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The Noisy Room
Tuesday May 12th, 2026 at 8:47 AM

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It began with a study. In December of 2025, Stanford researchers analyzed 2.2 billion social media posts looking for a pattern. They wanted to know what percentage of users posted severely toxic content. Not rudeness, not sarcasm, but speech that was so hateful that 90% of the world would flag it as being problematic.1

With this data in hand, they then asked thousands of people to answer a simple question:

Take a guess.

What percentage of social media users do you think post severely toxic content?

0%50%100%

3.1%

That's the actual number.

Your guess: 13%. You overestimated by 3x. The average American guessed 43% — a 13x overestimate.

They were surprised by the results. They had discovered an enormous reservoir of misperception that had been hidden in plain view.

The Bar

Here is the simplest version of the problem. Imagine walking into a bar with a hundred people inside.

Three of them are shouting — about politics, about each other, about whatever gets a reaction. The other ninety-seven are talking at a normal volume. But there's a bouncer at the door, and he gets paid by the minute you spend staring. So he's wired the three loudest people into the sound system and turned it all the way up.

You walk in, hear the roar, and conclude: this place is full of lunatics. Never hearing the 97 people having normal conversations a few feet away. You could leave, but all your friends are inside. You're stuck.

This is how social media deals with contentious topics. The bouncer is an algorithm. And whether you like it or not, you've been a bystander.

Pick a contentious topic. This is what your feed might look like.

@close_the_border_NOW

Every ILLEGAL crossing is a CRIME. Every sanctuary city is an ACCESSORY. These aren't "migrants" — they're INVADERS. The Great Replacement is not a theory, it's POLICY. 🚨🧱

♡ 11.2K💬 7,892↻ 4,301

@no_borders_no_nations

Borders are a colonial invention designed to hoard stolen wealth. NO human being is "illegal." Abolish ICE. Abolish CBP. Abolish the concept of citizenship. Full stop. 🌍✊

♡ 7,643💬 5,201↻ 3,187

@patriot_alert_2024

They're not sending their best. Actually, they're sending criminals, drug dealers, gang members. And YOUR tax dollars are funding their hotels. This is an INVASION and your government is COMPLICIT. 🇺🇸

♡ 8,901💬 6,334↻ 3,765

Reading this feed, you might reasonably conclude that the country is split between unhinged extremes. It is not. And the gap between what Americans actually believe and what the feed suggests they believe may be the most consequential thing the platforms haven't shown you.

See the Room

Let's visualize this as a single room with 100 people inside. This is what it looks like:

3 users who have posted toxic content

3%→33% On most platforms, ~3% of accounts produce 1/3 of all content

Your feed Engagement ranking amplifies high-reaction content from the prolific few

The actual room. 3 out of 100 users have ever posted severely toxic content.

This pattern repeats across platforms. On Twitter/X, toxic tweets receive ~86% more retweets and ~27% more visibility than non-toxic ones, 0.3% of users shared 80% of all contested news,14 and just 6% of users produce roughly 73% of all political tweets.16 On TikTok, 25% of users produce 98% of all public videos.15 The specific numbers vary. The dynamic is the same: a small minority of highly active users overwhelms the majority.

After a time consuming content in this room, your brain performs a kind of ambient demography. The feed becomes a sort of census. You conclude — logically — that the behavior must be widespread. The room might just be full of extreme people! Maybe most people do believe these crazy things.

This is not just about what we see on social media

If this were just about tone of our social posts, it wouldn't matter very much. But this distortion ends up causing some seriously bad patterns of behavior.

Pattern 1 The Majority Goes Silent

When the majority of people looks at the feed and assumes they're outnumbered, people will often self-censor.3 The dynamic replicates on social media17 — fear of social isolation suppresses opinion expression on platforms where it's perceived to be unwelcome. They go quiet, or they leave a platform entirely. They cede the space to users with more extreme politics.

Pattern 2 The Loud Minority Thinks It's the Majority

The minority who aggressively post end up with their own distortion – believing they are part of the majority.5

A study of 17 extremist forums found the same pattern: the more someone posted, the more they believed the public agreed with them. More engaged participation bred false consensus.

Pattern 3 Everyone Gets Each Other Wrong

Both sides develop wildly inaccurate beliefs about who the other side actually is.6 See how some of your own beliefs line up:

What percentage of Democratic supporters do you think are LGBTQ?

