Polypill no panacea

My son called me when the story broke.

“Hey, Mom, have you heard? There’s a new pill that can cut your risk of heart disease and stroke by 80%! It’s a combination of drugs … ”

If only it were that simple. I shudder to think how many people out there, far less educated than my son, have heard about this latest “magic bullet” and gotten their hopes up. I hate pharmaceutical marketers; I really do.

First, like most drug studies I’ve ever read or read about, this one was funded by the company that makes and hopes to market the drug being studied. In this study, it was the “Polycap” capsule made by Cadila Pharmaceuticals. Often the media doesn’t report this, so unless you have access to the original report, you won’t get that information. Even if Cadila doesn’t reap huge profits from combining a bunch of generic drugs into a single generic pill, you can bet they won’t walk away empty-handed either. Their particular combination is — tada! — a new drug.

And as always, when a pharmaceutical company funds a study of its newest wonder drug, I immediately suspect the objectivity of the study and its results.

Okay, granted, it might be convenient to have a 5-in-1 pill. Proponents argue the convenience will improve patient compliance. Maybe.  Maybe not. If my doctor tells me to take a pill every day to prevent a heart attack, chances are excellent that I’ll take that pill every day. Or five pills, if that’s what he tells me. And if I’m going to skip doses anyway, what difference does it make if I’m skipping one pill or five? One report commented on how large this megapill might be; without doubt, a big, hard-to-swallow pill would be a far greater obstacle for me than five little pills.

I suppose the researchers deemed this particular polypill safe because its component drugs don’t interact with each other in an adverse way. (It won’t poison you or explode when the ingredients mix.) But being “safe” is more complicated than that.

… combining the drugs into one tablet delivered a similar effect to each drug separately.

Now there’s a news flash for you.  It took an expensive scientific study to determine that? Those drugs have been prescribed in combination for years!

Reductions were seen in both blood pressure and cholesterol without any major side effects.

Golly gee. The pill’s component drugs are commonly prescribed to reduce blood pressure and cholesterol. Is it news that they still do so when squished into one pill? As for no major side effects … I suppose it depends on your definition of “major.” To me, eventual blindness is major. The Polycap contains a beta blocker, which would upset the very carefully adjusted doses of the two drugs I use to stave off glaucoma.

The components of the “Polycap” polypill are:

I can’t imagine the headaches of trying to figure out who should and shouldn’t take this newest “miracle drug.” A competent doctor is going to consider a number of factors when deciding which particular drug or combination of drugs is right for you and what the dosage(s) should be; I’d be seriously concerned about any doctor who just takes a shotgun approach with this polypill.

You can’t just pass these things out like candy and end stroke and heart attack in our time. The odds might be favorable in a population that otherwise gets no medical care at all. But what happens when a patient would benefit from some of the drugs but be harmed by others? What if the dosages are not ideally balanced for the individual? If there’s an adverse reaction, how do you determine which component(s) was the cause? Do you sort through the individual components to figure out where the problem is? Or do you just discontinue the pill altogether, throwing the baby out with the bath water?

I’ll wager most people over 55, if they are at the slightest risk of stroke or heart attack, are already taking a baby aspirin (81 mg) every day. And if they take a daily multivitamin, or eat the right foods, they’re already getting folic acid.

I’ve written before about over-the-counter drugs that contain multiple ingredients, some of which the consumer may not want or need.  I prefer to pick and choose the single ingredients I want.  The polypill is a much more complicated example of a combination drug. If it ever gets to market, doctors and their patients are going to have to be on their toes. It’s not a panacea. It cannot just be presecribed willy nilly to every person over 55 and magically eliminate half of all heart attacks and strokes.

We should view pharmaceutical studies and marketing with a very critical eye; we should do the same when medical reporters interpret study results for us. For that matter, you should be critical of my writing. If you can’t find, read, and understand the original study for yourself, talk with your doctor. Please, please, please do not rely solely on mainstream media for your health and medical information.