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Four-in-one pill prevents third of heart problems: study (bbc.com)
56 points by known 52 days ago | hide | past | web | favorite | 55 comments

A read through of the methodology makes it sounds like they took solid precautions to prevent biases that could taint the results- As an MD, I'm impressed by the design of this study, and the promising results.

This may be what more studies in the future will look like: Bundle multiple interventions together to help create statistically stronger results, at the cost of less clarity around each individual treatment.

EDIT: Someone else on HN noticed there possibly was no placebo for the control group- This worries me. Also, there's no indication in the methodology that the "field team" was blinded as to treatment groups :(

> This may be what more studies in the future will look like: Bundle multiple interventions together to help create statistically stronger results, at the cost of less clarity around each individual treatment

I'm probably stating the obvious, but it may also be that multiple interventions together have a larger net effect than the interventions separately would suggest. I recently read an article by a physician arguing for many of his patients, treating ADHD with a combination of a stimulant and a non-stimulant resulted in bigger benefits with less side-effects, due to being able to have a lower dosage for each individual medication[0].

[0] https://www.additudemag.com/adhd-medication-combination-ther...

I agree that synergy is an important element, but to me a study like this could make sense even without synergy: To me, it seems better to have 4x the statistical data on 4 drugs at once than just running the individual studies, given how long a study like this takes.

It bothers me that doctors are still out of the loop on chronic risky side effects of medication that are now becoming more prominent. Statins are quite bad for you and increase risk of death from all causes.

I agree with you mostly, but if we can establish with enough certainty that the benefits of something like this are far greater than the costs, it seems unwise to let "perfect" treatment be the enemy of "good" treatment.

I don't know if our research is good enough at all to adequately make the risk versus benefit distinction in risk factor but not imminent danger related medicinal decision making. I don't think the integrity of the system and the rate of technological advancement are allowing it to happen. Companies conduct dozens of trials with new drugs and toss out ones that don't surpass placebo and publish the one study that by chance did. I'm sure the thing that happened with Vioxx is happening more covertly on a much larger scale now. Most smart people are just avoiding doctors unless something obviously bad pops up. It's kind of tragic.

Yeah, unfortunately those are all good points...


Here's an excerpt from a video about double speak and it brings up statins.

It actually infuriates me that doctors try to bully people into medications that don't actually provide them a net benefit because the doctors themselves have been duped.

> Half the people were given the polypill and advice on how to improve their lifestyle, with the other half just getting the advice.

Why didn't the other half get a placebo? Or is this sloppy editing?

Not only do they miss the placebo effect but also the daily reminder to improve their lifestyle (pill as anchor)

That's a great point about the pill as a daily reminder -- the control and intervention groups otherwise received healthy lifestyle training every 6 months.

Did the study include looking at side effects or other causes of death besides strokes and heart attacks? Low-dose aspirin alone is dangerous enough that it's probably not worth taking unless you have some other risk factors for heart problems. https://www.health.harvard.edu/heart-health/is-low-dose-aspi...

According to the abstract[1], the polypill contains hydrochlorothiazide 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, and either enalapril 5 mg or valsartan 40 mg.

1: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

The four-in-one pill is known as the 'Polypill'.

Related: https://www.ncbi.nlm.nih.gov/pubmed/15604180

'The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%'

It actually sounds pretty tasty: https://en.wikipedia.org/wiki/Polymeal

> They suggest a person should consume, every day: 150 mL of red wine (about one glass), 100 g of dark chocolate, 400 g of fruits and vegetables, 2.7 g of garlic, 68 g of almonds, as well as 118 g of fish per day four times each week.

> tastier (than the Polypill)

You’re not supposed to chew the thing!

Proper diet, exercise, and avoiding smoking also prevents more than a third of heart problems. It’s safer than blood-pressure or cholesterol medications.

Guess what: fit people die too. Every day. As an athletic clean eater with heart problems, ignorant comments like this raise my BP even higher. All bodies have issues. We're complicated. You'll develop your own set of troubles at some point. When you do I'm sure you'll cherish the advice of ignorant strangers on the internet suggesting you just exercise, eat healthier, drink more water, etc as though that will literally prevent all health issues.

This a hundred times. I've had people suggest that I could help my sleep apnoea by losing weight or quitting drinking on the internet after I've mentioned it.

Never mind when I was first diagnosed I was actually underweight because the chronic lack of sleep had completely removed my appetite and that I only drink a couple of times a year.

