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Finally, great bat­tery life in a Framework Laptop

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17 hours

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Power-efficient mem­ory, made up­grade­able

We’re among the first to pair Intel® Core™ Ultra Series 3 with LPCAMM2. A high-den­sity in­ter­poser en­ables LPDDR5X in a mod­u­lar form, de­liv­er­ing 7467 MT/s and high per­for­mance per watt with­out sol­der­ing it down.

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You can cus­tomize it,

Pick your ports with the Framework Expansion Card sys­tem and in­stall them di­rectly into your lap­top with­out re­ly­ing on ex­ter­nal adapters. The mag­net-at­tach Bezel lets you cus­tomize with bold or translu­cent color op­tions.

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Storage - 250GB

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re­pair it,

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up­grade it.

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We don’t just sup­port Linux; we live in it. Framework Laptop 13 Pro with Intel® Core™ Ultra Series 3 is our first Ubuntu Certified sys­tem. We seed de­vel­op­ment hard­ware and pro­vide fund­ing to a range of other dis­tros like Fedora, Bazzite, NixOS, CachyOS, and more to en­sure re­li­able sup­port.

A sen­sory up­grade

13.5″ 2880x1920 Touchscreen Display

A cus­tom 13.5″ 3:2 touch­screen dis­play with sharp 2880×1920 res­o­lu­tion gives you the ver­ti­cal space you need for cod­ing and pro­duc­tiv­ity. A 30 – 120Hz vari­able re­fresh rate keeps mo­tion smooth while op­ti­miz­ing power, and with up to 700nits of bright­ness and a matte sur­face, it stays clear across a wide range of light­ing con­di­tions.

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The large 123.7mm × 76.7mm Haptic Touchpad, pow­ered by four piezo­elec­tric ac­tu­a­tors, de­liv­ers con­sis­tent, high-qual­ity clicks across the sur­face. Feedback and ges­tures are fully tun­able, so you can set it up ex­actly how you want.

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With 1.5mm of key travel, the key­board de­liv­ers deeper, more tac­tile feed­back than most mod­ern lap­tops with­out in­creas­ing noise. A CNC alu­minum Input Cover Frame re­duces deck flex for a more solid and con­sis­tent feel. Available in mul­ti­ple ANSI and ISO lay­outs, in black, black with laven­der, and black with gray and or­ange.

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Depth

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Weight

Open source ecosys­tems

We’ve open sourced de­sign files and doc­u­men­ta­tion for many core com­po­nents and firmware on GitHub, giv­ing you the free­dom to mod­ify, ex­tend, or re­pur­pose them.

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Privacy switches

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Testing con­ducted by Framework in April 2026 us­ing Framework Laptop 13 Pro tested with Intel® Core™ Ultra X7 358H Processor, Intel® Arc™ B390 graph­ics, 2.8K touch­screen dis­play, 32GB mem­ory and 1TB stor­age, with dis­play bright­ness set to 250nits, dis­play re­fresh rate set to 60Hz, speaker vol­ume as 30%, Dolby Atmos® dis­abled, and wire­less en­abled. Battery life tested by stream­ing Netflix 4K con­tent in the Netflix app on Windows 11 un­der Best Power Efficiency mode. Battery life varies by use and con­fig­u­ra­tion.

A col­lec­tion of prin­ci­ples and pat­terns that shape soft­ware sys­tems, teams, and de­ci­sions.

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Dynomight

Acetaminophen, ibupro­fen, and what doc­tors prob­a­bly want you to know.

Lots of peo­ple die af­ter over­dos­ing on ac­eta­minophen (paracetamol, of­ten sold as Tylenol or Panadol). In the U.S., it’s es­ti­mated to cause 56,000 emer­gency de­part­ment vis­its, 2,600 hos­pi­tal­iza­tions, and 500 deaths per year. 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.

Meanwhile, it seems to be re­ally hard to kill your­self by over­dos­ing on ibupro­fen (Advil, Nurofen, Motrin, Brufen). In 2006, Wood et al. searched the med­ical lit­er­a­ture and found 10 doc­u­mented cases in his­tory. Nine of those cases in­volved com­pli­cat­ing fac­tors, and in the 10th, a woman took the equiv­a­lent of more than 500 stan­dard (200mg) pills.

