Rethinking Gender and Epistemic Injustice: A Comparative Study of Male and Female Breast Cancer Memoirs

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

• Novelty: Is the question original and well-defined? Do the results provide an advancement of the current knowledge? This is an interesting manuscript that focuses on a novel issue regarding epistemic injustice and narratives of Female Breast Cancer patients (Riggs) compared to Male Breast Cancer Patients (Herbert).
• Scope: Does the work fit the journal scope*? It seems to.
• Significance: Are the results interpreted appropriately? Are they significant? Are all conclusions justified and supported by the results? Are hypotheses carefully identified as such? N/A
• Quality: Is the article written in an appropriate way? Are the data and analyses presented appropriately? Are the highest standards for presentation of the results used? The paper makes some claims that need greater support (see comments in text).
• Scientific Soundness: Is the study correctly designed and technically sound? Are the analyses performed with the highest technical standards? Is the data robust enough to draw conclusions? Are the methods, tools, software, and reagents described with sufficient details to allow another researcher to reproduce the results? Is the raw data available and correct (where applicable)? N/A
• Interest to the Readers: Are the conclusions interesting for the readership of the journal? Will the paper attract a wide readership, or be of interest only to a limited number of people? (Please see the Aims and Scope of the journal.)  Although the paper lapses into academic jargon, I think this could be relevant to a broad audience.
• Overall Merit: Is there an overall benefit to publishing this work? Does the work advance the current knowledge? Do the authors address an important long-standing question with smart experiments? Do the authors present a negative result of a valid scientific hypothesis? I think this manuscript has overall merit and should be published.
• English Level: Is the English language appropriate and understandable? The English is overall understandable.

Just a few more comments:

The author(s) takes a very long time before they get to the heart of this manuscript. If the focus of your paper is Riggs and Herbert, get to this sooner. It's not until line 192 that we finally get to this analysis.

Also, why did you select these two authors? How representative are they of these various genres?

The authors ignore a very large literature about the biopsychosocial model of care that has been around for nearly 50 years. This model is critical of the strong medical model that the authors rightly criticize.

The writing can be sharpened a bit. Paragraphs are way too long.

See the comments highlighted in the text.

 

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Please see above comments.

Author Response

Comments 1: The author(s) takes a very long time before they get to the heart of this manuscript. If the focus of your paper is Riggs and Herbert, get to this sooner. It's not until line 192 that we finally get to this analysis.

Response 1: The introduction is modified and the issue is resolved.

Comments 2: Also, why did you select these two authors? How representative are they of these various genres?

Response 2: The justification for selection of texts is added in the beginning.

Comments 3: The authors ignore a very large literature about the biopsychosocial model of care that has been around for nearly 50 years. This model is critical of the strong medical model that the authors rightly criticize.

Response 3: Incorporated.

Comments 4: The writing can be sharpened a bit. Paragraphs are way too long. See the comments highlighted in the text.

Response 4: Highlighted comments are addressed as following:

1. By “instituitional care”, we meant to say the care patients receive inside formal healthcare system.
2. Even though health professionals are trained to elicit the patient’s perspective when conducting medical interview, they end up using too many medical jargons due to their professional training. They also enjoy credibility excess because of their training and expertise in the fields “patients’ testimonies are often dismissed as irrelevant, confused, too emotional, unhelpful, or time-consuming” (Carel & Kidd, 2014, p. 530).

The sentence (original manuscript ll. 74-76) is reframed.

1. The details of Nina Riggs and Alan F Herbert are validated with appropriate citation.
2. The claim (original manuscript ll. 178-179) is validated with reference.
3. The discussion on Biopsychosocial model is incorporated along with the necessary citation (revised manuscript ll. 138-143).
4. The long paragraph is broken into three separate paragraphs.

Reviewer 2 Report

Comments and Suggestions for Authors

Review report: “Rethinking Gender and Epistemic Injustice: A Comparative Study of Male and Female Breast Cancer Memoirs”

 

The article consists of a comparative analysis of a female breast cancer memoir – Nina Rigg’s The Bright Hour (2017) – and a male memoir – Alan F. Herbert’s The Pink Unicorns of Male Breast Cancer (2016). The starting point for the analysis is a theoretical framework of epistemic injustice, a concept coined by the philosopher Miranda Fricker in 2007 and subsequently developed in various ways, including in the healthcare context in which the article is situated. However, the author of the article emphasizes that the discussion of illness and epistemic injustice has not sufficiently considered the gender perspective. Ultimately, this is what the article seeks to remedy by focusing on three aspects of female and male breast cancer narratives in the analysis of Riggs’ and Herbert’s memoirs. 

