Health News Review

Is it even worth it to draw attention to the UK Daily Mail’s headline this week calling aspirin a miracle pill?

Yes, clearly it is, because many, many other stories around the globe hyped the story – although most of them short of the degree to which the Daily Mail did.

Headlines were shouting advice such as “Aspirin should be taken by all over 50s to cut thousands of cancer deaths.”

But Medscape reported that it’s more complicated than that:

Should doctors routinely recommend aspirin for patients 50 to 65 years of age?

“The authors fall short of making an absolute recommendation about this,” Dr. Lichtenfeld noted. However, “the evidence is clearly strong that low-dose aspirin has been demonstrated to significantly reduce incidence and deaths from certain GI cancers,” particularly colorectal cancer.

An answer could come from the US Preventive Services Task Force, which has begun a comprehensive review of the role of aspirin for cancer prevention, according to Dr. Lichtenfeld.

“If the task force says people should be taking aspirin routinely, that’s a very strong recommendation,” he said. “That might be a game changer, but we don’t know yet.”

“Patients will need to make individual decisions about how much risk they are willing to accept to prevent cancer,” he explained. A person with a family history of colorectal cancer might be more willing to accept risk than a person with no such history. “That’s what informed decision making is all about.”

And MedPage Today reported:

In general, clinicians and researchers contacted by MedPage Today gave the study favorable reviews, but none said they were ready to start routine prescribing for average-risk patients. …

The study is a “fascinating” summary of the available data, said Marc Itskowitz, MD, of Allegheny Health Network in Pittsburgh.

“For a high-risk population for bowel and colon cancer, I would strongly consider using aspirin,” Itskowitz said. “However, in general I don’t recommend aspirin for primary prevention. … because we’re concerned that routine use of aspirin might cause gastrointestinal problems, including GI bleeding and maybe even intracranial bleeding.”

Here’s the study, published in the Annals of Oncology.

Dr. Margaret McCartney of the UK tweeted this graphic to explain the number needed to treat/number needed to harm for aspirin.

 

The Cancer Research UK organization wrote:

Pros:

Around 17 fewer deaths, including:

  • 16 fewer deaths from cancer overall
  • 1.4 fewer deaths from heart attacks

Cons:

Between two and three extra death from:

  • 1.4 more lethal strokes
  • 0.3 more serious peptic ulcers
  • 0.65 more lethal gastric bleeds

Sounds positive overall, right? Well there are a few important omissions from the analysis that begin to muddy the waters.

It’s a bit more complicated than that

These risks and benefits aren’t evenly spread around the population. Some are at higher risk of side effects. Some people’s genetic make-up means they break down aspirin at different rates – some faster, some slower, than average. Some will have a lower risk of cancer without even taking the drug, so they won’t benefit as much (though they may still experience side effects). It’s an extremely complex, and still slightly murky,  picture.

So to be able to recommend aspirin to people in the full knowledge that the risks are being minimised, and the benefits maximised, doctors need to have a better idea of the following:

  • What age should people start, and stop, taking aspirin?
  • What dose should they take?
  • What are the factors that should rule someone out from taking aspirin, and how should we test for them?

At the moment, frustratingly, there’s no clear, definitive answer to these questions. And until there are, we’re discouraging people from stocking up on their own supplies of aspirin without seeking medical advice first.

The National Cancer Institute in April posted, “No Easy Answers About Whether Aspirin Lowers Cancer Risk.”

I’ll end with the point Dr. Len Lichtenfeld made in the Medscape story above.  This is not a slam dunk for everyone.  This is about individualized, fully-informed, shared decision-making.  Sensational news stories should not drive water-cooler discussions about the miracle of aspirin – which is no more miracle today, as a result of this study, than it was yesterday.

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Comments

Laurence Alter posted on August 11, 2014 at 9:53 am

Gary,

As usual, the source is the story: high-level respected publications well be more correct and/or more fair in analysis THAN a run-of-the-mill source. The “Daily Mail”?? Kindly ask an intellectual (or non-intellectual) friend of yours from the United Kingdom what status is accorded it. I presume you know some British colleagues in your department. No? Well, cultivate their friendships: the American physician-establishment hardly recognizes their existence (“Oh, Lancet? I’ve heard of it”). New York City is also sadly overlooked in medical science and culture in general: a decent U.S. medical source should be quoting their health authorities, routinely and regularly.

A great project – which you’ll pass on, I predict – would be to order your sources by consistency of correctness (or number of measures that are satisfactorily completed in your checklist of criteria). You could offer it as: “Tiers of Trust” (or “Tears of Trust” for the worst-performing sources over time!) where Tier One would be the sources that have performed commendably well over a certain period of time (maybe Tier One would be 80% criteria met over a 12 month period).

“Medscape” – while not authoritative-sounding OR scholarly in reputation – is truly superb. For the semi-serious person about health issues, I’d name it #1 (and I read many sources, mostly from university departments like University of Maryland, U.C. Berkeley, Johns Hopkins, and Tufts – medical newsletters off the top of my head). You won’t find “Medscape” not meeting the majority of your measurements. Ever.

P.S.: I don’t know what “Death by MI” means in U.K.’s McCartney graphic (but, then, when did the British ever spell out words?)

Respectfully,
Laurence

    Gary Schwitzer posted on August 11, 2014 at 10:22 am

    Laurence,

    1. It’s not just that the Daily Mail wrote that. As I noted, it’s how many news sources picked up on what the Daily Mail wrote. You can sneer at them, but to ignore their reach is foolhardy, in my opinion.

    2. Back when we had funding (I’ve been keeping this site alive by myself without any funding for 13 months now), we DID offer a way to check news organizations overall grades. You apparently missed that feature. Here it is.

    3. MI is a very common acronym for myocardial infarction, or heart attack.

      Laurence Alter posted on August 12, 2014 at 5:39 am

      Thank you for the generosity of your time.

      It’s always educating for me.

      Respectfully,

      Laurence