Is Prilosec the new Vioxx?

Who would have thought that a pain-killer could hurt your heart? And now: who would have thought that a heartburn drug could cause intestinal problems? Possibly it can. According to this WaPo story about the burgeoning epidemic of a stubborn bacterial illness:

Canadian researchers, however, have found one possible culprit: popular new heartburn drugs. Patients taking proton pump inhibitors, such as Prilosec and Prevacid, are almost three times as likely to be diagnosed with C-diff , the McGill University researchers reported in the Dec. 21 issue of the Journal of the American Medical Association. And those taking another type called H2-receptor antagonists, such as Pepcid and Zantac, are twice as likely. By suppressing stomach acid, the drugs may inadvertently help the bug, the researchers said.

I have some personal experience with this. I have been taking Prilosec-type drugs (e.g., Nexium, generics) for heartburn. As we were leaving for our extended Asian jaunt, I asked my unusually well-informed doctor for advice. He said: stop the Nexium, if you can tolerate that, and explained that taking the drug would weaken my resistence to the local germs. I took his advice and actually felt fine for much of the trip, until I restarted the proton pump drug toward the end (too much curry).

Although there may be a problem here, I hope we don’t get the Vioxx “solution” – massive liability threat, and withdrawal of a drug that had net benefits for many patients. As I said more than a year ago about Vioxx, before the verdict:

In withdrawing Vioxx, Merck threw raw meat to the plaintiffs' lawyers who were already gearing up to prove that Vioxx was a dangerous drug. But most likely it was simply over-[prescribed] to people for whom the benefits (lower risk of internal bleeding) outweighed the cardiovascular risk. In this scenario, withdrawing the drug hurts the people who need it. Better labeling would have been the answer. . . . .

Think about the dilemma of people like me. I have mild arthritis, for which pain relievers would occasionally come in handy. But if I take Alleve, I get heartburn, which increases the need for Prilosec. I’m probably not in the small group susceptible to heart attack from Vioxx, so I might get a net benefit from that drug. But if I’m stuck with Alleve, then I might have to suffer heartburn, arthritis pain, or intestinal problems, depending on whether I also take Prilosec. My doctor seems to think that Prilosec is ok, unless I start getting intestinal symptoms or unless I’m in a high-risk category – e.g., traveling in India.

In other words, medical conditions call for individualized solutions, not the blunt instrument of drug-destroying liability.

In India I got a glimpse of where the lawsuit industry may be leading us. People there tend to rely on ayurvedic, or homeopathic, remedies. A little mint for what ails you. There’s not a lot of medical evidence that it helps, but it usually can’t hurt you, so at least it’s good for keeping the lawyers away.