The better pill

BY: MICHAEL HANLON From: The Australian April 07, 2012

Given that it has been suspected for half a century that aspirin can fight cancer, it is odd that there has not been more research into this wonder drug.

MOST medical breakthroughs that sound too good to be true are just that. There are often unforeseen side-effects or stratospheric costs and sometimes the first results turn out to be outliers; disappointing follow-ups show the drug doesn’t work as well as first thought.

But this one might be different. News that a low dose of aspirin taken daily for more than five years could prevent nearly a third of all cancer deaths is so startling that one is tempted to wonder if they’ve made a mistake. Professor Peter Rothwell of Oxford University, the lead author of a study published last month, went as far as to say:

“It is not impossible that if you take aspirin for 20 years you could add 6-12 months to life expectancy. You could treat 10,000 people with aspirin for the price of treating one with Herceptin [a drug used primarily to treat breast cancer] – and the thing is, the aspirin might work even better.” Professor Sir John Burn of Newcastle University in the UK, one of the world’s leading experts on the genetics of cancer, put it bluntly: “Whichever way you look at it, people who have been taking aspirin for some time get less cancer.”

Three papers published in The Lancet in March confirm decades of suspicion that aspirin has a powerful anti-cancer effect, as well as helping to prevent heart attacks and strokes. The research has shown that aspirin is effective against a range of cancers and that it may prevent metastasis – the spread of cancer from one part of the body. Even better, it is thought that the longer you take aspirin, the better its preventive effects become. Over three years it reduced cancer diagnoses by 19 per cent, and over five years by 30 per cent.

The findings came as a surprise even to those who have long advocated the protective benefits of the drug. “We knew that it reduced the long-term risk of cancer, but these latest results show that it seems to have an effect on reducing the risk of cancer in as little as three years,” says Keith Souter, author of An Aspirin a Day. “More than that, it seems to reduce metastasis. That is quite remarkable.” So is this really as good as it sounds? And how can a drug that costs a few cents a day turn out to be as effective – perhaps even more effective – than the expensive treatments for cancer that have emerged from the labs of big pharma?

Aspirin – formally acetylsalicylic acid – was synthesised in the 1890s by the German company Bayer and works by reducing the body’s natural inflammatory response. Like other anti-inflammatories, such as ibuprofen, it blocks the function of cyclooxygenase enzymes that in turn generate prostaglandins, the chemicals that trigger pain and tissue inflammation at a site of injury or infection. Inflammation is responsible for much of the tissue damage associated with conditions such as heart disease and many cancers.

In addition, aspirin prevents the coagulation of blood platelets, which may be why tumour cells find it harder to migrate around the body and “stick”, forming a new tumour. Aspirin is so effective against such a wide variety of ailments that some experts suggest we should rethink what it actually is. “Aspirin could be thought of less as a drug than as an essential nutrient,” says Burn. Indeed many scientists believe we should rebrand aspirin as vitamin S, after salicylates, naturally occurring aspirin-like chemicals.

One of the great mysteries of medicine is the marked increase in cancer, particularly in the West, in the past 80 years. Much of this can be put down to our longer lives and the fact that cancer is, mostly, a disease of old age. But this alone cannot explain the cancer epidemic. One hypothesis is that modern farming leaves the vegetables that we eat deficient in salicylates, which many plants accumulate in their tissues as a protective response to infection or attack by pests. “We never eat plants that have been infected these days; the leaves with black spots on them get thrown away,” says Burn. “The reason salicylate turns out to be so good for everything could simply be because we are a bit short of it.”

Some nations’ diets are naturally rich in aspirin-like compounds. “One of the richest sources of salicylate – even better than willow bark [the first source of aspirin identified] – is cumin,” says Rothwell. “And it is interesting that several cancers are far less common in India than in the West.”

Given that it has been suspected for half a century that aspirin can fight cancer – there were studies in mice as far back as the 1960s – it is odd that there has not been more research into this wonder drug. After all, governments and drug firms have invested hundreds of billions of dollars into other treatments, with precious little to show for the money. There have been successes, childhood leukaemia the most notable. But against many of the big killers – lung, liver, brain, bladder and ovarian cancer, to name but five – doctors are as powerless as ever, reduced to crude surgery and chemotherapy to fight a disease that nearly always wins in the end.

So why haven’t the scientists leapt upon aspirin? “It is a bit embarrassing,” says Burn. “People think aspirin is old and therefore boring.” He adds that getting funding for these trials has always been difficult. There is no money in aspirin, which has been out of patent for decades. And the medical profession has historically been far less interested in prevention than cure. “We are too conservative,” says Rothwell. Another obstacle is that in clinical trials aspirin is subjected to the same protocols as novel drugs. “We need to get the regulators off our backs and tell them we are testing something you can buy in the supermarket and to stop treating it like thalidomide,” says Burn.

The fact that aspirin is not entirely safe partly explains the reluctance of the medical establishment to endorse its use as a prophylactic. Overuse in the 20th century led to many deaths, and about one person in 10,000 who uses aspirin regularly will suffer serious side-effects such as intestinal or stomach bleeding or, in very rare cases, strokes. But evidence is growing that for a large group of the population – men and women aged 40 and above, and especially those with a close relation (parent or sibling) who has had cancer – these risks are massively outweighed by the benefits. The problem is that while a doctor can always point to (and theoretically be sued by) the rare patient who develops a perforated ulcer, he or she will never meet the person who didn’t get cancer.

The people behind the recent aspirin studies all say the same thing: talk to your GP before embarking on a course of prophylactic aspirin. The official line from health authorities in Australia and elsewhere is that it is too early to recommend it to healthy people to prevent cancer because it could cause catastrophic bleeding and slow bleeds that cause anaemia, especially in the elderly. It is also unclear what the best dosage might be.

But when pressed, scientists usually admit to taking aspirin themselves. “The thing is, the thing that is most likely to kill you in your 50s is no longer a heart attack, as was once the case, but cancer,” says Rothwell, who is 47. “I have three children under 10 and I want to see them grow up.” He has been taking aspirin for several years.

And this is a case where life really does come cheap – a possible extra year of healthy existence for a few cents a week. “I could literally afford to treat the whole country myself for a week,” says Burn. Which will be music to the ears of those in charge of health budgets if follow-up studies confirm that the aspirin miracle is real.

http://www.theaustralian.com.au/news/features/the-better-pill/story-e6frg8h6-1226317677069