The Food and Drug Administration and its Canadian counterpart, Health Canada, began reviewing the drugs, used by tens of millions of people, in May, when manufacturer AstraZeneca provided them an early analysis of two small studies that suggested the possibility of a risk.

Those studies compared treatment of the chronic heartburn known as gastroesophageal reflux disease with either of the two drugs or with surgery, and tracked patients for five to 14 years. The initial analysis found that more patients treated with the drugs had had heart attacks, heart failure or heart-related sudden death.

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The FDA followed up on those studies and found that they seemed skewed: Patients who underwent surgery were younger and healthier than those treated by drugs, suggesting that the heart link was a coincidence.

While the studies’ designs make safety assessments difficult, many of the participants who developed heart problems had risk factors before starting the drugs, Health Canada said.

The FDA then looked at 14 additional studies of the drugs and found no evidence of heart risks. In a few studies where patients received either medication or a dummy pill, those who took the heartburn drugs had a lower incidence of heart problems.

Does African Dust Affect Atlantic Hurricanes?

Storm scientists are taking a closer look at whether giant dust clouds from the Sahara could join the El Niño phenomenon as a leading indicator of the ferocity of Atlantic hurricane seasons.

Scientists are intrigued by preliminary research showing a direct correlation between the sandy plumes and tropical cyclones.

“What we’ve seen is: more dust, fewer hurricanes,” said William Lau, chief of the Laboratory for Atmospheres at NASA’s Goddard Space Flight Center.

The busy and damaging hurricane seasons of 2004 and 2005, which rattled global energy and insurance markets, have heightened interest in storm forecasting and in research on factors that make tropical cyclones either spin into monster storms or wither and die at sea.

El Niño, a warming of eastern Pacific waters, has become a dominant storm indicator because it can flatten an Atlantic hurricane season by increasing the wind shear that can rip apart cyclones.

Patients who take the popular brand-name proton-pump inhibitor known as Protonix, sold by New Jersey drug giant Wyeth, should know by Sept. 7 whether generic drug-makers will be able to make a cheaper copy of the drug, which has about 17 percent of the market for drugs in its class, according to industry figures. It would be the first major drug in the class to go generic since Prilosec five years ago.

Earlier this month two generic drug-makers agreed not to launch a generation of Wyeth’s Protonix before Sept. 7, Wyeth said. Meanwhile, a federal court in New Jersey is considering a request from Wyeth for a preliminary injunction against the generic makers that would in effect delay a generic Protonix.

Although the proton-pump inhibitors are all similar in safety and efficacy, doctors still prescribe primary brands Nexium, Prevacid, Protonix and Aciphex in large numbers. With $13.6 billion in sales last year, prescription proton-pump inhibitors were second only to cholesterol drugs in the amount of sales they reaped for the pharmaceutical industry, according to IMS Health. Cholesterol drugs such as Lipitor, Crestor and generic Zocor generated $21.6 billion in U.S. sales.

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But analysts expect brand name sales of Protonix and its rival brands would suffer if another cheaper generic proton-pump inhibitor were on the market. In the last five years Prilosec, a once-popular brand of prescription proton-pump inhibitor, became available in a generic version and eventually over-the-counter copies, and has put pressure on sales of rival brand names.

Health plans, citing doctor preference and scientific studies, increasingly prefer to cover generic Prilosec because it is similar to Prevacid, Nexium, Protonix and others, analysts say. Branded proton-pump inhibitors can cost $4 to $5 or more per pill compared with less than $3 for generic prescription Prilosec capsules or less than 80 cents a pill for over-the-counter Prilosec. Co-pays for brand proton-pump inhibitors can be $25 to $40 a month or more, compared with $10 for generic Prilosec, health plans say.

“A launch of generic Protonix would certainly rattle the proton-pump inhibitor market, in our view, due to strong 17.1 percent market share, trailing only Nexium [26.2 percent] in branded market share,” pharmaceutical industry analyst Joseph Tooley of A.G. Edwards & Sons Inc. wrote in a report.

