Wednesday, March 30, 2005

Terri Schiavo dies and confusion still reignsUPDATED

Terri Schaivo is dead and you can blame the videotape for much of the confusion surrounding her lamentable story

By Joel N. Shurkin

Terri Schiavo, 41, died this morning at her nursing home in Florida. She died 13 days after her feeding tube was removed and one day after her parents lost yet another futile legal manuever to have the tube replaced. An autopsy is scheduled.

What is usually a private matter amongst family members, became a major news event when the family split over her treatment. Her husband, Michael, wanted life support removed so she could die; her parents wanted her to be maintained on life support despite the fact she had virtually no chance of even a partial recovery.

She became the political symbol of craven and in some cases, hypocritical politicians and of social conservatives from the anti-abortion fringe. Her parents became the tools of extremists ranging from the demented Randall Terry to quacks making diagnosis from videotapes so they could get on television. By the time of her death, Congress had challenged the separate powers concept of the American constitution by intervening, and extremists were threatening the independence of the judiciary, even insisting that the governor of Florida send troops to rescue her, contrary to the rulings of both state and federal courts, essentially a coup. In the meantime, she served as the fulcrum for a serious and important debate on how to treat people who lie at the cusp between life and death. Thoughtful people were forced to confront their definitions of mortality, of the existence of a soul, and the powers of government. We owe her for that.

She knew none of this. Ms. Schiavo had been in a persistent vegetative state (PVS) for 15 years.

What that condition means, has been the topic of fervent debate, usually by people who have no clue what a persistent vegetative state is. Extremists have used those misconceptions and ignorance as weapons in their battles to enforce their religious views on everyone else.

The news networks--especially the cable networks--have been running a video tape for weeks that may be responsible for many of the misconceptions. It is a question of confusing coma with PVS. Had she been in a coma, we wouldn’t be paying much attention.

The tape, edited down from hours, shows her moving, seemingly smiling and reacting to stimuli from her family. Her eyes move, parts of her limbs tremble. It is not hard to assume, looking at the tape, that Terri Schiavo is in there somewhere. She probably isn’t.

"It confuses people who look at her," says Dr. Tom Raffin, the Colleen and Robert Haas Professor Emeritus of Medicine/Bioethics, Division of Pulmonary and Critical Care, and director emeritus of the Stanford University Center for Biomedical Ethics at Stanford University. "She does these things, but that doesn’t mean she can think."

There is a huge difference between a person in a coma and a person in a persistent vegetative state, Dr. Raffin says. A person in a coma is "locked in." If they recover--and many do--they may have cognition. Until then, they are unconscious, unmoving. Their brain has essentially shut down.

A person in PVS is not locked in.

"Their eyes are wandering and it looks as if something is going on, but nothing is," he said. "It is common for loved ones to think there is contact even when there isn’t. The patient reverts to primitive reflexes, the reptilian part of the brain. They can track people with their eyes without cognition. She [Ms. Schiavo] does those things. That doesn’t mean she thinks. She will have reflexes, be startled, but there is no cognition going on."

Brain scans show remarkably slowing brain waves, he said. Scans of Ms. Schiavo's brain also show the middle section almost scooped out, with the brain matter replaced with fluids. Any communication between her brain and her body is likely in one direction, the reflexive motions.

A person with PVS looks exactly as Ms. Schiavo does.

Her chances of recovery are "as close as you can get to zero," and any doctor who says she can recover with rehabilitation is "a liar."

Dr. Raffin said that if he were judge and there was evidence she was not in a PVS, he would not let them remove the feeding tube. But she clearly is.

The rulings by the Florida courts, which seem to so enrage a vocal minority of the population, are perfectly consistent with the law and precedent.

Two doctors in California were charged with homicide several years ago for withdrawing life support. A nurse complained to the district attorney. Charges were eventually dropped. There are cases in which doctors have refused family instructions to pull the plug, fearing malpractice suits, although they are very unlikely if the family wants the procedure.

In the "Baby Jane Doe" case in New York, a case with some parallels to the Schiavo case, parents of a severely retarded and crippled child born with spina bifuda refused to permit surgery that would have kept her alive, although still severely retarded and crippled. New York courts ruled in their favor. But an anti-abortionist doctor from Vermont took them to federal court to force the surgery, claiming the parents had no right to decide if the baby should die. Encouraged by the Reagan administration, he asked a federal court to intervene and order the procedures.

"These people have no right to be here at this time in our lives," the father said.

