Book Review: – Rhetoricians of Health and Medicine

Bodies in Flux: Scientific Methods for Negotiating Medical Uncertainty. By

Christa Teston. Chicago: The University of Chicago Press, 2017. $35.00 paperback.

https://press.uchicago.edu/ucp/books/book/chicago/B/bo25793951.html

Review By Lisa DeTora

Writing Studies and Rhetoric, Hofstra University, Hempstead, NY

Lisa.M.DeTora@hofstra.edu

Recommended Citation:

DeTora, Lisa. (2023) “Book review:Bodies in Flux: Scientific Methods for Negotiating Medical Uncertainty” Rhetoric of Health & Medicine: Vol. 6 : Iss. 1.

Read below or download here.

Reviewed by Lisa M. DeTora (unoffended by most personal pronouns), Hofstra University

Everything is ever always in flux. This is the basic premise upon which Christa Teston’s (2017) Bodies in Flux: Scientific Methods for Negotiating Medical Uncertainty rests. Teston develops a core idea: all medical knowledge about cancer is uncertain, even to the level of the evidence used to support scientific claims about its treatment. In other words, even though evidence is used to support medical knowledge—as well as attendant medical practice—the evidence itself is always changing, in part because it is evidence about things that themselves are undergoing change. Importantly, however, medical and scientific knowledge is often presented rhetorically and discursively as ‘fixed’ or ‘proven,’ which means that the language of medicine often operates in ways that are fundamentally at odds not only with personal experience but also with the epistemic realities of medical research. Uncertainty, and flux, as Teston insightfully explains, actually informs all aspects of the curation and interpretation of medical evidence, even to the level of personal experiences of health and illness. These observations, and the questions Teston examines, are critical to understanding the rhetorical functioning of any medical problem. As Ella R. Browning (2020) explains in a review, Bodies in Flux has only gained in importance following the emergence of Covid-19 as the need to manage changing health information has become an everyday reality.

Bodies in Flux purports to give an inside view of the ‘black boxes’ that characterize medical knowledge and decision-making, using the context of cancer as its focal point. Different chapters consider: how evidence is made to matter (and how evidence functions as matter), how visuals are used in biomedical science and advising, how scientists evaluate and apply evidence, and how bodies of evidence are synthesized into reviews; additional chapters consider computational methods for genetic analysis, and experiences of living with illness. Significantly, Teston uses distinct rhetorical approaches in various chapters, which means that the book lays out the affordances of rhetorical inquiry even as it analyzes various scientific and medical endeavors. Chris McCracken’s (2018) and Browning’s (2020) reviews ably break out and describe each of these chapters in detail. Several chapters also stand on their own as an individual study or a case; hence, individual chapters could easily be used in different pedagogical settings.

Teston intends to “trace how modern medicine does rhetorical work” (2017, p. 11), focusing on the performative nature of such work as a body of experience that is also related to embodied experiences of health and illness. The focus on rhetoric-as-medical-performance (or how medicine ‘does’ rhetoric) also provides a basis for discussing the discursive practices that occur within the field of medicine in ways that often remain unsatisfactorily tacit to those outside immediate, localized scientific and medical discourse communities. In other words, the ‘black boxes’ Teston examines extend not simply to the research practices that medical researchers might acknowledge as not routinely including outsiders, but also to the ways various rhetorical situations within medical research can compound a general discursive opacity. These ‘black boxes’ also include the workings of bodies affected by cancers that reframe bodily structures in unseen and unknowable ways. By seeking to unpack these boxes, Teston highlights the always provisional nature of knowledge in cancer research and care.

