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Rhetorical Approaches to Health and Medicine
Summary and Keywords
Rhetoric, commonly understood as the art, practice, and analysis of persuasion, has longstanding connections to medicine and health. Rhetorical scholars, or rhetoricians, have increasingly applied rhetorical theories, concepts, and methods to the texts, contexts, discourses, practices, materials, and digital and visual artifacts related to health and medicine. As an emerging interdisciplinary subfield, the rhetoric of health and medicine seeks to uncover how symbolic patterns shape thought and action in health and medical texts, discourses, settings, and materials.
In practice, rhetoricians who study health and medicine draw from the standard modes of rhetorical analysis, such as rhetorical criticism and rhetorical historiography, as well as from social science methods—including participant observation, interviewing, content analysis, and visual mapping—in order to deepen understanding of how language functions across health and medical objects, issues, and discussions. The objects of analysis for rhetorical studies of health and medicine span medical research, education, and clinical practice from laboratory notes to provider–patient interaction; health policymaking and practice from draft policies through standards of care; public health texts and artifacts; consumer health practices and patient advocacy on- and offline; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health information; popular entertainments and medical dramas; and alternative and complementary medicine. Despite its methodological breadth, rhetorical approaches to science and medicine consistently involve the systematic examination and production of symbolic exchanges occurring across interactional, institutional, and public contexts to determine how individuals and groups create knowledge, meanings, identities, understandings, and courses of action about health and illness.
Keywords: communication, health care, health, medicine, persuasion, public health, rhetoric, rhetorical analysis, rhetorical criticism, rhetorical theory, health communication
Rhetoric, conceived narrowly as civic oratory and broadly as any symbol use, has long been regarded as a constitutive force in communal life. People use language to persuade others to strengthen or modify their actions or beliefs and to build a sense of identity and belonging. The ancient Greeks, widely credited with developing the first systematic instruction in rhetoric during the 5th century bce, advanced a system for producing persuasive speech that permeated the Greco-Roman empire, although evidence of the robust speaking traditions of other ancient cultures appears across the extant texts of China, Egypt, India, Mesopotamia, and beyond (Kennedy, 1997). While the definitions of rhetoric have morphed over the centuries as its applications have expanded, the term rhetoric historically has emphasized the relationships among language and action, speech and persuasion, and symbols and public life; the term refers most basically to the art, practice, and analysis of persuasion.
The specific connections between rhetoric and medicine have been noted for centuries, as seen in ancient medical papyri that posited close connections between speech and healing. Mesopotamian medical fragments dating to 1400 bce discussed the importance of incantations and healing texts (Biggs, 1995), while Gorgias's Encomium of Helen likened the effects of speech to a drug in the 5th century bce (Sprague, 2001). The Hippocratic corpus includes works that explicitly advise healers on rhetorical matters such as the art of prognosis, as seen in this passage from Decorum: "by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of," the healer "will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to intrust themselves to such a physician" (Porter, 1999, p. 61). Classical Greek rhetoric and medicine thus mutually influenced one other. Ancient Greek philosophers employed metaphors of healing and drew on medicine to recast rhetoric as a true art, while Hippocratic physicians used rhetoric to forge a professional identity distinct from other healers of the time (Roth, 2008). The Hippocratic oath, named after the venerated physician of Kos, articulated an ethic of medical practice that forms the basis for contemporary professional oaths recited by health care providers at graduation ceremonies in many countries. As an example of epideictic or ceremonial rhetoric, the Hippocratic oath serves as a symbolic reminder of the well-worn connections between the fields of rhetoric and medicine (Keränen, 2001, pp. 55–68).
Given the rising prominence of health care around the globe and the fact that health and medicine are rife with persuasive products and practices, in the 21st century, rhetorical scholars, known as rhetoricians, from English, communication, and related disciplines have increasingly applied theories of persuasion—or "rhetorical theory"—to health and medical artifacts. Just as rhetorical theory in general tends to neglect rhetorical texts, figures, and precepts from after the fall of the Roman Empire through the early 20th century and from non-Western cultures and contexts, however, rhetorical scholarship analyzing health and medical rhetoric has also given scant attention to post–Roman Empire, Medieval, Renaissance, Enlightenment, and global medical and health rhetorics (Ding, 2014; Kennedy, 1997).1 Nonetheless, contemporary rhetoricians of health and medicine examine a wide swath of rhetorical artifacts from policy speeches about health care through the give and take of clinical encounters, from direct-to-consumer pharmaceutical advertisements through public wellness campaigns, and from online patient support groups through the notes recorded in patient charts, to name but a few examples. Each of these objects or processes depends on the strategic use of symbols, including words, visuals, and objects, to structure understanding and action about health and medical topics, practices, and issues. The rhetorics of health and medicine are therefore pervasive and consequential, appearing across interpersonal, institutional, public, mediated, and global contexts. Accordingly, rhetorical studies of health and medicine can not only increase understanding of how medicine and health care operate but also suggest improvements in contemporary medical and health care practice.
Some scholars who conduct rhetorically attuned analyses of health and medical rhetoric or who produce medical rhetoric have been trained in the rhetorical tradition and identify as rhetoric scholars, while others affiliate primarily with health communication, composition and technical writing, the health humanities, and/or allied areas. Because of the emergence of a growing community of scholars who self-identify as "rhetoricians of health and medicine" in the early 21st century, the bulk of this entry refers especially to the work of these rhetoricians of health and medicine who constitute the "emerging subfield" known as the rhetoric of health and medicine (Meloncon & Frost, 2015, pp. 7–14). However, it is important to note that not all scholars who conduct rhetorically attuned analysis of health and medical texts and objects or who produce health and medical discourses describe their scholarship and productive rhetoric using this designation. Other names that might encapsulate rhetorical approaches to health and medicine include "medical rhetoric," "discourse studies of health and medicine," "health rhetoric," "rhetorical health communication," and "rhetorics of health and healing."
Regardless of whether they self-identify as rhetoricians of health and medicine or not, scholars and practitioners of rhetoric are increasingly attending to the intertwined relationships among rhetoric, health, embodiment, and medicine. Considered as a whole, rhetorical approaches to health and medicine often involve close investigation of the language, structure, design, visual elements, reception, and delivery of health and medical texts, practices, and artifacts, which deepens understanding of past, current, and developing health and medical processes.
Key Assumptions
Rhetorical approaches to health and medicine are, by and large, committed to the investigation of health and medical discourses and practices using the lens of persuasion and the tools of humanities-based rhetorical analysis. The types of "problems" rhetoricians study are tied to language practices in the personal, professional, corporate, and/or public spheres, though a variety of research methodologies may be used to conduct rhetorical studies. Rhetoricians employ a variety of predominantly language-focused theories, concepts, and precepts to analyze the persuasive force of symbols across multiple contexts, genres, time periods, and cultures and to produce rhetoric that is attuned to audience, occasion, communicative purpose, and time. The objects of analysis for scholars who study the rhetoric of health and medicine are expansive and include, but are not limited to, texts and artifacts from medical research, education, and clinical practice; health policymaking and practice; public health discourses and practices; consumer health practices and patient advocacy; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health messages and infrastructure; and alternative and complementary medicine.
Despite their diverse foci, eclectic influences, and potential overlap with other areas of scholarly concern, rhetorical approaches to health and medicine do tend to share a number of distinctive assumptions:
1. Rhetorical approaches to health and medicine focus on persuasion or symbolic action in health and medical discourse—whether written, visual, digital, material, face-to-face—and in some cases embodied and technological practices, asking: "Who is persuading whom of what?," "What are the means of persuasion?," and "With what consequences?," (Derkatch & Segal, 2005, p. 139). In so doing, they investigate the relations among rhetor, audience, context, and messages that are produced in response to specific exigencies or that themselves craft specific exigencies in relation to health.
