I didn’t really expect much from 2026, but it’s still discouraging that it’s only the first week of January, and I am feeling compelled to say that you shouldn’t quadruple the recommended dose of a medication.
In a Wall Street Journal interview published Jan. 1, President Donald Trump’s physician confirmed that Trump is taking a full dose of aspirin, 325 mg daily, for “cardiac prevention.” Trump told the newspaper, “They say aspirin is good for thinning out the blood, and I don’t want thick blood pouring through my heart. I want nice, thin blood pouring through my heart. Does that make sense?”
I don’t want thick blood pouring through my heart. I want nice, thin blood pouring through my heart.
President Donald Trump
Aspirin doesn’t thin the blood — it is a platelet inhibitor that keeps clots from forming and blocking blood vessels. And a low-dose aspirin, — that is 81 mg — is recommended for some people to prevent a first heart attack or stroke. But Trump is taking four times that amount. “They’d rather have me take the smaller one,” he said. “I take the larger one, but I’ve done it for years, and what it does do is it causes bruising.”
For people’s Trump age, the harms of even a low-dose aspirin, including gastrointestinal bleeding, generally outweigh the benefits. So its routine use is generally not recommended by the U.S. Preventive Services Task Force (USPSTF) or the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Practice Guidelines.
There might be individual situations, including high risk for cardiovascular disease, that cause a physician to recommend 81 mg of aspirin daily to someone who’s almost 80. This may be the situation for Trump. In 2018, White House physician Ronny Jackson reported the president had high cholesterol and a high coronary artery calcium score, which indicates atherosclerosis. In these circumstances, the decision to start a medication with a non-zero risk for harm involves a discussion with a health care provider — and one’s own preferences.
Trump’s decision is different yet, in that, contrary to what he says his medical team has recommended, he is taking four times the preventive dose of aspirin, even though the ACC/AHA guidelines emphasize that while the risk of bleeding goes up with dose increase, the benefits of low dose and high dose aspirin are similar. In other words, a high dose of aspirin adds a negative with no counterbalancing positive.
When calculating risk of harm, the 81 mg to 325 mg aspirin dose difference is clinically meaningful. In my trauma center, for example, when we see a patient with an intracranial hemorrhage after a fall, we typically decide that those on low-dose aspirin are safe to go home after a brief period of observation. For those on a full dose of aspirin, we require a neurosurgical evaluation and admission to the intensive care unit due to high risk for poor outcomes.
Everyone should make the medical decisions they feel are best for them, in consultation with their doctors and after considering the risks and benefits. One only hopes the decisions people make fall within safe and reasonable parameters.
When calculating risk of harm, the 81 mg to 325 mg aspirin dose difference is clinically meaningful.
But it isn’t just about the aspirin. It’s really what’s reflected in the pulsing bravado of Trump blowing off professional advice, even that of his handpicked medical team, and the messaging that no authority or expertise needs to be taken seriously.
Trump casually dismissing national evidence-based recommendations from his doctors hits a deeper nerve in the context of his administration’s attack on the preventive services task force mentioned above. USPSTF’s recommendations support up-to-date, evidence-based health care across the nation, influencing practice decisions and insurance-covered services for millions of Americans each year. But their integrity is under grave threat, both because of large cuts to the scientific processes that fuel their development, and because of Health and Human Services Secretary Robert F. Kennedy Jr.’s interest in replacing its panel of experts. Kennedy Jr. has already replaced the members of the Advisory Committee for Immunization Practices to disastrous effect. Trump’s illogical quadruple dose of aspirin and his scorn for the standards and processes that advise against it connect in a straight line to the structural changes he’s inflicted on scientific and public health functions vital to this nation. The very oxygen has been taken out of our federal scientific research enterprise; the Centers for Disease Control and Prevention is so compromised in its functions that individual states and organizations have taken up the responsibility of maintaining evidence-based guidance around topics such as immunizing children against dangerous diseases. We’ve lost dozens of public health services and resources around the country, not to mention our withdrawal from global public health efforts, which affect the health and safety of our own country. It’s a topsy-turvy world. We are in the middle of the largest measles outbreak in 30 years. Annie Andrews, a pediatrician running for the Senate from South Carolina, which has reported 188 measles cases since July, is aptly running on the slogan, “It’s me or the measles.” Meanwhile, Kennedy is recommending cod liver oil over vaccines. I can say with confidence it’s going to be a long, long year for public health.
Dr. Esther Choo
Esther Choo, M.D. M.P.H., is an emergency medicine physician, health policy researcher and founding member of Equity Quotient, a company that advises organizations on building cultures of equity. She has provided commentary on the pandemic and other health care topics through appearances on MSNBC, CNN, the BBC and Yahoo! Finance and editorials published in The Lancet, the British Medical Journal, The Washington Post, NBC Think and USA Today. 
