Title: Disease Risk Factors
Credit: Sharon Sinclair www.ekgtechniciansalary.org
Uploaded from Flickr and used under Creative Commons – Attribution.
Parallels can be drawn between the ways in which medical screening (with mammography, for instance) can lead to over-reaction and over-treatment, and the ways in which socio-political screening for criminals or alleged “terrorists” (with social profiling and predictive policing) does the same. In the latter case, though, it’s more likely that we will all be “over-treated” collectively, rather than on an individual basis.
As reasons for screening expand in medicine, more and more of what can be identified is found to be of no consequence in that it will not lead to disease or death. So, too, in the political realm: screening, or perhaps more properly called profiling here, categorizes as potential risks individuals and groups who will never cause harm. And just as fear of disease becomes itself a disease alleged to need treatment, fear of “terrorism” has in itself aroused wide-ranging measures for its alleged control.
Screenings are based on some very problematic assumptions about fear: that there are conditions we should fear, that there are people we should fear. Further assumptions about how to identify what we should fear and what action then needs to be taken tend to fall into unproven syllogisms in which conclusions are drawn from two or more (often questionable) premises that are taken to be true:
- Screening/profiling will identify or predict sources of harm.
- Identifying/labelling/naming these sources of harm will lead to actions that prevent what is feared might happen.
- Therefore, screening/profiling is good.
In other words, screening and “predicting” are built on specifying certain fears and anxieties about health or safety as those about which we should be concerned. Fear is thus manufactured and given a “pedagogical” role used to raise awareness and lead to action. More specifically, predicting the future and then offering options for early action before harm spreads means that suspicions, often unproven, become grounds to rout out supposed threats in our bodies or on our streets. Furthermore, constructing and using fear in this way creates markets — for medicines, weapons, policing tools — and legitimizes state control whether by medical or political/police agents.
When fears are based on compilations of data and statistical computations (as is increasingly the case, given all the data gathered by medical personnel and by police forces), there is a not so subtle slippage between what is probable or actual and what is merely possible, with the latter being almost completely open-ended. If what is predicted need merely be “possible” — and true, we each do face some chance of developing some disease, even if the chance of this, its probability, is very low — we can all wind up labelled and expected to do something about it. Fighting the risk of disease, rather than fighting the dis-ease of the fear created, becomes normalized, and we are drawn into a kind of infinite loop — a Mobius strip that has no way out.
When applied to biomedicine, this looping is a bonus for neoliberal capitalism. However, technologically advanced screening methods aren’t always needed to get it started. Simple questioning (do you smoke? exercise? drink?) will uncover individual behaviours alleged to cause disease, and people can then be advised to make what is labelled a “responsible choice” (stop smoking, go to the gym, stop drinking) so as to avoid the ill health otherwise possible at some indeterminate future date.
When fear-raising (or indeed fear-mongering) occurs and individuals are framed as being responsible for taking action, those who fail to do so become targets for victim-blaming, while the societal and structural factors that limit options are left intact. The corporations that manufacture and sell unhealthy, if not dangerous, commodities (which are often subsidized or otherwise supported by government policies and practices) not only reap the profits from marketing their products. Not infrequently, they also commercialize medicines for treating conditions that they themselves have caused in the first place. An outstanding example: widely promoted statin medications prescribed to reduce some hypothetical risk of cholesterol-related heart disease in the future.
It’s hard not to feel that we are increasingly caught in multiple traps where dangers are said to be lurking inside our bodies, no less than on the streets all around us, and we are constantly being told that we need informers (whether of the human or man-made variety) to find these perils, so we can be “safe”.
But maybe we can turn these manufactured fears to our own advantage and reveal the real fears we face, rallying together to remove them. This could happen if we identified as truly fearful (if we were to identify anything at all) what could be called “industrial diseases” — those caused by or associated with corporations that are selling unhealthy or dangerous products, contaminating the earth, waters, and air on which we depend, marketing medicines of limited or no effectiveness, adhering to labour policies that expose workers to direct and indirect harm, and so on. Maybe it’s their bottom-line focused practices, policies, and products that we should fear, and which need to be screened for and eliminated. It could happen, too, if we banded together in opposition to societal dangers threatening social justice and our civil and social liberties and rights.
Once we enter a world where screening and “prediction” carry so much force — whether leading to some specific medical intervention or police action, whether for reducing an alleged risk of a future health problem or for keeping “terrorists” off the streets through police monitoring or medicalized forms of racial or other profiling — we are on very slippery ground. We are certainly far removed from the generally benign application of precautionary principles to avoid environmental disasters, and from the protections of rights and justice we are owed.
Risk and risk management have greatly dominated ways of thinking and practice for the past several years, paralleling all the fear-mongering that underpins these approaches. But though many have commented on the complexities and concerns associated with predictive medical testing, I’m not sure that important broader concerns have received sufficient attention, considering how such testing is an element in the financial planning of the pharmaceutical industry and the budgetary planning of austerity-driven governments. And it’s not clear, either, that there has been full exploration of how this ties in with the over-emphasis by governments and politicians on the needs for “security.”
Prediction as it is being enacted now, whether in government policies or in medical society guidelines, is dangerous to our health and well-being — and to a just society. In a climate where the government creates fear of crime among citizens to justify the mega-dollars to be spent on building new prisons and finding people to put into them; encourages fears of becoming ill, while at the same time reducing support for public health and health promotion; and demonizes “others” (immigrants, migrants, refugees) to justify its expulsion and rendition of individuals, based on the group they are part of — the idea of “prediction” has an almost instinctive appeal for many, despite the general lack of knowledge about its limitations and downsides.
Perhaps it’s time, and not too late, to get rid of all kinds of predictive policing — biomedical and socio-political — that harms individuals and groups, and focus on our fears of those doing this harm.
