17 ms·

New insights into why aspirin works so well

272 points by gumby 4y ago

ShadowBanThis01 4y ago
"it can cause detrimental side effects such as internal bleeding and organ damage" NSAIDs are also ototoxic, meaning that they cause hearing damage.
- paulpauper 4y ago
  Yeah, for all the hype about opioids being bad, these 'safe' drugs are way more dangerous than commonly purported. Acetaminophen is especially bad because the toxicity threshold is only slightly above the therapeutic dose. That is why they have to put so many warnings on this 'safe' drug. Yet let's blame opioids. https://en.wikipedia.org/wiki/Therapeutic_index https://en.wikipedia.org/wiki/Therapeutic_index
  - taneq 4y ago
    10:1 is still a pretty big ratio. You could take 20 Panadol every few hours before getting sick. That’s a LOT.
    - paulpauper 4y ago
      not really. you will be quite sick before you hit 10. also, double dosing is a major problem and makes it easier to hit the threshold .
      - taneq 4y ago
        Is the definition of “toxicity ratio” not “ratio of therapeutic dose to the amount required for toxic effects”?
  - TeaBrain 4y ago
    Acetaminophen is simply an analgesic. It isn't considered to be an nsaid.
  - rootusrootus 4y ago
    Acetaminophen has become a target lately, but the numbers don't really support that level of worry. Relatively few people are injured by acetaminophen overdose, and a large fraction of those are intentional suicide attempts. It's not even close to being the most dangerous OTC drug, ibuprofen kills way more people.
- autophagian 4y ago
  Yeah, I once managed to foolishly induce this while taking too much aspirin over a too long period to deal with tooth pain. I'll never forget the sensation: out of nowhere it sounded like someone was crinkling paper inside my head for about a second, and then quite loud and constant tinnitus with regular sounds becoming muffled. Was quite frightening. It thankfully went away after a day or so after I (immediately) stopped and I don't seem to have suffered any permanent damage that I know of, but it taught me to not fuck around with NSAIDs.
- spinningD20 4y ago
  You just sent me on a research adventure. I have struggled with chronic neck tension and pain for the last 15 years with no obvious origin event, and sometimes take 2-3 ibuprofen every day to take the edge off, when it's at its worst. Thank you for bringing this up! Background for me for those interested: Within a few years of struggling with chronic pain and tension headache episodes (vomiting, catch-my-breath level of pain for hours), I had my first "vertigo event". I was sitting in a chair in an office in front of a whiteboard, writing and thinking and chatting with a team, nothing special or different. Never had an inner ear issue before this moment. Since then, I have struggled (seemingly randomly) where I have ear fullness (almost entirely without hearing on left ear for a month about 6 months ago, then everything slowly came back, for example), varied tinnitus levels, light-headedness, unable to turn around too fast without losing balance... and it waxes and wanes. Now I am wondering if any of the waxing or waning of these symptoms have anything to do with my usage of ibuprofen. I found a study suggesting this back from 2010 just now, and wonder how I've never connected these two dots. Of course, I have to mention neck tension and inner ear related issue, aren't the only health issue I've had in the last 15 years. I've gained GERD (probably not surprising), hashimoto's and vitiligo, as well as sudden onset of mild astigmatisms after the first few years. I have tried my best to avoid using ibuprofen at all, but it is the only thing that can take the edge off of the neck trouble before it turns into that awful, torturous headache/barf session. PS) I know most folks will see "neck tension" + "inner ear problems" and jump to pinched nerve, spinal damage, ergonomics, posture, etc, but even after a great deal of lifestyle changes, reduced time at an office desk, yoga, Feldenkrais method, numerous physical therapy stints, I am confident that it is not the cause and "how good I am doing posture/movement" has no strong correlation to pain levels or inner ear trouble on any given day - it is seemingly random. PPS) Definitely open to suggestions or ideas, but I will be surprised if something is mentioned that I have not tried or looked into.
  - ShadowBanThis01 4y ago
    You're welcome! And thank you for expounding. I am very protective of my hearing, so I don't take NSAIDS and I carry earplugs to every restaurant, pub, and other noisy venue. Yet I recently suffered depressing and life-degrading damage to my hearing, which is being blamed on COVID vaccine. After it happened, people came out of the woodwork saying, "Oh yeah, I've heard of that." And now, too late for many of us, the information is trickling out. National Geographic featured an article about it last month. I've seen two of the top hearing specialists on the west coast (if not the USA), and both vehemently stated that this is a true phenomenon; one of them stated with equal assurance that information about it is being suppressed. Even vaccine experts are afraid of being "canceled." And indeed, my experience here reflects why. I have been buried and shadow-banned at least three times for posting references to reports of COVID-vaccine-induced hearing damage. It's disgusting and dangerous behavior that will cause more people's lives to be ruined. Obviously I'm not an anti-vaxxer; if I were, I wouldn't have had all my shots and a second (ultimately disastrous and nearly useless) booster. I hope you find relief. Here are some links to what I'm talking about yet again. There are probably more since I collected these. Unfortunately the Nat Geo one is paywalled and it seems my subscription has run out: https://www.nationalgeographic.com/magazine/article/covid-vaccine-trigger-tinnitus https://www.nationalgeographic.com/magazine/article/covid-va... https://www.abc15.com/news/local-news/investigations/can-the-covid-19-vaccine-lead-to-hearing-issues https://www.abc15.com/news/local-news/investigations/can-the... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443418/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443418/ https://www.news-medical.net/news/20220523/Pfizer-COVID-19-vaccine-associated-tinnitus-responds-to-transcranial-magnetic-stimulation.aspx https://www.news-medical.net/news/20220523/Pfizer-COVID-19-v... https://www.nbcnews.com/health/health-news/tinnitus-rare-side-effect-covid-vaccines-rcna20613 https://www.nbcnews.com/health/health-news/tinnitus-rare-sid... Facebook group for victims, with several thousand members: https://www.facebook.com/groups/265035901879921/ https://www.facebook.com/groups/265035901879921/
- jbjorge 4y ago
