The World's Fair is pleased to offer the discussion below about a fascinating new book, Magnetic Appeal: MRI and the Myth of Transparency, with its author Kelly Joyce. Joyce is an Associate Professor in the Department of Sociology at the College of William and Mary.
Professor Joyce has a degree in anthropology, a doctorate in Sociology, a resume that includes a few years of teaching at Harvard, and a kind demeanor. She is also the co-editor of the Encyclopedia of Death and the Human Experience (Sage, 2006). Magnetic Appeal will be published in June by Cornell University Press (but you can pre-order it now at the on-line vender of your choice). Among others, it speaks to issues of healthcare, public policy, diagnostic technologies, ways of knowing the body, and cultural images and narratives of progress in American culture. With those themes, the book, as Joyce explains below, is a contribution to the sociology of science and medicine, science and technology studies, and anthropology of medicine and technology. It is quite possible, perhaps very likely, I'll admit, that most people know very little about any of those fields of study. Hopefully this book can shed some light on what they are by dint of example. For those interested in an article on the subject that provides deeper historiacl and cultural context to the visual turn in medicine of which MRI is a part, you might check out Joyce's "From Numbers to Pictures: The Development of Magnetic Resonance Imaging and the Visual Turn in Medicine," in the journal Science as Culture (Vol. 15, pp. 1-22, March 2006).
This is the tenth in our series of "Author Meets Bloggers" posts, where we talk to authors about their new work. (See them all here.) What follows is part one of a four-part conversation about Magnetic Appeal. We encourage all questions and comments.
THE WORLD'S FAIR: A book about MRI comes across as imminently fascinating for perhaps the reasons you explain in your intro: that it is a cultural symbol of modern medical technology. So then: What's your book's main argument?
KELLY JOYCE: Okay, here it is: In the United States, MRI is socially constructed as a sacred technology--one that represents progress, certainty, and good health care. The technique's sacred status is achieved in part because cultural ideas link anatomical pictures and mechanical reproduction to transparency and truth. But, it is also achieved because information about contexts and actors is often missing from popular discussions of MRI. In Magnetic Appeal, I bring those contexts and actors back in to examine why MRI is perceived the way it is, how technologists and physicians make sense of and use the technology in clinical work, and how advertising, fear of litigation, reimbursement policies, and research funding all contribute to MRI in practice.
WF: Why do we need to know this stuff now?
KJ: In the United States we are taught that good health care equals access to MRI exams. This equation applies to human health care, and it is starting to apply to animal health care as well. (People may now have a veterinarian recommend an MRI for their pet). Given the cultural status ascribed to MRI as a diagnostic technology and the seriousness of health and illness issues, people may want to learn more about the machine, the exam, the medical professionals who conduct and use the exams, and the other issues (e.g., the pressure to increase productivity by seeing more patients, litigation concerns, advertising) that contribute to how the technology is used in clinical medicine.
Clearly, MRI is an important diagnostic technology. But, we should understand the limitations of the knowledge produced by its use as well as the other policies and practices that shape how clinicians use the technology in their practices. My hope is that Magnetic Appeal will start a dialogue with readers about perceptions of MRI and the changing conditions of work for medical professionals. I look forward to hearing what people think about these issues.
WF: The other angle here is: you've got a great title, a great subtitle, and a great cover image. Why push it? Why look inside? You had me at the cover.
KJ: The press created a good cover, I agree. But, you know this, we often talk about the culture/science tangle. Even this blog is part of Seed, with its "Science is Culture" tagline. This book offers an empirical inquiry into that issue. Following technologists and physicians in their daily work practices shows how medical professionals simultaneously contribute to and are shaped by cultural contexts. It also offers some insight into how policies and institutional practices contribute to work in imaging units. Health care and health issues touch us all, and we need more research and discussion on work practices in clinical medicine.
WF: You say too that it examines the cultural, political, and economic contexts that shaped MRI. Am I too bold to ask right off, what were they, those contexts? What's the answer?
KJ: Well, it is complicated. There are many cultural, political, and economic contexts that contribute to perceptions and uses of MRI in the United States. Let's start with cultural contexts. From picture-producing cell phones to DVD players and recorders, visualizing
machines are central to the construction and performance of identities and relationships in the United States. Moreover, anatomical images, although they can be challenged and debated, are often viewed as visual testimony--one that provides unmediated access to the body. Our personal access to MRI may be limited (e.g., clinician referral bias and the high cost of exams can affect one's ability to get an MRI). But, the presence of the visual in contemporary life and the link between images and truth provide the technological support and cultural familiarity needed to legitimize MRI as a producer of technoscientific knowledge and identities.
This turn toward the visual occurs simultaneously with cultural anxieties about chronic illnesses such as cancer, Multiple Sclerosis, and Parkinson's disease. So, we have a situation in which people are concerned about health issues and looking (rightly so) for ways to address these concerns.
WF: Okay, in addition to the cultural contexts, like the value of the visual, what would you say?
KJ: Economic and political factors such as marketing to physicians, hospital administrators, and patients; fee-for-service reimbursement schemes; diminishing reimbursement payments; the emphasis on productivity in clinical work; concern about litigation; research and development investments; and medical standards all contribute to current MRI use. I take up these issues in detail in Chapters 4 and 5 in the book. The important point here is that all these factors combined transform MRI into what sociologists Adele Clarke and Joan Fujimura call "the right tool for the job." Because of this, there is no easy fix for our reliance on MRI in medical practice.
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II: Cyrus Mody on nanotechnology, ethics, and policy.
III: Saul Halfon on population , demography, and women's empowerment.
IV: Kevin Marsh on wilderness, forestry policy, and environmental politics.
V: David Hess on Alternative Pathways in Science and Industry
VI: Lizzie Grossman on e-trash and global environmental policy
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Nice, timely article...I've just been involved in a MRI debacle of my own (re: broken leg, messed up ankle).
In short, my younger doctor who gives the impression of being rather dense at times insisted on the MRI because "it gives the best results." Neither my insurance company nor hospital would agree to tell me how much the procedure would cost (in fact, they both patently refused, claiming the other was obligated to tell me). In the end, the MRI ended up costing over twice what the general estimate on the insurance website quoted. The MRI ended up revealing nothing that my doctor didn't already know...and the hospital tried to double bill me for a host of related costs...which i called my insurance to adjust...which they did...INCORRECTLY...costing me more money...then i had to call them back and have them adjust it AGAIN...the results of which are still pending. I wish I had never gotten the #$%# MRI in the first place.
I envision some dinner party somewhere involving my doctor, my insurance company, the hospital staff, and, now, the MRI machine itself...where they are all snickering to themselves and keep offering each other congratulatory high-fives -- while buying each other rounds of shots with my money. But I wasn't invited.
F#$%$#%ers.