Kelly Joyce’s book, “Magnetic Appeal: MRI and the Myth of Transparency,” comes to you with one prestigious award and one small mystery.
The book was recently announced as the 2010 Eliot Freidson Outstanding Publication of the Medical Sociology Section of the American Sociological Association. That’s one of the biggest sections of the ASA, and the award actually covers books published in 2008 and 2009. Joyce, an associate professor of sociology at William & Mary, will receive her award next month in Atlanta.
Now the mystery: A book or journal article must be nominated for the Freidson. Any member of the Medical Sociology Section of the ASA is eligible to make a nomination. Joyce doesn’t know who did her the honor, but she’s grateful he or she appreciated her efforts.
“I really wanted to tell the story in such a way that would not lose the complicatedness of the tale but would let people read it,” she said. “I think it’s a mistake to think that you can’t talk about complicated ideas in good, lively, clear language.
“I think what makes the book come alive are the stories from the technologists and radiologists. You get to hear what they’re thinking as they are working and what they’re saying when they’re talking frankly about their jobs and what the technology can do.”
Joyce unearths several other curiosities in “Magnetic Appeal:”
• That the original name for Magnetic Resonance Imaging – MRI to you and me – was Nuclear Magnetic Resonance Imaging. That was before radiologists in the United States cringed in unison at trying to sell that to the public. The name was changed, and Joyce says people in other parts of the world are still a bit miffed.
• The fact that some mainstream media outlets, like Time Magazine, introduced MRI years ago by boasting that it was going to cure cancer and other diseases.
• The fact that early MRI scans produced in hospitals were in color, until medical professionals informed manufacturers that they did not have color printers, and they could make more effective use of gray scale images because they showed gradations between healthy and non-healthy tissue in the human body that color didn’t reveal.
• That there are a few tiny labs that have invested in training dogs to sniff out melanomas on a patient’s body, or to sniff their breath to see if they have lung cancer. These are tiny projects, Joyce says, but reporting on them helps engage the reader and gets us to imagine other ways of knowing the body beyond seeing.
Tasty as those factoids are, “Magnetic Appeal” succeeds because of the hard work Joyce put in during research she conducted from 1999-2006, and the way she brings that to the page. She studied MRI units in three different places, observing how technologists made the images, how radiologists interpreted them, and how physicians interpreted them.
She tells the history of the machines, interviewing inventors who subsequently won the Nobel Prize. She gathers candid interviews from everyone involved in MRI usage, many of whom told her that they had never been accorded the opportunity to talk.
And she argues that there is an over-reliance on the MRI.
Doctors confided in her that they order so many MRIs – only Japan uses them more frequently than the United States -- because they generally have little time with patients, not time enough for a thorough, hands-on examination.
“And these are people who are under enormous pressure to figure out how to do good medicine,” Joyce says.
Then there are the fee-for-service health-care plans. Most of us have them. MRIs generate enormous revenue for hospitals and providers, which only encourages their use as well as other tests.
The fear of malpractice, of course, plays a role. In court cases these days, the legal system decides what is good medicine. In general, the courts look favorably on MRI exams.
“One of the things I argue in the book is that part of the reason we love MRIs – and all of us love them, including health-insurance companies -- is that it creates pictures.” Joyce said. “As a culture, if we see a picture of the body, we think it’s real and true and that it’s equivalent to the body. And we have a deep reverence for these pictures.
“It’s also made by this incredibly high-tech machine. So we’ve got two things we love in the United States: a high-tech machine and pictures, anatomical pictures. The courts are no different.”
Joyce hastens to say that MRI “is a wonderful technology, and it really has an important place in medicine. It helps the doctor and clinicians diagnose diseases where they normally would have had to do surgery.”
That said, the results of an MRI are only as accurate as the human being operating the machine and the human being interpreting the scans. A technician can be just slightly off in deciding what part of suspicious tissue to MRI, and something serious can go undetected. And, a radiologist is needed to translate the scans into usable information about health and illness. Beyond this, we still need the referring clinician to make sense of the MRI findings as well as other information culled from tests and patient histories.
“You still need that human in the office thinking of how to put all of the pieces together that they gather about the body,” Joyce said, an elementary fact that she says society overlooked for years.
But, the reverence for MRI may be starting to change.
“A news article was not simply news, it was an advertisement for why you should go to this hospital or this imaging center, because they now have the biggest, best MRI machine,” Joyce said. “TV shows were the same way. (Now) In ‘House’ the MRI is no longer a sacred, reverent object. It is a routine object that is sometimes, often, wrong.
“I’m curious to see what happens as stories critical about MRI become routine. Is it not going to have that reverence—that belief that it is going to save us from other diseases we face, like cancer, or MS, things we’re hard-pressed to solve? I wonder.”