
Aspirin Really Is Kind of a Wonder Drug, Studies Continue to Show - evo_9
http://www.theatlantic.com/health/archive/2012/04/aspirin-really-is-kind-of-a-wonder-drug-studies-continue-to-show/256495/
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aantix
As for the internal bleeding "risks", I was wondering what the actual numbers
were. This is based on one low dose aspirin a day.

<http://www.medscape.com/viewarticle/545101_3>

"These results translate into an absolute rate increase with aspirin above
placebo (the incidence of cases of major GI bleeding attributable to low-dose
aspirin) of 0.12% per year (95% CI: 0.07–0.19% per year).[20] Based on this
value, 833 patients (95% CI: 526–1429 patients) would need to be treated with
low-dose aspirin instead of placebo to cause one major GI bleeding episode
during a 1-year period (i.e. the NNH is 833)"

Anyone else care to share quantitative risk numbers?

~~~
DavidAbrams
I don't know about bleeding, but what about the hearing loss that's associated
with regular aspirin and other NSAID use?

[http://www.news-medical.net/news/20100301/Regular-use-of-
asp...](http://www.news-medical.net/news/20100301/Regular-use-of-aspirin-
acetaminophen-and-NSAIDs-increases-risk-of-hearing-loss-in-men.aspx)

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DanielBMarkham
Please forgive a tiny bit of snark. I've long heard that if aspirin had been
discovered today, the FDA would have never allowed it to be sold OTC to
people. Along those lines, in aviation there's a saying: Wilbur and Orville
would have never gotten permission to build the Wright flyer if they applied
last year.

I'm a vitamin junkie (Don't pick on me, it's my FSM), so I've been taking low-
dose aspirin for over a decade now. If I remember my health-nut mythology
correctly, the theory is that inflammation (and especially inflammation
related to blood sugar spikes) is believe to be a contributing factor to a lot
of bad stuff: diabetes, cancer, aging, and so on.

Interesting to see aspirin continuing to make the news. Amazing drug.

~~~
jakeonthemove
I had the impression that any drug that is not addictive is generally
available without prescription?

Also, it's killing me: what does FSM stand for in your sentence? Flying
Spaghetti Monster? Fuel Supply Manifold? Free Speech Movement? Something else?

~~~
wmil
That's absolutely not true. Antibiotics require a prescription and aren't
addictive.

OTC medications are only approved if the drug and condition are mild enough
that a doctor doesn't need to be involved.

And it gets a little bit silly -- 200mg ibuprofen are OTC, 400mg require a
prescription.

~~~
elemeno
That's largely because there's the potential to abuse the drugs as well.
Giving people painkillers is good, giving them at a strength that makes it
easy for someone to overdose from one bottle, less good. For what it's worth,
you can easily get 400 or 500mg ibuprofen over the counter in the UK, but it
will probably involve interacting with a pharmacist who'll probably refuse to
sell them to you if they suspect you're going to abuse them.

With antibiotics there's a pretty good reason for them to prescription only,
namely that drug resistant strains of illnesses are becoming a serious problem
and it's only made worse by the over use of antibiotics. Plus, you likely
don't know what the appropriate antibiotics will be for what ever problem
you're trying to treat are.

~~~
trentmb
Pardon my ignorance... who abuses ibuprofen and why?

~~~
Duff
Many people pop OTC drugs like candy. Ibuprofen is often over-used by people
with chronic back pain or other inflammatory issues. They aren't addicts --
just people trying to get through the day.

The problem is, it is a rough drug on your kidneys and has potential cardiac
side effects.

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ekianjo
It's a bit improper to mix results from observational studies and controlled
studies together to show a reduction of cancer rate and so on. Such studies
are made in completely different conditions, it's like mixing apples and
oranges and telling you the total in bananas.

Plus, we'd need to seriously look at how patients were sampled and all in both
arms of the control study. This kind of article is obviously written by
someone who knows nothing about the science of clinical trials, which is a bit
of a shame. Tabloid level, really.

~~~
kvh
You're joking right? The fact that it even mentions the terms randomized and
observational puts it in the 99th percentile of medical science reporting.

And why can't you combine results from observational studies and controlled
studies? Surely they both provide evidence (albiet very weak evidence in the
former's case) of the effect.

~~~
ekianjo
Observational is not considered as evidence. At best, it gives you cues to
conduct a next research (randomized, double-blind, controlled) in order to
actually do Science.

There are tons of observational studies that tell sh*t like there are
correlations between eating cabbage and having great long hair, but most of
the time it's pure luck, sample bias, or just error range.

Observational studies are NEVER accepted as sufficient to claim anything with
authorities. At the most you can exercise caution based on risks observed in
Safety observational studies, but when it comes to proving efficacy ... you
will raise major criticism.

