Author Archive

NPR story on Cancer through History   1 comment

http://www.npr.org/2010/11/18/131406108/-emperor-of-all-maladies-traces-cancer-treatments

From the summary: “Mukherjee’s new book, The Emperor of All Maladies: A Biography of Cancer, grew out of his desire to better understand the disease he treats, through examining the way cancer has been described and treated throughout history. He chronicles the ways therapies evolved, particularly in the 20th century, as more treatment options became available and scientists worked to understand the underlying genetic mutations that caused the disease.”

Like  a semester summary. He even mentions the evolution of the “war against cancer” metaphor.

Posted November 18, 2010 by jbork in Uncategorized

Reverse Engineering Cyberchondria   1 comment

This chart tries to depict the operation of a common type of cyberchondriacal behavior, doing web searches and visiting web sites, that is not based on a particular, favorite destination (such as webmd) but rather the haphazard, intuitive browsing of successive sets of search results, that often yields threads in discussion groups.  While the article “What is Cyberchondria?” by Emilie Sennebogen that Genevieve cites suggests that some cyberchondriacs increase their anxiety because they escalate pathological results that appear at the top of the listings, I find that other criteria may influence the progression of a self-analysis.  For example, if a number of results link to detailed narratives in discussion group threads that sound similar to your own, you are more likely to follow those threads.  Then your next, more refined query may use language you picked up in those readings, tuning your initial diagnosis by changing the search terms.  Moreover, if remedies are suggested that do not involve going to the doctor, such as trying an OTC medication, then you may experiment with it, and revisit your searching in a day or so based on the outcome.   Thus, in addition to the tendency to jump to conclusions that one is afflicted with a serious condition, some cyberchondriacs may incline towards the least serious diagnoses, especially if they have the tools/medications ready-at-hand to test the hypothesis.  This might be called a “hacker” or “bricoleur” aspect of cyberchondria.

Oh, I have a bump on my skin Is it a bug bite? Is it a callous? Is it a disease?
Read search results about fleas
bed bugs
mosquitos
(eliminated possibility) acne
STDs
chicken pox/shingles
CANCER!!!!
Search again using refined pattern insect bite words
(eliminated possibility) acne terms
Try remedies suggested in credible narratives
hydro-cortisone cream
(retest in days)
(eliminated possibility) change diet
(retest in days)

Posted September 21, 2010 by jbork in Uncategorized

Roles of Technology in Medical Rhetoric   5 comments

The two readings from Judy Z. Segal’sHealth and the Rhetoric of Medicine and Mary M. Lay’s The Rhetoric of Midwifery present a number of examples of the roles that technology plays in medical thinking. I am referring first to rhetorical advantages technologies provide to entrenched power holders over those opposing them with respect to the rhetoric of death and dying and the debates over the status of midwifery in Minnesota. Segal argues that “end-of-life decision making frequently takes place in conversions between people who are medical experts and people who are not,” (94) a condition that often robs argumentation between medical experts and lay people of its grounds of validity, so that rhetors are “trapped inside the discourse that moved each of us to speak” (98). Here the epistemological authority of biomedicine “ summoned by its technologies in terms of both apparatus and language “ disables its interlocutor, always favoring the medical establishment. The Riverview study attempted to improve “the conditions for consensual decision making” (103) through rhetorical analysis, emphasizing the value of linguistic adjustments by both sides, but it “makes clear that the terms of a predominantly biomedical rhetoric of death and dying are not sufficient to provide a framework in which human beings can engage satisfactorily in a conversation about the end of life” (113).

The two chapters from Lay’s book, “Rhetorical Analysis and the Midwifery Debates” and “Licensing Rules and Regulations: Normalizing the Practice of Midwifery,” reiterate the point that entrenched, biomedical knowledge enables the established community to maintain its control and extend its power, in part by extending the domain of professionalism. Professionalism embodies technologies in its practices, its ways of learning, and especially its ways of communicating. Thus when the established medical community in the state of Minnesota tried to absorb the unlicensed, informal network of midwives during a number of hearings that Lay chronicles, a similar tension erupted. She notes, for example, that formal education and tests were initially proposed as requirements to allow midwives, even those with decades of experience, into the ranks of licensed practitioners. Both authors allude to Foucault for this role of technology as knowledge power (Segal in chapters 1 and 3; Lay on 31, 108, 130).

