Arguing about the evidence: readers, writers and inscription devices in coronary heart disease risk assessment

Abstract

This paper examines the history of tools developed to assess an individual's risk of coronary heart disease. A close reading of the tools themselves is combined with an analysis of debates published in medical journals such as the British Medical Journal (BMJ) and The Lancet. These literary conversations between scientists and doctors reveal complex negotiations about the form and meaning of medical technologies that have yet to become fully 'stable'. Early tools were promoted as a response to the high cost of cholesterol-lowering drugs (statins), but came to embody broader attempts to shape medical practice. These include the promotion of what has been understood as evidence-based medicine and regulation by political and professional actors, as well as the spread of 'risk thinking' more generally. Despite having a central place in recent British guidelines and policy, there is a surprising variety of tools in circulation, and ongoing uncertainty about their use and value.