The importance of discussing medications with your GP

Transcript: AMA Queensland President, Dr Nick Yim, ABC Radio Brisbane, Mornings with Steve Austin, Monday 5 August 2024

Subject: Proton pump inhibitors

For additional context, included is Steve Austin's interview with Special Counsel for Shine Lawyers Lorne Franks that aired before the interview with Dr Yim.

STEVE AUSTIN: A drug commonly prescribed, or a medicine commonly prescribed for heartburn is at the centre of a new class action here in Australia amid concerns that the medicine could cause cancer long-term and kidney failure. It’s specifically used for things like heart disease or gastric reflux, I think is another way of putting it. So, let's find out what the class action is about. Lorne Franks is Special Counsel for Shine Lawyers. I asked him to explain what the situation was firstly.

LORNE FRANKS: Hey Steve, well proton pump inhibitors, or we can just call them PPIs. They're widely used drugs very commonly prescribed for things like heartburn and reflux. And your listeners might know them better by their brand names. There's a few of them, but Nexium or Losec are some of the better known.

STEVE AUSTIN: All right. Now, the legal action is apparently claiming that there is a scientifically proven connection to these medicines, easily available over the counter at a chemist, and different forms of cancers or kidney failures. What's the backdrop, please?

LORNE FRANKS: Sure. Well, these drugs have been on the market since the early 1990s, about 30 years. But the reason we're investigating is long-term studies are starting to reveal some risks that weren't apparent earlier. Specifically, the stomach cancers and some of these kidney injuries. On top of that, there's also been some litigation in the United States on these issues. Thousands of cases have been brought in the past few years over there and many of them have settled as of late last year.

STEVE AUSTIN: So, AstraZeneca apparently agreed to a sort of settlement for kidney claims relating to Nexium and Prilosec, is that right?

LORNE FRANKS: That's right, and so Prilosec is the US name for Losec.

STEVE AUSTIN: Okay. So here in Australia, does that US settlement have effect or influence on a legal action here in Australia?

LORNE FRANKS: No, it doesn't. And that's why we're investigating closely whether those claims have any applicability to the Australian legal system, whether Australians have been affected and whether we might be able to, if so, bring the manufacturers to account for it.

STEVE AUSTIN: Okay. So, what would you be arguing in the class action? What's the case you're going to put forward?

LORNE FRANKS: It would be around that the products have a defect and/or that they should have come with adequate warnings for people who may not realise, or their doctors may not realise, that there were these adverse effects that you could suffer.

STEVE AUSTIN: What evidence is there that these drugs are linked to causing stomach cancer and kidney failures, Lorne Franks?

LORNE FRANKS: As I said, we're investigating that now, but there are a surprising number of scientific studies and other research that's come about particularly in the last few years. We'll be looking at those closely and talking with the experts in the field to be able to ascertain whether there's any merit to it.

STEVE AUSTIN: So, do these drugs for gastric reflux or heartburn or whatever you want to call it, do they have to be prescribed by a doctor? I know there are some products that I see advertised on television, not these ones that I recall, where they sort of claim to reduce acid reflux and the like. Does your matter only involve ones that are prescribed by a doctor or simple over-the-counter medications as well?

LORNE FRANKS: It's both actually. So, for the past decade or so, these medications have also been available over the counter, off the shelf, without having to speak to a chemist first. But certainly, majority of them are prescribed and many people have been on them for a very long time. And the evidence suggests that there's a greater risk of the adverse effects for people who've taken larger doses or use them for extended periods.

STEVE AUSTIN: What does Australia's medical regulator, like the Therapeutic Goods Administration, say in regard to these forms of medicine?

LORNE FRANKS: As I understand it, they acknowledge that these are serious medications, and they have the potential to cause adverse effects. And, they have been making some attempts to change the way they're prescribed in terms of the dosages and length of time. They tend to say something like – these medications should only be used for the minimum amount of time necessary and at the lowest dosage effective.

STEVE AUSTIN: Right, okay. So, who is actually doing the investigation into the drugs? You're a lawyer, not a medical investigator. Who's running the investigation side of things?

LORNE FRANKS: The investigation from our perspective, refers primarily to speaking with people who are doctors and medical experts and primarily, once we're satisfied that there is sufficient evidence that we might be able to prove that in court, we will then be working out whether it's appropriate to bring as a class action. And, you know, looking closely at the legal side which we're qualified to do.

STEVE AUSTIN: Lorne Franks, Special Counsel for Shine Lawyers.

The interview with Dr Nick Yim starts here:

STEVE AUSTIN: Dr Nick Yim is the President of the Australian Medical Association Queensland. Nick Yim, why do doctors prescribe these drugs for heartburn and the like?

DR NICK YIM: Good morning. So, these medications called proton pump inhibitors, they've been around for many decades. They're used to treat reflux and also to treat stomach ulcers. These medications have been very, very effective at treating these symptoms. Unfortunately, all medications that we take, some of them do have side effects that might be short-term or even long-term. But historically with these medications, most of these side effects have been relatively mild and uncommon.

STEVE AUSTIN: Okay, do doctors hold concerns about the type of drugs?

DR NICK YIM: So, for doctors, it's always about that risk-benefit profile. We know that for people with poorly controlled acid reflux, it can lead to really poor quality of life, that discomfort, sometimes even with dietary measures and food changes, people still have symptoms. So, these medications over the past three decades or more have been a life changer for much of the population.

STEVE AUSTIN: Okay. So, what are the potential problems if they go off these drugs?

DR NICK YIM: Good question. So, if anyone does have concerns about these medications, the key thing is to have that conversation with your general practitioner because going off these medications can sometimes lead to a recurrence of a stomach ulcer. As you can imagine, if someone does have a stomach ulcer, that can lead to bleeding, which can be quite catastrophic for some individuals.

STEVE AUSTIN: So, what do patients do? I mean, if you have to use these long-term, you don't want to be worried or concerned about getting some sort of cancer or kidney failure down the track.

DR NICK YIM: So it's really important to have that discussion with their general practitioner. If people are still having symptoms of their acid reflux, it might be an opportunity for that GP to do a referral to a gastroenterologist, to maybe have a bit of a camera test, to have a look what is going on in the stomach. At the same time, to have a discussion with their GP, because options could be to reduce the dose to using the lowest dose possible, or potentially there could be other alternatives.

STEVE AUSTIN: I'll leave it there. Nick Yim, thanks so much for your time.

DR NICK YIM: Always a pleasure. Thank you.

STEVE AUSTIN: Dr Nick Yim is President of the Australian Medical Association here in Queensland.