tag:theconversation.com,2011:/nz/topics/nurofen-3569/articlesNurofen – The Conversation2018-05-17T20:06:38Ztag:theconversation.com,2011:article/951482018-05-17T20:06:38Z2018-05-17T20:06:38ZIs it ok to give children pain killers? We asked five experts<figure><img src="https://images.theconversation.com/files/215131/original/file-20180417-101486-y014b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fever is a normal part of healing, so whether we should stop it with pain killers should be questioned.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Children get sick and hurt a lot. Whether it’s playground injuries or cold and fever, we’re frequently wondering if we should reach for the kids’ Panadol. </p>
<p>But pain relief has side effects, and we know as adults we shouldn’t take it too liberally, so what about for our kids?</p>
<p>We asked five experts if it’s OK to give our kids pain killers.</p>
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<a href="https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=99&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=99&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=99&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=125&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=125&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215130/original/file-20180417-101517-5fk0g2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=125&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<h2>Four out of five experts said yes</h2>
<p><strong><em>Here are their detailed responses:</em></strong></p>
<p><iframe id="tc-infographic-272" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/272/f65f8843d89ec9f868c80c6a59ca6edcbaa7433e/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
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<p><em>If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au</em></p>
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<p><em>Disclosures: Greta Palmer has previously received grant support from Cadence Pharmaceuticals for a paracetamol study in neonates.</em></p><img src="https://counter.theconversation.com/content/95148/count.gif" alt="The Conversation" width="1" height="1" />
Parents worry about giving their kids pain relief. Four out of five experts say it’s OK.Alexandra Hansen, Deputy Editor and Chief of Staff, The Conversation AUNZLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/906252018-01-25T05:15:11Z2018-01-25T05:15:11ZScrapping pre-approval of medicine ads will put consumers at risk<figure><img src="https://images.theconversation.com/files/203351/original/file-20180125-107943-1t0oa6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">vitamins</span> </figcaption></figure><p>A <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r5977">government bill</a>, currently before a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/TGA2017MeasuresNo1">Senate inquiry</a>, aims to simplify the process for advertising medicines. These include over-the-counter products such as Nurofen, and complementary medicines such as vitamins, herbals and homeopathic products. Advertising for prescription medication is not permitted in Australia. </p>
<p>If the bill passes, the current limited (but useful) process of pre-approving claims made in advertisements for medicines, to ensure they don’t mislead or deceive consumers, will be abandoned. This means advertisements are seen by two industry bodies before they are published or aired. Where problems are found, the bodies work with the advertiser to ensure compliance.</p>
<p>The government has argued removing the pre-approval process won’t put consumers at risk because other measures in the bill would compensate. These include greater surveillance when the product is on the market and increased penalties for regulatory violations. But <a href="http://regnet.anu.edu.au/news-events/events/7047/civil-society-hearing-therapeutic-goods-amendment-bill">civil society groups</a> want pre-approval to continue until these other measures have shown it’s no longer necessary. </p>
<h2>What is the current process for advertising?</h2>
<p>Advertisements for therapeutic goods directed at consumers must comply with the national <a href="https://www.legislation.gov.au/Details/F2015L01787">Therapeutic Goods Advertising Code 2015</a>. The object of the code is to ensure the marketing and advertising of therapeutic goods is conducted in a socially responsible manner that promotes their quality and safe use, and doesn’t mislead or deceive the consumer.</p>
<p>There are several other <a href="https://www.tga.gov.au/regulation-therapeutic-goods-advertising-australia">relevant laws and regulations</a>. For example, Section 22(5) of the Therapeutic Goods Act 1989 specifies advertising of a therapeutic good can only refer to indications or product claims that are included in the Australian Register of Therapeutic Goods (<a href="https://www.tga.gov.au/australian-register-therapeutic-goods">ARTG</a>). This is an electronic register on which information is entered by the manufacturer without oversight from the Therapeutic Goods Administration (TGA).</p>
<p>Manufacturers have worked around this provision by placing creative indications and claims on their ARTG entry, so they can make equally creative advertising claims.</p>
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<a href="https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pre-approval is only required for advertisements for medicines mainly in print, radio and TV – but not the Internet.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>The responsibility for authorising pre-approval has been delegated by the TGA to the advertising service managers of two industry associations: Australian Self Medication Industry (<a href="http://www.asmi.com.au/">ASMI</a>) and Complementary Medicines Australia (<a href="http://www.cmaustralia.org.au/">CMA</a>). </p>
<p>The assessments don’t usually extend to a detailed evaluation of the evidence used to support claims of efficacy, because of lack of time. Thus, pre-approval of an advertisement by one of the responsible industry bodies is not a guarantee the advertisement is compliant with all the requirements of the advertising framework. </p>
