Recipient of the 2011 Marie Hochmuth Nichols Award for Outstanding Scholarship in Public Address from the National Communication Association.
For classroom and reading group use, click here for a PDF version of this Discussion Guide. This volume is especially suitable for adoption in advanced undergraduate and graduate classes in medical rhetoric, rhetoric of science, bioethics and humanities, medical humanities, science communication, science studies, and research ethics.
(1) The author explores three dimensions of character: ethos, persona, and voice. These
dimensions are presented as complementary factors when it comes to character construction.
She considers the connotations, history, and use of each concept (see pp. 24‐33). In your
opinion, does one dimension seem more central to the process of character construction than
the others? Use an example from your own experiences to support your position. How might
context determine how each dimension is weighted during the process of character
(2) Keränen suggests that although "existing cultural forces limit the possibilities for character construction . . . rhetors still operate within a field of play in terms of their linguistic choices" (p. 32). Do you agree with this perspective of rhetorical exchange? Does the cogency of Keränen's overall argument (see p. 5) require that her readers share this perspective? Or, do you think that her argument maintains influence across perspectives of rhetorical exchange? Either way, what does this help us better understand about the relationship between language, character, and audience?
(3) Keränen discusses shifting relationships between the community of science and the state (see pp. 33‐34). Describe and interrogate how, in your opinion, this shift in affiliation has altered the practice of medicine. How, in your opinion, has this transformation altered the practice of government?
(4) In the chapter's concluding remarks, Keränen describes how reflection about characterizations of science can illuminate an audience member's own vision of the scientific endeavor. Before moving on to the next chapter take a moment to take inventory of your own "hopes and fantasies for science in the modern world" (p. 43). In your opinion, what ought a scientist be? What ought science be?
(1) Keränen uses a Janus analogy to help illustrate a bidirectional understanding of science and medicine, revealing an ongoing tension that exists between the physician and the researcher
and an ongoing struggle for each to determine their role in the practice of both science and
medicine. Specifically the Janus analogy juxtaposes a patient‐centered physician of the past
against a career‐minded researcher of the future (see p. 46). In your opinion, does this analogy
offer an accurate assessment of the current status of science and medicine? How might this
analogy impact the integrative capacities of science and medicine? In your opinion, what
would/does this integration look like?
(2) The concept of "healing ethos" (p. 48) is introduced in this chapter as a way to articulate the process by which physicians are able to negotiate between a necessary detachment from and a genuine concern for each individual patient. In your opinion, can these two factors – detachment and concern – be experienced simultaneously? Or, is this an irreconcilable paradox of medicine? Can such a thing as a "humane researcher" exist within the field of medicine?
(3) Take a moment to consider the implications of Poisson's decision to write an "open letter" of apology. What about a letter lends this mode of communication its persuasive appeal? What does this reveal about the relationship between rhetorical form and characterization? How did the publication of an open letter influence to the public's characterization of Poisson? What did the use of this mode of persuasion communicate about the issue at hand?
(4) The uncertainty principle asserts that "physicians who believe that one treatment is superior to another cannot in good conscience enroll a patient into a randomized trial testing that treatment," however, "when there is genuine indecision about which treatment is better, a physician may ethically enroll a patient into a randomized trial" (pp. 55‐56). How might the contingency of factors like "good conscience" and "genuine indecision" depend on historical, cultural, and or situational context? In what ways can professionals invoke rhetoric in order to actively manufacture indecision? How about certainty? What does this reveal about the fallibility of the conscience? Where does this leave us with regard to the uncertainty principle?
(5) At the end of this chapter the author poses a question: "to what extent are publics entitled to participate in facets of medical experimentation that affect their health and well‐being?" (p.72). Before proceeding to chapter three, consider your position with regard to this question. How do you currently negotiate the boundaries between self, other, and community? In your opinion, is health a public or private issue? What are the implications of choosing one orientation over the other?
(1) Within the field of health sciences, issues of accountability can illuminate the power structures
at work in the practice of medicine. Specifically, this chapter addressed how Dr. Fisher was
held accountable for the outcome of Datagate because he ultimately held authority over Dr.
Poisson. What are the consequences of normalizing the principle that those operating under
the direction of medical authorities should not be held responsible for personal actions?
Explore how this sentiment might influence relationships within the medical hierarchy. For
example, how might you expect issues of accountability to be resolved between patient and practitioner? Between practitioner and policy maker? Between physician and researcher? Between physician and surgeon?
(2) In the previous chapter Keränen examined how Poisson's contributions as both a scholar and a surgeon helped to illuminate "the multiplicity of roles physicians can be expected to play" (p. 49). Here in chapter three we learn that Fisher was also "partly a surgeon, partly a researcher" and that "this hybrid role further separated him from many more mainstream, conventional surgeons" (p. 79). In terms of both scientific and medical progress, what is beneficial about requiring physicians to enact multiple roles? What is detrimental about requiring physicians to enact competing roles? With reference to the experiences of both Poisson and Fisher, what types of contextual factors determine how competing identities serve the scientific process?
(3) In this chapter we learned how Fisher earned a reputation as a "vanguard of change" by "stressing the 'science' of randomized trials as superior to the anecdotal happenstance of days past" (p. 80). Recently, across academic communities there has been a push to reconsider the role of narrative in the theory and practice of medicine. How can narrative – "anecdotal happenstance" – serve the field of medicine? In what ways might narrative serve science? How might researchers work to establish the "science" of anecdotal happenstance?