Generic Prilosec had 24 percent market share of weekly prescriptions in an A.G. Edwards report Aug. 6, compared with 17.9 percent at the same time last year. By comparison, market share of rival brand names Nexium, Prevacid, Protonix and others were flat or down from the year ago.

Lake Forest-based TAP Pharmaceutical Products Inc., which sells Prevacid, is losing market share the fastest. Its share was 16.2 percent, down from 19.2 percent a year earlier, according to the A.G. Edwards report, which also cited IMS data.

The Food and Drug Administration and its Canadian counterpart, Health Canada, began reviewing the drugs, used by tens of millions of people, in May, when manufacturer AstraZeneca provided them an early analysis of two small studies that suggested the possibility of a risk.

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Those studies compared treatment of the chronic heartburn known as gastroesophageal reflux disease with either of the two drugs or with surgery, and tracked patients for five to 14 years. The initial analysis found that more patients treated with the drugs had had heart attacks, heart failure or heart-related sudden death.

The FDA followed up on those studies and found that they seemed skewed: Patients who underwent surgery were younger and healthier than those treated by drugs, suggesting that the heart link was a coincidence.

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While the studies’ designs make safety assessments difficult, many of the participants who developed heart problems had risk factors before starting the drugs, Health Canada said.

The FDA then looked at 14 additional studies of the drugs and found no evidence of heart risks. In a few studies where patients received either medication or a dummy pill, those who took the heartburn drugs had a lower incidence of heart problems.

Does African Dust Affect Atlantic Hurricanes?

Storm scientists are taking a closer look at whether giant dust clouds from the Sahara could join the El Niño phenomenon as a leading indicator of the ferocity of Atlantic hurricane seasons.

Scientists are intrigued by preliminary research showing a direct correlation between the sandy plumes and tropical cyclones.

“What we’ve seen is: more dust, fewer hurricanes,” said William Lau, chief of the Laboratory for Atmospheres at NASA’s Goddard Space Flight Center.

The busy and damaging hurricane seasons of 2004 and 2005, which rattled global energy and insurance markets, have heightened interest in storm forecasting and in research on factors that make tropical cyclones either spin into monster storms or wither and die at sea.

El Niño, a warming of eastern Pacific waters, has become a dominant storm indicator because it can flatten an Atlantic hurricane season by increasing the wind shear that can rip apart cyclones

The trend already is pinching the profit of big pharmaceutical companies, but it is rare good medical news for Americans’ pocketbooks.

The nation spends $275 billion a year on prescription medicine, but analysts forecast a golden era for generic drugs over the next five years as patents expire on brand-name medications with more than $60 billion in combined annual sales. That will open the door to copycats that can be 30 percent to 80 percent cheaper.

“There’s a tidal wave of generic drugs, and we are just in the beginning of the tidal wave,” said Laizer Kornwasser, an executive for Medco Health Solutions, which manages prescription drug plans.

The rise of generics has helped slow spending increases for prescription medication overall, even though aging baby boomers are consuming more drugs and even as new medicines enter the market, including cancer drugs costing tens of thousands of dollars.

Ronny Gal, an analyst for Sanford C. Bernstein and Co. who follows generic companies such as Teva Pharmaceutical Industries, Barr Pharmaceuticals and Mylan Laboratories, predicts 10 percent to 13 percent annual profit growth in the industry from now to 2010. He describes the generic trend as “good for everybody but the branded pharmaceutical companies.”

Last week, the big drug-maker Johnson & Johnson announced it would cut up to 4,800 jobs as it braces for generic competition to two of its drugs, Risperdal for schizophrenia and Topamax for seizures and migraine headaches. In the past year, combined U.S. sales of the drugs were $4 billion.

