Aspirin Starts 2nd Century as a Wonder Drug : Medicine: An old remedy turns out to have surprising importance. Its regular use can prevent heart attack, stroke and other ailments.
In the late 1800s a German scientist, looking to help his arthritic father, gave the 20th Century a cure for the next 100 years of headaches: a little white pill called aspirin.
That same little white pill has been rediscovered as a wonder in recent years. It no longer just relieves headaches or the joint pain of arthritis.
* Aspirin, it turns out, can preventing heart attacks and probably strokes.
* It seems to act in some way against cancer of the colon.
* It counters a sometimes fatal hypertension during pregnancy.
* It seems to slow the development of cataracts in the elderly.
* And it may enhance the ability of the immune system to fight off viruses and bacteria.
Yet, for all its widespread use for a century, aspirin remains one of the great medical mysteries. No one had an inkling as to how it worked, what it did in the body, until 1970. Even now, scientists wonder if they know it all.
Today Americans take more than 29 billion aspirin or aspirin-combination tablets a year--80 million a day. About 40% of them are taken for headaches, and they work. They work so well, in fact, that the little white pill has a strong psychological effect. One study found that some people felt relief when they only thought they were taking aspirin but weren’t.
Through the annals of modern medicine scientists and doctors extol the little white pill.
Dr. Charles Hennekens of Harvard Medical School and Boston’s Brigham and Women’s Hospital said:
“In a sense, aspirin is as old as medicine, because Hippocrates used the leaves and bark of the white willow tree--extracts from them--to relieve the aches and pains of his patients, which included women in labor. . . . So we’ve jumped from 500 BC to 1900, and in the next 100 years aspirin became the most widely used drug in the world.”
In 1948, when modern aspirin was just 50 years old, medical literature included 4,000 published reports on aspirin. In the 10 years from 1975 to 1986, 4,000 more were published.
In short, science is still probing and finding new uses for the little white pill.
Not all its effects are virtuous. Scientists knew early on that aspirin irritated the stomach and found ways to coat or buffer it so it would pass through to the intestines without causing harm.
In 1963, an Australian pathologist, R. D. K. Reye, implicated aspirin in a strange disorder that was given his name--Reye’s syndrome. Some children who took aspirin while recovering from influenza or chickenpox began to vomit and later showed signs of brain involvement ranging from sleepiness to aggressive behavior.
Though aspirin was not shown to be the cause, the evidence was strong enough in 1986 for the British Committee on Safety of Medicine to recommend that aspirin not be given to children under 12 except on a physician’s advice.
In any case, the occurrence of Reye’s syndrome is rare.
Aspirin is a non-prescription drug useful against ailments that require prescribed remedies.
“The more we learn about the science, how (aspirin) interacts in the body, there may be even more uses,” said Dr. Thomas Bryant, president of the Washington-based Aspirin Foundation lobby.
“But one must hasten to add it’s not a panacea, not a magic pill. People shouldn’t rush out and start taking a lot of aspirin. You don’t take it without some consequences. You can’t take a lot of it, and people should be aware of that. You should consult your physician and see if you are one of those who can benefit from it.”
Insights into aspirin’s marvels pile one upon the other. Twice aspirin research has won Nobel Prizes.
In 1970, John Vane, working with colleagues of London’s Royal College of Surgeons, showed that small amounts of aspirin irreversibly block an enzyme in blood platelets that causes the platelets to stick together, or clot. The same enzyme is part of the process that makes blood vessels clog up and leads to heart attacks and strokes. Vane won his Nobel Prize in 1980.
Another Nobel Prize-winning discovery, by Bengt Samuelsson of the Stockholm’s Karolinska Institute, uncovered another of aspirin’s actions. Samuelsson, working with Vane and others, found hormone-like chemicals called prostaglandins in the prostate gland (hence the name). It turned out that these chemicals are almost as ubiquitous as aspirin. They are produced throughout the body and affect everything from digestion and reproduction to circulation and the immune system.
Excess prostaglandins cause myriad ailments such as headache, fever, blood clots, menstrual cramps, inflammation and some aberrations in immune response.
Scientists then discovered that aspirin thwarts production of prostaglandins, which explains why it is useful against so many of those ailments.
Prostaglandins also help protect the stomach, which explains why aspirin sometimes upsets the stomach.
This year scientists from the Boston University School of Medicine reported another use for aspirin. They studied more than 1,300 patients with colon or rectal cancer and concluded that aspirin’s anti-prostaglandin action might help to retard development of such cancers. Regular use of aspirin, they reported in the Journal of the National Cancer Institute, may significantly lower one’s risk of bowel cancer.
Probably the most significant finding is that “an aspirin a day” reduces the risk of heart attack. It also can prevent a second heart attack and dramatically reduce the chance of death.
Hennekens and his cohort, Julie Buring, have tracked aspirin’s effectiveness in a number of ailments, including prevention of migraine headaches. They have mounted large random studies of thousands of doctors and nurses, some given aspirin and some not, to measure the effects of the little white pill.
