High blood pressure, heart attacks, strokes, Alzheimer’s disease, diabetes 2 and obesity are all consequences of eating too much of the wrong food, smoking tobacco, and living  sedentary lives. In Canada, a public financed health care system is too costly and is deteriorating rapidly as budget cuts reduce resources available. The tidal wave of food-related disease threatens to bankrupt health care systems if existing methods of diagnosis and treatment continue to be used.

The medical view is focused on each individual. The assumption is that medical doctors are available to rescue each person from any and all misadventures. The cost of individual rescues is high and increases every year. The solution in Canada to rising costs is to ration services, punishing all health care workers and many patients who are denied services and have to wait in queues. The medical view is that expensive measurements have to be made on each person and detailed images taken. MDs have an exclusive interest in drug treatments and see themselves as drug prescribers and not problem solvers. The cost of individual management is extravagant and many have argued that the results of individualized treatment of obesity, high blood pressure, elevated blood sugar and elevated blood fats are poor to very poor. If the results were excellent and the dire consequences of these risk factors were avoided, you could argue that high cost of individualized care was justifiable. funny games

A public health view can be quite different from a medical view. To pursue public health you need tools that reduce or remove the causes of disease. You also want strategies that improve an entire population’s resistance to disease. For example, you set up elaborate infrastructures to assure that the supply of water and food is relatively free of infectious agents. When you observe increasing obesity associated with increasing blood pressure, diabetes, heart attacks and strokes, you turn to tools of public education and persuasion hoping to modify the food selection and eating habits of everyone at risk. If you find that your public education efforts are not reducing high risk behaviors you might ask what general measures could be taken to mitigate the consequences. Seat belts mitigate high risk behaviors, reduce injury and reduce fatalities in car crashes, for example.

Nicholas Wald of the Wolfson Institute of Preventive Medicine in London, England has suggested that a “polypill” should be given to everyone aged over 55 to reduce heart disease and stroke by 80%. His idea would reduce most of the cost of individualized care. Several existing drugs would be combined: three different drugs to reduce blood pressure, as well as aspirin, a statin to reduce cholesterol, and folic acid to reduce homocysteine levels.  Wald estimates that the polypill could save some 200,000 lives each year in Britain alone.

If I were designing the polypill, I would include folic acid, pyridoxine, vitamin B12, ASA, chlorthalidone, atorvastatin and telmisartan. Taking a little step toward the polypill, the British government decided to license simvastatin for sale over the counter in July 2004. Other countries may follow suit, but some are concerned that easy access to the drug will jeopardize future research. The move toward a public health solution to expensive endemic diseases will be resisted by all who earn their living by offering individualized care and resisted even more vigorously by the pharmaceutical industry who shares a multibillion dollar market for  expensive drugs on the pharmacy shelf. 

Instead of the polypill, I advocate diet revision using the Alpha Nutrition Program, exercise and nutrient support with Alpha DMX a blend of all critical nutrients with therapeutic levels of key nutrients such as calcium, vitamin D, potassium, folic acid, pyridoxine and cyanocobalamin. I would refer people of all ages who are at risk of vascular disease to fitness centers with Alpha Nutrition Program food services. Alpha DMX would be distributed at low cost as a public health measure. Noncompliant people who continued high risk behavior would pay increased premiums for medical care.

Stephen Gislason MD