"What the parents want is not a factor here," the lawyer said.

The court ruled it was, and the surgery was never performed.

In the Karen Ann Quinlan case in New Jersey (1975), the courts ruled that without a directive from the patient herself, the family (she was unmarried), the doctor and the hospital’s ethics committee had the right to decide her fate. The respirator was turned off, but Ms. Quinlan lived another 10 years in a PVS before dying.

New Jersey courts and many others have ruled that what the patient wants, trumps all other considerations, and those desires "are not to be decided by societal standards or reasonableness or normalcy[emphasis added]. Rather, it is the patient’s preference--formed by his or her unique personal experiences--that should control." If the patient can’t decide, members of the family or whoever the physician thinks most appropriate decides. In most cases, that would be the spouse.

The Schiavo case fits well within that ruling law.

What did she want? According to the testimony of her husband, substantiated by others, she did not want to live as a vegetable. The judge believed the testimony--that she was in a PVS and she did not want to persist in that state--and ruled, as almost very other court would rule, that the husband has the right to decide, and if he says she should be taken off life support, that’s what should happen.

Dr. Raffin has seen this all before.

"It’s a very tragic situation," he said. "You have parents and siblings who want her alive. It’s not unusual.

These situations happen every day in hospitals, and no one says anything. It only becomes the lead story on CNN and Fox News when others get involved for reason that go well beyond the welfare of the patient.

"If I were King Solomon, I would say to Michael [Schiavo], why don't you divorce her and let her family decide. But things are too polarized by now for that to happen."

Ms. Schiavo likely felt no pain.

She was long since gone elsewhere and is, one hopes, at peace.

Tuesday, March 29, 2005

Schindler's shameful list UPDATED

Terri Schiavo's family sells their mailing list.
March 29, 2005
With their daughter not quite dead yet, the family of Terri Schiavo has sold a mailing list of their financial supporter to a conservative group that raises funds for anti-abortion and conservative causes. It’s all perfectly legal, just in appalling taste. Even supporters of the family are dismayed. The deal was brokered by Phil Sheldon, the son of the Rev. Lou Sheldon, one of the prime movers of the Christian political right wing. The company marketing the list, Response Unlimited said Robert Schindler, Ms. Schiavo’s father, agreed to rent the list as part of a seal to solicit money for the family, which undoubtedly has huge legal fees. Response Unlimited is asking $150 a month for 6,000 names and $500 a month for 4,000 e-mail addresses, people who responded last month to a plea from Mr. Schindler. The New York Times story is full of great quotes. Pamela Hennessy, the woman who runs the Schindler’s web page as a volunteer, said “It is possibly the most distasteful thing I’ve ever seen. Everybody is making a buck off of her.” Richard Viguerie, the king of conservative direct-mail operators, said “I think it sounds a little unusual right now because of the situation where she is in the process of dying. If you came across this information six months or a year from now, I don’t think you would give it much thought.” The best quote comes from Robert Gellman, a consultant. “I think it’s amusing,” he said. “I think it is absolutely classic America. Everything is for sale in America...”
And just to show everything is normal, Jesse Jackson showed up today. Considering the number of television cameras around, one wonders what took him so long.

Thursday, March 24, 2005

Actual facts in the Schiavo case UPDATED REPEATEDLY

Interrupting an emotional debate with real science.
March 24, 2005

It is always bad manners to interrupt an emotionally charged discussion with facts, but forgive me. Peggy Peck one of the country's best and most-respected medical writers, has covered the Schiavo case for years. In a discussion on the list serve of the National Association of Science Writers (NASW), Peggy put to rest several rumors and misstatements, many of them circulated by the yahoos who have intervened in this sad family matter for their own political purposes. With Peggy's permission, read on:

I've been writing about this for years. First, Michael Schiavo is her husband, not her ex-husband.

Second, the evidence from neurologists--with the exception of the bariatric chamber fan--is that she is in a persistent vegetative state, not a minimally conscious state. Here is an excerpt from one of my articles that explains the criteria for minimally conscious state:

What has confused many in the public--and a fair share of politicians--is the term "persistent vegetative state", says Joseph T. Giacino, PhD associate director of neurology, JFK Johnson Rehabilitation Center, New Jersey Science Institute, Edison, New Jersey. Dr. Giancino says this confusion is fed by a news media that uses the terms persistent vegetative state and coma interchangeably.

He notes that the three major disorders of consciousness are coma, vegetative state and minimally conscious state.

