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Aspirin About-Face
21–30 of 31 posts
Re: Aspirin About-Face
#22As others here have hinted at, while NNT and NNH are both extremely useful concepts, they (deliberately) leave the consideration of whether a treatment's level of effectiveness, or the magnitude of a harmful side effect, subjective. When, after all, should a negative side effect be counted as "harm"? This is especially true for NNH; there are usually far more possible (helpful or harmful) side effects than the one intended remedy for the ailment, for a given drug.
As an example, in one study, for elderly patients the NNT of a number of (admittedly different) sedative hypnotics was 13, while the NNH was 6 [1]. From that alone, you'd probably rightfully avoid using them! But for certain populations who have chronic insomnia, the benefits may still outweigh the risks.
Of course, there are ways to (less subjectively albeit still subjectively) quantify harm, and these get used to keep "harm" comparable to "treatment". But it can definitely be more of an art than an exact science.
Re: Aspirin About-Face
#23This piece entirely misses the point of the recommendation. The new recommendation is that aspirin should not be used to prevent heart attack in those without a history of heart disease (ie avoid routine aspirin for "primary prevention"). Aspirin for primary prevention has always been a grey area. The reversal came after a large trial in the New England Journal of Medicine looking at this. The trial showed the decrea…
Here is the actual draft of the recommendation as well as supporting evidence: https://www.uspreventiveservicestaskforce.org/uspstf/recomme... Edit: Here's the document that actually outlines "what changed" from 2016 to the current draft: file:///Users/nkrumm/Downloads/aspirin-use-cvd-prevention-draft-modeling-report.pdf
You may wish to edit your edit.
Re: Aspirin About-Face
#24> relative risk reduction [...] “is just another way of lying.”
> You read that a new drug reduces your chance of dying from Ryantastic syndrome by 40 percent. Here’s what that means in practice: if 10 in 100,000 people normally die from Ryantastic syndrome, and everyone takes the new drug, only 6 in 100,000 people will die from Ryantastic syndrome. Now let’s think about it from an NNT perspective.
> For 100,000 patients who took the new drug, four deaths by Ryantastic syndrome were avoided, or one per 25,000 patients who took the drug. So the NNT is 25,000; that is, 25,000 patients must take the drug in order for one death-by-Ryantastic to be avoided. Ideally, you also want to know the NNH, or “number needed to harm.”
> Let’s say that 1 in 1,000 patients who take the new drug suffer a particular grievous side effect. In that case, the NNH is 1,000, while the NNT is 25,000. Suddenly, the decision seems a lot more complicated than if you’re just told the drug will lower your chance of dying from Ryantastic syndrome by 40 percent.
Re: Aspirin About-Face
#25Anybody got the NNT vs NNH for the Pfizer covid vaccine?
Re: Aspirin About-Face
#26Is this an American thing? I've never heard of people (without any preconditions, or feaver, pain or illness) taking Aspirin on daily basis. But apparently 30 million US citizens do. How did that happen? (Was this only caused by the pre-reversal recommendation?)
Studies several decades ago indicated that daily low-dose aspirin (80mg or less per day I think) led to fewer heart attacks and strokes and this led to a lot of people taking a low-dose aspirin with their daily vitamins. When statins and other daily blood thinners started to be prescribed there was a group of people who learned that you should not mix aspirin and statins but in general the trend continued. Now it seems that the advice is that there are downsides in addition to the benefits and that they probably cancel out.
Me, I will continue to take my daily aspirin given a family history that indicates this might be wise.
Re: Aspirin About-Face
#27I would love to see this analysis for statins. On a slightly related note, it seems many people don't know (aren't being told) the risks associated with not taking a drug and taking it. It seems like is just "the FDA ruled the benefits out weight the risks" and that gets applied to everyone. Just like generally safe is often misinterpreted as completely safe.
Linked from the primary source of the article - https://www.thennt.com/nnt/statins-persons-low-risk-cardiova...
Re: Aspirin About-Face
#28Please no FB content here.
Use the archive.org link posted above and you avoid the FB loaded content.
Re: Aspirin About-Face
#29This is surprising for 2 reasons 1) that there was this significant bleeding from baby aspirin 2) that a miracle drug from 300bc is being found to have downsides. I'm still an aspirin proponent for treating sunburns and minor ailments. And salycilic acid for my face routine. Fish oil's recent science on hormone regulation and inflammation reduction should make it a first stop. Then there is AKG.
Asprin for sunburn?
thats a new one on me.
Re: Aspirin About-Face
#30I would love to see this analysis for statins. On a slightly related note, it seems many people don't know (aren't being told) the risks associated with not taking a drug and taking it. It seems like is just "the FDA ruled the benefits out weight the risks" and that gets applied to everyone. Just like generally safe is often misinterpreted as completely safe.
Linked from the primary source of the article - https://www.thennt.com/nnt/statins-persons-low-risk-cardiova...
Awesome. I can't believe I missed that.