The Wonder of Aspirin

Imagine a modern drug with the ability to reduce fevers, ease aches and pain, fight off inflammation, and act as an anticoagulant for heart disease patients. It might sound crazy, but a new drug with all of aspirin’s benefits would have a hard time getting FDA approval today. Chances are it would never make it to the FDA at all. In fact, if you were somehow able to rewrite history so that aspirin had been discovered this year, it is almost certain that it would die in the lab and no drug company would ever touch it.

The Test of Time

For over 2000 years, aspirin has been, and continues to be, an important medical tool. Derived from willow leaf, salicylic acid has been used for centuries to reduce fevers, headaches, and inflammation. Hippocrates—the father of medicine—made a yellow tea from it. The ancient Egyptians used willow and other plants high in salicylic acid to treat pain and fight infection. Lewis and Clark carried some, using it to reduce fevers during their expedition.

In the 1830s, physicians began experimenting with different forms of salicylic acid and prescribing chemicals related to it. At the time, these processes were deemed too difficult and time consuming, so the compounds were labeled impractical and set aside. In 1897, a German chemist named Felix Hoffmann rediscovered salicylic acid while searching for something to ease his father’s arthritic pain, and “aspirin” as we now know it was born.

An Aspirin a Day

The public first started to recognize aspirin as a “wonder drug” in the 1940s. Dr. Lawrence Craven, a general practitioner in California, noticed that aspirin reduced the risk of heart attacks in hundreds of his male patients. Craven is the first doctor to regularly recommend to his patients that “one aspirin a day” can dramatically reduce their risk of a heart attack. The anticoagulant benefit of aspirin was first publicized the same decade after clinicians observed children given aspirin-laced chewing gum following tonsillectomies bled more than those who did not chew the gum. They concluded that if aspirin could increase bleeding, then it could prevent blood clots and heart attacks. Because initial findings were published in obscure journals, the clinical recommendation to take an aspirin on a daily basis for the prevention of cardiac arrests was not immediately widely accepted. After controlled trials in the 1970s established that the earlier findings were true, doctors began routinely prescribing the drug.

Other Landmark Findings

The ability of aspirin to prevent heart attacks and strokes is now widely known. The U.S. Preventive Services Task Force (USPSTF) recommends a daily low-dose aspirin for men aged 45 to 79 and women aged 55 to 79. Research has shown that chewing an aspirin reduces the risk of death by 23% if administered when a heart attack begins. When a person takes an aspirin within the first hour of a suspected heart attack, it increases his or her chance of survival while minimizing damage to the heart. A recent landmark trial published in the New England Journal of Medicine found that a low-dose aspirin taken daily is as effective as the prescription drug Coumadin (warfarin sodium) in reducing the risks of a stroke.

Treatment with a daily low-dose aspirin for 5 years or longer has also been found to reduce the risk of colorectal cancer. Just 75 mg of aspirin each day can reduce the risk of someone developing colon cancer by up to 28%. According to some reports, several lines of evidence suggest that aspirin might also reduce the risks of other cancers, particularly those in the gastrointestinal tract. Proof of its role in fighting GI-specific cancers is still lacking, but data from a study of 25,000 patients over a 20-year period found that 1 low-dose aspirin taken daily can lower the risk of developing cancer by as much as 20%.

Most Successful Drug Ever

In recent years, Advil, Tylenol, and Aleve have been the top 3 over-the-counter pain relievers sold. Aspirin doesn’t even make the top 5. Clearly, aspirin is not the popular painkiller it used to be. Still, more than one-third of all adults, and 4 out of 5 people with heart disease, use the drug regularly. Today, aspirin is one of the most widely used and produced medications in the world.

• The most successful nonprescription medicine of all time
• A standard worldwide for pain, inflammation, and fever control
• Taken daily by millions to prevent heart attacks and strokes

As “wonderful” as this 2000-year-old drug may be, it should be noted that there are serious health risks associated with the daily use of aspirin. Its use more than doubles the risk of a severe gastrointestinal event—bleeding that is serious enough to require hospitalization. Aspirin use can also lead to asthma attacks, bleeding ulcers, and other stomach disorders. Such incidents, brought on by other oral anti-inflammatory drugs as well, are some of the most common and severe drug side effects ever seen in medical practice.

Yet, extensive clinical trials continue to serve up new uses for the drug to the medical community, specific patient groups, and the population at large.

With the onset of the “anticoagulant era,” aspirin has become known as a platelet antiaggregant widely used in medical treatments around the world. The many uses of modern-day aspirin reflect the ever-changing state of the medical industry’s eagerness to meet the needs of its patients. As the quest for more potent and effective drugs continues in this age of advanced technology, the 2000-year-old benefits of aspirin remain a constant.

Reference

1. Andermann AAJ, Cantab MP. Physicians, fads, and pharmaceuticals: a history of aspirin. McGill J Med. 1996. http://www.medicine.mcgill.ca/mjm/v02n02/aspirin.html.
2. Fascinating facts about the invention of aspirin by Felix Hoffmann in 1897. Idea Finder website. http://www.ideafinder.com/history/inventions/aspirin.htm.
3. History of aspirin. ASPREE website. http://www.aspree.org/AUS/aspree-content/aspirin/history-aspirin.aspx.
4. Landau E. From a tree, a ‘miracle’ called aspirin. CNN website. December 22, 2010. http://www.cnn.com/2010/HEALTH/12/22/aspirin.history/.
5. Rothwell PM, Fowkes FGR, Belch JFF, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet. 2011;377(9759):31-41. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62110-1/abstract.
6. Sollitto M. Chew aspirin to increase the chance of surviving a heart attack. Aging Care website. http://www.agingcare.com/Articles/chrew-aspirin-for-heart-attacks-142328.htm.