carnegie-hall-998879_640Yes…it’s an old joke and we all know it.  The answer to our question is ….”Practice, practice, practice.”

This old joke fits in with my follow-up post about ZE & PPI medications because the story of why we hear so many criticisms about PPI medication is based on how assistant professors become professors.  How?….Not practice, practice, practice…but publish, publish, publish!    And if you are an expert on ulcer medications and need to move up the academic ladder, you will not do it by inventing a new or better PPI medication.  The reason?  These medications are so effective and ideal, it’s virtually impossible to make a better PPI, so all the researchers have given up.  And with no improvements in sight, the researchers have set their sights on  tearing down their predecessors creationS.  PPI’s must be criticized.  Holes must be found in their armor; and so, they publish a variety of research on the negatives of PPI’s including:  causing low Vitamin B12, causing low magnesium levels, promoting infections in the lungs of GI tract.  Now, all of these have been found to a minor degree in long-term PPI users, but these negatives need to be put in the context of the improvements gained by acid suppression, ulcer prevention and acid reduction that prevents esophagus irritation, inflammation, and scarring.  Where is the balance?  It’s unclear, but when the press gets ahold of these critical comments on popular medicines, they love to publish them under headlines that they know will get readers.

Also, if the PPI medications can be shown to have dubious scientific backing, then the insurance companies can refuse to pay for ongoing use of these medication, especially since they are available over-the-counter.  They will use the argument that there is no scientifically valid proof that the long-term benefits outweigh the risks.

So…even the valid research that are reasonable criticisms of these medications have a backdrop of other factors that promote their publication and popular attribution.   Like too many things in this world, it’s much more complicated that one can possibly imagine.