Medicalising life

Medicines have been getting into the mainstream news quite a lot in recent times. A couple of days ago saw the publication in Annals of Oncology of a review of the evidence for a protective effect of aspirin in reducing cancer in the general population. The role of aspirin in cardiovascular disease prevention is well established, although the risks of bleeding have been considered to outweigh the benefits in a primary prevention setting. This latest study, however, concludes that there is evidence for benefits across a range of cancers – particularly colorectal. The overall net relative benefit (including cardiovascular events) based on 10 years of treatment was around 6%. The absolute risk reduction of all major events (including cardiovascular) was between 0.8-3.0%, with the greatest benefits seen in men and at older ages. The BBC quotes lead author Jack Cuzick as urging “all healthy people aged 50 and above to consider taking a small dose … every day for a decade.”

This follows on from last month’s publication of NICE’s revised guidance on lipid modification, advocating statins for primary prevention of cardiovascular disease in those with a 10% or greater 10-year risk of cardiovascular disease. Based on this, most adult men over 60 and most adult women over 65 are eligible for statin therapy. Rolling out statins in this way has the potential over three years to save an additional 4000 lives as well as preventing many more non-fatal MIs and strokes.

So public health authorities (and possibly pharma) are happy. I’m not sure I am. Understandable concern has been raised about the potential for adverse effects, although I’m not convinced the evidence necessarily strongly supports that argument. I am interested to know what the same public health authorities will do to manage the inevitable growing number of elderly who might not succumb to heart attacks or cancer, but will undoubtedly develop other medical problems. More pills presumably. This is the medicalisation of life. Some patients will be comfortable with this. Yet for the majority, a couple of tablets a day will not help them achieve a more fulfilling, higher quality of life. Most people will get no benefit, yet there seems to be a chance that popping a pill may end up being considered the norm, potentially at the expense of things like health education and improving lifestyles. I hope this is not the way medicine is going, and I hope as doctors we do not lose sight of our patients being individuals rather than public health numbers.

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