Citizen jury should consider aspirin prophylaxis

Editor—I smiled to read that the jury was still out on aspirin to prevent cardiovascular disease in elderly people in This week in the BMJ because, of course, there has never been any sort of jury on this topic.^1-2 This debate about aspirin has consumed the medical profession for over 30 years, yet almost no public participation or consultation has occurred.

Although aspirin has benefits, it is considered inappropriate for people with known contraindications. Its effects in symptom free subjects cannot be predicted. Standard advice is that subjects should consult a doctor before starting aspirin prophylaxis. However, perhaps patients, not doctors, should evaluate for themselves the possible outcomes and make decisions on the basis of their own evaluation of the risks and benefits.

Aspirin is not an alternative to health promotion or behavioural change in relation to exercise and diet. Nor is it a substitute for the appropriate treatment of high blood pressure. The possibility of a simple low dose pill taken daily, with the potential to achieve reductions in vascular events and even cancer and dementia requires serious consideration, as well as greater public discussion and participation in the debate.

Perhaps the public should be asked, for example, “Should every person over 50 in the United Kingdom be taking aspirin on a daily basis?” Such a debate would be a good model for illustrating the perennial questions in medicine about benefits outweighing harms, the extent to which decision making about preventive health measures should be shared between patients and professionals, and how best to involve the public in discussions about taking individual responsibility for health, a key objective in current healthcare policy. A citizens' jury on aspirin would be a good first step forward.