<p>Nurofen’s “<a href="https://www.accc.gov.au/media-release/court-finds-nurofen-made-misleading-specific-pain-claims">specific pain range</a>” is a good example of misleading claims that apparently slipped through the pre-approval system. The products were on <a href="http://www.adnews.com.au/news/nurofen-ad-pulled-pending-court-battle">sale and advertised</a> as targeting specifics types of pain (like migraine and backache), when they in fact contained the same ingredient. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tga-failure-gives-nurofen-consumers-a-headache-8762">TGA failure gives Nurofen consumers a headache</a>
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<p>Pre-approval is only required for advertisements for medicines (but not medical devices) in specified media – mainly print, radio and TV – but not the Internet. This is a problem, as it means the process has not kept up with current advertising trends.</p>
<h2>Pre-approval the only defence</h2>
<p>Removing pre-approval is a reduction in red tape as part of <a href="https://www.cuttingredtape.gov.au/">government policy</a>, and was a trade-off for industry accepting greater post-market surveillance and increased penalties and sanctions for regulatory violations. The bill also includes a controversial list of <a href="https://theconversation.com/new-complementary-medicine-health-claims-lack-evidence-so-why-are-they-even-on-the-table-80896">permitted indications</a>, which was meant to limit the industry’s ability to make creative claims about their products’ effectiveness.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-complementary-medicine-health-claims-lack-evidence-so-why-are-they-even-on-the-table-80896">New complementary medicine health claims lack evidence, so why are they even on the table?</a>
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<p>The pre-approval process is a form of weak co-regulation in a sector where some businesses can game the system. But it does give vendors, publishers and broadcasters some certainty about what is acceptable. Importantly, it seeks to prevent seriously harmful ads going live. It’s preferable to prevent harm from occurring than trying to remedy that harm after the fact.</p>
<p>Pre-approval is the only defence against seriously misleading advertisements appearing on prime-time television or in national newspapers. The <a href="https://www.doctorportal.com.au/mjainsight/2016/38/advertising-reform-watering-down-consumer-protection/">current process</a> reviews over 2,000 advertisements per year, with an average turnaround time of seven days. Most require changes, sometimes wholesale revisions.</p>
<p>The complaint system takes a long time to remove bad advertisements. Meanwhile, the damage has been done. It is also more economically efficient, given fraudulent therapeutic claims create unnecessary health expenditure and divert scarce health resources from remedies that work to ones that don’t.</p>
<p>The bill comes with a proposal from government for a three-year independent review. Consumer groups argue continuing the pre-approval process until this review would provide a good performance indicator to judge whether the new advertising system is better than the old one. One would expect the number of pre-approved advertisements requiring revision to fall if other measures in the package are successful.</p>
<p>Submissions to the <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/TGA2017MeasuresNo1">Senate inquiry</a> into the bill have emphasised policy-making on the basis of solid data rather than industry self-interest. The Senate is due to report on the legislation on February 2.</p><img src="https://counter.theconversation.com/content/90625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Harvey represents Choice (the Australian Consumers' Association) on the Therapeutic Goods Advertising Code Council and TGA stakeholder consultations on advertising and complementary medicine reform. He is also on the executive of Friends of Science in Medicine and a member of Skeptics Australia (Victorian Branch).
Asst Prof Arnold is a member of Friends of Science in Medicine.</span></em></p><p class="fine-print"><em><span>Bruce Baer Arnold is a member of Friends of Science in Medicine.</span></em></p>There is currently a weak process of checking claims made in advertisements for medicines, to ensure they don’t mislead or deceive consumers -this could be abandoned if a bill passes parliament.Ken Harvey, Associate Professor, School of Public Health and Preventive Medicine, Monash UniversityBruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/563462016-04-13T05:30:01Z2016-04-13T05:30:01ZWeekly Dose: ibuprofen – just because it’s freely available, doesn’t make it safe<figure><img src="https://images.theconversation.com/files/117046/original/image-20160401-28462-gpxq8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just because it's easily obtained, doesn't mean it can't be dangerous. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/meginsanity/6947900337/">Stars Apart/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><a href="http://amhonline.amh.net.au/">Ibuprofen</a>, like many other medications, can be obtained easily from supermarkets without consulting a health-care professional. This may make ibuprofen seem benign, and for the most part it is. However, like all all pharmacologically active substances, ibuprofen can have dangerous effects if used inappropriately.</p>
<p><a href="http://www.mimsonline.com.au">Ibuprofen</a> was first developed by <a href="https://www.researchgate.net/publication/51812511_50th_anniversary_of_the_discovery_of_ibuprofen_An_interview_with_Dr_Stewart_Adams">Dr Stewart Adams</a>. After completing his Bachelor of Pharmacy and PhD in Nottingham, UK, he begun working at Boots pharmacy on a project investigating new treatments for rheumatoid arthritis. At the time, rheumatoid arthritis research was dominated by development of steroid derivatives. In 1953, Adams began looking for non-steroid agents that had steroid properties; the term non-steroidal anti-inflammatory drug, or NSAID, was born.</p>
<p>In 1961, Adams patented a broad range of anti-inflammatory compounds, one of which was ibuprofen. Ibuprofen was approved for on-prescription use in the UK in 1969. It eventually became available over the counter.</p>
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<h2>How does it work?</h2>
<p>Ibuprofen, like all NSAIDs, exerts its action on the body by inhibiting the enzyme cyclooxygenase (COX), which is responsible for the production of prostaglandins. </p>
