Jay D. Amsterdam and Leemon B. McHenry : The Paroxetine 352 Bipolar Study Revisited : Desconstruction of Corporate and Academic  Misconduct 

Daniel Kanofsky’s comment on  Barry Blackwell’s comment

Some Reflections on Aspirin and the Spanish Flu Epidemic

        I am writing this during the week of Passover in the year of a plague. It began with my wanting to respond to a few comments Barry Blackwell made regarding the Paroxetine 352 controversy. Specifically: "Academic institutions and professional organizations increasingly collaborate with industry in for-profit and educational ventures and may become indebted or dependent on industry in ways that diminish their ability and willingness to identify, discourage or sanction conflicts of interest among their physician members."

        I had a desire to connect these comments to a question I wanted answered: Did the use of aspirin cause an increase in Spanish Flu deaths? My investigation led to my having more questions. Dr. Karen M. Starko, an infectious disease expert, discusses this topic in "Salicylates and Pandemic Influenza Mortality, 1918-1919 Pharmacology, Pathology and Historic Evidence," published in a 2009 issue of Clinical Infectious Diseases. This journal article states that what we now know to be toxic doses of aspirin - 8 to 30 grams per day, the current recommended maximum daily dose is approximately 4 grams - was frequently being prescribed for flu symptoms. She gives as major evidence for this that "in 1918, the US Surgeon General, The US Navy and the Journal of the American Medical Association recommended use of aspirin just before the October death spike."

        Dr. Starko suggests corporate maneuvers and advertisements by Bayer Pharmaceuticals and other aspirin producers may have been at least partially responsible for many young people being treated with toxic doses of aspirin to palliate flu symptoms with lethal results. Salicylate poisoning can produce pulmonary symptoms resembling those seen in gravely ill influenza cases. If true this might explain the otherwise puzzling high case mortality rate seen among young adults at that time.

        I mentioned this hypothesis to my old friend and medical school comrade Jay Amsterdam. He suggested I ask Ned Shorter about this. Ned Shorter is an esteemed medical historian who specializes in neuropsychiatric disorders. Dr. Shorter had heard about this theory but did not know how credible it was. He was skeptical that Bayer would have a motive to promote its aspirin since it had lost its US patent in 1917. He did however have a "further thought: at the same time as the Spanish flu, another epidemic of encephalitis lethargica (von Economo's disease) was raging. Its symptoms tend to overlap with the symptoms of Reyes-Syndrome, and I'm wondering if some of Reyes cases could have been undiagnosed EL, or conceivably some of the cases of EL could have been Reyes, caused of course, by aspirin overdoses. Just a thought." I find this a very fascinating aside.

        Renewing my literature search I found a 2009 New York Times review of Dr. Starko's hypothesis written by Nicolas Bakalar, "In 1918 Pandemic Another Possible Killer. Aspirin." Mr. Bakalar states: "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 brands purity just as the epidemic was reaching its peak. Aspirin packages were produced containing no warnings about toxicity and few instructions about use." Renderings of these American 1918 advertisements can be found on the internet.

        Bayer is a German company. In 1918 the United States and Germany were at war. Is it possible that Bayer may have been - at best - lackadaisical or - at worst - outright scheming when it promoted its aspirin product to US agencies - including the US Navy - during World War I? Could there have been any motives other than helping humanity and the profit motive? Could helping the German war effort ever have been considered? This sounds like a wild-eyed conspiracy theory and it probably is but I was to learn a much, much worse indictment against Bayer.

        In a 2004 British Medical Journal review of the book "Aspirin: The Remarkable Story of a Wonder Drug" Russian medical historian Baleslav Lichterman writes: "In the story of aspirin, politics and medicine are heavily intertwined. A chapter entitled 'A moral collapse' provides documented stories of Bayer AG sponsoring Dr. Mengle's experiments at Auschwitz. Information obtained from human guinea pigs was used for making and marketing commercial drugs. In 1956 the scientist Fritz ter Meer became a chairman of Bayer, after having been sentenced at the Nuremburg trials to seven years imprisonment for his part in carrying out experiments on human subjects at Auschwitz." The 2004 Lichterman book review only briefly notes: "Aspirin played a key role in the 1918 flu pandemic."

        I would be very curious to know how Bayer aspirin was promoted in Germany during the Spanish Flu epidemic which, of course, coincided with the last days of WWI. Were ailing German sailors and soldiers treated the same as flu stricken American servicemen? For me the trail ends here. I leave it to others to decide whether any of this is worth pursuing further.

References:

Bakalar N. In 1918 pandemic another possible killer. Aspirin. New York Times, October 12, 2009.

Lichterman B. Aspirin: The story of a wonder drug. BMJ, 2004; 329:1408.

Starko KM. Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology and historic evidence. Clinical Infectious Diseases, 2009; 49:1405-10.

September 17, 2020