SO again, from the population perspective, effective preventive strategies aided by legislation are required.

The government and our legislators have to show a more determined political will in instituting various preventive measures, most urgent of which are to discourage smoking and excessive drinking, and convincing food manufacturers to cut down the use of salt and other harmful chemicals they use in processing various food products.

Without this political will, the gains of the cheaper medicine law (RA 9502) and the executive order mandating a maximum retail price for essential products would be like water collected in a hole-filled container.

It would also seem like the government is trying to address the healthcare problem in the country by trying to put out the fire in one end, but not preventing people on the other end who are recklessly fueling the fire.

However, despite best efforts at preventive measures, many in the population will still get sick and need medicines. For cardiovascular diseases, which remain the leading cause of deaths in the country, it may be cost-effective for the government to consider the polypill solution for the masses.

Polypill concept

The polypill concept was proposed in 2003 when British health experts (Doctors Wald and Law) postulated that by using a combination of well-known, cheap medications in one pill which they called the ?Polypill,? it was possible to reduce complications of and deaths due to cardiovascular disease by more than 80 percent. This was shown by a statistical model they created based on data from many clinical trials using the individual components of the polypill. Side effects were to be expected in only 10-15 percent of recipients.

The polypill would contain three blood pressure medications at low dose: a diuretic, a beta-blocker and a drug working on the renin-angiotensin system. This is combined with a cholesterol-lowering drug (simvastatin), plus aspirin and folic acid. Folic acid has been shown to reduce the level of homocysteine in the blood which is another risk factor for heart disease.

Many scoffed at this postulate and labeled it as an unrealistic statistical fluke. But this year, Dr. Salim Yusuf of McMaster University in Canada and Dr. Prem Pais of St. John?s Medical College in India presented their study on the Indian version of the polypill.

The Indian Polycap Study (TIPS) evaluated the effect of their five-in-one-capsule drug, using similar drugs as proposed in the original British model, in 2,000 individuals with an average age of 54, all of whom had at least one heart disease risk factor: diabetes, hypercholesterolemia, hypertension, obesity or smoking.

In short, benefits from the polycap could translate into cutting the risk of heart disease by 62 percent and of stroke by 48 percent. The combined pill was almost as effective as the individual pills with no increase in side effects.

Best part

The best part of the story is that the Polycap, when manufactured in big volumes, would only cost roughly P5 per capsule. So, cost of monthly treatment would only be around P150. That would be all a big percentage of the high-risk population would need. Some would need additional doses of the individual components of the polypill but the total cost should still be affordable by the masses.

The polypill solution may look too good to be true, but we?ve tried all sorts of solutions and measures and none so far has effectively worked at the population level for cardiovascular disease. We?re not talking here about the top 30 or 40 percent of the population who can afford currently available drugs. We?re trying to come up with something which the masa, who ironically have more than their fair share of health problems, can very well afford.

The LRT or MRT is to the transport problem, as the polypill is to the healthcare problem of the country. Those who can?t afford to buy even the cheapest cars can still reach their destination by taking the mass transport system, so they don?t need to walk. Those who can?t afford medications even with their government-mandated reduced prices, need not face the bleak option of just not taking any medicine for their serious illnesses. They can take the pill for the masses?the polypill.

Legislation for effective preventive measures plus the polypill are probably our best shot in keeping Filipinos?the affluent and the masa alike?healthy, more productive and living more meaningful lives.