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RADICAL VISION:
A cocktail of cardiovascular drugs // Recommended for everyone over 55 // No prescription necessary // No need for a doctor’s oversight // The brainchild of overly ambitious would-be pioneers, or truly the world’s next wonder drug?

The Polypill

By Rachael Moeller Gorman // Illustrations by Christoph Niemann // Winter 2007
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Richard Smith, editor of the prestigious British Medical Journal, opened his June 28, 2003, editorial with this teaser: “It’s perhaps more than 50 years since we published something as important as the cluster of papers from Nick Wald, Malcolm Law and others.” Intrigued readers pored over the papers, which described an approach that “would have a greater impact on the prevention of disease in the Western world than any other single intervention.”

The intervention turned out to be a cardiovascular drug with an unusual strategy of delivery: Wald and Law envisioned that everyone over age 55, the population segment accounting for 96% of all deaths from coronary artery disease and stroke, would take the pill every day for the rest of his or her life. If all complied, 88% of heart attacks and 80% of strokes would be prevented, said the authors, who also opined that physicians need not be involved.

Wald and Law called their drug the Polypill, a combination of several powerful cardiovascular medications—a statin, an ACE inhibitor, a beta-blocker and a thiazide—as well as aspirin. And if in 2003 the Polypill was just a theory, last September at the World Congress of Cardiology in Barcelona, World Heart Federation president Valentin Fuster announced that a version of the pill could be introduced in Spain by 2009, while investigators in New Zealand and Australia are about to begin trials on alternate versions of the pill.

After the BMJ published the papers, physicians showered the journal with letters of concern—not only about whether the Polypill would work but also about whether it would even be desirable. “How nice…to live in a Polypill world,” wrote German scientists. “One for heart disease, one for mood, and maybe even one for finding the right partner.”

The Polypill idea is radical, in part because physicians generally prescribe powerful medications to healthy people only if they are at extremely high risk. But proponents contend that anyone living in the Western world today falls into the high-risk category and needs to reduce each of many cardiovascular-disease risk factors, not just the one or two surpassing some arbitrary threshold. Otherwise, those proponents warn, many of us could become part of the third of the population who die from an almost completely preventable disease.

Polypill fans or not, most physicians agree on one thing: Dying of a heart attack is not natural. “This is a disease we manufactured through the way we live,” says David Wald, a London cardiologist who is part of the Polypill team with his father, Nicholas, and Malcolm Law.

Cardiovascular disease is the No. 1 killer in the United States. In part, that prevalence stems from our lifestyles. We commute long distances to office jobs that allow no time for exercise and lead us to rely on processed or fast foods packed with salt, saturated and trans fats. As a result, our cholesterol and blood pressure readings are often too high to be healthy.

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Eat, Drink and Be Healthy

Eighteen months after the British Medical Journal launched the Polypill debate, epidemiologist Oscar Franco proposed a “Polymeal.”

The Parts of its Sum

What goes into a Polypill?

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hed-dossier

1.“A Strategy to Reduce Cardiovascular Disease by More Than 80%,” by N. J. Wald and M. R. Law, British Medical Journal, June 28, 2003. In the paper that kicked off the controversy, Wald and Law make the kind of grandiose claims that staid scientific papers typically eschew.

2.“The Polymeal: A More Natural, Safer, and Probably Tastier (Than the Polypill) Strategy to Reduce Cardiovascular Disease by More Than 75%,” by Oscar Franco et al., British Medical Journal, December 18–25, 2004. With stern warnings against possible adverse effects of the Polymeal (garlic could ruin a romantic rendezvous, redundant cardiologists could be retrained as Polymeal chefs), this satirical yet scientific paper is an enjoyable read.

3.“The Polypill: At What Price Would It Become Cost Effective?” by Oscar Franco, Ewout Steyerberg and Chris de Laet, Journal of Epidemiology and Community Health, March 2006. Franco is back—this time calculating the maximum annual price at which the Polypill would be cost-effective as a primary prevention of cardiovascular disease. The finding: $389 to $528 per high-risk man aged 50 to 60 years.

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