A Polypill of nutrients?
Richard Smith, the British Medical Journal's editor has once more returned to the subject of a previously hyped desire - a polypill that would prevent or cure a spate of diseases. No one seems to be willing to manufacture the monster, but CNN has treated its viewers to a service and a poll has apparently shown that 95 % of its viewers would take the pill if it was available, giving Smith a welcome occasion to take up the (non)subject of the combination medication again.
The question asked by Smith in his recent "editor's choice" article is "... whether the Polypill will make it on to the market. Research based pharmaceutical companies have tended not to be interested because their business model is to sell expensive drugs at a high margin to recoup the high cost of research. The Polypill will need to be cheap to be accessible, and it may reduce markets for their existing drugs. Generic companies, many of them from India, make their money from selling large volumes of drugs at low margin. But they don't tend to spend much on marketing, and the Polypill will need extensive marketing."
So in addition to being a bad idea from a health point of view, it seems to be also a dead loser from a business perspective. As Smith says, the pill would cut into the market shares of several of its more expensive and more profitable cousins, a no-no from the viewpoint of pharmaceutical executives. It would also need a lot of advertising to convince people to take it, so the generics manufacturers would tend to stay away from it.
Well - let's just put it down to a "bad idea" and sorry Richard Smith, if you won't find the pill on pharmacy shelves on your 55th birthday in 2007, even if it could "go to market before a major trial" (but why should it?), because there are better ways to protect our health than taking a "poly-symptom-reducer". We won't achieve good health by reducing the symptoms of several illnesses.
Here is my letter to Richard Smith of the BMJ:
Dear Mr Smith,
Your recent article Polypill may be available in two years was forwarded to me by a friend. At the time of the first mention, I was one of the people taken aback by the proposal for a "poly-pill" and have written about it on my personal site. Here are the links to the two articles.
Polypill - miracle cure or insanity? 28 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...
"Polypill" insanity again - I reported on the insane proposal of a hypothetical "polypill", a combination medication with several diverse pharmaceutical drugs all mixed into one, at the time it was floated by the British Medical Journal. All this proposal shows is the depth...
As you see, my opposition is heavy but probably quite in line with some of the other comments you have received.
If you would make the polypill a multivitamin, (poly-nutrients?) maybe you would have better chances of making a dent in incidence of illness, and less of a resistance from people who see through the pharmaceutical scam of providing symptom-specific medication without going to the roots of disease. The trouble with the poly pill proposal is that none of the medications you propose to combine actually go to the root of the illnesses - they are merely doctoring on symptoms - and doctoring on a multitude of symptoms at the same time will not make illness go away any more than pouring multiple perfumes on a bum will make the bad smell of an unwashed body go away.
p.s. Please see the following article illustrating why I would prefer a poly nutrient to a poly medication...
Study says daily multivitamin use by older adults could save $1.6 billion in Medicare costs over five years
(October 2, 2003)
The results of a new study indicate that the daily use of a multivitamin by older adults could lead to more than $1.6 billion in Medicare savings over the next five years. The study, which was funded by Wyeth Consumer Healthcare and conducted by a northern Virginia health care consulting firm, The Lewin Group, found that daily use of a multivitamin by older adults is a "relatively inexpensive yet potentially powerful way" to improve America's health. The study found that the health effects were particularly important for cardiovascular health and improved immune functioning.
"From the perspective of a payer," the report concluded, "the encouragement of the daily use of a multivitamin could be cost beneficial.
The study was a review of clinical studies on the effects of multivitamin use on adults over 65, and analyses of medicare claims files for 2001. Using Congressional Budget Office cost accounting rules, gross and net costs to a payer were determined for a five-year period (2004 - 2008). Potential savings would be achieved through a reduction in hospitalizations for infection and heart attacks, a reduction in Medicare nursing home stays for infection, and a reduction in home health care associated with infection (pneumonia).
