The only problem with the polypill is that it doesn't go far enough

Copperfield waxes lyrical about the virtues of a polypill for all over-50s

It’s great to see the polypill concept getting renewed impetus. And I am absolutely not being ironic here. The idea of a fire-and-forget preventive treatment containing low doses of CV-busting drugs doled out to everyone from aged 50 is the greatest medical idea ever.

Any naysayers must be so stupid/shortsighted that they should be denied the polypill and bow to survival of the fittest rules. What they’re overlooking is that the real beneficiaries of this wonder drug are not the pill-popping punters, but us GPs. The polypill would slash our workload by about 30% overnight, and the workload it’ll slash is the most brain-numbingly, eye-gougingly dull and thankless preventive stuff.

The only problem with the polypill is that it doesn’t go far enough. If I was in charge of the pestle and mortar, I’d slip in the following:

Amitriptyline: my ‘Desert Island’ drug. It helps insomnia, IBS, migraine, OABs, neuropathy, tension and fibromyalgia, all of which I have by close of play on a Monday. Only a low dose, tragically. Remember when we dished out 150mg/day for depression? Happy days. Literally.
SGLT-2i: amitriptyline v2.0, as its list of indications expands by the day. Bring it on.
Orlistat: just look around you. That’s got to go in.
SSRI: everyone should just cheer the f*** up and calm the f*** down. But that’s counselling, and it doesn’t work. Hence a dose of happy pill.
Paracetamol: if life’s such a pain, take something for it. And regular doses are best for chronic pain, right?
Metformin: if you’re not diabetic, you’re pre-diabetic, or pre-pre- diabetic, etc etc. Just a small dose ie pre-metformin.
Aspirin: stops heart attacks and cancer. Something like that. I may not be up to speed here.
Anti-emetic: all these drugs will make you feel a bit sick.
Laxative: or constipated.
PPI: or dyspeptic. Plus the aspirin needs PPI cover. Plus everyone’s on them already.
(For pink Polypill, female version) HRT: obvs.
(For blue Polypill, male version) Sildenafil: also obvs, plus it would improve concordance.

There, no one need ever come over ill, sad or dead again.

And for those who claim, usually while chewing on huge chunks of pizza, that they can’t swallow tablets, we’d have the ‘polyprick’: an injection containing, off the top of my head, inclisiran, vitamin B12, a GLP-1 agonist, haloperidol etc. A work in progress.

Worth thinking about, though, because one disadvantage of my polypill-plus is that it would be the size of a hockey-puck, so there’s a choking hazard. Now, that is ironic.

Dr Tony Copperfield is a GP in Essex