Product Description

An expert in the medical field uses the breast implant controversy to discuss the consequences of society's increasing dependence on technology and the resulting confusion over what scientific evidence means in terms of health and justice.

Product Details

• Amazon Sales Rank: #2239546 in Books
• Published on: 1996-06
• Original language: English
• Number of items: 1
• Binding: Hardcover
• 256 pages

Amazon.com Review
Introduced in 1962, silicone breast implants had been used by between one and two million women by the time they were virtually banned in 1992 by David A. Kessler of the Food and Drug Administration. While the ban came about because manufacturers had failed to demonstrate the safety of the devices, Marcia Angell, executive editor of The New England Journal of Medicine, argues that there actually was no medical consensus to support the contention that implants could cause widespread illness. Science on Trial examines the silicone debate and argues for the reliance on scientific evidence "to curb the greed, fear and self-indulgence" of such disputes.

From Publishers Weekly
Angell, executive editor of the New England Journal of Medicine, explores here a preposterous situation: an industrial giant, Dow Corning, forced into Chapter 11 bankruptcy by numerous lawsuits filed on behalf of recipients of Dow's silicone breast implants?despite the fact that medical evidence to date shows no link between implants and autoimmune disorders, cancer or any other disease. In a style that ranges from gently didactic to plodding, Angell describes the events leading up to the FDA's ban on implants, the torrent of lawsuits that followed and the implications of the verdicts?overwhelmingly favorable to the plaintiffs and often carrying cash awards in the millions of dollars?for science and industry. Manufacturers have threatened to stop producing heart valves, shunts and other vital medical devices because of the threat of liability; further, suppliers of raw materials for these devices often refuse to sell to American companies for fear of ending up in an American courtroom. The author gives a clear explanation of the way science calculates risk (by considering populations, not individuals) and ably contrasts this with our judicial system, where the focus is on the individual seeking restitution. Angell is an effective champion of the scientific method and does a good job of exposing the chaos caused by a runaway tort system, but she offers no resolution to the state of affairs she describes.
Copyright 1996 Reed Business Information, Inc.

From Library Journal
Angell, executive editor of the New England Journal of Medicine, addresses the controversy over silicone breast implants, which were banned and the subject of huge lawsuits despite dubious scientific evidence of harm. She suggests that lawyers and journalists have misinterpreted scientific results and ignored evidence, leading to the public's growing mistrust of science and the scientific method. Replacing cynicism with a more balanced ability to view scientific results critically is crucial to our health, notes Angell. But her case for scientific objectivity is disappointingly murky. She sweepingly dismisses the validity of controversial ideas only now being thoroughly researched (e.g., alternatives to technological medicine, criticisms of male biases in science), which undermines her credibility. Still, this remains a compelling book. Recommended for public and academic libraries.?Constance A. Rinaldo, Dartmouth Coll., Biomedical Lib., Hanover, N.H.
Copyright 1996 Reed Business Information, Inc.

Customer Reviews

lawyers' greed and science do battle
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.

Science, the public, and the breast implant controversy
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.

Medical evidence vs court testimony vs belief
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.