‘Prevention is better than cure, but …’: Preventive medication as a risk to ordinariness?

Abstract

Preventive health remains at the forefront of public health concerns; recent initiatives, such as the NHS health check, may lead to recommendations for medication in response to the identification of ‘at risk’ individuals. Little is known about lay views of preventive medication. This paper uses the case of aspirin as a prophylactic against heart disease to explore views among people invited to screening for a trial investigating the efficacy of such an approach. Qualitative interviews (N = 46) and focus groups (N = 5, participants 31) revealed dilemmas about preventive medication in the form of clashes between norms: first, in general terms, assumptions about the benefit of prevention were complicated by dislike of medication; second, the individual duty to engage in prevention was complicated by the need not to be over involved with one's own health; third, thepotential appeal of this alternative approach to health promotion was complicated by unease about the implications of encouraging irresponsible behaviour among others. Though respondents made different decisions about using the drug, they reported very similar ways of trying to resolve these conflicts,drawing upon concepts of necessity and legitimisation and the special ordinariness of the particular drug.

Keywords:

• prevention
• risk
• responsibility
• aspirin
• prophylaxis
• medication

Acknowledgments

We are grateful to the participants for their time and contribution. We thank the AAA trial team for help with recruitment to the qualitative study. The original qualitative study was funded through a Chief Scientist Office PhD studentship (for HE) and supervised by Prof Gerry Fowkes and Prof Sarah Cunningham-Burley. We thank Kate Weiner, members of the Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, and two anonymous referees for helpful comments on earlier drafts of the paper.

Notes

1. see http://controlled-trials.com/ISRCTN66587262/Aspirin.

2. The Carstairs deprivation index used for this study was based on postal code classification from 1991 census, with a range from I (most affluent) to VII (most deprived).