PPI “Dangers”?

PPIs are Proton Pump Inhibitors – e.g., Nexium, Prevacid, Prilosec, and Protonix.

For a long time, they were the second highest category of prescription spend (after anti-cholesterol drugs), but several of them are now available OTC (over-the-counter). 

In November, there was an article in the Experience Life magazine (from Lifetime Fitness) that highlighted a few things:

• A 2009 study in the American Journal of Medicine suggested that up to 60% of PPI Rxs for hospitalized patients were unnecessary.
• A 2009 study in Gastroenterology suggested that extended use of PPIs may worsen the symptoms they are designed to treat.
• A 2006 study in JAMA reported that people taking long-term, high dose PPIs are 2.65 times more likely to experience hip fractures.
• Studies published in JAMA in 2004 and 2005 reported that patients on acid-suppressing drugs are nearly twice as likely as unmedicated subjects to develop pneumonia. 

So, why were they so widely used?  Did the cure outweigh the risks?  Did physicians not know about these issues?  Was there no alternative?  Did direct-to-consumer advertising work?  Were the studies not valid?

I don’t know the answer, but I think it would be an interesting case study.