January 4th 2008, 16:54Nothing makes my blood run cold so much as hearing about a new variety of 'preventive' medicine. This alarming notion aims to stop disease in its tracks by treating the patient with a just-in-case remedy while he is still healthy. Yet, medical preemptive strikes don't have a good track record. They're usually at the heart of every bright idea gone bad, leaving carnage in its wake. Hormone replacement therapy, claiming to stave off not only menopause, but also heart attacks and cancer, turned out to increase the very diseases it was meant to prevent. Diethylstilbestrol (DES), the miracle drug taken to prevent miscarriage, caused cancer and infertility among an entire generation. The list goes on and on.
The most pervasive preventative of our generation is aspirin. Since the mid-1990s, this no-frills non-steroidal anti-inflammatory drug (NSAID) has been served up to patients as a cheap and safe means to prevent heart attacks and strokes and, lately, to reduce cancer.
But new evidence shows that, far from preventing death and strokes in the elderly, aspirin brings them on. Oxford University researchers who examined data from the last quarter-century's worth of aspirin preventative use found an astonishing sevenfold increase in bleeding in the brain-intracerebral haemorrhagic stroke-among elderly patients.
Aspirin and other NSAIDs have long been known to cause stomach bleeding-despite attempts at buffering these effects. However, the latest evidence, detailed in the January 2008 edition of WDDTY, finally places the damage in bold relief. Aspirin kills 20,000 Americans and puts another 100,000 in hospital every year through aspirin-induced GI haemorrhage.
Doctors have had numerous warnings that aspirin isn't the magic bullet as once thought. The 1994 meta-analysis that launched aspirin as a cardiac preventative medicine was based on faulty conclusions. The Antiplatelet Trialists' Collaboration (ATC), which pooled together smaller studies, concluded that a few weeks of antiplatelet therapy could halve the risk of deadly blood clots in high-risk patients (BMJ, 1994; 308: 235-46).
However, the Thrombosis Research Institute uncovered a laundry list of errors-including the shabby quality of the individual studies pooled, mistakes in reporting results, even basic errors in arithmetic and in the recommended dosages. The TRI concluded that the review did not provide adequate evidence to support the widespread use of aspirin to prevent stroke (BMJ, 1994; 309: 1213-7).
There is also an increasing incidence of what the medical community has chosen to call 'aspirin resistance'. Lately, doctors have discovered that many people who religiously take aspirin in the hopes that it will save them go on to develop blood clots that result in heart attacks and strokes (Am Heart J, 2005; 149: 675-80). This led doctors to wonder whether aspirin's effectiveness is hit and miss. But, as the Oxford evidence shows, aspirin not only fails to stop the thief in the night-it is itself the thief, responsible for haemorrhagic stroke. The Oxford researchers now believe that aspirin has outstripped high blood pressure as the leading cause of stroke in the elderly.
Ever on the look out for some quick fix to the catalogue of suffering they witness every working day, doctors uncritically embraced aspirin as a modern-day magic bullet: open to all to manufacture, within reach of the poorest of patients. But it's now clear that aspirin is just the very latest in a long list of drugs that causes the very condition it is intended to prevent.