Heart Disease HIV/AIDS Tuberculosis Malaria

http://www.who.int/mediacentre/factsheets/fs310/en/index1.html

Fight back with…. Aspirin - 1890s Antihypertensives Diuretics - 1950s Beta Blockers - 1960s Calcium Channel Blockers - 1960s ACE Inhibitors - 1980s Sartans - 1990s Statins (cholesterol) - discovered 1970s, boom in 1990s

Public health problem: how do we get these drugs to people around the world? Sample Polypill formulation Aspirin - 75 mg Folic acid - 0.8 mg Simvastatin - 20 mg Atenolol - 50 mg Hydrochlorothiazide - 12.5 mg Answer: The Polypill Combination medicine Cheap, efficient

Make Billions of pills - Distribute Widely One size fits all Long shelf life Give indiscriminately Instruct community leaders (e.g. village elders) - EVERYONE past age 35 should take pill every day

Polypill: Case Study of a Failed Product Dan Crean

Why??????? Conservatism Competition Inertia Hard to introduce new medicines. Competition For aid/relief dollars Inertia

Fear of change? Inherent cultural conservatism in medical profession worldwide International agencies reluctant to try new drug combo in poor countries until it has proven effective in rich countries Governments reluctant to allow drugs not used widely in rich countries

Supply Side Worries Side effects Concern about best pill formulation

Too easy? One-size fits all philosophy runs counter to trend toward personalized medicine. Worry about people neglecting other healthy lifestyle

Competition on supply side International NGOs prefer devices (e.g. new toilets, waste treatment) to drugs No corporate marketing budgets to convince consumers/ doctors/regulators of benefits Cost for FDA approval

Other diseases targeted with polypills The Future Idea not dead Other diseases targeted with polypills