Aspirin could dramatically cut cancer risk, according to biggest study yet | Hacker News Reader

Aspirin could dramatically cut cancer risk, according to biggest study yet

theguardian.com

152 pointswslh105 comments

This is one of the reasons why I want presence of governmental entities in drug research. There is very little incentive for a private drug companies to show that an el-cheapo generic drug that has had centuries of use (in some form or the other) behind it, can counter some serious diseases. Yes new use can be patented, but its really impractical to enforce. Sort of like those allergy drugs and sleeping aids, same exact composition but placed in different aisles with different names and grossly different prices. As much as I love the market, sometimes it is either insufficient, or works way too slow for a human lifetime.

[Digression: We either need a quantum increase in life-span, or a market force catalyst that will speed up market dynamics few orders of magnitude, so that the consequence of a market intervention affects the same guy who made that intervention]

Back to aspirin, its really somewhat of a wonder-drug without a hype, if you can stomach it that is.

> There is very little incentive for a private drug companies to show...

Yes, but let's consider why:

1- Government regulation (patents) creates an artificial concept of property that prevents humanity at large from benefiting from scientific advances that could be much cheaper. The reasoning for patents is that they are a required incentive from companies to go through expensive tests. But guess what...

2- It's government regulation that makes the tests so expensive.

So the government tries to solve a problem, then creates a new problem, then tries to solve the new problem, then....

Every step seems reasonable and in the interest of the consumer, but the end result is still that a majority of people do not have access the the level of health care that is scientifically and technically possible, and not even close. But at least they are protected from a number of things. Maybe.

We demand a high level of scientific rigor to accept a medication, but we don't demand the same high level of scientific rigor to accept government meddling. We just take it at face value that the benefits of regulation outweigh the costs and this premise is never tested at large.

> 2- It's government regulation that makes the tests so expensive.

Yes and no. You'll see numbers saying that each approved drug costs several billion, with most of that money going to clinical testing. The reason for that is that something like 90-95% of candidate drugs never make it through clinical testing. So if you add up the clinical testing costs for each of these failed drugs, and amortize them over the approved drugs, you get these astronomical costs.

But I'm not sure if the takeaway is the same as what you're saying. Would drug development be cheaper if these 90-95% of drugs that currently fail clinical testing made it onto the market? If you replaced the regulatory regime with the usual recourse of letting people sue for drugs that ended up being ineffective or harmful, then it probably wouldn't be any cheaper for the drug companies. And if you blocked the legal remedy, then you've just externalized the cost of ineffective or harmful drugs onto the public.

It's like a balloon: you can push all the air out of one side, and crow about how you've shrunk it down, but the air just goes to the other side. The fundamental issue is that drug development is intrinsically expensive: there's an expense to proving drugs safe and effective through clinical trials, there's an expense to allowing consumers to sue to recover for unsafe and ineffective drugs, and there's an expense in allowing unsafe and ineffective drugs to enter the market.

The problem is that in a first-world country, taking years off of someone's life is incredibly expensive, whether it happens because you sell a harmful drug, or because you sell an ineffective drug that precludes someone from taking an effective one. Let's say the social value of a human life is $1 million per decade. One source puts the cost of regulatory approval for 12 leading pharma companies from 1997-2011 at $57 billion per year on average (http://www.forbes.com/sites/aroy/2012/04/24/how-the-fda-stif...). What is that measured in person-decades? Only 57,000. Out of not just the 300 million people in the U.S., but the hundreds of millions if not billions of people around the world who piggy-back off of U.S. drug safety protocols.

I don't know the details of the testing regimen, but it seems to me that you're offering a false choice fallacy: that we must either do testing the way it's done today, or not do testing.

While I don't know what the alternative might be, it seems reasonable to assume that there are other levels of intermediate trade-off, where we're willing to accept somewhat higher risk for lesser expense (not to mention faster time-to-market).

There are an infinite number of intermediate points in the design space in which you trade off lower testing costs for higher risk. But what does "higher risk" mean? It means nothing other than costs borne by the public. And at $1 million per person-decade, those costs add up really quickly.

Those 90-95% of drugs that fail clinical testing have to go somewhere. Cheaper testing might mean that only 75% of drugs fail, and 25% end up in the market. Could this be more efficient overall? Maybe. Or it could be a lot less efficient, since 80% of those drugs are harmful or ineffective and would've failed more stringent testing!