<p>Prostaglandins are involved in inflammation and repair after injury. Inhibition of COX enzymes results in decreased production of prostaglandins and therefore decreased pain and inflammation after injury, as well as decreased temperature during fever.</p>
<h2>What is it used for? How much is used?</h2>
<p><a href="https://www.tga.gov.au/otc-medicine-monograph-ibuprofen-oral-use">Oral ibuprofen</a> is indicated for the “temporary relief of pain and/or inflammation” associated with a variety of conditions such as headache, tooth ache, muscle aches and pains. It is also indicated for the reduction of fever. </p>
<p>Topical ibuprofen is used for local pain relief due to sprains and strains only.</p>
<p>During the first 48 hours after an injury, both topical and oral NSAIDs like ibuprofen should be <a href="http://bestpractice.bmj.com/best-practice/monograph/578/treatment/step-by-step.html">avoided</a> because they may actually slow the healing process during this phase.</p>
<p>Generally speaking, the usual adult dose of oral ibuprofen is 200-400mg every six to eight hours (maximum of 2,400mg over 24 hours). Child doses are based on weight or age (always use the lower of the two); these can be found on product packaging. Children should have no more than three doses in 24 hours. </p>
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<span class="caption">Ibuprofen is often taken to reduce fever.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>Oral ibuprofen is relatively inexpensive when bought over the counter. Prices range from A$1.65 to over A$20 depending on formulation, brand and packaging size.</p>
<h2>Controversies</h2>
<p>The ACCC has <a href="http://www.accc.gov.au/media-release/court-finds-nurofen-made-misleading-specific-pain-claims">recently found</a> the brand Nurofen guilty of making misleading claims about its Nurofen Specific Pain products, which contain ibuprofen.</p>
<p>While each one of these products contained the same active ingredient, ibuprofen lysine 342mg, the packaging referred to specific types of pain such as migraine pain and period pain.</p>
<h2>Side effects</h2>
<p>Ibuprofen is readily available in pharmacies and supermarkets. However, as with any medication, there are serious consequences if used inappropriately. Side effects and interactions are still possible even with topical ibuprofen, although the risk is significantly lower.</p>
<p>Ibuprofen and other NSAIDs can cause gastric upset if taken on an empty stomach in some people, if this occurs it should be taken with food. This is why paracetamol is usually recommended in the first instance for <a href="http://www.cochrane.org/CD007789/MUSKINJ_oral-non-steroidal-anti-inflammatory-drugs-compared-with-other-oral-pain-killers-for-sprains-strains-and-bruises">aches, pains</a> and <a href="http://www.australianprescriber.com/magazine/31/3/63/5">fevers</a>. It has fewer gastric side effects and in most cases is just as effective as NSAIDs.</p>
<p>While reducing prostaglandin production results in ibuprofen’s therapeutic effects, prolonged reduction in prostaglandin production due to chronic NSAID use decreases the secretion of protective substances in the gut, changes platelet activity and decreases filtration rate and blood flow in the kidneys.</p>
<p>This can result in gastric ulcers and bleeds, increased blood pressure, decreased kidney function and renal failure, heart failure and cardiovascular events such as heart attacks and stroke. This is why all NSAIDs are recommended for short-term use only unless under the supervision of a medical practitioner.</p>
<p>You must see a doctor immediately if after taking ibuprofen you experience swollen ankles, difficulty breathing, chest pain, black or red stools, or dark, coffee-coloured vomit.</p>
<h2>Interactions</h2>
<p>Like all NSAIDs, there are a number of interactions to consider before taking it. When ibuprofin, a diuretic and specific types of <a href="https://www.tga.gov.au/publication-issue/australian-adverse-drug-reactions-bulletin-vol-25-no-5#a1">blood pressure medications</a> are taken in combination for a prolonged time this can result in kidney failure; this combination is known as the “triple whammy”. </p>
<p>NSAIDs can increase the risk of severe asthma attacks, even as a single dose, and should be avoided in those with a history of asthma. Ibuprofen can also decrease the efficacy of some medications, such as aspirin and blood pressure medications.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/117049/original/image-20160401-9712-16iqkii.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ibuprofen comes in many different brands and forms.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/joffi/4491646082/">Michael W May/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>While medications such as ibuprofen are readily available to the public, inappropriate or long-term use can have negative consequences. There is a large list of drugs that ibuprofen and other NSAIDs interact with. </p>
<p>Whether you are able to take this medication safely will depend on your individual circumstances. If you are unsure whether ibuprofen is the best option or feel you need to use it for longer than a week or two, it is best to be speak to your medical practitioner or pharmacist.</p>
<hr>
<p><em>Correction: the article was updated to say NSAIDS can cause stomach upset in _some</em> people._</p><img src="https://counter.theconversation.com/content/56346/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paulina Stehlik does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ibuprofen can be obtained easily from supermarkets without consulting a health care professional. While this may make it seem it’s benign, it can have ill effects if used inappropriately.Paulina Stehlik, Associate lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/524612015-12-18T16:56:56Z2015-12-18T16:56:56ZWhy do people choose expensive branded drugs over cheap generics?<p>The Australian federal court <a href="http://www.theguardian.com/business/2015/dec/14/nurofens-maker-admits-misleading-consumers-over-contents-in-painkillers">has accused</a> Reckitt Benckiser of misleading consumers. The UK-based company has been marketing products in their Nurofen range for specific types of pain. The truth is, they all contain the same active ingredient: an analgesic drug called ibuprofen. Ibuprofen can’t be targeted at any specific pains. </p>
<p>No real harm done, you might think, except that these products were sold for twice the price of “standard” Nurofen. </p>
