Statins Strife: Assessing the Expanding Pharmaceuticalisation of the Primary Prevention of Cardiovascular Disease

In July 2014 the National Institute for Health and Care Excellence (NICE) published updated clinical practice guidance dramatically shifting the cardiovascular disease (CVD) prevention landscape in England. The most publicly and professionally visible aspect of this guideline was the recommendation to lower the primary prevention risk threshold from ≥20% risk of developing CVD over ten years to a ≥10% risk over ten years. This was an extremely significant development not least because it vastly expanded the numbers of people eligible to be offered CVD risk assessment and potentially advice on prophylactic measures against CVD - including, saliently, the offer a pharmaceutical solution. It has been estimated that this guidance makes millions of additional people in England eligible for the class of drugs called statins. To sociologically analyse this case, this thesis utilises the conceptual lens of pharmaceuticalisation - a process whereby human conditions, problems, capabilities (and beyond) are made increasingly amendable to intervention by pharmaceuticals. The aim of this thesis is to analyse crucial driving forces behind this decision and the subsequent implementation of the guideline, looking across multiple dimensions of pharmaceuticalisation, as well as to assess the overall extent to which pharmaceuticalisation is occurring in this case. The thesis explores the following overarching question: to what degree is the further pharmaceuticalisation of the primary prevention of CVD occurring and what are the driving forces? To analyse this question, this thesis presents empirical qualitative research drawing on multiple methods (documentary analysis, media analysis, and semi-structured interviewing). The thesis focuses on several key actors and subprocesses existing within the 'pharmaceutical regime' that can be implicated in driving, facilitating and/or potentially constraining the extent of the widening pharmaceuticalisation of the primary prevention of CVD. The pharmaceutical regime is a core conceptual aspect of pharmaceuticalisation and is necessarily concerned with the analysis of the driving forces and extent of pharmaceuticalisation. In analysing the overarching question, first, the creation of the opportunity for pharmaceutical deployment by NICE is analysed, examining how the influences of and regulatory dependency on the pharmaceutical industry are widening the opportunity for pharmaceuticalisation in this case. The role of the print news medium is also analysed. The research shows how portrayals of statins and usage expansion within the context of this case were controversy-oriented. Finally, the understandings and approaches of GPs to the ≥10% threshold, another key actor in this case, are analysed - with the analysis highlighting the disparate manner in which GPs both understand the guidance and attempt to facilitate and guide the treatment of their patients. When considering multiple actors and competing driving forces within the pharmaceutical regime as a whole in this case, the analysis ultimately shows that pharmaceuticalisation is only partial in its overall extent. Critical and controversy-oriented newspaper coverage and evidence of resistance from GPs limits the extent of pharmaceuticalisation occurring in the case under study.