Aspirin Really Is Kind of a Wonder Drug, Studies Continue to Show | Hacker News Reader

Aspirin Really Is Kind of a Wonder Drug, Studies Continue to Show

theatlantic.com

137 pointsevo_991 comments

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?

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...

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.

Of course the Wright brothers wouldn't be able to do what they do today because the tehcnology has changed some much it would be incredibly foolish to put human beings on the original wright flyer. Why would you even want that? That's like saying "I want to build a tent and a fire pit and hunt and skin animals but my condo association won't let me do that in the yard!"

I'm really getting sick of the manufactured bogeyman of government regulation. These scenarios are at best fantasy and the advantages of proper regulation are obvious to see.

>>Of course the Wright brothers wouldn't be able to do what they do today because the tehcnology has changed some much it would be incredibly foolish to put human beings on the original wright flyer.

Considering that some people replicated what the wright brothers did I think the whole point is moot: http://www.youtube.com/watch?v=qo0kpCU03-U

Also, Asprain and related drugs kill ~40,000 people a year so I don't know it the pain relief is worth it. http://adjusthealth.info/health-news/89-40000-deaths-in-usa-...

The abstract also says that " Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS."

Aspirin is an OTC and thus excluded from those mortality statistics.

Additionally most of those deaths were from elderly people who suffer from arthritis and are taking NSAIDs daily and longterm.

Overall that is a very misleading headline.

Not trying to be mean, but why does it matter if you think it's worth it? It's my choice. If I choose a small percent chance of dying for some relief it's my choice.

It's just an opinion.

Plenty of people don't think the added safety of seat belts is worth it, the minor fine related to not using them seems like a tiny risk in comparison to dismemberment or death. However, many of those same people fear the fine more than physical harm which seems silly to me. Perhaps, if I was more empathetic I would 'get it', but I don't run things so I don't really feel the need to.

So that post just got several down posts. Why? I can get someone having a different utility function, but why do you care what my utility function is? Is it the fear of seeming foolish? It's like someone getting angry that I don't care about gold, yea it's shinny and yellow, but that's about it. Does that harm you?

Note: I am suggesting that the law needs to change or anything, just that I don't understand why people think in that fashion.

>> Why would you even want that?

Because it's the first manned flight?

>> That's like saying ...

No it isn't at all like that.

>> I'm really getting sick of the manufactured bogeyman of government regulation.

And I'm really getting sick of this place turning into reddit.

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.

Is daily inflammation a normal thing...? Maybe I'm just not observant enough, but I notice inflammation most often when I cut, bruise, scrape, or otherwise accidentally abuse my body - in which cases, memory tells me that (in the mild case) that's the right response.

Inflammation is extraordinarily common. It underlies hundreds of diseases, from asthma to arthritis (in fact, any disease that ends in "-itis"). It often occurs inside the body (not just on the skin), so you could have inflammation right now and not know it.

http://en.wikipedia.org/wiki/Inflammation#Inflammatory_disor...

Sure, but shouldn't you try to diagnose the problem, instead of medicating yourself daily for phantom diseases you probably don't have?

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?

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.

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.

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

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.

Someone who has some sort of pain but overdoses frequently would count I guess? At some point you should discuss your pain with a Doctor, instead of increasing the dose yourself.

I also meant abuse as a slightly nicer phrasing of "tries to deliberately overdose".

Flying Spaghetti Monster. The point is that my obsession with vitamins is irrational and I am aware of that fact.

Nope, all sorts of things that are not addictive are controlled by the FDA [insert long rant here]

The great thing about FSM is they had promo about irrational correlation that showed that the number of pirates(naval) was inversely proportional to global temperatures, just before the outbreak of hijackings off Somalia.

Edit:

Church leaders responded in 2008

Henderson interpreted the growing pirate activities at the Gulf of Aden as additional support, pointing out that Somalia has "the highest number of pirates and the lowest carbon emissions of any country."

Plenty of prescription drugs are not addictive, and plenty of OTC drugs are addictive. Your impression is incorrect.

Heh. I need a prescription to buy Vitamin K because it is in "prescription-strength" doses. Lovely self-circular logic.

Ketamine?

There is an actual vitamin K.

http://en.wikipedia.org/wiki/Vitamin_K

If I recall correctly, the health benefits of aspirin aren't primarily anti-inflammatory. Ibuprofen is a much better anti-inflammatory at moderate doses.

