Once again, aspirin has come out of the medicine cabinet and into the limelight.
The recent spate of publicity apparently confirming its role in warding off heart attacks is, more than anything, testimony to the remarkable staying power of a drug first patented by Bayer in 1899, a year after the German pharmaceutical house introduced a promising new cough medicine called heroin.
Since then, aspirin--originally an extract from willow bark--has risen and fallen from therapeutic grace, and suffered and repelled challenges by newer pain relievers. Through it all, sensational claims have mixed with public confusion over its benefits and side effects.
The latest round of fascination with the drug, first introduced as a fever fighter, was set off last week by news of a still-incomplete national study of more than 22,000 U.S. American doctors who found that taking a 325-milligram tablet of the aspirin product Bufferin reduced the odds of having a heart attack.
Stores quickly reported increased sales and aspirin makers lobbied retailers to add to their inventories. All but obscured in the commotion was the fact that a Glendale ear, nose and throat doctor had pioneered much the same theory in the early 1950s.
Now as then, the public was quick to pick up on the good news while ignoring the downside. "I think the public is looking for easy ways out," Dr. James Schoenberger, a prominent Chicago prevention expert, said of last week's report. "They want the magic pill, the magic bullet to prevent them from ever getting a heart attack."
But Schoenberger, like other experts, was quick to add: "If you're going to do something like start taking aspirin when you're 40, for the next 25 years, to prevent a heart attack, long-term effects of aspirin might be very important to you."
Just what are the pluses and minuses of this wonder drug?
Aspirin's staying power over the years has been primarily as a result of its versatility and low cost. Alex Savanian, an associate professor at the USC School of Pharmacy, said aspirin--now technically called acetylsalicylic acid--still offers such unique medicinal properties that it is likely to remain an important part of the pharmaceutical arsenal for at least the next 20 years.
This versatility, pharmaceutical experts agree, comes from aspirin's combination of three major effects on body chemistry: It relieves pain, primarily because it is a highly effective anti-inflammatory drug that reduces pressure in blood vessels; it reduces fever, apparently by muting effects of the fever center in the brain; and it impairs the clotting action of platelets, thus reducing risk of stroke or heart attack.
But like virtually all drugs, aspirin achieves these benefits at a sometimes high price. Overdoses can be fatal and side effects include sometimes-serious bleeding, a possible worsening of ulcers and upset stomachs.
Pregnant women are advised not take aspirin. People with hypertension should use it only under a doctor's care. And in children and teen-agers, it has such a high risk of causing the potentially fatal disorder called Reye's syndrome that warning labels have been required since 1986 as a result of pressure by consumer health groups on the U.S. Food and Drug Administration.
The saga of aspirin's transformation from pedestrian tenant of the medicine chest to perceived wonder drug counts among the stars of its cast the Glendale doctor who in 1956 published the first medical journal study concluding that two aspirins a day could prevent heart seizures and strokes.
Sensationalised at the time, the theory, proposed by Dr. Lawrence Craven, was for a time the talk of the Southern California medical community. Craven himself said he popped two pills every day in the belief it strengthened his heart. Craven said there had been no heart attacks among 1,465 patients to whom he recommended aspirin prevention therapy.
In language strikingly similar to headlines that greeted the release last week of the new study touting aspirin as a heart attack preventive, a tabloid in 1957 described Craven's work as "the one-pill-a-day defense against heart attacks." Aspirin, readers were told 31 years ago, was the " 'old' wonder-drug with a new job."
Ironically, Craven died a month later of a heart attack at age 74, and a physician friend recalled that his cause of death did much to discredit his maverick belief about aspirin.
"I know he (Craven) was taking two aspirin a day," said Dr. Maynard Bourdeau, a Glendale physician, now nearly 80, who knew Craven. "We would talk about it and he said he was on it and, at the time, of course, that made people skeptical. People thought it was a little funny that such a simple thing as aspirin would do any good."
But now, Bourdeau has started taking the advice seriously once again. "I'm on aspirin today," he said. "I had a coronary six months ago. It's a thing to do."