I recently recalled, apropos of the intermittent fasting/caloric restriction <\/a>discussion, a very good blog post on mortality curves and models of aging<\/a>:<\/p>\n

\n

For me, a 25-year-old American, the probability of dying during the next year is a fairly miniscule 0.03% — about 1 in 3,000.  When I’m 33 it will be about 1 in 1,500, when I’m 42 it will be about 1 in 750, and so on.  By the time I reach age 100 (and I do<\/em> plan on it) the probability of living to 101 will only be about 50%.  This is seriously fast growth — my mortality rate is increasing exponentially with age.<\/p>\n

...This data fits the Gompertz law almost perfectly, with death rates doubling every 8 years.  The graph on the right also agrees with the Gompertz law, and you can see the precipitous fall in survival rates starting at age 80 or so.  That decline is no joke; the sharp fall in survival rates can be expressed mathematically as an exponential within an exponential<\/em>:<\/p>\n

\"P(t)<\/p>\n

Exponential decay is sharp, but an exponential within an exponential is so sharp that I can say with 99.999999% certainty that no human will ever live to the age of 130.  (Ignoring, of course, the upward shift in the lifetime distribution that will result from future medical advances)<\/p>\n

...There is one important lesson, however, to be learned from Benjamin Gompertz’s mysterious observation.  By looking at theories of human mortality that are clearly wrong, we can deduce that our fast-rising mortality is not the result of a dangerous environment, but of a body that has a built-in expiration date.<\/p>\n<\/blockquote>\n

gravityandlevity then discusses some simple models of aging and the statistical characters they have which do not match Gompertz's law:<\/p>\n

    \n
  1. 'lightning' model: risk of mortality each period is constant; Poisson distribution:
    \n
    \n

    What a crazy world!  The average lifespan would be the same, but out of every 100 people 31 would die before age 30 and 2 of them would live to be more than 300 years old.  Clearly we do not live in a world where mortality is governed by “lightning bolts”.<\/p>\n<\/blockquote>\n<\/li>\n

  2. 'accumulated lightning'; like in a video game, one has a healthbar which may take a hit each period; similar to above:
    \n
    \n

    Shown above are the results from a simulated world where “lightning bolts” of misfortune hit people on average every 16 years, and death occurs at the fifth hit.  This world also has an average lifespan of 80 years (16*5 = 80), and its distribution is a little less ridiculous than the previous case.  Still, it’s no Gompertz Law: look at all those 160-year-olds!  You can try playing around with different “lightning strike rates” and different number of hits required for death, but nothing will reproduce the Gompertz Law.  No explanation based on careless gods, no matter how plentiful or how strong their blows are, will reproduce the strong upper limit to human lifespan that we actually observe.<\/p>\n<\/blockquote>\n<\/li>\n<\/ol>\n

    What models do<\/em> yield a Gompertz curve? gravityandlevity describes a simple 'cops and robbers' model (which I like to think of as 'antibodies and cancers'):<\/p>\n

    \n

    ...in general, the cops are winning.  They patrol randomly through your body, and when they happen to come across a criminal he is promptly removed.  The cops can always defeat a criminal they come across, unless the criminal has been allowed to sit in the same spot for a long time.  A criminal that remains in one place for long enough (say, one day) can build a “fortress” which is too strong to be assailed by the police.  If this happens, you die.<\/p>\n

    Lucky for you, the cops are plentiful, and on average they pass by every spot 14 times a day.  The likelihood of them missing a particular spot for an entire day is given (as you’ve learned by now) by the Poisson distribution: it is a mere \"e^{-14}.<\/p>\n

    But what happens if your internal police force starts to dwindle?  Suppose that as you age the police force suffers a slight reduction, so that they can only cover every spot 12 times a day.  Then the probability of them missing a criminal for an entire day decreases to \"e^{-12}.  The difference between 14 and 12 doesn’t seem like a big deal, but the result was that your chance of dying during a given day jumped by more than 10 times.  And if the strength of your police force drops linearly in time, your mortality rate will rise exponentially.<\/p>\n

    ... The language of “cops and criminals” lends itself very easily to a discussion of the immune system fighting infection and random mutation.  Particularly heartening is the fact that rates of cancer incidence also follow the Gompertz law, doubling every 8 years or so.  Maybe something in the immune system is degrading over time, becoming worse at finding and destroying mutated and potentially dangerous cells.<\/p>\n

