FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[OLD FASHIONED ASPIRIN: A CHEAP, POWERFUL AND EFFECTIVE DRUG]

Question: There are numerous commercials for ibuprofen and Tylenol, but I usually take aspirin when I get a headache or sore joints and muscles. Is there anything wrong with taking plain, old aspirin?

Answer: The "active ingredient" in aspirin is acetylsalicylic acid. This very effective pain killer and anti-inflammatory agent is classified as a salicylate by chemists. Salicylates have been used for thousands of years - at least since the time of Hippocrates - by people worldwide to help aches, pains and fever. For instance, North American Indians and the ancient Chinese knew of the benefits of willow bark - an unrefined source of salicylate.

The use of salicylates moved from folk remedies to mainstream medicine when the Rev. Edward Stone of Chipping Norton, England, submitted a letter to the Royal Society in 1763 describing his discovery of the benefits of willow bark for treating arthritis and fever.

Willow bark extract, though effective, had several major problems. In addition to its bitter taste, which most people probably found quite annoying, it caused noticeable stomach upset. Because of the stomach irritation, it was very difficult to take for more than a few days and was unsuitable for illnesses like arthritis where treatment lasts for years. Felix Hoffman, a chemist working at Bayer Industries in Germany, designed a more digestible form of salicylate for his father who suffered from rheumatoid arthritis. His discovery - acetylsalicylic acid - was given the trade name "Aspirin." It became commercially available in 1899 and has since become worldwide in its use.

Aspirin, which is no longer the exclusive trademark of the Bayer Co., is not without its side effects. Although to a lesser degree than unrefined salicylate, it still causes some stomach upset. When taken in large amounts for prolonged periods, it can also produce kidney damage. It can even cause death if it is consumed in huge quantities all at once.

Despite these potential risks, aspirin safely provides benefit to millions of people each day. It is primarily used - as you described - for the relief of everyday aches, pains and fever. However, it also reduces the inflammation of arthritis and the risk of heart attacks. It is truly an amazing drug with nearly a century of experience to document its safety record. For adults, most of the problems with aspirin are limited to patients who must take more than 12 regular strength (325 mg) tablets a day or lesser dosages for extended periods. So go ahead and take aspirin when you need it, but follow the package directions to avoid complications.

Question: Should I buy brand-name or generic aspirin?

Answer: It probably doesn't make any difference. However, I'd recommend that when you buy generic you pick a high-quality generic aspirin - such as that sold under the name of a national pharmacy chain. These products should work the same as the brand-name varieties. But be sure to watch the expiration dates on the aspirin products you buy. They can go bad sitting on the shelf in the store or in your medicine cabinet at home.

One final point about aspirin. It is still the standard by which the other drugs in its class are evaluated. For general use, none of the others are clearly superior to aspirin. You'd never know this, however, from the advertising blitz that's being conducted by the manufacturers of the products you mention. The companies have spent a lot of time and money in developing these aspirin substitutes and they want to recoup their investments. Their direct goal is to take some of the revenue away from aspirin sales. That's no small potatoes either. About 30 billion aspirin tablets are used in the U.S. each year. Wow, that's a lot of headaches and a lot of money to fight over. I get a headache just thinking about it!

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.