ABSTRACT
There has been a long-standing debate over the contribution that has been made by medical innovation to health improvement. Reference is often made, for example, to McKeown’s (1976) analysis of the limited contribution that medicine per se has made to population health, arguing that more progress has been made over the past century through general improvements in public health (especially in regard to sanitation and hygiene) than through the changes wrought by increasingly sophisticated health technologies (see Harris 2004). Sociologists have argued in a complementary way that health improvements are also about broader changes in social structure and a more equitable distribution of income and wealth. Yet, clearly, technical development in medicine has occurred and now enables clinicians to undertake quite routinely what have been in the past highly dangerous procedures. Heart transplants or brain surgery are cases in point. Genetics, and more recently genomics, are increasingly seen as fundamental to many if not all ‘breakthroughs’ in contemporary biomedicine. These innovations rely on ever greater technical sophistication and clinical skill, an
extensive range of support sciences (such as haematology, immunology or pathology), a supportive regulatory environment, and perhaps most important of all, willing patients who in the early stages of a technology act as ‘moral pioneers’ (Rapp 1999) negotiating the choices, risks and hazards of these new techniques on behalf of others. On the other hand, the increasing sophistication of health technology to probe, re-
chart, and redefine pathology may serve to generate new forms of disease, as Foucault (1988) has argued in regard to the role of screening in health care: this can simply produce the asymptomatically ill, as in screens for hypertension in assessing blood pressure levels, or the use of highly sophisticated molecular diagnostics that render conditions that are known as ‘clinically silent’: that is, they show no symptoms and indeed may never do. Innovative technologies here create and define diseased bodies and do so for people who have no sense, no lived experience of being ‘ill’: they are the ‘new ill’. To this extent, health innovation is generative of new uncertainties that cannot, as risks, be easily calculated. Much of the success of biomedicine has been in coping with acute medical problems, but in doing so this has relocated patients from acute illness into the category of the chronically sick.
