Aspirin: The Extraordinary Story of a Wonder Drug [Englisch] [Taschenbuch]

The engaging writing actually was worth 4 stars, while the medical accuracy was about 1 star. It was fascinating to read about the personal characters of many of the main players with aspirin.

For the primary prevention of heart attacks, the author failed to note that most or all of the subjects were men in the various trials. Based on later work available to Mr. Jeffreys, this omission was serious, since MDs and others recommended aspirin for women as though they had been tested from the beginning.

The Physicians Health Study (PHS) of 7 years duration that generated all the rave headlines (p262) in 1989 did cut mostly non-fatal heart attack risk to 0.31 of placebo. Mr. Jeffreys failed to mention that the all-cause death risk was 0.96 and not statistically significant. Further, he neglected to mention that the PHS did not use aspirin, but used Bufferin™. This is not a trivial difference because of the beneficial magnesium content of Bufferin™. The later UK trial of plain aspirin on 5,500 male physicians for 7 years told a different story. The risk of non-fatal heart attack was a less impressive 0.68, and the mortality risk was 1.06. A later trial of 3.1 years that included separate results for women taking daily aspirin of unknown form gave them a mortality risk of 1.12.

Mr. Jeffreys fell for the ruse of relative risk (RR) rather than absolute risk (AR); Big Pharma uses RR to generate bigger numbers. For the 22,000 men in the PHS the reduction of AR per year of a first heart attack was just 0.11%, not a big deal. Aspirin for primary prevention is not worth the risk.

For secondary prevention of heart attacks (ones other than the first), Mr. Jeffreys correctly presented the fact that the RR with aspirin was down to 0.75-0.80; but he failed to note that just 5 weeks of daily aspirin provided nearly all of the "benefit"; so it was never necessary to continue aspirin forever and suffer all the side-effects mentioned but minimized by Mr. Jeffreys. Aspirin is probably worth the risk for short-term use in secondary prevention. He did note that women were under-represented in these early trials, but did not come to the obvious conclusion that women should avoid aspirin. He failed to note that long-term use of aspirin was associated with cataracts. He failed to compare the minor effects of aspirin with those of valuable supplements, such as EPA/DHA from fish oil, magnesium, and even vitamin E.

In enthusing about aspirin as an anticancer drug, Mr. Jeffreys failed to note that the increased mortality rates noted above, which include cancer deaths, make it unlikely that aspirin will ever be a serious threat to cancer.

Mr. Jeffreys repeated the nonsense that fatty foods cause atherosclerosis leading to heart attacks (p235, 267), and presented the challenge to this dogma in a footnote that mentioned Uffe Ravnskov as a "lone wolf" dissenter. This is a propagandist trick as there have been many, many dissenters over the years to what is called the "diet-heart" theory. See www.THINCS.org. (What is true is that polyunsaturated fats or oils, especially ones made from the omega-6 linoleic acid and trans fatty acids from partial hydrogenation do cause both diabetes and atherosclerosis, not animal or tropical fats.)
*****
Minor problems were confusing heart attacks (myocardial infarctions) caused by broken pieces of plaque or congealed blood platelets (thrombi) with congestive heart failure, and by ignoring sudden cardiac death brought on by arrhythmias.

Beta-blocker drugs do not steady the heartbeat (p246) as antiarrythmics were supposed to do, but slow the heartbeat.

Salicylates are not alkaloids (p11).

Aniline is not isolated from coal tar (p42).

Acid anhydrides are not usually obtained when acids are separated from water (p46).

Aspirin is not metabolized by loss of the hydroxyl group (p47).

A paradox? "Aspirin didn't cure a single case of influenza, but it helped millions of people in their battle with the virus and undoubtedly saved many lives as a result." (p124)

Reverse snobbery? Some chemical names of 25 letters or fewer were fussed over. Would Mr. Jeffreys have done the same for the 28-letter name Abercrombie Featherstonehaugh? (p207, 214ff)

Aspirin was buffered in an attempt to ease stomach distress, not to speed up absorption (p210).

The great superiority of magnesium to aspirin in pre-eclampsia was ignored (p266).

The "polypill" containing aspirin, beta-blocker and statin drugs was presented as a great idea (p273). Those who understand more than Mr. Jeffreys have written that it is ridiculous. See www.THINCS.org.

