Heart attacks and strokes are among the leading causes of death globally, with millions suffering from cardiovascular diseases (CVD) every year. There are more than seven million people in the UK alone, with about 100,000 patients experiencing heart attacks annually. However, a group of researchers at University College London (UCL) estimate that one 'polypill' taken daily day could eliminate a majority of these cases dramatically lowering death tolls.

The proposed polypill, a combination of a statin and three blood pressure-lowering drugs, has been under study for over two decades. Experts argue that introducing this pill universally for individuals aged 50 and above could be more effective than the current NHS Health Check, which assesses risk factors every five years for those aged between 40 and 74.

Studies have repeatedly proven the effectiveness of the polypill in preventing CVD. A groundbreaking 2019 study in The Lancet found that five years' use of the polypill cut the risk of heart attack and stroke by a third. In addition, previous modelling analyses have estimated that if given universally to people over 55, the polypill might be able to prevent 80% of heart attacks and strokes.

Today, the NHS Health Check follows a risk-based model in which patients are tested for CVD risk factors and treated with drugs accordingly. Yet, as per UCL's study, this system has serious flaws:

Low Uptake: Just 40% of those eligible for the NHS Health Check choose to have it, leaving a considerable number of at-risk patients undiagnosed and untreated.

Ineffective Prediction of Risk: The majority of heart attacks and strokes happen to people at average risk levels, thus making it challenging to identify the need for intervention effectively.

Limited Effectiveness: Even at maximum take-up, the NHS Health Check programme is predicted to have fewer health impacts compared to a polypill initiative applied to the whole population.

Simplicity and Affordability of the Polypill Strategy

One of the big benefits of the polypill is that it is so easy. In contrast to the existing screening-based model, the polypill scheme would not involve complicated medical tests or lengthy risk assessments. Instead, people reaching 50 would just have to fill out a few questions to determine possible side effects before they were prescribed.

Professor Aroon Hingorani of the UCL Institute of Cardiovascular Science, one of the strongest proponents of this scheme, says:

"Finally, the time is now to do much better on prevention. A population approach would prevent a lot more heart attacks and strokes than is done today with a strategy of trying to target a smaller group only."

Aside from the possible health implications, the polypill is also an economic solution. The drugs used are off-patent, thus cheap to produce and distribute. With the vast economic cost of managing CVD-related illnesses, a preventive model could result in substantial cost-saving for the NHS in the future.

The polypill has been proven to be effective by numerous international trials. In 2019, a randomised trial in rural Iran discovered that participants who took the polypill for five years had a 34% reduced risk of having a heart attack or stroke compared to non-participants.

Likewise, modelling research has indicated that even if only 8% of people aged over 50 took up the polypill regimen, it would still be more beneficial to their health than the NHS Health Check programme.

Is This a Case of Over-Medicalisation?

One of the main objections to the polypill strategy is the suggestion that it might result in the unnecessary medicalisation of a significant proportion of the population. But, it is argued, it should be considered as a preventative measure, not as mass medication.

Professor Sir Nicholas Wald of UCL's Institute of Health Informatics explains:

"Instead of being a 'medicalisation' of a significant proportion of the population, a polypill programme is a prevention measure to prevent an individual from becoming a patient."

He compares it with public health measures like water fluoridation or compulsory seatbelts—interventions that have been shown to have a significant impact in reducing public health danger at low individual cost.

With the evidence in favour of the polypill's effectiveness and viability overwhelming, experts are calling on the NHS to act now. It is their belief that substituting the NHS Health Check with a polypill-based prevention program could be the UK government's flagship policy under its pledge to put disease prevention ahead of cure.

As Professor Hingorani points out, "The status quo is not a justifiable option." With CVD still a major cause of death globally, taking a population-wide polypill approach could be a turning point for preventative medicine, potentially saving thousands of lives annually. The question now is whether the NHS will take up this call and establish a policy with the potential to transform the prevention of cardiovascular disease on a national level.

A popular kratom drink, often marketed as a natural alternative to pharmaceutical drugs, could become the next major addiction crisis in the United States, addiction specialists are warning.

The substance, sometimes dubbed "gas-station heroin," is already banned in at least eight US states—Alabama, Arkansas, Connecticut, Indiana, Louisiana, Tennessee, Vermont, and Wisconsin. Several other states, including Iowa and Idaho, are considering restrictions or outright bans.

Tennessee looks to make a statewide ban effective from July 1. Earlier this month, Idaho Falls approved a local ban on kratom sales that will also take effect on July 1, the media report said.