2. Rhetorical approaches to health and medicine treat health and medical discourse as situated action, social action, and constitutive action (Hauser, 2002, p. 8), focusing on how "specific symbolic patterns structure meaning and action in health and medical contexts and practices" (Keränen, 2012, p. 37). This orientation of rhetorical study attunes scholars to the sociocultural functions, material contexts, and epistemological power of the language use, as rhetorical scholars also emphasize the relational, dynamic, and contingent nature of knowledge.
3. Rhetorical approaches to health and medicine employ rhetorical theory and technē (i.e., productive arts)—often alongside or merged with other interpretive frameworks—to make sense of and, in some cases, suggest improvements to health and medical discourses. In so doing, they display sensitivity to context, audience, and kairos, or timing, and emphasize the pragmatic function of rhetorical study.
Most broadly, though, rhetorical approaches to health and medicine involve the systematic examination of symbolic exchanges occurring across interactional, institutional, mediated, and public contexts to determine how individuals and groups create meanings, identities, knowledge, understandings, and courses of action about health and illness.
While some rhetorical scholarship about health and medicine remains largely descriptive, analytic, and evaluative, other scholarship explicitly seeks to make conditions better. In this sense, the goals of rhetorical inquiry into health and medicine are often, although not always, phronetic, that is, aimed at improving current practice (Tracy, 2013). By deepening the understanding of persuasive appeals occurring in and around medicine and health care, people may create, interpret, analyze, and understand health messages more mindfully, while scholars and practitioners may use rhetorical research to suggest improvements in discourse and practice (Lingard, Reznick, DeVito, & Espin, 2002). Still other rhetoricians not only analyze, interpret, evaluate, and build theory but also use rhetorical theory to design, craft, and produce health and medical texts and discourses (Meloncon & Frost, 2015). Beyond differences in scholarly intention, what might be most distinctive about rhetoricians of health and medicine is their willingness to self-label their scholarly identities as such, a trend that has become more prevalent in recent years (Scott, Segal, & Keränen, 2013).
Scholarly Antecedents
Understanding and producing contemporary health and medical rhetoric requires collaboration across disciplines and perspectives. As Judy Segal (2008, p. 235) put it, "rhetorically interested work across disciplines" can be considered as related to or part of the rhetoric of health and medicine corpus regardless of formal disciplinary affiliation. Although some scholars studying and practicing the rhetoric of health and medicine have been trained in rhetorical history and theory, some work commonly referenced by scholars studying the rhetoric of medicine and health has been authored by scholars working in anthropology, sociology, psychology, philosophy, history, and cultural criticism (Segal, 2005a). Most directly, however, rhetorical scholarship in health and medicine has arisen out of or alongside several longer-established areas of inquiry in English and communication studies: the rhetoric of science and technology, scientific and technical communication, critical and interpretive health communication, science and technology studies, the medical and health humanities, and health care ethics and narrative medicine. A number of rhetoricians of health and medicine have positioned their work as an outgrowth of these areas in part because several represent more established areas of inquiry and in part because the objects of their scholarship (e.g., medical research, training, and practice and uses of technology and documentation therein) overlap with major objects of investigation in these areas.
The Rhetoric of Science and Technology
The rhetoric of science and technology, itself an outgrowth of rhetoric studies more broadly and the rhetoric of inquiry more particularly, was influenced by Kuhn's (1962) notion of scientific paradigms, Toulmin's (1972) concept of argument fields, and Latour and Woolgar's (1979) studies of laboratory life. Scholarship in the rhetoric of science analyzes patterns of argument across scientific subfields with a focus on rhetorical invention, the process of discovering arguments and rhetorical appeals; and genre, the substantive, structural, and stylistic requirements of scientific and technical writing formats, including the journal article or the case report. One essay that anticipated some of the themes of later rhetoric of health and medicine scholarship is Lyne's 1990 "Bio-rhetorics: Moralizing the Life Sciences," which tracks the uses and implications of rhetoric about "selfish genes." In that particular essay, Lyne shows how discourses about biology mesh with political, moral, and social life, thus borrowing discourse strategies from one domain and bringing them into another. While early works from the 1970s through the 1990s drew from classical rhetorical concepts, rhetoric of science and technology scholars increasingly supplement classical rhetorical theories with transdisciplinary explanatory frameworks in their investigations of biomedical, scientific, and technological rhetorical appeals. For instance, Graham (2015) draws from both traditional rhetorical concepts and new materialism in his analysis of the politics of pain rhetoric, while Kinsella (2005) borrows from philosopher Foucault and organizational theory to explain contemporary institutional science.
Technical and Scientific Communication
A number of rhetoricians studying health and medicine have positioned their research at least partly in technical and scientific communication. Embedded in English studies or situated in stand-alone programs, this area was first established in the 1970s and '80s around the same time the rhetoric of science and technology was growing in communication studies. Scholars positioning their work under this umbrella have examined, among other things, generic conventions and writing practices, medical documentation and other types of user communication, science popularizations, and scientific or health risk communication. Seigel (2013), for example, situates her rhetorical study of pregnancy partly in technical communication studies, largely through her focus on the formation, design, and responses to prenatal care user documentation, while Ding (2014) positions her study of transcultural communication about severe acute respiratory syndrome (SARS) within professional and technical risk communication.
Critical and Interpretive Health Communication
Scholars in rhetoric and health communication have increasingly noted the connections between critical and interpretive health communication and rhetorical approaches to understanding science and medicine. Although the field of health communication, which arose in the late 1960s, has historically been dominated by post-positivist science, critical and interpretive approaches have existed for decades. For instance, Zoller and Kline's (2008) Communication Yearbook review of the theoretical contributions of critical and interpretive health communication included citations to a number of rhetorical studies of health and medicine. Additionally, Landau's (2015) edited forum in Communication Quarterly investigates the connections and tensions between rhetorical and health communication. One essay in the same collection by Lynch and Zoller (2015) explicitly addresses this theme. Scholars working in critical and interpretive health communication share theoretical and methodological sensibilities with many rhetoricians of health and medicine, including assumptions about the constructed nature of health realities, the roles of power and hegemony in health communication, and the need to study advocacy and resistance. In fact, several scholars trained as rhetoricians commonly conduct research using qualitative social science methodologies or partner with other scholars to do so. Because critical/cultural and interpretive health communication scholars continue to be in dialogue with rhetoricians of health and medicine, further cross-subfield fertilization appears likely and, as Lynch and Zoller (2015) suggest, both subfields would benefit from incorporating each other's work.
Science and Technology Studies
The rhetoric of health and medicine has been influenced by other, more interdisciplinary areas outside of English and communication—most notably science, technology, and society (also known as science and technology studies). Established in the 1960s, the interdisciplinary area of science and technology studies (STS) is invested in "creating an integrative understanding of the origins, dynamics, and consequences of science and technology" (Hackett, Amsterdamska, Lynch, & Wajcman, 2008, p. 1). Research in this area tends to be "characterized by its engagement with various publics and decision makers, its influence on intellectual directions in cognate fields, its ambivalence about conceptual categories and dichotomies, and its attention to places, practices, and things" (Hackett et al., 2008, p. 1). A number of scholars in this area focus on persuasive discourse, or rhetoric, around medical science and biotechnology. Developed by Latour, Mol, and other STS scholars, actor network theory (ANT) and new materialist approaches have specifically influenced some rhetoricians studying health and medicine's discursive-material practices (Graham & Herndl, 2013).
