Richard Smith: The polypill is about demedicalisation not medicalisation

Richard SmithOne of the things I love about the polypill is that it upsets everybody. (Just in case there are still people who haven’t heard of the polypill, it’s one pill that contains a statin, several drugs to lower blood pressure, and possibly aspirin that if everybody over 55 started taking daily might prevent three quarters of heart attacks and strokes.)

The polypill upsets drug companies because at a cost of a few dollars a month it can destroy highly lucrative markets. Public health people are upset because the polypill might be seen as an alternative to a healthy lifestyle. It upsets doctors—or at least cardiologists—because it illustrates how the traditional medical model of “diagnose and treat” doesn’t work because many people who die of heart attacks or strokes have been neither diagnosed nor treated.

Then there’s the issue of medicalisation. A follower of Ivan Illich, I’m very much against medicalisation, but use of the polypill, which could lead to a third of the population taking it, has been seen by some as an extreme form of medicalisation. So am I as a proponent of the polypill getting very confused?

Taking the five components of the polypill every night has led me to reflect on what is meant by medicalisation. I tried accessing an article in the Lancet that addressed exactly that question but couldn’t get in—bloody Elsevier. So next to Wikipedia: “Medicalisation is the process by which health or behaviour conditions come to be defined and treated as medical issues. The term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat.”

There seem to be two components to medicalisation—turning every day problems into medical problems and coming within the purview of doctors. I’m very much against the former—making shyness, baldness,  inattentiveness, procrastination, and the like into diseases worthy of treatment with drugs. But I’m taking the polypill to stop having a heart attack or a stroke, medical problems by anybody’s definition.

It’s falling into the hands of doctors that for me is the essence of medicalisation. My pills come through the post. I don’t go near a doctor. If I had to go every three months to the clinic to have my blood pressure and blood lipids measured then I wouldn’t take the pills. It’s the very fact that they may keep me away from doctors and hospitals that makes them so attractive. I’m in charge.

Maybe, indeed, taking the polypill is demedicalisation. I searched for what I have written myself on medicalisation and found this paragraph from an editorial that I wrote with Ray Moynihan: “Perhaps some doctors will now become the pioneers of de-medicalisation. They can hand back power to patients, encourage self care and autonomy, call for better worldwide distribution of simple effective health care, resist the categorisation of life’s problems as medical, promote the deprofessionalisation of primary care, and help decide which complex services should be available.”

To advocate the polypill is to urge most of what is in that sentence: hand back power to patients, encourage self care and autonomy, call for better worldwide distribution of simple effective health care (the polypill brings affordable treatment to people who cannot afford a doctor), and deprofessionalise primary care.

So the polypill is about demedicalisation not medicalisation. Whoopee.