Filed under: Uncategorized | Tags: epidemiology and community health, polypill
in The Jouranal of Epidemiology and Community Health, Drs. Holmes and Bhala (2013; 67:897-902 doi:10.1136/jech-2013-202690) lay out a cogent and interesting argument for the allocation of a polypill to the general adult population – one that includes low doses of drugs against cardiovascular diseases, hypertension, and potentially Alzheimer’s, diabetes, and certain forms of cancer (were appropriate and effective drugs for prevention made available). Though I appreciated many of the arguments, for example, that a polypill would reduce risk of diseases in all people uniformly, addressing genetic and environmental causes of diseases, that a polypill has similarities to vaccine programs and certainly to food supplementation programs, which rely on herd immunity or are used to benefit only a small proportion of the population, I found myself wondering about critical societal factors which are important determinants of the chronic diseases which would be addressed by a polypill.
Vaccination programs or micronutrient supplementation is employed because there is no other way for the government or society to intervene on the causes of these diseases. Indeed, efforts to reduce infectious diseases like cholera or influenza begin with environmental changes – cleaning the water supply or quarantining individuals – in conjunction with vaccination.
While governmental efforts to reduce chronic diseases have been established (Eat Smart, Move More for obesity, or dietary guidelines for sodium reduction for hypertension), there has not been the large-scale shift towards physical infrastructure, food system, or health system change needed to significantly reduce the burden of these diseases in the population. Until the government efforts to lower the risk of these diseases reaches businesses and their own strategies, rather than relying on recommendations to individuals, it does not seem that we have done enough to warrant a polypill as the most viable strategy.