Evaluating Risks and Benefits: Aspirin and Alcohol
by W. Lewis Perdue
If medical science came up with a miracle drug that could cut America's leading cause of death - fatal heart attacks - almost in half, people would rush to the drugstore for a dose of this lifesaving pharmaceutical. This happened.
The year was 1989; the miracle drug was aspirin. Yet another lifesaver, moderate alcohol consumption, has the potential to save many more lives than aspirin, and has been ignored and abused by the American government.
Comparing the health effects of aspirin and moderate alcohol consumption - their risks and benefits and the reactions to each of them - offers a revealing glimpse into how American society's deep-seated, ambivalent and irrational attitudes toward alcohol may be killing hundreds of thousands of people each year.
The advice to "take an aspirin and call me in the morning" received new urgency in 1989 when a study of 22,000 physicians indicated that those who took one aspirin every other day had 44 percent fewer fatal heart attacks than doctors in the control group who took a placebo ("sugar pill").
Today, cardiologists routinely advise patients at risk of heart attacks to take aspirin regularly. This advice is given despite the fact that aspirin - the commonest drug in the United States - can have serious side effects.
"Aspirin increases the risks of bleeding disorders, however, and can lead to gastrointestinal hemorrhage [bleeding] and even hemorrhagic stroke," said Dr. Curtis Ellison. "For individuals with a history of bleeding problems or ulcers, the risk of a hemorrhagic problem may exceed the potential benefits of taking aspirin to prevent a heart attack."
Dr. Dean Ornish, author of Dr. Dean Ornish's Program for Reversing Heart Disease, has even harsher words for aspirin. He points out that the doctors taking aspirin in the physicians study had twice as many sudden cardiac deaths, twice the incidence of moderate to severe hemorrhagic strokes and almost twice as many ulcers as those taking the placebo.
Dr. Ornish, who serves as an assistant clinical professor of medicine and attending physician at the University of California, San Francisco Medical School, emphasizes that while "the group taking aspirin had fewer heart attacks, overall there was no difference between the two groups in number of deaths resulting from heart disease or from all causes of death."
Despite powerful potential side effects (aspirin given to children or others with viral diseases can cause paralysis, brain damage or death), Americans rushed to their medicine cabinets and began swallowing aspirin at a prodigious rate.
Why? Because aspirin is a comfortable drug with which most Americans have grown up. It isn't associated with rowdy bars; aspirin abuse is not a visible societal problem which wrecks homes and causes accidents in which innocent people are likely to be injured or killed. Aspirin isn't linked with evangelical Protestant and Muslim religious prohibitions against consumption.
In short, aspirin lacks the emotional baggage of alcohol.
Alcohol May Save More Lives Than Aspirin
The emotional baggage attached to alcohol as a result of religious prohibition and abuse has made it almost impossible for the media and public policy makers to deal with it rationally. While 7 to 10 percent of Americans can't drink alcohol responsibly, public attitudes have been so thoroughly tainted that many of the remaining 90 percent of the population avoid even moderate drinking-despite the fact that it could save many more lives than aspirin, with the added benefit that moderate drinkers may find such a lifestyle choice enjoyable.
As numerous studies point out, moderate alcohol consumers have a 40 to 50 percent lower risk of having or dying of a heart attack, a protective effect comparable to aspirin. However, moderate alcohol consumption goes aspirin one better since moderate drinkers have at least a 10 percent lower death rate from all causes than do abstainers.
But alcohol also has side effects: abuse is the most obvious and serious problem which must be enthusiastically attacked without depriving 90 percent of the population of alcohol's benefits.
And like aspirin, alcohol consumption has also been linked with increased incidence of strokes. However, numerous studies show that people drinking one or two drinks per day have lower risk of strokes than abstainers. Indeed, even drinkers who reported consuming more than five drinks per day (in reality probably more due to under-reporting) showed a 40 percent greater risk than abstainers - far less than the 200 percent increase for people taking one aspirin every other day. Yet anti-alcohol advocates continually rail about the stroke danger from alcohol while ignoring a common drug with five times the risk.
The stroke danger associated with alcohol lies in abuse, not use.
In comparing aspirin and alcohol, Dr. Ellison said, "An individual with a history of drug abuse, or even for a person who is ascertained to be at increased risk of alcoholism (such as a family history of abuse), the potential for harm from the use of alcoholic beverages may exceed the potential benefits."
The job for American society - including government, industry and advocacy groups - is to develop a rational policy that: (1) removes the negative emotional smears of alcohol to allow the majority of 90 percent to benefit from guilt-free moderate consumption while (2) protecting society and abuse-prone individuals from the harm of immoderation. The job so far has been a miserable failure.
Lewis Perdue is a widely published writer on alcohol issues. He authored The French Paradox and Beyond in collaboration with Dr. Keith Marton (Chair of the Department of Medicine at California Pacific Medical Center and Associate Clinical Professor at the University of California's San Francisco Medical School) and Dr. Wells Shoemaker (a practicing pediatrician and the founder of the Intensive Care Nursery at Watsonville Hospital).
*Permission granted for reprint of this chapter of The French Paradox and Beyond by Renaissance Publishing. Copyright 1993.
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