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An Aspirin a Day
The Wonder Drug that Could Save Your Life
By Keith Souter, David Woodroffe
Michael O'Mara Books LimitedCopyright © 2011 Michael O'Mara Books Limited
All rights reserved.
ASPIRIN: THE HIGHLIGHTS
This book, in its entirety, offers a comprehensive and detailed analysis of aspirin, describing how it could help you with a range of medical conditions and providing an in-depth examination of the many ground-breaking studies into aspirin's role as a preventative drug.
However, this chapter simply presents the stark highlights of the drug's impact, so you can see – at a glance – the extraordinary results for yourself.
Aspirin: the results
Aspirin has been proven to help with a range of medical conditions, including, but not limited to, heart attacks, strokes, cancer and dementia. Some of the results are quite astounding – and so here are the highlights. Scientific studies have drawn the following key conclusions.
Heart attacks and strokes
Aspirin is proven to help people who have already had a heart attack. In such patients, taking a low dose aspirin on a daily basis reduces the risk of having another heart attack or a stroke by at least one third.
Aspirin has also been shown to be effective at reducing the risk of a first heart attack in those patients at high risk of having a heart attack or stroke. Some studies reduced the risk of such events by as much as 44 per cent.
When treating a heart attack, the death rate was reduced by 42 per cent in patients who received a dual treatment of aspirin and streptokinase.
If a patient has suffered a non-haemorrhagic stroke, the Royal College of Physicians recommends patients should be prescribed 50–300mg of aspirin daily indefinitely, as a preventative measure against further events.
Patients who have had a mini-stroke should take aspirin. Studies have shown that taking aspirin reduces the odds of suffering another stroke by 15 per cent.
According to the National Institute for Health and Clinical Excellence (NICE) recommendations, patients with the commonest type of irregular heartbeat, called atrial fibrillation, who are classified at low or moderate risk of a stroke, should be given aspirin in a daily dose of 75–300mg in order to prevent strokes and heart attacks.
A small daily dose of aspirin has been proven to reduce the overall cancer death rate by at least one fifth.
Aspirin needs to be taken for at least 5 years before an effect is seen in a reduction of the risk of cancer. After 5 years of taking aspirin, the death rate for all cancers fell by 34 per cent.
The longer the usage, the greater the reduction in risk: 20–25 years of usage gives the best protection. After that, there may be more risk of bleeds.
The peak time to start to reap the benefit seems to be when patients are in their late forties and fifties.
There is no difference in aspirin dose in this preventive role – 75mg seems sufficient to produce the effect.
Specific types of cancer
After 5 years of taking aspirin, the death rate for gastrointestinal cancers fell by 54 per cent.
Long-term use of aspirin is associated with a 30–50 per cent reduction in the incidence of the polyps (tumours) which may lead to colorectal cancer, actual cancer of the colon and rectum, and death related to this disease. One study in particular showed that aspirin reduced the risk of proximal colon cancer (cancer nearest the small intestine, rather than near the rectum) by 70 per cent.
Aspirin reduced deaths due to primary brain tumours during the first 10 years of follow-up.
The risk for prostate cancers fell after 15 years of aspirin usage.
Death rates dropped after 20 years of aspirin use:
By 10 per cent for prostate cancer.
By 30 per cent for lung cancer (but mainly for the adenocarcinoma type – defined here – which is more common in non-smokers).
By 40 per cent for colorectal cancer.
By 60 per cent for oesophageal cancer (of adenocarcinoma type).
More research needed
In one observational study into aspirin and patients with existing breast cancer, aspirin use was associated with a decreased risk for spread of cancer by 43–60 per cent, and a 64–71 per cent reduction in the risk for breast cancer-related death. While this study is promising, there is not yet enough research to suggest that well women should put themselves at risk of having an aspirin-related bleed in order to reduce their risk of breast cancer.
The effect of aspirin on stomach, pancreatic and brain cancers is hard to determine at present, since insufficient numbers have been seen in studies to do a clear statistical analysis.
Similarly, in the major studies, there have been too few women in the trials to determine the effects of aspirin on breast cancer or gynaecological cancers.
Aspirin has been shown to reduce the risk of developing Alzheimer's disease by 23 per cent.
Studies have indicated that long-term use of aspirin may reduce the incidence of Alzheimer's disease, provided that the use has started well before the onset of dementia.