0%50%100%

Your guess: 10%. In reality, 6% of Democratic supporters identify as LGBTQ. That’s a 2× overestimate.

What percentage of Republican supporters do you think earn over $250,000 a year?

0%50%100%

Your guess: 5%. In reality, 2% of Republican supporters earn $250K+. That’s a 3× overestimate.

The average American overestimates these kinds of figures by 342%. Social media turns the visible few into your mental model of the whole group.

The distortion extends to policy beliefs. Step through to see the perception gap on the issue of immigration.

On a scale of completely-open to completely-closed borders, where do Democrats place Republicans?

Source: More in Common (2019) & Moore-Berg et al., PNAS 2020. Illustrative.

Pattern 4 Politicians Follow the Perceived Room, Not the Real One

Elected officials are very good at sensing political sentiment. It's literally their job. (They are not elected to correct people's beliefs.)

Politicians who can build a coalition about a perceived belief are more likely to win. They position themselves against an opponent that doesn't exist, but their supporters think exists.

And remember: most of our politics now happens on social media. Candidates often read the same distorted feed. They are unlikely to change their minds.

The window of discourse shifts. Not because opinions changed, but because perceptions of opinions did.

Pattern 5 Misperception Turns into Hostility

When you believe the other side is extreme, you become more willing to treat them as a threat.7

Both Democrats and Republicans vastly overestimate how many on the other side support political violence. The result is a populace primed to assume the other side is ready to do horrible things.

"What percentage of the other side supports political violence?"

Democrats believe

estimate

of Republicans support political violence

Republicans believe

estimate

of Democrats support political violence

Both sides were wrong by 3 to 4 times. When researchers corrected these beliefs, partisan hostility dropped.

Each step feeds the next. The distortion is self-reinforcing.

Knowing Isn't Enough

Okay. So now you know that a small minority dominates the feed.

You know that Republicans and Democrats actually have a far more nuanced set of opinions about contested issues.

Does that fix it? Not really. You also know that everyone else doesn't know it. And if the world continues operating as if the distortion is real, you should probably act the same — even though you know it's wrong. The room hasn't changed, even if you know people inside it are confused.

This is called a common knowledge problem.

You’ve read the stat. But you have no idea who else has. The feed still looks the same. You still assume you’re outnumbered. You stay quiet.

Steven Pinker lays this out cleanly in his excellent recent book When Everyone Knows That Everyone Knows.8 Learning a fact changes what you know. Seeing it displayed publicly — where everyone else can see it too — where you know others can also see it, changes what everyone knows, and subsequently how they act.

Social media has no public square. It has 300 million private windows, each showing a different distortion of the same room. Illuminating the common thoughts between us has the potential to radically change it.

The Idea

So what can we do about this?

Fortunately, there's some good evidence showing how it can be fixed. Multiple studies show that when misperceptions are corrected in a public way, hostility drops. Mernyk et al. found that a single correction reduced partisan hostility for a full month.7 Lee et al. found that correcting overestimates of toxic users improved how people felt about their country and each other.1

We can do this today.

Imagine every post on a contested topic had a quiet link beneath it. Not a fact check, a label, or a warning. Instead — what if it had a Community Check?

↑ click here

A Community Check is an open-source design layer that could be deployed across social media, beneath contentious posts, to help users understand how other people on the platform (or the nation) actually feel about an issue.

It is a way of quickly adding context to the most hot-button viral issues, giving people more visibility into the opinions of the public.

The Idea in Action

Let's explore this intervention with a topic that cuts across political identity:

Money in Politics

On the surface, this seems contentious. But it's actually a supermajority issue: 81% are concerned about the influence of money on elections, including 78% of Republicans and 90% of Democrats. 75% say unlimited spending weakens democracy. Only 15% believe unlimited political spending is protected free speech.

And yet, very little changes, largely because everyone assumes the other side is fine with it. The feed is full of people defending their team's donors and attacking the other team's. It might look like a 50/50 partisan battle, but it's not. It's a majority consensus that cannot see itself.

What if you could see this consensus?

@real_talk_politics · 2h

Everyone complains about money in politics but the second their candidate gets a massive donation they shut up real fast. You don't hate money in politics. You hate when the OTHER side has more of it.

♡ 11,847💬 6,203↻ 2,891

↑ click here

Community Check draws from a random sample of platform users + robust national polls, surveyed independently of the content. The sample is statistically representative. The results update continuously. And critically: everyone sees the same numbers.

