Sunday, May 10, 2009

The Problems With the PolyPill

What if there were one pill that contained most of our drugs for managing coronary heart disease? We've already seen the marriage of antihypertensives with statins (a la Caduet). Why not add aspirin, too? But some point out there might be problems with this approach:
But Washington Hospital Center cardiologist Patricia Davidson raises concerns: What would happen if patients react badly to one component of the pill or suffer some other negative side effect, the cause of which can't easily be identified?

Aspirin, for example, causes bleeding in some individuals, but the problems caused by other drugs might be harder to identify. "It would be difficult to replace the three or four drugs when trying to eliminate the drug with the side effects," Davidson says.

Others have raised questions about the dosage levels of each of the ingredients in a single pill, which cannot be as readily adjusted to suit individual needs.

Beyond these concerns is a philosophical one: Should we expect a pill for every problem? Sure sounds good, as Robert Bonow recently pointed out at the American College of Cardiology annual meeting in Florida.

"A single pill," said Bonow, a professor of medicine at Chicago's Feinberg School of Medicine at Northwestern University, "is exactly what people would love to have." But Bonow argues that medication should not be thought of as a means to "continue smoking . . . keep on eating what you're eating and not exercising."
My feeling? The polypill is coming, despite doctors' misgivings, especially as the beleaguered pharmaceutical industry looks for new ways to repackage generic medications to make them look "new" again.



heartsaver said...

As a Cardiologist whose area of interest is cardiovascular prevention I have to say that although I share some of the concerns presented in your post, the initial study results look promising (including medication tolerance by participants). This concept is particularly powerful for developing countries with a high cardiovascular morbidity and mortality rate and few health care resources. In a country like that, the benefits of a polypill could be extremely significant.

I enjoy your blog.

Juan Rivera
Corazon Hispano

Anonymous said...

The same problem arises when the components of the polypill are prescribed as individual pills but started at the same time. It's simple enough to switch patients with polypill side effects to individual pills & start one drug at a time to see which one caused the side effect.