Choice, Information and the Body Female


January 24, 1992|By ELLEN GOODMAN

Boston. -- It is a story that might have sprung full- blown from the deep well of conspiracy fantasies. All the princes of darkness were there at the beginning of the Saga of Silicone. Racism. Sexism. Imperialism. Even the Military-Industrial Complex.

Silicone made its entry into the female body almost 50 years ago, because Japanese women were trying to attract American soldiers. The conquerors liked bigger breasts and so industrial strength transformer coolant was injected directly into these women.

The next stop in this tragic pro- gression was Las Vegas where some 10,000 women -- mostly waitresses and showgirls -- had liquid silicone injected. At the time it was nothing more than an investment in a topless career.

So, from the outset, the story held all the confusing elements of beauty and business, worth and self-worth. And there was even the secret sacrifice of health for ''self-improvement,'' a terrible price paid for beauty.

In time, too much time, the troubles with liquid silicone became clear. Then silicone, in gel form, was packed in an envelope before it was packed into a female body. But packed it was, into one to two million American women.

Only now, after three decades of breast implants, are we learning that women were part of some vast experiment. Perhaps ''experiment'' is too scientific a word for the poorly researched and weakly regulated free market in silicone.

In the weeks since the FDA called for a voluntary moratorium, we've gradually discovered that implants were used in women before the studies on animals were completed. We've learned that almost none of the studies tested silicone in the breast tissue of the animals.

We've learned too that some people at Dow Corning, the major silicone manufacturer, a descendant of the company that brought us napalm in Vietnam -- where is Oliver Stone when you need him? -- had safety concerns that were never followed up.

As Esther Rome, a long-standing health activist with the Boston Women's Health Collective says: ''The manufacturers lied to the plastic surgeons and the plastic surgeons lied to the patients.''

Most stunning is the discovery of just how little research was done over three decades. So little that we don't know the true danger of silicone implants.

Are there ''only'' a few thousand problems among the million or more women? Do only certain women develop immune diseases? Is every woman a walking time bomb?

In this state of swiss-cheese research, the FDA must decide what to do about silicone implants.

Despite all the confusion, the conflicts and the arguments about ''junk science,'' the way to begin is relatively clear. We have to make a distinction between the 80 percent of women who chose implants for cosmetic reasons and the 20 percent who chose them for cancer reconstruction.

This is not a judgment about worthy and unworthy patients, about vanity and need.

It's a judgment based on an ethical standard that balances risks and benefits.

We don't know how many women might refuse cancer surgery or postpone treatment out of terror of mutilation. But there are some. So for women with breast cancer, the options of reconstructive surgery, saline implants and silicone carry a different balance. The benefits for some may outweigh the risks.

Cosmetic surgery, on the other hand, begins with healthy breasts. This alone raises serious ethical issues. As Ms. Rome says: ''They are taking a healthy woman's functioning breast and cutting it open. I'm not sure it's even ethical.''

The plastic surgeons' association has labeled small breasts as ''deformities'' that were ''really a disease.'' Surgeons have described and measured the cure in terms of a patient's ''social functioning.''

But any way you look at it, such a dubious subjective benefit is worth only the most minimal risk -- and the risk today looks higher. So the moratorium on silicone implants for cosmetic purposes should be extended unless long-term research proves their safety.

It will be argued that women should have a ''choice.'' No federal agency should tell a woman what to do with her body.

But there is no informed choice without information. There is no ++ choice for women who were deceived.

And on my darker days, I wonder if the ''choice'' that American women make to get bigger breasts is any freer today than it was for the Japanese women nearly half a century ago.

Ellen Goodman is a syndicated columnist.

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