National Nurses United

Books:1 copy 9/2/09 3:35 PM Page 14 Summer eventually becomes active in helping other registered nurses with their addiction and an advocate in Connecticut of "diversion" programs for RNs, in which nurses who want to overcome their substance abuse and protect their licenses voluntarily undergo an alternative program of structured treatment. In exchange, they receive confidentiality and avoid the usual disciplinary process before the nursing board. Impaired is an emotionally and spiritually honest account of Holloran's journey. Any RNs interested in gaining more insight into the inner life of addicts or recovering addicts would do well to read this book. —lucia hwang Magnetic Appeal: MRI and the Myth of Transparency By Kelly A. Joyce; Cornell University Press agnetic resonance imaging (MRI) is revered as the most sophisticated diagnostic imaging tool available, a sacred technology that represents progress, certainty, and quality healthcare. With its ability to render anatomical images, MRI is understood to hold the truth about the body, possess the ability to "see" illness and disease, even save lives. But can a machine be worthy of all that? In Magnetic Appeal: MRI and the Myth of Transparency, author Kelly A. Joyce makes a strong case debunking the perceived infallibility of MRI. She challenges the "seeing is believing" ethos in medicine and exposes the political economy of MRI technology. A sociologist and self-identified science and technology studies (STS) scholar, Joyce excavates the origins of MRI, from its roots in nuclear physics and numerical data to its use by radiologists and transition to gray scale images. Her research is provocative, delving beyond the nuts and bolts of the science to illuminate how mass advertising, fear of malpractice litigation, fee-for-service structures, and research funding all contribute to MRI's status in modern medicine. Magnetic Appeal is a fascinating and superbly researched book. Relying on fieldwork at imaging sites, conferences, and interviews with medical professionals, Joyce focuses on how radiologists, referring physicians and technologists make sense of anatomical scans in clinical practice. We come to understand how the U.S. desire for scans reflects anxieties about the quality of healthcare, physician skills, and increased incidence of cancer, MS, and other chronic illnesses. M 14 REGISTERED NURSE Book Review The reader is drawn into the pressure-cooker of imaging units, where radiologists and technologists are under constant demand to accelerate their work practices. Though MRI does not use a lens to take pictures of the body—the image depends upon a translation from numbers to images—MRI has become ubiquitous with the visual. The visual is transparent truth. It's the machine, rather than trained radiologists who interpret the scans, holding the answers. "In a symbolic economy that equates the image with certainty," Joyce writes, "MRI is not just the right tool for the job. It is perceived as one of the few tools available." Yet, Joyce argues that MRI in most cases only confirms what other kinds of diagnoses already indicate. The point is made that MRI is an important diagnostic technology, but it should not supplant other forms of medical knowledge. Nor should it distract from the reality that medicine is an uncertain practice. MRI cannot provide objectivity attributed to it, Joyce says, nor can it provide cures for disease. Magnetic Appeal ultimately leads readers to question whether MRI use is out of control. One naturally wonders whether the profit incentive of MRI—both for manufacturers of the machine and clinics that own them—somehow skews patient care. Given the seriousness of our nation's healthcare crisis, people may want to learn more about the machine. —yomi wrong Never Good Enough: Health Care Workers and the False Promise of Job Training By Ariel Ducey; Cornell University Press n her book, Never Good Enough: Health Care Workers and the False Promise of Job Training, Ariel Ducey explores the ideology of the market and healthcare restructuring in considerable historical detail. She takes aim at the major values of individualism, competitiveness, and the pursuit of self-interest underlying U.S. health policy during the mid-1990s and the mantra of the inevitability of market-based reform. As a healthcare ethnographer and sociologist, Ducey's perspective comes from the study of the healthcare workforce training industry in New York City. In particular, she closely examines SEIU's New York City-based Local 1199, and its strategy of labor-management partnerships and embrace of workforce retraining programs in response to healthcare restructuring and the threat of hospital layoffs in the early to mid 1990s. At that time, community colleges, private universities, for-profit trainers, and unions like 1199 all competed for training funds that were made available to the state from the Health Care Reform Act (HCRA) and Community Health Care Conversion Demonstration Project (CHCCDP). These public funds supported a growing cottage industry for the retraining of healthcare workers, including educators and consultants. Ducey notes that a large portion of the educational training grants in New York went toward "soft skills" training and multiskilling initiatives which "were largely means of expanding the workload of the I W W W. C A L N U R S E S . O R G J U LY | A U G U S T 2 0 0 9

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