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.

Commonly known as the ‘morning-after pill’, emergency contraceptive pills will soon be sold with prominent warnings on packs.

The Union Health Ministry has proposed bringing levonorgestrel 0.75 mg and 1.5 mg emergency contraceptive tablets under Schedule K of the Drugs Rules, 1945, with mandatory warnings on their packaging and package inserts. The draft notification was issued on September 3 and is currently open to public objections and suggestions.

The proposed warnings are intended to make it clear that the pills are meant only for emergency contraception and that they are not a regular contraceptive method.

They will also indicate that they are not abortion pills and do not protect against HIV or other sexually transmitted infections. They would also warn that frequent use can lead to side effects and advise women seeking regular contraception to consult a healthcare professional.

What Do Emergency Pills Actually Do?

Levonorgestrel is a synthetic version of the hormone progesterone. When taken as emergency contraception, it primarily works by delaying or preventing ovulation, meaning it can prevent an egg from being released when sperm are present.

It is intended to be taken after unprotected sex or contraceptive failure, such as a broken condom. The World Health Organization recommends levonorgestrel emergency contraception as a single 1.5 mg dose, or 0.75 mg in two doses 12 hours apart. It works best when taken as soon as possible and can be used within 120 hours of unprotected intercourse.

Crucially, it does not terminate an established pregnancy. That is why it should not be confused with medication used for medical abortion.

Also read: Exclusive With Leading HIV Expert: What's Driving Rising HIV Cases Among India's Youth And How To Prevent It

Emergency Pills Cannot Protect Against STIs

One of the proposed warnings is meant to addresses a common misconception about emergency contraceptive pills prevents pregnancy, not sexually transmitted infections.

It is important to under stand that levonorgestrel does not protect against HIV, syphilis, gonorrhoea, chlamydia or other STIs. Sexually transmitted infections can be prevented by barrier methods like condoms, when used correctly.

The proposed Indian warning specifically states that emergency contraceptive pills “do not offer any protection against HIV or any sexually transmitted infections.”

Also read: 5 Reasons To Get Regular STI Testing If You’re 'Sexually Active'

Reason Behind The Move

The move follows recommendations from the Drugs Technical Advisory Board (DTAB) after an expert review of contraceptive use in India.

Minutes of the 67th Drugs Consultative Committee meeting recorded recommendations for the package warnings stating that levonorgestrel emergency contraceptives should not be used more than twice a month, that they do not protect against HIV or STIs, and that alternative contraception should be considered with a registered medical practitioner.

The latest draft notification also states that frequent use “may lead to side effects” and encourages women to seek medical advice. However, this does not mean emergency contraception is considered inherently unsafe.

The WHO says side effects like nausea, vomiting, fatigue and temporary menstrual changes are generally mild and can be resolved without treatment. It also states that emergency contraceptive pills do not cause any harm to fertility.

The concern is instead about using an emergency method as a substitute for regular contraception. Repeated use can lead to menstrual irregularities and side effects.

The proposal would place levonorgestrel 0.75 mg and 1.5 mg tablets under Schedule K, while retaining their availability without a prescription. The draft is therefore not supposed to make morning-after pills prescription-only.

India’s campaign to eliminate iodine deficiency has made a substantial progress. A recent Lancet Regional Health – Southeast Asia study has found that cases of goitre among school-going children have reduced significantly.

But the research has also highlighted that another thyroid concerns have surfaced among Indian children simultaneously. They include thyroid autoimmunity and thyroid dysfunction.

The nationwide study, conducted across eight centres, examined 8,903 school children between the ages of 10 to 18 years.

Researchers examined goitre, thyroid function, thyroid antibodies and iodine status as part of the ICMR-SALT-T 1 study.

Goitre Cases Have Gone Down After Decades Of Iodised Salt

India introduced universal salt iodisation in 1986 to tackle iodine deficiency, a major cause of goitre and other disorders that affect growth and brain development.

The new study found that 10.3% of children had goitre, a substantial decline from 23.5% in 2003 and 17.6% in 2012. Nearly 99% of the detected goitre cases were classified as grade 1.

The findings reflect the fact that India’s iodisation programme has helped extensively in eliminating iodine deficiency.

More than 90% of surveyed households reported using iodised salt, while 89% of 1,615 tested salt samples contained more than 15 parts per million of iodine.

The median urinary iodine concentration was 133.2 micrograms per litre, indicating adequate iodine nutrition at the population level.

India’s National Iodine Deficiency Disorders Control Programme continues to target household use of adequately iodised salt and regular monitoring of iodine levels.

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But Thyroid Autoimmunity Is Rising

Despite adequate iodine nutrition, 10.4% of the 5,726 children tested for thyroid antibodies were positive for anti-thyroid peroxidase, or anti-TPO, antibodies.

These antibodies are produced when the immune system mistakenly targets the thyroid. Their presence can be a marker of thyroid autoimmunity and may be associated with conditions like Hashimoto’s thyroiditis. But antibody positivity alone does not mean a child has thyroid disease.

