There’s a commercial that caught my eye during a recent spate of television watching with relatives, a spot for Prilosec, featuring a stand-up comedian, a veteran of the Blue Collar Comedy Tour. Actually it caught my eye several times because it was airing and then reairing again all through the holidays. It was disquieting. But obviously this was a good time to run a spot for a heartburn drug, during that period from Thanksgiving to the Super Bowl that is technically the Gluttony Season, as what better time to come down with a spot of heartburn? It’s ingrained in the advertising industry as the unintended consequence of the parties and banquets, the buffalo wings and beer, that we’ve subjected ourselves to. Watch enough TV, and you’ll learn heartburn is a fact of life, the price paid for good living.
And when you come down with it, you turn to a cure — big glasses of water, a Rolaids, maybe even a Prilosec. And as with anything, these come at a cost, a cost that may have gone up or down over time, comparatively. And so we ask the question, as we do every now and then, when you seek you rid yourself of that peculiar small gastric discomfort, are you paying more than your forebears, or less?
FIRST, WHAT THE DOCTOR SAYS
“Heartburn” is a convenient phrase (as Nora Ephron knew), but of course heartburn has nothing at all to do with your heart. In fact, let’s be very careful in delineating here, because what we’re talking about is what you could call an upset stomach, that rumble in the higher end of the guts which is easily attributed by the afflicted to recent consumption of food and/or drink. (Think, “I can’t believe I ate the whole thing.”) It’s what we called as kids “a tummy ache,” or might call now “acid indigestion.”
For help with the medical issues, I emailed with New York gastroenterologist Dr. Yasmin Metz. “It’s characterized by an uncomfortable, hot or burning sensation in the chest/abdomen. It can start in the upper abdomen and go up to the chest, sometimes up to the throat or radiate to the back. It can occur after eating, lying down, or bending over,” she wrote. However, Dr. Metz warns that chronic severe heartburn should never be taken lightly (i.e., see your doctor!) as it could be a symptom of gastroesophagal reflux disease (GERD), gastritis, peptic ulcer disease, and other conditions of the esophagus. And if that’s not enough to scare you into minding Dr. Metz, she continued, “In women middle-aged or older, it can be an atypical presentation of heart disease, and the most feared complication of untreated symptoms is esophageal cancer.” The fact that we are looking at heartburn remedies in the sense of the occasional, sporadic, post-Roman Feast sufferer is not intended to be a slight to those with more serious issues.
There are a comfortable number of options for the modern heartburn sufferer. You have your antacids, like your Tums and your Milk of Magnesia, which neutralize the gastric acids with alkalinizing agents (and are not too far removed from the heartburn recommendation of Pliny the Elder in the 1st Century AD, coral powder). By the way, an advance in the understanding of how the stomach works occurred in a little episode you might remember from Ripley’s Believe It Or Not — in the 1820s, Army surgeon Dr. William Beaumont had a patient who took a musket ball in the stomach, which (believe it or not) left a permanent hole, through which Dr. Beaumont could observe the stomach in action. Ew.
More recent innovations in heartburn relief required no abdominal peephole. You have your H2 blockers, which interfere with the histamine receptors in the stomach lining, which decreases the production of stomach acid. You also have your proton pump inhibitors. Proton pumps (which are biochemical pumps, which won’t make that phrase sound any less ridiculous) produce acid in the stomach, which get inhibited by the ingenious drugs with long and hard-to-remember names.
But the names you are familiar with are the trade names that the pharmaceutical companies devise and then market half to death: for H2 blockers, Tagamet and Zantac, and PPI, Prilosec and Prevacid. These drugs were only approved for over-the-counter sales (i.e., without prescriptions from a doctor) by the Food and Drug Administration in the past twenty years.
A difference among the treatment options is that antacids and H2 blockers are remedies that you take after you have the heartburn, and that PPIs are more of a long-term treatment (and accordingly, useful for some of the scarier gastric conditions mentioned above). A small distinction, but one that comes back (as it were).
