Skip to main content
SpringerLink
Log in

The rise of statins in Denmark: Making the case for a localized approach to the routinization of pharmaceutical prevention of cardiovascular disease

  • Original Article
  • Published:
BioSocieties Aims and scope Submit manuscript

Abstract

This article provides a socio-historical account of the rise of preventive medicine in Denmark by exploring details of how pharmaceutical cholesterol-reduction became routinized as a standard of care. While other accounts of mass-prevention with statins primarily focus on the role of the pharmaceutical industry, we aim to show how routinization in a welfare state with free access to healthcare and where direct-to consumer advertisement is prohibited bring to the fore other actors and entities that are pivotal for the transformation of new treatment logics. Based on the close scrutiny of three decades of discussions in the Danish Weekly Medical Journal and interviews with key experts, we point to the important role of general practitioners as the main executors of preventive medicine in practice. Furthered by the introduction of new techno-scientific innovations such as guidelines and assessment tool, the routinization of statins in Denmark happened as a bottom-up process championed by a local group of therapeutic reformers who successfully manoeuvered the realms of science, politics and practice in order to transform contested global evidence into the very foundation of a new standard of care. We argue that localized processes of routinization are incredibly important for any understanding of pharmaceuticalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. All quotes from the Danish Medical Journal are translated from Danish by the authors.

References

  • Abraham, J. 2010. Pharmaceuticalization of Society in Context: Theoretical, Empirical and Health Dimensions. Sociology 44 (4): 603–622.

    Article  Google Scholar 

  • Abramson, J.D., et al. 2013. Should People at Low Risk of Cardiovascular Disease Take a Statin? BMJ 347: f6123.

    Article  Google Scholar 

  • Agerbæk, H. 1989. Skader Kolesterolintervention? Ugeskrift for Laeger 151 (51): 3498.

    Google Scholar 

  • Andersen, D., and O. Færgeman. 1987. Konsensuskonferencer. Ugeskrift for Laeger 149 (12): 799–800.

    Google Scholar 

  • Anderson, P., A. Voss, and M. Hørder. 1990. Distribution of Serum Total Cholesterol in a Population with Varying Risks of Cardiovascular Disease. Ugeskrift for Laeger 152 (8): 523–526.

    Google Scholar 

  • Aronowitz, R. 2015. Risky Medicine: Our Quest to Cure, Fear and Uncertainty. Chicago: The University of Chicago Press.

    Book  Google Scholar 

  • Astrup, P., et al. 1975. Food for Man and Beast. Ugeskrift for Laeger 137 (51): 3056–3057.

    Google Scholar 

  • Astrup, P. 1989. The Danish Heart Foundation’s cholesterol campaign. Ugeskrift for Laeger 151 (45): 2991–2994.

    Google Scholar 

  • De Backer, G., et al. 2003. European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Heart Journal 24: 1601–1610.

    Article  Google Scholar 

  • Bang, H.O. 1987. Kolesterol. Ugeskrift for Laeger 149 (51): 3485.

    Google Scholar 

  • Bauer, S. 2008. Curating and Dis/Playing the Biopolitics of Prevention. A Risk Assessment Software as a Museum Object? NordNytt. Nordisk Tidskrift for Ethnologi og Folkloristik 105: 71–85.

    Google Scholar 

  • Bjerrum, L., J. Larsen, and J. Kragstrup. 2001. Guidelines Accompanied by Changes in Reimbursement Rules: Effects on Lipid-Lowering Drug Prescribing. Scandinavian Journal of Primary Health Care 19 (3): 158–162.

    Article  Google Scholar 

  • Bonnevie, L., T. Thomsen, and T. Jorgensen. 2005. The Use of Computerized Decision Support Systems in Preventive Cardiology—Principal Results from the National PRECARD survey in Denmark. European Journal of Cardiovascular Prevention & Rehabilitation 12: 52–55.

    Google Scholar 

  • Choudhry, N.K., et al. 2014. Despite Increased Use and Sales of Statins in India, Per Capita Prescription Rates Remain Far Below High-Income Countries. Health Affairs (Project Hope) 33 (2): 273–282.

    Article  Google Scholar 

  • Christensen, C.L., et al. 2016. LIFESTAT—Living with Statins: An Interdisciplinary Project on the Use of Statins as a Cholesterol-Lowering Treatment and for Cardiovascular Risk Reduction. Scandinavian Journal of Public Health 44 (5): 534–539.

