“Meet Virginia” is, I believe, one of the great rock singles of recent decades. It opens with a blue-sy, core-bending bassline and a thirsty guitar riff, as Pat Monahan etches a fantasy vamp. You will not forget Virginia.
“Train” is the band’s eponymous first album, and with other tracks like “Free”, “I Am”, “Egglpant”, and “Rat”, it does not falter. Incredibly, it’s nearly matched by “Drops of Jupiter”, their second album. “She’s on Fire” and “It’s About You” are lyrically brilliant curtains of sound, and the title track is a magical tribute to Monahan’s deceased mother. And yet it’s the deep cut, “Mississippi”, that closes the circle: Train makes albums. Old school, full-package, musical journeys. Not singles. Albums.
Which brings me to Donald Trump’s colorful hand, photographed and transmitted around the world this week:
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While media outlets fluttered joyously over the president’s mysterious (possibly fatal!) affliction, my first thought was of “Bruises”, a song by Train. In it, Monahan and country singer Ashley Monroe re-connect after years, to find loss and pain have changed them. The chorus digs into a lesson learned by anyone who's been to their high school reunion: “We all got bruises.” Take heart, DJT, you’re not alone.
Known in medical lingo as ‘ecchymosis’, bruises are bleeding under the skin. They happen with minor (or major) trauma, but sometimes they pop up spontaneously. As people age, the skin’s superficial vessels become increasingly fragile and bruising more common. Rarely, bruising is the flag for a disease—but rarely. When a man approaching 80 shows up with a hand bruise, it’s usually meaningless.
But then we learned that Trump takes daily aspirin—DUN-DUN. And, at a higher dose than normal—DUN-DUN-DUN.
There’s lots of data on the pros and cons of daily aspirin, which inhibits platelets and therefore makes blood clotting a bit less efficient. For a quick review (with help from Bill Murray in Meatballs) check out last year’s “It Just Doesn’t Matter.” In it I write (and talk) about how recent trials re-confirmed what I found in 2015 after reviewing the data: For people without known heart disease, daily aspirin is, on balance, more harmful than helpful.
But as the NY Times highlights in their finger-wagging explainer about Trump’s aspirin addiction, until 2022 the USPSTF (United States Preventive Services Task Force) was recommending daily aspirin.
Why?
The USPSTF and I saw the same data, but they’re bad at translating it. Which is sad, since their reviews set standards for insurance (insurance is legally forced to pay for many tests and treatments that are provably worthless because of the USPSTF). But I’ve discussed the task force’s failures, and while I believe there are good, well-intended people there, it was 100% predictable that aspirin would fail in the recent primary prevention trials—because it already had.
But I digress.
The bigger point here is that aspirin is a wonderful example of a preference-sensitive medicine. That is, people should know the pros and cons—and choose their poison. So here’s the (summarized) deal on daily aspirin for primary prevention:
* It does NOT reduce mortality (i.e. it doesn’t prevent death).
* It DOES prevent nonfatal heart attacks and strokes, for about 1 in every 250.
* It CAUSES bleeding in the brain for 1 in 1,000.
* It CAUSES other life-threatening bleeding (mostly gastrointestinal) for 1 in 200.
We can turn this into an easy comparison: For every 1,000 who take daily aspirin for primary prevention, 4 avoid a heart attack or stroke, 1 bleeds in their brain, and 5 have a different life-threatening bleeding problem.
A few factoids: First, any heart attack or stroke aspirin prevented was likely to be followed by full recovery. Meanwhile, bleeding in the brain is real real bad and typically leads to serious long term disability. Finally, the other bleeding problems mean hospitalization and treatment, but they too are rarely fatal and lead to full recovery.
So what does it all mean for our fearless leader, the new President of Venezuela?
There’s a better chance Trump will be harmed than helped, and he won’t live longer. BUT HE GETS TO CHOOSE. Perhaps he’s most afraid of a nonfatal heart attack or stroke, and doesn’t mind hand bruises and a 1 in 200 chance of serious bleeding. Though he IS taking a bigger dose of aspirin than in most trials, so his chance of bleeding is even a bit higher.
But the worst part for him, it seems to me, is that the press will be waiting for him to bleed, then lapping it up like a parched vampire. They will hover like vultures to bathe in the world’s most public case of bloody schadenfreude.
But in reality, as the tiny numbers for aspirin make clear, whether he bleeds or doesn’t, has a stroke or doesn’t, and dies or doesn’t, is far more likely to be determined by his genes, lifestyle, and luck.
Which calls to mind another Train song, “Calling All Angels.” Trump should check it out.
