BMJ  2003;327 (4 October), doi:10.1136/bmj.327.7418.0-g

Editor's choice

Polypill may be available in two years

Light the blue touch paper and retreat 5 metres. That's what we did when we published a series of papers suggesting that if everybody started taking a pill containing six ingredients at the age of 55 then deaths from heart disease and stroke would be reduced by 80%. The pill would contain aspirin, a statin, folic acid, and three antihypertensives at half dose. Versions of all the drugs are now off patent, and the pill could be produced for pence. Wild with enthusiasm, I suggested that the issue of the BMJ that published the articles might be the most important for 50 years and become a collector's item.

I've no idea how many readers have stored away that issue like a vintage bottle of claret, but clearly many readers thought that this illustrated my woeful lack of judgment and the general decline in the BMJ. A "preposterous Polypill panacea" wrote one lover of alliteration. Letters in response to the issue were mostly scornful (p 807). But could this be medical conservatism?

Readers of the BMJ may have been more taken aback than excited, but a search on Google shows that 2960 sites have mentioned the Polypill. We at the BMJ might flatter ourselves that this illustrates our worldwide impact, but much of what we publish disappears, as my predecessor would say, "like a doughnut into the North Sea." The world is interested in the Polypill, and a poll on the CNN website showed that 95% of its viewers would take the pill.

The question that interests me is whether the Polypill will make it on to the market. Research based pharmaceutical companies have tended not to be interested because their business model is to sell expensive drugs at a high margin to recoup the high cost of research. The Polypill will need to be cheap to be accessible, and it may reduce markets for their existing drugs. Generic companies, many of them from India, make their money from selling large volumes of drugs at low margin. But they don't tend to spend much on marketing, and the Polypill will need extensive marketing. Somebody at the press conference to launch the articles pointed out that the answer might be a company selling "over the counter" drugs. These companies have high volume, low margin businesses, and are also adept at marketing.

In fact several major companies are interested in the Polypill, and it could be on the market within a couple of years. It could even be a drug that would be available over the counter prescribed by pharmacists. A trial will probably be needed to confirm that the Polypill does reduce the risk factors—and that the drugs don't cancel each other out, though this is not seriously in doubt. But it might be that the pill could go on to the market before it would be necessary to do a major trial to show reduction in events such as heart attacks and stroke. It could be available for me to take on my 55th birthday on 11 March 2007 (no cards, please).

rsmith{at}bmj.com

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Rapid Responses:

Read all Rapid Responses

Popularity based medicine?

Adam Jacobs
bmj.com, 3 Oct 2003 [Full text]

Polypill: Why not Mega Pill ?

Anil Pandit
bmj.com, 3 Oct 2003 [Full text]

Defintely the drug companies will support that.

A.Karim Al-Sheikhli
bmj.com, 3 Oct 2003 [Full text]

Polypill Pyriform Paradox

Christopher N. O'Loughlin
bmj.com, 4 Oct 2003 [Full text]

Getting a grip on cardiovascular disease

Hans P Colvin
bmj.com, 4 Oct 2003 [Full text]

A weapon of mass salvation

John Hopkins
bmj.com, 5 Oct 2003 [Full text]

All changed, changed possibly.

James A R Willis
bmj.com, 7 Oct 2003 [Full text]

Bringing owls to Athens

Dr.Herbert H. Nehrlich
bmj.com, 16 Oct 2003 [Full text]

PolyPill or apple pie?

Eddie Vos
bmj.com, 17 Oct 2003 [Full text]

"your letter" The Polypill

Eric Frankel
bmj.com, 17 Oct 2003 [Full text]

Too Long A Wait For Tony Blair . . .

Joseph . C . Obi
bmj.com, 20 Oct 2003 [Full text]

PolyPill-My four year experience.

Sarosh A Khan
bmj.com, 8 Apr 2007 [Full text]