It also assumes that this advice isn't something my doctor wouldn't have given me if it were appropriate

In adults, the most common cause of obstructive sleep apnea is excess weight and obesity. That is a fact. If you’re very overweight and have sleep apnea, losing weight isn’t a crazy suggestion. If you’re skinny it obviously doesn’t make sense.

This isn’t about sleep apnea, but heart disease and stroke from high cholesterol and blood pressure, both of which diet and exercise are the leading cause.

Poor diet alone is linked to half of heart attacks and strokes. Poor diet and exercise has a large negative impact on health. It’s not some made up conspiracy to shame people.

I'm aware that losing weight would be good advice were I overweight. My comment was more trying to illustrate that people make assumptions and then give out advice based on them as if they are universally true

Why not both?

Because many drugs have side effects, especially when taken in the long term. Aspirin alone isn't without its issues (ulcers, etc), not to mention the statins, etc.

This advice may make sense on the aggregate, but for a truly healthy individual with otherwise low risk factors, this has the potential to do more harm than good.

I do agree that overall this makes sense for most people though - and that a combination of both approaches sounds like really good advice.

Edit: Clarified opinion.

I'm awfully confused why anyone would downvote this response. It seems like completely sane advice. Is it the smoking thing?

It is snark. It isn't meant to be constructive or add value to the thread, it is meant to condescend by saying something true but using that truism in order to imply it is also easy (in spite of all of the evidence to the contrary).

To quote the site's guidelines:

> Be kind. Don't be snarky. Comments should get more thoughtful and substantive, not less, as a topic gets more divisive.

It is snarky. It isn't thoughtful or substantive.

It is rather knee-jerk dismissive, true. Snarky? I'm not sure I have the evidence to claim that.

They do have a good point, but the discussion is obviously more nuanced than that. People generally know that exercise is good for them, yet many/most people don't engage in it to a healthy degree. So some discussion of other approaches is appropriate. Let's not make "the perfect the enemy of the good" and all that.

And we don't need to be either/or here. For individuals that have even a moderately elevated risk, doing both is probably a great idea (and of course this is already broadly recommended advice). Doing just one would still be better, and most people would choose a pill over exercise. Still a win in my book.

I see. I would NEVER encourage someone to exercise from some ivory tower. It's hard. I get it. Given the choice, I'd rather hang out on my couch. I've also had a heck of a health scare this year, so I advocate quite heavily: If you can get out and walk, do it! If you can make better choices in your diet, do it! No snark at all... more of a plea.

There's a lot of sensible things we should do but don't. Just because it's sane advice doesn't mean it will help reduce heart disease at a population level.

A practical solution would need to involve some compromise because people aren't perfect. The majority of people find it extremely hard to main a clean diet and get in 15 minutes of hard exercise a day.

If this pill can help then great, but I agree it shouldn't be viewed as the ideal solution. Diet and exercise is still the best fix in most cases.

I didn't downvote, but IMO if anything, it's the "dieting and exercise" part. You may as well ask water to flow uphill, for how productive that is on society-wide scale.

If intended at a personal volition / willpower basis, yes.

If aimed at society-wide transformations to built space, values, and practices, it could prove highly useful.

We once had environments in which the advice was essentially impossible to not follow. And though there were other health complications, and the issues of cardiac, pulmonary, and malignant diseases existed, they seem to have been somewhat less prevalent, even among otherwise susceptible (largely: elderly) populations.

Everybody can't go gangbusters on healthy diet and ample exercise. But those who can benefit. An environment which makes this integral to everyday routines helps massively. An environment which makes this a stuggle (viz: virtually all modern industrialised countries and practices to some extent or another) is an immense impediment.

I meant the willpower aspect in my comment and I agree with your analysis, with a caveat that out of two societal problems, obesity is better than starvation, which was the reality for most people until recently.

Understood, and true.

Why? In the context of this article, it's perfectly valid advice. Why should we instead further put our wellbeing in the hands of a morally bankrupt and maliciously negligent pharmaceuticals industry?

Because it could save a whole bunch of lives?

I won't need this pill (I don't think), but there's probably a tremendous number of people who could have extended lifetimes because of this. Yeah, they should improve their health choices, but good luck forcing that on people.

I suppose the downside is taking the pill and thinking you can eat like crap. (Like overeating on low-fat cookies - still an unhealthy choice).

It feels a lot like telling poor people to "just work harder"

Flawed analogy. If sweat was money you bet we would exercise for hours. Getting out of the vicious circle of poverty can be almost impossible, while improving your health is free.

