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They're back! The guys who brought us the Polypill have hatched another dubious plan

Sir Laugh-a-Lot

I’ve got good news and bad news.

First the good news: Wald & Law, two UK comedians, have staged a comeback. And they’re a laugh riot.

The bad news: Unfortunately, they’re not joking.

Couple of comedians

Wald & Law? Ring a bell? Let me refresh your memory.

In the e-Alert “With A Capital T, That Rhymes With P” (6/30/03), I told you about Nicholas Wald and Malcolm Law, two professors at London’s Wolfson Institute of Preventive Medicine. (Professor Wald is the director of the institute.)

In 2003, Wald & Law proposed a heart medication to end all heart medications: the Polypill. Over the past six years, other teams have put forth their concepts for a Polypill, but I believe Wald & Law were the first.

Their plan: In a single pill, combine a cholesterol-lowering statin drug, three different drugs to lower blood pressure, a low dose of aspirin, and some folic acid.

It’s a knee-slapper, right? Well hold on, because we’re just now getting to the punch line: In Wald & Law’s dream world, 80 percent of heart attacks and strokes might be prevented if the Polypill were taken by everyone with cardiovascular disease and everyone aged 55 and older.

What? You’re 58 and you have normal blood pressure and low cholesterol levels? Never mind that! You’re taking the Polypill, friend. It’s for your own good.

And don’t tell me you’re worried about side effects? Oh come on – relax! Wald & Law calculate that the side effects of the Polypill would be fatal in less than one person in 10,000. But let’s give those odds the benefit of the doubt and say one in every 15,000 users dies. That’s about 66 deaths per every million users (and W&L are thinking MANY more than a paltry million).

Sacrifice a few hundred to (in theory) save many? Hmmm…that’s not very funny at all.

Catching up

So what have Wald & Law been up to for six years?

Well, for one thing, Wald is now Sir Professor Wald. Seriously! Last year, Queen Elizabeth gave him a knighthood. Apparently someone at Buckingham Palace was dazzled by the idea of a Polypill. (To be fair, Sir Prof. W. has also done some key research of neural tube defects and Down’s syndrome screening.)

But the big news is a new study from Sir Wald & Law.

This time, the professors conducted a meta-analysis of nearly 150 trials in which blood pressure drugs were tested against placebo or other BP drugs.

Now, keep in mind that when you design a meta-analysis, YOU set the rules about how data is interpreted, and YOU choose the studies to be considered. So if you happen to have an agenda to promote and you happen to be motivated by enormous rewards if your agenda succeeds, then it’s fairly easy to create a meta-analysis that will tilt in your favor.

Also, with a meta-analysis, more is not necessarily better. As one doctor told heartwire, by examining 147 trials, Wald & Law had to make numerous assumptions, “some possibly valid, others clearly not.”

So! You’ll never guess what Wald & Law discovered in their meta-analysis! Apparently, using three different blood pressure drugs reduces risk of heart disease and stroke more effectively than using just one blood pressure drug. That’s some crazy coincidence that the Polypill JUST HAPPENS to contain three BP drugs!

But wait – you know with these guys there’s always more.

In their conclusions, Wald and Law wrote: “Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.”

Everyone. Just like the Polypill.

And Prof. Law told heartwire that everyone benefits from drugs that lower blood pressure. Prof. Law: “Whatever your blood pressure, you benefit from lowering it further.”

Really. He said that. As if he’d never heard of hypotension (low blood pressure), which can cause dizziness, fatigue, depression, nausea, and blurred vision.

Here’s what HSI Panelist Allan Spreen, M.D., had to say about Law’s comment: “If there ever was an irresponsible statement, that has to be one of ’em. How could moving any bodily function parameter from the normal range to an abnormal range be even remotely considered a ‘benefit’? Nobody would say such a thing unless there was a self-serving reason.”

As usual, Dr. Spreen nails it.

Sources:
“Use of Blood Pressure Lowering Drugs in the Prevention of Cardiovascular Disease” British Medical Journal, Vol. 338, 5/19/09, bmj.com
“Give Blood Pressure Drugs to All” Fran Lowry, Medscape, 5/28/09, medscape.com
“A Strategy to Reduce Cardiovascular Disease by More than 80%” British Medical Vol. 326, 6/28/03, bmj.com

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