The Medical Humanities
The medical humanities (or, more recently, health humanities) is another allied broad-based interdisciplinary area that explores meaning making and promotes compassionate and humane practice in medical education and health care using analytic and creative methods from literature and narrative, cultural studies, history, philosophy, and the visual and performing arts.2 As Kirklin explains, research in this area demonstrates how "application of the arts and humanities to medicine and health can illuminate thinking and understanding in relation to: illness; health and wellbeing; medical culture; the doctor/patient relationship, and the delivery of health care" (2004, p. 97). This area's emphasis on meaning making through narrative and other discourse aligns with rhetorical studies of health and medicine, and some rhetoricians (e.g., Judy Segal, Jenell Johnson) have merged rhetorical analysis with other humanities-based hermeneutic methods such as cultural critique and narrative analysis to study how persuasion animates health and medicine across time.
Health Care Ethics and Narrative Medicine
The 20th century witnessed rapid biotechnological advancement that challenged conventional understandings of the nature of human existence, the limits of modern medicine, the definitions of death, and the borders between different forms of life. In the latter half of the 20th century, bioethics, sometimes called "health care ethics" or "medical ethics," developed as a form of inquiry that bridged philosophical concerns with medical and legal ones, prompting analyses of the ethical questions that arise at the intersections of life, medicine, science, law, and philosophy. A recurring concern with preserving human dignity in the face of institutional medical care facilitated a growing focus on narrative medicine and the honoring of patient stories (Hartner, Japp, & Beck, 2005; Montgomery, 1991). Other bioethics texts offered a rhetorically informed approach, such as Tod Chambers's The Fiction of Bioethics (1999) and multiple treatises that focused on patient narratives. Scholarship at the intersections of narration and medicine—including rhetorical studies—has spawned the subfield known as narrative medicine, led by Rita Charon (2006) and others, which now includes degree programs and training in narrative medicine for health practitioners as well as social scientists. While medical practitioners increasingly delve into narration and rhetorical figures, rhetorical scholars have explored narrative as well. Yet they have also actively engaged with bioethics topics, analyzing texts pertaining to the end of life, human dignity, the U.S. President's Council on Bioethics, and medical research ethics, among others (Hyde & Herrick, 2013).
While 20th-century rhetoricians such as Kenneth Burke and Richard Weaver anticipated themes related to what would become the rhetoric of science (Foss, Foss, & Trapp, 2014), it was not until the early decades of the 21st century that the rhetoric of health and medicine became a distinct and identifiable subfield. Late 20th-century rhetorical scholarship claimed by what would later become known as the rhetoric of health and medicine examined the rhetorical dimensions of medical texts using standard rhetorical theories. For example, Martha Solomon's 1985 Western Journal of Communication essay used Kenneth Burke's pentad to examine the rhetoric of published medical articles from the U.S. Public Health Service's Tuskegee study, and Anderson's 1989 book Richard Selzer and the Rhetoric of Surgery deployed the classical concepts of invention, arrangement, and metaphor to examine how Selzer violated the generic expectations of medical writing and thus created vivid, artistic, and literary depictions of surgery. In 1990, Sharf argued that provider–patient communication constituted "interpersonal rhetoric" and urged a narrative approach to its study, which provided justification for rhetorical studies of provider-patient relationships.
Due in part to this wave of scholarship published in and after the 1990s, the rhetoric of health and medicine emerged as a discernable interdisciplinary area of study anchored by rhetoricians in communication studies, English, writing, and technical/professional communication programs. One of the first published monographs to announce this new area was Judy Segal's Health and the Rhetoric of Medicine (2005a). Along with a number of bibliographies, including those by Segal in Technical Communication Quarterly (2005b) and Eberhard (2012) in Present Tense, a bevy of special issues of journals have charted the landscape of this subfield. Major journals that have published special issues in the area include:
• Technical Communication Quarterly ("Medical Rhetoric" and "Online Health Communication")
• Journal of Business and Technical Communication ("The Discourses of Medicine")
• Written Communication ("Writing and Medicine")
• Present Tense ("Medical, Gender, and Body Rhetorics")
• Project on Rhetoric of Inquiry Journal ("Inventing the Future: The Rhetorics of Science, Technology, and Medicine")
• Journal of Medical Humanities ("Rhetoric and Biomedicine" and "Medicine, Health, and Publics")
• Communication Design Quarterly ("Rhetorics of Health and Medicine")
• Communication Quarterly ("Forum on the Rhetoric of Health and Healing")3
Other journals that feature work by rhetoricians of health and medicine include Rhetoric Society Quarterly, Literature and Medicine, Quarterly Journal of Speech, Western Journal of Communication, Science, Technology, & Human Values, and Health Communication.
Meloncon and Frost (2015) provide an abbreviated publication history, reviewing the first major round of monographs and edited collection published since the 2000s along with a large and growing number of journal articles—including those about the field's methods and trajectory. The area's rising prominence has also been documented by entries in the SAGE Handbook of Rhetorical Studies (Segal, 2008), the Encyclopedia of Science and Technology Communication (Keränen, 2010), the Encyclopedia of Health Communication (Keränen, 2014b), and (through this discussion) the Oxford Research Encyclopedia of Communication. And in late 2016, Reed published her article entitled "Building on Bibliography: Toward Useful Categorization of Research in Rhetorics of Health and Medicine," which offers a descriptive assessment of 54 rhetoric of health and medicine articles published between 2000 and 2014 specifically.
The burgeoning scholarship in the rhetoric of health and medicine has also been supported by a number of professional organizations. Several Association for the Rhetoric of Science and Technology (ARST) pre-conferences have focused on the rhetoric of health and medicine, dating back to the late 1990s, and in 2015, the organization incorporated "Medicine" into its formal title to become ARSTM. Starting in 2007, at least seven Rhetoric Society of America (RSA) Summer Institute seminars and workshops have focused on this area, and two of these have generated bibliographies. In 2016, the Conference on College Composition and Communication (CCCC) designated a Medical Rhetoric standing group, and a number of panels and presentations on the rhetoric of health and medicine now regularly appear at conferences of the National Communication Association (NCA), RSA, CCCC, Association of Teachers of Technical Writing (ATTW), and at other scholarly meetings.
In addition to finding an intellectual home in these and other venues, rhetoricians of health and medicine have self-organized into a scholarly community that traverses disciplinary boundaries. Led by Lisa Meloncon from the University of Cincinnati, scholars from English, communication, composition, and other fields have formed the biennial Discourses of Health and Medicine Symposium and maintain an associated Medical Rhetoric website. These and other scholars have also formed the "Flux" Facebook group and Medical Rhetoric blogs and websites.
As the rhetoric of health and medicine has coalesced into a discernable area, more scholars have explicitly identified their work as belonging to this subfield. Moreover, it is important to note that rhetoricians of health and medicine have tended to examine a wider range of cultural practices and employ a wider range of methodologies than traditional rhetorical scholars. Increasingly, rhetoricians of health and medicine examine the persuasive dimensions of both discourses and material practices, treating entities such as embodied subjects, technologies, viruses and diseases, treatments, and institutions as persuasive agents.
