Acetaminophen reduces empathy for pain (2016) | Hacker News Reader

Acetaminophen reduces empathy for pain (2016)

washingtonpost.com

133 pointslukas93 comments

The article doesn't make clear whether the study participants were given acetaminophen to relieve pain (e.g. a headache), or whether they were simply given the drug regardless of whether they were currently experiencing pain. So I looked up the pharmacological procedures in the study itself, which confirms that it's the latter case. The drug was administered regardless of whether the subjects were experiencing any pain for which acetaminophen would be an appropriate treatment.

I would think it's at least conceivable that the body reacts differently to acetaminophen when it's used to treat pain, versus when it's administered even if the subject is not in pain. And especially since most people take acetaminophen for some pain-relieving purpose, rather than for no purpose at all, I would think it's important to try to emulate those real-world conditions when designing studies like this (although clearly it's difficult to control for something as subjective as pain).

Side note: I absolute hate when articles about scientific studies don't even name the study so you can look it up. In this case, the study appears to be titled "From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain" and the full text is available here:

https://academic.oup.com/scan/article/11/9/1345/2224135/From...

Maybe you could hit study participants in the head with a stick.

I also remember reading that there was some evidence that acetaminophen (and possibly other NSAIDs) helped with anxiety [1] - the idea being that social pain and physical pain are similar.

It seems like reducing empathy might be the same thing - a more general dulling of emotions. On a personal note I've found Aleve works really well (better than Tylenol) when I'm feeling anxious, but maybe that's just placebo. I originally read about the Tylenol affect after feeling surprisingly less anxious when I took Aleve and searching around.

[1] https://blogs.scientificamerican.com/mind-guest-blog/tomorro...

FWIW, acetaminophen is not an NSAID.

Also, the common characteristic of NSAIDs is their anti-inflammatory nature (the AI in NSAID), which addresses injury-related pain by locally reducing swelling. This pathway for the class of drugs is unlikely to provide anxiety benefits.

Prostaglandin E2 inhibits the release of endorphins so suppressing prostaglandins may have an impact on anxiety.

they actually mention that and even cite a whole other study that test if physical side effects are different between people without pain and people with flu induced pain. spoiler, no.

I wonder if the outcome of the study could also be affected (in part) by emotional states associated with past uses of acetaminophen.

In the past, there have been people close to me that used aromatic "remedies" like essential oils for headaches and other ailments, to the point that now whenever I smell those scents, I unconsciously start feeling as though I am (or someone near me is) sick or in pain. I suspect there may be similar effects (conscious or not) with drugs that have historical associations in the minds of participants in the study. Rather than an associated smell, perhaps an altered state of body/brain chemistry could make similar memorable impressions.

Interesting to me -- as a kid, the only place I smelled lily flowers was at funerals. Their pungent and slightly unpleasant odor I thought was enbalming fluid, or something else associated with dead bodies. I can't smell them to this day without immediately associating them with the pallid, sunken skin of dead, elderly white folks.

There was also this paper from 2013, about acetaminophen relieving "existential dread". The experiemental setup induced subconscious anxiety by making the subjects watch David Lynch's short film "Rabbits", then measured it's effect on strictness when recommending fines for hockey rioters.

The researchers concluded, "Despite the many questions that these findings raise, they do demonstrate that acetaminophen has more far-reaching psychological consequences than previously realized, and that a single pill can serve as an effective manipulation in the lab."

https://www.sciencedaily.com/releases/2013/04/130416085431.h...

http://journals.sagepub.com/doi/10.1177/0956797612464786

So if it numbs not just pain but your empathy feelings as well, could it also numb feelings like depression or anxiety?

EDIT: After a quick search, the answer seems to be yes?

https://www.ncbi.nlm.nih.gov/pubmed/26357585

http://time.com/3825042/tylenol-emotion-acetaminophen/

https://www.sciencedaily.com/releases/2009/12/091222154742.h...

https://www.psychologytoday.com/blog/the-superhuman-mind/201...

Related: Opioids reduce feelings of loneliness.

I can attest to that. Please don't use them for this though. It can lead to a downward spiral, I went through that some years ago. Seek help, and keep seeking help. Mental health is neglected in our society, IMO.

I don't think it's that neglected, but it's incredibly expensive even with a good insurance policy.

Anecdotal but I believe this happened to me...I took maximum daily dosage for 2 years and most likely other factors resulted in this, but I wouldn't be surprised if this did too. I used to feel awful about people's problems, depressing stories used to make me want to do anything to help, seeing homeless on the street near a fast food place made me often buy them a meal, and I used to care so much about friends' problems but I 90% stopped caring. Honestly can't say it's a bad thing either, I finally am focusing more on myself but it is a huge change in my life.

Did the dosage cause a permanent shift in your behavior?