The longer aspirin has been used, the greater the reduction in risk. For any benefit it seems that aspirin has to be taken long term, probably for at least 5 years.
Can you take aspirin?
While aspirin is a drug that most people can take, to others it could be fatal.
You should NEVER take aspirin if you:
Have a history of stomach ulceration
Have a history of asthma
Have had a haemorrhagic stroke
Have any blood disorder or inherited condition such as Osler-Weber-Rendu disease (also known as hereditary haemorrhagic telangiectasia), which could predispose you to bleeding
Have had an allergic reaction to aspirin at any time in your life
Have a history of salicylate allergy
Are under sixteen years old
Are pregnant (unless prescribed aspirin by a doctor for a specific illness)
Are trying to conceive
Are on drugs like anticoagulants, or other drugs which could interact with aspirin to increase the risk of a bleed
Chapter 19 discusses these restrictions and the side effects of aspirin, so readers can make an informed choice about whether or not to take it.
These results are but the tip of a very large iceberg of aspirin studies. To understand the impact of the drug – and whether or not it is right for you – I would urge you now to read on, for more detail on this 'wonder drug' ... and how it could help to save your life.CHAPTER 2
ASPIRIN: THE WONDER DRUG?
In the modern world we are used to superlatives. Whereas once there were models and film stars, now there are supermodels and megastars. Is the term a 'wonder drug' just another example of modern society's desire to show that everything is getting better?
In days gone by, people hoped that they would find a magical cure-all, a panacea for all ills. In fact, the word 'panacea' comes from the name of one of the goddesses who was quoted in the original Hippocratic Oath, the vow all doctors take when they enter the medical profession.
Can a wonder drug exist?
For a drug to be considered a panacea, it would have to work for everything, and that simply is not possible. The human body is so complex that a simple chemical, or even a cocktail of chemicals, could never affect all of the many processes that go on in a living cell. To imagine that a drug could deal with all of the many pathological processes that result in illness is therefore sheer fantasy.
An ideal drug, on the other hand, would not necessarily have to be a panacea. It would not have to deal with all ailments, but it would have to work ideally in certain conditions and circumstances.
For example, an ideal antibiotic would be one that treated all infections and produced no side effects. Similarly, an ideal painkiller would only alleviate pain. An ideal anti-cancer drug would kill cancerous cells, yet have no effect on the surrounding normal and healthy tissues.
Unfortunately, no drug fits the bill of maximum benefit and zero side effects.
Aspirin is the most widely used drug in the world. About 35 metric tonnes are produced and consumed annually, which is enough to produce 100 billion tablets every year. It is readily available in most countries and can be bought over the counter in chemists, supermarkets, corner shops and even at the cash desks of garages.
It was taken to the Antarctic by Captain Robert Falcon Scott, to the top of Mount Everest by Edmund Hillary and to the Moon by the Apollo astronauts.
Aspirin is one of the most effective and versatile drugs that we know of, and every general practitioner will probably carry some in his bag, since it is known to be a life-saver after a heart attack.
The incredible thing is that, in one form or another, people have been using herbs or drugs containing aspirin-like substances for a range of conditions since the days of antiquity. The fact that these early medicines clearly worked led doctors and chemists to attempt to discover what the active ingredient was. We shall follow the convoluted history of aspirin in the next chapter.
The actual chemical in aspirin is called acetylsalicylic acid. It is a surprisingly simple molecule with the formula CHO. The science of aspirin is crucial to our understanding of how this wonder drug exerts its many effects, so we shall consider the known science in chapter 4.
It was the first of the group of drugs that became known as the Non-Steroidal Anti-Inflammatory Drugs, or NSAIDs.
Different forms of aspirin
Aspirin is usually taken in tablet form.
Available in 300mg or low dose 75mg
They can be taken with or without food, although with food seems less likely to result in any gastric upsets. Taking a little milk or a glass of water also seems to help.
Available in 300mg or low dose 75mg
They are dissolved or dispersed in a little water. Some people find these easier than having to swallow. A dispersed drug will also be less likely to erode the lining of the stomach, which a tablet lying directly in contact with the lining theoretically could do.
