one of the worse ways to go.
The positive of it is it got me in the habit of logging whenever I take it, either in a note on my phone or just a sheet of paper I place on my dresser under the bottle. This helps make sure I stay under the 3-4g/d limit.
Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis.
Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.
In my wilderness first responder class they emphasized taking a cocktail of ibuprofen and acetaminophen - both are effective pain relievers, each with different dangerous side effects.
The benefits stack, the side effects don't.
So if you are going to be loading up on higher doses of pain relief, take half acetaminophen and half ibuprofen.
P.S. like someone mentioned in a comment below happened to them, be careful with NSAIDs over the long term. Until recently I took them daily for better part of 3 years. I was recently diagnosed with chronic kidney disease. Can't definitively say causation, but they definitely contributed. They're fine for short term use but can really f$%# you up with long term, daily use.
It is absolutely valid to warn about long term use, and NSAIDs in particular (I was lucky and had a gastroscopy before they'd done any serious damage, but they found significant erosion of my stomach lining due to NSAIDs), but acetaminophen/paracetamol isn't an NSAID (ibuprofen and aspirin, for example, are)
To be clear, it was nabumetone, celecoxib or meloxicam (at various times, not overlapping) for me.
In mozambique i was committed to the hospital with my liver failing after spending two weeks taking acetaminophen daily because everyone at work got sick and someone had to keep the business up (it was a bank, our IT department was very specific and only 6 people knew that job and everyone got extremely hill). After two weeks, i finally went to the hospital and I couldn't leave; spent the next two weeks fighting for my life and at some point I was told I was not going to make it. All due a simple over the counter medicine... crazy. This was 2016. To this day I still get extremely tired if I take it, so I have to choose it carefully when to take it.
That sounds terrible! Glad you made it out alive and hopefully recovered well! Out of curiosity: how much did you take per day?
Agreed!! Here’s my trick: take 1g and set an alarm for +6 hours. If I don’t need it, fine. If I do, repeat.
I'm not disagreeing with you or trying to be disagreeable, but how do people accidentally exceed 3-4 grams daily? That's 6-8 pills!
It often happens when people take the max dose of straight paracetamol, and then also take another drug that has paracetamol in it without knowing that (e.g. a codeine/paracetamol or ibuprofen/paracetamol combination).
People who are in a lot of pain and don’t know the risks.
Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.
To be fair, the "real" limit depends on how lucky you are with your body's makeup. The safe limit is below that limit.
I know people with permanent pain due to medical conditions who have been given a doctor's approval to exceed the limits printed on the packaging (after having previously been monitored). You can exceed the limit on the packaging by one or two pills.
A bit more is often not deadly, but it's very easy to take more than a bit. When I had a messed up mouth for several days, I took the maximum doses and set timers to help me regulate the dosage throughout the day, but I sure wished I could've taken more at that time.
Okay that's right, if you just keep upping the dose because you're still in pain it might be easy to just slam a few every 4 hours
From personal experience if i have a headache I'll take 1000 mg all at once; it either works right away or it doesnt and I stop bothering until I've had a good nights rest...
Imagine if that rest will do nothing for that headache and its there morning day and night. Or some injury-related pain which simply can't be downtuned. Plus when old, half of the body aches, all old injuries and general deterioration.
I had only very brief experiences with longer intense pain but it made my mind into pudding and desperate knot of how-to-stop-this-at-all-costs. Normal life is not possible and sanity is not granted.
Yah...I've been there for 6 months now with a constant headache. The first month or so, I was taking 3.5g/day consistently. At hour 4.5 - 5, it would wear off. If it wasn't for my tracking, I probably would have ODed.
If you take 2 on average every 4 hours, you're at 12. If you're feverish or otherwise feeling ill enough and sleep deprived enough, forgetting when you took them last is easy. Personally I write down the time I took the last one.
You are running a high fever or have a massive headache, so know you are going to max out at 4g/day. At that point, it's kind of hard to keep track of the clock.
"My head is pounding. Shit...did I take this at 3PM or 5PM? I know I took it and then fell asleep, but I can't remember when. It is now 9PM, can I take more or not?"
Hot Coldrex (Tylenol) + Pills. People don't read.
My mother in law did this. There are a lot of ignorant and uneducated people out there. They think "take this for pain" = "take more for more pain", popping one an hour not really understanding how insanely dangerous it is since acetaminophen has such a subtle effect until it's too late.
It's in all kinds of medicine. People take some pills and then add a cough syrup, not noticing that the syrup also contains it as an active ingredient.
If you're taking a lot of pills, which ill people often do (e.g., cancer patients), it's easy to forget.
Also, people with memory issues...
It can also happen if the person has some disease that affects the liver, which in turns lowers how much of the drug they can take.
Something I'm surprised this article didn't mention is that sometimes the anti-inflammatory is the point. If you have swelling along with the pain then ibuprofen or any other NSAID is going to be much more effective. That would be the main reason to go with ibuprofen in my opinion. But again if you take medical advice from an internet comment you're already doing it wrong.
> if I needed a painkiller, I’d try to take ibuprofen rather than acetaminophen. My logic was that if eight grams of acetaminophen could kill my liver, then one gram was probably still hard on it.
This article is explicitly considering usage as painkiller.
You can’t use Tylenol as an anti-inflammatory so it’s meaningless to compare them for that distinction usage.
If you need a painkiller it's worth considering the source of pain you are trying to kill. This is an article with a chart considering 11 different situations you might be in and which pill is better for each. A 12th line for "there is also some swelling in the part of you that hurts" would make sense to me.
I had a swelling and even mild fever from an infection and what really helped was Loxoprofen, Ibuprofen did not do anything.
The right tool for the right job. When it comes to medication, in the right dosage.
I'm aware of acetaminophen's down sides, and yet recently I was taking it combined with 2 other medications at the time.
Why? Because all three medications are recommended for dealing with the issue I had. (Alone and in combination)
The moment it wasn't helping further? Done.
There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
All medications are potentially toxic, your body wants to dispose of them. In appropriate dosages they will benefit you, but more isn't inherently better.
Even water can kill you in sufficient quantity.
We do the same with diet; where someone declares one ingredient in a meal healthier than another; it isn't. A single ingredient isn't better or worse for you in a meal. Your diet however can be good or bad; over time that matters.
I agree with your overall sentiment. But allow me some objections:
> There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
But it is. The faster I go, the earlier I arrive at a destination. The more I eat, the later I'll be hungry again. The more I pay, the more I can buy. The more I smile, the more people smile back. It's all-pervasive in life, and "more is better for many things" is just obviously true. Not for all things and there are limits of course.
> More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
A higher dose gets broken down slower, as in, the threshold below which the effect is reduced is reached later. Not a reason to damage your kidneys and better take smaller doses more often, but it's not fully accurate to say there is a limit and anything above has zero effect.
Try dealing with a herniated disc, more ibu is definitely better. Too little wont do anything, proper dose and you feel healed
I had a herniated disc and severe nerve pain. I took 16 ibuprofen a day, 4 200mg pills every 6 hours, it did nothing that I could tell. I also used a methylprednisolone dose pack, also didn't seem to help. I also tried prescribed opioid (tramadol), didn't seem to help much.
Acetaminophen worked far, far better than all these. It worked so well, but i wanted to be careful to limit myself to 3000mg a day, so I took 1 500mg pill every 4 hours for a few days while awaiting surgery. It's the only thing that got me through it. Even a epidural lumbar steroid injection didn't help...