  ... and it has not become common knowledge yet that ibuprofen is not recommended for males due to its reductive effect on testosterone production
  - mock-possum 4y ago
    Not recommended by whom? I’ve never had a medical professional tell me that.
lispisok 4y ago
I've always though Aspirin was a deprecated drug but lately I've heard reports from people who claim it's the only thing that helps their arthritis or other issues. Maybe there is something behind it.
- readthenotes1 4y ago
  deprecated for children. works well for people with atherosclerosis. ibuprofen and acetominophen are hardly safe...
  - astrange 4y ago
    They are very safe when taken as prescribed but quite dangerous when you don't read the directions. Although IIRC taking fever reducers when sick significantly increases how long it takes to recover. Those fevers are there for a reason.
    - unlikelymordant 4y ago
      I guess theres always a caveat, but fevers can get too high and go for too long, in which case reducing the fever might be a good idea. But if it gets to that point, you should be working with a doctor to make those decisions.
      - dham 4y ago
        This is a misnomer though. Your body will not make the fever too high in the case of fighting a virus, so danger is low. From an evolutionary standpoint this would make no sense. For a bacterial infection I think the chance of going to the danger zone is higher though. Typically it's better to just let the fever ride when you have a virus, unless it's making you you so uncomfortable you can't rest/sleep.
        readthenotes1 4y ago
        Well, brain damage may not be a detriment to some. Btw, "misnomer" doesn't mean what you think it means.
waihtis 4y ago
This paper from 2005 suggests the same: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809338/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809338/
zabzonk 4y ago
annecdata: aspirin is pretty good as an anti-inflamitory and hence pain-killer. the reason i don't take it is that it irritates the stomach, and i have enough issues with my insides as it is (irritable-bowel syndrome - not fun) i currently use cocodamol (codeine and paracetomol) to control my arthritic pain, but it isn't doing so great. at the end of the day, if you really need pain control, you probably want a pure opioid of some kind. and yes, i do know that codeine is an opioid.
- jamal-kumar 4y ago
  I have a friend who has suffered from something known as juvenile idiopathic arthritis since he was still a teenager, and he doesn't function very well without pretty decent doses of CBD for the past long while I've known him. I recognize legality issues are prohibitive in many parts of the world but if this is an option to you I would suggest trying this or anything else that takes the actual inflammation down instead of dulling the pain. The other thing a friend of mine practicing general medicine who was working in a country where CBD wasn't legal yet used very large doses of carefully sourced curcumin - it's not something you want to eat tons of from the grocery store in many places as apparently there's a ton of contamination in the supply [1] but it's actually really easy to just grow tumeric and make sure you're getting it from a decent source in much of the world One thing may be about it, much like oregano, is that it might just naturally be a nice absorbent of heavy metals in the soil but the fact that people add stuff like lead or cadmium in there to improve color or weight is just terrifying. We need raman spectroscopes in every phone already. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415259/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415259/
  - zabzonk 4y ago
    thanks, but no thanks
    - jamal-kumar 4y ago
      There's something like a downward spiral into hell that is opiates which starts with low doses like what you're on and escalates into worse and worse bullshit because you're not even trying to treat the underlying inflammation before masking the pain with opiates, and then the movement the pain is trying to prevent you from doing happens anyways and you just end up with more damage. I'm telling you these alternatives because I know many more people than the ones I just told you about who are just fucking dead now. Opiates are fucked.
deafpolygon 4y ago
The OG COX blocker. Edit: we're all adults here, and a little humor on a wednesday morning never hurt.
- 4ggr0 4y ago
  > we're all adults here well there's no ID check to access HN :)
photochemsyn 4y ago
I imagine different people tolerate different anti-inflammatory over-the-counter drugs differently. Side effects of overuse are significant however and include liver, kidney, and gastrointestinal damage (acetaminophen, ibuprofen and aspirin respectively I think with some crossover effects). Use judiciously, and only take regularly under a doctor's supervision as side effects can be minimized with additional drugs while retaining the benefits, e.g. https://www.telegraph.co.uk/news/2017/06/13/daily-aspirin-behind-3000-deaths-year-study-suggests/ https://www.telegraph.co.uk/news/2017/06/13/daily-aspirin-be...
- deleted 4y ago
  [deleted]
- froggit 4y ago
  Ibuprofen and aspirin can both reliably produce internal gastrointestinal bleeds after a single dose in people with underlying digestive diseases. Over enough time with constant usage, they'll cause that in anybody.
  - theshrike79 4y ago
    Can confirm (anecdotally) Ibuprofen gives me either gas or the runs. Paracetamol works just fine - but it does have a liver effect, so it's a big no-no for hangovers.
    - carlmr 4y ago
      >Paracetamol works just fine - but it does have a liver effect, so it's a big no-no for hangovers. The worse part here for you is if you have hangovers too often. After dry January this year I noticed how much even non-hangover inducing alcohol usage decreases my QoL. I lost weight without trying, I was more awake, I felt fogged up in the brain less often. I reduced my alcohol consumption a lot now. And I wasn't even getting wasted often. I think it's worth trying if you don't want to destroy your body.
  - Reason077 4y ago
shusaku 4y ago
The article says > Peer-Reviewed Publication But the article seems to describe an upcoming poster?
- evanb 4y ago
  Some fields' conferences have refereed talks and posters, so it's not automatically suspicious. A prominent field where this is standard is computer science! Not sure about this particular instance, however.
DoreenMichele 4y ago
Tangentially, does anyone know how aspirin promotes bleeding? I've searched (and also searched nutrient depletions for aspirin) and I'm not really getting an answer.
- stouset 4y ago
  It’s an antiplatelet medication. How it’s that, I haven’t the faintest.
  - DoreenMichele 4y ago
    Thank you. That gives me a place to start: https://www.ncbi.nlm.nih.gov/books/NBK537062/ https://www.ncbi.nlm.nih.gov/books/NBK537062/
  - cfu28 4y ago
