rhetoric of health and medicine rhetoric of health and medicine the rhetoric of health and medicine (or medical rhetoric) is an academic discipline concerning language and symbols in health and medicine. rhetoric most commonly refers to the persuasive element in human interactions and is often best studied in the specific situations in which it occurs. as a subfield of rhetoric, medical rhetoric specifically analyzes and evaluates the structure, delivery, and intention of communications messages in medicine- and health-related contexts. primary topics of focus includes patient-physician communication, health literacy, language that constructs disease knowledge, and pharmaceutical advertising (including both direct-to-consumer and direct-to-physician advertising). the general research areas are described below. medical rhetoric is a more focused subfield of the rhetoric of science. practitioners from the medical rhetoric field hail from a variety of disciplines, including english studies, communication studies, and health humanities. through methods such as content analysis, survey methodology, and usability testing, researchers in this sphere recognize the importance of communication to successful healthcare. several communication journals, including communication design quarterly, journal of business and technical communication, technical communication quarterly, and present tense, have published special issues on themes related to medical rhetoric. the majority of research in the field is indexed in the academic database ebsco communication & mass media complete. in 2013, scholars in the field also began a biennial symposium, discourses of health and medicine. history of the field the rhetoric of health and medicine is tied to the emergence of rhetoric of science in the early 1970s and 1980s. contemporary theorists such as kenneth burke, michel foucault, thomas kuhn, bruno latour, and steve woolgar laid the theoretical groundwork for this early interest in the persuasive dimensions of scientific language. in the 1980s the field shifted when rhetorical critics like martha solomon and charles anderson began analyzing texts on biomedicine. solomon analyzed the rhetoric used in medical reports during the tuskegee syphilis project, while anderson examined the writings of surgeon richard selzer to comment on the rhetoric of surgery. in the 1990s, the rhetoric of health and medicine emerged more clearly as a field distinct from rhetoric of science. rhetorical scholar celeste condit raised questions about the historical and rhetorical dimensions of issues like abortion and genetics in works such as 1990's decoding abortion rhetoric: communicating social change and 1999's the meanings of the gene: public debates about heredity. in these seminal works, condit focused on what she called "rhetorical formations," or the multiple simultaneous discourses that surrounded each rhetorical object. the field also saw the rise of discussion on disability studies and illness narratives during the 1990s, which initiated the beginning of a special interest group on disability studies at the annual conference on college composition and communication (cccc), headed by brenda jo brueggemann. the initiation of this group then inspired a medical rhetoric special interest group, headed by barbara heifferon, which has continued to meet annually to present day. in the early 21st century, scholars began to pay increasing attention to various topics in the rhetoric of health and medicine. j. blake scott's 2003 book risky rhetoric: aids and the cultural practices of hiv testing used michel foucault's theory of examination, which defines rhetoric as a form of disciplinary power, to examine the cultural condition that influence hiv testing. he reported that the rhetoric used in public policy and various propaganda led to the stigmatization and discrimination of people with hiv/aids. in 2005, judy segal's health and the rhetoric of medicine gained recognition for highlighting the persuasive elements in diagnoses, health policies, illness experiences, and illness narratives. she also addressed direct-to-consumer advertising of prescription drugs, the role of health information in creating the "worried well," and problems of trust and expertise in doctor-patient relationships. in 2010, lisa keränen's scientific characters: rhetoric, politics, and trust in breast cancer research addressed issues of research viability and relationships among scientists, patients, and advocates. kimberly emmons’ work on the rhetoric surrounding depression, black dogs and blue words: depression and gender in the age of self-care, was published the same year. in 2018, methodologies for the rhetoric of health & medicine, edited by lisa melonçon and j. blake scott, was published, examining various methodologies in the field of rhetoric of health and medicine. research areas rhetoric of pharmaceutical and science commercialization the rhetoric of pharmaceutical and science commercialization is the study of the persuasive language and symbols that the pharmaceutical industry and biotechnology companies use to communicate and influence consumers, physicians, regulatory agencies, and other stakeholders in the commercialization of biotechnology. scholars have found that the language used to define, describe, and regulate pharmaceuticals influences the understanding and perception of the drugs among both the general public and experts. information about pharmaceutical products is highly regulated and filtered through many channels as it moves from scientist to consumer. despite the regulations on pharmaceutical advertising, pharmaceutical companies use carefully crafted direct-to-consumer advertising to rhetorically influence the patient-physician dialogue to drive consumption of specific pharmaceutical drugs. furthermore, pharmaceutical companies mislead physicians and scientists through deceptive rhetorical strategies in technical documentation (which both package inserts directed towards physicians and medical journal articles directed towards scientists). in a recent study, a pharmaceutical company disguised negative performance in one group of subjects by selectively merging data between different patient groups in clinical trials and carefully crafting supporting statements. this study shows that scientific data and knowledge is secondary to rhetorical messages supporting commercialization, and that human health is secondary to company profit. notably, technical information is subject to obfuscation and distortion so that the message communicated outside of a commercial organization aligns with the primary goal of selling a product. studying and trying to improve the rhetorical processes involved in pharmaceutical information as it moves through the chain of dissemination is a key concern of rhetorical scholarship on this topic. rhetoric of mental health the rhetoric of mental health considers how language functions in the production of knowledge on topics such as mental and psychological disorders, chemical imbalances in the brain, and variations on what are considered normal mental faculties. the $100 million brain research through advancing innovative