Prävention chronischer Herz-Kreislauf-Krankheiten

Following the algorithm: How epidemiological risk-scores do accountability

Epidemiological risk scores are calculative devices that mediate and enact versions of accountability in public health and preventive medicine. This article focuses on practices of accountability by following a cardiovascular risk score widely used in medical counselling in Germany. We follow the risk score in the making, in action, and in circulation to explore how the score performs in doctor-patient relations, how it recombines epidemiological results, and how it shapes knowledge production and healthcare provision. In this way, we follow the risk score's various trajectories - from its development at the intersection of epidemiology, general medicine and software engineering, to its usage in general practitioners' offices, and its validation infrastructures. Exploring the translations from population to individual and back that are at work in the risk score and in the primary prevention of cardiovascular disease, we examine how versions and distributions of accountability are invoked and practiced as the score is developed and put to use. The case of a simple risk score used in everyday counselling brings into relief some key shifts in configurations of accountability with emerging versions of 'health by the algorithm'. While there is an increasing authority of algorithmic tools in the fabric of clinical encounters, risk scores are interwoven with local specificities of the healthcare system and continue to be in the making.

Patients-in-waiting or chronically healthy individuals? People with elevated cholesterol talk about risk

Risk adopts an ambiguous position between health and illness/disease and is culturally salient in various health-related everyday practices. Previous research on risk experience has mostly focused on the illness/disease side of this risk ambiguity. Persons at risk have typically been defined as patients (of some kind) and their condition as a form of proto-illness. To allow for the cultural proliferation of health risk and to account for the health side of risk ambiguity, I chose to focus on elevated cholesterol, a condition both intensely medicalised and connected to the everyday practice of eating, among participants (n = 14) recruited from a consumer panel and approached not as patients, but as individuals concerned about their cholesterol. Utilising the biographical disruption framework developed by Bury, I show how the risk experience of my participants differed from the chronic illness experience. Instead of patients-in-waiting suffering from a proto-illness, they presented themselves as 'chronically healthy individuals' (Varul 2010), actively trying to avoid becoming patients through a responsible regimen of personal health care. The results call for a more nuanced approach to the risk experience, which accounts for both sides of the risk ambiguity.

[The Emergence of Genetic Prenatal Diagnosis from Environmental Research : On a Methodological Shift in Prevention Around 1970]

The history of genetic prenatal diagnosis has so far been analyzed as a part of the history of human genetics and its reorientation as a clinical and laboratory-based scientific discipline in the second half of the 20th century. Based on new source material, we show in this paper that the interest in prenatal diagnosis also arose within the context of research on mutagenicity (the capacity to induce mutations) that was concerned with environmental dangers to human health. Our analysis of the debates around the establishment of the German Research Foundation's (DFG) research program "Prenatal Diagnosis of Genetic Defects" reveals that amniocentesis was introduced in Western Germany by a group of scientists working on the dangers for the human organism caused by radiation, pharmaceuticals, and other substances and consumer goods. We argue that, in a period of growing environmental concern, the support of prenatal diagnosis aimed to close a perceived gap in the prevention of environmental mutagenicity, i. e. genetic anomalies induced by environmental factors. The expected financing of prenatal diagnosis by health insurance in the course of the reform of abortion rights was used as another argument for the new technology's introduction as a "defensive measure". Only in a second step did changes in research structures, but most importantly experience from gynecological practice lead to a reframing of the technology as a tool for the diagnosis and prevention of mostly genetic or spontaneously occurring anomalies. Eventually, prenatal diagnosis, as it became routinely used in Western Germany from the early 1980s onward, had little to do with "environmental" questions. This case study of the early history of genetic prenatal diagnosis analyzes the still poorly researched relationship between research in human genetics, environmental research and medical practice. Furthermore, we aim to shed new light on a shift in perspective in prevention around 1970 that has so far been described in different contexts.