Book review

1997 International Journal of Risk and Safety in Medicine  
Cosmetic surgery, whether one likes the fact or not, undeniably lives on the fringe of medicine. At its best, it is a fully respectable arm of plastic surgery, providing a remedy for physical defects which give rise to a great deal of anguish and mental suffering. At its least attractive, it merely allows ill-considered risks to be taken in the name of vanity. The Silicone Breast Implant Story examines a major issue in the field of women's health which has cast a long shadow over cosmetic
more » ... y in the last decade. The book does not set out to provide a scientific conclusion as to the degree or nature of risk which has accompanied the use of silicone implants. That issue has been fought out in the toxicological literature and in the U.S. Courts. Essentially, when threatened by massive litigation from women claiming to have been injured by implants, the major suppliers agreed to a $4.25 settlement; that agreement was followed in turn by new problems, since the number of complainants reached 400,000 by May 1995 (reducing the sum available to each to an absurdly low level) and one supplier then filed for bankruptcy. The women themselves had, however, been faced (and continued to be faced) by a further dilemma, namely whether to have their breast implants removed; plastic surgeons themselves were confused by the conflicting evidence as to whether or not the implants were indeed causing injury, and the need to weigh this against the inevitable risks of further surgery. The impulse for the study presented by Vanderford and Smith was given when, as ethicists, they were consulted by two surgeons struggling with the issue. Neither surgeon felt that the implants were in fact injurious, but both subscribed to the view that requests for removal were reasonable extensions of patients' rights to control their own bodies. How, they asked, should such a decision be taken and by whom? What happens if patients and physicians disagree on such a matter? And what is the source of the knowledge which has caused each to come to his or her views? It is clear that the mass media played an enormous role in women's, physicians' and the public's understanding of the implant situation. Women and physicians alike blamed the media for sensationalising the issue, yet women used the media to fulfill their real need for explanation, control and connection. The extent of media attention and the violence of the public controversy were attributable to the fact that the product in question was one with a high social value, yet that the data relating to its possible risks were uncertain. ("When low shared understanding and high controversy intersect ... they provide the conditions for an argumentative free-for-all.") The media reports singularly failed to provide information about benefits and risks in a manner which clarified the likelihood of occurrence of each, and they tended to confuse known and unknown risks; reports of silicone leakage, arthritis or cancer induced by silicone in animals were bundled together with evidence on autoimmune disease
doi:10.3233/jrs-1997-10314 fatcat:gavxsneqybgl7p5tsofrsqzmiq