Molecular gaze pdf download

Molecular technologies also quantify magnitude of disease in a way rather different from traditional imaging technologies.

Footnote 4 The main function of mammograms, CT scans and so on is to determine whether cancer is present in the body. In other words, their utility hinges on their ability to ascertain the disease's presence or absence. Thus, although imaging technologies are used in clinical staging, determining the extent of disease before direct examination of the tumour and its spread, this quantification process is not where their primary value resides and clinical staging is generally perceived as inferior to pathologic staging for this reason.

Molecular biomarkers, on the other hand, intrinsically involve a process of quantification. As Shostak , p. Thus, from a semiotic perspective, the molecular gaze may very well translate to a numeric gaze — a point to which I now turn. Sulik , , following Clarke et al , , has argued that the illness identity has increasingly become a technoscientific one, with many patients beginning to think of themselves in technoscientific terms. However, these tests only served to intensify uncertainty, creating a vortex of spiralling risk.

Abstract test figures thus became a strong focus in their lives and transformed their perception of their bodies, leading to a pervasive sense of felt risk. For example, my earlier ethnographic research with prostate cancer survivors attending a cancer support group suggested that for some men PSA monitoring facilitated a view of prostate cancer cells as lying dormant within them, ready to be reactivated at some future date Bell and Kazanjian, Thus, their emotional state became directly tied to their PSA levels, which were seen as a material index of cancer.

This phenomenon has also been frequently noted in anecdotal reports and empirical studies of ovarian cancer survivors, with the CA biomarker coming to play a prominent role in many women's experiences of cancer survivorship for example, Hamilton, ; Guppy and Rustin, ; Howell et al, ; Palmer et al, ; Parker et al, ; Chitale, According to Hamilton , p. Many women begin to identify their CA levels as the evidence of disease status …. Unfortunately, even normal insignificant fluctuations in CA levels take on enormous meaning.

As a result, emotional well-being may come to depend on lower CA numbers, even if numbers remain in the normal range. Cancer listservs attest to a similar phenomenon, with some patients assuming that rising tumour markers in the absence of other signs or symptoms of disease portent a recurrence.

Since then, everything has been going well as i have always been clear from my check ups and scans until last week.

My blood test result showed a high level of LDH [a molecular biomarker], when the normal range is between — After 3 weeks, koe reposted that he had completed another blood test, noting that his blood serum levels had dropped but were still outside the normal range.

Signs, as koe well knows, must signify something. What these various accounts allude to is the meaning numbers often come to hold in the lives of those monitored via molecular biomarkers, regardless of whether they are deemed to be at risk for disease or disease recurrence or progression. In this context, numbers are imbued with a seductive allure that is difficult to resist. That numerical information becomes an important reference point for cancer patients and patients-in-waiting has been noted previously, albeit primarily in the context of risk and survival estimates.

A similar fixation with prognostic estimates has been also been documented among cancer survivors Thorne et al, Although numbers are symbolic phenomena, they are distinct types of symbols.

There is generally understood to be an isomorphic relation between the structure of mathematics and the structure of reality Crump, , p.

Indeed, Peirce himself clearly placed mathematical reasoning in the realm of iconic signs, based on the likeness of mathematical equations to phenomena in the natural world that is, their ability to describe such phenomena. However, for Peirce , this iconicity did not extend to statistics, a field he spoke of rather disparagingly:. A probability … is the known ratio of frequency of a specific future event to a generic future event which includes it …. It plainly means nothing at all of any consequence.

Despite Peirce's disdain, statistics have become a pervasive aspect of our daily lives. As Hacking , p. For Hacking , p. More importantly, statistics carry the authority of science. Numbers do not seem arbitrary or biased; their rhetorical effectiveness is facilitated by their apparently neutral non-rhetorical nature and the assumption of calculation as an impersonal, mechanical routine impermeable to human desires and biases Potter et al, , p.

As Woodward , p. For the numbers generated through monitoring via molecular biomarkers may be symbolic , but they are simultaneously a direct numeric representation of a serum seen to index cancer's presence. In other words, the relationship is one of contiguity: cancer's presence causes an elevation in certain proteinic biomarkers. This is not the case for risk or prognostic estimates, which are both strikingly specific and bloodlessly vague Jain, After all, you will either be diagnosed with cancer or you will not.

