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Updated: May 1, 2026

Quadruple-Checkerboard: A Modification of the Three-Dimensional Checkerboard for Studying Drug Combinations
Published on: July 24, 2021
A single fixed-dose combination for all patients is bad medicine
1Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada; Robarts Research Institute, London, Ontario, Canada; Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
Abstract:
It has been proposed that cardiovascular risk could be markedly reduced by prescribing a single daily pill to all patients at risk. This concept is bad medicine, because each constituent has problems, and the problems are different for each patient. A key principle of clinical pharmacology is individualization of therapy. Patients are not all the same, so a single polypill cannot work for all of them. For patients with resistant hypertension, at least 3 different versions would be needed for patients with different causes of hypertension, and even then not one pill would be suitable for all patients.
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