Teston draws on several important bodies of theoretical knowledge that dovetail with current concerns in rhetoric, science and technology studies, and the new materialism. Given that individual chapters also illustrate rhetorical methods, notably a Toulmin analysis of evidence, the book could be used as an anchor text in different kinds of courses in rhetoric, technical communication, or science and technology studies. Rachel Bloom-Pojar (2020) observes, for example, that Bodies in Flux takes “a feminist approach” (p. 183) and by linking its project to other concerns, like the Flint water crisis, the book hints at the relational nature of care in many different settings outside of healthcare provision. The concluding chapter impressively balances different possible theoretical understandings of the cases Teston presented before suggesting that practical wisdom, or phronesis, should characterize not only the rhetorical practices of cancer care, but also medicine itself.

A strength of this book is how Teston balances the experiential with the intellectual and the scholarly. Teston’s choice of cancer, for instance, is framed in terms of personal experience as much as intellectual inquiry, which provides a solid basis for readers to see how life experience cannot be divorced from any body of research. Bodies in Flux opens with autoethnographic details that situate the book in such a way as to speak to myriad audiences. Anyone with any experience of or with cancer will be drawn immediately into a compelling series of thoughts and experiences. This move extends the idea of flux from intellectual concerns into the lived experience of inhabiting a body in flux. Teston grounds this type of perspective against multiple theoretical positions, providing a model for future researchers attempting to take up complex problems in science, technology, and/or medicine.

Another strength of the work is that Teston offers a useful method for understanding the operation of flux in medical endeavor: as a series of snapshots that must be interpreted in the context of a past, present, and future. For instance, she describes the Cochrane Systematic Review as providing a “stabilized-for-now set of guidelines” (2017, p. 24) that are commonly used to inform evidence-based decisions in day-to-day healthcare situations. This chapter, as noted by others (Bloom-Pojar, 2020; Browning, 2020; McCracken, 2018), uses the technique of Toulmin analysis to examine Cochrane Systematic Reviews about cancer therapies. Teston’s analysis shows how and where different claims made in the context of Cochrane Reviews might be seen to originate as well as the potential effects of different decisions made while collecting and evaluating information. The question of what counts (or not) as evidence in an evidence-based review then can be understood in terms of the many possible decisions that might have affected the quality or the interpretation of specific pieces of information. Teston also develops a new term, “evidential cutting” (2017, p. 24), to describe the process by which information is evaluated to include or exclude it from a systematic review. The idea of evidence about a given cancer therapy being stable ‘for now’ allows for scholars, and students, to understand how information in flux can be applied to a specific problem without shutting down the possibilities for different future interventions in the light of new information.

It is rather difficult to comment on a book that has already been so ably reviewed by more established rhetoricians of science, technology, and medicine. However, since rhetoric of health and medicine aims to participate not only in the rhetorically based fields but also within medical settings, a few words about the possibilities for reception within the ‘black boxes’ that Teston examines might be warranted. McCracken (2018), for instance, notes: “Bodies in Flux seems primarily aimed at rhetoricians of science, technology, and medicine who wonder how we might shift our work upstream from where rhetorical performances are ultimately staged into places like the biomedical backstage” (p. 193). And it is here that, for me, the book might begin to break down, because each of the cases I read seems to be informed by flaws of biomedical—although certainly not intellectual or rhetorical—knowing. For instance, Teston opens by characterizing medical diagnosis as ‘quixotic,’ a claim made again in the conclusion. Biomedical scientists and practitioners might, as I did, take offense at this term, or even use it as an excuse to stop reading/listening. Why? Because researchers and practitioners in biomedical contexts viewed diagnosis as conditional, or as Teston puts it herself, ‘stabilized for now,’ long before Teston began her research. In other words, Teston’s work begins and ends in a rhetorical register unlikely to reach many of the audiences that could benefit from her insights. Fortunately, the core endeavor of Bodies in Flux provides an immediate, built-in remedy to this problem: Teston herself acknowledges that her own project is influenced by flux. It must be, since she is examining discourses characterized by ongoing change. In fact, the discursive problem I just pointed out reinforces rather than negates Teston’s approach. This discussion, then, might be read as simply highlighting yet another ‘black box’ in the field of cancer research in need of unpacking. In other words, Bodies in Flux might be read as a jumping off point rather than an ending.

