The Future of Public Health through Science Fiction

Round 1

Reviewer 1 Report

This paper argues for the functional value of sf in “translating” medical humanities. Anchored by two intriguing short stories, the paper makes a case for how fiction of this kind may help promote equity in the health sector. The treatment of speculative fiction in relation to medical humanities is welcome, while the two articles in question highlight contributions by racialized authors that are underrepresented in the field. While I do appreciate the attention to psychiatry as a public health matter and the author’s reading of the first story as illuminating how a “pandemic can be managed through balancing public and private competency,” the argument seems to hinge largely on a claim about the capacity for literature to foster empathy and in that way provide alternatives to current clinical models of detachment in psychiatry and biomedicine. Building on the anthology’s introduction, the paper’s author seems to take this assumption as a given, although literary scholars like Suzanne Keen and others invite us to reconsider this notion as one lacking in empirical support. I wonder if the author might be on stronger ground by positioning speculative writing about public health in relation to social justice, drawing on recent work by Madison Powers and Alison Fadden and others.

At any rate, the author’s conclusion that these stories “expand the value of narrative in helping health agencies respond to medical crises” is not altogether convincing. Rather than making this large claim, other facets of the argument would benefit from careful elaboration, particularly that having to do with racial inequities, which is the most valuable aspect of the paper. Specifically, statements like the following require nuanced unpacking: “Together with his professional experience as a practicing psychiatrist, Key infuses his story with an awareness of his Black identity to promote a socio-cultural exploration of the future of psychiatry and the present disparity in mental health access and engagement with Black persons.” The analysis of positionality needs to be deepened here, or at the very least, could be articulated more effectively.

 

The paper also appears to ignore the development of health humanities and leans heavily on the important work of Rita Charon without acknowledging considerable contributions in recent years to the field, collected in volumes like The Routledge Companion to Health Humanities and The Handbook of Health Humanities. As such, it feels somewhat dated, and would benefit from more extensive research and revision.

 

The paper is somewhat uneven as it begins somewhat awkwardly, setting up its argument in several long, unwieldy paragraphs at the outset that would benefit from careful revision. For clarity’s sake, I recommend breaking up the first paragraph into a minimum of two, with the first dealing with the broader thesis about medical humanities and the second introducing the stories. By its sixth page, the paper improves considerably both in terms of style and quality of analysis. However, the paper in its entirety requires extensive editing. There are other examples of paragraphs that need to be broken up, while spelling errors abound, as in “The Access Campaign’ by Médecins Sand Frontières (MSF)” on p. 6, and “focuse” on p. 2. Some sentences are not completed as in “Key therefore echoes the claim that ‘misdiagnosis is more common in black patients, the consequences are serious for them and have implications for others’ (Adebimpe 1981, p. 279). addresses the consequences of underrepresentation of Black patients by imagining a future where the technology meant to improve the quality of healthcare further disadvantages the already disproportionately affected racial groups.”

 

There are some larger issues with grammar (including subject-verb agreement) that should be addressed as well. Example: “Despite the varying extent of technological advancements used by both writers, the message of their stories are the same: certain areas of public health need to be improved” (8).

 

My sense is that in its current form, this paper is not yet ready for publication. Extensive editing and development of its central ideas will lead to a piece that will be of genuine interest to readers from a range of areas and specializations.

Author Response

Resolved

• Discussion of Keen and Madison Powers as counterargument to empathy (lines 278-283 and footnote xi), as well as greater signposting of social justice throughout paper
• Scaling back large claims of paper to focus on profiteering and racial inequity (lines 640-641)
• Simplified expression of positionality (490-491)
• More recent sources used (lines 31-39, 294-298)
• Divided first paragraph into two
• Extensive grammer revisions applied.

Reviewer 2 Report

This is an interesting piece of work that draws attention to the possibilities of science fiction as a tool for exploring public health issues and messages. The two case study stories selected - "The Plague Doctors" and "The Algorithm Will See You Now" - are well selected and a real strength to the paper is the discussion of the two in connection with the privatisation of healthcare and technological advancements. A key difficulty of this piece lies in its lack of clarity. Throughout the article there are various different elements introduced and highlighted however it is never clear what particular trajectory the piece is trying to explore. Reconsidering the structure of this piece and the key arguments it wishes to focus upon would help greatly in the overall clarity of the piece. Alongside this specific suggested revisions would be: 

1) The use of the science fiction genre to explore these ideas within the medical humanities is a very interesting one however more discussion of science fiction and how it has already been used within the medical humanities is required to strengthen the piece. An academic literature review that charts the progress in this field would help to make important space for your own arguments. 

2) A stronger contextualisation of the translational medical humanities approach is required to support the arguments you are making in relation to this. This should be discussed more fully in the introductory section of the paper and appropriate references added.

3) The stories selected are fascinating and clearly very relevant to your discussions. However, it is difficult to understand the complexities of these stories and their arguments without an introduction to them and I would encourage you to add this.  

