Americans take 29 billion aspirin every year. That fact alone demonstrates how extraordinary the ordinary little tablet in everybody's medicine chest really is.
It relieves pain, it reduces fever. It can prevent a heart attack, or save a life if a person is having one.
Scientists think aspirin may even prevent some cancers and could slow the onset of senility.
But, where does aspirin come from?
Steven Weisman, a consultant for Bayer, explains: Hippocrates, considered the father of modern medicine, was prescribing willow bark tea [extracted salicyn is the ingredient in aspirin] in 400 B.C., but it wasn't until 1897, in the laboratories of a German manufacturer of dyes for fabric, the Friedrich Bayer Corp., that a chemist named Felix Hoffman, hoping to relieve his father's arthritis, made true aspirin -- acetyl salicylic acid -- out of coal tar.
Bayer knew a wonder drug when it saw one. They patented it, and trademarked the name "aspirin."
"There's some folklore around how the name aspirin came," says Weisman. "One is that it was named after St. Aspirinus, the patron saint of headaches. But, another legend is that it was actually named based on aceytyl, and spirin, for the spiria plant, which is a plant very similar to the willow tree in which salicylic acid, or salicyn is found."
At first, doctors dispensed aspirin by prescription to establish it as real medicine -- not something snake oil salesmen peddled.
"The doctor would actually measure a small amount of aspirin out, put it in a piece of paper and give it to his patient to take home to treat their fever or pain," says Weisman.
But one white powder can be substituted for another, so aspirin tablets, with the familiar Bayer imprint, appeared in 1900. It was the birth of the modern pharmaceutical industry.
It wasn't long before aspirin was such big business that it was a prize of war at the end of World War I. With Germany's defeat, not only was the map of Europe re-drawn, but Bayer's U.S. holdings were confiscated and sold to the Sterling Drug Company. For more than 70 years, Bayer aspirin wasn't even made by Bayer in America. Finally, in 1994, the German company bought back the right to use its own name in the United States.
Once Bayer's patent expired, the U.S. courts ruled anybody could make and sell acetylsalicylic acid and call it aspirin. By then, it was sold over the counter, so competitors exploited real or imagined differences between brands, such as Bayer's claim that its product had no effect on the heart -- an amazing irony given what is now know about aspirin.
Columbia University student Noah Burns first made aspirin in a freshman chemistry lab.
"What's stunning is that something that's so basic, so old news as chemistry, could reveal itself to be so cutting edge as medicine," he says.
Dr. Charles Hennekens says, "I regard aspirin to be the wonder drug of the 20th century and, possibly, the wonder drug of the 21st century.
Hennekens headed a landmark aspirin study conducted by Harvard Medical School in the 1980s. The "physicians health study," which tracked 22,000 apparently healthy male doctors, was supposed to be a 10-year study. It was stopped after five years because of its dramatic results.
"The chief reason that the data and safety monitors board made this recommendation was because of the emergence of a statistically extreme, 44 percent reduction in the risk of a first heart attack among the aspirin takers," says Hennekens. "When we started the study, we thought there might be about a 15 or a 20 percent reduction if one occurred at all."
At about the same time, other studies showed that taking low-dose aspirin regularly significantly lowered the risk not only of a second heart attack, but also of a stroke. Evidence showed that taking an aspirin within 24 hours of having a heart attack, the chances of dying is reduced by 23 percent.
The effectiveness of aspirin may be found in its ability to make small changes in the blood.
"If you cut yourself when you're shaving and you bleed, it's blood platelets that come together and stick together and initiate the stopping of that bleeding," says Hennekens. So, it was thought that if aspirin could decrease the tendency of blood to clot this way, it might break the chain of events leading to a heart attack."
Aspirin acts on hormone-like substances called prostaglandins, which tell the blood platelets to clot or not. English researcher Sir John Vane figured out the aspirin question in 1971. He discovered aspirin was a life-saving drug, and he won the Nobel Prize.
Some 40,000 women health care professionals, some still working, others retired, are about to make more aspirin history. They are participants in a 10-year Harvard Medical School study that concludes next month.
"I think all of us as human beings like to make a contribution to society at large, and this looked a relatively easy way of doing that," says Maria Bueche, a nurse practitioner with the Brigham and Women's Hospital.
Lead investigator Julie Buring wanted the study to do for healthy women what the physicians study did for men -- to find out if aspirin prevents heart attack and stroke. But it goes way beyond any previous study. It looks at whether aspirin can help prevent cancer, age-related vision loss, even the onset of senility.
A CAT scan is part of the next generation of aspirin science. A scan can measure calcium or plaque accumulating in the walls of the arteries for a patient at risk of a heart attack.
"What we have to find now, with the aspirin study, is whether we can show a change in the amount of plaque that people develop over time using both high and low doses of aspirin," says Buring. "There's no way to do that non-invasively by any other technique."
The sophistication of the machine will enable Janowitz and Hennekens to continue the process of fine-tuning who should be taking aspirin and how much -- recognizing that it has real, if rare, risks.
"If you think you're a candidate for aspirin, see your health care provider, because it's a decision that has to be based not just on your risk of getting a heart attack, but the side effects of the drug," says Hennekens. "The things that you worry about when you decide to prescribe aspirin for a patient are that there's about a 1 percent risk of a significant bleed among aspirin takers, and about a one in 1,000 or less risk of a bleed into the brain. So, you have to weigh that significant downside against these large benefits. In my own view, aspirin has the best benefit to risk ratio and benefit to cost ratio of any treatment of heart attacks.
When aspirin officially turned 100 a few years ago, Terry Sharrer, medical curator at the Smithsonian Institution, decided it belonged in the collection.
The humble aspirin finds itself in some pretty impressive company, such as Jonas Salk's original polio vaccine and a sample of Robert Koch's original tuberculin.
"Fifty-thousand tons of aspirin are sold today," says Hennekens. "It's arguably the most important pharmaceutical of all time."