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Aspirin has been long considered the proverbial magic pill—useful to treat headaches and fevers or used to prevent heart attacks and strokes. Not long ago were health systems—including in the UK and NZ—considering a polypill that included aspirin alongside statins and blood pressure pills that was to be given to everyone over 55! (The exclamation mark is because I am in that category). A paper in the British Medical Journal led by Professor Sir Nicholas Wald, (at that time the Director of the Wolfson Institute of Preventive Medicine at Barts and The London School of Medicine and Dentistry) even made a stupendous claim that if everyone started taking a polypill every day at the age of 55 years, about 75% of heart attacks and strokes could be prevented. It was presented as a “strategy to reduce cardiovascular disease by more than 80%.” Wald’s son happened to be a cardiologist, and the Professor had filed a patent for a polypill in Europe. But then things went quiet in medical circles, like a magician who had lost his mojo after a major performance. 

Aspirin has been around since antiquity. Sumerian texts dating back to 2000 BC and an Egyptian papyrus circa 1500 BC mention willow leaves as a remedy for rheumatism. Fast forward medical history to 1763 and we find Reverend Edward Stone informing the Royal Society about his success using the bark of the same willow tree to treat fever. However, it would be 1897 when the synthetic chemical found in willow bark was first made in the lab by Felix Hoffmann when he managed to produce stable acetylsalicylic acid from salicylic acid and acetic anhydride. This was not only a breakthrough, but also the birth of the pharmaceutical industry. But with any mass production comes an existential conflict in human societies that have only been around very recently in the grand scheme of things. Capitalistic business runs on a fundamental insincerity—sharp aggressive marketing as a reproach against egalitarianism. Not enough wars? Why don’t we just sell the extra assault weapons already manufactured into suburbia. Too many drugs to fit inside a physician’s diagnostic toolkit. How about we get aggressive about preventative medicine? In my book, The Genetics of Health (Simon and Schuster), I wrote that just as law isn’t justice, medicine is not health. To achieve wellness one has to take some personal responsibility. 

Against this backdrop of the mass production of pills, big pharma found its foothold with the advent of aspirin. Ill-defined science can sell quasi-therapeutic interventions easily to salarymen doctors who are supposed to be hands-on guardians of patient welfare, while running businesses. One only has to look at the opiate crisis in America and the role of the Sackler family of Purdue Pharma infamy (by the way, their bountiful baby, oxycontin, is widely used in New Zealand). Suddenly, cheap-as-chips aspirin became no longer a medicine known since ancient times, but a charming preventer—seemingly of everything. I encounter patients everyday who have no risk factors for heart disease but take aspirin because their doctor has recommended this based on—sometimes government guidelines—that often prescribe on a tightly defined array of ethnicities and body shapes. When I finished medicine, in 1988, cardiologists had first started using aspirin as immediate treatment for suspected heart attacks. Using aspirin as treatment of heart disease is fine; how strong is the science for aspirin as a preventer?

According to research published in the prestigious JAMA (Journal of the American Medical Association), low-dose aspirin does not prevent heart attacks or strokes in healthy adults and actually increases a person’s risk of a brain bleed. The authors suggested that aspirin should not be used as a preventer against stroke, because the drug may indeed end up causing one instead. The JAMA study was a randomized clinical trial of 19,000 adults (over age 70) from both Australia and America who did not have heart disease. This research was similar to others that led to a New York Times report that low-dose “baby” aspirin should not be prescribed for preventing a first heart attack or stroke in healthy older adults. Another study in the JAMA network noted that nearly ten million Americans, particularly those with diabetes, were taking aspirin when the science no longer recommended it. Science became an irritant in the business of helping people to survive for longer, and supposedly healthier.  

The Mayo Clinic advises that “because of bleeding risks, people aged 60 and older without known heart or blood vessel disease should not start taking a daily aspirin to prevent a first-time heart attack or stroke.” The Mayo Clinic was founded by the Mayo brothers, one of whom, William J Mayo—known to the public in those days as Dr Will—had said: “The aim of medicine is to prevent disease and prolong life, the ideal of medicine is to eliminate the need of a physician.”

An American Task Force that looked at prevention of heart disease has now downgraded aspirin’s hallowed status as a preventative wonder drug noting that there was “no net benefit” of taking aspirin for primary prevention of heart disease in those 60 and older; there could possibly be a “modest benefit” for those 40-50 provided that they didn’t have a risk of bleeding. Instead the taskforce found there was better benefit to be had from a diet high in fruits, vegetables, and whole grains. Minimizing the consumption of trans-fats (found in fast foods and instant meals), avoiding added sugars (including sugar-sweetened beverages), red meats, sodium, and saturated fats were considered better primary prevention options. Fish, legumes, and poultry were noted to be the healthiest sources of protein; not animal products such as dairy, beef and lamb. The food industry is now a globalised mass production machine too.

Hippocrates of Kos widely considered the father of medicine used the bark of the willow tree to treat fevers and pain. He used willow bark, where the origins of the chemistry of aspirin lies, to treat fevers and pain but not as a preventer, and is supposed to have said—although having read most of his writings, I have not come across this quote anywhere—”let thy food be thy medicine and thy medicine be thy food.” Amen to that. 

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IMPORTANT: This blog is about science-communication, education, interesting new science, and medical research to do with (mostly) health and skin. It is not individual one-on-one medical advice. Please do not stop any medications without consulting your own doctor.