Historically Speaking: Aspirin, a Pioneering Wonder Drug

The winding, millennia-long route from bark to Bayer.

The Wall Street Journal

February 1, 2024

For ages the most reliable medical advice was also the most simple: Take two aspirin and call me in the morning. This cheap pain reliever, which also thins blood and reduces inflammation, has been a medicine cabinet staple ever since it became available over the counter nearly 110 years ago.

Willow bark, a distant ancestor of aspirin, was a popular ingredient in ancient remedies to relieve pain and treat skin problems. Hippocrates, the father of medicine, was a firm believer in willow’s curative powers. For women with gynecological troubles in the fourth century B.C., he advised burning the leaves “until the steam enters the womb.”

That willow bark could reduce fevers wasn’t discovered until the 18th century. Edward Stone, an English clergyman, noticed its extremely bitter taste was similar to that of the cinchona tree, the source of the costly malaria drug quinine. Stone dried the bark and dosed himself to treat a fever. When he felt better, he tested the powder on others suffering from “ague,” or malaria. When their fevers disappeared, he reported triumphantly to the Royal Society in 1763 that he had found another malaria cure. In fact, he had identified a way to treat its symptoms.

Willows contain salicin, a plant hormone with anti-inflammatory, fever-reducing and pain-relieving properties. Experiments with salicin, and its byproduct salicylic acid, began in earnest in Europe in the 1820s. In 1853 Charles Frédéric Gerhardt, a French chemist, discovered how to create acetylsalicylic acid, the active ingredient in aspirin, but then abandoned his research and died young.

There is some debate over how aspirin became a blockbuster drug for the German company Bayer. Its official history credits Felix Hoffmann, a Bayer chemist, with synthesizing acetylsalicylic acid in 1897 in the hopes of alleviating his father’s severe rheumatic pain. Bayer patented aspirin in 1899 and by 1918 it had become one of the most widely used drugs in the world.

ILLUSTRATION: THOMAS FUCHS

But did Hoffman work alone? Shortly before his death in 1949, Arthur Eichengrün, a Jewish chemist who had spent World War II in a concentration camp, published a paper claiming that Bayer had erased his contribution. In 2000 the BMJ published a study supporting Eichengrün’s claim. Bayer, which became part of the Nazi-backing conglomerate I.G. Farben in 1925, has denied that Eichengrün had a role in the breakthrough.

Aspirin shed its associations with the Third Reich after I.G. Farben sold off Bayer in the early 1950s, but the drug’s pain-relieving hegemony was fleeting. By 1956 Bayer’s British affiliate brought acetaminophen to the market. Ibuprofen became available in 1962.

The drug’s fortunes recovered after the New England Journal of Medicine published a study in 1989 that found the pill reduced the threat of a heart attack by 44%. Some public-health officials promptly encouraged anyone over 50 to take a daily aspirin as a preventive measure.

But as with the case with Rev. Stone, it seems the science is more complicated. In 2022 the U.S. Preventive Services Task Force officially advised against taking the drug prophylactically, given the risk of internal bleeding and the availability of other therapies. Aspirin may work wonders, but it can’t work miracles.

Historically Speaking: Broken Hearts and How to Heal Them

Modern medicine confirms what people have known for thousands of years: heartbreak is more than a metaphor.

The Wall Street Journal

September 30, 2023

A mere generation ago, “heartbreak” was an overused literary metaphor but not an actual medical event. The first person to recognize it as a genuine condition was a Japanese cardiologist named Hikaru Sato. In 1990, Dr. Sato identified the curious case of a female patient who displayed the symptoms of a heart attack while testing negative for it. He named it “Takotsubo Syndrome” after noticing that the left ventricle of her heart changed shape during the episode to resemble a takotsubo, a traditional octopus-trap. A Japanese study in 2001 not only confirmed Sato’s identification of a sudden cardio event that mimics a heart attack but also highlighted the common factor of emotional distress in such patients. It had taken the medical profession 4,000 years to acknowledge what poets had been saying all along: Broken Heart Syndrome is real.

The heart has always been regarded as more than just a pump. The Sumerians of ancient Mesopotamia, now part of modern Iraq, understood it performed a physical function. But they also believed it was the source of all emotion, including love, happiness and despair. One of the first known references to “heartbreak” appears in a 17th century B.C. clay tablet containing a copy of “Atrahasis,” a Babylonian epic poem that parallels the Old Testament story of Noah’s Ark. The words “heart” and “break” are used to describe Atrahasis’s pain at being unable to save people from their imminent doom.

The heart also played a dual mind-body role in ancient Chinese medicine. There was a great emphasis on the importance of emotional regulation, since an enraged or greedy heart was believed to affect other organs. The philosopher Confucius used the heart as an analogy for the perfect relationship between the king and his people: Harmony in the latter and obedience from the former were both essential.

Heart surgeon Daniel Hale Williams. ILLUSTRATION BY THOMAS FUCHS

In the West, the early Catholic Church adopted a more top-down approach to the heart and its emotional problems. Submitting to Christ was the only treatment for what St. Augustine described as the discomfort of the unquiet heart. Even then, the avoidance of heart “pain” was not always possible. For the 16th-century Spanish saint Teresa of Avila, the agonizing sensation of being pierced in the heart was the necessary proof she had received God’s love.

By Shakespeare’s era, the idea of dying for love had become a cliché, but the deadly effects of heartbreak were accepted without question. Grief and anguish kill several of Shakespeare’s characters, including Lady Montague in “Romeo and Juliet,” King Lear, and Desdemona’s father in “Othello.” Shame drives Enobarbus to will his heart to stop in “Antony and Cleopatra”: “Throw my heart against the flint and hardness of my fault.”

London parish clerks continued to list grief as a cause of death until the 19th century, by which time advances in medical science had produced more mechanical explanations for life’s mysteries. In 1893, Daniel Hale Williams—founder of Provident Hospital in Chicago, the first Black-owned hospital in the U. S.—performed one of the earliest successful heart surgeries. He quite literally fixed the broken heart of a stabbing victim by sewing the pericardium or heart sac back together.

Nowadays, there are protocols for treating the coronary problem diagnosed by Dr. Sato. But although we can cure Broken Heart Syndrome, we still can’t cure a broken heart.