It's not testing that makes drug development expensive. That's just the symptom. What makes drug development expensive is that the science doesn't exist to let us improve on that 90-95% number.

"the science doesn't exist to let us improve on that 90-95% number."

I'd just like to add a note that we more or less know that, because reducing that 90-95% number would be tremendously profitable.

I don't know much about the regulations the government imposes on pharma companies, but I assume it's mostly to show that the new drug actually does something and is not dangerous.

I think those are reasonable. I don't want a few hundred people to die and their relatives to sue the company because it saved money on the safety checks before a drug is removed from the market. And I also don't want to go back to the time of snake oil salesmen traveling the country...

>Government regulation (patents) creates an artificial concept of property that prevents humanity at large from benefiting from scientific advances that could be much cheaper.

That regulation might be voted by government, but is lobbied for and pushed by the corporations. Like copyright is.

It's not inherent in government to have strong patent/copyright/etc regulation. In fact some of them that don't get pushed and attached diplomatically by more powerful governments working for private interests (like the US pressuring Sweden for the Pirate Bay etc).

People will always want things. If the government cannot balance and resist those influences then this is an inherent flaw of the government.

>If the government cannot balance and resist those influences then this is an inherent flaw of the government.

Or merely of the way government is practiced at a certain place and time.

Nothing has to be "inherent", especially since the word "goverment" is a shortcuts for tons of different methods, practices and cultures of government.

If the government is democratic then it's just a reflection of its society.

>2- It's government regulation that makes the tests so expensive.

Yes. I've heard that 80% of drug development costs go towards the elaborate testing required by regulations [0]. Perhaps we as a society agree that it is necessary to do all of that testing. However, it is important to acknowledge that the extra safety comes with a very high price tag.

[0] http://www.econtalk.org/archives/2009/05/boldrin_on_inte.htm... See the transcript at 50:49

"We demand a high level of scientific rigor to accept a medication, but we don't demand the same high level of scientific rigor to accept government meddling" that seems like fairly rational behavior right given one could be life threatening and one is a low level irritant that we feel like we can address at the next ballot box if we feel so strongly?

...and one is a low level irritant that we feel like we can address at the next ballot box if we feel so strongly?

But this is no longer true, for two reasons.

First, Congress has abdicated much of its power to regulatory agencies, which are where the actual regulations' details are determined. These bodies are not elected, so we can't vote them out. While it's true, in principle, that we could use the ballot to get Congress to claw back its power, or at least to influence the details, this would (a) take a really long time, and (b) is far too broad a brush to paint with. Being able to cast one vote every 2 years for my Representative, and one every six years for my Senator, is many orders of magnitude too gross a control to be able to influence specific regulations across the whole realm of governmental interest (suppose I hate the way the FDA is handling one thing, but love the way that the DOT is doing something else, etc.; how am I to influence all those factors with just two rare votes?)

Second, we're no longer able to determine with certainty what our government is doing, in order to exercise control over it as necessary. For example, just yesterday afternoon there was a story [1] on HN covering the government's efforts to actually rewrite the records of a court proceeding, so that we wouldn't know what had actually transpired in the court. And surely I don't need to go into detail about Snowden, FISA courts, National Security Letters, etc.

[1] https://www.eff.org/deeplinks/2014/08/unsealed-us-sought-per...

>we feel like we can address at the next ballot box if we feel so strongly?

Faith in the democratic system despite much evidence. How much change has there been since Obama got in? Its worth remembering this:

http://www.cnet.com/uk/news/obama-no-warrantless-wiretaps-if...

I was under the impression that the main point of government was to record and enforce property rights, which are, therefore, by definition artificial.

How do you decide which rights are "right"?

s/government/democratic society/g

If the alternative is an invisible hand without democratic constraints, this is a rather utopian ideal also without rigorous scientific evidence.

Social systems are hard to experiment with.

Are you seriously suggesting that we shouldn't thoroughly test drugs before selling them to sick people?

Hear hear, there are a lot of drugs in this position. c.f. Naltrexone 'low dose Naltrexone' and OGFr http://en.wikipedia.org/wiki/Met-enkephalin The lack of research into these drugs leads to a lot on-line mis-information and patient-led self-experimentation. This can work for some, it has for me with LDN and Crohn's but can leave others confused, disappointed and frustrated, as well as putting doctors in an awkward position.

