Being Singaporean it’s always struck me, when looking at US media that NSAIDs such as aspirin or ibuprofen were always the standard first choice analgesics to the point of genericity (“Take two aspirin and call me in the morning”). In Singapore (and Australia and India in my experience) however, the standard first line analgesic is paracetamol. I’ve always wondered why this very basic difference in medical practice existed.
Usually in situations like this one can generally put it down to countries choosing to follow British as opposed to American SOPs but the Brits like their NSAIDs too. South Asians, South-East Asians, and Australasians seem to be outliers here.
I don’t know whether this is actually true or not; Wikipedia says that paracetamol/acetaminophen “is the most commonly used medication for pain and fever in both the United States and Europe.”
Aspirin, however, has been readily available for a lot longer than competing pain relievers like paracetamol/acetaminophen and ibuprofen. The line “Take two aspirin and call me in the morning” is a cliche that may well date from the days before those others were around.
Nowadays, the real-world equivalent (let’s say, the advice you will receive over the phone from a medical helpline) tends to favour paracetemol/acetaminophen. If you are experiencing slightly more severe pain, the conversation will tend to include discussion of alternating doses of ibuprofen and paracetemol(possibly combined with codeine).
“Take two aspirin and call me in the morning,” doesn’t, confusingly enough, really mean take two aspirin. At least, it doesn’t anymore, and I doubt it ever did. What it really means is, “This doesn’t sound serious, it will probably go away on its own, so don’t bother me yet.” Aspirin was something seen as fairly benign that everyone had in their home, so telling someone to take it gave them something to do, perhaps exploited the placebo effect, and saved the doctor from having to treat a lot of self-correcting conditions.
In the real world today, in the US, paracetamol/acetaminophen and NSAIDs are treated fairly equally as first line treatment of pain, with considerations being based on the cause of pain and any personal health conditions or risks. If a person has a history of GI bleeds or poor kidney function, or is at high risk of cardiovascular disease, they’ll be told to take paracetamol/acetaminophen. If they’ve got liver disease, NSAIDs. If no risks either way and inflammation can be identified as a reason for the pain, then NSAIDs, although the antiinflammatory effect of NSAIDs actually takes several doses to begin effect. Otherwise, it’s mostly doctor habit to say one over the other.
I think it’s also largely a case of what people’s parents did also - most of these are over the counter meds that people don’t ask a doctor before they take, they just snag one (or two or three) out of the medicine cabinet in the bathroom because they’re hurting somewhere.
My parents favored ibuprofen, and aspirin was around for blood-thinner purposes and as “baby aspirin” for the little ones, and I never once saw a tylenol.
So now as an adult in my own house, I don’t ever think about aspirin as a pain killer, and I’ve always taken ibuprofen. I can probably count the times I’ve had tylenol on one hand (not counting the big guns - tylenol 3 or whatever that you get from the doctor after surgeries).
All of my friends appear the same - they have their preferred “type” of pain killer, and it’s different for all of them, even to the brand. It would be an interesting thing to study.
Tylenol (acetaminophen) got it’s big boost with aspirin’s association with Reye syndrome. It became the go to drug in medicine cabinets for a generation. Ibuprofen and other NSAID’s have made a big increase in homes in the past 20 years.
Acetominophen is also liked in hospitals because it does not affect blood clotting (through platelets) like aspirin and other NSAID’s.
It’s worth noting that while aspirin and NSAID’s do have some potentially dangerous side effects, those usually come with chronic use. Acetominophen has a much narrower therapeutic window, especially for drinkers and a subset of people with appropriate genetics, which makes them susceptible to possibly severe liver toxicity with a relatively modest overdose.
Acetominophen is incorporated into a horrifying number of over-the-counter and prescription meds (NyQuil, allergy pills, cough syrups, narcotic prescription pain pills and syrups), and when you’re not feeling up to snuff you may be taking some of those in addition to analgesics.
Personally I have no use for the stuff (it vastly underperforms aspirin and ibuprofen in my personal experience) but trying to leave my attitude out of the equation I’d say the main thing is check all the other meds you’re taking and include any acetominophen that’s in them in your calculations to make sure you don’t overdose on acetominophen if you choose to take it.
IIRC, that happened sufficiently after aspirin became “taboo” for kids for Tylenol to be “go to” over-the-counter med.
Also, the response by Tylenol manufacturer is still held up today as an exemplar of responsible and effective damage control in various news reports I’ve heard (sorry, I’ve got no cites).
