New Miracle Drug

Dec 14, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

There is a new miracle drug in the news! It definitely helps people with certain types of heart disease, and it might be able to treat lung, esophagus, and colon cancer! The name of the miracle drug is a mouthful. It is acetylsalicylic acid. And it has a history in as long as western medicine.

Have you ever heard of the Hippocratic Oath? It is an oath that new doctors take in which they promise among other things to First do no harm. The writing of that oath is attributed to Hippocrates, an ancient Greek healer who lived almost 2500 years ago. One of the medicines Hippocrates used was white willow bark. He prescribed it to patients to relieve pain and fever. Jump forward a couple thousand years to Germany in early 1800s. A German chemist working with white willow bark isolated the active ingredient and called it salicin. In the late 1800s another German chemist working at the drug company Bayer chemically tweaked salicin from the white willow bark into a more stable form called acetylsalicylic acid. The Bayer chemist used this acetylsalicylic acid to treat his fathers rheumatism.

Okay, so acetylsalicylic acid isnt exactly new. If you havent guessed yet, acetylsalicylic acid is the chemical name for ASA or aspirin. It was in the news for its possible cancer fighting properties, though. Before we talk about that trial, lets start with the other good things ASA does. ASA is a good pain killer and it is good at reducing fever. Just like Hippocrates day, ASA can make a twisted ankle feel better or bring a sick persons temperature down. ASA inhibits the cyclooxygenase enzyme which reduces the production of prostaglandins. That can be good and bad. This mechanism is one of the reasons ASA is good at reducing inflammation, like in the case of the sprained ankle. However, reducing prostaglandins is why ASA can cause stomach ulcers. ASA inhibits platelets. Platelets help the blood to clot. On the plus side that means low dose ASA can reduce clotting just enough to prevent heart attacks and strokes. Studies have shown that low dose ASA can reduce the rate of cardiovascular events like heart attacks by 25% in some people. On the negative side, regular doses of ASA can cause bruising and bleeding. Often this bleeding is in the stomach and intestine, but it can be in other places. Rarely, ASA can cause a type of bleeding called a hemorrhagic stroke. This is when you bleed into your brain and it can be fatal.

Any time I talk about ASA someone asks me if it can be given to their children. I tell them no. Then they say, Why are they called baby aspiring then? It is because yes, baby aspirin did used to be given to children. And yes, my mother gave me baby aspirin when I was a child too. We dont give ASA to children anymore. The worry is about something called Reyes syndrome. Reyes syndrome can cause a swelling of the brain and fatty infiltrates of the liver. It can cause seizures, permanent brain damage or death. Reyes syndrome is rare, but it is most often found in children who were given ASA to treat a fever due to a viral infection. There has been a marked decrease in the number of cases of Reyes syndrome since the late 1970s when parents stopped giving ASA to their sick kids.

The ASA cancer fighting trial that made the news was published in the Lancet in December 2010 by Peter Rothwell, et al. It wasnt a double blind placebo controlled trial. It was an observational study. They took the results of other trials that werent necessarily looking at cancer rates and threw the results from all those people into a big computer to see what would pop out. There were lots of holes in the study. They knew the patients in the various trials took ASA for about 5 years. They dont know if the patients continued to take ASA or not. Only about 1/3 of patients in the study were women. There is always the chance of bias pick which trials to follow in your study.

However, all those issues aside, the trial did provide some interesting results. There was almost no difference in cancer rates between the ASA group and the control group for the first 5 years. However, at 20 years the ASA group was dying less often than the control group for several types of cancer. The cancer death rates were reduced in cancers of the esophagus, the colon, and the lung.

What is the take home message from this study? More study should be done to see if ASA really does effect cancer. This study definitely does not say is that everyone should start taking an ASA per day to prevent cancer. ASA has risks including the risk of serious bleeding. For example, in the general population, the risk of gastrointestinal bleeding is about 5 per 1,000 people. That is low, but significant. However, if your doctor already put you on ASA, maybe this potential reduction in cancer risk will give you another good reason to take your medication.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

 


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