Americans tend to like magic bullets and a polypill might seem to fit the bill, but a majority of 番茄社区app readers are not convinced such a pill is the answer.
A total of 56% of the more than 2,100 voters who responded to last week's survey suggested they would not prescribe a polypill comprised of fixed doses of aspirin, a statin, and two hypertension drugs.
"A polypill may increase patient adherence but it doesn't seem like it is completely effective. Seems like a shortcut that doesn't lead to the right destination," commented a reader who sounded a theme voiced by others.
"Just another gimmick to get brand name prices for generically available drugs," chimed in another skeptic.
"This pill is not a multi-flavored ice cream. These are very toxic drugs that must be controlled separately. In my view, it's a dangerous money scam," said another.
Whatever the motives of pharmaceutical companies for producing a polypill, many readers acknowledged the problem of polypharmacy -- patients taking five to 30 pills three times a day -- "which borders on madness."
So, if the polypill is not the answer, what is?
A polypill might, and the operative word is "might," help with compliance, but a better strategy, suggested by readers, would be for physicians "to work more closely with patients, educate them, have medical teams perform supportive telephone follow-ups."
That might be fine and dandy for Americans, but the picture may be different in emerging economies, as readers suggested.
"In India, a prescription containing multiple drugs is very common and it is also widely propagated by the pharmacological companies. The majority of patients -- being less educated and coming from low economical status -- prefer fewer pills. For them the polypill is an advantage."
But let's here from those who are in favor of the polypill. "To me it's a no-brainer. It would increase patient compliance, be cheaper, and only involve one copay," said one reader.
And another commenter added this: "Improving patient compliance is an important goal. Making medical regimens simpler, especially for older patients, even when the gains are modest in terms of ultimate result (no one has yet proven conclusively that reducing blood cholesterol reduces cardiac events), is beneficial for patient well-being. When this study came out last week, I polled a very small sample of people taking all three of the medications in the polypill and 100% stated they would rather take a single pill."
A reader identified as a pharmacist said to forget the polypill and instead initiate a "polymeal," which would be "better tolerated and avoid any claims of conflict of interest."
In line with that sentiment, another reader said he refused the advice to undergo bypass surgery for unstable angina and instead decided to make some lifestyle changes including eating a low-fat, high-fiber vegetarian diet. "I have been leading an active life after 6 months. A polymeal is what is needed, not a pill," the reader said.
One of the commenters suggested the study was skewed in favor of the polypill because polypills were distributed free, but patients in the control group had to pay for their drugs. "Of course adherence is going to be better if a drug is free."
The final word from one expert is that the "polypill isn't a panacea and shouldn't replace clinical judgment."