Bodies in flux : scientific methods for negotiating medical uncertainty

Doctors, scientists, and patients have long grappled with the dubious nature of “certainty” in medical practice. To help navigate the chaos caused by ongoing bodily change we rely on scientific reductions and deductions. We take what we know now and make best guesses about what will be. But bodies in flux always outpace the human gaze. Particularly in cancer care, processes deep within our bodies are at work long before we even know where to look. In the face of constant biological and technological change, how do medical professionals ultimately make decisions about care? __Bodies in Flux__ explores the inventive ways humans and nonhumans work together to manufacture medical evidence. Each chapter draws on rhetorical theory to investigate a specific scientific method for negotiating medical uncertainty in cancer care, including evidential visualization, assessment, synthesis, and computation. Case studies unveil how doctors rely on visuals when deliberating about a patient’s treatment options, how members of the FDA use inferential statistics to predict a drug’s effectiveness, how researchers synthesize hundreds of clinical trials into a single evidence-based recommendation, and how genetic testing companies compute and commoditize human health. Teston concludes by advocating for an ethic of care that pushes back against the fetishization of certainty—an ethic of care that honors human fragility and bodily flux. Uncertainty in cancer care is mitigated, albeit only in part, through medical evidence. But not all evidences are equally persuasive. What materials and methods, therefore, make some medical evidences mean more than others? What historical, political, economic, and ideological assumptions are built into the biomedical backstage’s evidential practices? This book seeks to answer such questions by investigating the inventive ways humans and nonhumans work together to manufacture medical evidence. Each chapter analyzes one specific scientific method for negotiating medical uncertainty in cancer care: evidential visualization, evidential assessment, evidential synthesis, and evidential computation. Case studies unveil how practitioners, researchers, and policy-makers rely on technically sophisticated visualization techniques to evince and make decisions about disease, mobilize inferential statistics to assess a drug’s effectiveness, synthesize hundreds of clinical trials to compose a cancer-screening recommendation, and compute and commoditize genetic material. Analyses rely on theories in material feminism while reanimating classical and contemporary constructs in rhetorical theory (e.g., kairos, enthymeme, poiesis, boundary objects, phronesis). After propping open cancer care’s black boxes, biomedicine is characterized as a practice that requires rhetorical skill—including the capacity to attune to and dwell with constantly changing phenomena. The book concludes by advocating for an ethic of care that pushes back against the fetishization of certainty and, in its stead, honors both bodily flux and human fragility Bodies in Flux explores the inventive ways humans and nonhumans work together to manufacture medical evidence. Each chapter draws on rhetorical theory to investigate a specific scientific method for negotiating medical uncertainty in cancer care, including evidential visualization, assessment, synthesis, and computation. Case studies unveil how doctors rely on visuals when deliberating about a patient's treatment options, how members of the FDA use inferential statistics to predict a drug's effectiveness, how researchers synthesize hundreds of clinical trials into a single evidence-based recommendation, and how genetic testing companies compute and commoditize human health. Teston concludes by advocating for an ethic of care that pushes back against the fetishization of certainty--an ethic of care that honors human fragility and bodily flux. --Publisher description Medical professionals, scientists, and patients have long grappled with the dubious nature of medical 'certainty' regarding diagnosis, treatment, and prognosis of disease states. Constructing certainty requires reductions and deductions. It requires us to take what we know now and make best guesses about what will be. We try to make peace with medical uncertainty by monitoring symptoms, modelling risk, and looking toward evidence. But bodies in flux always outpace the human gaze. With research, technologies, and patients themselves constantly changing, how do practitioners ultimately make decisions about care? 'Bodies in Flux' looks at the many ways humans coproduce medical knowledge Contents 8 Acknowledgments 10 1. Evidential Matter(s) 12 2. Evidencing Visuals 37 3. Assessing Evidence 71 4. Synthesizing Evidence 105 5. Computing Evidence 145 6. Dwelling with Disease 180 Appendix A. ODAC Hearings Post-Avastin, 2011–2013 (Not Including Pediatric Hearings) 198 Appendix B. CSR Outlines 208 Appendix C. Genetic Testing Methods and Techniques, 1950–1990 215 Notes 216 References 226 Index 244