Health: Polypill

Baroness Brinton Excerpts

Monday 7th July 2014 Lords Chamber

[Baroness Brinton (LD)]

My Lords, the name polypills is slightly unfortunate. When I heard about this, I immediately drew parallels with polyclinics, keeping it in the health arena, at least; but one of my adult children wondered whether this was veterinary medication for our avian friends. The principle, as the noble Lord, Lord Hunt, has outlined—I thank him very much for securing this debate—is that the polypill combines four medicines into one; three to lower blood pressure and one to lower cholesterol. Personally, I prefer the name that they have used in Australia and New Zealand, SPACE: single pill to avert cardiovascular events. It seems a neater acronym and explains much more simply what it does.

I thank the Library for its very helpful research pack, not least because it references the proposal that all over-50s should take it. This is some of the research referred to by the noble Lord, Lord Hunt. Some even suggest that those over 35 who have an at-risk profile might consider taking it every day. Indeed, Dr David Wald at Queen Mary University of London, after his trial, says that 28% of people will benefit by avoiding or delaying heart attacks. However the QMUL studies trial was only 84 patients; perhaps I should say “people”, since it was targeting people who were not yet unwell. Those results show that the blood pressure of around 12% of participants was reduced and 39% had reduction in cholesterol. All this is good, but to have a drug compulsory—because that is how it would be seen, even if it were voluntary—for anyone over 50 seems to me a fairly low benefit ratio.

The papers also describe a cost of “only 50p per day”. This sounds relatively cheap, but it is £15 per month or £180 per year. Even more than that, Dr Wald suggests that it could be sold over the counter and not as a prescription-only medicine. I do not know what the current rate is, but the per-patient allocation for medication in the NHS is not large, and anything over £100 starts to raise eyebrows. The pill would therefore be a substantial burden on the pharmaceutical bill, especially if it was to be used for the entire population over 50 rather than for those who need it.

Even if we accept that there is a good reason to give four tablets in one for healthy people, other considerations still need to be aired. The first is side-effects. The noble Lord, Lord Hunt, referred to statins —I suspect that we all know somebody who is on them—the side-effects of which can range from memory loss, muscle problems, polyneuropathy, acidosis, anaemia, cataracts, immune depression and pancreatic and liver disease. Even if you are lucky enough not to have a response to a single one of those drugs, mixtures of drugs may well have combination side-effects. I know from my own area of rheumatology that some people react badly when a mixture of drugs is taken, and they are instructed to take certain drugs in the morning and others in the evening to avoid such contraindications.

I am slightly unhappy about the reference made by the noble Lord, Lord Hunt, to the polypill being parallel to vaccination. I would much rather that people who were thought to be at risk, which could well be anyone over 50, went down the public health route and were asked to consider lifestyle changes, including stopping smoking, looking at their diet, having their cholesterol tested regularly and, most importantly, undertaking some activity. A lot of publicity was given two or three weeks ago to evidence showing that, for the population over 50, you do not have suddenly to become a Tour de France cyclist or a marathon runner and that steady walking that raises your exertion level a bit every day will do the trick.

I therefore wonder whether this “wonder drug” is not trying to solve too much in one easy go, but I am not alone. In an article that appeared in the Daily Telegraph on 19 July 2012, Dr Margaret McCartney, a Glasgow GP, was reported as saying that more evidence was needed before a mass programme was embarked on and:

“The history of medicine is rich with ideas that sounded great but either didn’t prove effective—or worse, did harm”.

Natasha Stewart, a senior cardiac nurse at the British Heart Foundation, was reported as saying:

“Research into polypills is encouraging, but there are still many questions to answer before this ‘wonder drug’ is prescribed … However interesting this potential new pill is, medicines are not a substitute for living a healthy lifestyle”.

The polypill sounds very enticing, but I am concerned about it for three reasons. First, it is already being described as a wonder drug long before extensive research and careful monitoring of side-effects, including those caused by combining four into one, have been done. As I said earlier, many people are already under strict instructions not to mix certain drugs because they interact. Secondly, the cost at 50 pence a day is not insignificant. To prescribe the pill for a large number of people who will not need it in the longer run seems futile. Like Public Health England, I would much rather see proper medical assessment MoTs being given at 35 and 50, so that people becoming more at risk can be given lifestyle change advice, have regular tests on cholesterol and other things that will indicate whether they are at risk, and can consider whether their level of activity is appropriate. My final concern is that, if the polypill is made available across the counter and not on prescription, some—perhaps many—may think that the pill alone will protect them without their looking at their own lifestyle issues.

Having been pretty depressing about all this, I want to end on a positive note. If further research at a statistically significant level can demonstrate the benefit of the pill, and if the Medicine and Healthcare products Regulatory Agency is satisfied with its efficacy, quality and safety, then, yes, I would welcome it, but there is too little for us to go out and be utterly positive about at the moment.