    Article  Google Scholar 

  • Collin, J. 2016. On Social Plasticity: The Transformative Power of Pharmaceuticals on Health, Nature and Identity. Sociology of Health & Illness 38 (1): 73–89.

    Article  Google Scholar 

  • Dumit, J. 2012. Drugs for Life: How Pharmaceutical Companies Define Our Health. London: Duke University Press.

    Book  Google Scholar 

  • Fleck, L. 1935. Genesis and Development of a Scientific Fact. Chicago: The University of Chicago Press.

    Google Scholar 

  • Fox, R.C., and J.P. Swazey. 1978. The Courage to Fail: A Social View of Organ Transplants and Dialysis, 2nd ed. Chiacago: University of Chicago Press.

    Google Scholar 

  • Færgeman, O. 1986. Heart diseases until year 200. Ugeskrift for Laeger 148 (46): 3039–3042.

    Google Scholar 

  • Færgeman, O., et al. 1986. Hyperlipidemia. Diagnostic and therapeutic guidelines. Ugeskrift for Laeger 148 (13): 775–780.

    Google Scholar 

  • Færgeman, O. 1988. Lovastatin and a Little of Everything. Ugeskrift for Laeger 150 (16): 951–952.

    Google Scholar 

  • Færgeman, O. 1983. Forebyggelse af iskæmisk hjertesygdom eller det forsømte barn i badevandet. Ugeskrift for Laeger 145 (22): 1791.

    Google Scholar 

  • Færgeman, O. 1976. Indikationer for Lipidsænkende Lægemidler. Ugeskrift for Laeger 138 (5): 291–293.

    Google Scholar 

  • Færgeman, O., and T. Haghfelt. 1995. The Scandinavian Simvastatin Survival Study. Ugeskrift for Laeger 157 (4): 458–460.

    Google Scholar 

  • Færgeman, O., T. Haghfelt, and T.T. Nielsen. 1998. Respons to Contribution to anticholesteremic agents. Ugeskrift for Laeger 160 (24): 3575–3576.

    Google Scholar 

  • Gabe, J., et al. 2015. Pharmaceuticals and Society: Power, Promises and Prospects. Social Science and Medicine 131: 193–198.

    Article  Google Scholar 

  • Garrety, K. 1997. Social Worlds, Actor-Networks and Controversy: The Case of Cholesterol, Dietary Fat and Heart Disease. Social Studies of Science 27 (5): 727–773.

    Article  Google Scholar 

  • Gerdes, L.U., and O. Færgeman. 1988. Screening for Risk of Cardiovascular Diseases at the Arhus Town Hall. Ugeskrift for Laeger 150 (15): 906–910.

    Google Scholar 

  • Godlee, F. 2016. Statins: We Need an Independent Review. British Medical Journal 354: i4992.

    Article  Google Scholar 

  • Godlee, F. 2014. Statins and the BMJ. BMJ 349: 5038.

    Article  Google Scholar 

  • Gram, J.B. 1995. The Scandinavia Simvastatin Survival Study (4S). Ugeskrift for Laeger 154 (14): 2020.

    Google Scholar 

  • Greene, J.A. 2007. Prescribing by Numbers. Drugs and the Definition of Disease. Baltimore: The Johns Hopkins University Press.

    Google Scholar 

  • Hilden, T. 1989. Isaksson B, Osler M. Kost og hjertesygdomme. Ugeskrift for Laeger 151 (41): 2680.

    Google Scholar 

  • Hilden, T. 1986. Kolesterol og Iskæmisk Hjertelidelse. Ugeskrift for Laeger 148 (51): 3463.

    Google Scholar 

  • Hilden, T., and P.B. Andreasen. 1983. Intervention i udvikling af Iskæmisk Hjertesygdom. Ugeskrift for Laeger 145 (22): 1690–1692.

    Google Scholar 

  • Hjerteforeningen. 2012. 50 år på rette sted Hjerteforeningens historie 1962–2012. København: Hjerteforeningen.

    Google Scholar 

  • Jasanoff, S. 1995. Science at the Bar: Law, Science, and Technology in America. Cambridge: Harvard University Press.

