Look at us! Read what we have to say! Media is less about informing than it is about stirring up controversy , especially when it comes to reporting about things medical. Recently, 2 studies have gained attention because they call into question readily available medications widely used for common conditions: Acetaminophen (Tylenol) and niacin.
Don’t rely on news reports to determine if your treatment is appropriate. The devil is in the details, which typically go unreported or described well after the misleading headline message has sunk in.
A recent report in the New England Journal of Medicine raises concerns about the use of niacin as a tool to reduce heart attack and stroke risk. The study showed that adding niacin in patients who were already managed to goal with an effective combination of 2 other drugs made by the study’s sponsor was no more effective in preventing death compared to the control group that did not receive niacin. The headline: The demise of Niacin!
The reality: When added to other medications that already are getting good results, niacin may do more harm than good. The same could be predicted with almost any “piling on” scenario. Adding even more sugar or spice to flavor food doesn’t predict a better taste beyond a certain measure.
But many other studies and experience treating individual patients demonstrate niacin’s superior effects in patients with high risk due to specific lipid abnormalities. And, if you know a few simple “tricks” it can be taken and tolerated. If care is individualized, it remains an option and a benefit for many patients.
The other drug under attack is acetaminophen for low back pain. The Lancet published a study showing that patients recovered from low back pain in the same amount of time whether they received acetaminophen or not. This is no surprise since the only known action of acetaminophen is pain relief, i.e analgesia. It has never been understood or expected to affect the underlying disease process or speed healing, such as by reducing inflammation (anti-inflammatory.)
It allows one to suffer less while time heals the injury. Acetaminophen remains a readily available treatment for mild to moderate pain and is safe when used in recommended dosages. It is safer than anti-inflammatories (e.g. ibuprofen or naproxen) or stronger analgesics (e.g. codeine and other opioids).
So, why are we looking for reasons to decrease its use? Could it be to discourage self-treatment and drive visits to health care providers and prescriptions for more expensive drugs? Human beings with biases and self-interest design every study. Look for such bias when challenging studies are reported.
These readily available inexpensive treatments will never be studied in large expensive clinical trials. There is no return on such an investment.
If something works for an individual patient, is well tolerated and affordable, it is wise to continue what is working while monitoring for problems of all kinds.
Beware the headlines! There is more to the story. Think for yourself and work with your doctor to determine the right treatment for YOU!
Craig A. Backs MD