Here’s a quick drug quiz: How many medicines do you know that are over 120 years old, are readily available and cost a few pennies a pill? And that’s for the brand, not the generic. As far as we can tell, there is only one: aspirin! Bayer aspirin is available for a tad more than a nickel a pill. The Bayer label calls it “THE WONDER DRUG.” Does that translate to aspirin a miracle? New research suggests that as little as 100 mg of aspirin daily appears to reduce the likelihood that older people will develop type 2 diabetes by 15% (2003 meeting of the European Association for the Study of Diabetes). More about that shortly!
Why Are Doctors Now Down on Aspirin?
There was a time when many physicians recommended routine use of low-dose aspirin to prevent heart attacks and strokes. Many doctors are now negative about aspirin. To the question: Is aspirin a miracle? they might reply, no! It’s a menace.
Although people who have had heart attacks or who have been diagnosed with cardiovascular disease [CVD] may still be told to take low-dose aspirin, most others have been warned away. Whenever there is a negative report about aspirin, it seems that a lot of doctors are happy to pile on.
The U.S.Preventive Services Task Force put out a “Final Recommendation Statement” on April 26, 2022:
“The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older.”
“The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small.”
What About NSAIDs?
We do not disagree with these statements. Aspirin can be very irritating to the stomach lining. Even low doses can cause stomach irritation, lesions or even bleeding ulcers. All NSAIDs (nonsteroidal anti-inflammatory drugs) can do this, however.
We wish doctors were as concerned about certain drugs they prescribe such as celecoxib, diclofenac, ibuprofen, meloxicam or naproxen. Not only can such NSAIDs cause the same kind of stomach irritation and bleeding that is seen with aspirin, these drugs can also trigger many other adverse reactions. NSAIDs can raise blood pressure and increase the risk for heart attacks and strokes. (Aspirin, on the other hand, lowers the risk for heart attacks and ischemic strokes). Heart failure is another complication of NSAIDs along with fluid retention, liver and kidney damage.
The Latest on Aspirin vs. Diabetes:
At the meetings of the European Association for the Study of Diabetes between October 2-6, 2023, Australian researchers will present evidence that low dose aspirin could reduce the risk of diabetes by about 15% in older people. Over 16,000 volunteers were randomized to receive either 100 mg aspirin or placebo.
They were followed for about 5 years. Those taking aspirin had better blood sugar control than those on placebo. They were also more likely to develop intestinal bleeding, however. No one should take aspirin on a regular basis without medical supervision.
Aspirin-Like Drug Salsalate vs. Diabetes:
We’ll bet you have never heard of salsalate (Disalcid). It is a kissing cousin of aspirin. This drug belongs in the class of medications called salicylates. Aspirin is acetylsalicylic acid. Salsalate has had the acetyl group removed (non-acetylated salicylate, aka salicylsalicylic acid). OK, that’s a tad too much medicinal chemistry for most folks. The bottom line is that salsalate is a chemical cousin of aspirin.
Salsalate is prescribed (it is a prescription salicylate) to ease inflammation, just like aspirin. The FDA has approved its use for osteoarthritis and rheumatoid arthritis along with other rheumatic disorders. A fascinating article published in the journal American Health & Drug Benefits (June, 2014) was titled:
“Salsalate, an Old, Inexpensive Drug with Potential New Indications”
The authors note:
“Salsalate has been suggested as a possible treatment for diabetes as early as 1876 and as recently as in a 2013 study.”
Please note the date! That was nearly 150 years ago, before insulin or other treatments for diabetes. The article goes on to state:
“As shown in this review, salsalate therapy at the dose of 3 g to 4.5 g daily can lower insulin resistance and reduce the levels of glucose, triglycerides, and free fatty acid concentrations with minimal side effects. This inexpensive medication could be a useful option in the treatment of prediabetes. Larger clinical trials are needed, but the data are encouraging and should lay the foundation for further investigation and grant funding.”
Based on prior research, it should not come as a huge surprise that salicylates like aspirin could lower blood sugar levels. Sadly, no drug company is likely to spend the money to test aspirin or salsalate against prediabetes or diabetes. No patent = no big financial bonanza.
A Little Aspirin History:
The roots of AcetylSalicylic Acid (ASA, aka aspirin) can be traced back over 3500 years. Healers in ancient Egypt and Sumeria used willow bark to ease pain and lower a fever (Vascular Pharmacology, Feb. 2019). Hippocrates, the father of modern medicine, told women in labor to chew willow bark to ease pain. The Greek physician Dioscorides gave willow bark to his patients for inflammation during the first century.
In 1828 a German pharmacologist isolated the active ingredient, salicin, from willow bark, and in 1838 it was given the name we know today – salicylic acid. By the mid 1850s, Germany dominated the willow bark business.
Tummy Trouble:
Natural forms of aspirin were tough on the tummy:
“Users of the time compared them to having fire ants in the stomach” (Wall Street Journal, Feb. 19, 1988, p. 1).
The Human Guinea Pig:
Soon synthetic variations became available. By 1877, British, German, and French physicians had reported treatment success for rheumatic fever, rheumatoid arthritis, and gout. Unfortunately, these salicylate derivatives were also hard on the digestive tract.
Dr. Felix Hoffman, a German chemist charged with developing dye for the Bayer company, began searching for something better. He synthesized pure acetylsalicylic acid on August 10, 1897.
The story, which has been challenged, attributes this development in part to Hoffman’s arthritic father. He was taking sodium salicylate and complaining bitterly of stomach pains.