    Aspirin inhibits COX-1 and COX-2 irreversibly, which decreases synthesis of thromboxane which is key to platelet aggregation and vasoconstriction
- wbl 4y ago
  COX enzymes produce a promotor of platelet activity and aspirin knocks it out. That's why they thought COX-2 selective inhibitors would be better.
- cfu28 4y ago
  Prevents arachidonic acid from being converted to thromboxane needed for platelet aggregation. Here's a diagram I find helpful of the arachidonic pathway and which drugs inhibit which parts of the pathway: https://files.mari.casa/aapathway.jpg https://files.mari.casa/aapathway.jpg
  - DoreenMichele 4y ago
    Thanks, I'm kind of stuck on the arachidonic acid bit. When I was very ill, I read a comment by a guy with a PhD in chemistry who probably typoed arachidic acid and ..ugh. I need to at some point sort a few things out. Linoleic acid can be converted by the body into arachidonic acid, so that part I got right all those years ago.
NoZebra120vClip 4y ago
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- eraserj 4y ago
  Poe's law apply here again.
drKarl 4y ago
When I was a kid aspirin was used for everything, from a headache to fever, etc, now no one uses it anymore, and everyone uses paracetamol and ibuprofen instead...
- jeffparsons 4y ago
  It's shocking to me how we still refer to paracetamol and ibuprofen in the same breath when their relative risks are so different.
  - onethought 4y ago
    What risks are you referring to? I think the fact that for most people there is almost no risk is why they are mentioned in the same Breathe
    - jeffparsons 4y ago
      For most people oxycodone presents very little risk, and it is an extremely effective painkiller. But for some people it will ruin their lives, so (at least in Australia) it is tightly regulated. It's the risk of seriously damaging a small subset of people even if they stick strictly to the recommended dosage that I find strange. Maybe that's the case for a lot of medicines and I'm just less aware of those. But I see people popping ibuprofen like candy and I don't think many of them have even considered whether they might be in that small group of people that definitely shouldn't touch it.
  - nobody9999 4y ago
    >It's shocking to me how we still refer to paracetamol and ibuprofen in the same breath when their relative risks are so different. And it's shocking to me how we still refer to paracetamol (Acetominophen for us USAians) and ibuprofen in the same breath, when paracetamol might as well be a sugar pill, for all the good it does and ibuprofen is the liniment of the gods!
    - drKarl 4y ago
11235813213455 4y ago
I use nothing for reducing inflammation, nor any drugs since decades, when I'm ill from time to time (once or twice a year), I let the fever go, the body is just working actively, it's not especially uncomfortable
- swidi 4y ago
  Yes, and everybody here thinks you're a brave little boy. Have a lollipop.
  - phs318u 4y ago
    Perhaps the parent’s anecdote s not particularly instructive, but your comment is not what this site is about and goes against the posting guidelines.
  - 11235813213455 4y ago
    yea and if you think a bit more, you could see it's applicable to almost everyone. This article explains how it's counter-productive to do anything else, there are working on new molecules that will be found later than similarly they inhibit something else..
- 9dev 4y ago
  The body handles inflammations just fine, but you can actively help it to get it done more quickly. Doesn't have to be Aspirin though, chamomile tea and lots of other things work wonders, too.
  - DrDoonothing 4y ago
    Actually there are a lot of things which do not do anything. Its probably one of the most fake markets out there.
  - kensai 4y ago
    Although HN is not a medical site, comments like yours need a disclaimer. Cause even the phrase “the body handles inflammations just fine” needs a it depends clarifier.
a_c 4y ago
I used to have the impression that the advance of LLM is peak human ignorance - we know how things work in a recipe like fashion, but not why. I even compared this with tribal rituals - follow a recipe with a probably misguided why. News like this gradually make me realize that this is how human wisdom have long been working, discovery and invention first, understanding later.
- szundi 4y ago
  Hopefully we realize and reach the off-switch before too late
  - bratbag 4y ago
    Are you suicidal, or is there a deeper meaning to your comment that I missed?
    - jackstraw14 4y ago
      It's the doomer narrative around GPT, nothing to see here.
- M3L0NM4N 4y ago
  Airplanes and lift are an example of this that I always come back to.
seiteamoebe 4y ago
I remember an old interview with Milton Friedman where he stated using aspirin every other day to reduce the dangers of heart attacks. My grandfather did the same. So I guess this wasn’t such a good idea after all?
- robbiep 4y ago
  no it is still a mainstay of treatment for those at high risk
- znpy 4y ago
  my father in law (76 years old) does the same, but it's not the same kind of aspirin i'd take. Iirc there's a special version for that use. I think it's called cardio-aspirin or something? The downside is that it's an anti-coagulant, so if you bleed for any reason it will not stop bleeding as easily as without the cardio-aspirin.
  - thenerdhead 4y ago
    It’s just a baby dosage of it 81mg.
sammalloy 4y ago
I had to stop taking aspirin in all forms about ten years ago because it produces tinnitus-like symptoms, even in small dosages. No idea why.
- Traubenfuchs 4y ago
  Aspirine considered harmful. By me. Even single dosages reliably induce tinnitus for me. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025186/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025186/ > With short-term administration, the effects appear to be completely reversible whereas long-term administration appears to induce a unique form of damage to SGN (spiral ganglion neurons)
- deleted 4y ago
  [deleted]
- ycombinete 4y ago
  It’s ototoxic and damages your hearing, causing tinnitus, that’s why.
INTPenis 4y ago
When you say in 2023 that they have "new insights" as to why a common over the counter drug works it really doesn't instill great confidence in pharma. Seems like we're still grinding up rhino horns and tiger penis and hoping for the best outcome, just that we do it with extensive testing now so we get a statistically acceptable outcome viable for marketing.
- selfmodruntime 4y ago
  No. Science has all along been testing if something works and then finding out why. Often the „why“ is orders of magnitudes harder to find out than the „if“. For example, we can observe how the brain functions in some instances, but why it works like does will elude us perhaps forever. Highly complex systems like the inner biomechanical workings of our brains are essentially a black box.
