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MRIs and the Perception of Risk

Published online by Cambridge University Press:  06 January 2021

Steven Goldberg*
Affiliation:
Georgetown University Law Center

Extract

The most important safety decision concerning MRIs was to change the name of the procedure. In the late 1970s, the procedure known as nuclear magnetic resonance (NMR) became magnetic resonance imaging (MRI) because of the negative connotations the word “nuclear” invited. Since then, the use of MRIs has flourished. The procedure is now routinely conducted to make medical diagnoses and to study the brain functioning of healthy volunteers participating in research studies devised by, among others, neuroscientists and economists.

There is nothing intrinsically wrong with changing a procedure's name to respond to a public perception of risk, especially when experts do not share that perception. Yet, while MRIs rarely injure patients or test subjects, there is reason to believe that they have important health and safety consequences not captured in standard informed consent forms. These concerns ironically involve perception of risk. On the one hand, unexpected incidental findings of clinically significant conditions in volunteer research subjects raise a host of ethical concerns.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2007

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References

1 See discussion infra Part III.

2 See discussion infra Part IV.

3 Meaney, Thomas F., Magnetic Resonance Without Nuclear, 150 Radiology 277, 277 (1984).CrossRefGoogle ScholarPubMed

4 This account of the scientific origins of MRI technology is drawn from two sources. The National Academy of Sciences has produced a series of articles on basic research entitled Beyond Discovery. See http://www.beyonddiscovery.org/content/view.article.asp?=60 (last visited September 21, 2006). The article on Magnetic Resonance Imaging is my primary source. See Roberta Conlan, A Life-Saving Window on the Mind and Body: The Development of Magnetic Resonance Imaging, Beyond Discovery, Mar. 9, 2001, http://www.beyonddiscovery.org/content/view.txt.asp?a=129 [hereinafter NAS] (last visited September 21, 2006). To a lesser degree, I relied on the far more detailed account in the leading text on the history of MRIs, James Mattson & Merrill Simon, The Story of MRI: The Pioneers of NMR and Magnetic Resonance in Medicine (1996) [hereinafter Mattson].

5 NAS, supra note 4.

6 Id.

7 Id.

8 Id.

9 Id.

10 Id.

11 Mattson, supra note 4, at 613.

12 NAS, supra note 4.

13 Id.

14 See id.

15 Tom Siegfried, MRI Nobel Signals New Way to Teach Science, Dallas Morning News, Oct. 13, 2003, at 3E.

16 John Cassidy, Mind Games: What Neuroeconomoics Tells Us About Money and the Brain, The New Yorker, Sept. 18, 2006, at 32.

17 See, e.g., Michael D’Antonio, How We Think: Brain Researchers Are Using MRIs to Predict Our Decisions Before They Are Made, L.A. Times Magazine, May 2, 2004, at 18.

18 NAS, supra note 4; Siegfried, supra note 15.

19 See Steven Goldberg, Culture Clash: Law and Science in America 132 (1994).

20 NAS, supra note 4.

21 Meaney, supra note 3, at 277.

22 NAS, supra note 4.

23 Meaney, supra note 3, at 277.

24 Id. The leading text on the history of MRIs says the name change was undertaken “primarily to avoid the misleading implication that the technology uses radioactive materials.” Mattson, supra note 4, at 613. .

25 Howell, Joel D., Symposium on Biomedical Technology and Health Care: Social and Conceptual Transformations: Technical Article: Diagnostic Technologies: X-Rays, Electrocardiograms, and CAT Scans, 65 S. Cal. L. Rev. 529, 529 n.2 (1991).Google Scholar

26 See, e.g., Judith Vandewater, Overused Technology Can Be Dangerous As Well as Expensive, St. Louis Post-Dispatch, Sept. 26, 2004, at A11.

27 He led an unsuccessful effort to fund the Super Collider. See Steven Goldberg, Seduced By Science: How American Religion Has Lost Its Way 119 (1999).

28 Leon Lederman, Basic Research's Big Payoff: A Case In Point, N.Y. Times, Dec. 19, 1982, § 4, at 16.

29 Goldberg, supra note 19, at 96.

30 See Stephen Breyer, Breaking the Vicious Cycle: Toward Effective Risk Regulation 34 (1993) (exploring the difference between public and expert assessments of risk from nuclear accidents).

31 For a detailed discussion and critique of current regulatory efforts to assess fear, see Adler, Matthew D., Fear Assessment: Cost-Benefit Analysis and the Pricing of Fear and Anxiety, 79 Chi.-Kent L. Rev. 977, 980-81 (2004).Google Scholar

32 See, e.g., The World of Nuclear Science, Household Uses of Radiation, http://library.thinkquest.org/C004606/applications/household.shtml. (last visited Sept. 22, 2006).

33 See Goldberg, Steven, Cloning Matters: How Lawrence v. Texas Protects Therapeutic Research, 4 Yale J. Health Pol’y L. & Ethics 305, 306 (2004).Google Scholar

34 Id. at 307.

35 Id.

36 Id.

37 Id. at 307-08.

38 Id. at 312.

39 See, e.g., Peter Gorner, Wisconsin Weighs Ban on Cloning: Both Sides Accused of Verbal Dishonesty in Stem Cell Debate, Chi. Trib., Sept. 19, 2005, at 16; Tom Pelton, Ads Paint New Image For Cloning: Those Opposed to a Ban Stress Medical Benefits of Cells from Lab Embryos, Balt. Sun, Apr. 25, 2002, at 3A.

