A SMALL WHITE PILL

The seeds of great discoveries are constantly floating around us, but they only take root in minds well prepared to receive them.

Joseph Henry (American scientist)

There is a small white pill which is swallowed by millions of Indians everyday either for relief from pain or fever or even as a preventive measure. The pill is marketed in bottles or in small strips which grace the medical shelf of almost every household.

It is low-priced, obtainable easily without a prescription, and can be purchased anywhere either in the large departmental stores and pharmacies in all major cities or even in the smallest grocery shops in the remotest villages of the country. The pill which is commonly known by the brand name ‘Aspirin’ was perfected in a simple and safe form for the first time as acetylsalicylic acid in 1897 by Felix Hoffmann, a German chemist working at Friedrich Bayer and Company–as a remedy for pain a compound related to acetylsalicylic acid had been used even in the fourth century bc by the famous Greek physician, Hippocrates who had been advising women experiencing labour pains to chew willow leaves to get relief. He had been unaware of the presence of salicin in those leaves and had perhaps relied mainly on experience and observation.

European doctors in the eighteenth century had similarly been using these leaves in the treatment of fevers and aches. Even though acetylsalicylic acid had been purified in the last century it had not begun to be used due to its corrosive effect on the stomach and mouth.

It was only after World War I, when America had obtained the trade mark for aspirin from Germany, that it had become proverbially known all over the world for its qualities of relieving pain. But till the early 1970s people had not been aware about the precise mechanism of operation of aspirin in the human physiological system. The credit for the scientific and systematic study of aspirin should go to the British pharmacologist John Vane who along with Sune Bergstrom and Bengt Samueleson of Sweden shared the Nobel Prize in the year 1982 for their work on the role of prostaglandins.

Prostaglandins are substances similar to hormones which have a short existence and are found in almost all the cells of the body and govern several important processes. They also come into play when the body is under attack. In 1971 John Vane showed that acetylsalicylic acid, a substance found in pain-relieving and fever-reducing medications like aspirin, works by inhibiting the formation of prostglandins. In 1976 he discovered the prostacyclin prostglandin, which expands the smallest blood vessels and, unlike certain other prostglandins, inhibits the formation of blood particles called platelets that cause blood to coagulate.

Prostaglandins had first been discovered in the 1930s by UlfVon Euler, a Swedish physiologist. A couple of decades later his student Bergstrom had purified and crystallised the first two prostaglandins. This work had inspired his own student Samuelson to conduct further researches.

John Vane was working on his own independently in London. Prostaglandins are found to be responsible for the formation of the mucous lining inside the stomach that protects it from its own acid. Prostaglandins in fact regulate the production of the acid itself. Prostaglandins also have the property of enabling platelets in the blood join together thus stimulating the clotting process, which is initiated by the release one kind of prostaglandin called thromboxane from the platelets.

Prostaglandins also have other properties such as their ability to reduce blood pressure, stimulate muscular contractions, and modify the action of some hormones. Vane had shown for the first time in 1971 that aspirin had the effect of inhibiting the production of prostaglandins, leading to relief from pain and fever. Scientists had also found that aspirin inhibited the production of prostaglandins by inactivating cyclooxygenase, an enzyme.

This property of aspirin leads indirectly to the stoppage of formation of the mucous lining inside the stomach. It is for this reason that aspirin is thought to cause stomach irritation, though by itself it does not interfere with the digestive system. When the local physician advises his patient against taking aspirin in the interest of preventing a stomach upset, what he really means is that aspirin could stop the formation of the mucous lining in the stomach and thus leave it defenceless against the acid.

The other property of aspirin is its ability to prevent clotting by interfering with the formation of prostaglandins, which has become the subject matter of intense speculation among doctors all over the world. It is commonly known for example that one of the causes of heart attacks as well as strokes is the formation of blood clots in the arteries. Doctors had observed that people taking aspirin appeared to be getting comparatively lesser number of heart attacks but they had no clear evidence to accurately correlate the two factors, i.e. the intake of aspirin and the occurrence of heart attacks or strokes.

However, research carried out in the early 1970s seemed to indicate that low daily doses of aspirin could reduce the chance of a second attack by 20 per cent and a second stroke by nearly half. It therefore, seemed justifiable to infer that this drug which could have such an influence on the probability of occurrence of a second heart attack or stroke could have a similar effect on the possibility of occurrence of the first heart attack or stroke itself.

Doctors were already in a position to say that an aspirin every other day would definitely keep a heart attack away.

A daily dose is not being advocated since a compromise has to be made between the aim of preventing heart attacks and aspirin’s known tendency to cause stomach irritation. Millions of people all over the world have already benefited from such therapy.

Researches seemed to indicate that aspirin could have several other potential benefits such as inhibiting the formation of some chemicals in the lens of the eye which are responsible for making it opaque. Once this condition known as cataract is established aspirin would not be able to reverse it, but scientists are hopeful that aspirin can be used as a preventive measure. The other benefit of aspirin is the stopping of the production of excessive mucin by the gall bladder which could act as a nucleus for the formation of stones. It can also prevent damage to the eye due to clotting in the blood vessels near the eye in patients with diabetes by inhibiting the formation of clots and also prevent the spread of tumours or cancers by its effect on prostaglandins.

However, despite these benefits and advantages aspirin could have certain dangerous side-effects which have to be borne in mind. Most of the contraindications are known to the medical profession and a wise physician would advise certain persons against taking aspirin.

There are people with ulcers, people taking anti-coagulant drugs or other medicines which react with aspirin in an adverse manner, and pregnant women in whom aspirin could trigger off bleeding or birth defects in the new born. Excessive intake of aspirin can prove very dangerous by making the entire system acidic and upsetting the metabolism. Being a non-steroidal anti-inflammatory drug( NSAID) it can lead to lead to kidney failure, in kidney patients.

One other serious side-effect of aspirin has also recently been discovered. It would appear that giving aspirin to a child who is suffering from chicken pox or some other viral infection such as flu or chicken pox could result in a condition known as Reyes’s syndrome, whose symptoms include liver failure and inflammation of the brain. Reyes syndrome, which affects children below the age of 15, is usually fatal.

While there are physicians who would like to argue that the evidence in this respect is still inconclusive most doctors abroad have already begun to take the statistical data available rather seriously and generally seem to feel that aspirin should not be given to a child having in giving aspirin to a child who has a viral fever, particularly Chicken pox. discretion is the better part of valour.

Aspirin’s analgesic property’s well as its efficacy as an anti- inflammatory agent have been well established. But scientists have found evidence to suggest another remarkable property.

Aspirin is also a chemoprotective agent. As such it may reduce overall cancer incidence and mortality in colorectal, esophagus and gastric cancers. It also has smaller effects on prostate, breast and lung cancer. Randomised control trials in laboratory conditions showed that doses of Aspirin between 75 and 300 mg daily reduced overall cancer incidence by 12% after 3 years and also demonstrated a 33% reduction in mortality and 25% reduction in the incidence of colorectal cancer with a median follow up of 18.3 years.

I would like to end this essay by stating that the small white pill is truly a wonder drug.