Leisure, Lifestyle & Wellness
Poly-pill: The case of missing evidence

There is no scientific study to tell us if at all is safe to combine drugs in one poly-pill

A few years ago, the British Medical Journal wrote an editorial on the need to have a broad perspective on killer diseases like heart attacks, strokes and their risks. I was a bit confused by the editorial and the connected articles in that issue. Fiona Godlee, the editor-in-chief, and the authors of the cited articles were advocating a broad perspective in preventing cardiovascular diseases, and rightly so. However, at the same time, they were forgetting the most important aspect of the risk factors for cardiovascular diseases: the mind. Several studies, including the White Hall study, had shown that hostility, clinical depression and various other work-related stressors are risk factors. While the editor-in-chief and the contributors seemed engrossed in some of the questionable risks like cholesterol, raised sugar and arterial pressure, the vital role of the human mind was ignored.

The editorial is all about the new brahma-astra against many deadly diseases like stroke, heart attack and sudden death. The single-pill-for-life therapy is to start at the age of around 55 and go on till death! The drug, known as polypill, contains small doses of many drugs, namely, aspirin, three blood pressure (BP) lowering drugs, statins and folic acid. All the drugs are in sub-optimal doses. There is no scientific study to tell us if at all it is safe to combine these drugs in one pill. What has happened to our evidence base?

What is the basis of selecting people at the age of 55 for the pill? Many younger people die of heart attacks and stroke too. Should we not protect them also? From that point of view, it will be nice to start the polypill from birth, like the multitude of untested vaccinations that we give to kids today! I am worried about another fallout. For a healthy person aged 55, if three anti-hypertensive drugs are given unnecessarily, there is a chance of his BP plummeting. At the age of 55, most, if not all, people will have some degree of coronary artery blocks that are normal and do not produce diseases.

However, coronary filling occurs in diastole only. During sleep, these unfortunate victims’ BP could go so low that the diastolic filling in the partially blocked coronaries might get jeopardised leading to death! The multitude of possible adverse reactions of these drugs in combination could be mind-boggling. Although we have known aspirin for 350 years, we still do not know its ideal dose! That said, what of the other drugs in the polypill that haven’t stood the test of time?

All the components of the polypill are advocated in the editorial as panacea for prevention. When tested individually, even in adequate doses, it did not significantly reduce the likelihood of stroke, heart attack or death. While there were significant ‘relative’ risk reductions, the absolute risk reductions were negligible and the number needed to treat was prohibitively high, with dangerous (even fatal) adverse drug reactions. Ebrahim Shah and GD Smith went one step further to show that the ‘pooled effect’ of multiple risk-factor interventions on mortality was insignificant and very small. Professor Michael Oliver, Fellow of the Royal Society, Edinburgh, has shown that drug use for risk reduction is almost useless. GD Smith and M Egger ask a very pertinent question in their journal titled Who Benefits from Medical Interventions. All these add up to the case of the missing evidence of Sherlock Holmes. To cap it: the very basis of fat hypothesis in the causation of killer diseases is being questioned even in Western science!

All these efforts to use drugs at the drop of a hat are due to the inseparable marriage between the pharmaceutical lobby and the medical profession. In the words of one of the leaders in the field, Marcia Angell, former editor of the New England Journal of Medicine, “The ties between clinical research and industry include not only grant support, but also a host of other financial arrangements. Researchers serve as consultants to companies whose products they are studying, join the advisory boards, and the speakers’ bureaus, enter into patent and royalty arrangements, agree to be listed authors of articles ghost written by interested companies, promote drugs and devices at company sponsored symposia, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in companies.” Human illness and wellness need a very broad perspective, indeed! Our present perspective will not pass the scrutiny of Sherlock Holmes.

Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.



nagesh kini

3 years ago

This business of polypack is ostensibly a coverup for FDA norms and PCO norms. It will not hold good for all times.

Pulse Beat

Medical developments from around the world

Fruits and Vegetables Can Cure Cancer

According to Natural News, a non-profit website dedicated to individual empowerment, a raw diet with plenty of fresh fruits and vegetables could be a powerful adjunct to cancer therapy. Jay Kordich, known as the ‘father of vegetable juicing’ attributes consumption of raw foods to overcoming bladder cancer. One of his followers, John Kohler, has been on raw diet, mainly on juices. “Not only did he survive his spinal meningitis, but he also lost weight and is living life more healthfully than ever,” writes Mike Adams in Natural News.
Medical Tests and Interventions To Avoid
* Avoid inducing labour or C-section before 39 weeks, unless there is a medical reason to terminate pregnancy before the 39th week. Routine delivery before that is unhealthy for the baby, according to the American Obstetricians Association.

* Avoid routine annual pap smear test. One cannot predict the future from one test.

* Avoid CT scans to evaluate minor head injuries as each CT scan gives as much radiation as 100 chest X-rays.

* Avoid stress echocardiography as it does not give any additional information.

* Tight control of blood sugars, especially in the elderly, is dangerous. Do not repeat the blood sugar tests frequently.

* Avoid routine electro-encephalography for recurrent headaches. Clinical evaluation is good enough.

* Avoid drug treatment of acid reflux. Most of the drugs used could be dangerous. Raw green plantain could be a good antidote.

* Avoid lipid profile tests. They are expensive and provide little benefit.

* Avoid mammograms which are otherwise called ‘scammograms’. They do more harm than good. The false negative and false positives in mammograms are 30% and 89%, respectively.

* Prostate specific antigen (PSA) testing has been officially banned in the USA. Please do not get your PSA test done as its specificity and sensitivity are less than 50%. Hence, whether it is positive or negative, it does not matter.