Is there a stomach which can handle aspirin regularly (even in small doses) without the risk of getting ulcers and bleeding? If there is... where's the line to get one? :)

Just dissolve the tablet in a spoon of water. Will pass through the stomach fast enough. Also there are PPIs which can help with ulcer risk reduction... I mean, between cancer and aspirin...

How fast the aspirin passes through your stomach has no impact on ulceration and bleeding. It's not a contact effect, it's a systemic effect that reducing the stomach's ability to protect itself.

I've been taking a low-dose aspirin for 10+ years with my morning meal and I've never had issues with ulcers or bleeding.

Bayer sells a lot of Aspirin. It's clearly in their interest. They even have a site called wonderdrug.com just for it.

It's also in the interest of generic Aspirin makers to prove such.

Competing interests exist in a free market and counter the problem you contend.

They do, but with such old generics, the profit per unit would really be peanuts compared to newer fad'ish drugs, regardless of whether they are more effective than their older kin. Dont have the numbers but I would guess the market price of generic aspirin would have reached the zone shade above its marginal cost by now. A company would spend only so much effort here. The effect is more pronounced for poor man's diseases and health care issues.

Which would in turn create a massive opportunity for companies like Bayer to undercut the market. The concept that the government would be more incentivized and thus more likely to discover novel uses for a product than it's sellers doesn't really make sense to me.

Really the big difference is that with the government their motivation will always (in theory, of course) be finding the best cure, whereas for businesses it could go either way. Sure, Bayer might have a great opportunity to undercut the market. Alternatively Bayer might have a less efficient but more-profitable drug which incentivates them away from stuff like this.

with the government their motivation will always (in theory, of course) be finding the best cure

Well, that ignores all of public choice theory. Under this model, the entities of government (the politicians, the regulators, the regulatory agencies) only have the incentive to ensure their own outcomes. That overlaps to a certain extent with finding the best cure, but it's far from synonymous.

Much as I love the market (I'm a Hayek groupie), I think there's a free rider problem here. Why would Bayer invest in improving the market for aspirin (paying for research, marketing, etc.) when the benefit of that investment would be enjoy by countless other generic makers, with Bayer reaping hardly any of it?

But is the government more incentivized? If so why?

I hadn't heard of this, more info:

http://boards.bootsnall.com/sleeping-pills-benedryl-allergy-...

Aspirin's reduction of cancer risk has been on relatively solid epidemiological footing for a long time, it's simply not a big enough protective effect to balance the risk of bleeds etc:

http://www.uspreventiveservicestaskforce.org/uspstf/uspsasco...

Now, if you were to consider all cancers plus cardiovascular benefit, and target folks who are more likely to benefit and/or less likely to have adverse events, it might be useful. Trying to sort some of this out with genomic data was the subject of my MSc, but I couldn't make it work.

I worked in biomedical research for a while and few things seem to trigger controversies like Aspirin does. Many MDs believe it's evil and don't condone its use for pretty much anything, but on the other end of the spectrum some medical professionals seem to self-medicate with it religiously.

Personally, I've been taking it for many years, for many reasons. I am genetically predisposed to colorectal cancer and serious cardiovascular problems - both led to the death of many relatives and my father has been battling both for a long time now.

Since my adolescence I've also been a migraine sufferer, which is where I originally "discovered" Aspirin, because it helps lessen the impact like no other substance and over the years I found that regular preventive usage reduces the frequency of bad episodes to below 1/y, which is simply awesome. It's probably important to mention that I got the stomach for it, too, which is something that precludes many people from taking it on a regular basis.

With my anecdotal history in mind and weighing my person risk factors against the known complications (I dread ever being in a serious accident where blood loss becomes an issue), I have elected to take it every day.

Pharmacists are horrified, by the way. "Don't take it for longer than 3 days!" "Wouldn't you prefer Ibu instead? You should."

Aspirin's action (activation etc) is well defined at chemical level. Of course, we probably don't know the entire pharmacokinetic/pharcodynamc action of the drug. But if the patient is not on other drugs that could interact with aspirin (e.g. anticoagulants, β2-blockers, antihypertensives, etc.) why not take half if not one aspirin per day?

