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Polypill – Preventive Medicine Gone Too Far?

Several recent research studies on statins suggest that their health benefits may not be only limited to those with high risk of cardiovascular events. Even in individuals with no history of cardiovascular disease, reducing cholesterol by 1mmol/L helped decrease cardiovascular mortality by 15% and overall mortality by 9%. Studies show that statins can be beneficial no matter how modest our increased risk may appear to be.

The distinction between preventive medicine and medicating society is largely distorted as we become more and more a ‘drug first and ask questions later‘ society. An excellent example to illustrate this is the proposal of the polypill, a kind of cocktail of cardiovascular medications (including a statin) to be given to all individuals over 50 years of age. An indiscriminate drugging practise, determined solely on the basis of age. It costs money to screen individuals but given that the vast majority at risk of cardiovascular events are people over 50, why not simply prevent these potential events and drug the population, whether they need it or not. Now, with the most recent research findings, the calls for universal drugging have once again begun.

Undoubtedly, our health is in dire straits. We are plagued by a burgeoning burden of chronic diseases which, if not confronted, will overwhelm and cripple our society. We have reached a critical point and hard decisions have to be made. It is time to give up on the ‘idealistic notions’ and accept the truth that disease is the inevitable side effect of our modern lifestyles. But then should we embrace the medicine creep and realise that without medicines to prop us up we are doomed?

To begin with, let us have a look at how appealing an en mass drugging of the population with statins actually is. First of all, there is a whole range of different side effects, affecting as many as 20% of patients treated with statins. These include confusion and memory loss, muscle related adverse effects, increased liver enzymes and type-2 diabetes. These side effects are so bad that only 25% of individuals without cardiovascular disease manage to adhere to the statin therapy for at least two years.

Secondly, it is the false sense of security that such notional immunisation against heart disease would cause. Just imagine you would be exempt from speeding tickets when driving. As a result many of us would start driving faster. You can apply the same concept to becoming ‘exempt’ from heart disease. Healthy lifestyle will no longer be needed if instead of dropping bad habits such as smoking, drinking less and bothering with healthy eating and exercise you will have a potent pill to protect you. Good, you will be saved from heart disease, but you will be on track for a head on collision with many other chronic ailments. Is this really an effective approach to improving health of our and future generations?

The other and the only available option is to rely on what we have been doing for our health for ages. That is consuming a naturally diverse diet and being physically active. Such a ‘prescription’ will beat chemical drugs every time when it comes to chronic disease prevention. Although changing our diet and lifestyle behaviour can be a lot more difficult than popping a pill, its benefits will extend to every facet of our wellbeing.