4 ms·

> aspirin wouldn’t pass We have a number of drugs in the same class that are as or more effective with less frequent adverse effects, and the same price to mar

> aspirin wouldn’t pass We have a number of drugs in the same class that are as or more effective with less frequent adverse effects, and the same price to market. It is also one of the leading causes of toxic ODs presenting to the ED. Aspirin shouldn’t pass as an over the counter Anywhere, and wouldn’t but for historical inertia. Don’t confuse familiarity with safety. > efficacy testing doesn’t appear to do much good Efficacy testing is literally how we determine whether a drug works, and what the magnitude of its effects are. Without it, we’d have no idea if a drug worked, if it worked better or worse than competitor drugs, if it worked better or worse for some conditions or sub populations, etc. It’s -the- key information generating step on drugs. This comment is ridiculous to the point of caricature. >fdareview A site from the far-right, unknown-anywhere-but-Fox-news Independent Institute. Can you guess before popping the link open whether they advocate on lightening regulatory burdens on pharma companies?

opo 9y ago
>> aspirin wouldn’t pass >We have a number of drugs in the same class that are as or more effective with less frequent adverse effects, and the same price to market. It is also one of the leading causes of toxic ODs presenting to the ED. Aspirin shouldn’t pass as an over the counter Anywhere, and wouldn’t but for historical inertia. Don’t confuse familiarity with safety. Could you add some more data to back up your statements? For example, you state "It is also one of the leading causes of toxic ODs presenting to the ED" >...During the latter part of the 20th century, the number of poisonings from salicylates declined, mainly because of the increased popularity of other over-the-counter analgesics such as paracetamol (acetaminophen). Fifty-two deaths involving single-ingredient aspirin were reported in the United States in 2000; however, in all but three of these cases, the reason for the ingestion of lethal doses was intentional—predominantly suicidal. https://en.wikipedia.org/wiki/Salicylate_poisoning https://en.wikipedia.org/wiki/Salicylate_poisoning Considering that literally thousands of tons of aspirin are consumed every year, this safety record likely compares well with other drugs. As a comparison, the most commonly used alternative to aspirin is acetaminophen and that is certainly much more dangerous: >...Many over-the-counter and prescription-only medications contain paracetamol. Because of its wide availability paired with comparably high toxicity, (compared to ibuprofen and aspirin) there is a much higher potential for overdose.[88] Paracetamol toxicity is one of the most common causes of poisoning worldwide.[22] In the United States, the United Kingdom, Australia, and New Zealand, paracetamol is the most common cause of drug overdoses.[17][89][90] Additionally, in both the United States and the United Kingdom it is the most common cause of acute liver failure.[91][7] https://en.wikipedia.org/wiki/Paracetamol_poisoning https://en.wikipedia.org/wiki/Paracetamol_poisoning >...A site from the far-right, unknown-anywhere-but-Fox-news I agree with you that efficacy testing of potential new drugs is important, but adding a statement with pejorative labelling like this feels somewhat like you are simply trying to poison the well.
- arkades 9y ago
  >Data The most recent public data from the american association of poison control centers is 2016. For toxicity events alone they don't break out analgesics into sub-groups, but for fatalities acetaminophen is in fifth place with 5.39% (there's also acetominophen combinations but those really don't count - they're all opioid combinations, and really represent an entirely different phenomenon). Aspirin is in 16th place, with 1.91% of fatalities. For scale, opioids are 8.3%, and anticonvulsants are 1.76%. Most of these are multi-substance exposures. For instances where there was only a single substance exposure, acetaminophen was about 12% and aspirin 3% (opioids 6.4%, anticonvulsants 0.51%). Ibuprofen, with 81k case mentions (vs. acetominophen's 58k and aspirin's 17k), didn't make the top-25 killer list. I didn't dig up the AAPC article mentioned in wikipedia, as it's about two decades old now, but the AAPC annual report I'm looking at right now shows most (~13k/17.5k) sole aspirin exposures were in the <12 crowd. It's not a big demographic for suicide. As to my statement that we have better drugs, the Oxford Pain Group has released the Oxford League Table for relative comparisons between NSAIDs, based on a meta-analysis of comparative trials. With a standardized measure of "50% of pain relief over 4-6 hours" as a successful treatment, the league table ranks NSAIDs by the number of patients you need to treat to achieve said outcome for one patient. Aspirin 1200s (.3 of your max recommended daily dose) are in 16th place, with an NNT of 2.4. Acetaminophen 1000s (1/4 of your daily max dose) are in 34th place with 3.8. Ibuprofen 800 (1/4 of your daily max dose), drug of choice for every doc I know, are in second place with an NNT of 1.6. >Paracetomol wikipedia tox I didn't say aspirin was the single biggest killer. I said we had other drugs "as or more effective with less frequent adverse effects, and the same price to market," and that "it was one of the leading causes," not the single biggest cause. I don't think the wikipedia page really contradicts that? > but adding a statement with pejorative labelling like this feels somewhat like you are simply trying to poison the well. I disagree. If someone links to a peer-reviewed article in a respected journal and the response is "that author is a shill," you're coming down on the side of ad hominem. But when someone links to an NRA website and says "you should read more here about gun safety here," ... it's entirely appropriate to point out the source of that information. Lobbyists, propagandist "think tanks," and other highly partisan groups that build a business model on trotting out talking points for their respective parties absolutely deserve being identified on sight as such.

