By Dr. Terry Maguire, a Northern Irish Community Pharmacist, senior lecturer at School of Pharmacy (Queens University Belfast) and Belfast LCG member.
Read all about it!
Just out of the BBC’s Belfast HQ answering questions on the week’s biggest headline; “Aspirin Reduces Cancer Risk!”. Below the myriad headlines reporting on a the paper published by Cuzick, et al., in Annals of Oncology, journalists were insisting that those of us over fifty are verging on moral bankrupcy if we do not do the right thing and start taking an aspirin a day. On air I tried to qualify the hyperbole and put back some balance into the story but my telephone audience were already committed “aspirinophiles” and fought back . “This man [me] is wrong; we should all be taking an aspirin a day to stop us getting cancer and heart disease” said Desmond from Dundonald.
My objectives when agreeing to do the interview were twofold. First I wanted to ensure that the risks associated with long-term aspirin use were discussed and understood – the study did not identify the most effective daily dose and if this turns out to be 325 mg then the risk of gastric bleed after 10 years use is increased by some 70%. We indeed might have 7% – 9% less cancers but a lot of deaths from bleeding uclers! Hard choice?
Secondly I wanted to re-enforce the public health messages that we already have, which are very safe ways to massively reduce our risk of developing; cancers, diabetes, cardiovascular disease and stroke and that is; stopping smoking, taking more exercise, eating the right amount and quality of calories and managing stress. How perfectly dull and boring that sounded when I said it on air and I almost heard my audience expel a collective sigh of ennui.
But the facts are impressive and the quality of the science that gives us these facts has stood the test of time. The Framingham Study started in the 1950, the Million Women Study from the 1980s and the Finnish Life style study are massive studies involving up to a million subjects and this has given us much of the epidemiology that allows us to stay; stop smoking and your risk of small cell carcinoma of the lung drops by 85%. Eat a balanced diet and take moderate exercise 5 days in the week and you reduce your risk of developing type 2 diabetes by nearly 60%, your stroke risk is down by 68%, you are less likely to fall if you are old and you are 30% less likely to develop mental health problems such as depression or dementia. Take exercise and eat a healthy diet and your cancer risk falls 40%.
I suppose that’s the rub for sensational headlines. There is less public interest in lifestyle ways to support better health particularly those that require denial and effort. Popping a pill is so much more convenient and scientific-sounding.
The aspirin story was only one of two prominent medical stories in the press in the first week of August. The other was about a vitamin. “Vitamin D will cut you risk of dementia in half” shouted the other headlines. At the back of this story was a study that claimed to show that those with low levels of vitamin D were twice as likely to develop cognitive impairment in their sunset years.
So this story was essentially the same as the aspirin story; just bung in a few milligrams of Vitamin D every day and bingo the gaga-tsumani of dementia that very nation is dreading will not happen. Give me a break!. Our journalist go to journalism school not science school so they sadly are not well versed in the scientific method. As every good pharmacist knows correlation and causality are not the same. Now write 50 times you dumb jurno “Correlation and causalit……. There is a very strong correlation between the number of babies born and the storks flying into Norway. But no matter how you spin it storks don’t bring babies!
Some significant drawbacks in this study were glossed over when they were covered in the red tops. Patients who had low blood levels of vitamin D had those levels because of a range of reasons not only a diet poor in fish oil. Vitamin D levels are strongly influenced by exposure to sunlight and it might be that those who had low levels were the odd types, the ones who seldom leave the confines and security of their homes and who have a daily routine with all the excitement of the little men and women in the cookoo clock. As a result these shy types seldom meet other people, they are not really curious about life, they get very little exercise, they are scared and stressed. We know that social interaction helps people to form and reform brain connections and it is this constant forming and reforming that maintains the plasticity (and health) of the human brain and wards off cognitive degeneration.
So it might be, and we need to do some more research as the grant-hungry academics always say, it just might be that the correlation of vitamin D levels and the incidence of dementia in old age is merely a reflection of a more complex process that is more to do with a lack of social contact.
No one is denying that the results of the aspirin and vitamin D studies are encouraging and add to our scientific understanding of cancer and dementia. However, the methodology of the studies do not have the absolute rigour to allow anyone to say that a dose of aspirin or Vitamin D every day will transform the national cancer and dementia landscapes. To be fair the authors of the studies clearly state this in the study conclusions.
So as pharmacists we shouldn’t yet recommend public dosing with aspirin or vitamin D and its likely that that day will never come yet our jurnos seem happy to misreport to the masses and in doing so strongly influence the behavious of people like Desmond from Dundonald.