In 1898, Dr. Hoffman’s father became a guinea pig for acetylsalicylic acid and found that it was more effective for his arthritis and less irritating to the stomach. On March 6, 1899, the official trade name Aspirin was granted to Bayer AG. The drug was launched later that year.
A Different Perspective:
Here is a different history of aspirin. It is a tale of Nazi Germany and a Jewish chemist by the name of Arthur Eichengrun. He was Hoffman’s superior. After World War II ended, he wrote that he directed Hoffman to synthesize aspirin. It is speculated that anti-Jewish sentiment in the 1930s led to the credit going to Hoffman. Read about the aspirin controversy in the BMJ (Dec. 23, 2000).
Aspirin and the Spanish Flu:
Aspirin became enormously successful during the flu epidemic of 1918 because it was effective in lowering a fever. There is controversy about this too.
The influenza epidemic of that era infected approximately 500 million people and killed tens of millions worldwide. Fever was a hallmark of the disease.
Aspirin became the drug doctors turned to in order to control the fever. That may have been in part because of an advertising campaign in August 1918 promoting aspirin to lower a fever.
Some experts now believe that (Clinical Infectious Diseases, Nov. 15, 2009):
“…aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively.
“In summary, just before the 1918 death spike, aspirin was recommended in regimens now known to be potentially toxic and to cause pulmonary edema and may therefore have contributed to overall pandemic mortality and several of its mysteries. Young adult mortality may be explained by willingness to use the new, recommended therapy and the presence of youth in regimented treatment settings (military). The lower mortality of children may be a result of less aspirin use.”
Some experts now believe that aspirin and other NSAIDs (like ibuprofen) may block antibody production, essential for mobilizing an immune reaction to viral infections. This may have led the French Health Minister to suggest that ibuprofen and other NSAIDs be avoided during the coronavirus pandemic. Read more about this controversy at this link:
Should You Avoid Ibuprofen for COVID-19 Fever?
The French Minister of Health recently warned his nation not to take ibuprofen for COVID-19 symptoms. Did he frighten people without cause?
Aspirin a Miracle for the Heart?
A family physician in California in 1948 was the first to apply aspirin’s blood thinning properties for heart attack prevention. Dr. Lawrence Craven gave his tonsillectomy patients the brand-new aspirin-containing chewing gum Aspergum to relieve post-op pain. Some liked it so much that they chewed more than he had prescribed. They developed bleeding and sometimes needed to be re-hospitalized.
Instead of giving up on aspirin, though, Dr. Craven realized that the anticoagulant properties of the drug might help prevent heart attacks. He began an informal study and published his positive results in the journal Annals of Western Medicine (Feb. in 1950).
Dr. Craven’s discovery was mostly ignored by the medical establishment. But in the 1970s, researchers began to study aspirin as a way of preventing heart attacks. In 1989 the American College of Chest Physicians recommended one aspirin daily for people at risk of coronary artery disease. The cardiologists may have been encouraged by the results from the Physicians’ Health Study (New England Journal of Medicine, July 1989).
In this study, more than 20,000 doctors were randomly assigned to take aspirin or placebo for about five years. Those taking aspirin were 44 percent less likely to experience heart attacks, though this benefit was seen primarily among men over 50 years old.
During the subsequent decades, aspirin became a staple for heart attack prevention. Many physicians considered aspirin a miracle and prescribed it liberally. The Bayer label, “THE WONDER DRUG,” seemed appropriate.
Then the risks of bleeding ulcers or even hemorrhagic (bleeding) strokes began to loom large in medical recommendations. People were advised not to take aspirin for prevention unless they were at extremely high risk for heart disease.
Aspirin a Miracle Against Cancer?
Not long ago, health care providers began to recognize that the pendulum may have swung too far against aspirin. The United States Preventive Services Task Force recommended low-dose aspirin to prevent heart disease and colorectal cancer for people in their 50s with at least a 10 percent risk of heart disease over the next decade (Annals of Internal Medicine, April 12, 2016). [As noted at the top of this article, the USPSTF has changed its mind a bit about aspirin. It is more cautious about routinely recommending aspirin to people in their 50s unless the heart attack risk is pretty high.]
Colorectal cancer is not the only malignancy that is less common among aspirin users. A Swedish study concluded that low-dose aspirin significantly lowers the risk of liver cancer (HCC) among those at high risk (New England Journal of Medicine, March 12, 2020).
Moreover, a meta-analysis published in JAMA Internal Medicine (March 1, 2020) concluded that aspirin was just as effective as pricey anticoagulant medicines for preventing dangerous blood clots after hip or knee replacement. People taking aspirin were no more likely to have serious side effects compared to other anticoagulants.
So…Is Aspirin a Miracle or a Menace?
All drugs have side effects. All you need to do is watch pharmaceutical ads on television. The announcer frequently rattles off side effects for drug X that can cause heart attacks, strokes, kidney damage, hallucinations, liver failure or death. We need to recognize that there is always a downside to medications, even if they can be purchased over the counter. Anyone who takes aspirin regularly should be under medical supervision.
Even after 100 years, aspirin continues to reveal new benefits. Like all drugs, though, it has benefits and risks and needs to be treated with respect.
Would you like to learn more about whether aspirin is a miracle or a menace? Here is a link to the anticancer potential of aspirin:
The Resurrection of Aspirin as an Anticancer and Pregnancy Drug
We used to say that aspirin was the Rodney Dangerfield of drugs…it didn’t get much respect. New evidence suggests aspirin as an anticancer agent should.
Share your own thoughts about aspirin in the comment section below. What do you think? Is aspirin a miracle or a menace?
