Every year, North Americans consume between 25 and 50 million pounds of ASA in search of relief from fever, inflammation and pain. Long identified with minor afflictions, ASA (acetylsalicylic acid, popularly known by brand names such as Aspirin, Anacin and Excedrin) has been taken for granted as the lowliest drug in the medicine cabinet. But studies that have been conducted in increasing frequency over the past decade indicate that the commonplace white tablet may have value as a potent medication. The latest preliminary evidence, gathered by researchers at Yale University, suggests that ASA may be effective in preventing cataracts. These findings join a spate of studies raising the possibility that ASA may be helpful in treating such debilitating ailments as stroke and heart attack. As the “wonder drug” news rolls in, accounts of its adverse effects have been drowned out, creating fears that an excited public may misuse a drug they know little about.
In an attempt to offset the potential problem of ASA misuse, some pharma-
cists are seeking greater control over its sale and use. Throughout Canada, ASA is on a free list and in fact is not a drug by definition, meaning it can be sold in places like supermarkets, gas stations and corner stores,where no drug counsel is available. Last December, the Ontario College of Pharmacists sent a letter to the minister of health, Dennis Timbrell, proposing that ASA be sold only in pharmacies. Bill Wensley, registrar of the college, believes ASA should be classified as a “controlled nonprescription or a prescription drug” to limit its distribution to pharmacies.
The controls are incidental to the college’s real concern that a pharmacist be available when ASA is purchased to answer questions and inform buyers of possible hazards. Even now, says Wensley, some pharmacists have taken ASA off the shelves and distribute it only from the dispensary.
The pharmacists are not just crying wolf to boost profit. Some of the hazards of ASA use are life-threatening. Because ASA interferes with blood clotting, it may cause serious drug interactions for heart or stroke patients already on certain anticoagulants for abnormal blood clotting. For women who take ASA in the last three months of pregnancy, there’s a higher than normal risk of bleeding at birth and a possibility that the child may hemorrhage in the brain or elsewhere.
Other ailments such as stomach upset are more common, afflicting five per cent of ASA users. The acidity of ASA irritates the stomach lining, and a full daily dosage of eight five-grain tablets causes most people to lose one-half to two teaspoons of blood from the stomach. Even if the tablets are buffered or swallowed with milk, peptic ulcer patients risk serious hemorrhaging and rupture from the irritation.
As well, ASA can be harmful as a cure for a hangover. Dr. Wilma Basser, a Toronto gastroenterologist, warns, “If you drink, don’t take aspirin.” She cites the example of a 47-year-old man who just before Christmas drank socially on three successive days and took two or three tablets each day for the headaches. He was rushed to the hospital vomiting blood from ASA-induced erosions of the stomach. “And he was just an ordinary guy,” says Basser, “with no history of stomach problems.”
Not surprisingly, the pharmacists’ proposal isn’t receiving many plaudits from the major ASA manufacturers, such as Sterling Drug Ltd., which produces Aspirin, and Whitehall Laborato-
ries, which makes Anacin. ASA products are their bread-and-butter items, and the companies feel the information presented on or in the package itself is sufficient. “There is a fair amount of information and cautions in the package,” says Joe Kiefer, director of corporate relations for Sterling. “It could be of help if someone had a condition such as stomach upset and hadn’t been dealing with a doctor.”
Sterling has invested in a possible expanding market by providing funds for
therapeutic uses. So far the company hasn’t felt the impact of ASA’s new applications, but it clearly anticipates an upward turn in sales. Says Kiefer: “I think there will be a broadening of the use of the drug once doctors assimilate the information.”
The revelation of ASA’s broad potential came in 1971 with the discovery by Dr. John R. Vane of the Royal College of Surgeons in England that the drug inhibits the production of prostaglandins, hormone-like fatty acids that cause blood platelets to stick together and clot. A major Canadian study, released in 1978 by London, Ont., neurologist Dr. Henry Barnett and his colleagues, found that moderate doses of ASA (four tablets a day) reduced the incidence of stroke in men over 50 years old by 48 per cent. Strangely, the same benefit did not apply to women tested. There is recent laboratory speculation that with lower doses of about a half-tablet daily, women may also be able to use ASA to prevent stroke.
Until more clinical research comes in from other centres, Barnett still recommends a four-tablet dose. But the federal Health Protection Branch is so confident of the new findings that it will be proposing a new labelling and bottling of a reduced-dose aspirin for stroke patients which, in line with Ontario’s proposal, may be sold only in pharmacies. Dr. Ian Henderson, director of the branch’s Bureau of Human Drugs, predicts: “What we’re heading toward here in Canada is a half-tablet, about 125 mg, that is plenty for this problem. But we don’t feel that people should be selfmedicating for the prevention of stroke, especially the high-risk patients with high blood pressure.”
In a similar vein, ASA was shown by Dr. Richard Peto in Oxford, England, to reduce heart attacks by 21 per cent in
people who had already experienced one attack. His tests also showed cardiovascular mortality dropped by 16 per cent. Preliminary studies in more innovative uses of the drug are sending ripples of excitement and skepticism through the medical community. Findings suggest ASA may be useful in preventing sunburn and even in containing cancer.
As if that news wasn’t good enough for the ASA manufacturers, federal officials are monitoring test results of “a better ASA tablet” combining ASA with either dipyridamole or sulphinpyrazon for heart and stroke patients. Ultimately, government policy-makers feel ASA’s pros outweigh the cons, and Henderson argues that “restricting distribution at this stage isn’t feasible.” Even the pharmacists admit that controls could be unfair to headache-sufferers in isolated communities, on highways and on Sundays.
Nevertheless, Ontario is not alone in its bid for changes in ASA sales. Quebec pharmacists have been making the same proposal since 1973, as has B.C., but without success. The consensus is that ASA users don’t know as much about the drug as they should. And the beatification of a formerly pedestrian drug must take into account the most formidable obstacle of all—the psychological bent of the user. He wants to take two of them, whatever they are.
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