Heartburn
The American Gastroenterological Association has issued guidelines on the management of Gastroesophageal Reflux Disease (GERD), which can be loosely described as persistent and troublesome heartburn or asymptomatic reflux that causes esophageal injury. The guidelines recommend a proton-pump inhibitor treatment (e.g. Astra Zeneca’s Nexium or TAP Pharmaceuticals’ Prevacid) — once a day, twice if necessary.
What the guidelines do not recommend is routine lifestyle changes, such as weight loss or reducing intake of coffee or alcohol. “The problem,” the authors write, is that there are “simply too many recommendations … to enforce the whole set on every patient.”
That may indeed be the case – an absence of evidence to support lifestyle changes. Do these things work? As long as the research enterprise is dominated by pharmaceutical studies, we may never know. But as long as the treatment guidelines are written by people who have financial ties to the companies selling the drugs, the public is likely to suspect their recommendations. All three authors of the AGA guidelines are consultants to, speakers for, and/or receive research support from Astra Zeneca and TAP Pharmaceuticals, among other companies. The AGA itself receives funding from more than a dozen of the companies whose products it recommends.
October 22nd, 2008 at 10:40 am
You should tell your readers that if their doctors prescribe a PPI for persistent GERD, they can buy OTC Prilosec, which is the same exact thing as Nexium at less than half the price. Of course, for some patients, that doesn’t make economic sense since the price of OTC Prilosec (which won’t be reimbursed by insurance) may be more than the co-pay on Nexium. Of course, Nexium didn’t get to $6 billion a year in sales or whatever it is now by simply be prescribed for persistent GERD.
October 23rd, 2008 at 10:19 am
Thanks so much for pointing this out. I was referred here by Pharmalot. I am 24 and suffer from GERD. None of the standard meds worked for me, I tried them all, and the only one that worked was Zegerid– which is extremely pricey and I was taking it twice a day ($250 a month for those without insurrance!). I stopped taking it because it was costly and even that didn’t work that well. I watch what I eat, but there’s only so many sacrifices one can make. My biggest sacrifice? Now I eat saurkraut every morning and evening. It’s just nasty. But it helps tremendously because of its natural fermentation process. I wish the AGA would put out a list of other helpful foods like saurkraut, instead of telling me to take their drugs.