Depends on the organism, some tolerate aspirin some ibuprofen, some nimesulid, some only paracetamol.

But Aspirin gas proven itself over the years extremely successfully as an anti-pyretic, analgesic, anticoagulant. That's not common among drugs.

I'll try to speak on behalf of the MDs opposed to the general population using Aspirin at all. I think the main reason is that it's easier to take risks for yourself where you'd be hesitant to exposing someone else to the same risk. And they do have a point.

People with bio/medical knowledge are probably able to recognize signs such as stomach problems and act accordingly, but they can't really expect patients to. Aspirin messes up coagulation beyond belief. While that is a boon to some people, issuing a blanket blessing of the substance means people will die in emergency rooms and on operating tables, people who could have been saved if they weren't on ASS. For most MDs, weighing that statistical certainty against a comparatively fuzzy list of preventive benefits which may or may not be favorable for some patients is not a hard decision to make. Hence the verdict: "don't use it, even though I myself do use it".

Again, accepting this for yourself can be an informed decision, but it's not one you want to make on behalf of the general population.

In my case, it's similar. I judge my risk factors in a way that Aspirin is more likely to prolong my healthy life, but I know there is increased risk of complications in other areas. I have no doubt that 90% of all GPs when asked would categorize my taking 250mg per day as abuse.

"Since my adolescence I've also been a migraine sufferer, which is where I originally "discovered" Aspirin, because it helps lessen the impact like no other substance and over the " Really? I've been a migraine sufferer since adolescence and nothing short of morphine would make any difference.

Perhaps you are not referring to actual "migraines" but simply bad headache (the term gets tossed around loosely a lot but it actually does mean something very specific, not just a headache)?

Yes, really.

I think the misunderstanding here comes from your assumption that I'm using Aspirin as an analgesic, which is incorrect. For me, it drastically reduces the frequency of the attacks, not their severity - but then again, I already said that ;)

Sorry to judge too quickly. I'm sure if you suffer from real migraines you know what I mean about people claiming they have a "migraine" which turns out to be just a headache.

I can say for certain what you describe never worked for me but good for you if you found something.

From the abstract this study finds that taking Asprin from 50-65 should yield a 4% reduction in deaths over a 20 year period. It specifically says that at least for 50-65 year olds, the benefits outweigh the risks of bleeding.

Sweet! I haven't read the article (or even the abstract) yet, glad to hear that they were able to nail down a recommendation. Thanks for letting me know.

You wrote a comment refuting the article's headline before looking at the article itself?

I meant that I hadn't yet read the original scientific publication [1] (I have now), not that I hadn't read the Guardian piece.

I also wouldn't agree that I was refuting the headline, I was just giving background. The scientific paper is very clear that this is an advance along precisely the lines I said were needed (ie defining a group for whom benefits outweigh harms), but the Guardian piece makes it sound like Aspirin's chemopreventive effect had just been discovered whole cloth.

[1] http://annonc.oxfordjournals.org/content/early/2014/07/30/an...

Welcome to the internet.

You know, all of these meta-analyses for years have been turning in estimates of lowering all-cause mortality. It's not new.

The USPSTF recommendation in your link is from 2007, so it may perhaps be out of date.

Also, the recent study directly challenges the USPSTF position [1]:

"The US Preventive Services Task Force (USPSTF) have reported on benefits and harms of aspirin use for prevention of specific diseases like colorectal cancer (CRC) and cardiovascular disease (CVD). However, they have not investigated overall benefits and harms based on all major diseases."

I assume the figure of 130,000 lives saved over 20 years takes into account the increased risk of intestinal bleeding and stroke.

[1] http://annonc.oxfordjournals.org/content/early/2014/07/30/an...

You're right, this work is an advance along precisely the lines I claimed were needed. Time to update my opinion!

Yes - there is lots and lots of research that suggests that inflammation is the cause of a whole host of "western" diseases.

Sugar and fructose cause heart disease (not fat) by irritating the lining of the heart over and over and over again. Wheat causes inflammation because most people are allergic to it in some way. Constant insulin response that we have with all the sugar hidden (and not so hidden) in everything we eat causes swelling and fat storage. Even the fruits we have now have been bred to be much much sweeter than 60 years ago.