Not outwards behavior but things that used to seem like such a big deal became trivial. Again anecdotal so don't put any stock in what I'm saying, I just found this to be interesting

Sometimes those anecdotes are actually pretty revealing.

Get a liver enzyme test. It's very hard on the liver, especially if you consume alcohol at the same time. Acetaminophen/paracetamol is not as harmless as most people think. It has wrecked many-a-liver.

It's the #1 cause of liver failure in the United States. [1]

[1] https://www.medpagetoday.com/psychiatry/depression/2233

But your link is talking about short term use - deliberate or accidental overdose. It's not talking about normal long term use.

Paracetamol is commonly used in overdosing because people don't understand how dangerous an overdose is; they don't understand how painful a death from liver failure is; paracetamol is available off the shelf in large quantities; and many people have stocks of it in their homes.

Indeed, your link suggests that long term use is not harmful:

> But in an accompanying editorial, John G. O'Grady, M.D., of the Institute of Liver Studies at King's College Hospital in London cautioned that there's no need for panic, because acetaminophen-associated liver toxicity is uncommon, and the drug itself is not toxic.

> "Measures to minimize acetaminophen hepatotoxicity are important but need to be considered in the context that the apparent scale of the problem is a reflection of the huge number of patients taking acetaminophen with good effects and in the absence of any adverse event," Dr. O'Grady wrote.

> "Educational initiatives to highlight the range of preparations containing acetaminophen, together with reiteration of advice on maximum daily dosing, have potential benefits, especially with respect to unintentional overdosing," he added.

And it says this:

> The data suggest that consistent use of as little as 7.5 g/day of acetaminophen could lead to severe hepatic injury, Dr. Larson and colleagues wrote.

That's a lot! The recommended dose on the box is 4 g per day - 4 doses of 1 g each, with 4 hours in between them.

You may have been experiencing "compassion fatigue":

https://en.wikipedia.org/wiki/Compassion_fatigue

"Compassion fatigue, also known as secondary traumatic stress (STS), is a condition characterized by a gradual lessening of compassion over time. It is common among individuals that work directly with trauma victims such as, therapists (paid and unpaid), nurses, teachers, psychologists, police officers, paramedics, animal welfare workers, health unit coordinators and anyone who helps out others..."

I had never heard the name "Acetainophen", apparently it's the same as Paracetamol.

From wiki:

"Both acetaminophen and paracetamol come from a chemical name for the compound: para-acetylaminophenol and para-acetylaminophenol."

The former is the name used by the United States Adopted Name (USAN) while the latter is the (International Nonproprietary Name (INN) one.

Ah, that explains why I've only heard the name acetaminophen (I'm an American)

Same for Tylenol (most common branded version of the drug, at least in the US): para-acetylaminophenol

Paracetamol is the far more common name. In the US and a handful of other countries they call it "acetaminophen", though.

"If your job ... depends on feeling empathy for others, you might want to reconsider reaching for the Tylenol"

I'm afraid many "competitive" jobs depend on the opposite.

Like those thousands Facebooks and Reddit mods, whose job is to deal with unspeakable horrors every day.

Though I suspect that acetaminophen might not be enough in this case, and they use a stronger drug with proven effect of easing emotional pain: ethanol.

I wonder if other pain relievers do the same. Has there been any work with aspirin, ibuprofen, or prescription pain relievers along these lines?

This is exactly my question. We know that many painkillers work on the pain caused by heartbreak, for example. Does this effect have a similar root cause? If so, it would be reasonable to conclude that many painkillers would cause this as well. The advice in the article would therefore be at best useless.

> About a quarter of all Americans take acetaminophen every week.

Wow. That seems rather high.

The reference they give is http://jamanetwork.com/journals/jama/fullarticle/194572 . Apparently it's the most commonly taken drug, number 2 and 3 were ibuprofen and aspirin.

To be precise, in a given week, 23% of Americans had taken Acetaminophen. (I guess the sentence is a bit ambiguous.)

>in a given week, 23% of Americans had taken Acetaminophen

That's still wildly high though, no? So nearly a QUARTER of Americans are on that painkiller at any given time (give or take duration). Never mind A painkiller...that particular one???

The whole concept of ~25% painkiller usage just blows my mind. And that's from someone that used to take heavy grade stuff for a year straight. (Now I just take the occasional ibu for some DOMS).

5% of Americans aged 15 to 64 took an opioid pain killer last year.

http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta...

Could this be broadened to say that those who have coping mechanisms for pain have less empathy for the pain of others? As an explanation why the well off seem to have less empathy for the less well off.

I suspect that this result extends to most painkillers. It was demonstrated before that emotional pain and physical pain are partially regulated by the same mechanisms, so painkillers work for emotional pain too (though less effective than specialized drugs) -- which will prevent sharing emotional pain from some situations, which can be reinterpreted as diminished empathy.