A second set of rhetorical advantages are successful actions taken by the opposition using specific technologies fostering rhetoric to counter the prevailing sway of the enfranchised power authorities, the hospitals and government agencies, what Feenberg calls tactics. Lay recounts a number of ways in which technologies played a mitigating role against the entrenched authority and its implicit rhetoric. Two examples Lay repeatedly mentions are the use of online text messaging communities and the use of shared documents. Listserv systems enabled rhetors among midwives to conduct dialogue in a common but geographically and temporally distributed environment giving them similar affordances as salaried, institutionalized workers, and also amenable to their desire for anonymity without sacrificing self regulation to the point that enlightened, scientifically rigorous, if necessary, argumentation could not be made. The Listserv-mediated discourse was joined with another technological tool, shared documents, for drafting reports and proposals, including the proposed legislation itself, by the midwife community, rather than forcing them to fill in the blanks on a ready made form provided by the establishment, the default technologies it enjoys whose possession supports its power.

These are what Feenberg might call tactics employed by the boundary, periphery, not-of-the-ruling-class. This is analogous to the position of witness in “the existing dominant discourses” that Jen brought up. My focus, though, is on the emancipatory technologies. Those of you who know me may see where this is going .. the free, open source option.  I believe it can inform our discussion of electronic health records.

Posted September 14, 2010 by jbork in Uncategorized

Local News: Docs Consider Switch to Elecronic Medical Records   Leave a comment

A timely, informative local story heard on public radio this morning (luckily heard in between fund drive pitches):

http://www.healthystate.org/content/docs-consider-switch-elecronic-medical-records

The story echoes some of the benefits and concerns we have already discussed: upfront cost, reduction in efficiency while implementing, large quantity of records makes them harder to sift through, redundancy; and the advantages: being able to read the doctor’s writing, reduced records transfer costs. One important point that touches on the doctor/patient relationship that reminded me of my dentist visit, “I rather have you look at me when I’m talking to you, rather than busy with the computer.” The story does not mention patient benefits of EMRs as consumable items for self-service, highlighting the potential rhetorical importance of promoting that aspect.

Posted September 8, 2010 by jbork in Uncategorized

Epistemology in How Doctors Think   1 comment

Montgomery introduces the epistemological questions relevant to medical professional practice by appealing to the enormous complexity of causal relations at work in the human body. The familiar, positivist epistemology on which simple sciences are based must be reconsidered in light of the almost perverse multiplicity and interrelated complexity of things relating to human bodies. She writes that

biology is multileveled and more contingent than the physical sciences. . . . Seen in a systems-theory progression from microbe to cultural context, biomedical science is even more complex than the rest of biology, even less capable of certainty, because illness exists on so many levels. Medical events and conditions can be described as cellular, organic, organismic, personal, familial, and cultural, and their causes can be too. What’s more, cause runs both ways on the scale from cell to society since illness behavior is also social behavior, and microbial activity often depends upon it. (71)

I encountered this depiction of the complexity of the human life world in readings for Sean Gallagher’s “Philosophies of Embodiment” course that I took this spring. In this context, the argument is that it is incredibly difficult to mark the boundary between the human body and the rest of the world, favoring instead a perspective like the one here in which “cause runs both ways on the scale from cell to society.” A recurring theme, then, is the tension between the faith that science can answer all questions, given time and technological advances, and the evidence that human bodies, and minds, in particular, are so deeply embedded in their environment that traditional, positivist scientific accounts that may be satisfactory for Newtonian physics are totally inadequate. Montgomery reiterates this point again and again throughout her text. The underlying epistemological complexity of the human body feeds deeply rooted tensions in clinical practice, such as the tension between parsimonious, single cause explanations of symptoms and the reality that “the quest for an elegant single solution is contradicted by the very real possibility, especially among the elderly and the poor, that one patient really does have two new diseases” (114). Another manifestation is the invocation of maxims and anecdotes in clinical training. Montgomery is quick to point out that for many of the social sciences “an appreciation of interpretive rationality has replaced earlier aspirations to become an exact science” (41). She invokes Richard Rorty’s notion of “abnormal discourse” and Bruno Latour’s concept of hybrids to describe this revised nature of medical thinking. The answer to how doctors think includes terms like “narrative rationality,” “wholisticness,” and “clinical intuition,” pointing to the need to more thoroughly probe the epistemological prejudices affecting current practice and education, to look towards “real benefits if clinical education included some attention to medicine’s epistemological predicament, its phronesiology, and the use of competing maxims as interpretive strategies for coping with uncertain knowledge” (136) rather than leaving medicine’s epistemology naiveté alone.

Posted August 31, 2010 by jbork in Uncategorized