    ...Who are the criminals and who are the cops that kill them?  What is the “incubation time” for a criminal, and why does it give “him” enough strength to fight off the immune response?  Why is the police force dwindling over time?  For that matter, what kind of “clock” does your body have that measures time at all? There have been attempts to describe DNA degradation (through the shortening of your telomeres<\/a> or through methylation<\/a>) as an increase in “criminals” that slowly overwhelm the body’s DNA-repair mechanisms, but nothing has come of it so far.<\/p>\n<\/blockquote>\n

    This offers food for thought about various anti-aging strategies. For example, given the superexponential growth in mortality, if we had a magic medical treatment that could cut your mortality risk in half but didn't affect the growth<\/em> of said risk, then that would buy you very little late in life, but might extend life by decades if administered at a very young age.<\/p>","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.lesswrong.com/posts/GytPrQ9cT46k9etoz/living-forever-is-hard-or-the-gompertz-curve"},"headline":"Living Forever is Hard, or, The Gompertz Curve","description":"I recently recalled, apropos of the intermittent fasting/caloric restriction discussion, a very good blog post on mortality curves and models of agin…","datePublished":"2011-05-17T21:08:20.080Z","about":[],"author":[{"@type":"Person","name":"gwern","url":"https://www.lesswrong.com/users/gwern"}],"comment":[{"@type":"Comment","text":"

    \n

    This offers food for thought about various anti-aging strategies. For example, given the superexponential growth in mortality, if we had a magic medical treatment that could cut your mortality risk in half but didn't affect the growth of said risk, then that would buy you very little late in life, but might extend life by decades if administered at a very young age.<\/p>\n<\/blockquote>\n

    This isn't an anti-aging strategy, but it is an anti-death<\/em> strategy: low-dose aspirin<\/strong>. As explained in this New York Times article<\/a> on December 6, 2010, "researchers examined the cancer death rates of 25,570 patients who had participated in eight different randomized controlled trials of aspirin that ended up to 20 years earlier".<\/p>\n

    Eight. Different. Randomized. Controlled. Trials. Twenty-five thousand people.<\/p>\n

    They found (read the article) that low-dose aspirin dramatically decreased the risk of death from solid tumor cancers. Again, this ("risk of death") is the gold standard - many studies measure outcomes indirectly (e.g. tumor size, cholesterol level, etc.) which leads to unpleasant surprises (X shrinks tumors but doesn't keep people alive, Y lowers cholesterol levels but doesn't keep people alive, etc.). Best of all is this behavior: "the participants in the longest lasting trials had the most drastic reductions in cancer death years later."<\/p>\n

    Not mentioned in the article is the fact that aspirin is an ancient drug, in use for over a century<\/a> with side effects that, while they certainly exist, are very well understood. This isn't like the people taking "life-extension regimens" or "nootropic stacks", who are, as far as I'm concerned, finding innovative ways to poison themselves.<\/p>\n

    Yet the article went on to say this:<\/p>\n

    \n

    But even as some experts hailed the new study as a breakthrough, others urged caution, warning people not to start a regimen of aspirin without first consulting a doctor about the potential risks, including gastrointestinal bleeding and bleeding in the brain (hemorrhagic strokes). <\/p>\n

    “Many people may wonder if they should start taking daily aspirin, but it would be premature to recommend people starting taking aspirin specifically to prevent cancer,” said Eric J. Jacobs, an epidemiologist with the American Cancer Society.<\/p>\n<\/blockquote>\n

    I'm a programmer, not a doctor - but after looking around, I concluded that the risks of GI bleeding were not guaranteed fatal, and the risks of hemorrhagic strokes were low in absolute terms. Also, aspirin is famously effective against ischemic strokes. According to Wikipedia<\/a>: "Although aspirin also raises the risk of hemorrhagic stroke and other major bleeds by about twofold, these events are rare, and the balance of aspirin's effects is positive. Thus, in secondary prevention trials, aspirin reduced the overall mortality by about a tenth."<\/p>\n

    So unless aspirin's risks are far more grave than I've currently been led to believe, as far as I'm concerned, people saying "hey, even if you're not subject to aspirin's well-known contraindications, you shouldn't start low-dose aspirin just yet" are literally statistically killing people. Cancer is pretty lethal and we're not really good at fixing it yet, so when we find something that can really reduce the risk (and there aren't many - the only other ones I can think of are the magical substances known as not-smoking and avoiding-massive-doses-of-ionizing radiation), we should be all over that like cats on yarn.<\/p>\n

