Friday 30 July 2004

Keep taking the tablets

Forget the scare stories, says Diarmuid Jeffreys, author of a history of aspirin – the little white pill is ‘one of the most amazing creations in medical history’.

In the opening pages of Aspirin: The Remarkable Story of a Wonder Drug, Diarmuid Jeffreys describes this little white pill as ‘one of the most amazing creations in medical history, a drug so astonishingly versatile that it can relieve headache, ease your aching limbs, lower your temperature and treat some of the deadliest human diseases’.

Evidence shows that aspirin can prevent heart attacks, strokes and deep vein thrombosis, as well as bowel, lung and breast cancer, cataracts, migraine, infertility, herpes, Alzheimer’s disease and more.

Yet news headlines tend to highlight the risks rather than the benefits associated with pharmaceutical products, from gastointestinal bleeding to overdoses. According to the headline of a recent BBC News article, ‘Medicines are “killing 10,000 people”’; it was reported that one in 16 people admitted to two hospitals in Merseyside ‘had been admitted because of an adverse reaction to drugs such as aspirin’.

‘The media will often go for simple headlines’, says Jeffreys, who has worked in the media industry for years, as a journalist and a producer of current affairs and documentary programmes such as Newsnight and the Money Programme. So is the book an attempt to rebalance the debate about drugs? ‘To some extent, yes. I wanted to correct the impression given by the media.’ While recognising that there are risks associated with aspirin - just as there are with every other drug - Jeffreys argues that ‘you have to set these numbers against the thousands and thousands of people whose lives can be saved by taking aspirin on a daily basis’.

After his father suffered a heart attack 12 years ago and was put on a daily dose of aspirin, Jeffreys was struck by how ‘a very ordinary, everyday, humdrum pill that could be found in just about every bathroom cabinet when I was a kid could have morphed into something so life-saving’. He decided then that he would one day investigate how this could be, and now he has done just that. He found ‘it was like peeling away the skin of an onion. I came across Bayer’s story [the drug company that first patented aspirin over 100 years ago] and then I looked a little further and a little further, and a kind of mosaic of people, places and events began to emerge’.

Jeffreys’ book shows that aspirin did not just emerge out of nowhere. He provides a fascinating account of the history of the drug, which is ‘a product of a rollercoaster ride through time, of accidental discoveries and intuitive reasoning, of astounding scientific ingenuity, personal ambition and intense corporate rivalry’ (1).

Ancient Egyptian physicians used extracts from the willow tree as an analgesic. Centuries later the Greek physician Hippocrates recommended the bark of the willow tree as a remedy for the pains of childbirth and as a fever reducer. But it wasn’t until the eighteenth and nineteenth centuries that salicylates - the chemical found in the willow tree - became the subject of serious scientific investigation. The race was on to identify the active ingredient and to replicate it synthetically. At the end of the nineteenth century a German company, Friedrich Bayer & Co, succeeded in creating a relatively safe and very effective chemical compound, acetylsalicylic acid, which was renamed aspirin.

Within 15 years aspirin was one of the most widely used drugs in the world - ‘a pharmaceutical superstar’, as Jeffreys says. A few years later aspirin faced its greatest challenge, when influenza swept the world between 1918 and 1919. The pandemic was devastating, killing tens of millions of people. Aspirin didn’t cure influenza but what Jeffreys shows is that ‘it helped millions of people in their battle with the virus and undoubtedly saved lives as a result.’ (2)

In the course of telling aspirin’s story Jeffreys engagingly grapples with challenging questions about the nature of innovation and the impact of commercial rivalry on scientific advancement.

He argues that the late nineteenth century was a more fertile period for experimentation, partly because of ‘the hunger among scientists to crack some of the great secrets’, but also because ‘those secrets - that were the first and second layer of scientific discovery - were within their means to crack’. He shows that one scientist in a laboratory with some chemicals and a test tube could make significant breakthroughs - whereas today, in order to map the human genome for instance, ‘one would need an army of researchers, a bank of computers and millions and millions of dollars’.

