Editing Polypill (section)

==For preventive medicine==

=== Origin of preventive medicine applications ===
[[Nicholas Wald|Wald]] and [[Malcolm Law|Law]] had first proposed using a combination of well-known and inexpensive medications in one pill for protection against cardiovascular disease.<ref name="pmid12829553"/> They presented a [[statistical model]] which suggested widespread use of such a polypill could reduce mortality due to [[heart disease]] and [[stroke]]s by up to 80%, while the drugs and their respective interactions are already fairly well known and understood due to many years of being prescribed together (via separate pills). They proposed combining six medications already established in treating [[cardiovascular disease]] and associated conditions, providing these in a single pill to people in Western countries aged 55 years or more as a preventive measure (albeit in lower doses than when used for treatment).<ref name="pmid12829553"/>

=== Developments of preventive medicine applications ===

Any physician could currently prescribe all the components of many proposed polypills separately for their patients, whether therapeutically or preventively.  And since the ingredients of many possible polypills are off [[patent]], it can be cheap to commercialize, although FDC products with novel combinations or formulations can sometimes themselves be patented.  Of course, for any FDC product, the potential market for a given combination of drugs/dosages would need to be sufficiently large to justify the clinical trials and other expenses associated with mass-producing a new drug.

=== Producing countries ===
The polypill, drugs to lower blood pressure, is produced<ref>{{cite web |title=بازتاب دستاورد جدید ستاد اجرایی فرمان امام در تولید دارویی برای سکته قلبی و مغزی|url=https://www.isna.ir/news/98060402209/%D8%A8%D8%A7%D8%B2%D8%AA%D8%A7%D8%A8-%D8%AF%D8%B3%D8%AA%D8%A7%D9%88%D8%B1%D8%AF-%D8%AC%D8%AF%DB%8C%D8%AF-%D8%B3%D8%AA%D8%A7%D8%AF-%D8%A7%D8%AC%D8%B1%D8%A7%DB%8C%DB%8C-%D9%81%D8%B1%D9%85%D8%A7%D9%86-%D8%A7%D9%85%D8%A7%D9%85-%D8%AF%D8%B1-%D8%AA%D9%88%D9%84%DB%8C%D8%AF-%D8%AF%D8%A7%D8%B1%D9%88%DB%8C%DB%8C-%D8%A8%D8%B1%D8%A7%DB%8C|website=Isna |access-date=23 August 2019}}</ref><ref>{{cite web |title=تولید داروی پلی پیل و کاهش 50درصدی سکته قلبی و مغزی |url=https://www.farsnews.com/news/13980605000100/%D8%AA%D9%88%D9%84%DB%8C%D8%AF-%D8%AF%D8%A7%D8%B1%D9%88%DB%8C-%D9%BE%D9%84%DB%8C-%D9%BE%DB%8C%D9%84-%D9%88-%DA%A9%D8%A7%D9%87%D8%B4-50%D8%AF%D8%B1%D8%B5%D8%AF%DB%8C-%D8%B3%DA%A9%D8%AA%D9%87-%D9%82%D9%84%D8%A8%DB%8C-%D9%88-%D9%85%D8%BA%D8%B2%DB%8C |website=فارس}}</ref> in [[Iran]] by the support of [[Execution of Imam Khomeini's Order]] was designed 14 years ag and called "PolyIran". According to the study was conducted by doctors from Tehran University, the University of Birmingham in Britain and other institutions and published by The Lancet, it worked quite well in a new study, slashing the rate of heart attacks by more than half among those who regularly took the pills. The pill in the study, which involved the participation of 6,800 rural villagers aged 50 to 75 in Iran, contained a cholesterol-lowering statin, two blood-pressure drugs and a low-dose aspirin.<ref>{{cite news |last1=Gallagher |first1=James |title=Four-in-one pill prevents third of heart problems |url=https://www.bbc.com/news/health-49434337 |access-date=23 August 2019|work=BBC News |date=2019-08-23 }}</ref><ref>{{cite news |last1=McNeil Jr. |first1=Donald G. |title=This Daily Pill Cut Heart Attacks by Half. Why Isn't Everyone Getting It? |url=https://www.nytimes.com/2019/08/22/health/heart-disease-iran-study.html |newspaper=The New York Times |access-date=22 August 2019|date=2019-08-22 }}</ref>

Certain "cardiovascular polypills" are currently available in [[India]] and have been extensively studied there (see [[Polycap]] and [[PolyIran]], for examples). Also, cardiologists in Spain are developing a polypill for secondary cardiovascular prevention.<ref>{{cite journal |vauthors=Sanz G, Fuster V |title=Fixed-dose combination therapy and secondary cardiovascular prevention: rationale, selection of drugs and target population |journal=Nat Clin Pract Cardiovasc Med |volume=6 |issue=2 |pages=101–10 |date=February 2009 |pmid=19104519 |doi=10.1038/ncpcardio1419|s2cid=205339553 }}</ref>

=== Preventive use rationale: Treatment of population risk ===
Some preventive-use advocates propose that everyone over a given age (e.g., 55) should take such medications for preventive health, irrespective of individual risk factor levels. The idea is that most people in western countries are at high overall risk, thus lowering risk factor levels will provide broad benefit. This approach emphasizes the perspective that risk factors are continuous, and rigid dichotomies such as "hypertension" and "no hypertension" may be over-simplified and can be viewed instead as continuums of inter-connected factors.<ref>{{cite journal |vauthors=Law MR, Wald NJ |title=Risk factor thresholds: their existence under scrutiny |journal=BMJ |volume=324 |issue=7353 |pages=1570–6 |date=June 2002 |pmid=12089098 |pmc=1123506 |doi=10.1136/bmj.324.7353.1570}}</ref>

In this paradigm, doctors would in effect be treating population risk rather than individual risk factor thresholds as is current mainstream practice. So, if everyone were given a relevant kind of polypill, the average blood pressure and cholesterol levels in the population would fall, thus reducing overall population risk. Perhaps ironically, this is in a sense going in the ''opposite'' direction from [[personalized medicine]], since mass-produced or fixed-dose-combination polypills are in some tension with the goals of personalized medicine, due to the "fixed" nature of the "dose combinations." Proponents of this population-focused approach contend that the advantages of drug consolidation can outweigh any reduction in personalization of drug and/or dose selection. Also, depending on the demographic distribution and market size, there may be room for some different alternative versions of certain general FDCs to be manufactured with differences in their respective dosages and/or drugs. A widely distributed polypill could contain three blood pressure medications at low dose: a [[diuretic]], such as [[hydrochlorothiazide]], a [[beta-blocker]] such as [[atenolol]], and an [[ACE inhibitor]] such as [[lisinopril]]; and these could be combined with a [[statin]] such as [[simvastatin]], [[aspirin]] at a dose of 75&nbsp;mg, and [[folic acid]], which has been shown to reduce the level of homocysteine in the blood, which is another risk factor for heart disease.