Lets not even start on how fibre seems to protect against some of the terrible effects of fructose on the body (rapid conversion to fat - the body can't tolerate fructose in the blood) and how removing the fibre in the form of fruit juice or high fructose corn syrup is a disaster for your body.

Probably taking aspirin is unnecessary if you were to avoid the main things which irritate and cause an immune response in your body. I can bet you that turmeric tea from the root is going to be as good as aspirin at protecting you from these diseases but the best plan is to avoid sugar, wheat and high GI carbohydrates.

Most people are allergic to wheat? Can you please share some references on that?

This is a good read about the reversal of the gluten sensitivity study, "Researchers Who Provided Key Evidence For Gluten Sensitivity Have Now Thoroughly Shown That It Doesn't Exist" http://www.businessinsider.com/gluten-sensitivity-and-study-...

While I agree that the "most people are allergic to wheat" thing needs a lot more support, I'd like to make the small note that 95% of articles did a really terrible job of understanding the important takeaway of that study. I think this one did better: http://www.npr.org/blogs/thesalt/2014/05/22/314287321/sensit...

Thanks for linking that article. I had not heard of FODMAP before.

Well, you are correct that fat has been incorrectly vilified.

Most of the rest of what you say is logical leaps based on inconclusive data, which is just as bad as what the fat haters did years ago.

Don't get me wrong, a lot of what you say is even a good best guess based on what we know right now, but so was fat hating at one time, and stating best guesses like proven fact is what gets us to the point of having entrenched, demonstrably incorrect policy.

Let's just say "currently best available evidence..."

Yes I'd agree with everything you have said! Definitely not proven and loads of supposition. However I'd be willing to make a substantial bet that I'm correct.

Wait until you hear my crackpot theory that chemotherapy is only as effective as the starvation and reduction in human growth hormone it causes ;-)

The thing is though who is going to do a trial comparing controlled calorific intake (say < 600 calories per day for several days per week) with chemotherapy treatments - certainly not drug companies.

Rather than explain in detail I recommend people just try eating unprocessed food (with minimal grains) and see what happens. The lifestyle choices rub off on others. Weight loss is the most visible benefit, but measurable markers of blood cholesterol improve too.

The easiest benchmark: you should never feel tired after eating.

"you should never feel tired after eating."

this is why I stopped eating as much meat and switched to mainly beans / rice.

I am curious what studies have linked sugar and fructose to heart disease over fat + cholesterol.

I did find this Harvard study: http://www.health.harvard.edu/newsletters/Harvard_Heart_Lett...

However, it seems to be that it is the breakdown of high fructose (not the type found in fruit) which leads to the creation of fats that is not good for the heart.

1. http://www.ncbi.nlm.nih.gov/pubmed/20888548

2. http://www.ncbi.nlm.nih.gov/pubmed/16391215

3. http://jama.jamanetwork.com/article.aspx?articleid=202339

4. http://jama.jamanetwork.com/article.aspx?articleid=377969

5. http://www.bmj.com/content/346/bmj.e8539

6. http://www.ncbi.nlm.nih.gov/pubmed/16340654

7 http://www.ncbi.nlm.nih.gov/pubmed/23021013

8. http://www.jissn.com/content/1/1/45

9. http://www.nutritionandmetabolism.com/content/2/1/25

10. http://ajcn.nutrition.org/.../01/13/ajcn.2009.27725.abstract

11. http://www.ncbi.nlm.nih.gov/pubmed/19364995

12. http://ajcn.nutrition.org/content/67/5/828.short

13. http://www.ncbi.nlm.nih.gov/pubmed/21735439

14. http://www.ncbi.nlm.nih.gov/pubmed/12535503

15. http://www.metabolismjournal.com/.../S0026-0495.../abstract

16. http://link.springer.com/article/10.1007%2Fs00394-012-0418-1

17. http://www.nature.com/.../jou.../v64/n6/abs/ejcn201045a.html

18. http://ajcn.nutrition.org/content/92/1/34

19. http://www.nutritionj.com/content/3/1/9

20. http://www.ncbi.nlm.nih.gov/pubmed/11838888

21. http://www.ncbi.nlm.nih.gov/pubmed/20565999

List lovingly stolen from https://www.facebook.com/PerfectBalanceHealth give him a follow if you are interested in this stuff. He's very very thorough with his research, much more scientific than me. Some would say obsessive.

