Leading doctors say the NHS must prepare for much greater use of medicines to prevent rather than just treat disease.
The Academy of Medical Sciences says personalised medicines tailored to the individual present a "great opportunity" to protect health.
It says this is the way public health should go.
But critics say the emphasis in preventing illness must be on lifestyle.
The Academy says scientific advances mean in future there will be more opportunities to intervene with treatment before there are any symptoms.
It argues developments in genetics present a great opportunity to develop highly effective targeted therapies, with a clear idea of who will benefit and who will not.
That could include drugs to prevent rather than treat disease.
The Academy's new president, Prof Sir Robert Lechler, says the NHS should prepare for this.
"I think it's unarguable that prevention is better than cure, and if you wait until the patient presents with signs or symptoms of kidney disease, liver disease, heart disease, very often most of the damage is done and can't actually be recovered.
"So if it were possible to take steps while still in health to prevent or delay the onset of disease that seems to make very good sense."
Sir Robert says he does not just envisage drug interventions for pre-emptive treatment - but his comments have raised renewed concerns about people being "over-medicated".
This issue has already provoked fierce debate over the use of statins for people at low risk of heart attack and stroke.
Professor Carl Heneghan from the Oxford University Centre for Evidence-Based Medicine, says the focus with disease prevention should be on issues such as physical activity, smoking and diet.
"What we have to do is look at clear lifestyle risk factors. The future of healthcare is a healthier lifestyle. Only in certain diseases such as cancer will we find personalised treatments are effective."
A prominent London cardiologist, Dr Aseem Malhotra, says over-medication is a major problem.
"The fact that prescription drugs are the third most common cause of death after heart disease and cancer should make policy makers wake up.
"Having a real impact on reducing demand and improving quality of care in the NHS will only happen when the root cause of lifestyle-driven disease is tackled head on and through de-prescribing; that is reducing an increasingly over medicated population."
Sir Robert Lechler argues as long as patients are given the best possible evidence, they should be given a choice. He says he welcomes a public debate on this issue.
Work with industry
The academy is also calling for closer collaboration between the NHS, academia and the pharmaceutical industry in finding new drugs. It says the current model of development is ineffective.
Some critics, though, feel industry already has too much power and influence in the way drugs are researched, developed and promoted.
Prof Heneghan says the public needs better protection.
"There are too many people with conflicts of interests taking decisions about policy and the way forward.
"What we need is an independent organisation, something like the Bank of England, that makes key decisions, in the public's interest, about how best to prevent disease and advise the public at large."