Yeah can confirm. I try to keep it low but then pain lingers for days and cumulatively over the days most probably I took as much as I should have taken in stating few days already.
yeah tried to reserve ibu for sleep and during the day walking as much as possible. I know not everyone feels better while walking, luckily I did.
No, moving definitely works. I can almost predict when my sciatica pain will be coming - usually when I work long hours sitting and don't do enough movement. I struggle to be more active than just going to the gym. I think we - those who suffer from herniated disc and sciatica, need to move much more than those who don't.
desk treadmill really helped me
Spine issues are the single thing that pish me to ibuprofen or naproxen over acetaminophen. The latter does nothing for my issues.
yeah, its the inflammation going down that reliefs the nerve.
Took me 3 months, out of 2 i wasn't able to sit. Luckily I could walk and that give me great relief. So walked for hours.
Keeping the habit, will mostly being coding from my phone & walking from now on.
Really nice you found a workaround. I am constantly trying different ways to alleviate my pain without drugs.
Anecdotally: ibuprofen, methylprednisolone, epidural lumbar steroid injection all did little to nothing for my herniated disc nerve pain.
Acetaminophen worked wonders, even better than an opioid.
I grew up with the understanding that acetaminophen was the safe choice for fever or aches, and ibuprofen what the more potent compound for inflammation and severe pain. I recall casual anecdotes that "my doctor said 1.5x or 2x ibuprofen dose is ok when warranted" to address major incursions.
I've never once thought about taking more than the recommended dosage of acetaminophen, largely because I had no expectation that it would provide additional benefit..
In reality, I try to consume 1/2 doses of anything or nothing at all, unless it's a serious medical treatment being administered by a professional.
> largely because I had no expectation that it would provide additional benefit..
An interesting thing with ibuprofen is that at the regular dose of 400mg it inhibits pain but if you take 1600mg it doesn't inhibit much more pain than the 400mg dose, but the inflammatory effect does increase significantly. A lot of people don't know that and take too much thinking it scales linearly.
Some know that you can combine ibuprofen with paracetamol to get extra pain suppression.
And when you want to be gentle, you alternate between them.
I think most overdoses happen as a result of someone trying to hurt themselves, but I’ve also previously been in sufficient pain (always dental) that I’m counting the minutes down to when I can take more painkillers, so it’s easy to see how you could take double the expected dosage.
It’s also easy to imagine that you may be in a state of confusion and lose track of time and/or the count of doses.
If your doctor recommends to take a specific dose, take the specific dose. Don't half it. Taking half of stuff can also cause further damage. Like with antibiotics, where it can lead to bacteria becoming resistant.
So don't be the "smarter" person. Do as your doctor says and if you have doubts, consult another doctor before just doing what you think is safe, but actually isn't.
Yes that's correct, but in doing so remember that only person that cares most about you and your health is YOU - doctor cares about you for 10-15min, then next patient is waiting, and the level of doctor's care is inversely proportional to the level of burnout.
This. But also don't trust doctors and always remember Richard Feynman's Wife. Science is hard.
Is this not the case for OTC drugs? Specifically, the two mentioned in the article. I rarely take either of them, but if my doctor tells me to take 1 ibuprofen every 6 hours or so, if I halve that am I actually doing more damage?
> Is this not the case for OTC drugs?
In general, taking a lower dose than recommended can cause problems, but aside from antibiotics, the problems are probably going to be from insufficiently treating the underlying condition, rather than the medication itself. Most OTC drugs give a single recommended dosage for all adults, so some people will necessarily get a lower "effective" dose than others (eg. a 200 lb man compared to a 90 lb woman).
> Specifically, the two mentioned in the article. [...] but if my doctor tells me to take 1 ibuprofen every 6 hours or so, if I halve that am I actually doing more damage?
With the caveat that I'm not a doctor, you should be fine: the only effect of acetaminophen is pain suppression, so if the pain is tolerable, then you should be fine. Ibuprofen has some anti-inflammatory effects that could be important here, but realistically, if the anti-inflammatory effects are the primary reason for the prescription, then your doctor is more likely to prescribe naproxen or celecoxib.
But if this ever comes up for you again, probably the best solution would be to tell your doctor/pharmacist "I have a high pain tolerance, would it be okay if I take less?", since in my experience, medical practitioners are generally pretty happy to hear when you want to take less drugs.
Scattered throughout this discussion are a number of comments concerning the potential damage to the stomach lining from ibuprofen, naproxen and aspirin. This is an important consideration when choosing a painkiller. According to a recent Washington Post article by Trisha Pasricha, MD, "You should avoid taking nonsteroidal anti-inflammatory drugs, or NSAIDs — such as ibuprofen, naproxen and aspirin — whenever possible. If you do need to take them, use the smallest dose for the shortest time feasible."
Dr. Pasricha adds: "I don’t get too concerned if my patients take one or two doses every now and then. But through regular use, such as several times a month or more, NSAIDs are well-known to increase intestinal permeability. In other words, NSAIDs can damage the lining of our guts. That’s because NSAIDs reduce the blood flow in the tiny vessels feeding our guts and disrupt the intestinal cells forming a barrier between the outside world and your insides. This has been proven over and over again through decades of research."
Conclusion: Acetaminophen is generally safer than ibuprofen, naproxen and aspirin.
https://www.washingtonpost.com/wellness/2024/12/09/ibuprofen...
https://archive.is/XRZEU
Anecdotal, but this is what got me to finally see a doctor about purpose-made migraine abortives. I was taking huge doses of naproxen multiple times a week, until I started to get terrible heartburn with every dose.
My father, who is otherwise in very good health for a ~60 year old, has severely reduced kidney function from taking an ibuprofen+antihistamine most days of his early life to deal with allergies.
I'll second the claim that no doctor at any point in his life had told him the risks of doing that, and many encouraged the use of ibuprofen over any other alternative (including the alternative of not using OTC painkillers every single day).
If there's one thing I'm hopeful for regarding all this AI hype, it's that some day we might actually get the Expert Systems we were promised decades ago. Then, finally, we can stop expecting human doctors to know everything. There's just so much going on inside our bodies and it's unrealistic.
I had a relative with a different story in the same theme. It sucks and I want to see this technology do something truly beneficial for a change....
The expert system relies on training data, and most of the medical data on the internet is either outdated or outright wrong. AI is not going to solve what the existence of Google hasn't solved already.
[dead]
We have this already; the side-effect reporting and post-marketing studies.
It's a very strange cultural thing too, Australians (and I presume other Commonwealth countries) default to paracetamol (acetaminophen) before ibuprofen
Paracetemol has always been seen as first thing you'd take for pain relief, and you'd "step up" ibuprofen as an escalation, but that might more to do with marketing of Panadol (paracetemol) vs Nurofen (ibuprofen).
We'd look on at the US where you were taking Advil like candy in confusion.
One great thing you learn as a parent, you can alternate acetaminophen and ibuprofen. Both of them are recommended every four hours, but you can stagger one by two hours to maintain consistency of pain-relief taking ibuprofen then paracetemol two hours later
> I presume other Commonwealth countries) default to paracetamol (acetaminophen) before ibuprofen
Can confirm this is true in India.
Paracetamol is widely used. Paracetamol + Ibuprofen is more common than Ibuprofen by itself.
> Australians (and I presume other Commonwealth countries) default to paracetamol
The same is the case in the Netherlands.
In the article it is mentioned but it is worth stressing that N-acetylcysteine is a trivially available antidote for paracetamol overdose (and you may have it at home without knowing, Fluimucil, Mucomyst, NAC or alike).
Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric. AFAIK liver failure because of paracetamol in Europe is very rare. So here there could be cultural issues at play (medical culture of what is prescribed, and the fact that Europeans in general take lower dosages of everything).
