BMJ  2003;327:E248 (4 October), doi:10.1136/bmjusa.03090001 (published 30 September 2003)

BMJ USA: Editor's choice

Unconventional wisdom

From BMJ USA 2003;September:458

Doctors spend a lot of time telling patients that there are no easy fixes. There is no substitute for regular physical activity, a sensible diet, and constant seatbelt use. Although Americans love shortcuts, there isn't a pill for everything, we say.

Except that we may be wrong. In this issue we reprint papers and an abstract by Wald and Law (BMJ USA p 476, BMJ USA p 482, BMJ USA p 498) proposing what they call the Polypill, which would combine six commonly available medications into one chemoprophylactic tablet. If taken by patients with heart disease and everyone over 55, Wald and Law state, the Polypill could reduce heart disease – related deaths by up to 80 percent: an astounding and already controversial claim.

BMJ readers clearly did not all agree that the Polypill articles made the June 28 issue what editor Richard Smith called "the most important BMJ in 50 years." We've reprinted some of their most trenchant comments as well (BMJ USA p 481).

The press coverage of Wald and Law's modest proposal usually did not mention a second important finding of their work: the efficacy of low-dose combinations of antihypertensive medications. One of their meta-analyses (BMJ USA p 482) demonstrated that three antihypertensives taken at half dose provide 80 percent of the benefit with a dramatically reduced incidence of adverse effects. A case of where more may in fact be less, flying in the face of standard teaching that we shouldn't prescribe multiple medications for the same condition.

In another challenge to conventional wisdom, Hinman et al (BMJ USA p 493) studied physical therapist – applied therapeutic taping as a treatment for osteoarthritis of the knees. In a six-week randomized controlled trial they found a significant improvement in pain and disability scores in patients who had their knees taped, compared with two types of controls: a no-tape group and a group who received control taping. But a US orthopedic surgeon we asked to comment is not convinced (BMJ USA p 497).

Finally, Noakes points out (BMJ USA p 467) that the common practice of drinking large amounts of sports drinks before and during exercise is not only wrong but potentially dangerous. The evidence-based take-home message is to let thirst guide intake.

Common sense validated.

---

Articles cited in Editor's Choice are listed below, beginning with their BMJ USA page number

BMJ USA p 476 A strategy to reduce cardiovascular disease by more than 80% (Wald et al)

http://bmj.bmjjournals.com/cgi/content/full/326/7404/1419

BMJ USA p 482 Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials (Law et al)

http://bmj.bmjjournals.com/cgi/content/full/326/7404/1427

BMJ USA p 483 Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial (Hinman et al)

http://bmj.bmjjournals.com/cgi/content/full/327/7407/135

BMJ USA p 497 An orthopedist responds

bmj.com/cgi/doi/10.1136/bmjusa.03090004

BMJ USA p 467 Overconsumption of fluids by athletes (Noakes)

http://bmj.bmjjournals.com/cgi/content/full/327/7407/113

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Rapid Responses:

Read all Rapid Responses

DHEA and exercise might do the same...

James M. Howard
bmj.com, 1 Oct 2003 [Full text]