  - marginalia_nu 4y ago
    "Why" questions in general are pretty difficult question to answer in a satisfactory way. [1] https://www.youtube.com/watch?v=36GT2zI8lVA https://www.youtube.com/watch?v=36GT2zI8lVA
    - rcme 4y ago
      I think “how” is more appropriate in the GP’s comment.
      - thomastjeffery 4y ago
        We can understand a thousand instances "how", but it will always be "why" that ties them together. Like software incompatibility: every program is the story of "how", written explicitly, and translated into instructions. The only way to fit them together is to implement "why". If we could write both stories together, we could factor out incompatibility.
    - thisismyswamp 4y ago
rramadass 4y ago
Must read BBC article : The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-that-change-who-we-are https://www.bbc.com/future/article/20200108-the-medications-...
- jackdh 4y ago
  Discussed here at the time: https://news.ycombinator.com/item?id=22019202 https://news.ycombinator.com/item?id=22019202
Traubenfuchs 4y ago
PSA: Are you using minoxidil for treating hair loss? In that case you must not take Aspirine, as it significantly reduces the effectivity of minoxidil. https://pubmed.ncbi.nlm.nih.gov/30226287/ https://pubmed.ncbi.nlm.nih.gov/30226287/
paulpauper 4y ago
Thousands of people are hospitalized yearly due to bleeds from 'allegedly' safe drug. The overdose occurs due to double-dosing or people taking too much owing to the drugs not working. Same for drugs containing acetaminophen. Overall, overpriced , infective drugs that cause more harm than good except for the most minor of pain. The notion that these drugs are supposed to be safer seems clearly false.
- Helmut10001 4y ago
  You can overdose with everything. I use half an aspirin once in every 12 months. This is the only drug I ever use 'regularly' and I feel an immense impact: I sleep 12 hours from this half-portion because I my body is not used to any drugs.
- cromulent 4y ago
  "The dose makes the poison", as Paracelsus said. Everything (including water and oxygen) is toxic at the wrong levels.
daneel_w 4y ago
For me Aspirin takes about three times longer to reach effect compared to Ibuprofen or Paracetamol which "kicks in" after just 15 to 20 minutes. As for getting rid of a headache they're all equally efficient on me.
thenerdhead 4y ago
Aspirin has been a life changer for long Covid. The other painkillers make symptoms 10x worse. Many people wonder if aspirin anti platelet/blood thinning capabilities is helping breakup microclots which brings relief. There’s also a thing called nattokinase that apparently has similar properties to aspirin and is being studied for heart disease. It has been shown to break down blood clots and even degrade the spike protein. NK might be a viable alternative. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043915/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043915/
- IE6 4y ago
  Do you have any good literature on Aspirin and LC? Not a doubter, actually I have LC myself.
  - thenerdhead 4y ago
    I do not. I have my personal anecdote and experiences with common painkillers and LC. I've had it since January 2021 so there wasn't really anything known when I started taking aspirin outside of the many years of research as mentioned in OP's article. Here's my experience so far. https://jondouglas.dev/long-covid/ https://jondouglas.dev/long-covid/ I've swapped aspirin about a year in for nattokinase and have noticed much better management. I still take aspirin here and there, but NK is doing its job. https://pubmed.ncbi.nlm.nih.gov/36080170/ https://pubmed.ncbi.nlm.nih.gov/36080170/ https://www.webmd.com/covid/news/20221207/microclots-may-explain-long-covid-symptoms https://www.webmd.com/covid/news/20221207/microclots-may-exp... https://pharmd.substack.com/p/frequency-asked-questions-nattokinase https://pharmd.substack.com/p/frequency-asked-questions-natt... Hope that helps you. EDIT: I heard about triple anticoagulant therapy but never realized aspirin is included in it. Check out this study here: https://www.researchsquare.com/article/rs-2697680/v1 https://www.researchsquare.com/article/rs-2697680/v1
    - neom 4y ago
      Just adding a +1 for long covid and aspirin, aspirin + CBD cream (Momma Canna Cream, I think only available in Canada) was a game changer for me! I rubbed the CBD cream into my head and neck and took bayer "daily" low dose aspirin till I started to feel normal again (brain fog cleared).
Thaxll 4y ago
I heard that if Aspirin would be discovered today it would not be sold as over-the-counter by big pharma because too dangerous.
MisterBastahrd 4y ago
I rarely take any sort of medication other than my daily allergy tablet and usually a Mucinex during the allergy seasons. My exception is either BC Powder or Goody's for tension headaches and migraines. I'll have em once or twice a month, almost always after sleeping at a crooked angle due to my adjustable bed, and my solution is two packets of powder that usually eradicate the pain within 20 minutes.
daveslash 4y ago
An old mentor of mine used to say: "If they ever invent a miracle drug, it will be aspirin"
SoftTalker 4y ago
"It’s important that we understand how it works so we can develop safer drugs with fewer side effects." Allow me to translate: it's important to understand how it works so we can develop a patented drug that costs 100x more per dose, then we will work on getting aspirin banned due to its "side effects"
1MachineElf 4y ago
Today an allergist told me the random lip swelling I experience (angioterma) has been caused in many other patients by NSAIDs like Aspirin, Tylenol (acetaminophen), and a Alleve (naproxen sodium). I hate to think that's true, but apparently it is a studied phenomena: https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-3-1-24 https://aacijournal.biomedcentral.com/articles/10.1186/1710-...
- orev 4y ago
  > Tylenol (acetaminophen) Is not an NSAID. One of its primary uses is as a medication for people who can’t use NSAIDs.
  - m3047 4y ago
    NSAID: Non Steroidal Anti Inflammatory Drug Tylenol: * Non steroidal? Check. * Anti inflammatory? Hrmmm... not so much. So what are you taking it for again? https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory_drug https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory... It's still a COX-2 inhibitor.
- mongol 4y ago
  I also get reactions. My eyes get swollen. It works very well as painkiller though but I feel I must avoid it.
jdthedisciple 4y ago
Fun fact: They would give Aspirin to Tzar Nikolas II's (or III?) son who suffered from hemophilia. Came Rasputin the mystic around the corner and advised the Tzar's wife to keep the doctors off her son. As she did, her son miraculously recovered to a great degree. Turns out little did they know Aspirin actually worsenes hemophilia due to thinning the blood.

