{"id":189,"date":"2017-09-04T18:45:54","date_gmt":"2017-09-04T18:45:54","guid":{"rendered":"http:\/\/medicalrhetoric.com\/symposium2017\/?page_id=189"},"modified":"2018-05-31T14:31:39","modified_gmt":"2018-05-31T14:31:39","slug":"kristen-bivens","status":"publish","type":"page","link":"https:\/\/medicalrhetoric.com\/symposium2017\/profiles\/kristen-bivens\/","title":{"rendered":"Kristin Bivens"},"content":{"rendered":"

\"KristinTitle: <\/strong>Associate Professor of English<\/p>\n

University: <\/strong>Harold Washington College<\/p>\n

Email: <\/strong>kbivens@ccc.edu<\/p>\n

Twitter: <\/strong>kmbivens<\/p>\n

Website: <\/strong>kristenbivens.com<\/p>\n

Description of Work:<\/strong><\/h3>\n

As a RHM scholar, I typically strive to conduct research projects that I deem worthy, as well as potentially ameliorative.\u00a0 My studies in neonatal intensive care units (NICUs) have focused on the necessary emotional labor a researcher performs before and during researching with these participants (see my chapter in Meloncon & Scott\u2019s Methodologies for the Rhetoric of Health and Medicine<\/i>, 2017). Interestingly, NICU aural rhetoric has occupied many of the recent RHM arguments I have made with regard to the multiple layers of health literacy needed to use healthcare technologies. In January 2018 in Kairos<\/i>, Lora Arduser, Candice Welhausen, Michael Faris, and I will have a piece about layered health literacies: \u201cA Multisensory Literacy Approach to Biomedical Healthcare Technologies.\u201d We wrote this in the abstract:\u00a0\u00a0<\/span><\/p>\n

In this webtext we borrow Kelli Cargile Cook’s (2002) concept of “layered literacies” in technical communication to argue that health literacy is an embodied, multisensory experience that is invariably mediated by healthcare technologies. We illustrate this concept through three case studies that describe scenarios in which non-experts and lay experts engage in non-discursive literacy practices: parents caring for an infant in a neonatal intensive care unit (NICU)[Bivens], people with type 1 diabetes (T1D) self-managing their treatment [Arduser], and public audiences reporting symptoms to a crowd-sourced flu-tracking program [Welhausen]. We propose that the literacy practices we identify in each scenario–aural, tactile, and visual, respectively–are fundamentally shaped by the use of specific healthcare technologies unique to that scenario: physiological monitors, insulin pumps, and crowd-sourced flu maps. More specifically, we argue that these technologies enable, constrain, and integrate multisensorial literacy practices in ways that complicate the concept of health literacy.\u00a0\u00a0<\/span><\/p>\n

My current work, including the Methodologies <\/i>and Kairos <\/i>pieces I mention above, stem from rhetorical listening operationalized in what I call a metaphorical echo methodology. In other words, using sound and the trope of comparison\/contrast to compare healthcare technologies\u2019 sounds. It has been interesting work, which I have been involved in since I realized the only common\/same factor I could reasonably derive from a NICU research site in Denmark and one in the United States was a healthcare technology monitor.\u00a0 To my mind, there was nothing else that was apples-to-apples comparable.\u00a0\u00a0\u00a0<\/span><\/p>\n

I am currently revising an article where I argue healthcare technology does the work of paternalism in biomedicine in NICUs. Essentially, even though sounds are not actions, they still have effects. I realized the importance of these effects\/these sounds\/these noises while watching the National Resource Defense Council\u2019s documentary, Sonic Sea<\/i>. In other words, sounds\/noises communicate messages even when devoid of language, and it is my argument that we need to attend to these sounds in NICUs, especially since the infants cannot communicate with language. The concept I use to make the argument is rhetorical ventriloquism.\u00a0 In other words, biomedicine and its inherent paternalism, are rhetorical ventriloquists for the sounds and noises in NICUs.\u00a0 Specifically, I look at healthcare technology as the producers of sounds and noises that impact communication in NICUs. I anticipate having this article in review in late summer\/early fall.\u00a0\u00a0<\/span><\/p>\n

All of these research projects dovetail with my goal for worthwhile, potentially ameliorative research projects, like the one I will share at the RHM Symposium: \u201cThe Opioid Overdose Epidemic, Lay Expertise, and Naloxone.\u201d Basically, as a RHM scholar, I hope to make apparent the impact sound has on neonatal infants in NICUs, as well as show how expertise (and perhaps a misapplication of it) might contribute to opioid overdose.\u00a0\u00a0<\/span><\/p>\n

Symposium Submission:<\/strong><\/h3>\n

The Opioid Overdose Epidemic, Lay Expertise, and Naloxone<\/strong><\/p>\n

Specifically, the work I describe below can be categorized as a Multiple Media Elements submission. Currently conceptualized as an article-length project, it is rooted in the exigent opioid overdose (OD) epidemic in the United States. For the article I propose with this submission, I will examine \u201cthe many and varied media involved in health and medical communication\u201d with regard to the current opioid epidemic.<\/p>\n

Specifically, I aim to 1) foreground the opioid epidemic, 2) provide background on current attempts to combat the opioid overdose and intoxication, nationally and locally (and interruptions of those attempts), 3) explore one of those attempts: the FDA\u2019s (2016) app programming competition, and 4) argue for an unexpected reliance on lay expertise to contribute to reducing deaths from opioid use.<\/p>\n