Key Methodologies
Rhetorical studies of health and medicine initially focused primarily on medical texts and related communications but have since expanded to include a broader array of health practices and publics, including those around public health, consumer health, everyday personal health management, and health advocacy and activism. Nosology, or the practice of naming in medicine, alongside definition and medicalization are key rhetorical processes involved in creating health and medical knowledge and identities, as well as in coordinating care, which lends some thematic consistency to the rhetoric of health and medicine corpus. Many, though not all, rhetoricians of health and medicine adopt a discourse-focused, social constructivist ontology in which language and temporally situated cultural mores are seen as shaping understandings of particular health conditions, embodied ways of being, health identities, and medical practices. Many are also concerned with the power dynamics of health care and medical communication.
Given the wide array of potential entry points, scholarship in this area has expanded its methodologies from rhetorical criticism and analysis to a variety of mixed or hybrid approaches that include social scientific methods of data collection and analysis, from interviews and quasi-ethnographies to discourse and qualitative analysis. Methodologically, the rhetoric of health and medicine exists at a point of intersection between empirical, interpretivist, and critical research paradigms. As Melocon and Frost (2015, p. 8) argue: "Unlike the debates happening between medical humanities and health humanities about boundaries and territories … the rhetorics of health and medicine are comfortable navigating a myriad of sites and locations and texts," "working with a host of actors within health care," and employing a variety of rhetorically-grounded methodologies. Indeed, rhetoricians who study health and medicine bring a diverse set of tools, methods, and ideologies to their analyses.
Rhetorical Historiography
Rhetorical histories of health and medicine document how specific discourses, their meanings, and their effects have changed over time by examining historical records or traces of those discourses. In some cases, rhetorical historians have focused on discourses specific to medicine. Wells's Out of the Dead House (2001), for instance, chronicles the contributions of 19th-century women physicians to medical discourse as the modern medical profession was developing. Other histories examine changing medical or health practices by putting them in conversation with patient narratives, public responses, and other related discourses; good examples of this type of rhetorical history include Condit's The Meanings of the Gene (1999) and Koerber's history of cultural knowledge-making around breastfeeding in Breast or Bottle? (2013). Still other histories cast their nets even wider, untangling a broad array of discourses and meanings both over time and across cultural areas. For example, Stormer (2002) explains how 19th-century American medical writings on abortion worked with other discourses and their rhetorical-ideological frameworks to form cultural memory about nation and race. In another example, Johnson's history of the lobotomy in America untangles a "thick knot of meanings emerging from a snarl of cultural contexts" and public discourses, from techno-medical arguments to horror films and science fiction (2014, p. 13). To borrow Johnson's words, a rhetorical historian of science and medicine might "theorize why a marvel [or any medical practice] emerged at a particular place and time; hunt for the origins of its polysemic tendrils in cultural narratives, social structures, and political events; and track how a marvel is transformed when transmitted, repeated, and bounced 'across bodies of discourse and across bodies' " (2014, p. 13).
Rhetorical Analysis and Criticism
The term rhetorical analysis refers broadly to the application of rhetorical theories and principles in the study of symbolic materials. It references using the materials of rhetorical study to enhance understanding of symbolic action. While rhetorical analysis can encompass both social scientific and humanities-based approaches to understanding symbolic action, the term rhetorical criticism generally refers more specifically to a humanities-based critical practice of close textual reading in which rhetoricians describe, analyze, interpret, and evaluate the persuasive force of messages in and across health and medical texts. Examples include Segal's (2005a) reading of (auto)biographical narratives about illness as epideictic rhetoric and Reeves's (1990) analysis of rhetorical moves to establish and explain a new syndrome in three early medical reports on AIDS. For the study of health and medicine, it is important to note that the term text can refer to any artifact or form of symbolic communication (including digital and embodied) that attempts to persuade. Further, rhetorical critics or analysts examine persuasion in and across a range of levels of text and language, sometimes in combination, from linguist units, genres, events, and conversations to intertexts, corpuses, and historical-cultural discourses. Often indistinguishable from rhetorical criticism, rhetorical analysis similarly examines texts and discourses, though some versions do not rely only on interpreting meanings through close textual analysis, instead employing a broader array of analytic approaches using rhetorical theory to critically examine the persuasive features and functions, circulation and transformation, and effects of discourses and, in some cases, extra-discursive actors.
Beyond traditional readings that focus on the persuasive elements of health or medical texts and the functions of such texts in discrete rhetorical events or situations, however, rhetorical criticism and analysis of health and medicine tends to examine texts across events and in relation to larger cultural discourses or what Condit (1999) calls "rhetorical formations" in her study of themes, stories, and values about genetics in twentieth-century popular media. As Condit explains, "To study rhetoric is not to seek for a single unifying principle. It is to seek for the important discursive units that recur in discussions of an era and to explore their interactions" (1999, p. 253). Some examples of such analyses track the circulation, uptake, and responses of specific health or medical texts and information across contexts, including such non-medical contexts as online activity, personal decision-making, and community interactions. Others, like Condit's, take a broader approach in tracking the emergence and circulation of larger cultural discourses. Another example of the latter is Keränen's call for scrutiny of a "wide swath" of intersecting biosecurity discourses (2011, p. 238). In one sense, biocriticism would "seek to uncover, analyze, and question the evolving symbolic and material rhetorics of germs, disease, and contagion and place them in broader conversation with politics, security, and culture" (Keränen, 2011, p. 236). In a broader and more Foucauldian sense, biocriticism would "address the range of discursive formations and material practices that comprise 'life' by investigating 'vitality,' the politics, possibilities, and perils of 'making live' " (Keränen, 2011, p. 238).
Below we briefly review several more specific forms of rhetorical or rhetorically oriented discourse analysis employed by scholars in the subfield. Although studies categorized under each type primarily analyze persuasive language use from a distinct level and dimension of discourse (e.g., cultural discourses, discursive events, linguistic units), they also tend to relate these to other levels and dimensions, as in discourse analyses that relate patient–provider interactions to larger power dynamics or clinical conversational genres or in discourse or genre analyses that examine linguistic patterns or historical changes in discourse. Consider, for example, Berkenkotter's (2009) rhetorical study of historical changes in the genre of the psychiatric patient case history, particularly its use of patient narrative—a study that combines elements of historical, genre, and narrative analysis. Indeed, this multi-scalar, multi-dimensional approach to analyzing language use is a common feature of the rhetoric of health and medicine.
All of the types of analysis mentioned below draw on theories of persuasion (from rhetoric and sometimes also from other areas) to help interpret and explain how language is functioning, though some studies employ more grounded or open-ended analyses before determining which theories to use.
Rhetorical-Cultural Analysis
Some scholars have merged rhetorical and cultural-critical analytic approaches. For example, Scott's study (2003) of HIV testing examines a range of cultural discourses but also material actors (e.g., embodied responses, technologies, institutions, and the virus itself) that shape testing practices in order to identify ways to improve them. His approach of rhetorical-cultural analysis involves three methodological moves: uncovering the cultural and historical conditions that make a health practice or technology possible, mapping dynamic networks and power relations of actors involved, and ethically critiquing and attempting to improve harmful effects. In The Politics of Pain Medicine, Graham (2015) develops what he calls "rhetorical-ontological inquiry," which merges rhetorical and multiple ontologies analyses to examine the actor-networks (including "brute matter" and other nonhuman actors) that shape health and medical science and policymaking, in his case around pain science. In yet another example, Ding (2014, p. 25) employs what she calls a "critical contextualized methodology" to track and rhetorically analyze the transcultural flows and transformations of risk discourses around SARS.
