It might seem strange to have a popular book of more than 300 pages dedicated to just one drug. But aspirin is a special case. One of the most brilliant medical historians and journalists of our time, the late Roy Porter, wrote a book called The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (BMJ 1998;316: 713). Replace “humanity” for “aspirin” in the title, and it would ideally fit the book under review. Diarmuid Jeffreys, a journalist and television producer, has written an inspiring story based on archival sources, interviews, and an amazing knowledge of the relevant literature. His book clearly demonstrates that the border between academic medical history and journalistic investigation is blurred.
Figure 1.
Diarmuid Jeffreys
Bloomsbury, £16.99, pp 352 ISBN 0 7475 7077 9 www.bloomsbury.com
Rating: ★★★★
Jeffreys describes aspirin as, among other things, “the most remarkable drug the world has ever seen,” “one of the astonishing inventions in history,” and “one of the most endurably successful commercial products of all time.” Such claims are well substantiated. Aspirin is not only the subject of about 26 000 scientific papers, but also a cultural icon that has appeared in the writings of George Orwell (The Road to Wigan Pier), Graham Greene (Stamboul Train), and Edgar Wallace (The Door with Seven Locks). In 1930 the Spanish writer Jose Ortega y Gasset dubbed his era “the aspirin age.”
Figure 2.
Where there's a willow...
The aspirin age is not yet over. Mashkovsky's manual, a standard reference book on pharmaceuticals for medical practitioners in the former Soviet Union, lists about 50 synonyms of aspirin with the following footnote: “The multitude of synonyms indicates the prevalence of this drug.” Acetylsalycilic acid and drugs that contain it are produced by dozens of manufacturers from different countries.
Aspirin is divided into three parts. Jeffreys follows the story from ancient Egypt, where willow was used as a medicine, through to 18th century England, when the Reverend Edward Stone attempted to use willow bark for the treatment of malaria. In 1853 the French chemist Charles Gerhardt synthesised acetylsalicylic acid—the active ingredient of willow bark. In 1897 Arthur Eichengrun, a chemist employed by the Bayer company in Germany, gave his younger colleague Felix Hoffman the task of finding a version of salicylic acid that did not have the unpleasant side effects of nausea and gastric pain. Hoffman repeated Gerhardt's experiments, but Heinrich Dreser, head of the pharmacology department at Bayer, rejected the new substance.
It was Eichengrun who first tried the drug on himself and then arranged secret clinical trials in Berlin to demonstrate its efficacy. Eichengrun also coined the name of the new drug in January 1899. Since salicylic acid could be obtained from the meadowsweet plant, an abbreviation of the plant's Latin genus—Spiraea—was put at the heart of the new brand name. “A” was added at the beginning to acknowledge acetylation, whereas “in” was tacked on to the end for easier pronunciation. However, Eichengrun was excluded from the official version of Bayer's history since 1934 because of his Jewish origin. Instead, it was claimed that aspirin was “discovered” by an “Aryan” scientist, Felix Hoffman, to alleviate the sufferings of his rheumatic father. Surprisingly, Bayer AG is still perpetuating this myth (www.bayeraspirin.com/questions/hundred_aspirin.htm).
The second part of the book covers the story of the wonder drug from 1899 to 1945. Aspirin played a key role in the 1918 flu pandemic. It might also have had a crucial part in the collapse of the Russian empire. It is thought that Prince Alexei (the son of the last Russian emperor), who had haemophilia, was prescribed aspirin to reduce pain in his joints. This increased his bleeding. The illiterate quack Grigory Rasputin convinced the empress, Alexandra, to abandon modern treatments. Without aspirin the prince's health improved. The subsequent growth of Rasputin's power over the royal family “had been a significant factor in turning Russians against the Czar and in favour of revolution,” says Jeffreys.
In the story of aspirin, politics and medicine are heavily intertwined. A chapter entitled “A moral collapse” provides documented stories of Bayer AG sponsoring Dr Mengele's experiments at Auschwitz. Information obtained from human guinea pigs was used for making and marketing commercial drugs. In 1956 the scientist Fritz ter Meer became a chairman of Bayer, after having been sentenced at the Nuremberg trials to seven years' imprisonment for his part in carrying out experiments on human subjects at Auschwitz. Auschwitz survivor Eva Mozes Kor, whom Jeffreys interviewed for his book, says that she has always tried to avoid taking any Bayer drugs, including Bayer aspirin.
The third part of the book tells the story of “aspirin's renaissance” in the second half of the 20th century. Prostaglandins were found to be responsible for pain and blood clotting. In June 1971 Nature published a seminal paper by John Vane and Priscilla Piper, “Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs.” The antiplatelet activity of aspirin has resulted in a new use for an old drug. After several clinical trials aspirin began to be marketed as a preventive treatment for secondary heart attacks. The next step was to use it for prevention of primary heart attacks and stroke. Recent studies demonstrate aspirin's potentially preventive effect on different types of cancer.
The aspirin companies quickly grasped the commercial possibilities of these new uses. The author notes that had it not been for those who ruthlessly exploited the commercial value of aspirin the drug might not have survived long enough to reveal its remarkable therapeutic secrets.
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