Correct, Ibuprofen is much stronger for anti-inflammation. Aspirin is a blood thinner and a painkiller, at least these are its main accepted functions so far.

Another layer of irony: the wright brothers at the time used a different government bureaucracy (namely patents) to stop other people from building planes.

http://en.wikipedia.org/wiki/The_Wright_brothers_patent_war

There's explicit provision in the law allowing for people without a pilot's license to fly an experimental aircraft. I'm sure you can still get in massive trouble for flying through the upside-down layercake above airports, but it's not flat-out forbidden everywhere.

low-dose aspirin for over a decade now. --> please enlighten me. I am curious why would you do that ?

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.

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.

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.

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.

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.

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

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

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..."

This is true. However, you are going to get a far more informed opinion talking to your doctor than you are here or on any other web forum.

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.

What if the gastrointestinal bleeding is the cause of the decrease in cancer?

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.

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).

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

That bleeding can cause other problems like anemia, and aspirin can also cause ulcers, which besides the discomfort, can become a serious medical emergency.

This is truly a balancing act, and we really don't know enough to balance it for generally-healthy people at large.

All pills can do that? I thought many were designed to dissolve in your stomach like tums. Not sure why they should be exceptionally bad, unless tums cause issues too.

I read "pills" as referring to other Aspirin-class medications (OTC NSAIDs and/or pain relievers), such as Naproxen Sodium, Paracetamol and Ibuprofen.

A pill, after all, is just a transport mechanism. It's the substance of the pill that determines side effects and risk. For example, you don't often hear about multivitamins causing stomach bleeding.

Well they all MIGHT. My understanding is that most pills these days have some kind of protection for your stomach. But it doesn't work 100%, and it doesn't work perfectly on everybody.

Yes, please ask your doctor. Daily aspirin use can cause some problems in some people, such as stomach bleeding, which can be deadly.

Oh god no. Please keep in mind, Aspirin also kills over 20,000 people annually from both gastrointestinal problems and Reye Syndrome.

It might do wonders for the many, but it also has harmful side effects. Me personally knowing and feeling the anguish of those who has lost loved ones to Aspirin.

I personally will NEVER take aspirin opting for other forms of medication.

http://www.wddty.com/aspirin-it-kills-20-000-americans-every...

http://en.wikipedia.org/wiki/Reyes_syndrome

Reye syndrome affects children under 19 (some say under 16) with a median age of 6 who ingest aspirin after a (typically) viral infection. It is not something that adults should be worried about.

"NSAIDS such as asprin" (wddty.com). So that means that 20,000 is ascribed also to ibuprofen, naproxen, ketoprofen, ketorolac, etc. While there is risk from all of them, the risk is dose-dependent.

The comment was for aspirin daily. So dose dependent is definitely a big thought here.

You'd probably ridicule Jenny McCarthy for what she says about vaccines, but your comment is roughly the same thing.

Thanks for the constructive thoughts you add to HN.

Thanks for the ad hominem instead of refuting my point. I attacked your comment, not you.

Digging deeper into the Jenny McCarthy hole, frankly.

That is exactly my question as well. I have been reluctant to take it every day, even though I see so many articles talking about the benefits.

I did some research and I found this as well:

http://kill-or-cure.heroku.com/#term34

http://www.drweil.com/drw/u/id/QAA326650

It is very disappointing that we cannot reach a conclusion, but let's be honest the question everybody is asking is if Aspiring can prevent ALL types of cancer. I think we should start narrowing it down.

Keep in mind that what matters is total mortality and total morbidity, not risk of cancer.

This is absolutely right from the perspective of a primary prevention task force. Individuals might have slightly different values, so perhaps they would accept some tradeoff. (E.g., reducing a 20% lifetime cancer risk down to 10%, while increasing a lifetime fatal bleed risk from 1% to 5%, might be acceptable to some.)

Unfortunately, I readily admit that (1) we can't yet do a reasonable job of giving people their lifetime risk of X; and (2) people (doctors included) aren't great, generally, at statistical thinking.

So yeah, the goal should be to reduce total morbidity and mortality.

I'm not too sure about aspirin, but long-term use of NSAIDs seems like a good way to screw up your stomach.

http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory...

