Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, January 30, 1992 TAG: 9201300395
SECTION: EDITORIAL PAGE: A11 EDITION: METRO
SOURCE: VIRGINIA POSTREL
DATELINE: LENGTH: Long
BREAST IMPLANTS LET WOMEN CHOOSE THEIR OWN RISKS
THE UNITED STATES has become a society fragmented not only by ethnicity and race, but also by a multiplicity of cultural divisions of the sort that the British scientist and writer C.P. Snow once warned could destroy a society's ability to communicate.These cultural divides are especially striking in the current debate over whether to ban silicone breast implants.
On an obvious level, someone living in Southern California, where plastic surgery is common, is less likely than a Northeasterner to see the subject as trivial. In a culture of audacious self-fashioning, cosmetic surgery is just another manifestation of the will to determine one's identity.
But the breast-implant debate reveals at least three other fundamental divisions - about the interests of consumers, of women and of science - that reflect very different sets of values and ways of understanding the world: How much justification must consumers give the government for their choices? Are women liberated by rediscovering their natural femininity or by seizing control over their biological destinies?
"Vital-need" puritans vs. pro-choice consumers:
Patients generally go to cosmetic surgeons not because their health is threatened, but because they want to look different. This is as true of post-mastectomy patients and burn victims as it is of women who have small breasts. Cosmetic surgery is a matter of personal desire, not medical necessity.
In its letter to the Food and Drug Administration requesting a ban on the implants, the advocacy group Public Citizen repeatedly emphasized the frivolous nature of cosmetic surgery: "Because approximately 80 percent of these devices have been used for breast augmentation, as opposed to reconstructive purposes, the overwhelming `public need,' not the public-psychological needs of women who seek breast augmentation are legitimate public-health needs within the meaning of the [Food, Drug and Cosmetic] Act."
This failure to accept the desires of women to decide how to spend their own money on their own bodies puts Public Citizen clearly on the side of defining "vital needs." A self-styled consumer group, its goal is to stand in for consumers, to make choices for them.
Facing the FDA we find women who want breast implants, whether for augmentation or restoration, defending their right to choose.
Rather than having sovereignty over their bodies and bank accounts, these consumers are forced by aggressive regulators to give a "good reason" for their choices.
Earth Mother feminism vs. self-made-woman feminism:
The debate over breast implants is, most obviously, a debate over the role of women and their personal choices. Should women be allowed to choose unnecessary and potentially risky surgical procedures? Should a woman be allowed to alter her natural form to conform with her ideal of beauty? To make her life more convenient?
The notion that breast augmentation is simply wrong undergirds much of the hostility to the procedure. In her widely discussed book "The Beauty Myth," Naomi Wolf characterizes breast augmentation as "sexual mutilation." And Public Citizen declares in a press release, "The widespread use of silicone gel implants for surgery that is purely cosmetic is a particularly egregious aspect of the issue."
The Earth Mother argument goes beyond breast implants, however. It is a federal crime to obtain birth-control pills without a prescription, which, of course, entails seeing a doctor. To reduce unwanted pregnancies, some women's-rights advocates want to make low-dose birth-control pills available over the counter.
Making the pill available over the counter would empower women, giving them new control over their bodies. But it would not please the Boston Women's Health Book Collective, publishers of "Our Bodies, Ourselves," and vocal opponents of breast implants.
The collective is quite hostile to the pill, because it introduces synthetic hormones into women's bodies. Because both technologies may have long-term effects, women who use them "become subjects in prolonged experiments." So the collective would rather not allow women to choose their own risks.
The clinical view vs. the statistical view.
This is the deepest cultural chasm, dividing medical practitioners from medical scientists and everyday experience from systematic research. The groups that stand on either side of this divide do not even comprehend each other's arguments.
Take the claim that silicone breast implants cause scleroderma, a connective-tissue disorder that leads to a painful tightening of the skin. To lead into its program on the implant, a May 1991 literature search under the auspices of the American Medical Association turned up only 28 women who had developed connective-tissue disorders after receiving silicone gel implants.
In evaluating the safety of breast implants, the FDA and the courts should view the evidence rationally, with an eye toward real epidemiological proof rather than emotional claims. Regulators should seek to inform women of risks, not deprive them of choices. And those women who do want the freedom to make informed choices must take responsibility for the consequences, rather than going to court later to demand compensation for bad outcomes.
Above all, the FDA should avoid taking refuge in extremist, paternalistic views of what women should be and what women should want.