According to Thomas Edison (1847–1931): ‘The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease’ (Anonymous, 2025). Notwithstanding Edison's achievements as an inventor, a gift for clairvoyance eluded him, since his prediction has not yet been realised.
For example, in their review and meta-analysis, Delara et al (2022) reported that the ‘pooled estimated prevalence of polypharmacy in the 54 studies reporting on polypharmacy in all medication classes was 37%.’ And Bennie et al (2024) note that ‘[t]he prevalence of polypharmacy of 5–9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany).’
Yet despite this dependence on medication, might the era of polypharmacy be supplanted with what we might term ‘monopharmacy’? It's a question that warrants reflection in the light of increasing attention being given to the apparent virtues of the so-called polypill, a word first coined by Wald and Law (2003). They estimated that the combination of six ingredients: namely, a statin like atorvastatin or simvastatin; three blood pressure lowering drugs; folic acid; and aspirin ‘reduces ischaemic heart disease events by 88% … and stroke by 80% …’ (Wald and Law, 2003).
By March 2025, in an opinion piece by Jordan et al (2025), which noted that the polypill approach was first proposed in a patent application in 2000, the authors suggest that this ‘is more than a pharmaceutical formulation; it is a public health strategy in which everyone in the population above a specified age (currently judged to be 50 and over) would be offered a polypill without medical examination or testing but simply an inquiry to identify a few specific contraindications.’
Among the evidence supporting this ‘public health strategy’ was the PolyIran study – not a randomised controlled trial but a cluster trial undertaken in rural Iran – from which Roshandel et al (2019) concluded that the ‘polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in low-income and middle-income countries.’
But despite this seemingly glowing prospect for a universal polypill, obesity researcher Dr Zoë Harcombe has demonstrated that it has severe shortcomings. Thus, ‘You don't need to be an eagle-eyed reader to spot that the PolyIran tested in the Iranian study was not the polypill on the polypill website’ (Harcombe, 2025). Whereas PolyIran tested a ‘four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan’ (Roshandel et al, 2019), the Polypill.com website (Polypill Prevention Programme, 2025) describes it as comprising rosuvastatin, hydrochlorothiazide, amlodipine, and losartan. Only hydrochlorothiazide is common to both polypills.
Further, the University College London (UCL) website states: ‘In their piece, the authors pointed to a randomised trial in rural Iran, whose findings were published in 2019, showing that a polypill taken for five years reduced heart attacks and strokes by a third’ (UCL, 2025). But Harcombe (2025) points out that this assertion is contradicted by the Polypill website Home Page (2025), which states ‘Reduce your risk of heart attack and stroke by two thirds.’ Harcombe (2025) asks: ‘A third or two thirds? Which is it?’ One might reasonably expect that those who are promoting ‘a public health strategy’ (Jordan et al, 2025) as a serious proposition should get their facts right.
Leaving aside the ongoing debate about the questionable merits of the cholesterol hypothesis, on which statin-based lipid-lowering strategies are based, Fiuza-Luces et al (2013), as the title of their paper makes clear, assert that ‘exercise is the real polypill’, and suggest that ‘additional and important health benefits of exercise interventions that are unlikely to be achieved by polypills are significant decreases and increases in adiposity and cardiorespiratory fitness, respectively.’ Fiuza-Luces et al (2013) also adduce evidence suggesting that rates of tolerability/adherence to exercise are favourable ‘with an average drop-out from the exercise programmes of 10%, whereas those taking polypills are more likely to discontinue medication compared with placebo or one drug component (20% vs. 14%).’
Perhaps we might allow ourselves to reflect on the possibility that, if claims about polypills are subjected to rigorous scrutiny, Edison's optimism might one day be realised.