Screening and the consequences of knowledge (part one)

What are the consequences of knowledge?

As midwives, we do lots of things, often simultaneously. We build relationships, gather information, determine and meet needs, offer tips, reassurance, information and advice, soothe concerns and much, much more. During an antenatal check, for example, we might do all of these things while also assessing the health of women and their babies by means of carrying out those screening tests which have become a routine part of such meetings; blood pressure, urinalysis, examining the woman’s abdomen and listening to the fetal heart. Often, depending on the circumstances, we may also be talking to the woman about whether she would like to avail herself of other available screening tests such as blood and antibody checks, ultrasound, glucose tolerance testing, maternal serum screening and group B strep testing. While our activities are myriad, a fair proportion of our time is spent undertaking activities which relate to the search for knowledge that may help prevent or detect problems.

On the surface, focusing on preventative health and undertaking screening tests seems like a jolly good idea. If we can detect potential problems at an early stage, we can put measures in place in an effort to prevent those problems being harmful to women or their babies. This rather lofty aim, however, is merely the tip of the iceberg that is screening, and a whole raft of issues is raised by this concept in practice. This is the first of a series of blog posts in which I share an article that focuses on the consequences of the knowledge that is gained by undertaking screening tests and raises questions about whether this knowledge carries risks as well as benefits.

Beginning with bloods…

Once upon a time, I shared a house with a couple of scientist friends who worked in a laboratory. At that time, I was (temporarily) vegan, they were both dedicated carnivores and we had a very friendly and very ongoing argument over our dinner most evenings. This argument was based around whether or not, as a non meat-eater, I could have a reasonable haemoglobin level. One day I invited them to draw a few millilitres of my blood and spin it in the lab so that they could check my haemoglobin for themselves and we could finally settle this argument one way or the other. This idea went down really well; one of them was also a phlebotomist and he gathered his kit and was literally just about to put the needle in when he suddenly stopped and swore quietly under his breath.

I asked him whether there was a problem and he said, “I’ve just realised … I can’t do an Hb independently of a full blood count”.

“OK”, I smiled. “Do a full blood count then, I don’t mind.”

“Well…” he replied.  “Trouble is … what about if I find out that you have acute lymphoblastic leukaemia? Would you want to know?”

I can’t say that was the first occasion on which I ever thought about the potentially enormous consequences of the kinds of information that we gather daily and routinely, but when I am asked to speak to groups of midwives about screening I often begin with that story as an illustration of how very momentous the implications of even the simplest tests can be.  In just a few decades, Western culture has embraced the notion that preventative health care and screening are beneficial tools and there has been a metaphorical explosion in the growth of technologies related to this area. Knowledge, however, can have serious consequences and simply because we can know something doesn’t necessarily mean that we always should know it.  Because of this, I believe that it is important to consider the consequences that can arise from the gathering of information about the human body.

You can read the next part of this article here.

 

A version of this article was originally published as Wickham S (2009) Screening and the consequences of knowledge. Birthspirit Midwifery Journal 2: 9-12.

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