First, the article aims to highlight the forms of testimonial injustice – i.e. epistemic injustices of not being recognized as credible – experienced by both female and male breast cancer patients, which are expressed in different ways in Riggs’ and Herbert’s memoirs. Second, the article focuses on arguing that male breast cancer patients are more likely to experience hermeneutical injustice than female breast cancer patients because male breast cancer, given its cultural invisibility, is more difficult to communicate than female breast cancer, where other hermeneutic resources are available. 

In conclusion, the article argues for the importance of paying closer attention in a healthcare context to the kind of illness narratives exemplified by Riggs’ and Herbert’s memoir in order to recognize and potentially redress the epistemic injustices that is so prevalent from a patient perspective. In particular, the author of the article advocates for the importance of more male breast cancer memoirs, precisely because they are less common than female ones.  

The strength of the article lies primarily in its theoretical focus on epistemic injustice and the analysis of how the examined memoirs thematize this from a patient perspective. However, considering that the research on women’s breast cancer narratives is much more extensive than what is presented in the article, its concrete research contribution can mainly be seen in the analysis of Herbert’s memoir as a rare example of a male breast cancer narrative.

Nevertheless, given the persistent advocacy in Medical Humanities and Narrative Medicine for doctors and other health professionals to engage with literature to enhance empathy and compassion, the article’s concluding plea for this seems somewhat lacking. At the very least, the author of the article should have more clearly grounded the argument in relevant research in these fields, such as Rita Charon’s Narrative Medicine:  Honoring the Stories of Illness (2006), which underscores the importance of doctors reading to become better listeners. Additionally, Arthur W. Frank, in his classic The Wounded Storyteller: Bodies, Illness, and Ethics (1995/2013) emphasizes how patients’ narratives serves as a form of “talking-back” in response to a medical science that often disregards the patient’s voice – highlighting one of the epistemic injustices addressed in the article. 

One weakness of the article overall is its lack of grounding in previous research in the medical humanities, particularly concerning autobiographical illness narratives, both in general and in relation to female breast cancer narratives specifically. While the article extensively covers the concept of epistemic injustice, research on the latter is largely absent. DeShazer’s Mammographies (2013) is briefly mentioned, yet there are several other relevant books that could have been utilized, such as G. Thomas Couser’s Recovering Bodies: Illness, Disability, and Life-Writing (1997), an early exploration of the literary genre of female breast cancer narratives that emerged in the United States in the 1980s and 1990s. Additionally, Emelia Nielsen’s Disrupting Breast Cancer. Stories of Rage and Repair (2019) examines female breast cancer narratives that challenge the narrative scripts of the so-called Pink Ribbon culture, a topic further investigated by Gayla A. Sulik in Pink Ribbon Blues. How Breast Cancer Undermines Women’s Health (2011). 

Failing to incorporate this research into the analysis of Rigg’s memoir is, in my opinion, a significant oversight, particularly since the author of the article often employs formulations that suggest Rigg’s breast cancer narrative represents all women’s breast cancer experiences. Furthermore, as previous research has demonstrated, the Pink Ribbon culture, which is positively valued in the article as a hermeneutic asset for the female breast cancer patient, also in many cases perpetuate other forms of epistemic injustice by promoting an ideology centered on happiness and survival. 

By extension, this raises questions about the selection of the primary material discussed in the article, which is never justified. Given the abundance of autobiographies and memoirs about female breast cancer, there is no in-depth discussion of why the article focuses on Rigg’s breast cancer narrative and not others. In short, what makes this female breast cancer memoir particularly suitable for discussing the issue of epistemic injustice? And, as touched on above, in what ways can Rigg’s memoir be considered representative of female breast cancer narratives in general? 

Even concerning the choice of Herbert’s memoir, the article could have justified why this particular one is analyzed. Although it is implied that there are a limited number of memoirs about male breast cancer, the author of the article does not elaborate on how the male breast cancer genre has been shaped. Are there other works that would have been appropriate to analyze in this context? 

Another general objection related to the above concerns the article’s ambition to present a comparative analysis of a female and a male breast cancer narrative. It becomes somewhat unclear what the author of the article aims to achieve with this comparison. Considering the extensive research on women’s breast cancer narratives, wouldn’t it have been more appropriate to focus solely on male breast cancer narratives? 

