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One of the Most Dangerous Ideas in All of Medicine…

Aspirin is not a panacea. And neither is reason.

by
Theodore Dalrymple

Bio

April 22, 2014 - 1:00 pm
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There are few phrases more dangerous in medicine than “it stands to reason,” because what stands to reason may in fact not be a good idea, however brilliant it may once have seemed. This is because reality is always more complex than our theories about it; grey is theory, said Goethe, but green in the tree of life.

Perhaps the greatest single intellectual advance in the medicine of the last century was the realization that “it stands to reason” is no reason at all; everything must be studied in the light of experience. There was a good example of this necessity in a recent edition of the New England Journal of Medicine, which studied the effect of giving patients doses of aspirin or clonidine before and after undergoing non-cardiac surgery.

One of the most serious and feared complications of such surgery is heart attack, especially as the age at which people are operated on has increased. There are good theoretical reasons for believing that either aspirin or clonidine, or both, given peri-operatively might reduce the rate of heart attack in the first month after operation. Aspirin prevents the blood platelets from sticking to one another and the lining of the blood vessels, agglomeration of platelets being one of the mechanisms of heart attack; clonidine blocks the activity of the sympathetic nervous system whose overactivity is thought to be another such mechanism. Therefore it stands to reason, if anything does, that making the platelets less “sticky,” or the sympathetic nervous system less active, before, during and after operation might reduce the rate of post-operative heart attack. But does it?

A large trial was conducted in 135 hospitals in 23 countries, comparing the rates of heart attacks of people given aspirin, clonidine or placebo before and after operation. 10,010 patients were recruited in all, and the rate of follow-up was so high (99.9 percent) that it resembled the results of a Soviet-era election. Surprisingly, more than 40 percent of the patients were already taking low-dose aspirin prophylaxis when they entered the trial; but they were treated in exactly the same fashion as their peers who were not on aspirin.

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All Comments   (12)
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What about the massive doses of cortisone they give everyone pre-operative?

Getting back to the purported topic, I'd suggest you take a course in philosophy of science rather than try to reinvent it. What you are really asking is which comes first, the theory or the evidence, and the answer is they are interwoven. Any rational prediction has to be validated, and any body of evidence will only answer such questions as you put to it.

What are you suggesting, that people throw out the textbooks and don't read new research? What then would be left?

The most dangerous idea in medicine is a failure to keep eyes and mind open, and to think that anything in this world is easy or certain, especially with the high stakes in medical practice.
17 weeks ago
17 weeks ago Link To Comment
I just got back from a trip overseas and after the first flight my feet and ankles were swollen. I mentioned to my traveling companion that I needed to buy some aspirin once we get there. While boarding the plane, the steward was arranging some medications and there was aspirin. He took me aside gave me one with water and another for later. That evening I bought some. I have had chronic pain in my right thumb for almost 2 years, for which I have tried every medication (non-narcotic, including prescription) with no results. For the last 6 months I followed a gluten-free diet in hopes of relief, but alas, during that first week I was practically pain free (while eating gluten). I didn't even put 2 and 2 together until my next dose. Aspirin! My pain issues I believe are nerve related. I could not be more thankful for this drug.
17 weeks ago
17 weeks ago Link To Comment
So does low dose aspirin taken each day in those with no cardiovascular issues do any good by preventing heart attacks or is this an urban rumor, too?
18 weeks ago
18 weeks ago Link To Comment
There was just some report saying not, but so far I'm still taking mine. Depending on other interactions with health, diet, and other medications I suspect it is helpful in some cases, ... and in my case I would probably take it for other reasons anyway.
17 weeks ago
17 weeks ago Link To Comment
This is exactly why we need to support ideologically pure politicians, rather than pragmatists.
18 weeks ago
18 weeks ago Link To Comment
Another thought provoking article. Thanks. But Dr. D, the science is settled and objectors are bigoted hateful reality deniers. At least that's what my congressman tries to tell me.
18 weeks ago
18 weeks ago Link To Comment
Every single instance of medical advice in the past few decades has been discarded by doctors, from what to eat to the value of strenuous exercise.
Why listen?
18 weeks ago
18 weeks ago Link To Comment
The practice of Medicine is not a science. It is an Art that uses science.
18 weeks ago
18 weeks ago Link To Comment
Dr. Dalrymple, what is your take on that other medical panacea that may not be questioned, so called, 'medical marijuana?.........
21 weeks ago
21 weeks ago Link To Comment
As a 61 year old stage 3c ovarian cancer patient who pain pills don't work on, (not opiates & not NSAIDS), I had the lovely OPPORTUNITY to lie in bed crying & screaming in agonizing pain for months on end during chemo. Even now, (thankfully in remission), I STILL have symptoms that I would LOVE to try medical cannabis for. However, here in NV, we STILL don't have any open dispensaries...SO I CONTINUE TO SUFFER & WAIT!! Currently, you have to break the law BEFORE you can comply with the law. I am NOT going to break the law because Hubby is here on a Green Card from Canada & I can't risk getting busted, getting him deported back to Canada & having a felony drug charge on my record so I could never enter Canada...what kind of marriage would that be ? Please refrain from ridiculing MEDICINE that some of us CANNOT access because of our country's LAME 21st century Prohibition. My 38 year old cousin died of an accidental overdose of a "Dr. prescribed" pain pills (the kind of toxic, highly additive, narcotic that Big Pharma wants us ALL to take). God forbid that we could use "medicine" that grows out of the Earth, like good food!!
17 weeks ago
17 weeks ago Link To Comment
As I like to say, "Theory is fine, data is better."
21 weeks ago
21 weeks ago Link To Comment
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