The Patient Paradox and Panoptic Policy

I am currently reading The Patient Paradox, by Margaret McCartney. I highly recommend it. The author considers how

“our obsession with screening swallows up the time of NHS staff and the money of healthy people who pay thousands to private companies for tests they don’t need. Meanwhile, the truly sick are left to wrestle with disjointed services and confusing options.”

That synopsis alone prompts two thoughts:

  1. This describes an approach to healthcare which is inefficient and ineffective. The two terms are not synonymous: the former describes how well the service is delivered (which can be measured by the efficiency of the processes,  the unit costs for resources); the latter describes the service from the perspective of the recipient, in this case the patient. It is undermining the NHS.
  2. By altering a few words this can describe the approach, or policy towards, many other things in our society.

For example, welfare:

“our obsession with scrounging swallows up the time of welfare staff and the public money paid in millions to private companies for tests they don’t need. Meanwhile, the truly needy are left to wrestle with disjointed services and confusing options.”

or crime:

“our obsession with crime prevention swallows up the time of police and the public money paid in millions to private companies for cameras they don’t need. Meanwhile, the victims of crime are left to wrestle with disjointed services and confusing options.”

The obsession with screening is clearly visible in the area of “national security”.

Consider, for example, the Coalition Governments resuscitation of the previous administration’s plans for communications surveillance. This is a proposal to store and analyse electronic communications such as emails and internet traffic to support criminal and terrorist investigations. We are to be persuaded that this will make us safer and is a price to be paid for our safety and security. But, to draw on Dr McCartney’s warnings about health tests, what of the false positives and false negatives that will undoubtedly be thrown up by any such screening? With so much data and with far from perfect algorithms for analysing it, the results will be that some criminals or terrorists will escape the surveillance while many more innocent individuals will be wrongly implicated.

What is described for healthcare in the The Patient Paradox seems to have commonality with the panoptic approach towards at least welfare, crime, and security. The neoliberal urge to create reality rather than to live with and manage it proclaimed by the arrogant neocons who devised the invasion of Iraq is permeating our consciousness. Consider the following correspondences between the screening approach to health, crime, and security:

  1. Fear of an unknown or unseen enemy which is about to attack.  This might be an aneurysm, coronary disease or a cancer; it might be a predatory pedophile or identity thief; it may be a terrorist planning a bomb attack. The common factors are that the attack be imminent, will be deadly, and you are currently unaware.
  2. Threat which can be visualised easily.  It will be a threat which can be used to stimulate the fear in 1, above. It will be a threat which you can be made to respond to readily by people practised in manipulation: the marketing specialists in healthcare or security firms, their advertising companies, the right-wing thinktanks and media, or political spin-doctors, or governments using all of the previous resources.
  3. Risk which you can be exploited  by those who know how fallible people are at understanding and assessing risk, such as those same marketing specialists, salesmen, advertisers, and spin doctors.
  4. High-tech presented as infallible solutions such as MRI and CAT scanners; sophisticated policing and military hardware; or computer programmes, database mining, and IT systems.
  5. Private providers of screening and medical treatment, or monitoring and video systems, or military hardware, or security services.
  6. Pre-emptive action such as medical treatment, control orders, or remote-controlled weaponry. However, the pre-emptive action must be taken immediately.
  7. Semblance of choice, but a choice prescribed by specific options represented by technical or scientific solutions which are presented as “clean-cut” and infallible  – providing a resolution by completely removing the threat. There is no information or discussion about the risk of the solutions.
  8. Semblance of personal control. The action of being screened or of using screening appears voluntary and decisive, but is actually driven by the manipulation through fear, poor assessment of risk, and misinformation.
  9. Absence of evidence that the screening or the consequent resolution will actually work – or work permanently. The screening approach is the opposite of evidence-based policy or action and a terrible misdirection from the real problems, and finding solutions to real problems.
  10. Simple problems, simple solutions. Who was it said that for every problem there is a single, neat, elegant solution: which is entirely wrong? The screening approach seems sensible only to those whose critical thinking has been dulled, or who have not been provided with critical-thinking skills.

The urge to pre-emptive action against a perceived threat through inaccurate screening is leading to unnecessary and possibly risky treatment in healthcare. It is leading to the deaths of individuals, many entirely innocent, as a consequence of remote drone attacks by the USA in Pakistan and the Yemen.

Please read and consider the messages of The Patient Paradox. It may well be good for your health, and might provide insights not just into what is being done to healthcare but to other aspects of society by the propagation of neoliberal thought.

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