    Google Scholar 

  • Jasanoff, S.S. 1987. Contested Boundaries in Policy-Relevant Science. Social Studies of Science 17 (2): 195–230.

    Article  Google Scholar 

  • Jensen, G. 1992. Answer to [What is the correct answer in the cholesterol debate?]. Ugeskrift for Laeger 154 (24): 1718.

    Google Scholar 

  • Kallerup, H.E.S. 2000. Den praktiserende læge som “forebygger”: Dansk Selskab for Almen Medicin. Ugeskrift for Laeger 162 (12): 1709.

    Google Scholar 

  • Kaufman, S.R. 2015. Ordinary Medicine: Extraordinary Treatments, Longer Lives, and Where to Draw the Line. Durham: Duke University Press.

    Book  Google Scholar 

  • Koenig, B.A. 1988. The Technological Imperative in Medical Practice: The Social Creation of a “Routine” Treatment. In Biomedicine Examined, ed. M.M. Lock and D. Gordon, 465–496. Dordrecht/Boston/London: Kluwer Academic Publishers.

    Chapter  Google Scholar 

  • Kristensen, B.Ø., and P. Henningsen. 1989. Hvad nytter kolesterolreduktion egentlig? Ugeskrift for Laeger 151 (43): 2821–2823.

    Google Scholar 

  • Kristensen, M.L., P.M. Christensen, and J. Hallas. 2015. The Effect of Statins on Average Survival in Randomised Trials, an Analysis of End Point Postponement. British Medical Journal Open 5 (9): e007118.

    Google Scholar 

  • Latour, B. 1987. Science in Action. Cambridge MA: Harvard University Press.

    Google Scholar 

  • Latour, B., and S. Woolgar. 1979. Laboratory Life: The Construction of Scientific Facts. Beverly Hills and London: SAGE Publications.

    Google Scholar 

  • Lau, S.R. 2014. Using Ethnography to Understand Patients’ Perspectives of Medicine Use: The Case of Hypercholesterolemia and Statins. Research in Social and Administrative Pharmacy 10 (5): e60–e61.

    Article  Google Scholar 

  • Loevschall, F. 1987. Is it decent? Ugeskrift for Laeger 149 (4): 230.

    Google Scholar 

  • Lupton, D. 1995. The Imperative of Health. Public Health and the Regulated Body. London, Thousand Oaks, New Delhi: Sage Publications.

    Google Scholar 

  • Mabeck, C.E., H. Kallerup, and M. Maunsbach. 1999. Den motiverende samtale. Aalborg: Dansk Selskab for Almen Medicin.

    Google Scholar 

  • Marks, H.M. 1997. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990. Cambridge: Cambridge University Press.

    Google Scholar 

  • Meinertz, H. 1984. Treatment of Hypercholesterolemia Prevent Ischaemic Heart Disease. Ugeskrift for Laeger 146 (11): 823–824.

    Google Scholar 

  • Foucault, Michel, et al. 1988. Technologies of the Self: A Seminar with Michel Foucault. Amherst, Michigan: University of Massachusetts Press, University of Michigan.

    Google Scholar 

  • Møller, J.E. 2014. Selvteknologier i Sundhedspraksis. Teknologi i sundhedspraksis, 105–128. København: Munksgaard Danmark.

    Google Scholar 

  • NIH. 1985. Lowering Blood Cholesterol to Prevent Heart Disease. JAMA 253 (14): 2080–2086.

    Article  Google Scholar 

  • Ong, A., and S.J. Collier. 2005. Global Assemblages. Technology, Politics, and the Ethics as Anthropological Problems. Massachusetts, Oxford, Victoria: Blackwell Publishing.

    Google Scholar 

  • Pedersen, K.M., J.S. Andersen, and J. Søndergaard. 2012. General Practice and Primary Health Care in Denmark. Journal of the American Board of Family Medicine: JABFM 25 (Suppl 1): S34–S38.

    Article  Google Scholar 

  • Petursson, H. 2012. The Validity and Relevance of International Cardiovascular Disease Prevention Guidelines for General Practice. Trondheim: Norwegian University of Science and Technology.

    Google Scholar 

  • Ravnskov, U. 1992. Cholesterol Lowering Trials in Coronary Heart Disease: Frequency of Citation and Outcome. BMJ 305 (6844): 15–19.