272 points by gumby 4y ago

"it can cause detrimental side effects such as internal bleeding and organ damage" NSAIDs are also ototoxic, meaning that they cause hearing damage.

paulpauper 4y ago
Yeah, for all the hype about opioids being bad, these 'safe' drugs are way more dangerous than commonly purported. Acetaminophen is especially bad because the toxicity threshold is only slightly above the therapeutic dose. That is why they have to put so many warnings on this 'safe' drug. Yet let's blame opioids. https://en.wikipedia.org/wiki/Therapeutic_index https://en.wikipedia.org/wiki/Therapeutic_index
- taneq 4y ago
  10:1 is still a pretty big ratio. You could take 20 Panadol every few hours before getting sick. That’s a LOT.
  - paulpauper 4y ago
    not really. you will be quite sick before you hit 10. also, double dosing is a major problem and makes it easier to hit the threshold .
    - taneq 4y ago
      Is the definition of “toxicity ratio” not “ratio of therapeutic dose to the amount required for toxic effects”?
- TeaBrain 4y ago
  Acetaminophen is simply an analgesic. It isn't considered to be an nsaid.
- rootusrootus 4y ago
  Acetaminophen has become a target lately, but the numbers don't really support that level of worry. Relatively few people are injured by acetaminophen overdose, and a large fraction of those are intentional suicide attempts. It's not even close to being the most dangerous OTC drug, ibuprofen kills way more people.
autophagian 4y ago
Yeah, I once managed to foolishly induce this while taking too much aspirin over a too long period to deal with tooth pain. I'll never forget the sensation: out of nowhere it sounded like someone was crinkling paper inside my head for about a second, and then quite loud and constant tinnitus with regular sounds becoming muffled. Was quite frightening. It thankfully went away after a day or so after I (immediately) stopped and I don't seem to have suffered any permanent damage that I know of, but it taught me to not fuck around with NSAIDs.
spinningD20 4y ago
You just sent me on a research adventure. I have struggled with chronic neck tension and pain for the last 15 years with no obvious origin event, and sometimes take 2-3 ibuprofen every day to take the edge off, when it's at its worst. Thank you for bringing this up! Background for me for those interested: Within a few years of struggling with chronic pain and tension headache episodes (vomiting, catch-my-breath level of pain for hours), I had my first "vertigo event". I was sitting in a chair in an office in front of a whiteboard, writing and thinking and chatting with a team, nothing special or different. Never had an inner ear issue before this moment. Since then, I have struggled (seemingly randomly) where I have ear fullness (almost entirely without hearing on left ear for a month about 6 months ago, then everything slowly came back, for example), varied tinnitus levels, light-headedness, unable to turn around too fast without losing balance... and it waxes and wanes. Now I am wondering if any of the waxing or waning of these symptoms have anything to do with my usage of ibuprofen. I found a study suggesting this back from 2010 just now, and wonder how I've never connected these two dots. Of course, I have to mention neck tension and inner ear related issue, aren't the only health issue I've had in the last 15 years. I've gained GERD (probably not surprising), hashimoto's and vitiligo, as well as sudden onset of mild astigmatisms after the first few years. I have tried my best to avoid using ibuprofen at all, but it is the only thing that can take the edge off of the neck trouble before it turns into that awful, torturous headache/barf session. PS) I know most folks will see "neck tension" + "inner ear problems" and jump to pinched nerve, spinal damage, ergonomics, posture, etc, but even after a great deal of lifestyle changes, reduced time at an office desk, yoga, Feldenkrais method, numerous physical therapy stints, I am confident that it is not the cause and "how good I am doing posture/movement" has no strong correlation to pain levels or inner ear trouble on any given day - it is seemingly random. PPS) Definitely open to suggestions or ideas, but I will be surprised if something is mentioned that I have not tried or looked into.
- ShadowBanThis01 4y ago
  You're welcome! And thank you for expounding. I am very protective of my hearing, so I don't take NSAIDS and I carry earplugs to every restaurant, pub, and other noisy venue. Yet I recently suffered depressing and life-degrading damage to my hearing, which is being blamed on COVID vaccine. After it happened, people came out of the woodwork saying, "Oh yeah, I've heard of that." And now, too late for many of us, the information is trickling out. National Geographic featured an article about it last month. I've seen two of the top hearing specialists on the west coast (if not the USA), and both vehemently stated that this is a true phenomenon; one of them stated with equal assurance that information about it is being suppressed. Even vaccine experts are afraid of being "canceled." And indeed, my experience here reflects why. I have been buried and shadow-banned at least three times for posting references to reports of COVID-vaccine-induced hearing damage. It's disgusting and dangerous behavior that will cause more people's lives to be ruined. Obviously I'm not an anti-vaxxer; if I were, I wouldn't have had all my shots and a second (ultimately disastrous and nearly useless) booster. I hope you find relief. Here are some links to what I'm talking about yet again. There are probably more since I collected these. Unfortunately the Nat Geo one is paywalled and it seems my subscription has run out: https://www.nationalgeographic.com/magazine/article/covid-vaccine-trigger-tinnitus https://www.nationalgeographic.com/magazine/article/covid-va... https://www.abc15.com/news/local-news/investigations/can-the-covid-19-vaccine-lead-to-hearing-issues https://www.abc15.com/news/local-news/investigations/can-the... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443418/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443418/ https://www.news-medical.net/news/20220523/Pfizer-COVID-19-vaccine-associated-tinnitus-responds-to-transcranial-magnetic-stimulation.aspx https://www.news-medical.net/news/20220523/Pfizer-COVID-19-v... https://www.nbcnews.com/health/health-news/tinnitus-rare-side-effect-covid-vaccines-rcna20613 https://www.nbcnews.com/health/health-news/tinnitus-rare-sid... Facebook group for victims, with several thousand members: https://www.facebook.com/groups/265035901879921/ https://www.facebook.com/groups/265035901879921/
jbjorge 4y ago
... and it has not become common knowledge yet that ibuprofen is not recommended for males due to its reductive effect on testosterone production
- mock-possum 4y ago
  Not recommended by whom? I’ve never had a medical professional tell me that.