And just putting "observational" and "randomized" does not mean he understands
the terms. When you write "Aspirin Really Is Kind of a Wonder Drug" without
substantial evidence in your article, without dissociating observational and
randomized results, I have a hard time believing this is from a science-
educated person.

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parasubvert
Two recent personal aspirin anecdotes.

Late 2011, I contracted acute idiopathic pericarditis. The medication was
fairly simple - a ton of aspirin. 4x 650mg Aspirin daily, to be precise, along
with colchicine. It healed after a couple of months.

This month, I recently had a cardiac catheterization in my right radial artery
(wrist) - my (now healed, but thickened) pericardium likely was constricting
my heart. The wrist pain got worse during the healing process - apparently my
whole forearm was clotted. 2x 650mg aspirin was the recommendation due to both
the blood thinning as well as the anti-inflammatory nature. Pain became
manageable the next day, and my arm seems to be healing. Not clear if I've
recovered my radial artery yet, though.

I was an Ibuprofen fan for a long time, but Aspirin for me seems to have been
what the doctors keep recommending, and has been indispensable these past 4
months. No stomach bleeding, as they usually prescribe Pantoprazole along with
it to reduce acid buildup.

~~~
carbocation
Aspirin is an irreversible ('suicide') platelet inhibitor, whereas ibuprofen
is reversible. Basically, you don't want those platelets in that thrombus to
ever become active again.

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josefresco
The question is; Should I, a relatively healthy 31 year old male start taking
Aspirin daily?

~~~
mhurron
Maybe you should ask a real doctor. Right now you're just going to get people
who play doctor on the internet.

~~~
aespinoza
I think at this point, even doctors don't know. See I have talked to several,
and the answers are always mixed.

Some believe the results, some are just waiting for a more definitive study.

In the end one doctor said "..not to take it even if it has _SOME_ benefits.
Aspirin, like any other pill can cause gastrointestinal bleeding. So if there
is no reason to take it avoid it..."

~~~
Florin_Andrei
If there's a marked decrease in cancer, associated with a mild increase in
gastro-whatever bleeding, then it's probably a good trade-off.

~~~
aespinoza
If it is mild, it might. I don't know if everybody is willing to take that
trade-off. It seems like fixing one problem with another problem.

~~~
Florin_Andrei
It's funny, though, how _everyone_ already takes similar trade-offs all the
time. E.g., we're trading a high risk of dying a violent death at the hands
(or claws) of enemies and predators (life in the primeval savanna) for a lower
risk of dying of obesity, diabetes, and so on (modern "civilized" life).

~~~
philwelch
No one's making that choice, it just kind of happened.

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CWuestefeld
If aspirin were being considered as a drug today, would it ever pass FDA
tests? It does lots of great stuff, but it's also got lots of nasty side
effects (I'm not allowed to take it, due to its effect on my Crohn's disease).

~~~
vacri
Plenty of FDA-approved drugs have nasty side effects. Isotretinoin _will_
cause such massive birth defects that usually a doctor will get a female user
to sign an agreement that she won't get pregnant while taking it.

It has a number of other significant side effects - for me, _marked_ loss of
physical strength, plus delicate skin susceptible to sunburn while taking it.
But the 6-month course was worth it - cleared up my facial acne to an
incredible degree. I had simply gotten used to the fact that my face was
always in pain. Now I still get the odd pimple (like most people), but nothing
like the boils I used to get.

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protomyth
It does make one wonder what other plant products would have done if they had
got in before the whole "war on drugs".

~~~
chimeracoder
The funny thing is, I'm not sure it would be that different.

I'm being tongue-in-cheek. That is, the _effectiveness_ of the medicines would
be very different, but the actual substances available in some way would
barely be different.

With the exception of marijuana, almost every drug with medicinal use is
either available medically in _some_ form _or_ unavailable, but with very
related 'cousins' readily available.

Marijuana is available as Marinol - it just doesn't work, because it's
synthesized without the full set of ~70 cannabinoids. MDMA isn't available
(outside of very restricted research), but it's closely related to
methamphetamine, which is available with a prescription. (People are often
surprised to hear that one). GHB is available with a prescription. Heroin is
really just a synthesized and concentrated form of morphine (available with
prescription), and peyote is available for some religious ceremonies.
[Psilocybin is not, but oddly enough, I believe mushroom spores are legal,
even though the mushrooms are not (because the spores don't contain any
psylocybin - I believe this may depend on your jurisdiction, though, and as
always, IANAL.).]

So what's the end result? We've criminalized drugs not based on their
underlying chemistry - there is almost no Schedule I drug that doesn't have a
closely related (and oftentimes _identical_!) counterpart in Schedules II-IV
or not scheduled at all.

If I were the conspiracy-theory type, I'd say that this is a way of saying
that drugs can only be useful if a pharmaceutical company is profiting off of
it. Though I'm inclined to side with Hanlon's razor on this one - that's not
really how it came about historically, even if 'Big Pharma' does benefit off
of it now. I don't really care - I just wish we'd start drafting laws based on
science, not fear.