Thanks, the conclusions of these articles seems to be that there is not conclusive evidence that high fat diets are linked to heart disease.

Well if we're honest you can cherry pick your research can't you and how you interpret the results. Can you in return point to me a study that shows increasing carbohydrate and reducing fat decreases heart disease? I'd suggest in modern research such findings don't exist.

Aspirin has anti-inflammatory properties. Could it be that some cancers are a consequence of a long-term, low-grade inflammation (possibly, a consequence of infection with some kind of unknown virus)?

Is low-grade inflammation detectable by blood tests?

We know that many cancers are a result of this. For example smoking related cancers of the lungs and oropharynx, alcohol related cancers to the oropharynx, gastrointestincal cancers from H. Pylori, Adenocarcinomas of the oesophagus from stomach acid due to GORD, some squamous cell carcinomas of the skin. Yes it is detectable, to an extent. But inflammatory markers change on an hour to hour basis, so a one-off test is not useful. And There is no benefit to testing on an extremely regular basis. Chronic high-level inflammation is easier to detect as there are certain proteins and blood markers that only change over the longer term however these are signs of chronic disease or even cancer itself and thus not really useful as a prevention. The cellular dysplasia that occurs is a better sign that some pathological process is underway and we utilise this information, collected through biopsy of skin lesions, examination of pap smear cells and other biopsy specimens to work out if we can do some procedure to reverse a potentially cancerous lesion.

But there is no way to work out some global low level inflammation as the insult that causes many of these cancers occurs locally, and you really need to look at the tissues in the areas of the insult (as we already do) to see how far along it is; even if you could perform a blood test that would tell you that 'there is some low level chronic inflammatory process occuring that may lead to cancer' you would need to be able to localise that inflammation in order to work out how to reverse it

I ain't no doctor! But that logic would also follow in prescribing regular aspirin for heart attacks:

http://circ.ahajournals.org/content/105/9/1135.full

Atherosclerosis, formerly considered a bland lipid storage disease, actually involves an ongoing inflammatory response...

And if you want to get downright controversial,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/

ketogenic diets are prescribed for the same reason (carbohydrates cause inflammation in a lot of people)

That popped into my head as well.

I have a similar hypothesis about moderate alcohol intake. Maybe it's not the flavanoids etc. in wine that provide the most benefit, but rather the stress-reduction effect of regular moderate alcohol consumption.

Chronic stress is extremely underrated as a contributing factor in long term declining health. I wonder if there might be evidence of a similar connection with Asprin.

depends on defining "low-grade" exactly but there's http://en.wikipedia.org/wiki/C-reactive_protein (specifically the high-sensitivity one)

I know next to nothing about medicine, but at least some cancers (can?) derive from human papillomavirus[0] infections.

[0] http://en.wikipedia.org/wiki/Human_papillomavirus

That's probably because papillomavirus inactivates two tumour suppressing proteins in order to allow the host cell to proliferate. Nothing to do with inflammation per se.

The full article is freely available [1],and reading the abstract will be more informative and more accurate than the Guardian article for most HN readers, I believe. Science journalism has a long ways to go before it can reliably communicate science results.

[1] http://annonc.oxfordjournals.org/content/early/2014/07/30/an...

It is not just science journalism it is all journalism. In my experience the most accurate reporting is in science.

Outside of science any reporting that I have had any personal knowledge of has been so distorted that I wonder if journalists and I inhabit different universes.

> In my experience the most accurate reporting is in science.

I agree with your general claim about journalism, but really, "the most accurate reporting is Science" ? There are so many fallacies embraced by journalists whenever they review Scientific results (the largest one being the lack of understanding of the differences between causation and correlation), that I can't even begin to fathom while that would be more accurate than the rest.

I said the most accurate, not accurate :)

In general science reporting is appalling bad, while non-science reporting is total fiction with a malign bias.

Got it, I see what you are saying now :)

The attention economy (the limits of human cognition) vs deadlines.

My group championed private voting, public counting. We tried to influence policy, with mixed success. I spent years becoming an expert on election integrity, voting rights, election administration, etc.

