It is easy to get a thousand prescriptions but hard to get one single remedy. ~Chinese Proverb

December 16th, 2010 by Dr Wheeler

15. At 09:43am on 07 Dec 2010, Alan Hammond wrote:

“When will they make up their MKNDS about Asprin
First they say that one a day is good for you
Then thay say it is NOT good for you and one should stop taking it
And NOW again they are saying it is Good for you
I was told NOT to take it and that STILL stands as far as I am concerned”

I have no idea who Mr Hammond is (if that is his real name.) He is a random poster on the BBC news site who has expressed a view which I fear is probably quite widespread at the moment.

When you are given medical advice you want it to be authoritative.  You want it to be based on good evidence… and most importantly you want the advice to cause you more good than harm.  This is all very reasonable – but the recent aspirin debacle brings into sharp focus the fact that unfortunately doctors often operate on a level where there is constant uncertainty as to best practice.

The BBC article on the recent research in ‘The Lancet’ (read it here).  Is a good precis of the new information available on aspirin therapy.  In a nutshell,  it states that taking aspirin will in the long run reduce deaths in individuals through a combination of vascular disease prevention and reduced cancer risk.  This contradicts other advice that has been coming out over the past 2 years regarding the use of aspirin in healthy individuals because of the risk of gastrointestinal bleeding which has been guiding my practice over the past 6 months or so.

Over the years I have learnt to be sceptical about any new research that tries to overturn long held ideas.  Often those who jump on new medical bandwagons early on end up with egg on their faces when new evidence comes to light a few months or years later.  But in the case of aspirin therapy I think the majority of GP’s in the UK have been increasingly convinced that giving aspirin to their healthy patients was a bad idea.  This meant a lot of difficult discussions  about coming off pills that had been used for decades in some cases – raising the question “why had we been treating these patients with aspirin for all these years if it wasn’t the best thing for them?”

The reasons are mainly related to the technical details of how hard it is to do gold standard medical research – a subject of interest to me, but possibly not to the majority of patients who just want to be well.  There is no simple way to resolve the issue – we just all need to accept that what we think is good for you today might be thought to be bad for you tomorrow… and muddle through as best as we can.

So should you take aspirin?

In a nutshell the figures as far as I can tell are this…. taking an aspirin a day from the age of 50 onwards… for at least 5 years – but potentially until you are 75… could reduce your risk of dying from cancer by 25% in the short term, 20% over the long term.

Not related to this new study – the latest data would suggest a possible reduction in heart attacks by 20% in addition to the cancer risk improvement.  The old idea that it would also reduce your stroke risk is now no longer thought to be true.

The downside is an increase in risk of bleeding from your guts…. which can be fatal.  The figures from the BBC are that it doubles your risk from 1 in a 1000 to 2 in a thousand.  In fact my reading of the data is that in fact the figures are 0.7 in a thousand and 1 in a thousand respectively – so not quite as bad.

So…. from an objective statistical point of view it would seem to be a no brainer… the advice now would be to take the aspirin after all as the pros outweigh the cons (assuming you are otherwise fit and well / not on other medications – those patients who don’t fit this description would be wise to phone for tailored advice.)

Beware though… ask me next week and I might have a different answer… and remember the old chinese proverb quoted above next time you get contradictory advice about your medication.

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