Public Understanding of Medicine

Instructor: Benjamin R. Bates

Office: 211 Lasher Hall

Office Hours: To be Announced

E-Mail: batesb@ohio.edu

Course Website: http://oak.cats.ohiou.edu/~batesb/pubmed/

Course Description: See the course vision.

Required Texts:

Lederer, Susan E. (2002). Frankenstein: Penetrating the Secrets of Nature. Piscataway, NJ: Rutgers UP. ISBN: 0813532000

Baer, Hans A. (1997). Medical Anthropology and the World System: A Critical Perspective. Wesport, CT: Greenwood. ISBN: 0897895398

Smith, Susan L. (1995). Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950. Philadelphia: University of Pennsylvania Press. ISBN: 0812214498

Lorber, Judith & Moore, Lisa Jean. (2002). Gender and the Social Construction of Illness. Lanham, MD: Rowman & Littlefield. ISBN: 0759102384

Foucault, Michel. (1994). Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage. ISBN: 0679753346

Adelman, Mara & Frey, Lawrence J. The Fragile Community: Living Together with AIDS. Lawrence Erlbaum. ISBN: 0805818448

Condit, Celeste M. (1999). Meanings of the Gene. Madison: University of Wisconsin Press. ISBN: 0299163644

Lewontin, Richard C. (1993). Biology as Ideology: The Doctrine of DNA. New York: Harper/Perennial Press. ISBN: 0060975199

Jones, James H. (1993, rev. and exp. ed.). Bad Blood: The Tuskegee Syphilis Experiment. New York: Free Press. ISBN: 0029166764

 Grade Distribution:

380-400 = A

332-447 = B

292-307 = C

252-267 = D

360-379 = A-

320-331 = B-

280-291 = C-

240-251 = D-

348-359 = B+

308-319 = C+

268-279 = D+

≤ 239 = F

 Performance Criteria:

The following criteria are necessary for completing this course. Should you have any questions regarding the course criteria or related issues, please ask them in a timely fashion. Do not ask immediately before the due date.

 Assignment Values:

Literature Review/Theory Background Paper:   100 points

Communication Analysis/Research Proposal:     200 points

Discussion Leadership and Overview Paper:     50 points

Class Participation and Decorum:                     50 points

Literature Review/Theory Paper:

The literature review/theory paper is designed to be an exhaustive overview of literature relevant to the communication phenomenon or text that you will explore through your final study or research proposal. There may be additional literature obtained by the completion of your study. This early paper is designed to tell me that you have:

1.      selected an important and interesting phenomenon or text.

2.      have uncovered previous research on the phenomenon or text (or related phenomena or texts, should your phenomenon or text be a "fresh" research area).

3.      indicated how this study will add to knowledge in communication studies.

 The literature review will be evaluated for these three topic areas. It will also be evaluated for clarity and direct correlation to the two central components of this class: communication and public understanding of medicine. The literature review will provide a conceptual framework for exploring the communication phenomenon or text of your choice. I will provide suggestions and feedback to assist you in your final study or critical paper. I urge you to take these seriously.

 Communication Analysis/Research Proposal:

If you classify yourself as a rhetorician/critical analyst, you are expected to perform a complete analysis. Texts rarely have human "subject" rights, although certain media fora, like internet chat rooms, may require IRB approval. If you classify yourself as a social scientist or an ethnographer, I understand that there are certain barriers imposed by IRB restrictions. Thus, social scientists are required to design their scale instruments, interview forms, or other methodologically relevant materials for approval and to complete an IRB form for submission. Should you receive approval for your study from the IRB, I urge you to perform the actual study as well. I will do my best to assist you in this completion. I encourage teamwork.

 a. The communication analysis is a research study you will be responsible for conducting and completing by semester's end.  This study will be an exploratory investigation of communication and health and the complexities raised in this intersection. At center, your study will demonstrate how communication formations shape the understanding of personal or public health. The goal of this study is to provide increased knowledge of how communication shapes perceptions of health, health relationships, the understanding of health care, or a similarly relevant health issue. Your study should be grounded in communication or rhetorical theories that will serve to explain the communication phenomenon or variable that you chose in the literature review/theory background paper.

 After presenting the literature review (you should be able to insert much of your revised first paper), the communication analysis will then be presented as a specific area of research. You may employ hypotheses, research questions, or critical claims as best suits your study. These items should aim to investigate a specific way that communication is central to your study. Here, the two forms of papers may diverge. If you classified yourself as a rhetorician or critical analyst, go to b. If you classified yourself as a social scientist or ethnographer, go to c.

 b. After concluding your literature review, you will be expected to perform an insightful and compelling critique. The next section will address the theory that you will use to examine the text. A thorough explanation of the steps utilized in your theory and the key terms involved in your analysis will e included for a complete description of your research process.

