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If you want an edifying look at how the drug business in this country works, you'd do well to read the article in today's New York Times (registration req'd) about the shortage of Prilosec OTC, the heartburn medication made by Astra Zeneca.

Seems that the popular heartburn medication, the sole over the counter offering for this ailment, is in short supply. And so sufferers are turning to Nexium, another Astra Zeneca drug, which is prescription only. Nexium costs about $4 a pill. Prilosec OTC costs 70 cents a pill. Lo and behold, wouldn't you know it, they're the same drug! "Over-the-counter Prilosec works as well. It's an utter travesty for the American consumer," says Michael Krensavage, a drug industry analyst at Raymond James. Well, how about that. as Mel Allen used to say.

The story only gets more deliriously maddening as you follow the twists and turns of who's to blame for the Prilosec shortage, how Merck fits into this, the boondoggle that's let Astra Zeneca have a monopoly on the over-the-counter heartburn market after its patent expired, the cost to our health care system, and more. It's enough to give you heartburn.

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  • Dima

    What they don't say is that heartburn drugs are usually prescribed for life (more specifically you use them when you need it - and lots of people need it all the time) - so just imagine what fortune they make out of each sufferer.


  • Rayne

    Maybe that's the kind of thinking that got Andy Fastow where he is today..."What's ethics got to do with it?"


  • Danny C.

    Why should 'ethics' play a role in how Astrazeneca grabs market share? According to Astrazeneca's shareholders [and board of directors - receiving bonus incentives for increased profits], this is brilliant strategy.

    It's not the company's fault the general public is gullible.

  • Rayne

    I've written about Nexium some time ago, both in my blog and as a paper for a marketing class. Astrazeneca's marketing of this product is simply unethical and unacceptable:

    "...there is one product on the market for which I am disgusted with the marketing mix. Nexium (brand name for the drug esomeprazole magnesium) is a proton pump inhibitor manufactured by AstraZeneca LP, prescribed for severe gastroesophageal reflux disease (GERD); it acts to turn off stomach acid production and is used when other treatments have failed. Initial treatments for GERD include dietary changes (elimination of fatty foods, mints, chocolate, alcohol, coffee, and tea, nicotine from cigarettes or chewing tobacco), lifestyle changes (eating more than two hours before bed, not lying down after eating, stress management and exercise), use of antacids (over-the-counter preparations like Tums) and H2-blockers (drugs like Tagamet, Pepcid, Axid, and Zantac which may be available in over-the-counter and prescription formulations). There are competitors in the same space which are also proton pump blockers: Prilosec, Prevacid, Aciphex, and Protonix. Surgery is the last alternative available to GERD patients, assuming that the underlying problem can be treated with surgery.

    My problem with this particular drug's marketing is that Nexium's use should be rare, given the number of other initial treatments patients should implement prior to beginning use of any proton pump blockers. Consequently, marketing should be highly targeted, reaching only those persons identified as patients already suffering from GERD for whom all other treatments short of surgery have failed. Any marketing outside of this target group is wasteful, adding to the drug's cost.

    Nexium's manufacturer has elected to use mass marketing to promote this particular product. Advertising appears in all sorts of magazines which are sold to adults, from household magazines to sports magazines. In addition to print ads, television ads are used to promote "the purple pill". The ads show a variety of adults standing around on shifting ground, stepping to safety upon the appearance of purple pills. The ads are typically placed during programs of broad appeal to a wide-ranging audience. During initial introduction of this drug, not an evening would go by without seeing at least one advertisement for Nexium. Frequently there would be more than one ad.

    Unfortunately, my children and I watch these same programs. The ads were inescapable; if the ad would appear on one station, I would quickly change the channel, only to find the ad on another major station at the same time. My children were beginning to ask me about "the purple pill" every time they saw it on television; I had to explain to my four-year-old every time the ad appeared on TV that this "purple pill" was not necessary, that nearly every adult he knew would not need this drug and that it was not for use by kids. He does not yet grasp the concept that advertising is intended to get people to give up money to a producer in exchange for a product, necessary or not.

    I began to worry that this was not a true statement since the ads had become so ubiquitous; I asked my primary care physician, a family practitioner, if this drug was as commonly prescribed as the quantity of advertising led one to believe. He told me that he did not prescribe it for GERD, choosing instead to prescribe a far less expensive competitor, and that assured me the percentage of the population requiring this drug was rather low. He also told me he shies away from prescribing drugs which use this kind of excessive promotion since they are generally far more expensive and no more effective than generics or other competitors in the same space (when chemically similar or identical).

    I feel that while this product may be effective for its intended use, its maker, AstraZeneca, has failed the public trust with its mass marketing of Nexium. This product is not the kind of thing of which children should be conscious; excessive use of television ads has elevated this "purple pill" to a level of everyday commonality in the minds of persons who'll never legitimately have a need for this product. Additionally, the entire concept of excessively promoting a "purple pill" makes it appear to children that drugs are a normal, commonplace item in our lives. This maybe the agenda of drug companies, but it is not right. Health is that which should pursue without drugs wherever and whenever possible; adults should not expect that drug use is a preferred and normal consequence. Further, normalization of drug use in the minds of children is a slippery slope leading towards inappropriate or illegal drug use. In my opinion, AstraZeneca has acted unethically in its mass marketing promotion of Nexium."

    The first thing that any and every heartburn sufferer should do is lifestyle modification -- like losing weight and eliminating tobacco -- but that doesn't make drug companies any money.

    What does make pharma lots of money is wall-to-wall oversaturation of the marketplace, so that every time a patient experiences heartburn they run to their doctors. Unfortunately the costs to our society are increased healthcare costs for no greater efficacy in treatment and a pervasive mindset that drugs cure everything.

    We need to get smarter, more skeptical about drug therapies; we need to start asking our doctors what we can do to help ourselves without drugs instead of trying to take the easy-but-costly way out by popping pills. And we need to demand real ethical behavior, both from our regulatory agencies and drug companies.