In 1918 Pandemic, Another Possible Killer: Aspirin

[Cees Binkhorst]

REPLY TO: D66 at nic.surfnet.nl

Een verrassende ontdekking!
Die grote vraagtekens zet bij het A(H1N1)-beleid gebaseerd op het aantal
doden in 1918.

Daarnaast, en dat zie ik niet in dit artikel terug, heeft salycilzuur
(=aspirine) invloed op de chemische pathways in de hersenen. De details
heb ik alleen op papier en niet de tijd om nu te zoeken. Bij de vogelgriep
kwam dit naar voren.

Groet / Cees


http://www.nytimes.com/2009/10/13/health/13aspirin.html
October 13, 2009
In 1918 Pandemic, Another Possible Killer: Aspirin
By NICHOLAS BAKALAR

The 1918 flu epidemic was probably the deadliest plague in human history,
killing more than 50 million people worldwide. Now it appears that a small
number of the deaths may have been caused not by the virus, but by a drug
used to treat it: aspirin.

Dr. Karen M. Starko, author of one of the earliest papers connecting
aspirin use with Reye’s syndrome, has published an article suggesting that
overdoses of the relatively new “wonder drug” could have been deadly.

What raised Dr. Starko’s suspicions is that high doses of aspirin, amounts
considered unsafe today, were commonly used to treat the illness, and the
symptoms of aspirin overdose may have been difficult to distinguish from
those of the flu, especially among those who died soon after they became
ill.

Some doubts were raised even at the time. At least one contemporary
pathologist working for the Public Health Service thought that the amount
of lung damage seen during autopsies in early deaths was too little to
attribute to viral pneumonia, and that the large amounts of bloody, watery
liquid in the lungs must have had some other cause.

Dr. Starko acknowledged that she did not have autopsy reports or other
documents that could prove that aspirin was the problem. “There was a lot
of chaos in these places,” she said, “and I’m not sure if there are good
records anywhere.”

But of the many factors that might have influenced the outcome in any
particular case, Dr. Starko wrote, aspirin overdose stands out for several
reasons, including a confluence of historical events.

In February 1917, Bayer lost its American patent on aspirin, opening a
lucrative drug market to many manufacturers. Bayer fought back with
copious advertising, celebrating the brand’s purity just as the epidemic
was reaching its peak.

Aspirin packages were produced containing no warnings about toxicity and
few instructions about use. In the fall of 1918, facing a widespread
deadly disease with no known cure, the surgeon general and the United
States Navy recommended aspirin as a symptomatic treatment, and the
military bought large quantities of the drug.

The Journal of the American Medical Association suggested a dose of 1,000
milligrams every three hours, the equivalent of almost 25 standard
325-milligram aspirin tablets in 24 hours. This is about twice the daily
dosage generally considered safe today.

Dr. Starko’s paper, published in the Nov. 1 issue of Clinical Infectious
Diseases, has stirred some interest, if not enthusiastic endorsement,
among other experts.

“I think the paper is creative and asking good questions,” said John M.
Barry, author of a book on the 1918 flu titled “The Great Influenza.” “But
we don’t know how many people actually took the doses of aspirin discussed
in the article.”

The pharmacology of aspirin is complex and was not fully understood until
the 1960s, but dosage is crucial. Doubling the dose given at six-hour
intervals can cause a 400 percent increase in the amount of the medicine
that remains in the body. Even quite low daily doses — six to nine
standard aspirin pills a day for several days — can lead to dangerously
high blood levels of the drug in some people.

Peter A. Chyka, a professor of pharmacy at the University of Tennessee,
said he found Dr. Starko’s theory “intriguing.” Little was known about
safe dosages at the time, he said, and doctors often simply raised the
amount until they saw signs of toxicity.

“In the context of what we know today about aspirin and aspirinlike
products, Starko has made an interesting effort to put this together,” Dr.
Chyka said. “There are things other than flu that can complicate a disease
like this.”

Although he doubted that more than a small number of deaths could be
attributed to aspirin overdose, Dr. David M. Morens, an epidemiologist
with the National Institutes of Health, said the paper was valuable in
that “it makes an attempt to look at environmental or host factors that
may be involved.” He said, “We haven’t been able to explain all the deaths
in young adults with the virus itself.”

Dr. Starko was hesitant to estimate how many deaths aspirin overdose could
have caused, but suggested that military archives might be one place to
look. “I’m hoping others will follow up,” she said, “by examining
available treatment records.”

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