Regarding the comparative analysis of Rigg’s and Herbert’s breast cancer narratives, there is a consistent lack of in-depth analytical focus, especially considering their nature as narratives/representations of human experience. Throughout the analysis, there is a general tendency to treat these breast cancer narratives as accounts from any informant, which prompts further questions about the choice of material. For example, would it have been equally effective to analyze interview material? In other words, the analysis lacks a level of aesthetic awareness that also pertains to the illness memoir as a genre.

If the analysis of Riggs’ and Herbert’s breast cancer memoirs could have been expanded further, the theoretical discussion could have been somewhat reduced. A concrete suggestion in this regard is to formulate the article’s purpose and research questions from the outset, as currently, they are only presented on pages 4 and 5. 

In conclusion, I believe that the focus on epistemic injustice is interesting and justified from a research perspective. However, the article should undergo thorough revision before it can be considered for publication. 

 

More detailed comments are provided below: 

 

Line 25: Complete data for Kidd and Carel 2019 and 2017 are missing in the bibliography.

Line 79: The wrong year is stated for Younas 2021. According to the bibliography it should be 2020.

Line 105: It’s unclear why these particular sources are cited here. 

Line 116: The use of the phrase “natural history” is unclear.

Line 121: Ravandi-Kashani and Hayles 1998 is not in the bibliography. NOTE! Older sources here.

Line 129: It’s unclear why these sources are cited here. They are hardly any authorities. 

Lines 139-148: The first time the examined memoirs are presented, but it’s unclear why they are presented here.

Lines 148-149: The formulation “Thus, MBC patients face hermeneutical injustice more than their female counterpart” seems too generalizing and the article’s argumentation does not benefit from this kind of polarization between male and female breast cancer narratives.

Lines 170-171: Also, here a tendency to unnecessary polarization through the statement that “men with BC are more victimized” …

Lines 172-173: Here, the question of the material is raised. As a reader, one becomes curious about the actual publication of MBC memoirs and how your example of analysis reflects other MBC stories.

Lines 211-214: The questions are formulated in general terms and do not specifically address the memoirs under investigation. Such a link is directly necessary for the analysis to have scientific legitimacy. Also, it would be better to examine questions 1 and 2 in greater depth and delete question 3, as it adds little from a scientific perspective.

Line 221: The use of ‘has’ in writing about the memoirs examined is unclear. This is something that recurs throughout and which indicates that the author of the article misses the aesthetic dimension. 

Line 233: Unclear wording: “Alan's memoir is not his voice confronting...”

Line 238-239: Unclear wording: “Another similar BC story Alan has referred to where the patient's credibility is doubted” is what?

Lines 288-290: A somewhat trivial conclusion.

Lines 334-338: How do these observations about Rigg’s reading follow on from the previous argumentation?

Line 338: Word choice – “describes” instead of “shares”?

Line 348: What does “chemo school” mean here?

Lines 349-352: A somewhat generalizing and polarizing statement

Lines 382-384: No source to support the statement starting with “For women the narrating BC experiences...”

Lines 382-403: Here it is suddenly emphasized how Alan does not, in the same way as Riggs, end up in an existential crisis because of losing a breast or losing his hair, which is related to the issue of masculinity. The author of the article could do more with this as it clearly points out that even in the case of breast cancer, women are in some respects even more exposed to epistemic injustices than men, precisely because of prevailing ideals about what a female body should look like, etc. 

Line 411: Unclear who the reader mentioned here actually refers to.

Lines 425-426: Unclear how the quotation refers to what is mentioned in the previous sentence.

Lines 434-435: The point that the particularized experience of breast cancer expressed here goes against how the article tends to fall back on the generalization about what distinguishes female and male breast cancer narratives. 

Lines 443-444: The argument that Nina, as an FBC patient, is in a more “advantageous position to overcome challenges as multiple discourses on FBC are available for her”, completely ignores how the research has highlighted the epistemic injustice of, for example, the Pink Ribbon culture’s privileging of a certain breast cancer ideology focusing on survival and happiness. Here, too, a more problematizing approach would have been appropriate, one that did not take for granted that all discourses on female breast cancer are good. 

