This thesis provides a social history of the introduction the Pap smear and the expansion of population-based cervical screening programs in Australia throughout the latter decades of the twentieth century. By placing cervical screening in a broad social context, this history helps to reveal the complex interrelationship between developments in scientific medicine, social, political and economic concerns, changing beliefs and attitudes, and the growing influence of commercialisation and consumerism. It also highlights the tendency for public health strategies to serve as a means of social and moral control. Furthermore, the thesis examines the conflict between the population-based approach of public health and the concern of clinicians for the welfare of individual patients. This conflict has emerged in other areas of medicine. In casting light on such conflict, the thesis will provide historical insight into reasons for why medicine is often perceived to be in a state of crisis today.

Screening is generally considered a useful strategy in the prevention of chronic diseases. The notion is that early detection through the use of certain screening tests can facilitate effective preventive measures to be undertaken which can then lead to improved prognosis from or ultimate avoidance of serious clinical diseases. The enthusiasm for screening in the United States is high and can be seen by the size of public demand for it. Rapid technological advances and knowledge expansion in the past decade have further facilitated the introduction of new tests and screening opportunities. In the mean time, the concept of screening has undergone subtle changes. Previous emphasis on clear and demonstrable population health benefits has been slowly replaced by an emphasis on individual responsibility for the surveillance of personal health risks. Disease screening is frequently advocated as part of a health promotion programme. As a clinician who has worked in breast cancer screening and who is wary of the complexities and problems associated with disease screening, my contention is that the enthusiasm for screening may not ultimately be conducive to health and well-being. This thesis represents an effort to understand the popularity and enthusiasm for disease screening, how it has come about and, why it may not be conducive to health and well-being. The thesis begins with a description of the phenomenon to be followed by a detailed examination of the scientific principles behind disease screening. It then moves on to discover how the phenomenon might have come about by first considering the evolution of biomedicine over the centuries and then its present endeavour in the form of surveillance medicine as well as the latter�s relationship with today�s market economy. Using relevant case studies that involve, for example, cancer and prenatal genetic screening, this thesis explores different concerns relating to health and well-being, including such topics as the creation of health roles, the reconfiguration of human values and interpersonal relationships as well as medicalisation. A final chapter offers an account of health and well-being and sums up why the enthusiasm for screening may not be conducive to health and well-being. The enthusiasm for screening compels people to assume health as a moral virtue. Screening is turned into a ritual that people consume to attain salvation. Since diseases may lead to death, diseases must be avoided though screening. Yet health is not just about the absence of disease. Health and well-being can only be realised by the individual within the context of the individual�s life as a whole. The institution of biomedicine has undeniable responsibility to ensure that screening will not be used to the detriment of individuals� health and well-being. Without condemning disease screening as a potentially useful tool in the prevention of disease, this thesis advocates prudence in its utilisation. People must not be compelled to attend screening through programmes of promotion (commercially related or not). Rather, autonomous decisions must be facilitated as far as possible through the provision of clear, accurate and factual information.

Freie Universiẗat, Diss., 2006--Berlin. / Dateiformat: zip, Dateien im PDF-Format.

University, Diss., 2007--Frankfurt (Main). / Zsfassung in engl. und dt. Sprache.

Universiẗat, Diss., 2007--Frankfurt (Main). / Zsfassung in dt. und engl. Sprache.

Thesis (Ph.D.)--University of Adelaide, Dept. of Statistics, 1998? / Bibliography: leaves 223-229.

Univ., Diss.--Kiel, 1998.

Univ., Diss.--München, 1999.

Thesis (Ph. D.)--University of Canterbury, 2008. / Typescript (photocopy). "October 2008." Includes bibliographical references (p. 230-243). Also available via the World Wide Web.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2008. / Includes bibliographical references.