<h2>Profiteering or just brilliant marketing?</h2>
<p>While there may be some value in allowing people to shop by symptom, rather than active ingredient, the price seems inappropriately high. But perhaps not high enough to warrant the media outrage expressed. Is the real issue that we’re squeamish about companies making a profit from our suffering?</p>
<p>A time-starved generation of “baby boomers” convinced that “we’re worth it”, together with the entitled narcissism of the “millennials”, believe that when we’re in pain, we want the absolute best thing there is to treat it, quickly, with no compromise. As well as the simplified choices of shopping by symptom, products seemingly designed to treat our exact discomforts (period pain, headaches, hangovers) are likely to be seen as more effective than a general purpose painkiller. </p>
<p>Also, we believe in science – and particularly medical science – as a credible, rational source of authority; hence all those ads featuring men (usually men) in white coats. Surely these patricians wouldn’t mislead us, just for profit? </p>
<h2>Does the court’s decision really benefit us?</h2>
<p>The Australian federal court’s protective policing may benefit the consumer in the short term, but there is a flip side. We are likely to be reassured by this that future claims will be “legal, decent, honest and truthful”, making us more likely to give them credence, rather than taking a look at the small print and thinking for ourselves a little – the last thing that most brands would want.</p>
<p>So far, so heinous. Such claims - identical products, different promises, and different prices - seem worthy of an Apprentice facing the boardroom wrath of Lord Sugar for shady dealing on a market stall.</p>
<p>However, imagine for a moment that you’re a GP in private practice. Concerned parents of a six-year-old in pain bring her to see you. With no underlying trauma or organic condition to treat, you decide that the pain will certainly stop after a few days. A mild analgesic will help a little in the meantime, but the effects will be significantly boosted if the little patient can be convinced that her medicine is made specially to treat her tummy-ache. Even more so, if her loving parents also believe this. And, for her parents to really believe, you will need to charge them many times what they would pay for the same drug at a chemist. What price truth then?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/106351/original/image-20151216-30098-17qll1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/106351/original/image-20151216-30098-17qll1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106351/original/image-20151216-30098-17qll1x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106351/original/image-20151216-30098-17qll1x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106351/original/image-20151216-30098-17qll1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106351/original/image-20151216-30098-17qll1x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106351/original/image-20151216-30098-17qll1x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This is expensive, so it’s going to work.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?autocomplete_id=&language=en&lang=en&search_source=&safesearch=1&version=llv1&searchterm=placebo&media_type=photos&media_type2=photos&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=325195844">www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>The power of belief</h2>
<p>Numerous studies have demonstrated the potency of the placebo effect. So, although at face value it seems unfair to market an identical ibuprofen product for specific aliments or to different consumer segments (leading perhaps to multiple purchases where one would have sufficed), there may be an argument that doing so can genuinely increase its effectiveness in the areas specified through the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17550344">sheer power of the belief</a>. </p>
<p>While “rational” commentators can decry this as foolish, the science would suggest it works. Further, because of our tendency to alter our views to reduce cognitive dissonance (the mental discomfort we feel when we hold two or more conflicting ideas or values), by charging a premium for such “targeted” products, we – the consumer – may well <a href="http://www.neurology.org/content/early/2015/01/28/WNL.0000000000001282">amplify any placebo effect</a> present in order to justify our purchase (as when people claim fantastic efficacy for expensive branded wrinkle creams, while thinking the “Lidl equivalent” to be ineffective).</p>
<p>Although there is nothing in the public domain to suggest any noble purpose on the part of Reckitt Benckiser, an unintended effect of removing this “targeted” range may be to leave some consumers less able to treat their pain. Placebos add a tint of grey to ethical considerations in medical treatment. Greater leeway might be of genuine value, beyond just profit, in how some products are described or positioned. Rather than simply exploiting our fears and playing to our baser instincts, perhaps effective marketing, in this arena at least, could contribute something to the sum of human happiness.</p><img src="https://counter.theconversation.com/content/52461/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie Hallam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Packaging and pricing have their own healing properties says an expert on the psychology of advertising.Leslie Hallam, Course Director, Psychology of Advertising Masters Programme, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/471562015-09-30T19:41:25Z2015-09-30T19:41:25ZDo you need to take some painkillers with food to protect your stomach?<figure><img src="https://images.theconversation.com/files/95315/original/image-20150918-12371-19slt8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is little hard data on whether taking ibuprofen with food prevents gastric damage.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/jodigreen/7294862082/in/photolist-c7C5mb-8YGBgm-8xGZZf-sNQyEc-c29559-c7C5gu-6jQM1g-c7C5c5-81dyMa-6FpGRK-8Z7zem-a8mUbD-8vHMU-hNn9e-MJTqQ-2mRMyP-jgPugB-qVt7gW-7Rc4k-dQtU8f-ecBUvW-fvQEvL-qQ6Yy1-51cFx5-ov5T3e-q1k9H6-4iKaQh-9ovudD-9ovsFK-9ovvUg-3sBKG-9oyx3E-82vrM-tsSM3-4YzWZ2-4ZfkcN-7auKWr-8Z6NkM-3gRnw5-zmbBo-9bpCS-HAHBB-4wgEuR-beaF4-5mEBMu-dRsLkh-84DMvo-8sQ6Gv-cwEfdL-hM3GFy">Jodi Green/Flickr</a></span></figcaption></figure><p>Medical media recently <a href="http://www.6minutes.com.au/news/latest-news/ibuprofen-ok-on-an-empty-stomach">reported</a> that a clinicians’ reference handbook had changed advice on how to take the painkiller <a href="http://www.nps.org.au/medicines/muscles-bones-and-joints/anti-inflammatory-medicines-nsaids/ibuprofen">ibuprofen</a> - commonly sold under the brand names Nurofen and Advil. </p>
