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One idea was to devise a Prilosec 2. In some cases, removing one of the isomers can reduce side effects or make a drug work a little bit better, and in all cases the Patent Office recognizes something with one isomer as a separate invention from something with two. So AstraZeneca cut Prilosec in half. In one study, half the patients took Prilosec, and half took Son of Prilosec.

After one month, the two drugs were dead even. A patent was filed, the F. It is now one of the half-dozen top-selling drugs in America. In the political uproar over prescription-drug costs, Nexium has become a symbol of everything that is wrong with the pharmaceutical industry. She thinks that they charge too much, engage in deceptive research, produce inferior products, borrow their best ideas from government-funded scientists, and buy the affections of physicians with trips and gifts.

Of course, it is also the case that Nexium is a prescription drug: every person who takes Nexium was given the drug with the approval of a doctor—and doctors are professionals who ought to know that there are many cheaper ways to treat heartburn. It could have picked up the tab for Nexium only if the patient had first tried generic Tagamet.

Or it could have discouraged Nexium use, by requiring anyone who wanted the drug to pay the difference between it and generic omeprazole. Prilosec is identical to prescription Prilosec and effectively equivalent to prescription Nexium, and it costs only twenty dollars a month. Throughout the current debate over prescription-drug costs—as seniors have gone on drug-buying bus trips to Canada, as state Medicaid programs and employers have become increasingly angry over rising health-care costs, and as John Kerry has made reining in the pharmaceutical industry a central theme of his Presidential campaign—the common assumption has been that the rise of drugs like Nexium is entirely the fault of the pharmaceutical industry.

Is it? If doctors routinely prescribe drugs like Nexium and insurers routinely pay for them, after all, there is surely more than one culprit in the prescription-drug mess.

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