Terri Schiavo's parents, Bob and Mary Schindler, went public with a video tape of that appears to show Mrs. Schiavo responding to her mother. Her husband, on-the-other hand, claims the tape snippet that has been widely broadcast is actually a single event edited down from hours and hours of video tape.

Dr. Giacino cautioned against jumping to conclusions based on the video evidence. The only way to confirm a diagnosis of minimally conscious state, is with bedside examination by two examiners who can confirm the presence of four key criteria, one of which must be met before the diagnosis can be made. Moreover, those criteria should be reproducible during a single assessment.

First, the patient should be able to reproduce a simple command such as "Raise your hand" or "Stick out your tongue". Other criteria include the ability to speak one word, even if the word is spoken out of context and evidence of communication, which can include subtle signs such as eye movements. Finally, the patients should demonstrate a behavior that shows a relationship to an environmental event. For example, if a patient cries when shown a family picture.

Finally, the signs of minimally conscious state should be clear and unambiguous, Dr. Giacino said. He said there is no evidence that Schiavo has met these criteria in the last 15 years. " Chances are that is the way it will continue and another week or two is not going to make her better," he said.

You can read more of her work here and here. [It's a University of Pennsylvania site and free and relatively harmless registration is required].
And for an excellent story on the ethics of doctors who diagnose via videotape and reason through religion (including, apparently, the Senate Majority Leader/transplant surgeon) see Schwartz and Grady in the New York Times.
For more on the religious differences, see Watanabe and Stammer in the Los Angeles Times.
For a fine story on what's terribly wrong with that videotape the networks show ad nauseam, try Kennedy in the New York Daily News.
Every television news director in the country should be strapped to a chair and read that story aloud into their ears before running that tape again.

Wednesday, March 23, 2005

A breakthrough—sex is unnecessary!

When genes correct themselves, especially when they shouldn't March 23, 2005
The most misused word in science journalism is "breakthrough." I'’ve flunked papers in journalism classes that use the word because real breakthroughs in science are extremely rare, and the word ought to be reserved for findings that shift paradigms or something. We may, however, actually have one now. Researchers at Purdue University, reporting in Nature, have found plants with the ability to revert to a backup version of its genes in order to correct mutations. If this stands up, it would be a major exception to what everyone thought they knew about the rules of inheritance since Gregor Mendel. The plants, arabidopsis (the fruit-fly of plant biology), had parents both containing mutated genes, called hotheads, that produced clumped petals instead of normally formed ones. According to the rules, there would be no way those plants would not have clumped petals. But 10% did. And when Robert E. Pruitt and Susan J. Lolle and colleagues went back to look, they found no DNA copy of the correct genes. The plants had apparently stored a backup somewhere, possibly in RNA, and reverted to it rather than produce abnormal petals. No one has a clue how. Interestingly, other scientists had seen this happen before and simply assumed they had screwed up and the reversion was due to contamination or goofy procedures. But the Purdue scientists persisted. Now, if evolution depends on mutations to move ahead, here is a potential brake on the process, complicating things. Presumably, it is a rare event. And if it works on plants, how about humans? And does this really mean that sex is unnecessary (a line we’ve all heard at one time or another)? One rationale for sexual reproduction is that by combining two sets of genes, really bad mistakes are avoided. This should invoke yet another rule of science: the findings have to be replicated. Interestingly, neither Nick Wade in the New York Times nor Rick Weiss in the Washington Post, writing about the findings, reported any skeptics. They quoted researchers not involved with the work as saying they were surprised and amazed, and seemed thoroughly tickled by the findings, and they projected that it might be true in humans and might open all kinds of doors. An actual breakthrough?

Sunday, March 20, 2005

Politicians, medical ethics and bills of attainder

Congressional “conservatives” radically impose themselves in a medical dispute.
March 20. 2005

