Part 2 with Kelly Joyce, author of Magnetic Appeal: MRI and the Myth of Transparency, follows below. All entries in the author-meets-bloggers series can be found here.
WF: You also discuss the importance of the users of technologies in the development and identity of those technologies (like MRI), right?
KJ: Right. In studies of science and technology, scholars can and do study how users of a technology actively contribute to its design, creatively negotiate design limitations (e.g., how old people put tennis balls on a walker's legs to create traction), or meaningful interpret it. Although this body of work is excellent, it tends to define users as consumers or the public. In contrast, scientists are not generally understood as users even though they can also contribute to, negotiate, and symbolically interpret technological design. This conceptual move may unintentionally establish the idea that scientists are distinct and different from consumers/the public when it comes to using technologies. While there are differences between these two groups, there are also similarities. In my work, I focus on medical professionals as users of MRI technology and try to expand our understanding of users to include scientists as well as the general public.
WF: Who am I kidding, I want to get back to the visualization theme, which has absorbed this site for a few months now (might as well start with this preface and work your way through). Visualization in medical practice has been the subject of even greater scholarly attention than the users-producers tension, and you quote Foucault's observation about the birth of the clinical gaze in the 18th century to this effect. How about how visualization technologies fit into a larger story of the history of science and medicine?
KJ: That's fair, but we have to back up for a second. Let's talk about the relation between visualization, medicine, and other areas of social life. A central argument of Magnetic Appeal is that the development of MRI technology and our desire to use it must be understood in relation to the broader socio-technical turn toward visualization. From family pictures and personal videos to the mass media of television, movies, and newspapers, all that stuff I mentioned a few questions ago, we are inclined to represent life in picture form and to perceive the stories pictures present as meaningful representations of events, social relations, and people. Biomedical practices are part of this socio-technical turn: They simultaneously contribute to and are shaped by the proliferation of the ways in which we represent ourselves and our world visually.
WF: There are a host of other issues that unfold from this, I take it.
KJ: Visualization technologies are crucial components of medical work, and, as you point out in the question, are one way the clinical gaze gets enacted. And you're right, there are a lot of issues we could discuss here (e.g., the relation between corpses and medical knowledge; surveillance), but one is the concern that reliance on the visual causes a devaluation of and/or a lack of investment in other ways of knowing the body. In the final chapter of the book I talk about the importance of patient histories in diagnostic work, research that trains dogs to sniff out melanoma, and biochemical diagnostic procedures. Of course, these techniques should not replace MRI, but we may want to consider the value (or lack of value) placed on them as knowledge producing tools.
WF: How about that whole NMR-to-MRI switch. Is there more of a back story to the one I know - that patients didn't like to have "nuclear" tests performed on them?
KJ: There are two things to consider about the switch. First, there is a difference between what patients actually thought or said and what physicians believed patients would think or say about the technology. As far as I can tell, the name change occurred because physicians were concerned that patients might react negatively to a machine call nuclear magnetic resonance imaging (which was the initial name of MRI). This concern caused the American College of Radiology to endorse the change from NMR imaging to MRI. If anyone knows of actual patient negative reactions to the name NMR imaging in the 1980s (which is when the name change occurred), I would love to hear about it.
Second, some say that change from NMR to MRI was part of a professional turf struggle. When MRI was first developed, it wasn't clear which medical profession would control it. Nuclear medicine physicians and radiologists were two possible choices. In this explanation, radiologists advocated for the change to help cement their control over MRI technology. The name NMR imaging aligned the technique with nuclear medicine whereas the name MRI distanced the technology from that profession. Again, if people have more info on this explanation, I would love to hear it.
WF: You're being modest in a way there, because actually I can't believe how many people you talked to in your research, how many journals you read, how many hospitals you spent time at doing your field work. You liked that work? Or was it just a drag?
KJ: Fieldwork and tracking down information by calling people at various organizations (e.g., the Food and Drug Association, cryogen companies, the Centers for Medicare and Medicaid, private research firms) were incredible experiences. The people I observed and spoke to were knowledgeable about their work, organizations, etc., and extraordinarily generous with time and information. So yes, I loved it, and I valued their willingness to share their ideas and perspectives with me.
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This interview is skirting around the key question so far. First, the book subtitle calls the MRI the "myth" of transparency. The Amazon blurb for her book states, "Kelly A. Joyce shows how MRI technology grew out of serendipitous circumstances and was adopted for reasons having little to do with patient safety or evidence of efficacy."
These are much more provocative claims than have not been covered in this Q&A so far. Why is transparency a "myth"? Granted we aren't seeing everything within the body, but MRI definitely shows us things that were previously opaque or required invasive technologies.
As for the claim in the Amazon blurb, where is the evidence of little regard for safety? Have known risks been hidden? Are the many studies on safety missing obvious issues that the author has identified? Are screening protocols to keep metal out grossly ignored? I'd like to hear why the author things there are unresolved safety issues.
The author then says there is little evidence for efficacy. She talks about litigation and defensive medicine issues in the Q&A, but saying we're using MRI much more often than necessary is very different from saying there is little evidence of efficacy. Most neurologists can diagnose an amazing array of conditions with only a few hand tools. Still, MRIs are often ordered because they know the limits of their tools and for serious conditions more sources of data really do help with diagnosis and treatment plans. Ask a neurosurgeon to perform major neurosurgery without MRI guidance. Even the ones who worked pre-MRI would never do it today because the accuracy is so much higher. I can keep going, but I'd definitely like to hear more support for this claim of no proof of efficacy.
I have just read the Amazon blurb from the Zondervan NIV Study Bible, Personal Size, and it said, "The Worlds Best-Selling Study Bible Now Raises the Standard Even Higher That's because its celebrated study notes have been thoroughly revised. Turn to any page and discover the difference: over 20,000 of the Zondervan NIV Study Bibles Gold Medallion Award-winning study notesnow meticulously updated and expanded to reflect the most current conservative Bible scholarship. Unmatched in any other study Bible, these notes place at your fingertips a treasury of instant commentary from todays top evangelical scholars. Icons highlight notes of special interest in the areas of character study, archaeology, and personal application. Simply put, you won't find study notes as complete, up-to-date, helpful, and easy to use anywhere else."
I'm sorry, but where's the evidence for "unmatched" and "meticulously updated"? I've found most bibles just drone on and on about judgment and then, crazily, shift to forgiveness. I am unhappy.
Iwn, I'm not sure what your point is. The Amazon blurb is from the publisher as a way to sell the book. This is an interview with the author of the book. Asking an author, especially a sociologist, why a book is marketed in a certain way seems very reasonable.
I'm not sure if this interview was done in a single session and is being posted serially or was conducted in separated session (I assume the latter), but it would be nice if through the interview or these comments, the author would be willing to address at least what she sees as the "myth" part of MRI.
The 3rd part of the interview doesn't seem to address these questions either.
bsci -- If any, I'd say the blame here is on me. You've asked a question that I hadn't and thus, not surprisingly, it has not been answered. I needed to ask Prof. Joyce this: "What does 'myth' refer to in the sub-title, 'The Myth of Transparency'?"
She may get a chance to reply to that in this space, but we are operating on different academic schedules so I can't say how quickly that would happen.
I suspected the interview was already completed, but I figured that this is about as good a place as any to ask the question. Thanks for the reply.