Polypill - miracle cure or insanity?
Categories28 June 2003 - The mainstream British Medical Journal announced in an editorial that a "magic bullet" combination pill containing aspirin, a statin, three blood pressure lowering agents in half dose, and folic acid could have enormous potential, especially in developing countries.
The story had previously been published in New Scientist.
Should we really throw out all we know about medicine and research for this pharmaceutical moneymaker?
According to an article in the Fresno Bee, "the American Heart Association cautioned such a pill might be dangerous for healthy people and not strong enough for those with heart trouble."
Others agree that the idea is a dangerous departure from sanity.
Update on 30 June 2003:
One of the ingredients in this proposed new wonder drug is a statin. Here is a page with information about and the dangers they pose to health. I wonder whether, in assessing and adding together the supposed positive effects, the scientists who made this proposal have also thought of adding up the side effects of their ingredients and the probabilities of causing death in unsuspecting patients.
RED FLAGS WEEKLY editor Nicholas Regush wrote:
THE POLYPILL
This is the brazen idea being promoted by UK researchers to slash heart attacks and strokes. As the New Scientist puts it, "a wonder pill that could slash the rate of deaths from heart attack or stroke by over 80 per cent." Another round in the dumbing down of medical science as we know it.
There are two articles you might read:
AN EDITORIAL IN THE BRITISH MEDICAL JOURNAL
AND HERE ARE LINKS TO STUDIES PUBLISHED IN THE BMJ
What is this wonder pill all about? It's the idea of a combination pill that everyone over the age of 55 (or younger) would take - and could reduce the incidence of cardiovascular disease by over 80%.
Is there actual data for this humdinger? No, there is not. The authors propose this idea based on a review of other studies, and strangely believe that the data all could add up to a huge reduction in the incidence of cardiovascular disease.
This has got to be one the dumbest ideas that I have ever come across in all my years as a health reporter. That the authors actually have the support of the British Medical Journal is truly amazing and dangerous. All these so-called health professionals actually have convinced themselves that if you put six different drugs together, they will all add up to one big cure of sorts. This is not only junk science at its worst, but reveals the sloppy intellectual processes going on in focusing attention on such complex issues (and controversial ones, I might add) surrounding cardiovascular disease. Furthermore, to assume that each and every one of these drugs used for different purposes in the battle against heart disease is, for one thing, the best approach in providing treatment for heart trouble, and then to assume that you can batch them, on the basis of what they appear to be doing on their own, is fool's gold. It's also nutty, and frankly, you can't get nuttier than that in medical science, particularly when you don't have a scratch of evidence that such a polypill will be safe and effective. There is simply no evidence worth anything - and I mean anything - that this approach can work to reduce heart disease. This blatant move to incorporate a variety of theories about cardiovascular disease into one package reveals a total disregard for scientific principles and for the human condition, which is far more complex than these nutty researchers seem to think. They all need to go back to school and get themselves properly educated. They should be sharpening pencils in some back room rather than using other people's money to do research not worth a dime.
An incredulous friend from Ireland saysYesterday we read that antioxidants reduce the risk of cancer by 31%.
Today we read that the BMJ has launched the 'Polypill' which "is like vaccination in a community that has the disease all over the place".
For those of you who haven't read about it yet, this pill offers the over-55s an average extra 11 years of life free from a heart attack or stroke. We are now being offered this wonderful pharma innovation of a combination "for only £ 1 per day" of aspirin, a cholesterol-lowering drug, three drugs that lower blood pressure and folic acid! It is being claimed that this pill could have "a greater impact on the prevention (prevention???) of disease in the Western world than any other known intervention". This pill is being touted as "medicine's answer to man's frailty", because although the same effect could be obtained from eating a diet of fruit and veg, taking exercise and giving up cigarettes, "changing the total diet of the nation is really quite impractical". All this from Prof. Wald of the Wolfson Institute of Preventative Medicine, University of London.
Thrown in for good measure is his comment: "At least a third of adults already took daily pills in the shape of vitamin supplements which had uncertain benefits."
