Old is the new new: What does aspirin mean for public health?

According to Professor Karol Sikora in the Telegraph yesterday,  aspirin’s newly discovered anti-cancer properties “will prove to be useful, but let’s not think we’ve discovered a panacea – the future of cancer care is much more interesting than that.”

Here is an interesting bit of history of medicine trivia – Bayer Aspirin was the first drug ever to be marketed in tablet form, in 1899 as a powder. However by 1900 aspirin was being compressed into a water-soluble tablet. This new method eliminated the need to package individual doses and thus cut costs. Aspirin is consumed in a variety of ways. The French prefer suppositories to pills, the Italians take fizzy forms akin to Alka-Seltzer and the British like aspirin powders to be dissolved in water. Aspirin has often been lauded for its’ role in cutting the risk of heart disease and ischemic stroke.

The new revelations that aspirin has anti-cancer properties only now is astonishing, after such an involved history of using willow bark to medicate for pain.

Tackling the incidence of disease is the fundamental to any prevention strategy-which brings us full circle to the Public Health association. The role of inflammation in cancer causation is clear. Aspirin as a low toxic anti-inflammatory. If we can vaccinate against the cause of various inflammations, we can remove or at least lower risks. This will lead to such questions – Can’t we just get everyone to take a dose of aspirin a day and write-off the rest of public health?

It is important to reason with these media announcements of new or in this case ancient “wonder drugs”.

Doctors are cautious of mass medication of populations, not just because of the associated risk (adversely affecting the lining of the stomach) with long-term self medication but because of question of effectiveness and efficacy. The future of cancer prevention as with much of disease, will be about individual’s understanding and living with risk.

To reiterate Katora, what we do now about prevention will impact on frequency and type of cancer incidence in future generations. Disproportionately  only 2 per cent of the total cancer research budget is spent on prevention, but the question remains about the perceived value of treatment over and above that of prevention. Why do we think we are getting a better deal if we get the most expensive drugs in late stage cancer, than if we are encouraged to prevent cheaply by taking a boring 75mg of aspirin everyday?

In a climate of individualisation of risk through genomic mapping and increasingly effective focused prevention – aspirin probably only has a small part to play in the the future of cancer care….the rest is likely to cost much more than 43p for 16 caplets.

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