To paraphrase the Irish writer Brendan Behan, there is no situation so bad that cannot be made worse by the appearance of a politician. [He said “policeman” but he hung around bars a lot.] And the worse thing that can happen is Congress showing up, a pack Mark Twain described as America’s only criminal class. Now, they have intervened in the sad case of Terri Schiavo in Florida. She has been in a persistent vegetative state for 15 years because of a heart attack that led to brain damage. Only a courageous state judge and Ms. Schiavo’s husband stand in the way of one of the grossest invasions of private life--and of an independent judiciary--in recent times. Congress is passing a bill that would force doctors to reinsert the feeding tube to Ms. Schiavo despite repeated and consistent court rulings that they need not sustain her life. President Bush is flying to Washington a day early from vacation to sign it. To take matters from the inconceivable to the preposterous, the last people you would expect to be involved in this government intrusion would be politicians who describe themselves as “conservatives.” There is nothing conservative about Congress jumping into the medical decision of a single family against the rulings of the judicial branch. Real conservatives should be having apoplexy. (But then, these are the same people who think Presidents can send 100,000 troops to invade another country without a declaration of war by Congress and that it’s cool to run up billions of dollars in debt, but that’s a different story). Virtually none of the newspapers reporting the story could find lawyers who agreed Congress had a legal right to interfere. Republicans involved said it was not a political issue, but the Washington Post printed an unsigned memo distributed to Republican senators saying the stand would appeal to the party’s base. Among the problems the bill should--but won’t--incur in Congress, is that it probably is a bill of attainder, legislation that singles out an individual for punishment or a loss of rights or property without a trial (Ms. Schiavo’s husband, perhaps even Ms. Schiavo, herself), which is expressly forbidden in the U. S. Constitution [Article 1, Section 9, Pgh 3]. This kind of legislation is what we fought the Revolution over. [The legally obsessed are invited to see Plaut v Spendthrift Farms, Inc., written by Justice Antonin Scalia, of all people.] The Florida judge (who is now under police protection) essentially told them to shove it. So has the Supreme Court [audio]. Virtually no one outside of Congress--or perhaps including no one in Congress--thinks they have a legal right to interfere. Ignoring which side is right in this issue--and both sides can make a moral argument deserving respect--this is a simple outrage. Watching politicians masturbate is not a felicitous sight under any circumstances. This, however, is simply too much!

Wednesday, March 16, 2005

That leaves sex and lower back pain

New vitamin E study shows we haven't found the elixir of life quite yet.
March 16, 2005
There are three things your doctor doesn’t know a thing about: vitamins, sex and lower back pain. If you are interested you might check out the latest on that first category: the alleged benefits of vitamin E. [Confession: I take 400 IU daily and have for years--which shows you how much I know]. The newest study, published in the Journal of the American Medical Association, this time out of Canada, shows absolutely no benefit in preventing cancer or cancer deaths, and for some people--those with diabetes or heart disease--it may actually be dangerous. Evidence in the study--the well-respected Heart Outcomes Prevention Evaluation or HOPE study--shows an increase in heart attacks. Even the people doing the study were surprised. Dr. Eva Lonn, of McMaster University in Hamilton, Ontario, said “When we designed the trial, we expected this intervention, vitamin E supplements, to be beneficial. We were surprised that there were no benefits.” The study seems to replicate an earlier study done at Hopkins last year. Vitamin E is one of those oxidants touted for years (I’ve done stories myself) as a sovereign elixir that prevented cancer, heart disease and cured everything except perhaps flatulence. For most of these supplements, the evidence is real if a tad tenuous. Laboratory rats, of course. Vitamin E, was regarded for many years as the most complex and beneficent of the anti-oxidants, but the research on actual humans, has not supported the hype. Now the picture is worse. Will people now taking the vitamin stop? Not yet. Not yet.

Monday, March 14, 2005

Angels on needles, embryos in the lab

Is there a compromise in the stem cell debate?

March 14, 2005.
No issue is so wrought with profound ethical considerations as the stem cell debate, the cloning of human embryos to produce stem cells that might—might—help in the amelioration or cure of some seriously awful diseases. The issue was brought to the fore a week ago at the President’s Council on Bioethics in Washington. In a deeply thoughtful discussion of that meeting and another in Rome called by the Vatican, Slate’s William Saletan points out the complexity and also the philosophical-religious differences. “It was like Socrates trying to carve up a bowl of chicken soup,” he wrote. How you stand could depend on whether you are Catholic or Jewish. (The presumption is that Protestants are all over the place). Catholics are more certain about things (Is there life after death? Of course and here’s what it’s like) than are Jews (Unless someone dies and come back how could we possibly know, but if there is one it might be like this...), yet more attuned to reason, while Jews are more often happier with intuition. Catholics give answers; Jews raise questions. Hairs were split and Saletan found himself surrounded by white-robed monks with Ph.D.s in biology from M.I.T., and discovered that the head of the Vatican office that used to be called the Inquisition is named Charlie Brown. The Washington Post’s Charles Krauthammer, a physician (a psychiatrist, actually), who happens to also be Jewish and a member of the bioethics commission, wrote thoughtfully in the Post of a compromise that might bridge the theological gaps. No creating human embryos for experimentation—which would require growing embryos that were designed not to develop further—but using left-over embryos from fertility clinics. In other words, we should be able to use embryos created for the potential development of human life but not those created to be destroyed. Krauthammer, a conservative, separates himself from President Bush’s position banning federal funds for these experiments, pointing out that, however, it only is a ban on federal funds, not the experimentation itself.