Why This Isn't Fact Checking or Audience Polling

Traditional fact-checking is a top-down approach that often feels like it's dictating from above. This is hard for people to stomach. Content moderation for many years now has been perceived as removing speech. This simply adds context, much like the crowdsourced feature Community Notes (an inspiration for this project).

Nor is this just a user-poll under a post. Instead it's drawing from all platform users, coupled with statistically significant national surveys. It's an actual window into the views of the majority, not just the views of those looking at the post.

It Works for Video Too

Short-form video is the fastest-growing vector for political distortion. The same dynamic applies — a small minority of creators produce the vast majority of political content — but video bypasses the pause that text gives you. Community Check can adapt. Tap through to see how.

Money IS free speech.

Deal with it. 🇺🇸

Citizens United was CORRECT

@liberty_caucus_tv Follow

#FreeSpeech #CitizensUnited 🔥

A political video crosses the engagement threshold. 51K views, 612 comments (1.2%), 1.7K shares (3.4%). The feed shows outrage. But what do people actually think?

See technical specs for how it works below ↓

We Could Do This Now

Platforms already have a lot of these capabilities. They already survey users. They even know how to run sophisticated polls. There are a few technical details to work out (spec here), but this is not a hard problem to solve.

The unseen majority is the public. And the public deserves to know itself.

A tiny minority, dominating the feed. That's all it ever was. The rest of us were here the whole time, quiet and decent and waiting to be seen.

Follow my other work here

Community Check is a free and open specification.

The complete technical spec, research base, and open questions are published for researchers, engineers, and platform designers to stress-test and build on. Please steal it with attribution.

View on GitHub

Common Questions

You can't flood a system that chooses its respondents randomly. Community Check uses stratified random sampling — the gold standard in survey methodology (Groves et al., Survey Methodology, 2nd ed., Wiley, 2009). You don't volunteer to respond. You're selected, like jury duty. Each user responds once per question per 90-day cycle. Coordinated response patterns are anomaly-detected and excluded. The sampling algorithm and exclusion criteria are open-source and auditable.

This is the same methodology behind national polls that reliably measure opinion across 330 million people using samples of just 1,000–2,000 respondents. The key isn't sample size — it's random selection. A platform with hundreds of millions of users has an even larger pool to draw from, making representative sampling more robust, not less.

Right now, a single viral post from one account can shape the perceived consensus of millions. Community Check replaces that with N>100,000 randomly selected responses — orders of magnitude larger than any national poll, and a dramatically higher bar than the status quo.

In the ideal implementation, questions are governed by a bridging algorithm — the same approach Community Notes uses. Questions are proposed by a diverse pool of contributors and only enter the active taxonomy if they earn approval from contributors who historically disagree with each other. Loaded or partisan questions are filtered out structurally, not by any single editorial board. AAPOR standards for neutral question design apply: balanced language, all reasonable response options, no leading framing.

For the open-source starting point, questions come from established polling organizations (Pew, Gallup, AP-NORC) with published methodology. The full question taxonomy is open — any researcher or journalist can audit the wording. That's a level of transparency no social media algorithm currently offers.

Right now, the system already silences the actual majority. The spiral of silence — people self-censoring because they falsely believe they're in the minority — is one of the most replicated findings in political communication (Noelle-Neumann, 1974). Hampton et al. (Pew Research, 2014) found social media makes this worse: people who sensed their Facebook network disagreed with them were less likely to speak up both online and in person. Community Check breaks that cycle.

It also explicitly displays minority positions — when 15% hold a view, that number appears clearly. A minority position accurately shown at 15% is far healthier than one that looks like 50% through amplification or 0% through suppression. Everyone benefits from seeing the real picture.

Election forecasting and opinion measurement are different things. Community Check doesn't predict elections. It measures policy preferences — "Do you support background checks?" — which are far more stable and far easier to measure than vote intention. When Pew reports 87% support for background checks across 15 years of polling with N=5,000+, that's a measurement with a published margin of error, not a prediction.

The platform sample adds N>100,000 — 50–100x larger than typical national polls, with margins of error below ±0.5%. That's an extraordinarily reliable signal, and it updates continuously.

Your perception is already being shaped — by algorithms that prioritize engagement over accuracy. Community Check simply makes additional information visible: what a representative sample of people actually believe. You can agree, disagree, or ignore it entirely.

