Ever since an 18th century English clergyman discovered that eating willow bark was a good way to reduce fevers, people have depended on aspirin -- the drugstore descendant of that home remedy -- to relieve the temperatures and assorted pains that ail them.
But recent revelations that aspirin carries previously hidden powers against heart attacks, stroke and migraines and possibly colon cancer have caused many consumers to ask whether this seemingly innocent pill may rightly be called a wonder drug.
And even if it isn't, isn't it harmless enough to place on the kitchen counter right beside the daily vitamins?
To these questions, doctors are saying, "Hold on."
Although studies demonstrate rather clearly that aspirin is a powerful weapon against heart attack and stroke -- at least in men, the population on whom it has been widely tested -- specialists agreed yesterday that this week's announcement that it may prevent colon cancer deaths is intriguing but far from conclusive.
And although the little white pill is cheap, generally safe and effective against many ailments, doctors insisted yesterday that its potential to cause stomach ulcers, allergic reactions and even brain hemorrhages is a powerful reason to view aspirin with respect.
Anyone considering taking it daily should first consult a physician, they said.
Many doctors have insisted for years that it's a serious drug: often as effective against inflammation and headache as prescription drugs and just as fraught with complications.
"For years, we've been trying to convince patients that when we say, 'Take aspirin,' we're talking about a real drug," said Dr. Stephen J. Gottlieb, a cardiologist at the University of Maryland Medical Center. "Just because it's available without a prescription doesn't mean it's not a good drug."
A wonder drug?
"No," Dr. Gottlieb added. "It's a good drug. It's just a wonder because people can't believe it's a real drug."
Sales of aspirin grow at a pace of 1 percent to 2 percent a year, according to Eugene Melnitchenko, a health care analyst with Legg Mason Wood Walker Inc. This year, aspirin accounts for about 40 percent of the $2.5 million market for analgesics -- a class of pain-relieving drugs that also includes acetaminophen, which appears under such brand names as Tylenol.
However unwilling to turn cartwheels over recent reports about aspirin's benefits, doctors said they were indeed impressed with the string of remarkable studies charting aspirin's usefulness against a variety of serious illnesses.
The clearest cases for aspirin's potential to work wonders come from studies published over the last four years, that document its benefits in preventing heart attacks.
In 1983, 22,000 healthy male physicians volunteered for a long-term study of the effects of aspirin in preventing heart attacks: Half would take a buffered aspirin every other day, and half would take a placebo.
By 1988, aspirin had so clearly demonstrated its ability to prevent heart attacks that the study was stopped, three years ahead of schedule.
But even those studies have their limits.
Dr. Charles Hennekens, the Harvard Medical School professor who headed the study, said the most he can say is that people who have already suffered a heart attack should take an aspirin a day to prevent the very real possibility of recurrence. People with high cholesterol or family histories of heart disease may also, with the concurrence of their physician, benefit from aspirin.
They shouldn't, he cautioned, take aspirin and forget to exercise and eat a low-fat, high-fiber diet.
"Do we want healthy people to start widespread aspirin use?" Dr. Hennekens said. "The data is incomplete on men and nonexistent on women." For healthy people, he said, the risk of getting an ulcer or other unforeseen side effects may outweigh the possible benefit of preventing a heart attack. So until further studies are completed, wait.
Studies over the last decade have also demonstrated that aspirin can be an effective weapon against stroke. Dr. Thomas Price, director of the stroke center at the University of Maryland Medical Center, said three or four aspirin a day are commonly prescribed for people who have had small "transient" strokes.
And two years ago, a study demonstrated that people suffering from atrial fibrillation -- the abnormal heart rhythm that struck President Bush earlier this year -- can also reduce their stroke risk if they take aspirin. This year a Dutch study also suggested that an aspirin a day may be just as effective as the three-aspirin dose that's standard practice.
News that aspirin may be effective against stroke and heart attackreally came as no surprise to many cardiologists, who said that scientists have long known that aspirin prevents the collection of platelets -- particles that cause blood to clot. Blood clots have long been implicated as the culprits in both heart attacks and strokes.