The praxis of evidence-based anticipatory healthcare is warranted by a combination of a) neoliberalism’s demand for innovation and b) scientific pragmatism. Scientific pragmatism is a philosophy of science, or way-of-knowing, based on radical empiricism. This values, that is, takes into account, expert impressions, thoughts and opinion as if they are empirical facts. And, according to pragmatism, social progress is made through trial and error, that is to say, by inquiries into the effects of actions to solve problems according to their intended consequences, and, notably, not according to their collateral, albeit unintended, harms.
In this chapter the example of breast cancer screening helps the reader understand the way neoliberal pragmatism works in practice.
Elite experts warrant the UK breast cancer screening programme as ‘a good thing’ despite its harms. This judgement, and its discourse, is critically analysed in terms of the way persuasive rhetoric fixes value and meaning to the intended reduction of cancer deaths. The rhetoric is shown to transform the signification of harms as harms as such, into number-facts that signify trustworthy transparent expertise. And, it ignores the impossibility of any individual valuing overdiagnosis as a personally relevant potential harm.
This chapter shows how subjective elite neoliberal pragmatism distorts evidence so that anticipatory healthcare is being intensified regardless of its collateral, albeit unintentional, iatrogenic harms.