Appraising screening, making risk in/visible. The medical debate over Non-Rare Thrombophilia (NRT) testing before prescribing the pill

Non-rare thrombophilias (NRT) are hereditary predispositions to thromboembolism, the most severe side-effect of hormonal contraception. In the mid-1990s, the identification of NRT stirred up a controversy over the possibility of investigating these genetic variants in women wishing to use contraception. Appraising how to handle this test led the medical profession to reconfigure the risk visibility on hormonal contraception. Through a review of scientific literature, this paper reconstructs the debate over whether and how NRT genetic tests should enter the distribution system of pharmacological contraception. The main arguments concern their epidemiological, social, economic, and clinical consequences of these risk factors. We analyze this debate as a process consisting in shaping the risk visibility. To those who opt for selective thrombophilia screening, this test should become a part of the medical decision-making process, and its visibility should be kept under medical control to protect contraception safety. To advocates of universal or “extended” screening, NRT visibility becomes a moral/legal obligation, and the test a valuable, if not mandatory, means to assure contraception safety. Risk visibility reveals assumptions about medical power, women’s responsibility, and drug safety, and points to an appraisal process as an ideal field to explore political and epistemological implications of screening.

• Ciencia y tecnología
• Cultura y ocio
• Educación
• Salud
• Sector público

• http://vocabularies.unesco.org/thesaurus/concept1014
• http://vocabularies.unesco.org/thesaurus/concept11771