    I make damn sure to take my low-dose aspirin every day. I started it before reading this article on the advice of my doctor who thought my cholesterol was a little high - I'm almost 28, so it'll have many years in which to work its currently poorly understood magic.<\/p>\n

    That said, this reduces the risk of one common cause of death (two or three if you throw in heart attacks and ischemic strokes). There are lots of others out there. Even if you could avoid all of them (including the scariest one, Alzheimer's - it's insanely common, we have no fucking clue what causes it or how to stop it, and it annihilates your very self - even if cryonics is ultimately successful, advanced Alzheimer's is probably the true death), humans pretty clearly wear out with an upper bound of 120 years. Maybe<\/em> caloric restriction can adjust that somewhat. But I think I'll sign up for cryonics sooner rather than later - I'm in favor of upgrading probability from "definitely boned" to "probably boned but maybe not".<\/p>\n","datePublished":"2011-05-18T06:50:13.441Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}],"comment":[{"@type":"Comment","text":"

    The meta-analysis you cite is moderately convincing, but only moderately. They had enough different analyses such that some would come out significant by pure chance. Aspirin was found to have an effect on 15-year-mortality significant only at the .05 level, and aspirin was found not<\/em> to have a significant effect 20-year-mortality, so take it with a grain of salt. There was also some discussion in the literature about how it's meta-analyzing studies performed on people with cardiac risk factors but not bleed risk factors, and so the subjects may have been better candidates for aspirin than the general population.<\/p>\n

    The Wikipedia quote you give is referring to secondary prevention, which means "prevention of a disease happening again in someone who's already had the disease". Everyone agrees aspirin is useful for secondary prevention, but there are a lot of cases where something useful for secondary prevention isn't as good for primary. In primary prevention, aspirin doesn't get anywhere near a tenth reduction in mortality (although it does seem to have a lesser effect).<\/p>\n

    I would say right now there's enough evidence that people who enjoy self-experimentation are justified in trying low-dose aspirin and probably won't actively hurt themselves (assuming they check whether they're at special risk of bleeds first), but not enough evidence that doctors should be demonized for not telling everyone to do it.<\/p>\n","datePublished":"2011-05-19T12:56:25.624Z","author":[{"@type":"Person","name":"Scott Alexander","url":"https://www.lesswrong.com/users/scottalexander","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":1580},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":217}]}],"comment":[{"@type":"Comment","text":"

    \n

    Aspirin was found to have an effect on 15-year-mortality significant only at the .05 level, and aspirin was found not<\/em> to have a significant effect 20-year-mortality, so take it with a grain of salt.<\/p>\n<\/blockquote>\n

    Can you provide your reference for this? I looked at the meta-analysis<\/a> and what I assume is the 20-year follow-up<\/a> of five RCTs (the citations seem to be paywalled), and both mention 20-year reduction in mortality without mentioning 15-year reductions or lack thereof.<\/p>\n

    Edit:<\/strong> Never mind, I found it, followed immediately by<\/p>\n

    \n

    the effect on post-trial deaths was diluted by a transient increase in risk of vascular death in the \naspirin groups during the first year after completion of the trials (75 observed vs 46 expected, OR 1·69, 1·08–2·62, p=0·02), presumably due to withdrawal of trial aspirin.<\/p>\n<\/blockquote>\n

    I'd like to see 20-year numbers for people who maintained the trial (and am baffled that they didn't randomly select such a subgroup).<\/p>\n","datePublished":"2012-01-17T03:12:12.864Z","author":[{"@type":"Person","name":"Luke Stebbing","url":"https://www.lesswrong.com/users/luke-stebbing","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":52},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":0}]}]},{"@type":"Comment","text":"

    \n

    The meta-analysis you cite is moderately convincing, but only moderately. They had enough different analyses such that some would come out significant by pure chance.<\/p>\n<\/blockquote>\n

    Their selection methodology on p32 appears neutral, so I don't think they ended up with cherry-picked trials. Once they had their trials, it looks like they drew all conclusions from pooled data, e.g. they did not<\/em> say "X happened in T1, Y happened in T2, Z happened in T3, therefore X, Y, and Z are true."<\/p>\n","datePublished":"2012-01-17T05:32:09.919Z","author":[{"@type":"Person","name":"Luke Stebbing","url":"https://www.lesswrong.com/users/luke-stebbing","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":52},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":0}]}]}]},{"@type":"Comment","text":"

    And I think I have my answer:<\/p>\n

    \n

    Last week, researchers in London reported that they had analyzed nine randomized studies of aspirin use in the United States, Europe and Japan that included more than 100,000 participants. The study subjects had never had a heart attack or stroke; all regularly took aspirin or a placebo to determine whether aspirin benefits people who have no established heart disease.<\/p>\n

