Thursday, July 6, 2017

Heartburn medicine hysteria: Garbage in garbage out again.

Awhile back I linked to a study why GP's and other ordinary docs don't follow "expert" advice, and although I am still trying to find the original article, this study that is in all the newspapers is an example why.
Heartburn medicine causes a 25 percent higher death rate, cries the headlines.

Uh, what from? And what is the actual numbers you are talking about?

from lots of different diseases, a fact that suggests that maybe it's not the medication:

roton pump inhibitors or PPIs, have been tied to a wide range of side effects including fractures, dementia, heart disease, pneumonia and kidney disease, the study's senior author Dr. Ziyad Al-Aly of Washington University School of Medicine in St. Louis told Reuters Health in a telephone interview.

so they compared groups of people with severe heartburn with those who don't have heartburn.

 They also compared PPI users and non-users within a group of nearly 3.3 million people, and PPI versus no PPI and no H2 blockers among about 2.9 million people.
ah, but what causes heartburn?

People who smoke (more heart attacks).

People who take NSAIS like motrin or advil (more fractures from falls in arthritic patients)

People who drink (more heart attacks, more falls with fractures)

People with Gastroesophogeal reflux (who have an increase rate of pneumonia from aspiration, and who tend to be obese and often diabetic or elderly)

and don't forget that many diabetics and pre diabetics are obese and have reflux

and then there is the problem of "heartburn": Sometimes "heartburn" is not from acid reflux, but angina, i.e. a symptom of heart disease.

the dirty little secret is that this relieves symptoms a lot better than earlier medicines like H2blockers or antacids.

and as I said before: one reason that we family docs don't always obey the elite studies is that we deal with real patients.

Here is the elite answer to not using the medicine:

When a person has heartburn or reflux, he added, possible root causes like obesity, poor diet or smoking should be addressed first. "Any intake or use of PPIs should be under the watchful and vigilant eye of a physician, for the smallest dose that's effective and the shortest period of time," he said.

As if we didn't already try these things already. But trying to get people to do these things in the real world is hard

And if you think people have nothing better to do than see their doctors all the time, you are wrong. Believe me, make these drugs hard to get and you will have  grannies buying and selling them on the street to make money, the way our elderly arthritic patients used to do with their tylenol 3's.

can you say "garbage in/garbage out" Children?

I'm not saying that this shouldn't be a "headsup" to oversue of the medicine, but you know that chronic reflux does have it's own side effects aside from pain:

Complications may include: Worsening of asthma A change in the lining of the esophagus that can increase the risk of cancer (Barrett esophagus) Bronchospasm (irritation and spasm of the airways due to acid) Chronic cough or hoarseness Dental problems Ulcer in the esophagus Stricture (a narrowing of the esophagus due to scarring)

finally, patients like the drug because it means they can eat stuff they usually had to avoid (spicy foods).
In my case I mainly take the medicine when I use NSAIDs for my aches and pains (osteoarthritis).

Now, since NSAIDs also affect the kidneys and heart by fluid retention etc should I stop using them too? And stop exercizing, and fall down a lot more due to stiffness?

Medicines all have side effects. Use them wisely but don't panic over scare articles.

---cross posted from my other blog.

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