Friday, May 09, 2008

The alleged polypill miracle

There is absolutely no evidence for the longevity claims below and there have been some scathing criticisms of the leap of faith embodied in the claims. It is all a statistical extrapolation from dubious data. All the ingredients have negative as well as positive effects and the bottom line could be a SHORTENED lifespan. The "polymeal" proposal is based on similar logic and yet we know from longevity studies that diet and lifestyle changes have negligible effects on lifespan. Remember that hard-won bit of wisdom: "The miracle cure of today is often the iatrogenic disaster of the future"

A five-in-one polypill developed by British doctors could prevent 100,000 premature deaths from heart conditions every year. The inventors of the pill - which could be taken daily by everyone over 55 at a cost of about 7 pounds a week - claim it could prevent 80 per cent of heart attacks and strokes among those who use it.

The drug, which combines five individual treatments, has received the backing of Prof Roger Boyle, the Government's national director for heart disease and stroke, who has called for it to be prescribed on the NHS. Prof Nicholas Wald, the director of the Wolfson Institute of Preventive Medicine, said: "I am delighted we have reached this milestone. Now we want to get it out there so people can use it. "Our mission is to make this available to everyone over 55 at an affordable price. ''The founders of our group would like this pill to be available to everyone for about 1 pound a day."

The polypill has been in development for several years. Research published by Prof Wald in 2003 concluded: "The polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. ''It would be acceptably safe and, with widespread use, would have a greater impact on the prevention of disease in the western world than any other single intervention." The paper added that a third of people taking the drug would benefit, gaining an extra 11 years of life on average.

More than 130,000 people suffer a stroke in Britain every year, half of whom die. Heart attacks affect up to 230,000 people each year, claiming the lives of 30 per cent of them. Prof Boyle said the polypill ''would certainly have a big impact''. He added: ''We need to remember that one third of deaths are due to cardiovascular disease, despite substantial reductions over the past few years."

The polypill comprises a cholesterol-reducing statin, three types of medicine to lower blood pressure and a folic acid that reduces levels of an amino acid implicated in heart attacks and strokes. Clinical trials have established that the individual ingredients prevent heart attacks and strokes, so the combined pill would only require small-scale trials to ensure it behaves in the same way. The inventors can then apply for a licence in Britain, leading to the pill becoming available within two years. It will be made by Cipla, one of India's largest pharmaceutical companies.


"Healthy lifestyle" absurdities in Australia

READING policy documents can be a hard way to make a living. But sometimes you simply can't believe what you are reading. Last year the Labor Party released its GP super clinics policy, co-authored by Kevin Rudd and Nicola Roxon, which contained the following statement: "Preventative health care needs to be made more accessible to ordinary Australians struggling to find the time in their busy lives to look after their own health. We can't expect people to take better care of their health if we won't help provide the health services they need to make this a reality."

Not sure whether to laugh at the absurdity or be outraged by the patronising tone, I was intrigued to figure out how anybody could endorse such an extraordinary notion. Public health experts have argued since the 1970s that people make unhealthy choices out of ignorance and that governments, therefore, have a duty to tell them through public health education campaigns how to change their lifestyle to protect their health. For more than 30 years, Australian governments have told us to quit smoking, eat moderately and exercise regularly, most memorably through the "Life! Be In It" campaign. We have listened, up to a point at least, and the easy prevention work has now been accomplished.

Many middle-class people are converts to the wellness cult: they have stopped smoking, improved their diet and started to exercise. But many others, particularly those on lower incomes, prefer to live for the day and have ignored the healthy lifestyle message. Recent reports on public health policy in Britain and Australia found that despite decades of spending on prevention programs, levels of physical activity have not increased and obesity levels have shot up. Obesity-related chronic disease already puts pressure on the health system and it will accentuate the challenges we face as the population ages.

Prevention hasn't worked because however intensively the health lifestyle message is pushed, it comes down to individuals to have the will, self-discipline and impulse control to change longstanding behaviours that are often pleasurable. As international studies have found, the main reason anti-obesity initiatives have failed is that many people find it difficult to sustain lifestyle modifications for long periods.

But instead of acknowledging these limits to prevention, public health experts are going further, to justify even greater public health spending. Obesity has been redefined as an epidemic, as if victims passively contract it (infected, of course, by wicked and coercive fast-food advertising). As the victims of this epidemic are concentrated in lower-income groups, obesity has also been classified as health inequality, which makes it a social problem. The blame for it falls on "a catastrophic failure of governments to implement effective evidence-based action".

Even though governments took health experts' advice and spent millions on preventive education, it is now the government, rather than the individual, that the experts deem responsible for obesity, because it has not done enough to force people to drop their hamburgers and get off the couch. While this obviously ignores the role individuals play in continuing to make unhealthy lifestyle decisions, this argument has nevertheless managed to convince some politicians that governments must indeed take action to stem the epidemic.

Hence we have the truly remarkable, paternalistic policy endorsed by the Labor Party. The Government's policy documents acknowledge that public health campaigns had at least made most people aware of the lifestyle changes required to promote good health. But in Rudd and Roxon's view, what recent history - the failure to curb obesity - really demonstrates is how the system failed to provide help to turn knowledge into practice. So-called ordinary Australians therefore need Medicare-funded preventive health care, of course, because unless the government was prepared to help them, how could they be expected to take care of their own health.

The Labor Party has announced an initiative: a national network of super clinics to be located in lower-income communities. In a forerunner of the Prime Minister's one-stop shop childcare centres proposal, the Government's plan in health is to bring a range of allied health services under one roof, so super clinics can deliver what are ominously titled lifestyle interventions. The Government will pay teams of sleek middle-class health professionals to harass the bulging lower orders and help them eat food they don't like and get exercise they don't want to take.

Life! The Government Will Make You Be In It: this could be the slogan of the super clinics. But the Government can't make you be in it, and its policy is neither evidence-based nor effective. Unsurprisingly, studies show that even high-intensity lifestyle interventions have little impact, especially on long-term diet and exercise habits. Why, then, is the Government lumbering all of us with the cost of ineffective preventive care?

Cheered on by the experts, the Rudd Government is determined to unfurl a new range of preventive policies to try to contain the future cost of Medicare. Prevention's better than cure, as they say. But the evidence suggests the Government's policies won't work. It should let ordinary Australians be and help ordinary taxpayers instead. Millions of taxpayers' dollars are already wasted every year preaching the virtues of brown bread, wheatgrass juice and jogging to those who won't be converted.


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