Lines 456-458: Unclear why the article ends by advocating for more MBC memoirs. Increased publication of MBC memoirs and other male breast cancer narratives does not necessarily mean that epistemic injustices are corrected, but, as the research on women’s breast cancer narratives has shown, they can create new norms and demands for writing about breast cancer in the “right” way. Here too, a more problematizing approach to the “pink ribbon and blue-ribbon culture” is called for.

Line 465: Who refers to the term “the readers” here? Cf. line 411.

 

 

Author Response

Thank you so much for your insightful comments.

Comments 1: Nevertheless, given the persistent advocacy in Medical Humanities and Narrative Medicine for doctors and other health professionals to engage with literature to enhance empathy and compassion, the article’s concluding plea for this seems somewhat lacking. At the very least, the author of the article should have more clearly grounded the argument in relevant research in these fields, such as Rita Charon’s Narrative Medicine:  Honoring the Stories of Illness (2006), which underscores the importance of doctors reading to become better listeners. Additionally, Arthur W. Frank, in his classic The Wounded Storyteller: Bodies, Illness, and Ethics (1995/2013) emphasizes how patients’ narratives serve as a form of “talking-back” in response to a medical science that often disregards the patient’s voice – highlighting one of the epistemic injustices addressed in the article. 

Response 1: Incorporated (revised manuscript ll. 61-64)

Comments 2: One weakness of the article overall is its lack of grounding in previous research in the medical humanities, particularly concerning autobiographical illness narratives, both in general and in relation to female breast cancer narratives specifically. While the article extensively covers the concept of epistemic injustice, research on the latter is largely absent.

Response 2: As the article is based on epistemic injustice, it discovers a major gap in research because epistemic injustice is largely studied in the context of chronic illnesses. However, the studies are specifically not abundant in the context of breast cancer. Only Younas et al. (2019) and Younas (2020) addressed the challenges of epistemic injustice in the context of male breast cancer.

Comments 3: Regarding the comparative analysis of Riggs’ and Herbert’s breast cancer narratives, there is a consistent lack of in-depth analytical focus, especially considering their nature as narratives/representations of human experience. Throughout the analysis, there is a general tendency to treat these breast cancer narratives as accounts from any informant, which prompts further questions about the choice of material. For example, would it have been equally effective to analyze interview material? In other words, the analysis lacks a level of aesthetic awareness that also pertains to the illness memoir as a genre.

Response 3: The primary focus of the paper is to identify instances of epistemic injustice that grow at the intersection of gendered experiences of a chronic illness. Memoirs generally appear as instances of qualitative interviews wherein narratives with their nuances often emerge. It is true that illness memoirs are also studied for their aesthetic qualities. Since this paper primarily deals with an ethical question, the authors preferred to not mix the analytical appraches.

Comments 4: Line 25: Complete data for Kidd and Carel 2019 and 2017 are missing in the bibliography.

Response 4: The missing citations are added. They are highlighted in yellow.

Comments 5: Line 79: The wrong year is stated for Younas 2021. According to the bibliography it should be 2020.

Response 5: The year is changed.

Comments 6: Line 105: It’s unclear why these particular sources are cited here.

Response 6: Those three references are three extremely important works to showcase how women’s breast cancer challenges are widely studied. Further, it will lead to the establishment of the lack of scholarly works on male breast cancer narratives.

Comments 7: Line 116: The use of the phrase “natural history” is unclear.

Response 7: “Natural history” is a biomedical term that means induction and progression of the disease. The article mentioned as in-text citation has used the term “natural history.”

Comments 8: Line 121: Ravandi-Kashani and Hayles 1998 is not in the bibliography. NOTE! Older sources here.

Response 8: It is added in the bibliography now. Another newer study (published in 2005) is added additionally to validate the point.

Comments 9: Line 129: It’s unclear why these sources are cited here. They are hardly any authorities.

Response 9: The citations are removed.

Comments 10: Lines 139-148: The first time the examined memoirs are presented, but it’s unclear why they are presented here.

Response 10: This section is incorporated in the beginning as introduction of the article. 

Comments 11: Lines 148-149: The formulation “Thus, MBC patients face hermeneutical injustice more than their female counterpart” seems too generalizing and the article’s argumentation does not benefit from this kind of polarization between male and female breast cancer narratives.

Response 11: There is no attempt at polarizing the experiences. In fact, Hermeneutical Injustice happens when there is a gap in collective understanding, making it difficult for certain groups (in this case, men) to communicate their experiences because the concepts or language needed to express them are not widely recognized or understood.

