Interpreting Hope: Scans as Life/Death Technology   Leave a comment

My first introduction to the PET scan was in regards to my mom’s often-referenced cancer diagnosis. I had heard the term, along with X-Ray, MRI, CAT scan, and other non-invasive viewing technologies (I use the term non-invasive loosely), but did not know what distinguished one from the other and certainly did not know how political its history and use could be. As far as my family is concerned, the PET scan is the method to delineate the location and advancement of cancerous tumors, and is the most advanced approach to track the return or growth of said tumors. Our reliance on such technology is literally based on life and death; all courses of my mother’s treatment have been determined using PET scans and, of course, the interpretation of them by her oncologist and his research team. Needless to say, reading this book (as well as last week’s class discussion) has been disconcerting and casts doubt on the very tool we have relied so heavily upon.

PET scans, along with other imaging technologies, are one part machine and one (or more) parts human interpretation. Such technologies are meaningless without human interaction. Like a car that sits immobile in a driveway until an individual starts the ignition, scans are meaningless without expert interpretation. Dumit plays on the “age-old axiom that a picture is worth a thousand words” to elucidate the complexity of PET image interpretation, indicating that perhaps “PET images require millions of words to be understood” (24). Each time my mom had a scan, we were given a printed sheet with results. The first time we had no idea what the numbers and references meant, and relied upon the doctor to decipher and translate for us. The second time, we put the results from each scan side by side and compared the numbers. “Look! All the numbers have gone down; that must mean the tumors are shrinking!” we so aptly determined. Of course this could have meant any number of things, but we read it as we wished, applying a combination of hope and common sense.

My mother’s doctor did not initially rely solely on the PET scan to determine her course of treatment. He also surgically removed a tumor and examined it “in person,” under a microscope, and confirmed what the PET scan “told” him. He has since only utilized scans (and physical exams) to track her recovery and remission. We feel comfortable with this for multiple reasons: 1) we have been taught to “believe” images (“seeing is believing,“ as referenced last week in class); 2) we have been taught to trust technology; 3) medical images are thought to produce “objective” data on which we can base our decisions; 4) our doctors tell us these images are reliable and we tend to trust doctors. As Dumit argues, “Brain’s imaging power comes to be a combination of scientific and medical authority, machinic and now digital objectivity, as well as cultural norms and social desirability” (113). The combination of such scientific and digital objectivity, paired with the role of doctors in our cultural and social contexts is powerful and leads to often unquestioned dependence on such technologies.

That judges are careful about the use of such imagery in the courtroom creates an interesting (and disturbing) paradox. Why are we willing to utilize and trust these images in the context of medicine and life/death treatments but not to trust them when determining innocence or guilt? Simply put, because jurors cannot interpret such images appropriately but bias can be produced through them. Dumit points to the power of images when interpreted by lay people or the public. He also addresses the role of rhetorical choices regarding such images. When doctors and such experts read these images, they do so through a different framework based on physiology and professional medical knowledge. Jurors do not have access to such knowledge so images can be misleading (and/or jurors can be persuaded based on such images and the choices that accompany their presentation). Much like we infused those PET scan results with our own meaning, jurors may do the same, creating another type of “life or death” situation based on easily manipulated and highly confusing images.

My discussion question is not necessarily related to my response but is something I thought about while reading: How do doctors or other “experts” negotiate “normal” brain scans with mentally ill patients? If we look to brain scans to explain abnormal behavior, how does this work when a “normal” brain results in “abnormal” behavior? Or vice-versa?

Posted November 9, 2010 by Lela in Uncategorized

Where’s the rhetoric?   1 comment

As always NPR kept me company on my home from UCF Monday evening. It was a great coincidence that Dr. Timothy Johnson was being interviewed about the healthcare bill and the state of healthcare in the US in general.

He asserted in no uncertain terms that the US spends two dollars for every one dollar spent in other developed nations and does not achieve better results. He also made the point that the healthcare exchanges that would be allowed under the new healthcare plan is the same as the healthcare provided to members of congress. This type of pick and choose plan is extremely popular and effective. Dr. Johnson goes so far as to call those senators and congress people who use terms like ‘government takeover’ hypocrites.

A wonderful analogy he offers to those so sure that government involvement will kill the insurance industry and devastate medical care quality is that the airline industry is heavily regulated by the government yet this industry makes money, and consumers are not in danger of safety regulations changing once the plane flies across the line between two states.

I write this not to complain yet again about the healthcare industry but to ask: Where is the rhetoric?  Where are the rhetors? Why don’t Americans–all Americans not just the one’s who listen to NPR–know that the healthcare plan will benefit the insurance agencies, and that it is the same coverage provided to congress members? How difficult it is to get this message out there? 

http://www.onpointradio.org/2010/11/healthcare-problems-pushback

Elle

Posted November 9, 2010 by elleok in Uncategorized

Cartwright Educational Films   Leave a comment

Two Educational Films found in Lisa Cartwright’s book. We can discuss them tomorrow during the presentation John and I are giving.

http://www.archive.org/details/they_do_come_back_1940

http://www.archive.org/details/let_my_people_live_1938

Posted November 9, 2010 by capochetta in Uncategorized

Ideas for Tag Lines for Patient/Community Education Campaigns   4 comments

Feel free to add to these. Let’s discuss all of our ideas in class tomorrow:
Breaking Down Barriers (to health care)
Convenient Connectivity
Healthy Connections
Streamlining Your Health (with EHRs)
Modernize Your Health (with EHRs)
Boost Your Health (with EHRs)
Health Care Records Made Easy
Connect, Share, Empower

Posted November 8, 2010 by jblakescott in Uncategorized

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.

Posted November 2, 2010 by MGalbreath in Uncategorized

Google Health and UnitedHealth Group   Leave a comment

SOOOO…apparently…after UHG signed on for a pilot of google health……they ended up creating their own “free” EHR hosting website that also offers information on diseases and wellness.  What I think is REALLY interesting is that, to use this site, you do NOT have to be an insurant of UHG….so access is not limited…..interesting.

 

http://www.myoptumhealth.com/portal/

Posted October 27, 2010 by terieleawatkins in Uncategorized

Oliver Sacks on Fresh Air   Leave a comment

I heard a portion of this interview on my way to work today, and I thought it really ties into Stacey’s text. Among other things, Sacks recounts his experience with a tumor which cost him the vision in his right eye.

http://www.npr.org/templates/story/story.php?storyId=130732146

Posted October 26, 2010 by MGalbreath in Uncategorized