{"id":1942,"date":"2014-05-12T11:00:25","date_gmt":"2014-05-12T01:00:25","guid":{"rendered":"http:\/\/blog.panicola.com\/?p=1942"},"modified":"2014-05-12T11:00:25","modified_gmt":"2014-05-12T01:00:25","slug":"polypill-barriers","status":"publish","type":"post","link":"https:\/\/blog.panicola.com\/?p=1942","title":{"rendered":"Polypill Barriers"},"content":{"rendered":"

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https:\/\/www.mja.com.au\/insight\/2014\/16\/polypill-barriers-remain<\/p>\n

Polypill barriers remain<\/h1>\n
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Nicole MacKee<\/div>\n
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Monday, 12 May, 2014<\/span><\/div>\n
\"Polypill<\/div>\n<\/div>\n<\/div>\n
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BARRIERS to the global availability of a polypill to prevent cardiovascular disease remain despite growing evidence of its clinical potential, according to former\u00a0BMJ\u00a0<\/em>editor and long-term advocate of the polypill, Dr Richard Smith.<\/p>\n

Dr Smith, who was in Melbourne last week to attend the Cardiovascular Combination Pharmacotherapy Global Summit, in conjunction with World Congress on Cardiology, said momentum was starting to gather with growing evidence of increased adherence and clinical benefit with the polypill \u2014 a fixed-dose combination of commonly used blood pressure and cholesterol-lowering medications, and aspirin.<\/p>\n

\u201cBut in terms of actually getting it made available to lots of people, the progress is fairly slow because, although the big drug companies are the people who know how to get a drug on the market, they\u2019re generally not interested\u201d, Dr Smith told\u00a0MJA InSight<\/em>.<\/p>\n

Dr Smith, director of the Ovations Chronic Disease Initiative, welcomed findings from the Single Pill to Avert Cardiovascular Events (SPACE) project that showed the polypill was associated with a 43% boost in patient adherence to medication at 12 months.\u00a0(1)<\/a>\u00a0(2)<\/a><\/p>\n

\u201cThat\u2019s tremendously dramatic\u201d, he said, of the research that was presented at the cardiology congress. \u201cGenerally, if you have people taking treatment for life … after a year [of starting therapy], you\u2019ve only got about 50%\u030460% of people [still] taking the treatment, so anything that can increase adherence is really important.\u201d<\/p>\n

The SPACE project, led by researchers from the George Institute for Global Health, analysed data from three clinical trials involving 3140 patients, including the Kanyini-GAP trial in Australia.\u00a0(3)<\/a><\/p>\n

Dr Ruth Webster, of the George Institute, said the polypill\u2019s capacity to prevent cardiovascular events was \u201cpotentially massive\u201d.<\/p>\n

\u201cIn Australia, 50% of people who should be taking these combination medications don\u2019t take them\u201d, she said. \u201cGlobally at least 90% of people in lower income countries who would potentially benefit from these medications are not taking them.\u201d<\/p>\n

Dr Webster said the affordability of the polypill could ensure that its benefits were felt in low- as well as high-income nations.<\/p>\n

\u201cOne of the key aims of the polypill has always been \u2026 to make it cheap so that patients can afford it\u201d, said Dr Webster, adding that governments and health care organisations could use their buying power to ensure a cheap and effective pill was available globally.<\/p>\n

Although a polypill is available in some Latin American and Asian countries, the UK, the US and Australia do not yet have one on the market.<\/p>\n

Dr Webster said the George Institute was actively involved in efforts to have a polypill made available in Australia.<\/p>\n

Dr Smith said that Iran was trialling providing the polypill to everyone over the age of 50 years who had at least one risk factor for cardiovascular disease. \u201cThe future is going to come not from Australia or Britain or the US, but from these kinds of countries, where \u2026 there\u2019s much more to gain \u2026 as there are many people not being treated [at all]\u201d, he said.<\/p>\n

In addition to regulatory hurdles, cardiologists were also a barrier to polypill development, said Dr Smith, who recently wrote about the key barriers to polypill uptake in his\u00a0BMJ<\/em>\u00a0blog.\u00a0(4)<\/a><\/p>\n

\u201c[Cardiologists] think \u2026 that constantly titrating the drugs you give people, measuring their blood pressure regularly and their lipids \u2026 is a better way of doing things. But the problem is that we have this famous rule of halves \u2014 of all of the people at risk, half are not diagnosed; and of the half that are diagnosed, half are not treated; and the half that are treated, are not treated adequately\u201d, he said. \u201cSo you end up with a very high proportion of people who are at risk who are not getting good treatment.<\/p>\n

\u201cThe strongest argument for the polypill is how bad things are at the moment. Not just in low- and middle-income countries where, on the whole, they are terrible, but also in high-income countries because a lot of people are not getting adequate treatment.\u201d<\/p>\n

Dr Smith said the polypill had also faced opposition from public health experts concerned that giving people such a pill would discourage improvements in lifestyle and diet.<\/p>\n

\u201cBut I think that\u2019s a myth that\u2019s been laid to rest because in three trials that have looked at lifestyle, people on the polypill don\u2019t get fatter, they don\u2019t smoke more, they don\u2019t eat unhealthier diets\u201d, he said.<\/p>\n

1.\u00a0Nature 2007; 450: 494-496<\/em><\/a>
\n2.\u00a0George Institute for Global Health: SPACE Project<\/a>
\n3.\u00a0BMC Public Health\u00a0<\/em>2010; Online 5 August<\/a>
\n4.\u00a0BMJ Blogs\u00a0<\/em>2014; Online 1 May<\/a><\/p>\n

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  https:\/\/www.mja.com.au\/insight\/2014\/16\/polypill-barriers-remain Polypill barriers remain Nicole MacKee Monday, 12 May, 2014 BARRIERS to the global availability of a polypill to prevent cardiovascular disease remain despite growing evidence of its clinical potential, according to former\u00a0BMJ\u00a0editor and long-term advocate of the polypill, Dr Richard Smith. Dr Smith, who was in Melbourne last week to attend the Cardiovascular … Continue reading Polypill Barriers<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33,9,10,29,22,6,3],"tags":[],"class_list":["post-1942","post","type-post","status-publish","format-standard","hentry","category-health-market-quality","category-healthcare","category-healthy-habits","category-management-and-leadership","category-policy","category-politics","category-rapid-learning-health-systems"],"_links":{"self":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1942","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1942"}],"version-history":[{"count":1,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1942\/revisions"}],"predecessor-version":[{"id":1943,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1942\/revisions\/1943"}],"wp:attachment":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1942"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1942"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1942"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}