chapter  1
The care paradox
ByOwen Dempsey
Pages 11

Population-based screening programmes and genetic or molecular diagnostic technologies provide a) anticipatory diagnoses of disease or b) risks by what is known as ‘personalised’ or 4PM (Predictive, Preventive, Personalised, and Participatory) Medicine. This is anticipatory healthcare and it is a growing industry, marketed aggressively, and promising to transform healthcare by preventing future diseases such as cancer. But, the care paradox is that it is causing increasing levels of overdiagnosis and other harms.

The anticipatory healthcare paradox exists because this form of care, in the name of doing good, is causing harm. This chapter introduces some of the key ideas and sites for analysing this paradox. These are: ‘doing the good’, overdiagnosis, politics and science, and opportunity costs.

Key drivers of this praxis of Evidence Based Healthcare (EBHC) are identified as neoliberalism’s demands for deregulation and innovation, and scientific pragmatism. The idea of absolute health as total freedom from symptoms is identified as a driver of innovation acting as an always desirable but elusive aim of care that exploits individual desire. The chapter introduces the medical or iatrogenic harms of anticipatory care, such as overdiagnosis, and the opportunity costs that reduces presence to suffering, that is, the possibilities for caring for those who are already suffering with symptoms of ill health.

The question is then raised: should care-providers be protecting the lay public from the way anticipatory healthcare exploits desire?