So, for many years, 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. I’m fond of my liver and did­n’t want to cause it any un­nec­es­sary in­con­ve­nience.

But guess what? My logic was wrong and what I was do­ing was stu­pid. I’m now con­vinced 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. In fact, I think many doc­tors think it’s ob­vi­ous. (Source: I asked some doc­tors; they said it was ob­vi­ous.)

Should this have been ob­vi­ous to me? I fig­ured it out by ob­ses­sively re­search­ing how those drugs work and mak­ing up a story about meta­bolic path­ways and blood flow, and amino acid re­serves. It’s a good story, one that re­vealed that my logic stemmed from an egre­gious lack of re­spect for bi­ol­ogy and that I’m a big dummy (always a fa­vorite sub­ject). But if the clear­est road to some piece of knowl­edge runs through meta­bolic path­ways, then I don’t think that knowl­edge counts as ob­vi­ous.

So how is a nor­mal per­son meant to fig­ure it out? Why does­n’t the fact that ac­eta­minophen is typ­i­cally safer than ibupro­fen ap­pear on drug la­bels or gov­ern­ment web­sites or WebMD? Are nor­mal peo­ple sup­posed to fig­ure it out, or has so­ci­ety de­cided that this is the kind of thing best left il­leg­i­ble?

Note: You should not switch med­ica­tions based on the un­in­formed ram­blings of non-trust­wor­thy pseu­do­ny­mous in­ter­net peo­ple.

How does ibupro­fen work?

Ibuprofen in­hibits the body’s pro­duc­tion of the Cyclooxygenase (COX) en­zyme. This in turn in­hibits the for­ma­tion of mes­sen­ger mol­e­cules in­volved in in­flam­ma­tion, which leads to less phys­i­cal in­flam­ma­tion and thus less pain.

The same story is true for al­most all over-the-counter painkillers, which is why they’re al­most all con­sid­ered “non-steroidal anti-in­flam­ma­tory drugs,” or NSAIDs. This in­cludes ibupro­fen, as­pirin, naproxen (Aleve), and a long list of re­lated drugs. But it does not in­clude ac­eta­minophen.

How does ac­eta­minophen work?

Nobody knows!

Like ibupro­fen, ac­eta­minophen in­hibits some COX en­zymes. But it does so in a weird way that barely af­fects in­flam­ma­tion or mes­sen­ger mol­e­cules, so it’s un­clear if this mat­ters for pain re­duc­tion.

In the brain,  ac­eta­minophen is me­tab­o­lized into a mys­te­ri­ous chem­i­cal called AM404. This ac­ti­vates the cannabi­noid re­cep­tors and in­creases en­do­cannabi­noid sig­nal­ing, which seems to re­duce the sub­jec­tive ex­pe­ri­ence of pain. AM404 also ac­ti­vates the cap­saicin re­cep­tor, which is as­so­ci­ated with burn­ing sen­sa­tions that you’d nor­mally ex­pect to in­crease pain, but maybe some de­sen­si­ti­za­tion thing hap­pens down­stream? And maybe ac­eta­minophen also in­ter­acts with sero­tonin or ni­tric ox­ide or does other stuff? How this all comes to­gether to re­duce pain is still some­what a sci­en­tific mys­tery.

Aside: When try­ing to un­der­stand painkillers, it’s nat­ural to fo­cus on chem­istry and mol­e­c­u­lar bi­ol­ogy. But the un­known phys­i­cal ori­gins of con­scious­ness are al­ways nearby, loom­ing omi­nously.

What risks does ibupro­fen have?

In an ideal world, the only thing ibupro­fen would do is re­duce in­flam­ma­tion in the part of your body that hurts. But that is not our world. When ibupro­fen in­hibits the COX en­zymes, it does so through­out the body. And mostly, that is bad.

For one, ibupro­fen re­duces pro­duc­tion of mu­cus in the stom­ach. That might sound okay or even good. But stom­ach mu­cus is im­por­tant. You need it to shield the lin­ing of your stom­ach from your ex­tremely acidic gas­tric juice.1

Having less mu­cus can lead to gas­troin­testi­nal prob­lems or even ul­cers.

