Editorials

Medicalisation, limits to medicine, or never enough money to go around?

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7342.864 (Published 13 April 2002) Cite this as: BMJ 2002;324:864

Spending on preventive treatments that help a few is unaffordable

  1. Nick Freemantle, professor of clinical epidemiology and biostatistics (N.Freemantle@bham.ac.uk),
  2. Suzanne Hill, senior lecturer in clinical pharmacology
  1. Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT
  2. Faculty of Medicine and Health Sciences, University of Newcastle, Newcastle, NSW 2300, Australia

    Ivan Illich, in Limits to Medicine, commented: “The more time, toil and sacrifice spent by a population in producing medicine as a commodity, the larger will be the by product, namely the fallacy that society has a supply of health locked away which can be mined and marketed.”1 Rich Western societies are investing in preventive treatments that will benefit only a minority of those who take them for a long time, a situation well illustrated by the statins. Widespread use of statins is scarcely affordable in the developed world and unachievable in developing countries, although the drugs are still marketed heavily there. Using resources to purchase statins means other effective treatments may not be available.

    From the perspective of the pharmaceutical industry, statins are an ideal group of drugs. They are, with one exception, safe and free from common side effects. They achieve a premium price and potentially have an increasingly wide market in the primary and secondary prevention of cardiovascular disease. About 11.5 million adults (5.4% of the adult population) in the United States are currently taking either atorvastatin, simvastatin, or pravastatin, all of which are in the top 40 most commonly prescribed pharmaceuticals in the United States.2 Indeed, atorvastatin (Lipitor) is now the biggest prescription-only drug in the world.

    It is paradoxical that while achieving benefits in reducing mortality …

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