An Aspirin a Day, May Not Keep the Doctor Away! By Mrs Vera West

     Many otherwise “healthy” people are taking a baby aspirin a day for cardiovascular health, but a study has questioned the benefits of this: J. J. McNeil (et al.), “Effect of Aspirin on Disability-Free Survival in the Healthy Elderly,” New England Journal of Medicine, October 18, 2018:

Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disability-free life in healthy seniors is unclear.

From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or =65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage.

A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were nonwhite, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11; P=0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001).

Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.”

     I understand this to mean that elderly adults who have not had cardiovascular problems (e.g. a stroke) will not benefit from the daily baby aspirin consumption. The study however does not draw conclusions about people who do in fact have such cardiovascular problems. Thus, the now common practice of people without medical advice,  simply swallowing down these aspirins each day in the hope that it will have protection, may be misplaced. Individuals need to consult with their doctor about aspirin consumption, and in fact to assesse whether other substances consumed (such as herbal supplements) may have an interaction. If your doctor is inadequate, and only is concerned with offering a quick script and getting his/her fee, get another.

     Can I get this of my chest? I wanted to get a clean of the calculus off of the few remaining teeth I have left. The dentist was usually good, but when I asked for just a simple clean, she had me boked down, without my consent for more complex and massively expensive treatments. Business must be slow. I emailed them to get the basic clean, saying that I did not have the money this close to Christmas. Then I got an email back saying that they has cancelled my appointment and booked another for the more expensive treatments early next year. So, I will get another dentist and see if there is a violation of medical ethics here or are they allowed to do this? People go on about doctors ripping people off, but dentists seem to get off lightly.

“Dentists are ripping off patients in Australia and overseas, doing inadequate work and at least 80 per cent should be avoided, according to dental technician Werner Sauer. Mr Sauer, who runs Werner Sauer Oral Design in Brisbane, said many Australian dental technicians would not recommend 80% of dentists to customers, family or friends and some would be even more selective. Having worked in the industry for 43 years, he regularly sees first hand the lack of quality and care taken by many dentists worldwide. Mr Sauer said patients needed to be informed about their dental treatment, especially cosmetic procedures. “If teeth are not functioning properly, it could lead to neuromuscular problems such as migraines, neck and jaw pain,” Mr Sauer said. “With an oversupply of dentists and people travelling overseas for treatment, dentists are under more pressure to cut costs. This has been compounded by corporations and health funds buying up dental practices and pushing their employed dentists to produce more work for lower costs and KPIs.” He said young dentists were no longer mentored by their employers, as had previously happened in traditional family practices and were not receiving adequate on-the-job training. “The focus is on profits, not patient care,” he said. “Almost 70 per cent of dental lab work is going offshore and the savings are not passed on to the patient. Some dentists are buying dental crowns in China for about $50 and selling them fitted to patients for up to $2100.” He said the local cost of a crown was about $250 to $400, yet regardless of where the dentist bought it from, they still charged ridiculous prices and ‘pocketed the difference’. “Patients are not told where their crowns are being made.”

     Moral: clean your teeth regularly, eat healthy, and mininise being ripped of by dentists!  



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