opo 9y ago

>> aspirin wouldn’t pass >We have a number of drugs in the same class that are as or more effective with less frequent adverse effects, and the same price to market. It is also one of the leading causes of toxic ODs presenting to the ED. Aspirin shouldn’t pass as an over the counter Anywhere, and wouldn’t but for historical inertia. Don’t confuse familiarity with safety. Could you add some more data to back up your statements? For example, you state "It is also one of the leading causes of toxic ODs presenting to the ED" >...During the latter part of the 20th century, the number of poisonings from salicylates declined, mainly because of the increased popularity of other over-the-counter analgesics such as paracetamol (acetaminophen). Fifty-two deaths involving single-ingredient aspirin were reported in the United States in 2000; however, in all but three of these cases, the reason for the ingestion of lethal doses was intentional—predominantly suicidal. https://en.wikipedia.org/wiki/Salicylate_poisoning https://en.wikipedia.org/wiki/Salicylate_poisoning Considering that literally thousands of tons of aspirin are consumed every year, this safety record likely compares well with other drugs. As a comparison, the most commonly used alternative to aspirin is acetaminophen and that is certainly much more dangerous: >...Many over-the-counter and prescription-only medications contain paracetamol. Because of its wide availability paired with comparably high toxicity, (compared to ibuprofen and aspirin) there is a much higher potential for overdose.[88] Paracetamol toxicity is one of the most common causes of poisoning worldwide.[22] In the United States, the United Kingdom, Australia, and New Zealand, paracetamol is the most common cause of drug overdoses.[17][89][90] Additionally, in both the United States and the United Kingdom it is the most common cause of acute liver failure.[91][7] https://en.wikipedia.org/wiki/Paracetamol_poisoning https://en.wikipedia.org/wiki/Paracetamol_poisoning >...A site from the far-right, unknown-anywhere-but-Fox-news I agree with you that efficacy testing of potential new drugs is important, but adding a statement with pejorative labelling like this feels somewhat like you are simply trying to poison the well.

arkades 9y ago
>Data The most recent public data from the american association of poison control centers is 2016. For toxicity events alone they don't break out analgesics into sub-groups, but for fatalities acetaminophen is in fifth place with 5.39% (there's also acetominophen combinations but those really don't count - they're all opioid combinations, and really represent an entirely different phenomenon). Aspirin is in 16th place, with 1.91% of fatalities. For scale, opioids are 8.3%, and anticonvulsants are 1.76%. Most of these are multi-substance exposures. For instances where there was only a single substance exposure, acetaminophen was about 12% and aspirin 3% (opioids 6.4%, anticonvulsants 0.51%). Ibuprofen, with 81k case mentions (vs. acetominophen's 58k and aspirin's 17k), didn't make the top-25 killer list. I didn't dig up the AAPC article mentioned in wikipedia, as it's about two decades old now, but the AAPC annual report I'm looking at right now shows most (~13k/17.5k) sole aspirin exposures were in the <12 crowd. It's not a big demographic for suicide. As to my statement that we have better drugs, the Oxford Pain Group has released the Oxford League Table for relative comparisons between NSAIDs, based on a meta-analysis of comparative trials. With a standardized measure of "50% of pain relief over 4-6 hours" as a successful treatment, the league table ranks NSAIDs by the number of patients you need to treat to achieve said outcome for one patient. Aspirin 1200s (.3 of your max recommended daily dose) are in 16th place, with an NNT of 2.4. Acetaminophen 1000s (1/4 of your daily max dose) are in 34th place with 3.8. Ibuprofen 800 (1/4 of your daily max dose), drug of choice for every doc I know, are in second place with an NNT of 1.6. >Paracetomol wikipedia tox I didn't say aspirin was the single biggest killer. I said we had other drugs "as or more effective with less frequent adverse effects, and the same price to market," and that "it was one of the leading causes," not the single biggest cause. I don't think the wikipedia page really contradicts that? > but adding a statement with pejorative labelling like this feels somewhat like you are simply trying to poison the well. I disagree. If someone links to a peer-reviewed article in a respected journal and the response is "that author is a shill," you're coming down on the side of ad hominem. But when someone links to an NRA website and says "you should read more here about gun safety here," ... it's entirely appropriate to point out the source of that information. Lobbyists, propagandist "think tanks," and other highly partisan groups that build a business model on trotting out talking points for their respective parties absolutely deserve being identified on sight as such.