Think of nutrition labels. The Nutrition Labeling and Education Act of 1990 didn't tell people what to eat — it made the information available. Community Check does the same for public opinion: standardized, transparent data beneath content that is already shaping how you see the world.

They solve different problems. Community Notes evaluates whether specific claims are true or false, written by self-selected volunteers rated via a bridging algorithm (Wojcik et al., 2022). Community Check doesn't assess truth — it shows what people think about the policy topic a post discusses. A post can be entirely accurate and still create a distorted picture of where the public stands.

The data source matters too. Community Notes contributors self-select in — and More in Common (2019) found that the most politically engaged users have the largest perception gaps (nearly 3x more distorted than disengaged users). Community Check uses random sampling and peer-reviewed national surveys. Both tools are valuable; they complement each other.

The research consistently shows the opposite. The social norms approach — correcting misperceived norms by showing accurate data — has been validated across 200+ studies (Berkowitz, Changing the Culture of College Drinking, Hampton Press, 2004). Tankard & Paluck (2016) found that accurate norm information corrects misperceptions without coercion — it reveals what people already privately believe, rather than pressuring them into something new.

Mernyk et al. (PNAS, 2022, n=4,741) showed this directly: correcting inaccurate metaperceptions reduced support for partisan violence, with effects lasting ~26 days. People didn't conform — they recalibrated, and felt better about each other as a result.

Community Check doesn't claim majority opinion equals truth. It provides a map of what people actually think — which is valuable precisely when your estimate of the room is off by 200–400%, as Ahler & Sood (2018) documented. If 70% of people believe something you disagree with, knowing that number helps you understand the world you're operating in. Hiding it doesn't make the disagreement go away.

Both majority and minority positions are always displayed with their numbers. This isn't "the crowd says you're wrong." It's "here's what the room actually looks like" — and that's useful no matter where you stand in it.

Correct — by design. Community Check activates only when reliable polling data exists, a documented perception gap has been identified, and a post reaches >10K impressions. That covers ~50–100 major policy questions. Posts about niche topics or emerging controversies without polling data get no Community Check.

The topic-matching confidence threshold is 0.8 — if the system isn't sure, it stays silent. False positives are worse than gaps. This is intentionally focused on the specific, well-documented cases where perception gaps are largest: gun policy, climate, immigration, healthcare, money in politics. Start where the data is strongest, and expand from there.

This is a legitimate question, and one worth exploring carefully. It's entirely possible that a government — or any well-resourced actor — could try to use a system like this to pollute polling data and distort public perception. The history of opinion measurement is full of attempts to do exactly that. For this reason, transparency is the most important property of the design.

The architecture is built to make manipulation detectable. Data comes from independent polling organizations — not governments, not platforms. The sampling algorithm is open-source. Question wording is published. Methodology is auditable. Quarterly transparency reports detail every step from sampling to display.

Compromising it would require simultaneously infiltrating multiple independent polling organizations, altering open-source code inspected by thousands of researchers, and evading anomaly detection. That's a high bar — and one that gets higher as more independent eyes are watching. Today's platform algorithms shape public perception at scale with zero transparency and zero public oversight. Community Check raises the baseline significantly, but it depends on a vigilant community of researchers, journalists, and engineers continuing to inspect it.

Independent thinking requires accurate inputs. Right now, the feed is giving you wildly inaccurate ones. Sparkman et al. (Nature Communications, 2022, n=6,119) found Americans underestimate popular climate policy support by nearly half — 80% actually support renewable energy siting, but people estimate 43%. Moore-Berg et al. (PNAS, 2020) found partisans overestimate the other side's hostility by roughly 2x. These aren't matters of opinion — they're factual errors about the world around you.

Community Check doesn't ask you to care what others think. It gives you an accurate picture so your independent opinions are based on reality, not on an algorithmically curated distortion of it.

Correcting metaperceptions — beliefs about what others believe — works differently than correcting factual beliefs. Factual corrections can trigger defensiveness. But learning "the other side is less extreme than you thought" tends to be relieving, not threatening. It lowers the temperature.

Lee et al. (PNAS Nexus, 2025, n=1,090) found that correcting overestimates of toxic social media users improved positive emotions and reduced perceived moral decline. Mernyk et al. (PNAS, 2022, n=4,741) found effects lasting ~26 days from a single correction. Community Check targets this same mechanism — not what you believe, but what you believe others believe. That's where the distortion lives, and that's where the correction is most effective.

