Indeed, new generations of children will be no less the object of future health education and health promotion efforts than they are today. They must be persuaded and supported in their efforts to control weight, resist smoking, and maintain physically active lifestyles, not just to prevent CVD, but all the other diseases and conditions that are consequent to these lifestyle behaviors and the conditions that produce them.
Primary prevention and secondary prevention, as complementary to a Polypill harm reduction strategy, must be seen as part of a comprehensive strategy for chronic disease control. Among the relevant, and possibly most compelling, experiences from the tobacco control policies and programs in which this author was immersed before being drawn into the Polypill debate was the tilting of the balance of interest from primary prevention to harm reduction. The progress in tobacco control seemed to make its greatest leap forward when the field backed away from its prior preoccupation with relatively ineffective strategies of primary prevention—trying to get youth not to start smoking—and redirected its priorities toward the harm reduction of separating smokers from others who were exposed to their second-hand smoke.
This accomplished a denormalizing of smoking and a consequent strengthening of the motivation of smokers to quit smoking Green et al, b. In setting long-range y national goals for reduction of tobacco consumption, we had to face the demographic reality in the United States that the number of youth susceptible to starting smoking was far less than the number of smokers susceptible to stopping smoking Green et al, a.
That same population bulge is now passing age 55, and bringing with them unprecedented rates of obesity and overweight, diabetes, and other CVD risk factors. The most hopeful harm reduction strategy at hand when the tobacco control field recognized the need to make a renewed push on smoking cessation was nicotine replacement therapy NCT.
The use of NCT in the form of chewing gum, skin patches, lozenges, and other delivery mechanisms was, at first, available only by prescription. Then, with new rulings by the federal Food and Drug Administration, the NCTs were made available as over-the-counter nonprescription drugs.edewomamer.gq/the-health-of-aging-hispanics-the-mexican-origin-population.php
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The parallel with the Polypill strategy offers a source of evidence on the potential effect of making the Polypill, consisting of drugs mostly available heretofore only by prescription, available without prescription. When NRT became available by prescription from medical doctors, the uptake in its use was some 2. With the release of the prescription requirement, however, NRT reached far more people who could buy it over the counter without a physician consultation.
The other more intensive professional support methods shown behavioral counseling and inpatient care are more effective for smokers reached by these methods, but far fewer people avail themselves of such methods, so their impact is much less.
Generalizing this harm reduction strategy to a Polypill's impact is a stretch, but the main inference is that a much larger impact on the population is possible, assuming roughly equal efficacy rates for the drugs as when prescribed by physicians. This impact differential might be less in Europe, with universal coverage of health care, than in the United States, where physician access is more restrained by the economics of medical care. These provide more direct evidence insofar as they are ingredients that would be part of the proposed Polypill.
The aspirin experience is informative for its long-standing availability over the counter, and the growing public knowledge that it can be protective against coronary heart disease through its reduction of blood platelet activity. What might be more encouraging for the Polypill is that most of the 1. Both of these studies offer encouraging evidence of the potential for greatly expanding the reach and for the appropriate use of the drug OTC.
Potential drug—drug interactions remain a concern, but appeared infrequently in the studies so far. Whether in the form of a Polypill containing just two of the ingredients proposed by Wald and Law, or a larger number of ingredients, the need to prepare for the arrival of combinations of pharmacotherapies is incumbent on those professionals who work with patients on chronic disease prevention and management, and those who educate the public on the prevention of disease.
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The Polypill is almost certainly coming soon in some developing countries, notably India, where the patent issues have been resolved to their satisfaction and where the impact in numbers could be even greater than in the high-income countries. Their experience is likely to fuel a greater demand for something similar in Europe, North America, and other countries. Those of us struggling with the issues of patient adherence and other social and behavioral aspects of nutritional and other CVD risk reduction, represented in this issue of the EJCN , should be especially prepared to integrate the Polypill into our practice.
Nothing else we have designed as an intervention could make such a large difference in so many lives. Brass EP : Consumer behavior in the setting of over-the-counter statin availability: lessons from the consumer use study of OTC Mevacor. David H : The pill is good for you. Entre Nous Cph Den. Health Prom. Public Health 90 , — New York and London: Bloomsbury. BMJ , Pearson TA ed : Expanding primary prevention efforts: allowing consumers access to over-the-counter statins.
Addiction 99 , — Robertson LS : Causal webs, preventive brooms, and housekeepers.
Editor's choice. BMJ , 0. BMJ , — Erratum in: BMJ 37 , Download references. This paper represents the personal views of the author and not necessarily those of the Committee, the Expert Panel, or the CDC. Correspondence to L W Green. To obtain permission to re-use content from this article visit RightsLink.
Meaning of "polypill" in the English dictionary
What is your opinion: could the use of the Polypill contribute to a supportive environment? Green : Yes. This is an environmental intervention…. Let me put it this way.
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I think that attention for environmental support to reduce risk factors is worthy of consideration. With tobacco control, it was not until we started addressing environmental factors seriously that we began to have an impact on behavior…. For example, lifestyle education to prevent obesity early in childhood. Brug : I do not think that this is only an environmental intervention. It is behavior. People need to take those pills.
And in the way they are supposed to take it; not take two when they have had a big meal. Helman : I am worried that studies on which the Polypill is designed were not conducted with non-selected over y-old people. Truswell : I have three additional concerns. First, the pharmaceutical question: Are all these ingredients compatible in one pill?
The acid nature of some components might damage some of the other components. Secondly, are we going to see people living 3—6 months longer, and more of them coming to some kind of cancer or Alzheimer's; a lot of older people would prefer to have a brisk stroke or coronary than most cancers or certainly Alzheimer's.
And thirdly, this may not save money on health services. People are not going to live forever. They will still have diseases when they are somewhat older. Becker : I have concerns about the anticipated magnitude of effect. A cheap, single pill taken once a day that combines four common drugs is safe and reduces the risk of events such as heart attacks, strokes and sudden death in people over the age of 50, research has found.
Daily pill to save millions
The study, the first large-scale trial to date, looked at the effectiveness of a so-called polypill — a four-in-one therapy containing drugs to lower cholesterol and blood pressure that was first proposed more than 15 years ago. While different formulations have been studied, previous trials have only been conducted in small groups of people and over short periods of time. These studies have primarily looked at the impacts of cholesterol on blood pressure, relying on models to predict the impact on cardiovascular events such as strokes — meaning the full potential of the polypill has remained unclear.
The latest study tackled both of these problems. Writing in the Lancet , researchers from the UK, US and Iran reported that 3, people were given only minimum care, such as help with controlling blood pressure or cholesterol if needed, as well as lifestyle advice on topics such as diet, exercise and smoking. A similar number of people were, in addition to this, also given the polypill. Participants were followed up for five years. Both groups showed similar low levels of problematic events including internal bleeding and peptic ulcers. Overall, the results suggested that two major cardiovascular events would be avoided for every 69 people taking the tablet for 5 years.