chapter  8
The opportunity costs of neoliberal pragmatist anticipatory care – a case history
A molecular genetic ‘signature’ for cancer risk
ByOwen Dempsey
Pages 10

Neoliberal pragmatism combines: a) a scientific-political philosophy that gives elite expertise power to warrant new forms of care that achieve narrow intended targets regardless of collateral harms; with b) a political-economic philosophy that uses political-expert sovereignty to prohibit, or make taboo, any economic limits on the circulation of commodities. It is the basis for the relentless expansion of anticipatory, (predictive, preventive, personalised) care such as screening.

This chapter is a health economic analysis of a case history, based on a UK example: this is the marketisation and licensing for the UK’s National Health Service, by the National Institute for Health and Care Excellence, of a molecular genetic signature, called Oncotype-DX. This test is used to stratify patients who have been treated for early breast cancer according to the risk of suffering a future recurrence.

This chapter shows that neoliberal pragmatism, a scientific-political-economic power, forbids any limits to the sacrifice of cost effectiveness to public health services by the introduction of new forms of care.

This chapter also shows that anticipatory care is being expanded without limit and that this has serious opportunity costs: it is destroying the effectiveness of public health services, destroying the capacity of care to respond to present symptomatic need and suffering and, in the private sector, causing individual financial toxicity.