A paper in JAMA Internal Medicine this week, “The Association of Aspirin Use With Age-Related Macular Degeneration,” concluded:
“..from this prospective population-based cohort that regular aspirin use is associated with a 2-fold increase in risk of age-related macular degeneration (AMD) during a 15-year period. These findings appear to be independent of cardiovascular disease, smoking, and other risk factors.”
The journal invited a commentary, in response, from Drs. Sanjay Kaul and George Diamond, who wrote, “Relationship of Aspirin Use With Age-Related Macular DegenerationAssociation or Causation?” It was a very thoughtful commentary that analyzed “useful and time-tested considerations for determining whether an association is causal.” They concluded:
“The evidence is insufficient to adjudicate the relationship between aspirin and AMD, thereby challenging causal inferences…From a purely science-of-medicine perspective, the strength of evidence is not sufficiently robust to be clinically directive. These findings are, at best, hypothesis-generating that should await validation in prospective randomized studies before guiding clinical practice or patient behavior.”
In other words, slow down, and take a deep breath. Maybe not yet ready for prime time.
Kaul/Diamond then went on to address possible considerations from an “art-of-medicine perspective” and the shared decision-making aspects of the decisions about aspirin use that should now take place between doctors and patients.
Journal editor Kenneth Covinsky, MD, worried about how journalists would react, in an Editor’s Note:
“After the editors decided to accept this article, we discussed the risk that press reports would fall into the trap of reporting this study as definitive. This study provides an opportunity to educate the public about the subtleties and incremental nature of medical research. Our understanding of disease etiology advances as evidence accumulates from multiple good studies.”
From what we saw, most news stories did a responsible job in reporting on the study. Perhaps that was because many stories also cited the Kaul/Diamond commentary which did a terrific job putting the results into context. Nonetheless, we saw a few stories, make statements that sounded definitive, such as:
“Raises…doubles the risk…increases blindness risk” is probably exactly the kind of causal language that the journal editors feared. At least it occurred in the minority of stories that we saw.
As always, we refer journalists and consumers to our primer, “Does The Language Fit The Evidence? Association Versus Causation.”
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