<p>While the <a href="https://amhonline.amh.net.au/">Australian Medicines Handbook</a> previously advised this drug must be taken with food, the <a href="https://amhonline.amh.net.au/chapters/chap-15/musculoskeletal-conditions-other/nsaids/ibuprofen">updated version says</a>:</p>
<blockquote>
<p>Take oral doses with a glass of water. It may be taken without food but if this upsets your stomach, try taking it with a meal.</p>
</blockquote>
<p>The change isn’t particularly remarkable. Minor adjustments are often made to how we dose drugs as our knowledge improves. And yet a few medical media outlets considered it interesting enough to be <a href="https://ajp.com.au/news/ibuprofen-safe-to-take-with-water-alone-new-advice/">a story</a>. So why the kerfuffle? </p>
<p>Ibuprofen, together with drugs such as <a href="http://www.nps.org.au/medicines/pain-relief/simple-pain-reliever-and-fever-medicines/aspirin">aspirin</a> and <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/cmipages/CMI11358">diclofenac</a> (Voltaren), belongs to a class of medicines called <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Medications_non-steroidal_anti-inflammatory_drugs">non-steroidal anti-inflammatory drugs</a> (NSAIDs). Chronic use of these can <a href="http://pmj.bmj.com/content/77/904/82.full#ref-1">damage</a> the stomach lining, leading to gastritis and <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/stomach_ulcer">ulcers</a>. </p>
<p>Until recently, medical advice in Australia and Europe (but not the <a href="http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm125225.htm">United States</a>) to take the painkillers with food was based on the assumption that it reduced the risk of stomach damage. Does the change in advice mean the assumption has also changed? And are we risking stomach damage when taking anti-inflamatories without food?</p>
<h2>Gastric damage</h2>
<p>Our stomach walls (made of protein) need protection from stomach fluid, which is highly acidic and full of enzymes dedicated to breaking down proteins in food. On an empty stomach, gastric fluid acidity ranges from that of battery acid to lemon juice.</p>
<p>To protect itself, the stomach secrets a layer of mucus, which can control the amount of stomach acid and neutralise it. When one or both of these mechanisms go awry, stomach lining damage and ulceration can occur.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96587/original/image-20150929-30964-166zcvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96587/original/image-20150929-30964-166zcvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96587/original/image-20150929-30964-166zcvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96587/original/image-20150929-30964-166zcvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96587/original/image-20150929-30964-166zcvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96587/original/image-20150929-30964-166zcvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96587/original/image-20150929-30964-166zcvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Typical over-the-counter doses of ibuprofen are up to 1200mg per day and can be taken for up to three days.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jeepersmedia/15026174567/in/photolist-oTP5ci-oTNs9u-p9ggXW-p9ggPE-pbijWz-pbghEb-oTP2ru-oTP2hm-pbghqy-oTMWXT-oTP23U-p9gg3u-p9gg2C-pbggRC-pb2AAi-oTP1sA-pb2AqD-oTMW2e-oTMVVT-oTMVTP-62aNWn-7xLez8-bncpSZ-jNEwz-r9m85P-6kK9Qm-5F7o6e-6MxNr1-6MUwJN-4aEptY-7KQRvq-9LpQnC-9vFvsd-9vFBqd-9vCtsr-9vCtzi-9vCtht-9vCsAM-3KxyJp-9vFzch-9vFwt9-9vFwfq-6D6TBx-moAj6d-aS78wg-5rQf5B-4WWEEN-6MuQ7d-e7Z8DD-bzXNH8">Max Mozart/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Ironically, due to their pain-relieving properties, NSAIDs can cause <a href="http://physrev.physiology.org/content/88/4/1547">serious damage to stomach lining</a>. This is because they decrease pain and inflammation by inhibiting production of <a href="https://en.wikipedia.org/wiki/Prostaglandin">prostaglandins</a>, a group of fatty acids that promote inflammation and increase pain perception.</p>
<p>But prostaglandins also protect the stomach lining from acid, by decreasing acid production and increasing mucus secretion and its neutralising properties. So inhibiting prostaglandins also reduces their protective functions. </p>
<p>NSAIDs are commonly used to manage the pain and inflammation of arthritis and musculoskeletal disorders. People also take them for short-term pain relief: for headaches, migraines and period pain, as well as to reduce fever. There’s an important difference between the risk to long-term users compared to someone who takes them for the occasional headache.</p>
<p>Gastric ulceration, where irritation to the stomach erodes its surface, can be severe. Symptoms include internal bleeding, indigestion, nausea, vomiting and weight loss. Studies show that, in relation to NSAIDs, ulceration is <a href="http://www.ncbi.nlm.nih.gov/pubmed/18335848">time- and dose-dependent</a>. </p>
<p>Typical over-the-counter doses of ibuprofen are up to 1200mg per day and can be taken for up to three days. There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/22420652">either no or minimal gastric damage</a> at doses of less than 1600mg a day over three days. But people who take prescription doses for a month or more have a <a href="http://jama.jamanetwork.com/article.aspx?articleid=193062">2% to 4% chance of developing ulcers</a>.</p>
<p>It has long been thought that <a href="http://www.sciencealert.com/why-do-we-take-some-medications-with-food">food “cushions” the stomach</a> from acidity. But, surprisingly, there is <a href="http://www.ncbi.nlm.nih.gov/pubmed/22420652">very little hard data</a> to support that it can <a href="http://www.ncbi.nlm.nih.gov/pubmed/23163547">protect the stomach from NSAID damage</a>.</p>
<h2>NSAIDs with food</h2>
<p>Food does reduce stomach acid, from around battery acid levels to somewhere around that of tomato juice or black coffee. </p>
