Within Radiology, the word commodity is becoming heard with increasing frequency. The customary definition of commodity is a physical good, something useful in commerce. Recently its meaning has been extended to individual services and often, specifically, the services rendered by a radiologist. One of the bugbears causing consternation in our specialty is the so-called commodification of radiology, a process in which the service we provide is no longer considered by the consumers of our consultative expertise as a distinctive, avidly sought manifestation of special competence, but rather as a standardized product that could be offered by anyone with a modicum of training who can be situated either nearby or at some remote distance from the site of clinical encounters.

But while the specter of the commodification of our capabilities is perhaps a real threat, we face and have faced threats also with regard to the traditional meaning of commodity—that now relates to the withholding of actual physical “stuff” crucial to our work. Radiology services are beholden to very sophisticated machines, devices and medicaments consisting of materials rendered through intricate processes into special, often ingenious products that we may use routinely, even as they are really at the cutting edge of technology. And many of the ingredients that comprise these goods are expensive, exotic and limited in supply. Moreover as we have entered into the era in which science and engineering are now globalized, we depend for our livelihood on the availability of these substances extracted from remote locations and mined and/or fabricated in only a few places, mostly outside the United States. Yet the realization of such international extractive and manufacturing preparation is subject to the whims of unanticipated political considerations as well as the machinations of global markets, sometimes manipulated by greedy souls inimical to patient needs in particular, and to the provision of healthcare in the United States in general.

We in Radiology may think we only deal with a few equipment purveyors. We might assume that innovation and availability depend on their policies alone. But in actuality, in many instances, our famous corporate suppliers are in a sense only middlemen subject to the motivation of the owners and extractors of commodities which are vital components of the machines that may bear the name of GE, Siemens or their competitors.

In this discussion, I wish to relate four instances in which radiologists were bamboozled by commodity restrictions. Two are historical, one began to be a problem 2 years ago, and the most recent one is still playing itself out today. For this last example the longstanding implications are the most wide ranging.