The Opioid Epidemic<\/strong>
\nOpioids include those medically and legally prescribed, including morphine, oxycodone, and fentanyl (among others). According to the Gateway Foundation, heroin is \u201cthe most abused and rapidly acting of the opioids\u201d has \u201cno legal use.\u201d Additionally, heroin is highly addictive. Opioid overdose (OD) in Chicago, greater Chicagoland, and other parts of the United States is at epidemic levels. In healthcare spaces, morphine, oxycodone, and fentanyl are typically prescribed by physicians and administered to relieve pain. However, when a physicianprescribed method to acquire opioids for pain management ceases, illegal opioids, like heroin, are used as a substitute.<\/p>\n

The opioid family of drugs–or opioids–are highly addictive. For 2014, the Illinois Department of Public Health (IDPH) reported nationwide deaths from opioid OD more frequent than those killed by homicide (45% more), motor vehicle crashes (25% more), and guns (http:\/\/www.dph.illinois.gov\/topics-services\/prevention-wellness\/prescription-opioids-andhero, para. 3). The CDC has reported that opioid OD has more than quadrupled since 1999 and within those numbers, 91 people die of opioid OD everyday across the United States (https:\/\/www.cdc.gov\/drugoverdose\/epidemic\/, para. 1). Public health agencies at the national and state-level agree that opioid overdose has reached epidemic levels. And, the CDC (2016) has declared a list of preventative measures to \u201cExpand access and use of naloxone\u2014a safe antidote to reverse opioid overdose\u201d
\n(https:\/\/www.cdc.gov\/drugoverdose\/epidemic\/index.html, para 4) and stop opioid intoxication.<\/p>\n

U.S. Federal Agencies & Naloxone<\/strong>
\nSince 1971, injectable Narcan, now known by the generic naloxone (since 1985), has stopped opioid overdose and temporarily reversed OD (Gupta, Shah, & Ross, 2016). According to Gupta, Shah, and Ross, the FDA fast-tracked naloxone as a fixed dose auto injection in 2014 for non-experts to administer. And since 2015, with FDA fast-tracked approval, a fixed dose nasal spray injection has been available for non-experts to administer. Strategically, to combat opioid OD, federal agencies (Substance Abuse and Mental Health Administration, Department of Health and Human Services, and the CDC) have sought to design naloxone for users.<\/p>\n

The FDA\u2019s App Competition & Price Gouging<\/strong>
\nFurther, the user-friendly material design of naloxone and the FDA\u2019s support in making the product available over the counter (OTC), has prompted the FDA to endorse a competition to crowd source a Naloxone app to connect opioid users with pharmacies that carry naloxone spray. The competition took place in October 2016. And the winning team created a video to explain the naloxone app they created, OD Help. Similar to apps that rely on lay expertise like My Eyes and connect off duty health professionals like Pulsepoint, OD Help is described as \u201ca mobile application designed to connect potential opioid overdose victims with a crowd-sourced network of naloxone carriers.\u201d To reduce the numbers of the opioid epidemic, it is clear that federal agencies are looking to users to help, in the case of naloxone, users.<\/p>\n

While it is clear that federal agencies are interested in reducing the number of deaths from opioid OD, like the auto-injectable EpiPen (epinephrine auto-injection), in \u201cThe Rising Price of Naloxone–Risks to Efforts to Stem Overdose Deaths\u201d (2016), manufacturers have increased prices for naloxone. For example, approved in 2014, Kaleo has increased the price from $690 to $4,500 for an \u201cauto-injector, two-pack of single use prefilled auto-injectors (Evzio)\u201d–a 500% increase in two years (Gupta, Shah, & Ross, 2016, p. 2214). In the article, I will show how some manufacturers, like Kaleo, impede on the federal government\u2019s attempts to reduce OD opioid deaths.<\/p>\n

Lay Expertise to Reduce Deaths<\/strong>
\nIn my proposed article, I consider naloxone use and its user-friendly, fast-tracked design in the context of the FDA\u2019s app Competition, the Chicago Recovery Alliance\u2019s rescue training, and similar apps (My Eyes and Pulsepoint). Further, I will argue naloxone is similar to the EpiPen and insulin pumps in its immediate life-saving benefit and its use by non-experts in special life and death circumstances. An auto injectors is \u201ca device for injecting oneself with a single, preloaded dose of a drug that typically consists of a spring-loaded syringe activated when the device is pushed firmly against the body.\u201d However, naloxone exists in context beyond typical health scenarios. Additionally, I will argue for atypical opportunities in healthcare situations with regard to naloxone and the aforementioned apps.<\/p>\n

Given naloxone\u2019s unique context of use and design for users (in both senses of the word), health and medicine communication scholars will find interest in the similarities and ease of use of the new kind of life-saving drugs and accompanying technologies, like the apps. In the case of naloxone, the provision of increased agency for non-experts is peculiar and unfamiliar. In the article I propose, I will examine what this case study offers medical rhetoricians, as well as those who are impacted by opioid OD.<\/p>\n

References<\/strong><\/p>\n

Gateway Foundation. (2017). Heroin.<\/p>\n

Gupta, R., Shah, N. D., & Ross, J. S. (2016). The Rising price of naloxone\u2014Risks to efforts to stem overdose deaths. New England Journal of Medicine, 375(23), 2213-2215.<\/p>\n","protected":false},"excerpt":{"rendered":"

Title: Associate Professor of English University: Harold Washington College Email: kbivens@ccc.edu Twitter: kmbivens Website: kristenbivens.com Description of Work: As a RHM scholar, I typically strive to conduct research projects that … Continue reading “Kristin Bivens”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-189","page","type-page","status-publish","hentry"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/189","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/comments?post=189"}],"version-history":[{"count":6,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/189\/revisions"}],"predecessor-version":[{"id":671,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/189\/revisions\/671"}],"up":[{"embeddable":true,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/2"}],"wp:attachment":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/media?parent=189"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}