Magnetic Appeal: MRI and the Myth of Transparency

Abstract

Joyce, K. A. Magnetic Appeal: MRI and the Myth of Transparency . London : Cornell University Press 2008 . 208 pp. $21.95. (pbk) ISBN: 978-0-8014-7456-9 Magnetic Resonance Imaging (MRI) occupies a privileged position in health care. MRI exams produce anatomical images that are used to diagnose pathologies in patients’ bodies. In Magnetic Appeal, Kelly Joyce rewrites the story of MRI, situating its use within its cultural, historical, and political economic contexts. Since its introduction to clinical practice in the 1980s the use of MRI for medical diagnosis and treatment has been dramatically increasing. Rejecting the simple explanation that ‘we use it because it is the best’, Joyce demonstrates how culture, politics, and economics make MRI the right tool for the job. An excellent example of methodological inclusiveness, Magnetic Appeal draws on seven years of in-depth research including interviews, content analysis, multi-sited fieldwork, and targeted literature reviews. The methodology, which is detailed in the appendix, allows Joyce to capture the complexity of forces that constitute MRI. Magnetic Appeal’s six chapters are written as standalone essays. Taking her cue from Donna Haraway, Joyce describes the essays as ‘diffractions’ into the world of MRI. Every chapter interrogates MRI from a different angle, each in turn questioning cultural assumptions in conjunction with the social, political and economic relations that support and define the use of MRI. Taken together the chapters of Magnetic Appeal open a fascinating window into the realm of medical imaging technology. Rejecting causal explanation in favour of the co-production of social phenomena Joyce paints a complex picture of MRI that challenges our understanding of technology and its use in healthcare. The rise of MRI technology is situated within a broader trend of visualisation where everyday life is increasingly transformed into visual images. Cultural beliefs that equate seeing with believing make the anatomical pictures produced by MRI the equivalent of an unmediated depiction of the inside of the body. In this cultural context, MRI is a technology of truth. But, MRI exams do not reflect the interior of the body, they produce it. Joyce argues that linguistic tropes used to talk about MRI in popular discourse erase the processes of human decision-making and interpretation that construct the anatomical images produced by MRI and support its increasing use. Joyce challenges the authority accorded to medical images by revealing the actual practices that go into creating and interpreting the images produced by MRI. Interviews and observations with the technologists and radiologists who use MRI machines provide access to the tacit knowledge that reveals the work of creation, interpretation and translation that produce the body in MRI exams. Technologists make decisions about the parameters of the images that MRI machines will produce that affect the final image outcome, while radiologists are responsible for sorting out pathology from normality in the scans that often contain ambiguous ‘artifacts’ and unidentifiable ‘objects’. The tacit knowledge of radiologists and technologist challenges the belief that MRI exams reflect the inner body by highlighting the uncertainties of diagnosis through medical imaging technology. Ethnographic methods also bring to light how MRI workers are constrained by forces such as pervasive organisational emphasis on speed and efficiency rather than quality of patient care. The book includes a political economy chapter, where MRI is analysed as a commodity, situated within corporate and governmental structures. In this diffraction MRI use is promoted by factors including advertising, fee-for-service reimbursements, government investment and policies, medical standards of evaluation, and fear of litigation. The analysis of the circuits of exchange adds depth to the book and expands the analytical terrain of studies of medical imaging technology and illuminates how the forces of profit in conjunction with the cultural prominence of imaging technology support the rising trend of MRI use. Physicians and radiologists are aware of this connection between the bottom line of MRI machine producers and how that affects their work practices. Acutely aware of how fear of litigation affects MRI use, the phrase ‘cover your ass medicine’ is used to describe how some doctors order unnecessary scans to avoid malpractice suits. Although each chapter contributes significantly to the overall picture, it is not until the final chapter that Joyce weaves all the strands together. In the last chapter, Joyce suggests that we think of MRI as a sacred technology. As computer imaging becomes increasingly critical to how we understand our bodies and our selves, technologies such as MRI become symbols of hope that can magically show us the way to health and happiness. The connection to religion highlights the faith that we have in medical imaging technology and most powerfully emphasizes the significance of the multi-sited study of MRI. A valuable read for those interested in medical technology, trends in healthcare, and science and technology studies, Magnetic Appeal brings to light the multiple factors that constitute our faith in medical technology.