Friday, November 21, 2008

Future - Start Simple, Think Big, Think Polypill, Think Pevention, Think Longevity


In apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events.


Paul Ridker, and 14 others, “Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein,” New England Journal of Medicine, November 20,2008

As I read the above, three things popped into mind:

1) A 2003 article on the polypill, a pill containing a statin, aspirin, a diuretic, folic acid, and an ACE inhibitor, which supposedly would prevent vascular disease and prolong life by 15 years by all people over 55 if taken once a day (1)

2) A 2007 piece by Dr. Srinath Reddy, president of the Public Health Foundation of India, Professor of Cardiology at the All India Institute of Medical Sciences, and developer of the Red Heart Pill, a polypill costing $1 for a month’s supply and containing aspirin, a statin, a thiazide, and an ACE inhibitor, and now under clinical trials. (2)


3) The nature of big innovations, such as medical imaging (MRIs and CTs), oral contraceptives, polio vaccines, renal dialysis, statins (Lipitor et al), the Internet (ubiquitous, free information 24/7), and now the polypill (a universal pill for preventing premature vascular death).

No Fool

I am no fool. I appreciate sensible critics who say the polypill is a bad idea, bad science, too good to be true, an egregious example of polypharmacy, a recipe for overpopulating the planet, and akin to using a shotgun where a series of rifle shots is needed to reduce cardiovascular risks.

But I am also aware a team funded by the Welcome Trust in London, the British Heart Foundation, Anthony Rodgers of the University of Aukland is recruiting volunteers for a massive study to test the polypill. I also know of the work of Dr. William Bestermann in Kingsport, Tennessee. Leader of COSEHC (Consortium foe Southeastern Hypertesion Control). Bestermann argues that hypertension, diabetes, obesity, dyslipiemias, coronary disease, and stroke, represent global metabolic disorder and should be approached and treated aggressively. Finally, I’m cognizant pharmaceutical companies would have much to lose with a successful polypill, and would be motivated to kill the polypill in its infancy.

Not for The Timid

Major society-changing innovations are not for the timid or for seeker-of-devils-in-the-details or sludge-in-the-entrails.
Major innovations begin with 2 steps:

1) Start simple.

2) Think big.

What could be simpler than taking one pill a day to prevent future vascular disease for humankind? What could be bigger than warding off premature death in millions of people with interrelated metabolic disease?

This monumental innovation may not happen, but it’s worth a series of clinical trials, already underway. For the polypill manufactured by Dr. Reddy’a of Hyberabad, India, it’s a case of Reddy, Aim, Fire!

Conclusion

• Think future not past.
• Think opportunities not problems.
• Start simple with big idea.
• Do something big that will make a difference, rather than what is safe and easy to do.

References

1.Wald, NJ, and Law, MR, A Strategy to Reduce Cardiovascular Disease by more than 80%, BMJ, Page 1419, 2003.
2.K.Srinath, The Preventive Polypill – Much Promise – Insufficient Evidence, NEJM, Page 212, January 18, 2007.

1 comment:

ChiMoose said...

Dr. Reece:
Thanks so much for this post . . . I had not previously been aware of the PolyPill. The concept is a fascinating one, and actually jives quite nicely with this recent blog post [http://tinyurl.com/5r9c24] from Humana's Innovation Center (Full Disclosure: I work in the IC).
I think that we are going to need to find "instant" solutions to our health problems; what do you think about the parallel path of trying to make traditionally more healthy activities FUN?