Now That MRI Has Got Its Nobel Prize

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      
were awarded the Nobel Prize in medicine for their contribution
to the development of Magnetic Resonance Imaging
(MRI). I would like to take this opportunity to congratulate
Paul Lauterbur, who has been associated with the
University of Illinois at Urbana-Champaign for more than
fifteen years.
From the vantage point of the present the emergence of
MRI as a cutting-edge diagnostic imaging technology may
seem to have been inevitable. However, if we examine the
history of MRI we find that its development in the last
thirty years has been uneven and contested. In the early
1970s even the scientists were not convinced about the
possibility of magnetic resonance imaging. And in most of
the later half of the 1970s very few had faith that a diagnostic
technology using magnetic resonance could be developed.
The path of MRI development has also been contested,
with the continuing dispute over its “discovery”
between Raymond Damadian and Paul Lauterbur played
out in different arenas even after the award of the Nobel
Prize. And there have been other areas of contestation, too.
For example, in the mid-1980s MRI used to be called
Nuclear Magnetic Resonance (NMR) because it had developed
out of this technology. But radiologists did not wish
to use the word “nuclear” because of its negative connotation
and hence, in spite of the protests of scientists, decided
on the name MRI.
The development of MRI occurred at the intersection
of the interests of scientists, radiologists,multinational and
insurance companies, as well as government regulating
agencies located in several nations. If technology development
and deployment is located at the crossroads of so
many interests, it makes me wonder why there is so much
resistance to regulation of healthcare benefits such as MRI
scans in the United States. The pros and cons of healthcare
in the US in contrast to Canada, where the government is
the healthcare provider, have been debated for a long time.
Yet somehow there is a sort of (often resigned) acceptance
that the US healthcare system as it is presently set up is
It is not that the US government has not tried to regulate
the development and deployment of medical technologies.
Yet at present nearly half the MRIs in the world
are in the US and MRI scans continue to be very expensive
here. In the 1970s the Federal Drug Agency’s (FDA)
approval of medical technologies before they could be
marketed was made mandatory. MRI received the FDA’s
approval in 1984. At the same time, however, the Certificate
of Need (CON) was legislated to control the proliferation
of expensive technologies such as MRI. But private
clinics remained outside the purview of CON. The result
was the emergence of a new professional class of radiologist-
entrepreneur in the US. Many MRIs were installed in
private clinic settings and this led to another problem. It
was found that in many cases radiologists who had ownership
rights of particular MRI imaging clinics tended to
markedly over-refer patients for MRI scans. The ineffectiveness
of CON in controlling the proliferation of expensive
technologies led to its being disbanded in most states.
Does the failure of CON, however, strengthen the case
against regulation of healthcare? In the American public
discourse we cannot discount the power of the twin
inevitabilities of technology development and free market
Two years ago a friend of mine was having severe back
pain and he decided to go to one of the local clinics in
Urbana for a check up. The doctor said that he would need
an MRI scan of my friend’s back so that he could make a
better diagnosis. Before going to the radiological laboratory
my friend checked his insurance coverage. The insurance
agent told him that actually he was not covered at all
during the summer so he would have to pay around $2000,
and this did not include doctor’s fees. The cost of MRI
scans in the US varies from region to region, ranging
between $700 and $2000. With 43.6 million people without
medical insurance in the US, it is difficult to imagine
how they manage to get even basic health care. However, is
it possible to regulate the development, deployment and
cost of MRI?
With the development of better imaging techniques
high-resolution MRI images can be produced by much
lower magnetic fields. Use of magnets with a lower magnetic
field can reduce the cost of MRI by half. Radiologists
in India are shifting to lower magnetic field MRIs precisely
for this reason. According to them these MRIs are very
effective for most pathologies and if there are more complicated
cases, as for example with multiple sclerosis, higher
magnetic field MRIs could be used. Such changes would
need a regulation of the healthcare system in the US, but
there appears to be little interest for such changes. I think
the public discourses around the American need for ever
more sophisticated technologies and free-market propelled
equity is the biggest hindrance in having a more balanced
and perhaps even more effective healthcare system
in the US.

Amit Prasad earned his B.Sc. and masters
at Delhi University and is currently
a Ph.D. candidate in the department of
sociolgy at UIUC. His dissertation is a
cross-cultural study of MRI research
and development in the United States
and India.

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