Discourse Analysis
Although not unrelated to and sometimes merged with rhetorical analysis, discourse analyses contextually (and often qualitatively and/or quantitatively) analyze patterns in the features or rhetorical functions of conversations and other discursive events or interactions (Barton, 2004). Typically this work pays close attention to the power dynamics among discursive agents. For example, Popham and Graham (2008) analyze how the formats of electronic mental health chart records impede evaluative communication between providers and caregivers, Ravotas and Berkenkotter (1998) analyze how psychotherapists include reported speech in their written assessments to "recontextualize the client's lifeworld perspective," and Owens (2015) analyzes the discursive influences on, linguistic-rhetorical appeals of, and interactions around women's birth plans.
Genre Analysis
Some scholars have drawn on genre theory to rhetorically and qualitatively examine how specific types of health care texts—including clinical protocols, case presentations and deliberations, referral letters, medical records, and end-of-life interviews—function as typified forms of rhetorical and social action (Schryer & Spoel, 2005, p. 251). Schryer, McDougall, Tait, and Lingard (2012, p. 113), for example, qualitatively analyze end-of-life "dignity" interview transcripts to examine how patients rhetorically negotiate eulogistic genre conventions "to create discursive order out of the events of their lives." In their analysis of how medical students establish professional identity through case presentations, Schryer and Spoel (2005, p. 249) explain how rhetorical genre theory can help conceptualize social context, professional identity formation, and genres as functioning but hierarchical networks in health care contexts. Teston (2009) offers an example of a hybrid rhetorical-qualitative study of genred guidelines in cancer care deliberations, combining Toulminian analysis with a grounded process of analyzing the guidelines' uses in the contexts of patient case presentations.
Linguistic Analysis
Other studies use rhetorical and qualitative analysis to identify and interpret patterns in the linguistic features and structures of oral, print, and/or digital texts. Barton (2000), for example, used conversation analysis to examine the linguistic features of referral interactions between families and providers, comparing those of families who display expertise and compliance with those who do not. Aldridge and Barton (2007) offered a similarly structured conversational analysis in a case comparing linguistic expressions of negative outcomes in end-of-life discussions that shifted from treatment to comfort care with those discussions that did not. In another example, Kelly closely examines the standardization of linguistic features in the DSM-5 draft diagnostic criteria and public comments about it, explaining how they recontextualize the spoken discourse of patients "as the product of scientific inquiry and the organization of psychiatric knowledge" (2014, p. 171).
Participatory Rhetorical Studies
In some cases overlapping with the categories above, other rhetorical studies of health and medicine involve directly engaging people as well as texts, often through interviews (including discourse-based interviews) and/or participant observations as well as community research collaborations. In a few such studies, scholars have interviewed and/or otherwise engaged health providers or researchers to better understand their communicative intensions and processes. Lay's The Rhetoric of Midwifery (2000), for example, draws from her observations of medical board hearings and guild meetings, interviews with midwives, and participation on a listserv for midwives to inform her study of Minnesota midwives' rhetorical-political efforts to gain professional standing and jurisdiction as medical experts. Fountain's Rhetoric in the Flesh: Trained Vision, Technical Expertise, and the Gross Anatomy Lab (2014) used ethnographic methods to track how the language and practices of the cadaver lab transform medical students into professionals and paid particular attention to how people interacted with bodies during dissection.
Other such studies have engaged patients or health consumers/users in order to better understand how they understand, evaluate, and act on health and medical messages. Spoel, Harris, and Henwood (2012), for instance, interviewed older adults about the relative roles and responsibilities of the government and individual citizens in facilitating "healthy living," revealing these participants' "vernacular critiques" of government-sponsored messages and efforts. Lawrence, Hausman, and Dannenberg (2014) collected and rhetorically analyzed data from observations, a survey, and follow-up interviews of parents in a local community who were asked to have their children vaccinated against influenza; such participatory data collection enabled them to better understand contextualized reasons for vaccine skepticism and to propose a more nuanced approach to communicating with local publics about such skepticism. Bellwoar (2012) conducted a series of discourse-based interviews with a patient about how she used and repurposed prenatal medical texts in concert with other textual, visual, oral, and embodied sources of information in her everyday life. Bellwoar proposes that studying such "chains of reception" in and across their cultural contexts, in her case using cultural-historical activity theory (CHAT), can help us better understand how literate activity shapes people's understanding of and decision-making around health and medical messages (2012, p. 328). To inform his analysis of rhetorical-embodied acts of resistance to the FDA ban on blood donation from men who have sex with men, Bennett (2009) conducted extensive interviews with gay men who either "passed" and donated or protested the ban.
Still other rhetoricians of health and medicine collaborate with or as part of health-related communities or organizations to conduct community-based participatory research (CBPR), often analyzing health campaigns or practices. For instance, Meloncon worked with an interdisciplinary team to develop and test an environmental health communication campaign in the Appalachians (Haynes et al., 2011). In another example, Bloom (2014, p. 268) co-developed and studied language interpretation strategies—which move "across, between, and among different languages, dialects, and nonverbal gestures"—by participants in temporary medical and dental clinics in the Dominican Republic. In such cases rhetoricians often lend their communication sensibilities and theories to practitioners in collaborative working groups, while still another group, often aligned with technical writing and professional communication, helps medical and health practitioners to improve their oral and written communications.
Key Concepts
Drawing from a rich, long history of theorizing about persuasion in relation to medicine and the public good, rhetoric offers a variety of words and concepts used to identify and explain the connections between language and actions as they relate to health behaviors, norms, and values. To name only a few, this toolbox includes ancient concepts such as definition, ethos, kairos, phronesis, stasis, and topoi and more contemporary foci that include narrative, publics, risk, agency, and professionalism. These concepts appear across a variety of rhetorical work focused on health and medicine because of their ability to help illuminate dimensions of artifacts that influence audiences to think, feel, and act in prescribed (and sometimes predictable) ways. Next, we highlight seven of these concepts as examples of how rhetorical theory regularly inflects contemporary critical practices and vice versa.
Given the contingencies of health and illness and the privileging of patient autonomy in Western health discourses, it is not surprising that the question of agency—the power to effect change—motivates a number of rhetorical studies of health and medicine. Some rhetoricians, for example, have focused on identifying and understanding rhetorical enactments of agency by patients or health citizens (Bennett, 2009). Stone's (1997) early contribution to the corpus demonstrated how medical rhetorics of adherence and compliance limit patient agency over abilities to personally manage diabetes. Koerber's (2013 qualitative-rhetorical study of breastfeeding advocates and their clients also identifies the agency of patients resisting stigmatizing medical norms; she argues that some of these women's discursive-embodied acts of resistance disrupt what seems possible within the framework of regulatory medical rhetoric. Like Koerber, Owens (2015) arrives at a nuanced understanding of patient agency through her analysis of women's birth plans and their enactments. Birthing women experience what Owens (2009) calls "rhetorical disability" that can only partly be confronted by their birth plans, particularly when providers do not fully heed these plans. Other rhetoricians have proposed more distributed notions of agency. In her analysis of an end-of-life code status preferences worksheet, Keränen (2007) concludes that interlocking institutional, technical, and vernacular end-of-life rhetorics constrains patient and family agency and calls for supplementing notions of patient autonomy with collaborative models of decision making agency.