Thus, unlike statistical estimates of risk and prognosis, biomarker counts seem to belong to the world of hard facts: they represent a truth extracted from one's blood c. Biehl et al, Of course, this distinction is more artificial than real. However, the work of counting is rendered invisible and naturalised. As the name of the syndrome suggests, the inspiration for this ongoing sense of embodied vulnerability was the legend of Damocles, who was forced to eat at a magnificent banquet with a sword hanging over his head, suspended from the ceiling by a single hair and poised to plunge into his neck at any moment.

Is the retreat of symptoms partial or total? In consequence, the absence of symptoms of disease provides little reassurance regarding the absence of disease itself — after all such absence generally characterises the context of diagnosis in the first place.

To quote Jain , p. Cancer is creepy. After it shows up one realizes that it must have been there for a while, growing, dispersing, scattering, sending out feelers and fragments. Paradigmatically speaking, absence is semiotically loaded — ripe with meaning.

As William James pointed out, the absence of an item determines our representations as much as its presence could ever do cited in Chandler, , p. The anxiety absence produces seems to permeate the experience of cancer itself — from diagnosis through treatment, as well as after therapy has ended. Thus, my previous research suggests that cancer patients undergoing chemotherapy may occasionally experience more distress from the absence of treatment side effects than from the side effects themselves because of the ways that toxicity is seen to index effectiveness, providing an apparently objective measure of how well the treatment is working Bell, In a much earlier study of patient experiences of chemotherapy, Nerenz et al , p.

When the disease is directly palpable, it has definite size, shape, consistency, and location. Changes in disease status can be directly and objectively monitored so that even an increase in size of palpable nodes can be processed objectively. When the disease is not palpable, however, there is no way to control such emotional states as fear or anxiety about spread of the disease by resorting to objective indices of its change.

Clearly, molecular biomarkers provide such an indices for some patients — albeit one entirely removed from the embodied signs that precede it during cancer treatment for example, hair loss, flaky skin, reduction in palpable nodes.

Footnote 6. For six years it was under I went from going every 3 months to every 6 months to once a year. For six years I had nothing.

I never even thought about it, you know. I never once had a dream about cancer. I thought I was cured … because I was asymptomatic and my CA was always under 30, which means there was no tumor activity going on. Because that always goes up when there's tumor activity for sure. Far more meaningful to Arthur were his PSA numbers, which he made promiscuous reference to throughout the interview.

For example, when conversation turned to whether Arthur had received PSA testing since his treatment ended, he responded:. Ah, yeah, and it was very, very low, like 0. And so things look really good right now. But, you know, they take these PSA tests regularly, and what they are watching for is sudden spikes, suddenly it goes up, shoots up.

Then there's an indication that there's a problem, if it stays, you know, around 0. Once it was 0. For Arthur and his physician, his PSA number indexed what was happening inside him. So, it's not just wishful thinking , it's a case of, you know, the way it went, and the PSA count is so low now, it's looking good. Arthur's statements suggest that in a context marked by ongoing uncertainty and fear, the semiotic potency of biomarker numbers as transparent, material indices may be substantially heightened.

Increased diagnostic testing has meant that patients are increasingly caught in an ever-expanding web of tests, with their putative associations between objective signifiers of clinical variation and the probabilities of different diseases Aronowitz, , p.

The language required to understand biomedical technoscience is esoteric, complex and virtually incomprehensible to patients, granting authority to biomedical knowledge and positioning as experts those who produce and communicate it Sulik, , p.

Rendered mute, you can only listen to the din. The diagnosed must work within this paradigm to understand biomedical information, make medical decisions, manage medical interactions and understand their illness experience Sulik, , p.

However, although biomarkers are generated in the context of complicated laboratory tests, in some respects this numeric data seems easier to grasp than the other technoscientific information patients are frequently presented with X-rays, CT scans, biopsies and so on , which must be interpreted by a specialist.

One must learn how to read the blurred and shadow-filled landscape of the X-ray — how to distinguish the topography of the body's organs from artefacts introduced during the process of image production.

