Risky Medicine

Statistics have been on the minds of more people than usual in the run-up and post-mortem of this past U.S. presidential election; some feel as though they were misled by numbers intended to lend a modicum of certainty to the complex calculus of modern life. But while election predictions come and go, the "empire of chance" lays siege to more and more aspects of daily life, alongside increasing possibilities for technological intervention--nowhere, perhaps, is this more clear than in medicine. Robert Aronowitz's Risky Medicine: Our Quest to Cure Fear and Uncertainty (University of Chicago Press, 2015) is both a nuanced and accessible exploration of the historical transformation of risk in modern biomedicine. Through a series of case studies and broader reflections on the ways in which modern medicine has become "risky," Aronowitz teases out salient features of an increasingly complex system of interventions and indicators. In the book, Aronowitz defines three key aspects of our modern "risky medicine." The first one discussed is a converged experience of risk and disease, exemplified in cancer screening in which bodies-at-risk can be subject to similar treatment and prevention regimes as those marked by a chronic condition or trying to prevent remission. Another aspect is the notion of risk reduction standing in place of efficacy for the psychological and social work it performs, which provides some explanation for the costliness of American medicine relative to the outcomes it achieves. Finally, Aronowitz argues that risk interventions have been driven by expansion of the medical market, and calls upon policymakers to become aware of the control pharmaceutical companies have in the generation of new health risks and the data to support them. One way of understanding Aronowitz's contribution is to contextualize it within the trajectory of sociological work on risk in modern society. Originally published in 1986 (in German), Ulrich Beck's Risk Society: Towards a New Modernity was a watershed book for the understanding of modernity and technological change. Much of Beck's account is concerned with environmental risks; the book came out on the heels of the Three Mile Island and Bhopal disasters. However, Beck's take on medicine is somewhat lacking. Beck presciently calls attention to the "reflexive market strategy" of pharmaceutical companies, in which they profit from self-produced risks--echoing the third aspect of "risky medicine'--but misses its more immediate social and psychological dimensions, stating merely that the rise of chronic disease is evidence of a divergence of diagnosis and therapy. Aronowitz's case studies suggest even more immediate consequences at hand. The importance of Risky Medicine is evident in how it disaggregates the changing landscape of health and medicine from an inexorable creep of modernity, spelling out the logic subjecting more bodies to greater interventions and recovering the relationship between experience and an ambivalent, anticipatory social order.