The idea that perceptions of character are persuasive mechanisms is ancient, with evidence of the concept dating back to the pre-Socratics. Early notions of ethos position it as a dwelling place, a shared set of common habits and orientations shared by people or animals that resided together. Elaborating on this sense of ethos, Hyde explained "ethos antedates specific ethical prescriptions and prohibitions and marks out a region of knowing and working together in advance of strategies to achieve consensus in the public forum" (2004, p. vii). In Aristotle's model of ethos, which informed much modernist work in rhetorical theory, ethos comprises one of three artistic proofs (entechnic pisteis) that, along with pathos and logos, can be used to form persuasive appeals. Whereas logos involves the strategic use of reason, and pathos, the emotions, ethos appeals to the character of the speaker (Aristotle, 2007). Aristotle further divided ethos into three components: phronesis (practical wisdom), arête (virtue), and eunoia (goodwill). Keränen (2010b) offers a three-part model for analyzing ethos in contemporary biomedical controversies that cross public and technical realms. She distinguishes ethos, understood in its pre-Aristotelean sense as widely shared communal norms, from persona, the stereotypical role types with which one becomes associated, and voice, an individual's linguistic stamp on language. Further studies of ethos have examined patient and citizen constructions of ethos. For instance, in her field-based study of an outpatient community mental health facility, Molloy (2015) noted several types of everyday rhetorical performances through which participants create what she calls a "recuperative ethos," wherein they attempt to reclaim a sense of dignity and agency amidst identity-threatening stigma. Similarly, in Autism and Gender, Jack (2014) describes a process whereby mothers of children with autism renarrativized their roles in relation to the condition to make use of "a rhetoric of recovery" that insisted autistic children could be saved. Advancing a narrative about the "maternal heroine" specifically "[set] out an argument for maternal expertise that would be taken up by many women in later years, it [created] a new character with greater ethos that mothers could use" to engage with health and medical institutions moving forward (Jack, 2014 p. 56). Whidden (2012) has also tracked maternal ethos in her rhetorical analyses of contemporary anti-vaccination arguments.
As a form of analogy that compares two unlikes, metaphors about health, medicine, and the body abound. More than mere linguistic ornamentation, metaphors comprise a way of knowing in that they orient thought and action through association. Battle and war metaphors for disease are ancient, recurring, and constitute a dominant trope in contemporary rhetoric about illness, viruses, and disease in the contemporary world. Susan Sontag's Illness as Metaphor and AIDS and Its Metaphors (2001) are canonical texts about how metaphors carry with them ascriptions of responsibility that can blame and stigmatize people who are ill. Operating squarely within the rhetorical tradition, Segal (1997) has examined five major metaphors found in contemporary health discourse: medicine as war, body as machine, diagnosis as health, medicine as business, and a person as genes, while Condit (1999) and her co-authors have examined lay metaphors about genetics and Jensen (2015) has investigated the metaphors of barren and sterile specifically. Emmons's Blue Words and Black Dogs (2010) tracks how different metaphors used commonly to talk about depression tend to portray the person with depression as an isolated and gendered figure even as some metaphors open up space for dialogue.
Narratives pervade the realm of health and medicine. Patients narrate their illness experiences; health care providers translate patient accounts into medical language and use stories to reach patients and families. Pharmaceutical advertisers, too, mobilize narratives to reach wider audiences. The study of personal narratives of illness, also known as illness narratives or pathographies, took off in the 1990s with the publication of several high-profile books, authored by non-rhetoric scholars, which reflected on the importance of narrative in medical encounters, including Arthur Frank's the Wounded Storyteller (1995) and Arthur Kleinman's Illness Narratives (1988). In his personal account of illness, Frank described the realm of health and medicine wherein patients narrate their use of stories to describe illness to others. Frank outlined three basic genres or types of narratives: quest, restitution, and chaos narratives. Most notably, what Frank's narrative typology demonstrated was that illness is not just a topic for a story—illness is a rhetorical call for story. In other words, it is through storytelling that individuals come to redefine themselves according to the needs of a new health identity.
A number of rhetoricians have demonstrated the complexity and consequences of narration, particularly in relation to patient subjectivity, in health settings and broader cultural discourses. For example, Segal (2012) has discussed how generic conventions of breast cancer narratives regulate which experiences count as attention-worthy, Malkowski (2013) examined strategic incorporations of narrative by a pharmaceutical company used to promote a product via storytelling, and Arduser (2014) analyzed the oral histories of the diabetes projects in a way that illustrates the value of combining structural and performance-based understandings of narrative. Distinctly, however, most rhetoricians of health and medicine take up the cultural work and implications of dominant and resistant narratives.
Publics and Counterpublics
From its beginnings, rhetoric and ideas about publics and public participation have been intimately linked. Since classical times, however, conceptions of public-ness, publicity, and public engagement have shifted in response to social and political circumstance (Keränen, 2014a). As Segal notes, "rhetoric is useful as a means of studying health and medicine as a public discourse," (2005, p. 154) where the term public draws attention to qualities of the modern health care experience that must be considered for rhetoricians of medicine to thoroughly investigate the ethical, linguistic, and political dimensions of modern medicine. What the rhetorical perspective consistently offers to the study of publics in relation to health and medicine is sensitivity to the persuasive mechanisms at work in public discourse, a vocabulary for assessing the influence and dynamics of "medical or health publics," and a platform to track the consequences of representing people and institutions as "invested publics." Applying Perelman's theories of argumentation to an Institute of Medicine report, for example, Hamilton (2002) has demonstrated how discursive attention to social, economic, behavioral, and political dimensions of health effectively expand conventional boundaries for public health policy and practice. Rhetorical sensitivity for understanding publics has been culled, shaped, and refined across intellectual histories to better understand how and why collective action occurs (Keränen, 2013).
Counterpublics also provide analytic grounding for rhetorical scholars. Nancy Fraser defined counterpublics as "parallel discursive arenas where members of subordinated social groups invent and circulate counterdiscourses to formulate oppositional interpretations of their identities, interests, and needs" (1992, p. 123). Extending Fraser's original conception, Warner (2002) reinterpreted the concept of counterpublics to focus on the discursive presence of groups as they form and transform in direct response to political and social issues, leaving behind textual traces that provide rhetoricians multiple points of entry for examining controversial health practices and their stakeholders. For example, Pezzullo (2003) examines the San Francisco-based Toxic Links Coalition's (TLC) annual "Stop Cancer Where it Starts" tour in contention with official positions on breast cancer. The study, in part, used an oppositional framework to organize and describe action and understand competing groups as different publics. Similarly advancing an understanding of resistance in relation to the status quo, in her study of a controversial group called "bug chasers," Malkowski (2014) tracks scholarly characterizations of a potentially mythical counterpublic. She concludes that talk about counterpublics often works to contain controversial health behaviors (in this case, e.g., sex practices presumably aimed at HIV transmission) rather than learn from them, and she suggests that health institutions, in doing so, miss valuable opportunities to discover counterarguments that could enhance public health philosophies and practices overall.
Whereas risk is often understood in realist terms as a probability or likelihood of an event occurring, rhetorical scholars conceive of risk as a malleable social construct that evolves over time. As such, risks are culturally and socially defined. Arduser, Dura, and Malkowski work from the ideas of Ulrich Beck and others (e.g., Dean, 1999) who theorize risks as cultural perceptions and rhetorical constructions to highlight "the pressing need for rhetoricians of science and medicine to address complexity, uncertainty, and ambiguity as they relate to contemporary risk responses" (Arduser, Dura, & Malkowski, 2015, p. 7). In one rhetorical study of risk, Scott argues that the U.S. government's and pharmaceutical industry's risk management responses (e.g., public health containment, reputation management) to the 2001 anthrax attacks were indeterminate in the face of rapidly shifting and proliferating risks and their unintended consequences that left all parties vulnerable. Other studies of risk, such as Scott's Risky Rhetoric (2003) and Bennett's Banning Queer Blood (2009), focus on how risks have been mapped onto populations and bodies marked as "risky," "at risk," or "risk free." Ding's Rhetoric of a Global Epidemic (2014) examines the transcultural communication of risk, including identity-based risk, around SARS by health officials and groups of citizens within and across the United States, China, and Canada. Still other rhetoricians have studied public health risk messages and citizens' responses to them in more locally grounded ways, as in Lawrence et al.'s (2014) engagement of vaccine skeptics and refusers in a specific rural community.