It's not possible to convey all that knowledge casually. So you have to work very, very hard on messaging. And then tenaciously pound the same point over and over again until it gets thru.

Most interesting part, IMO -

"All the cancers in which aspirin has a beneficial effect have some lifestyle causes – from smoking in lung cancer to alcohol in oesophageal cancer and obesity in all of them. Taking aspirin, said Cuzick, "should not be seen as a reason for not improving your lifestyle". The drug, however, would reduce the cancer risk even in people who have a healthy lifestyle, he said."

Now I left in the last part to be fair, but it seems like perhaps the risks (bleeding etc) may not outweigh the benefits for people with a healthy lifestyle.

Aspirin has potential. It might also help with mood disorders if or when they are connected to low level chronic inflammation.

(big if, nothing conclusive, just interesting connection)

http://apt.rcpsych.org/content/14/4/248.full

http://www.ncbi.nlm.nih.gov/pubmed/15867179

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535180/

What I find interesting about aspirin is that no one really knows how it works (its "mechanism of action"). Its anti-inflamatory effects are a consequence of something else, not the cause.

In the book "Power, Sex, Suicide"[1], Nick Lane states:

"Curiously, aspirin is also a mild respiratory uncoupler; I do wonder how many of its more mysterious benefits may relate to this property"

He is talking about the mitochondrial respitarory chain. In this context, "uncoupled" means that the electron flow does not generate any ATP; instead, all the energy is dissipated as heat. The interesting thing is that uncoupling the electron transport chain reduces electron leakage ("free radicals") and less free radicals has been associatted with ageing and disease.

Will less electron leakage reduce chronic inflamation ? Who knows ...

Once again, the analogy with computer systems is pretty straightforward: If our back-end system is "inflamed" (read, under heavy load) due to incoming HTTP requests, uncoupling it with a message queue system will have anti-inflammatory effects.

[1] http://www.amazon.com/Power-Sex-Suicide-Mitochondria-Meaning...

[2] http://sciencecases.lib.buffalo.edu/cs/files/dinitrophenol.p...

Hi there,

I think you need to explain yourself a bit better - you have made a statement that is demonstrably false, at least in the sense that you have used it -

aspirin is that no one really knows how it works

- Aspirin works by a very well understood mechanism of binding irreversibly to the COX enzyme, with a preference for COX1 over COX2. there is no debate about this.

Thankyou for pointing me down the rabbit-hole regarding uncoupling and the decrease in free radical production this creates [2], something I was not previously aware of

[1] Uncoupling of intestinal mitochondrial oxidative phosphorylation and inhibition of cyclooxygenase are required for the development of NSAID-enteropathy in the rat doi/10.1046/j.1365-2036.2000.00723.x/

[2] Mitochondria and reactive oxygen species 10.1016/j.freeradbiomed.2009.05.004

Indeed. Wording is important.

I meant that the known mechanism that you have mentioned does not explain all its reported benefits. Specifically in the anti-inflammatory effect, it seems like inhibition of prostaglandin synthesis (via COX enzyme binding) is not the reason[1].

As aspirin has so many potential benefits, it seems to me that it has to have some effect in some very basic and common site and the mitochondrial respiratory chain is a good, if not best, candidate.

If you are interested in uncoupling and free radical production, Peter[2] has a good amount of info about it.

At any rate, aspirin has many knowns unkowns; that´s what I meant in my original post.

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213311/

[2] http://high-fat-nutrition.blogspot.com.es/

Thanks for pointing me to that blog, really interesting stuff. Rob

Aspirin is very well understood, Wikipedia has a very extensive article about how it works. It's a pro-drug, when activated takes a place. Search for Arachidonic Acid pathway if you are interested.

Also, By binding free radicals ( a we'll know, side-effect of aspirin and Vitamin C) you get less chances of getting cancer for one.

I meant that the known mechanisms do not explain all its reported benefits. In the Wikipedia article that you mention this is clearly stated:

"However, other effects of aspirin, such as uncoupling oxidative phosphorylation in mitochondria, and the modulation of signaling through NF-κB, are also being investigated."

Am I correct in saying "This isn't a new trial-based study; it's really just an analysis of available study data based on either (a) other previously published analyses of this type, or (b) an interpretation on follow-ups of clinical trials"?

