Super-Aspirin

With the rise of wonder drugs, the common aspirin might have been expected to suffer a decline. But instead, doctors say that use of aspirin is steadily on the rise (the U.S. alone consumes 42 million tablets a day). One of its chief uses: treatment of rheumatoid arthritis, one of the nation's commonest chronic illnesses.

Recently, several drug firms produced a "super-aspirin"--a combination of aspirin and a small amount of steroid hormones --which is being publicized as a spectacular remedy for arthritis.

Last week at the meeting of the American Rheumatism Foundation in Bethesda, Md., some of the nation's most prominent rheumatologists suggested that aspirin would have been better left alone.

Since both hormones and aspirin have proved effective remedies for arthritis, super-aspirin backers claim that the two together exert a synergistic effect on patients, i.e., produce greater benefit than the sum of each used separately. But 1) the evidence for super-aspirin's synergistic effect is questionable; 2) aspirin can be taken safely by almost any patient, while hormones are suitable only for some patients. Cortisone, ACTH, prednisone and other hormones sometimes produce such undesirable side effects as peptic ulcers, edema, mental disturbances and high blood pressure.

"The importance of the aspirin-steroid [hormone] tablet has been exaggerated way out of proportion," said Dr. Joseph J. Bunim, clinical director of the National Institute of Arthritis and Metabolic Diseases. "Even though the hormone aspirin pills are a prescription drug, there is a real danger that the patient will get too much of them and knock out his adrenal glands. In many instances the patient won't realize he is not taking ordinary aspirin. In others he will enjoy the lift he gets from them and take more and more. In still others, the physician will respond to the pleadings of his patients and prescribe the pills in huge amounts, not realizing the consequences." Dr. Roger Black of the institute's clinical branch had similar complaints: the physician cannot regulate relative doses of steroid and aspirin in the combined pills to suit the requirements of the individual patient; some patients will be getting less steroid or aspirin than they need, others too much. Drs. Alan K. Done and Vincent C. Kelley of the University of Utah College of Medicine produced new scientific evidence of a theory that might obviate any need to soup up common aspirin. In addition to acting on inflammations, said Drs. Done and Kelley, salicylates (aspirin's family) affect the pituitary-adrenal system, increasing the body's own production of cortisone-like hormones (TIME, June 7, 1954). These body-produced hormones may be as effective in treating arthritis as more dangerous artificial hormones.

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