Felix Hoffman at Bayer Industries synthesized aspirin over 100 years ago. Today there have been many ads promoting aspirin’s potential to reduce the risk of heart attack and stroke in certain people. However, the decision to use aspirin as a preventative is not as simple as it looks. What generally has not been analyzed are the risks and costs associated with aspirin therapy.
In the January issue of The Annals of Pharmacotherapy the authors analyze the lifetime cumulative risk, the potential negative effects on quality-adjusted-life-years (QALYs), life expectancy, and cost of aspirin therapy. The authors construct a model of healthy individuals starting at age 50 taking a 325 mg enteric-coated daily aspirin. Based on numerous references the authors take into account adverse effects such as upper gastrointestinal bleeding, quality of life factor, and aspirin cost.
Based on their analysis, aspirin therapy only had a modest negative effect on both QALYs and life expectancy. The average lifetime cost was determined to be $460 per person.
However, the authors found that, “for every 15 healthy 50-year-old men started on aspirin therapy, one will have a complication in his lifetime; for every 556 individuals started on aspirin therapy, one will die from complications.” Comparison of death risk of lifetime aspirin therapy (1 in 556) versus other mortality risks were listed as follows: hip surgery (1 in 345), cardiac catheterization (1 in 500), general anesthesia (1 in 3,685), annual accidents (1 in 3,014), food poisoning (1 in 56,424), sky diving (1 in 70,130 per dive), and yearly driving with a cell phone (1 in 76,900).
The authors also note that, “starting aspirin at an earlier age resulted in a larger absolute reduction in both QALYs and life expectancy, increased cost, and not surprisingly, a greater number of complications.”
The authors also analyzed the use of proton pump inhibitors (PPIs) to reduce the aspirin risk. They determined a modest increase in quality of life and life expectancy, and a decreased risk in major and intermediate GI (gastrointestinal) bleeds by 50%, but at a substantial increase in cost. The addition of PPIs resulted in an increase from an average lifetime cost of $460 per person to $18,400.
The authors do not attempt to incorporate any of the potential benefits of aspirin. On the contrary, as the aim of the study was to determine the risk, all complication rates attributable to aspirin from numerous scientific sources were utilized. The authors note that, “although good published data exist to accurately model the drawbacks of aspirin therapy, the benefits of aspirin in cancer chemoprevention are preliminary at best and will likely not be apparent for at least 10 years of aspirin therapy. Short-term data for the efficacy of aspirin for the prevention of primary coronary events exist, but long-term data are currently unavailable.”
Source: The Annals of Pharmacotherapy, January 2005
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But it’s possible the one super drug is not new and really is a super drug. In fact, it’s one of the oldest medications available, and that would be aspirin- the first non-steroidal anti-inflammato ry drug (NSAID).
Noted as ASA by doctors typically, aspirin effects have been noted for thousands of years, as the active ingredient comes from the bark of a White Willow tree, and long ago, patients with pain or a fever would chew on this bark for relief.
Fast forward to over a hundred years ago and Bayer pharmaceuticals (pronounced ‘Beier’), which is the same company that brought us heroin, which was named for its ‘heroic’ properties as a non-addictive substitute for morphine at the time, as well as mustard gas and methadone.
The company originated in Germany, but presently has its U.S. headquarters in New York. Felix Hoffman, seeking to develop an agent for his father’s rheumatism, was involved in the development of what is known now as aspirin.
And it was a difficult task to develop this drug, as it was toxic to the stomach due to the nature of the active ingredient again obtained from the bark of the white willow tree. Dr. Hoffman and others at Bayer developed a drug that proved to be tolerable to patients while keeping the active ingredient in tact through a method of delivery developed by Dr. Hoffman’s team at Bayer.
After launching the medication, aspirin was priced at about 50 cents an ounce, as at the time it was only available in power form. Soon before 1920, aspirin developed the tablet form of the drug and was then available by prescription. Regardless, aspirin was responsible for one third of sales for Bayer during this time, due to its popularity at that time.
While all drugs have side effects, aspirin is one of very few drugs that provides great efficacy and indications, with limited side effects. In fact, some of aspirin’s additional uses have been recently discovered. This may be why the New York Times called aspirin a wonder drug in the 1960s. In the 1970s, the mechanism of aspirin was isolated, which is the blockage of prostaglandins.
With Aspirin and its potential life-extending benefits:
Aspirin has been associated with decreased risk of asthma and prostate cancer in the elderly. Also, aspirin has been linked with lowering the risk of breast cancer and colon cancer as well. Aspirin is a blood thinner, and has been associated with decreasing the risk of heart attacks and strokes in certain patient populations, as the drug prevents clots.
This was first suggested in the 1940s and the FDA suggested that it be the drug of choice for those who experienced a heart attack over a decade ago. Aspirin intake is beneficial for those after coronary bypass procedures. A topical formulation of aspirin was developed recently for those experiencing Herpes pain.
The drug has been proven beneficial for those experiencing migraine pains. Aspirin at low doses is taken by many as a preventive drug to decrease cardiovascular incidents that may occur.
Aspirin has been the best selling painkiller since the 1950s. It is not as addictive as other choices for patients regarding pain relief in particular. It is also the most studied drug- with over 3000 scientific papers published worldwide.
Also, over 15 billion tablets of aspirin are sold annually, which amounts to about 80 million aspirin tablets consumed daily by others. This amounts to over 16,000 tons of aspirin consumed during this time, or about 70,000 metric tons of aspirin a year. Over a decade ago, a study was performed and concluded that twice as many people would choose aspirin over a computer, given the two choices, because of the benefits of the drug.
Side effects would include GI bleeding if taken in large amounts, along with an association of Reye’s syndrome in children, yet both are relatively rare. Yet all things considered, clearly the benefits of aspirin outweigh any risks of the drug.
Lately, there have been issues with other NSAIDs, such as Cox II inhibitors, without full recollection or knowledge that aspirin is in fact the world’s most widely used drug, and for good reasons.
At times, something newer is not always better.
“We might die from medication, but we sure killed all the pain.” --- Conor Oberst
Dan Abshear