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Risky Medicine: Our Quest to Cure Fear and Uncertainty
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Review
“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.” (Discover)“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.” (Financial Times)“With approaches from multiple disciplines such as sociology, anthropology and history, and drawing on personal experiences as a physician, Aronowitz’s book offers a critical perspective of the expanding centrality of risk in medicine and its effects on public health systems, clinical practice and disease experience. In this sense, Aronowitz’s work is part of emerging scholarship on the centrality of risk in science and medicine. . . . The book is, therefore, both relevant and an important read for historians of medicine and science, economists, public health policy makers and medical practitioners.” (Medical History)"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." (Boston Review)"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)
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About the Author
Robert Aronowitz is professor and chair of the history and sociology of science at the University of Pennsylvania; he earned his medical degree from Yale University. His books include Making Sense of Illness: Science, Society, and Disease and Unnatural History: Breast Cancer and American Society. He lives in Merion Station, Pennsylvania.
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Product details
Hardcover: 288 pages
Publisher: University of Chicago Press; 1 edition (September 16, 2015)
Language: English
ISBN-10: 022604971X
ISBN-13: 978-0226049717
Product Dimensions:
6 x 1.1 x 9 inches
Shipping Weight: 1.6 pounds (View shipping rates and policies)
Average Customer Review:
4.4 out of 5 stars
5 customer reviews
Amazon Best Sellers Rank:
#1,030,672 in Books (See Top 100 in Books)
Medical care is the real "Risky Business"...the authors perspective is that we are investing heavily in risk reduction, even when the risk of disease for us as individuals is small compared to the known ill affects of many of the treatments offered. Treating disease without the concomitant population benefits is delivering a message we are unprepared to hear...unless of course you read this book.
Bought it as a gift - great book!
Great book to read. Outlines the main issues that can occur when we assume if a little medicine is good then more is better. It is very tough when the test itself might be simple, but the consequences are significant. Each test generates a set of options, each with their own problems and complications.Very clear discussion of what constitutes evidence and what constitutes benefit. Shines a light on how messy medical data can be, particulary the use of end points that may or not have any relationship to life expectancy or quality (cholesterol numbers)As a specialist in urology I have a couple of quibbles with Dr Aronowitz, who is a primary care doctor. The evidence for PSA testing between 55-70yr suggests minimal benefit. In response urologists are trying to get data on 45-55 yr who we think would gain more benefit.What is not discussed to such great detail is the legal framework doctors work within. A specialist carries more legal risk than a PCP. Therefore until society accepts there are risks and they are never zero testing will happen. It does not matter when the evidence shows more testing and imaging leads to fewer lawsuits against specialists.
Robert Aronowitz does a masterful job in articulating a central and generally unrecognized problem which pervades contemporary health care delivery. We have moved from emphasizing treatment of disease and suffering to attempting to mitigate risk. Unfortunately, most of those involved do not recognize the differences between being afflicted by disease (a bad outcome in and of itself) and being at risk for disease.
The central premise of this well-written book is that modern medicine emphases treating risk, which has fundamentally changed how disease is defined and treated. The author points out that much of the emphasis on treating risk can be attributed to economic incentives. Providing products that treat risk (instead of disease) opens up vast new markets for pharmaceutical companies.The important thing to remember is that no intervention is void of side-effects, but this doesn't mean all interventions/tests are always bad either. I wish this book had provided a bit more practical knowledge in terms of which tests/procedures are on shaky grounds.
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