Tuesday, March 13, 2007

Breast Implants and Chicken Little - A Cautionary Tale

Remember the story of Chicken Little, the one where the chicken gets hit on the head by a falling acorn she doesn’t see, and leaps from that partial evidence to her panicked cry “The Sky is Falling! The Sky is Falling!” The other animals turn into a frightened pack and follow Chicken Little in a mass flight to safety. Now consider the analogous story of silicone breast implants. Not a fable, but certainly a cautionary tale.

To learn the lessons from the silicone saga you have to go back in time to the day the acorn fell. In November 1988, The Health Research Group, associates of Ralph Nader’s Public Citizen, sounded the alarm that silicone breast implants cause cancer. They based their claim on documents from Dow Corning, the silicone manufacturer, indicating that in one test, a group of rats injected with silicone got 23% more tumors at the site of the injection than a control group. Cancer is a pretty big acorn.

The health advocates also claimed that Dow Corning had hidden those findings from the FDA and the public. Now you not only have Cancer, but a lying chemical company protecting their profits at the expense of public health. That would understandably feel like the sky is falling if you happened to be one of the tens of thousands of women who had these devices in your chest.

About two years later, the fear multiplied significantly when the press…we’ll call them Turky Lurky…added their loud voice to the alarm after a high-profile piece on a CBS news program. Most of the newspapers and TV stations in America joined the Sky is Falling chorus, as they usually do with the latest risk du jour. (Mea culpa. I was one of those reporters who did numerous stories on this awful new bogeyman, without really checking out the evidence.)

Women who were suffering scarring and immune system problems and other ailments got understandably scared, and angry. The lawsuits started. The public hearings started. Advocacy groups formed. Politicians took up the cause. And the federal government did what it has to do in a democracy. It responded to the Sky is Falling fears, and in 1992 banned the devices for almost all uses.
No matter that the kind of tumors those lab rats got don’t occur in humans. Never mind that dozens of other studies indicated silicone is not a carcinogen. Never mind that Dow Corning had indeed reported its findings to the government and hadn’t kept them secret. Never mind the far more plausible explanations for why breast implants were harming women.

Time and again this is how we react to the first hints that something is dangerous. We jump to the worst-case possibility on sketchy evidence, and protect ourselves with fear and precaution. Fear is not automatically a bad thing. It helps protect us. And precaution is a great idea and should be the starting place of all government policies.

But too much fear and precaution, too fast, based on not enough information, can do us more harm than good. Thousands of women experienced additional suffering because too little attention was paid to the far more likely reasons for their health problems. Many, afraid of cancer, had their implants removed, running a far more likely risk of serious infection and scarring. How about the excruciating stress hundreds of thousands of women endured? Chronically elevated levels of stress can cause cardiovascular damage, weaken the immune system, contribute to depression, impair fertility, weaken bones. Finally, millions were spent researching the cancer claim, and much less was spent researching the other ways breast implants harm women.

Remember what happened at the end of one version of the Chicken Little story? The frightened animals ran into a cave where they figured they’d be safe from the falling sky. Only to be eaten by Foxy Loxy. Their fear, based on the powerful drive for self-protection but only the sketchiest evidence, did them more harm than good.
Bravo to the advocates who sound the alarm that something out there might be dangerous. But shame on those Chicken Littles who immediately jump from small bits of evidence to “The Sky is Falling.” And shame on all of us, the press and the public, if we blindly subscribe to such alarmism and run to hide in some cave without giving at least a little careful thought to how real the latest peril might be.