40 The report of the workshop, which was sponsored by the American Association for the Advancement of Science and the Dana Foundation, may be found at Neuroscience and the Law: Brain, Mind, and the Scales of Justice (Brent Garland ed., 2004).

41 See id. at 107-108 (discussing future use of functional MRIs without mention of dangers).

42 Mattson supra note 4, at 729.

43 See, e.g., Prithi Yeleja, Up Close and Personal With an MRI Scan, Toronto Star, Feb. 9, 2002, at Y13; RadiologyInfo, Safety: Magnetic Resonance Imaging (MRI) 1-2, (Jan. 10, 2005), http://www.radiologyinfo.org/en/pdf/sfty_mr.pdf [hereinafter RadiologyInfo]. There is some concern that new EU safety rules designed to reduce exposure to electromagnetic fields might restrict some MRI usage. See James Meikle, Science: Scientists’ Fears Force Review of New Restrictions on MRI Scanners: Electromagnetic Exposure Limits Threaten Treatments: MPs find No Justification for Curbs on Medical Staff, The Guardian, June 29, 2006, at 8.

44 Yeleja, supra note 43, at Y13; RadiologyInfo, supra note 43, at 2.

45 Ian Marland, Fears Over MRI Scanners, The Scotsman, May 19, 2003, at 2; U.S. Food and Drug Administration, MRI Safety (Sept. 18, 2001), http://www.fda.gov/cdrh/safety/mrisafety.html.

46 See, e.g., Curtis v. MRI Imaging Serv. II, 956 P.2d 960, 961 (Or. 1998); Cassidy, supra note 16, at 37.

47 For an example of standard informed consent language used for MRI research, see Standard Informed Consent Language for MRI Related Research, Memorial Hospital of Rhode Island Committee for Use of Human Subjects in Research, http://www.brainscience.brown.edu/MRF/MR.Risks.pdf (last visited Sept. 25, 2006).

48 Jamie Talan, The Ethics of Scan and Tell, Sci. Am. Mind, June 2005, available at http://www.sciammind.com/print_version.cfm?articleID=000F3D24-647A-128AA3C683414B7F0000.

49 Id.

50 See Katzman, Gregory L. et al., Incidental Findings on Brain Magnetic Resonance Imaging From 1000 Asymptomatic Volunteers, 282 JAMA 36, 36-39 (1999).CrossRefGoogle ScholarPubMed

51 See, e.g., Judy Illes et al., Incidental Findings in Brain Imaging Research, Sci., Feb. 10, 2006, at 783 (discussing research studies as well as an NIH workshop); Kim, Brian S. et al., Incidental Findings on Pediatric MR Images of the Brain, 23 Am. J. Neuroradiology 1674, 1674 (Nov.-Dec. 2002)Google ScholarPubMed (studying “the prevalence of incidental findings in a healthy pediatric population”).

52 Illes, supra note 51, at 783-84.

53 Id. at 783.

54 Id.

55 Illes, Judy, Pandora's Box’ of Incidental Findings in Brain Imaging Research, 2 Nature Clinical Prac. Neurology 60, 60 (Feb. 2006).CrossRefGoogle ScholarPubMed

56 Press Release, Memorial Sloan-Kettering Cancer Center, MRI May Help Find Missed Breast Cancers in High Risk Women: High False Positive Rate Must Be Considered, available at http://www.mskcc.org/mskcc/html/13823.cfm (last visited Sept. 25, 2006).

57 Deyo, Richard A., Magnetic Resonance Imaging of the Lumbar Spine: Terrific Test or Tar Baby?, 331 New Eng. J. Med. 115, 115 (July 14, 1994).CrossRefGoogle ScholarPubMed

58 Guzelian, Christopher P., A Quantitative Methodology For Determining the Need for Exposure-Prompted Medical Monitoring, 79 Ind. L.J. 57, 84 (2004).Google Scholar

59 Id. at 69.

60 Id. at 84.

61 Illes, supra note 51, at 783.

62 See, e.g., Huber, Peter, The Old-New Division in Risk Regulation, 69 Va. L. Rev. 1025 (1983).CrossRefGoogle Scholar

63 See, e.g., Merrill, Richard A., FDA's Implementation of the Delaney Clause, 5 Yale J. On Reg. 1, 76 n.367 (1988).Google Scholar

64 Sunstein, Cass R., Which Risks First?, 1997 U. Chi. Legal F. 101, 101 (1997).Google Scholar

65 Schumacher, Karin, Note, Informed Consent: Should It Be Extended to Vaccinations?, 22 T. Jefferson L. Rev. 89, 119 (1999).Google ScholarPubMed

66 Coleman, Carl H., Rationalizing Risk Assessment in Human Subject Research, 46 Ariz. L. Rev. 1, 4 (2004).Google ScholarPubMed