(4) The rise and fall and subsequent rise of Fisher as a scientific figure presents a recognizable if not expected storyline found across histories and, indeed, across the fairytale genre. With this in mind, is Fisher's experience unique? Or, did it follow a predictable trajectory? How might predictability operate with regard to public expectations for how a 'scandal' is handled? Is there such thing as proper vindication for a public scapegoat? Who – the scapegoat, the public, the persecutor – benefits most from the tragic hero narrative?
(5) At the end of this chapter we are once again left to ponder the relationship between big science and the public. Specifically, we witness how competing characterizations of Fisher during Datagate work to situate science as an institution that remains "largely separated from public participation" (p. 118). Revisit the implications of maintaining a separation between the "knowledge‐producing domain" of science and the lived experiences of publics at the receiving end of scientific progress. Who holds jurisdiction over expectations for what is meant by terms like 'health' and 'well‐being'? Can the practice of science benefit from a mindful consideration and inclusion of the public's expectations for what they desire as 'well‐being'? Or should science strive toward an objective standard of 'perfect health'? Are something like 'well‐being' and/or 'perfect health' even attainable? If so, what do/should they look like? Ultimately, what might be beneficial about preserving scientists' "jurisdiction over their knowledge‐producing domain" (p. 118)?
(1) In this chapter the concepts of agency and representation are introduced as essential
components of the patient experience. Where agency refers to "the ability for one's speech and
action to make a difference" representation refers to "the ability to speak and act for oneself or
another" (p. 121). Within the field of medicine, how are these abilities commonly measured?
Are agency and representation based in patient‐perception, or are these concepts quantifiable
facets of the medical context? Can agency and representation be monitored during the medical
process, or can both agency and representation only be measured via procedural outcomes?
What types of insights do these understandings of agency and representation offer critics of the patient‐practitioner and/or patient‐researcher relationships?
(2) How does emotion factor into the field of medicine? How should emotion factor into the field of medicine? Do medical authorities have the responsibility to protect the patient's emotional interests? Or is access to and exposure to all available knowledge about a particular condition the only way to ensure patient autonomy within the medical context? Are sufferers of certain conditions to be expected to always enact the role of a knowledge partner? Or are there situations in which this expectation could cause more harm than good? Who decides? And, moreover, what are the implications of these types of decisions with regard to the infrastructure of medicine?
(3) Keränen suggests that three dominant characterizations dominated the representation of
women during Datagate. These characterizations included the knowledge consumer, the subject
of science, and the knowledge partner. In your experience, are there other dominant
characterizations of women currently influencing the public's understanding of women's
health issues? How have characterizations of breast cancer and breast cancer advocates
changed since the Datagate controversy? What do shifts in character representations over
time indicate about the contemporary practice of medicine? What do shifts in character representations over time indicate about the status of science in relation to women's health?
(4) The history of the feminist movement suggests that "a surge of breast cancer activism in the 1970s confronted and eventually transformed the doctor‐knows‐best model of patient care" and encouraged women to become "active partners in their care" (see p. 124). What does it mean to be an 'active partner' within the healthcare context? How might media facilitate the patient‐as‐active‐partner standard? What other means of partnership are available to the modern patient? Evaluate the status of women as active partners since the women's health movement of the 1970s and 1980s (see the overview on pp. 153‐154).
(5) In chapter two Poisson was described as "a caring and committed surgeon with a profound interest in helping women with cancer save their breasts" (p. 48). Although Keränen goes into some depth about the reasons for and implications of fixating on any particular body part during a time of medical crisis, here in chapter four she revisits the female breast as a motivating symbol. How might focus on the male anatomy change discourse about cancer? Specifically, consider how factors of gender, symbolism, and expectation guide your consideration of the following question: "Would headlines report that men with testicular cancer 'fretted' if their doctors falsified data?" (p. 130). Why or why not? Which cultural norms regarding gender lend you certainty with regard to your prediction?
(1) At the close of this book take time to reconsider how trust factors into the practice and theory of science. How do you foresee issues of trust and distrust influencing the future of science? How do you foresee issues of trust and distrust shaping the practice of medicine? And, how might issues of trust and distrust further negotiate the relationship between science and medicine?
(2) Keränen began her book with a brief introduction of how this historically significant debate came to be dubbed 'Datagate' (see pp. 2‐3). Although her explanation suggests that this title was adopted early on with regard to public perceptions of the situations at hand, if knowing what you know now about the course of the investigation how might you rename the episode to better re‐present the overall course of Datagate and to better re‐present the people involved? What does this re‐naming exercise work to suggest about the role that labels play before, during, and after historically significant events.
(3) This controversy presents us with the opportunity to evaluate institutional memory. Ultimately, do you feel that the scientific community learned anything, if at all, from the Datagate scandal? If you feel that the scientific community has learned valuable lessons from the Datagate trial, provide an example from a current science‐related debate that helps to illustrate the lessons that were learned and the subsequent standards that have been adopted in the practice of science. If you do not feel that the scientific community was positively altered on account of Datagate, provide an example from a current science‐related debate that works to suggest that science continues to operate as usual. What are the implications of each position?
(4) How do you conceptualize "public engagement" with regard to the field of science (see p. 164)? In general, what do you consider to be your level of engagement with science? What personal responsibilities do you assume when you identify as a patient? As a researcher? As research participant? As a medical student or bioethicist? What do these shifts in responsibility signify about the limits of the public's ability to engage with the field of science?
* This discussion guide was prepared by Jennifer Malkowski of the University of Colorado Boulder,
with support from a College of Liberal Arts & Science Dissemination Grant from the University of
Rhetoric, Politics, and Trust in Breast Cancer Reseach
Recipient of the 2011 Marie Hochmuth Nichols Award for Outstanding Scholarship in Public Address from the Public Address Division of the National Communication Association.
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