Sunday, June 19, 2016

Medical Drugs as Lifestyle Choice

Omeprazole was invented in 1979 and marketed in the U.S. by 1989, under the name Losec, which was changed in 1990 to the name Prilosec that we know today. It's the first of a class of drugs called proton pump inhibitors (PPIs). Basically these drugs reduce the production stomach acid (hydrochloric acid) from the cells of that organ which produce it. A lot of people think stomach acid helps digest food. That's only sort of true. Really all it does is break down some of the bonds in protein-based foods, but it doesn't digest food per se. The acid does signal the intestine to get ready to do the actual work of digestion. And it helps reduce the number of germs we ingest when we eat.

In people with heartburn and "reflux"--a condition in which the stomach acid splashes up into the base of the esophagus and causes pain, cough, etc.--and in people with ulcers, these "PPIs" help to reduce the acid enough that the stomach can heal a bit.

When these drugs first came out, they were prescription-only, and they were said to be limited to 8 weeks' use. There was a concern that they could cause stomach cancer if used too long. Over the decades, evidence for this didn't emerge, and in June 2003, the U.S. FDA approved omeprazole for over-the-counter use.

Now, it's hard to turn on the TV without running into Larry the Cable Guy (comedian Daniel Lawrence Whitney) selling Prilosec OTC. He's also usually seen enjoying foods traditionally thought to cause heartburn: fried chicken, barbeque, and so forth. The idea you're supposed to get is that if you want to eat that junk on a regular basis, just take some Prilosec OTC and you can go nuts on potato salad, hot dogs, and beer. Here's a typical commercial:

(By the way, food is only a small part of heartburn, reflux, and ulcer disease.)

Sometimes it takes quite a while--and a bit of careful observation--to sort out the real hazards of a drug or class of drugs. With PPIs we've been learning some interesting things.

One is this little tidbit from the Journal of the American Medical Association: Neurology (JAMA Neurology), from February, and follows up on and confirms the findings of a previous and smaller study. Turns out that the risk for dementia increases with the use of PPIs.

Now don't freak out if you have taken Nexium or Prevacid or something like that for a short period, say, to treat an active stomach ulcer or esophagitis, because it's likely the benefits far-exceeded the risks. And if you have used one of these a few times for bad heartburn, don't fret. This study looked at duration of use of these drugs. Basically, the more the subjects had used these drugs, the more likely they were to be diagnosed with dementia. Duration of use had to be over 18 months to be really significant. More intermittent "regular" use was associated with lower risk. Occasional use didn't display any significant risk. The study controlled for many of the other possible causes of dementia.

Research shows that up to 70% of the use of these drugs does not fall into the recommended guidelines for their use. In other words, some comedian on a TV commercial says "Hey take this for heartburn..." and that's what people do. If you clicked on the video link, you'd see the safety caption warning against use for longer than 2 weeks. But I ask: do you think people really follow that?

In my experience, people often self-treat until they can't anymore. And doctors often have people on these drugs for years.

My aim here is not to criticize what may be some medically appropriate drug use (Rx or OTC), but to illustrate how unintended consequences may stem from the casual application of therapeutics we don't fully understand, especially when that application rests on a relatively shallow "suppress the symptom" approach to health and healing.

And fried chicken? Heck, that's ok now and again, but should we really be encouraging people to use OTC drugs to promote eating badly? What about the basic causes of such digestive complaints? Shouldn't we, at some point, ask ourselves if there's a more fundamental treatment to get at the cause or imbalance that led to the complaint? This is why I do what I do. Homeopathy, Chinese medicine, and other medical approaches that try to get at the root imbalance often reverse the problem, and hence reverse the symptoms, as opposed to merely suppressing them, the duration of which may be indefinite!

Sometimes we need drugs. Sometimes we need to suppress a symptom to relive short-term suffering, to get a handle on things and buy some time. But do we need to promote this approach as a lifestyle?

No comments:

Post a Comment