05/02/2009 05:12 am ET | Updated Nov 17, 2011

Two Cheers for Cardiac Superpill

It looks like the next big product at McDonald's will be the healthy, happy meal that will provide us with a Big Mac, a jumbo order of fries, a large Coke and perhaps a mini-pie as well as the new polypill created by the cardiac community that promises to reduce heart attacks and strokes by at least half.

The pill would significantly improve our health to a point where we could go back to eating as much as we liked of whatever we liked without worrying about shortening our lives. It wouldn't solve all our problems. We'd still worry about obesity and diabetes, but there's new evidence that bariatric surgery, which remains a bit more expensive than the one-dollar polypill, can reverse both of these troubling conditions.

I'm not curmudgeon enough to rain on the parade of those celebrating this new pill, but it does remind me again of the tension between those who nag us to take better care of ourselves -- and are often ignored -- and those who have faith that science will solve our problems. This is America, so it isn't surprising that the latter group is winning.

And it is probably too early to start contemplating what disease will subsequently explode to take up the slack if we move toward broad use of the polypill, but I'd be willing to place a modest bet on dementia, which seems to be getting a fair amount of attention. Hovering in the background is the question of whether it is preferable to die slowly from Alzheimer's, quickly from a massive heart attack or confront a range of choices that come with having a stroke.

Even in our world, few talk seriously about defeating death, so it is prudent to acknowledge the question even if raising it is hardly a compelling argument against the polypill.

A more immediate question is how plausible the new projections are, even assuming that the research is strong and the side effects minor. Our losing war against obesity suggests that people don't quickly and naturally change their behavior simply because they're told it would be prudent to do so. So while it may be possible to reduce heart attack and stroke deaths, the numbers we're now hearing are probably exaggerated.

There's some evidence from those who deal with compliance issues that those who could be helped most -- if only because they are the most at risk at the start -- are the hardest to convince. Providing a pill won't help people who don't take it.

Perhaps our next study should enlist McDonald's to grind up the ingredients of the polypill and cook the result into the fast food items we order. That could make a big difference.

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