~~~
Produce
>Heroin is really just a synthesized and concentrated form of morphine

The pharmacology nerd inside me is reeling. Heroin is a semi-synthetic, since
it's derived from the naturally occuring opiate Morphine. Concentrated is the
wrong word - vodka is more concentrated than beer because it contains more
ethanol per ml. Heroin has a (slightly) different chemical structure to
Morphine, though it is more _potent_ by weight. You can't say that it's more
concentrated without changing the meaning of the word.

>I just wish we'd start drafting laws based on science, not fear.

Completely agree and to add to that, I wish we'd start drafting laws which
protect people instead of harming them.

~~~
Alex3917
"Heroin has a (slightly) different chemical structure to Morphine, though it
is more potent by weight."

If I remember correctly it crosses the blood brain barrier faster, but once
it's in the brain it acts exactly the same as morphine. I've heard it's
actually less potent than morphine gram for gram if you eat it, but I'm not
sure.

~~~
gamache
Morphine becomes heroin (diacetylmorphine) upon replacing the naturally-
occurring hydroxyl groups (-OH) with acetyl groups (-OCOCH3). This increases
fat solubility, which allows it to cross the blood-brain barrier much more
quickly than morphine.

The acetyl groups get removed in the brain, and the resulting morphine has the
traditional effects. Since heroin includes the extra weight of acetyl groups,
it's implied that heroin is less strong per gram than morphine, but is easier
to deliver.

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kjhughes
The critical reader would be well served to observe the "really is" and
"wonder drug" lexical red flags and read Jonah Lehrer's "Trials and Errors:
Why Science Is Failing Us" in the January issue of Wired:
<http://www.wired.com/magazine/2011/12/ff_causation/all/1>

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DanBC
People in this thread have mentioned gastric bleeds.

I haven't seen anyone mention the increased risk of hemorrhagic stroke. Heart
attacks are serious and they kill many people, but so do strokes.

The end of the article mentions CVD. Here's a Cochrane review of aspirin for
CVD:

([http://www.imbi.uni-
freiburg.de/OJS/cca/index.php?journal=cc...](http://www.imbi.uni-
freiburg.de/OJS/cca/index.php?journal=cca&page=article&op=view&path%5B%5D=3179))

tl;dr: 5% or greater risk of CVD over 5 years the risks are there but less
than the risk of CVD. 5% to 1% risk of CVD over 5 years the risks are there,
and probably about equal to CVD, so you need to talk to a doctor to assess.
Risk lower than 1% of CVD over 5 years means the risks are more severe than
the risk of CVD.

The article is pretty lousy. There's no direct link to the original research,
so it's harder for people to see if the science is good or hopeless.

> _One type of cancer called metastatic adenocarcinoma, which can affect the
> prostate, lungs, and colon, was reduced by 46 percent in people who took
> aspirin._

Most people have no idea how to interpret this sentence. Most people have no
idea how many people - out of say 100,000 - will get adenocarcinoma. (Am I
reducing my risk from 2 in 100,000 to 1 in 100,000? Or from 300 in 10,000 to
150 in 10,000?)

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endtime
This is consistent with the notion that many (most?) neolithic diseases are
caused by inflammation, often expressed by people with
paleo/primal/archevore/etc. diets.

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mcollinsblog
Hasn't aspirin been shown to cause tinnitus too?

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georgieporgie
Another recent article about Aspirin:

[http://www.abc.net.au/science/articles/2012/04/20/3481356.ht...](http://www.abc.net.au/science/articles/2012/04/20/3481356.htm)

"scientists have now discovered that aspirin also activates an enzyme that
burns fat, a finding that could unlock its cancer fighting properties,
according to a new study."

(I've read before about aspirin -- or white willow bark -- being a critical
element in an Ephedra-Caffeine-Aspirin stack's so-called thermogenic effect)

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DavidAbrams
Could cost you your hearing, though:

[http://www.news-medical.net/news/20100301/Regular-use-of-
asp...](http://www.news-medical.net/news/20100301/Regular-use-of-aspirin-
acetaminophen-and-NSAIDs-increases-risk-of-hearing-loss-in-men.aspx)

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makmanalp
This is also a pharma company's nightmare. Built and sold cancer reducing drug
for dirt-cheap? Ooops.

