Mar 26, 2012

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I like the movie the Matrix. Yes, some of the reasons I like it are obvious. I like watching Neo dodge bullets. I like the freeze frame 360 degree flying through the air fight scenes. I like Trinity in her skin tight leather outfits. But what I really like are the mundane things, the little things. When Neo goes to talk to the Oracle, she isnt a beautiful goddess living in a fantastic floating emerald castle in the sky. The Oracle, an all knowing, possibly omnipotent being is a heavy set woman in her 60s. She isnt on a throne but in a tiny apartment kitchen. The kitchen has a bright window but faded yellow wall paper. The Oracle is sitting on a stool baking cookies. She lights up a cigarette after she takes them out of the oven. These little mundane details make me think the story of the Matrix is more real, and it could really happen. Little things are important.


ASA, also known as acetylsalicylic acid or aspirin, is an important little thing. ASA or substances like it have been around for a very long time. White willow bark has been used to treat pain and fever since before we wrote down our history. Hippocrates, the Greek healer who was the original western physician, wrote about powdered willow bark over 2500 years ago. The active ingredient in White Willow Bark is thought to be Salicin. Salicin is eventually changed in our bodies to salicylic acid and that is the same substance ASA is changed into.


In the late 1800s chemists at the Germany company Bayer made a synthetic version of Salicin. This eventually became ASA or acetylsalicylic acid. Bayer gave ASA the trade name Aspirin.


ASA does interesting things in the body. It mainly affects the enzyme cyclooxygenase and this decreases the pro-inflammatory chemicals the prostaglandins. We think that decreasing these prostaglandins is what causes ASA to be able to decrease pain and inflammation. We think that the decrease of the prostaglandin E1 in the brain is what causes ASA to be able to decrease fever. ASA also affects platelets. Platelets are these little things in your blood that helps it clot. ASA stops the cyclooxygenase enzyme in the platelet from forming thromboxane. This means the platelets wont be able to clot. ASA permanently disables the platelet from being able to clot for the life of the platelet which is 7 to 10 days.


When you go down the pain killer aisle at the pharmacy, you have three main choices: ASA, acetaminophen (or Tylenol) and ibuprofen. They all treat pain and fever. Acetaminophen is the safest for most people because it wont bother the stomach and wont make you bleed more easily. However, acetaminophen is also probably the weakest pain and fever fighter. Ibuprofen and ASA both do a good job on pain and fever and both reduce inflammation, which acetaminophen doesnt. Ibuprofen has been more popular lately because although both ASA and ibuprofen can be hard on the stomach, ibuprofen doesnt increase how much you bleed as much as ASA does.


Because of this increase in bleeding, ASA has fallen out of favor as a pain and fever fighter and taken on a new role. Low dose ASA is now used routinely to prevent heart attacks and strokes in certain patients. Researchers have found that when we give ASA at low doses, it doesnt bother the stomach as much, but still completely knocks out enough platelets to stop blood clots forming in dangerous places. If a blood clot forms in the brain, a part of the brain dies and that is a stroke. If a blood clot forms in a vessel feeding the heart muscle, a piece of the heart muscle dies and that is a heart attack.


Researchers now think ASA may also help fight cancer. In March 2012 issues of the Lancet and Lancet Oncology researchers led by Peter Rothwell and John Radcliffe looked at some interesting stuff. In one meta-analysis they looked at 51 studies in which some people were put on ASA to prevent heart attacks and strokes and some werent. The ones who werent put on ASA got cancer more often. In another paper they looked at 5 big ASA trials to prevent heart attack and stroke. They were looking to see how cancer spread or metastasized. Again the people on the ASA had less cancer spread than those not on ASA. Although these papers are very interesting, they arent randomized, double blind placebo controlled trials. The patients they were looking at were actually heart patients, some of which happened to have cancer. Ideally we would like to see a large group of people without cancer half be given a sugar pill and half be give low dose ASA. Then after a number of years the researchers would check to see which group got cancer more often. Then we would like to see a trial in which a large number of people with cancer are half given a sugar pill and half given ASA and see in which group the cancer spreads the fastest. That way we would have a better idea if this ASA effect on cancer is real or not.


In a medical world full of big expensive surgeries, MRI machines and gene therapy we must not forget about the little things. We already know that the little, inexpensive ASA pill can prevent heart attacks and strokes in some people. Maybe in the future we will be able to stay this little ASA thing can prevent cancer too.


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

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.


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