Uncertain Enthusiasm: PSA Screening, Proton Therapy and Prostate Cancer

Abstract

The twentieth century decline in the incidence and prevalence of infectious disease has long been recognised by historians as coinciding with a renewed biomedical focus on the ‘disease management’ of the chronically ill.’ During the 1960s and 1970s the use of ‘risk factors’ — clinical indicators, genetic markers, lifestyle choices, and the like — began to increase the frequency and intensity of similar disease management interventions in seemingly healthy populations. During the past 40 years the global health care industry has engineered hugely profitable markets from healthy ‘patients’ largely by appealing to the value of preventative intervention in the battle against the new diseases of civilisation: hypertension, cancer, and diabetes.² Ilana Löwy, Robert Aronowitz, and Charles Rosenberg have all recently documented some disturbing trends in disease management directed at the aggressive prevention of anticipated undesirable outcomes.³ New diagnostic tools and larger programmes of more biologically sensitive screening have lead to ever greater ‘early detection’ of ‘pre-cancerous’, ‘pre-diabetic’, and ‘pre-hypertensive’ patient populations. As Aronowitz points out, the experiences and patient-pathways of these ‘pre-patient’ patients can become almost indistinguishable from those patients with serious clinical symptoms of disease.⁴ While the consequences of this elision between statistical risk of disease and actual organic illness can be relatively benign, Aronowitz, Löwy and Rosenberg highlight at least one dire consequence of this trend: the rising number of healthy but ‘BRCA positive’ women undergoing extremely drastic measures such as prophylactic double mastectomies.