As Dumit , p. Aronowitz, This attachment to biomarker levels as a way of exerting some control over treatment is evident in several published accounts of the experiences of cancer survivors. For example, an ovarian cancer survivor in Howell et al's , p. So, in the same way as that in the beginning, I was saying, you know, here are these symptoms and something's wrong. So eventually, when my CA went up again , you know, in the fall of last year,. I started to ask about treatments.

The apparent objectivity of this numeric sign, with its comparatively unambiguous meaning, provided a means of counteracting her oncologist's dismissal of her subjective sense of dis-ease. Thus, it was when her CA marker started to rise that she began to push for treatment. Patricia recounted the following conversation with her oncologist regarding her concerns about metastases:. To the obvious annoyance of her physician, Patricia was not prepared to brook his dismissal of her concerns before documenting her tumour markers; these, rather than his professional opinion, would determine what course of action was warranted.

The role of molecular biomarkers in empowering patients to challenge physician decision making — especially in circumstances where physicians are seen to be overly passive or nihilistic — is evident in the accounts of some cancer survivors in my ongoing research. She described her response to this off-hand comment in the following way:. Evident in these accounts is women's awareness of the hierarchical relationship between signs and symptoms see Foucault, Each invokes the sovereignty of the sign over the symptom to advocate a particular course of action.

Notably, instead of generating a sense of resignation or passivity in the face of biological destiny and biomedical expertise, the forms of subjectification facilitated by molecular markers produce in these women an active orientation to the future c. Novas and Rose, However, although such markers have become a standard component of disease surveillance for people diagnosed with a variety of cancers, questions about their reliability remain in the field of biomedicine — and are the subject of ongoing debate.

These debates speak to the unevenness of processes of molecularisation — with moments of retreat as well as embrace. As Hogarth et al , p. The recent CA controversy is a case in point. The findings of a large randomised clinical trial Rustin et al, have created intense debate about the role of CA in monitoring ovarian cancer survivors.

In this trial, those patients treated once they were symptomatic, as opposed to when molecular signs of recurrence manifested measured via a doubling of serum marker levels , fared no worse — suggesting no survival advantage from intensive CA surveillance.

Particularly fascinating is the ways this debate about CA surveillance came to centre on the semiotic properties of the biomarker. For this woman echoing the cancer survivors documented above , the ability of biomarker numbers to visualise the invisible is intimately tied up with their value.

The overall consensus to emerge from these discussions appears to be that the technology itself is beneficial when used judiciously — as a sign whose meaning must be evaluated syntagmatically, in relation to a web of other signs and symptoms of disease recurrence.

The underlying discourse here is of the emotional and misinformed patient and the complicit physician who panders to her whims inappropriately drawing on health care services — a focus that becomes explicit in the emphasis on health care costs that has accompanied debates about these markers see Chitale, , p. Patient education: the now-universal response to any evidence of a disjuncture between patient and physician perspectives on health, risk and illness see Parker et al, This is, of course, exactly the rhetoric that surrounds PSA screening — a test similarly marred by controversy surrounding its utility in secondary cancer prevention.

However, a brief look at PSA screening demonstrates the limitations of the patient education model. Despite the controversy surrounding PSA screening, it is an extremely common test; for example, although it is not recommended in the Canadian guidelines, almost 50 per cent of Canadian men over 50 report being screened at some point Beaulac et al, It therefore seems reasonable to surmise that if the opportunity for CA monitoring exists most ovarian cancer survivors would choose to avail themselves of it, regardless of any stated limitations.

Indeed, patients priorly monitored through CA are often quite distressed when their access to the test disappears, as has happened in some clinical settings in the United Kingdom since the debates about CA monitoring first occurred Amy Ford, personal communication. Beyond the impossibility of limiting semiosis in this way, it speaks to the ongoing inability of biomedicine to deal with meaning ; that is, its continual turn away from illness in favour of disease Kleinman, To quote Kleinman , p.

Molecular technologies thus operate in a political and ethical field in which individuals are obliged to formulate life strategies, maximise their life chances, take actions or refrain from them in order to increase their quality of life and to act prudently in relation to themselves and others Novas and Rose, , p. The pursuit of health is both a civic and individual duty. If processes of molecularisation have transformed the face of primary and secondary cancer prevention, engendering new forms of somatic individuality in asymptomatic populations, their impact in the realm of tertiary prevention is no less fundamental albeit far more overlooked.