    Article  Google Scholar 

  • Ravnskov, U. 2000. The Cholesterol. Myth Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease. Washington DC: NewTrends Publishing.

    Google Scholar 

  • Rose, G. 1985. Sick individuals and sick populations. International Journal of Epidemiology 14: 32–38.

    Article  Google Scholar 

  • Sackett, D.L., et al. 1996. Evidence Based Medicine: What it is and What it isn’t. BMJ 312 (7023): 71–72.

    Article  Google Scholar 

  • Scandinavian Simvastatin Survival Study Group. 1994. Randomised Trial of Cholesterol Lowering in 4444 Patients with Coronary Heart Disease: The Scandinavian Simvastatin Survival Study (4S). The Lancet 344 (8934): 1383–1389.

    Google Scholar 

  • Steinberg, D. 2007. The Cholesterol Wars—The Skeptics vs. the Preponderance of Evidence. San Diego: Elsevier.

    Google Scholar 

  • Sundhedsdatastyrelsen (2017) Lægemiddelstatistik.

  • Sundhedsdatastyrelsen (2015) MedicinForbrug—INDBLIK, København.

  • Sundhedsstyrelsen (1999) Tidsskrift om forebyggelse: Tema - Folkesundhedsprogrammet 1999–2008. Vital—Sundhedsstyrelsen (2).

  • THINCS. 2014. The International Network of Cholesterol Skeptics (THINCS).

  • Thomsen, T.F., et al. 2001. A New Method for CHD Prediction and Prevention Based on Regional Risk Scores and Randomized Clinical Trials; PRECARD and the Copenhagen Risk Score. Journal of Cardiovascular Risk 8 (5): 291–297.

    Article  Google Scholar 

  • Timmermans, S., and M. Berg. 2003. The Gold Standard: The Challenge of Evidence-Based Medicine. Philadelphia: Temple University Press.

    Google Scholar 

  • Wahlberg, A. 2016. The Birth and Routinization of IVF in China. Reproductive Biomedicine & Society Online 2: 97–107.

    Article  Google Scholar 

  • Wallach Kildemoes, H., et al. 2012. Statin Utilization According to Indication and Age: A Danish Cohort Study on Changing Prescribing and Purchasing Behaviour. Health Policy 108 (2–3): 216–227.

    Article  Google Scholar 

  • Walley, T., et al. 2005. Trends in Prescribing and Utilization of Statins and Other Lipid Lowering Drugs Across Europe 1997–2003. British Journal of Clinical Pharmacology 60 (5): 543–551.

    Article  Google Scholar 

  • Will, C.M. 2005. Arguing About the Evidence: Readers, Writers and Inscription Devices in Coronary Heart Disease Risk Assessment. Sociology of Health & Illness 27 (6): 780–801.

    Article  Google Scholar 

  • Williams, S.J., P. Martin, and J. Gabe. 2011. The Pharmaceuticalisation of Society? A Framework for Analysis. Sociology of Health & Illness 33 (5): 710–725.

    Article  Google Scholar 

Download references

Acknowledgements

This manuscript comprises original material that is not under review elsewhere. The studies on which the research is based have been subject to appropriate ethical review. The authors have no competing interests – intellectual or financial – in the research detailed in the manuscript.

Author information

Authors and Affiliations

  1. Department of Anthropology, University of Copenhagen, LIFESTAT, Øster Farimagsgade 5, 1353, Copenhagen, Denmark

    Sofie Rosenlund Lau & Bjarke Oxlund

  2. Department of Public Health, Section of General Practice, University of Copenhagen, LIFESTAT, Copenhagen, Denmark

    John Sahl Andersen

  3. Department of Biomedical Sciences, X-lab, University of Copenhagen, LIFESTAT, Copenhagen, Denmark

    Flemming Dela

Authors
  1. Sofie Rosenlund Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Sahl Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Flemming Dela
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bjarke Oxlund
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sofie Rosenlund Lau.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lau, S.R., Andersen, J.S., Dela, F. et al. The rise of statins in Denmark: Making the case for a localized approach to the routinization of pharmaceutical prevention of cardiovascular disease. BioSocieties 14, 228–250 (2019). https://doi.org/10.1057/s41292-018-0126-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/s41292-018-0126-z

Keywords

Search

Navigation