Dr. David Agus, tireless promoter of his book, “The End of Illness,” and whose involvement in an ABC news story about a reporter’s coronary calcium CT scan led to the network correcting/retracting the piece, is now at it again.
The New York Times published his op-ed piece, “The 2,000-Year-Old Wonder Drug,” the start of which strikes us as ironic given the ABC story retraction:
The op-ed begins:
“The inexorable rise in health care spending, as all of us know, is a problem. But whats truly infuriating, as we watch Americas medical bill soar, is that our conversation has focused almost exclusively on how to pay for that care, not on reducing our need for it. In the endless debate about health care reform, few have zeroed in on the practical actions we should be taking now to make Americans healthier.”
One of the reasons US health care spending is soaring is non-evidence-based promotion and use of things like the coronary calcium CT scan that Agus promotes.
But his focus in this piece – the 2,000 year old “wonder” drug – is aspirin. His hyperbole is off the charts. Excerpts:
“The data are screaming out to us. …
…given the evidence we have, why is it merely voluntary for physicians to inform their patients about a health care intervention that could not only help them, but also save untold billions in taxpayer dollars each year?
For some men over the age of 45 and women over 55, the risks of taking aspirin outweigh any benefits and patients should talk with their doctors before taking any medication, including something as familiar as aspirin.
But with such caveats in place, it still ought to be possible to encourage aspirins use in those for whom the potential benefits would be obvious and the risks minimal. Just as we discourage smoking through advertising campaigns, for example, shouldnt we suggest that middle-aged Americans speak to their doctors about aspirin? Perhaps pharmacists or even health insurance companies should be enlisted to help spread the word about this disease-prevention drug?
The right policy will have to be hammered out, of course. But if were going to address the countrys sky-high medical bill, were going to have to address the need for Americans to be active in protecting their own health.
Everyone may want the right to use tobacco products and engage in other behaviors that are unequivocally linked with disease or have the right not to wear a seat belt and refrain from other actions that may protect their well-being. But, if so, should society have the obligation to cover the costs of the consequences?
Mandatory physician discussions with patients about aspirin?
Ad campaigns urging people to ask their doctors about aspirin?
My friend Alan Cassels, a drug policy research at the University of Victoria, wrote:
“I think David Agus might be a little innumerate, or at least his suggestions fall into the category of overhyped relative risk reductions.”
Cassels refers to data that show that for primary prevention of cardiovascular disease, aspirin’s NNT, or number needed to treat = 120; And the NNH, or number needed to harm = 73.
The NNT helps you think about how many people need to be treated in order for one to benefit. The NNH is a look at how many patients need to be exposed to something over a specific period to cause harm in one patient that would not otherwise have been harmed.
Cassels writes that “things look marginally better if you have established heart disease. Then the NNT=50, or so.
And for cancer, Cassels reports that the NNT = 147.
Another friend wrote me:
“I’m not sure what’s worse — the stupidity of his argument or the New York Times’ poor judgment in running the piece.”
One thing is certain: Dr. Agus knows how to draw publicity.
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