Comment by hilbert42 | Hacker News Reader

Comment by hilbert42 | Hacker News Reader

I've railed against acetaminophen, aka paracetamol for years. That said, I still take it with care because there's no other drug suitable for the ailments I take it for. Aspirin and other NSAIDs such as ibuprofen are harsh on the stomach, the big guns—the opiates—are totally inappropriate painkillers in all but the most severe pain because of potential for addiction—witness the opioid epidemic—and the newer selective COX-2 NSAIDs, rofecoxib (Vioxx) and celecoxib (Celebrex) have major side effects. Vioxx was banned some years back because it caused heart and related problems in some people and Celebrex has the potential to cause heart issues and is hard on the kidneys.

Essentially, the fallback drug is acetaminophen because there's nothing else. Unfortunately, acetaminophen is an ancient drug discovered in the mid Nineteenth Century and it's been in service for about a century but mainly since WWII. It's classed as coaltar antipyretic which covers a whole range of similar drugs that were or are manufactured from precursors that come from coal. Many of them are related and some are very dangerous (many were withdrawn in the first half of the 20th Century because they literally killed people).

The precursor to acetaminophen is phenacetin which until about thirty years ago was a principal painkiller but was withdrawn from the market after mixtures of it, aspirin and caffeine were found to be rotting people's kidneys out. Phenacetin is also considered carcinogenic.

We still have to rely on this ancient 150+ year old dangerous drug that's barely effective because of a major failing of medical science/pharmaceutical research.

It really is high time we researched much better more effective and safter painkillers and ditched all current coaltar antipyretics, they really aren't that effective and none have been found to be safe.

> We still have to rely on this ancient 150+ year old dangerous drug that's barely effective because of a major failing of medical science/pharmaceutical research.

No it's because we care more about stopping people from getting high than stopping them from being in pain. You said it yourself:

> the big guns—the opiates—are totally inappropriate painkillers in all but the most severe pain because of potential for addiction

Who cares??? It's better to be addicted than suffer. And I have lots of doubts about their addiction potential, because of all the people who have a backwards sense of medicine.

I thought it was the other way around - ibuprofen was generally safer than acetaminaphen

It really depends who you are, but NSAIDs also have their fair share of potential dangers. They are particularly linked to higher risks of heart attacks and strokes [1], but also ulcers and in rare cases other problems.

As for me, whenever I take an NSAID (including Aspirin), my chest feels like it's going to explode. It's not a painful feeling, but it is not a good feeling. It also sometimes gets difficult to breathe. And it's been this way my entire life, so I shun them completely.

As for acetaminophen, the dangers mainly stem from overdose, overuse, and using it with alcohol consumption. Avoid that and it's pretty safe.

[1] - https://www.mayoclinic.org/diseases-conditions/heart-attack/...

Ibuprofen is generally considered safer than Acetaminophen BUT non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen can trigger dangerous stomach acid over production in some patients (source: finding myself in excruciating pain followed by a doctor pushing a camera probe down my throat to examine the damage when this happened to me). That's a minority of patients, obviously, but there are classes of patients who need to take Acetaminophen instead of NSAIDs for various reasons.

Acetaminophen is similar to NSAIDs in many of its beneficial effects but is sufficiently different chemically as to not trigger many of the (rarer) negatives that NSAIDs can trigger.

You don't think research is searching for a safer alternative? It would be a major blockbuster drug.

The reasons we have acetaminophen with all its risks is because there is nothing better.

slow release oxycontin is safe and effective. except when people abuse it by crushing the pills.

Right, opiates work wonderfully effective but how do you stop the abuse and subsequent addition and deaths?

You offer good addiction programs, and stop punishing people with jail for them.

For years pain research and pain alleviation was considered low priority by the medical profession. It strands to reason we need to understand and to continue researching pain before researching painkilling drugs—so we are coming from a low base.

Even after the opioid epidemic and those disreputable Sackler bastards came to worldwide prominence there's been no national initiative like, say COVID research. The problem is that there is not enough research. That's clearly obvious—or it ought to be.

Pain research is front and center for many companies. Look at the Nav1.7 programs - many big pharmaceutical companies are working on them.

I disagree 100% it's not a priority. The companies know they could make a ton of money off of an effective, but more safe pain medicine.

> The reasons we have acetaminophen with all its risks is because there is nothing better.

Of course there are better drugs. But they are not patentable, they are not profitable, and they are not synthesized by chemical factories like the Union Carbide in Bhopal. All of that makes them really unpopular!

Acetaminophen is not patentable and it's dirt cheap to produce. So what unpatentable drugs are better?

That depends on what you call a "drug". Are we using the FDA definition?

FDA or not, what are they?

This is a talking point I hear a lot that has little basis in fact.

There are many active pharmaceutical ingredients that are natural products, modified natural products, or analogues of natural products. See Metformin and French Lilac.

In fact, a big part of what medicinal chemists do is designing “better” molecules. And some well capitalized pharma companies even come out and say their strategy is “best in class, not first in class”.

I mean, most OTC analgesic drugs aren't patentable either, yet companies happily sell them for a profit.

Please list these "better" drugs, I'm eager to start a business around them.

> The reasons we have acetaminophen with all its risks is because there is nothing better.

There is, but we care more about stopping people getting high than we care about stopping people from being in pain.

My wife had an outpatient surgery, and had muscle spasms from incisions. She was SCREAMING in pain. She was brought in by ambulance (who did not give her anything - sort of understandable because sometimes you need to have the patient identify the pain).

Despite continuing to SCREAM in pain, the nurse refused to do anything or contact the doctor, because she was sure she was a druggy just faking it. It took all my energy not to start throwing punches. (A doctor finally got her pain meds.)

Our society is unjust.

Why not take Kratom, or CBD oil? They are extraordinarily effective, no prescription, and very cost-effective. I picked up about 50 doses worth for $20 at a store 2 blocks away, which is closer than the pharmacy, smells nicer, and friendly staff.

Because it's a prohibited substance where I am.

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