Technical Specification

How Community Check would work in practice, from data sources to platform integration.

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You’re probably taking the wrong painkiller by dynomight
Wednesday May 6th, 2026 at 7:57 AM

DYNOMIGHT
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This is an essay that recently appeared in Asterisk. Consider the rest of the risk issue for all your risk needs.


Lots of people die after overdosing on acetaminophen (paracetamol, Tylenol, 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 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:

Situation Acetaminophen safe? Ibuprofen safe?
Fasting No. Fasting leads to low glutathione and the risk of liver damage. No. Risks pain or bleeding in the stomach, could damage kidneys.
Dehydrated Yes. No. Could damage kidneys.
Liver Disease Maybe (low dose). Often preferred by doctors at <2g/day. No. Increases bleeding risk, could damage kidneys.
Stomach Ulcers / Heartburn Yes. No. Strips protective mucus.
Chronic Heavy Drinking Maybe (low dose). Seems safer if limited to <2g/day. No. Risk of stomach bleed.
Kidney Disease Yes. No. Puts stress on the kidneys.
Heart Conditions Yes. No. Interferes with blood clotting, raises blood pressure.
Active bleeding Yes. No. Inhibits clotting.
After drinking (a little) Maybe (low dose with food). Alcohol depletes glutathione, raising risk of liver damage. Maybe (low dose with food and water). Alcohol and ibuprofen both irritate the stomach. Alcohol also leads to dehydration.
After drinking (a lot) No. No.
Hangover No. The liver is already depleted. Maybe (with food and water). But never when dehydrated.

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 saf_er_. 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) creates 10 a “drug facts” label for over-the-counter drugs.  

Here’s what that looks like for ibuprofen:

ibuprofen label

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

acetaminophen label

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.

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.

  1. 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. ↩

  2. 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. ↩

  3. 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. ↩

  4. 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. ↩

  5. 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. ↩

  6. 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. ↩

  7. 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. ↩

  8. 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. ↩

  9. 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. ↩

  10. 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  ↩

  11. 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. ↩



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emrox
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(comic) The OKR Trap by Work Chronicles
Wednesday May 6th, 2026 at 4:32 AM

Work Chronicles
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emrox
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Cognitive Surrender
Wednesday May 6th, 2026 at 4:30 AM

AddyOsmani.com
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Cognitive offloading is delegating to the AI and still owning the answer. Cognitive surrender is when the AI's output quietly becomes your output and there is nothing left to check. For software engineers the line between the two moves under your feet most days, and most of us are crossing it without noticing.
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Why are the Artemis II photos on Flickr? - Anil Dash
Monday May 4th, 2026 at 11:52 AM

Anil Dash
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If you followed along with the recent joyful celebrations of the Artemis cruise around the moon, and took a moment to dive into the photographic archives of the mission, you might have noticed that all of the original images were shared by NASA on the venerable photo sharing service Flickr. What you might not know is… why?

Here’s the TL;DR:

  • Flickr comes from (and helped start!) the Web 2.0 era, which was based on users having control over their data
  • Tools at that time began giving creators the power to decide what license they wanted to release their content under, including permissions about how it could be shared, used, or remixed
  • Because the people who made platforms back then were users and creators themselves, they thought about the long term and wanted to be able to preserve people’s work
  • After lots of corporate shuffling, Flickr ended up in the hands of a family-owned company, SmugMug, and they made the Flickr Foundation to preserve public photos for the next 100 years
  • NASA’s images should only be on a service where they can be stored in full resolution, for the long term, dedicated to the public domain — which the other social media apps of today can’t do

The Photographic Record

First, some background for folks who might not know what Flickr is, or who may have forgotten. Flickr is a social sharing site for photography which was founded in 2004, and these days people might say that it shares some of its cofounders with Slack, though back when Slack started, everybody said that the company was started by some of the founders of Flickr. That’s because Flickr was arguably the most influential site of the Web 2.0 era, helping define everything from the user interface design to the bright colors to the easy way that developers could access data from the platform. A lot of the things that we take for granted on the modern social internet, like a friendly “voice” used to communicate to users, were pioneered by Flickr, and then quickly came to be considered standard expectations for the apps and sites that followed. It’s hard to imagine that sites from Tumblr to Grindr would have omitted their final “e”s without Flickr’s precedent.