Thursday, March 10, 2005

The incomplete Gödel

Is Kurt Gödel's famous incompleteness theorem completely useless?
March 10, 2005
There’s a wonderful picture (alas not this one) of Albert Einstein , smoking his pipe, bundled against the cold, smiling at a much-more-serious Kurt Gödel, the strange and transcendental mathematician, as they walked home from the Institute for Advanced Study. Einstein once said he joined the faculty of the Institute, in part so he could walk home with Gödel. The folks in Princeton could look out their windows of an afternoon and see two of the greatest brains that ever existed walking down the street. In Slate, Princeton mathematician Jordan Ellenberg explains that while Gödel’s work, especially his incompleteness theorem, is the kind of stuff that romantics in mathematics and scientists adore (“Given any system of axioms that produces no paradoxes, there exist statements about numbers which are true, but which cannot be proved using the given axioms”), it doesn’t mean much in the real world. Ellenberg is writing because a sometime-neighbor, philosopher and novelist Rebecca Goldstein, has a new book out, Incompleteness, and he disagrees with her on just how important the theorem is. (Goldstein is best known for two novels, including the simply amazing Mind-Body Problem and Mazel, the latter having nothing to do with science but has one of the great endings in recent literary fiction). People have even used the theorem to demonstrate the validity of faith or disprove evolution. Goldstein elevates the Incompleteness Theorem to relativity and quantum mechanics, but Ellenberg says it ain’t so, it bears no relevance to the real world. You can be a full-blown professional mathematician or theoretical physicist and not mess with Gödel at all. You can be a journalist and have the same privilege. But Einstein found Gödel a wonder—as did Doug Hofstadter—despite the fact the two men seemed to come from different planets. You can get a headache from all of this.

Wednesday, March 09, 2005

Soul of America saved!—AstroTurf is dead!

National League moves from polypropylene to the leaves of grass.
March 9. 2005
This is more sports than science, but spring training for baseball has begun, so apologies to foreign readers. The really good news [we'll get to steroids some day] is that AstroTurf is dead, or almost. For the first time in almost 40 years, the National Baseball League will play every game on grass. God’s grass. Not Monsanto’s plastic. There are few things in the world more beautiful than walking into a baseball stadium and seeing the deep green grass glowing in the sun. No grass anywhere has the same color or is tended with the same care. The result of coming on blue-green plastic was akin to nausea. It wasn’t just esthetics; the game of baseball was changed profoundly by the use of AstroTurf, which made its first appearance in the Astrodome in Houston in 1966. The ball bounced higher and moved faster, and the same could probably be said for the players. That stadium was followed by a score of multipurpose stadia for use both by baseball and football teams, and in every case, they had to use plastics such as nylon, polypropylene or urethane because the grass couldn’t stand the wear and tear. Teams such as the St. Louis Cardinals actually designed their team for the stuff: speed over power, running over thinking. Players believed that artificial turf had a serious affect on their health and careers because it was hard and unyielding and destroyed skin and more important, knees. The research to support that notion is sketchy, but to hell with research. "If a horse won't eat it, I won't play on it," sniffed the Phillies' Richie Allen. (Football players actually have it much worse, with the surfaces clearly causing more concussions and really screwed-up toes.) The trend in baseball was reversed in 1992 with the opening of Camden Yards in Baltimore, still one of the best places to watch a baseball game in the world. Now, with the Expos abandoning Montreal for Washington, the last National League stadium with plastic turf is gone. The American League still has to put up with Toronto, Bloomfield, Minn. (easily the worst stadium in the Bigs), and Tampa, all with doomed domed buildings, ignoring the Natural Law that baseball is an outdoor sport. Now there remains only the abomination of the designated hitter, but that’s a story for another day. OK, back to science, but spring training just does things to me....