EDIT: trick, if you very rarely take paracetamol and other pain medications, the next time try to take just 250mg. It works for most people, no need to take 750 or even 1 gram of paracetamol. 500 works for almost everybody, 250 for many folks.
> Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric.
This is not my experience. After moving to Germany from the UK, I feel like people take and expect Ibuprofen far more often than Paracetamol. It seems like the first port of call for colds and general headaches, with Paracetamol being treated with some suspicion, despite it being far more effective in my experience for certain things (I've taken a lot of Ibuprofen and other NSAIDs in my time so am quite familiar with how they affect me).
Didn't expect that, my feeling was that the situation in most continental Europe was like in Italy and the UK, and even more in France! (I believe they have the record of use), in such places paracetamol is very strong.
This is some of the most useful information I've received in a while. Like the author, the low overdose threshold of acetaminophen made me avoid it, even though I always take low doses anyway and ibuprofen gives me acid reflux almost every time.
Still take it with a huge grain of salt. Even official advice usually has severe limitations due to its broadness or straight politics, so medical analysis from random blogs truely isn't the best.
Acetoaminophen also has issues for people with weaker stomachs (I can attest), and will come with additional medication to cover these effects as needed. The whole "Is it safe yes/no" table has many asterixes and might be outright false depending on the how you look at it.
As usual, it's just complicated.
Never take anything that written on the medications with a grain of salt. Disregard everything that you have read online. The medicine instructions are your single source of truth
Is the salt supposed to offset hyponatremia or something?
Same here. Great article.
I avoid both and stick with naproxen sodium. Any issues with that one? Lasts the longest too.
Both ibuprofen and naproxen sodium are NSAIDs and are bad for your kidneys especially in long term. I had kidney failure due to what was eventually diagnosed as an autoimmune disease but they first thing the ER doctor will ask is if you have been taking NSAIDs. My nephrologists told be its still safe to take acetaminophen at the proper dose.
None of us are your doctors but Naproxen has well-known gastric issues up to ulcers and stomach bleeding which is why it's advised to be taken with food and why it's also often prescribed with a PPI or H2 Antagonist. Cox-2 selectives such as Celecoxib greatly reduce this risk but seem to be associated with some small cardiovascular risk (admittedly this is a feature of all NSAIDs though less so in Naproxen apparently).
Cardiovascular risk increase is not a feature of aspirin, the original NSAID. Aspirin lessens cardiovascular risk which is why we give it to patients in the initial stages of a heart attack: It decreases the likelihood of further clotting.
Some believe naproxen sodium is worse for you because it lasts longer. Longer duration for reduced mucous membrane coverage in your stomach and intestine. Longer duration for reduced blood flow to your kidneys.
I would definitely have a chat with a doctor about it.
I had to use naproxen for some time as most effective way to control inflammation. Actually the only way, ibuprofen had some effect only in horse dozes. After visiting doctor, analyses, checking available sources was able to eliminate the reason of inflammation. Apparently it was a well known problem/solution. So far so good. Not sure about the long lasting effects of naproxen use.
Looking at the Wikipedia article, it seems naproxen is a NSAID like ibuprofen and can cause all the same gastrointestinal issues.
Naproxen sodium has much higher risk of GI damage especially with long term use.
All the over the counter NSAIDs have a similar safety profile.
wait, how are you getting naproxen?
Whenever its prescribed here, its paired with some sort of intestine protection medicine to stop it burning holes in your stomach/intenstines
Ibuprofen is much safer, so long as you eat with it.
Paracetamol is also safer, so long as you don't OD.
BUT! so long as you stay below 4 grams a day, you'll be safe. (yes yes, in some situations you can take double, but unless you are under supervision, thats asking for liver pain.)
In the US, Aleve is the name-brand pill for naproxen, available in grocery stores next to everything else. I have a bottle of 160 gelcaps. Each pill is 220mg naproxen sodium or in parentheses 200 mg of naproxen. The advertised effect is 12 hours / all day, getting anywhere near 4g would only happen in a suicidal "swallow bottle of pills" situation.
GP meant 4g is the safe limit to paracetamol (hence "liver pain"). About 8 typical doses over 24 hours. It's little known amongst the general population, who have the occasional extreme of people taking double doses every few hours
So its a bottle, not a blister pack?
wild.
I know that blister packs are a pain, but in the places that they are introduced they reduce pill based suicide by up to 40%[1]
Sorry I should have been more clear about the 4g, that was for paracetamol. I have no idea what it would be for naproxen
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC526120/
That combo is naproxen/esomeprazole. The brand name is Vimovo, but they don't have a patent, so you can get it as a generic. To work, though, it has to be taken 30 minutes before food.
IANADATINMA.
Max dose combination (IBU/APAP FDC) can be useful as a substitute in emergency therapeutic situations compared to opiates. Not recommended ordinarily because of liver, kidney, and stomach impairment.[0]
Taking ibuprofen with questionable stomach condition may want to consider taking a famotidine adjuvant or duexis [1] or acetaminophen instead.
Overdose treatment of acetaminophen poisoning is the stinky N-acetylcysteine (NAC), so that maybe worth stocking whenever Tylenol is kept in a house with kids. Overdose of ibuprofen is palliative, requiring IV fluids and dialysis.
0. https://www.researchgate.net/publication/382639515_Ibuprofen...
1. https://pubmed.ncbi.nlm.nih.gov/25516006/
For those who struggled similarly to me:
I Am Not A Doctor And This Is Not Medical Advice.
(I think?).
Should definitely hold up in whatever court they’re trying to avoid being in, lol
Both of these pills are really dangerous for dogs.
Ibuprofen damages the kidneys -- and that damage is often permanent. The little filtering devices inside the kidneys don't grow back once they're destroyed. A dog who survives the poisoning can end up with lifelong kidney disease, which means special diets, more frequent vet visits, and a shorter life than she should have had.
(I watched this happen to my own dog after a house sitter stepped on her paw and gave her ibuprofen to "help." My dog lived, but she needed a special diet for the rest of her life.)
Acetaminophen wrecks the liver, and it also can damage red blood cells so they can't carry oxygen properly. A poisoned dog may get lethargic, vomit, start to breathe heavily... This is especially dangerous for older dogs, or any dog whose red blood cells are already compromised, by conditions like IMHA.
Most human medicines would be dangerous to dogs, what is your point?
Mine was awareness.
Yours is just rudeness. (=
I've known people who've overdosed on Tylenol and died. I'm not saying that ibuprofen won't give you acid reflux and won't damage your kidneys, but due to <reason> I tend to take a lot of ibuprofen and also for <reason> take another medication that constricts my arteries and for <reason> get a lot of blood/urine work done... and my kidney function is good and despite everything I'm generally healthy. So I would say, like many things, what medicines you take probably depend on your specific body and situation. Regardless, you won't die accidentally from an acute ibuprofen overdose. You just might die from taking tylenol if you don't realize your liver is already damaged for other reasons. So there you go!
> You just might die from taking tylenol if you don't realize your liver is already damaged for other reasons.
If you don’t realize your kidneys are already damaged you might die from kidney failure because of ibuprofen.
My mom fell (88 yo) X-rayed, nothing broken but ignored her history of ulcerative colitis (tough to do, given the colostomy bag she’s worn for 50 years). Sent her home with Motrin. Ended up in the hospital for two weeks with bleeding ulcers.
How the hell did the attending physician not see a colostomy bag during the exam?!
Unless you’re in Rhabdo. If you’re in so much muscle pain and your kidneys are working overtime to clear broken down tissue and you then hit them with too much ibuprofen, then you can go into kidney failure and die accidentally.