I'm not used to reading science journals so it's possible that I missed something.

http://annonc.oxfordjournals.org/content/early/2014/07/30/an...

Methods The effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer.

http://en.wikipedia.org/wiki/Meta-analysis

In classic biological fashion i.e., everything is connected and has side-effects, consistent use of aspirin is also linked to macular degeneration:

http://www.webmd.com/eye-health/news/20130118/aspirin-blindi...

Cancer or blindness?

should I start taking it now, in my 20's, or wait till I'm in my 50's?

No definitely don't start in your 20s. There's no evidence that the benefits outweigh the risks at your age.

The article did not say what sample size the new research was based on or how it was conducted, but provided detailed projections over the next 20 years. Media still giving us all the numbers except the ones that matter.

The answer to those questions is not simple; this is reviewing a bunch of studies and outcomes, so the answer is, it depends. As usual, there is no substitute for looking at the fulltext, eg http://annonc.oxfordjournals.org/content/early/2014/07/30/an... (Looks like it omits the metric of most interest to me personally, RCT results for all-cause mortality, where I believe the cumulative n is ~10-20k.)

I wouldn't just randomly start taking aspirin every day because of this article... Im sure the next big aspirin discovery will be "oops all that asprin is actually bad"

My father does it, many people do in Greece. Not every day regularly but 3-4 times a week. He is fine so far, extremely healthy for his age.

But what you said above could be told/discovered for jus about any drug.

I like more tomato sauce to prevent cancer...

http://www.ted.com/talks/william_li

Last time a "cure cancer" article appeared on HN, someone posted a link to their site, which I found pretty entertaining:

http://kill-or-cure.herokuapp.com/

I am disappointed that The Daily Mail has not yet found an inanimate object starting with Z that can cause or prevent cancer. How could they have missed this on Zinc Oxide [1]!

Edit. I spoke too soon. Thee sleuths at the DM have picked this up [2].

[1] http://www.huffingtonpost.co.uk/2012/05/09/suncream-skin-can...

[2] http://www.dailymail.co.uk/health/article-2141257/Suncream-i...

It's particularly funny to have this article open along with the OPs side-by-side: http://www.dailymail.co.uk/health/article-205490/Asprin-link...

Yes! One magic pill will cure everything!

Next I'll be hearing I should chew willow bark instead of paying for Aspirin :)

Even if this worked, the amount of misinformation about this has inoculated me against taking medical decisions myself (other than avoiding the free Twix littered in the office kitchen).

John Oliver covered this style of journalism, rather sarcastically a while back.

https://www.youtube.com/watch?v=WA0wKeokWUU#t=13m09s

Meadowsweet or black birch would both be much more sensible than willow bark. I've heard it claimed that black birch is safer than aspirin, though I've never seen any evidence of this.

Time to start selling shares in aspirin producing companies as the naifs rush in to buy up?

So far anybody found out the root cause of cancer. Without knowing the root cause difficult to find a good bug fix.

There is no root cause since Cancer is a description of a set of symptoms, not a single disease. Trying to find the root cause of cancer is like trying to find the root cause of broken legs.

There is an idea among some medical professionals that cancer is a natural mutation, survival of the fittest at the cellular level. In other words, if we figured out a way to "cure" aging and live forever, everyone would still die of cancer eventually.

Wait, what!? One of my favorite online health info sources just yesterday headlined "FDA Reverses Its Position on Daily Aspirin" http://articles.mercola.com/sites/articles/archive/2014/08/0... which says only certain ppl may benefit from regular aspirin. The data do not support the use of aspirin as a preventive medication ...

No one should be using mercola.com as a source for information on anything. It's one of the most well-known dens of harmful and dangerous pseudoscience on the internet (see: http://www.sciencebasedmedicine.org/joe-mercola-quackery-pay... for one of many articles the excellent folks over at Science Based Medicine have written about the site).

Your link is not particularly believable considering that their last point is "Improve Your Blood Viscosity by Grounding Yourself to the Earth". You'll forgive me if I just completely discount everything on that website.

The abstract contradicts it; at least, while perhaps finding that those individuals suffering from internal bleeding from aspirin may not find it a net benefit, the abstract seems to primarily be concerned with the massive reduction in cancer risk as regular dosing of aspirin goes up.

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