The history of Aspirin, a genericized trademark for acetylsalicylic acid (ASA), and more precisely, aspirin precursors, is a long and winding one, which goes all the way back to ancient Sumer and Egypt, with the famous Hippocrates referring to the use of salicylic tea to reduce fever circa 400 BC. Now, since I’m sure you haven’t come here for a complete history of Aspirin from ancient times to present day, especially since you want to understand the relevance of this discussion sooner rather than much later, we’re going to skip ahead to 1897.

In 1897, Felix Hoffmann and/or Arthur Eichengrün of Bayer was the first to produce acetylsalicylic acid in a pure, stable form. It was only two short years later before Bayer began to sell the drug globally under the brand name of Aspirin, with the first tablet appearing in 1900. It wasn’t long before Aspirin’s popularity took off as it was touted as a “turn of the century miracle drug“, especially since early trials (published in an 1899 study in the journals Die Heilkunde and Therapeutische Monatshefte) demonstrated that Aspirin was indeed superior to other known salicylates. Moreover, since this drug was deemed to be considerably safer and comparably less toxic to the drugs it was replacing, it was fast-tracked through review and approval processes and first became available to the public without a prescription in 1915, only 15 years after the first tablet appeared. If you consider the rate of progress and introduction of new technologies at the turn of the century, this was blazingly fast for the time.

It’s quick, and early, introduction arguably made it the first modern over-the-counter mass market pharmaceutical product as well as a household name across the world. As the first generally available pharmaceutical anti-inflammatory and pain-killer, it changed societies. It allowed anyone to deal with mild to moderate pain and continue to function. It allowed doctors to quickly get inflammation and fever under control and spend more time diagnosing the cause, or simply move onto the next patient if it was a flu or infection they couldn’t do anything about (and the patient just had to survive long enough to fight it off on their own). Since there was no technology to quickly develop a vaccine for a heretofore unknown virus back in 1916, it was hailed as the literal lifesaver during the Spanish Flu pandemic of 1918. Even though that pandemic [which infected over 20% of the global population] killed an estimated 50 MILLION people, or almost 3% of the global population at the time, (which means COVID really wasn’t that bad with a global death toll of 7 Million, or a mere 0.1% of the global population) it is believed that many more people would have succumbed to the Spanish Flu without Aspirin that helped them control the fever (and the pain) long enough for their body to fight off the infection on its own. (And many articles to this day claim this, including this 2019 article from the Saturday Evening Post.)

But guess what? Aspirin didn’t save. Aspirin Killed!

In 1916 Aspirin was still new and physicians didn’t understand the long term effects or the proper dosage levels. Moreover, the sicker you were, the more they’d give you. Regimens were 8g to 31g a day, which, by the way, is two to four times the maximum safe dosage for an average adult (of 4g). Two to four times! What’s even worse is that at those levels, 33% and 3% of patients will experience hyperventilation and pulmonary edema, respectively. The last thing you want when experiencing a high fever and pneumonia is hyperventilation. The stress on an older adult or one with already compromised lungs (due to smoking, coal mining, asbestos production, or genetic conditions) could literally be lethal. Moreover, pulmonary edema generally is, unless you have immediate access to an expert physician who can drain the fluids without collapsing your lung. As per recent research, it’s likely that at least 3% of those administered Aspirin for the Spanish Flu died from the Aspirin overdoses they were being given.

Of course, the damage done by Aspirin was not limited to the Spanish Flu Epidemic. It wasn’t long before Aspirin was prescribed for everything. Common cold? Check. Sore throat? Check. Arthritic pain? Check. Heart problems? Check. See the 1933 Advertisement in the linked Saturday Evening Post article above. (Note that a tablet at that time would have been about 325 grams [Source], like today, and the advertisement was recommending 1.3 grams in 4 hours and gargling with 975 grams, of which you need to expect some additional absorption (of 5% to 10%, we’ll assume worst case), bringing that total to 1.4 grams. While not nearly as bad as the Spanish Flu level prescriptions, that’s still twice the amount that should be taken in a 4 hour window, and that was being taken in 2 hours.)

When we say damage, we mean damage. Moreover, the damage goes beyond the almost 60 side effects you can find on the Mayo Clinic page.

This is because regular use and/or overdoses of aspirin:

• increase the risk of developing stomach ulcers,
• agitate and stomach exacerbate ulcers and can cause bleeding, and
• can increase non-life threatening ulcer or gastrointestinal bleeding to the point of life threatening

Moreover, in some people it can irritate the lining of the stomach and begin the formation of an ulcer after just a few doses!

But the general population didn’t know this in the 1930s. Heck, it was the 1950s or 1960s before it started to become common knowledge that aspirin wasn’t good if you have an upset stomach or an ulcer. (As far as I can tell, while the first study of aspirin on the stomach was in a 1938 publication by A. H. Douthwaite and G. A. M. Lintott, the subject matter and research was not taken seriously until the 1950s and 1960s, where you had publications like this by R. A. Douglas and E. D. Johnston on Aspirin and the Chronic Gastric Ulcer, which also references the 1938 publication.)

Which means millions of people around the world were using a medicine on a daily basis that was, due to misuse, often harming them as much as it was helping them. And this is only ONE of the 60 potential side effects. (And how many were known, or communicated, in the 1920s through 1950s?)

Because, like many of the breakthrough technologies that came before, it was not only rolled out before the side effects, and more importantly, the long term effects, were well understood, but before even the proper use for the desired primary effects were well understood (as evidenced by the fact that the best physicians were routinely prescribing two to four times the maximum safe dosage during the Spanish Flu Pandemic almost 20 years after first availability). And while there were benefits, there were consequences, some of them severe, and others deadly.

So what’s the relevance? Stay tuned.