5 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 m

by opo 8y 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 8y 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 8y ago
  >...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. One obvious issue is that this data isn't the complete picture - obviously the amount of consumption of the drug is the other half of the picture. I've seen estimates that over 100 billion aspirin doses are consumed each year of aspirin - I doubt that much is consumed of other drugs you listed. If aspirin was no longer available over the counter, wouldn't that just increase the risk of overdose for its competitors? (Particularly for acetaminophen). In terms of safety,. the FDA has also singled out Ibuprofen and other non aspirin NSAID drugs for: health risks that (they claim) aspirin doesn't have: >...People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as ibuprofen may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. https://medlineplus.gov/druginfo/meds/a682159.html https://medlineplus.gov/druginfo/meds/a682159.html Any of these deaths caused by other NSAIDs would likely not be attributed to Ibuprofen on the death certificate. In terms of efficacy, you wrote: >...Ibuprofen 800 (1/4 of your daily max dose), 3200 mg is the daily max dose when under the care of a Doctor. The instructions on the OTC bottle will say to use 1200 mg per day. So as an OTC drug (which is what we are talking about here) that is more like 2/3 of the suggested daily dose. >…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? What you originally wrote was: >…Aspirin shouldn’t pass as an over the counter Anywhere, and wouldn’t but for historical inertia. Aspirin is likely available over the counter in just about every country in the world. Considering the massive usage of this drug, the adverse incidents seem low. The number of deaths from overdose are minuscule compared to the usage and I think you agree it is safer than other OTC counter drugs such as acetaminophen. In terms of efficacy as an OTC drug it seems comparable to the competitors. >...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. You weren't just pointing "out the source of the information" - the group behind the info is on first page, that wasn't a secret.. What you wrote was: >…A site from the far-right, unknown-anywhere-but-Fox-news Independent Institute. Terms like "far-left" and "far-right" are often casually used as a pejorative against a person or group. Neither of these terms is well defined, but most people consider "far-right" to be related to Nazis, skinheads, etc. - i.e. (possibly dangerous) kooks who should be ignored. Looking at the wikipedia entry for the Independent Institute: https://en.wikipedia.org/wiki/Independent_Institute https://en.wikipedia.org/wiki/Independent_Institute I don't see any evidence that they are a hate group. You also wrote >…unknown-anywhere-but-Fox-news Are they often quoted as a source on Fox news or a guest on a Fox show? From the wikipedia page it sounds like they would be in disagreement with Fox news on various issues like the Iraq War. Intentional or not, trying to shut down discussion by labelling someone you disagree with like that is poisoning the well. Far too many members of the public just stay in their ideological bubble and ignore any arguments except those they agree with. It is easy for the average person to be skeptical of ideas they disagree with, it is much harder for them to be skeptical of ideas they want to believe. There is nothing wrong with pointing out disagreements with an argument someone makes (as you did earlier) or pointing out possible conflicts of interest that weren't disclosed by the authors, but labelling someone you disagree with as a kook that should be ignored on principle isn't really the same thing.

by opo 8y ago

arkades 8y 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 8y ago
>...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. One obvious issue is that this data isn't the complete picture - obviously the amount of consumption of the drug is the other half of the picture. I've seen estimates that over 100 billion aspirin doses are consumed each year of aspirin - I doubt that much is consumed of other drugs you listed. If aspirin was no longer available over the counter, wouldn't that just increase the risk of overdose for its competitors? (Particularly for acetaminophen). In terms of safety,. the FDA has also singled out Ibuprofen and other non aspirin NSAID drugs for: health risks that (they claim) aspirin doesn't have: >...People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as ibuprofen may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. https://medlineplus.gov/druginfo/meds/a682159.html https://medlineplus.gov/druginfo/meds/a682159.html Any of these deaths caused by other NSAIDs would likely not be attributed to Ibuprofen on the death certificate. In terms of efficacy, you wrote: >...Ibuprofen 800 (1/4 of your daily max dose), 3200 mg is the daily max dose when under the care of a Doctor. The instructions on the OTC bottle will say to use 1200 mg per day. So as an OTC drug (which is what we are talking about here) that is more like 2/3 of the suggested daily dose. >…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? What you originally wrote was: >…Aspirin shouldn’t pass as an over the counter Anywhere, and wouldn’t but for historical inertia. Aspirin is likely available over the counter in just about every country in the world. Considering the massive usage of this drug, the adverse incidents seem low. The number of deaths from overdose are minuscule compared to the usage and I think you agree it is safer than other OTC counter drugs such as acetaminophen. In terms of efficacy as an OTC drug it seems comparable to the competitors. >...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. You weren't just pointing "out the source of the information" - the group behind the info is on first page, that wasn't a secret.. What you wrote was: >…A site from the far-right, unknown-anywhere-but-Fox-news Independent Institute. Terms like "far-left" and "far-right" are often casually used as a pejorative against a person or group. Neither of these terms is well defined, but most people consider "far-right" to be related to Nazis, skinheads, etc. - i.e. (possibly dangerous) kooks who should be ignored. Looking at the wikipedia entry for the Independent Institute: https://en.wikipedia.org/wiki/Independent_Institute https://en.wikipedia.org/wiki/Independent_Institute I don't see any evidence that they are a hate group. You also wrote >…unknown-anywhere-but-Fox-news Are they often quoted as a source on Fox news or a guest on a Fox show? From the wikipedia page it sounds like they would be in disagreement with Fox news on various issues like the Iraq War. Intentional or not, trying to shut down discussion by labelling someone you disagree with like that is poisoning the well. Far too many members of the public just stay in their ideological bubble and ignore any arguments except those they agree with. It is easy for the average person to be skeptical of ideas they disagree with, it is much harder for them to be skeptical of ideas they want to believe. There is nothing wrong with pointing out disagreements with an argument someone makes (as you did earlier) or pointing out possible conflicts of interest that weren't disclosed by the authors, but labelling someone you disagree with as a kook that should be ignored on principle isn't really the same thing.