There is a medical reversal pattern that may help explain this week’s apparent twist in this old advice aspirin Daily to prevent heart attacks and strokes. In fact, there has been some evidence that this can do more harm than good to many people.
The latest news should not be an accusation against drugs, but a warning to be skeptical about certain types of recommendations. This includes any medical intervention designed for healthy individuals, 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 “safer than sorry” approach. The problem is that they often confuse the preventative side with the curative side, as has happened for years when they thought they had to wait until they had evidence that dietary fat was safe before removing it from the list of unhealthy foods. They must recognize that it was safer to allow people to continue eating as they have eaten for thousands of years, rather than change anything without fairly strong evidence.
I recently had a conversation for a podcast episode on the subject with Dr. Gilbert Welch, he is the author of the book “Less Medication, More Health.” “It’s hard to improve a healthy person, but not so hard to make it worse.” This sounds 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 tests that are forced 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 are receiving medications or interventions as a healthy person, they should be supported by solid evidence, as is the case with vaccines COVID19: Huge clinical trials and then large-scale data from Israel, showing that harm is possible, but it was quite rare that the benefits of protection far outweigh the risks.
We also have large clinical trials comparing aspirin to placebo, which show enough risks to raise the balance against the daily use of healthy people who have not had heart attacks or strokes.
One experiment, 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. Both came to similar conclusions: there was no measurable benefit, but there was some risk of measuring dangerous bleeding, such as cerebral hemorrhage and gastrointestinal bleeding. Also, in the APSREE trial, more people died in the aspirin group than in the placebo group during the study period.
I asked Gilbert Wallach about some dubious methods I had experienced with my doctor. I doubt they had any record of a COVID-19 vaccine last spring at the Vaccine Center, but they never called to ask about this important contraceptive. Instead, they called me several times for a checkup, threatening that they might not be able to give me the referrals I needed so that my insurance would pay if I was sick or injured.
So I went, got the test and came out with a mammogram prescription, even though I have no symptoms, no risk factors or a family history of breast cancer. Annual mammograms remain part of standard practices despite growing evidence that they can do more harm than good for many women.
Welch said that cancer screening procedures are cost-effective for medical centers, and individual physicians often receive ratings or reviews from their medical system that depend on persuading patients to undergo these screening tests. It may interest the doctor more than me.
Another excellent book on the shortcomings of medicine is “Overkill” by Paul Opit, which contains an insight chapter into why you should better evaluate your doctor’s advice on taking vitamins. Opit has long been a prominent supporter of vaccines, which means it does not oppose the treatment of healthy people as long as the treatment has passed the difficulties of scientific testing. The chapter on vitamins refers to a number of studies in which people in the vitamin group developed cancer more frequently than those in the 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 components. All this is beneficial for healing the sick and wounded.
Sometimes it is impossible to expect more circumstantial evidence when it comes to a deadly disease, such as early AIDS. So it may be better to use unproven treatments for the problem if there is a hypothetical chance that they will work, and if not, there is no hope. But perhaps instead of always thinking that prevention is better than medicine, doctors and their patients can appreciate the adage “if it’s not bad, don’t fix it.”