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.

1 comment:

Anonymous said...

You ended this entry with the question: Why does aspirin work differently in women than in men?
The real question is why should we expect aspirin, or any drug, act the same way in women and men, or for that matter, adults and children?
The reasons why there are differences in drug reactions in women and men are no real mystery: estrogen during development, cycling estrogen and progesterone, lower body weight, and different muscle to fat ratios. What we don't know is what these hormonal and physical differences affect, and what they do not.
The divergent reactions in the effect of aspirin in women is not the first example of sex differences in response to drugs (over the counter and prescription drugs). Think back to 2000 when a Yale study found, and the FDA announced a warning, that common OTC cold meds and appetite suppressants containing phenylpropanolamine caused an increased risk of stroke in women 18-49 years old.
We are beginning to realise that many things, not just drug effects, are different in women and men, one pertinent example is the differences in causes and symptoms of heart attacks in women and men.
Until recently, these differences were not seen, or were dismissed, and women were not a part of FDA clinical trials on drugs, due to potential pregnancy and risk to the fetus.
We do not yet know enough about the effects of drugs in general on women.
Thankfully, medical science is paying more attention to these meaningful differences and beginning to react accordingly.
I hope these findings spark more research (and more funding) for similarities and differences in women and men's (and children, and adolescent's) reactions to commonly available pharmaceuticals.