Shortly after the Johnson & Johnson statement, Sanofi-Aventis announced it had been hard hit by low-cost alternatives to its sleeping pill Ambien, which became available in generic form in April. As frequently happens when generics go on the market, sales of the name-brand Ambien plunged - to $91 million in the second quarter from $420 million in the same period last year. Generics already account for 60 percent of prescriptions in this country. That portion is expected to rise as cheaper substitutes arrive to treat many chronic conditions.

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Already this year, consumers have flocked to new generic versions of five major drugs, including Ambien and discount alternatives to Norvasc for high blood pressure.

Next year, generics competition is expected to hit Fosamax, a $2 billion drug in this country that slows bone loss and often is used by postmenopausal women. In 2009, the heartburn and ulcer medication Prevacid, a $3.5 billion product in this country, is expected to become available as a generic product. And by 2011, a generic substitute is expected to be available for what has been the world’s single best-selling medicine, the cholesterol drug Lipitor, a drug with annual U.S. sales exceeding $5 billion.

Several experts predict that generic drugs will keep drug price inflation in the single digits for the next several years.

“It’s much better than it was in the ’90s before these drugs started going generic,” said Steven B. Miller, chief medical officer for Express Scripts, another company that manages drug benefit plans. “The drug trend was always double digit.” As recently as 2002, he notes, the annual drug inflation rate was 18.5 percent.

Companies such as Express Scripts are promoting the use of generics by setting lower co-payments for them, reducing the amount patients must pay out of pocket.

Also helping to propel the copycat drug trend is the success of generic manufacturers in challenging patents held by brand-name companies. Another reason is that many patents simply are expiring on drugs that were introduced during the late 1980s and early 1990s, an unusually productive era of research and development for the pharmaceutical industry.

Patents provide 20-year protection from generic competition. Because companies often apply for patents in early stages of drug development, before drugs are approved, pharmaceuticals may have fewer years of what is called effective patent protection.

Now, as nearly every big drug-maker watches its bestsellers fade away, there are fewer potential blockbuster drugs waiting to take their place.

The FDA approves generic drugs that contain the same active ingredients as brand-name pharmaceuticals and says that generic drugs meet the same quality standards.

Ginger is believed to help reduce acid secretion so you can try sprinkling ginger in a glass of water or buy it in tea form.

Eating papayas may help relieve the pain because the tropical fruit has an enzyme that can neutralize stomach acid.

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Another suggestion is mixing a half a teaspoon of apple cider vinegar into a glass of water and drink it.

Dr. Jennifer Christie says, “It’s counter-intuitive to think something acidic could decrease acid and decrease symptoms of heartburn. However, a number of people have tried it and found that it works, but the results are variable.”

Also make gravity work for you and sit upright or stand. This way the acid is more likely to stay in your stomach and not travel up your esophagus.

And stay away from carbonated drinks. All those bubbles can expand your stomach and make your heartburn worse.

Drug companies have been very good at creating medications that shut down stomach-acid production. Medications like Aciphex, Nexium, Prevacid, Prilosec and Protonix are among the most frequently prescribed drugs in the country. Prilosec OTC, available without a prescription, has become one of the most popular heartburn pills in the pharmacy.

Indigestion is unpleasant. It can turn a delightful dining experience into a bad memory and wake you in the middle of the night. Repeated reflux can scar the esophagus and possibly even increase the risk of cancer.

Suppressing acid seems like a logical solution. But why do we have acid in the first place? Most animals (dogs, cats, cows, snakes, sheep and sharks) make a lot of stomach acid. In fact, paleontologists have found sophisticated systems for creating stomach acid in just about every vertebrate species for the past 350 million years.

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Could something that has survived for so long be a cosmic mistake? Just because we can now suppress acid production so effectively does not mean that this is the perfect solution to heartburn.

Controversy about the long-term effects of acid suppression has been swirling in the medical community for decades. Concerns have been raised about reduced absorption of important nutrients such as vitamin B-12 or an increased risk of stomach cancer.