At least with the folks i hang around, liver damage from years of over-drinking is probably more likely
Just don't take it on an empty stomach.
That's ibuprofen. Which can be partially mitigated by famotidine.
IBU: -stomach -kidneys -bp+ -clotting --NERD --NECD --NEUD --SNIUAA --SNIDR --DRESS
APAP: -liver --DRESS
-- extreme, rare side-effects
You expect us to know those acronyms?
I thought they were cheat codes.
--DRESS means your clothes with fall off.
No, troll, it's actually your skin falls off dead and your organs are injured. It's similar to SJS/TEN.
Only twice have I ever used Acetaminophen close to the max daily limit, and those were both when I was experiencing a raging tooth infection. I'd pop 2x500 mg paracetamol 4 times a day, which helped just enough to get through the day. The tooth infections were so severe that the dentist had to put anesthesia directly into the root / nerve, multiple times - felt like a lightning strike each time. One of these times I'd put the pain level at a 9 out of 10. I'm just going to assume that 10 out of 10 pain is when you basically consider ending it all, purely in the heat of the moment.
Having gout, I've also had some pretty severe bouts where the pain level has been in the 8/10 range. Unfortunately nether paracet or ibuprofen worked.
In any case, when I see regular people eating these painkillers as candy, I'm starting to wonder what pain levels they are experiencing. I'm generally very cautious of using this stuff.
Pain is weird. It's extremely subjective, not only between people but also within your own body. Paraphrasing something Paul Rozin mentioned in a paper on so-called benign masochism: people can learn to enjoy eating the most extremely spicy food, but even those people will still scream out in pain you rub the ghost pepper they're eating in their eyes. Pain sensation is therefore localized and contextual.
So we should not be too quick to dismiss the pain of others.
As far as 10/10 pain goes, I've heard cluster headaches can get so bad it has driven people to suicide during an episode.
Acetaminophen (paracetamol) is the drug of first choice for addressing pain and fever, in India at least. To the extent that it's regularly abused, and I know people who have been hospitalized because of abuse.
Even then, doctors are usually disapproving of ibuprofen (or some combination of it with paracetamol) unless paracetamol is contraindicated for some reason, and I had always wondered why.
I did listen to this 99% Invisible story about the use of NSAIDs in India once[1]
What you describe in an interesting contrast to the situation in The Netherlands. Here, virtually no one is prescribing ibuprofen _without_ also prescribing a baseline of paracetamol.
[1]: https://99percentinvisible.org/episode/579-towers-of-silence...
Acetaminophen has a quirky effect if you’re on a CGM. It makes your interstitial glucose read higher than your blood glucose.
Context: I’m t1 diabetic.
I was recovering from an injury, and I switched from ibuprofen to acetaminophen. But the whole time I was on it, my sensor glucose was reading 50-60 mg/dl higher than my blood glucose. This is really bad on a closed loop system as my pump kept trying to lower my blood sugar, but it was pushing me into hypoglycemia (50 mg/dl).
Turns out this is a common effect, but a relatively new discovery that no one told me about.
I went from introvert only-child to married with kids. As they hit daycare, I was perpetually riddled with disease for about 15 months. I still had to take care of the kids though, so I was liberally taking Ibuprofen. At some point, I started to get horrible heartburn. I tried all kinds of dietary restrictions until I realized it was probably the Ibuprofen. Now, if I take even one pill, the heartburn comes back. I switched to Acetaminophen and found it was much more effective at reducing fever with no apparent side effects.
Yeah our son became eligible for creche just when covid came. All at home but we couldn't take full time care for him forever so eventually he started going in (they can start at 6 months here in Switzerland if you are lucky and get the spot, we did it gradually since 9 months). Then daughter came and same cycle.
Needless to say we had covid at least 12 times at this point, all with positive tests so no mistake there. Plus few other questionable cases without tests. Some were brutal, like first and second one, that was before vaccines, and then a recent one when we seem to have lost most of immunity. Back then I lost taste for few weeks completely and smell didn't fully come back till 6 months after (sniffing bottle of vodka did smell like forest air, even later my perfume smelled rotten). Weird times, eating nice looking gunk and trying to imagine how it tasted before.
I don't think I had flu that many times over my whole life, hate that shit with fiery passion and having small kids in creche/school is just a 24/7 virus importing service. None of our peers had it as bad as we did, no idea why the 'luck'.
One weird analgesic/antipyretic is metamizole/dipyrone[1]. It's banned in the US and some of Western Europe (and prescription-only in other countries). Yet it's by far the most used medication here in Brazil and I have actually never heard of adverse effects, except some allergies
[1] https://en.wikipedia.org/wiki/Metamizole
I created this open-source application (https://alexcpn-faers-signal-detection.hf.space/) to analyse the FDA FAERS data set a few weeks back, just to do some good work and use Claude Code completely. I got roasted on Reddit for attempting this. But this is meant for specialists to use, as most platforms that analyse this data charge a lot from what I read.
FDA FAERS is the official dataset for reporting Adverse events from taking a drug. FDA adverse event reports about 2 million cases and 4,067 unique drugs
I agree the results are not easy for non medical professionals to interpret correctly. For example DEATH is very strong with Parecetemol and so is DEPENDECE. The latter because from AI it is a confounding factor. Acetaminophen/parecetemol is frequently co-formulated with opioids (like Hydrocodone or Codeine). The "Dependence" signal is likely attributed to the opioid, not the Acetaminophen itself...
Adverse Event Acetaminophen PRR (95% CI) Acetaminophen n ibuprofen PRR (95% CI) ibuprofen n ACUTE KIDNEY INJURY 0.87 (0.80-0.96) 498 4.27 (3.91-4.67) * 483 ANAPHYLACTIC REACTION 0.61 (0.51-0.72) 122 9.85 (8.90-10.90) * 382 ANGIOEDEMA 1.31 (1.13-1.53) 170 15.26 (13.77-16.92) * 378 DEATH 1.44 (1.40-1.49) 3958 0.07 (0.06-0.10) 42 DEPENDENCE 237.12 (231.51-242.88) * 39679 0.02 (0.01-0.05) 4 DEPRESSION 2.18 (2.05-2.31) * 1157 0.39 (0.29-0.52) 43 DRUG EFFECTIVE FOR UNAPPROVED INDICATION 16.77 (16.11-17.46) * 3180 44.17 (42.18-46.25) * 1921 DRUG HYPERSENSITIVITY 0.57 (0.51-0.64) 327 3.30 (2.98-3.65) * 372
I had intestinal bleeding after double ibuprofen dosage over several weeks for back pain. Definitely watch out for any prolonged and heavy use of NSAIDs.
If you take either of these medications regularly talk to your doctor.
I’ve alternated these for fever, especially for kids, especially when it’s high and hard to control. That way you keep below the daily limit of each and don’t overdose on either.
Have gotten into a habit of keeping a note of which med when on the fridge.
Cool, throughout this entire read I was thinking "I'm gonna save this, it reads a lot like dynomight". And then at the end it turns out it was dynomight all along. I guess I should read headers more carefully.
Unfortunately, both of these medicines have substantially adverse effects on me. Ibuprofen destroys my stomach, often affecting me for days after a single dose. Acetaminophen leaves my stomach fine, but has subtle, but noticeably negative affects on my cognition and general energy levels. Both are often ineffective for bouts of significant pain, which is frequent for me.
To mitigate this, I supplement with NAC (N-Acetyl-L-Cysteine) anytime I'm forced to take acetaminophen. I will also sometimes take Betaine Anhydrous.
