The decision to ban implants was just the sort of thing one would expect from a regulatory body that puts so much emphasis on safety that it can't take anything else into account. New England Journal of Medicine Editor Marcia Angell has said that the FDA probably acted the way it did because implants are cosmetic and are therefore of only subjective worth. Such worth, says Angell, can't be plugged into Kessler's cost-benefit analysis.
In an NEJM editorial, Angell noted that nobody questions allowing the use of automobiles, even though they kill over 40,000 Americans a year, because we all have a common understanding of the worth of cars. "In the case of breast implants" though, wrote Angell, "the benefit has to do with the personal judgments about the quality of life, which are subjective and unique to each woman." But given "the difficulty of assessing the benefits, the FDA has acted as though there were noneat least when implants are used for augmentation." The result, said Angell, "is that [FDA Commissioner Kessler] may be holding breast implants to an impossibly high standard: Since there are no benefits, there should be no risks."
The FDA's pseudo-scientific approach lends support to the more obviously ideological attack on breast implants from feminists. To many of the most vocal and influential feminists, a preference for big breasts represents female oppression. Susan K. Brownmiller, in her landmark 1984 book Femininity, opined that "[e]nlarging one's breasts to suit male fantasies" represents the exploitation of women. "Big breasts are one of many factors that have slowed women down in the competitive race of life," she said. "Symbolically, in the conservative Fifties, when American women were encouraged to stay at home, the heavily inflated bosom was celebrated and fetishized as the feminine ideal. In decades of spirited feminist activity such as the Twenties and the present when women advance into untraditional jobs, small, streamlined breasts are glorified in fashion."
If large breasts signal oppression, say these feminists, then the implants used to enlarge one's breasts are tools of oppression. Scarsdale psychologist Rita Freedman, writing in Beauty Bound, claims, "Having been taught that feminine beauty means having full, softly rounded breasts, women judge themselves against this standard. Missing the mark, they put on padded bras or suffer silicone implants." Naomi Wolf, in her 1991 bestseller The Beauty Myth, states, "Breast surgery, in its man gling of erotic feeling, is a form of sexual mutilation."
Having gone this far with imagery, it's a small step to start blaming implants for physical ills. This is precisely what happened after anecdotes began to appear linking implants to disease. Susan Faludi, in her popular book Backlash: The War Against Women , wrote matter-of-factly that leaking implants "could cause toxicity, lupus, rheumatoid arthritis, and autoimmune diseases such as sclero derma."
To such polemicists, it doesn't matter that the evidence for negative effects was weak. It was just too fitting that something in their minds so harmful to women as a class should be harmful to them as individuals.
Two women on the FDA panel translated such thoughts into direct action. Vivian Snyder, the panel's "consumer representative," told Kessler in a letter that "[t]he federal government now has the power to deliver a profoundly important message to the American public involving basic values, concepts of beauty and health," adding, "it would really be wonderful if the FDA could address such attitude-impacting mental health issues as what is really healthy and normal and maybe even beauti ful."
The other panelist was Beauty Bound author Rita Freedman. She sent a letter to Kessler decry ing that implants "perpetuate the myth of Barbie Doll's Body" and asked whether breast augmenta tion will become, "like rhinoplasty [nose surgery], a rite of passage for affluent teens."
Such feminist participation in the anti-implant crusade has proven ironic, since the FDA's virtual ban has denied what feminists have always proclaimed as their goala woman's right to choose for herself. Faludi herself acknowledges that at one time the leading feminist journal, Ms., "deemed plastic surgery a way of 'reinventing yourselfa strategy for women who dare to take control of their lives.'"
Writing in NEJM, Angell says, "It is possible to deplore the pressures that women feel to conform to a stereotyped standard of beauty, while at the same time defending their right to make their own decisions." If anything, says Angell, the act of withdrawing implants could be viewed as sexist because "people are regularly permitted to take risks that are probably much greater than the likely risk from breast implants," citing cigarette smoking and excess alcohol consumption.
When the FDA slapped the moratorium on implants, the impact went far beyond prohibiting a single surgical technique. "The widespread fearand the multimillion-dollar lawsuitshave dated largely from the FDA's removal of breast implants from the market," says Angell.
One study comparing the attitudes of women with implants before and after the FDA morato rium found that after the moratorium the level of satisfaction dropped markedly, from 98 percent satisfied to 7179 percent satisfied. The study authors said their findings were similar to those of the American Society for Plastic and Reconstructive Surgery in another poll.
As for prompting the "multimillion-dollar lawsuits," one need look no further for evidence than so many of the attorney advertisements soliciting silicone implant recipients. "THE FDA WARNS THAT SILICONE GEL-FILLED BREAST IMPLANTS PRESENT HEALTH RISKS" blared a typical ad of this sort in the Newark, New Jersey, Star-Ledger. Implant critics often cite money as the only concern of Dow Corning and other manufacturers. But few notice that the group which stands to gain the most from liability casestrial lawyershas a love of filthy lucre. In a single case involving three women complaining of implant-related illness, a jury in 1994 awarded $33.5 million, although the judgment was later reversed by an appeals court and then settled. Thirty -three percent of a multimillion-dollar awardlawyers typically take a third off the topcan be a powerful incentive for a law firm.
It's hardly surprising, then, that the American Trial Lawyers Association conducts regular seminars for implant plaintiffs' attorneys. It does so using selected data provided by Sidney Wolfe of Public Citizen, the group most identified with criticism of implants. For $750, Public Citizen will also provide trial lawyers a list of medical experts and consultants, FDA reviews and FDA panel testimony, and a variety of other litigation documents. It will also refer clients to those lawyers.
Suing implant manufacturers has become a boom industry in the United States, with lawyers out to convince women that even though they may feel just fine they are really sick and must be properly compensated. With so much money to spread around, it also isn't difficult to get doctors to find patients.
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