This is a detailed report on the recent U.S. Preventive Services Task Force (USPSTF) recommendation statement on the use of aspirin, one of two stories we reviewed on this topic (here’s the other, from CBSNEWS.com). It is a relatively thorough discussion, with an impressive array of physicians parsing the guidelines and informing us who is likely, or not likely to benefit from taking aspirin, the likelihood of benefit and harm, and the importance of gauging one’s personal set of risk factors before deciding if a daily aspirin is right for you.
One issue this story could have made clearer is the quality of evidence behind the task force’s recommendations. Some important limitations are discussed, but not in a direct way. This issue–the relatively thin evidence behind the recommendations–made the rounds among physician news sites, and ideally would have been emphasized more in general news coverage.
Aspirin is widely prescribed or purchased over-the-counter for aches and pains, and increasingly used to prevent cardiovascular events, such as heart attack and stroke, over the long term. Better public understanding of the benefits and harms of aspirin, and clearer delineations of the science around who is likely to benefit from taking it, are all likely to have an important health impact.
It is universally known that aspirin is cheap, sold widely and in a manner where its cost will not be a barrier to consumption, so the cost information is not necessary to reiterate in this report.
One of the commentators, Charles Hennekens, gave an excellent summary of the quantified benefits citing both absolute and relative numbers.
As above, Hennekens gave a description of the absolute harms involved in aspirin, particularly related to gastrointestinal bleeding, and several of the other sources also discussed this important harm.
While it could have been discussed in a more direct way, some important limitations to the quality of the evidence in the task force’s recommendation can be inferred by various statements from the sources in this story. For example, Hennekens states that “the totality of the evidence is incomplete,” and that the evidence in the task force report hasn’t advanced much since the 1980s. He also cites ongoing studies that will hopefully fill in some of these gaps. Other sources in the story discuss how complex the evidence is.
There is no evidence of disease mongering here, as cardiovascular disease is the top cause of death in the U.S. for both women and men.
We applaud the breadth of sourcing in this piece. Readers are told that Kirsten Bibbins-Domingo, is the vice-chair of the US Preventive Services Task Force, and she weighs in with her assessment. Other physicians, however, seem independent of the USPSTF and are unlikely to be financially conflicted with the manufacturers of aspirin.
Alternatives are mentioned (smoking cessation, eating a balanced diet, getting sufficient exercise), and that’s sufficient to rate as Satisfactory. The piece would be strengthened by comparing the relative benefits of the other options.
It’s pretty clear that aspirin is ubiquitous and sold almost everywhere as an over-the-counter drug, so we’ll rate this one N/A. This story, and the other we reviewed, might have benefited from mentioning that the drug has a generic name (known as ASA or acetylsalicylic acid). Generic versions of the drug do exist, are likely cheaper than the brand name, and equally effective.
There are no spurious claims made here about the “novelty” of aspirin’s effects, or the recommendations in the report, yet maybe a bit of confusion when one of the physicians said that aspirin’s effects on colorectal cancer were “provocative.” What is a reader to make of that relatively unhelpful statement? This could have been clearer.
With a full slate of outside observers commenting on this study, it is unlikely to be overly reliant on any news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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