Polypill or Polymeal?

I say, if they put you on drugs it’s your fault! (and by the way, your doctors really mean well!)

In recent years doctors and researchers have been busy proposing, extolling and developing “the polypill”. The polypills or polycaps will be low drug combinations aimed at preventing cardiovascular disease.

What’s in it? A cholesterol lowering statin and often three different high blood pressure drugs plus aspirin.

Would you take a polypill?

Wald and Law, publishing in the May 19th 2009 issue of the British Medical Journal concluded, “Blood pressure lowering drugs should be offered to everyone, regardless of their blood pressure level.”

This came after a review of 147 trials including nearly 1 million participants.

The accompanying editorial suggests that a polypill may become the “standard of care” IF YOU ARE OVER 55, WHETHER YOUR BLOOD PRESSURE IS NORMAL (like 110/70) or not.

This year in the prestigious journal The Lancet, Dr. Christopher Cannon declares that the concept of a polypill has, “obvious appeal and vast implications for global health.”

A recent “polycapsule” trial in India was presented last March at the American College of Cardiology Scientific Sessions by an enthusiastic Dr. Salim Yusuf. During a three month trial with just over 2000 participants, each with at least one risk factor for heart and blood vessel disease, and aged between 45 and 80, there was an 18% drop out rate.(ie participants who just stopped taking the drug).

The hope was that a polypill would lead to people finding it easier to “stick with the programme.”

The reductions in cholesterol and blood pressure were real but lower than hoped, leading to risk reduction projections of 62%  for heart disease and 48% for stroke.

Impressed?

If you believe drugs are the best approach for your health, stay tuned. Your doctor will tell you when the drugs have been passed and made available.

For me, the “take a pill for it!” is as much against my personal philosophy as taking alcohol for depression (exercise works better) or robbing your neighbour because you’re short of cash. These are short term solutions which miss the point. What’s the underlying problem in each case and how will your life be greatly enriched if you address the real problem?

“Depression is not a Prozac deficiency,” to quote Dr. Mark Hyman (my often quoted Wellness Revolution hero!).

And Cardiovascular Disease is a Lifestyle disease not a polypill deficiency!

As for the meta-analysis of 1 million people other doctors have questioned the method of analysis, and suggested that the data may have been abused and misinterpreted. They were polite enough not to add “willfully.”

As, Dr. Franz Messerli says, “A meta-analysis is like a sausage, only God and the butcher know what goes in it and neither would eat any.”

Unlike, Wald, Law, Cannon and Yusuf who all declare ties to patents or drug companies, Dr. Franz Messerli has declared no such financial interest.

The good doctors of course, mean well but they just have a different philosophy and all our choices rest on the philosophies that drive us, what we truly believe.

Yusuf for example does not believe that lifestyle changes can be enough, the polypill should be “on top” of lifestyle changes, he says.

Another colleague, Dr. Rodgers in a related comment refers to the NEED TO OVERCOME the public perceptions that “drugs are bad and that physicians should tailor treatments to each individual.”

INTERPRETAION:  MASS TREATMENT WITH GOOD DRUGS!

We as doctors are trained to believe that clients are UNLIKELY TO ADHERE TO LIFESTYLE CHANGES AND DRUGS ARE THEREFORE NECESSARY.

So if after minimal advice and maybe a referral to the dietician, after three months your cholesterol is still high we, (they I mean) put you on a statin, meaning well of course.

Nonetheless, others suggest that since food talks to our genes (Welcome the emerging science of Nutrigenomics!) you can reduce your risk of all heart disease by 75% and increase your life span by seven years.

Consider then, the polymeal, also described in the British Medical Journal, which reduces your risk of all cardiovascular disease by 75%. No side effects. Daily variations advised.

Four ounces of wild fish (eg salmon)

Five ounces of red wine (Muslims will have to look to nuts and grapes for similar benefits)

3.5 ounces of dark chocolate (Green and Black’s Organic Chocolate is my favourite)

2.5 ounces of almonds

One pound of fruits and vegetables

One glove of garlic

So what do we really need?

A cultural change. How about a six hour work day (we will all be more efficient that way) so we can build in the time we need to prepare proper meals, grow organic, exercise and relax. Or just exercise and relax if you can pay someone else to the other two.

Me? If I’m sick, 95% of it is likely to be my fault. There’s too much knowledge out there about prevention for me to blame anybody.

And as long as our doctors are deciding for us that lifestyle changes don’t work because we aren’t disciplined enough to make them work, what can I say?

Polypill anybody? Let me stop.