You’ve got persistent heartburn happening two or more days a week — something generally diagnosed as acid reflux disease these days. Which of the many available drugs should you take:

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Or something else?

Sounds confusing, doesn’t it?

It isn’t, really. These drugs all do the same thing in basically the same way. And I hate to say it, but a big reason there are so many variations on the market has less to do with helping you than with lining the pockets of big pharmaceutical companies.

You see, two of the best-selling acid reflux drugs — Prilosec and Nexium — are essentially the same drug marketed by the same company, AstraZeneca. Nexium is derived from Prilosec, and AstraZeneca argues that it’s more effective, and has been aggressively making its case to doctors (helped by its wine-’em-and-dine-’em sales force.)

However, many critics believe AstraZeneca is full of it. For example, Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, last year accused AstraZeneca of doctoring its comparative studies to produce a difference that wasn’t there.

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I know — you’re probably not interested in the politics. Just understand that a lot of things go into the creation of new drug brands besides a concern for helping the patient.

The bottom line is that all of these drugs are something called “proton pump inhibitors,” and while there are some chemical differences among them, there is no definitive research that shows one more effective than another. That said, you as an individual patient may respond differently to each of the drugs — in terms of efficacy and side effects. So try one, and if it isn’t effective, try another. Zegerid, for example, combines the active ingredient with a sodium bicarbonate, which allows it to be sold as chewable tablets. This is good for folks seeking immediate relief.

As always, consult with your doctor and rely on his or her guidance in making a decision.

One other note: There’s a very important step you should take before getting a prescription for ANY of these medications. You should change your diet. A big reason acid reflux disease is rampant in the United States today is because our diets are terrible. Please follow these diet tips before starting on any medication.

Remember, taking an acid reflux drug caused by a poor diet only treats the symptom. It doesn’t make you healthier. That acid reflux may be your body’s way of telling you to feed it something else.

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