Cycling Stuff Exercise Healthy Living

Saying No to the Polypill

The tweet said that experts were debating the merits of a polypill? I had to click that link.

Yes. I was right; there were actually “eminent” cardiologists suggesting that a pill containing 4 different medicines (a statin, aspirin, beta-blocker and an ACE-inhibitor) “might change the face of cardiovascular medicine.”

The direct quote from Dr Salim Yusef, one of the most eminent heart doctors, went like this:

“We have to think of the polypill not as a pill, but as part of a strategy to completely change our approach to prevention,” said Yusuf. “Instead of saying lifestyle first and drugs next, why don’t we say that drugs are the basis, then get the patients contemplating prevention, and then get them to modify their lifestyle. Maybe that will work, because the reverse strategy hasn’t.”

Maybe it was jet lag?

Sometimes I wonder how it would be if I were really smart. Would having all that brain power blur the fact that a pill would never be better for our hearts than going to bed on time, eating less food, treating people kindly, and carving out 20-30 minutes a day to simulate chasing food down, like our ancestors did before there were triathlons and personal trainers?

Don’t get me wrong; if you have heart disease, like many of my ICD patients, there is little doubt that those four medicines—along with a healthy lifestyle—will prolong your life. Smart people call this secondary prevention. I call it “the plan,” or “the program.”

But if you don’t have heart disease, the best way to avoid getting it is so simple, so easy to understand and so not up to your doctor.

That’s it, I am taking a stand: put me down as strongly against the idea of a polypill, regardless of the p-values.

Put this B-student down for not giving up on the idea that pills should never be the basis of preventing heart disease. Call it mean if you will, but I believe that people, not doctors, can make the greatest impact on reducing the burden of heart disease.


Disclosure: I wrote this piece shortly after participating in an amazingly uplifting two-hour cyclocross practice. That, my friends, can be called bias.

Reference: Experts debate merits of polypill, by Michael O’Riordan,


8 replies on “Saying No to the Polypill”


One could argue aging demographics vs specialist ratio, the current state of the “medical system”, or the hectic lifestyles that befalls most, but the first thing that springs to mind is that the United States is, per capita, the most obese, sedentary populations on the planet.

And as this obesity pandemic sweeps your nation, it is aiming younger and younger, to the point that in 20 years a “healthy lifestyle” will be considered pulp fiction. Children live what is modeled and according to your media outlets it is fast food, home theatres and lap bands/gastric bypass.

So why not realistically look at your demographics and build your policy models around them? Insurers would benefit and when insurers benefit, isn’t it a win-win for everyone?

Sorry to be so jaded, but this incredibly active 40 yr old mother of three is having her life choked out by blood clots, my Pradaxa is on back order (seriously) and my beta-blocker/aspirin cocktail just isn’t cutting it. What I wouldn’t give to have choices……


It’s hard me to express how strongly I feel that good health begins at a societal level. With the children, who should play outside, not drink chocolate milk and have time for gym class.

Sometime could you please weigh in on the Sanjay Gupta CNN special about “The Last Heart Attack”? Apparently his thesis is that heart disease could be eradicated if we would all adopt a no/low oil vegan diet. What do you think about that? Do we have to give up all the animal products forever?

Thx Allison,

No…I do not believe that eliminating animal protein from our diet would eradicate heart disease. Though it is hard to knock a plant-based diet. The problem with the western diet is the large amounts of processed fats and simple sugars that so many have grown accustomed to eating.


I’m all for promoting healthy lifestyles and applaud your efforts in the clinic and through your blog.

Given the well established challenges that we have all seen changing lifestyle, it seems a little naive to me to suggest that we put all of our eggs in that one basket.

If the polypill can maintain health and save lives in a scientifically validated and cost effective manner, I’m all for it.

There’s no reason we can’t also pursue lifestyle changes in a parallel manner at the same time.


Hey Jay…Thanks for voicing your views. I appreciate, and learn from other viewpoints.

Two comments: First, I think what got my dander up was the suggestion that pills should lead the way, before exercise and diet. I want our leaders to use their voice to help change the conversation–from treatment to prevention. I don’t want our leaders to throw in the towel. Second, I didn’t mention the complexity of using polypills in the post in the interest of brevity. Combo pills are tricky to use. Consider the not uncommon instance when a patient has side effects; it’s hard to know which of the agents is the problem.

Terrific article, Dr. John. It’s good to hear a physician who recognizes, embraces emphasizes and encourages lifestyle modifications before any other type of medication is prescribed. Certainly, medications can be beneficial, but in my opinion, it should be a last resort – after doing everything possible to let the body repair itself through proper dietary and exercise protocols have been exhausted. The more we learn about exercise, the more we discover the far-reaching benefits that it has. It’s really quite simple: we were designed to exercise and eat wholesome food. It’s as though the more sophisticated we become, the harder it is for us to realize the fundamental truths.

Overall, I agree with your polypill comments. However, as a CDH patient and an avid Iron distance triathlete, I am already slamming down those four pills every morning and would love to simplify my morning routine. Doesn’t sound like a big deal, but sometimes it’s the little things that have a way of impacting the psyche. I completely get the argument that prevention starts with your lifestyle habits, not some magic pill. Agree completely. Pills are not the answer. Everyone wants an easy fix. Overweight? Here’s a pill that burns the fat away (or a surgery to shrink your stomach). High BP? Take one of these and call me in the morning. I can’t disagree more. But as I said, there is a place for something like this, and I fall into that camp. One pill vs 4? Answer is easy.

Comments are closed.