The Dangerous Polypill

The pharmaceutical companies are excellent examples of corporate success. They exist to maximise the profits for their shareholders and have been very successful both in terms of growth and returns for many years. They are one of the engines of the Western economies.

Any successful business has to keep growing and replicating itself. It will be ruthlessly measured by the markets in the US on a quarterly basis, including growth and return of numbers to shareholders. If these do not meet expectations then share prices will fall and senior executives may lose their jobs. Throughout the second half of the last century, the constant process of discovery of new drugs and the absorption of smaller companies meant that the growth of the pharmaceutical giants was exponential. In the current decade though, there are fewer new discoveries and those there are have become increasingly expensive to bring to market. Added to this, many proprietary drugs are now out of patent and purchasers can buy much cheaper and less profitable generic versions of the same thing, reducing pharmaceutical profits.

New marketing tactics are required to maintain growth and profit levels. These were helped enormously by the inflated fears of so-called pandemic threats like bird and swine flu, where enormous stockpiles of anti-viral doses were ordered by governments, only to be thrown away later. The latest idea, to maximise profits, is the development of the polypill. This is a combination of small amounts of generic drugs in a single pill which aim to treat general health risks. These “cocktail” drugs are then promoted on the basis that everyone over the age of 50 should take them for the rest of their lives in order to “stay healthy”. Based on NHS prices the value of the ingredients in the pills would be around 10 pence.

The manufacturers of one of these pills, the Red Heart Pill, say that it will help you live longer, a significant claim. So let’s examine the formulation of this polypill to see what is actually inside and whether it can meet this claim.

Now we know that, where the is no specific organ damage that restricts the flow of blood, raised blood pressure is caused exclusively by the loss or rarefaction of capillaries, and no other cause, in 95% of all cases. Blood is pumped by the heart through the arteries, and subsidiary vessels until they reach the capillaries where the oxygen and nutrients in the blood are exchanged with the cells and waste products taken away. The arterial system is very flexible and can expand to mange even very high pressure levels. On the other hand, capillaries are non-compliant; they cannot stretch and they cannot take on the load meant for their neighbours. This means that, if one capillary is lost, then there is nowhere for that capillary’s share of the blood to go and blood pressure rises. In a hypertensive person, hundreds of thousands, if not millions, of capillaries have been lost and this is the cause of their problems. If a drug aimed at high blood pressure does not address this problem then it will not be effective.

The first thing that the polypill contains is 75mg of aspirin. This is the same dosage as a junior or cardiovascular aspirin which many people took on a regular basis. Aspirin thins the blood and is an antiplatelet; it stops blood from clotting. Because the platelet patch can become too large and also block blood flow, locally and downstream, aspirin is also used long-term, at low doses, to help prevent heart attacks, strokes and blood clot formation in people at high risk for developing blood clots. It has also been established that low doses of aspirin may be given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue. Some experts believe that low doses of aspirin, such as 75mg a day, carry little risk of side effects. However, this theory has been debunked by scientists at the Radcliffe Infirmary in Oxford, who found that long-term use of the drug, even at low doses, does have potentially harmful side effects. Users of low dose aspirin over long periods suffer a significant risk of gastro-intestinal bleeding and related problems including stomach cancers. Researchers said “There is no doubt that aspirin is an effective drug. Because of this problem with gut bleeding though, aspirin treatment should be used only when there is good reason to do so.” A study by researchers at the Wolfson Institute of Preventive Medicine in London published earlier this year found aspirin was linked to a risk of serious bleeding in men with high blood pressure. The conclusion must be that it is best to avoid aspirin, other than for short term analgesic effect.

The second ingredient is a statin, Simvastatin. The aim of this is to break up cholesterol. The use of statins has always been controversial. There is still no scientific evidence that ingesting cholesterol leads to a build up of cholesterol in the arteries. In fact, it has been shown that animal fats, particularly dairy, act to surround and carry harmful fats out of the body. It is also argued that the build up of cholesterol is caused by raised blood pressure, rather than the other way round. The medical journal, the Lancet, claimed that the drugs don’t benefit women or elderly men if they have not had a previous cardiovascular problem and, for younger men, the reduction in risk was very slight. On the other hand, there can be very serious side effects of taking statins including muscular problems, mood effects, amnesia and cognitive problems.

Next, there are three different ingredients aimed at lowering blood pressure. Two of the three if you have heart problems, and two for stroke prevention (and one of these could kill you). These drugs have the following effects;

Atenolol. This is a beta blocker that prevents the operation of the hormone adrenaline and slows down the heart reactions. It reduces the heart rate and is very useful for treating heart abnormalities. Because it slows the heart down, then the rate of push of the blood through the arterial system is reduced. Atenolol does have some side effects and it can be dangerous to patients with lung problems and, paradoxically heart patients because it slows the heart down too much. It should only be used under medical supervision and it should not be withdrawn suddenly as this can cause heart attacks. Atenolol does nothing to restore capillary health.

Lisinopril. This drug belongs to a group of medicines called AC Inhibitors. These act to relax the artery walls causing them to widen and therefore be able to contain a greater volume of blood and thus reducing blood pressure. The drug brings with a considerable catalogue of side effects and, again, should only be taken under medical supervision. Because the drug makes the walls of the arteries softer they are more likely to accumulate cholesterol in resulting fissures and cavities. A healthy artery has firm and smooth walls and there are fewer places where cholesterol and other impurities can cluster. Although Lisinopril will reduce blood pressure, albeit temporarily, it does nothing to restore capillary health.

Hydrochlorothiazide. This drug is a diuretic that inhibits the kidneys’ ability to retain water. It acts by decreasing the amount of salt in the blood supply. The effect of osmosis then results in the brain decreasing the body’s intake of water and increasing urination. The body needs water which circulates throughout the body with blood in serum. The effect of reducing the amount of water in serum means that there is less liquid to pump round so blood pressure reduces. However, the consequence of diuretic action is to promote dehydration which can affect all of the organs of the body and, ultimately, lead to death. It is well known that, in the event of almost any medical emergency, response staff will boost the water levels in serum by providing a saline drip. Also, the body defends osmosis and interfering with this process can have unwanted complications including loss of homeostasis. Very few doctors would prescribe diuretics for high blood pressure today. People who live in warm environments, or who exercise regularly, are at significant risk of dehydration if they take diuretics. Diuretics do nothing to restore capillary health.

In summary, far from helping you to live longer, polypills do very little to contribute to improved health and are more likely to produce unwanted side effects. If you have had a stroke or heart attack, you will be under the care of a doctor who will prescribe medication that is directly relevant to your condition rather than a polypill.

© Graeme Ward, May 2010

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