All is not lost—medicine’s great cheap wonder is still available.
March 2, 2005
With the fall of the Cox-2 inhibitors insufficient attention has been given to the one drug that works almost as well and is much cheaper—perhaps the great wonder drug of the 19th century. OK, 1899, when it was first marketed. [Picky]. We speak of aspirin, of course. In a fine piece by Elizabeth Large at the Baltimore Sun, she points out that aspirin fell out of favor largely because it’s been around for 100 years and everyone assumes the new drugs are better, if for no other reason than they are more expensive. It also lost market share with the arrival of acetaminophen (Tylenol). Acetaminopen doesn’t have the same risk of causing internal bleeding as does aspirin, but is otherwise inferior to salicylic acid. It does nothing, for example, for inflammation and is not a better pain killer. Since pain is largely subjective, aspirin may work as well as Vioxx, Celebrex and Bextra for some people without the risks of those drugs, and aspirin does lots of things the Cox-2 inhibitors don’t. Aspirin in small doses (81 milligrams—or what used to be called “baby“ doses) can prevent heart disease and strokes; may cut the risk of colorectal cancer; help prostate cancer victims live longer; treat pre-eclampsia; possibly reduce the risk of Alzheimer’s, and could help the immune system. The evidence mounts: In a new study in the New England Journal of Medicine, aspirin was shown to reduce the risk of stroke in women by 17 percent, especially ischemic stroke. It showed no significant reduction in fatal heart attacks (the exact opposite of men) but that may be because, as Tom Maugh pointed out in the LA Times, the bulk of women in the study may have been just too young. Well, the real question is why aspirin works differently with men than it does with women.