Writing in the Saturday (how to make it look like you're rich edition) of the Wall Street Journal, Marisa Acocella Marchetto mentions an expensive, branded drug--Nexium--eight times. She even mentions its slogan ("the purple pill")!
As Mark has written elsewhere, it's moronic to take Nexium because there are cheaper, efficacious alternatives, such as Prilosec, which is available over the counter. Consumer Reports noted in 2010 that Nexium was the most expensive PPI, at $248 a month, and that cheaper generics and over the counter medicines were available.
In the story, she describes being trapped on an airplane without her precious Nexium and in serious pain (why not try something that would immediately stop the pain, such as Tums?). She begs for Nexium, and lo--another passenger has a doctor misinformed enough to prescribe it. But the evil flight attendant won't let her have it, falsely believing that Marchetto was having a heart attack. Finally, there is an emergency landing, and an Irish physician treats her and "handed [her] a Nexium." How convenient!
I wonder why the editors of the Journal allowed this specific and expensive product to be mentioned so many times. Ironically, if she had simply asked for a antacid, she would have had been given Maalox by the flight attendant. Problem solved. The entire article could have been rewritten: "How I caused an international flight to be diverted because I demanded to be provided an expensive prescription drug by a flight attendant and how if I had just asked for an antacid everything would have been fine."
The article makes me recall the time I was in Atlanta airport, and the person in front of me asked a cashier, "all you have is water--don't you have Dasani?" It's that type of stupidity that keeps brands alive and wastes billions of consumer dollars.
Full disclosure: although I mentioned Nexium(R) numerous times in this blog post, I have not received any material support from AstraZeneca nor am I taking the Purple Pill and washing it down with Dasani.
I'm so glad you guys are back!
I self-medicated my frequent heartburn with Pepcid for years before the doc put me on Nexium (first as samples, then a longer-term prescription), and the result was pretty awesome. That said, I'm lucky to have good enough insurance that I didn't know what the actual cost was. Considering that I could never keep straight whether I was taking Nexium or Prilosec in the first place, it's interesting to know that they're largely interchangeable. I'll keep that in mind if my symptoms ever get as bad as they were before.
As someone who probably has a bit o' the nasty GERD, and who took Nexium for awhile, it seems like this lady wasn't even doing it right. At least on my pill bottle, it said "take one capsule by mouth every morning," not "take this when symptoms arise." If it were me, I'd much rather have something chewable and immediate at that point, if only for the "I think this is supposed to treat sudden symptoms" placebo effect.
Incidentally, if the manufacturers of Nexium or Prilosec or Pepcid want to throw some money at me for this comment, I won't complain.
Mostly I treat acid reflux with a water, tap water is fine. If that doesn't work a couple of Tums, generic mostly, works wonders. A friend was suffering with acid reflux and I suggested that he drink some water. He had never heard such nonsense but humored me. After a few minutes he noticed, much to his amazement, that the problem was gone.
Yes, there are serious cases of acid reflux that may need Pepcid or Prilosec, perhaps there is even a case to be made for the overpriced Nexium, repackaging in a pretty purple capsule has to be worth something, but I suspect that many people taking this stuff regularly don't need it every day.
Evidently, many docs are so busy writing prescriptions for Nexium, and attending AZ sponsored conferences in Bermuda, that they neglect covering quicker, easier, cheaper, and safer treatments that work in many cases.
Tom Foss is right -- if this woman was on Nexium before the flight, she probably* wasn't taking it correctly (though I can say from experience that missing just one or two doses in a row can lead to excruciating pain; you get "rebound reflux" that's worse than what you had before you started the drug) and she clearly didn't understand that it wouldn't relieve her immediate pain.
Then again, you don't think straight when you're hurting. I can understand the woman's panic (esophageal spasm is very painful, and it *does* present a lot like a heart attack). I have GERD bad enough to require prescription-strength omeprazole (Prilosec, though I'm cheap and favor generics). Water is basically a placebo for me. At most, it triggers swallowing, which jams the stuff down for a while. Crackers or chewing gum are much more effective -- dry stuff helps weight the stomach contents down so they don't ride up as easily, and chewing triggers the release of saliva, which is mildly alkaline and is thus a natural antacid. (It likely evolved to be alkaline for this very reason; during swallowing, it is possible for stomach acid to splash up, so sending a bit of base down with the food can protect the esophagus.) Tums works much better, as do other antacids which react directly with the hydrochloric acid in the stomach. But I used to take thousands of miligrams of Tums a day and still I had erosive esophagitis, even after changing my diet and sleep patterns; Prilosec changed my life. I hadn't even realized that heartburn like that is not normal.
Now, the lady on the plane -- Nexium was presumably her regular drug. It would therefore be reasonable to ask for it. But it'd be unlikely anyone on board had any. She was fortunate there was a doctor able to give her a prescription so she could get some on landing. And I'd expect a doctor in that circumstnace to write a prescription only for whatever the patient was already taking. Whether you agree with the original doctor or not, you don't just switch a patient's meds willy-nilly, especially if they're not *your* patient and you're just making sure they can get their meds on arrival. However, I would *ALSO* expect the doc to explain, both to her and the flight attendants, that Nexium cannot provide immediate relief. In fact, if you've not taken it before, you can expect it to take several days before you have full relief of symptoms. For immediate relief, take Tums or Maalox or Rolaids or something like that. They don't interact with the Nexium; it's perfectly safe to do that.
I do understand the airline electing to divert the flight. This is not because the passenger demanded Nexium but because she was complaining of severe chest pain. Esophageal spasm is very painful, and you cannot expect a flight attendant to distinguish it from a heart attack. Even a doctor will want to run tests. Consider this -- if the patient had demanded Nexium and they had not diverted and *then* found out that it really was a heart attack and not the heartburn she thought it was, what would the WSJ have been writing about then? The flight was not diverted because of a brand-name medication. It was diverted because of a passenger experiencing severe chest pain.
*I say "probably" because I know from experience that you can take it correctly and still get awful heartburn. I learned this the last time I had gastroenteritis. One dose came back up before it could do anything useful. The next one galloped through my system too fast to be fully effective, and then, wham, rebound reflux. A few days later, things were back to normal, but I went through a fair bit of Tums in the meantime.