Flickr spun out of a Canadian gaming company called Ludicorp, founded by Stewart Butterfield (later CEO/co-founder of Slack) and Caterina Fake (later an investor and chair of Etsy). The photo-sharing service was extracted from the pieces of a somewhat unsuccessful attempt at multiplayer gaming called “Game Neverending”, but it retained the playfulness of that game even as it became a social app. Flickr also inherited the fine-grained privacy controls and thoughtful community features of earlier social platforms like LiveJournal — along with being actively, intentionally moderated by actual humans who worked diligently to prevent destructive behaviors on the platform. This meant that, more than 20 years ago, this early photo sharing community typically had better social norms than people see on today’s social media apps. (A little side note: Part of Flickr/Ludicorp’s initial funding was with public money. What a remarkable way to fund lasting innovation!)

With all of these groundbreaking features, Flickr didn’t just inspire lots of other entrepreneurs to create a new wave of Web 2.0 startups, it also attracted millions of users who, for the first time, began taking photos with the primary goal of sharing them online. Prior to this moment, the earliest phones with decent cameras were coming to market (it would be years until the iPhone came out), and other photo services of the time were still often oriented towards taking film to processing facilities, and then having the professionals at those facilities scan the resulting images and post them to a clunky online service where you could tediously click through them in a virtual album. Until Flickr, photo sharing online was essentially still analog, even if the experience was technically happening online.

In Focus

Flickr wasn't a social platform first — it was a photography platform first. That means it was designed to store high-resolution versions of every image, and didn't distort pictures with things like filters. Every image showed details like what kind of camera had taken the photo, and even what specific settings were used to take the shot. People started building communities around the then-new idea of using tags to help them find content by topics online — an idea that would directly influence the creation of hashtags on Twitter a few years later.

Another core idea of the time was a firm belief in open data: people should own and control their own work. Eventually, some experts (including a then-teenage Aaron Swartz, who we'd later talk about in the early days of Markdown) created a set of standards called Creative Commons licenses, now maintained by an organization of the same name. Flickr made it easy for users to describe what permissions people had for reusing or remixing any photos they posted. (I was helping out with a blogging platform back then, and I think we were the first tool to support this stuff. It felt like a big deal at the time!)

People's Flickr images started popping up in corporate PowerPoint presentations or commercial advertising almost immediately. A little sidebar: the incredibly positive and generous intent of these open licenses has since been exploited by extractive Big AI companies, who ransacked all of the images on Flickr that had permissive licenses without any consent from, or compensation to, the creators. That might be legal by most readings of the licenses, but if you have hundreds of billions of dollars and don't think you should at least have a conversation with the photographers whose work you're using, you're probably an asshole.

Archival Prints

Our close-knit community of people building the new era of web apps was keenly aware that our users were creating culture. This realization brought a huge amount of responsibility — not just in enabling users to express themselves, but in thinking about the long term for people's ownership of their works. Public institutions had just begun to use these platforms, which meant that the content being shared wasn't just a nice picture to look at: it might be socially or even historically significant.

What happened in the years that followed was… a lot of corporate machinations. Flickr got bought by Yahoo. Flickr's founders left Yahoo. Yahoo got bought by Verizon. You can imagine how all of that went; the details aren't all that important, except to say that by the time Instagram launched, Flickr had begun to fade into obscurity. People were focused on mobile phones instead of the desktop, on sharing square images with filters instead of full-resolution photography, and on connecting socially instead of caring about photos as art or a cultural record. Nobody would post the canonical historical photo of an event with a Valencia filter on it. Most of Flickr's users moved on, rarely checking their old accounts — until a family-owned photo service named SmugMug bought the service from Yahoo. A human-scale operation with some actual heart and a love of photography was a much better home for the platform than some random division of Verizon.

Commons Sense

In 2022, the new team at SmugMug that owned Flickr decided to focus on Flickr’s larger place in culture. Many major institutions around the world had chosen to archive their public photos on Flickr because of its superior support for high-resolution imagery, its unique ability to declare explicit legal licenses (including public domain licenses), and its long-term reputation for reliably hosting content without any of the harms or abuses that typical social networks had inflicted on users. Museums around the world had entire catalogs on the platform, and governments routinely used it to document their public events. When I had a photo taken at an official White House event with President Obama, his team sent me the final image afterward by sending me a Flickr link; when Zohran Mamdani met King Charles, the NYC Mayor’s Office shared those pictures on Flickr, too.