Comments 12: Lines 170-171: Also, here a tendency to unnecessary polarization through the statement that “men with BC are more victimized” …

Response 12: Same as response 11 above.

Comments 13: Lines 172-173: Here, the question of the material is raised. As a reader, one becomes curious about the actual publication of MBC memoirs and how your example of analysis reflects other MBC stories.

Response 13: The modified Introduction shows how Herbert’s memoir is a representative of other MBC memoirs.

Comments 14: Lines 211-214: The questions are formulated in general terms and do not specifically address the memoirs under investigation. Such a link is directly necessary for the analysis to have scientific legitimacy. Also, it would be better to examine questions 1 and 2 in greater depth and delete question 3, as it adds little from a scientific perspective.

Response 14: Problem of research questions is resolved with apt modifications.

Comments 15: Line 221: The use of ‘has’ in writing about the memoirs examined is unclear. This is something that recurs throughout and which indicates that the author of the article misses the aesthetic dimension. 

Response 15: Instead of present perfect tense, simple present tense is used. The whole analysis section is modified accordingly.

Comments 16: Line 233: Unclear wording: “Alan's memoir is not his voice confronting...”

Line 238-239: Unclear wording: “Another similar BC story Alan has referred to where the patient's credibility is doubted” is what?

Response 16: The above-mentioned sentences are modified.

Comments 17: Lines 288-290: A somewhat trivial conclusion.

Response 17: Modified. Highlighted in yellow.

Comments 18: Lines 334-338: How do these observations about Rigg’s reading follow on from the previous argumentation?

Response 18: The above-mentioned comments are incorporated. The observation is accordingly modified.

Comments 19: Line 338: Word choice – “describes” instead of “shares”?

Line 348: What does “chemo school” mean here?

Response 19: The changes are incorporated. Highlighted in yellow.

Comments 20: Lines 349-352: A somewhat generalizing and polarizing statement

Lines 382-384: No source to support the statement starting with “For women the narrating BC experiences...”

Response 20: The statements are modified. Reference added.

Comments 21: Lines 382-403: Here it is suddenly emphasized how Alan does not, in the same way as Riggs, end up in an existential crisis because of losing a breast or losing his hair, which is related to the issue of masculinity. The author of the article could do more with this as it clearly points out that even in the case of breast cancer, women are in some respects even more exposed to epistemic injustices than men, precisely because of prevailing ideals about what a female body should look like, etc.

Response 21: These lines present the existential crisis both Riggs and Herbert are likely to experience and they do. Women do experience the existential crisis, but men experience it even more as there is hardly any epistemic scaffolding in comparison to that available with respect to FBC. However, crisis of masculinity can be addressed in a separate study as it is not under the current scope of this study.

Comments 22: Line 411: Unclear who the reader mentioned here actually refers to.

Lines 425-426: Unclear how the quotation refers to what is mentioned in the previous sentence.

Response 22: The reader here refers to those whoever read these memoirs. Issues with clarity are resolved as per the suggestions.

Comments 23: Lines 434-435: The point that the particularized experience of breast cancer expressed here goes against how the article tends to fall back on the generalization about what distinguishes female and male breast cancer narratives.

Response 23: The particularization of BC experience is an instance of how each BC patient is poised for a unique yet a more generalizable experience. Memoirs serve both as individual and collective accounts.

Comments 24: Lines 443-444: The argument that Nina, as an FBC patient, is in a more “advantageous position to overcome challenges as multiple discourses on FBC are available for her”, completely ignores how the research has highlighted the epistemic injustice of, for example, the Pink Ribbon culture’s privileging of a certain breast cancer ideology focusing on survival and happiness. Here, too, a more problematizing approach would have been appropriate, one that did not take for granted that all discourses on female breast cancer are good. 

Response 24: The article is premised upon the argument that with respect to FBC there is a very thin chance of encountering hermeneutical injustice. However, male breast cancer patients are bound to suffer that fate as there is no trail of discourses concerning the experience of MBC. Hence, Nina is at an advantageous position in terms of hermeneutical injustice.

Comments 25: Lines 456-458: Unclear why the article ends by advocating for more MBC memoirs. Increased publication of MBC memoirs and other male breast cancer narratives does not necessarily mean that epistemic injustices are corrected, but, as the research on women’s breast cancer narratives has shown, they can create new norms and demands for writing about breast cancer in the “right” way. Here too, a more problematizing approach to the “pink ribbon and blue-ribbon culture” is called for.