* Avoid routine colorectal cancer screening. Nearly 71% of the so-called cancers are NOT cancers at all. This has now been admitted by the American Cancer Institute.

India Is a Fertile Ground for Drug and Vaccine Testing
India has become a hotbed of pharmaceutical fraud, as unscrupulous Western drug giants use India’s poor as human guinea pigs in their unethical and inhumane clinical trials. Clinical research organisations are big brokers who recruit Indian doctors and hospitals to do these trials as they are now almost banned in the West.

If the reader wants to know the truth about these trials, s/he should read a wonderful book titled Truth about Drug Companies: How They Deceive Us and What To Do about It’, authored by Marcia Angell, former editor of New England Journal of Medicine. She was the editor for 20 years. Her book is a great revelation for the novice. We have obliging doctors in India who help the drug giants to get what they want—for a good price!


Tarun Tejpal’s ThinkWorks took over highly profitable THiNK Fest in 2012 at no cost

The 2011 director’s report of Anant Media, publisher of Tehelka, claimed credit for THiNK Fest, the annual Goa jamboree in 2011. But next year, this highly profitable event came under the control of Tarun Tejpal-controlled ThinkWorks but no consideration seems to have been paid to Anant Media

THiNK Fest, the big annual event that has mired into a big controversy after Tehelka's editor Tarun Tejpal allegedly sexually assaulted a woman journalist from his magazine during the event, is claimed by Tehelka owners to be a product of ThinkWorks Pvt Ltd and not Anant Media Pvt Ltd, which owns the magazine. However, the directors’ report of Anant Media in 2011-12 (the latest available) claims great success for THiNK Fest in 2011. The directors’ report of Anant Media of that year says: “The company organised a mega event at Goa THiNK Fest 2011, which was a mega hit in the year 2011.” Anant Media is the owner of Tehelka.


According to a report in the Indian Express, THiNK Fest is organised by ThinkWorks, which is owned by Tarun Tejpal, his sister Neena Sharma (who signed as Neena Tejpal in the ThinkWorks directors report) and the Tehelka magazine's managing editor Shoma (Suparna) Chaudhary. "The only association of Thinkworks with Anant Media Pvt Ltd, which publishes Tehelka, is that it buys advertisement space from the magazine, though the sponsors said their understanding was that THiNK Fest was organised by Tehelka magazine," the report says.


So, when the highly successful property THiNK Fest come under by control of ThinkWorks?


Going by the directors’ report, the event was owned by Tehelka, at least till 2011. If so, Tarun Tejpal, his sister Neena Sharma along with Shoma Chaudhary acquired control of this highly successful event the very next year. In 2012, ThinkWorks was a shell company, and was earlier called Babbler Brooks Pvt Ltd. In 2012-13, ThinkWorks earned Rs14.26 crore as revenues from the event and just under Rs2 crore as profit. This year’s event was even bigger and more profitable. There is not only no evidence that Anant Media, owner of Tehelka was paid any consideration to pass on the THiNK Fest property to ThinkWorks, but also no cost or revenue-sharing with Anant Media.


Interestingly, while Tehelka and Anant Media are trying hard to align themselves from the THiNK Fest (due to the controversy) their respective logos still shows the 'crow' in high esteem!

Even, on the THiNK Fest website, if one wants to read any article, it redirects to Tehelka portal showing the connection between the two.


Subsequent to the revelation that THiNK Fest is not a Tehelka event, critics have asked if THiNK Fest is owned by a separate firm, then why were Tehelka magazine staffers forced to work in it, leading to the alleged sexual assault on a woman journalist by Tejpal. 


The alleged incident happened in a lift in a five-star hotel in Goa earlier this month. The Goa police had on 22nd November lodged an FIR against Tarun Tejpal under sections 376 (rape), 376 (2)(k) (rape by a person of a woman in his custody taking advantage of his official position) and 354 (outraging modesty) of IPC in connection with the incident. Conviction under section 376 of IPC entails a maximum of life term in jail.


According to another report from Indian Express, Tarun Tejpal had joined hands with controversial liquor baron Ponty Chadha before he was killed last year to start an exclusive private club for "select urban Indians" called Prufrock.


Officials in Wave Industries, the flagship company of the Chadha Group, told the newspaper that Chadha decided to invest in Prufrock in early 2012 after Tejpal made a business presentation on the concept of an exclusive private club.

Chadha was killed in a shootout in his farmhouse in Delhi in November 2012, but his son Manpreet 'Monty' Chadha decided to honour all business commitments of his father, the report says.


Prufrock, the private club, is owned by Thriving Arts Pvt Ltd, which was set up in June 2013. On 10th July, the company issued shares to two stakeholders at Rs10 per share — 72% to Tejpal and 28% to his sister Neena Tejpal.


On 26th August, Chadha Hotel's Pvt Ltd invested Rs2 crore for 11,111 shares issued at Rs1,800 per share in the venture, the news report says.




3 years ago

There is an interesting article in Firstpost about the financial engineering by Tarun and Shoma. As per the article, even though Tehelka cannot boast of healthy profits, apparently, Tarun and Shoma sold some of their shares, which were bought at Rs.10, at about Rs.13,000 to some entities who are obscure.


nagesh kini

In Reply to KAVIRAJ B PATIL 3 years ago

"Dal mey kala hai" something fishy!


3 years ago

As long as the Congress is in power, it will go to any length to protect one of its own!

nagesh kini

3 years ago

Have the transactions between the two seperate legal entities been 'at arm's length tractions' and appropiately disclosed in the Related Parties Transactions as required by Schedule VI to the Companies Act, 1956. The ROC needs to inquire!

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