lispisok 4y ago

I've always though Aspirin was a deprecated drug but lately I've heard reports from people who claim it's the only thing that helps their arthritis or other issues. Maybe there is something behind it.

readthenotes1 4y ago
deprecated for children. works well for people with atherosclerosis. ibuprofen and acetominophen are hardly safe...
- astrange 4y ago
  They are very safe when taken as prescribed but quite dangerous when you don't read the directions. Although IIRC taking fever reducers when sick significantly increases how long it takes to recover. Those fevers are there for a reason.
  - unlikelymordant 4y ago
    I guess theres always a caveat, but fevers can get too high and go for too long, in which case reducing the fever might be a good idea. But if it gets to that point, you should be working with a doctor to make those decisions.
    - dham 4y ago
      This is a misnomer though. Your body will not make the fever too high in the case of fighting a virus, so danger is low. From an evolutionary standpoint this would make no sense. For a bacterial infection I think the chance of going to the danger zone is higher though. Typically it's better to just let the fever ride when you have a virus, unless it's making you you so uncomfortable you can't rest/sleep.
      - readthenotes1 4y ago
        Well, brain damage may not be a detriment to some. Btw, "misnomer" doesn't mean what you think it means.

waihtis 4y ago

This paper from 2005 suggests the same: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809338/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809338/

zabzonk 4y ago

annecdata: aspirin is pretty good as an anti-inflamitory and hence pain-killer. the reason i don't take it is that it irritates the stomach, and i have enough issues with my insides as it is (irritable-bowel syndrome - not fun) i currently use cocodamol (codeine and paracetomol) to control my arthritic pain, but it isn't doing so great. at the end of the day, if you really need pain control, you probably want a pure opioid of some kind. and yes, i do know that codeine is an opioid.

jamal-kumar 4y ago
I have a friend who has suffered from something known as juvenile idiopathic arthritis since he was still a teenager, and he doesn't function very well without pretty decent doses of CBD for the past long while I've known him. I recognize legality issues are prohibitive in many parts of the world but if this is an option to you I would suggest trying this or anything else that takes the actual inflammation down instead of dulling the pain. The other thing a friend of mine practicing general medicine who was working in a country where CBD wasn't legal yet used very large doses of carefully sourced curcumin - it's not something you want to eat tons of from the grocery store in many places as apparently there's a ton of contamination in the supply [1] but it's actually really easy to just grow tumeric and make sure you're getting it from a decent source in much of the world One thing may be about it, much like oregano, is that it might just naturally be a nice absorbent of heavy metals in the soil but the fact that people add stuff like lead or cadmium in there to improve color or weight is just terrifying. We need raman spectroscopes in every phone already. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415259/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415259/
- zabzonk 4y ago
  thanks, but no thanks
  - jamal-kumar 4y ago
    There's something like a downward spiral into hell that is opiates which starts with low doses like what you're on and escalates into worse and worse bullshit because you're not even trying to treat the underlying inflammation before masking the pain with opiates, and then the movement the pain is trying to prevent you from doing happens anyways and you just end up with more damage. I'm telling you these alternatives because I know many more people than the ones I just told you about who are just fucking dead now. Opiates are fucked.

deafpolygon 4y ago

The OG COX blocker. Edit: we're all adults here, and a little humor on a wednesday morning never hurt.

4ggr0 4y ago
> we're all adults here well there's no ID check to access HN :)

photochemsyn 4y ago

I imagine different people tolerate different anti-inflammatory over-the-counter drugs differently. Side effects of overuse are significant however and include liver, kidney, and gastrointestinal damage (acetaminophen, ibuprofen and aspirin respectively I think with some crossover effects). Use judiciously, and only take regularly under a doctor's supervision as side effects can be minimized with additional drugs while retaining the benefits, e.g. https://www.telegraph.co.uk/news/2017/06/13/daily-aspirin-behind-3000-deaths-year-study-suggests/ https://www.telegraph.co.uk/news/2017/06/13/daily-aspirin-be...

deleted 4y ago
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froggit 4y ago
Ibuprofen and aspirin can both reliably produce internal gastrointestinal bleeds after a single dose in people with underlying digestive diseases. Over enough time with constant usage, they'll cause that in anybody.
- theshrike79 4y ago
  Can confirm (anecdotally) Ibuprofen gives me either gas or the runs. Paracetamol works just fine - but it does have a liver effect, so it's a big no-no for hangovers.
  - carlmr 4y ago
    >Paracetamol works just fine - but it does have a liver effect, so it's a big no-no for hangovers. The worse part here for you is if you have hangovers too often. After dry January this year I noticed how much even non-hangover inducing alcohol usage decreases my QoL. I lost weight without trying, I was more awake, I felt fogged up in the brain less often. I reduced my alcohol consumption a lot now. And I wasn't even getting wasted often. I think it's worth trying if you don't want to destroy your body.
- Reason077 4y ago

shusaku 4y ago

The article says > Peer-Reviewed Publication But the article seems to describe an upcoming poster?

evanb 4y ago
Some fields' conferences have refereed talks and posters, so it's not automatically suspicious. A prominent field where this is standard is computer science! Not sure about this particular instance, however.

