Saturday, February 18, 2006

Polypill versus Polymeal

A meta-analysis (basically a summary of all quality studies) was published in the British Medical Journal (BMJ) a couple of years back. It became known as the Polypill study.

In essence, it is a strategy to reduce the risk of cardiovascular disease, the biggest killer in Western society. Specifically, it aimed to reduce several risk factors clearly associated with cardiovascular disease, such as blood pressure, cholesterol, and clotting propensity. It provided some evidence that if everyone over 55 or with a history of cardiovascular disease starting popping this combination pill, the incidence of heart attacks and strokes would drop by 80-90%.

There has been considerable debate about this. Some question the methodology and statistical leaps of faith of the researchers. Some question cost effectiveness. A Dr Trewby, a Darlington physician, took the trouble to review the statistical claims in detail. He points out that, "if a typical 55 year old took the Polypill for the next 10 years the chance of benefit will be less than 1% per year and that of side effects 6% overall, some of which (such as aspirin related gastro-intestinal haemorrhage) may be life threating".

"There are three types of lies - lies, damn lies, and statistics." (Mark Twain)

A rather whimsical response to the Polypill proposition was published in the BMJ a year or so later: the Polymeal. By careful wording of statistical results adopting this particular dietary approach suggested a 76% reduction in cardiovascular events.

Ingredients of most benefit were red wine (1/2 a glass a day), fish four times per week, lots of fruit and vegetables, of course, almonds, garlic, and...100 grams per day of dark chocolate. The last one got a lot of lay press attention, that's for sure. Most didn't realise the whole exercise was a bit tongue in cheek, and the evidence tenuous. dinner plans for tonight are garlic bread followed by a fish meal, accompanied by red wine, with a chocolate dessert.


1 comment:

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