Pro-Choice No More

Why can't NOW keep its hands off women's breasts?

For decades members of the National Organization for Women and other groups that support abortion rights have been urging politicians to "keep your hands off our bodies!" Today women who want to enhance their appearance with silicone breast implants can justly turn this slogan against NOW, which is pro-choice on abortion but anti-choice on cosmetic surgery.

NOW President Kim Gandy says the controversy over whether the Food and Drug Administration should allow wider use of silicone breast implants, which are currently limited mainly to reconstructive surgery following mastectomies, is about "science and medicine." But while science can tell us (in theory) what risks the implants pose, it cannot tell us whether the risks are justified.

Different women will answer that question differently, depending upon their values, tastes, and circumstances. In sharp contrast with its position on abortion, however, NOW argues that they should not be allowed to do so.

Gandy says women who want augmentation surgery cannot make an informed choice between silicone and saline implants until more research has been done. This wait-and-see stance may seem reasonable. It was clear from the deliberations of the FDA's advisory committee, which recently recommended that one manufacturer's implants be approved for general use but said more information was needed about the long-term performance of another's, that there are still legitimate questions about how well the current models hold up after the first few years.

But the determination of how much information women need to make a choice is itself a value judgment. Mentor, the company whose implant found favor with the advisory committee, reported a cumulative rupture rate of 0.8 percent among about 1,000 patients over three years. Based on longer-term studies by other researchers, it estimated 9 percent to 15 percent of patients would experience ruptures after 12 years.

NOW says Mentor should wait until the company's own 10-year study is completed. But that would mean women who are willing to accept both the risk and the uncertainty in exchange for the superior look and feel of silicone implants (preferred by nine out of 10 patients in countries where silicone implants are widely available) would not be permitted to make that tradeoff.

In any case, NOW's objections to silicone implants extend far beyond well-established local complications such as implant rupture, infection, inflammation, and collapse of the scar-tissue capsule surrounding the implant. The group continues to lend credence to the unsubstantiated fears of systemic illness that led to the FDA's 1992 decision to limit sales of silicone implants.

"Hundreds of thousands of women have been injured and become seriously ill after receiving silicone gel breast implants," says Gandy in a December 2004 article on NOW's Web site. The article explains that "breast implant patients report a variety of immune disorders such as rheumatoid arthritis, scleroderma, fibromyalgia, Sjogren's disease and lupus."

Gandy brags of being "informed by the personal stories of these survivors." The problem is that such stories don't prove anything, relying on emotion and post hoc, ergo propter hoc reasoning instead of scientific evidence.

In a comprehensive 2000 report on the safety of silicone breast implants, the National Academy of Sciences concluded that "silicone implants do not cause major disease." As The New York Times notes, "nearly all studies have found no link between silicone implants and serious disease."

Yet NOW encourages the belief that research will one day "conclusively demonstrate that silicone gel should never be introduced into the human body," as Gandy put it in 2003. In addition to immune disorders, NOW raises the specter of lung cancer, brain cancer, suicide, and harm to fetuses and nursing children. It throws in "rashes, hair loss, open sores, aching muscles and joints, mental confusion and memory loss" for good measure.

Given the multitude of allegations and the difficulty of teasing out small risks from epidemiological research, NOW's demand for "complete information" about silicone breast implants will never be met. In practical terms it is indistinguishable from a demand for a permanent ban.

The question is why NOW does not apply the same impossible standard to abortion, which has its share of complications and side effects, both known and hypothesized. I hesitate to suggest a nonscientific explanation, but perhaps it's because NOW—which complains of "slick advertising campaigns" that manipulate women into getting boob jobs and dresses its activists in T-shirts declaring their breasts "100% all natural"—would prefer that certain choices not be made at all.