Wednesday, December 12, 2012

What Was the Cause of the Stomach Upset?

Last week my Best Beloved pointed me to this article in the New York Times on line. The topic is a new research study that takes a close look at one of the most common medicine regimens in use: taking low dose aspirin to prevent clots that might lead to heart attack or stroke.

The article highlights several questions about aspirin therapy that have come up over the years. There’s general agreement that a lot of folks benefit from taking low dose aspirin. On the other hand, aspirin, even at low doses, has some risk of irritating the stomach lining and causing some bleeding. So, does an enteric coating – a coating that delays the digestion and absorption of the aspirin – spare the stomach and prevent the bleeding? On the other hand, does it interfere with absorption so that the benefit isn’t as great? There has been a theory, too, that some people don’t benefit at all from the aspirin because of “aspirin resistance.” So, is that a real problem? Or does perhaps the enteric coating prevent the absorption, creating the symptoms of “aspirin resistance?”

This is a news article. While it provides a good general description of the clinical questions, it doesn’t go into detail. I’m sure that articles written for more clinical audiences will address the scientific questions in more detail.

However, what I really do like about this article is how well it highlights the various conflicting interests. Read it at all carefully, and you’ll see the questions the reporter raises about the relationships between research funding and research results. There are legitimate questions, really. I believe that the researchers want to benefit patients. I believe they look at their research results and interpretations, and are honest. At the same time, it’s also clear that there are commercial supporters for each position, prepared to fund further research that will help seem to argue for their products. And while correlation is not causation, those connections between research funding and research results are as worthy of study as the medications themselves.

So take a few minutes with this article. It’s hardly definitive. There will need to be more research to justify any of these clinical positions. But it shines a light on the interconnections between research, researchers, and funders – connections that are arguably troubling.

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