Evidential Matter(s)

Not only is everything changing, but all is flux. That is to say, what is is the process of becoming itself, while all objects, events, entities, conditions, structures, etc., are forms that can be abstracted from this process.

David Bohm, Wholeness and the Implicate Order

Medicine is a heterogeneous coalition of ways of handling bodies, studying pictures, making numbers, conducting conversations. ... There is multiplicity even inside medicine's biomedical "core."

Annemarie Mol and Marc Berg, introduction to Differences in Medicine

After gradual loss of his mobility and speech, on June 17, 2014, my paternal grandfather died of multiple system atrophy — a rare and relatively mysterious degenerative disease that affects the brain. Fewer than twelve months later, at only age fifty-nine, my uncle died of an aggressive form of brain cancer. As I grieve for my grandmother, Bernice, who in one year lost both her son-in-law and her life partner of five decades, I am struck by the degree to which medical professionals struggled to name and navigate our loved ones' illnesses. Because disease seemed to sneak up on my grandfather and uncle and then slowly whittle away at their brains and bodies, I've become hyperaware of my father's tendency to repeat a story for the second or third time. When dad suffers a minor injury now and then because of what appears to be mere clumsiness or overexertion, I worry. Concerned that his forgetfulness, muscle pulls, and pain might be signs or symptoms of something ominous, I try and take comfort in recent medical tests and scans that indicate dad's brain and body are in pretty good shape.

Uncertainty posed by the ambiguous space between living and dying is mitigated, albeit only in part, through medical evidence. But how are evidential worlds assembled from bodies in perpetual flux? From where does medicine's evidential weight hail? What protocols and procedures elevate everyday biological activities to positions of argumentative authority? This book seeks answers to such questions through an exploration of the backstage, behind-the-scenes biomedical practices that materially render medical evidence both visible and actionable. Bodies in Flux is inspired by medical professionals' success with and failures at navigating not knowing. Each chapter investigates one of four specific scientific methods for negotiating medical uncertainty in cancer care: evidential visualization, evidential assessment, evidential synthesis, and evidential computation.

Defining and diagnosing disease is a kind of quixotic empiricism. It requires taking what's known now and making best guesses about what's to come. Yet, as physicist and philosopher David Bohm (1981) argues, "all is flux" (61). Inspired by partnerships with nature, premodern medical and scientific practitioners once used astrological evidence to manage bodily flux. For example, constellations once aided in predicting astral circumstances of birth, controlling parts of a body, and determining when and where to let blood or take medicine (French 2003, 132). Today's attempts at managing bodily flux involve monitoring corporeal symptoms and modeling risks. From telescopes to stethoscopes to microscopes, biomedical projections have always resulted from human and nonhuman partnerships. The always already collaborative nature of attempts at forecasting corporeal futures complicates contemporary biomedical practice and precision. Bodies in Flux explores such complications.

I invoke "flux" not only in reference to cancer care's corporeal contingencies but also to orient readers' attention toward scientific indeterminacy (Barad 2007) — the kind of contingencies and indeterminacy that Heraclitus may have had in mind when he famously declared the impossibility of stepping into the same river twice. As a concept, flux highlights the evidential complexity of being (a body) in the world. In rhetorical theory, flux counters the notion that rhetoric, and decision making in particular, consists of discrete and autonomous elements such as audience, purpose, or context. Contesting the reductive nature of a or the rhetorical situation, Jenny Edbauer (2005), Louise Weatherbee Phelps (1991), Laurie Gries (2015), and several other rhetoric scholars have advocated for an ecological view of rhetoric that situates suasive activity within (and because of) a "wider sphere of active, historical, and lived processes" (Edbauer 2005, 8). An ecological model of rhetoric characterizes "rhetoric" as a verb. A performance. A constant process of unpredictable unfolding. To study rhetoric, therefore, is to study flux and flow. To study rhetoric is to explore processes of becoming (Bohm 1981).

In the following chapters, I trace processes of becoming in the biomedical backstage. That is, I trace how modern medicine does rhetorical work. To do this, I identify and analyze biomedical practitioners' material-discursive negotiations with matter, movement, and time. I do so motivated by the troubling awareness that well prior to medical practitioners' attempts at understanding my grandfather's, uncle's, and father's corporeal conditions through freeze-framed abstractions (such as medical images or blood tests), processes deep within their bodies were and are always at work. Material actions — some seen, some unseen — perform our bodily being long before doctors even know to look.

Bodies in Flux is about and for those who compose, communicate, contend, and cope with biomedical evidence as material made to mean. Each chapter's investigation of medical practitioners' attempts at managing bodies' inherent indeterminacy is written with patients, practitioners, policy makers, technical communicators, rhetoricians, medical humanists, and science and technology scholars in mind. Exigencies for a book about how biomedical evidence is made to mean are abundant. In response to evidence-based medicine's fetishization of medical evidence many wonder: Whose evidence? What counts as evidence? And how is evidence tallied and made to matter? Commoditized, direct-to-consumer genetic testing kits and government-mandated electronic medical records invite additional scrutiny: Who owns my medical evidence? Who should or should not have access to it? Evidential complexities such as these have implications not just for decision making. Evidential complexities such as these also have economic and ethical effects.

The rate of women in the United States choosing to undergo what is now referred to as a "bilateral risk-reducing mastectomy" has increased by 50 percent in just the last five years. As I write this, these rates, along with what is colloquially referred to as the "Angelina Jolie effect," have sparked a cultural firestorm of debate about medical certainty, women's choice, and biomedical...