 Once the theoretical guiding section has been presented, the text will then be analyzed and interpreted. The critical claims that guided the study will be addressed as well as any additional findings or insights that emerge from the reading. After the interpretation, the implications of the text for the understanding of rhetorics of health, and rhetoric generally, will be presented. Do not forget that your reading should present a coherent whole; the literature review is still relevant here. You should also inform the reader how your analysis assists future researchers as well as providing directions for future research. Now, go to d.

 c. After concluding your literature review, the next section, "research methods," will address the subjects involved in the study (actual or desired demographics) and other related variables (such as the instruments that will be used or the structure of the interview/ethnographic observation sheets). You should also describe the means of data collection. At this point – after consultation with the instructor – the IRB form should be written and submitted for approval. (A completed study will be of benefit to the student and the instructor.)

 After IRB approves the study, data will be collected. The data will then be analyzed and interpreted in a results section. The research questions or hypotheses (or if appropriate, both) that guided the study will be addressed as well as any additional findings that emerge from the data. A strong explanation for the communication phenomena as reported by the subjects will be presented. After presenting the results, suggestions for future research will be presented that promote the continued study of the phenomenon. Additionally, criticisms and possible improvements on the present study, data collection, tools of measurement, among other observations should be suggested if the study is to be replicated in the future. Now, go to d.

 d. The research project will be evaluated on all of the elements previously addressed and its presentation in a scholarly fashion. The project should be of journal submission length (about 6,000 words, less tables) and properly written in APA, MLA, Index Medicus or Chicago format (as best fits the study). Please consult an APA, MLA, Index Medicus or Chicago manual as needed.

 Discussion Leadership and Overview Paper:

Each student will lead discussion for an hour on a given week. When leading discussion, you are responsible for addressing issues of methodology, communication, and health as they are related to the day's assigned readings. You should provide a discussion leadership paper to all other members of the class at least 2 days before you are to lead discussion. Your discussion leadership paper should be 3 to 5 pages in length and will address the implications of what we have read and the contributions to understanding rhetorics of health. You should provide topoi for discussion. Superior overview papers will relate the week's discussion to previous sessions and/or draw in additional literature that you feel is relevant.

 Class Participation and Decorum:

Class participation involves active participation in the course through its entirety. Each student is expected to participate in class discussion and contribute to increased knowledge on the course topic. To each class, bring a set of discussion questions. These questions will be turned in to the instructor. Comments and questions should come primarily from the class readings as well as outside readings pertinent to your research project. Decorum means that you will speak with sincerity, but also with propriety. Rude and abusive interaction is not tolerated.

Tentative Schedule

All readings must be completed before the class meeting.  This requirement includes the first week.  T

Week 1: Foundations of the Public Understanding of Medicine

READ:            

For the curious and interested:

  • Kreps, G.L. (2001). The evolution and advancement of health communication inquiry. Communication Yearbook 24, 231-253.

  • Kaplan, R. (1997). Health outcomes and communication research, Health Communication 9, 75-82.

  • Vanderford, M.L. et al. (2001). Communication challenges for experienced clinicians: Topics for an advanced communication curriculum. Health Communication 13, 261-284.

Week 2: Ideological Foundations of PUM

READ:             Lewontin

                        Selections from Krementsov, Soviet Science

For the curious and interested:

  • Hibbard, J.H. (2003). Engaging health care consumers to improve the quality of care. Medical Care 41. I61-I70.

  • Galvin, R.S. & McGlynn, E.A. (2003). Using performance measurement to drive improvement: A road map for change. Medical Care 41, I48-I60.

  • Marshall, M.N. et al. (2002). Attitudes to the public release of comparative information on the quality of general practice care: Qualitative study. British Medical Journal 325, bmj.com.

  • Berry, D.C. et al. (2003). Patients' understanding of risk associated with medication use. Drug Safety 26, 1-11.

Week 3: Mythological Foundations of PUM

READ:             Lederer

For the curious and interested:

  • Shuchman, M. & Wilkes, M.S. (1997). Medical scientists and health news reporting: A case of miscommunication. Annals of Internal Medicine 126, 976-982.

