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medpundit |
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Thursday, June 26, 2003A single pill containing aspirin, folic acid and drugs to lower blood pressure and cholesterol could cut heart attacks and strokes by more than 80%, a newly released study claims. Researchers, writing in the British Medical Journal, said the "Polypill" would have a greater impact on the prevention of disease in the Western world than any other single intervention. ....They came up with a pill containing six active components - aspirin, folic acid, a cholesterol-lowering drug and three drugs to lower blood pressure at half the normal dose. The pill would contain these components, according to the article: The formulation which met our objectives was: a statin (for example, atorvastatin (daily dose 10 mg) or simvastatin (40 mg)); three blood pressure lowering drugs (for example, a thiazide, a blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg) Of course, this is all theoretical, and it's all based on a stastical analysis rather than reality. The doctors looked at the percentage risk reduction that each drug provides separately and combined those reductions to predict an 80% reduction in risk. What they can't tell is how all of those drugs will react with one another when someone takes them all at the same time. Each drug alone has its own potential for side effects, especially in the elderly and the chronically ill who don't metabolize well. Taken together, they have the potential to enhance one another's adverse effects. The accompanying editorial minimizes the potential risks, pointing out that each drug alone appears to be pretty safe and with few side effects. But that isn't true. I've had to stop statins in patients because of elevated liver enzymes or muscle aches; thiazides and ACE inhibitors because of electrolyte imbalance or renal insufficiency; beta blockers because of low heart rates or pulmonary complications, and aspirin because of bleeding, or gastric ulcers. By combining all of them in one pill, there's a potential for disaster. Imagine if people taking the pill have higher rates of hepatitis, bleeding ulcers, myositis (muscle inflammation), bradycardia, and acute renal failure all at the same time. Can you say "class action lawsuit"? Of course, the "polypill" won't be approved unless it proves itself safe and effective, but the trend toward pill-popping madness to prevent rather than treat disease is worrisome. As a profession, we're beginning to forget the old maxim "first do no harm." posted by Sydney on 6/26/2003 07:55:00 AM 0 comments 0 Comments: |
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