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LETTERS: Lexley M Pinto Pereira Aspirin for everyone over 50?: Avoid the harm BMJ 2005; 331: 160-b [Full text]

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Cost effectiveness

Muhammad A. Rahim   (20 July 2005)

Nay, some outlive the doctor's pill

Dr. Herbert H. Nehrlich   (23 July 2005)

Cost effectiveness 20 July 2005
Muhammad A. Rahim, Clinical Attache Gen. Surgery PR2 7AU Send response to journal: Re: Cost effectiveness	Although Aspirin has shown to be effective in patients for prevention of further thrombotic events, there has been no comprehensive study to determine whether it does the same in healthy people. We may have to take into account the overall incidence of CVA and IHD in a particular geographic population and determine not only the risk benefit ratio but also the cost benefit ratio of aspirin use on a mass scale. If it is beneficial then it would usher in the new era of "drug fad" where medicines may be used for prophylactic purposes just because the incidence of a particular disease is high. If this argument is viewed in another perspective, we can say that by authorising aspirin use on a large scale by all, we may be turning the whole healthy population into patients. Think of the repercussions it may have on emergency and elective surgical procedures. To conclude therefore I must say that there are too many blanks which need to be filled before authorising aspirin use for preventive purposes in a healthy population. Competing interests: None declared
Nay, some outlive the doctor's pill 23 July 2005
Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507 Send response to journal: Re: Nay, some outlive the doctor's pill	I fully agree with Dr. Rahim. However, the world-wide trend seems to be exactly that, to turn into patients as many people as possible, leaving just a handful of recalcitrant hippies or proponents of radical organic living. It is interesting to see, if one wants to scratch a bit below the surface, how a specific group feels about its own recommendations. A few years ago, a popular newsmagazine in Germany (Focus)ran a series of medical articles and surveys. Mostly to introduce top specialists and what they were offering and in what hospital. One survey consisted of asking the country's leading cardiologists, then internists, then GP's how they felt about taking aspirin as a preventive. From less than perfect recall I do remember that the doctors who themselves were taking or would consider taking aspirin were in the minority, something like near 30 %. Perhaps it has to do with the long ago acquired desire of humans to find a magic cure for all ills, preferably a pill. If the oldest pill in the world can do the job it would add a little more value to it (something like "it's been there all along under our very eyes"). Competing interests: None declared