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EXTRA!

July 12, 2003

Guest Column

TO REDUCE THE RISK OF HEART DISEASE, WHY DON’T WE ALL CUT OFF OUR EAR LOBES?

By Dr. Peter H. Langsjoen

The British Medical Journal (BMJ) recently published a proposal calling for the development of a "polypill," a medication consisting of six different drugs, aimed at reducing the risk of cardiovascular disease by 80 per cent or more.

This proposal is an unbelievable exaggeration of any drug benefits that such a polypill could possibly provide, and it represents a great minimization of potential drug side effects.

At its core, the proposal, in effect, implies that risk factors are causative. If that’s the case, why don’t we do some novel prevention work. For example, since a deep ear lobe crease is a risk factor for coronary artery disease, why not cut off our ear lobes after the age of 55, or for that matter, why not start snipping them off at birth? After all, the sooner the intervention, the better, and the small inconvenience is certainly worth the millions of lives and billions of dollars that might be saved.

Then there’s the issue of adverse drug effects. It is a basic principle of medicine to start medication (when necessary), one prescription at a time, so that when a patient develops an adverse effect it is simple to identify the offending agent and alter treatment.

The polypill would include three anti-hypertensive drugs:

* A thiazide diuretic, which, for example, may be associated with rash, sun sensitivity, leg cramps and potassium depletion.
*A beta blocker, which, for example, may be associated with fatigue and impotence.
* An ACE inhibitor, which, among other things, may be associated with a cough.

Next: aspirin, which may be associated with allergic reactions, GI distress and iron deficiency anemia.

Then, of course, the polypill would include what I believe is the most insidious toxin ever prescribed to humans: a statin (cholesterol-lowering) drug.

At least commonly toxic drugs, such as chemotherapeutic agents, are obvious in their rather immediate side effects. Statins, on the other hand, bring about a gradual, insidious state of fatigue, muscle soreness and eventually heart muscle weakness, which comes on after many months or years. Furthermore, there is evidence for statin-related increases in cancer, peripheral neuropathy and cognitive impairment.

Folic acid would also be part of the polypill. It is associated with homocysteine lowering and therefore makes some theoretical sense. Perhaps the polypill proponents may have added this to give their proposed product an aura of safety.

Last, but not least, I am dumbstruck by the idea of making the polypill available without a medical examination. Would such a pill be sold over-the-counter? According to BMJ editor, Richard Smith, it might even be washed down with wine at a pub. What an insult to good wine! Can you imagine having a wonderful evening at the pub only later to discover that you’re impotent from the beta-blocker, coughing your head off from the ACE inhibitor, having terrible leg cramps from the diuretic, and awakening the next morning having forgotten everything due to statin-induced memory loss!

If we are gullible enough to believe that we are all somehow diseased after age 55, and that in order to save ourselves, we must swallow this toxic garbage pill, with blind confidence in the pharmaceutical/medical industry, then perhaps there is more than a little of the lemming in us all. Maybe in some mysterious way humans need to run off a cliff from time to time.

Peter H. Langsjoen, MD, is a cardiologist and biochemist with a clinical practice in Tyler, Texas. He comments frequently on cardiovascular issues and he has helped to pioneer research on Co-Enzyme Q10.

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