Ibuprofen also af­fects the heart. When ibupro­fen in­hibits the COX en­zymes there, this in turn in­hibits one chem­i­cal that pre­vents clot­ting and an­other that causes clot­ting. In bal­ance, this seems to lead to more clot­ting, and an in­creased sta­tis­ti­cal risk of heart at­tacks 2

. If you’re healthy, the risk of a heart at­tack from an oc­ca­sional low dose of ibupro­fen is prob­a­bly zero. But if you have heart is­sues and take medium to large doses reg­u­larly for as lit­tle as a few days, this might  be a se­ri­ous con­cern.

Ibuprofen also af­fects the kid­neys. If you’re stressed, or cold, or de­hy­drated, or take stim­u­lants, your body will con­strict your blood ves­sels. That squeezes your kid­neys’ in­take tube, de­priv­ing them of blood. Your kid­neys don’t like that, so they re­lease sig­nal­ing mol­e­cules to lo­cally re-di­late the blood ves­sels.

Trouble is, when ibupro­fen in­hibits COX en­zymes in the kid­neys, it in­hibits those sig­nal­ing mol­e­cules. If every­thing is nor­mal, that’s okay, be­cause the kid­neys would­n’t try to use those mol­e­cules any­way. But if your body has clamped down on the blood ves­sels, then the kid­neys don’t have the tool they use to keep blood flow­ing, mean­ing they don’t get as much blood as they want. This is bad.3

There are many other less com­mon side ef­fects, in­clud­ing al­ler­gies, res­pi­ra­tory re­ac­tions in asth­mat­ics, in­duced menin­gi­tis, and sup­pressed ovu­la­tion. If you take a lot of ibupro­fen, this could hurt your liver. But the ma­jor con­cerns seem to be the stom­ach, the heart, and the kid­neys.

What risks does ac­eta­minophen have?

Acetaminophen also in­hibits some COX en­zymes. But un­like ibupro­fen, the ef­fect is min­i­mal out­side the cen­tral ner­vous sys­tem. Thus, ac­eta­minophen has lit­tle ef­fect on stom­ach mu­cus, blood clots, or blood flow, and so pre­sents al­most none of the risks that ibupro­fen does.

Even so, if you take too much ac­eta­minophen at once, you could eas­ily die.

How does this hap­pen? Well, when ac­eta­minophen is me­tab­o­lized by the liver, it’s mostly bro­ken down into harm­less stuff. But a small frac­tion (5 – 15%) is bro­ken down by the P450 sys­tem into an ex­tremely toxic chem­i­cal called NAPQI.

Ordinarily this is fine; your body cre­ates and neu­tral­izes toxic stuff all the time. For ex­am­ple, if you drank 20 grams of formalde­hyde, you’d likely die. But did you know that your body it­self makes and processes ~50 grams of formalde­hyde every day? When liver cells sense NAPQI, they im­me­di­ately re­lease glu­tathione, which binds to NAPQI and ren­ders it harm­less.

But there’s a prob­lem. If you take too much ac­eta­minophen at once, the path­ways that break it down into harm­less stuff get sat­u­rated, but the P450 sys­tem does­n’t get sat­u­rated. This means that not only is there more ac­eta­minophen, but also that a much larger frac­tion of it is bro­ken down into NAPQI. Soon your liver cells will run out of glu­tathione to neu­tral­ize it. Then, NAPQI will build up and bind to var­i­ous pro­teins in the liver cells (especially in mi­to­chon­dria) caus­ing them to mal­func­tion and/​or com­mit sui­cide. This can cause to­tal liver fail­ure.

So you should never take more than the rec­om­mended dose of  ac­eta­minophen.4

If you do take too much, you should go to a hos­pi­tal im­me­di­ately. They will give you NAC, which will re­plen­ish your glu­tathione and neu­tral­ize the NAPQI. Your prospects are good as long as you get to the hos­pi­tal within a few hours. 5

6

Acetaminophen has lots of other pos­si­ble side ef­fects, like skin is­sues and blood dis­or­ders. But these all seem to be quite rare.

What if you have liver is­sues?

The pri­mary con­cern with ac­eta­minophen  is liver dam­age. So if you have liver dis­ease, then surely you’d want to avoid ac­eta­minophen and take ibupro­fen in­stead, right?

