Perfectable Medicine   2 comments

As Cartwright points out, technologized medical imaging, beginning with the X-ray, “has been crucial in the shaping of public perceptions of life, health, and the body” (108). As modern consumers of medical lore, our ideas of health reflect our cultural belief in the primacy of science and technology. And the technology is wonderful; I have a good friend who is alive today because of MRI imaging. Still, I wonder if the drive to deliver a transparent body—the technological trajectory John Lamothe referred to in his post last week—is only for the good?

Van Dijck sounds a skeptical note in his questioning of virtual endoscopy, but my concerns fall closer to something he touches on much earlier, when he mentions that diagnostic imaging is a very profitable business “approaching a $100-billion-a-year business in 2004” (9). Ah, yes—the buck stops here. Even though technologically mediated “transparency has come to connote perfectibility, modifiability, and control over human physiology” (van Dijck 5), there is something else the technologies of transparency perform: they also help define affordable and unaffordable medical care. The focus on rendering some bodies transparent—those with access to healthcare—results in the unintended consequence of rendering other bodies invisible—those without access to healthcare.

Van Dijck asserts that “every instrument that opens up new vistas also sets new restrictions” (70), an observation that reminds me of Paul Virilio’s concern over the unintended consequences of run-away technology. Virilio tells us that each invention brings with it its own form of accident: “when the railway was invented, derailment was invented too” (Virilio 82). We see this in Cartwright’s history of the X ray, where even those who understood the dangers were seduced by the belief in the X ray’s transformative potential, a belief that could cost a life. And this is not something limited to the nineteenth and early twentieth century: earlier this year, the F.D.A. was accused of ignoring known dangers from CT scans, and allowing patients to be exposed to dangerous levels of radiation (Harris).

New imaging technologies not only potentially provoke new interventions, such as the complications van Dijck lists with endoscopic gall bladder surgery (70), but also potentially limit access to curative actions by normalizing very expensive procedures. I’m thinking of my father as I write this; he died from colon cancer in a time before endoscopic examinations became the normalized process for detecting pre-cancerous polyps. Such an examination could very well have saved his life—or maybe not, since for most of his life he was a non-union carpenter without health insurance. Early detection, even if the technology had existed, would have been out of reach.

The only way most patients can access the latest imaging technologies is with a good insurance plan, as these procedures are very expensive; nevertheless they are marketed to us as easy, available options. Van Dijck relates the television shows which make “endoscopic operations look easy, painless, and sometimes even pleasurable” (81); he is concerned with the ethics of the medical specular gaze. I wonder at the ethics of a system which focuses so much time, energy, and intellect producing technologies that may save some lives, but at what cost? A medical system that places most care—even basic care—financially out of the reach of a significant portion of the population challenges the true utility of sophisticated equipment. Van Dijck’s observation that “medical futurologies challenge and complicate our ability to distinguish between reality and fantasy, projection and extrapolation” (77) is aimed at virtual surgical techniques, but also applies to our understandings, as a society, of the definition of “rational expectations” when it comes to medicine.

My question: What are the social implications of a technologically advanced diagnostic/treatment system that achieves “perfectibility” for some, but leaves a significant portion of the populace dependent on what becomes perceived as archaic or ineffectual practices?

Sidenote: My favorite metaphor of the semester is in van Dijck’s text: “images of pastoral bioscapes” (12). This is paired with the very disturbing account of the suffocating cat in Janker’s experiment (Cartwright 133-34). When I read about his clinical detachment, I couldn’t help but think that serial killers start with cruelty to animals. Then it turns out he’s a Nazi.

some interesting sites:

Here’s the GE “Take a Look” ad: http://www.ge.com/audio_video/ge/advertising/take_a_look.html

The guys who make the technology: http://www.aapm.org/medical_physicist/info.asp

Works Cited:

Cartwright, Lisa. Screening the Body: Tracing Medicine’s Visual Culture. Minneapolis: U of Minnesota P, 1995. Print.

Harris, Gardiner. “Scientists Say F.D.A. Ignored Radiation Warnings.” New York Times, March 28, 2010. newyorktimes.com. Web. 1 Nov. 2010.

Van Dijck, José. The Transparent Body: A Cultural Analysis of Medical Imaging. Seattle: U of Washington P, 2005. Print.

Virilio, Paul, Friedrich Kittler, and John Armitage. “The Information Bomb: a Conversation.” Angelaki 4: 2 (1999): 81-90. Informaworld. Web. 1 Nov. 2010.

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Posted November 2, 2010 by MGalbreath in Uncategorized

2 responses to “Perfectable Medicine

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  1. Hi:

    Since you brought up the money aspect–and how coud one not?

    I remembered an NPR story from a while back about medical care in the US having no clear cut price consistent from hospital to hospital or city to city. A 900.00 MRI of the shoulder costs 450.00 at a facility literally on the same street somewhere in Pensacola Florida.

    A real shocker in the story was that one interviewee was surprised that his MRI cost over 1700.00 after insurance haggling. Why was this a shocker? The man was/is
    a professor of diagnostic radiology and also of management, also of public health, and also of economics at Yale University. If he does not know the what, how, and why of medical imaging costs, what chance do the rest of us stand?

    In Japan the same procedure that this prof paid 1700 for costs 160. Why? Because in Japan consumers do not mind machinery being last year’s model. In the US we want the newest shiniest pimped out scanners available–even the med students will do residencies only where the technology measures up to the bells and whistles in the med school.

    Elle

    http://www.npr.org/templates/story/story.php?storyId=120545569

    • How interesting about the Japan story–you are right on the mark, in the US we somehow think we are being shortchanged if the technology we have to use is outdated or outmoded. Call it successful marketing–the mindset of technophilic desire is manufactured just as surely as the machinery itself is manufactured.

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