Australia has been rewarded for the high quality of its healthcare systems by a progressive increase in life expectancy - over 80% of its population now survive beyond 70 years. Survival beyond this age is often accompanied by physical or cognitive disability and a poor quality of life. An increasing imperative for preventive medicine is to preserve mental and physical health as long as possible. One strategy to help achieve this goal is through ‘preventive’ medications that now contribute substantially to health expenditure.
This presentation will focus on the challenges of determining whether preventive medications are effective, using the ASPREE trial as an exemplar. Prior to the publication of ASPREE between 30-40% of elderly Americans took low-dose aspirin regularly to ward off heart disease and stroke and maintain health. However ASPREE clearly indicated that there was no basis for its use in primary prevention in this age group and is likely to be doing more harm than good.
In the future many more such agents are likely to be developed and promoted, with the aim of delaying the onset of conditions ranging from dementia to disability to declining organ function. Australia is well placed to play an important international role in evaluating these agents as our health system makes large community based trials easier to conduct here than in many other countries.