[...]

Aspirin is follows aspirin through its birth (Ancient Sumer and/or Egypt using willow bark as medicinal treatment), childhood (purification, chemical synthesis), adolescence (the race for monopoly and profit), adulthood (most popular drug on the planet), mid-life crisis (advent of new drugs such as Tylenol and ibuprofen), and its sudden discovery that there is life after middle-age (use as heart medicine and its possible use for a variety of other medicinal purposes).

The story is well-paced for the most part and the writing is strong. It's always clear, even when explaining the chemistry, and Jeffreys knows when enough is enough and how to move fluidly from one stage of development to the next. He also does an excellent job of making this as much about people as about chemistry, offering up small but memorable characterizations of the many people involved in aspirin's development, beginning with a young Egyptologist who bought a "found" papyrus that turned out to be the largest medical reference of ancient Egypt.

Sometimes in his enthusiasm for his subject Jeffreys may overstate aspirin's influence a bit, such as its historical role in World War II and the Nazi govt. or its efficacy during the flu pandemic of the early 20th century or still-to-be-proven uses such as a cancer fighting drug. But none of these are way out of line and they happen so rarely, and are so reasonable that they detract hardly at all from the book's pleasure.

Personally, I found the ancient history and its early history the most interesting and compelling, while the sections on German Bayer's attempts to corner the market and its later influence in Nazism to be a little overlong. Not that they weren't interesting in their own right, just that they could have been cut a bit more. Again, a small quibble.

In fact, there's very little to complain about here. An interesting read, a quick one, a clear explanation of science and the intersection of science/medicine/capitalism, an enjoyable examination of scientists and inventors little known to the vast majority of us. Recommended.

We take aspirin for granted; we have had it as a handy analgesic since 1899. It has, however, a history far longer than that, and during its subsequent time as a commercial tablet, it has been at the heart of medical, advertising, scientific and historic controversies. In _Aspirin: The Remarkable Story of a Wonder Drug_ (Bloomsbury), Diarmuid Jeffreys has told the whole story of a drug that became a standard tablet only after many centuries of use, and then, when other pain relievers were crowding it out, became a nostrum for heart attack and stroke prevention, as well as other indications. It is a terrific story of many side branches, and Jeffreys has told it with a lively sense of humor (for there are many wrong-headed notions along the way, and many peculiar people) and also admiration for those who have pursued the development and use of aspirin in a scientific way.

Physicians in ancient Egypt used extracts from willow trees as analgesics, and probably learned about them from the Sumerians before. Hippocrates and Galen knew of it, but we lost wisdom about such things in the Middle Ages. The modern story begins with the Reverend Edward Stone who lived in Chipping Norton, England. Around 1757, Stone came to correct conclusions about willow bark, but used doubtful reasoning, for instance that it was bitter like quinine and so would help fevers. There was a boom in chemical synthesis in the nineteenth century, and Friedrich Bayer & Co., a German firm, succeeded in making pure ASA in quantities, and christened it Aspirin. There were few proven drugs on the market at the time, drugs like quinine and digitalis, and other than the opiates, there were no proven analgesics. This meant that Aspirin quickly became one of the most widely used drugs in the world. In 1920, the trade name Aspirin was legally determined to have passed into common usage, and from then on, anyone, not just Bayer, could make ASA and call it aspirin. Aspirin makers fought in advertising, but by the sixties, they had other battles to fight; Tylenol was launched as a prescription drug in 1955, soon going over-the-counter. Motrin came out, too. It seemed to some in the 1960s that aspirin was going to continue to fade, but then it was reborn. Doctors noticed that patients on aspirin seemed to have fewer heart attacks, and researchers began the laborious process of confirming this in large tests.

Aspirin has been found to have promise of helping to prevent different cancers, too, and maybe even Alzheimer's. This is not all a story of benevolent chemistry; after all, Aspirin had made the Bayer company, which was part of I. G. Farben, the giant chemical cartel that used slave labor during World War II and supplied lethal gas to extermination camps. There are certainly darker sides to the way big business, cutthroat competition, and backstabbing chemists brought us this wonder drug; intrigue, ambition, and greed are all here. Jeffrey's book tells all this darkness as well as the promises that the drug has fulfilled and may have in the future; in that way, it is an inspiring story of how base motives can sometimes produce a miracle.