Nope. It’s the op­po­site. Liver dis­ease shifts the bal­ance of risk in fa­vor of ac­eta­minophen.

With liver dis­ease, it’s hard for blood to flow into the liver, mean­ing that blood tends to pool in the ab­domen. To counter this, blood ves­sels else­where in the body con­tract. This in­cludes blood ves­sels around the kid­neys.

Remember the kid­neys? Again, when blood ves­sels are con­stricted, the kid­neys send out sig­nal­ing mol­e­cules to lo­cally re-di­late the blood ves­sels. But those sig­nal­ing mol­e­cules are blocked by ibupro­fen. So if you have liver dis­ease, tak­ing ibupro­fen risks starv­ing your kid­neys of blood just like if you were de­hy­drated.

Meanwhile, peo­ple with mod­er­ate liver dis­ease are usu­ally still able to process ac­eta­minophen with­out is­sue, as long as it’s in smaller amounts. So doc­tors usu­ally tell pa­tients with liver dis­ease to avoid ibupro­fen and take  ac­eta­minophen in­stead, just with a max­i­mum of two grams per day in­stead of four.

(Obviously, if you have liver dis­ease, then you should talk to a doc­tor, I beg you, for the love of god.)

What about other sit­u­a­tions?

The main take­away from all this is that the risks of both drugs emerge from the mad­house of com­plex­ity that is your body. Surely there are some sit­u­a­tions where ac­eta­minophen is more dan­ger­ous than ibupro­fen?

I tried to cap­ture the most com­mon sit­u­a­tions in this table:

It’s ac­tu­ally fairly hard to find sit­u­a­tions where ibupro­fen is safer than ac­eta­minophen. Possibly this is true if you’re hun­gover, but I would be very care­ful, be­cause you tend to be de­hy­drated when hun­gover, rais­ing the risk of kid­ney dam­age. (It’s prob­a­bly op­ti­mal, from a health per­spec­tive, to avoid tak­ing recre­ational drugs at doses that leave you phys­i­cally ill the next day.)

Aside from hang­overs, the only sit­u­a­tions I could find where ibupro­fen might be safer than ac­eta­minophen  are if you’re tak­ing cer­tain anti-seizure or tu­ber­cu­lo­sis drugs or maybe if you have a cer­tain en­zyme de­fi­ciency (G6PDD).

So…

What have we learned so far?

1. The body is re­ally com­pli­cated!

2. The main risk of ac­eta­minophen is liver dam­age by cre­at­ing too much NAPQI. Taking too much at once can eas­ily kill you. However, as long as you don’t take too much at once and your liver is­n’t de­pleted, then your liver will main­tain NAPQI lev­els at zero and it will be com­pletely fine. And there are very few other risks.

3. Meanwhile, ibupro­fen poses a risk of gas­troin­testi­nal is­sues, heart at­tacks, or kid­ney dam­age. The risk varies based on lots of fac­tors like whether you’ve eaten food, whether you’re de­hy­drated, your blood pres­sure, and your heart health.7

4. Therefore, ac­eta­minophen is prob­a­bly safer, pro­vided you never take too much.8

I don’t want to be alarmist. If you’re healthy, the risk from tak­ing an oc­ca­sional dose of ibupro­fen as di­rected is ex­tremely low. Given that so many peo­ple find that ibupro­fen is more ef­fec­tive for many kinds of pain, it’s to­tally rea­son­able to use it. I do so my­self.

Still, it seems to be the case that in the vast ma­jor­ity of sit­u­a­tions, ac­eta­minophen is safer. Personally, if I have pain, I first take ac­eta­minophen, and then add ibupro­fen if nec­es­sary. I’m pretty sure many ex­perts think this is some­where be­tween “sensible” and “obvious.”

But if ac­eta­minophen is safer, then why don’t of­fi­cial sources tell you that?9

I can get doc­tors to ad­mit this off-the-record. I can find ran­dom com­ment threads with sup­port from peo­ple who seem to know what they’re talk­ing about. But why does this fact never ap­pear on gov­ern­ment web­sites or drug la­bels?

Let’s look at those drug la­bels

In the U.S., the Food and Drug Administration (FDA) cre­ates10

a “drug facts” la­bel for over-the-counter drugs.

