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Message from the MGH

Thoughts on impersonal medicine.

Winter 2007
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The notion of personalized medicine is all but irresistible. One day, perhaps, we will base disease prevention and treatment on an individual’s unique genetic profile, creating a precisely tailored prescription for each of the globe’s 6.5 billion souls, the ticket to a long, satisfying, disease-free life.

But this price-is-no-object scenario, if it happens at all, is likely to unfold first in the United States or some other wealthy nation. In contrast, the concept we explore in this issue of Proto seems the antithesis of personalized medicine, and it could prove most useful in the world’s poorest developing countries. This radical concoction, the Polypill, is medicine for the masses, an off-the-rack approach to heart disease prevention and treatment. The pill’s inventors would recommend a daily dose to everyone over age 55, no prescription or doctor visits required.

In theory, this makes sense. Much of the risk of heart attack and stroke is of our doing, the consequence of sedentary lifestyles and high-fat, high-calorie, supersize diets. Giving everyone a daily pill—which would combine a statin, three blood pressure medications and aspirin—might be more realistic than trying to reform society’s ways. The Polypill could prevent 80% of strokes and 88% of heart attacks, according to the British researchers who dreamed up the one-size-fits-all pill in 2003.

This is hardly medicine’s first stab at preventing disease in a single broad stroke. We add iodine to salt and fluoride to water, and vaccinate whole populations against devastating illnesses. Yet many physicians consider the Polypill a cop-out, an abdication of medicine’s responsibility to push for healthy lifestyles. Other critics point to the risks of people taking drugs they might not need, or, in the case of those with heart disease, getting too small a dose. And many dislike leaving physicians out of the loop.

The main obstacle, though, is lack of data. Clinical trials are only now beginning, in New Zealand, Australia and Spain. The information needed to formulate a reasonable opinion for or against this big idea is five or more years away.

Will the Polypill fulfill its promise of longer, healthier lives, particularly in parts of the world that may never see personalized medicine? Or is it an ill-conceived, overly simplified, even dangerous proposition? Read our article—and stay tuned.

Peter L. Slavin, M.D.
President
Massachusetts General Hospital
David F. Torchiana, M.D.
CEO and Chairman
Massachusetts General Physicians
Organization
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