    In the combined analysis, the researchers found that regular aspirin users were 10 percent less likely than the others to have any type of heart event, and 20 percent less likely to have a nonfatal heart attack. While that sounds like good news, the study showed that the risks of regular aspirin outweighed the benefits.<\/p>\n

    Aspirin users were about 30 percent more likely to have a serious gastrointestinal bleeding event, a side effect of frequent aspirin use. The overall risk of dying during the study was the same among the aspirin users and the others. And though some previous studies suggested that regular aspirin use could prevent cancer, the new analysis showed no such benefit. Over all, for every 162 people who took aspirin, the drug prevented one nonfatal heart attack, but caused about two serious bleeding episodes.<\/p>\n<\/blockquote>\n

    http://well.blogs.nytimes.com/2012/01/16/daily-aspirin-is-not-for-everyone-study-suggests/<\/a><\/p>\n","datePublished":"2012-01-17T00:17:03.867Z","author":[{"@type":"Person","name":"gwern","url":"https://www.lesswrong.com/users/gwern","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":11613},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":185}]}],"comment":[{"@type":"Comment","text":"

    Thank you, very interesting. <\/p>\n","datePublished":"2012-01-17T04:27:46.654Z","author":[{"@type":"Person","name":"jsalvatier","url":"https://www.lesswrong.com/users/jsalvatier","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":1586},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":66}]}]},{"@type":"Comment","text":"

    From the abstract at:<\/p>\n

    http://archinte.ama-assn.org/cgi/content/abstract/archinternmed.2011.628v1<\/a><\/p>\n

    \n

    During a mean (SD) follow-up of 6.0 (2.1) years involving over 100 000 participants [...] There was no significant reduction in CVD death (OR, 0.99; 95% CI, 0.85-1.15) or cancer mortality (OR, 0.93; 95% CI, 0.84-1.03)<\/p>\n<\/blockquote>\n

    I am suspicious of the 6-year followup. In the original paper linked elsewhere in this comment tree, the observed reduction in cancer mortality grew over time.<\/p>\n

    I would be more willing to believe this new study if it followed patients for a longer period of time, observed the reduction in cancer mortality, and still concluded that the risks outweighed the benefits.<\/p>\n","datePublished":"2012-01-17T00:46:50.474Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}],"comment":[{"@type":"Comment","text":"

    I'd like to point out that this pooled analysis of healthy people covered more than 4 times as many healthy people as your original citation covered sick people.<\/p>\n","datePublished":"2012-01-17T01:04:15.021Z","author":[{"@type":"Person","name":"gwern","url":"https://www.lesswrong.com/users/gwern","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":11613},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":185}]}],"comment":[{"@type":"Comment","text":"

    Do you think that the "sick people" were somehow susceptible to cancer in an aspirin-prevention-friendly manner, while the "healthy people" weren't?<\/p>\n

    (I am considering cancer separately from cardiovascular disease and bleeding risks, as they can be analyzed separately before overall risk-benefit is determined. I would not be surprised to learn that aspirin is very effective at reducing cardiovascular disease among those at risk, while not being worth it for cardiovascular disease among the general population.)<\/p>\n","datePublished":"2012-01-17T02:07:29.039Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}],"comment":[{"@type":"Comment","text":"

    I'll try again: your original cite said the cancer benefit was detectable at 5<\/em> years, and later. I've presented you with a 4<\/em> times larger study, in the relevant subpopulation, at 6<\/em> years which found no cancer benefit - and you are still asking rhetorical questions and coming up with excuses.<\/p>\n

    Do you think that if you had seen the evidence the other way around that you would be asking the same questions?<\/p>\n","datePublished":"2012-01-17T02:28:21.719Z","author":[{"@type":"Person","name":"gwern","url":"https://www.lesswrong.com/users/gwern","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":11613},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":185}]}],"comment":[{"@type":"Comment","text":"

    No matter which study I saw first, the other would be surprising. A 100k trial doesn't explain away<\/em> evidence from eight trials totaling 25k. Given that all of these studies are quite large, I'm more concerned about methodological flaws than size.<\/p>\n

    I have very slightly increased my estimate that aspirin reduces cancer mortality (since the new study showed 7% reduction, and that certainly isn't evidence against<\/em> mortality reduction). I have slightly decreased my estimate that the mortality reduction is as strong as concluded by the meta-analysis. I have decreased my estimate that the risk tradeoff will be worth it later in life. I have very slightly increased my estimate that sick people are generally more likely to develop cancer and aspirin is especially good at preventing that kind of cancer, but I mention that only because it's an amusingly weird explanation.<\/p>\n

