By Dr. Anthony Policastro

One of the interesting things about medicine is that sometimes things change and then later they go back to the way they were.

A good example of that is dealing seizures associated with childhood fevers. In the old days the thought was that febrile seizures were common and benign. 

Then there were instances where children had problems after a febrile seizure. The result was that we started treating all children with a febrile seizure with phenobarbital

It was a real problem keeping the levels up because of missed doses. There were side effects from the medication. Then a large study showed that febrile seizures were indeed benign. Those children who had pre-existing problems are the only ones with severe issues after such a seizure. 

Normal children did not need treatment for febrile seizures. Now we no longer use phenobarbital.

We have seen similar changes when it comes to using aspirin to prevent heart disease and stroke. At one time no one took aspirin on a regular basis.

Then we went through a period where one baby aspirin a day was recommended as preventive medication. It interfered with blood clotting. Clotting was a major issue in both heart disease and stroke.

However, sometimes interfering with blood clotting can cause gastrointestinal bleeding. Over the last few years there have been a number of studies looking at the role of aspirin.

It appears to work very well in those individuals who have a pre-existing condition. Those who have an acute vascular event need things like aspirin to keep it from getting worse. That is why people who dial 911 for a possible heart attack should take a dose of aspirin.

For those individuals who have not had a vascular event, it looks like using aspirin is not necessarily the thing to do. The evidence suggests that as individuals age their risk for gastrointestinal bleeding from aspirin increases.

There is also evidence that diet, exercise and treatment of things like hypertension and high cholesterol do much more to prevent cardiac events than aspirin ever could.

The bottom line is that the pendulum has now swung back to where it used to be. There are indeed individuals who should take aspirin daily because of their medical history. That is something that they need to discuss with their physician. 

However, for most individuals there is no longer a need to take a baby aspirin every day. Those who are still doing so should check with their physician to see if they still need to take one.

It is kind of like the old saying: “The more things change, the more they remain the same.”

COVID update- The media has been stirring up rumblings about the “failure” of Pfizer’s antiviral drug Paxlovid. The goal of the drug is to prevent severe illness if used within five days of symptom start. It does that very well. So it does exactly what it was meant to do. 

About two percent of treated individuals relapse after the five day course of treatment. That is likely because they had a high viral load to begin with. The relapses remain mild. 

A trial of the medication in household contacts showed it did not prevent those contacts from becoming ill. That was not its original purpose. It would have been nice if it did. However, that finding changes nothing about its effectiveness in preventing severe illness in symptomatic patients. 

The medication continues to do exactly what it was meant to do in the first place – prevent severe illness in those who take it within five days of symptom onset.