Considered together, these seven terms represent merely the beginning of the rhetorical concepts rhetoricians of health and medicine bring to bear on their objects of analysis. Other important terms include but are not limited to invention, arrangement, audience, prepon, decorum, network, epideixsis, kairos, genre, definition, context, analogy, and paradox, metonomy, synechdoche, public and moral reasoning, personification, and rhetorical situation.
Conclusion and Future Directions
Given that the rhetoric of health and medicine is an emerging and expanding transdisciplinary subfield, the topical and methodological scope of its scholarship will continue to evolve. Future rhetorical studies of health and medicine will likely continue to employ additional forms of mixed methodologies involving empirical data collection and qualitative analysis in order to account for various types of material factors—from bodies, diseases, and technologies to institutions, political access, and economic conditions—that co-shape health-related persuasion. Although a number of the subfield's studies have included historical analysis, a need for more sustained histories exists, including those that use rhetorical histories to inform contemporary practices. From rhetorical analyses and histories to mixed-method methodologies, rhetorical studies of health and medicine should continue to do important theory-building work, which can take a number of forms including but not limited to extending a theoretical concept by fleshing out its contextual nuances, merging explanatory concepts from different theoretical traditions, testing observations shaped by existing concepts, and addressing interpretative gaps in an existing theoretical framework. For example, studies that track the circulation, uptake, and remixing of health rhetorics, both on the everyday lifeworld and transnational scales, will enable continued theory building around rhetorical movement and adaptation (Scott et al., 2013).
The subfield's theory building work, like its other contributions, need not lead to direct applications to health and medical practices, though some of it likely will. To borrow a distinction of Segal's (2005), our scholarship can also offer useful knowledge, or knowledge that can help us more critically interpret and explain, indirectly inform, and build rhetorical resources for studying and addressing health and medical issues. Or, as Meloncon and Frost put it:
There is also a capaciousness to rhetoric that affords scholars lots of room to maneuver and find their own voice, while still feeling as though they belong to a specific community. A variety of approaches can find there [sic] way under the tent of rhetoric of health and medicine including disability studies, feminist approaches, visual communication and rhetoric, theoretical approaches from science and technology studies, quantitative approaches, as well as textual and qualitative approaches from scholars in sociology, anthropology, literature, history, and art. Moreover, the capaciousness of rhetoric and the long standing belief that it is a useful tool in both creating and critiquing discourse helps us to mark the territory of the field.
(2015, p. 9)
Extending Meloncon and Frost's projections for the capaciousness of rhetorical studies of health and medicine, topical areas of growth will likely include processes of medicalization, visual and multimodal medical and health communication, the roles of new technologies (e.g., electronic health records) on patient-provider relationships, emerging forms of online health advocacy, transnational public health and activist discourses, patients' or consumers' everyday health management practices, virality, affective dimensions of health rhetorics, and the use of big data in medical or health communication.
Emergent lines of inquiry suggest several key questions that rhetorical studies of health and medicine will likely take up or extend. In addition to questions about how rhetoric moves along multiple scales, these include questions about the rhetorical agency and empowerment of patients and other health stakeholders. A number of studies have examined the extent to and mechanisms by which various stakeholders can rhetorically and provisionally shape the power dynamics and conditions of health care. Most such studies have focused on more distributed, networked forms of agency that include technologies, microbes, institutional protocols, economic conditions, and other nonhuman actors and forces. Another related line of questioning that the subfield should continue to explore concerns the relationships among discursive and embodied forms of knowledge, including language acts and larger rhetorical formations but also lived experience and affective embodied intuitions and responses. Some such studies could also compare the discursive and material qualities of rhetorical publics and counterpublics. A growing body of scholarship should address how the discourses around and uptake of new technologies, including wearable and other direct-to-consumer ones, are reshaping notions of self and other, layperson and health expert. This lattermost effort has begun, at least in part, with the publication of one recent Rhetoric Society Quarterly special issue edited by Gouge and Jones (2016) that hosts discussion of wearable devices and their effects on embodiment and rhetorics of the body. Finally, rhetorical studies of health and medicine should continue to including studies that explore new forms of biopower, including self-enlisting and self-regulating ones, and emerging conceptions and instantiations of health citizenship, particularly in relation to health-related risk management. As health care increases globally, the importance of the study and practice of the rhetoric of health and medicine can only be expected to increase.
Primary Sources
The preserved historical record of medicine and health is rife with primary documents that supply source material for future studies of medical rhetoric.
Historical Documents and Records
The Alan Mason Chesney Medical Archives: Part of the Johns Hopkins Medical Institutions, these archives contain biographical, institutional, material, photographic, and personal papers related to Johns Hopkins's history as a medical institution, including the papers of medical luminaries, such as surgeon William Stewart Halsted's papers from 1890–1922.
The Archives of the U.S. National Library of Medicine: These archives contain a large number of documents and materials pertaining to the history of medicine, including 300 Persian, Turkish, and Arabic medical manuscripts from 1094 and more than 200 manuscripts that pre-date 1601. Most documents, books, and material objects date from the 1700s to the present. In addition, the Archives include the papers of the U.S. Surgeons General and major NIH-funded scientists.
The Otis Historical Archive: Part of the National Museum of Health and Medicine, this collection preserves manuscripts, institutional records, photographs, manuscript collections and other materials related to the museum and its holdings, with an emphasis on wartime medicine from the Civil War through more recent engagements in Iraq and Afghanistan. Particularly strong are collections related to medical illustration, tropical disease, reconstructive surgery and prosthetics, and battlefield surgery.
The Wellcome Library's Archives: The collections focused on the history of medicine specifically contain Europe's most extensive collection of more than 9,000 historical manuscripts and artifacts related to the history of medicine, which date from antiquity to the present.
The Health and Medical Care Archive: Part of the data archive of the Robert Wood Johnson Foundation, this collection is managed by the Interuniversity Consortium for Political and Social Research (ICPSR) at the University of Michigan and is a data repository that seeks to increase understanding of U.S. health care by sharing study data from Robert Wood Johnson Foundation–funded health care studies.
Primary Texts
Other primary texts are wide-ranging and ubiquitous and include, but are not limited to, the following:
Public health texts. Web pages of the U.S. Centers for Disease Control and Prevention, the World Health Organization, and other major health agencies—both governmental and nongovernmental—provide a plethora of primary documents regarding public health policy and practice.
Health journalism and popular media texts. From international wire stories through local health news reports and from PBS documentaries to blockbuster films, a wealth of primary cultural texts from journalism to entertainment media deserve scrutiny for how these texts structure meaning and action related to health and wellness.
Patient documentation and instructions, and heath consumer texts. Technical health communication documents from package inserts through patient after care instructions similarly serve as important sites for scholarship and rhetorical analysis. Documents, forms, and rhetorics of organizational origin are prominent here.
Interviews with and observations of patients and patient advocacy groups, as well as patient-generated pathographies, advocacy discourse, and online support groups. The discourses of patients, citizen health consumers, health advocacy groups, and online support groups provides a window into how health meanings are being actively renegotiated, creating new health identities and resistance strategies.