    If this new study is continued with similar results, or even if its data doesn't show increased reduction when sliced by quartile (4.6, 6.0, 7.4 years), I would significantly lower my estimate of the mortality reduction.<\/p>\n

    I'll continue to take low-dose aspirin since my present risk of bleeding death is very low, and if the graphs of cumulative cancer mortality reduction on p34 of the meta-analysis<\/a> reflect reality, I'll be banking resistance to cancer toward a time when I'm much more likely to need it. I can't decide to take low-dose aspirin retroactively.<\/p>\n","datePublished":"2012-01-17T05:32:57.198Z","author":[{"@type":"Person","name":"Luke Stebbing","url":"https://www.lesswrong.com/users/luke-stebbing","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":52},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":0}]}],"comment":[{"@type":"Comment","text":"

    \n

    A 100k trial doesn't explain away evidence from eight trials totaling 25k.<\/p>\n<\/blockquote>\n

    It doesn't have to, since they are not trials involving the same populations.<\/p>\n","datePublished":"2012-01-17T15:56:32.752Z","author":[{"@type":"Person","name":"gwern","url":"https://www.lesswrong.com/users/gwern","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":11613},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":185}]}]}]},{"@type":"Comment","text":"

    Perhaps I'm misunderstanding the numbers ("OR, 0.93"), but the new study observed a 7% decrease in cancer mortality, which they called "not significant".<\/p>\n

    \n

    Do you think that if you had seen the evidence the other way around that you would be asking the same questions?<\/p>\n<\/blockquote>\n

    I would be unhappy with the other study's population, but very happy with its followup period. (The fact that the observed benefit grew with the length of time taking aspirin was especially convincing, as I mentioned earlier. That is a property that is very unlike "maybe we're seeing it, maybe we're not" noise at the threshold of detection.)<\/p>\n

    Last year, I told you that polio had no natural reservoirs, and you continued to believe otherwise, so I am not especially inclined to argue further.<\/p>\n","datePublished":"2012-01-17T02:43:43.105Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}],"comment":[{"@type":"Comment","text":"

    \n

    Perhaps I'm misunderstanding the numbers ("OR, 0.93"), but the new study observed a 7% decrease in cancer mortality, which they called "not significant".<\/p>\n<\/blockquote>\n

    No, that's correct. If you want to use stuff that doesn't reach significance, I can't stop you. (You didn't reply to Yvain's points, incidentally.)<\/p>\n

    \n

    Last year, I told you that polio had no natural reservoirs, and you continued to believe otherwise, so I am not especially inclined to argue further.<\/p>\n<\/blockquote>\n

    And you misunderstood the point about carriers defeating eradication attempts.<\/p>\n","datePublished":"2012-01-17T02:52:47.327Z","author":[{"@type":"Person","name":"gwern","url":"https://www.lesswrong.com/users/gwern","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":11613},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":185}]}]}]}]}]}]}]}]},{"@type":"Comment","text":"

    "Cancer is pretty lethal and we're not really good at fixing it yet, so when we find something that can really reduce the risk (and there aren't many - the only other ones I can think of are the magical substances known as not-smoking and avoiding-massive-doses-of-ionizing radiation), we should be all over that like cats on yarn."<\/p>\n

    Maintaining moderately high blood levels of vitamin D may reduce over all cancer rates by up to 30%. There is also evidence for green tea significantly reducing cancer rates. <\/p>\n

    Aspirin is an anti-coagulant so wounds take longer to stop bleeding. A surgeon will require that you stop taking aspirin long enough for the blood clotting factors to recover. (Surgeons hate it when they can't stop the bleeding.) If I were under 30 I wouldn't take a daily aspirin as I doubt it provides any benefit and does increase risk slightly. By the time you are 40 your body tissues are in a state of mild, chronic inflammation. That may be good for fighting off infections but isn't so good for the cardiovascular system, lungs, and brain. I recommend baby aspirin for anyone over 40.<\/p>\n

    Moderate alcohol use is correlated with a significant reduction in cardiovascular events. As with aspirin I would only recommend it for older people and then only if the likelihood of abuse is small.<\/p>\n","datePublished":"2011-05-18T23:21:05.024Z","author":[{"@type":"Person","name":"Fly","url":"https://www.lesswrong.com/users/fly","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":13},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":0}]}],"comment":[{"@type":"Comment","text":"

