Our Quest to Cure Fear and Uncertainty
Our Quest to Cure Fear and Uncertainty
Exploring the transformation of health care over the last several decades that has led doctors to become more attentive to treating risk than treating symptoms or curing disease, Aronowitz shows how many aspects of the health system and clinical practice are now aimed at risk reduction and risk control. He argues that this transformation has been driven in part by the pharmaceutical industry, which benefits by promoting its products to the larger percentage of the population at risk for a particular illness, rather than the smaller percentage who are actually affected by it. Meanwhile, for those suffering from chronic illness, the experience of risk and disease has been conflated by medical practitioners who focus on anticipatory treatment as much if not more than on relieving suffering caused by disease. Drawing on such controversial examples as HPV vaccines, cancer screening programs, and the cancer survivorship movement, Aronowitz argues that patients and their doctors have come to believe, perilously, that far too many medical interventions are worthwhile because they promise to control our fears and reduce uncertainty.
Risky Medicine is a timely call for a skeptical response to medicine’s obsession with risk, as well as for higher standards of evidence for risk-reducing interventions and a rebalancing of health care to restore an emphasis on the actual curing of and caring for people suffering from disease.
“Americans have the most advanced (and expensive) health care—but not the best health. Science and sociology historian Aronowitz suggests that our market-driven, risk management-focused health care culture has led to excessive tests and overdiagnosis. The cure? Reforming how we think about health and how it’s practiced.”
“Aronowitz poses useful questions about how societies should decide which innovations to adopt and how much people should choose to know about what is happening inside their bodies.”
"The rise of medical statistics has not just changed the way physicians evaluate therapies. It has also fundamentally changed our understanding of health and disease. As physician and historian Robert Aronowitz argues in Risky Medicine: Our Quest to Cure Fear and Uncertainty, it is no longer necessary to feel ill in order to be ill. A patient may feel fine and yet be treated as sick because her indicators point to elevated risk of disease or premature death. The experience of being “at risk” has, Aronowitz contends, converged with the experience of disease itself."
"In Risky Medicine: Our Quest to Cure Fear and Uncertainty, physician and leading medical historian Robert Aronowitz maps the historical emergence of the risk paradigm in health: the notion that the task of medicine is to reduce and manage the probability of future illness rather than treating present disease."
American Sociological Association
“Risky Medicine examines the tremendous implications of the collapsing of risk and disease in contemporary American biomedicine. Across a series of historical and contemporary cases, and with great acuity, clinician/historian Aronowitz explains how we have come to the point where much of our medical care, health policy, and patient experience is shaped less by illness itself than its potential threat. This immensely intelligent, bold, yet humane book offers vital insight into the problems of overtreatment as well as new dimensions of embodiment and anxiety that follow from our focus on risk.”
Julie Livingston, author of Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic
“An important, timely, and provocative analysis of our contemporary style of managing—and experiencing—disease. In today's world of ‘risky medicine’ we have come to diagnose and treat likelihoods—risk—as much as pain and incapacity, without evaluating the costs as well as benefits of this novel medical regime. Aronowitz’s forceful analysis makes clear the necessity for that critical evaluation; this book should be widely and enthusiastically reviewed.”
Charles E. Rosenberg, author of Our Present Complaint: American Medicine, Then and Now
“In Risky Medicine, Aronowitz brilliantly analyzes the essential ironies of contemporary biomedicine. In our efforts to reduce the risk of disease, we may augment those very risks. In our efforts to reduce uncertainties about our health, we introduce new uncertainties. The traditional medical dictum of ‘do no harm’ becomes virtually impossible in a technocentric medical world of monitoring, testing, and treatment. Physicians, historians, policy makers, and patients will all benefit from this powerful precautionary tale.”
Allan M. Brandt, author of The Cigarette Century
“How did risk reduction become the mantra of modern medicine? Risky Medicine tells the important story of how disease and the risk of it have become collapsed to the point that it’s no longer always clear which one we’re actually treating. A physician and historian of medicine, Aronowitz surprises the reader with his counterintuitive arguments but never oversimplifies debates or caricatures the doctors, researchers, patients, and policy makers who figure in this compelling and incisive account. He shows us how medicine’s risk revolution matters, both for individuals who must manage their fears in the face of uncertainty and for societies intent on improving health outcomes while controlling costs.”
Steven Epstein, author of Inclusion: The Politics of Difference in Medical Research
“In this important new book, Aronowitz shows us how all aspects of the US health system, from prevention to cure, hospital stays to outpatient visits, fee-for-service to managed care, have become entangled in a sprawling morass of ‘risky medicine’: a preoccupation with reducing and managing risks of future disease rather than treating present illness. Risky Medicine skillfully traces how it is that we came to think of health and disease in terms of risks instead of symptoms, demonstrates why our increasing concern with risk leads to more healthcare spending without necessarily improving quality of life, and offers keen analysis and concrete policy suggestions to rethink the role of risk in health policy and medical practice. This should be required reading for anyone with a serious interest in the past, present, or future of health care in America.”
Jeremy Greene, author of Generic: The Unbranding of Modern Medicine
"Aronowitz explores the transition from a time when medical encounters were primarily dealt with the management of felt bodily experience and physical signs to highly probabilistic risk knowledge that increasingly generated by medically-directed surveillance and probing. In tracing this transformation, Aronowitz aims to contribute to the history and sociology of medicine, in particular the study of disease and the disease experience as well as to our thinking about policy choices."
Table of Contents
1 Risky medicine: Our quest to cure fear and uncertainty
2 The converged experience of risk and disease
3 The social and psychological efficacy of risk interventions
4 The Framingham Heart Study: The emergence of the risk factor approach
5 Gardasil: A vaccine against cancer and a drug to reduce risk
6 Lyme disease vaccines: A cautionary tale for risk intervention
7 Cancer survivorship: The entangled experience of risk and disease
8 The global circulation of risk interventions
9 Situating health risks: An opportunity for disease prevention policy
10 Epilogue: The risk system