From: brandon@caldonia.nlm.nih.gov (Brandon Brylawski)
Subject: Re: From _Scientific American_
Organization: National Library of Medicine
X-Newsreader: Tin 1.1 PL4
Date: Wed, 27 Jan 93 15:09:24 GMT

minsky@media.mit.edu (Marvin Minsky) writes:

[Parts of Tim Starr's Posting]

: I found the article pretty convincing.
: 
: The article did not mention another important issue here: There is (I
: estimate) a Billion Dollar industry in promoting the Anacin-type
: drugs.  Their advertisements often boast about being Aspirin Free, but
: do not say that they lack some of the anti-inflammatory and
: anti-clotting effects of aspirin.)  It is presumably the latter that
: save cardiac lives.  

Acetaminophen does relieve pain adn fever as well as aspirin does,
and these are after all the overwhelming reasons that people use aspirin.
As far as anti-inflammatory effects go, one has to take a much larger dose
of aspirin than most people normally do to get much effect. There are 
many other drugs (e.g. Ibuprofen) that have more anti-inflammatory effect
than aspirin relative to their side effects.

: 
: Now why would one prefer the phenacetins to the aspirins?  The
: commercial reason is obvious: the aspirin patent ran out decades ago.

Does Anacin use only acetaminophen? I presume this is the drug you mean.
Phenacetin is a drug related to acetaminophenthat is little-used nowadays.
Acetaminophen has been in the public domain for decades as well. The
reasons for preferring acetaminophen to aspirin are its lack of 
side effects, notably stomach irritation for some people.


: Also, there are some people who get gastric irritation from aspirin
: (and I've been told that almost everyone gets a small amount of
: gastric bleeding from it).  However, if you're not aspirin-intolerant,
: then the benefits appear to be enormously in favor of aspirin.  And
: I've also been told that there are also comparably serious side
: effects from the anacin-type drugs, only they don't manifest
: themselves with such evident gastric irritation symptoms.

Side effects from acetaminophen taken in normal doses are very rare, such
that I have never seen or heard of a single case in my practice. Another
occasional side effect from aspirin is interstitial nephritis, a kidney
inflammation that can be lethal. This is very uncommon, but potentially
quite harmful; fortunately, it only seems to occur in people who
take aspirin or other anit-inflammatory drugs in large doses on a regular
basis.
  The most important side-effect of aspirin is its anti-platelet activity.
While this seems to be strongly beneficial (in very low doses) in
preventing heart attacks for those who are at risk, it definitely 
seems to increase the risk of bleeding in people who take it regularly.
The concern is that if people take aspirin indiscriminately they will
have more strokes, and those they have will be more severe because they
will bleed into damaged areas of their brains. So while a population may
have fewer heart attacks, it might have more strokes. They way to
use aspirin effectively for prevention of heart attack is to give it
selectively to those people who are most likely to have heart attacks,
especially older men with cardiac risk factors.

: Final question: is it true that aspirin retards the destructive
: effects of chronic arthritis, whereas anacin merely hides the pain?

Acetaminophen is simply a pain-killer and does not counteract the 
inflammation of arthritis, while aspirin taken in large doses 
(16-20 regular-strength tablets a day) and other anti-inflammatory drugs
(e.g. ibuprofen, naproxen, diclofenac, ketoprofen, ketorolac, etc) do.
The latter category are thus greatly preferred in the treatment of 
arthritis, except in those few who cannot tolerate them.

Brandon Brylawski
Xref: sparky talk.politics.drugs:8216 talk.politics.guns:27060 talk.politics.medicine:658