WHEN did you last pop a pill? The chances are it was recently, no matter how healthy you are. A growing number of us are taking medicines as part of our daily routine, not because of illness, but to prevent it (see graph). A recent survey found that 43 per cent of men in England and 50 per cent of women , and half of those had taken three.
āWhat weāve seen is a massive rise in reliance on medicines as a panacea for all our woes,ā says , former chair of the UKās . āThereās been a big rise in screening to look for diseases before they happen, and we have begun treating people ājust in caseā.ā
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With life expectancies stretching, many of us have come to see prevention as a sensible route to living a greater number of disease-free years (see graph). And the evidence shows this strategy can work, for us and for health services. āThereās a very strong argument for saying that screening allows us to intervene to reduce the risks and consequences of developing the illness,ā says , who studies obesity medicine at University College Hospital in London.
But there is reason to be cautious, too, and take stock of how medicalised our society is becoming. āPreventive drugs can be of huge benefit to people at high risk of disease, but weāve gone too far,ā says Gerada. As a doctor, she says itās not unusual to see patients on 15 different medications.
Doctors and decision-makers can become so focused on a drugās benefits that they overlook the wider effects on patients, says , an epidemiologist at the University of Oxford. āItās a benign arm of paternalism. They donāt think about what itās like to take a drug every day for the rest of your life.ā
āDoctors donāt think about what itās like to take a drug every day for the rest of your lifeā
For some people it may feel comforting to be taking pre-emptive action. But at times that can be an illusion, as the examples on the following pages show. What is more, it can distract us from the wider social causes of disease, like alcohol, obesity and loneliness, Gerada says, none of which can be treated with a pill.
Taking several medicines at once can be risky, too. āWe might know what will happen if someone takes a statin, but we donāt know what happens if theyāre on a statin, and a vitamin D pill, an aspirin and a proton pump inhibitor to stop the side effect of stomach bleeds,ā Gerada says. One British study found that .
Central to the debate is how the evidence for preventive medication is established. Many are prescribed to prevent conditions they were not developed to treat, for example. āWe invent a drug which has an effect on peopleās complaints, test it to see what it does and end up using it not for therapeutic reasons but for prophylactic reasons, where the benefits are much less and where the possible harms may be much greater,ā says McPherson.
Preventing illness should save money in the long term, but channelling limited resources into treating healthy people could come at a cost to those who are sick right now, leaving clinicians tied up with patients who arenāt even ill. What is more, doctors and patients alike can be bamboozled by evidence, often apparently contradictory, which frequently makes headline news.
Understanding the risks and statistics surrounding health can be puzzling for even the most mathematically literate. But as our society becomes increasingly medicalised, we need to arm ourselves with the information to help us decide whether we should be swallowing those pills. āI am surprised at how few people now complain about the number of medications they are on,ā says Gerada. āEven a decade ago, people would come and question whether they needed them all.ā
So should we embrace a drug regimen to promote better health, or accept treatments only when we need them? Over the following pages, we assess the evidence for the five most common ā and controversial ā everyday medicines.
Read more: āOur daily pills: What everyday drugs are really doing to youā
Leader: āAre you going too far in your quest to keep well?ā
This article appeared in print under the headline āShould you swallow it?ā
(Image: Ballyscanlon/Plainpicture)