Free but very, very hard because it goes against our instincts, yet easier than "stop being poor" because you're changing yourself, not your society.

That's interesting. Taking a walk a few times a week can cost nothing (if one has the time). Choosing not to eat a diet of sugar and fat can be cheaper... So while I get the whole "telling someone who is unhealthy to 'be more healthy'" thing is not a good approach. it's also PROVEN that diet and exercise _do_ have an effect. So I can't imagine why encouraging folks warrants a downvote. But, here I am on this train now too!

Because if just telling people this was the solution, we wouldn't have this problem. It comes across as snarky because it treats a difficult and complex problem as a simple one.

I see your point. But treating this as if it is only a "try harder" or "you've got what you had coming to you" isn't a very interesting conversation either.

> That's interesting. Taking a walk a few times a week can cost nothing (if one has the time).

you keep just glossing over the costs. "if one has the time". it's an opportunity cost.

Because on HN stating anything obvious that might offend someone is against the rules. HN prefers mindless optimism over snark.

If I had said “great development, [something about how clinical trials need to be disrupted], [summary of article]” I would be upvoted.

That's not entirely true, though engaging with doses of realism is a bit of an uphill battle.

My own brand of mildly pessimistic realism has proved reasonably successful here. Though it's involved adaptations. And occasional "what, me worry" parries.

There will be a time in the future, when we look back on pills as a laughably crude form of treatment, similar to how we look back on bloodletting now.

Take X pill to solve Y, but side effect(s) are Z.

Your best bet in life now is to invest in your health early. It's a compounding effect. Walk regularly. Exercise. Eat healthy (mostly vegetables, fruit, reduce animal products). Sleep well.

I don't want to downplay the importance of investing in your health early, but I generally disagree with the sentiment. Pills are possibly the best form of treatment that exists (so long as there is a pill that can treat your condition, like there's no pill to treat a severed finger).

People have been taking medicines for mellenia, and pills are just medicine that has been measured and packaged in a convenient way. Its the difference between telling patients "Go find a willow tree and eat some of its bark" vs. "take two aspirin".

I don't disagree that they're the best form of treatment right now. I can see how the tone of my post definitely disregards the importance of pills right now.

I just feel like they are a disappointing "solution" to a yet fully understood problem. I'm hopeful that we (humanity) continue to invest in real cures, rather than treatments that often come with side effects.

I think you are disappointed in the practice of treating symptoms when no cure is available, rather than disliking pills as a delivery mechanism for medicine, which is how your first comment reads.

It's entirely possible that some diseases will be cured by pills, as they are just a delivery mechanism for medicine (and I would like to reiterate they are pretty great at that).

To your main point about treating symptoms vs. creating cures, yes its pretty unfortunate. But most likely, we will be finding cures for diseases one at a time, and there will always be conditions where we can only treat the symptoms.

> there's no pill to treat a severed finger

I’m pretty sure we have a pill to stop you from worrying so much about that problem.

Or: 'Sure, you can have diner at MacDonalds every day. Just take those pills after each meal'.

Big Mac and Big Farm love you ;-)

The best form of medicine? That should be food or whole plant medicine. When we isolate components into pill form we lose the aspects we don't understand yet.

Food is not medicine though, so it did not come into consideration

Hopefully it'll be the time where pill-equivalents will contain sophisticated nanomachines (read: e.g. proteins) specifically crafted to solve Y without side effects.

Until then, I'll happily take my ibuprofen pill instead of wondering where my life went wrong so that I now have fever and am in pain.

One of the markers I'm definitely looking from the health community are "containers" that can contain drugs, and unlock only at specific sites, so that we're not spraying pills all over the body, but only where they need to be.

It's a really hard problem, in all sorts of ways. We're still at a very preliminary phase of that research. But that'll really help with the "side effect" problem.

Bloodletting was almost always ineffective. Pills work.

Your best bet in life now is to invest in your health early. It's a compounding effect. Walk regularly. Exercise. Eat healthy (mostly vegetables, fruit, reduce animal products). Sleep well.

Why not both?

If I did half the things I already know to do, I would be in great shape. Tell me how to make myself do the right things so that I actually do them consistently, and you will be immensely wealthy after you publish that self-help book.

You forgot about fluoride in toothpaste (sarcasm)

Fluoride gives some people issues. Meat gives other people issues. Vegetables others. Latex others. Peanuts others. Coffee others.. Don't mock people because you don't have that issue. Fluoride processing involves the liver...

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