The drugs don't sell: DIY heart health and the over-the-counter statin experience

This paper draws on a study of over-the-counter statins to provide a critical account of the figure of the ‘pharmaceutical consumer’ as a key actor in the pharmaceuticalisation literature. A low dose statin, promising to reduce cardiovascular risk, was reclassified to allow sale in pharmacies in the UK in 2004. We analysed professional and policy debates about the new product, promotional and sales information, and interviews with consumers and potential consumers conducted between 2008 and 2011, to consider the different consumer identities invoked by these diverse actors. While policymakers constructed an image of ‘the citizen-consumer’ who would take responsibility for heart health through exercising the choice to purchase a drug that was effectively rationed on the NHS and medical professionals raised concerns about ‘a flawed consumer’ who was likely to misuse the product, both these groups assumed that there would be a market for the drug. By contrast, those who bought the product or potentially fell within its target market might appear as ‘health consumers’, seeking out and paying for different food and lifestyle products and services, including those targeting high cholesterol. However, they were reluctant ‘pharmaceutical consumers’ who either preferred to take medication on the advice of a doctor, or sought to minimize medicine use. In comparison to previous studies, our analysis builds understanding of individual consumers in a market, rather than collective action for access to drugs (or, less commonly, compensation for adverse effects). Where some theories of pharmaceuticalisation have presented consumers as creating pressure for expanding markets, our data suggests that sociologists should be cautious about assuming there will be demand for new pharmaceutical products, especially those aimed at prevention or asymptomatic conditions, even in burgeoning health markets

Involuntary autonomy: Patients' perceptions of physicians, conventional medicines and risks in the management of atopic dermatitis

Consumerism is a major force in western health care. It defines the process in which patients should or do play a more active and central role in making informed choices about health and illness. The talk of patients as consumers is closely linked, and is especially pertinent for patients managing a chronic illness. This article presents findings from a Danish qualitative study that set out to broaden the sociological debate on patients as consumers by including patients' perceptions of conventional medicines. In-depth interviews were carried out with 24 people who medically managed their own or their child's atopic dermatitis. The informants were recruited via the Division of Dermatology in a Danish Hospital which was planning an Information Day on atopic dermatitis (AD). The findings reveal how many of the informants who on the surface appear to match the profile of the so called 'consumer', by being active, critical, informed etc., in fact prefer to consult a patient-centred medical expert (a dermatologist) with good communication skills, who is able to inform, advise and support on issues of managing atopic dermatitis. These people are not seeking more independence but rather a partnership where responsibility for treatment (medicines) is shared. This preference appears to be closely linked with a sense of insecurity about what an outbreak of atopic dermatitis may lead to and insecurity about the medicines. Ultimately, the findings stress that health care politicians and professionals need to reflect upon patient's wants and needs when designing future health care. Turning health care into self-care may not be an appropriate strategy.Denmark Consumerism Risk Conventional medicine Patient-physician relationship Atopic dermatitis Self-care

The medicine user--Lost in translation?: Analysis of the official political debate prior to the deregulation of the Danish medicine distribution system

This paper presents results from a qualitative analysis of official documents dealing with the deregulation of the Danish medicine distribution system, 2001. In an attempt to clarify how consumerism within health care is manifested in policy, this study explores how central actors in the political process explicitly referred to the needs, interests and problems of the users of medicine. The results show that explicit references to the users of medicine by central actors in the political process were limited. Based on this we argue that in this case, although the debate centred on liberal ideas it seems as if chief values of classic liberalism were lost in the process of translating a political idea into political practice.Medicine Distribution System Consumer Participation Health Policy Health Care Reform Denmark