Heartburn

Robert Kuttner, co-editor of The American Prospect magazine, had experienced a few bouts of mild heartburn, when a particularly severe episode sent him to the emergency room. After his doctor prescribed Prilosec (omeprazole), a common heartburn therapy, he thought that this would resolve his condition.  He never imagined that this drug — intended to treat his symptoms — would actually make them worse, and that he would become dependent for years on ever-increasing doses of the medication in a dangerous cycle ending only after he stopped taking Prilosec and switched to other, safer therapies.

This story is likely all too common among patients placed on a widely used class of medications known as proton pump inhibitors (PPIs) — Prilosec being the most common — which suppress stomach acid and are used to treat conditions such as heartburn and other, more severe illnesses.  The drugs have traditionally been considered largely harmless by patients and physicians alike. Yet PPIs have been increasingly associated with a range of dangerous, and sometimes fatal, side effects and can even cause, as in Mr. Kuttner’s case, long-term dependence.

In August 2011, Public Citizen filed a petition with the Food and Drug Administration (FDA) to put black box warnings on all PPIs to warn doctors and patients of these life-threatening side effects and to remind doctors that there are many safer alternatives for everyday conditions, such as acid reflux, that often work just as well. The petition was supported by Mr. Kuttner and Dr. Helge Waldum, a physician-researcher and author of 135 scientific papers, among them the first study showing that patients could become dependent on PPIs.

The absence of prominently displayed risk information in PPI labels is likely a key contributor to the vast amount of overuse of the drugs, as doctors may not be aware that such serious risks exist and thus resort to PPIs as a first option for even mild cases of heartburn. Most patients on the drugs do not even have a documented need for the therapy, and many more could easily be switched to safer options.

Even the most popular over-the-counter remedies for heartburn, like Tums and Rolaids, have risks if they are used in high quantities.  Many of these problems can be cured by overcoming dietary misperceptions.  A popular Prilosec TV commercial contains implications that heartburn is caused by highly spiced foods; in fact, the heartburn is probably more closely associated with the high-fat-content foods that are the carriers of the spices, and not the spices themselves.  The late Senator Joseph McCarthy, a prodigious drinker of Scotch whiskey, had the practice of consuming a stick of butter to protect his stomach, before settling in to his Scotch, never realizing that the butter was not a buffer against, but actually a primary cause of, his chronic heartburn.

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