Here’s what that looks like for ibupro­fen:

And here’s what it looks like for ac­eta­minophen (acetaminophen):

I feel dumb say­ing this, but when I saw those la­bels in the past, I thought of them as a bunch of ran­dom in­for­ma­tion thrown to­gether for le­gal rea­sons. But af­ter spend­ing a lot of time try­ing to un­der­stand these drugs my­self, I now re­al­ize that these la­bels are… re­ally good?

Imagine you work at the FDA and it’s your job to write a safety la­bel. You need to syn­the­size a vast and murky sci­en­tific land­scape. Your la­bel will be read by peo­ple with min­i­mal sci­en­tific back­ground who are likely cur­rently in pain, and who could die if they take the drug in the wrong sit­u­a­tion.

If I were in that sit­u­a­tion, I’d think about all the dif­fer­ent sit­u­a­tions in which tak­ing one of these drugs could lit­er­ally kill some­one, and then — af­ter a quick panic at­tack — I’d write a la­bel that screamed, HEY, IF YOU ARE IN ANY OF THESE SITUATIONS, TAKING THIS DRUG COULD LITERALLY KILL YOU. Then I’d think about all the other sit­u­a­tions where tak­ing the drug might be okay de­pend­ing on a set of com­plex sci­ence stuff and tell peo­ple in those sit­u­a­tions to PLEASE TALK TO A DOCTOR FOR THE LOVE OF GOD be­cause I DON’T KNOW IF YOU’VE HEARD BUT SCIENCE IS COMPLICATED. Everything else would be a mi­nor con­cern.

From that per­spec­tive, these la­bels are a tri­umph. This is­n’t ran­dom in­for­ma­tion — every word is a syn­the­sis of a moun­tain of re­search, care­fully op­ti­mized to save lives.

FDA good

How did those drug la­bels come to be?

If you want a taste for the FDA’s process, I en­cour­age you to skim the 2002 Federal Register doc­u­ment in which the FDA pro­posed to up­date ibupro­fen’s safety la­bel and to for­mally clas­sify it as Generally Recognized as Safe. It’s more than 21,000 words long and — I think — as­ton­ish­ingly good. It not only sum­ma­rizes the en­tire med­ical lit­er­a­ture on ibupro­fen, it sum­ma­rizes it well. Here is onerep­re­sen­ta­tive bit:

Bradley et al. (Ref. 42) con­ducted a 4-week, dou­ble-blind, ran­dom­ized trial in 184 sub­jects com­par­ing the ef­fec­tive­ness and safety of the max­i­mum ap­proved OTC daily dose of 1,200 mg of ibupro­fen (number of sub­jects (n) = 62) to that of a pre­scrip­tion dose of 2,400 mg/​day (n = 61), and to 4,000 mg/​day of ac­eta­minophen (n = 59) for the treat­ment of os­teoarthri­tis. While there were no sig­nif­i­cant dif­fer­ences in the num­ber of side ef­fects re­ported dur­ing this study, the study demon­strated a trend to­wards a dose de­pen­dent in­crease in mi­nor GI ad­verse events (nausea and dys­pep­sia) as­so­ci­ated with higher doses of ibupro­fen (1,200 mg/​day: 7/62 or 11.3 per­cent; ver­sus 2,400 mg/​day: 14/61 or 23 per­cent). In ad­di­tion, two sub­jects treated with 2,400 mg/​day of ibupro­fen be­came pos­i­tive for oc­cult blood while par­tic­i­pat­ing in the study.

Bradley et al. (Ref. 42) con­ducted a 4-week, dou­ble-blind, ran­dom­ized trial in 184 sub­jects com­par­ing the ef­fec­tive­ness and safety of the max­i­mum ap­proved OTC daily dose of 1,200 mg of ibupro­fen (number of sub­jects (n) = 62) to that of a pre­scrip­tion dose of 2,400 mg/​day (n = 61), and to 4,000 mg/​day of ac­eta­minophen (n = 59) for the treat­ment of os­teoarthri­tis. While there were no sig­nif­i­cant dif­fer­ences in the num­ber of side ef­fects re­ported dur­ing this study, the study demon­strated a trend to­wards a dose de­pen­dent in­crease in mi­nor GI ad­verse events (nausea and dys­pep­sia) as­so­ci­ated with higher doses of ibupro­fen (1,200 mg/​day: 7/62 or 11.3 per­cent; ver­sus 2,400 mg/​day: 14/61 or 23 per­cent). In ad­di­tion, two sub­jects treated with 2,400 mg/​day of ibupro­fen be­came pos­i­tive for oc­cult blood while par­tic­i­pat­ing in the study.

