BOOK REVIEWS : Vision From Inside the Prison of Society’s Tests

Dangerous Diagnostics: The Social Power of Biological Information by Dorothy Nelkin and Laurence Tancredi (Basic Books: $18.95; 207 pages)

One of the most compelling and unnerving depictions of contemporary life was written by the French philosopher Michel Foucault, who described social institutions as prisons where everyone is watched, recorded, disciplined and forced to conform.

Foucault’s vision is more insidious and more frightening than George Orwell’s “Big Brother is watching you.” For Foucault, there is no Big Brother. Everyone is watching everyone else. There is no “bad guy” that you can point to as the cause of the trouble--or that you can revolt against. It is the system itself, in the name of efficiency, that makes prisoners of us all.

In “Discipline and Punish” (1977), Foucault described how hospitals, schools and workplaces have become places of control, where knowledge literally is power. The price we pay for an efficient economic machine is very high. We sacrifice much of ourselves to the machine.

Now come Dorothy Nelkin and Laurence Tancredi to paint a very Foucaultian picture of the growth and dangers of medical testing in hospitals, schools and workplaces, a vision that once again pits the needs of society against the rights of individuals.

In the name of efficiency--always in the name of efficiency--we are blithely accepting the arguments of insurance companies, employers, health-care providers and courts, and unthinkingly allowing ourselves to be tested and controlled.

In “Dangerous Diagnostics,” an important book that deserves wide attention, Nelkin and Tancredi describe the coming use of a wide variety of less-than-reliable medical tests--including genetic screening and psychiatric evaluation--and the coercive and subtle threats that accompany them.

“While biological tests enhance institutional control, they can also conflict with social considerations of civil liberties, human integrity or personal privacy,” the authors write.

“They can bear on people’s economic interests, the cost of their insurance, their access to jobs and educational opportunities. They can affect personal well-being, how people are labeled, their self-conceptions, their exercise of free will. They can influence social relationships, leading to stigmatization and discrimination.”

Nelkin and Tancredi seek to launch an informed discussion about what is occurring in the hope that stringent limits will be placed on the use of biological tests.

The debate in the last few years over AIDS testing (and the potential social, psychological and economic devastation that may come to someone who tests positive) is a harbinger of much more testing yet to come, the authors say.

As insurance companies seek to insure only healthy people, and as employers shun applicants who may become ill, “we risk increasing the number of people defined as unemployable, uneducable or uninsurable,” they write. “We risk creating a biologic underclass.”

These results can occur even though an individual has no sign of a particular disease and, in fact, may never get it. The individual just tested positive for the tendency or for the genetic defect that is linked to its occurrence. “Tests that identify genetic traits are intrinsically incapable of accounting for the other variables--diet, life style, the effect of environmental or social interactions--that may influence their manifestation in disease,” the authors write.

In the area of psychological testing, much uncertainty and lack of knowledge is being swept under the rug in the interest of objective tests and conformity. “The boundaries of the ‘normal’ or the ‘healthy’ are often fuzzy,” they say. “At what point, for example, should a person with borderline behavior be labeled learning-disabled or mentally ill?”

Nelkin, who is a sociologist and science writer, and Tancredi, a professor of medicine and law, write in measured tones, but the dangers they write about are real and threatening. Drug testing in the workplace has received much attention in recent years, but it is just the tip of the iceberg.

We are on the verge of turning over much of our individual privacy and well-being to batteries of tests that may or may not be accurate and may or may not be useful. Even if they turn out to be 100% accurate--which they are far from being--all of the dangers to individuals need to be weighed against the claimed benefits to society.

“Guided by the assumption that conformity will enhance efficiency and further their primary goals, schools, law-enforcement agencies, employers, health-care providers, and third-party payers use testing as a means of social control,” Nelkin and Tancredi warn.

Foucault asked, “Is it surprising that prisons resemble factories, schools, barracks, hospitals, which all resemble prisons?”