Could an aspirin a day keep the doctor away?

We have all heard the famous saying that “an apple a day keeps the doctor away”, however, is this to be replaced with  “an aspirin a day keeps the doctor away”?

Writer: Anna Wiecek
Editor: Marie Emilie Maeland
Artist: Eshka Chuck

Despite its humble beginnings as an ancient herbal pain medication, the development of aspirin showcases one of the first and biggest success stories in the pharmaceutical industry, which transformed our approach to modern medicine. An expanding list of benefits of this drug has previously triggered its repurposing as a preventative treatment for heart attacks and strokes. Currently, aspirin could once again be reincarnated, this time as a cancer treatment. 

The story of how the modest aspirin pill ended up on supermarket shelves across the world spans centuries. Dating back to 4000 BCE the practice of using herbal extracts from myrtle, meadowsweet, as well as willow tree bark, to treat pain, inflammation, and fever was common across many ancient civilizations. Unbeknown to the people at the time, salicin, the raw ingredient of aspirin, present in these herbal concoctions, infused the medical traditions around the world. 

By the 18th century, the first scientific study of the benefits of willow bark was performed by an English clergyman called Edward Stone. The positive outcome of this study led to a cascade of scientific achievements including the modification of salicin to acetylsalicylic acid, now known as aspirin, by Charles Gerhardt and by Bayer Industries in 1899. In a testament to the age of aspirin, Bayer Industries, now a multinational pharmaceutical company, still functioned as a dye factory at the time. By reducing stomach irritation, a major side-effect of salicin, this modification allowed aspirin to become the first mass-marketed pain medication available over-the-counter. It instantly became a household name. Not only did it change people’s relationship with pain, but it also changed our approach to drug development. It was the first time we could manipulate the structure and properties of a compound for medical purposes.

However, despite the initial success, aspirin has faced many ups and downs. Even before the discovery of its mechanism of action, the popularity of aspirin began to decline after the development of newer painkillers with decreased side effects, such as paracetamol. Ironically, it was the off-target action of aspirin as an anti-clotting agent that brought about its resurgence.In line with current clinical guidelines, prescribed at low doses to individuals with cardiovascular disease, aspirin graduated from its job as a mere painkiller to life saving medicine. By stopping platelet cells from clumping together inside blood vessels, aspirin now prevents blood clots from forming in at-risk individuals.

Today, once again, aspirin has been thrown back into the limelight, this time as a potential cancer treatment. While it is already prescribed to patients at high risk of developing colon cancer, there are increasing links between aspirin consumption and reduced risk of other malignancies such as breast and prostate cancer. This seems to boil down to the anti-inflammatory action of aspirin. Inflammation does play an important part in the immune response during infection and injury. However, recent research has highlighted that various lifestyle factors such as diet, stress, disturbed sleep, and physical inactivity can contribute to a state of chronic inflammation in our bodies which encourages the development of cancer and other inflammatory diseases such as cardiovascular disease and diabetes.  Therefore, It is easy to speculate that aspirin could have wider applications than currently appreciated. 

So, after reading this should you rush to the local shop to get some aspirin? 

Probably not, unless your doctor told you to do so. Throughout its history, aspirin has become a lifesaving drug that has informed us of the approaches we can take to treat major health problems. However, like any drug, aspirin has adverse side effects. Therefore, identifying which individuals are likely to benefit and with which doses is key. Time will also tell if aspirin will be replaced by newer and improved anti-clotting and anti-inflammatory medications. Regarding cancer treatment, the world’s largest clinical trial looking at whether aspirin can prevent cancer recurrence is underway until 2023, so the jury is out until then. Regardless, miracle drug or not, it’s important to acknowledge the progress in medicine made since its development.

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