title: Coronary artery disease and the contours of pharmaceuticalization.
abstract: Coronary artery disease (CAD) has dominated mortality for most of the past century, not just in Europe and North America but worldwide. Treatments for CAD, both pharmaceutical and surgical, have become leading sectors of the healthcare economy. This paper focuses on the therapeutic landscape for CAD in the United States. We hope to add texture to the broader conversation of pharmaceuticalization explored in this issue by situating pharmaceutical therapies as just one element in the broader therapeutic terrain, alongside cardiac surgery and interventional cardiology. Patients with CAD must navigate a therapeutic landscape with three intersecting paths: lifestyle change, pharmaceuticals, and surgery. While pharmaceuticals are often seen as a quick fix, a way of avoiding more difficult lifestyle changes, it is surgery and angioplasty that promise patients the quickest fix of all. There also is another option, often overlooked by analysts but popular among physicians and patients: inaction. The U.S. context is often critiqued as a site of excessive treatment with respect to both drugs and procedures, and yet there is deep stratification within it--over-treatment in many populations and under-treatment in others. People who experience the serious risks of CAD do so in a racialized terrain of durable preoccupations with difference and unequal access to care. While the pharmaceuticalization literature disproportionately attends to lifestyle drugs, which some observers consider to be medically inappropriate or unnecessary, CAD does remain the leading cause of death. Thus, the stakes are high. Examination of the pharmaceuticalization of CAD in light of surgical treatments and racial disparities offers a window into the pervasiveness and persuasiveness of pharmaceuticals in an increasingly consumer-driven medicine, as well as the limits of their appeal and their reach.
authors.affiliation: Georgia Tech, Skiles Building Room 360, Atlanta, GA 30332, USA. Electronic address: apollock@gatech.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Pollock
authors.affiliation: Harvard University, Science Center 371, 1 Oxford St., Cambridge, MA 02138, USA. Electronic address: dsjones@harvard.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Jones
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D000067490:Prescription Drug Overuse; D063505:Racism; D014481:United States; D019564:Unnecessary Procedures; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D002317:Cardiovascular Agents
keywords: United States; angioplasty; blockbuster drugs; bypass surgery; coronary artery disease; heart disease; pharmaceuticalization; racial disparities