The Poly Pill - Can Scientists Successfully Imitate Nature?

The newest creation to save humanity from itself is the polypill, designed to treat the ravages of widespread gluttony. In a recent issue of the British Medical Journal, researchers claimed a combination of popular medications into one pill could slash the rate of deaths from heart attack or stroke by over 80 percent—designed for people eating a high-fat, Western-type diet and practicing a destructive lifestyle.¹  Because of the potential benefits, the polypill has been recommended for all people over 55 years old—and plans are to sell this wonder-cure without a prescription (over-the-counter) for a little more than $1 per daily dose.  The present prototype for the polypill would contain a cocktail of six existing drugs known to treat the four key risk factors for heart disease and stroke—high cholesterol, elevated blood pressure and homocysteine blood levels, and increased blood clotting.  (This is not a joke, but a serious recommendation by the scientific-medical community for helping with our current health crisis.)

One of the polypill’s inventors, Nicholas Wald of the Wolfson Institute of Preventative Medicine in London, said, “It is a complementary measure. Indeed, if we all had the right diet from the day we were born, it would not be needed. But changing the diet of an entire nation is impractical.”² He is right; historically, for most people, taking drugs has been far more popular than eating vegetables. And a pill might be a reasonable alternative if it worked; but, the truth is, no amount of medication will compensate for the ravages caused by the rich Western diet.

The Poly-pill Replaces Poly-pharmacy

Noon-time educational conferences at hospitals are sponsored by drug companies—they pay for the lunch and the speaker—a small price for a doctor’s mind.  I learned about the “proper care” of a person with type-2 diabetes at one of these weekly promotional events.  By the end of an hour-long presentation most of the physicians in attendance were thoroughly convinced that the optimal way to treat someone with diabetes was to prescribe 20 different kinds of medications. A feeling of importance was given to this multidrug approach by introducing a new and high-tech-sounding term to describe this manner of practice: poly-pharmacology. Yes, a “competent” physician was going to be putting his sick patients on a regime of poly-pharmacy.  

The polypill is simply a more convenient way to practice poly-pharmacology—rather than taking pills from many bottles each day, one pill contains all the separate medications.  However, widespread use of the polypill is unlikely because it would mean a serious loss of profits for the drug industries.  As Dr. Wald puts it, “Pharmaceutical companies need to make money and the concept of the polypill for some will erode their existing market.”²

The Polypill Is a Poly-fantasy

The polypill has yet to be tested in any clinical trials—but from what scientist theorize, a healthy 55-year-old man or woman has less than 1% per year chance of benefit over the next 10 years and a 6% overall chance of side effects—some of which (such as aspirin-related gastrointestinal hemorrhage) may be life threatening.⁴  The benefits of the individual ingredients have been overstated—previous McDougall Newsletters have addressed the limitations of blood pressure medications, aspirin, and folic acid.⁵  Although cholesterol-lowering statin medications can reduce the risk of heart attacks and strokes, worthwhile returns are primarily limited to people who are already very sick with clinical artery disease (with a past history of a heart attack, stroke, bypass surgery or angioplasty).^6,7  Even these dismally-inadequate results from drug therapy can occur only if people actually swallow the pills.

Problems with taking medications are well-known. Of all written prescriptions, 14% are never filled and an additional 13% are filled but never taken.³ For pills that treat the so-called “silent diseases,” compliance is even worse.  Only half of all blood pressure prescriptions are taken and about 40% of people stop their cholesterol-lowering “statins’ within a year. (How dare doctors criticize the McDougall Diet for lack of compliance, when they can’t even get patients to take their tiny pills? Compliance, judged by objective improvements, is easily appreciated with at least 60%, possibly as many as 90%, of those people who attend our live-in McDougall Program.)

Accept the Obvious Pill?

People love the easy way out and the population-curing polypill could be a license for some people to follow an unhealthy diet and lead unhealthy lifestyles—if it worked as advertised—but it doesn’t.  The pill that works is two to five pounds of low-fat, plant-based foods daily and a pair of walking shoes.  Besides, taking pills is one more bothersome addition to a person’s already busy daily routine and is an unnatural behavior—people must eat as a normal part of their lives—so the most practical way to real population-cure is simply a substitution of the rich Western diet for the McDougall Diet.

References:

1)  Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003 Jun 28;326(7404):1419.

2) Wald quotes:  http://www.guardian.co.uk/uk_news/story/0,,985670,00.html

3) Mulrow C, Kussmaul W. The middle-aged and older American: wrong prototype for a preventive polypill? Ann Intern Med. 2005 Mar 15;142(6):467-8.

4) Trewby P, Trewby C."Polypill" to fight cardiovascular disease: patients before populations. BMJ. 2003 Oct 4;327(7418):807;

5) McDougall Newsletters addressing the limitations of antihypertensive medications, aspirin and folic acid:
July 2004: Over-treat Your Blood Pressure and You Could Die Sooner
July 2005: Neither Aspirin Nor Vitamin E Will Save Women
October 2005:  Folic Acid Supplements are a Health Hazard 

6) Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R; Cholesterol Treatment Trialists' (CTT) Collaborators.Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005 Oct 8;366(9493):1267-78.

7)  Messori A, Santarlasci B, Trippoli S, Vaiani M. Questionable cost-effectiveness of statins for primary prevention of cardiovascular events [electronic response to Wald et al]. bmj.com 2003. bmj.com/cgi/eletters/326/7404/1407#34612

8) Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-52.