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October 2002 Issue
Aspirin ... that simple, innocuous pill ... is neither.
by Michael Fick
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Aspirin is the oldest and most common of a family of non-steroidal anti-inflammatory drugs (NSAID), which also includes Motrin, Anaprox, Lodine, Meclomin, Nalfon, Naprosin, Ponstel, Relafen, Toradol, Tolectin, Indocin, Advil, ibuprofen, etc. It was invented a century ago to fight arthritis, and is proven every few years to combat yet another disease. All the NSAIDs fight pain and inflammation, but aspirin alone also helps cure or prevent arthritis, heart attacks, deaths from heart attack if taken quickly, other cardiovascular diseases and symptoms, brain attacks (stroke), breast and colon and prostate cancer, and maybe pancreatic cancer and Alzheimer's. It's dirt cheap (anything over a penny is a waste of money), and in rational doses is safe for most people. In every sense, it qualifies as a miracle drug. While NSAIDs kill 5-10,000 U.S. citizens annually, the proper use of aspirin alone could save 10,000 other lives and relieve much suffering in millions.

Let's examine both sides of the aspirin dilemma.

Bayer claimed in the 1920s that aspirin would not affect the heart. Fortunately, that was untrue. Aspirin has a dramatic, beneficial effect on the entire cardiovascular system. Of all the NSAIDs, only aspirin helps blood platelets slide over each other, helping to prevent blood clots, which block blood and oxygen flow to the heart (heart attacks) and the brain (brain attacks, aka stroke). It combats heart attacks better than some drug therapies costing thousands of dollars. No other pain reliever or fever-reducing drug has demonstrated aspirin's beneficial impact on cardiovascular health, probably because they have no effect on platelets. That anticoagulant effect is so pronounced we should stop taking it a week before surgery or our next bicycle tumble.

Given those benefits, should we all eat it like popcorn? Certainly not:

  • Aspirin increases the risk of excessive bleeding, probably including one kind of stroke.
  • Many large, sound studies established that long-term aspirin therapy, even lower-dosage or modified-release versions such as enteric-coated baby aspirin, even when taken with meals, is associated with a gastrointestinal (GI) hemorrhage risk in about one percent of patients treated for 28 months, up to three percent in patients over 60. It can irritate the stomach lining and cause heartburn, pain, nausea, vomiting, ultimately internal bleeding, ulcers, and holes in the stomach or intestines. 76,000 Americans are hospitalized annually with GI bleeding from NSAID use, and about 10% of them die from it. Both duration and dose affect GI impact, the former more so.
  • Way before GI bleeding, the risks of esophageal stricture and subsequent necessity for dilation (ever swallow a baseball bat?) are very real.
  • People who drink three or more alcoholic beverages a day are at increased risk of liver damage and stomach bleeding from most over-the-counter pain-killing drugs, including aspirin and Tylenol/acetaminophen.
  • High doses of aspirin may cause temporary and usually reversible ringing in the ears and hearing loss.
  • Two of every thousand people are allergic to aspirin, and may get swelling or asthma from it.
  • It can cause a rare and serious brain and liver disorder called Reye's syndrome in children and teenagers.
  • NSAIDs, including aspirin, can produce a number of temporary or permanent adverse effects on the kidneys and liver, especially with pre-existing liver disease, juvenile arthritis, or rheumatic fever.
  • NSAIDs may also exacerbate hypertension or interfere with the effectiveness of blood pressure medications.
  • Topical NSAIDs, which are rubbed on the skin to provide joint pain relief, produce little therapeutic benefit beyond placebo effect, yet have led to some increased risk of GI bleeding and kidney impairment.
  • The long-term, heavy use of pain killers, especially those with caffeine or codeine, can exert direct toxic effects on kidney cells in people with kidney problems.

Oh, there's more ... much more ... on both sides of the argument.

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