<p>NSAIDs are better absorbed from acidic, rather than neutral, solutions. So an acidic stomach environment, after a night of fasting for instance, means NSAIDs will reach a higher blood concentration than after a meal. But a less acidic environment created by food will <a href="http://onlinelibrary.wiley.com/doi/10.1111/bcp.12628/epdf">slow NSAID absorption</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/96566/original/image-20150929-30964-1cpf3jy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/96566/original/image-20150929-30964-1cpf3jy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=545&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96566/original/image-20150929-30964-1cpf3jy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=545&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96566/original/image-20150929-30964-1cpf3jy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=545&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96566/original/image-20150929-30964-1cpf3jy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=685&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96566/original/image-20150929-30964-1cpf3jy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=685&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96566/original/image-20150929-30964-1cpf3jy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=685&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stomach ulcers can cause vomiting and weight loss.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>In studies where <a href="http://www.ncbi.nlm.nih.gov/pubmed/7084604">animals were given high levels of NSAIDs</a> after 24 to 48 hours of fasting, they developed ulcers in the stomach. On the other hand, animals that had been fed got ulcers in their intestine instead of their stomach. That is, ulcers developed in both circumstances - they were just found in different locations.</p>
<p>However, whether these effects are applicable to humans, especially with the typical doses used for pain relief, and whether different food components play a role in this shift from stomach to intestine ulceration, is unclear. </p>
<p>Pain relief is related to the <a href="http://onlinelibrary.wiley.com/doi/10.1111/bcp.12628/epdf">concentrations</a> of painkillers in the blood. There’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/15460211">reasonable evidence</a> that faster ibuprofen, or other NSAID absorption, will lead to faster pain relief.</p>
<p>Peak concentrations of ibuprofen in blood occur between <a href="http://www.medsafe.govt.nz/profs/datasheet/i/IbuprofenArrowcaretab.pdf">1.5 to three hours after a 200mg dose</a> in people who take it with a meal. For those who take it with just water, the maximum concentration is reached after 45 minutes. </p>
<p>So taking ibuprofen with water is likely to result in better pain control and also <a href="http://www.ncbi.nlm.nih.gov/pubmed/23969325">reduce the need</a> to take more. Having to take fewer doses in turn reduces the likelihood of gastrointestinal effects. Also, people who put off taking ibuprofen until they eat will suffer pain for longer than necessary. </p>
<p>Overall, changing from taking NSAIDs like ibuprofen with food to just water - unless there is stomach upset - may improve pain relief and is very unlikely to harm people who take the drug occasionally and as directed. Those who use ibuprofen and other NSAIDs for chronic pain relief, however, should consult their doctor about how best to take it.</p><img src="https://counter.theconversation.com/content/47156/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adulterants and contaminants of herbal medicines, and has received past funding from the Australian Research Council to study nutracueticals and amyloid toxicity. </span></em></p>It’s long been thought anti-inflammatory painkillers need to be taken with food to protect the stomach. But a handbook for doctors has recently moved away from this advice.Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/137982013-05-27T20:14:15Z2013-05-27T20:14:15ZTargeted pain relief or targeted marketing? The truth hurts<figure><img src="https://images.theconversation.com/files/23590/original/z8nqp2h6-1368405623.jpg?ixlib=rb-1.1.0&rect=3%2C223%2C1076%2C690&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The dizzying range of "targeted" pain-relief options in pharmacies can make your head hurt.</span> </figcaption></figure><p>A visit to the pharmacy for pain relief can be complicated. As consumers, we are faced with a bewildering choice of pain relief options. But why?</p>
<p>Within <a href="http://www.nurofen.com.au/pain-relief/products/specific-pain.php">the Nurofen range</a> we have Nurofen for back pain, Nurofen for tension headaches, Nurofen for migraines, Nurofen for period pain, Zavance. Within <a href="https://www.panadol.com.au/All-Products/">the Panadol range</a> we have Panadol back and neck, Panadol rapid, Panadol Osteo. And then we face the choice of gel caps, caplets, tablets, soluble tablets …</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/23587/original/bshpgvxy-1368405347.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">markkilner</span></span>
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<p>So is there really a difference in these types of products or is it just a marketing ploy that leaves our homes resembling a pharmacy?</p>
<p>The short answer is … the latter! While there are some small differences between products mostly this is marketing. Generally speaking, all of these products contain the same amount of <a href="http://pharmacy.about.com/od/Glossary/g/What-Are-Active-Pharmaceutical-Ingredients-Or-Apis.htm">active ingredient</a> – a substance that is biologically active – and will provide approximately the same level of pain-relief as the next box of Panadol or Nurofen. </p>
<p>Nurofen for tension headache, period pain and back pain all contain exactly the same medication at the same dose (342mg of <a href="http://www.drugs.com/ppa/ibuprofen-lysine.html">ibuprofen lysine</a> which is equivalent to 200mg <a href="http://en.wikipedia.org/wiki/Ibuprofen">standard ibuprofen</a>).</p>
<h2>Target practice</h2>
<p>Put simply, Panadol and Nurofen (and other equivalent brands) are unable to “target” specific regions or types of pain. These medications work by blocking enzymes (everywhere in the body, not just the area the is currently painful) which help to make chemicals called <a href="http://medical-dictionary.thefreedictionary.com/prostaglandin">prostaglandins.</a>.</p>
