Polypill inventor puts product online after failing to get backing from industry
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3991 (Published 19 June 2013) Cite this as: BMJ 2013;346:f3991
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The polypill has been launched as an online product for purchase by 'healthy people with no history of cardiovascular events' after the inventors failed to find commercial backing. Though fascinated by the thinking behind the product, we too wonder whether there will be much of a market.
Kmietowicz reports that when the polypill was first discussed in the BMJ 10 years ago, respondents raised doubts about the rigour of the biological science associated with it. Our own doubts, however, are about the social science on which the idea is premised - in particular, what would motivate someone with 'no history of heart disease' to buy and take the polypill?
Our doubts are three-fold: first, we already know that people are reluctant to take medicines long term, and 'resistance' to prophylactic medication may be particularly pronounced (1,2). This is evidenced by low levels of adherence, which for prescribed statins may be lower than 50% (3,4).
Second, research suggests that people struggle to make sense of cardiovascular risk (5). In our own qualitative study of people taking low dose statins (both prescribed and over the counter), we found that respondents did not think about drugs as a response to risk - being told you have high cholesterol or high blood pressure appears to be less abstract and to resonate more as a reason for taking medication (6). We reason that pills taken solely on the basis of age are unlikely to be popular.
Third, we are curious about the likely success of prescription over the internet, given the story of Zocor Heart Pro. This was a low dose statin licensed for OTC sale in the UK in 2004, which was quietly withdrawn in 2010, after low sales in high street and online pharmacies. We interviewed a small number of people who had been buying this product online. Almost all did this after discussing cholesterol tests with their own GP, not on the basis of a general awareness of CVD risk. This suggests to us that clinicians continue to have an important role in bringing the issues of cholesterol and blood pressure to the attention of their patients, by providing tangible evidence of risk in the form of test results and proposing prophylactic medicines.
Supporters of the polypill concept argue that if people took the product long term it would bring important improvements in cardiovascular health, a laudable goal. However we think that many of the potential users would prefer not to take medication in the absence of symptoms, or at least out-of-range physiological measures, and are unlikely to initiate or sustain prophylactic treatment without the involvement of their GP. We will be intrigued to see whether the model proposed last week does lead to significant use of this product.
1. Pound P., Britten N., Morgan M. Resisting medicines: a synthesis of qualitative studies of medicine taking. Social Science & Medicine, 2005; 61: 133-55.
2. Benson J. and Britten N. Patients’ decisions about whether or not to take antihypertensive drugs: a qualitative study. BMJ 2002; 325: 873-7.
3. Benner J.S., Glynn R.J., Mogun H., Neumann P.J., Weinstein M.C., Acorn, J. Long term persistence in use of statin therapy in elderly patients. Journal of American Medical Association 2002; 288: 455-461.
4. Mantel-Teeuwisse A.K., Goettsch W.G., Klungel O.H., de Boer A., Herings R.M. Long term persistence with statin treatment in daily medical practice. Heart 2004; 90: 1065-6.
5. Durack-Bown I, Giral P, d’Ivernois JF, Bazin C, Chadarevian R, Benkrity A and Bruckert E. Patients’ and physicians’ perceptions and experience of hypercholesterolaemia: a qualitative study. British Journal of General Practice 2003; 53: 851-857.
6. http://www.esrc.ac.uk/my-esrc/grants/RES-000-22-3324/read
Competing interests: No competing interests
Re: Polypill inventor puts product online after failing to get backing from industry
I know that many doctors without clinical disease but with cardiovascular risk factors (including myself, not overweight, non smoking, healthy diet and exercise) are already taking a “polypill” albeit in a form of several pills. I’d rather take one polypill instead.
Medicalisation or not the fact is that cardiovascular diseases are common and lead to considerable suffering and disability during the life course. And use of many drugs when clinical disease emerge. Polypill earlier or polypharmacy later?
I very well understand that people are non-adherent to drugs given the nocebo-promoting media atmosphere. But Big Placebo with its phony products is selling well, so maybe it’s a question about marketing? I would raise an ethical issue: should the doctor recommend a polypill to those individuals at cardiovascular risk who take inactive but costly dietary supplements giving false security.
Competing interests: President of the Finnish Hypertension Society, minor amount of stock in a pharmaceutical company (listed company). I support the polypill concept.