I do the same for ibuprofen, but sans betaine and instead take aloe, probiotics (bacillus subtilis/coagulans, Mastic Gum and experiment with other things.
For acute pain, neither does anything. And though I'll get attacked for this here, I find a stout dose of quality, lab tested Kratom (red strain) to be far more effective than both acetaminophen and ibuprofen combined. However, for regular pain, this is not a good plan, as the withdrawals can exceed the nature of the problem itself.
I sure do wish we'd get over the anti opiate [1] craze someday, or at least discover and make available an effective alternative.
1. Aside from constipation and obvious risks of dependency (or abuse), opiates have none of the deleterious effects of ibuprofen or acetaminophen, and the constipation is easily mitigated, and a bit of agmatine sulfate for saying adios when the pain subsides.
I always use acetaminophen as ibuprofen doesn't seem to do anything for me...
I have personally never found a use for ibuprofen that ever made any noticeable impact for me. I have tried it for headaches, fever, muscle pain, nerve pain, etc. It never made a noticeable improvement for any of these while acetaminophen works amazingly for all these. Acetaminophen even works better for me for pain than an opioid like Tramadol...
I don't understand it, but it is what it is.
Ibuprofen works for me about the same as acetaminophen but it tears my stomach up. If I use it for more than a two or three days at labeled usage rates, I’ll feel like I have an ulcer.
The article mentions this but it’s my answer to “how are laymen supposed to know?” In my case it’s painfully obvious to use ibuprofen with caution
My US doctors almost never recommended Ibuprofen over Acetaminophen for mild pain. In fact, I don't remember them ever recommending Ibuprofen for anything while I hear about Tylenol pretty often.
I've had doctors prescribing short runs of opioids (2 weeks for surgery recovery) but they always said "try Tylenol first and if the pain is too much you can fill the prescription". I liked having the option but never really used it up to this point.
Interesting! In the UK the common wisdom is paracetamol is the safest. Ibuprofen is available but not the first choice. Aspirin is considered bad.
I wish people would stop saying "drinking" to mean alcohol consumption. I genuinely thought it meant after drinking any fluid until I read the description and realised it meant alcohol. I also don't like how alcohol is singled out as a "special" drug. What about other drugs? Is alcohol special in this regard?
At least in the US, its hard to find single-purpose over the counter medicines. Most "cold" remedies now also include acetaminophen. So that makes it easier to OD on acetaminophen if you take some by itself and then don't realize that your cough syrup also includes it. I think this (bundling acetaminophen) should be banned for safety reasons.
I thought this was partly intentional to discourage DXM tripping. Same reason the only opioid they seem to give anyone now is the shitty hydrocodone/acetaminophen mix.
> You should not switch medications based on the uninformed ramblings of [crazy] people.
For migraines, I take two CVS Migraine about every week to ten days. It's a cocktail of acetaminophen, aspirin and caffeine which tallies to 500 mg of acetaminophen, well under then 4g limit. It's good for four hours but you can only take two per day.
I didn't know about this acetaminophen risk. So I'll be looking for alternatives. Ibuprofen is for inflammation and not headaches. Naproxen is a candidate.
> Ibuprofen is for inflammation and not headaches
Ibuprofen is very well supported as a treatment for migraines. Not necessarily headaches generally, but definitely migraines.
But there are multiple classes of abort drugs now that a doctor might be able to prescribe you, like triptans and CGRP inhibitors, that work much better than either NSAIDs or acetaminophen.
High dose aspirin (1000mg) + caffeine worked much better for me for migraines than paracetamol/ibuprofen/naproxen which did nothing. There're some studies supporting this too...
Why don't we package Acetaminophen with NAC? The reason I can think of is it will be delivered earlier than it normally is in cases of overdose. That would mean there will be less NAC in your system than at the peak dosage when the body starts using the pathway that needs it. But every little bit must help, no?
Interesting, I've always preferenced ibuprofen because I was concerned with long-term liver effects from acetaminophen as a casual drinker and someone who is a bit overweight (both things negatively impact the liver). I think one thing that's hard to understand as someone with no medical background is the long-term impacts of medications, it sounds like once it's processed there's no long-term negative impact for acetaminophen, where-as alcohol does have long-term negative impacts on the liver even after processing. Also, there's not enough information placed on the label or known how important not being dehydrated is to having good outcomes with ibuprofen. Obviously dehydration is bad, but it's also very commonplace.
"since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen." [1]
But yet in some countries pediatricians will libreally prescribe it to toddlers
[1] https://www.bmj.com/content/368/bmj.m1086
Also from [2] "In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution."
https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.1451...
One of the problems is that if you give it to kids with chicken pox it can cause complications. There was also some hints early in the pandemic that ibuprofen had a similar effect on covid-19. However as you link to, the data doesn't really support that view anymore.
After severe cramps once when I had to use a lot of ibuprofen (dental surgery / wisdom tooth) I now only use ibuprofen with a stomach protector to avoid stomach cramps, H. Pylori, and reflux.
Acetaminophen is part of ECA stack weight loss formula, while article says not OK with fasting. Either way, more safe solutions are known these days.
I keep reading about this lately but what doesn't make sense then is how few deaths/injuries there are relative to how much acetaminophen is consumed. If tens of millions take it every day, that's billions of doses a year of acetaminophen. Why don't we see MORE injuries/deaths?
"Acetaminophen toxicity is the second most common reason for liver transplantation worldwide and the most common cause of acute liver failure in the United States. Responsible for 56,000 emergency department visits and 2600 hospitalizations, acetaminophen poisoning causes 500 deaths annually in the United States."
56,000 emergency room visits is the key here, because "the mortality associated with acetaminophen overdose is low if recognized and treated within the first 8 hours after an acute ingestion."
So I guess it depends on if you think 56,000 is low or not.
Source: "Acetaminophen Toxicity", David H. Schaffer; Brian P. Murray; Babak Khazaeni. 2026/02/19. https://www.ncbi.nlm.nih.gov/books/NBK441917/
About 50% of overdoses are intentional (especially suicidal teenagers), with the other 50% accidental.
So when pondering the issue of numbers, it matters what path people took to overdose.
For all accidental acute poisonings leading to hospitalizations from OTC drugs amongst adults and adolescents, the top culprits are:
1. Acetaminophen: Dangers noted in article, and stats given in my parent comment
2. NSAIDs: "NSAIDs are ingested commonly in overdose, however severe toxicity is rare"
3. Salicylates "Severe salicylate poisoning follows ingestion of greater than 500 mg/kg". For an adult weighing 150lbs that is 68kg, which means severe poisoning requires 34g of aspirin, which at 325mg per pill is 104 pills total. Hardly easy to do this accidentally.
[1] "Acute poisoning: understanding 90% of cases in a nutshell", S L Greene, P I Dargan, A L Jones, Postgrad Med J 2005;81:204–216
Considering its ubiquitous and regular consumption in general population, doesn't alcohol shift the balance in favour of ibuprofen?
Also, possible blood clotting or stomach issues sound scary, but Aspirin has similar (opposite) issues. Pharmacists regularly push its combinations with Acetominophen (which has, of course, synergetic bonuses, but is not the reason) under multitude of brands with a hefty premium when people ask for either one. So in many situations you need to consider the added risks from Aspirin too.
Ideally, I'd like to have an optimized strategies of using all three of the aforementioned substances for common situations. Like, is rotating ibuprofen/acetominophen during the day safer than consuming just one?
This article was eye opening.
