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development of clinical disease.8 Despite their potential for saving lives, the drugs used in
the Polypill have not been used optimally in developed countries.
Poor adherence to multidrug regimens is a common barrier to effective therapy
almost everywhere. Moreover, the availability of most of these drugs in generic form
would reduce the cost of the Polypill. Economic analyses suggest that such multidrug
regimens would be quite cost effective in reducing the burden of cardiovascular disease.
The Pitfalls
One of the drawbacks is patients’ complacency. In other words, patients rely on the
pill rather than adhering to a healthy lifestyle. And, of course, it is imperative that the
Polypill’s value be clearly demonstrated through long-term clinical studies rather than
simply assuming that it works.
There are also difficulties in conducting studies. In the UK, for example, cardiovas-
cular screening requires participants in the placebo group with problems identified by
baseline tests to get some treatment, making it harder to show the Polypill’s effects.9 The
US Food and Drug Administration (FDA) requires evidence of efficacy in populations
with low risk as well, perhaps as evidence that each component of the Polypill adds some-
thing important.10
There are also side effects to consider, i.e., aspirin-induced bleeding. In the study
mentioned above, about one in six patients experienced a side effect in the short term.
Most were mild, but about one in 20 patients overall stopped treatments due to side
effects, indicating that treatment is best targeted to those at elevated risk of disease.11 Side
effects may take five to seven years to emerge.12
Even though the drugs used are generic, there are doubts as to whether develop-
ing countries could afford to provide them broadly to everyone over 55 years of age.
Cardiologists are critical of the one-size-fits-all treatment of patients who may not be at risk.
Many physicians want to be involved in personalized care.13 At least one blogger
notes that the Polypill may keep patients away from doctors and hospitals. According to
the writer, not all patients are ready to assume self-care and autonomy, and he is against
medicalization. This is a term defined as the process by which health or behavior condi-
tions come to be defined and treated as medical issues, and thus come within the purview
of doctors and other healthcare professionals to engage with, study and treat.14
Final Thoughts
According to Science News Daily, the Polypill will be available soon in India, then else-
where within a few years, based on regulatory timelines within each individual country.
That may not be true in the US, where it is more difficult to gain approval for combination
drugs.
However, there may be an alternative: the polymeal, a safer, non-pharmacological,
natural and tastier choice. The polymeal combines seven food components in a healthy
diet: chocolate, wine, fish, nuts, garlic, fruit and vegetables.
All are known to have a positive effect on cardiovascular disease enjoyed by human-
kind for centuries. The combined meal could reduce heart disease by more than 75% based
on the Framingham heart study and the Framingham offspring studies used to build life
tables to model the benefits of the polymeal in the general population from age 50.15
References
1. Safire W. “Why die?” New York Times. 1 January 2000.
2. Beyond Therapy: Biotechnology and the Pursuit of Happiness. President’s Council on Bioethics. October 2003.
3. Watts G. “What happened to the Polypill?” BMJ. 2008 337:786.
4. Wald NJ, Law MR. “A strategy to reduce cardiovascular disease by more than 80%.” BMJ. 2003 326:1419–24.
5. Reardon S. “Experts debate Polypill: a single pill for global health.” Science. 2011 333:181.
Polypill: A Means to Live Longer?
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