Author Response

Resolved:

• Headings added (lines 243, 393, and 519) to set trajectory. Also, earlier indication of argument in lines 86-91
• More contemporary research in medical humanities and science fiction added (lines 31-39, 195-199)
• Emphasis on translation in lines 31-39 with appropriate reference

Unresolved

• Introduction to stories
  • Reason: introduction to each story already exists (lines 136-173)

Reviewer 3 Report

I am pleased to see this kind of work: these two SF stories come from very important anthologies for any consideration of the current state of science fiction and the medical/health humanities. The Lord story is also particularly prophetic in its apprehension of how the profit motive could exacerbate global inequalities and in fact harm (global) public health during a deadly pandemic. I do, however, have several suggestions for how the author might improve the piece prior to publication.

First, I would recommend that the author spend some time early on in the piece more precisely defining what is meant by “translational” in this context, especially because the term can mean very different things in medicine and in the humanities, and has been used in different ways even within the field of medical humanities. The definition could therefore be made via other medical humanities scholars who have used the term prominently, such as Douglas Robinson -- https://www.routledge.com/Translationality-Essays-in-the-Translational-Medical-Humanities/Robinson/p/book/9780367410735 -- or more recently Engebretsen et al.: https://mh.bmj.com/content/46/2/e2 (or not). Such a discussion could help the author clarify later on what exactly is meant by such constructions as “translating science” or “translating public health policy”: in the essay as written, the same term sometimes seems to mean “critique” and sometimes “make available to non-specialists,” and even more.

More generally, if the author is looking to ground this study in the most recent humanities scholarship, I would emphasize that much of the most important work on science fiction and the medical humanities is tied to the ongoing research project led by Gavin Miller and Anna McFarlane, which has produced a special journal issue -- https://pubmed.ncbi.nlm.nih.gov/27885035/ -- and a forthcoming companion from Edinburgh University Press. (See also the following: https://scifimedhums.glasgow.ac.uk/ & https://www.academia.edu/32537640/Science_Fiction_and_the_Medical_Humanities.) The old Amis book cited is foundational but can feel somewhat antiquated as far as science fiction scholarship is concerned, as if a medical text were to cite Galen.

For the most part the essay reads smoothly enough. The most problematic syntax actually occurs in the abstract. Page 1, line 8 reads, “The stories, although set in unrealized futures and describe,” which I assume should instead be “describing,” or some other parallel form. I would also use long dashes for clarity after “advancements” and “down” to set off the embedded phase. The construction “The stories […] allow us to confront how these futuristic stories” should also be rephrased so that the stories themselves are not what allow us to confront how the stories achieve an effect. I found fewer syntactical issues elsewhere in the submission, but these several cluster in the abstract for some reason.

Finally, a few additional minor points. For one, the essay’s first line claims (unsourced?) that medical humanities is a new concept but dates it to the 60s (which hardly seems new to me), and some would of course trace its origin point even earlier; see for example Klugman and Jones (2021): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455303/. The term “health humanities” is perhaps more in favor now as a category and concept: I don’t know if the author ought to at least register this term that is rapidly gaining ground or not. (I notice it is used once within the piece without clarification or distinction from the medical humanities.)

Another minor issue: elsewhere, the use of the terms “public” and “private” was initially misleading: I took them to be referring to a contrast between government and corporate projects, whereas the term “private” mainly refers later to actions taken by individuals rather than profit-seeking entities.

I might also move up or repeat the well-articulated conclusion that “The story’s ending provides an indication of what the future of health needs to involve: community-wide competency along with equitable and ethical access to healthcare” earlier in the piece, perhaps in the introductory paragraph. 

I would also rewrite the sentence that follows “Lord’s focus […] changes in scope”] does not make logical sense, unless Lord were the author of Key’s story. The author means that THEY are changing focus from the one to the other, and should say so more clearly.

Lastly, the word “tenuous” also may not be the ideal word choice in the contexts where it is used: rephrase? Vexed, etc.?

Other than that, I would say that the essay is nearly ready for publication. I did wonder if the author had anything to say about race in Lord's piece, which might parallel or diverge in interesting ways from Key's. 

Author Response

Resolved

• Definition of translational in the context of medical humanities provided in lines 31-39 which includes scholarship by Engebretsen et al.
• Added mention of Anna McFarlane and Gavin Miller in lines 194-198 as well as another mention in lines 233-237
• Corrected problematic syntax in abstract, lines 8-16
• Referenced the earliest usage of the term 'medical humanities in line 24. Footnote added in line 25 to provide more information
• Earlier mention of health humanities as a more evolved concept of medical humanities in line 31
• Clarification of public and private in lines 3290330
• Conclusion restated in lines 86-91
• Sentence beginning "Lord's focus" rewritten in line 385

Unresolved

• Race in Lord's story 
  • Reason: It isn't a major issue which I interpret as a deliberate move to steer clear of race and maintain focus on health.

Round 2

Reviewer 2 Report

I enjoyed reading the revised version of this piece and acknowledge that the suggestions made have been sufficiently considered.