The Pursuit of Signs (Routledge Classics)

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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.

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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.

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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.

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  • 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.

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    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.

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    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. After the treatments, often one hasn't any idea if it is still there, slinking about in organs or through the lymph system — those parts of the body you can't really even visualize. 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.

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    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. They didn't catch it really early, they didn't catch it late'. 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. You know this is all going to take years to work its way through your body'.

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    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.

    It's looking good, yeah '. 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 Pursuit of Signs: Semiotics, Literature, Deconstruction

    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. It swirls around you, looping endlessly in patterns and figures you can't quite recognize' quoted in Jain, , p.

    The diagnosed must work within this paradigm to understand biomedical information, make medical decisions, manage medical interactions and understand their illness experience Sulik, , p.

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    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. When I started having the recurrence, I started to feel as though my oncologist wasn't listening.

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