"The five-year estimate of potential savings (or cost offsets) resulting from improved immune functioning and a reduction in the relative risk of coronary artery disease through providing older adults with a daily multivitamin is approximately $1.6 billion," the report states.
"The five-year estimated cost offset associated with avoidable hospitalization for heart attacks is approximately $2.4 billion," it adds.
Over five years, the report concludes, it would cost $2.3 billion to provide daily multivitamins to every senior in the United States, for a net savings of $1.6 billion.
The Lewin study refered to the Journal of the American Medical Association (JAMA), which last year reversed its policy of 20 years and encouraged all adults to take a multivitamin every day. Two Harvard Researchers, Robert H. Fletcher, MD, M.Sc., and Kathleen M. Fairfield, M.D., Dr.P.H., of Harvard Medical School and the Harvard School of Public Health reviewed more than 30 years of English-language articles about vitamins in relation to chronic diseases and published their findings in June, 2002 in two companion
In the scientific review article, the two physicians consider the evidence that suboptimal intakes of a number of vitamins are associated with increased risk of chronic diseases including cardiovascular disease, cancer, and osteoporosis. In a clinical commentary, they note that "a large proportion of the general population" has less-than-optimal intakes of a number of vitamins, exposing them to increased disease risk.
The researchers stated in the issue of JAMA that "we recommend that all adults take one multivitamin daily."
When reporting on the Lewin study earlier today Reuters said the study was also sponsored by the U.S. Centers for Medicare and Medicaid Services (CMS) at the Health and Human Services Department, and that CMS Commissioner Tom Scully was scheduled to comment on the report later today. Later Reuters updated the story to show that CMS did not sponsor the study and that "CMS denies that Scully was ever scheduled to appear and comment on the study."
See also related articles:
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 day
Sarah Boseley, health editor
Friday December 17, 2004
Never 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 Rotterdam.
"The Polymeal promises to be an effective, non-pharmacological, safe and tasty alternative [to the Polypill] for reducing cardiovascular morbidity and increasing life expectancy in the general population," they write.
The doctors searched medical literature to find foods that have been proven to lower the risk of heart disease. Drinking 150ml of wine a day cuts the risk by 32%, they say, and fish consumed four times a week reduces it by 14%. A daily intake of 100g of dark chocolate and 400g of fruit and vegetables lower blood pressure, further cutting the risk of heart disease. Garlic and almonds both lower cholesterol levels. The daily Polymeal contains 2.7g of garlic and 68g of almonds.
"Combining all the ingredients of the Polymeal resulted in cardiovascular disease being reduced by 76%," they write. "Whether increasing the amount of each ingredient would increase the effect of the Polymeal is uncertain. On the other hand, decreasing the quantities could be expected to reduce the effects of the Polymeal."
Men would not only have a longer life expectancy, but also live nine years longer without heart disease, while women would be free of it for eight years longer.
The Polymeal has no serious side-effects, they say, in contrast to the Polypill. But they do note: "Fish consumed in larger amounts than recommended as part of the Polymeal has been related to raised blood mercury concentrations, especially with large fish such as shark and swordfish."
There are issues around garlic, but not in the long term. "Adverse effects reported for garlic include malodorous breath and body odour. As garlic is destined for mass treatment, few people will still notice this after a while," they say.
However, they add: "We do not recommend taking the Polymeal before a romantic rendezvous, unless the partner also complies with the Polymeal."
The Polymeal can either be eaten as an entire meal - a recipe by the chef Raymond Blanc suggests watercress soup, grilled fillet of mackerel with a tagine of winter root vegetables, chickpeas, toasted almonds and roasted garlic, followed by chocolate mousse - or the ingredients can be eaten separately during the day, say the doctors.
They warn that the Polymeal should not be taken with excess alcohol, to avoid compromising the health benefits and "in order to avoid intoxication and conflicts with friends, relatives and authorities".
posted by Sepp Hasslberger on Friday October 3 2003
updated on Tuesday December 21 2010
URL of this article:
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