Nick Wald's great brainstorm, which came to him a few years ago during his father-in-law's struggle with cardiovascular disease late in life, has the virtue of utter simplicity, and perhaps also its drawbacks. Watching as the old man downed the usual cocktail of heart medications, Wald, a professor of preventive medicine at the Wolfson Institute in London, realized that his father's trouble could have been averted, or at least minimized, if he'd begun his regimen years earlier. Of course, he didn't have symptoms then, but that's the point: half the population in Britain eventually develop serious heart disease. Rather than try to identify which half, why not just give the medication to everyone older than 55?
Out of that hunch came the Polypill. It would consist of six relatively inexpensive, generic components: a statin (to lower cholesterol), three different drugs to lower blood pressure, aspirin (to interfere with blood-clot formation) and folic acid (to reduce levels of circulating homocysteine, a suspected risk factor for heart disease). These are all drugs commonly prescribed for patients at risk for heart disease, and folic acid is found in multivitamins, but the idea of giving them routinely to everyone over a certain age is, as Wald and collaborator M. R. Law admit, "radical." In publishing their paper last summer, the editor of the British Medical Journal suggested the issue in which it appeared might be "the most important for 50 years."
It certainly has proved to be one of the most controversial. Critics argued that even aspirin has the potential to cause serious or even fatal side effects, such as gastric bleeding. And some British doctors seemed uneasy with the idea of a pill you give to everyone. "Let's take this to its logical conclusion," wrote one medic, "and put every drug known to medical science in the water supply."
A more measured response comes from Dr. Robert O. Bonow, president of the American Heart Association. "It's not totally a bad idea," he says. "Cardiovascular disease is the leading cause of death worldwide, and we're not going to be able to do enough angioplasties to treat entire populations." But he worries that packaging six drugs in a single pill carries the twin dangers of unnecessary side effects for people at low risk, and, conversely, undertreating those who need more aggressive care. The availability of such a pill might also deter people from making healthy lifestyle changes (such as losing weight and stopping smoking). "My idea of a polypill," says Bonow, "is exercise and a good diet."
Undaunted, Wald hopes to begin clinical testing of the Polypill soon. He doesn't imagine its being sold over the counter, at least initially. People with certain conditions (such as asthma or bleeding ulcers) shouldn't take one or more of the proposed ingredients, and you wouldn't want to give the pill to someone who was already taking some of the components in another form. "There's much to gain and little to lose by the widespread use of these drugs," Wald writes. "No other preventive method would have so great an impact on public health in the Western world."