Marissa Buccilli: Translating medical uncertainty and risk

The following story was written in Fall 2025 by Abbie Smith in ​ENGL ​4824​: Science Writing ​as part of a collaboration among the English department, the Center for Communicating Science, and the U.S. National Science Foundation COMPASS Center. The COMPASS Center is tackling the grand challenge of uncovering the genetic, molecular, cellular, and chemical rules of life underlying virus-host interactions through community-based and ethically grounded research. It is one of four Predictive Intelligence for Pandemic Prevention (PIPP) centers funded by the National Science Foundation.

First, the trial stopped. Then the headlines hit. Seemingly overnight, exam rooms filled with fear. 

    In 2002, the Women’s Health Initiative (WHI), a landmark study of postmenopausal women, halted a hormone therapy trial after preliminary data suggested an increased breast cancer risk. Patients stopped medications and clinicians scrambled to explain what the numbers really meant. The question on many women’s minds was: What happens next? 

    Marissa Buccilli, a Ph.D. candidate in Virginia Tech's Writing and Rhetoric program, investigates this exact question. Her dissertation examines the words surrounding that moment and focuses on how clinicians waded through the uncertainty and made population findings usable in everyday care. 

    “We know what was being said publicly,” Buccilli explained. “But what were the clinicians saying? What were the experts saying?” 

    Buccilli’s path to health communication wasn’t linear. 

    “My master’s thesis was on Confederate monuments and the materialistic and rhetorical effects of public spaces,” she said. However, that pivoted in her first semester at Tech. 

    “I was paired to work with Julie Gerdes, whose background is in vaccine rhetoric and risk communication. And I just loved the work that we were doing,” Buccilli said. “It was deeply community-engaged [and involved] a lot of participatory research.” 

    The mix of interests ran in her family. 

    “In my family, you're either in education or the medical field, and I find that I'm a hybrid of both,” Buccilli said.

    The Women’s Health Initiative study also became personal. 

    “My mom has over 30 years in the medical field, and yet, even her understanding of medical evidence and terminology didn't seem to give her any clearer answers,” she said. 

    Rather than re-analyze the medical results of the study, Buccilli looked at clinical discourse itself: “I wanted to understand how clinicians reason through turbulent times of medical and scientific uncertainty.”  

    She built a dataset of 27 editorials and opinion pieces from medical journals (narrowed from 100+) and coded them inductively using a qualitative data analysis program called  MAXQDA. Her goal was to understand how clinicians transform confusion into clarity and how they take uncertain data and turn it into usable knowledge for real patients. 

    Two patterns emerged from her research. First, many authors criticized how the WHI trial was set up. 

    “Many of the clinicians found the design of the Women’s Health Initiative to be methodologically limiting,” she said, pointing to “population discrepancies,” especially participant age. “A lot of the women who were in this particular trial were older, way older than the age of women who would even be entertaining the idea of hormone therapy, which means there’s automatically an increased risk for these older women.”

    Second, despite the limitations of the study, clinicians tried to make the findings usable in practice. 

    “Even with these discrepancies, clinicians still were finding ways to reinterpret the evidence so that the data was still usable,” a process that involves what Buccilli termed “risk proxies.” Through these proxies, clinicians narrowed broad population-level results to specific medical variables, creating a shared language for reasoning about risk in individual patients.

    Working in the clinical editorial genre brought its own challenges. 

    “I’m not a medical professional,” Buccilli said. “At first, I was overwhelmed. . .I’m approaching this from a rhetorical standpoint, I’m trying to see not exactly what they’re saying, but how they’re saying it.” 

    To bridge that disciplinary gap, she used artificial intelligence as a kind of intellectual sounding board. 

    “AI has helped me to understand medical and scientific terms that I don’t understand and also has been a way for me to work out some of my ideas. . .not generating the ideas for me, but just being kind of a dialogue partner, especially when dealing with medical terminology.” 

    As she analyzed, her thinking shifted. Clinical trials, Buccilli explained, often carry the optics that the evidence they produce is inherently true or broadly generalizable. 

    “And in some ways, and in some cases, there is truth to that,” she said. “But what this project really taught me is that rhetoric isn’t something on the periphery of science and medicine. It’s an integral part of it, because it’s a necessary part of clinical interpretation.” 

    Essentially, she came to understand that the way evidence is framed, qualified, and contextualized shapes how it can be used in practice.

    That insight opened onto a second question, one that reaches beyond the Women’s Health Initiative itself and into women’s health more generally. The WHI trial was an attempt to provide answers to long-standing clinical questions, yet it ultimately generated new forms of uncertainty. 

    “What does that say about the kind of medical knowledge we produce for women?” Buccilli asked. “I don’t have the answers to that yet,” she said. “But I’m thinking about it.”

    She also noticed how clinical interpretation can narrow who those findings are seen as applicable to. 

    “It’s almost like they’re trying to construct the right patient,” she said. “We can apply these findings to this patient or that patient, but who does that leave out? There’s some gatekeeping happening there. And I think we see that all the time in women’s health.”

    For Buccilli, naming these rhetorical moves matters beyond the page. 

    “We’re always going to have clinical trials that produce controversial questions. . .we can’t throw away that knowledge. And so what does that look like to maybe reinterpret that data in a way that’s usable still, or it’s conditionally valid, [as if you’ve] put a box around it?” she asked. By identifying how clinicians frame those “boxes,” she hopes to make moments of uncertainty less intimidating for both sides of the exam room. 

    “If a patient says, ‘I don’t want to take hormone therapy because you can get breast cancer from it,’ that’s a learning opportunity for [the] clinician to explain a little bit of the controversy,” Buccilli pointed out. 

    Buccilli wants doctors-in-training to have practical tools for that moment. She hopes to collaborate with medical schools on courses in scientific writing, risk framing, and communicating uncertainty. 

    “Evidence is always evolving,” she said. Helping future clinicians show how they interpret evidence, in terms of what they accept, condition, or reject, could build trust when it matters most. 

    Her next step is to translate these findings into short, teachable frameworks that medical educators and practitioners can use to make risk communication more transparent. She also hopes to extend the project methodologically by incorporating qualitative interviews with clinicians themselves. Moving beyond published texts, Buccilli wants to understand how these interpretive practices show up in everyday clinical reasoning and conversation, not just on the page.

    Nearly 24 years after the WHI headlines, the questions haven’t vanished. Instead, they’ve evolved. Buccilli’s work shows that transparency in medicine isn’t just about data, but also about dialogue. The ways in which clinicians frame uncertainty can shape both treatment and trust between patient and provider.

    Buccilli is now applying her knowledge of risk communication and her understanding of risk proxies to topics of pandemic prediction and prevention as a graduate research assistant with the U.S. NSF COMPASS Center (National Science Foundation Center for Community Empowering Pandemic Prediction and Prevention from Atoms to Societies). In this capacity, Buccilli is working with Gerdes to explore how communication shapes risk perceptions when it comes to pandemic science. As in the Women’s Health Initiative, evidence related to pathogens that have the potential to cause pandemics is rife with uncertainty and requires dialogue with scientific experts, policymakers, and those affected in the community.