I'll admit I find ibuprofen to be a bit of a wonder drug. When I have a cold or flu, ibuprofen by itself is the most impactful medicine I take. The anti-inflammatory effects make my whole body better, including my sinuses (my sinuses are a disaster normally anyway, though). I do avoid taking it otherwise because my headache doctor says it causes rebound headaches, though.
But if I need to go out somewhere and am not feeling well? 2 advil and I'm good to go. The only medicine I've found more effective for that is (real) sudafed, but if I take that after like 10am I won't sleep that night.
Why are COX-2 drugs like Celebrex still prescription only ? Seems like it would theoretically be a lot safer to offer a medium low dose of it over the counter vs other NSAIDs
That being said I weirdly find Naproxen the most effective of all of these. Everyone is different though
"Why are COX-2 drugs like Celebrex still prescription only ?"
Why? Because Celebrex (celecoxib) is a dangerous drug which can cause irreparable harm (heart attacks and related) if taken for long periods. In fact, its sister drug Vioxx (rofecoxib) was banned and Merck had to pay billions in damages. There's more here: https://news.ycombinator.com/item?id=47835635#47862704
Whilst Celebrex is safer than Vioxx it still has the same side effects profile as the latter.
I'd also recommended you watch the YouTube video in the link on Vioxx, it demonstrates the dangers of COX-2 drugs shouldn't be underestimated.
Wouldn't the other non selective NSAIDs also have this risk ? Or is Celebrex unique ?
This American Life had a good 2013 episode on the tricky dosing of acetaminophen [1]. It's also worth saying that capsaicin is used for pain relief[2]! Especially for things like muscle and joint pain.
[1] https://www.thisamericanlife.org/505/use-only-as-directed
[2] https://my.clevelandclinic.org/health/drugs/18080-capsaicin-...
It is a damn shame bordering conspiracy that metamizole (https://en.wikipedia.org/wiki/Metamizole, known as Analgin in eastern Europe and the Balkans, apparently also India) is not more widely available in the west. It's literally a wonder drug, the only non-narcotic (hence non-addictive) that actually relieves serious pain (including post-op) pain in my experience.
Since I've had a fair share of it in my life so far (more than 1kg of it so far, in total), and I investigated the disparaging studies and they are definitely not convincing at all; more recent ones somewhat absolve it (check the Wikipedia page).
I've never had any side effects from it, and I don't know anyone who did, unlike for any other painkiller (diclofenac, ketoprofen, ibuprofen, acetaminophen / paracetamol).
It is a medicine where I'm almost 100% sure the studies against it are intentional sabotage by pharma companies, and the vigor and persistence this is done with is really telling (lots of doctors and pharmacists in my extended family, including in regulatory bodies). The campaign against it never ends.
Metamizole is an amazing drug, I'm always grateful that I work and live in an area where it is available.
But it is not a miracle drug. Metamizole-induced agranulocytosis absolutely exists, and the insidious thing is that you don't know in advance if you will get it or not. You're trading common but avoidable side effects (ibuprofen, APAP/paracetamol) for rare but unavoidable ones (metamizole).
I've seen patients with severe side effects of all three classes of non-opioid painkillers (severe GI bleeds from ibuprofen-induced ulcers; acute liver failure from APAP overdose; metamizole-induced neutropenic fever). None of them seemed very pleasant. But if I had to choose, I'd still use APAP first line because it's the only one where you can avoid the severe side effect with certainty, by simply staying under the recommended maximum intake.
The article is not signed, we don't even know if the person writing it has any sort of medical background, take it with a grain of salt, the about page lists people and none of them has a medical background
Anectdotally, I had a headache, and the woman I was seeing in the UK said get the paracetamol unless it was killer, then get the Nurofen (ibuprofen) if I needed the heavy-duty medicine.
The following article showing a link between Acetaminophen/Paracetamol usage and decline in positive empathy is highly relevant here;
The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-...
Excerpt:
Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.
Mischkowski wondered whether painkillers might be making it harder to experience empathy
And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy.
For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.
Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes).
The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.
Also see the previous thread; A social analgesic? Acetaminophen (paracetamol) reduces positive empathy - https://news.ycombinator.com/item?id=31263305
> Mischkowski suspects that this would also be more difficult to summon after taking the drug.
Why should I trust someone who doesn’t test properly but just suspects?
What? Read the article fully; it has to do with "negative empathy" different from "positive empathy".
Dominik Mischkowski is a Pain Researcher at Ohio University who has been studying this for a while. The word "suspects" here is statistical research-speak meaning there is a correlation (w.r.t. positive empathy) but more studies are warranted (w.r.t. negative empathy). That is all.
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For the rest of the world:
Acetaminophen = Paracetamol
Reminds me when I was on a business trip in California and bought some Acetaminophen thinking "I'm in the USA - this has to be the hard stuff, right?", only to discover it was just paracetamol.
The article doesn't touch on it, but from what I've read NSAIDs like ibuprofen also slow healing. I have also read, but am unsure how reliable this is, that they can harm the remodeling process during healing and lead to chronic pain.
That said, I've found great relief at times taking a moderately large dose of ibuprofen for several days to break what seems to be a cycle of persistent inflammation. YMMV I guess.
To the author, my guy, you are clearly not an endocrinologist stop pretending you are, and trust the people that study these things for a living.
Not only you can't take more than 4 grams of paracetamol per day, you must not take it for more than 3 days straight, it says so on the leaflet.
Biochemistry and medicine are hard and complex, all the quacks out there that preach snake oil treatments went down the path of thinking their domain specific knowledge in random domains somehow transfers to medicine it does not.
Is this comment in the wrong place? The article is literally about how the medical establishment gives good advice on acetaminophen and ibuprofen, but it's not getting through to people.
He gets there after exposing a bunch of "research" he did himself and after admitting he was using ibuprofen for a long time because he "thought" it was safer.
In my personal experience, paracetamol hardly does anything when it comes to alleviating fever symptoms. Like I'm not sure whether I'd be able to distinguish it from placebo. I always default to ibuprofen and the difference it makes is like night and day. I only take it like a handful of times a year and usually no more than 1000mg a day so I'm hoping I'll be fine.
Acetaminophen and Ibuprofen are taken for different things and can be taken together as well, it's not a versus...
Ibuprofen is mostly for inflammation and Acetaminophen for fever and pain. Now there's overlap in that both work on headaches and some other kinds of pain but the main use case for each is different.
about once a month since my childhood i get an awful, slowly ramping headache that makes it unable for me to think or function.
it seems to happen more when i'm overweight, making me think it's blood pressure (BP) related, but then doing the valsalva maneuvre, which spikes BP, doesn't cause any problems at all.
i've tried acetaminophen, even 1.2g of it, to no avail. it doesn't help.
i've also tried every other remedy, such as curcumin, fire/ice locally, hot and cold showers, neck massages, working out muscles that may be involved in it, everything. nothing helps.
except for ibuprofen. 400-600mg kills it every time.
at least for me, there seems to be a definite difference, as ibuprofen can anecdotally help in some situations that acetaminophen can't. i wonder what exactly it can / can't treat and why.
To me it's obvious that acetaminophen and ibuprofen do not target the same kind of problems. I am not a woman, but my wife says acetaminophen does not work on menstrual pain for instance.
I take acetaminophen for fever, and those kind of full-body diffuse ill-feeling.
I take ibuprofen for localized intense pain.
I take aspirin for headaches and sore muscles.
I once read that if acetaminophen were introduced today it 100% would require a prescription because of how dangerous an overdose is.
Unrelated, but it feels like an oversight that this article said nothing about how both acetaminophen and ibuprofen reduce fevers. They aren't used solely for reducing pain.