But is an understanding of the nature of science and scientific inquiry enough to explain how society innovates? Jeffreys acknowledges the connection between the late industrial revolution and scientific advance, explaining ‘there was nothing predestined about the industrial formulation of aspirin, any more than there was about the invention of the internal combustion engine or the building of the Suez Canal. But fortunately for us, the nineteenth century was a period when people frequently had the means, motive and determination to take an idea and turn it into reality. In the case of aspirin that happened piecemeal - a series of minor, often unrelated advances, fertilised by the century’s broader economic, medical and scientific developments, that led to one big final breakthrough’ (3).

The relationship between big money and pharmaceutical innovation is a very important one, argues Jeffreys. ‘Had it not thrived through profit-driven competition, [aspirin] might never have survived to release its incredible therapeutic benefit.’ Aspirin’s continued shelf life was ensured ‘because for the first 70 years of its life, huge amounts of money were put into advertising and promoting it as an ordinary everyday analgesic’. In the 1970s, when discoveries were made regarding its beneficial role in preventing heart attacks, strokes and other afflictions, other analgesics, such as ibuprofen and paracetamol, were entering the market. Had it not been for the recent discoveries of aspirin’s therapeutic benefit this pharmaceutical marvel may well have disappeared.

So the relationship between big money and drugs ‘is an odd one’, says Jeffreys. Commercial markets are necessary for developing new products and ensuring that they remain around long enough for scientists to carry out research on them. But the commercial markets are just as likely to kill off certain products when something more attractive comes along. So if ibuprofen or paracetamol had entered the market just a decade earlier, he says, ‘aspirin might then not be here today. It would be just another forgotten drug that people hadn’t bothered to explore’.

‘If I have an argument with the relationship between drugs and money, it is because sometimes it gets completely distorted’, he says. A potential ‘wonder drug’ was around for over 70 years without anybody asking how it worked, because ‘they were making more than enough money out of it as it was’.

None of the discoveries of aspirin’s benefits were made by the big pharmaceutical companies; they were made by scientists working in the public sector. ‘The reason for that is very simple and straightforward’, Jeffreys says. ‘Drug companies will only pursue research that is going to deliver financial benefits. There’s no profit in aspirin any more. It is incredibly inexpensive with tiny [profit] margins and it has no patent any more, so anyone can produce it.’ In fact, there’s almost a disincentive for drug companies to further boost the drug, he argues, as it could possibly put them out of business by stopping them from selling their more expensive brands.

So what is the solution to a lack of commercial interest in further exploring the therapeutic benefits of aspirin? More public money going into clinical trials, says Jeffreys. But the future doesn’t look rosy. The EU Directive on Clinical Trials has arguably made conducting research into drugs such as aspirin more difficult (4). It states that every clinical trial needs to have one sole sponsor, so that if something goes wrong (and the EU seems to believe that there are a lot of rogue trials going on out there) one institution or ‘sponsor’ can be held responsible.

‘The financial risks associated with this are enormous’, says Jeffreys. ‘A university or academic institution cannot carry that load alone. Previously they would have combined with others to spread the starting costs and any legal liability.’ So what should be done? ‘If I were the Department of Health, I would say “this is a very inexpensive drug. There may be a lot of other things we could do with it.” We should put a lot more money into trying to find out.’

Jeffreys’ book - which not only tells the tale of a ‘wonder drug’ but also explores the nature of innovation and the role of big business, public money and regulation - reminds us why such research is so important.

Aspirin: The Remarkable Story of a Wonder Drug by Diarmuid Jeffreys is published by Bloomsbury, 2004. Buy this book from Amazon (UK) or Amazon (USA)

(1) Aspirin: The Remarkable Story of a Wonder Drug, Diarmuid Jeffreys, Bloomsbury 2004, p2

(2) Aspirin: The Remarkable Story of a Wonder Drug, Diarmuid Jeffreys, Bloomsbury 2004, p124

(3) Aspirin: The Remarkable Story of a Wonder Drug, Diarmuid Jeffreys, Bloomsbury 2004, p35

(4) Clinical trials directive 2001/20/EC

First published by spiked