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Silicone Breast Implant Story. By Marsha L Vanderford and David H Smith. (Pp 218; $19.95.) Mahwah, New Jersey: Lawrence Erlbaum, 1996. ISBN0-8058-1707-7.
This book, subtitled ‘communication and uncertainty’, is a treatise on how information about silicone breast implants was conveyed to and obtained by the public. The topic of silicone implants remains a highly charged and controversial issue. Opinion in the medical community continues to be divided as to whether or not the implants cause disease. Perhaps the most interesting aspect of this issue for rheumatologists concerns the medical and scientific arguments that can be constructed from both sides of the debate. Equally fascinating are the serpentine political and legal ramifications. The book under review, however, ignores these obvious angles and approaches the topic from a completely different perspective, which is interesting in its own right. The issue at hand is really how increasingly complex medical-scientific information gets presented to the public in general and, more specifically, to patients. The authors seem to contend that when it comes to the silicone implant issue, neither the implant manufacturers, the plastic surgeons nor the news media have adequately communicated the benefits and the risks of these cosmetic devices. This argument is well documented in the book and is probably correct.
The authors claim that they were inspired to produce this work after receiving inquiries from plastic surgeons in Florida regarding the ethics of removing silicone breast implant from women who were otherwise healthy. These women were presumably concerned about possible adverse health risks from the silicone based upon information generated by the media. In the prologue, the authors describe themselves as ‘scholars in the health field’ and for the rest of the book they refer to themselves as Dave and Marsha. We are told that Marsha did interviews with the women so they would feel comfortable discussing sexual topics. We learn nothing else about the authors except their academic affiliations (Dave is at Hong Kong Baptist University, a connection that aroused my curiosity). Ordinarily I would not be concerned about the lack of an MD or PhD behind the author’s name, but the book that follows unfolds information and even data that are somewhat softer than the type of scientific work that physicians might have anticipated. The style also lacks the bite of an investigative report from a seasoned journalist.
In this controversial environment the authors go out of their way to maintain a tight and occasionally artificial balance between the two sides of the issue. In chapter 8 for example they find fault with one of the major implant manufacturers, which when attacked by the media, failed to offer ‘additional examples of research that revealed implant safety.’ As is typical in the book, the authors see this as a public relations problem when in fact, the manufacturers could not come up with enough safety data to satisfy the Food and Drug Administration, therefore leading to the removal of implants from the US market. There has not even been clear cut agreement upon numbers regarding such basic problems as the percentage of implants that harden or rupture. ‘Several women related to me that they had been informed prior to having their implants that the chance of sustaining a rupture was 1:10 000. New information indicates that this figure may be as high as 50% or even greater.’ If one can get past these examples of superficial and somewhat misleading analysis, the book is of interest.
The book can be roughly divided into two halves with the second being be far more valuable than the first. From the very beginning we are told that the ‘narrative concept’ will be used and we will be treated to a ‘series of stories.’ The first half of the book contains condensed interviews of patients who have had both positive and negative experiences with their implants, and snippets of physician commentary on both sides of the controversy. These vignettes are a dry read and are often truncated to the point of lacking the pathos of a true to life story.
The second half of the book is an analysis of how the news media presented the implant issue to the public. Almost all the news references are from 1992 or earlier, which was the very initial part of this controversy. The authors accumulated news items about implants from the local Tampa Bay, Florida area and national press. They tabulated the number of positive and negative statements about implants and came to the conclusion that the negative ones predominated. The methodology is never delineated and no weight was given to different sources. Stories from national nightly news, for example, may have had more influence than a story in a local newspaper. The authors then sampled 400 women in the Tampa Bay area and administered a questionnaire about attitude towards implants and the women who have them. As soft as these data appear to be, some interesting conclusions were drawn that are food for thought. Although women portrayed themselves as uncertain about the safety and hazards of implants, they overwhelmingly rejected the thought of having this operation for themselves, even if they were sure that the implants were safe. The participants in the survey also did not seem to think that the women with implants who had filed lawsuits were mostly motivated by money.
Although much of the information presented in this book is far from hard data, the book will be of interest to those who are particularly concerned about communication with patients and the mixed blessings of media derived patient information. It is a work that provokes more thought than a text to be referenced.
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