I just wish they had been as responsible in dealing with the overdosage issue, especially for babies. ‘This American Life’ had a nice discussion.
This is anecdotal, but I find that acetaminophen just doesn’t work as well for me as ibuprofen. With ibuprofen, I get significant relief from my aches and pains; the result from acetaminophen is negligible. This became an issue a while back when I was in chemotherapy and was told to avoid NSAIDs because the chemo was suppressing my platelet counts and bleeding became a potential issue. At times, it seemed there was just no relief from pain at all.
Ok so pretty much the same as in my experience and the percieved prevalence of aspirin is just a cultural artifact as it were. Makes sense given that aspirin is problematic with younger teens and children.
Yup I understood that- just wondered if aspirin really was still that prevalent in the US or if the phrase was just a cliche from past decades, which has been answered.
For most Americans, going to the doctor was a major expense in the old days. A doctor might cost $5.00 or 1% of an annual working class income. That’s equivalent to almost $500 today. OTOH, they worried as much as they do today, especially about their children.
The cliche of “Take two aspirin and call me in the morning” is partly a knock on doctors not wanting to make a house call in the middle of the night for something that was likely to be temporary and trivial. But it’s also a recognition that many ailments don’t appear as serious the next morning as they seemed. That saved the family a much-needed $5.00.
The doctor would show up for a true emergency, though; they had to learn how to listen to a call and make that determination. Of course, between their being human and most people’s inability to properly convey symptoms, sometimes they made a bad call, with horrible results.
And sometimes the placebo effect of taking the only known OTC painkiller at the advice of a doctor would itself be helpful in getting people through the night.
In more recent times, in the U.S. aspirin has become closely associated with a daily heart-disease prevention regimen. IIRC, there was even an aspirin commercial that played on this idea, in which a person who was told to try aspirin for pain responded that they weren’t having a heart attack.
General recommendations for pain tend to reference Tylenol (acetaminophen) or Advil (ibuprofen).
That the cliche is a later invention and not really something that got said is confirmed by Google ngrams.
The phrase doesn’t exist until the late 1960s and then its use zooms upward.
That was also the end of a period when another cliche had it that you couldn’t find a doctor on a Wednesday, because that’s when they were all playing golf. The medical profession has changed radically in the last half century.
No. Acetaminophen is a very common source of liver failure:
*Liver damage[edit]
Acute overdoses of paracetamol can cause potentially fatal liver damage. In 2011 the US Food and Drug Administration launched a public education program to help consumers avoid overdose, warning: “Acetaminophen can cause serious liver damage if more than directed is used.”[40][41][42] In a 2011 Safety Warning the FDA immediately required manufacturers to update labels of all prescription combination acetaminophen products to warn of the potential risk for severe liver injury and required such combinations contain no more than 325 mg of acetaminophen (within 3 years).[43][44] FDA has likewise requested prescribers limit combination opioids to 325 mg of acetaminophen. Such overdoses are frequently related to high dose recreational use of prescription opioids as these opioids are most often combined with acetaminophen.[45] The overdose risk may be heightened by frequent consumption of alcohol.
Paracetamol toxicity is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.[46][47][48][49] According to the FDA, in the United States there were “56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths per year related to acetaminophen-associated overdoses during the 1990s. Within these estimates, unintentional acetaminophen overdose accounted for nearly 25 percent of the emergency department visits, 10 percent of the hospitalizations, and 25 percent of the deaths.”[50]
Paracetamol is metabolised by the liver and is hepatotoxic; side effects are multiplied when combined with alcoholic drinks, and are very likely in chronic alcoholics or patients with liver damage.[51][52] Some studies have suggested the possibility of a moderately increased risk of upper gastrointestinal complications such as stomach bleeding when high doses are taken chronically.[53] Kidney damage is seen in rare cases, most commonly in overdose.[54]
*
The main reason is that Tylenol/Acetaminophen/Paracetamol is hidden in many OTC drug concoctions. It’s really easy to get a overdose by chugging your Nyquil and also taking 3 Extra Strength Tylenol- and some booze. It’s also really common in narcotic prescription pain pills, and of course those are very commonly abused.
Yes. I never take anything that has it in it. It is very easy to overdose it. Liver failure is far worse than a stomach upset or even a GI bleed from an NSAID. Plus NSAIDs have anti-inflammatory effects that are very useful for most conditions that you want to take a painkiller for. Considering that a significant percentage of the Asian population has been exposed to hepatitis viruses, I’m surprised anyone there would be wiling to take acetaminophen to further stress their livers.