New evidence suggests that taking a combined cocktail of preventive medications can help us live longer. In these times of soaring health expenditure this should be good news to public health. But governments seem reticent to invest in combined preparations even when they can potentially extend life, minimize morbidity and deliver cheap pharmaceuticals.
The problem is that, where pharmaceuticals are concerned, governments are not supporting research and innovation that finds new ways of increasing the impact of existing medicines. At the moment most public sector investment is at the other end of R&D: in regulating pharmaceutical products to keep them safe and affordable.
Polypills could make a big difference to aging populations in first world countries.
Big pharmaceutical profits come early in the shelf life of a drug. This is because by the time medications are established and safe enough to use in combinations, they are almost out of patent and ready for mass production by third world countries. (A commercially available polypill, recently introduced in Central America, is less than 50% of the price of its components purchased separately).
And yet, polypills could make a big difference to aging populations in first world countries. By the time we are pensioned off we can expect to have accumulated a number of non-lethal treatable diseases, including the big ticket items like heart disease, that will require more than one tablet a day.
Multiple pill consumption is not a new concept. Children in hospital receive an average of 20 different medications during a single stay; a third of us take over the counter multivitamins at least once a month to prevent anything from cramps to colds; women have been taking the oral contraceptive (a combination pill) for over half a century and most of us have been vaccinated with combination vaccines for measles, mumps and rubella.
The other problem for governments is that the evidence around our major non communicable diseases and the prophylactic polypill is confusing. The large scale HOPE 3 trial found that no medication gave better outcomes for patients with moderate high blood pressure than a combination pill. Whether that means that moderate hypertension should not be treated at all or just not with combinations is not clear.
While more research into the role of polypills would clear things up, commercial trials will never happen because research costs billions and the profits from polypills are too small to attract major drug manufacturers.
But the potential benefits to society from polypill is all the more reason for governments to start investing now in initiatives that require less workforce intervention and offer timely solutions to the increasing needs of our ageing communities.