ABSTRACT
A scientific positivism is allied with a humanist pragmatism to form the actual real life ‘scientific’ warrant for the praxis of Evidence Based Healthcare. This is permissive: it permits those in power, the expert elite and politicians, to determine what forms of care should guide practice regardless of their collateral harms. At the same time political-economic neoliberalism demands innovation and deregulation of the market so that harms to social justice are no longer relevant and all that matters is the continuing circulation of commodities. Anticipation, and anticipatory healthcare, turns future life itself into a commodity that promises the possibility of immortality; it depersonalises even as it individualises and responsibilises, and incites a perversion of care where intervention is valued for its own sake.
This care has been shown to exploit the desires of the divided subject, who is constructed discursively – that is, by discourse structures. It is not only anti-democratic because of the inherent knowledge imbalance between carer and the cared-for, but is also destructive: it coerces compliance and consumption under the illusion of transparent shared decision-making and its false premise that overdiagnosis can be valued by an individual as a personally relevant harm; it has opportunity costs that are continuously reducing the effectiveness of public healthcare services; it reduces the presence of care to symptomatic needs and suffering, causes individual financial toxicity, and has unknown impact on individual potential to self actualise health.
On this basis, then, two key questions emerge: can anticipation in medicine, and healthcare in general, in the form of population-based and marketed, personalised interventions that diagnose embodied disease or risk, be re-imagined as: a) always destructive of health and healthcare or b) particularly coercive and anti-democratic because it exploits the invisibility, unimagine-ability, and effective meaninglessness of overdiagnosis as a personally relevant personal harm? Is the ‘liberal’ in neoliberal a seductive cover for exploiting personal desire by a system that scientifically, politically and economically demands technological innovation and incites perverse care and interventions for the sake of the market?
