Aspirin: The Ancient Remedy We Keep Forgetting (Until We Need It Again)

Science, to me, is about wonder, about unlimited curiosity; it is about benevolence and the thrill of discovery - and it is also, supposed to be about step-wise, incremental progress, with that occasional "EUREKA!" Yet, time and again, we find ourselves rediscovering what was already known (or what probably could've at least been known much sooner).

Take aspirin, a drug whose roots trace back to ancient herbal medicine. For thousands of years, civilizations used willow bark to relieve pain and fever, but the active compound, salicin, was only isolated in 1828 (by Johann Buchner). It was later purified (by Raffaele Piria) - but it was found to be really nasty to the stomach.

Then in 1897, Felix Hoffmann (a chemist at 拜耳 ) synthesized a more stable, less irritating form - by acetylating it. And acetylsalicylic acid was patented by Bayer in 1899, under the brand name: "Aspirin" (a combination of "A" from acetyl, "spir" from Spiraea ulmaria - the meadowsweet plant that is rich in salicin, and that de rigueur pharmaceutical suffix, "in").

Aspirin soon became a global medical staple, valued for its pain relief, anti-inflammatory properties, fever reduction, and, later, for its cardiovascular protective capabilities. But aspirin’s true potential was only just beginning to be understood.

Aspirin: The Drug That Kept Proving Itself

During World War I, Bayer lost its trademark on aspirin (due to war reparations), making it a generic drug worldwide.

Then, in the mid-20th century, it was uncovered how aspirin works - by inhibiting prostaglandins, the compounds responsible for inflammation, pain, and fever. By the 1970s, pharmacologist John Vane discovered that aspirin specifically blocks cyclooxygenase (COX-1 and COX-2) - the enzymes that drive inflammation and clot formation. That got him the Nobel Prize in Medicine in 1982 - not too shabby!

Aspirin’s benefits are really quite extraordinary:

• It kills pain!
• It reduces fever, making it a core treatment for flu and infections (at least before paracetamol took over).
• It is anti-inflammatory.
• It protects the heart, reducing heart attack and stroke risk.

Plus, it is one of the most widely and long-studied, versatile drugs ever discovered.

And yet, despite all of this, aspirin was pushed aside.

Paracetamol: The Overhyped Successor?

Enter paracetamol (acetaminophen) - often touted as a more effective and “safer” painkiller. It became the default pain medication worldwide, but I've always had serious doubts:

• Paracetamol is not anti-inflammatory (well, minimally, at best). Paracetamol works mainly on the CNS, dulling our perception of pain rather than impacting the causes. So, unlike aspirin, it is poor at reducing inflammation, making it far less effective for conditions involving swelling, joint pain, or injury.
• It is hepatotoxic. In overdose (or even sustained high doses), paracetamol is metabolized into NAPQI, a highly toxic byproduct that can cause liver failure by depleting glutathione, a critical antioxidant.
• The Fix Exists - but it is apparently repeatedly dismissed. N-acetylcysteine (NAC) restores glutathione and prevents liver damage. So why is NAC only given after poisoning, rather than being added? I recognize that the challenge is whether the simplicity of adding methionine or NAC to the pill would still be effective - is it protective or corrective? NAC administration is currently only done after overdose. and it may only work then because of how the liver metabolizes paracetamol. But, shouldn't we be really looking into it?
• No cardiovascular benefits. Unlike aspirin, paracetamol does not protect the heart.

If we were truly prioritizing public health over profit, paracetamol would have been reformulated with NAC or methionine years ago. But doing so would mean admitting the current formulation is flawed - and it would reduce profit margins and raise costs to reformulate. Plus, the cynical side of me wonders if the fact that preventing liver toxicity from the get-go would also reduce the revenue from treating liver failure might be a factor somewhere...

Ibuprofen: The Middle Ground That Still Falls Short

At least ibuprofen is anti-inflammatory, making it a superior option to paracetamol for injuries and arthritis. However, it still lacks aspirin’s cardiovascular protection and has its own risks:

• Higher cardiovascular risks in long-term users.
• Gastrointestinal irritation (though less severe than aspirin for some).

So why did aspirin lose its dominance? Because, I'd wager, marketing, not medicine, dictated the shift. Aspirin’s fall from grace was arguably due to a combination of factors: safety concerns, shifting medical recommendations, and commercial trends:

1. Gastrointestinal issues – Aspirin can cause ulcers and stomach bleeding in some users.
2. Reye’s syndrome – A rare but serious condition in children, leading to caution in pediatric use.
3. Industry-driven shifts in preference ("Big Pharma" priorities): Lack of reformulation efforts – Unlike aspirin, paracetamol has remained the default pain reliever despite its well-documented hepatotoxicity, with no serious efforts to add protective compounds like NAC.

If safety were truly the driving factor, why was aspirin abandoned over stomach risks, while paracetamol - which can cause fatal liver failure - remained untouched? Aspirin was reduced in use due to long-term gastric bleeding risks, while paracetamol's danger is acute overdose toxicity, meaning the risks are not quite identical. But, doesn't this still feel more like a case of partiality rather than a rational balance of the relative risk levels?

Aspirin’s True Legacy: The Wisdom of Our Ancestors

What is especially frustrating is that aspirin’s origins lie in traditional medicine - the same knowledge that modern pharmaceutical companies often dismiss.

Our ancestors knew that willow bark and meadowsweet contain powerful pain-relieving, inflammation-reducing, and fever-lowering compounds. It took us centuries to isolate salicin, refine it into aspirin, and recognize its true medical potential - only to push it aside again.

And now, we are once again “rediscovering” its benefits.

The Latest Revelation: Aspirin and Cancer Prevention

And now, serendipity strikes again - new research suggests that aspirin may help prevent cancer from spreading.

A UKRI-backed study is investigating aspirin’s potential to inhibit metastasis, yet another remarkable benefit of a drug that has largely been sidelined.

How much sooner could we have discovered this had aspirin remained a primary focus of medical research (or even medical use) rather than being replaced by more profitable pain relievers?

And more importantly - what else might we have overlooked by dismissing a drug that keeps proving itself time and again?

The Lost Art of Effective Pain Relief

Aspirin’s sidelining is not an isolated case. Cue the controversy...

The same pattern has happened with opiates. Once a valuable, carefully managed tool for pain relief, now demonized to the point where even the safest, most effective combinations - like aspirin + codeine effervescent tablets, which always worked wonders for my migraines - seem to have all but disappeared.

Opiates like codeine are also highly effective as antitussives (cough suppressants) and antidiarrheals - again, multi-use, but 'pariahed'...

Instead of refining what works, we seem to abandon effective treatments in favor of newer, patent-protected, and far more expensive alternatives - often bolstering fear to justify our biases.

The Future: Progress or Just Reinventing the Past?

Aspirin’s cancer research resurgence is, to my perhaps somewhat jaded perspective, just the latest reminder that we too often discard old wisdom in favor of marketing hype. It raises important questions:

• If aspirin has been so effective (and so widely so) for this long, why did we abandon it so easily?
• If research now suggests it could prevent cancer metastasis, how much sooner could we have found this out, and what else might we have been missing from neglecting such a powerful drug?
• If paracetamol could be made safer, why has it not been reformulated?
• And if ancient herbal wisdom led us to aspirin, what else have we ignored and what else might we still be ignoring or denying in the witch-hunt against traditional medicines and pharmacognosy?

Sometimes, progress is not about new discoveries - it is about revisiting and recognizing the ancestral wisdom we arrogantly toss-aside in the hubris of our perceived techno-superiority...

Is it time to stop letting profit dictate medicine?