Wow, pretty crazy find. Seems like a decent sample size too. I hope someone tries to reproduce the results!

I wonder if opiates (or other painkillers) have the same effect. Most of the opiate drugs, such as hydrocodone, are mixed up with acetaminophen anyway in pill form. For example, a norco 5/325 is 5 mg of hydrocodone and 325 mg of acetaminophen.

I googled and found this article, which suggests they would. http://www.sciencemag.org/news/2015/09/dulling-pain-may-also...

Apparently, in this experiment they did not use actual opioid drugs but instead used a placebo protocol (to avoid side effects), but they did produce the empathy reduction effect. And this effect was cancelled out by giving the test subjects naltrexone, so it does seem to be dependent on the opioid receptors.

In regards to the second experiment, isn't that kind of an obvious result? You take a painkiller, so the white noise causes you less pain, so you think that other people in the study are in less pain, which makes you seem less empathetic?

No mention of effect size. N=200 is pretty small. Smells a bit like BS. Anyone have the original paper?

You're down voted but I agree. 200 participants split into A/B for yes/no drugs, 8 scenarios and 3 different tests makes the sample incredibly small.. would like to hear statistical arguments opposing my PoV

Pretty standard for this type of research

"Everybody does it" is not really a statement about its validity.

Straight from the paper:

> we determined sample size based on previous research which indicated that a sample size of about 40 participants per cell provides sufficient power to detect a behavioral effect of acetaminophen (Durso et al., 2015). For Experiment 2, a power-analysis based on a power criterion of (1−β) = 0.80 and effect sizes obtained in Experiment 1 indicated that a mean cell size of n = 54 was sufficient to replicate significant findings

I imagine military should be very interested in this.

The Infantry are already Tylenol's biggest fans...

Might explain baby boomer behavior

There is unlikely to be a cultural or generational explanation other than having the benefits of working when there was decent income combined with mostly less violence plus higher civilized behavior standards.

https://www.ted.com/talks/paul_piff_does_money_make_you_mean

https://en.wikipedia.org/wiki/The_Better_Angels_of_Our_Natur...

Nice istock photo there.

May 12, 2016

Acetaminophen

Hate the click bait headlines, totally degrading to a paper like Washington post that presumably wants to maintain respectability. But you won't believe what happens next!

Nowadays I never visit the actual article, just going through HN comments will often summarize the topic better.

Probably not the best idea. While they do tend to summarise well, comments tend to be filled with opinion - generally a better idea to ensure you form your own, rather than rely on a potentially biased third party.

The original article is also generally biased and filled with opinion. At least the comments might have a diversity of bias.

This is what I've been telling myself. Usually skim the article and then read the comments.

Just accept you're being lazy. Nothing wrong with that, though.

I also find that the discussions in certain comments/responses can tend to go largely off topic. When you're on mobile, instead of scrolling ALL the way down to the next parent comment, you (I, at least), tend to navigate away to other HN posts.

HN has comment folding. Activate it by clicking the minus sign next to the "timestamp" to hide the comment and it's children.

But the article is a biased opinion of a single third party? It's better to rely on HN comments where the discussion is open rather than blindly accepting what a journalist writes.

This + the fact it feels like every other article being posted on HN is behind a paywall

On HN, you'll sometimes even get domain experts weighing in with commentary, and links to other relevant material.

Here's the original article, with weighting[1] and in fulltext[2]:

1 = https://pubrank.carbocation.com/pmid/27217114

2 = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015806/

My favorite HN moment was when we were all debating whether a crew could burn a shipwrecked boat for several years. Someone who happened to be burning a boat for fuel for years stepped in and confirmed it. https://news.ycombinator.com/item?id=10803552

Thank you for posting this!

Mine (in this vein at least) was when someone posted an article about optimizing FedEx's location and then someone who was involved with it stepped in and gave the real story: https://news.ycombinator.com/item?id=9281466

I do the same when I'm roaming and need to save bandwidth! Very efficient.

Also, it doesn't "kill kindness", it reduces the empathy of test subjects, but actually what they measured is estimations of the pain experienced by others. Which doesn't seem exactly like empathy, and definitely isn't kindness, because kindness is action.

It's total clickbait, and misleading too.

After the Bezos acquisition, the Washington Post abandoned their already lowered standards. They're now racing to the bottom to become BuzzFeed 2.0.

Don't forget their long status as a mockingbird operation. You got downvoted with no comment because there is very little intellectually honest retort to be had, but in their defense, the surveillance state and general degredation of journalism as a whole has affected much more than just WaPo.

The fourth estate is dying and the internet, which should be it's replacement, is under legislative attack because it is a threat to the oligarchy.