And Dr. Metz listed some of the non-drug treatments that a physician might recommend: “It is generally advised to wait three hours prior to lying down after eating a meal. Patients can also sleep with their heads elevated and on their left side.” And of course, the potential patient could opt for the ounce of prevention. “Patients are told to avoid caffeine (coffee/chocolate) which can weaken the lower esophageal sphincter, the junction between the esophagus and stomach, that usually prevents acid from refluxing from the stomach into the esophagus.” And if that sounds like a tall task, Dr. Metz suggested, “Cigarette smoking, alcohol, fatty foods, citrus products, peppermint, tomato sauce, onions, garlic and spicy foods should be avoided as well.”
A CURE FOR CORNDOGS
Earlier we mentioned the marketing efforts of pharmaceuticals. Let’s take a look at one in specific, maybe think of it as more of a cultural phenomenon, regardless of how disquieting it may be, to me or anyone else. The commercial is from the current Prilosec campaign, featuring “spokes-comedian” Dan Whitney (p/k/a Larry The Cable Guy), called “Demolition.”
Here’s a brief description (a recap, if you will), but please watch, as that’s the intended use of commercials.
Larry the Cable Guy is looking at the camera, almost threatening, and behind him normal folk, like you and me, are passing. It’s a fair or something. “You know what I love about this country?” But guess what? “Trick question!” he says, “I LOVE EVERYTHING ABOUT THIS COUNTRY!” Of course he does. He presents the product to the camera “Includin’ Prilosec OTC!” The reveal.
Now he’s in a late model sedan, wearing a crash helmet, with a young-ish couple in the back seat. The car is in motion! “You know one pill each mornin’ treats frequent heartburn,” LTCG says, “so you can enjoy all this great land of ours has to offer.” Guess where LTCG is driving! “Like demolition derbies,” LTCG says coolly. And now they’re pulling up to a quickie wedding chapel! “And drive-through weddin’s!” LTCG grins. And now they’re back at the derby, and guess what they’re eating? Corn dogs, from a stand with the banner COLOSSAL CORN DOGS! LTCG continues: “So if you’re one of those people who gets heartburn and then treats, day after day, block the acid with Prilosec OTC, and don’t get heartburn in the first place.” Guess what? He’s trying to help you! He’s grinning! They medical warnings are flashing! It’s time for the announcer! “One pill each morning. Twenty-four hours. Zero heartburn.”
This spot does engender a little bit of dissonance, inasmuch as it advocates not so much the treatment of a malady but the preventative treatment of a malady. Of course that makes sense with something like, say, syphilis or the flu, but in this case the malady in question is one that is can be caused by volitional behavior. If one’s heartburn is caused by excessive enchilada consumption, then one could, at least theoretically, avoid heartburn by not eating enchiladas. The occasional heartburn that is the target of these marketing campaigns, the heartburn that is caused by eating the colossal corn dog, has more to do with the hangover than it does the flu. But ain’t that America.
At the same time, the spot is an excellent example of the importance of marketing to this sector of pharmaceuticals. Alka-Seltzer is a somewhat famous
example of 20th-century marketing, already spending one- to one-and-a-half-million dollars per year on advertising in the late 30s, not ten years after its debut (and well before the television age, as a point of reference). Alka-Seltzer was adept at creating (or hiring ad agencies to create) mascots, like “Speedy”, an anthropomorphized Alka-Seltzer tablet featured in an extensive TV campaign featuring him from 1953 to 1964, and catchphrases, like “Try it, you’ll like it,” and, “That’s a spicy meatball!” (Here, have a watch.) In fact this relentless campaigning did more than promote the product, it actually was related to changing the product. In 1975, TV ads began to run with the jingle, “Plop plop fizz fizz/oh what a relief it is.” Prior to the start of the campaign, the recommended dose was one tablet. The campaign effectively doubled the dosage, and sales increased accordingly. (You can see that double dosage in the 1977 ad shown up top.)
Which is all that Prilosec and its spokes-comedian are trying to do as well — induce more people to put Prilosec in their bellies. Which, depending on the way you look at it, can be the behavior of a company in its natural habitat, or it can be a little bit creepy.
