“Polypill” to fight cardiovascular disease: Universal polypharmacy goes against recent beliefs in prescribing practice

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7418.807-b (Published 02 October 2003) Cite this as: BMJ 2003;327:807
  1. Mark Powlson (powlson7{at}aol.com), managing editor Prescribers' Journal
  1. Bedford MK41 7DY

    EDITOR—Your advocacy of universal polypharmacy—as evidenced by the paper by Wald and Law1—is somewhat against recent beliefs in prescribing practice. Has there been sufficient emphasis on the fact that the proposal is a theoretical construct (admittedly enticing), based on extrapolation of data from many disparate studies, rather than on a trial itself? Indeed, why bother with new trials if one can find such apparently definitive answers so conveniently from existing data?

    Apart from immediate practical considerations—such as a reliable source and supply system—little thought seems to have been given, among other matters, to:

    • Potential adverse events (particularly in certain population groups, such as those with asthma or allergies)

    • Duration of benefit and possible implications on further treatment should it be required

    • The effects on those unable to tolerate such a Polypill or on the 20% who would not benefit, and how to identify them

    • Adverse lifestyle behavioural changes that might occur were it to be perceived that a universal cardiovascular panacea might be available to pick up the pieces of adverse lifestyle choices

    • Alternative causes of death, which may substantially reduce any putative gains.

    This is a worthy idea, meriting future debate and research, but I fear that it will meet the fate of many such papers in the public and media viewpoints—namely, that publication in a reputable scientific or medical journal is the end point of research and a finished piece of wisdom, rather than the start of a process of refutation or affirmation that might, at some future date, lead to an acceptable truth (if such there is). I wonder how many doctors were asked for the magic heart pill on the day after this paper was published.


    • Competing interests MP has worked for medical journals that received money for advertisements for pharmaceutical advertisements.


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