    Vitamin D is really important. There is an established causal<\/em> link between vitamin D and immune function<\/a>. It doesn't just enhance your immune response - it's a prerequisite<\/em> for an immune response.<\/p>\n

    Anecdote: Prior to vitamin D supplementation, I caught something like 4 colds per year on average. I'm pretty sure I never did better than 2. I started taking daily D supplements about a year and half ago, and caught my first cold a few days ago. It's worth taking purely as a preventative cold medicine<\/a>.<\/p>\n","datePublished":"2011-05-19T17:48:46.787Z","author":[{"@type":"Person","name":"loqi","url":"https://www.lesswrong.com/users/loqi","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":377},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":0}]}]},{"@type":"Comment","text":"

    \n

    Maintaining moderately high blood levels of vitamin D may reduce over all cancer rates by up to 30%.\nThere is also evidence for green tea significantly reducing cancer rates.<\/p>\n<\/blockquote>\n

    I haven't seen thoroughly convincing studies, but it's quite possible that I missed them (among the blizzard of junk studies).<\/p>\n

    \n

    Aspirin is an anti-coagulant so wounds take longer to stop bleeding.<\/p>\n<\/blockquote>\n

    This is true, although I've noticed no significant effects. (When the air is cold and dry, I'm sometimes prone to nosebleeds, but they didn't get worse after I started low-dose aspirin).<\/p>\n

    It's also a bug and a feature<\/em>. Heart attacks and ischemic strokes are no fun at all.<\/p>\n

    \n

    A surgeon will require that you stop taking aspirin long enough for the blood clotting factors to recover.\n(Surgeons hate it when they can't stop the bleeding.)<\/p>\n<\/blockquote>\n

    Not a problem for elective surgery (just stop taking it). If you need immediate surgery (e.g. because of an accident), then low-dose aspirin may be a slight risk - but it doesn't transform you into an instant hemophiliac.<\/p>\n

    \n

    If I were under 30 I wouldn't take a daily aspirin as I doubt it provides any benefit<\/p>\n<\/blockquote>\n

    Eight different randomized controlled trials<\/em> suggest you're wrong. I'm unsure as to whether they studied relatively young adults like me - the problem is that it'd take even more decades to notice an effect. I consider aspirin's effects in older men to be persuasive evidence that it has the same effects for women and younger men like me. (In fact, as I mentioned, my doctor saw my slightly elevated cholesterol and told me to start fish oil and low-dose aspirin when I was 25 - it was only later that I saw the article about cancer.)<\/p>\n

    \n

    I recommend baby aspirin for anyone over 40.<\/p>\n<\/blockquote>\n

    Citation needed. Do you really think that, in your 20s and 30s, your cells aren't accumulating damage that eventually leads to cancer, so that low-dose aspirin has nothing to prevent? Really?<\/em> It's possible that the cumulative damage hypothesis, for lack of a better name, is false, but I consider it overwhelmingly likely to be true.<\/p>\n

    Obviously, in making this decision, my own health is at stake - and I am very careful. In my judgment, trying to be as rational as possible, I believe that the risks of starting low-dose aspirin in my 20s are very small, and outweighed by the cumulative benefit, when I'm older, of having taken it for so long (the time-dependent nature of the benefit is important).<\/p>\n","datePublished":"2011-05-19T05:51:41.106Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}],"comment":[{"@type":"Comment","text":"

    "Eight different randomized controlled trials suggest you're wrong."<\/p>\n

    If the studies were done 20 years ago my guess is that the original trials were performed to see if aspirin reduced the risk of heart attacks. (At least that is what I recollect from that time period.) I doubt there were many people under 30 in those trials. I saw no indication in the linked article that ages were broken out so that one could determine whether people in their 20s who took aspirin for several years had less cancer 20 years later. Since few young people would be expected to get cancer I doubt the studies show that people in their 20s developed significantly fewer cancers from taking aspirin. My guess is that most of the people in the studies were men in their 40s, 50s, and 60s, i.e., those most at risk of heart attack.<\/p>\n

    "Do you really think that, in your 20s and 30s, your cells aren't accumulating damage that eventually leads to cancer, so that low-dose aspirin has nothing to prevent?"<\/p>\n

    My opinion is that the typical young person under 30 who doesn't abuse their body by smoking or excessive drinking has sufficient mechanisms to repair molecular damage so that aspirin will provide no additional benefit. Metabolism causes damage but it only becomes a problem when the body systems have deteriorated to the point where the body no longer keeps up with the damage done.<\/p>\n