The Flickr team at SmugMug did something special with their responsibility about these public works, due to their cultural significance to the world. They made the Flickr Commons, and brought in a team with expertise in digital archiving and community. This is a project of The Flickr Foundation, designed to preserve digital legacies, and begun in collaboration with no less than the U.S. Library of Congress (back before that was an institution under siege.) They are developing a hundred year plan for how to care for these works, which is virtually unheard-of in the digital world. (You should absolutely donate to support the Flickr Foundation in their mission to preserve these vital public resources for many years in the future.)

It’s in this context that NASA has long been sharing its imagery on Flickr, for all of its missions — not just Artemis II. There’s even a special section for NASA on The Commons. And since everything is provided in incredibly high-resolution and has every single detail about the photo and how it was taken, it’s possible to combine the information about the photo with other data and create amazing resources like this beautiful timeline of the entire mission. You can see Hank Green’s wonderful narration of his inspiration and creative journey behind the timeline right here:

Why Not With Us?

Anybody who’s read my site for a while knows that I’m a huge proponent of owning your own website, and having your own content live there. Shouldn’t NASA, of all institutions, have their photos live on their own nasa.gov website? Well, yes! But.

One complication is that many large institutions, especially ones that have developed complex processes for good reasons, like government agencies and big businesses, often have trouble maintaining public-facing web infrastructure over long timeframes. Running a website that millions of people can access requires constant updates and maintenance, guarding against a never-ending onslaught of security challenges (a task that’s rapidly getting more difficult!), and the internal knowledge on how a site was created in the first place often leaves when employees do.

In contrast, platforms that are run by technically fluent, well-intentioned and thoughtful technologists can be very effective in maintaining content over a timescale of decades. The SmugMug team has been very thoughtful in managing both their business and their technical infrastructure in order to sustain Flickr’s public archives for years to come. (Though, as mentioned, you should still donate to ensure they can keep doing so!)

What’s more painful is the more recent threats to public stewardship of this kind of content. The traditional authoritarian impulse to destroy or falsify the public record has not spared the digital realm under the current administration. Wide swaths of the government’s websites have been erased, taken offline, or had their content modified to either delete or adulterate the content. Leaders who regularly post AI slop on their social media accounts, and who have begun posting lies and distortions on major websites like the White House’s, will of course not hesitate to modify or remove photos from public archives as well. By having the public’s images preserved in an independent archive in standard formats, we increase the likelihood of future generations being able to access accurate copies of these historical records.

We’ll be glad to have archives like Flickr’s in the future, and people around the world will be glad for its place in archiving even much more mundane aspects of culture.

Taking off

I was honored to get to reflect on my long history with Flickr, and with online community, in an interview with my old friend Jessamyn West, for the Flickr Foundation’s blog. In a conversation that unspooled over a few months, I think we covered so many of the themes that resonated in what I’ve mentioned here, and what struck me most was how much I wanted a new generation of people on the internet to have their own version of the communities and experiences that we got to have when sites like Flickr were first being made. People still cherish those values!

The beautiful thing about communities and platforms like Flickr is that they remind us that not everything on the internet has to be ephemeral, not everything on the web has to be hyper-commercial. Sometimes a bunch of decent people can do a good thing for the right reasons, and the result of that work can persevere for decades. Then, others who do some of the most ambitious and astounding things imaginable can build on that work to inspire us. And then, some more regular folks can build on top of that and help us waste a little bit of time just clicking around on something fun. That’s what the internet is supposed to be about!

This isn’t just about recounting old web lore — this is about explaining the internet we have right now. Hank’s timeline site is brand new, entertaining a whole new generation, and probably the majority of the audience who are looking at it weren’t even born when Flickr was first conceived. But the reason he can build that site is because of the values and the inventiveness of the team and community who created a platform like Flickr — and because those kinds of values are durable. They might not be as loud or flashy, but they are still everywhere, quietly enabling a lot of the things we enjoy most every day.

Public dollars helped make a fascinating community, then public dollars enabled a breathtaking journey into space, and then a public commons helped a creator make a novel way to explore that journey. Lots of people chose, over and over, to be generous with their genius. These are all gifts that a bunch of strangers gave each other, over hundreds of thousands of miles, and many years. Inspiration is all around us!

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