I kind of doubt that, to be honest, given how much more effective and less directly damaging it is during normal use compared to NSAIDs.
I find it interesting that people take these as fever reduction mechanisms. Fevers are a defence mechanism, not just an inconvenience. Maybe it makes more sense in places without decent workers' rights (like having a limited amount of sick days you need to manage), but it feels weird for me to actively harm your body's defence mechanisms unless you're in "you should see a doctor" territory already.
Well, I mean, drats. I too always assumed Ibuprofen was safer than Acetaminophen; not the least because of massively oversimplificatic "reduced inflammation - GOOD!" 'Logic'. I'm 47 now and have probably preferred ibuprofen for last 27 or so.
You can combine the two for better effect.
1g of Paracetamol with 400mg of Ibuprofen gives similar pain relief as 2mg of IV morphine.[1]
[1] https://pubmed.ncbi.nlm.nih.gov/29017585/
Plus caffeine, for those who don't drink coffee. Quite standard combo for people suffering from migraine. I stick to 500mg+200mg and I find it suspicious adverts for painkillers somehow always show 2 pills while dosage recommend in leaflet is just one.
Could they safer and/or higher dose acetaminophen pills if they included NAC?
https://www.eurekalert.org/news-releases/1086746
This is semi recent research on how it might be blocking pain
I feel like this article leaves out the latest research pointing to acetaminophen having a negative effect on fertility, hindering embrionic development and potentially also also follicular development in baby girls. It's a trade-off for sure, but if you're trying to have a baby, you may want to swing back to ibuprofen.
[1] https://pubmed.ncbi.nlm.nih.gov/40819833/
[2] https://ddeacademy.dk/ddea/what-new-research-reveals-about-p...
This is a repost from an article that was posted last week: https://news.ycombinator.com/item?id=47799088
If acetaminophen was invented today it would almost certainly be available by prescription only because of the safety concerns. There are far more benign medications that are Rx only.
Sort of mentioned in one of the side notes:
Acetaminophen is the only medication of its kind approved for infants under six months because the liver develops faster than the kidneys.
For those wondering why it's acetaminophen and paracetamol, the name difference is because they both took different random letters from an even longer name.
Honestly this article is mixing a lot of different factors
> Acetaminophen has a scarily narrow therapeutic window. The instructions on the package say it's okay to take up to four grams per day. If you take eight grams, your liver could fail and you could die.
Gee I don't know, I think this is a wide enough window to not miss it. That difference is 8 500mg pills
> that for most people in most circumstances, acetaminophen is safer than ibuprofen, provided you use it as directed. I think most doctors agree with this.
Could be but I think a lot of doctors underestimate the dangers of paracetamol as well
All of the factors the author mentions about IBP are true. But it's all about the details. Safer? Safer in which condition?
"Dehydrated" ok take a glass of water. Active bleeding? Most NSAIDs interfere with that, and no you won't become a hemophiliac by taking one Ibuprofen
Also, some countries do add a notice for kidney problems for Paracetamol as well (e.g.) https://www.medicines.org.uk/emc/product/5164/pil
An as a conclusion, I find it "funny" that nobody considers how healty/safe it is to take paracetamol and have mild analgesia (translation - you're still in pain) and taking ibp and having better analgesia
OMG! I have been taking Dayquill/Nyquill in syrup form when having cold/cough and often without formally measuring! Will be careful from now on.
After reading this, I wonder whether maybe low doses of morphine over a short period are safer than either.
No, even if morphine were metabolically safer (I don't know), its addictive potential would outweigh the potential safety benefit.
On the other hand, if in the early 2000s you were to share those concerns with certain doctors, they would propose a more effective and non addictive alternative to morphine instead. Only the first part of what they would tell you was true.
Don’t anyone mentioning this, but alternating acetaminophen and ibuprofen every 6 hours as needed works well
This was a masterclass in science writing for laypeople. Going to find more from this author.
This is why asking for medications based on the last thing you saw on social media is a really bad idea.
What about cox-2 like celoxib? Chronic pain for 15 years checking in.
If you don't make a habit of taking either, what actually performs better?
Depends what you’re taking it for. Generally people take NSAIDs for muscle and dental pain, or anything that’s obviously inflammation, and paracetamol for anything else, particularly headaches, and is a common adjunct treatment if you have a cold or flu.
> If you don't make a habit of taking either, what actually performs better?
Tylenol/acetaminophen is good for fever which NSAIDs won't help. Otherwise, take both and alternate their dosing times for better pain coverage.
"Good for fever"? Only ignorant consumers would attempt to counteract the body's very own defenses against infection and disease.
A fever is not dangerous within normal parameters, except for being dangerous to the virus and bacteria that threaten the body. Your body runs a fever because it engages in a battle to the death with these microbes.
If you defeat the body's own defenses by lowering the fever, for example if you are a nervous mother who hates her baby's fussing, or if you're hospitalized and the nurses are laser-focused on "number go down" treatments, then you can expect to be ravaged by the contagion for much longer than expected.
The priorities have drifted. In the middle of night I don't care about getting healthy, I need to get rid of fever, so I can fall asleep and able to got to work/school in the morning. And somehow there is never right time to be sick and everyone just want to supress syndromes here and now.
> "Good for fever"? Only ignorant consumers would attempt to counteract the body's very own defenses against infection and disease.
Yes, ignorant consumers and physicians across the world.
You can't just 'vibe medicine' or 'vibe biology' - please don't comment if you don't know what you're talking about.
Someone with a basic understanding of evolution and biology understands that evolution will take any free lunch it can get.
The vast majority of the time medicine can only ever help with (acute) symptoms and rarely the underlying cause unless it is something like vaccines or antibiotics.
Medicine has side effects because if there was a free lunch to be obtained from medicine, the human body would have synthesized the medicine directly. Hence medicine is always about making tradeoffs.
When it comes to general health, there is always a causal chain of cause -> primary symptom -> secondary symptom -> tertiary symptom -> ... and a lot of medicine tends to work on the secondary or tertiary symptom.
Pain evolved to be an accurate indicator of damage to encourage you to stop ruining your body and not a punishment.
I am forever astounded by the self-satisfaction of programmers as they talk about domains unfamiliar to them.
Just imagine someone trying to lecture a network engineer about how really async bugs should really never be different than bugs you see single-threaded if you use a semaphore. I mean, that's why we have semaphores!
Anyway, the temperatures attained during fevers are at best bacteriostatic (read not helpful in actually treating an infection that would lead you to seek medical care). If you've got evidence-based arguments, happy to counter them. Just please don't evoke 'evolution' to explain your bias-du-jour.
Evolution didn't create the personal computer or build a skyscraper. We're firmly in uncharted territory wrt things our bodies were evolved to deal with. As a great example, human temperature has been going down over time—evolution tells us that must mean we're all more susceptible to getting sick!!! https://med.stanford.edu/news/all-news/2020/01/human-body-te...
This is a good argument, but it has a flaw here, which is that a systemic fever during illness may still be an evolutionarily beneficial adaption on average if there are a some situations where it can be the difference between life and death, e.g. bacterial pneumonia or sepsis, but that doesn't mean it's equally useful for all types of illness.
I did a fevered research dive last time I had the flu and came to the conclusion that there wasn't really any good evidence that fever is helpful for flu, and I should have few compunctions about suppressing it. (And that most of the situations where fever is really valuable for are ones where in the modern world you should go to a hospital and in the case of a bacterial infection be given antibiotics)
For non-habitual pain relief, combinations outperform either in isolation. Studies show a significant effect, and anecdotally for me it's often the difference between dampening and outright curing a headache. Combo pills are widely available in most countries (branded as Advil Dual Action and Motrin Dual Action in the US), but they're pretty new so consumer awareness isn't yet super high.
