Antidote

As a medical journalist, I receive advanced notice of many studies. As soon as I saw that the Journal of the American Medical Association was about to publish a big study from Britain which showed an almost 50% increase in hip fractures in elderly patients taking the stomach drugs Nexium, Prevacid and Prilosec, I knew I would be receiving many anxious phone calls.

Sure enough, as soon as the study was published, the calls started. Many of my patients were frightened to continue taking drugs which only a day before had helped them live pain-free, reflux-free lives. I explained to them that these drugs, known as proton-pump inhibitors, are the most effective drugs we have to decrease stomach acid. Not only that, but they have been shown to be effective, safe, ulcer treatments, and they are part of the mainstay of treatment against the nasty stomach bug H. Pylori, which not only leads to ulcers, but sometimes causes cancer.

For most patients, the fear of ulcers and cancer was enough to overcome the fear of fractures, but I realized that there had to be a better way of encouraging a patient to take a pill. I looked more closely at the study that had caused the scare, and I realized that most of the patients who had sustained the fractures were men. This was strange because osteoporosis is much more common in older women who stop making bone-protecting estrogen.

But many women take calcium. Since it is best absorbed by the stomach at a normal or even acidic PH, it is likely this absorption is interfered with by the PPI drugs in a way that can be overcome by taking supplemental calcium.

So once again, over-interpretation of a perfectly good study and fear leads to good drugs becoming instant bad guys. Of course, many doctors are sure to continue using PPIs, if for no other reason than because we really don't have good alternatives to these drugs. But if we did, too many of us might have been too quick to leave behind the tried and true in favor of something less effective.

Marc Siegel, MD, is an internist and associate professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear

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