Still booming

More than 100 years ago it was the first medication to be mass-marketed in tablet form. Today, more than 80 million tablets are taken by Americans every day, and worldwide sales will top $29 billion dollars this year. There have been contenders and there have been pretenders, but for sheer longevity as a household word, no pharmaceutical has ever had a run quite like aspirin.

An HSI member named Elizabeth prompted today’s e-Alert topic with this question: “I want to ask what you think of the large advertising campaign and increasing usage of baby aspirin as a prevention for cardiovascular problems. Do stomach problems possibly counter-balance any benefits from this therapy?”

You might think that after a century of research that has produced more than 23,000 scientific papers, the answer to Elizabeth’s question would be simple. But contrary to its reputation, almost nothing about aspirin is simple.

Bringing up baby

The term “baby aspirin” doesn’t apply to a type of aspirin, of course, but rather a low dosage tablet designed for children. In recent years, this low dosage (commonly, 81 mg in the U.S. – a bit lower in Europe) has been promoted as a preventive for cardiovascular disease – by some estimates, accounting for as much as 50 percent of the total aspirin market in the U.S. This is largely due to a high profile advertising campaign from Johnson & Johnson for their low-dosage St. Joseph’s brand aspirin. Their target is the heart-health-conscious, baby boomer demographic – all the grownup Mouseketeers who remember taking St. Joseph’s when we were children.

But does it really work? And is it risky?

One possible answer to that first question can be found in a study published earlier this year in the British Medical Journal. Scientists at Oxford University reviewed 287 studies that involved more than 200,000 subjects. Noting that many previous studies had confirmed that aspirin may prevent blood platelets from sticking together and forming clots, the Oxford team concluded that a daily low dose of aspirin reduces the risk of heart attack and stroke by 25 percent.

As for gastrointestinal risk, all nonsteroidal anti-inflammatories (NSAIDs), including aspirin and ibuprofen, have been shown to contribute to stomach upset, ulcers, and liver and kidney impairment. For most people, however, a low dosage intake of aspirin presents a low risk of these problems. But that doesn’t mean you’re out of the woods.

No place to run

Here’s a scenario that I’m sure is played out, in variations, for many thousands of people every day: Joe is approaching retirement age. Concerned about his high homocysteine and LDL cholesterol levels, he takes 81 mg of aspirin daily to reduce his heart attack risk. But he’s also experiencing some arthritis pain in his knees, which he finds he can control reasonably well with a few ibuprofen tablets every week. The problem here is how the two analgesics interact.

In an e-Alert I sent you last December (“Hidden Risks of Over-the-Counter Painkillers” 12/21/02) I told you about a study reported in the New England Journal of Medicine that showed how ibuprofen use can block aspirin’s antiplatelet abilities. So while Joe takes care of his arthritis pain, his aspirin regimen to protect his heart becomes useless. But that same study showed that acetaminophen does not negate the heart-healthy effects of aspirin. So, reading about this, Joe jumps from ibuprofen to acetaminophen to treat his arthritis pain, secure in the knowledge that his aspirin is effective again.

But now Joe has set up other potential problems. In that same e-Alert I told you about another study that shows how regular use of acetaminophen and aspirin together more than DOUBLES your risk of serious organ failure. So if Joe should have a sudden flare up of his arthritis pain and responds by increasing his acetaminophen intake, he’s suddenly putting himself at greater risk of liver and kidney damage.

Shelter from the storm

At this point, Joe is probably feeling like he can’t win. But he does have alternatives.

In the HSI Members Alert last March (“Natural Version of ‘Super Aspirins’ Stops Inflammation, Pain – and May Prevent Ulcers Rather than Cause Them”) we told members about bromelain; a safe, natural alternative to NSAIDs that can relieve arthritis pain AND thin the blood without damaging side effects. A protein-digesting enzyme found in pineapple, bromelain is often used as part of a nutritional approach to arthritis management, and has also been shown to reduce platelet aggregation.

There are also alternatives to acetaminophen in treating headache, fever, muscle aches, menstrual cramps and toothaches. In an e-Alert I sent you earlier this month (“How Do You Spell Respect?” 11/5/02), I told you about the herb white willow – an anti-inflammatory pain reliever that has compounds similar to aspirin. In fact, white willow’s salicylic acid is the parent compound of aspirin (acetylsalicylic acid). Salicylic acid, however, has the benefit of being less abrasive to the stomach and intestine. And a study published last year in the journal Rheumatology, showed an extract of willow tree bark to be as effective as a prescription drug in the treatment of lower back pain.

So even though aspirin is relatively simple compared to the rest of the pharmaceutical world, it should still be given the respect that you would give any medication – that is: it’s a useful drug with a number of benefits and some obvious drawbacks. Not to mention a few natural and effective alternatives.

To Your Good Health,

Jenny Thompson
Health Sciences Institute