However, this comment is also a word of caution. Bodies in Flux bristles with new terminology to describe medical genres or practices, which in quite a few cases might be seen by the medical community as inaccurate. For instance, abbreviating ‘Cochrane Systematic Review’ as CSR ignores the Cochrane Group’s own terminology and also co-opts an abbreviation already used in that setting to mean something else. And ‘evidential cutting’ could suggest that evidence is being cut, as opposed to following scientific standards for separating ‘information,’ or ‘data,’ from ‘evidence.’ While this type of semantic slippage is forgivable in the light of the masterful intellectual work in the book, this circumstance has the potential to move the rhetoric of the rhetorically informed fields in which Teston participates further away from the discourse practices they seek to examine. In other words, this examination of the ‘black boxes’ of biomedicine also highlights the ways in which rhetorical study creates its own ‘black boxes.’ I see this as a necessary step to enhanced understanding, but I would be remiss not to suggest that some version of the phronesis Teston recommends should come into play for those seeking to forward Teston’s work and to examine other elements in the ‘backstage’ of biomedicine. In other words, a deeper attunement to the source discourses under analysis is needed, again, just as Teston suggests.

A final word on diversity, equity, and inclusion is also warranted. Bodies in Flux, like many of the works that fall under a broad umbrella of RHM is susceptible to criticism based on its adherence to—and examination of—specific scholarly traditions that may be coded as white. By concentrating on practices such as Toulmin analysis or feminist study, Teston might be seen as eliding the important work done by scholars of color seeking to decolonize the ‘black boxes’ under examination in Bodies in Flux. Thus, a further direction for future research would be to identify appropriate approaches, such as culturally sensitive or culture-centered communication (see Dutta 2007), that might be employed to decenter and trouble the primacy of certain biomedical discourses in lived experience. Once again, the idea of phronesis, while susceptible to interpretation as ‘white,’ might be employed. In interpreting the various ‘black boxes’ in the ‘backstage’ of medical research, it will be important to consider how culturally sensitive communications might fail to illuminate the epistemological limitations of such work. Culture-centered approaches might be used to identify the practical wisdom necessary to address various audiences and communities affected by cancer.

Lisa DeTora (PhD, Rochester University, MS Albany Medical College) is Associate Professor of Writing Studies and Rhetoric and Director of STEM Writing at Hofstra University. Lisa teaches in women’s studies, rhetoric, biology, chemistry, sports science, and disability studies and serves as guest faculty in medical humanities for the Zucker School of Medicine at Hofstra/Northwell.

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References

Bloom-Pojar, Rachel. (2020). [Review of the book Bodies in flux: scientific methods for negotiating medical uncertainty, by Christa Teston]. Rhetoric & Public Affairs, 23(1), 181–184.

Browning, Ella. R. (2020). [Review of the book Bodies in flux: scientific methods for negotiating medical uncertainty, by Christa Teston]. Communication Design Quarterly, 8(1), 37–39. https://doi.org/10.1145/3375134.3375138

Dutta, Mohan. J. (2007). Communicating about culture and health: theorizing culture-centered and cultural sensitivity approaches. Communication Theory, 17(3), 304–328. https://doi.org/10.1111/j.1468-2885.2007.00297.x

McCracken, Chris. (2018). [Review of Bodies in flux: scientific methods for negotiating medical uncertainty, by Christa Teston]. Technical Communication Quarterly, 27(2), 191–194. https://doi.org/10.1080/10572252.2018.1425821

Teston, Christa. (2017). Bodies in flux: scientific methods for negotiating medical uncertainty. The University of Chicago Press.

References

Bloom-Pojar, Rachel. (2020). [Review of the book Bodies in flux: scientific methods for negotiating medical uncertainty, by Christa Teston]. Rhetoric & Public Affairs, 23(1), 181–184.

Teston, Christa. (2017). Bodies in flux: scientific methods for negotiating medical uncertainty. The University of Chicago Press.