In recent months, scientists reported that long-term use of proton pump inhibitors (PPIs) like Nexium, Prilosec or Prevacid is associated with an increased risk of hip fracture (Journal of the American Medical Association, Dec. 27, 2006). The authors suggested that the PPIs might interfere with absorption of calcium so that a deficit develops over time.

The trick was - no, not the one about stealing signs from the center-field scoreboard - those Giants never let one loss infect their pursuit of the Dodgers or distract them from their mission.

Then again, the trick might also have been those Giants never had Mike Mussina, Kei Igawa and Matt DeSalvo set up one-two-three in the starting rotation to follow any one of those seven defeats.

The Yankees reached their quota about a month ago on games they could afford to let get away, yet another one got away from them at the Stadium yesterday afternoon when, out of nowhere, Toronto scored three in the seventh against Chien-Ming Wang for a 3-2 victory that prevented the home team from sweeping a four-game series.

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They can say accurately, as they did in the immediate aftermath of the defeat that was more improbable than Tuesday’s extra-inning victory they achieved after tying the score in the ninth on a balk, that they’re playing good ball and that they’ll take winning three out of every four games.

But there is no doubt that this one caused heartburn even as it is currently impossible to determine whether this will be the one to ultimately cause heartbreak if the Yankees can’t make it all the way back against Boston in the AL East or against Cleveland in the wild-card chase.

This one caused heartburn because the Yankees lost with their ace on the mound and a 2-1 lead with seven outs to go. This one caused heartburn because they scored twice before making an out then got nothing the rest of the way. This one caused heartburn because of the question marks concerning who will take the mound tonight and in tomorrow’s split doubleheader against the Devil Rays.

Your recent symptoms may — or may not — be related to your hiatal hernia. If the hernia does turn out to be the cause, surgery could be a good option.

A hiatal hernia exists when part of the stomach is within the chest instead of the abdomen. Usually, the esophagus (food pipe) connects to the stomach right at the level of the diaphragm (the breathing muscle that separates our chest from our abdomen). In hiatal hernia, the stomach and esophagus join together at a higher level, above the diaphragm.

Some physicians think people are born with this condition. Others believe acid reflux irritates and shortens the esophagus and pulls the stomach into the chest — causing the hiatal hernia. Another view is that weight gain causes the hernia, with increased abdominal pressure pushing the stomach into the chest. The bottom line is that we really don’t know why people have this common condition.

We do know that small hiatal hernias often don’t cause any problems. Larger hernias may cause health concerns. Some people have much of their stomach up in their chest. The larger the hernia, the more likely it is to cause symptoms.

Years ago, hiatal hernia was used synonymously with gastroesophageal reflux disease (GERD). There’s overlap but they aren’t the same. If you have a hiatal hernia, your risk of GERD is higher, with symptoms such as heartburn, acid regurgitation (especially when lying down), and difficulty swallowing. But you can have GERD without a hiatal hernia, and vice versa.

It’s possible that the nausea and regurgitation of food you describe are symptoms of GERD, but they would be unusual symptoms for that condition.

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Another possible cause of your symptoms is gastroparesis, where food doesn’t leave the stomach as quickly as it should, resulting in vomiting. People with gastroparesis often have GERD, too. In this case, the gastroparesis causes the GERD.

Another possible explanation for your symptoms is a severe motility disorder, such as achalasia, where food collects at the bottom of the esophagus because the esophagus lacks normal muscle contractions that move food along. This is a rare condition and so this is less likely.

Given there are several possible overlapping causes for your symptoms, it’s important to work with your physician to determine a diagnosis and treatment plan.

GERD treatment starts with lifestyle changes and often requires taking medications long term. Eating smaller meals more frequently, avoiding big meals, not lying down right after eating. and sleeping with the head of the bed elevated all can help. So can losing weight and avoiding tight clothing around the waist.

