Thursday, June 21, 2012

Don't Take Two Aspirins...

We all grew up with the old adage of "take two aspirins and call the doctor in the morning." This saying referred to the advice doctors often gave patients who bothered them by phone late in the day with what the doctor perceived to be a triviality that could wait until the next day or forever, for that matter. Today, when you try to call you doctor later in the day, you often get a voice message that states, if this is an emergency, please call 911 or go to the nearest emergency room. So was it good advice?

Clearly, aspirin is an effective enough fever reducer, pain reliever and anti-inflammatory medicine for mild ailments. However, it's hardly used for such purposes anymore because of superior medications such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil, etc.) and other non-steroidal anti-inflammatories (NSAIDS).  Aspirin began to decline in usage for pain and fever not only because of the more potent alternatives, but also because an increasing number of people were having allergic reactions to it and it was discovered that children (and some adults) were at risk of developing Reye's Syndrome.

Reye's Syndrome is a deadly disease that strikes quickly and can affect people of all ages without warning. It affects the entire body, but the brain and liver are the most harmed. Although the exact cause and cure are unknown, there appears to be a link between it and aspirin and other salicylate containing medications, and it seems to affect people who have had a chicken pox infection at some point. As the use of aspirin declined, the incidence of Reye's Syndrome has also markedly declined to very rare occurrences. It should stay that way.

More recently, aspirin has regained center stage due to its anti-platelet, anti-clotting abilities. It has also been linked to possible benefit in reducing the risk of colon cancer.  Unfortunately, it also is responsible for most bleeding episodes in the U.S. and is reported to be among the top four reasons for emergency room visits. The bleeding risks are increased by concomitant use of other NSAIDS, and unfortunately, enteric-coated aspirin, does NOT appear to decrease the bleeding risk.  Aspirin can also cause gastric ulcers, and I can confirm that from personal experience.

Therefore, the recommendation to consume a baby aspirin (81mg) to prevent blood clots must therefore be balanced against the risk for bleeding, ulcer formation, and the long-shot Reye's Syndrome. A thorough discussion with your doctor can determine if it is the right choice for you based on your risk factors for blood clots. Taking it on your own would not be advised.

That's what most doctors agree is the prudent course, but then again Dr.Oz is no longer like most doctors. An article appearing in this week's People magazine quotes him as saying that everyone should take two baby aspirins every day. Without knowing your risk factors and apparently throwing caution to the wind, he appears to ignore the risk factors for bleeding and ulcers and continues to make this foolhardy recommendation. Sometimes he recommends a fluid with it, but I have heard him say on his show to take aspirin without mentioning the need for fluids. Fluids are said to decrease the corrosive nature of aspirin on the lining of your stomach. I wish he would add at least a whisk of caution to his recommendation, if not stop it altogether.

By the way, you may ask, why do I keep writing about Dr. Oz?  As I've said before, it's because he's everywhere I turn (everyone turns) and quoted widely. His words are taken seriously by many people and I fear for the consequences.

A reporter for a Canadian major newspaper, whom I wrote about previously and spoke to the other day, told me that when she was among other reporters interviewing Dr. Oz when he visited Canada, she was the only reporter who did not get a hug because she asked him tough questions he apparently didn't appreciate.  Her conclusions after interviewing him is that he rationalizes promising miracle cures and magic pills (which he knows don't exist) and pushing products that are potentially harmful by telling himself that people need false hope and emotion to drive change.

I say people need good information to make good choices in consultation with their doctors. On that point, Dr. Oz and I seem to be diametrically opposed and that is why I keep trying to educate the public. 


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