Further Reading
Condit, C. (1999). The meanings of the gene: Public debates about human heredity. Madison: University of Wisconsin Press.Find this resource:
Derkatch, C., & Segal, J. Z. (2005). Realms of rhetoric in health and medicine. University of Toronto Medical Journal, 83, 138–142.Find this resource:
Eberhard, J. M. (2012). An annotated bibliography of literature on the rhetoric of health and medicine. Present Tense, 2. Retrieved from http://www.presenttensejournal.org/volume-2/an-annotated-bibliography-of-literature-on-the-rhetoric-of-health-and-medicine/.Find this resource:
Graham, S. S. (2009). Agency and the rhetoric of medicine: Biomedical brain scans and the ontology of fibromyalgia. Technical Communication Quarterly, 18, 376–404.Find this resource:
Heifferon, B., & Brown, S. (Eds.), (2008). The rhetoric of healthcare: Essays toward a new disciplinary inquiry. Cresskill, NJ: Hampton Press.Find this resource:
Keränen, L. (2010). Rhetoric of medicine. In S. H. Priest (Ed.), Encyclopedia of science and technology communication (Vol. 2; pp. 638–642). Thousand Oaks, CA: SAGE.Find this resource:
Keränen, L. (Ed.), (2013). Inventing the future: The rhetorics of science, technology, and medicine. Special issue of POROI: An Interdisciplinary Journal of Rhetorical Analysis and Invention, 9, 1–149.Find this resource:
Leah, J., & Dysart-Gale, D. (Eds.), (2011). Rhetorical questions of health and medicine. Lanham, MD: Lexington Press.Find this resource:
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Meloncon, L., & Frost, E. A. (2015). Charting an emerging field: The rhetorics of health and medicine and its importance in communication design. Communication Design Quarterly, 3, 7–14.Find this resource:
Scott, J. B. (2003a). Extending rhetorical-cultural analysis: Transformations of home HIV testing. College English, 65, 349–367.Find this resource:
Scott, J. B. (2003b). Risky rhetoric: AIDS and the cultural practices of HIV testing. Carbondale: Southern Illinois University Press.Find this resource:
Scott, J. B., Segal, J. Z., & Keränen, L. B. (2013). Rhetorics of health and medicine: Inventional possibilities for scholarship and engaged practice. POROI: An Interdisciplinary Journal of Rhetorical Analysis and Invention, 9, 1–6.Find this resource:
Segal, J. (2005a). Health and the rhetoric of medicine. Carbondale: Southern Illinois University Press.Find this resource:
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Segal, J. Z. (2008). Rhetoric of health and medicine. In A. A. Lunsford, K. H. Wilson, & R. A. Eberly (Eds.), The Sage handbook of rhetorical studies (pp. 227–246). Thousand Oaks, CA: SAGE.Find this resource:
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Ding, H. (2014). Rhetoric of a global epidemic: Transcultural communication about SARS. Carbondale: Southern Illinois University Press.Find this resource:
Eberhard, J. M. (2012). An annotated bibliography of literature on the rhetoric of health and medicine. Present Tense, 2. Retrieved from http://www.presenttensejournal.org/volume-2/an-annotated-bibliography-of-literature-on-the-rhetoric-of-health-and-medicine/Find this resource:
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Gouge, C. & Jones, J. (Eds.) (2016). Wearables, wearing, and the rhetorics that attend to them. Special issue of the Rhetoric Society Quarterly, 46, 199–206.Find this resource:
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Keränen, L. (2010a). Rhetoric of medicine. In S. H. Priest (Ed.), Encyclopedia of science and technology communication (Vol. 2; pp. 638–642). Thousand Oaks, CA: SAGE.Find this resource:
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(1.) Exceptions obviously exist. For instance, for cross-cultural comparative work, see Kennedy (1997). For a contemporary book about global health rhetoric, see Ding (2014).
(2.) Prominent scholars in this area include but are not limited to Rita Charon, Paul Crawford, Kirsten Ostherr, Kathryn Montgomery, Arthur Frank, Arthur Kleinman, Lester Friedman, Delese Wear, David Morris, and Therese Jones.


text:
The U.S. MNT Players Will Donate Game-Worn Jerseys against France on Veterans Day
Nov. 11, 2011
© ©isiphotos.com
CHICAGO (Nov. 11, 2011) – In honor of the U.S. Men's National Team playing France on Veterans Day, the players will autograph and donate their game-worn jerseys for an online auction to benefit the Disabled American Veterans organization.
U.S. head coach Jurgen Klinsmann has selected 21 players to the roster for the match against France today at the Stade de France in Paris. Following the match, each jersey will be washed and then signed by the player. Information on how fans can participate in the online auction for the jerseys will be made available early next week.
"We are honored to have the opportunity to help assist disabled veterans," said U.S. captain Carlos Bocanegra. "They have made a great sacrifice in the course of defending our country, and we are grateful for their service. They certainly deserve our support."
Proceeds raised through the auction will be given to Disabled American Veterans (DAV), a non-profit organization that represents the interests of America's disabled veterans, and their families and survivors. The 1.2 million-member DAV provides free benefits, counseling and representation for those seeking benefits and services from the Department of Veterans Affairs and other federal and state agencies.
"The U.S. Men's National Team's game jersey auction will mean a great deal to the men and women who have served and sacrificed for our country," said National Commander Donald L. Samuels. "The team's generosity will help us continue providing our free services to veterans of all eras, including those returning from the wars in Afghanistan and Iraq."
In honor of Veterans Day, the U.S. Men's National Team also wrote a letter of thanks to veterans.
The match against France kicks off today at 3 p.m. ET, and the match will be broadcast live on ESPN2, ESPN3, Univision and Univision.com. Fans can also follow along on ussoccer.com's MatchTracker and on Twitter @ussoccer.
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subset: commoncrawl


text:
Organization of the Colombian electrical generation market. An application of technological indexes and H-H and C-4 concentration indexes, 1995-2004
The present article analyses the evolution of the concentration of the Colombian electrical generation market based on the technological diversification indexes and H-H and C-4 concentration indexes, during the period 1995-2004. Concentration herein is an enterprise behavior which, from the regulator's perspective, can attempt against efficiency results expected upon reformation of the industry's rules of the game. The conclusion after the analysis, on the one hand, is that the concentration levels have decreased in the study period, passing from a strong oligopoly to a moderate one; on the second hand, indexes are those with high technological diversification.
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Volume (Year): (2005)
Issue (Month): 62 (Enero-Junio)
Pages: 207-299
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text:
The Sea Shepherd ship Steve Irwin has been given a warm welcome by the French Research base at Dumont d' Urville.
On Friday, December 18, Sea Shepherd helicopter pilot Chris Aultman and Steve Irwin's First Officer Locky MacLean visited the French base.
The Sea Shepherd ship Steve Irwin had been given permission to enter the Territorial waters of France. The Japanese harpoon vessel tailing the Steve Irwin neither requested nor was granted permission to enter the French waters. They did so regardless and in complete contempt of French sovereignty.
Marie France Roy, the District Chief for Terre Adelie presented Locky MacLean with a plaque for the Steve Irwin and a letter of support.
In it she writes, "Our sympathy goes out towards this ship's activities in enforcing the recommendations of the International Whaling Commission."
The Steve Irwin will remain at anchor off the Adelie Coast for three days to await back up from the Sea Shepherd vessel Ady Gil.
"Once we unite with our other vessel we should be in a position to seriously turn the tables on this Japanese security ship that is stalking us," said Captain Paul Watson.
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