For the Sake of Heaven
On Aspirin, Medical Research, and the Confluence of Cardiology and Rabbinics
© Photo by Bertie
Sometimes things fit together in unexpected ways.
Last week, my colleague sent me her synagogue’s newsletter written by the rabbi. I started reading, and before I knew it, the rabbi was telling a story featuring… me.
He described coming in for a routine checkup. He was in great shape, exercised regularly, felt fine. But a few red flags in his history caught my attention, and I recommended cardiac testing. He humored me, and the tests showed a critical blockage in his left main coronary artery. A cardiologist placed a stent, likely preventing an unexpected heart attack.
Lucky for him, admittedly gratifying for me.
Then, just this week, two articles in the New England Journal of Medicine landed with uncanny relevance: both addressed whether we should stop aspirin early after treating acute coronary syndromes, essentially the exact situation my patient is now in.
The first study, by Tarantini et al., found that in low-risk patients with myocardial infarction who’d had complete revascularization, stopping aspirin after one month and continuing a P2Y12 inhibitor alone was noninferior to dual therapy and caused less bleeding.
The second, by Guimarães et al., found that in a broader acute coronary syndrome population, early aspirin withdrawal was not noninferior for preventing death or ischemic events—though again, bleeding was reduced.
(By the way - “not noninferior”? In fact - not the same as inferior. One day I’d love to write a blog post just on that).
The editorial boiled the message down to this: ultra-early aspirin withdrawal (within days) appears unsafe; withdrawal after a month may be reasonable for carefully selected low-risk patients; but we still don’t know exactly who those patients are.
Not exactly earth-shattering (but nevertheless, not non-earth-shattering).
Meanwhile, I have no idea whether any of this will change my patient’s management. I’ll find out at his follow-up and from his cardiologist. But the convergence of his story and these journal articles reminded me of what I love about medicine when it’s done right.
I love that the NEJM is willing to publish studies that tug in opposite directions - not because the editors like contradiction but because they understand that medical knowledge progresses by triangulation.
I love that they headlined research with inconclusive results - which pushes back against the escalating pressure to trumpet splashy findings.
I love that these studies revolve around aspirin, the cheapest, most generic drug we have, which means the science in this case wasn’t driven by market pressures that can bias medical research.
And most of all I love that the results aren’t theoretical; they matter immediately to a real human being whose life - and by extension the lives of those around him - will be impacted by the outcome.
Maybe because my patient is a rabbi, the whole thing called to mind something I encounter in Talmud study: the idea that truth emerges not from conformity of ideas but from disagreement. Debate and opposing views can either clarify or distort, depending on motive. In Jewish thought, arguments “for the sake of heaven” are the main path to truth; arguments “for their own sake” are mainly a path to discord.
Despite everything, I think medicine still aims for the former. The arena may be messy, the evidence incomplete, the conclusions provisional, the incentives misaligned and sometimes even perverse - but then there’s the patient.
Not the customer; not the consumer; not the client; not the guest - the patient- whose human presence in the exam room can still cancel the noise, purify the motives, and root the debate in an honest search for truth.