While some jurisdictions are targeting synthetic forms of kratom rather than the plant itself, concerns over addiction, overdose risks, and easy accessibility continue to grow.

Last year, US Health and Human Services Secretary Robert F. Kennedy Jr. criticized the widespread availability of kratom products, many of which are sold at gas stations and marketed in child-friendly forms such as gummies.

"It is a sinister, sinister industry," Kennedy said.

What Is Kratom?

Kratom is a plant-based substance derived from the Mitragyna speciosa tree, native to Southeast Asia. Traditionally used in countries such as Thailand and Malaysia for pain relief and increased energy, it has gained popularity in the US as an over-the-counter supplement.

Kratom products are sold in various forms, including powders, capsules, teas, drinks, and gummies.

At lower doses, kratom acts as a stimulant. At higher doses, it can produce sedative and opioid-like effects. While it remains legal in many parts of the US, the Food and Drug Administration (FDA) has classified kratom as a "drug of concern" and has not approved it for any medical use.

Rising Hospitalizations Fuel Concerns

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Health experts point to a sharp increase in kratom-related hospitalizations as evidence of a growing problem.

According to a University of Virginia study, there were 43 hospitalizations linked solely to kratom in 2015. By 2025, that number had risen to 538.

Researchers noted that the surge coincided with the emergence of highly concentrated synthetic products, including 7-hydroxymitragynine (7-OH), a potent kratom-derived compound.

"It is increasing the prevalence of opioid use disorder," Dr. Andrew Kolodny, director of the Opioid Policy Research Collaborative at Brandeis University, was quoted as saying to The Guardian.

"Being able to buy an opioid at a convenience store is going to make the opioid crisis worse," he added.

Industry Pushes Back

Mac Haddow, the association's senior fellow for public policy, denied that kratom itself is inherently addictive or dangerous. He argued that the real issue is 7-OH, which is significantly more potent than traditional kratom powder.

7-hydroxymitragynine (7-OH) is a naturally occurring compound found in kratom, and it is far more potent. While kratom itself contains a mixture of alkaloids, 7-OH is an isolated extract or concentrated form that interacts with the body’s opioid receptors much more strongly.

Kratom To Cause Addiction Crisis

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Dr. Angad Madan, Medical Director of St. Peter's Addiction Recovery Center (SPARC), said many users mistakenly believe kratom is simply a harmless herbal supplement.

"Many patients do not know that it's a substance of addiction or misuse. Many patients just think it's a herbal supplement. I think it's false advertising, and it's resulting in another opioid epidemic that New York doesn't really need," he was quoted as saying to WNYT.

Madan added that kratom-related dependence is becoming increasingly common in treatment settings.

"Kratom, also known as 7-OH or 7-hydroxymitragynine, is the number one new substance addiction that I've seen at SPARC across all levels of care," he said.

Hypertension remains one of the leading causes of illness and premature death worldwide. Yet a handful of countries have managed to significantly reduce their impact through effective public health strategies.

South Korea—best known globally for K-pop, K-dramas, and K-beauty—is among just four countries in the world to achieve a hypertension control rate above 50 per cent, joining Canada, Costa Rica, and Iceland.

According to the latest Korea Hypertension Fact Sheet, South Korea's blood pressure control rate has climbed to 62 per cent, making it one of the highest in the world. This means that more than half of people diagnosed with high blood pressure have successfully brought it within a healthy range through treatment.

"The Republic of Korea is one of only four countries in the world that have reached a hypertension control rate above 50 per cent," said World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus in a post on X.

Canada, Costa Rica, and Iceland also have hypertension control rates exceeding 50 per cent.

"South Korea continues to demonstrate high performance in hypertension management at the population level, with steady improvements in awareness, treatment, and control," the fact sheet, published in the journal Clinical Hypertension, noted.

How Did South Korea Achieve It?

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According to the WHO, South Korea's hypertension control rate was only about 5 per cent two decades ago. Since then, the country has achieved a remarkable turnaround, contributing to an estimated 83 per cent reduction in stroke-related deaths.

“It’s the single most important thing to get right in healthcare… but most countries don’t,” Dr Tom Frieden, president of Resolve to Save Lives, an initiative working on global health threats, told The Telegraph. “South Korea is one of the rare successes in the world, on both the treatment and prevention of high blood pressure.”

As per experts, Korea's success is a result of

• targeted salt-reduction campaigns,
• affordable and accessible combination therapies,
• routine screening.

