Customer Reviews

Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case

5 star:		(3)
4 star:		(3)
3 star:		(0)
2 star:		(0)
1 star:		(3)

 

 

Marcia Angell's Science on Trial: The Clash of Medical Evidence and The Law in the Breast Implant Case demonstrates what can happen when members of the bar -- and some highly paid experts -- have too much imagination. We have all read that the FDA banned silicone breast implants from the market and of the many large verdicts for women who had such implants. Angell looks at the science and policy beyond both these actions. As to the FDA's decision, she notes that the law requires the manufacturer of a medical device prove the device to be safe; the manufacturers, she concludes, had not taken this rule seriously, and suffered the consequences when the political winds changed direction at the FDA. As to the jury verdicts, she takes issue with the court adversary system itself, where each side hires experts (who often make a very good living at it) and lawyers with the stated objective of proving their side, not finding the "truth." She finds this particularly problematic in the breast implant context because no peer-reviewed epidemiological study finds any correlation between the implants and the conditions alleged. However, because juries are not scientists, and because courts are often ill-equipped to decide what is "good" science, "junk" science gets into evidence, and (to her) unsupportable verdicts occur. I find many of her points well taken, but I do not believe the system needs the extensive overhaul she recommends. What is needed (and what is happening in many courts) is closer control by judges in admitting expert proof to ensure that it has some valid, scientific basis. This is a thought-provoking and important book.

Please note that the more or less average "average ratings" come from reviewers who either rate this one star or four to five stars. In my opinion this illustrates the main point of the book, i.e. that people either evaluate things based on medical evidence, on the opinion of experts, or on their personal belief based on personal life experience/expectations. The different ways of evaluation produce conflicting perceptions, conflicting world views which we see played out many aspect of life. I think that Dr. Angell is gutsy to even take on an issue which generates tremendous controversy. I believe that she presents the arguments for medical evidence very well. Chapter 5 is the best brief and understandable description of what medical evidence is (and is not) that I have ever read. I recommend the book on that alone. I hope that some day Dr. Angell will update the book to include more recent research.

For anyone interested in the interaction between science and society, Marcia Angell presents an excellent case study of what's wrong. Using her impressive credentials, she critically reviews the silicone breast implant case and examines the roles of greed, ideology, junk science, sensationalism and ignorance in this controversy. Specifically, she highlights two issues: the flaws in the legal system in evaluating science, and the rejection of sound scientific consensus. You come away with a strong sense of how people misunderstand science and of how values and politics influence science. For anybody worried about the future of science and society, this is an important book. It reinforces the perception of the decline of science in the public perception.

This is short but wholesome book about evidence, as seen by scientists vs. lawyers. The case in question is silicone breast implants. Angell describes both scientific studies on silicone health effects, and the courtroom battles. This is also a primer in epidemiology, and of media hysteria surrounding science/technology dangers. For an European reader, this is also a horror story about the American legal system (a really good one).

I read this book back in 1996 before the issue of implant safety was settled. I recall the impression it made on me with regard to the widespread ignorance that surrounds us, not only on specific scientific principles but also on the whole idea of the scientific method. This book illustrates why hypotheses and theories can never be evaluated by a court of law. It also illustrates why in any critical review of data one must have a control. If the incidence of a disorder is the same in a group getting implants as it is in a group that does not get implants then it is impossible to reasonably argue that there is any connection between implants and the disorder. Silicone is one of the most inert materials around and people are exposed to it all the time. I strongly recommend this book for anyone looking for further proof that our schools do not teach science adequately.

People have a tendency to let their emotions rule their mind, or in this case, their breasts. Luckily, this book chooses the mind.

This book is a waste of time to read and a waste of money. The author spends far more time telling the reader what to think rather than giving the reader facts on which to base an opinion. She has the credentials to evaluate the studies, but why her opinion on the legal system, the media, and her un-critical, unthinking total dismissal of a wide range of groups (humanists, feminists, environmentalists, ecologists, proponents of alternative medicine) is laughable. (She does point out in one sentence that not all members of these groups reject science, but you'd never guess that from the remaining discussion). For example, she goes from "In their [humanists] view, the deference to science that has characterized intellectual life for much of this century has contributed to a devaluation of humanist thought and the emergence of a callous, technology-enthralled society." In the very next sentence, she says "in rejectiong the uses to which science has been put..." What? Because humanists see problems arising from "deference to science" they are "rejecting the uses to which science has been put"? So since Angell is questioning the legal system's use of medical evidence, I can conclude she is rejecting all aspects of the legal system?

In short, there is little in this book worth reading; certainly the title of the book is misleading. A more apt title would be "What Angell Thinks about Americans, the media, and the legal system."

For the true story behind implants, one's time is better spent reading John Byrne's "Informed Consent". He was in charge of Dow's "ethics" program and his wife also had implants. Contrary to what Dr. Angell writes in her book, there are many studies showing immunological responses to silicone oils (most recently a study by researchers at the FDA - June 1999). The Institute of Medicine in their recent report termed the FDA study "interesting", choosing to rely on previous, and seriously flawed, studies purporting to show no link between silicone and disease (the same studies quoted in Dr. Angell's book). One of the studies looked at women who had implants for only one month (!), which is as ludicrous as determing smoking doesn't cause cancer after studying a person who smoked for only a brief time. There are thousands of court documents proving fraud on the part of the implant manufacturers. Reading through them makes one realize how powerful corporations are and how the bottom line is far more important than the health and safety of the consumer. Breast implants (saline and silicone) have NEVER been approved for safety by the FDA. They only have pre-market approval, which means they can be on the market pending the manufacturers submission of safety data. To date, the manufacturers have been UNABLE to prove implants safe. Unfortunately, the medical community and the corporate community are oftentimes inextricably intertwined. Money is the motivator. When Dr. Angell speaks of greed, I'm sure that's at least one thing she knows a lot about.

this woman is a front for the plastic surgeons and the chemical cos. who are responsible for the largest cover-up of facts in the history of plastic surgery--the media pr and the cruel slap at sick women and children is disgusting--she also came out against agent orange problems (also a DOW product--if the public ever gets the real story in this silicone disaster it wont be thru drs and health persons like her--she is so tainted by dow et/al money that this book reeks --its smells of corporate cover-up and misinformation--GET THE FACTS ON THIS WOMAN AND HER BACKERS!