DoreenMichele 4y ago

Tangentially, does anyone know how aspirin promotes bleeding? I've searched (and also searched nutrient depletions for aspirin) and I'm not really getting an answer.

stouset 4y ago
It’s an antiplatelet medication. How it’s that, I haven’t the faintest.
- DoreenMichele 4y ago
  Thank you. That gives me a place to start: https://www.ncbi.nlm.nih.gov/books/NBK537062/ https://www.ncbi.nlm.nih.gov/books/NBK537062/
- cfu28 4y ago
  Aspirin inhibits COX-1 and COX-2 irreversibly, which decreases synthesis of thromboxane which is key to platelet aggregation and vasoconstriction
wbl 4y ago
COX enzymes produce a promotor of platelet activity and aspirin knocks it out. That's why they thought COX-2 selective inhibitors would be better.
cfu28 4y ago
Prevents arachidonic acid from being converted to thromboxane needed for platelet aggregation. Here's a diagram I find helpful of the arachidonic pathway and which drugs inhibit which parts of the pathway: https://files.mari.casa/aapathway.jpg https://files.mari.casa/aapathway.jpg
- DoreenMichele 4y ago
  Thanks, I'm kind of stuck on the arachidonic acid bit. When I was very ill, I read a comment by a guy with a PhD in chemistry who probably typoed arachidic acid and ..ugh. I need to at some point sort a few things out. Linoleic acid can be converted by the body into arachidonic acid, so that part I got right all those years ago.

NoZebra120vClip 4y ago

eraserj 4y ago
Poe's law apply here again.

drKarl 4y ago

When I was a kid aspirin was used for everything, from a headache to fever, etc, now no one uses it anymore, and everyone uses paracetamol and ibuprofen instead...

jeffparsons 4y ago
It's shocking to me how we still refer to paracetamol and ibuprofen in the same breath when their relative risks are so different.
- onethought 4y ago
  What risks are you referring to? I think the fact that for most people there is almost no risk is why they are mentioned in the same Breathe
  - jeffparsons 4y ago
    For most people oxycodone presents very little risk, and it is an extremely effective painkiller. But for some people it will ruin their lives, so (at least in Australia) it is tightly regulated. It's the risk of seriously damaging a small subset of people even if they stick strictly to the recommended dosage that I find strange. Maybe that's the case for a lot of medicines and I'm just less aware of those. But I see people popping ibuprofen like candy and I don't think many of them have even considered whether they might be in that small group of people that definitely shouldn't touch it.
- nobody9999 4y ago
  >It's shocking to me how we still refer to paracetamol and ibuprofen in the same breath when their relative risks are so different. And it's shocking to me how we still refer to paracetamol (Acetominophen for us USAians) and ibuprofen in the same breath, when paracetamol might as well be a sugar pill, for all the good it does and ibuprofen is the liniment of the gods!
  - drKarl 4y ago

11235813213455 4y ago

I use nothing for reducing inflammation, nor any drugs since decades, when I'm ill from time to time (once or twice a year), I let the fever go, the body is just working actively, it's not especially uncomfortable

swidi 4y ago
Yes, and everybody here thinks you're a brave little boy. Have a lollipop.
- phs318u 4y ago
  Perhaps the parent’s anecdote s not particularly instructive, but your comment is not what this site is about and goes against the posting guidelines.
- 11235813213455 4y ago
  yea and if you think a bit more, you could see it's applicable to almost everyone. This article explains how it's counter-productive to do anything else, there are working on new molecules that will be found later than similarly they inhibit something else..
9dev 4y ago
The body handles inflammations just fine, but you can actively help it to get it done more quickly. Doesn't have to be Aspirin though, chamomile tea and lots of other things work wonders, too.
- DrDoonothing 4y ago
  Actually there are a lot of things which do not do anything. Its probably one of the most fake markets out there.
- kensai 4y ago
  Although HN is not a medical site, comments like yours need a disclaimer. Cause even the phrase “the body handles inflammations just fine” needs a it depends clarifier.

a_c 4y ago

I used to have the impression that the advance of LLM is peak human ignorance - we know how things work in a recipe like fashion, but not why. I even compared this with tribal rituals - follow a recipe with a probably misguided why. News like this gradually make me realize that this is how human wisdom have long been working, discovery and invention first, understanding later.

szundi 4y ago
Hopefully we realize and reach the off-switch before too late
- bratbag 4y ago
  Are you suicidal, or is there a deeper meaning to your comment that I missed?
  - jackstraw14 4y ago
    It's the doomer narrative around GPT, nothing to see here.
M3L0NM4N 4y ago
Airplanes and lift are an example of this that I always come back to.

seiteamoebe 4y ago

I remember an old interview with Milton Friedman where he stated using aspirin every other day to reduce the dangers of heart attacks. My grandfather did the same. So I guess this wasn’t such a good idea after all?

robbiep 4y ago
no it is still a mainstay of treatment for those at high risk
znpy 4y ago
my father in law (76 years old) does the same, but it's not the same kind of aspirin i'd take. Iirc there's a special version for that use. I think it's called cardio-aspirin or something? The downside is that it's an anti-coagulant, so if you bleed for any reason it will not stop bleeding as easily as without the cardio-aspirin.
- thenerdhead 4y ago
  It’s just a baby dosage of it 81mg.

sammalloy 4y ago

I had to stop taking aspirin in all forms about ten years ago because it produces tinnitus-like symptoms, even in small dosages. No idea why.

Traubenfuchs 4y ago
Aspirine considered harmful. By me. Even single dosages reliably induce tinnitus for me. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025186/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025186/ > With short-term administration, the effects appear to be completely reversible whereas long-term administration appears to induce a unique form of damage to SGN (spiral ganglion neurons)
deleted 4y ago
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ycombinete 4y ago
It’s ototoxic and damages your hearing, causing tinnitus, that’s why.

