On Breast Implant Hysteria

Ed Uthman, MD

Diplomate, American Board of Pathology

31 Mar 1996

I would like to make two points here:

1. I am against using implants for enlarging small, but otherwise normal breasts. Aesthetically, they look and feel unnatural. Any woman whose Significant Other wants her to undergo surgical breast enlargement needs to get a new Significant Other, not new breasts. Medically, there are several local complications of implants which can be quite deforming and are enough to rule out the procedure for anyone except those who have a severe disfigurement, such as post-mastectomy patients.

2. That said, the current claims that breast implants cause everything from peripheral neuropathy to rheumatological disease have no scientific basis. Although there have been false claims throughout the history of medicine, the ongoing controversy over breast implants is especially destructive, since an unprecedented amount of money has been spent to try to influence the content of scientific literature on this topic.

In the typical "scientific paper" on "implant-related disease," the authors find a few dozen women with rheumatologic and/or neurologic symptoms who just happen to have had breast implants, and publish a paper describing the disease under a misleading title, carefully avoiding any definitive statements about whether or not a control (non-implanted) group has the disease at the same or similar prevalence. Then, voila!, guess who gets to be a plaintiff's "expert witness" at hundreds of dollars an hour plus expenses? And you can bet there are going to be some nice hotels, fine dining, and first-class air travel involved in that latter category.

On the other side of the coin, I attended a meeting of the US-Candian Academy of Pathology in 1995. The winner of the resident's poster session was a paper entitled something along the lines of "Breast Implants Do Not Cause Rheumatologic Disease." Of course, this is also a totally bogus statement from a scientific standpoint. It will probably never be possible to prove that every given case of systemic disease is not caused by a reaction of the body to the silicone. All you can say is that there is not (or is) an excess number of cases of systemic disease in the implanted group as compared to a rigorously selected control group. But you can bet the author of the above paper will be getting lucrative offers of expert witness jobs and further research money from implant manufacturers.

Of my years in pathology, I have never seen such high-profile behavior and deliberately misleading literature from physicians as I have seen surrounding breast implants. A family practitioner friend of mine related an anecdote to me of one of his patients who had had implants. She was totally asymptomatic, subjectively healthy, and happy with her implants. She had a friend who was a judge and suggested at some social occasion that she should see one of the local breast implant lawyers and "get her name on the list" for the big settlement in case she should have problems in the future. She did so, and the lawyer sent her to a local physician who apparently does little else except evaluate women with alleged breast implant "disease." This physician ran a test and detected "silicone antibodies" (another bogus test, by the way), gave her a diagnosis of some sort of implant-related disease, and rated her at a 60% disability! The woman called up my family practice friend, worried that she was sick and didn't know it. The reason he called me was to get information about the diagnostic utility of silicone antibody tests, which of course I could not give him, because those tests have never been validated nor standardized, much less shown to have any predictive value for any disease.

As doctors scramble for their piece of an ever-shrinking pie, I think it is very likely we will see more of this type of behavior. Eventually I think we will have the same very broad, evenly distributed spectrum of ethics (and lack thereof) among physicians that we have among lawyers today. My advice to any health professional trying to learn the truth behind the claims is to look for the financial motivation behind the purveyors of those claims. We may have to ultimately accept the fact that with so much money riding on this argument, we may never know the truth concerning the harmfulness or innocuousness of breast implants.

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