Statistics & Prognosis: Living in Disease Categories

Prognosis of life-threatening illnesses is a challenge faced by both the medical staff who deliver a prognosis and the patient who receives it. Nicholas Christakis’s chapter on prognosis in Death Foretold shows how when “physicians prognosticate, they confront some of the most serious, emotional, and meaningful aspects of their professional practice” (Christakis, 1999).  Diagnosis has become a bureaucratic institution that,  “is a cognitively and emotionally necessary ritual connecting medical ideas and personnel to the men and women who are its clients” (Rosenberg, 2010). Too, prognosis can be seen as an emotionally charged ritual and a social construction. In fact, it is the emotion attached to prognosis that makes it so difficult a topic to approach. Christakis discusses “the progressive omission of prognosis.” Prognosis is less prominent in situations where “diagnosis is straightforward and many effective therapies are available” (Christakis, 1999). It is in situations where options for care are limited that physicians focus on prognosis.

Adrienne Rich’s selected poems carry the theme of cancer as a construct that brings maturity, and ends innocence and naivety. The poem’s focus on breast cancer highlight cancer in relation to femininity. “The lines “your unfair, unfashionable, unforgivable/women’s death,” show how breast cancer is associated with the destruction of femininity (Rich, 2001). Here “women’s death,” not only refers to the death of the woman herself, but also the death of her femininity through the removal of her breasts. Furthermore, the poem contains the line “you played heroic necessary games with death,” which reminded me of the piece “The Median Isn’t the Message,” which discusses how “statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death” (Rich, 2001) (Gould, 1985). The “heroic necessary games with death” is, in a sense, a battle against the odds, or against the prognosis. Gould fought this battle with a “sanguine personality” and ironically through the use of logic and statistics. Indeed, Stephen fought off the despair often associated with a poor prognosis with a more thorough understanding of statistics and the differences between a mean and a median. In understanding how statistics can be skewed in favor of certain positions, Gould did the very same; did research that helped validate his desire to fight death by cancer.

Building off of this, prognosis is often associated with statics (i.e. “what are my chances of survival). Gould argues that “many people make an unfortunate and invalid separation between heart and mind, or feeling and intellect” (Gould, 1985). We see this separation in diagnosis, where the patient is impersonalized in order for the physician to separate feeling from intellect. In terms of prognosis, the wide acceptance of statistics as truth instills fear. Certain illnesses like HIV/AIDS and caner are personified in ways that convey cynicism, alienation, and  despair. In many ways cancer and HIV/AIDS have come to represent certain truths. Rich touches on this in the line “how the body tells the truth in its rush of cells” in her poem. It is human nature to understand hard science as an indisputable truth, but it is important to recognize the scope within which a statement is made. As Gould points out two statements can be made about income that are both true but which carry very different meaning. I get the sense that Gould sees life as something that itself has become categorized; like prognosis, life is defined by statistics and graphs.

Prognosis as a social construction defines the value, quality, and even nature of life itself which is so shaped by sociocultural and political and economic contexts. Christakis highlights “the impact of poverty, race, religion, and social support on medical outcomes, even after taking into account the patient’s diagnosis and treatment,” thereby showing how “the patient’s capacity to interact socially may transcend its impact on biological course and come to influence how physicians formulate a prognosis” (Christakis, 1999). What this means, is that prognosis is very much dependent upon sociocultural circumstances and individual approaches to a life-threatening illness and not simply on the “hard science.”

Nicholas Christakis, Stephen Gould, and Adrienne Rich discuss the impact of disease categories on the those suffering from an illness, those closely associated with the patient, and those who must deliver the prognosis. Living in disease categories with a given prognosis is immensely difficult, especially in a world that is consumed by statistics and numbers. Gould shows how statistics represent only segments of truth and stresses the importance of recognizing the bigger picture. Christakis discusses the social construction of prognosis and the power of the prophecy a prognosis carries. Adrienne Rich, in her poem, magnifies the social implications of cancer on the patient, but also on those who hold the patient close to their hearts. Cancer, like statistics, carries the ability to strip one of their innocence and naivety.  In many ways the two are similar; both present a certain truth that is seen by many as irreversible, and in many cases is. From a social standpoint, cancer, prognosis, and the statistics associated with the two have the power to impact a human life in a large way; the three shape the way we look at our own lives and the lives of others.

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