Magnetic Appeal: MRI and the Myth of Transparency

5. The Political Economy of Magnetic Resonance Imaging

5 The Political Economy of Magnetic Resonance Imaging M agnetic resonance imaging, like all medical procedures, is a commodity that operates within political and economic systems of exchange. It represents multiple industries that generate income for the owners and producers of machines, parts, and accessories. Continuing to work with the concepts of commodities and mass production , this chapter maps the flow of capital in MRI manufacturing and service industries. Five factors—advertising, fee-for-service reimbursements, government investment and policies, medical standards of evaluation, and fear of litigation—operate in conjunction with cultural beliefs that link the image to transparency to co-produce the exchange of money in the visual medical marketplace.1 Attending to the corporate structure of medical knowledge illustrates how the growth and configuration of MRI industries are part of the economic transformations in U.S. health care that occurred during the 1980s and the 1990s. During this period, for-profit hospitals increased in number, 1 Co-production theories call attention to the relations between science and society, and examine how each constitutes the other (Jasanoff 1995, 2006). In this framework, science is not a reflection of the social (defined primarily as political institutions), nor is the subjective nature of the social removed by science. Clarke et al. (2003) expand the co-production framework by theorizing the co-constitutive relations among culture, economic relations, state policies, technoscience, and actors. Their understanding of co-production complicates the definition of society, showing how it is comprised of many components—each of which is worthy of sustained attention. replacing nonprofit institutions, and private companies owned and operated more areas of research, products, and services (Clarke et al. 2003; Turnbull 1996; Relman 1997a). As medicine moved toward a market model of health care delivery, patients became positioned as consumers. This was a time when advertisements for hospitals, drugs, and services proliferated, and the media told patients (now customers) to shop for the best treatment prices (i.e., ask for generic drugs, compare costs). The U.S. government even followed a consumer-choice model when it told seniors to evaluate and choose from a myriad of different Medicare plans for drug reimbursements. To discuss the new economic and political dimensions of post-1980s biomedicine, sociologists Adele Clarke, Janet Shim, Laura Mamo, Jennifer Fosket, and Jennifer Fishman (2003) coined the term Biomedical TechnoService Complex, Inc. The concept, through the use of the words techno and service, highlights the shift toward a boutique model of health care delivery—one in which technologically produced information (and the resulting identities) are commodities for sale in a stratified marketplace . Complex and Incorporated denote the networks that resulted from the mergers and acquisition of hospitals, insurers, and pharmaceutical companies and the growing presence of private, multinational corporations in health care. They also signal the influence and significance of health care industries to the national economy, which represent “13 percent of the $10 trillion annual U.S. economy” (Clarke et al. 2003, 167). As we will see, MRI–related industries are an important component of the Biomedical TechnoService Complex, Inc. The diffuse networks of industries and professions that produce and distribute MRI machines and examinations constitute a lucrative medical information industry—one that illustrates how anatomical images (and the knowledge produced through their use) can be understood only through analysis of corporate and consumer practices. How Many MRI Examinations and Machines? The number of MRI examinations performed in the United States and the income generated for multiple industries involved in MRI is quickly increasing . The IMV, a private research corporation, estimates that 21.9 million were performed in 2002 and 26.6 million procedures were performed in 2006 (Information Means Value [IMV] 2005, 2007). Industry analysts predict this number will continue to grow as new applications are found for the technology and it replaces computed tomography (CT) technology in some areas of body imaging. 110 MAGNETIC APPEAL In fact, total MRI usage rates have increased every year except for 1993 since the technology’s introduction to clinical medicine in the early 1980s.2 The health care debate in the first Clinton administration is thought to have slowed down MRI use in 1993 as physicians and health care professionals became more aware of possible scrutiny (Bell 2004). MRI exams generate a constant stream of revenue for imaging centers, radiologists, and (as discussed below) a stream of revenue for the...