From the depths of a small white pill has come more than 100 years of hope.
As pedestrian as a headache, as common as the willow bark from which it was first extracted, aspirin has helped an untold number of sufferers find relief from various ills.
"As far as the kind of bread-and-butter drugs we've had over the years, aspirin is one of the best," said James McCoy, owner of a pharmacy in Abilene, Tex. "Even with some of its reported side effects, it's still a very safe, effective medicine."
Now flung far from the pain-relieving qualities that gave the medicine its fame, aspirin has flown to unanticipated heights, including a role in treating conditions such as coronary heart disease and in the possible treatment and prevention of some cancers.
Helping the heart
Dr. Charles Hennekens, a professor at Harvard Medical School, is known as one of the most prominent aspirin researchers in the country due to his efforts that led to many current conclusions about the drug and its role in heart health and stroke prevention.
Aspirin's unique nature is its seemingly endless ability to provide more and more uses without changing any aspect of its age-old formula, he said.
"In some sense, aspirin is as old as medicine itself," Hennekens said. "Hippocrates prescribed the bark of the white willow tree to relieve patients' aches and pains around 300 B.C., and of course it is from this base understanding that aspirin as we know it would come into being."
But it wasn't until the 1970s that some inkling began to manifest of aspirin's potential role in preventing and assisting in recovery from cardiovascular disease.
"The real breakthrough came when a physician who was using aspirin to treat people for rheumatoid arthritis noticed that his patients were having fewer heart attacks," said Thomas Bryant, president of the National Aspirin Foundation. "What had once just been a headache remedy of choice was showing a whole new side of itself."
Hennekens headed a major aspirin-related study that began in the 1980s, the so-called Physician's Health Study. More than 44 percent of the men participating in the study, all physicians, suffered fewer first heart attacks if they were given 325 milligrams of acetylsalicylic acid on alternate days.
The Food and Drug Administration approved the use of aspirin to prevent a recurrent heart attack and a first heart attack in people with unstable angina in 1985, perhaps ironic for a medicine which, when first advertised, was said to "not affect the heart."
These days, thanks to further research and understanding, the American Heart Assn. recommends taking an aspirin as soon as the warning signs of a heart attack occur, unless you have an allergy to aspirin or a condition that makes using it too risky.
But taking aspirin is not advised during a stroke, because it could actually make the latter strokes more severe.
Such advances are tempered by an advanced understanding of how aspirin affects some individuals, particularly those who are allergic to it and young children, who can be at risk of contracting serious viral infections if given aspirin in some cases.
But for those who can take the drug, either in controlled amounts or relatively freely, the upper limits of aspirin's abilities have not yet been reached.
"Aspirin has been called the wonder drug of the 20th century and I genuinely believe that it will be the wonder drug of the 21st," Hennekens said. "Studies have indicated that it may help promote a lower risk of colon cancer and that it may have some role in preventing cognitive loss among older people."
Aspirin, unlike most drugs, does not treat just a single disease but seems to have a small but significant effect on any number of conditions, he said.
"We're getting very close to knowing how aspirin really works," Bryant said. " I can't wait to see what we come up with in the future."