ABSTRACT
Preventive programmes are usually described as primary, secondary or tertiary. In this area of tertiary prevention, the reduction in the complications caused by illness, there is much scope for releasing resources. If the authors consider two examples the strength of this argument may become more apparent. The first is the introduction of a cardiac rehabilitation programme and the second the aggressive management of early osteoporosis. The loss of bone density with age is a universal and physiological rather than pathological process. Typically, those with osteoporosis follow a fracture career which starts with a Colles' fracture of the lower arm in their sixties, progresses through vertebral fractures in their seventies and culminates with a hip fracture in their eighties. A health policy which suggests that half of the population over the age of around 45 should be on permanent and medication will quite rightly raise ethical issues.