<p>Less prostaglandin means less pain and inflammation. It is not known exactly how paracetamol works but it does not reduce inflammation. Paracetamol is used to treat pain. </p>
<p>The type of painkiller you need depends upon the type of pain you have. Paracetamol is normally suitable if your pain is not too serious and you do not have inflammation whereas medications such as Nurofen are generally recommended for people who have pain and inflammation, as might be the case with back pain.</p>
<p>Thus if you take the Nurofen specifically for period pain it will work in exactly the same way and produce the same amount of pain relief for a tension headache.</p>
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<a href="https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=556&fit=crop&dpr=1 600w, https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=556&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=556&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=698&fit=crop&dpr=1 754w, https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=698&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/23593/original/vs5xwk92-1368405906.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=698&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">estherase</span></span>
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<p>The main difference between the products is in relation to how quickly our bodies absorb the medication (how quickly it is going to work) or for how long they work (if the product is sustained or immediate release). </p>
<p>There are a multitude of techniques drug companies use to increase the rate medications are dissolved in the stomach and thus absorbed into the blood stream. </p>
<p>Examples include using water-soluble salts such as ibuprofen lysine versus ibuprofen acid (standard ibuprofen), or having it already in a liquid form – gel capsule versus solid tablet. </p>
<p>Or they even might add extra ingredients, such as Panadol’s <a href="http://www.panadol.com/me/collective-knowledge/what-is-optizorb.html">Optizorb®</a> – a patented technology that “allows the tablet to start disintegrating in as little as five minutes”.</p>
<h2>Know your pain</h2>
<p>The choice of whether to take paracetamol or ibuprofen should be highly dependent on the pain you are suffering from (ibuprofen has more <a href="http://www.patient.co.uk/health/anti-inflammatory-painkillers">anti-inflammatory</a> properties than <a href="http://www.nlm.nih.gov/medlineplus/painrelievers.html">pain-relieving</a>, whereas paracetamol relieves pain rather than inflammation) and what other tablets you are taking or medical conditions you have. </p>
<p>So, instead of stocking up your bathroom cupboards with every type of pain relief under the sun it is important to check which medication is most appropriate for you. Your pharmacist can help with this.</p>
<p>Although manufacturers of paracetamol or ibuprofen always stress how safe these medications are, it’s vital you follow the directions written on the packet closely.</p>
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<a href="https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=793&fit=crop&dpr=1 600w, https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=793&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=793&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=996&fit=crop&dpr=1 754w, https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=996&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/23592/original/h5jg4sym-1368405806.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=996&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">longhairbroad</span></span>
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<p>To start, only take the recommended maximum number of tablets each day. This is no more than 4 grams of paracetamol or 1.2 grams of ibuprofen (two tablets three times a day). </p>
<p>Many cold and flu preparations also contain pain relievers so it is important you keep track of the total amount of paracetamol or ibuprofen you are taking throughout the day. </p>
<p>Exceeding the maximum dose of paracetamol can lead to liver toxicity; whereas exceeding the ibuprofen daily dose can cause severe irritation to the gut lining.</p>
<p>In addition, there are a few health conditions in which ibuprofen should be taken with caution. Like aspirin, ibuprofen can trigger an asthma attack in some asthmatics. </p>
<p>People with high blood pressure or history of gastric ulcer/severe heartburn should avoid taking ibuprofen because this medication may worsen both conditions. </p>
<p>Ibuprofen can also increase the blood-thinning action of aspirin, <a href="http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682277.html">warfarin</a> and other anticoagulants.</p>
<p>As always, be sure to check with your pharmacist if you’re in any way uncertain about dosage, and even whether you should be taking a given drug.</p>
<p>And just remember, regardless of the marketing, these drugs can’t “target” a specific type of pain. </p><img src="https://counter.theconversation.com/content/13798/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A visit to the pharmacy for pain relief can be complicated. As consumers, we are faced with a bewildering choice of pain relief options. But why? Within the Nurofen range we have Nurofen for back pain…Felicity Veal, PhD Candidate, University of TasmaniaJuanita Breen (previously Westbury), Lecturer in Pharmacy Practice and Research Fellow, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/87622012-08-10T01:14:27Z2012-08-10T01:14:27ZTGA failure gives Nurofen consumers a headache<figure><img src="https://images.theconversation.com/files/14108/original/3zjg6wdj-1344494375.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nurofen was criticised for claiming its products "target" different sites of pain.</span> <span class="attribution"><span class="source">samcatchsides.com/flickr</span></span></figcaption></figure><p>In 2010, the promotion of the Nurofen range of products “targeting” migraine, back pain, tension headache and period pain was awarded a <a href="http://www.choice.com.au/reviews-and-tests/awards/shonky-awards/shonkys/the-2010-shonky-awards.aspx">CHOICE shonky award</a>.</p>
<p>This was because all these products contained the same active ingredient (ibuprofen) and there’s no evidence that ibuprofen specifically “targets” the sites of pain. </p>