INTPenis 4y ago

When you say in 2023 that they have "new insights" as to why a common over the counter drug works it really doesn't instill great confidence in pharma. Seems like we're still grinding up rhino horns and tiger penis and hoping for the best outcome, just that we do it with extensive testing now so we get a statistically acceptable outcome viable for marketing.

selfmodruntime 4y ago
No. Science has all along been testing if something works and then finding out why. Often the „why“ is orders of magnitudes harder to find out than the „if“. For example, we can observe how the brain functions in some instances, but why it works like does will elude us perhaps forever. Highly complex systems like the inner biomechanical workings of our brains are essentially a black box.
- marginalia_nu 4y ago
  "Why" questions in general are pretty difficult question to answer in a satisfactory way. [1] https://www.youtube.com/watch?v=36GT2zI8lVA https://www.youtube.com/watch?v=36GT2zI8lVA
  - rcme 4y ago
    I think “how” is more appropriate in the GP’s comment.
    - thomastjeffery 4y ago
      We can understand a thousand instances "how", but it will always be "why" that ties them together. Like software incompatibility: every program is the story of "how", written explicitly, and translated into instructions. The only way to fit them together is to implement "why". If we could write both stories together, we could factor out incompatibility.
  - thisismyswamp 4y ago

rramadass 4y ago

Must read BBC article : The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-that-change-who-we-are https://www.bbc.com/future/article/20200108-the-medications-...

jackdh 4y ago
Discussed here at the time: https://news.ycombinator.com/item?id=22019202 https://news.ycombinator.com/item?id=22019202

Traubenfuchs 4y ago

PSA: Are you using minoxidil for treating hair loss? In that case you must not take Aspirine, as it significantly reduces the effectivity of minoxidil. https://pubmed.ncbi.nlm.nih.gov/30226287/ https://pubmed.ncbi.nlm.nih.gov/30226287/

paulpauper 4y ago

Thousands of people are hospitalized yearly due to bleeds from 'allegedly' safe drug. The overdose occurs due to double-dosing or people taking too much owing to the drugs not working. Same for drugs containing acetaminophen. Overall, overpriced , infective drugs that cause more harm than good except for the most minor of pain. The notion that these drugs are supposed to be safer seems clearly false.

Helmut10001 4y ago
You can overdose with everything. I use half an aspirin once in every 12 months. This is the only drug I ever use 'regularly' and I feel an immense impact: I sleep 12 hours from this half-portion because I my body is not used to any drugs.
cromulent 4y ago
"The dose makes the poison", as Paracelsus said. Everything (including water and oxygen) is toxic at the wrong levels.

daneel_w 4y ago

For me Aspirin takes about three times longer to reach effect compared to Ibuprofen or Paracetamol which "kicks in" after just 15 to 20 minutes. As for getting rid of a headache they're all equally efficient on me.

thenerdhead 4y ago

Aspirin has been a life changer for long Covid. The other painkillers make symptoms 10x worse. Many people wonder if aspirin anti platelet/blood thinning capabilities is helping breakup microclots which brings relief. There’s also a thing called nattokinase that apparently has similar properties to aspirin and is being studied for heart disease. It has been shown to break down blood clots and even degrade the spike protein. NK might be a viable alternative. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043915/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043915/

IE6 4y ago
Do you have any good literature on Aspirin and LC? Not a doubter, actually I have LC myself.
- thenerdhead 4y ago
  I do not. I have my personal anecdote and experiences with common painkillers and LC. I've had it since January 2021 so there wasn't really anything known when I started taking aspirin outside of the many years of research as mentioned in OP's article. Here's my experience so far. https://jondouglas.dev/long-covid/ https://jondouglas.dev/long-covid/ I've swapped aspirin about a year in for nattokinase and have noticed much better management. I still take aspirin here and there, but NK is doing its job. https://pubmed.ncbi.nlm.nih.gov/36080170/ https://pubmed.ncbi.nlm.nih.gov/36080170/ https://www.webmd.com/covid/news/20221207/microclots-may-explain-long-covid-symptoms https://www.webmd.com/covid/news/20221207/microclots-may-exp... https://pharmd.substack.com/p/frequency-asked-questions-nattokinase https://pharmd.substack.com/p/frequency-asked-questions-natt... Hope that helps you. EDIT: I heard about triple anticoagulant therapy but never realized aspirin is included in it. Check out this study here: https://www.researchsquare.com/article/rs-2697680/v1 https://www.researchsquare.com/article/rs-2697680/v1
  - neom 4y ago
    Just adding a +1 for long covid and aspirin, aspirin + CBD cream (Momma Canna Cream, I think only available in Canada) was a game changer for me! I rubbed the CBD cream into my head and neck and took bayer "daily" low dose aspirin till I started to feel normal again (brain fog cleared).

Thaxll 4y ago

I heard that if Aspirin would be discovered today it would not be sold as over-the-counter by big pharma because too dangerous.

MisterBastahrd 4y ago

I rarely take any sort of medication other than my daily allergy tablet and usually a Mucinex during the allergy seasons. My exception is either BC Powder or Goody's for tension headaches and migraines. I'll have em once or twice a month, almost always after sleeping at a crooked angle due to my adjustable bed, and my solution is two packets of powder that usually eradicate the pain within 20 minutes.

daveslash 4y ago

An old mentor of mine used to say: "If they ever invent a miracle drug, it will be aspirin"

SoftTalker 4y ago

"It’s important that we understand how it works so we can develop safer drugs with fewer side effects." Allow me to translate: it's important to understand how it works so we can develop a patented drug that costs 100x more per dose, then we will work on getting aspirin banned due to its "side effects"

1MachineElf 4y ago

Today an allergist told me the random lip swelling I experience (angioterma) has been caused in many other patients by NSAIDs like Aspirin, Tylenol (acetaminophen), and a Alleve (naproxen sodium). I hate to think that's true, but apparently it is a studied phenomena: https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-3-1-24 https://aacijournal.biomedcentral.com/articles/10.1186/1710-...

orev 4y ago
> Tylenol (acetaminophen) Is not an NSAID. One of its primary uses is as a medication for people who can’t use NSAIDs.
- m3047 4y ago
  NSAID: Non Steroidal Anti Inflammatory Drug Tylenol: * Non steroidal? Check. * Anti inflammatory? Hrmmm... not so much. So what are you taking it for again? https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory_drug https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory... It's still a COX-2 inhibitor.
mongol 4y ago
I also get reactions. My eyes get swollen. It works very well as painkiller though but I feel I must avoid it.

jdthedisciple 4y ago

Fun fact: They would give Aspirin to Tzar Nikolas II's (or III?) son who suffered from hemophilia. Came Rasputin the mystic around the corner and advised the Tzar's wife to keep the doctors off her son. As she did, her son miraculously recovered to a great degree. Turns out little did they know Aspirin actually worsenes hemophilia due to thinning the blood.