One Pill to Cure All?

— Imagine a single pill that could lower not only cholesterol, but also blood pressure and the risk of heart disease and stroke, all at the same time.

That's what a new study is proposing: a "polypill" that could reduce cardiovascular disease by more than 80 percent. Could this be the "magic bullet" towards a cure?

A Provocative Proposal

The authors of the study, published today in the British Medical Journal, claim that such an intervention would have a "greater impact on prevention of disease in the Western world than any other known intervention." The study was written by researchers at Queen Mary's School of Medicine and Dentistry at the University of London.

The strategy is to combine many of the most well-known medicines into one cheap and safe pill. The ingredients of such a polypill would contain aspirin, a cholesterol-lowering statin, three blood pressure-lowering agents in half dose, and folic acid.

The drug would be targeted to people with vascular disease and those over the age of 55.

To come up with the components for their polypill, the researchers analyzed data from more than 750 trials with 400,000 participants. The goal was to simultaneously reduce four cardiovascular risk factors and find the best ingredients to achieve that.

Based on their results, the scientists estimated that such a pill would reduce heart disease and risk of stroke by more than 80 percent, while causing withdrawal symptoms in two per 100 people and fatal side effects in less than one in 10,000 users.

The implications for such a drug are enormous. Since many of the polypill's components are common, it could be made from generic drugs, likely making it easy to produce.

Patients who take multiple pills or forget to take all their pills would also probably prefer an all-in-one pill, if it could do the same job with few side effects.

The combination treatment would also have enormous potential for developing countries, where cardiovascular disease is on the rise and multiple drugs can be expensive and more difficult to deliver, medical experts said.

Unproven Risks?

But some doctors and experts say not so fast.

"Both the concept and the likelihood that someone is likely to try this scare me to death," says Thomas Schwenk, chair of the Department of Family Medicine at the University of Michigan. "This almost sounds like an April Fool's Day article in the Journal of Irreproducible Science."

The main problem, according to critics of the polypill concept, is that the polypill challenges the idea of individualized medicines with its one-size-fits-all approach.

Some drugs, such as those used to control blood pressure, must often be catered specifically to the needs of each patient. A standard polypill, they argue, would not take into consideration such factors and could also make it difficult to deal with the individual and combined effects of each component.

"Patients differ in their need for, and tolerance of, medications. The one-size-fits-all mentality does not work when you are dealing with individual patients. In addition, while each therapy has benefit, it is not proven that the combination would be additive in its effect," said Richard L. Page, cardiology head at the University of Washington School of Medicine.

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