Editor's Note: America's Digestive Health...An Opportunity for Pharmacists

Some food for thought for pharmacists and their patients-is there a relationship between the obesity epidemic and the prevalence of gastrointestinal disorders?

A few issues crossed my mind as I thought about the theme of this month’s Pharmacy Times—digestive health.

A recent survey released by the Centers for Disease Control and Prevention’s National Center for Health Statistics showed that obesity among adults continues to rise and is at its highest level since the government began compiling these data in 1997. The survey found that 28% of US adults aged 20 years and older were obese. Those in mid-life (aged 40 to 59 years) had higher obesity rates (31.6%) than the other adult age groups.

It was also reported that two thirds of those interviewed said their own health was excellent or very good. This suggests there is a disconnect between Americans’ perceptions of their own health status and the effects of obesity on their personal health. Does this report suggest a role for the pharmacist?

Checking online on the size of the US market for gastrointestinal (GI) disorder treatments, I found a BCC Research report on GI pharmaceuticals, published in September 2009, reporting overall sales as $34.2 billion in 2007, decreasing slightly to $31.1 billion in 2009, and expected to increase modestly to $32.2 billion by 2014. Prescription GI drugs accounted for $26.3 billion of this total in 2009, and that amount is projected to increase to $27 billion in 2014.

In our May issue’s Rx Focus,“Top 200 Prescription Drugs of 2009,” Nexium was reported as being the number-2 product in the US market by sales and number 7 by dispensed prescriptions—suggesting that the GI market is very important to pharmaceutical companies and to community pharmacy. What should a pharmacist make of these facts?

Newspaper columnists Joe and Terry Graedon’s “The People’s Pharmacy” column (December 7, 2009) reported on a gastroenterology study that demonstrated perfectly that healthy people experience significant heartburn symptoms they had never had before when they go off a proton pump inhibitor (PPI) after 2 months. The writers also reported on their Web site (dated June 2, 2010) that reports in the Archives of Internal Medicine caused the FDA to issue a caution to physicians and patients about an increased risk of fractures associated with some PPIs. The FDA did caution that this is only a possible risk, and the concern is for long-term use.

Should either of these reports be of interest to pharmacists? Let me try to tie these issues together. The obesity epidemic presents a number of implications—and opportunities—for pharmacists. Many have suggested that our country needs to refocus our medical care efforts from a “sick care” system to a “wellness care” system. This new focus could create a niche market opportunity for the community pharmacist to offer weight management programs. Whether pharmacists use a franchise program or develop their own educational and coaching program, it seems like an ideal way to begin repositioning one’s own pharmacy as a health center.

I wonder what the relationship is between the obesity epidemic and some common digestive diseases. I know before I lost some weight, I was taking histamine₂ blockers regularly to control a gastroesophageal reflux disease problem. Could the size of the GI pharmaceuticals market be influenced by patients who are looking for an easy way out? Controlling caloric intake requires discipline, but taking a pill seems like an easy solution. Based on the few reports of some of the consequences I mentioned earlier, this treatment may be leading to longer-term adverse consequences.

How many of these possible consequences should a pharmacist share with a patient taking one of these agents? I would like to hear from you on this and the other important issues surrounding today’s digestive health scene.

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.