Proof by Lawsuit: Stories Replace Science in the Courtroom

August 15, 1994|By JAMES P. RICHARDSON

The press reports a possible link between medical treatment for one condition and another illness. How does our society decide whether the treatment causes the illness? Usually we are content to allow the scientific community to gather evidence and reach a conclusion. But according to a recent editorial in the New England Journal of Medicine, a new practice has emerged: Sue those you blame. If the suits are successful, then causation has been successfully established.

The belief that women with silicone-gel breast implants are more likely to suffer from arthritis and other connective-tissue disorders such as lupus is the latest example of this ''proof by suit.'' Two years ago, prompted by stories appearing in the lay press that appeared to link implants to arthritis-like disorders, the FDA removed silicone-gel breast implants from the market while awaiting further studies.

Nature abhors a vacuum. So too, apparently, do juries. As Dr. Marcia Angell reports, although there were no hard scientific data to support the link between implants and arthritis, juries began awarding millions of dollars to plaintiffs. As judgment after judgment was announced, the link between these conditions became accepted as incontrovertible. Finally, in April 1994, breast-implant manufacturers agreed to a $4.2 billion settlement for women with implants who developed arthritis.

In the minds of the scientific community, however, the question is still unanswered: Do silicone-gel breast implants cause arthritis?

This is a difficult question to answer, far more difficult than many (including lawyers) seem to understand. There are literally hundreds of possible reasons that arthritis may appear to be more common in those who have had breast implants. To eliminate as many of these as possible, it is important to carefully match a group of patients who have had implants to another who have not had this procedure. If these groups are very similar, then later differences should be a result of the implants.

Such a study was published in the New England Journal of Medicine in the same issue as Dr. Angell's editorial. researchers at the Mayo Clinic found that 749 women with breast implants were no more likely than 1,498 similar women without implants to develop arthritis. This was true for women undergoing breast implantation after cancer surgery as well as for those undergoing the procedure for cosmetic reasons only.

This is not proof-positive that there is no association between breast implants and arthritis, but it casts significant doubt on this connection. Too bad it comes too late for consideration by judges and juries. The wheels of justice may turn slowly, but apparently they can turn much faster when billions of dollars grease the tracks.

The acceptance by juries of such anecdotal evidence as proof is the re-emergence of a non-scientific tradition. Prior to the modern age, stories were the only way events could be linked. Sometimes experiments later showed that these connections were correct; often they were not. Today it is still common to hear coincidental events joined in causal relationships (e.g., cold weather, not viruses, causes colds; full moons produce irrational behavior), but it is distressing to see such evidence sanctioned by our courts.

Our population is better educated and more sophisticated than ever before, yet most Americans remain quite ignorant of the scientific method, research methodology and statistics. The press, eager to sell cereal, beer, cigarettes and tires, is eager to report the latest scare; the public accepts these possibilities as proof.

Our educational system is doing all of us a large disservice if basic scientific principles are not taught. Just as an educated person need not be an expert in 19th-century British literature to be able to write a modest essay, one should not consider oneself educated if one cannot discern that the tales of a handful of plaintiffs may not tell the whole story of breast implants and arthritis.

James P. Richardson is a Baltimore physician.

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