In this article, the author describes how the experience of risk has converged with the experience of chronic disease in the United States. He claims that there has been a transformation in how ill health is produced, labeled, managed and ultimately experienced. He suggests five reasons why chronic disease has become more risky:
- New clinical interventions have directly changed the natural history of disease.
- We now have a greater knowledge of chronic disease risk.
- More people are being diagnosed with chronic disease due to new screening and diagnostic technology and disease definitions.
- There are new ways of conceptualizing efficacy.
- Providers offer more intense diagnostic testing and medical interventions.
He explains how people even at different points on the disease continuum experience risk in similar ways and use the same decision-making strategies and styles regardless of the probabilities of bad outcomes. For example, women are just as likely to opt for mastectomies whether they are at a higher risk of recurrence of breast cancer or not. The author laments the fact that there is little evidence-based scrutiny on the surveillance of existing disease and secondary prevention compared with primary prevention.