European Journal of Epidemiology

, Volume 29, Issue 6, pp 383–390 | Cite as

Personalised medicine, disease prevention, and the inverse care law: more harm than benefit?

  • Jack E. James

More than 40 years ago, Julian Tudor Hart wrote that the “availability of good medical care tends to vary inversely with the need for it in the population served” (p. 405) [1]. This pithy aphorism, which Hart named the inverse care law, was conceived not as a law of nature but as a heurist to elucidate aspects of healthcare delivery in the market economy. Hart proposed that the inverse care law is most evident “where medical care is most exposed to market forces, and less so where such exposure is reduced” (p. 405) [1]. His account has inspired numerous analyses of the distribution and quality of healthcare, and warrants revisiting in the context of personalised medicine, which some have argued has unprecedented potential to prevent disease and deliver major population-wide gains in health [2, 3, 4].

Personalised medicine

The optimism that accompanied completion of the Human Genome Project a decade ago included predictions about an impending “paradigm shift” in healthcare from...


Personalised medicine Inverse care law Inverse benefit law Preventive medicine GWAS Omic technologies Pharmacogenomics 


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Reykjavík UniversityReykjavíkIceland
  2. 2.National University of IrelandGalwayIreland

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