Exercising Uncertainty: Identifying and Addressing "Gray Areas" in a Case Study Involving Corporate-Funded Research on the Effects of Sugar-Sweetened Beverages.

• Date: 22 March 2023
• Author: Ryan, Cynthia

Rhetoric of health and medicine (RHM) scholars posit that health and medicine texts cannot be divorced from the rhetorical conditions in which they are shaped and disseminated. This assertion runs counter to traditional biomedical values grounding messages about the body in positivist evidence and universal standards. As this issue of the founding journal in RHM demonstrates, a disciplinary response to a biomedical ideology should undergird not only the approaches scholars take to their research, but also the models of learning they bring to the classroom. In this essay, I present a case study assignment used in an undergraduate science writing course that aims to encourage critical thinking skills that extend beyond dichotomous understandings of both the material body and knowledge-production influencing how the body is situated in institutional settings. Following a discussion of relevant RHM scholarship, I provide details about the institutional context in which I work, a description of the assignment developed for this student population including sample student responses, and consideration of the strengths and limitations of the approach alongside strategies for adapting the assignment to other student populations and environments.

RHM's EMPHASIS ON FLUIDITY AND UNCERTAINTY

RHM scholars are a rebellious lot, united in their desire to interrogate the narratives through which knowledge about the body is constructed and conveyed. Studies in the field play out against a combative backdrop in which the deviant body is surveilled under a watchful authoritative gaze and targeted by therapies deployed to destroy the enemy of health, whether a virus, an unexpected conglomeration of cells, or a mutilation of the ideal corporeal landscape. At one time or another, all human bodies are called to engage in this antagonistic setting, a truth that reveals the need to equip ourselves and our students (among other publics) with alternative conceptualizations of bodily states.

In response to the polarizing construction of bodies in traditional medical spheres, J. Blake Scott and Lisa Meloncon (2018) note that RHM work represents a "range of disciplinary and interdisciplinary bodies of scholarship" more invested in "advanc[ing] knowledge in an indeterminate manner" than committed to "align[ing] and standardiz[ing]" (pp. 3-4) a rigid set of practices. In their pursuit of knowledge, RHM scholars open themselves to divergent ways of seeing as a means to offer a multitude of arguments pertaining to health and medicine, some of which unsurprisingly usurp dominant understandings.

In short, a biomedical perspective represents a static orientation towards the body and states of health and illness. Doctors, for example, are taught to isolate and examine the physical body in concert with the specific patient complaint, and then to compare their findings to other "normal" and "deviant" bodies in the quest for an accurate diagnosis and potential fix. In modern times, the "medical gaze" chronicled by Michel Foucault (1973) finds plentiful support for expert interpretations, particularly in the context of a sophisticated technological landscape where visualization of the body is presented as unbiased evidence in the decisionmaking process. The "rub" of this approach to peering inside and making sense of the corporeal specimen, according to Christa Teston (2017), is that "in the time it takes to visually evince disease, the evidential artifact itself becomes a kind of relic" (p. 27) given the complexities and fluctuations endemic to human bodies. T. Kenny Fountain's (2014) description of the "contemporary anatomy lab" where "future doctors, dentists, physical therapists, and nurses encounter the cadaveric body of traditional Western medicine--the body that is anatomical knowledge made flesh" (p. 24) offers a postmortem perspective on the use of rhetorical devices to influence how the singular body lying before students offers explicit knowledge about bodies in general--both their makeup and the value they provide to the work of the living.

Widespread assumptions about the certainty of scientific research findings also play a pivotal role in the acceptance of clinical decision-making practices. Historically, the "hard" sciences, especially, have been characterized by investigators' commitment to objectivity in both methodological protocols and interpretations of data. These claims of non-bias, despite recognition of limitations and use of qualifiers in conventional Introduction, Methods, Results and Discussion (IMRD) arguments, fuel perceptions of scientific data as "correct" in the public, and ideally to a lesser extent, the scientific, domain. From a rhetorical standpoint, scholars including Jeanne Fahnestock (1998) articulate the genre work driving both scientific inquiry and the presentation of research data by "science accommodators" (p. 334), challenging the notion that scientific facts and reasoning are neutral and somehow more "real" and reliable than knowledge discovered through assumedly less rigorous methods. Nevertheless, admissions of gray areas and problematic findings, a necessary feature of sound argumentation, are regularly glossed over in communication of scientific knowledge. RHM scholars often work in these "gray areas" to elevate and make visible uncertainties that are not only ignored by many, but also contribute to social inequities and unjust practices. As educators of both students entering science and medical fields and those pursuing other academic and career paths, our work in RHM exposes an ethical responsibility to introduce variations to dichotomous understandings of the body as object into the classroom.

INSTITUTIONAL CONTEXT

I have used versions of the assignment discussed in this essay in numerous sections of a science writing course that I initially developed in 2005 when the [redacted], a Research I institution, launched its Science and Technology Honors Program (STHP). The course is offered at the freshman level, and students enroll in a designated section of either EH 102 (the research-based writing course required for all university students) or EH 202 (for those who have previously earned credit for 102 but not taken a course focusing on the conventions of scientific discourse). While the assignment that I describe in this essay was developed with this particular population in mind, the assignment itself and variations on the principles driving the assignment can be adapted to diverse student groups. The ethical imperative to engage students participating in the medical sphere from a host of positions makes this approach relevant to many institutional settings.

Acceptance to STHP is competitive, and students pursue diverse majors: chemistry, biology, physics, biomedical engineering, neuroscience, genetics, public health, and computer science, to name a few. Many enter [institution] under the Early Medical School Acceptance Program, ensuring them a spot in the institution's highly ranked medical school following graduation. STHP applicants undergo a rigorous review process (demonstrating excellence in academic preparation and a keen interest in research), and throughout their time in the program, they enroll in seminars addressing methodological approaches to scientific inquiry; work in on-campus labs and clinics, contributing to innovative research, grant applications, and published papers; and produce and defend honors theses reporting on their contributions to current conversations in science and technology. The majority of STHP graduates continue their education in Ph.D., M.D., and combined M.D./Ph.D. programs at institutions across the country. STHP students are consistently named as recipients and finalists for awards including the Rhodes, Clinton, Marshall, and Fulbright Scholarships. I provide this information not just to brag on the students--though bragging is always a delightful perk of the job--but to suggest the caliber of the students enrolled in the course. It is important, I think, to acknowledge that many of them have landed in STHP and continue to excel in part because of their success in achieving benchmarks of learning that value objective measurements of knowing. In brief, these are students who have played by the rules, the ones rewarded for answering questions in the "right" way and adhering precisely to the requirements of an assignment. Many find it downright uncomfortable to dwell in the land of uncertainty, a place to which my course, and this assignment in particular, is designed to transport them. The prioritizing of "correct" answers and absolute understandings is certainly not limited to students in my course, however. Students across academic institutions have encountered positivist pedagogy, and despite efforts to widen their perspectives on gradations of knowledge and the complexities of learning...