1. Heart Disease
HIV/AIDS
Tuberculosis
Malaria

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

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

5. 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

6. Polypill: Case Study of a Failed Product
Dan Crean

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

8. 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

9. Supply Side Worries
Side effects
Concern about best pill formulation

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

11. 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

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