I spend a lot of time com­plain­ing about bad sta­tis­ti­cal writ­ing. A lot. Probably too much. But I’m here to tell you, that para­graph is gor­geous. The writ­ing is clear and pen­e­trat­ing. It con­tains all the im­por­tant de­tails, but no other de­tails. Compared to the ab­stract of the orig­i­nal pa­per, the above is shorter and eas­ier to un­der­stand yet si­mul­ta­ne­ously more in­for­ma­tive. Five stars.

The rest of the doc­u­ment is equally good, with clear and sen­si­ble ex­pla­na­tions for var­i­ous rec­om­men­da­tions. For ex­am­ple, they dis­cuss a pro­posal from the National Kidney Foundation for ad­di­tional warn­ing about risks to kid­neys, ex­plain why they think that pro­posal has merit, and then rec­om­mend a shorter ver­sion, which ap­pears on every pack­age of ibupro­fen sold to­day.

As far as I can tell, this level of qual­ity is typ­i­cal. For ex­am­ple, the FDA’s 2019 pro­posed rule on sun­screens is sim­i­larly mas­ter­ful.

So why?

This leaves us with this con­stel­la­tion of facts:

1. Acetaminophen is, in gen­eral, safer than ibupro­fen.

2. The FDA does­n’t tell you that. Neither do other re­spectable au­thor­i­ties.

3. The FDA is highly com­pe­tent.

So what’s hap­pen­ing here? Have the ex­perts con­spired to keep this knowl­edge se­cret?

I don’t think so. Mostly, I think this is down to two fac­tors. First, the FDA does­n’t re­ally have a mis­sion of de­ter­min­ing “in what cir­cum­stances is drug A safer than drug B?” Their goal is to take in­di­vid­ual drugs and de­ter­mine how peo­ple can use them safely. They seem to be quite good at this.

Second, every­one is mor­tally afraid of giv­ing “medical ad­vice.” It varies by ju­ris­dic­tion, but in gen­eral, giv­ing “wellness ad­vice” is OK, but if you give per­son­al­ized ad­vice, you risk go­ing to prison. The more cred­i­ble you are, the higher that risk is.11

Stepping back, how should we think about this sit­u­a­tion?

The body is com­pli­cated. When ex­perts give the pub­lic ad­vice on drugs, they are try­ing to in­su­late us from that com­plex­ity. But there is no way to do that with­out mak­ing trade-offs. Society has im­plic­itly cho­sen trade­offs that mean cer­tain “less im­por­tant” facts are de-pri­or­i­tized. It’s not ob­vi­ous that this is the wrong choice. I feel fool­ish for not hav­ing more re­spect for the body’s com­plex­ity and for the dif­fi­culty of the task all the ex­perts are try­ing to ac­com­plish. This is not med­ical ad­vice.

For some rea­son, hu­mans have gas­tric acid that is more acidic than most other an­i­mals, and is only matched by an­i­mals that spe­cial­ize in eat­ing car­rion.

At least two NSAIDs (rofecoxib and valde­coxib) have been with­drawn from the mar­ket due to an in­creased risk of heart at­tacks. For the same rea­son, the US re­fuses to ap­prove etori­coxib.

Nephrologists hate ibupro­fen. (Source: nephrol­o­gists.) If it was up to them, maybe ibupro­fen would come with a “HAVE YOU CONSIDERED TAKING ACETAMINOPHEN INSTEAD?” warn­ing. It con­fuses me that the safety la­bel for ibupro­fen does­n’t warn you about the dan­ger of tak­ing it while de­hy­drated and qui­etly dam­ag­ing your kid­neys. My best guess is that this is be­cause other doc­tors don’t hate ibupro­fen as much as nephrol­o­gists.