Medication options include antacids, acid blockers and proton pump inhibitors (PPIs). The esomeprazole (Nexium) that you take is a PPI. These medications counter the effects of acid or block its production, and are available both over-the-counter and in prescription strength.

Surgery is another option for long-term treatment of GERD. In a procedure called fundoplication, the top of the stomach is wrapped around the lower esophagus so stomach acid can’t reflux. The procedure often is done laparoscopically, with a tiny incision. A hiatal hernia can be repaired with the same procedure. For patients with a large hernia causing the symptoms, surgery is probably the best option. — G. Richard Locke, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

While stress affects people in a variety of ways, everyone experiences stress at some point in life. Stress can even lead to behaviors that may aggravate symptoms of certain conditions, such as acid reflux disease, which affects more than 7 million Americans. Conversely, engaging in healthy behaviors in response to stress may prevent symptoms of reflux from getting worse.

“Stress from things you can’t control, such as traffic on the way to work, may lead to behaviors that can have an effect on your health,” said Nancy Mramor, PhD, noted health psychologist. “My goal is to help people take steps to lessen their stress and have a healthy response to stress.”

According to Richard Sigmon, MD, internist and gastroenterologist, Charlotte Medical Clinic, “In my practice, I see an increasing number of patients suffering from acid reflux disease. While stress does not cause acid reflux disease, it can lead to behaviors, such as eating too much or eating unhealthy foods, which may aggravate the condition.

“In addition to finding ways to lower their stress levels through lifestyle changes, there are treatment options for acid reflux disease available to patients, such as ACIPHEX(R), or rabeprazole sodium, a prescription medication that reduces acid production in the stomach. People should talk to their doctors to find out what they can do to control their acid reflux disease,” Dr. Sigmon said.

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According to Dr. Mramor and Dr. Sigmon, the following simple lifestyle changes can help ease stress:

– Lead a healthy lifestyle. Eat sensibly, get enough rest, exercise regularly and balance work with play. Be sure to check with your doctor before starting any new exercise program. Watch your caffeine and alcohol intake - both can upset your sleep patterns as well as trigger acid reflux disease. — Make time for yourself. Take the time to read a book, watch a movie, garden or indulge in a warm bath. You may also want to try a new hobby or join a club. — Set realistic goals. Don’t try to take on too much at once. If you feel overwhelmed by responsibilities and events in your schedule, learn to say “no” or at least to find an acceptable compromise. — Find someone with whom you can talk. Seek out the support and guidance of friends, colleagues and family members. You may find that you are not the only one having a bad day. — Don’t worry about what you can’t control. Some things are completely out of your control, like traffic and the weather. Identify what you can’t change and learn to let it go. About ACIPHEX(R) (rabeprazole sodium)

ACIPHEX(R) is a prescription medication. One ACIPHEX 20 mg tablet daily is used for the treatment of persistent, frequent (2 or more days a week) heartburn and other symptoms associated with acid reflux disease.

ACIPHEX is also used for the short-term (4 to 8 weeks) treatment in the healing and symptom relief of damaging (erosive) acid reflux disease (gastroesophageal reflux disease) and to maintain healing of damage (erosions) and relief of heartburn symptoms that happen with acid reflux disease. ACIPHEX has not been studied for treatment lasting longer than 12 months (1 year).

Chronic Pain

This study will evaluate the safety and effectiveness of an investigational medication to manage breakthrough pain. Volunteers 18-80 who have had chronic pain for at least three months may be eligible.

The research site is in Phoenix, Ariz.

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Gastroesophageal Reflux Disease (GERD) or Heartburn

Volunteers 18 and older who have endoscopically confirmed erosive esophagitis may qualify for this study of GERD and heartburn.

The research site is in Mount Pleasant, Ohio.

Bipolar Disorders

Feelings of being on an “emotional roller coaster” may be a symptom of bipolar disorder, also known as manic depression. This study is enrolling adults 18 and older who may have bipolar disorder.

The research site is in Portland, Ore.