I am confused by this debate. The researcher who is now opposing the use of aspirin for prevention is the one who wrote: “The worldwide meta analysis of anti-platelet trials shows that low dose aspirin reduces non fatal myocardial infarction, non fatal stroke and vascular deaths in a wide range of patients. (1) ” He was critical of Cleland’s articles on aspirin in the BMJ and The Lancet.(2) (3) (4) Today I am surprised that he thinks that aspirin might not be safe in elderly people for prevention of vascular events as the risks might outweigh the benefits.





Meta-analysis is the worst kind of statistical science that we could rely on. I had written earlier about the mix-master technique of meta analysis in the BMJ rapid responses.(5) Recently, a well known Professor of solid state at the Penn State U’sity in the US, was telling me that we doctors rely too much on a science that is unreliable-statistical science. He was of the opinion that it is not the real science. In his book SCIENCE WITHOUT SENSE, Dr. Steven Milloy, a well known statistician-epidemiologist, was of the same opinion.(6) Based on meta analysis treating “otherwise well persons” with drugs may not be good practice.





To interfere in human life when they are well definitely needs stronger evidence. Treating them when they are ill is a different cup of tea altogether. At the end of the day aspirin might only change the label on the death certificate without altering the date. My gut feeling is that this kind of intervention might even advance the date on the death certificate for the unfortunate victim of intervention.



References:

1) Baigent C, Collins R, Peto R. Article makes simple errors and could cause unnecessary deaths. BMJ 2002; 324: 167.

2) Cleland JGF. Preventing atherosclerotic events with aspirin. BMJ 2002; 324: 102-103.

3) Cleland JGF. No reduction in cardiovascular risks with NSAIDs-including aspirin. Lancet 2002; 359: 92-93.

4) Cleland JGF. Chronic aspirin could be effective if data are massaged. BMJ 2002; 324: 295.

5) Hegde BM. Mix master technique. BMJ.com/cgi/eletters/330/7492/0.

6) Milloy S. Science without Sense. 1997. Cato Institute, Washington DC.