Available in 300mg or 75mg
These are given to people with sensitive stomachs. The theory is that the enteric coat will prevent the aspirin being dissolved in the stomach, but once it gets into the small intestine, it will be dissolved and absorbed. This will help reduce gastric irritation to an extent, but gastric side effects are still possible.
Available in 300mg and 150mg
As these are absorbed through the rectal mucosa, rather than the stomach, one would think that gastric side effects would be removed. However, gastric side effects are still possible.
Aspirin – a drug full of paradoxes
The truth is that aspirin has always been a bit of a paradox. For most of the twentieth century, aspirin was considered one of the most successful painkilling and anti-rheumatic drugs available to doctors, yet many people seem reluctant to use it.
Sometimes this is due to reported side effects. Some patients found that they were unable to take aspirin because it caused gastric irritation, heartburn, stomach ulcers or seemed to promote minor bleeding disorders. As a consequence, many doctors became biased against aspirin because of its potential to cause such side effects – yet as this book will show, such side effects tend to be limited among patients and are certainly not as widespread as anti-aspirin propaganda would have you believe.
For others, the fact that aspirin is so readily available without the need of a doctor's prescription (although it is also obtainable on the NHS with a doctor's prescription) has tended to make people regard it as little more than a household remedy. In fact, more and more research is demonstrating that these small, white, unassuming tablets are veritable life-savers.
Perhaps most importantly, although its effectiveness as a painkiller and drug that can reduce fevers and inflammation has never been in doubt, aspirin's cheapness works strangely against it.
Psychologists tell us that people are liable to believe that a cheap drug is going to be of less value and benefit than a more expensive and more attractive tablet or capsule. This is fascinating, since there are considerable amounts of money to be made from the sale of different painkilling drugs. The pharmaceutical industry is highly competitive and potentially very lucrative. The fact that aspirin is cheap and therefore perceived by consumers to offer less benefit is of demonstrable financial value to the pharmaceutical industry, enabling them to promote alternative drugs – at higher cost to the consumer.
Cheap as chips
So why is aspirin so cheap in some countries? Well, the reason is tied into the first global conflict of the twentieth century.
The name 'Aspirin' was originally patented by the German pharmaceutical company Bayer in 1899. Consequently, during the First World War, the Allies had difficulty in obtaining aspirin, so an alternative method of manufacture was devised, as we shall read about in chapter 3.
After the war, Germany was forced to make reparations. Part of this reparation meant that Bayer lost its registered trademark in France, England, the USA and Russia. Other companies could now make aspirin in these countries – and so the price of the drug dropped due to competition in the market.
What's in a name?
Today, 'aspirin' is a generic word in Australia, France, India, Ireland, New Zealand, Pakistan, Jamaica, the Philippines, South Africa, the United Kingdom and the United States. This means that other pharmaceutical companies can prepare the drug under the name of aspirin. This makes it a cheap purchase in these countries.
However, Bayer still holds the trademark in about 80 countries around the world, including Germany, Switzerland, Canada and Mexico, where only they can market it as Aspirin. They use a capital A in their branding, but this is merely aesthetic: in countries where the trademark is held, no one else can use the name aspirin, with or without a capital letter. A generic drug in these countries can only be sold as acetylsalicylic acid, which doesn't sound quite so user-friendly. The trademarking also means that aspirin cannot be sold below a certain price, as Bayer alone determines this.
Note: For the purposes of this book, the generic version of 'aspirin' used in the UK, France and the USA will be used throughout, unless the Bayer-owned trademarked drug is referred to.
Aspirin vs paracetamol
There is not a great deal of money to be made from the sale of generic drugs such as aspirin. It is patented drugs, i.e. drugs that can be sold by only one company, that are the real money-spinners, since the company with the monopoly can set the price as high as the market will stand.
Consequently, for pharmaceutical companies there is a financial drive to promote patented drugs over generic drugs like aspirin – such as the various branded paracetamol-containing drugs that aspirin is often confused with.
Aspirin and paracetamol are very different drugs, although they are both effective painkillers and efficient at reducing fevers.
Aspirin has significant anti-inflammatory effect, while paracetamol has little. Crucially, it is this anti-inflammatory effect that seems to give aspirin its great usefulness across a whole range of areas.
Excerpted from An Aspirin a Day by Keith Souter, David Woodroffe. Copyright © 2011 Michael O'Mara Books Limited. Excerpted by permission of Michael O'Mara Books Limited.
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