Happened to me, and I'm only 20. Apparently doctors prescribe these as painkillers all the time, and the gastrointestinal bleeding that sometimes results is one of the main ways prescription drugs kill people.

No.

You expose yourself to known and unknown risks for slight (if any) known benefits and unknown benefits.

Should you, as a relatively healthy 31 year old male, eat better, get more exercise, stop smoking, drink alcohol sensibly, drive safer, etc? I have no idea about you personally, but most people could make reasonably simple lifestyle choices and dramatically reduce their risks of a bunch of stuff and increase their quality of life.

(As always, I'm not a doctor, I have no medical training, etc etc. Disclaimers aren't needed for HN, are they?)

See my numbers cited above. 1 incident of GI bleeding per year out of 833 people taking a once daily, low-dose aspirin. I find those numbers acceptable and will continue to take aspirin. If there are any other medications involved, this further complicates the risk numbers and must be considered. You may not find them acceptable.

Isn't G.I. bleeding grounds for a trip to the emergency room?

This seems like a bigger risk than dying in a car accident by a decently large margin.

1/833 of having the bleeding, _not_ fatal bleeding. Compared to 1/83 lifetime risk of dying in a car accident. http://well.blogs.nytimes.com/2007/10/31/how-scared-should-w...

People (all of us, I'm not picking on you) are terrible at relative risks.

Er, that 1/833 is not a lifetime risk though, it's a yearly risk. So more like 1/10 lifetime risk of a GI bleed. Which is not great, but it depends on how often they're fatal I guess.

saw this last month:

Daily Aspirin May Help Prevent and Treat Cancer.

Taking aspirin every day may significantly reduce the risk of many cancers and prevent tumors from spreading, according to two new studies published on Tuesday.

http://www.nytimes.com/2012/03/21/health/research/studies-li...

http://www.webmd.com/cancer/news/20120320/daily-aspirin-may-...

you'll get a lot of bruises if you take too much

This is what I want to know!

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).

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.

I always get a chuckle when reading up on prescription-only drugs that are (often significantly) safer than Tylenol. :-)

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

Here is a pretty good list:

http://www.scribd.com/renaxgade81/d/63057989-Granny-s-List-J...

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.

>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.

"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.

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.

In terms of analgesic potential anyway - http://jpet.aspetjournals.org/content/136/1/43

Orally, Heroin has a bioavailability of between ~25% and ~65%, depending on dose and tolerance, whereas Morphine has a bioavailability of 20-40%, making Heroin the more efficient of the pair.

> The pharmacology nerd inside me is reeling.

Yes, I guess potent would have been a better word choice, but you get the idea. I was trying to explain it without using terms like bioavailability and analgesic potential... I assume that anybody who understands those words doesn't need me to point out my main point, which was simply that it's hard to make a argument based on biochemistry and pharmacokinetics alone for the current drug schedules!

The skeptic within would tend to agree with the conspiracy-type within you.

It would seem that the simplest solution be to step back and change legislation on various chemicals/compounds to be in accordance with scientific findings/changes in cultural perception. The logical question is then, what exists to prevent this? I think a careful shave with Occam's razor uncovers the possibility/probability of corporate interests being too high to ignore, rendering Hanlon's razor a little too blunt.

I think that though this is indeed one aspect of it, there's also the law of inertia (also known as habit/tradition/dogma). Most people are not mindful enough to adapt to their environment readily and end up lagging behind the reality they are faced with. Just look at the music and movie industries - they're not evil, just too stupid to adapt.

So it is with society and the bigger picture of economics and survival. We have all this crazy technology to automate everything from growing crops to wiping your ass yet we still work the same hours. We know that cooperation is superior to competition when it comes to survival yet we still run an outdated economic model. We know that keeping things like medical knowledge open and accessible benefits everyone yet we still grant corporations monopolies on it.

It's like Tupac said, this isn't idealistic, it's just real.

Oh you mean like the one that the government spends millions and ruins lives over every year that is being turned into yet another expensive prescription drug?

Yeah. http://www.foxnews.com/health/2012/01/23/pot-based-prescript...

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

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...)

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?)

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.

Hasn't aspirin been shown to cause tinnitus too?

Another recent article about Aspirin:

http://www.abc.net.au/science/articles/2012/04/20/3481356.ht...

"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)

Could cost you your hearing, though:

http://www.news-medical.net/news/20100301/Regular-use-of-asp...

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

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