"Globally, every hour, over 1,000 lives are lost to strokes and heart attacks from high blood pressure, while hypertension control is one of the most cost-effective interventions in public health. This is why I call on world and health leaders to heed the Republic of Korea's experience," Tedros added.

What Can Other Countries Learn?

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Prof. Hyeon Chang Kim, Professor in the Department of Preventive Medicine at Yonsei University College of Medicine, highlighted three key lessons from South Korea's success that other countries can adopt to improve hypertension control.

1. Make Hypertension Control a Health-System Priority

2. Invest in Data and Monitoring

3. Ensure Long-Term Continuity of Care

The South Korean experience shows that sustained care, regular follow-up, and strong healthcare systems can significantly improve blood pressure control and reduce deaths from heart disease and stroke.

Hypertension: The Silent Killer

The Lancet estimates that approximately 1.7 billion adults worldwide are living with hypertension. However, fewer than 20 per cent have their blood pressure adequately controlled.

Hypertension can quietly damage the heart, brain, kidneys, and blood vessels for years before symptoms appear. Because it often causes no noticeable signs, many people remain unaware they have the condition.

"Nine out of 10 times, hypertension does not cause symptoms. The only way to detect it is through regular screening," said Dr. Ambuj Roy, Professor of Cardiology at the All India Institute of Medical Sciences (AIIMS), New Delhi.

How to Lower Blood Pressure Naturally

To help reduce blood pressure and improve heart health, Dr. Roy recommends:

• Being physically active for at least 150 minutes per week
• Limiting processed and salty foods
• Staying adequately hydrated, especially during heatwaves
• Following a DASH-style diet rich in fruits, vegetables, whole grains, and low-fat dairy products.

Duloxetine, a widely prescribed antidepressant, has been recalled in the United States after the US Food and Drug Administration (FDA) found potentially cancer-causing impurities above federal safety limits.

According to the Cleveland Clinic, duloxetine is commonly used to treat depression, anxiety, fibromyalgia, and certain chronic pain conditions.

The FDA issued a notice stating the presence of N-nitroso-duloxetine, a nitrosamine impurity detected at levels exceeding the agency's recommended safety threshold. The recall affects nearly 370,000 bottles of prescription-only duloxetine delayed-release capsules USP, 30mg, 1000 Capsule bottles, distributed across the US.

The agency warned that exposure to nitrosamine impurities "may increase the risk of cancer if people are exposed to them above acceptable levels and over long periods of time."

The agency classified the action as a Class II recall, indicating that use of or exposure to the product may cause temporary or medically reversible adverse health consequences, while the likelihood of serious health effects remains low.

How Is Duloxetine Linked to Cancer?

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Notably, this is the second duloxetine recall linked to the same impurity. In October 2024, more than 7,000 bottles were recalled because of potential nitrosamine contamination.

According to the FDA, people who take medications containing nitrosamines—even daily for up to 70 years—are not expected to face an increased cancer risk if nitrosamine levels remain at or below the recommended limits.

There is currently no direct evidence linking N-nitroso-duloxetine itself to cancer. However, it belongs to a class of compounds known as nitrosamines, some of which are considered probable human carcinogens.

Moreover, health risks associated with nitrosamines generally depend on both the amount and duration of exposure. Higher levels over extended periods are considered more concerning.

The US National Library of Medicine describes N-nitroso-duloxetine as a compound that is "suspected of causing cancer" and notes that it is toxic if swallowed.

At the same time, the California State Board of Pharmacy emphasizes that exposure does not automatically result in cancer. The agency notes that nitrosamines are commonly found in water and foods, including cured and grilled meats, dairy products, and vegetables.

"Everyone is exposed to some level of nitrosamines," the board states. "These impurities may increase the risk of cancer if people are exposed to them above acceptable levels over long periods of time."

What Are Antidepressants?

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Antidepressants are prescription medications used to treat depression, anxiety disorders, chronic pain, and other conditions by increasing levels of certain brain chemicals involved in mood regulation.

Common classes of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine-dopamine reuptake inhibitors (NDRIs)

These medications often take several weeks to achieve their full therapeutic effect. Common side effects may include dry mouth, dizziness, nausea, and weight changes. Emerging research also suggests that side effects can vary significantly depending on the specific medication.

What Is Duloxetine?

Duloxetine belongs to a class of antidepressants known as SNRIs.

Cleveland Clinic explained that duloxetine is used to treat depression, generalized anxiety disorder, fibromyalgia, and certain types of chronic pain, including nerve, bone, and joint pain.

The medication works by increasing levels of serotonin and norepinephrine in the brain—neurotransmitters that help regulate mood and pain perception.