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Aspirin and Deadly Reye's Syndrome: Warnings Can Be Missed

May 31, 1987|LARRY DOYLE | United Press International

Jessica Van Dyke was an exceptionally bright 13-year-old. Her parents cannot believe she would have taken aspirin for chicken pox if she had thought it anything but safe.

"Our philosophy has always been, when there's any doubt, you don't do it," said Roger D. Heller, her stepfather. "That's what we always taught Jessica."

Jessica liked to write poetry and played field hockey at Wiley Middle School in University Heights, a suburb of Cleveland. She came down with chicken pox the week she was to perform in a school production of "Bye Bye Birdie," the 1960 play that launched her grandfather, Dick Van Dyke, as a stage and screen star.

On the last Monday in March, Jessica, fighting a slight fever, took four tablets of acetylsalicylic acid, the substance known for nearly 100 years as aspirin.

Three days later she began vomiting. An infection--medical science has yet to isolate the cause--had entered her brain and liver. She entered Rainbow Babies' and Children's Hospital, where she died April 6.

"God knows," her stepfather said, "we never knew about Reye's syndrome."

Recently Identified Illness

The illness that killed Jessica Van Dyke is rare. Reye's syndrome progresses from vomiting to disorientation to loss of consciousness, sometimes with convulsions. It is almost always serious and often fatal. First identified in 1963, the federal Centers for Disease Control did not keep continuous records on it until 1977.

As of Aug. 22, 1986, known American cases of Reye's totaled 2,729. Of these patients, 1,135 had died and about a third of the others had suffered serious brain damage. The oldest fatality was 59, but only a few were older than 20.

Research has found that more than 90% of those young victims first came down with chicken pox or the flu, then took aspirin or a similar medication.

Jessica's parents had heard something about Reye's syndrome afflicting small children with the flu, but nothing about chicken pox. "We had no conception that Reye's was a disease that could affect a 13-year-old," Heller said.

It was "horrible irony," he said that just four days after Jessica died, the Public Health Service published a major study showing a fortyfold increased Reye's risk associated with aspirin.

That study was not the first, however. Medical authorities have advised since 1982 that children and teen-agers should not be given aspirin for chicken pox or influenza, and all aspirin labels have carried mandatory warnings since May 30, 1986.

Warning on Bottles

"I know," Heller said. "We looked, and they're there. It's a little difficult to read, of course, and we have old aspirin bottles that don't have it on it.

"And who reads aspirin bottles?"

Aspirin makers say that the labels clearly warn that a doctor should be consulted before the medication is given to children with chicken pox or the flu. The warning mentions Reye's syndrome, but does not say why.

Jessica's parents did talk with her doctor. He did not tell them to give her aspirin, but he did not tell them not to. The Hellers also had consulted several medical guides, one of which they had bought only two months before. No book warned them against giving aspirin to a child with chicken pox. In fact, at least one guide recommended it.

Seven years have passed since the first evidence linking Reye's syndrome and aspirin was published in the journal Pediatrics. It has been five years since the Food and Drug Administration first called for warning labels.

Five major government studies since 1980 have shown the same link, and each subsequent study has sent a stronger, clearer message, yet the mandatory warnings are less than a year old. The current edition of Dr. Spock's Baby and Child Care Book recommends aspirin for flu symptoms, and gives dosages.

Industry Pressure Blamed

Some government researchers, public health authorities and consumer activists say that the aspirin industry has made every attempt to delay or prevent the widespread publication of information that threatened aspirin sales. They also charge that the deregulation-minded Reagan Administration helped to further that goal, at least in the beginning.

Dr. Sidney M. Wolfe, director of the Public Citizens Health Research Group, a Washington-based consumer lobby founded by Ralph Nader, is highly critical of aspirin companies:

"They have put pressure wherever they could, and they have been responsible for the years' delay in getting these warning labels," he said. "None of these companies has been anything but horrendous about this."

Dr. Edward Mortimer Jr., professor of epidemiology, biostatistics and pediatrics at Case Western Reserve University in Cleveland, also questions the Administration's role in the matter.

Mortimer, a consultant to the FDA, says that the Reagan Administration has been too willing to accommodate industry, and that federal policies designed to remove cumbersome regulations have also limited the government agencies' ability to act effectively on matters of public health.

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