  • Purvis-Cooper, C. & &Yukimura, D. (2002). Science writers' reactions to a medical "breakthrough" story. Social Science & Medicine 54, 1887-1896.

  • Bader, R.G. (1990). How science news sections influence newspaper science coverage: A case study. Journalism and Mass Communication Quarterly 67, 88-96.

  • Reeves, C. (1990). Establishing a phenomenon: The rhetoric of early medical reports on AIDS. Written Communication 7, 393-416.

  • Molitor. F. (1993). Accuracy in science news reporting by newspapers: The case of aspirin for the prevention of heart attacks. Health Communication 5, 209-24.

  • Harter, L.M. & Japp, P.M. (2001). Technology as the representative anecdote in popular discourses of health and medicine. Health Communication 13, 409-25.

Week 4: Ideographic Foundations of PUM

READ:             Condit

For the curious and interested:

  • Clayton, E.W. (2002). The complex relationship of genetics, groups, and health: What it means for public health. Journal of Law, Medicine, & Ethics 30, 290-7.

  • Vahakangas, K. (2001). Ethical implications of genetic analysis of individual susceptibility to diseases. Mutation Research 482, 105-10.

  • Michael, M. & Carter, S. (2001). The facts about fictions and vice versa: Public understanding of human genetics. Science as Culture 10, 5-32.

  • Condit, C.M. et al. (1998). Determinism and mass-media portrayals of genetics. American Journal of Human Genetics 62, 979-84.

  • Bates, B.R. et al. (2003). What does "a gene for heart disease" mean? A focus group study of public understandings of genetic risk factors. American Journal of Medical Genetics 116, 385-92.

Week 5: PUM and social capital          

READ:             Adelman and Frey

For the curious and interested:

  • Leeder, S. & Dominello, A. (1999). Social capital and its relevance to health and family policy. Australian and New Zealand Journal of Public Health 23, 424-9.

  • Lomas, J. (1998). Social capital and health: Implications for public health and epidemiology. Social Science & Medicine 47, 1181-8.

  • Singh-Manoux, A. et al. (2003). Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study. Social Science & Medicine 56, 1321-33.

  • Bailis, D.S. et al. (2001). Perceived control in relation to socioeconomic and behavioral resources for health. Social Science & Medicine 52, 1661-76.

  • Person, P. (2002). Retrenchment and restructuring in an age of austerity: What (if anything) can be learned from the affluent democracies? Cadernos de Saude Publica 18, S7-S11.

  • Grundy, E. & Sloggett, A. (2003). Health inequalities in the older population: The role of personal capital, social resources and socio-economics circumstances. Social Science & Medicine 56, 935-47.

  • McCulloch, A. (2003). An examination of social capital and social disorganisation in neighbourhoods in the British household panel study. Social Science & Medicine 56, 1425-38.

Week 6: PUM and gender

READ:             Lorber

TURN IN the Literature Review/Theory Paper

For the curious and interested:

  • Vlassoff, C. & Moreno, C.G. (2002). Placing gender at the centre of health programming: Challenges and limitations. Social Science & Medicine 54, 1713-1723.

  • Miers, M. (2002). Developing an understanding of gender sensitive care: Exploring concepts and knowledge. Journal of Advanced Nursing 40, 69-77.

  • Covello, V.T. & Peters, R.G. (2002). Women's perceptions of the risks of age-related diseases, including breast cancer. Health Communication 14, 377-395.

  • Crenshaw, C. (1995). The "protection" of "woman": A history of legal attitudes towards women's workplace freedom. Quarterly Journal of Speech 81, 63-82.

  • Crenshaw, C. (1996). The normality of man and female otherness: (Re)producing patriarchal lines of argument in the law and the news. Argumentation & Advocacy 32, 170-84.

  • Corebett, J.B. & Mori, Motomi. (1999). Medicine, media, and celebrities: News coverage of breast cancer. Journalism & Mass Communication Quarterly 76, 229-249.

  • Schofield, T. et al. (2000). Understanding men's health and illness: A gender-relations approach to policy, research, and practice. Journal of American College Health 48, 247-256.

  • Inhorn, M.C. & Whittle, K.L. (2001). Feminism meets the "new" epidemiologies: Toward an appraisal of antifeminist biases in epidemiological research on women's health. Social Science & Medicine 53, 553-567.

Week 7: PUM and socio-economic status

READ:             Smith

For the curious and interested:

  • Karlsen, S. & Nazroo, J.Y. (2002). Relation between racial discrimination, social class, and health among ethnic minority groups. American Journal of Public Health 92, 624-631.