neurotechnologies (brain) initiative, introduced by the obama administration in 2013, is testament to the emerging importance of brain science and mental health in medical science and public policy debate. neurorhetoric, the study of how language is used in the creation, distribution, and reception of science about the brain, has recently become an important topic in medical rhetoric and composition studies, as well as in popular science publications targeted at non-scientists. information and texts relevant to the rhetoric of mental health include psychotropic pharmaceutical regulations, their production, prescription, advertising, and consumption, and scientific and popular discussions about major depressive disorder, bipolar disorder, obsessive-compulsive disorder, schizophrenia, autism, and other mental disorders. the diagnostic and statistical manual of mental disorders (dsm, now in its 5th edition) is a central text for the study of the mental health profession. patient narrative patient narrative is the clinical story of a person's past and present medical history documented by a medical clinician. the patient narrative can also be referred to as the medical history, the history and physical (h & p), or the clinical narrative. the h&p includes a subject, objective, assessment, and plan (soap note), which summarizes the patient's narrative or history of medical illness, objectively reports the patient's clinical data and lab results, assesses diagnoses and prognoses, and often recommends how to address the patient's clinical situation. as part of the american recovery and reinvestment act of 2009, the government enacted the health information technology for economic and clinical health (hitech) act, which mandates that health providers transition from handwritten (typed) patient narratives to electronic patient narratives in forms such as the electronic medical record (emr) or the electronic health record (ehr). the emr and ehr are of interest to communication scholars because they economize the words and space of the traditional patient narrative into a structured system of navigation screens and checkboxes. rhetorics of alternative medicine the rhetoric of alternative medicine differs from traditional medical rhetoric in its emphasis on the persuasive aspects of language related to holistic or other nonstandard approaches. some of these alternative medical practices include acupuncture, massage therapy, and chiropractic care. scholars further explore alternative medical practitioners’ claims that they take a holistic approach to medical treatment, assessing a person's body, mind, and spirit, rather than just treating a disease. patient-physician communication starting with references to medical care in ancient greece, plato's “dialogues”, expressed that physician-patient communication should not include any “lively interactions” between the physician and patient. in the age of enlightenment, dr. john gregory began to emphasize patient-physician communication by introducing the idea of preventative care for “gentleman of a liberal education.” few found his suggestive style of care useful, and the view that “physicians must assume sole responsibility for protecting the ignorant public from its folly” lived on for some time. as late as the 1980s, the american medical association still had not incorporated regulations into their code of ethics that required physicians to incorporate patient opinion into the decision-making process. it was not until 1996 when the health insurance portability and accountability act (hipaa) was created to protect patient rights and privacy. this law was intended to assure patients that their wishes would be considered in treatment decision-making. professional opportunities for students who take a more applied approach to health and medical rhetoric, there are an increasing number of employment opportunities in industry, government, and nonprofit organizations. such opportunities fall into two broadly defined categories: service and advocacy. service service is a situation in which a communication expert helps a healthcare professional be more effective in his or her communication efforts. this might mean the communicator is paid to assist with a task like grant writing, editing, or authoring a medical document. medical transcriptionists, represented by the association for healthcare documentation integrity (ahdi), provide another form of professional communication in medical discourse. the ahdi is the world's largest nonprofit organization representing individuals and organizations in healthcare documentation. by ensuring documentation's accuracy, privacy, and security, the organization aims to protect public health, increase patient safety, and improve quality of care for healthcare consumers. other professional medical writing associations include the american medical writers association (amwa) and the international academy of nursing editors (inane). sometimes these medical authors are considered “ghostwriters,” or paid writers who write a communicative piece but are not formally acknowledged as a text's author. karen l. wooley says that professional writers must adhere to ethical guidelines that ghostwriters may not be expected to follow. while authors control their content when working with a professional medical writer, wooley says that ghostwriters may try to take control of the content away from the author and hide certain facts, such as where a project's funding comes from. researchers such as elliott moffatt are concerned that medical ghostwriting, especially in the context of pharmaceutical research, is dangerous to public health. possible dangers can include misrepresenting the data and subtly influencing the way clinicians and patients perceive the data. advocacy advocacy in medical rhetoric is a situation in which the communicator addresses a health-related topic, empowering the citizens of a community to understand how that issue impacts them. this type of health communication enables the public to understand a health issue more thoroughly, providing them with the tools necessary to challenge or change existing power structures within their own communities. advocacy is often associated with risk communication, the process of explaining natural disasters, human-made hazards, and behavioral practices to the public in a way they can understand. theorists such as don nutbeam propose a need for advocacy and say that health literacy, or people's ability to access and make decisions with health information, is an important part of empowerment. nick pidgeon and baruch fischhoff say that communicating complex medical or health information to the public is difficult because past scientists failed to base their communication on solid principles and evidence. based on these past failures, pidgeon and fischhoff argue for a simpler and trustworthier model of science communication. in response to this issue, jeffrey t. grabill and w. michele simmons propose that technical communicators can provide advocacy because they have both good writing skills and an ability to understand and convey information to patients. rhetorical concepts rhetoric, like any field of study, is