Heart attacks and the efficacy of polypills – a hard pill to swallow? | Letters | Science

Your headline (Single polypill reduces risk of heart attacks and strokes, study finds, 23 August) should really have been tempered by quoting the absolute rather than the relative risk-reduction figures.

The 34% reduction in major cardiac events you quote is calculated from “on the ground” reduction in events from 8.8% over five years in those not on the polypill to 5.9% in those receiving it – that is a 2.9% chance of benefit over five years to the individual and with no effect on mortality.

Archie Cochrane , the doyen of evidence-based medicine, said we should ask three questions of any intervention: can it work, does it work and is it worth it? The relative risk reduction you quote tells us of population benefit and answers the first two questions, but it is the absolute risk reduction that answers the “is it worth it?”question. Many patients would be reluctant to take a tablet if told there was a greater than 97% chance that they would derive no benefit from taking it over five years and it had no positive effect on their length of life.

Add to that the differences between the UK and rural Iran where the study was carried out, plus the risk of medicalising healthy patients and the constant risk of side-effects, and surely the answer to “is it worth it?” must be “no”. It is only the absolute risk-reduction figures that allow us to make that decision.
Dr Peter Trewby
Richmond, North Yorkshire

• It is by no means a novelty that medical researchers unashamedly pay lip service to big pharma. But the idea of suggesting a polypill as an extensive remedy to prevent illnesses in huge parts of a population takes this strategy to a new level.

Especially upsetting is the composition of said pill. If applied with blanket coverage, its aspirin is likely doing harm to many patients who tend towards bleeding. And by including substances that aim at lowering “bad” cholesterol, those experts are barking up the wrong tree anyway. They ignore the fact that it is widely acknowledged among experts that a high level of cholesterol is not a disease in itself, but a clear sign of increased levels of oxidants in the body cells.

And as a healthy body generally self-regulates its level of cholesterol, the approach here should be treating underlying chronic diseases, and not influencing a single body parameter with a chemical drug. Instead, professors would be well advised to focus on the real causes of the diseases they want to prevent: unhealthy lifestyles and nutrition.
Oliver Lepen
Radbruch, Germany

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