If you have serious pain, you probably need both of them.
Don't forget ye olde aspirin. It has a cheat mechanic: https://en.wikipedia.org/wiki/Salicylate_poisoning
You take too much and it can give you a fever, which might entice you to take more aspirin. Nasty.
Obligatory Reye's mention:
https://www.uspharmacist.com/article/reyes-syndrome-a-rare-b...
and my own editorializing -- this is not just a problem for little kids. As various articles explain, if you've had flu-like symptoms (from whatever cause) you should be wary of aspirin. Will one standard dosage kill you? Unlikely. But if you've got better options, particularly pre-loading NAC before Tylenol, why not consider them first?
Further reading:
https://www.nhs.uk/medicines/low-dose-aspirin/who-can-and-ca...
And for those of you with kids: https://www.nhs.uk/conditions/kawasaki-disease/
Of course it's not all bad. There's even some discussion of anti-cancer potential. How might this work? One hypothesis: https://www.nature.com/articles/srep45184
This topic is a bit personal for me and I'm glad it's getting some attention here. Bravo, hackers.
Without resorting to research or statistical inference engines, based only on the average knowledge explained by my colleague OP, I will say that paracetamol is also toxic in continuous doses (people with chronic pain who resort to the medication for daily use) and has drug interactions with other agents (such as alcohol). Aspirin and Ibropufen are great but really do have a risk of ulcers. As for the thrombo-prophylactic issue, it is very poorly explained and I completely disagree. My readings to date have shown that both have a very slight rebound effect on the formation of thrombi and the main problem is the release of thrombi that have already formed, prior to the use of the medication.
What about low dose aspirin?
there is an antidote for paracetamol: ACC (Acetylcysteine)
> Acetylcysteine
That's NAC (N-acetylcysteine, C5H9NO3S), mentioned in the article many times.
my bad
why they don't make pills with ibuprofen + nac?
Frankly, very few people should be taking either of these drugs. Sometimes I forget how often people pop these things, it's really crazy. Consider just having a headache and dealing with it.
Nice, now do Acetminophen vs Dexibuprofen.
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This is pretty misguided.A casual mistake like forgetting your cough syrup has acetaminophen can easily cause an overdose and then you fucking die. That’s not the risk profile you want for “most people in most circumstances”.
500mg from a capsule and 500 from cough syrup 4 times a day is still fine. With a 100% safety margin still.
If you’re taking more meds than that without clinical supervision Id say something is wrong in the system or your medicine practices.
Where I’m from it’s common to walk to the nearest pharmacy and get meds when needed. Even over the counter stuff like paracetamols. And talking to the pharmacist. They’ll ask what you’re already taking and tell you what else to get.
Yeah this is optimizing for the good case instead of tail risks and mistakes and we see too many overdoses already.
Of course, we could press the fix this immediately button by requiring acetaminophen to be sold mixed with NAC but that would be too easy.
8g is not an insignificant amount. That's 16 500mg pills. You really need to mess up to take 16 pills and not realise you're doing something wrong. If a patient is not lucid than we have bigger issues.
And from what I see in pharmacies, you would rarely see a "cough syrup" called just like that if it contains paracetamol. It would usually be marketed as a flu-relief all-around symptom relief.
You don't want either of these; what you want is naproxen.
It works similarly, but stays a lot longer (half life is cited as being anywhere from 12 to 17 hours).
Acetaminophen and ibuprofen are just for temporary problems, like a headache that would go away on its own in a couple of hours.
They are uneconomic and inconvenient if you have something more persistent to keep at bay. Four ibuprofens or one naproxen? No brainer.
The main disadvantage of naproxen is that it's not approved for kids. So there is no naproxen syrup for infants or anything of the sort. Thus, you still need acetaminophen for that.
As pointed out in the article, naproxen is an NSAID like Ibuprofen, though slightly more COX1 selective. It likely has a somewhat lower risk of serious renal and cardiovascular events, but higher risk of GI bleeds. There are some studies that show little to no increase cardiovascular risk, but most do show some or even comparable to ibuprofen.
Convenience vs ibuprofen is a thing given the longer half life, but it still generally comes with similar risks. If you are taking anything for more than just an occasional headache, definitely discuss with a doctor, COX2 selectives like celecoxib may be a better risk profile and even more convenient.
(COX1 and COX2 selectivity loosely separate which systems get the brunt of the side effects)
I weirdly always found Naproxen much more effective than ibuprofen but also find Celebrex great which seems to further confuse the whole COX 1 vs 2 situation
Recently, I've had to take Celebrex (celecoxib) for a back injury and I've been taking it longer than is normally recommended—and that truly worries me (I've determined I have to come off it ASAP).
Where I am (Australia), most doctor's prescriptions that have to be taken long-term are issued as the first script plus five repeats. Not so with Celebrex, a script can only be dispensed three times (3 x pk of 30 200mg capsules — one per day, for 90 days max) and scripts can only be dispensed every 21 days. Reason: Celebrex is only recommended for short-term use because it's considered a dangerous drug with possible irreversible side effects if taken for too long.
This was not news to me even before taking Celebrex, way back in the 1990s I was prescribed its sister drug called Vioxx (rofecoxib) for back pain and it was much more effective than Celebrex (at least it was for me).
Anyway, sometime around 2000 I read an article in the journal Science about a significant statistical increase in deaths by heart attack, stroke etc. by those talking rofecoxib. At the time I said to myself it won't be long before Vioxx is banned. It took another three to four years for that to happen as Merck Pharmaceuticals fought the decision every inch of the way. It's worth reading the Wiki about this (when it's between a drug company and millions of dollars profit patients come off second best):
https://en.wikipedia.org/wiki/Rofecoxib
What's relevant here is that the related drug Celebrex survived because its side effects—whilst manifestly similar—aren't quite as bad as Vioxx. In short, Celebrex's COX-2 selectivity versus other less selective NSAIDs like aspirin (which target both COX-1 and COX-2) was deemed sufficiently beneficial despite its potential serious side effects.
Note: I'm not offering medical advice here and you should always take that from your medical practitioner. I mention this because only several days ago I had a discussion with two younger doctors who'd never heard of Vioxx let alone the Vioxx/Celebrex controversy.
You may be interested in this YouTube video on Vioxx. Unfortunately it's over hyped and designed to alarm but it's essentially factually correct: https://m.youtube.com/watch?v=K0GrFnOpJoU
Thanks for that; it's good to know about celecoxib and rofecoxib.
The higher risk of GI bleeds is could be somewhat balanced by not having to take as many.
There are also slow release forms of naproxen. (Which make sense given its long action: lets people fade in the next one while the previous dose slowly fades out). That could also help make it easier on the GI tract.
> The higher risk of GI bleeds is somewhat balanced by not having to take as many!
Unless I am missing something, the data really doesn't back that up. naproxen is much more longer lasting and has a higher chance of causing ulcers. Hence why its not over the counter in the UK and is prescribed with omeprazole to reduce the risk of issues.
I'm reading about this in more detail. Indeed, it's not the contact between the medication and the digestive tract that is the problem, but simply its presence in the blood stream. By inhibiting those certain enzymes, it reduces the production of prostaglandings, causes problems for the lining.
Naproxen will be around longer due to its long half-life, so it creates more opportunity for this problem.
No. There is no one solution. For some things Naproxen simply doesn't work.
Do you mean, compared to drugs in the same family that work via the same mechanism?