Tuesday, March 08, 2005

Cleary's requital

A brief essay on science journalism
By Joel N. Shurkin
Once there was a medical journalist named David Cleary, who worked for many years at the late and lamented Philadelphia Bulletin. Cleary was my competition but I rarely broke out in a sweat.
Cleary went through life sort of backwards and his life was instructive in many ways. He was, for instance, a pleasant drunk, cheerful, friendly and helpful. It was only when he was sober—fortunately, not often—that he was a mean, disrespectful bastard. But in one incident, he was enshrined in my memory forever. In those days, the cancer and heart societies held meetings for medical writers to announce their latest breakthroughs and advances in cures and treatments. By no coincidence, the meetings (held every year in posh resorts) coincided with their fund raising efforts. One day, at a press conference for the president of the American Cancer Society, Cleary stood up and announced he had a list in his hands of every breakthrough announced at the meeting five years earlier. He read them off and then asked whatever happened to those “breakthroughs?” The answer, of course, was nothing. They led nowhere or maybe moved knowledge perhaps a smidgeon. Science doesn’t work in leaps. Science journalism shouldn’t pretend it does.
But of course, we know journalism does. Want to keep your job? Keep writing those stories about how x cures y in mice, how mixing z with w will produce vast amounts of cheap energy, and why the sky is falling in—or not. But we know better, don’t we?
Cleary’s life was instructive in another way, but I'm not sure what the lesson is. After he lost his job at the Bulletin (before, I think, the paper folded under the massive assault of Gene Roberts and the Inquirer), he wound up driving a cab. He ended up getting murdered by one of his passengers. I presume he was sober.

Thursday, March 03, 2005

Skolnick‘s revenge

That prisoners in America receive terrible health care should be shocking but it shouldn’t be a surprise.
March 3, 2005

On Sunday, the New York Times began a series on how merely going to jail could be a death sentence because of the quality of medical care prisoners receive in New York state. For several prisoners, it was, largely because prisoner health had been privatized in New York just as it had in many other states. The story, by Paul von Zielbauer, centered on one company, Prison Health Services. Readers of the story may have been surprised to read all the gory details, and that’s too bad because the state of prison medical care is no secret. Forget about what kind of doctors take jobs in prisons. In 1998, science writer Andrew Skolnick and reporters from the St. Louis Post-Dispatch, using Skolnick’s grant from the Rosalynn Carter Felllowship in Mental Health Journalism, wrote about another company’s services in several states’ prisons, every bit as ghastly. The series appeared in the Journal of the American Medical Association (JAMA). It won all kinds of awards, but when the company, Correctional Medical Services, threatened to sue JAMA, the journal, in an astounding act of unvarnished cowardice, fired Skolnick. It took almost a new generation of science writers before JAMA’s news section regained its reputation. The company did pay a settlement on his civil suit, but his career has never actually recovered. Skolnick himself told Harpers Magazine a few years ago, the result of his story was legislation in Missouri protecting the company and making matters worse. Maybe he feels better now.

Wednesday, March 02, 2005

Take two aspirins. Just take the aspirins—UPDATED

All is not lost—medicine’s great cheap wonder is still available.
March 2, 2005

With the fall of the Cox-2 inhibitors insufficient attention has been given to the one drug that works almost as well and is much cheaper—perhaps the great wonder drug of the 19th century. OK, 1899, when it was first marketed. [Picky]. We speak of aspirin, of course. In a fine piece by Elizabeth Large at the Baltimore Sun, she points out that aspirin fell out of favor largely because it’s been around for 100 years and everyone assumes the new drugs are better, if for no other reason than they are more expensive. It also lost market share with the arrival of acetaminophen (Tylenol). Acetaminopen doesn’t have the same risk of causing internal bleeding as does aspirin, but is otherwise inferior to salicylic acid. It does nothing, for example, for inflammation and is not a better pain killer. Since pain is largely subjective, aspirin may work as well as Vioxx, Celebrex and Bextra for some people without the risks of those drugs, and aspirin does lots of things the Cox-2 inhibitors don’t. Aspirin in small doses (81 milligrams—or what used to be called “baby“ doses) can prevent heart disease and strokes; may cut the risk of colorectal cancer; help prostate cancer victims live longer; treat pre-eclampsia; possibly reduce the risk of Alzheimer’s, and could help the immune system. The evidence mounts: In a new study in the New England Journal of Medicine, aspirin was shown to reduce the risk of stroke in women by 17 percent, especially ischemic stroke. It showed no significant reduction in fatal heart attacks (the exact opposite of men) but that may be because, as Tom Maugh pointed out in the LA Times, the bulk of women in the study may have been just too young. Well, the real question is why aspirin works differently with men than it does with women.