A proposal by Wald and Law (2003) for a single pill containing a statin, three half-dose antihypertensives, aspirin, and folic acid, met with a storm of controversy and seemed to have been relegated as much to the fanciful as to the accolades it might have deserved. The benefits such a Polypill could confer on people age 55 þ y were to reduce both cardiovascular and stroke events by 80% or more. Considering the daunting and, at best, slow process of changing the same risk factors through health promotion interventions on food policy, dietary and physical activity behaviors, and urban planning to make less prevalent the sedentary lifestyles developed over decades, the argument here is to view the Polypill as a harm reduction strategy that would complement health promotion, as Nicotine Replacement Therapy did for tobacco control, seat belts did for traffic injuries, and needle exchange programs did for secondary complications of injection drug use.

First, to the extent that current drug-related policies embody culturally conditioned fears, simple factual information on the lack of effectiveness of current policies is unlikely to lead to different policies. Indeed, data showing that current policies are not effective in controlling drug use and its adverse consequences may provoke a fear arousal situation in which the most likely response is intensification of the present policies (i.e., if a policy is not working, apply it more intensely.) Second, new policies that might endanger monies for the current nonmedical drug industries or for the illegal drug control/law enforcement industry will provoke strong resistance. This resistance may include the giving of large financial contributions to influence the political decision-making process.