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Mythbuster: ibuprofen and women

Ibuprofen and women
Mythbusting
Results
Comment

Bandolier seems to have spent a lifetime being told things that, on chasing up, were just not true. In the medical world, this can be a reference to a reference to a reference, which, when read, finds that something was tried in two men and a dog, and the dog got better (or died). Or it can even be that a much-quoted reference does not actually exist. These things are irritating beyond belief, but ultimately one has the satisfaction of nailing the myth.

Other myths and legends are much more difficult. They are vague, or seemingly unimportant, or seemingly important but apparently backed up by evidence of a sort (there is evidence that...). Bandolier finds that so often this sort of evidence turns out to be a distortion of facts or statistics, but unless the myth or legend immediately sets alarm bells ringing, it gets past the filters and directly into memory. The first Mythbuster is about a myth that immediately set alarm bells ringing and was nailed.

Ibuprofen and women

A researcher was told by a chiropractor that ibuprofen was ineffective in women, based on an article in the New Scientist in January 2002 written by a science writer in residence at the Novartis Foundation. A single study of experimental pain in 10 women and 10 men was the source of the assertion that ibuprofen was ineffective in women, supported by the claims that this was clinically important. A further assertion was that women were under-represented in clinical trials of analgesics, which was why clinical trials had failed to show the ineffectiveness of ibuprofen. The researcher just happened to be updating a Cochrane review on ibuprofen, so alarm bells were a bit loud.

Mythbusting

This took the form of:

1 Searching for papers relating to ibuprofen in women, especially systematic reviews and meta-analysis.

2 Analysing individual patient data for differences in response between men and women.

3 Examining randomised trials of ibuprofen in acute pain for the presence of women in the trials.

Results

Searching showed that there was abundant evidence that ibuprofen did work in women. For example:

The paper also looked at 37 trials comparing ibuprofen and placebo in acute pain. None had fewer than 45% women. Thirty-two had more than 50% women. Eight trials enrolled only women, and no trial enrolled only men. Individual data from over 300 women and 300 men showed no difference in the range of responses with ibuprofen (Figure 1).



Figure 1: Pain relief experienced by women and men given 400 mg ibuprofen













Comment

Ibuprofen works in women, and women have predominated in clinical trials involving it. Recently the myth that it does not work in women has appeared again, and seems continually to be recycled in magazines. This seems to be the way of myths and legends.

How did it start? Selective reporting of data. Picking out a single study that supported a proposition, and then hyping it with other selected quotes and comments, and with an agenda about medicines not being tested in women overlaying it. An argument was built on sand, but believable because of the highly respected journal in which it appeared. And the original study itself was suspect - very small and in experimental pain, which those in the field know bears no relation to clinical work.

Don't forget to give importance to the dogs that didn't bark in the night. Ibuprofen has been around for decades. Does anyone really think that millions of clever-clogs medical professionals might have overlooked the lack of pain relief in half the population that used it?

Reference:

  1. J Barden et al. Ibuprofen 400 mg is effective in women, and women are well represented in trials. BMC Anaesthesiology 2002: 2:6 (www.biomedcentral.com/1471-2253/2/6)

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