Response 25: Yes, the argument is right. Creating new norms and demands for writing about breast cancer in the “right way” will be facilitated when more male patients will voice their narratives. Every narrative has the capacity to enrich the field because each person’s voices showcase varied stories of epistemic injustice.

Comments 26: Line 465: Who refers to the term “the readers” here? Cf. line 411.

Response 26: Same as response 22.

Reviewer 3 Report

Comments and Suggestions for Authors

At a few points, the authors substitute "victims" for "patients"--see p. 2 of 11; keep "patients" consistent throughout;

Similarly, "woman's disease" becomes "woman's complaint" on 3, and this also weakens the discussion;

In the last paragraph on p. 4, I would like to see a little more elaboration around the subject of  "insufficiently articulated empathy";

Where is Alan located, as his situation is contrasted with that of the UK on p. 5.

In general, the long body paragraph following 3 on p. 5 is sloppily written. I recommend more precision in the points stated. For example, I don't understand the use of "has referred to" and "has emphasized" as opposed to "refers to" and "emphasizes" given that points in literature are always ongoing. This issue with verb tense continues on p. 6.

On p. 8: "In Alan's case, he has found himself in a part of the world with utter confusion..." I do not follow how "in a part of the world" is being used here;

Comments on the Quality of English Language

In the conclusions section on p. 9, I would like the authors to address if there is crossover or mutual value in the gendered memoirs in relation to breast cancer.

Author Response

Reviewer 3:

Comments 1: At a few points, the authors substitute "victims" for "patients"--see p. 2 of 11; keep "patients" consistent throughout;

Similarly, "woman's disease" becomes "woman's complaint" on 3, and this also weakens the discussion;

Response 1: The suggestion is incorporated. The word “victims” is replaced with “patients” and “woman’s complaint” is replaced with “woman’s disease”.

Comments 2: In the last paragraph on p. 4, I would like to see a little more elaboration around the subject of "insufficiently articulated empathy";

Response 2: The suggestion is incorporated. One sentence is added to elaborate the matter.

Comments 3: Where is Alan located, as his situation is contrasted with that of the UK on p. 5.

Response 3: Alan was born in west London but he currently stays in Netherlands. He provides the male breast cases from the UK in his memoir

Comments 4: In general, the long body paragraph following 3 on p. 5 is sloppily written. I recommend more precision in the points stated. For example, I don't understand the use of "has referred to" and "has emphasized" as opposed to "refers to" and "emphasizes" given that points in literature are always ongoing. This issue with verb tense continues on p. 6.

Response 4: The long paragraph is modified to add precision. The issue with present perfect tense is resolved by using simple present tense instead.

Comments 5: On p. 8: "In Alan's case, he has found himself in a part of the world with utter confusion..." I do not follow how "in a part of the world" is being used here;

Response 5: The phrase “in a part of the world” is removed as per the suggestion.

Comments 6: In the conclusions section on p. 9, I would like the authors to address if there is crossover or mutual value in the gendered memoirs in relation to breast cancer.

Response 6: The suggestion has been addressed in the conclusion (revised manuscript ll. 542-546)

Reviewer 4 Report

Comments and Suggestions for Authors

The topic of this paper, the relative "epistemic injustice" between male and female cancer patients, is worthy and of interest.  My judgment is that the essay is not appropriate for Humanities, or for a special issue on Literature and Medicine, in that it does not demonstrate close-reading or a literary approach to the two memoirs under consideration.  

Comments on the Quality of English Language

The topic of this paper, the relative “epistemic injustice” experienced by male and female breast cancer patients, is worthy and compelling.  I regret that I don’t think this approach is appropriate for the journal Humanities or their special issue on Literature and Medicine in that it does not take or demonstrate a close-reading or literary approach to the memoirs under consideration. 

Author Response

Comments 1: The topic of this paper, the relative "epistemic injustice" between male and female cancer patients, is worthy and of interest.  My judgment is that the essay is not appropriate for Humanities, or for a special issue on Literature and Medicine, in that it does not demonstrate close-reading or a literary approach to the two memoirs under consideration.  

Response 1: The article employs a close reading of the two literary texts that fall under the life writings genre to explore the nuanced understanding of literature and medicine each one of them contains. The authors are convinced that the paper is about the interconnections between literature and healthcare.