Watch out for com­bi­na­tion med­i­cines (like cold or flu med­i­cines or opi­ate painkillers) that in­clude ac­eta­minophen. Arguably, ac­eta­minophen is a vic­tim of its own suc­cess here. It’s in­cluded in these things be­cause it is bet­ter tol­er­ated than NSAIDs. But it’s easy to miss.

Oddly, NAC is con­sid­ered a nu­tri­tional sup­ple­ment, mean­ing ba­si­cally any­one can buy it. But there’s also al­most no reg­u­la­tion, so who knows if the thing you bought ac­tu­ally has NAC in it? Do not screw around try­ing to self-med­icate an ac­eta­minophen over­dose. Go to a hos­pi­tal.

At one point while re­search­ing all this I had what I thought was a good idea: Why not sell ac­eta­minophen in pills bun­dled to­gether with NAC? The NAC would re­plen­ish glu­tathione stores in the liver, seem­ingly re­duc­ing the risk of over­dose. Later on, I de­vel­oped more hu­mil­ity and felt very stu­pid for fan­ta­siz­ing that such an ob­vi­ous idea could be novel or use­ful. I think that this is in­deed a bad idea be­cause NAC it­self has side ef­fects, though I can’t find much for­mal dis­cus­sion. In fact, I found a 2010 ed­i­to­r­ial called “Why Not Formulate an Acetaminophen Tablet Containing N-Acetylcysteine to Prevent Poisoning?”  In an­other study, Nakhaee et al. (2021) ac­tu­ally tried giv­ing NAC to­gether with ac­eta­minophen to rats and found that this seemed to make it bet­ter at re­duc­ing pain. So maybe this is­n’t a com­pletely stu­pid idea. That last pa­per also led me to dis­cover that “rat hot plate test” is a stan­dard phrase, and one that dri­ves home what hu­man­i­ty’s do­min­ion over na­ture means in prac­tice.

Above, we men­tioned that ac­eta­minophen over­dose is es­ti­mated to cause around 500 deaths per year in the U.S. It’s much harder to give di­rect num­bers for how many peo­ple die from tak­ing ibupro­fen, be­cause NSAIDs don’t re­ally di­rectly “kill” peo­ple, but rather in­crease the risk of dy­ing in var­i­ous ways. The best es­ti­mates seem to be that NSAIDs cause 5,000 – 16,500 deaths each year in the US via gas­troin­testi­nal com­pli­ca­tions, and some­thing sim­i­lar via heart at­tacks. These num­bers are not a good way of quan­ti­fy­ing the rel­a­tive risk of drugs, be­cause they rep­re­sent dif­fer­ent peo­ple tak­ing dif­fer­ent amounts for dif­fer­ent rea­sons. But they do show that ibupro­fen is not with­out risk.

There are prob­a­bly some peo­ple who are too dis­or­dered to track much ac­eta­minophen they’ve taken. For such peo­ple, ibupro­fen might be the safer choice. Though I’m skep­ti­cal that many such peo­ple are found among the read­ers of Asterisk.

There are two cases where of­fi­cial sources are clear that ac­eta­minophen is safer than ibupro­fen: for use by preg­nant women and small chil­dren. This does­n’t ap­pear on the safety la­bel, but if you’re preg­nant and go to a doc­tor, they will prob­a­bly tell you to take ac­eta­minophen but not ibupro­fen or other NSAIDs. And if you have a new­born baby, their doc­tor will prob­a­bly tell you that you can give them ac­eta­minophen but not ibupro­fen or other NSAIDs.

Technically, for many drugs to­day, it is the drug man­u­fac­turer that “creates” the la­bel, which is why they can be slightly dif­fer­ent. However, the FDA strongly reg­u­lates what is on it, in­clud­ing most of the lan­guage and even de­tails about the font and so on. The fed­eral reg­is­ter con­tains a tem­plate the FDA pub­lished for ibupro­fen which is al­most iden­ti­cal to what ap­pears on the side of drugs to­day

Unlike in most places, in the United Kingdom it seems to be per­fectly le­gal for peo­ple to give each other med­ical ad­vice, pro­vided they don’t mis­rep­re­sent them­selves as li­censed doc­tors. This is not le­gal ad­vice.