<p>CHOICE noted that filling up your medicine cabinet with different painkillers for every type of pain was unnecessary, not to mention wasteful, especially if they expired before you used them all. </p>
<p>CHOICE concluded, “the shonkiest aspect of this type of marketing is that the fast-acting painkillers labelled for specific pain types are more expensive – costing almost twice as much in some stores we surveyed – than their ‘all-pain’ fast-acting equivalent, Zavance caplets, which contains a comparable fast-acting form of ibuprofen.” </p>
<p>In August 2011, in response to a complaint submitted by Professor Paul Rolan about the promotion of Nurofen for headaches on television, the <a href="http://www.tgacrp.com.au/index.cfm?pageID=13&special=complaint_single&complaintID=1850">Complaint Resolution Panel</a> (CRP) requested Reckitt Benckiser (Australia) Pty Ltd “withdraw any representations, in the context of headaches, that the advertised product goes straight to the source of pain or targets pain.”</p>
<p>In September 2011, Reckitt Benckiser said it <a href="https://www.australiandoctor.com.au/news/latest-news/nurofen-maker-says-ads-will-carry-on">did not agree</a> with the CRP, “Nurofen advises that consumers will continue to see the familiar branding of the Nurofen target and messages of Nurofen working at the site of the pain. This branding includes TGA approved claims on packs that Nurofen provides targeted relief from pain.” Subsequently, the CRP referred this non-compliance to the delegate of the Secretary (the Therapeutic Goods Administration). </p>
<p>In August 2012, the TGA <a href="http://www.tga.gov.au/industry/advertising-reg9-2011-06-001-reckitt-benckiser.htm">published</a> the outcome of their review. The delegate of the secretary ordered Reckitt Benckiser (Australia) Pty Ltd to, “withdraw the ‘Live Well Headache’ television advertisement about the therapeutic good ‘Nurofen’ which was the subject of the complaint” and “to withdraw any representations, in the context of headaches, that the advertised therapeutic good ‘Nurofen’ goes ‘straight’ to the source of the pain”. </p>
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<img alt="" src="https://images.theconversation.com/files/14105/original/2qp2rz65-1344493430.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/14105/original/2qp2rz65-1344493430.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/14105/original/2qp2rz65-1344493430.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/14105/original/2qp2rz65-1344493430.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/14105/original/2qp2rz65-1344493430.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/14105/original/2qp2rz65-1344493430.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/14105/original/2qp2rz65-1344493430.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There’s no evidence that products claiming to target sites of pain actually do so.</span>
<span class="attribution"><span class="source">Back ache photo from Shutterstock</span></span>
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<p>In response, regional director of Reckitt Benckiser, Lindsay Forrest, said he was, “delighted with the TGA Delegate’s ruling as it validates our decision to challenge the CRP findings, specifically in relation to our ability to communicate our long standing messages of targeted pain relief in relation to pain, including headaches”. The media statement continued, “Reckitt Benckiser’s current media plan will not be impacted by the TGA Delegate’s decision as it currently complies with all the TGA Delegate’s findings”.</p>
<p>It is my view that TGA delegate’s ruling has unnecessarily and incorrectly limited the Regulation 9 order to the specific words, “goes straight to the source of the pain” thereby failing to taking into account the CRP’s equal concern about the words, “targeted relief from pain”. In addition, by focusing only on the television ads for headaches and not taking into account the wider ongoing Nurofen campaign that uses look-alike branding the TGA delegate has failed to protect consumers.</p>
<p>In my opinion, the ongoing promotion of Nurofen products using claims such as “targeted relief”, “targets the source of pain”, “targeting the site of pain”, target imagery, both on the pack and in numerous advertisements, and television ads showing an animated target travelling through the body to end in the head, all breach the specific wording of the CRP determination and also the meaning that the average consumer would attribute to the delegate’s determination. </p>
<p>I note that a current “TGA medicine labelling and packaging review” has <a href="http://www.tga.gov.au/newsroom/consult-labelling-packaging-review-120524-13-appendix1.htm">proposed</a>, “Products cannot be marketed as'BRAND headache’, ‘BRAND backache’, ‘BRAND joint pain’ if they include the same active ingredients in the same quantity.” </p>
<p>Accordingly, I have now submitted a complaint to the CRP, TGA and ACCC alleging that the current promotion of Nurofen by Reckitt Benckiser (Australia) Pty Ltd is in breach of the Competition and Consumer Act 2010 (misleading and deceptive conduct) and also a number of sections of the Therapeutic Goods Advertising Code (2007).</p>
<p>Finally, I believe this case shows up major defects in the current complaint handling system. Sponsors can disagree with the independent CRP determination and continue to promote while the problem is referred to the TGA. TGA regulation 9 determinations are slow (and in this case legalistic and missing the wood by focusing on a tree); meanwhile promotion continues. The sponsor can advise they have complied (using a strict legalistic interpretation of words) but in fact, questionable promotion continues.</p>
<p>It is my view that promotion should cease once a CRP determination has been made and until such time as any review has exonerated the claims made. The current system is heavily weighted in favour of the sponsor and provides consumers with little protection. </p><img src="https://counter.theconversation.com/content/8762/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Harvey is affiliated with CHOICE (the Australian Consumers Association).</span></em></p>In 2010, the promotion of the Nurofen range of products “targeting” migraine, back pain, tension headache and period pain was awarded a CHOICE shonky award. This was because all these products contained…Ken Harvey, Adjunct Associate Professor of Public Health, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.