GUT CHECK

DAN ALAIMO

The population is getting old, life is more stressful and there is a wide selection of over-the-counter gastrointestinal medications to choose from, many backed by some high-powered national marketing.

In supermarket pharmacies across the nation, this often plays out into a situation calling for pharmacist counseling. While the result is often a well-informed purchase and a patient successfully treated for an unpleasant if not painful malady, sometimes the best recommendation is no product at all.

A visit to the doctor or emergency room may be advised for symptoms of serious problems, and the result could be the creation of a highly loyal customer.

When Procter & Gamble, Cincinnati, brought Prilosec OTC to market in the fall of 2003 with one of the heaviest advertising and promotional campaigns yet seen for an OTC switch product, it called attention to a category that had long enjoyed good but unspectacular sales. After the introduction came big sales increases and even some shortages in the product's first year of availability.

It was a case of a marketing campaign and a product well-timed for changing consumer trends.

"Overall, we are getting older," said Michele Snider, director of pharmacy, Save Mart Supermarkets, Modesto, Calif. "We can't tolerate the spicy foods we used to eat. Everybody is pressed for time and stressed, and all of that leads to increased use of stomach medications."

Overall, gastrointestinal tablets were up 0.9% for the 12 months ending Dec. 25, 2005, to $579 million in the food channel, as tracked by Information Resources Inc., Chicago. Prilosec OTC was up 10% to $90 million. For the year ending Dec. 26, 2004, the category was up 6.8% to $575 million, with Prilosec OTC growing 13.4% to $82 million.

In the full year prior to the Prilosec OTC launch (the 12 months ending Dec. 29, 2002), the overall category of gastrointestinal tablets was down 2% to $529 million in the food channel. It rose 1.8% to $538 million for the 12 months ending Dec. 28, 2003, according to IRI. Prilosec OTC officially launched on Sept. 15, 2003, and registered $24 million in supermarket sales before year's end.

Prilosec OTC jump-started the category, noted John Beckner, director, pharmacy and health services, Ukrop's Super Markets, Richmond, Va., agreeing with other executives interviewed during the recent Supermarket Pharmacy Conference of the Food Marketing Institute, Washington. This success is owed to both marketing and demand.

"There was tremendous marketing. Marketing sells and in combination with a need, the market at that time really took off," Beckner said. Contemporary lifestyles are a factor, he said. "People not eating right, eating on the run, stressful jobs - heartburn. You combine that with a very effective marketing campaign, and the results speak for themselves."

Prilosec OTC "more than jump-started the category, it gave the sales numbers a great boost," said Curtis Hartin, director of pharmacy, Schnuck Markets, St. Louis. Meanwhile, "other products, the Pepcids and the Zantacs are still doing well out there," he said.

"The category continues to build. People are more comfortable seeking out those products and taking them with the aid of some good advice," he said.

Because gastrointestinal difficulties could signal more serious problems, and because there are significant differences in how products in this category work, a pharmacist can play a vital role when their advice is sought by patients.

"Prilosec takes a little longer to work. Pepcid and Zantac probably work a little quicker. Of course, the good old antacids still work the fastest," said Greg Jones, director of pharmacy, Harmons, West Valley City, Utah. "So, if somebody needs something that is going to work right now, Tums and Mylanta still work great. Short-term, Zantac and Pepcid are pretty good, and if they are going to take it for longer, maybe Prilosec is the right answer."

It was not very many years ago that many of these products were prescription items, so a pharmacist can help a patient make sure they are taking them for the right situations. "We always worry that somebody has a bleeding ulcer, or a serious problem that they really need to see a doctor for. So, it is important to ask questions and find out exactly what is going on with the patient," Jones said.

Verne Mounts, director of pharmacy, Buehlers Food Markets, Wooster, Ohio, encountered exactly this kind of situation one of the last times he worked behind the counter. Because he wrote a local newspaper column, a customer sought him out one Saturday morning as an accessible health care expert. Her husband was waiting in the car and she was asking about several stomach medicines. A sequence of questions brought out the information that the husband previously had a bleeding ulcer. Mounts sold them nothing and advised them to go directly to the emergency room, which turned out to be the right call. The man was having a recurrence, spent several days in the hospital, and eventually returned to the store to thank Mounts.

"Sometimes the most powerful recommendation we can make is to sell no product whatsoever and to be the triage mechanism to get people inserted into the health care system at the appropriate level," he said. "Would I have had that opportunity if there were fewer selections up front? Maybe not. Maybe they would have just picked up a couple of items on their own."

On the other side of the patient spectrum are those with knowledge and familiarity with Internet resources, and the ability to successfully self-medicate, said John Fegan, senior vice president, Ahold USA, Braintree, Mass. "Today's consumer is a lot different from those 10 or 20 years ago when they depended on somebody else for knowledge," he said.

When asked, pharmacists will often try to start patients out with the milder products, like the antacids, but now there are some potentially more effective alternatives, said Rose Dickison, pharmacy supervisor, ShopRite of Hunterdon County, Flemington, N.J. "It's nice to know that there are different levels of intensity to treat different levels of symptoms and severity."

Pharmacists still get many questions from customers about stomach remedies, said Snider of Save Mart. "The pharmacist needs to be proactive, helping guide the patient to decide whether they need to see a physician or not."

"I see the professional role as trying to determine for the patient what their symptoms are and either getting them some relief from an over-the-counter product, or referring them to a physician for professional help," said Jim Linden, director of pharmacy, Nash Finch Co., Edina, Minn.