I have been reading the NPS information on Proton Pump Inhibitors - PPIs - as I imagine many of us pharmacists have recently with the mailing of an excellent Prescribing Practice Review - PPR -to pharmacists along with an NPS Pharmacy Letter.
The PPR is headed "Proton Pump Inhibitors: too much of a good thing? " and raises some interesting questions for me as an older pharmacist musing on how this dyspepsia /reflux condition has been dealt with over the years therapeutically.

What was the cost of the old Belladonna/phenobarbitone in Mist Mag Trisil?
I have manufactured literally buckets of this potion to deal with the gastric complaints over the years until we now have these collective huge cost items (PPIs) available to the dyspeptic/refluxing nation.
The cost of $320 million on PPIs per annum is almost scandalous and it is rising - 20% over the year 2002-03.
No wonder the question is asked whether the PBS is sustainable.
This is only one class of drug too the public purse is committed to supply.
Certainly there are off sets to this cost; the drugs are very effective and prevent many nasty health outcomes from rampaging acid.
They must also save lives!
I remember a colleague of my father dying from a ruptured peptic ulcer.
This was a huge surprise for me, not realising such a demise was possible and made me wonder why when as an apprentice I also dispensed vast quantities of diluted HCl.
Is this ever needed these days?
As my next topic of academic detailing to GPs in the Melbourne division is on the prescribing of PPIs I have been honing up on the vast literature written on the gastric tract and the dilemmas of too much HCL and loose sphincters.
It is so interesting to muse on what is known today and what was so unknown in the days of Mist. Mag Trisil.
However it all comes at a cost and poses the question of how much is enough and what measures need to be taken to rein in some of the huge public spend whilst retaining the benefits we all enjoy today in this therapeutic sophisticated age.
Certainly the principals of QUM are applicable here.
Prescribing in accordance with the evidence of good outcomes, judiciously, and looking at life style measures that can affect health outcomes.
The obesity epidemic does not help reflux and increased exercise and healthy eating again proves its benefits not only to the individual but also to the community as a whole.
We have also discovered Helicobacter pylori and introduced widely into the community the NSAIDS. The H.pylori was always there as an ulcer producing agent, hidden in the folds of gastric mucosa undetected and prolific in the population.
We can zap that now and PPIs can take some of the credit for that.
The other ulcer-producing agent is a challenge to us being so available as it is now but no less our responsibility in reducing the potential harm that can come from NSAID use.
There is not a lot pharmacists can do in curtailing the costs of prescribing PPIs where there is room to do so from the prescribing angle.
But there are many pointers in the NPS PPR that are important to consider; establishing whether ongoing therapy with PPIs is necessary for each patient; using low doses or intermittent symptom driven therapy where appropriate; encouraging the community to exercise, control weight and eat a healthy diet and being available to discuss therapy with the most evidence based information.
These measures help to raise QUM awareness in the community and contribute to the ultimate cost the public has to bear for a very efficacious class of drugs, but at a price.
Pharmacists can certainly contribute to the value the community reaps from this therapeutic revolution we are experiencing and help in the reduction of overuse and wastage.
This is where the professionalism we crave, comes in !