In this installment of “Dear Julia,” Vox health reporter Julia Belluz takes on a reader question about pain medications. The reader wants to know which over-the-counter (OTC) pain reliever is the best for treating pain – Tylenol, Advil or aspirin. The story presents evidence from high-quality studies and opinions from three pain experts. The story carefully explains that it’s not appropriate to state unequivocally that one beats the other because it’s not a one-size-fits all situation. In general, though, ibuprofen (name brand Advil) is more effective and safer than acetaminophen (Tylenol) and aspirin in beating minor pain.
The “Dear Julia” column, which debuted earlier this month, promises to answer “everyday health questions on anything from the science of hangovers to the mysteries of back pain.” The column is off to an auspicious start, and we look forward to more of its practical, evidence-based responses. You can submit a question for the column here.
Americans spent $4.4 billion on OTC analgesics in 2014, according to the Consumer Healthcare Products Association. Despite wide use and efforts by public health efforts to inform consumers about safety issues, there’s still a lot of confusion about which medication works best for different ailments. As the article points out, acetaminophen is the most popular selling OTC pain reliever but not always the most effective or safest.
The story doesn’t mention costs but since these over-the-counter medications have been widely available for a long time it doesn’t seem like an important omission. Because aspirin has been available the longest and is manufactured by literally hundreds of companies, it is by far the cheaper of the three.
The article takes a close look at the drawbacks and benefits of each drug. For example, while the experts said acetaminophen is less effective than ibuprofen in treating pain (and carries more risks than the others), it is beneficial in treating fever, especially in children age three and up. Ibuprofen is deemed less toxic for pain relief but it carries the risk of bleeding in the gastrointestinal tract and kidney damage. There’s also a reasonable amount of quantification provided by an expert source, Dr. Andrew Moore, who says: “If you’re talking about aspirin in doses of 500 to 1,000 mg or two tablets, 30 percent of people get relief from acute pain. For acetaminophen at doses of 500 to 1,000 mg, about 40 percent have a success. For ibuprofen, in its normal formulation at something around 400 mg or two tablets, about 50 percent have success.” The story would have been even stronger had it provided links or additional details regarding where this expert obtained his estimates.
The story comprehensively describes the harms from each drug based on different uses and patient populations. We especially liked this quote: “Don’t believe that just because something is over-the-counter, it’s safe.”
The story cites and links to reliable evidence sources, including a systematic review of randomized controlled trials on back pain published in the BMJ.
There are no examples of disease mongering in the story.
Sourcing is a very strong component of the article. The story quotes three pain experts from three different institutions as sources. No conflicts of interest were apparent.
The main premise of the story was comparing which pain medication was the best for different types of pain. The comparisons are covered in depth with perspectives from three sources.
It’s obvious from the story that all of the medications profiled have been widely available without a prescription for many decades. Aspirin, a modified version of salicyclic acid, was created by a Bayer chemist in 1897; acetaminophen followed in 1956; and ibuprofen in 1962.
The story establishes that it’s responding to a reader question about three well-known and widely used medications. It also notes the gap between public perception about these drugs and what pain researchers think of them.
Since this article was prompted by a reader question and includes comments from three expert sources, we are confident it isn’t based on a news release.