    I believe that the cancer and Alzheimer prevention benefits from aspirin are due to reducing inflammation. I doubt people in their 20s typically experience mild chronic inflammation so I doubt aspirin will be beneficial. (I don't have specific papers to cite. This is just my impression from reading about cancer, Alzheimer's Disease, and inflammation for decades. I suspect you could find papers that discuss increasing inflammation levels with age and other papers that discuss the connection between inflammation and cancer and AD and other papers that discuss aspirin and inflammation reduction.) By their 40s such inflammation is common. For people in their 30s I viewed it as a toss-up.<\/p>\n

    I doubt most people in their 20s or 30s will be troubled by cancer or Alzheimer's Disease. There should be effective cures and preventative measures long before they are at significant risk.<\/p>\n","datePublished":"2011-05-19T07:29:47.877Z","author":[{"@type":"Person","name":"Fly","url":"https://www.lesswrong.com/users/fly","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":13},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":0}]}],"comment":[{"@type":"Comment","text":"

    \n

    If the studies were done 20 years ago my guess is that the original trials were performed to see if aspirin reduced the risk of heart attacks.<\/p>\n<\/blockquote>\n

    Yes. The study's full text said: "We therefore determined the effect of aspirin on risk of fatal cancer by analysis of individual patient data for deaths due to cancer during randomised trials of daily aspirin versus control (done originally for primary or secondary prevention of vascular events) in which the median duration of scheduled trial treatment was at least 4 years."<\/p>\n

    \n

    There should be effective cures and preventative measures long before they are at significant risk.<\/p>\n<\/blockquote>\n

    Hope is not a plan.<\/p>\n","datePublished":"2011-05-19T12:14:19.104Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}],"comment":[{"@type":"Comment","text":"

    \n

    Hope is not a plan.<\/p>\n<\/blockquote>\n

    I don't know if this is original, but it reminds me of the unofficial motto of Google's Site Reliability Engineering organization: "Hope is not a strategy."<\/p>\n","datePublished":"2011-06-09T22:09:29.829Z","author":[{"@type":"Person","name":"gwillen","url":"https://www.lesswrong.com/users/gwillen","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":499},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":7}]}],"comment":[{"@type":"Comment","text":"

    First I heard this phrase was a book by the Army chief of staff: Hope is not a method<\/a>.<\/p>\n","datePublished":"2011-12-23T04:46:20.805Z","author":[{"@type":"Person","name":"PhilGoetz","url":"https://www.lesswrong.com/users/philgoetz","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":3784},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":244}]}]},{"@type":"Comment","text":"

    Hm? No, that's about as official as we have.<\/p>\n","datePublished":"2011-10-22T13:25:24.046Z","author":[{"@type":"Person","name":"Baughn","url":"https://www.lesswrong.com/users/baughn","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":645},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":3}]}]}]}]}]}]}]},{"@type":"Comment","text":"

    You've convinced me to look into this. Do you have a link to the metastudy? Have you considered a top level post about this? <\/p>\n","datePublished":"2011-05-18T15:31:57.236Z","author":[{"@type":"Person","name":"jsalvatier","url":"https://www.lesswrong.com/users/jsalvatier","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":1586},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":66}]}],"comment":[{"@type":"Comment","text":"

    I got curious too and found an online copy<\/a>. Reference: Rothwell et al. (2011), "Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials", The Lancet<\/em>, vol. 377, pp. 31-41.<\/p>\n","datePublished":"2011-05-19T04:58:24.070Z","author":[{"@type":"Person","name":"satt","url":"https://www.lesswrong.com/users/satt","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":1155},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":2}]}],"comment":[{"@type":"Comment","text":"

    Fascinating - I learned several things from the full text. Have an upvote!<\/p>\n","datePublished":"2011-05-19T06:32:57.941Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}]},{"@type":"Comment","text":"

    \n

    Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials<\/p>\n<\/blockquote>\n

    Based just on the title, they seem to be looking at the wrong thing. You want to know the effect of daily aspirin on long-term risk of death, not on long-term risk of death from cancer. Your life isn't improved much if you trade death from cancer for death from (say) depression and suicide. (I have no reason to expect such a trade.)<\/p>\n

    I read the abstract too, and my concern was not changed. I have not read the whole paper.<\/p>\n