Girls were about twice as likely as boys to test positive for anti-TPO antibodies. Children with goitre were also more likely to have the antibodies.

The study also found hypothyroidism in 13% of the 5,512 children for whom thyroid-function data were available.

In this condition, thyroid-stimulating hormone is elevated but thyroid hormone levels can remain within the normal range. Anti-TPO positivity was independently linked with a higher likelihood of hypothyroidism.

Also read: The Growing Burden of Autoimmune Disorders: Can Ayurveda Offer a Holistic Solution?

Does Iodised Salt Cause Autoimmunity?

Researchers note that previous studies conducted after the introduction of universal salt iodisation had raised questions about iodine excess and thyroid autoimmunity.

Excess iodine can affect thyroid function and has been proposed as one possible contributor to autoimmune thyroid disease.

But it is important to note that thyroid autoimmunity has multiple possible influences, including genetic, environmental, nutritional and lifestyle factors.

The new Indian study is cross-sectional, which means it captures thyroid and iodine status at one point in time. It therefore cannot determine whether iodine exposure caused the antibody findings.

The findings do not undermine the public-health value of salt iodisation. Instead, they suggest that India’s priorities may now need to include continued monitoring of iodine intake alongside thyroid function and autoimmunity.

After US President Donald Trump’s executive order to split MMR into three shots came out in August, he put forth a proposal recently for some childhood vaccines to be divided into five doses.

Trump recently said his administration plans to push vaccine makers to split some childhood vaccines into five separate shots, believing and claiming that giving smaller amounts at longer intervals could lead to a significant reduction in autism.

Trump made the claims on September 18 but did not specify which vaccines he wants divided into five doses, nor did he provide scientific evidence linking vaccination schedules to autism. He said the doses would be given at six-month intervals.

The proposal follows an executive order Trump signed in August, directing changes to federal childhood vaccine recommendations, including separating the combined measles, mumps and rubella (MMR) vaccine into three individual shots and administering them at separate visits.

What Is Trump’s Proposal?

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On Friday, the President Trump said that his administration is planning to recommend that certain childhood immunizations should be separated into five shots, each with a “small amount of the vaccine.” He added that these doses would each be given six months apart.

“Instead of a child going in and having a tremendous amount of different vaccines pumped into a big proportion of the body … we’re going to recommend that they do five doses marked one, two, three, four, five and that they be given in six-month intervals, so that a small amount of the vaccine gets pumped into the body,” Trump said.

He also said he expects that this could lead to a “massive reduction in autism.” However, it remains unclear which childhood vaccines would be affected or how such a five-dose schedule would be implemented.

HHS Secretary Robert F. Kennedy Jr., who was standing by Trump as he announced the vaccine changes, received a standing ovation Thursday at the conference of the anti-vaccine advocacy group Children’s Health Defense.

He praised Trump’s embrace of vaccine skeptics, stating, “You have a strong and steadfast friend at the White House” and said that he would “stay in this fight.”

Vaccine formulations and dosing schedules are established through clinical research and regulatory review. So, Trump’s proposal to divide an existing dose has sparked reactions.

No Evidence That Vaccines Cause Autism

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Decades of research have not established that childhood vaccines cause autism. The CDC's current vaccine-safety information says multiple studies have found no link between MMR vaccination and autism.

In August, Trump signed an executive order to change the federal government’s approach toward childhood vaccines, insisting that infants should receive fewer immunizations over a longer period.

He advised that the measles-mumps-rubella (MMR) vaccine be separated into three individual shots, despite little to no scientific evidence. Research also proves that there is no published scientific evidence showing a benefit from separating the combined MMR vaccine into three individual shots.

However, the CDC's current website reflects the Trump administration's position, stating it has not definitively ruled out every possible relationship between infant vaccines and autism. It also says that HHS is funding further research into biological mechanisms.

The strongest available evidence for MMR specifically continues to show no association with autism, according to the CDC's cited evidence reviews.

Would Splitting Vaccines Make Them Safer?

There is currently no evidence that splitting combination vaccines into smaller doses prevents autism. The CDC also says there is no published scientific evidence that separating MMR vaccine into individual measles, mumps and rubella vaccines provides a safety benefit.

Experts have also questioned the idea that simply dividing a vaccine dose would change its safety profile.

José Romero, a former senior CDC official, told The Washington Post that vaccines are formulated in a way, so the total dose produces the intended immune response.

Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia told CNN that Trump’s plan would render vaccines ineffective and wouldn’t make them safer necessarily.

Offit said, “When you create a vaccine, you do a dose response curve, and you’re trying to give the least amount of vaccine that induces an immune response that’s protective. So, you don’t want to give too much, where you know you don’t need all that, and you don’t want to give too little, where it’s you know sub-immunogenic.”

He added, “What he’s suggesting would not work. He’s basically saying he wants to give vaccines in a manner in which they wouldn’t be protective.”