Dump in daily aspirin reveals medicine’s flaw: F. Flam

(Bloomberg) – There is a pattern to medical reversals that may help explain this week’s apparent twist on that age-old advice to take one aspirin a day to prevent heart attacks and strokes. In fact, evidence had accumulated for some time that this could do more harm than good to many people.

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This latest news should not be an accusation against medicine, but a warning to be skeptical of certain types of recommendations. That includes any medical intervention aimed at healthy people, especially treatments that are not supported by a series of controlled clinical trials.

Doctors sometimes recommend unproven interventions because they believe they are taking a “better safe than sorry” approach. The problem is that they often confuse the prevent side with the cure side, as happened for years when they thought they had to wait until they had proof that dietary fat was safe before removing it from the list of unhealthy foods. They should recognize that it would have been safer to let people continue to eat the way they had for millennia, and not have changed anything without reasonably strong evidence.

I recently had a conversation for a podcast episode on this topic with Dr. Gilbert Welch, he is the author of the book “Less Medicine, More Health”. “I am a conventionally trained physician and I believe that medical care can do a lot of good, particularly for people who are sick and injured,” he said. “It is difficult to make a healthy person better, but it is not so difficult to make him worse.” This sounds strangely obvious, and yet it does not reflect the way our medical system works.

The podcast was not related to aspirin, but to all the tests and examinations that are imposed on people who feel good. Some will be diagnosed with cancer, others will undergo surgery or chemotherapy, and most will assume that the treatment saved their lives. But there is evidence that this is not necessarily the case and that, for many types of exams, they can do more harm than good.

If you accept any drugs or interventions as a healthy person, they should be supported by strong evidence, as is the case with COVID-19 vaccines – huge clinical trials and then large-scale data from Israel, showing that it was possible that damage did occur, but that it was small enough that the benefits of protection far outweighed the risks.

We also have large clinical trials comparing aspirin to placebos, showing enough risks to tip the scale against its daily use in healthy people who have not previously had heart attacks or strokes.

One such trial, called ARRIVE, followed more than 12,000 people from seven countries for more than six years. Another trial, called ASPREE, followed nearly 20,000 people in the United States and Australia. They both came to similar conclusions: there was no measurable benefit, but there was some measurable risk of dangerous bleeding, such as brain bleed and gastrointestinal bleed. Also, in the APSREE trial, more people died in the aspirin group than in the placebo group during the study period.

I asked Gilbert Welch about some questionable practices that I had experienced with my own doctor. I doubt they had any record of me getting vaccinated against COVID-19 last spring at a vaccination center, but they never called to ask about this important preventative measure. Instead, they called me multiple times to get a checkup, threatening that they might not be able to give me the referrals I needed so that my insurance would pay if I got sick or injured.

So I went, got the checkup, and came out with a prescription for a mammogram, even though I have no symptoms, no risk factors, or a family history of breast cancer. Annual mammograms remain part of standard practice despite growing evidence that they can do more harm than good for many women.

Welch said cancer screening procedures are lucrative for medical centers, and individual doctors often get ratings or reviews from their medical system that depend on convincing patients to undergo these screening tests. It may be of more interest to the doctor than to me.

Another excellent book on the shortcomings of medicine is “Overkill” by Paul Offit, which contains an insightful chapter on why you should better evaluate your doctor’s advice to take vitamins. Offit has long been a prominent advocate for vaccines, which means that he is not against treating healthy people as long as the treatment has gone through the rigors of scientific testing. The chapter on vitamins refers to several studies in which people in the vitamin group had cancer more often than those in a placebo group.

Medicine is not exactly a science, it is a combination of things, with some science in the mix. There is a reason we have a science-based medicine movement, but not a science-based physics movement. Medicine is also based on tradition, intuition, compassion, and various other ingredients. All this is useful to heal the sick and wounded.

Sometimes you can’t expect more than circumstantial evidence when it comes to a deadly disease, such as early AIDS. Then it might be better to use unproven treatments for the problem if there is a hypothetical chance that they will work, and if they don’t, there is no hope. But perhaps instead of always thinking that prevention is better than cure, doctors and their patients could evaluate the adage “if it’s not bad, don’t fix it.”

Nota Original:Reversal on Daily Aspirin Shows Medicine’s Weak Spot: Faye Flam

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