AS Micro: Offering heart drugs by default

Should we screen for signs of disease or change the default and provide drugs as a default option beyond a certain age? In a fascinating new study, medics from the Wolfson Institute at Barts and the London Medical School have put forward the case for offering everyone statins over the age of 55 preventative as treatment for blood pressure and cholesterol - they claim that offering relieving drugs might prevent as many as 100,000 heart attacks and strokes each year in England and Wales alone. It is an interesting example of a cost-benefit approach when allocating health service spending.

The alternative is a screening approach involving blood tests and medical examinations with drugs offered for those subsequently thought most at risk of strokes or heart attacks. Screenings by their very nature are costly because of the huge labour input involved. The proposal focuses only (for the moment) on narrow risk assessments of blood disorders and coronary problems - and keep in mind that the incidence of diabetes and chronic kidney disease continues to rise, the former linked strongly to the rising problem of obesity. Screenings would likely continue for younger people in higher risk groups such as those with a family history of heart disease, people of South Asian origin and people with diabetes

Coverage of the report focuses on one of the key issues - the rate of false positives - namely the percentage of people wrongly diagnosed as being at particular risk. The new report claims that by prescribing statins for anyone over the age of 55, doctors would achieve an 84 per cent accuracy rating for spotting heart problems - a similar false positive rate as the current system of screening.

What might be some of the unintended consequences of moving to default drug provision linked to age? Some medical experts have raised concerns that taking statins might cause people to ignore other aspects of their health such as diet and exercise. A case of moral hazard perhaps? Would you take a pill by default if you had not been screened and assessed beforehand?