Monday, January 31, 2011

The Power of Biomedicine

Until reading both Good (1995) and Hahn and Kleinman (1983), I hadn’t fully recognized the extensive power afforded to biomedicine by Western society. This power is pervasive and appears to encompass all aspects of our modern medical system, from healthcare delivery to medical research and technology, from the provision of health information to the public to medical training institutions. I found myself continually drawing examples from my own research and personal experience that matched the hegemonic influences of the biomedical system presented by these authors.

For instance, Good spends a considerable amount of her piece discussing the biomedical model’s focus on cutting-edge technology as a medium of conveying hope. She notes, “American willingness to invest both public funds and private monies in experimental chemotherapies and clinical trials illustrates high commitment to biotechnology and the biotechnical fix” (p. 465). It is true that, in today’s society, competent oncological practice often entails knowledge and skillful use of new technologies. Finding a doctor with the newest and brightest treatment tool was the first task for my friend when diagnosed with cancer, and no amount of money or number of miles traveled could compete with that doctor’s willingness to help “cure” my friend. Now that the cancer has metastasized, leaving my friend in even more medical debt, we’re all wondering if the experimental treatment was worth the cost.

Good also discusses the role of ambiguity in biomedical research. She suggests that, “Bioscience narratives often introduce ‘facts,’ ambiguities and uncertainties that are selectively employed by clinics depending on the clinical culture in which they work” (p. 465). Even as statistics are used to convey certainty, they equally convey ambiguity when treatments and chances are placed in the language of odds and ratios. Harkening to the research of Jensen and colleagues on the role of hedging in scientific findings, the presentation of results as uncertain (which considering the role of probability in social scientific research, all results are) leads to a general lack of confidence in resultant findings. As such, the mass media is often left representing scientific conjecture as scientific truth in order to appeal to the desired sense of novelty required by the news-hungry public. This can have damaging effects on what the public comes to believe about any given health treatment or technology. In analyzing the presentation of information about genetic testing on a number of breast cancer websites, it was astonishing to see how much variation there was in the presentation of statistics regarding the efficacy of testing in detecting genetic markers. Outside of statistical presentation, the inclusion and omission of such material, often controlled by the amount of commercial interest held by the organization sponsoring the site, was equally surprising. Based on these findings, I’m left to question who would be accountable if a woman read her over-the-counter genetic breast cancer test as positive and concurrently acted as though this result (and her fate) was 100% certain?

Good also argues that “local medical cultures as well as political economies influence the way in which clinical science and technologies are institutionalized in medical practice” (p. 462). For example, as researchers investigated why breast conservation surgery wasn’t highly adopted in particular communities, they found that those who resided outside urban areas (thus outside of influential spheres and markets of academic teaching and research hospitals) were less likely to have the surgery. Such an example was particularly telling for me, considering my interests in rural health disparities. I particularly loved her quote: “The products of biotechnology are often promoted even with the most basic elements of infrastructure for competent medical practice lacking.” So true!

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