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I saw this xkcd comic and one of the unsolved entries was "How does Tylenol work?".

So I googled and found a lot of explanations for what acetaminophen does. A bunch of articles says it regulates some brain thing to reduce swelling or something. Seems like we know how it works.

What did Randall mean by this? Do we know how Tylenol works? Seemed like we do.

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  • $\begingroup$ Sure, it does something to something to produce an effect. But just how does it regulate ’some brain thing’ in detail? Perhaps better on Bio SE. $\endgroup$
    – Jon Custer
    Commented Nov 18, 2022 at 15:54
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    $\begingroup$ It must be Tylenol (paraacetamol - pharmacology/acetoaminophen) $\endgroup$
    – Poutnik
    Commented Nov 18, 2022 at 16:14
  • $\begingroup$ He meant what he said. You could find numerous papers about that, but if it was really known only one would suffice. Non-steroid painkillers may be more common, but are stumping scientists more than general anesthesia. $\endgroup$
    – Mithoron
    Commented Nov 18, 2022 at 16:44
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    $\begingroup$ I’m voting to close this question because you'll have to ask Randall. $\endgroup$
    – Todd Minehardt
    Commented Nov 28, 2022 at 23:48

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Just because we know one thing it does doesn't mean we know all the things it does.

And just because one of the things it does is inhibit cyclooxygenase, and another thing it does is relieve pain, doesn't mean that inhibiting cyclooxygenase always relieves pain.

And just because acetominophen does inhibit cyclooxygenase and relieve pain in most people doesn't mean it does that in all people.

And since the placebo effect is a thing, and most people don't take acetominophen while "blinded" as part of a study, and since the placebo effect is particularly strong at pain relief, a lot of the effects of acetominophen itself will often be confounded with placebo effects.

So, we know some ways that acetominophen works. But we're pretty far away from a complete theory of how acetominophen works, because (a) biology is messy, (b) humans even moreso, and (c) we don't have a complete all encompassing theory of general pharmacology to unambiguously map particular molecules to their effects on mammalian bodies anyway.

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