Well, the internet is also under attack from various actors seeing to distort the narrative for their own means. Tons of planted comments and highly questionable "news" websites".

Traditional media had similar problems, but to a much lesser extend... and the biases/propaganda were much more obvious.

Indeed, the sockpuppetry really hit hard around 2010/2011, and I've yet to see a website handle it very well. Honestly HN is one of the last places I take the actual time to comment on because of it. There are some methods that slashdot uses that I think could also be helpful, but there is no easy fix.

Like you said though, one interesting side-effect is that for the astute reader you can discern what the talking points of the day/week/month are by paying attention to the narrative.

For folks who didn't understand the Operation Mockingbird reference, it seems to refer to the CIA in the 50s - 70s hiring the publisher & co-owner of the Washington Post, to run a propaganda operation feeding misinformation to reporters at all the major newspapers in the US:

https://en.wikipedia.org/wiki/Operation_Mockingbird

I dunno, personally I feel they've done decently with covering politics lately.

If I'm going to read a daily, it's probably the Washington Post, NY Times or the WSJ. I haven't noticed a particular drop in quality of any of those three. Why do you think the Post has gotten worse?

In case there are any Non-Americans here wondering what Acetaminophen is, it's Paracetamol.

We've updated the title from “This popular painkiller also kills kindness” to that of the linked study: https://academic.oup.com/scan/article/11/9/1345/2224135/From....

The entire news industry is in dire straits so clickbait is only going to get worse. I remember it was just 10 years ago, the news industry was desperately trying to game the SEO to stay afloat, now they have entire social media teams dedicated to clickbaiting headlines and spamming stories on social media. WaPo got a huge cash infusion from Bezos ( AMZN founder ) and they hired a bunch of social media "experts" so they will be at the forefront of the new clickbait norm. Despite Bezos' assertions, he is going to expect "dividends" from his investment in WaPo.

Whereas other industries fully recovered from the financial crisis via cheap debt, the news industry only stopped the bleeding. Their wound hasn't healed and only that cheap debt goes away, the blooding letting in the industry is going to happen again. So you can't blame them for trying any desperate tactic to stave off layoffs/collapse/etc.

But if you think about it, the news industry has always been at the forefront of clickbait. In the late 1800s, during the heyday of yellow journalism, Hearts and Pulitzer intentionally lied and pushed clickbait via their news properties. If you were around during 2000, you know that the news industry feasted on the Y2K scaremongering clickbaits.

I think the clickbait was always there. It's just now, people are more aware of it.

The same story without an ad-blocker-blocker http://www.independent.co.uk/news/science/popular-painkiller...

Thanks! Time to build an ad-blocker-blocker-blocker.

Turn on the Adblock Warning Removal List and Anti-Adblock Killer in uBlock Origin.

There is one. It's called: just disable javascript.

uBlock Origin already has this. I don't see any ads on the article.

I’d be in favor of two changes to the HN title:

1. s/This popular painkiller/Acetaminophen/

2. (2016)

s/This popular painkiller/Acetaminophen, the active ingredient in Tylenol,/

I, for one, never studied chemistry.

Everywhere other than the US, it's far more commonly known as paracetamol.

In much the same way that nobody calls aspirin "acetylsalicylic acid", paracetamol is the generic name, except in the US for some reason.

Follow-up question: why does it seem like some drugs are packaged kinda like candy for the American market? (https://www.google.de/search?q=tylenol&tbm=isch vs. http://www.verschnupft.com/wp-content/uploads/Paracetamol-Ra...)

There's off-brand / store-brand drugs that are the same and usually packaged with less marketing, but flashy packaging with name-brand products sell more. They usually charge more too.

I think it's the difference between brand names and non-brand names. Tylenol is a brand-name thus tries to distinguish itself from the generics on the shelf next to it.

This happens in the UK/IE as well.

As a comparison.

Panadol (UK/IE) brand name for acetaminophen: https://www.google.de/search?q=panadol&tbm=isch

Walzyr. US "generic" anti-histamine: https://pics.drugstore.com/prodimg/419979/450.jpg

Claratin. US Brandname anti-histamine: https://images-na.ssl-images-amazon.com/images/I/91rArvDAp9L...

The US also tends not to have true generic drugs, but 'store brand' generics. So a store will carry Tylenol + a single store brand generic, instead of Tylenol + 5 different companies generic brands.

And I never lived in North America - acetaminophen is used in 6 countries, the international name otherwise is paracetamol. Tylenol is a brand name in 14 countries worldwide. (Numbers from Wikipedia.)

I find using brand names for drugs less-than useful in international contexts. Brand names differ between countries, generic names don't (except paracetamol/acetaminophen).

As a Brit, I would have no idea what "Tylenol" is, so I'd question the usefulness of using brand names.

Mods, this is a repost from (2016).

Reply on news.ycombinator.com