Heartburn drug illuminates growing mistrust of pharmaceuticals

This week, a study reported that heartburn medications can exacerbate existing conditions instead of alleviating them. The study, which said that Prilosec and similar drugs can cause more -- and more painful -- heartburn, reminded me of a realization made at a marketing focus group. The goal of the session was to review taglines for a local teaching hospital and medical center, but our disparate group was unable to come to even the most minor consensus. The group's designers had done their job too well and we represented both ends of every conceivable opinion spectrum.

We were, however, united in one thing: our universal, even hostile, mistrust of pharmaceutical companies. And the way this study was designed is destined to reinforce that mistrust. Copenhagen University scientists recruited 120 healthy adults with no stomach problems and put half of them on a proton pump inhibitor (PPI) drug, and half on a placebo. The study participants took the pills daily for three months. At the end of the period, the researchers stopped the treatment and measured heartburn, acid reflux and indigestion. Of the group with the PPIs, 44 percent had developed symptoms of some stomach problem, compared to nine percent of the placebo group; a very significant outcome.

So while PPIs do reduce stomach acid, they are created in such a way that they must be taken forever, even if they are administered to patients whose stomachs are already in healthy balance. It's a pharmaceutical company's dream drug; if, that is, ethics are ignored. According to Dr. Kenneth McColl of the University of Glasgow, who wrote an editorial in the journal Gastroenterology, the PPIs are too effective and too well promoted by companies like Procter & Gamble (PG) which makes Prilosec and Astra-Zeneca (AZN), which makes Nexium, approximately five percent of the developed world now receives the treatment, due to the "liberal usage of these powerful drugs," which he suggests is over-prescribing on the part of physicians. He remarks dryly that it "would be better to have a drug that controlled acid and acid-related symptoms during treatment and left them no worse or even better after stopping the treatment." You think?

I wouldn't believe this was at all the intention; no one would knowingly profit by creating a sick person out of a healthy person -- would they? And then I just have to look at the substantial evidence of companies profiting by doing so and I, too, get heartburn. My stomach churns. (I need a pill, don't I?) If it weren't for the duh-obvious example of tobacco companies, who after decades of science demonstrating that smoking kills people still manage to walk to the proverbial bank to deposit their paychecks without being struck by lightning, perhaps I'd stop thinking about it. (And then I remember, oh! fast food! and soda! and I realize that most of our consumer products industry is about getting us hooked on unhealthy things that cause us to need ever more.)

But the list is long and pharmaceutical companies seem too glib to quit. Despite considerably negative coverage last week following Pfizer's (PFE) record-breaking fine of $2.3 billion for promoting off-label prescribing of its pain management drugs, a spokesperson interviewed on NPR never said anything along the lines of "we're sorry" or "we did something wrong." Instead she answered every question with some variation of "we're such an ethical company and we're thrilled that we can now talk more about that!" An actual quote from the interview: these fines "bring final closure to significant legal matters and help to enhance our focus on what we do best - discovering, developing and delivering innovative medicines." She went on to say how "proud" the company was to "strengthen our internal controls." Does anyone really believe this, I wonder? Does she?

Pharmaceutical companies are barely even liked by their own employees; a relative who is a drug rep tells stories of drugs whose price is doubled weeks before going off patent protection, to be replaced by a "cheaper" alternative that has just been slightly reformulated to obtain the new intellectual property rights. He was not bragging about the company's "pioneering practices."

Despite this news, I predict it will be many years before consumers stop asking for the purple pills (of various shades) and doctors stop prescribing this "shotgun to kill a fly," as one pharmacologist describes PPIs. We distrust the companies. But we're hooked.

Sounds just like cigarettes.

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