Let’s give the final word on this to the medical warning that flashes in the spot, right after LTCG says, “…and don’t get heartburn in the first place.”
It’s possible while taking Prilosec OTC. Use as directed for 14 days to treat frequent heartburn. Do not take for more than 14 days or more often than every 4 months unless directed by a doctor. Not for immediate relief.
Prilosec would like you to take Prilosec OTC all the time, because you eat and drink unwisely. Except not for more than 14 days. In any four-month period.
THE ADJUSTED FOR INFLATION NUMBERS
So let’s look at some numbers, which we obtained from our friends at the Morris County Library in Morris Township, NJ, which keeps an archive of historic consumer prices, including the prices of some heartburn remedies. And we’ll adjust the prices to 2012 values, in parentheses, using the BLS CPI Inflation Calculator. (The current price is taken not from the research of the Morris County Library but according to the Walgreens in Boonton, NJ, and as the library’s managed to not mention a heartburn remedy in the entirety of the 90s, the 1995 value is taken from a contemporaneous newspaper article.)
1933 — Milk of Magnesia (bottle): $.21 ($3.71)
1938 — Alka-Seltzer (package): $.50 ($8.14)
1944 — Alka-Seltzer (25 tablets): $.49 ($6.39)
1954 — Alka-Seltzer (25 tablets): $.54 ($4.61)
1965 — Alka-Seltzer (25 tablets): $.47 ($3.43)
1974 — Alka-Seltzer (36 tablets): $.81 ($3.77)
1980 — Maalox (12 oz. bottle): $1.89 ($5.27)
1986 — Alka-Seltzer Plus (20 tablets): $2.27 ($4.76)
1995 — Alka-Seltzer (24 tablets): $4.25 ($6.40)
2006 — Tums (150 ct.): $3.99 ($4.54)
2013 — Alka-Seltzer (36 tablets): $5.79
There’s going to be a certain squishiness in the results here, for a number of reasons. Sadly, the newspapers surveyed by the Morris County Library had not a lick of information concerning OTC drugs ever, making our imperfect survey even more imperfect.
Which is a shame, as there was a Prilosec shortage in 2005, just two years after it was approved by the FDA, and it would’ve been fun to see if it the shortage was reflected in the prices. (There was not, however, a shortage in the prescription version of a drug similar to Prilosec manufactured by a co-owner of Prilosec, which prescription version was coincidentally more expensive than Prilosec. Ah life.)
Also we’re dealing with different products, and sometimes the number of doses per product are not always noted, it’s a shockingly small sample size, etc. It’s a range of five dollars, with a little trough in the 60s that would be the low point for the price, eventually settling in to the roughly $5.00 mark. More of a wobble than a distinct increase or decrease.
However, in this instance the information on Alka-Seltzer is specific enough that we can whittle this down to something like “cost per dose” or some other value that represents how much each individual heartburn (and the alleviation thereof) would run, if Alka-Seltzer was your remedy of choice. And remember, as per “Plop plop fizz fizz,” post-1975 dosages are doubled — so 20 tablets becomes equal to 10 dosages.
1944 — Alka-Seltzer (25 tablets): $.02 ($.25)
1954 — Alka-Seltzer (25 tablets): $.02 ($.18)
1965 — Alka-Seltzer (25 tablets): $.02 ($.14)
1974 — Alka-Seltzer (36 tablets): $.02 ($.10)
1986 — Alka-Seltzer Plus (20 tablets): $.22 ($.48)
1995 — Alka-Seltzer (24 tablets):$.35($.53)
2013 — Alka-Seltzer (36 tablets): $.32
And now we see a much more interesting trend: a slow erosion in the cost of having an Alka-Seltzer-cured heartburn, followed by a couple hundred percent jump at the point when Alka-Seltzer’s version of “lather, rinse, repeat” took effect. Profit, like love, will find a way.
There is one set of data that we are not including: the cost of not eating that nacho burger, not guzzling that IPA, maybe cutting down on the coffee or quitting smoking. Zeros make us nervous.
Previously: How Much More Does A Steak Dinner Cost Today