Why do we overmedicate babies for heartburn?

How to fix health policy.
June 17 2010 9:35 AM

The Reflex To Treat Reflux

Why do we overmedicate babies for heartburn?

(Continued from Page 1)

In many patients, heartburn has little to do with acid reflux. Most likely the symptoms come and go randomly, with no relation to reflux or any medication use. Further, while acid blockers are useless against nonspecific belly pain—because there's no hydrochloric acid in your intestines, liver, or other organs of the digestive tract—doctors frequently prescribe them for so-called "non-ulcer dyspepsia." The British Medical Journal in 2008 estimated that anywhere from one-quarter to three-quarters of all acid blockers like Nexium were prescribed for no good reason.

Because almost 20 percent of all adults complain of reflux-type symptoms, doctors tend to throw the drugs around at the first mention of mild heartburn. Ideally, physicians should endorse simple dietary changes (avoiding caffeine, high-fat meals, and eating just before bedtime), mention cheaper alternatives (like Tums), and explain the random ups and downs of the pain. But they don't. Across the globe, Nexium is over-prescribed for the most banal of reasons: It's less work to write a prescription and pretend the problem is solved.

Advertisement

The consequences of this worldwide clinical laziness are serious. Once you start the drugs, it's very, very hard to stop; even the stomachs of healthy people become "addicted" to the drugs. In 2009, studies showed that volunteers with no heartburn symptoms who took the anti-reflux drugs for two months actually experienced heartburn and reflux when they tried to stop. Further, the acid blockers increase the risk of fractures by one-quarter in women, are associated with more deaths after angioplasty, and increase the risk of major gut infections.

And now the war on stomach acid has a new front: babies with colic. Normal infants reflux all the time (the average preemie, for example, has 71 minor spit-ups daily), but fewer than one in 300 has any evidence of damage to the esophagus. Randomized studies regularly show that acid blockers do nothing to help baby reflux. Worse, drugs like Nexium or Zantac (which blocks acid in a slightly different manner) may increase brain bleeds and gut damage in preterm infants as well as the risk of food allergies in older infants.

Yet, in parallel with the jump in adults, the number of acid-blocker prescriptions for colicky infants recently quadrupled. Bemoaning this trend, Philip Putnam of Cincinnati Children's wryly observed that "gastric acid rivals mucus as the most maligned secretion from the body."

The overuse of drugs like Nexium isn't a new problem. For years, doctors prescribed COX-2 inhibitors like Vioxx and Celebrex, though they worked no better than Tylenol and ibuprofen. Pediatricians use antibiotics to treat almost half of all kids with colds, though the powerful drugs do no good and drive up the number of resistant microbes. Can we really blame the drug companies for these messes? Malcolm Gladwell, writing on the prescription drug crisis, notes, "For sellers to behave responsibly, buyers must first behave intelligently." For many adults with heartburn and for many babies with colic, doctors regularly write useless prescriptions and insurers happily pay to fill them.

That's the little-known secret of drug expenses. Our nation's drug bill has are risen not because the drugs cost more: Only one-third of the 9 percent annual jump comes from higher prices. The truth is that grown-ups and now babies are simply taking more pills. This situation will persist until health insurers, who inexplicably cough up billions of dollars for me-too drugs like Nexium, demand value for their outlays.

In the meantime, the next time your pediatrician suggests Nexium, Prilosec, or Zantac for your baby's mild spit-ups, ask her to explain their necessity better. Tell her you don't need any fancy pills. You would prefer a far more powerful therapy—words of explanation.

Like Slate on Facebook. Follow us on Twitter.

TODAY IN SLATE

Foreigners

More Than Scottish Pride

Scotland’s referendum isn’t about nationalism. It’s about a system that failed, and a new generation looking to take a chance on itself. 

IOS 8 Comes Out Today. Do Not Put It on Your iPhone 4S.

Why Greenland’s “Dark Snow” Should Worry You

How Much Should You Loath NFL Commissioner Roger Goodell?

Here are the facts.

Three Talented Actresses in Three Terrible New Shows

Science

The Human Need to Find Connections in Everything

It’s the source of creativity and delusions. It can harm us more than it helps us.

Jurisprudence

Happy Constitution Day!

Too bad it’s almost certainly unconstitutional.

The Ungodly Horror of Having a Bug Crawl Into Your Ear and Scratch Away at Your Eardrum

My Father Was James Brown. I Watched Him Beat My Mother. Then I Married Someone Like Him.

  News & Politics
The World
Sept. 17 2014 4:08 PM How Teflon Is Vladimir Putin's Popularity?
  Business
Business Insider
Sept. 17 2014 1:36 PM Nate Silver Versus Princeton Professor: Who Has the Right Models?
  Life
Outward
Sept. 17 2014 1:59 PM Ask a Homo: Secret Ally Codes 
  Double X
The XX Factor
Sept. 17 2014 4:36 PM Is Nonfiction the Patriarch of Literary Genres?
  Slate Plus
Slate Fare
Sept. 17 2014 9:37 AM Is Slate Too Liberal?  A members-only open thread.
  Arts
Brow Beat
Sept. 17 2014 4:07 PM Kern Your Enthusiasm: The Genius of Jenson’s Roman
  Technology
Future Tense
Sept. 17 2014 12:35 PM IOS 8 Comes Out Today. Do Not Put It on Your iPhone 4S.
  Health & Science
Bad Astronomy
Sept. 17 2014 11:18 AM A Bridge Across the Sky
  Sports
Sports Nut
Sept. 17 2014 3:51 PM NFL Jerk Watch: Roger Goodell How much should you loathe the pro football commissioner?