Hennekens said results of earlier and smaller studies, grouped together, indicated that heart attack and stroke patients “had lower risk of developing subsequent heart attack, lower risk of developing subsequent stroke, actually a 15% lower risk of death.”That so impressed the Food and Drug Administration that in 1985 it ruled that aspirin could be prescribed for treatment in survivors of heart attack.
Armed with those statistics, researchers mounted a random study that found that if you gave aspirin “within 24 hours immediately following the symptoms of a heart attack, you would find they would have a significantly lower rate of a second heart attack, a subsequent stroke and death, a 23% lower death rate over five weeks and this difference persists up to one-year follow-up.”
When those statistics came out, Hennekens says, only about one in three patients having a heart attack were given aspirin.
“I’m told that now it’s up to 60% or so, but that’s too low because in the United Kingdom and Europe almost everybody who comes in for treatment of a heart attack gets aspirin.
“And unless there’s a specific contraindication, that is they are allergic or they are actively bleeding at the time they come in, aspirin should be the drug of choice.”
Dr. Richard Peto of Oxford University, who works with the Harvard team, says that half an aspirin a day would save 10,000 lives a year for every million people treated.
“The curse is,” he observed ruefully, “that the drug is so bloody cheap that nobody takes it seriously.”
The Harvard team has assembled 22,071 physicians in what is called the Physicians’ Health Study to better understand the limits of aspirin therapy. They asked the question, “What about the apparently healthy person?”
Initial results show a 44% decrease in first heart attack among middle-aged men. More study is needed to confirm the statistical effectiveness in stroke.
But considering that 936,000 Americans die every year of cardiovascular disease, the impact can be considerable.
The same Harvard team has assembled a separate study group composed of almost 88,000 women from 30 to 55. Called the Nurses’ Health Study, its early results conclude that the use of one to six aspirin a week apparently reduces the risk of first heart attack among women. The group is the subject of a randomized trial in which women over 50 will be given low-dose aspirin--less than a baby aspirin a day to measure more precisely the effects.
The American Cancer Society drew on its ongoing mortality study called the Cancer Prevention Study II, composed of about 662,000 men and women. By analyzing their self-reported use of drugs, the researchers concluded that “regular aspirin use at low doses may reduce the risk of fatal colon cancer.”
It confirms a laboratory study in which aspirin and other non-steroidal anti-inflammatory drugs were found to inhibit colon tumors in rodents. But clearly a randomized, double-blind study, in which some people get aspirin or other anti-inflammatories and some do not, is indicated for more definite results.
Dr. Judith Hsia of George Washington University has been looking into aspirin’s effect on the immune system.
“What we’ve found is that in normal adults aspirin stimulates production of naturally occurring proteins that regulate the immune system, interferon and interleukin-2.”
These are effective virus-fighters and are used as chemotherapeutic agents, but they are expensive and quite toxic in that mode.
One of the thoughts was if you could reduce the amount of these drugs by giving aspirin at the same time, you might enhance their effectiveness and save money at the same time, Hsia says.
So her research team gave volunteers colds by having them inhale cold viruses. The patients were then locked up in a hotel for five days and fed by room service, given aspirin, and their nasal mucous, tissue use and fevers were measured, as well as their interferon and interleukin production.
Unfortunately, it did not show any benefit from the aspirin so far as the cold symptoms or transmission was concerned.
But it did show that the interferon and interleukin-2 production increased in the aspirin group and not in the group given placebo.
“What we are looking at now is aspirin to improve flu shot responses,” Hsia says. “The reason we are doing this is that there are large segments of the population that are not getting good protection from vaccination, especially the elderly and people with chronic medical problems like diabetes or HIV infections. Of course these are the very people who need to have the best protection against flu.”
If aspirin can enhance the immune response in the 281 elderly people in the sample, she says aspirin can have a lot of public health implications, since it is cheap and readily available in Third World countries.
They did a study last winter on “old mice” and the ones that received aspirin did much better than the ones given placebo.
Certainly the little white pill devised by scientist Felix Hoffman, working for the Bayer Division of I.G. Farben in 1898, has come a long way. His arthritic father had been taking sodium salicylate in massive doses but it caused chronic and acute stomach troubles which were worse than the disease they were intended to cure.
Hoffman hit on the less-acidic acetylsalicylic acid, which was effective in much lower doses. Bayer patented aspirin in 1899, deriving the name from the spirea plant, which has quantities of the naturally occurring chemical.
But even Hennekens advises that the drug is not a blank check, not a quick fix. “In society today people would rather be prescribed something that would reduce their risk of disease than proscribed some things that might cause it,” he says.
Anyone who takes aspirin instead of quitting smoking is not reducing his risk of heart disease, he says. “And even if we prove that aspirin reduced the risk of colon cancer, the benefits from the aspirin would be less than the benefit of weight loss, more exercise and a prudent diet.”
Hennekens points to a cartoon of a fat man smoking a cigarette who orders a burger, french fries, a shake and an aspirin.
“Got to take care of the old ticker, you know,” he explains to the take-out clerk.