    Nevertheless, if that's the best available information, that's worth knowing. Thanks for posting it. Have an upvote.<\/p>\n","datePublished":"2011-05-20T22:35:30.028Z","author":[{"@type":"Person","name":"TimFreeman","url":"https://www.lesswrong.com/users/timfreeman","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":311},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":6}]}],"comment":[{"@type":"Comment","text":"

    I haven't read the whole paper, but I also wanted to see what aspirin's effect on all causes of death was. (I wondered whether the higher risk of bleeding would offset the lower risk of cancer; it didn't.) The magic keywords to Ctrl-F for are "all-cause".<\/p>\n

    p. 34:<\/p>\n

    \n

    The reduction in cancer deaths on aspirin during the trials resulted in lowered in-trial all-cause mortality (10.2% vs<\/em> 11.1%, OR 0.92, 0.85–1.00, p=0.047, webappendix p 4), even though other deaths were not reduced (0.98, 0.89–1.07, p=0.63).<\/p>\n<\/blockquote>\n

    p. 36:<\/p>\n

    \n

    In patients with scheduled duration of trial treatment of 5 years or longer, all-cause mortality was reduced at 15 years’ follow-up (HR 0·92, 0·86–0·99, p=0·03), due entirely to fewer cancer deaths, but this effect was no longer seen at 20 years (0·96, 0·90–1·02, p=0·37). However, the effect on post-trial deaths was diluted by a transient increase in risk of vascular death in the aspirin groups during the first year after completion of the trials (75 observed vs<\/em> 46 expected, OR 1·69, 1·08–2·62, p=0·02), presumably due to withdrawal of trial aspirin.<\/p>\n<\/blockquote>\n

    p. 39:<\/p>\n

    \n

    Fourth, we were unable to determine the effect of long-term (eg, 20–30 years) continued aspirin use on cancer death or all-cause mortality because of the finite duration of the trials.<\/p>\n<\/blockquote>\n

    and<\/p>\n

    \n

    Our analyses show that taking aspirin daily for 5–10 years would reduce all-cause mortality (including any fatal bleeds) during that time by about 10% (relative risk reduction). Subsequently, there would be further delayed reductions in risk of cancer death, but no continuing excess risk of bleeding.<\/p>\n<\/blockquote>\n

    The big caveat I have in light of this is that the trial patients were in their 40s and older. I would guess the cost-benefit balance tilts the other way for sufficiently young people because younger people have a lower risk of cancer or CVD.<\/p>\n","datePublished":"2011-05-21T05:17:36.593Z","author":[{"@type":"Person","name":"satt","url":"https://www.lesswrong.com/users/satt","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"},"userInteractionCount":1155},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"},"userInteractionCount":2}]}]}]}]},{"@type":"Comment","text":"

    \n

    You've convinced me to look into this.<\/p>\n<\/blockquote>\n

    Cool. I also convinced LukeStebbing, my best friend, to begin taking low-dose aspirin. He researched (i.e. looked up on the Internet) its interaction with moderate alcohol consumption, which I currently don't consume (although if he's right about its health benefits, I should - the problem is that there aren't any massive RCTs demonstrating a clear effect). I'm harassing him now to add a comment about what he learned.<\/p>\n

    \n

    Do you have a link to the metastudy?<\/p>\n<\/blockquote>\n

    The NYT linked to its abstract<\/a> at The Lancet's website. The full text is behind a paywall.<\/p>\n

    \n

    Have you considered a top level post about this?<\/p>\n<\/blockquote>\n

    If post-ifying long comments is kosher, I could do that - but I really have nothing more to add, except one more thing I remembered. Aspirin and its NSAID relatives share similar-but-different mechanisms of action - aspirin is special because it has irreversible effects, see Wikipedia's article<\/a> for more info. In particular, this means that other NSAIDs can interfere with aspirin (not in a way that's likely to do nasty damage to you - there are plenty of those<\/em> interactions - but in a way that blunts aspirin's special effects). As a result, while I used to occasionally take ibuprofen for headaches, when I began low-dose aspirin I stopped doing that. Now, when I have a rare headache, I'll take full-strength aspirin.<\/p>\n","datePublished":"2011-05-19T05:17:28.341Z","author":[{"@type":"Person","url":"","interactionStatistic":[{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/CommentAction"}},{"@type":"InteractionCounter","interactionType":{"@type":"http://schema.org/WriteAction"}}]}],"comment":[{"@type":"Comment","text":"

    I didn't actually do much research; I just went through several pages of hits for aspirin alcohol<\/a> and low-dose aspirin moderate alcohol<\/a>. I saw consistent enough information to convince me:<\/p>\n