Editor’s note: This is the first of two opinion pieces by Dr. Steele about the American pharmaceutical industry, its power and the growing number of challenges to it.

Nexium is “The Little Purple Pill” designed to heal two things: your heartburned esophagus and its manufacturer’s financial bottom line. In the battle over high prescription drug costs in this country, the Nexium story should give us all pause and ulcers.

As the year 2001 approached, Nexium’s manufacturer, pharmaceutical giant AstraZeneca, was facing a $6 billion problem; its patent on the heartburn wonder drug Prilosec was due to run out in October 2001. By then it was selling $6 billion a year in Prilosec, making it one of the most successful drugs ever sold, and AstraZeneca needed a way to keep this pharmaceutical cash cow alive when that patent expired. The company knew that when Prilosec “went generic,” AstraZeneca was no longer going to be able to sell Prilosec at $3 a pill because other companies were going to make and sell generic Prilosec (omeprazole) at a lower price. Then, General Motors, which was spending more than $50 million a year on Prilosec for its employees, and other companies like it, were going to switch thousands of employees on company health plans to generic omeprazole. AstraZeneca was going to lose a lot of that $6 billion.

But AstraZeneca is in the business of making money. It was not about to let Americans off its $6 billion Prilosec hook, so it developed something to replace Prilosec and prevent an ulcer in its own bottom line.

First, AstraZeneca sued companies that planned to make and sell generic omeprazole when the Prilosec patent ran out. By doing so, it ultimately forced three of those four companies to drop their plans, and delayed introduction in the United States of generic Prilosec. One company survived its suit, and the generic version of omeprazole finally made it to the U.S. market this year. Round one to AstraZeneca. (Just recently, two additional companies said they would brave lawsuit threats from AstraZeneca and market their own generic Prilosec versions, according to The New York Times.)

While it was tying its generic competition up in court, AstraZeneca lined up its big right hook, Nexium. Its scientists basically changed what amounted to one molecule on omeprazole and voila, made esomeprazole, the chemical isomer of omeprazole, the son of Prilosec. AstraZeneca marketed esomeprazole as Nexium (probably because calling it BillionsForAstraZenecium seemed like a bad marketing idea).

In 2001, with the generic competition delayed in court and Nexium now ready to go, AstraZeneca set about the work of convincing Americans and their doctors to switch millions of Prilosec users to Nexium, instead of to generic Prilosec when it became available. Now, convincing Americans patients and doctors to use name brand Nexium/esomeprazole at about $3 a pill instead of cheaper generic Prilosec would take real work, but AstraZeneca, with billions of dollars at risk, was up to the task. Beginning in 2001, AstraZeneca mounted one of the most comprehensive pharmaceutical marketing campaign in U.S. history to sell Nexium.

It made Nexium in a color that looked like the original Prilosec. It hired hundreds of new salespeople to market the drug, and advertised the drug on TV, in magazines and to doctors. It flooded doctors’ offices with free samples of the “Little Purple Pill,” a technique widely used by pharmaceutical companies to get patients started on free versions of a new medicine. (Then, when the freebies run out the patient has to buy the drug with a prescription.) It offered some hospitals breaks on the price for Nexium, so hospital doctors would use Nexium in the hospital and send patients home on Nexium prescriptions. In 2001 alone AstraZeneca spent almost $500 million marketing Nexium.

Most prominent was Nexium’s slick TV “heal the damage” ad campaign, which was aimed directly at the American consumer. It urged heartburn sufferers to talk to their doctors about what might be “severe erosions in your esophagus” and Nexium. You could not watch the national evening news without hearing about how “I didn’t know” about the risk of heartburn and the miracle of Nexium.

AstraZeneca even signed a deal with minor league baseball for the “Pitching for Community Health” campaign, in which Hall of Fame pitcher Jim Palmer talked at minor league baseball games about his struggle with heartburn and “the importance of recognizing and treating health symptoms in everyday life.”

And it all worked, and Rounds 2-14 have gone to AstraZeneca. Nexium is selling like hotcakes, and to date an estimated 40 percent of patients who were formerly on Prilosec have switched to Nexium. America’s doctors have allowed themselves to be buffaloed and hoodwinked into writing Nexium prescriptions by the millions. America’s health care industry has stood by ineffectually, as have patients and employers, all rolled over by AstraZeneca’s masterful marketing of the Son of Prilosec. Nexium has healed lots of patients, but heartburned many in the health care system who had hoped to save patients and payors millions of dollars by using generic omeprazole.

While Americans continue to pay millions of unnecessary dollars for their heartburn prescriptions, I am going to heal my own heartburn over this issue; I have written my last prescription for Nexium. AstraZeneca can “heal the damage” to its bottom line without my help. I apologize in advance to my patients who take the medicine; we will work something out.

As for the ubiquitous Nexium ads in which everyone says “I didn’t know” about Nexium and heartburn? Now you do. Go fight Round 15.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.