And here a more detailed comment from US based health journalist Bill SardiBritish Doctors Claim Polypill (6-drugs-in-one-tablet) Would Reduce Cardiovascular Risk by 80%; Good Multivitamin Would Accomplish More Without The Cost And Side Effects
Without a clinical trial, and borrowing from science that has already been conducted, British researchers claimed today that "a once-a-day pill for everyone over 55 could undo some of the ill-effects of a sedentary, high-cholesterol, western lifestyle and slash the rate of strokes and heart attacks by more than 80%." [Guardian June 27, 2003; British Medical Journal Volume 326, June 28, 2003]
Known as the "polypill," it would combine five drugs (cholesterol-lowering statin drug, diuretic water pill, calcium blocker, blood pressure pill, aspirin) and one vitamin (folic acid) in a combo vita-drug that could put cardiologists out of business, says the editor of the British Medical Journal which published the report yesterday.
Calling its current issue "the most important in 50 years," the British Medical Journal heralded this bold approach even before it has been proven.
The authors of the polypill concept, who have filed for a patent on their idea, claim it might add as much as 11 years of life to the over-55 population by preventing strokes and heart attacks. The life lengthening benefits of the polypill are questioned in some regards. For instance, the amount of statin drug provided in polypill to reduce cholesterol may lower lipid profiles but has not been found to reduce mortality rates. When higher doses of are used, which do reduce mortality, the incidence of side effects rise, some of which can be mortal. in the combo pill may reduce the risk of strokes and heart attacks, but because two of the ingredients in the polypill reduce levels of coenzyme Q10 needed for heart muscle energy, it may also increase the risk of heart failure.
The authors claim that side effects would be minimal with polypill, even though most of the drugs included in the polypill deplete the body of essential nutrients. The thiazide water pill depletes the body of coenzyme Q10, magnesium and potassium, all essential nutrients required for maintenance of normal heart rhythm. It appears some of the ingredients in the polypill are needed just to counter side effects and deficiencies caused by the cure-all pill itself. For example, aspirin, one of the components of the polypill, depletes the body of folic acid.
Replacement for some nutrients depleted by the drugs in the polypill, such as coenzyme Q10, magnesium, potassium and vitamin C, are not even considered by its inventors. Magnesium is a natural calcium blocker and would eliminate the need for a synthetic drug. High-dose vitamin B6, not included in the polypill, could replace the need for a blood pressure drug (angiotensin II receptor antagonist).
The originators of the polypill included folic acid in their combo pill to reduce undesirably high levels of homocysteine, a protein that can build up in the blood circulation and is associated with strokes and blood vessel disease. Yet recent studies indicate vitamin B12 is also needed to effectively reduce homocysteine, a vitamin that was not included in the polypill, but is included in most multivitamins.
It is obvious that a well-designed multivitamin containing magnesium, potassium, coenzyme Q10, folic acid, vitamin B12, vitamin B6, vitamin C in ample amounts may equal or exceed the proposed benefits of the polypill and be more affordable in third-world countries where the polypill is suggested for use. Many heart attacks, in particular the sudden-death variety, are prompted by a shortage of magnesium, which is a heart muscle relaxant. The omission of magnesium from the polypill ingredients is a major oversight.
The addition of herbal ingredients such as Ginkgo biloba, green tea, ginger root and bioflavonoids may further enhance the cardioprotective properties of a multivitamin.
As a counterpoint, here a recent article in The Guardian. It seems that food may be more effective and have less side effects than a combination of pharmaceuticals...
How to live longer: a Polymeal a daySarah Boseley, health editor
Friday December 17, 2004
The GuardianNever mind the tablets - heart disease could be cut by 76% and men could expect to live more than six years longer if they simply ate the right meal once a day, doctors said yesterday.
Last year the British Medical Journal ran a paper advocating the "Polypill" - combining aspirin, folic acid and cholesterol-lowering and blood-pressure drugs - for everybody over 55. But an article in the Christmas issue says a "Polymeal", containing fish, wine, dark chocolate, fruits and vegetables, garlic and almonds, would achieve roughly the same effect.
Men on the Polymeal would increase their life expectancy by 6.6 years and women by 4.8 years, say the authors, Oscar Franco and colleagues from the department of public health at Erasmus University in
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