TAKE five tried-and-tested drugs and one well-known vitamin. Mix them into a single pill and give it to everyone over the age of 55. Stand back as deaths from heart attacks and strokes plummet by an astonishing 80 per cent and life expectancy soars鈥�
The idea is so bold and simple that when British scientists unveiled the concept of the polypill last week, many people just didn鈥檛 know how to react. Would the pill be a lifesaving innovation on a par with the invention of vaccines and antibiotics, or an unnecessary 鈥� and possibly risky 鈥� recipe for the mass medication of the healthy? A revolutionary step forward, or a dubious get-out-of-jail-free card for couch potatoes who would be better off mending their ways than popping pills designed to protect them from the worst ravages of their lifestyle?
On present evidence, the polypill could be all or none of these things. The pill has yet to be made, and until the results of proper trials are in we cannot be sure it will live up to even the most basic expectations of its advocates (see 鈥淪heer brilliance or utter madness?鈥�).
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What is clear is that if the polypill does work, there will have to be a major debate about its social desirability. Heart attacks and strokes are a blight on life in many affluent western countries. In Britain alone, half the population is killed or seriously injured by them, and the sad truth is that promoting healthier lifestyles has made little difference. Indeed, doctors are braced for more cardiovascular disease as obesity spreads.
But is medicating every late middle-aged person really the answer? At first blush, targeting treatments at those predicted to be at risk of having a heart attack or stroke seems more sensible. But how to identify them? Risk factors such as high blood pressure and cholesterol will only pick out those at highest risk. Most people who have a stroke or heart attack have normal blood pressure and cholesterol levels.
Hence the notion of prescribing the polypill on the basis of just one risk factor: age. The logic echoes an idea put forward in the 1980s by the late British epidemiologist Geoffrey Rose, who argued that it is not only individuals who are at risk of cardiovascular disease, but the whole population 鈥� so treat the population. A pill is not the only way of achieving this. Governments could increase taxes on fatty, sugary foods so as to put up prices and reduce consumption. But such measures are always going to be resisted on the grounds that they unfairly penalise the poor over the rich.
The polypill too, of course, has potential downsides. The 13-year wrangle over the safety of tamoxifen as a preventive against breast cancer shows how tough it can be to prove that the collective benefits of medicating healthy people outweigh the risks to individuals. In an age of pharmacogenomics, when medicine is supposed to be tailored to individuals, the idea of giving fixed doses of the same six chemicals to everyone seems an old-fashioned recipe for intolerable side effects and unforeseen drug interactions. Even taken separately, some of the ingredients in the polypill can have nasty side effects: one is a blood-pressure lowering drug called a beta-blocker that should never be given to asthmatics. For now, about 1 person in 10,000 is expected to die just from taking the tablet. How the families of these people might be compensated could be a factor in whether the public will go for it.
There are plenty of other issues that could stop the polypill reaching the public. Drug companies with expensive new products for treating heart disease and strokes will want nothing to do with it. Even if it is made and licensed, who will pay for it? So far, it is not clear whether the pill will reduce the costs of health insurers or state-run health services.
One useful by-product of the polypill is the stark light it casts on the dearth of ideas from governments for encouraging people to lead healthier lives. To adopt the polypill without addressing this is to treat the symptoms of disease but not the underlying cause.
Yet for all its possible drawbacks, the polypill is a radical idea whose potential benefits are too great to be dismissed at this early stage. At the very least it deserves the chance of a clinical trial. Let us also hope that it fires up governments and their citizens to reflect on how their attitudes towards exercise and a healthy diet have created the need for the polypill in the first place.