  • Sondik, E.J. et al. (2000). Race/ethnicity and the 2000 census: Implications for pubic health. American Journal of Public Health 90, 1709-1713.

  • Krieger, N. (2003). Does racism harm health? American Journal of Public Health 93, 194-199.

  • Bugra, D. & Bhui, K. (1999). Racism in psychiatry: Paradigm lost – Paradigm regained. International Review of Psychiatry 11, 236-243.

  • Bhopal, R. (1997). Is research into ethnicity and health racist, unsound, or important science? British Medical Journal 314, 1751-6.

  • Braun, L. (2002). Race, ethnicity, and health: Can genetics explain disparities? Perspectives in Biology and Medicine 45, 159-74.

  • Furr, L.A. (2002). Perceptions of genetics research as harmful to society: Differences among samples of African-Americans and European-Americans. Genetic Testing 6, 25-30.

Week 8: PUM and social control

READ:             Foucault

For the curious and interested:

  • Abraham, J. (2003). The science and politics of medicines control. Drug Safety 26, 135-43.

  • Balis, D.S. et al. (2003). Two views of self-rated general health status. Social Science & Medicine 56, 203-217.

  • Crimmins, E.M. & Saito, Y. (2001). Trends in healthy life expectancy in the United States, 1970-1990: Gender, racial, and educational differences. Social Science & Medicine 52, 1629-1641.

  • Jhyla, M. et al. (1998). Is self-rated health comparable across cultures and genders? Journal of Gerontology 53B, S144-S152.

  • Litva, A. et al. (2002). "The public is too subjective": Public involvement at different levels of health-care decision making. Social Science & Medicine 54, 1825-37.

  • Manderbacka, K. et al. (1999). Do risk factors and health behaviours contribute to self-ratings of health? Social Science & Medicine 48, 1713-1720.

  • Reich, M.R. (2002). Reshaping the state from above, within, from below: Implications for public health. Social Science & Medicine 54, 1669-75.

  • Robinson, J.D. (1998). Getting down to business: Talk, gaze and body orientation during openings of doctor-patient consultations. Human Communication Research 25, 97-123.

  • Wiseman, V. et al. (2003). Involving the general public in priority setting: Experiences from Australia. Social Science & Medicine 56, 1001-12.

Week 9: PUM and comparative analysis

READ:             Baer

For the curious and interested:

  • Each issue discussed above has created a plethora of readings.  Good journals include, International Journal of Public Health, Journal of Health Communication (International Perspectives), Social Cadernos de Saude Publica (many articles are in Portuguese or Spanish), and British Medical Journal (offers studies from across Europe). The publications of each nation’s medical associations are also good places to look, but nearly always require advanced linguistic skills in languages other than English.  International perspectives in health communication may also be found in outlets like European Journal of Communication (Europe), Asian Journal of Communication (Asia), and Australian Journal of Communication (Australia, New Zealand, and Micronesia.

Week 10: PUM and ethics

READ:             Jones

For the curious and interested:

  • Gamble, V.N. (1993). A legacy of distrust: African Americans and medical research. American Journal of Preventive Medicine, 9, S35-8.

  • Quinn, S. (1997). Belief in AIDS as a form of genocide: Implications for HIV prevention programs for African Americans. Journal of Health Education, 28, S6-11.

  • Green, B., Maisiak, R., Wang, M., Britt, M., & Ebeling, N. (1997). Participation in health education, health promotion, and health research by African Americans: Effects of the Tuskegee syphilis experiment. Journal of Health Education, 28, 196-201.

  • Corbie-smith, G. (1999). The continuing legacy of the Tuskegee syphilis study: considerations for clinical investigation. American Journal of Medical Science 317, 5-8.

  • Freimuth, V.S., Quinn, S.C., Thomas, S.B., Cole, G., Zook, E., & Duncan, T. (2001). African Americans' views on research and the Tuskegee syphilis study. Social Science and Medicine 52, 797-808.

  • Gamble, V.N. (1997). The Tuskegee syphilis study and women's health. Journal of the American Women's Medical Association 52, 195-6.

  • Gamble, V.N. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health 87, 1773-8.

  • Reverby, S.M. (2001). Tuskegee: could it happen again? Postgraduate Medical Journal 77, 553-4.

  • Roy, B. (1995). The Tuskegee syphilis experiment: biotechnology and the administrative state. Journal of the National Medical Association 87, 56-67.

 Week 11: Presentation of final papers and research agendas