Risky Medicine: Our Quest to Cure Fear and Uncertainty by Robert Aronowitz (review)

In this highly relevant book, Robert Aronowitz explores the rise of a risk-dominated experience of ill health. As Aronowitz explains, our previous focus on relieving and treating symptoms has made way for a growing preoccupation with managing fear, uncertainty, and lack of control. This approach to health and disease, or “risky medicine,” has led to a pivotal shift in our collective definition of medical efficacy itself—from an orientation around curing disease to impacting the signs and symptoms of disease; around prescribing medications, surgical procedures, and other interventions that target the risk factors for disease, rather than disease itself. Risky Medicine helps readers grasp the significance of this shift as well as its consequences—among which are the growing costs and inefficacies of American medicine.

The book itself is divided into three parts. Part I describes the risk-dominated experience of ill health and the entangled technological, epidemiological, and scientific developments that have enabled it to emerge over the past few decades. Beyond these developments, and perhaps more important, is the social and psychological work performed by risk-oriented interventions (oftentimes in the absence of proven clinical efficacy) by ameliorating the fear and sense of loss of control brought on by chronic diseases.

In part II, Aronowitz introduces a series of sociohistorical case studies on the emergence of and on the work done by risky medicine. It locates its scientific origins in the risk factor approach, made possible in large part by the Framingham study. In detailed case studies of vaccines aimed at reducing risk, Aronowitz shows how the concept of risky medicine has impacted both the successful diffusion of a new vaccine (Gardasil) and the withdrawal of another (LYMErix). It also takes a closer look at how risk has influenced the experience of cancer, making cancer survival a lifelong experience, or career, of individuals cured of, or merely at risk for, cancer.

Part III informs us how existing approaches to health policy fail to address the sneakiness of risky medicine—how current health policy has not evolved to manage the consequences of risky medicine in ways that maintain the costs of healthcare and ensure improvements in health outcomes. Aronowitz offers provocative suggestions about how the scope and approach of healthcare policy making might be adapted to address the impact of risky medicine. He explores the unanticipated consequences of how risk-reducing interventions, when marketed to poorer countries, can have the problematic effect of increasing demand for the diagnosis and treatment of asymptomatic risks in countries unable to afford the basic costs of treating actual disease. Isn’t it especially important, he questions, to promote cheaper, more impactful population-level approaches in such countries than introduce the demand for lower-impact interventions targeted at individual risk reduction?

Perhaps most provocatively, Aronowitz calls for policy makers to become more savvy about the natural history of risk interventions so that they can intervene before the creation of (and public demand for) risk interventions. Risky Medicine details various upstream opportunities for policy intervention to manage the risks of risky medicine (e.g., regulating research on health risks and the process of making risks more visible). Aronowitz convincingly argues the need for a broadened approach to health policy making in general if we are to address a key reason for why American medicine is so maddeningly costly yet relatively ineffective.

All in all, Risky Medicine is a must-read for health policy makers, students and scholars of health and medicine, and a general public increasingly concerned about our broken healthcare system. Aronowitz takes his readers by the hand when examining the nuances of risky medicine along with its social, psychological, medical, and economic repercussions. He provides a powerful framework for understanding contemporary approaches to health and disease, engaging and challenging us to see and act on the social context at work in health and medicine today. Risky Medicine provides the needed traction on which to engage much...