When Medicine Becomes a Market

Over many years, I have watched modern healthcare change in a way that should concern us all. Increasingly, medication has become the first response, not the last resort. People in pain, people labelled as "at risk", and people with borderline clinical readings are routinely placed on long-term drug regimens, often without proper discussion of alternatives, without sufficient clinical discretion, and without honest conversations about long-term consequences.

This is not an attack on medicine, nor a rejection of science. It is, quite simply, a call for restraint, integrity, and ethical clarity. Somewhere along the way, we have drifted from healing individuals towards "managing populations."

By "managing populations," we mean a system where doctors are encouraged to follow broad rules designed for large groups rather than making careful, individual decisions. People are treated not because they are unwell, but because they might become unwell in the future. A borderline reading or a calculated risk score can lead to medication for life, even when the person feels fine. In this approach, patients become "risks to be controlled" instead of individuals receiving personalised care.

A Concern Backed by Major Medical Authorities

This concern is not fringe, and it is not ideological. Some of the world's most respected medical authorities have repeatedly warned about what is happening. The World Health Organisation has highlighted the growing harms of over-medicalisation and polypharmacy, particularly among older people and those living with stable, manageable conditions. Leading journals such as The Lancet and the British Medical Journal have questioned how disease definitions continue to expand, how risk thresholds are lowered, and how probability is increasingly treated as pathology.

The Reality of Over-Prescription

Normal ageing, moderate discomfort, and early or borderline indicators are now frequently reframed as medical conditions requiring lifelong pharmaceutical intervention. In everyday clinical practice, pain is often medicated before non-drug options are seriously explored. Borderline cholesterol, early respiratory symptoms, stress-related issues, or manageable musculoskeletal pain can all trigger immediate prescriptions, sometimes intended to last a lifetime.

What is rarely explained to patients is that many of these decisions are based on population-level evidence. In simple terms, what reduces risk across a large group does not necessarily deliver meaningful benefit to the individual sitting in the consultation room. The statistical benefit may be marginal, yet the personal cost, including side effects, dependency, and reduced quality of life, is very real.

The Industry Influence We Cannot Ignore

Alongside this sits an uncomfortable truth. The pharmaceutical industry now plays a significant and often unseen role in shaping healthcare decisions, influencing research, clinical guidance, and prescribing practices, often without patients being fully aware of it. This culture did not emerge overnight, and it did not happen by accident. Industry-funded research, sponsored education, overseas conferences, travel grants, advisory roles, and scholarships have become normalised across healthcare systems worldwide. These relationships are not always corrupt, but they are rarely neutral.

Clinical guidelines increasingly rely on studies funded by the manufacturers of the very drugs being recommended. This creates a structural conflict of interest, not an incidental one. Regulators can no longer afford to treat this reality as benign or harmless.

The Opioid Crisis: A Stark Warning

The opioid crisis in the United States stands as a stark warning of what happens when these dynamics spiral out of control. That crisis was not caused by a single bad actor. It arose from a system that failed at multiple levels. Oversight was weakened, marketing downplayed genuine risks, evidence of harm was suppressed or minimised, and healthcare systems became conditioned to trust pharmaceutical solutions over clinical scepticism. While opioids represent an extreme case, the underlying forces that enabled that catastrophe are far more widespread across modern medicine.

Fear, Dependency, and the Cost of Caution

Fear plays a powerful role in all of this. Patients warned of heart attacks, strokes, diabetes, or decline are understandably anxious. In that emotional space, "a prescription can feel like protection," even when the long-term benefit to the individual is uncertain or modest.

Preventive prescribing often means exposing everyone to side effects in order to reduce risk for a small proportion. Over time, dependency is reframed as "management". Side effects lead to further prescriptions. Withdrawal becomes harder than the original condition ever was. Quietly, the burden of systemic uncertainty is transferred onto the patient's body and daily life.

A Call for Balance, Transparency, and Reform

This is why the call for balance, transparency, and reform is no longer optional. A credible, patient-centred healthcare system must:

• Treat medication as one tool among many, not the default response
• Prioritise informed consent, lifestyle measures, and non-pharmacological care
• Enforce full transparency around industry funding and conflicts of interest
• Restore genuine regulatory independence, supported by meaningful post-market surveillance

At Its Heart, This Is About Values

For policymakers and regulators, the question is no longer whether over-medication exists. The real question is why it continues to be tolerated.