Analysis of The Deceptive Marketing of PPIs Like Nexium And Prilosec

Executive Summary

  • Nexium and Prilosec were widely used for decades and were deceptively promoted.
  • Now that health problems have come to light, it is good to review this advertizing.


  • PPIs are an example of how the FDA and pharmaceutical companies conspired to have patients continue to use, even though the problems with the long-term use of PPIs were well known.
  • A major part of the creation of the extensive market for PPIs was due to disease mongering, and part of this was paying off MDs to prescribe PPIs and another part was deceptive advertising.

Our References for This Article

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The History of PPIs

This video explains how information about highly problematic outcomes from this drug category has come to light. 

How Nexium and Prilosec and Other PPIs Were Marketed

After reading the above, now is a good time to review how deceptively these drugs were marketed.

Nexium Ad #1

This is a typical PPI ad. It completely plays down the problems with PPIs and oversells their benefits. 

Through aggressive marketing and compensating doctors to prescribe, makers of PPIs were able to push PPIs to people who should not have taken them and normalized PPIs to where people thought they would be ok if they took PPIs for longer periods.

is explained in the following quotation.

Use of PPIs has grown almost exponentially over the past couple of decades due to their considerable effectiveness for certain conditions, widespread inappropriate use for indications for which there is no evidence of benefit, and incorrectly perceived lack of side effects. All of this is worsened by massive promotion of these products. A 2009 analysis using the National Ambulatory Medical Care Survey found an increase in the frequency of prescription PPI treatment from less than five prescriptions per 1,000 GERD-related physician visits in 1995 to 43.9 prescriptions per 1,000 visits in 2006 in the U.S., a more than eight-fold increase to 139 In 2009. – Public Citizen

Let us pause to think about that growth in usage for a minute. How did that many people suddenly develop a condition of gastric acid?

The quote continues…

Nexium grossed the second highest amount ($5 billion) in U.S. retail sales — and had the second highest number of prescriptions (26.5 million) filled of all brand-name drugs.

There were a total of 119 million U.S. prescriptions filled in 2009 for all PPIs, 141 totaling $13.6 billion in U.S. sales.

However, unnecessary and inappropriate use is widespread. Studies have estimated that potentially one-half to two-thirds of all patients on PPIs do not have an appropriate indication. In addition, many patients are using PPIs chronically, beyond the indicated time frame, for conditions such as GERD. Here we outline four key reasons for PPI overuse, followed by recommendations to mitigate this extensive and dangerous problem. – Public Citizen

PPIs Prescribed for No Reason Given?

In 194 of the patients in the above study who lacked a verified indication, 119 (61%) had previously attempted withdrawal unsuccessfully. A German study analyzing hospital discharge letters found that less than one-third of all patients with a hospital discharge letter recommending a PPI had an evidence-based indication. In addition, in patients lacking a clear indication for the PPI, there was no reason given for the recommendation in 37.8% of these patients. – Public Citizen

It is obvious from reading this quote and other information what was happening. And it was happening globally.

PPIs were seen as safe and easy to prescribe a drug that required very little analysis on the part of the doctor. Furthermore, it was so common that, in many cases, no evidence was considered necessary to list.

That explains the earlier comments that they were being prescribed “like candy.”

Here is another advertisement for Nexium.

Nexium Ad #2

Pharmaceutical ads have this tactic of making it appear responsible to talk to your doctor about their drugs. They leave out that their pharma reps have already talked to your doctor, provided that doctor with false information, provided the FDA with a rigged study, paid off members of the FDA on the advising panel with various consulting arrangements, and future employment to get the drug approved.