Wednesday, November 22, 2023


Environmental & Science Education, STEM, Health, Medicine, Nature of Science, History of Science

Ed Hessler

This essay written by Christopher Labos for the Montreal Gazette caught my attention because a simple addition to a drug to protect the patient's gut cannot be taken for granted not to have an effect. It, too, must be carefully tested to see what effects it has, if any.

It also merits attention because it is about decision making in medical practice. Clinicians must also take other data into account. It introduced me to some aspects of Aspirin of which I was unaware and was also a short review of the history of Aspirin.

The drug in question is coated v. uncoated Aspirin. Labos put it this way. "In theory, coated Aspirin is supposed to protect your stomach. But the theory could in theory slow its absorption and hinder its effectiveness." 

That these are hypotheses is not of importance to me. Scientists and clinicians are often "guilty" of not making this distinction and you have to get used to it when you hear them speak or write for the general public.

Aspirin has been used for a long time, certainly centuries. You will recall that early humans  chewed on willow bark, a source of natural Aspirin. But Aspirin only began to be prescribed in cases of cardiovascular disease in 1988. Labos discusses its general use in high doses and the risk it posed, one of the reasons that other drugs were developed without the risk Aspirin posed to the lining of the stomach.

It was learned that at lower doses, "it can inhibit the platelets that form clots in the blood and (it became) the cornerstone of treating heart attacks and strokes." Labos unravels this complicated scientific and medical history. A medical trial that appeared to support the bleeding hypothesis even with coated Aspirin was reanalyzed. The patients involved were separated into two groups: one receiving uncoated Aspirin and the other coated Aspirin.

This reanalysis is a recent study that allowed "researchers (to) see whether the enteric coating, at either dose, had any effect in terms of reducing cardiovascular end points (like heart attack, stroke or death) or bleeding end points (hospitalization requiring a transfusion or a bleed in the brain)."

"In short, the coated Aspirin offered little advantage or disadvantage. The cardiovascular end points were largely the same."  In other words it "may not really matter at all.

In closing, Labos includes a great discussion on the nature of bleeding and what drives it, closing with "the "important point Aspirin highlights in medicine. Basic biology and laboratory results inform clinical practice but they are not a substitute for clinical end points. The adage of treat the patient, not the number still holds true." 

This is a study in the nature and history of science, one that shows the questioning nature of scientists. Do we have all the data? What does it "say"?  Do we trust the data? Are there other hypotheses? How might these be tested?

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