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

One of the most interesting characteristics of Science on Trial is the author’s frame of mind. Marcia Angell, who is executive editor of the New England Journal of Medicine, tells a compelling tale of scientific evidence run amok in a series of trials against breast-implant manufacturers by women who claim to have developed an unusual constellation of connective-tissue disorders. The allegation against the manufacturers is that silicone leaking from implants injures the immune system, which then turns on the body to produce autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and other painful conditions. The women have prevailed, but to this very day it is unclear whether many of the plaintiffs suffer from any immune disorder that affects connective tissue, or whether silicone actually damages the immune system.

According to Angell, the breast-implant saga began in Australia in 1982 when a physician reported that three women with silicone breasts also had connective-tissue disease. From there, she reports, “events then began to move rapidly, driven largely by a small number of people who happened to be in the right place at the right time” (p. 52). One of these people was a newly minted attorney in San Francisco who sued manufacturer Dow Corning on behalf of a woman who claimed that her breast implant caused disease. The attorney won, and exhibited the lust for money that afflicts a certain type of lawyer when companies with “deep pockets” are sued in cases where the jury is likely to be sympathetic to the innocent victims of profit-driven big business. In the decade and more following the California case, individual and class-action suits flooded the courts as all four companies that make (or made) breast implants were sued. In the early 1990s the Food and Drug Administration banned silicone implants, and even now lawsuits continue to occupy the courts, with women winning Pyrrhic victories nearly every time because well over 50 percent of the monetary damages awarded end up in the bank accounts of the attorneys, rather than of the ailing victims.

So far, this sounds like a classic story of big business getting what it deserves. The rub, which Angell details with careful clarity, is that there is virtually no scientific evidence to support the claim that silicone implants cause immune-system disease: neither epidemiology nor pathophysiology can bring data to bear on cause and effect. To compound the problem, there are no data showing that most of the plaintiffs actually have any diagnosable connective-tissue disease. In short, Angell tells a tale about plaintiffs with no credible disorder winning claims against manufacturers whose product has done no harm.

When the history of tort law in the twentieth century is written sometime in the twenty-first, Science on Trial will stand as a valuable guide to the ways in which science can so easily be abused by law. But one of the most important pieces of that story rests in Angell’s frank acknowledgment of the role played by the larger society in letting good law go bad: the culprit here is the pervasive and knee-jerk liberal attitude that reviles big business and champions the downtrodden.

In her introduction, Angell exposes her own biases: “I consider myself a feminist,” she writes. “I am also a liberal Democrat. . . . Because of this view, I am quick to see the iniquities of large corporations” (p. 13). Why disclose this to the reader? Because “the facts were simply not as I expected they would be” (pp. 12–13). Only by following the data with a dispassionate, open mind did Angell see that in this case, the manufacturers were often wrongly accused and the lawyers unjustly enriched. Science lost, and so did the women who believe they have been injured and who will continue to see themselves as victims.

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