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

摘要

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.