{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:49:36Z","timestamp":1792136976684,"version":"4.4.0"},"reference-count":101,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Sociology Health &amp; Illness"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Sociological interest in pharmaceuticalisation continues to grow, especially regarding the expansion of pharmaceutical use in society. This article presents the first major empirical study focusing on the directionality of pharmaceuticalisation by taking cost\u2010effectiveness assessment and regulation of anticoagulants in England by the National Institute of Health and Care Excellence (NICE) as a case study. During this century, anticoagulant therapy for the prevention of stroke and systemic embolism has changed direction profoundly away from warfarin towards newer and markedly more expensive direct oral anticoagulants. Drawing on established theoretical frameworks of pharmaceuticalisation, together with years of documentary research, interviews and observations of stakeholder meetings, it is demonstrated that this directional change cannot be adequately accounted for solely by reference to biomedicalism. Rather, such change must also be explained by key sociological factors, including the adoption of the permissive principle towards the newer drugs by the NICE regulatory system, pharmaceutical industry influence on governance processes, the \u2018coincidence\u2019 of expansion in diagnostic criteria for stroke risk with the introduction of the new direct oral anticoagulants, and the promotion of neoliberal patient choice and innovation by the regulatory state. Finally, the generalisability and policy implications of our findings for other therapeutic and institutional contexts are considered.<\/jats:p>","DOI":"10.1111\/1467-9566.70279","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:23:28Z","timestamp":1792135408000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inside the \u2018Black Box\u2019 of Pharmaceuticalisation: NICE, the Permissive Principle and the Case of Anticoagulants"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0643-0274","authenticated-orcid":false,"given":"John","family":"Abraham","sequence":"first","affiliation":[{"name":"Department of Medical Education Brighton and Sussex Universities Medical School (BSMS)  Brighton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gowree","family":"Balendran","sequence":"additional","affiliation":[{"name":"Faculty of Medicine &amp; Health Sciences Keele University  Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_18_2_1","unstructured":"ABPI [Association of the British Pharmaceutical Industry].2013. \u201cABPI Supports Launch of NICE Implementation Collaborative Concordat.\u201dhttp:\/\/www.abpi.org.uk\/media\u2010centre\/blog\/2013\/march\/130313\/."},{"key":"e_1_2_18_3_1","volume-title":"Science, Politics and the Pharmaceutical Industry","author":"Abraham J.","year":"1995"},{"key":"e_1_2_18_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/13698570210292"},{"key":"e_1_2_18_5_1","doi-asserted-by":"publisher","DOI":"10.1215\/03616878\u20102009\u2010032"},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0038038510369368"},{"key":"e_1_2_18_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467\u20109566.13878"},{"key":"e_1_2_18_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0306312709103480"},{"key":"e_1_2_18_9_1","volume-title":"Regulating Medicines in Europe","author":"Abraham J.","year":"2000"},{"key":"e_1_2_18_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/713670172"},{"key":"e_1_2_18_11_1","volume-title":"The Therapeutic Nightmare: The Battle Over the World\u2019s Most Controversial Sleeping Pill","author":"Abraham J.","year":"1999"},{"key":"e_1_2_18_12_1","doi-asserted-by":"publisher","DOI":"10.47772\/IJRISS.2024.8120099"},{"key":"e_1_2_18_13_1","unstructured":"AstraZeneca.2003. \u201cExanta (Ximelagatran) Receives First Approval.\u201d Press Release 23 December."},{"key":"e_1_2_18_14_1","article-title":"Position Statement: Opportunistic Screening for Atrial Fibrillation in Local Populations for Individuals Aged 65 Years Old and Over","author":"Bakhai A.","year":"2015","journal-title":"UCL Partners AF Programme"},{"key":"e_1_2_18_15_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2261-13-108","article-title":"Patient Perspective on Management of Atrial Fibrillation in Five European Countries","volume":"13","author":"Bakhai A.","year":"2013","journal-title":"BMC Cardiovascular Disorders"},{"key":"e_1_2_18_16_1","doi-asserted-by":"publisher","DOI":"10.55016\/08mb7908"},{"key":"e_1_2_18_17_1","volume-title":"FDA Medical Review \u2013 Dabigatran","author":"Beasley N.","year":"2010"},{"key":"e_1_2_18_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmp1103050"},{"key":"e_1_2_18_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2012.04.002"},{"key":"e_1_2_18_20_1","first-page":"203","article-title":"Too Big to Lose Weight: How Pharmaceuticalization Corrupts the Right to Health","volume":"27","author":"Benavides X.","year":"2025","journal-title":"Health and Human Rights"},{"key":"e_1_2_18_21_1","unstructured":"Blank M. 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