Examined from a semiotic perspective, there are important differences between these molecular technologies and the array of imaging technologies they now supplement. Thoroughly indexical, these technologies serve to quantify disease along a continuum, potentially producing an orientation to the self that is as much mathematical or numeric as molecular. Numbers, with their apparent transparency and neutrality, become a powerful lens through which experience is filtered.

This is particularly true of the biomarkers used in tertiary prevention, which some cancer survivors perceive as a material index of cancer's presence in the body. Although molecular biomarkers may create a sense of measured vulnerability in cancer patients, by making the invisible visible they are simultaneously a reassuring sign — potentially more reassuring than absence itself, given its semiotic potency.

Moreover, their apparent simplicity and transparency may also serve to provide a sense of control and empowerment, enabling cancer survivors to challenge medical decision making and generating an active orientation to the future.

That said, I do not intend to suggest that the effects of these technologies are universal or uniform. Sulik is careful to point out that patients who go on to develop technoscientific illness identities may incorporate them in a partial rather than complete way.

According to Clarke et al , p. However, there is danger in ignoring the semiotic dimensions of these technologies — or, worse still, assuming that they can be reduced to their biomedical meaning and pathologising those for whom a number becomes more than just a number. For a cancer survivor, is a cigar ever just a cigar? Or a headache ever just a headache, or a sore joint ever just a sore joint? As Staiano-Ross , p. These are fully embodied attitudes and perceptions.

If, as I have speculated in this article, the molecular gaze translates into a numeric gaze, we must more clearly grapple with the meaning of biomarker numbers for patients. As I have tried to show, semiotically speaking, these numbers differ in fundamental ways from the statistics and probabilities that precede and accompany them.

Instead, they purport to speak a more direct and personal truth: one taken directly from the patient's own blood. Although the PSA test is widely available, its use as a screening tool remains controversial, with the originator of the test condemning its role in cancer screening based on available evidence that PSA screening does not lead to fewer deaths from prostate cancer but leads to substantial over-diagnosis and over-treatment of the disease Ablin, CA is not currently recommended for population-level screening, but the National Institute of Health and Clinical Excellence, the organisation responsible for determining clinical and public health guidelines in the United Kingdom, has recently and controversially recommended the use of the test in primary care settings for women who present with symptoms associated with ovarian cancer see Olaitan, Women concerned about ovarian cancer can also request the test see Fayed, HPV testing is a standard component of cervical cancer screening, along with the pap smear itself.

Importantly, these modes of relationship are ideal types; in reality, signs partake of all three qualities to varying degrees Peirce, — , 2.

As Roskies demonstrates in her work on neuroimaging, although these images are understood as photographs of brain activity, what they are sensitive to is not visual information but magnetic signals. Interestingly, this phenomenon is also evident in MacIntyre's study of the emotional role of T cells counts in the lives of men living with asymptomatic HIV. I freely acknowledge that this largely contradicts my prior reading of PSA monitoring see Bell and Kazanjian, Sorry, a shareable link is not currently available for this article.

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The work of dis- than beauty. Some memes propagate from mind to mind in a viral credited stem cell researcher Woo Suk Hwang highlighted the principal way by creating shared discomfort.

There may be no significance to ethical bottleneck to stem cell research: the treatment of women willing their spread other than the spread itself. This idea, which I think was to donate their oocytes. The hot-buttons of sensation are too world. Biologists may breast cancer cells proliferating is enough to give it uncanny layers of be robust enough not to be shocked—and certainly not in New York, emotional resonance.

I have to admit there are exceptions that forced me to reevaluate what must be forgotten, mislabeled, transformed, infected, freezer- this view, like the poignant photo by Rosamund Purcell page 70 in burned and expired samples. No researcher would leave even one of which a little hydrocephalic skeleton bows to show where its skull flares these freezers open for more than a few seconds, but the artist leaves open like a tulip.

I finished the book convinced by Anker A worse monster than the chimera is the false friend. Although forgery is the common enemy of transgenic future.